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Sexual minority adults have higher rates of cannabis use, relative to heterosexual adults, possibly attributed to lower harm perceptions. Although prior research has typically used self-report (i.e., explicit) measures to capture cannabis harm perceptions, implicit cognitions can also be examined. This study examined associations between implicit and explicit cannabis harm perceptions and the associations with cannabis use outcomes (likelihood of any past 30-day cannabis use, past 30-day cannabis frequency, problematic use), as well as differences based on sexual identity (sexual minority vs. heterosexual). Participants were 254 college students who completed a laboratory session to examine cannabis use behavior (any past 30-day use, frequency, and the Cannabis Use Disorder Identification Test-Revised), explicit cannabis harm perceptions, and implicit harm perceptions using an Implicit Association Test. Implicit and explicit cognitions were weakly associated (B&#x2009;=&#x2009;0.20, SE&#x2009;=&#x2009;0.025, p&#x2009;<&#x2009;0.001). Sexual minority participants were more likely to use cannabis and held lower implicit cannabis harm perceptions than heterosexual individuals. Those with lower explicit cannabis harm perceptions were more likely to use cannabis. Heterosexual participants with higher implicit cannabis harm perceptions had a higher probability of CUD. The association between implicit cognitions and CUD was not significant for sexual minority participants. Implicit and explicit cognitions may be complementary measures to examine harm perceptions of cannabis. Public health messaging should provide factual knowledge about the harms of cannabis from reliable and relatable sources which may impact implicit and explicit harm perceptions and ultimately prevent cannabis initiation and escalation to problematic use.

Cannabis use is linked to elevated psychosis risk, yet the neurobiological mechanisms that couple use to symptom expression remain unclear. Because glutamatergic dysregulation has been implicated in both cannabis effects and psychosis vulnerability, we examined whether brain glutamate relates to dimensional psychosis symptoms as a function of cannabis use across the psychosis spectrum. Seventy-nine participants-typically developing controls, clinical high-risk individuals, and patients with psychosis-completed dimensional clinical assessments, detailed cannabis use surveys, urine toxicology, and ultra-high-field 7T magnetic resonance spectroscopy (1HMRS) of the anterior cingulate cortex (ACC). Linear models assessed the main and interactive effects of ACC glutamate and cannabis use on psychopathology symptoms. Self-reported cannabis use showed good concordance with urine toxicology, with strongest agreement among frequent users. Both lower ACC glutamate and higher cannabis use were independently associated with positive and negative psychosis symptoms. Notably, lower glutamate levels were associated with higher positive symptoms in cannabis users but not cannabis non-users. Exploratory analyses suggested interactions for depressive and manic symptoms, indicating that glutamatergic abnormalities may amplify the overall severity of cannabis-related symptoms. Sensitivity analyses revealed lower ACC glutamate in psychosis patients-especially cannabis users-highlighting diagnostic group differences and reinforcing the link between cannabis exposure and glutamatergic dysfunction. These findings implicate ACC glutamatergic dysfunction as a transdiagnostic correlate of symptom burden, particularly in those with psychosis who are cannabis users. Glutamate-targeted interventions and longitudinal designs will be needed to examine causal pathways linking cannabis exposure to psychosis-relevant outcomes.

The Acquired Preparedness Model (APM) theorizes that psychosocial learning is a mechanism linking impulsive personality traits to various risky behaviors. Prior research on acquired preparedness has predominantly examined between-person associations, enrolled civilian samples, and focused on one behavior (e.g., alcohol use). This secondary analysis used three waves of biannual survey data to test temporal relations among impulsivity, alcohol and cannabis use expectancies, and quantity/frequency among Veterans deployed post-9/11/2001. Veterans reporting lifetime cannabis use (N=361) completed measures of urgency (UPPS-P), alcohol and cannabis use expectancies, and past-month alcohol and cannabis frequency and quantity at baseline, 6 and 12-months. Four separate Random Intercept Cross-Lagged Panel Models tested between- and within-person associations among urgency, alcohol/cannabis expectancies, and alcohol/cannabis use frequency or quantity. Within persons, 6-month alcohol or cannabis expectancies did not mediate associations between baseline urgency and 12-month alcohol or cannabis use indices. Urgency was not associated with positive alcohol or cannabis expectancies at any assessment. Between persons, urgency was associated with more positive alcohol and cannabis expectancies. Positive expectancies were associated with higher use frequency and quantity across both substances, whereas negative expectancies were associated with lower cannabis use frequency and quantity. Acquired preparedness may be more applicable to predicting alcohol and cannabis use behaviors between rather than within Veterans over time. Future research should consider how sociocultural factors may impact acquired preparedness among Veterans, and whether these processes unfold differently in relation to substance use outcomes during shorter time periods and across unique developmental stages.

