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PURPOSE: Several states, particularly in the Southeast, have restrictive medical marijuana laws that permit qualified patients to use specific cannabis products. The majority of these states, however, do not provide avenues for accessing cannabis products such as in-state dispensaries. METHODS: We conducted a survey of patients registered for medical marijuana (low tetrahydrocannabinol [THC] oil cards) in an ambulatory palliative care practice in Georgia (one of the states with restrictive medical marijuana laws). RESULTS: We had a total of 101 responses. Among our sample of patients who use cannabis as part of a state-approved low THC oil program, 56% were male and 64% were older than age 50 years. Advanced cancer was the most common reason (76%) for granting the patients access to a low THC oil card. Although patients reported cannabis products as being extremely helpful for reducing pain, they expressed considerable concerns about the legality issues (64%) and ability to obtain THC (68%). Several respondents were using unapproved formulations of cannabis products. For 48% of the patients, their physician was the source of information regarding marijuana-related products. Furthermore, they believed that their health care providers and family members were supportive of their use of cannabis (62% and 79%, respectively). CONCLUSION: Patients on Georgia’s medical marijuana program are most concerned about the legality of the product and their ability to obtain marijuana-related products. Therefore, we recommend that states with medical marijuana laws should provide safe and reliable access to cannabis products for qualifying patients.

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ImportanceMounting evidence supports the role of spiritual, existential, religious, and theological components in mediating psychedelic-assisted therapy, yet integration of these elements into the clinical setting is laggingObservationsAlthough psychedelic-assisted therapy commonly produces spiritually, existentially, religiously, or theologically relevant experiences for patients, these have not been systematically integrated into the psychotherapies that accompany therapeutic uses of psychedelics. As a key feature and potential mediator of therapeutic effects, evidence-based psychedelic-assisted therapies should include these topics in the treatment model. Research across multiple diagnostic targets and treatment contexts suggests that spiritually integrated psychotherapies are effective, feasible, and produce add-on benefits in spiritually, existentially, religiously, and theologically relevant outcomes, which are particularly germane to psychedelics. Established standards in spiritually integrated psychotherapy may be fruitfully applied to psychedelic-assisted therapy. Objectives for spiritually, existentially, religiously, and theologically integrated psychedelic-assisted therapy based on these standards and informed by considerations specific to psychedelics are recommended.Conclusions and RelevanceSpiritual, existential, religious, and theological topics’ integration in psychedelic-assisted therapy is needed to ensure culturally competent, evidence-based treatment aligned with the highest standards of clinical care. Neglecting to address these topics can detract from cultural competence, contribute to risks for patients, and potentially undermine treatment success.

BACKGROUND:Cancer survivors are at elevated risk for developing mental health (MH) disorders. This study assessed MH service use and unmet service needs among a nationally representative sample of cancer survivors. METHODS: Respondents aged 18 to 64 years were identified from the 2015-2018 National Survey of Drug Use and Health data. Outcomes assessed past-year MH service use and selfreported unmet MH needs. Outcomes were compared between respondents who reported a cancer history (survivors) and those who did not (controls), descriptively and in adjusted analyses controlling for sociodemographic factors and health status. Analyses were stratified by age groups (18-34, 35-49, and 50-64 years). RESULTS: Comparing 3540 survivors with 149,843 controls, within each age group, a higher proportion of survivors than controls received any MH service (P values < .05); this difference persisted among those aged 35 to 49 years (P = .004) in fully adjusted models. Moreover, a higher proportion of survivors than controls reported an unmet need for MH care; this difference was larger among young adults aged 18 to 34 years (20.8% vs 9.0%; P < .001) than those aged 35 to 49 years (9.4% vs 5.3%; P < .001) and 50 to 64 years (4.8% vs 3.4%; P = .029). In fully adjusted models, the survivor-control difference in self-reported unmet MH needs persisted among young adults (24% relative increase; P = .023). Among cancer survivors, young adult survivors had the highest likelihood of reporting unmet MH needs. CONCLUSIONS: This nationally representative study found an increased perception of unmet needs for MH care among cancer survivors, particularly among young adult survivors, compared with the general population without cancer.

