Patients undergoing certain major operations may be in line for a shorter length of recovery – if they have a history of cannabis use.
That is according to a new study published last month in the journal Arthroplasty. The research centered on patients who have undergone total joint arthroplasty (TJA), or an operation where the individual has their hip or knee replaced.
According to the authors of the study, patients with a history of “cannabis use disorder,” or “CUD,” “had significantly shorter length of stay (LOS) and higher rates of home discharge following primary TJA compared to the control group.”
As the authors pointed out, the shifting laws and attitudes in the United States toward cannabis use has forced a reckoning for the medical community in how they manage treatment for their patients. The growing “legalization and decriminalization of cannabis across the United States has been associated with a considerable rise in self-reported cannabis use amongst surgical patients, including those undergoing total joint arthroplasty,” they wrote. Although “cannabis is primarily used for recreational purposes,” they said, “cannabinoid metabolites have shown analgesic and anti-inflammatory properties and have thus been proposed as an alternative to opioids in the management of acute and chronic pain.”
And while “cannabis use may conceivably be beneficial in the postoperative setting, cannabis use disorder (CUD), defined in part as a problematic pattern of cannabis use leading to clinically significant impairment or distress, has been correlated with increased postoperative pain and opioid use following orthopedic surgical procedures.”
“Progressive legalization of cannabis use makes it increasingly important for clinicians to understand the characteristics of this evolving patient population. As this growing population continues to evolve, understanding their comorbidities, behavioral characteristics, and postoperative clinical and economic outcomes allow orthopedic surgeons and the multidisciplinary healthcare teams to better tailor their care and management of these patients,” the authors wrote.
Taken together, the authors said that means that subsequent research “should aim to more closely and comparatively assess the demographic profile of patients with both recreational use and substance use disorder, along with potential barriers in their access to medical care.”
“This understanding should be associated with the expansion and improvement of public health initiatives and the development of frameworks to better deliver substance use screenings and interventions to this patient population. Such initiatives, combined with the development of standardized perioperative protocols, have the potential to optimize postsurgical and overall health outcomes in this at-risk patient population,” the authors wrote.
The authors did, however, offer up some caveats, noting that the “study is limited for several reasons.”
For example, they pointed out that patients with cannabis use disorder “would be incentivized to leave the hospital as soon as possible and return home to continue use of cannabis and potentially other substances.”
“Because such use may be associated with problematic behavioral changes and abandonment of social, occupational, or recreational activities, these patients may be at risk for worse postoperative and overall health outcomes in the postoperative, post-discharge period. In contrast, the preoperative and in-hospital period, during which a multidisciplinary team has full access to care for these patients, can thus serve as an opportune time for comprehensive social and medical intervention. As such, orthopedic surgeons and the multidisciplinary medical and social service team should remain aware of the risks these patients face, and perioperative interventions should be considered to optimize both long-term outcomes and general health improvement in these patients,” they wrote.
As NORML noted, other “studies have reported contrary findings, including a paper recently published in The Lancet which determined that patients diagnosed [with] cannabis use disorder more often required advanced post-procedural health care than did those with no recent history of use.”
We used to just call people stoners, that was enough. But the medical world always likes things to be more specific, and so now we have the term ‘cannabis use disorder’. But is this really a thing? Or a combination of fear-mongering, and over-enthusiasm to make everything into a problem? Read on and form your own opinion.
How is cannabis use disorder defined?
Though cannabis use goes back for thousands of years without a use issue stated, somehow, when legalizations started happening in the US, it popped up as a disorder. It’s currently listed in the DSM V, which came out in 2013. The DSM (Diagnostic and Statistical Manual of Mental Disorders) states the qualifications for psychiatric diagnoses. Since there aren’t medical diagnoses for these issues, this guide is meant to tell doctors how to diagnose psychiatric problems. In the previous edition which was used between 2000-2013 (the DSM IV), cannabis was associated with ‘dependence’ and ‘abuse.’
According to VeryWellMind, cannabis use disorder denotes “problematic marijuana use.” The site then goes on to list the symptoms related to this problematic use. These symptoms include:
“Continuing to use cannabis despite physical or psychological problems; continuing to use cannabis despite social or relationship problems; craving cannabis; difficulty controlling or cutting down cannabis use; giving up or reducing other activities in favor of cannabis use; problems at work, school, and home as a result of cannabis use; spending a lot of time on cannabis use; taking cannabis in high-risk situations; taking more cannabis than was intended; tolerance to cannabis; withdrawal when discontinuing cannabis.”
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However, given all this, it then goes on to stipulate: “Just because the name has changed and the term “cannabis use” has replaced “cannabis abuse” or “cannabis dependence” doesn’t mean that cannabis is not addictive. In fact, research shows conclusively that cannabis is addictive.” However, contrary to this article, research, in fact, does not show any ability for a physical addiction to cannabis, as well as no death toll; and the fact it was downgraded in this way, really says a lot about how innocuous it is.