Despite growing cannabis use rates among US rural-residing young adults, less research has examined associations of rural-urban residence with cannabis use influences (e.g., harm perceptions, peer use) or behaviors (e.g., use frequency, driving under the influence of cannabis [DUIC]). Using 2023 online survey data from 1961 US young adults (aged 18-34) reporting past-month cannabis use (Mage&#x2009;=&#x2009;26.86 [standard deviation&#x2009;=&#x2009;4.61], 14.7% rural-residing, 38.2% racial/ethnic minority, 59.2% female), multivariable regressions controlling for sociodemographics and state non-medical cannabis legalization examined associations of (1) rural-urban residence with cannabis use influences (motives, perceptions, mental/physical health, parent/peer use, advertising exposure); and (2) rural-urban residence and use influences with use behaviors (past-month days of use, past 6-month DUIC, consequences). Rural (vs. urban) residence was associated with three use influences (i.e., greater coping motives, lower perceived harm of cannabis use, higher odds of a mental health diagnosis), more frequent cannabis use and DUIC, but fewer use consequences. All three influences were associated with more frequent use and having a mental health diagnosis was associated with more frequent DUIC. Greater coping motives and lower harm perceptions were associated with fewer consequences, and having a mental health diagnosis was associated with greater consequences. Rural (vs. urban) young adults reported more frequent cannabis use and DUIC, which may be associated with low cannabis-related harm perceptions and using cannabis to cope with stress/mental health symptoms. Interventions targeting rural young adults that address mental health symptoms and risk perceptions, including DUIC-related risks, may be needed.

Controlled-environment cultivation of medicinal cannabis (Cannabis sativa L.) typically optimizes light conditions to enhance the biosynthesis of pharmaceutically important metabolites like cannabinoids. Such experimental strategies may also influence other specialized metabolites like terpenoids, flavonoids, alkaloids, among others. Previous untargeted metabolomics studies testing short-wavelength conditions like UV and blue light have shown that terpenoids and prenylated flavonoids in cannabis leaves respond differentially. However, since metabolomic studies in cannabis have so far mostly focused on floral cannabinoids, a comprehensive untargeted study into cannabis' floral metabolome response to short wavelengths is currently lacking. Our study investigates the impact of short-wavelength usage on cannabis specialized metabolism, and in particular the influence of UVB, UVA, and blue light on the cannabis floral flavonoid metabolome and associated glycosylation moieties. Cannabis plants were grown under a white background light and exposed to supplemental UVB, UVA, or blue light during the generative phase of the cultivation cycle. Treatments were compared to a reference white background light without UV or blue light. Metabolites from floral tissue were extracted and analysed via ultra-performance liquid chromatography-tandem mass spectrometry. A comparative metabolomics workflow was designed and used to characterize the floral flavonoid metabolome and associated glycosylation moieties. Our results demonstrate how short wavelengths differentially affect the metabolism of natural product compound classes including polyketides and phenylpropanoids/shikimates. Blue light induced flavonoids similarly to how UVB did, while both UVA and blue light specifically induced flavanones accumulation. UVB showed the strongest regulatory effect on flavonoids production and glycosylation patterns. UVB reshapes the cannabis floral flavonoid metabolome by selectively stimulating the accumulation and structural modification of flavonoids. Therefore, UVB represents a potential horticultural strategy to enhance flavonoid-related aspects of medicinal cannabis inflorescence phytochemical quality, without affecting cannabinoid levels.

