Evaluating cannabis substitution for alcohol within the context of a canadian managed alcohol program

Introduction: Managed Alcohol Programs (MAPs) provide beverage alcohol alongside housing and social supports to mitigate alcohol-related harms among individuals experiencing severe alcohol use disorder (AUD) and unstable housing. MAPs have been shown to stabilize alcohol use, reduce alcohol-related harms, improve quality of life, and decrease emergency service utilization. However, concerns about the long-term health risks associated with high levels of alcohol use have driven interest in cannabis substitution as an additional harm reduction strategy. Given the lower harm profile of cannabis, its integration into MAPs offers a promising avenue for further reducing alcohol-related harms. This study evaluates a novel cannabis substitution program within a Canadian MAP, leveraging the unique context of cannabis legalization and harm reduction programming.

Methods: Beginning in January 2023, participants (N = 35) were offered the choice of a pre-rolled cannabis joint or their prescribed alcohol dose multiple times per day. Data were drawn from five waves of quantitative surveys (January 2023 to February 2024; n = 20), two years of program records (January 2022 to February 2024; N = 35), and qualitative interviews (n = 14). Hierarchical mixed-effects models were used to predict alcohol use by cannabis use and time. Qualitative data were analyzed using interpretive description methodology.

Results: The final model found evidence of a substitution effect: participants who used more cannabis on average also consumed less alcohol overall. Specifically, each additional 0.4-gram joint consumed (approximately 15.2 standard THC units or 76 mg THC) was associated with an estimated 2.43 fewer mean daily standard drinks. Within-person cannabis use was not a significant predictor, indicating that short-term fluctuations in cannabis use were not associated with concurrent changes in alcohol consumption. Alcohol use also declined over time. Qualitative findings provide insights into the dynamic factors shaping drinking and cannabis use patterns.

Conclusion: This study highlights the potential for cannabis substitution to meaningfully reduce alcohol-related harms. Implications for program development and future research evaluating changes in health, wellbeing, and harm outcomes are discussed.”

https://pubmed.ncbi.nlm.nih.gov/41313909

“Emerging evidence suggests that cannabis substitution for alcohol may offer a promising approach to mitigating alcohol-related harms. Cannabis is associated with lower toxicity, fewer long-term health risks, and a lower likelihood of overdose compared to alcohol.”

https://www.sciencedirect.com/science/article/pii/S0955395925003792?via%3Dihub

Cannabinomics in the flower of Cannabis sativa: a systematic review of extraction, analytical identification, and micro/nanoencapsulation methods for bioactive metabolites

Introduction: The use of Cannabis sativa has evolved from textile applications in ancient times to a growing interest in its therapeutic and nutraceutical properties. Its regulation varies worldwide, with restrictions on ∆9-THC concentrations depending on the country. Cultivation factors, such as temperature, humidity and photoperiod, affect the concentration of their bioactive metabolites, among which phytocannabinoids have demonstrated impact on the biological regulation of the human organism. Their application in the pharmaceutical, cosmetic and food industries has prompted research into the optimization of their production and extraction.

Objective: The purpose of this systematic review is to identify methodologies for the extraction, analysis and application of cannabinoids in various industries, focusing on agro-industrial transformation to increase their added value and optimize their therapeutic use.

Methodology: A systematic search was performed in the Scopus database on November 14, 2024, identifying keywords and their synonyms for each research question, using Boolean operators. Studies published between 2015 and 2025 related to cannabinoid extraction, identification and application methodologies were included, excluding non-scientific papers. The PRISMA methodology was applied to filter and select articles.

Results: The studies analyzed show that extraction and metabolomic analysis methodologies have gained relevance in recent years, especially for obtaining bioproducts for therapeutic purposes. It was identified that cannabinoids, mainly THC and CBD, have potential in the treatment of inflammatory, neurological and chronic pain diseases. In addition, the application of emerging technologies for the micro and nanoencapsulation of cannabinoids, optimizing their bioavailability, was evidenced. However, there are still gaps in the literature on the correlation between extraction operating conditions and the efficiency of the final product, which hinders its industrial scalability.

Conclusions: The growing interest in Cannabis sativa research has led to the exploration of various techniques for the extraction and analysis of its metabolites. However, despite advances in laboratory methodologies, the industrial application of these processes remains a challenge. The lack of studies correlating operational variables with extraction efficiency limits the standardization of bioproducts. Future research should focus on articulating technology and applied science to establish production models to improve the traceability and safety of Cannabis sativa extracts, favoring their integration into the pharmaceutical and agro-industrial industry.”

https://pubmed.ncbi.nlm.nih.gov/41291955

https://link.springer.com/article/10.1186/s42238-025-00350-3

Chronic cannabis use in people with bipolar disorder is associated with comparable decision-making and functional outcome to healthy participants

“Impaired decision-making is often seen in people with bipolar disorder (BD), even those undergoing treatment. Targeted therapeutics are therefore needed.

