Introducing the evidence-based population health tool of the Lower-Risk Cannabis Use Guidelines to Brazil

Fischer, Benedikt; Malta, Mônica; Messas, Guilherme; Ribeiro, Marcelo

doi:10.1590/1516-4446-2018-0239

Cited by 11 publications

(16 citation statements)

References 56 publications

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“…at most.” – In a cohort of 50,000 Swedish Army conscripts, it was found that using cannabis 50 times (e.g., once a week for one year) by the age of 18 (in 1969) resulted in a 3.7 higher risk of schizophrenia, a 2.2 higher risk of brief psychosis and a 2.0 higher risk of other non-affective psychoses. Contrary to what Fischer et al claim,1 the risks of schizophrenia and depression are not the same, and schizophrenia carries a much worse prognosis. Other consequences from cannabis use include amotivational syndrome, impaired memory, schizotypal personality features, and subsyndromal psychotic symptoms.…”

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confidence: 62%

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Can we brace for a Canadian-type cannabis storm?

Gentil

2019

Braz. J. Psychiatry

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Fischer et al. 1 have now translated the 2017 Lower-Risk Cannabis Use Guideline (LRCUG) to Brazilian Portuguese. The LRCUG includes ''a set of 10 recommendations on how cannabis users may most effectively reduce the risks for associated health harms,'' being aimed at those who are already using cannabis. I offer the following comments on the recommendations:Recommendation 1 -No comment. Recommendation 2 -''y most clearly that which begins before age 16 yearsy is associated with multiple subsequent adverse health and social effectsy'' -Cannabis interferes with the 'pruning' of synapses, myelination, and other milestones in the development and maturation of the nervous system since conception, and it does not stop at age 16. This recommendation could help prevention efforts by stating: ''y initiation, if inevitable, should be delayed until full adulthood (age 22-25 years).'' Recommendation 3 -''y it is advisable to use cannabis containing high CBD:THC ratios'' -High doses of CBD may lead to dissociative states. 2 A safer recommendation might be: ''Do not use cannabis. If you cannot abstain, avoid preparations rich in THC and low in CBD.'' Recommendation 4 -The authors consider the available evidence limited. Synthetic cannabinoids are full agonists of cannabinoid receptors, are more potent than THC, are clearly associated with psychotic states, and may be more neurotoxic than phyto-cannabinoids. 3 Recommendation 5 -''it isy preferable to avoid routes of administration that involve smoking combusted cannabis material (e.g., by using vaporizers or edibles)'' -Vaping is increasingly used in North America, including by minors, which involves the possibility of inhaling high THC concentrations from cannabis oil, wax, or liquid preparations. 4 Recommendation 6 -''y avoid practices such as 'deep inhalation' breath-holding, or the Valsalva maneuvery as these practices disproportionately increase the intake of toxic material into the pulmonary system.'' -This recommendation could mention the higher blood and brain levels of THC and other cannabinoid substances, with their own toxic effects from these maneuvers.Recommendation 7 -''y keep cannabis use occasional (e.g., use only on 1 day/week, weekend use only, etc.) at most.'' -In a cohort of 50,000 Swedish Army conscripts, it was found that using cannabis 50 times

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confidence: 62%

“…

Fischer et al 1 have now translated the 2017 Lower-Risk Cannabis Use Guideline (LRCUG) to Brazilian Portuguese. The LRCUG includes ''a set of 10 recommendations on how cannabis users may most effectively reduce the risks for associated health harms,'' being aimed at those who are already using cannabis.

…”

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confidence: 99%

Can we brace for a Canadian-type cannabis storm?

Gentil

2019

Braz. J. Psychiatry

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“…The detection of Cannabis consumption markers in biological specimens is an important task for clinical and forensic toxicology laboratories (Fischer, Malta, Messas, & Ribeiro, 2019; Toennes, Hanisch, Pogoda, Wunder, & Paulke, 2015). In Brazil, around 6.9% of the population has used Cannabis at least one in their lifetime (Jungerman et al, 2010).…”

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confidence: 99%

Determination of cannabinoids in plasma using salting‐out‐assisted liquid–liquid extraction followed by LC–MS/MS analysis

Silva

Dalpiaz

Gerbase

et al. 2020

Biomedical Chromatography

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The detection of the markers of Cannabis consumption in biological specimens is an important task for drug testing laboratories in varous contexts. A simple assay combining salting‐out assisted liquid–liquid extraction sample preparation and LC–MS/MS analysis was applied to the measurement of Δ9‐tetrahydrocannabinol, 11‐nor‐9‐carboxy‐Δ9‐tetrahydrocannabinol (THC‐COOH), 11‐hydroxy‐Δ9‐tetrahydrocannabinol, cannabinol and cannabidiol concentrations in 100 μl plasma specimens. The assay had linearity of 1–100 ng ml−1 for THC‐COOH and 0.5–50 ng ml−1 for the other tested cannabinoids. Assay validation criteria were fulfilled. Extraction yields (88.7–97.3%) and internal‐standard correct matrix effects (−9.6 to +5.4%) were acceptable. The assay was applied to 238 clinical specimens from trauma patients, with 19 samples presenting quantifiable concentrations of at least one of the target compounds. The developed assay is a simple and efficient strategy for simultaneous measurement of Δ9‐tetrahydrocannabinol, THC‐COOH, 11‐hydroxy‐Δ9‐tetrahydrocannabinol, cannabinol and cannabidiol concentrations in plasma specimens.

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“…At a time when several countries have been discussing different degrees of cannabis liberalization, the work by Fischer et al is timely 1. Furthermore, it has the merit of reviewing the acute and chronic effects of the use of cannabis, especially by young people.…”

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confidence: 99%