What is already known on this topic Cannabis use is increasingly documented in EHR narrative text, but structured fields do not capture use status or symptom related motivations, limiting research on pain self-management strategies in autoimmune rheumatic diseases. What this study adds We developed a natural language processing pipeline using large language models to identify cannabis use status (4-class) and reasons for use (6-class), with best performance from fine-tuned GatorTron for status and an LLM for reasons. How this study might affect research, practice or policy This scalable approach can support real-world evidence studies on symptom management, medication use, and outcomes among ARD populations, and it provides a methodological template for extracting under-documented patient behaviors from narrative notes. The primary objective is to develop and evaluate a scalable and reproducible natural language processing (NLP) approach using large language models (LLM) to identify cannabis use status and reasons for cannabis use among patients with autoimmune rheumatic diseases (ARDs) from unstructured electronic health record (EHR) clinical notes. We conducted a retrospective study using EHR clinical notes from patients with ARDs (2015-2024). Notes were screened for cannabis-related mentions using fuzzy string matching against a curated keyword lexicon with a similarity threshold of 90, extracting 50-word context windows (&#xb1;25 words). Two domain experts annotated 886 randomly sampled snippets across four classes: (1) not a true cannabis mention/uncertain, (2) denial of use, (3) positive past use, and (4) positive current use. Using these annotations, we compared multiple LLM prompting strategies (zero-shot to few-shot; temperature tuning) and a fine-tuned clinical model (GatorTron 345M). For "reason for use," 1,027 snippets were annotated into six categories: pain, nausea, sleep, anxiety/stress/mood, appetite, and not mentioned/unknown. Models were evaluated on a held-out validation set using accuracy, F1, recall, and precision. We then aggregated snippet-level predictions to patient level to describe temporal trends and subgroup differences. For cannabis use status classification, the fine-tuned GatorTron model achieved the highest performance (accuracy 0.90; F1 0.91; recall 0.90; precision 0.90). For the reason of cannabis use classification, GPT-OSS-20B achieved the highest performance (accuracy 0.90; F1 0.90; recall 0.90; precision 0.92). Patient-level analyses characterized trends in documented cannabis use from 2015-2024 and compared clinical characteristics between current users and patients denying use. High-precision extraction of cannabis use status and reasons for use from EHR notes is feasible using a combination of fine-tuned clinical language models and LLM-based classifiers. This approach enables scalable measurement of patient-reported symptom self-management strategies in ARDs, supporting observational research and potential clinical decision support.

In 2023, Luxembourg partially legalised cannabis, permitting home cultivation and private-domain use. The current study aimed to evaluate the short-term impacts of this reform on consumption patterns, market dynamics, product potency, and cannabis-related driving-under-the-influence cases (DUI). An interdisciplinary approach was applied, combining data from cannabis seizures, wastewater analysis, toxicological data from DUI cases, and a WEB-based survey among adults who indicated to have used cannabis in the past 12 months. Indicators were compared before and after the policy change. Most indicators suggested a limited overall impact of partial legalisation in the year following the reform. Tetrahydrocannabinol (THC) concentrations in seized herbal and resin samples remained stable, as did THC metabolite loads in wastewater. Results of the WEB-based survey indicated little change in patterns of use, prices, or acquisition channels, with most survey respondents continuing to purchase from illicit sources. Only a minority of respondents reported personal or intended future cultivation. In contrast, cannabis-related DUI cases increased significantly. Although average THC concentrations in blood samples remained unchanged, elevated levels of THC metabolites suggested a potential increase in chronic use among some individuals. Partial cannabis legalisation in Luxembourg appears to have had only moderate impacts on market dynamics, patterns of use, and product potency during the first year, but was associated with an increase in cannabis-related DUI cases. Similar to findings in other countries, new initiation of cannabis consumption was limited, while people with an established pattern of frequent use may have intensified their use. These findings highlight the need for continued monitoring of impaired driving, cannabis consumption patterns, and emerging trends in self-cultivation, alongside public education on health risks.