Have I ever seen a real example of cannabis use disorder in life?
No, not really. And that means something. I can’t speak for every person reading this, but I can speak for my own experience. I’ve been smoking weed for well over 20 years. I admit I never got into it in high school, but when college came around I finally understood what all the hype was about. In reality, I had tried it in high school a couple times with some (now I realize) low-grade herb stolen out of the top drawer of my stepfather’s dresser. He had back issues and had likely procured the green for his pain.
I was one of those people who simply couldn’t get the inhale right. The non-cigarette smokers among us sometimes have problems with this in the beginning. But in the throes of university, I figured it out, and by the end of my junior year, I was a full on stoner. In fact, I went from 0 to 100 in no time at all.
I’ve had times in my life when I wouldn’t go places without a joint rolled or a one-hitter in my pocket. I used to be the one stinking up greyhound buses with my bag of weed stuffed in my backpack, and the scent emanating out. It used to be customary for me to sneak a smoke break in my car at lunch, or to go for a walk and toke up, pretty much whenever possible. My habit might have been irritating to those who didn’t understand my desire to constantly be high.
But the truth is, I never had to do it. If a situation arose whereby I couldn’t have weed, I might have complained, but it was more of a superficial thing. My body wasn’t upset by not getting it. I didn’t go into DTs, or get incredibly sick. I wasn’t irritable and in a generally bad mood; and if I was, it was related to me, not the weed. Because I was never addicted to it.
It also never messed anything up for me. I never prostituted myself to get it, robbed anyone or anything for the money, or missed out on something because of it. It didn’t cause me to fail out of school, lose friends, or become a social outcast. The most is did was make me lazy, and hurt my lungs (the latter of which was rectified by vaping over smoking).
Want the real reality check? Most of the time I’ve used like that, I’m unhappy in general, or stressed out in life, with no other way to deal with it. You know that whole idea of self-medicating? It isn’t that a person wants to be blown out of their mind, its that they’re trying to fix a problem, whether consciously or subconsciously. What my weed use indicates to me, is a discomfort in life and in myself, and that has nothing to do with a use disorder, but rather, a reason for use. As in, something not right = more weed use, feeling okay = less. I expect this is true for nearly every person who uses a substance regularly.
Most users I know go through different periods in life with their consumption. And many people seem to cut down on their own when the time is appropriate, or if they feel they’re going overboard. A real drug use disorder involves a lack of control to the point of a problem, but that indicates it needs to cause a real problem. I have yet to see even one person directly ruin their life because of weed. Which, in my opinion, makes for no actual use disorder attached.
Have YOU ever seen a real example of cannabis use disorder in life?
Are you a weed consumer? And if so, how would you characterize your own use? Do you feel compelled at any point to use it? Do you feel like your life is lacking something because of it? Do you feel out-of-control in your ability to use or not use it? Now think of the people around you. Do they seem out-of-control on weed? Like, unable to make decent decisions? Unable to stop from doing more? Unable to stop themselves from tanking out their lives? And all due only to weed?
And have you seen it fundamentally mess up another person’s life? Job lost, partner left, family leaves them behind? Have you seen anyone destitute on the side of the road because they just couldn’t stop smoking weed? Have you heard of a store being burglarized because of it, or a person performing sexual acts to get it? Maybe you have, I can’t say, but I’d certainly bet not. If you had seen it, I probably would have too.
Now, last, have you watched person after person, unable to stop using weed? Trying to quit repeatedly, and unable to consume less, or stop at all? Have you ever heard anyone talk about needing an AA style meeting, or a counselor to get them through the hard part? Has anyone ever disclosed to you their painful experience of trying to leave weed behind? Again, if you say ‘yes’, I won’t argue, but I expect if this were a thing to see, I’d have seen it in my over 20 years of being in the weed scene.
So is there really a cannabis use disorder?
In order for the medical community to prescribe you a medication for anything, they legally need a reason to do it. That reason comes as a diagnosis that creates a need for a treatment, which is then prescribed as a medication. The diagnosis acts as a justification to allow the patient to have a specific medication. A doctor can’t prescribe a medication that requires a prescription, without that justification.
If you go to a doctor with a urinary tract infection, that infection is tested for, and the diagnosis made based on the results of the tests. As in, it’s a verifiable problem, for which a medication exists to treat it. There’s 100% no subjectivity there. These are objective tests. This is the same for any medical issue, with a medical definition. Cancer is definable, the flu is definable, a broken bone is definable, a genetic mutation is definable.
Then we get to psychiatric disorders, and the process is the same, but with one not-so-minor stipulation which gets constantly steamrolled over. Psychiatric conditions have no medical diagnosis. There’s nothing to verify they exist, and no way to test for them, or differentiate them. Now, if you’re thinking ‘I’m sure that doctors can test and diagnose issues like schizophrenia’, the sad truth is they uniformly cannot, as there is no true verification method. All diagnoses therefore come from the opinion of each specific doctor. They are only subjective, with absolutely no objectivity involved.
