Author Archives: David Worrell

Cannabis Laws and Opioid Use Among Commercially Insured Patients With Cancer Diagnoses

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“Importance: Pain is a prevalent cancer-related symptom, but limited research investigates whether cannabis is an effective analgesic for cancer pain.

Objective: To examine the association of medical and recreational cannabis dispensary availability on prescription opioid dispensing among commercially insured patients with cancer.

Design, setting, and participants: This cross-sectional study used synthetic control to investigate the association of cannabis dispensary openings with pain medication dispensing among patients with cancer. Data were extracted from Optum’s deidentified Clinformatics Data Mart database from January 1, 2007, to December 31, 2020. The study population included patients aged 18 to 64 years with a cancer diagnosis and at least 6 months of continuous enrollment. Associations were estimated by age, race and ethnicity, and sex. Data were analyzed between December 2024 and February 2025.

Exposures: Exposures included indicators for whether a medical or recreational cannabis dispensary was open in each state-quarter.

Main outcomes and measures: The outcome measures for opioids prescriptions were (1) the rate of patients with a prescription per 10 000 patients, (2) the quarterly mean days’ supply per prescription, and (3) the quarterly mean number of prescriptions per patient.

Results: The study included a mean (SD) of 3.05 (0.86) million patients annually across the US (mean [SD] age, 43.7 [9.6] years; mean [SD] 59.0% [0.32%] female). Medical cannabis dispensary openings were associated with significant reductions in all opioid outcomes. The rate of patients with cancer with opioid prescriptions changed by -41.07 per 10 000 (95% CI, -54.78 to -27.36 per 10 000; P < .001), the quarterly mean days’ supply by -2.54 days (95% CI, -3.16 to -1.92 days; P < .001), and the mean number of prescriptions per patient by -0.099 (95% CI, -0.121 to -0.077; P < .001). Recreational dispensary openings were also associated with reductions in opioid outcomes, though estimated treatment effects were smaller. The rate of prescriptions changed by -20.63 per 10 000 (95% CI, -35.35 to -5.91 per 10 000; P = .049), the mean daily supply by -1.09 days supplied per prescription (95% CI, -1.72 to -0.46 days; P = .04), and the mean number of prescriptions per patient by -0.097 (95% CI, -0.134 to -0.060; P = .01).

Conclusions and relevance: This study’s findings indicate cannabis may be a substitute for opioids in the management of cancer-related pain. However, further research directly observing cannabis use is needed to evaluate the efficacy of cannabis as a treatment for cancer-related pain.”

https://pubmed.ncbi.nlm.nih.gov/41105418

“Results of this study suggest that cannabis may serve as a substitute for opioids in managing cancer-related pain, underscoring the potential of cannabis policies to impact opioid use.”

https://jamanetwork.com/journals/jama-health-forum/fullarticle/2840030

Motor-Related Neural Dynamics are Modulated by Regular Cannabis Use Among People with HIV

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“Recent work has shown that people with HIV (PWH) exhibit deficits in cognitive control and altered brain responses in the underlying cortical networks, and that regular cannabis use has a normalizing effect on these neural responses.

However, the impact of regular cannabis use on the neural oscillatory dynamics underlying motor control deficits in PWH remains less understood. Herein, 102 control cannabis users, control nonusers, PWH who regularly use cannabis, and PWH who do not use cannabis performed a motor control task with and without interference during high-density magnetoencephalography.

The resulting neural dynamics were examined using whole-brain, voxel-wise statistical analyses that examined the impact of HIV status, cannabis use, and their interaction on the neural oscillations serving motor control, spontaneous activity during the baseline period, and neurobehavioral relationships.

Our key findings revealed cannabis-by-HIV group interactions in oscillatory gamma within the prefrontal cortices, higher-order motor areas, and other regions, with the non-using PWH typically exhibiting the strongest gamma interference responses. Cannabis-by-HIV interactions were also found for oscillatory beta in the dorsal premotor cortex. Spontaneous gamma during the baseline was elevated in PWH and suppressed in cannabis users in all regions exhibiting interaction effects and the left primary motor cortex, with spontaneous levels being correlated with behavioral performance.