Cannabis use is increasing, even during pregnancy. The purpose of this study was to investigate how women of childbearing age perceive the safety of cannabis use during pregnancy compared to alcohol and tobacco use. Cloud Research recruited a national U.S. cohort of women of childbearing age (N&#x2009;=&#x2009;622) to complete an anonymous online survey assessing cannabis, alcohol, and tobacco use during pregnancy. Validated tools measured perceptions of safety and risks to fetal, birth, and infant development. Data analyses included descriptive statistics, McNemar's tests, and repeated-measures ANOVA with post-hoc comparisons. The average age was 29.47&#xa0;years (SD&#x2009;=&#x2009;6.83, range: 18-42). Participants self-identified as White (65.9%, n&#x2009;=&#x2009;410), Black or African American 28.1% (n&#x2009;=&#x2009;175), Asian 5.9% (n&#x2009;=&#x2009;37), American Indian or Alaska Native 3.9% (n&#x2009;=&#x2009;24), or Other 4.7% (n&#x2009;=&#x2009;29); 17.7% (n&#x2009;=&#x2009;110) identified as Hispanic or Latino. Most participants identified as heterosexual (82.0%, n&#x2009;=&#x2009;510). Among participants who had been pregnant (N&#x2009;=&#x2009;351), 25.9% reported cannabis use during pregnancy, compared with 23.6% for tobacco and 8.2% for alcohol. The median frequency of prenatal cannabis use was twice weekly, with joints and blunts being the most common methods. Reported reasons for use included relief of nausea, anxiety, sleep disturbance, and pain. We used a five-point Likert scale to determine whether they thought cannabis, alcohol, and tobacco were safe to use during pregnancy, where 1&#x2009;=&#x2009;not at all safe, and 5&#x2009;=&#x2009;completely safe. Prenatal cannabis use was rated as safer (M&#x2009;=&#x2009;3.85, SD&#x2009;=&#x2009;1.46) than alcohol.&#xa0;(M&#x2009;=&#x2009;4.86, SD&#x2009;=&#x2009;0.54, p&#x2009;<&#x2009;.001) or tobacco (M&#x2009;=&#x2009;4.79, SD&#x2009;=&#x2009;0.63, p&#x2009;<&#x2009;.001). Findings indicate that women of childbearing age perceive cannabis as relatively safe during pregnancy, particularly for symptom management. These perceptions underscore the need for targeted education, accurate messaging, and consideration of the social, cultural, and emotional factors that influence substance use during pregnancy to safeguard maternal and fetal health.

BackgroundPatients are increasingly using cannabis products to manage a wide range of symptoms; however, few studies have examined the symptom burden of patients with cancer receiving palliative care who self-report using cannabis products.ObjectivesThe purpose of this investigation was to compare the symptom burden of palliative care patients with cancer who self-reported using cannabis products vs those who did not.DesignRetrospective study.Setting/Participants100 patients who self-reported using cannabis products and 300 patients who did not were randomly selected as the case and control groups, respectively. All participants were evaluated during their first consultation at a supportive clinic in a tertiary cancer center in the United States between January 1 and December 31, 2024.MeasurementsData collected included self-reported cannabis use, demographics, primary cancer diagnosis, cancer treatment, symptoms, performance status, and medications.ResultsThe proportion of patients who self-reported using cannabis products was 11.14%. Multivariate logistic regression analysis showed that female sex, older age, and Black or African American race were associated with lower odds of self-reported cannabis use. In contrast, living alone, higher levels of pain, anxiety, and appetite disturbance, were associated with increased odds of cannabis use.ConclusionsPatients with higher symptom burden are more likely to report cannabinoid use. Universal screening accompanied by patient education is important in palliative care.

Lumbar arthrodesis is commonly required for a number of spinal pathologies. The increasing use of cannabis and its legalization in many countries has the potential to impact spine surgical outcomes. There is a scarcity of research on the association between cannabis use and the need for revision surgery after lumbar fusion. The purpose of this study is to evaluate the relationship between cannabis use and the need for revision surgery after lumbar arthrodesis. A systematic review, utilizing a comprehensive search strategy, was implemented to identify relevant studies, focusing specifically on the association between cannabis use and the incidence of revision surgery following lumbar fusion procedures. The primary outcome was the need for revision surgery. A subsequent meta-analysis was then performed. Data were synthesized using odds ratios (ORs) and the Mantel-Haenszel method, with a random-effects model to account for between-study variability. In addition, heterogeneity was assessed using I&#xb2; statistics, sensitivity analyses were conducted to evaluate the robustness of the findings, and potential publication bias was examined using funnel plots. Five studies with a total of 9983 patients were included in the meta-analysis. Our analysis showed a significantly increased risk of revision surgery in patients with cannabis use compared with nonusers [OR: 2.27 (95% CI: 1.27-4.05)]. The high heterogeneity (I&#xb2;=95%) suggests differeces in patient populations, definitions of cannabis use, and follow-up durations across the included studies. Cannabis use is associated with a significantly increased risk of revision surgery after lumbar fusion. These findings highlight the importance of targeted preoperative counseling and postoperative monitoring.

