http://www.policyalmanac.org/crime/archive/marijuana.shtml

http://www.policyalmanac.org/crime/archive/marijuana.shtml

http://www.policyalmanac.org/crime/archive/marijuana.shtml

Marijuana use in adolescence and adulthood Risk factor for schizophrenia Worse outcomes

frequent and longer periods of hospitalization higher relapse rates even in first-episode patients elevated rates of extrapyramidal motor symptoms

(EPS), lower medication compliance higher rates of unemployment, violence, higher rate of criminality increased risk of suicide

Side effects of heavy marijuana use

Barnett et al. 2007Verdoux and Tournier 2004Stefanis et al. 2004

Patients with cannabis abuse/dependence smaller fronto-temporal WM volumes

Significant CNR1 (rs12720071) genotype-by-marijuana-use effects on WM volumes neurocognitive impairment

Side effects of heavy marijuana use

Agarwal et al,2009

Marijuana use in CVS

> 40% of adult CVS patients use marijuana

More likely to be male and young

CVS ( n=82)

Functional vomiting (n=62)

Odds ratio for CVS( 95% CI)

P value

Age (mean±SD)

30±11 36±13 0.7(0.5-0.9)

0.005

GenderFemale ( n=71)Male (n=73)

33 (40%)49 (60%)

38 (61%)24 (39%)

0.4(.2-0.9) 0.02

Cannabis use

30 (37%) 8 (13%) 2.9(1.2-7.2)

0.02

Retching 55 (67%) 25 (40%) 4.4(2-9.7) 0.0003

Depression 2 (2%) 4 (6%) 0.4(1.2-2.6)

0.35

Anxiety 1 (1%) 2 (3%) 0.3(.03-4.5)

0.41

Other psychiatric disorders

11 (13%) 21 (34%) 0.3(0.1-0.7)

0.006

Marijuana use in CVS

Choung R.S.et al, Neurogastroenterology and Motility, 2012

Retrospective chart reviews Review of 31 published case reports Case series of 98 patients

Association with chronic, daily marijuana use Long duration of use preceding onset of

symptoms (2-10 years) Duration of follow up ( variable)

Cannabinoid hyperemesis syndrome

Wallace E.A. et al, S Med Journal, 2011Simonetto DA et al, Mayo Clinic Proceedings, 2012

Total of 437 patients with CVS Mean age was 34 ± 12 Mostly Caucasian (92%) Eighty-one % of patients reported use of

marijuana to treat their symptoms Marijuana users were more likely to be male

and have associated anxiety

An Internet survey of marijuana use in CVS

Experimental Brain research,2014

This patient like several CVS patients

took hot showers that soothed her

Janet Leigh in “Psycho”

Self reported effects of marijuana in patients with CVS

0

10

20

30

40

50

60

70

80

90

100

Overallsymptoms Nausea Vomiting Appetite General

well-beingStress level Vertigo

Perc

enta

ges

Made a lotbetterNo difference

Made a lotworse

Venkatesan et al, International Conference of Nausea & Vomiting,Pittsburgh,2013

Hypothesis

The activity of the endocannabinoid system (ECS) is significantly altered with an associated increase in salivary cortisol and alpha amylase.

CVS patients n=22

Controls n=12

P value

Age 40±11 37±12 NS

GenderFemaleMale

17 (77%)5 (23%)

10 (83%)2 (17%)

NS

BMI 29.7 28.6 NS

Marijuana use 8 (40%) 0 (0%) 0.002 *

Pittsburgh Sleep Quality Index (PSQI) scores

12 ± 1 6 ± 1 0.0008 *

Anxiety 10 ± 1 5 ± 1 0.002 *

Depression 7 ± 0.4 1.6 ± 1 0.002 *

Baseline characteristics

Serum 2-AG and NAE concentrations in CVS patients and controls

Data analyzed using one way ANOVA ,comparisons between groups were carried out using Bonferroni’s t-tests. * p<0.05; **p<0.01.

Venkatesan et al ,DDW2013

Variable Patients – well phase

Patients - sick phase

Controls P value (Sick vs well phase in patients)

Salivary cortisol(s cort)

6.7 (4.0-19.5) 16 (2.6-51.4) 10.5 (3.4-11.3)

0.09

Salivary alpha amylase

214 (13.5-272.2)

285 (11.5-586.0)

138 (44.2-322.0)

NS

Salivary cortisol (nmol/L; median [range]), and salivary alpha amylase (U/ml; median [range]) in

the well phase and during an episode in CVS patients and controls

Venkatesan et al ,DDW2013

Future direction

Novel therapy New drugs-manipulation of the ECS and HPA

axis

Future direction

Thank you

Kathleen Adams & Mollie

Sharon Coffie with GI nurses

B Li

Regal team of royal retchers!

Cecilia HillardHershel RaffReza ShakerMeganYelena Melanie ShanikaCindySam