People with BD report that cannabis use (CU) attenuates such cognitive and behavioral symptoms.

We hypothesized that 1) people with BD who do not use cannabis would exhibit poor decision-making and functional capacity relative to healthy comparison (HC) participants and 2) CU in people with BD would be associated with decision-making and functional capacity comparable to that of HC participants who do not use cannabis.

HC and BD participants that either reported regular (≥4x/weekly) CU or no-CU were recruited (n = 87). Participants were tested on decision-making and functional capacity using the Iowa Gambling Task and UCSD Performance-based skills assessment (UPSA-2), respectively.

CU was associated with impaired decision-making in healthy participants while CU in participants with BD was associated with better decision-making than their non-using counterparts and equivalent to decision-making in non-CU HC participants.

Additionally, CU in people with BD was associated with UPSA-2 scores comparable to non-CU HC participants. Studies are needed to determine whether cannabinoid-related treatments improve such decision-making and function in people with BD.”

https://pubmed.ncbi.nlm.nih.gov/41309543

“In summary, people with BD who use cannabis had decision-making and functional capacity comparable to non-CU HC participants.”

https://www.nature.com/articles/s41398-025-03718-4

A Longitudinal Assessment of Endometriosis Patients Prescribed Cannabis-Based Medicinal Products: A Case Series From the UK Medical Cannabis Registry

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Background: Although there is growing evidence supporting the use of cannabis-based medicinal products (CBMPs) for the management of chronic pain, there is a paucity of data on their effect on endometriosis-associated chronic pain.

Aims: This study aimed to perform an analysis of pain-specific and general health-related quality of life (HRQoL) outcomes for patients with endometriosis-associated chronic pain treated with CBMPs.

Materials and methods: Primary outcomes included changes in patient-reported outcome measures (PrOMs) from baseline to 1, 3, 6, 12 and 18 months. A repeated measures ANOVA was applied to assess changes in PrOMs at 1 to 18 months from baseline. Secondary outcomes included incidence and frequency of adverse events (AEs).

Results: Sixty-three patients met inclusion criteria. Initiation of CBMPs was associated with improvements in all pain-specific PrOMs from baseline to 18 months (p < 0.050). EQ-5D-5L index value showed improvements between baseline and all months (p < 0.050). Anxiety and sleep quality PrOMs showed improvements from baseline to 18 months (p < 0.050). Minimal clinically significant differences (11%-37%), moderately important improvements (5%-22%) and substantial improvements (0%-11%) were observed in the Brief Pain Inventory (BPI) and pain severity visual analogue scale. Sixty-two adverse events were reported by 16 (25.40%) participants.

Conclusions: This study observed an association between CBMP treatment and improvements in pain and HRQoL in patients with endometriosis. Causality cannot be inferred due to the nature of this observational study; however, these findings provide complementary evidence for the development of randomised controlled trials to assess the efficacy of CBMPs for endometriosis-associated chronic pain.”

https://pubmed.ncbi.nlm.nih.gov/41305963

“Cannabis-based medicinal products (CBMPs) that contain phytocannabinoids, such as (−)-trans-Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD), have been identified with potential to manage endometriosis-related pain.”

“Overall, these results provide a signal towards improvement in short-term pain severity and interference for endometriosis patients after the initiation of CMBP treatment, although there was diversity at different pain intervals.”

https://obgyn.onlinelibrary.wiley.com/doi/10.1111/ajo.70078

Tetrahydrocannabinols: potential cannabimimetic agents for cancer therapy

“Tetrahydrocannabinols (THCs) antagonize the CB1 and CB2 cannabinoid receptors, whose signaling to the endocannabinoid system is essential for controlling cell survival and proliferation as well as psychoactive effects.

Most tumor cells express a much higher level of CB1 and CB2; THCs have been investigated as potential cancer therapeutic due to their cannabimimetic properties. To date, THCs have been prescribed as palliative medicine to cancer patients but not as an anticancer modality.

Growing evidence of preclinical research demonstrates that THCs reduce tumor progression by stimulating apoptosis and autophagy and inhibiting two significant hallmarks of cancer pathogenesis: metastasis and angiogenesis. However, the degree of their anticancer effects depends on the origin of the tumor site, the expression of cannabinoid receptors on tumor cells, and the dosages and types of THC.