Cannabis use has been associated with persistent perceptual disturbances, but systematic clinical characterization remains limited, particularly regarding multimodal sensory involvement. To characterize persistent perceptual disturbances following cannabis use, focusing on symptom profiles, temporal patterns, and clinical features. This exploratory observational study was conducted across the Valle d'Aosta and Piemonte regions of Italy between 2020 and 2025. We characterized 13 patients with persistent visual/auditory symptoms following cannabis exposure through comprehensive clinical assessment, neurological examination, neuroimaging, and standardized questionnaires. Given the small sample size, analysis focused on clinical characterization rather than statistical inference. Thirteen patients (10 males, mean age 24.3&#x2009;&#xb1;&#x2009;4.1&#x2009;years) had used natural cannabis (69.2%) or synthetic cannabinoids (30.8%). Visual snow was universal (100%), with high rates of trailing phenomena (92.3%), halos (84.6%), and color changes (76.9%). A novel finding was the presence of auditory hypersensitivity in 61.5% of patients. Symptoms emerged at a mean of 3.2&#x2009;&#xb1;&#x2009;2.4&#x2009;weeks following cannabis cessation. All neurological investigations were normal. Comorbid anxiety disorders were present in 84.6% of patients; functional impairment was severe in 30.8%, moderate in 46.2%, and mild in 23.1%. This exploratory study describes persistent multimodal sensory disturbances in patients after cannabis exposure. Consistent visual snow, frequent auditory hypersensitivity, and normal neurological investigations suggest a distinct phenotype warranting systematic investigation. While preliminary and requiring validation in larger samples, these findings highlight a potentially underrecognized cannabis complication meriting clinical attention.

To analyze the incidence of ocular inflammatory diseases and related ocular complications in patients with and without a history of cigarette, cannabis, vaping, and chewing tobacco use or exposure to tobacco smoke. Patients aged 18 years and older with and without a history of cigarette, vape, cannabis, or chewing tobacco use, patients with and without a history of exposure to second-hand smoke, and patients with a diagnosis of an ocular inflammatory disease were included in our study. Odds ratios (ORs) were calculated to analyze the proportion of individuals who developed uveitis, scleritis, ocular mucous membrane pemphigoid (oMMP), and each ocular complication after cigarette, cannabis, vaping, and chewing tobacco use and exposure to tobacco smoke, compared to nonusers or those not exposed to tobacco smoke. Compared to nonsmokers, the OR for developing uveitis was 1.459 times higher for cannabis users (P = 0.016, 95% confidence interval [CI]: 1.072-1.985) and 1.712 times higher for those exposed to tobacco smoke (P < 0.001, 95% CI: 1.366-2.146). The odds of developing scleritis were 2.596 times higher for cannabis users (P = 0.002, 95% CI: 1.389-4.853), 1.667 times higher for vape users (P = 0.008, 95% CI: 1.14-2.438), and 1.612 times higher for chewing tobacco users (P = 0.013, 95% CI: 1.102-2.357). The odds of developing oMMP were 1.923 times higher for cigarette users (P = 0.042, 95% CI: 1.011-3.657). The odds of developing glaucoma were 1.551 times higher for cigarette users (P < 0.001, 95% CI: 1.234-1.95), 1.547 times higher for vape users (P < 0.002, 95% CI: 1.223-1.956), 1.574 times higher for chewing tobacco users (P < 0.001, 95% CI: 1.25-1.982), and 1.707 times higher for those exposed to tobacco smoke (P = 0.001, 95% CI: 1.229-2.37). Finally, the odds of developing cataracts were 2.513 times higher for cigarette users (P < 0.001, 95% CI: 1.821-3.469), 1.923 times higher for cannabis users (P = 0.005, 95% CI: 1.204-3.069), 2.151 times higher for vape users (P < 0.001, 95% CI: 1.509-3.064), 2.162 times higher for chewing tobacco users (P < 0.001, 95% CI: 1.525-3.064), and 4.205 times higher for those exposed to tobacco smoke (P < 0.001, 95% CI: 2.89-6.068). History of cannabis use and exposure to second-hand smoke are significantly associated with an increased risk of uveitis, whereas a history of chewing tobacco, vape, and cannabis use is significantly associated with an increased risk of scleritis. Cigarette use is also associated with a significantly increased risk of oMMP.