Ever heard of two doctors having two different opinions? Happens all the time! And that can mean two wildly different diagnoses depending on the specific beliefs of the individual doctors. And two wildly different medications prescribed, that can have wildly different effects. Breast cancer is breast cancer no matter which doctor you go to. But depression might be depression to one, bi-polar to another, and a personality disorder to a third. All the doctors will pick up on what they see, which is usually centered on their ideas and beliefs. Now think of how opinionated most doctors are.
So does cannabis use disorder actually exist? Or is the medical community trying to make an unnecessary label so it can prescribe you more meds? It’s not my place to say for sure, but I can give my opinion. Remember that part where I’ve been both a weed user and in the weed community for over half my life? If I can go this long without seeing something that mirrors the conditions of this disorder, than far as I can tell, it’s pretty much the last thing you’ve got to worry about.
Want to worry in life? Worry about getting addicted to opioids, or benzodiazepines, or meth. Worry about your alcohol intake and how you’ll get home without driving drunk. Worry about the boxes of cigarettes you go through and how they affect your health and the health of those around you. And worry about why your governing bodies are consistently pushing you to use unhealthy options over healthier ones.
Worry about the pollution in the air and water, the chemicals in your food, and the long hours you’re made to work that take you away from your family for most of your waking hours. Worry about the stress that gets piled on you, and the terms used to describe the ways you deal with it. But if you like to de-stress yourself with weed, maybe don’t worry so much that you have a so-called disorder, since it doesn’t look to actually cause problems.
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Smoking too much cannabis and it’s beginning to affect your life in negative ways? Pretty soon a drug in capsule form could be the answer, if pharmaceutical drug developers get their way.
South Florida-based clinical research network Segal Trials announced it will conduct a Phase 2B study to investigate a new drug, AEF0117-202, created by Aelis Farma to treat cannabis use disorder (CUD), according to an October 5 press release. It is a randomized, double-blind, placebo-controlled, 4-arm, parallel-group, prospective, multicenter study, determining the efficacy of a drug that reacts to the same receptors as THC.
Under a new pharmacological class of drugs, called sCB1-SSi, AEF0117-202 is the first clinical candidate for the treatment of CUD, which is often defined as the inability to stop using cannabis—even if it’s causing health and social problems.
How much is too much pot? For this study, the criteria to meet CUD is defined as people who consume cannabis at least five times per week or more. To determine if the pill works, the orally administered drug will be given to a group of study participants, and a second group will receive a placebo. Then researchers will begin their work to determine the efficacy of the drug.
Three doses—1.0, 0.3, and 0.1 mg—and a placebo were given to study participants in capsules. “AEF0117 acts in the same parts of the brain as THC (tetrahydrocannabinol), the active ingredient of marijuana, and may temporarily alter some of cannabis’s effects,” researchers wrote in the summary. They explained their reasoning in the press release:
“Chronic marijuana use can drastically impact individuals’ social and professional lives in many ways, from poor work or school performance to mood disorders,” said Rishi Kakar, MD, chief scientific officer and medical director at Segal Trials. “This Phase 2B study gets us closer to the prospect of effectively treating people who want to end their reliance on cannabis but don’t have the tools to quit.”
“Addiction” can mean many different things, ranging from severe physical withdrawal symptoms from drugs like opiates or alcohol, or unhealthy psychological patterns. This study’s summary describes cannabis withdrawal symptoms as including irritability, mood and sleep difficulties, decreased appetite, cravings, restlessness, and occasionally physical discomfort.
According to the Centers for Disease Control and Prevention, one study estimated that approximately 3 in 10 people who consume cannabis have CUD. Another study estimated that people who use cannabis have about a 10% likelihood of becoming addicted.
Researchers Blame Potency for Rise in CUD
The rise in dabbing, and better and more powerful concentrates has been pinpointed as the culprit in the rise in cases of cannabis use disorder.
“The potency of cannabis products has increased significantly over the past twenty years,” which may have contributed to the rise of cannabis-related adverse effects,” said Dr. Kakar. “With no approved drugs available to treat chronic cannabis use, Aelis Farma’s drug has the potential to make a significant, positive impact for millions of marijuana users seeking to end their dependence on cannabis.”
The Segal team will conduct the trial at its Center for Psychedelic and Cannabis Research, which was specifically built using pharmaceutical and regulatory feedback to create a structured inpatient environment that ensures both patient safety and patient comfort.
Interestingly, the team has also worked with psychedelics. Segal Trials also recently announced it was the first in the United States to conduct a large, randomized clinical trial to investigate MM-120 (LSD D-tartrate) to treat Generalized Anxiety Disorder (GAD).
Segal has already succeeded in developing 54 FDA-approved medications and devices. The company says that its trials focus on psychiatry, neurology, addiction, insomnia, infectious diseases, vaccine development, and women’s health.