This review summarizes the current state of knowledge on the molecular processes that THCs target for their anticancer effects. It also emphasizes the substantial knowledge gaps that should be of concern in future studies. We also discuss the therapeutic effects of THCs and the problems that will need to be addressed in the future. Clarifying unanswered queries is a prerequisite to translating the THCs into an effective anticancer regime.”

https://pubmed.ncbi.nlm.nih.gov/36696005/

https://link.springer.com/article/10.1007/s10555-023-10078-2

Analysis of Anti-Cancer and Anti-Inflammatory Properties of 25 High-THC Cannabis Extracts

“Cannabis sativa is one of the oldest cultivated plants. Many of the medicinal properties of cannabis are known, although very few cannabis-based formulations became prescribed drugs. Previous research demonstrated that cannabis varieties are very different in their medicinal properties, likely due to the entourage effect-the synergistic or antagonistic effect of various cannabinoids and terpenes.

In this work, we analyzed 25 cannabis extracts containing high levels of delta-9-tetrahydrocannabinol (THC). We used HCC1806 squamous cell carcinoma and demonstrated various degrees of efficiency of the tested extracts, from 66% to 92% of growth inhibition of cancer cells.

Inflammation was tested by induction of inflammation with TNF-α/IFN-γ in WI38 human lung fibroblasts. The efficiency of the extracts was tested by analyzing the expression of COX2 and IL6; while some extracts aggravated inflammation by increasing the expression of COX2/IL6 by 2-fold, other extracts decreased inflammation, reducing expression of cytokines by over 5-fold.

We next analyzed the level of THC, CBD, CBG and CBN and twenty major terpenes and performed clustering and association analysis between the chemical composition of the extracts and their efficiency in inhibiting cancer growth and curbing inflammation.

A positive correlation was found between the presence of terpinene (pval = 0.002) and anti-cancer property; eucalyptol came second, with pval of 0.094. p-cymene and β-myrcene positively correlated with the inhibition of IL6 expression, while camphor correlated negatively. No significant correlation was found for COX2. We then performed a correlation analysis between cannabinoids and terpenes and found a positive correlation for the following pairs: α-pinene vs. CBD, p-cymene vs. CBGA, terpenolene vs. CBGA and isopulegol vs. CBGA.

Our work, thus, showed that most of high-THC extracts demonstrate anti-cancer activity, while only certain selected extracts showed anti-inflammatory activity. Presence of certain terpenes, such as terpinene, eucalyptol, cymene, myrcene and camphor, appear to have modulating effects on the activity of cannabinoids.”

https://pubmed.ncbi.nlm.nih.gov/36144796

“Cannabis sativa is a plant with a long history of consumption as food and medicine. Delta-9-tetrahydrocannabinol (THC) is one of the main cannabinoids in cannabis; it has many properties, including anti-cancer, anti-inflammatory, analgetic and others.”

https://www.mdpi.com/1420-3049/27/18/6057/htm

Administration of Δ9-Tetrahydrocannabinol Following Controlled Cortical Impact Restores Hippocampal-Dependent Working Memory and Locomotor Function

Hypothesis: Administration of the phytocannabinoid Δ9-tetrahydrocannabinol (Δ9-THC) will enhance brain repair and improve short-term spatial working memory in mice following controlled cortical impact (CCI) by upregulating granulocyte colony-stimulating factor (G-CSF) and other neurotrophic factors (brain-derived neurotrophic factor [BDNF], glial-derived neurotrophic factor [GDNF]) in hippocampus (HP), cerebral cortex, and striatum. 

Materials and Methods: C57BL/6J mice underwent CCI and were treated for 3 days with Δ9-THC 3 mg/kg intraperitoneally (i.p.). Short-term working memory was determined using the spontaneous alternations test during exploratory behavior in a Y-maze. Locomotor function was measured as latency to fall from a rotating drum (rotometry). These behaviors were recorded at baseline and 3, 7, and 14 days after CCI. Groups of mice were euthanized at 7 and 14 days. Extent of microgliosis, astrocytosis, and G-CSF, BDNF, and GDNF expression were measured at 7 and 14 days in cerebral cortex, striatum, and HP on the side of the trauma. Levels of the most abundant endocannabinoid (2-arachidonoyl-glycerol [2-AG]) was also measured at these times. 

Results: Δ9-THC-treated mice exhibited marked improvement in performance on the Y-maze indicating that treatment with the phytocannabinoid could reverse the deficit in working memory caused by the CCI. Δ9-THC-treated mice ran on the rotarod longer than vehicle-treated mice and recovered to normal rotarod performance levels at 2 weeks. Δ9-THC-treated mice, compared with vehicle-treated animals, exhibited significant upregulation of G-CSF as well as BDNF and GDNF in the cerebral cortex, striatum, and HP. Levels of 2-AG were also increased in the Δ9-THC-treated mice. 