These findings suggest that regular cannabis use has a normalizing effect on the neural oscillations serving motor control and the abnormally elevated spontaneous gamma activity that has been widely replicated in PWH, which may suggest that cannabis has at least some therapeutic utility in PWH.”

https://pubmed.ncbi.nlm.nih.gov/40473990

“The current study found evidence of multiple novel interactions between cannabis use and HIV status in beta and gamma interference responses across a broad network of brain regions. Further, these findings corroborate multiple recent studies showing elevated spontaneous gamma activity in PWH, and that regular cannabis use is associated with a marked suppression in such spontaneous activity.”

https://link.springer.com/article/10.1007/s11481-025-10219-0

Cannabidiol in Gliomas: Therapeutic Potential and Nanocarrier Strategies, with an Emphasis on Vesicular Delivery Systems

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“Cannabidiol (CBD), a nonpsychoactive phytocannabinoid extracted from Cannabis sativa, has emerged as a compound of considerable therapeutic interest across numerous medical disciplines, including pain management, anti-inflammatory therapy, and oncology.

This review critically examines the potential of CBD in the treatment of glioblastoma multiforme (GBM), one of the most aggressive and treatment-resistant primary brain tumors.

Particular emphasis is placed on the molecular mechanisms underlying CBD’s antitumor activity, including the modulation of key signaling pathways, inhibition of tumor proliferation, and enhancement of chemosensitivity. Furthermore, the review highlights the increasing role of nanotechnology in overcoming the intrinsic pharmacokinetic limitations of CBD, particularly its low oral bioavailability, which presents a significant challenge to its clinical application. Advanced nanocarrier platforms, including nanoemulsions, nanoparticles, nanoparticle-based transdermal systems, nanocapsules, and liposomes, have shown promise in optimizing CBD delivery to the central nervous system (CNS).

Notably, the integration of CBD into lipid-based drug delivery systems (LBDDS) is highlighted as a particularly promising strategy to potentiate its therapeutic efficacy. This approach enhances bioavailability and may amplify synergistic effects when combined with conventional chemotherapeutics or targeted agents.

Overall, the synergistic use of nanotechnological approaches and CBD-based therapies may open new avenues for research, offering the potential to significantly advance treatment efficacy in glioblastoma and other diseases.”

https://pubmed.ncbi.nlm.nih.gov/41288593

https://pubs.acs.org/doi/10.1021/acs.molpharmaceut.5c00853


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

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“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

Chemical Profile, Bioactive Constituents and In Vitro Growth Stimulation Properties of Cold-Pressed Hemp Seed Oils from Romanian Varieties: In Vitro and In Silico Evaluation

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“Industrial hemp (Cannabis sativa L.; Cannabaceae), traditionally cultivated for fiber, also represents a valuable source of nutrient-rich seed oil.

In this study, cold-pressed hemp seed oils from three Romanian varieties (Teodora, Silvana, and Armanca) were evaluated for their fatty acid composition, minor bioactive constituents, antioxidant activity, growth-promoting property toward probiotic strains in vitro, and molecular docking interactions with probiotic targets.

Gas chromatography revealed a fatty acid profile dominated by linoleic (49.4-51.9%), oleic (16.3-22.8%), and α-linolenic acids (9.8-14.4%), resulting in favorable PUFA/SFA ratios (5.17-6.39) and ω-6/ω-3 ratios (3.93-5.53).

The oils also contained phenolics (118-160 mg GAE/kg), chlorophylls (6.18-8.31 mg/kg), and carotenoids (2.58-3.37 mg/kg), which contributed to their antioxidant activity (DPPH inhibition 35.92 µM TE/100 g-43.37 µM TE/100 g).

Broth microdilution assays against Lacticaseibacillus rhamnosus GG, L. paracasei ATCC BAA-52, and L. acidophilus ATCC 4356 demonstrated strain- and dose-dependent potential to promote probiotic growth under in vitro conditions. While L. rhamnosus and L. paracasei were inhibited at low concentrations and only mildly stimulated at higher levels, L. acidophilus showed robust growth promotion, reaching +54.7% effect and CP = 1.55 with Teodora oil at 16 mg/mL.