Cannabis co-use is common among people with HIV (PWH) who smoke cigarettes yet is infrequently measured in smoking cessation trials. We report the relationship of baseline co-use status, HIV-related variables, and factors associated with tobacco treatment success (e.g., psychosocial characteristics) among PWH enrolled in an ongoing RCT evaluating a tailored app-based smoking cessation treatment. U.S. adults who smoked &#x2265;5 cigarettes per day and were willing to set a quit date were recruited nationally online and via community-based HIV clinics in Florida. At baseline, HIV-related variables, socio-demographics, psychosocial characteristics, tobacco use history, cannabis use history and modality, and other substance use were assessed. Participants were classified as co-using at baseline if they reported using any form of cannabis in the past 30 days. Participants who co-used cannabis (n=142, 28%) vs. did not (n=370, 72%) were more likely to be younger, Black, lesbian, gay, or bisexual, live in a household with another person who smokes, use other combustible tobacco products, report other recreational drug use in the past year, and have higher self-reported health. Compared to participants who did not use cannabis, co-use participants more often reported missed doses of ART in the past month (53% vs. 37%), loss of appetite or change in the taste of food (48% vs. 38%), frequent alcohol use, financial strain, loneliness, discrimination, and better perceived general health (p values < .05). They frequently reported blunt use and same-occasion cannabis and tobacco use. Study findings indicate that PWH who co-use experience elevated behavioral and psychosocial risk factors associated with reduced smoking cessation success and worse HIV-related outcomes.

Compulsive Sexual Behavior Disorder (CSBD) and problematic pornography use (PPU) frequently co-occur with substance use disorders, yet their associations with specific substances in non-clinical populations remain poorly understood. The present study examined associations between alcohol and cannabis use severity and CSBD and PPU symptoms in a non-clinical adult sample. Eligible adults were invited to complete an anonymous online survey between May and October 2025. Alcohol and cannabis use severity scores were assessed using AUDIT and CUDIT-R questionnaires, respectively. Participants compulsive sexual behavior disorders (CSBD) and problematic pornography use (PPU) scores were assessed using CSBI-13 and BPS questionnaires. Associations between substance use severity and compulsive sexual behaviors were assessed using linear adjusted regression. A total of 158 adults (61.4% women) aged 18-60 years were analysed with a mean alcohol and cannabis use severity scores of 16.29 (&#xb1; 4.53) and 15.49 (&#xb1; 5.08), respectively among current users, and a mean compulsive sexual behavior disorders of 21.14 (&#xb1; 7.74), with a mean PPU score of 6.99 (&#xb1; 2.55). In unadjusted regression models, increases in alcohol and cannabis use severity were associated with increases in CSBD and PPU scores. However, no significant increase of both outcomes was observed for alcohol use severity (CSBD: B = 0.18, 95% CI [-0.13; 0.49], p = .251; PPU: B = 0.04, 95% CI [-0.05; 0.13], p = .381) and cannabis use severity (CSBD: B = 0.09, 95% CI [-0.13; 0.31], p = .409; PPU: B = 0.03, 95% CI [-0.03; 0.09], p = .325) after controlling for age and gender. Our study showed a positive but non-significant association between alcohol and cannabis use severity with both CSBD and PPU after controlling for age and gender, suggesting the underlying associations may be explained by sociodemographic differences in the study population. However, longitudinal studies and advanced analysis approaches including those that handle zero inflated data or latent dependant variable are needed to validate these findings.

Asthma exacerbations pose substantial risk to adolescents. We evaluated whether documented nicotine use, cannabis use, or concurrent use is associated with increased emergency department (ED) management intensity and adverse short-term outcomes during asthma exacerbations. Using the TriNetX database, we identified adolescents aged 11 to 21 years presenting to the ED with an acute asthma exacerbation from January 1, 2015, to January 1, 2025. Patients were categorized into nicotine-only, cannabis-only, or concurrent nicotine-cannabis cohorts based on documented International Classification of Diseases, 10th Revision (ICD-10) codes and matched to controls without such diagnoses. Outcomes were reported as risk ratios (RRs) with 95% CIs during 0 to 1-day and 1- to 30-day intervals. After matching, cohorts included 4604 nicotine-only, 2679 cannabis-only, and 1045 co-use patients. During their ED encounter, co-use patients demonstrated the strongest associations with acute respiratory failure (RR, 4.63; 95% CI, 2.71-7.89), hospital admission (RR, 2.47; 95% CI, 1.80-3.38), and critical care services (RR, 1.92; 95% CI, 1.19-3.09). Nicotine-only and cannabis-only cohorts also showed increased pharmacologic escalation and diagnostic testing. Between 1 and 30 days, co-use patients had higher rates of repeat exacerbation (RR, 1.72; 95% CI, 1.36-2.17), ED revisits (RR, 1.54; 95% CI, 1.29-1.85), pneumonia (RR, 2.20; 95% CI, 1.05-4.62), and critical care use (RR, 2.07; 95% CI, 1.10-3.90); nicotine-only and cannabis-only cohorts additionally demonstrated this association to a lesser degree. Adolescents with documented nicotine or cannabis use, especially concurrent use, experience more intensive ED management and worse short-term outcomes during asthma exacerbations, supporting consideration of targeted acute care pathways.