Conclusion: Administration of the phytocannabinoid Δ9-THC promotes significant functional recovery from traumatic brain injury (TBI) in the realms of working memory and locomotor function. This beneficial effect is associated with upregulation of brain 2-AG, G-CSF, BDNF, and GDNF. The latter three neurotrophic factors have been previously shown to mediate brain self-repair following TBI and stroke.”

https://pubmed.ncbi.nlm.nih.gov/34747647

https://www.liebertpub.com/doi/10.1089/can.2021.0053

The association between marijuana use and oral cancer risk: a systematic review and meta-analysis of case-control studies

“The relationship between marijuana use and oral cancer risk remains controversial, with conflicting evidence from epidemiological studies. This systematic review and meta-analysis aimed to synthesize available evidence on the association between marijuana consumption and oral cancer incidence.

Following PRISMA guidelines, we conducted comprehensive searches across Scopus, PubMed, Web of Science, and Embase databases up to August 2025. We included only case-control studies reporting quantitative risk estimates for marijuana use and histologically confirmed oral cancer (ICD-10 codes C00-C06). Data extraction followed standardized protocols, and study quality was assessed using the Joanna Briggs Institute checklist. Statistical analyses were performed using Comprehensive Meta-Analysis software with random-effects models. Heterogeneity was evaluated using I2 statistics, and publication bias was assessed through funnel plots and Egger’s regression test. Six case-control studies involving 4,686 cases and 10,370 controls were included.

The pooled odds ratio demonstrated a statistically significant inverse association between marijuana use and oral cancer risk (OR = 0.659, 95% CI: 0.500-0.869, p = 0.003, I2 = 47.35).

Subgroup analyses were performed based on the duration of use, gender, and age at initiation of marijuana use; however, no clear dose-response relationship was observed. Sensitivity analyses confirmed robustness of findings, with ORs ranging from 0.599 to 0.708 across iterations. No significant publication bias was detected (Egger’s test p = 0.532). Three individual studies showed statistically significant protective effects, while three others were non-significant.

This meta-analysis suggests marijuana use is associated with reduced oral cancer risk.

However, given methodological limitations, heterogeneity in exposure assessment, and conflicting recent evidence, these findings require cautious interpretation. Future large-scale prospective cohort studies with standardized exposure measurements are essential for definitive conclusions.”


https://pubmed.ncbi.nlm.nih.gov/41236922/

https://www.tandfonline.com/doi/full/10.1080/15332640.2025.2581692

Cannabinoids shift the basal ganglia microRNA m6A methylation profile towards an anti-inflammatory phenotype in SIV-infected rhesus macaques

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“Epitranscriptomic modifications [N6-methyladenosine (m6A)] regulate various diseases, including cancer and inflammation. Despite their functional relevance in neural development and differentiation, the role of m6A modifications in HIV neuropathogenesis is unknown. Using anti-N6-methyladenosine (m6A) antibody-immunoprecipitation and microarray profiling, we identified m6A modifications in miRNAs in basal ganglia (BG) of uninfected (VEH) and SIV-infected Rhesus macaques (RMs) on combination anti-retroviral therapy (ART) and either VEH-treated (VEH/SIV/ART) or THC:CBD-treated (THC:CBD/SIV/ART).

HIV/SIV infection promoted an overall hypomethylated miRNA m6A profile. While THC:CBD did not significantly impact the overall hypomethylated m6A profile, specific miRNAs predicted to target proinflammatory genes showed marked m6A hypomethylation compared to VEH-treated RMs. Additionally, specific BG m6A-modified miRNAs were detected in BG-derived extracellular vesicles. Mechanistically, the DRACH motif in the miR-194-5p seed region was significantly m6A hypomethylated in THC:CBD/SIV/ART RMs. Unlike wild-type, in-vitro transfected m6A-modified miR-194-5p mimics failed to downregulate STAT1 protein expression. Further, compared to VEH/SIV/ART RMs, THC:CBD significantly reduced m6A methylation of 44 miRNAs directly involved in regulating CNS network genes.

Our findings indicate that m6A epi-transcriptomic marks in the seed nucleotides can impair miRNA function and that cannabinoids may preserve it by reducing m6A methylation levels, thus providing a mechanistic explanation underlying their anti-neuroinflammatory effects in HIV/SIV infection.”

https://pubmed.ncbi.nlm.nih.gov/41286161

https://www.nature.com/articles/s42003-025-09049-w

Advances in the Quest for Safe and Effective Drugs That Target the Cannabinoid Receptor Type 1 (CB1)

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“Pain management costs the world billions of dollars each year, and there are limited nonopioid options to treat people suffering from chronic pain. Opioids are excellent analgesics but are liable to abuse and fatal overdoses. This Microperspective summarizes challenges and opportunities pertaining to creating nonopioid drugs that could be used to treat chronic pain, substance abuse, fatty liver, or obesity by targeting the cannabinoid receptor type 1 (CB1).”

https://pubmed.ncbi.nlm.nih.gov/41257001

https://pubs.acs.org/doi/10.1021/acsmedchemlett.5c00402