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As growing numbers of Americans use federally unregulated cannabis products and develop complications-such as psychosis, cannabis use disorder, and electronic-cigarette, or vaping, product use-associated lung injury (EVALI)-the need to facilitate research on the products that our patients purchase from dispensaries is becoming increasingly pressing. Patients in our clinics routinely report using vape pens, dabs, waxes, edibles, and oils purporting to contain various concentrations of cannabinoids such as cannabidiol (CBD) and tetrahydrocannabinol (THC). Physicians register patients to obtain medicinal cannabis, counsel them on safe use of cannabis products, and monitor them for side effects of such products, yet they don't have access to reliable evidence on the effects of the products that patients are using. Currently, if researchers plan to conduct clinical trials using cannabis, they must first seek separate approvals from the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA). 1 Navigating this process can take a year or more. Once federal approval is granted, investigators can study cannabis obtained from only one government-authorized farm at the University of Mississippi, which contracts with the National Institute on Drug Abuse (NIDA) to cultivate cannabis for research purposes. The cannabis produced by this farm doesn't reflect the wide variety of products and cannabinoid formulations that patients obtain from commercial dispensaries. What's more, a lawsuit filed against the DEA alleged that the University of Mississippi product was contaminated with mold and of inconsistent quality. This lack of variety and alleged poor product quality limits the generalizability of potential findings from clinical trials. The challenges associated with conducting high-quality research on cannabis were highlighted during a U.S. House Committee on Energy and Commerce Subcommittee on Health hearing on cannabis policy on January 15, 2020. In her opening statement, Representative Anna Eshoo (D-CA) described the "Catch-22" facing cannabis researchers: investigators cannot conduct research on cannabis until they demonstrate that it has medical use, and they cannot show that it has medical use until they conduct research. 2 This dilemma was underscored by witnesses from federal agencies who testified before the House subcommittee. To date, 33 states and Washington, D.C., have legalized cannabis for

5198 Introduction: Lymphoma is a common hematologic malignancy, etiology of which remains largely unclear. Obesity and overweight have been associated with an increased risk of developing lymphoma; however, with conflicting results. The main objective of this meta-analysis is to evaluate the potential relationship that overweight and obesity may have in the development of lymphoma in adults. A secondary objective was to evaluate the risk of separate lymphoma subtypes, such as Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL) and the most common NHL subtypes – diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) – in overweight and obese individuals. Methods: A MEDLINE search from January 1950 to December 2010 was undertaken using: (obesity OR “body mass index” OR BMI OR overweight) AND (leukemia OR lymphoma OR myeloma). Only prospective cohort studies reporting on the incidence of lymphoma were included. Retrospective case-control and cross-sectional studies were excluded. Meta-analyses were performed for HL, NHL and NHL subtypes. The outcome was calculated as relative risk (RR). Overweight was defined as body mass index (BMI) 25–29.9 kg/m2 and obesity as BMI ≥30 kg/m2, according to the WHO criteria. The quality of the studies was determined by the Newcastle-Ottawa scale (NOS). The random effects model was used to calculate the combined outcome. Heterogeneity was assessed by the I2 statistic. Publication bias was assessed by the trim-and-fill analysis. Meta-regression analyses were performed to evaluate the association between BMI, as a continuous variable, and the incidence of HL and NHL in general and NHL subtypes. Literature search, data gathering and study quality assessment were performed independently by at least two of the investigators. All graphs and calculations were obtained using Comprehensive Meta-Analysis version 2 (Biostat, Englewood, NJ). Results: From 758 returns, 22 prospective cohort studies evaluating the association between obesity and lymphoma were identified. All the studies were of high quality (NOS >7 points). For NHL, the overall RR was 1.06 (95% CI 1.02–1.10; p=0.001). For overweight and obese patients, the RR were 1.04 (95% CI 1.01–1.07; p=0.02) and 1.11 (95% CI 1.06–1.16; p<0.001), respectively. Meta-regression showed a linear association between BMI and incidence of NHL (p<0.001). For DLBCL, the overall RR was 1.14 (95% CI 1.01–1.29; p=0.03). Overweight and obese patients had a RR of 1.08 (95% CI 0.96–1.22; p=0.22) and 1.24 (95% CI 1.08–1.44; p=0.003), respectively. Meta-regression showed a trend towards a significant association between BMI and incidence of DLBCL (p=0.1). For FL, the overall RR was 1.11 (95% CI 0.99–1.25; p=0.08). Overweight and obese patients had a RR of 1.10 (95% CI 0.94–1.28; p=0.25) and 1.15 (95% CI 0.97–1.36; p=0.11), respectively. Meta-regression showed no association between BMI and incidence of FL (p=0.78). For HL, the overall RR was 1.10 (95% CI 0.97–1.26; p=0.15). Overweight and obese patients had a RR of 0.91 (95% CI 0.80–1.03; p=0.13) and 1.23 (95% CI 1.05–1.44; p=0.009), respectively. Meta-regression showed a statistically significant linear relationship between BMI and incidence of HL (p=0.009). Conclusions: Obesity was associated with a mild increased risk of developing HL (23%), NHL in general (11%) and DLBCL (24%), but there was no association with FL. There was a statistically significant linear association between BMI and HL as well as for NHL in general, but only a trend towards an association with DLBCL. Disclosures: Castillo: GlaxoSmithKline: Research Funding; Millennium Pharmaceuticals: Research Funding.