Cannabis sativa L. is a compelling model species for studying how human selection has shaped plant traits through domestication. Cannabis hemp-type varieties are grown for fibre and seed, whereas drug-types are cultivated for high cannabinoid content in pharmaceutical and recreational use. These contrasting selection criteria have led to divergent physiological and morphological traits, providing a valuable model to investigate underlying molecular and physiological mechanisms. Cultivation of hemp on more marginal soils has favoured a greater capacity to acclimate to nutrient limitations, particularly phosphorus deficiency. However, the mechanisms underlying enhanced phosphorus acclimation in hemp remain poorly understood. Using Weighted Gene Co-expression Network Analysis (WGCNA) of RNA-seq data from multiple organs of hemp-type Cannabis grown under contrasting phosphate supplies, we performed a global transcriptome analysis to capture organ-specific and phosphate-responsive gene expression dynamics. This analysis identified twelve co-expression modules capturing coordinated gene expression across organs and phosphate conditions, reflecting processes related to organ function (e.g. root development, fibre production, and flower development) and metabolism (including photosynthesis, nutrient transport, and lipid remodelling), as well as their relationships to physiological traits. Two modules, representing leaf- and root-specific responses, were strongly associated with plant phosphorus status, and cross-comparison with genes under selection during Cannabis domestication showed significant overlap with these modules. Gene regulatory network analysis revealed how gene expression supports prioritisation of resource allocation towards reproductive organs, with the Cannabis homolog of SPX DOMAIN GENE3 (SPX3) identified as a central hub in leaf tissues coordinating the shoot phosphate starvation response. In the root-specific module, root system architecture remodelling was mediated by transcription factors including SCARECROW-LIKE (SCL) family members and a homolog of the C2H2-type transcription factor SENSITIVE TO PROTON RHIZOTOXICITY (STOP). Strigolactones emerged as key hormonal regulators of the root-specific PSR, highlighting their role in phosphate deficiency tolerance in hemp. These findings provide an integrated, organ-specific view of gene networks underlying the phosphate starvation response in hemp and reveal distinct features of nutrient adaptation following domestication. They identify targets for improving nutrient use efficiency in hemp and support comparative studies across Cannabis germplasm.

Given the rising prevalence of cannabis use as an alternative strategy for managing mental health symptoms, there is a crucial need to understand the determinants of substitution behavior, particularly among midlife women who may experience distinct psychosocial and clinical profiles. This study examined the predictors of cannabis substitution among midlife women by comparing profiles of women who substituted cannabis for antidepressant medications versus those who substituted for anxiolytic medications. A cross-sectional survey of 172 women who reported substituting cannabis for either anxiety or depression medications was conducted. Measures included the PHQ-8, OASIS, AUDIT, and ACEs. Logistic regression was used to identify predictors of substitution behavior. Among participants, 88 (51%) substituted cannabis for antidepressants and 84 (49%) for anxiolytics. Clinically significant anxiety (M&#x2009;=&#x2009;12.5, SD&#x2009;=&#x2009;4.3) and depression (M&#x2009;=&#x2009;11.6, SD&#x2009;=&#x2009;5.3) were observed. Average ACE scores exceeded four in both groups. In multivariate models, sleep difficulties (OR&#x2009;=&#x2009;4.2, 95% CI: 2.1-8.0) and alcohol use (OR&#x2009;=&#x2009;1.1, 95% CI: 1.01-1.09) predicted substitution for anxiety. For depression, predictors included sleep difficulties (OR&#x2009;=&#x2009;6.6, 95% CI: 3.1-14.1), alcohol use (OR&#x2009;=&#x2009;1.1, 95% CI: 1.1-1.2), lower education (OR&#x2009;=&#x2009;0.71, 95% CI: 0.53-0.95), and loneliness (OR&#x2009;=&#x2009;2.0, 95% CI: 1.2-3.8). Sleep difficulties and alcohol use were found to be strong predictors for substituting cannabis for anxiety and depression medications among middle-aged women. These findings highlight the need for clinical awareness of symptom-specific substitution patterns and emphasize the importance of addressing co-occurring sleep and substance use problems.