Molecular docking highlighted strong binding affinities of γ-linolenic and linoleic acids with key metabolic enzymes involved in probiotic metabolism (hydratase, enolase, glyceraldehyde-3-phosphate dehydrogenase, ribonucleoside hydrolase), forming stable hydrophilic and hydrophobic interactions which are explored in defining the stability of the ligand-protein complexes.

These results indicate that both major fatty acids and minor bioactive constituents contribute to the nutritional and antioxidant value of Romanian hemp seed oils and reveal a potential to promote probiotic growth under in vitro conditions, as supported by complementary in silico evidence.”

https://pubmed.ncbi.nlm.nih.gov/41304617

“This study demonstrated that cold-pressed hemp seed oils from Romanian varieties are rich in polyunsaturated fatty acids, with favorable PUFA/SFA and ω-6/ω-3 ratios that support their role as health-promoting dietary fats. Alongside their fatty acid profile, the oils contain phenolic compounds, chlorophylls, and carotenoids, which contribute to antioxidant stability and may synergize with PUFAs to enhance biological effects.”

https://www.mdpi.com/2223-7747/14/22/3465


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

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“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

Characterization of cell-type specific knockout of different elements of the endocannabinoid system in cortical glutamatergic neurons in the context of stress-induced behavioral phenotype

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“Background: Chronic stress is an important factor for the development of mental health impairments, such as depression and generalized anxiety disorder. Chronic social defeat (CSD) stress is an ethologically valid model of chronic stress in rodents, combining elements of psychological and physical stress. The endocannabinoid (eCB) system plays important roles in maintaining the homeostasis of biological systems through the tuning of neuronal excitability, thereby mediating a protective role after prolonged stress exposure.

Methods: In the present study, we investigated genetically modified adult male mice where the eCB signal via anandamide (AEA) was reduced (by deletion of the AEA synthesizing enzyme NAPE-PLD) or enhanced (by deletion of the AEA degradation enzyme FAAH), as well as mice lacking the cannabinoid CB1 receptor. These genetic manipulations were induced in glutamatergic neurons of the dorsal telencephalon. After the application of CSD stress, the phenotypes of these mutant mice were investigated in a battery of behavioral tests assessing sociability, anxiety, memory, shelter-seeking behavior, and despair.

Results: We could confirm a robust anxiogenic effect of CSD in the EPM test. Interestingly, we have not observed a stress effect on the sociability of any of the mouse lines as identified in the SI test. Under non-stress conditions, we observed an anxiogenic phenotype in Glu-CB1-KO and Nex-NAPE-PLD KO, and hyperlocomotion in Nex-FAAH KO mice. Additionally, we could confirm a drastic reduction of FAAH protein levels in cortical and subcortical regions of Nex-FAAH line, and a moderate reduction of NAPE-PLD protein in cortical regions of Nex-NAPE-PLD KO mice.

Conclusions: In conclusion, genetic manipulation of the endocannabinoid system in cortical glutamatergic neurons did not result in persistent effects of prolonged stress exposure. Detected differences between the genotypes in the non-stressed groups points toward baseline differences that could mask or over-power the effect of stress.”

https://pubmed.ncbi.nlm.nih.gov/41310892

https://link.springer.com/article/10.1186/s42238-025-00368-7

The Endocannabinoid System in Human Disease: Molecular Signaling, Receptor Pharmacology, and Therapeutic Innovation

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“The endocannabinoid system (ECS) is a primary regulatory system in human physiology that serves to help maintain homeostasis throughout the nervous system, immune system, and gastrointestinal system.

This review has the goal of evaluating the unique opportunity for the ECS to provide a regulatory axis within the microbiota-gut-brain axis, particularly with regard to neurodevelopment, immune tolerance, and gut health.

Cannabinoid receptors CB1 and CB2 and endogenous ligands anandamide (AEA) and 2-arachidonoylglycerol (2-AG have the ability to provide a variety of signaling pathways that can regulate cognitive resilience, emotional tuning, and immune regulation. Because the ECS has the ability to regulate multiple neurochemicals, alter immune cell functions, and maintain gut barriers, the ECS exists at the crossroads of many physiological systems, which also have a predictive role in neurodegenerative disease, chronic inflammation, and mental illness.