The relationship between cannabis use and psychotic-like experiences (PLEs) remains a crucial area of investigation, particularly regarding different consumption patterns. This cross-sectional study examined 150 participants divided into three groups: heavy cannabis users (n&#x202f;=&#x202f;43), occasional users (n&#x202f;=&#x202f;47), and non-users (n&#x202f;=&#x202f;60). Participants were classified using CUDIT-R scores combined with self-reported frequency of use. Assessments included the Community Assessment of Psychic Experiences (CAPE) scale, Global Assessment of Functioning (GAF), and Clinical Global Impression (CGI) scales. Cannabis use patterns, age of onset, and duration were documented. Heavy users (mean age 23.6&#x202f;&#xb1;&#x202f;4.9 years) showed significantly higher scores on positive symptoms (38.4&#x202f;&#xb1;&#x202f;6.2) compared to occasional users (28.6&#x202f;&#xb1;&#x202f;5.4) and non-users (18.2&#x202f;&#xb1;&#x202f;4.2; p&#x202f;<&#x202f;0.01; &#x3b7;2p&#x202f;=&#x202f;0.24). Depressive symptoms were also elevated in heavy users (18.6&#x202f;&#xb1;&#x202f;3.8) versus occasional users (15.4&#x202f;&#xb1;&#x202f;3.2) and non-users (12.2&#x202f;&#xb1;&#x202f;2.8; p&#x202f;<&#x202f;0.01; &#x3b7;2p&#x202f;=&#x202f;0.19). No significant differences were found in negative symptoms across groups (p&#x202f;=&#x202f;0.24; &#x3b7;2p&#x202f;=&#x202f;0.02). Earlier age of onset (<16.4 years) correlated with increased PLEs (r&#x202f;=&#x202f;0.27, p&#x202f;<&#x202f;0.05) and poorer functioning. Heavy users demonstrated strong correlations between cannabis use frequency and both positive symptoms (r&#x202f;=&#x202f;0.58, p&#x202f;<&#x202f;0.01) and depressive symptoms (r&#x202f;=&#x202f;0.52, p&#x202f;<&#x202f;0.01). The findings suggest a frequency-related association between cannabis use and PLEs, particularly for positive and depressive symptoms. Early onset of use appears to be a significant risk factor for developing psychotic-like experiences, while negative symptoms remain largely unaffected. These results highlight the importance of considering consumption patterns when assessing the psychological impact of cannabis use.

LGBTQA+&#x2009;people are at greater risk of using cannabis at earlier ages, in greater frequencies and quantities and over longer periods of time compared with their cisgendered, heterosexual peers. Prescribed medicinal cannabis is becoming increasingly commonly utilised in Australia to treat a variety of conditions including pain, mental health diagnoses and sleep. There is currently little research looking into the motivations and experiences of LGBTQA+&#x2009;people accessing medical cannabis (MC) through healthcare providers. To explore differences in patterns, reasons for using, and experiences of accessing medicinal cannabis between LGBTQA+ people and their cisgender, heterosexual peers. We utilised data collected from an online anonymous cross-sectional survey of individuals (CAMS-22 survey), consisting of adult Australians who had utilised cannabis to treat a medical condition in the previous year. Participants were asked questions about their gender and sexuality, demographic characteristics, patterns and characteristics of MC use, conditions treated, and accessibility to and satisfaction of treatment. Of the 3107 respondents included in these analyses, 2332 (77.3%) self-identified as heterosexual and 686 (22.7%) as sexually diverse. Over 95% of participants identified as cisgender (n&#x2009;=&#x2009;2932), with only 148 (4.8%) identifying as trans. Sexually diverse participants commenced regular MC use at an earlier age, were more likely to identify a mental health condition and less likely to identify pain as their primary reason for MC consumption, and reported less satisfaction with treatment compared to heterosexuals-primarily around provision of information. Trans participants commenced MC use at an earlier age; were more likely to identify a mental health condition or sleep as their primary reason for MC use; and also reported less satisfaction with treatment than their cisgender counterparts for more interpersonal reasons. LGBTQA+&#x2009;people use cannabis for medical purposes at significantly earlier ages and primarily to address mental health and substance use concerns. Future research should explore ways in which prescribers can specifically tailor support to meet all physical and mental health needs of LGBTQA+&#x2009;people, (beyond simply prescribing MC), not only through treatments that they offer, but also through adjunct and complementary services.