Our goal is to present the latest and best recent advances in the ECS literature and establish evidence that there exists some modest potential for the therapeutic modulation of the ECS to improve pathological manifestations of cross-system dysregulation. In addition to cellular signaling pathways, the ECS affects other homeostatic processes, such as synaptic plasticity and the level of neuroprotection in the CNS, immune-related homeostasis, and coordinating the composition of gut microbiota.

We argue that the ECS represents a suitable new therapeutic target that could modulate dysregulation across these systems more inclusively. This paper aims to emphasize the proposed potential of the ECS’s position in this axis and propose advanced cannabinoid-based interventions as a novel mechanism for developing personalized medicine and health systems through multi-system integration.”


https://pubmed.ncbi.nlm.nih.gov/41303613/

“In summary, the ECS presents the opportunity to appreciate how modern biology is reconstituting the definition of health—not as an absence of disease but in promoting maintenance of the homeostatic ability of the organism to interact with heterogeneous systems.”

“Collectively, the convergence of biotechnology, engineering, AI, and multi-omics is transforming ECS research and its translational potential. This convergence provides a platform for developing personalized ECS interventions that consider the interplay among the neural, immune, and microbiota systems in a unified therapeutic approach.”

https://www.mdpi.com/1422-0067/26/22/11132

Enhanced Antibacterial and Anti-Inflammatory Activities of the Combination of Cannabis sativa and Propolis Extracts: An In Vitro Study

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“Sore throat, commonly associated with pharyngitis and tonsillitis, is primarily caused by bacterial pathogens. Conventional therapies rely on antibiotics and anti-inflammatory drugs; however, concerns about adverse effects, antibiotic resistance, and drug interactions have encouraged the search for alternative remedies. 

Cannabis sativa L. (CS) has demonstrated potential in relieving sore throat and inflammation, while propolis, a bee-derived natural product, exhibits notable antibacterial and anti-inflammatory activities.

This study aimed to investigate the enhanced antibacterial and anti-inflammatory effects of combining CS and propolis extracts (PE).

Results found that CS and PE exhibited antibacterial effects against Streptococcus pyogenes DMST 4369, Staphylococcus aureus ATCC 25923, and Pseudomonas aeruginosa ATCC 9027. Their combination produced additive antibacterial effects against S. pyogenes and S. aureus.

Cannabidiol (CBD) was identified as an active antibacterial constituent against S. pyogenes. Additionally, the PE-CBD in CS solution combination at concentration 625:0.125 µg/mL significantly reduced NO production and suppressed proinflammatory cytokines in LPS-stimulated macrophages.

This study highlights the enhanced antibacterial and anti-inflammatory potential of the C. sativa and propolis combination, emphasizing the need to verify synergistic effects and determine the appropriate ratio for rational product development. Further research is needed to investigate the underlying mechanisms of action, particularly the anti-inflammatory pathways, in animal models. In addition, studies on hepatotoxicity should be conducted to ensure safety.”

https://pubmed.ncbi.nlm.nih.gov/41303662

“PE is commonly used for sore throat relief and is recommended for bacterial infections, and CBD derived from C. sativa is known for its analgesic and anti-inflammatory properties. This study explores the combination of propolis and C. sativa extract, hypothesizing that an optimized combination may work additively to enhance the antibacterial and anti-inflammatory effects.

The findings demonstrate that propolis and C. sativa extract exhibit antibacterial activity against pathogens such as S. pyogenes and S. aureus. Moreover, a combination of C. sativa solution and propolis solution at a ratio of 1:0.5 and 1:1 indicated that they exerted additive antibacterial effects.

Notably, CBD and Δ9-THC were identified as active compounds against S. pyogenes, an important respiratory tract pathogen.

In addition, the combination of C. sativa solution and propolis at a ratio of 1:0.5 at concentrations of 0.125 µg/mL and 625 µg/mL, respectively, significantly reduced NO generation and suppressed the release of proinflammatory cytokines (TNF-α, IL-6, and IL-8), thereby providing enhanced anti-inflammatory effects compared to the individual extracts.

Overall, this novel combination shows significant advantages over existing treatments by enhancing both antibacterial and anti-inflammatory effects, suggesting its potential for further development in herbal pharmaceutical formulations. Given its local action and ease of administration, this combination may be considered promising for future formulation as an oral spray.”

https://www.mdpi.com/1422-0067/26/22/11181

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