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Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map

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Official websites use. Share sensitive information only on official, secure websites. This is an open access article distributed under the Creative Commons Attribution License 4. Cannabinoids are an increasingly popular therapy among orthopaedic patients for musculoskeletal conditions. A paucity of evidence to support their use in orthopaedics exists, likely because of the incongruence of federal and state legalization and the stigma surrounding cannabis. The purpose of this study is to elucidate sentiments and knowledge base of the orthopaedic trauma community with regard to cannabinoid-containing compounds. A question online survey was distributed to the members of the Orthopaedic Trauma Association with a response window of 3 months. We evaluated responses. Sentiment toward cannabinoids among orthopaedic traumatologists is remarkably favorable; however, in-depth understanding is admittedly poor and routine use is uncommon. More clinical research for cannabinoids is needed to help orthopaedic traumatologists provide guidance for patients seeking advice for this recently popular therapeutic. Cannabinoid compounds have been used for medicinal purposes for over 5 millennia. Cannabinoids are naturally occurring compounds in the Cannabis sativa plant, which is more commonly known as marijuana. Cannabinoids act through the endocannabinoid system, which is a lipid-signaling system involved in maintenance of physiologic homeostasis. THC is a cannabinoid found in the cannabis plant; it is responsible for the psychoactive effects of cannabis. CBD is also a cannabinoid found in the cannabis plant. However, it has no psychoactive effects; instead, it has analgesic, anti-inflammatory, and anticonvulsant effects. Cannabinoids bind cannabinoid receptors CB 1 and CB 2 and affect appetite, mood, and pain. CB 1 receptor abundance in nociceptive centers has led to research into how cannabinoids possibly play a role in the modulation of pain. Conversely, the CB 2 receptor is primarily found within the immune system and, therefore, is believed to be involved in the regulation of inflammatory processes. Despite increasing public enthusiasm, political support, and research in the medical applications of cannabinoids, a stigma regarding their use persists in both patients and practitioners. The sources of this stigma are myriad, but minimal research has been conducted regarding the current knowledge and sentiments that medical professionals have regarding cannabinoids. As it stands currently, several factors eg, sentiments among the medical community, stigmatization regarding the use of cannabinoids, and legislation likely contribute to the lack of higher-quality studies into the use of cannabinoids within the field of orthopaedics. The purpose of this survey study was therefore to elucidate the sentiment and knowledge of cannabinoids within the orthopaedic trauma community. L, and J. The questions were transferred onto an online survey software system, Qualtrics, which was also used to collect the survey data. After approval, the survey was posted on the OTA website for a three-month period. Electronic mail was sent by the OTA to all members soliciting participation in all posted surveys. Finally, direct communication by the senior authors P. L and J. Survey participation was voluntary. Survey responses were collected. Microsoft Excel was used for tabulation of the survey data and statistical analysis. In total, Almost all respondents More specifically, Only 2. Six percent of respondents did not identify the state where they practiced, and 0. The survey contained five questions to evaluate respondents' knowledge of cannabinoids. The distribution of the responses is summarized in Figure 1. Seventy-nine percent were correct in their understanding that CBD did not have psychoactive effects. The responses to questions relating to knowledge on cannabinoids are further delineated by state legalization status Figure 3 and age group Figure 4. No statistically significant difference was found in knowledge based on respondents' age group or state legal status of cannabis. Bar graph showing survey responses that highlight surgeons' knowledge of cannabinoids. Bar graph showing survey responses that highlight surgeons' knowledge of cannabinoids by state legal status. Bar graph showing survey responses that highlight surgeons' sentiments on cannabinoids by age group. The survey contained 11 questions to evaluate respondents' sentiment on cannabinoids. The distribution of the responses is summarized in Figure 2. Notable findings are reported here. Seventy-three percent of respondents believed that cannabis or CBD products play a role in management of postoperative pain. Two-thirds of survey respondents did not believe that they would be stigmatized if they suggested cannabis to patients. Eighty-three percent of survey respondents did not believe that they would be stigmatized if they suggested CBD to patients. Sixty-two percent do not believe that cannabis is a gateway drug. Bar graph showing survey responses that highlight surgeons' sentiments on cannabinoids. The majority, regardless of state legalization statuses, have not suggested cannabis to patients as a means of treating postoperative pain. Most respondents would recommend CBD if it were medically and recreationally legal. The survey contained two questions to evaluate respondents' knowledge of the effects of cannabinoids on fracture healing. No statistically significant differences were found in fracture healing sentiments when separating out respondents by age group or state legalization status. This survey study is the first and only time the orthopaedic surgery community has been assessed for its knowledge and opinion regarding cannabinoids. Our results provide the best available consensus on cannabinoids among practicing orthopaedic surgeons and allow them to understand how their peers are responding to the recent flood of cannabinoid products that are popular among patients, yet lack any endorsable research support. Cannabis and its derivatives have become more mainstream, with a variety of products used by the young and the old, for recreation and for medicinal purposes. Although some research on cannabinoids regarding fracture healing, 20 total knee arthroplasty, 21 , 22 arthritis, 23 and spine-related pain 24 exists, high-quality evidence with respect to cannabis for management of musculoskeletal pain is scarce. The legal status of cannabinoids has been convoluted by regulatory differences between states and the federal government, whereas popular enthusiasm and anecdotal evidence is far outpacing scientific data. According to our survey results, the interest in cannabinoid products among orthopaedic trauma surgeons seems to mirror that of the public in terms of knowledge and sentiment. Many of the respondents believe in the existence of a role for cannabis or CBD in managing postoperative pain; however, a majority of respondents were not confident with their knowledge of the mechanism of action of cannabis or CBD. Most were correctly informed about the respective psychoactive effects or lack thereof for cannabis and CBD, respectively. As this survey was of fracture specialists, nearly all respondents were in agreement with the belief that no known effect on fracture healing is associated with cannabis or CBD. Previous studies have found that patients using cannabinoid products were stigmatized, 25 , 26 but most orthopaedic trauma surgeons who responded to this survey did not believe that they would be stigmatized for suggesting them as providers. In particular, respondents felt that even less stigma surrounds the suggestion of CBD products. Most respondents did believe that a topical form of cannabis would be more accepted than an oral or inhaled form. Despite these opinions, only a third of respondents have acted on this belief and suggested cannabis or CBD to patients. Not surprisingly, only two-thirds of respondents were familiar with their states' laws governing marijuana or CBD use as this scenario is rapidly changing. That is, only three states remain without any form of legalized cannabis in the United States. However, state and federal legal differences on cannabinoids pose a significant challenge to studying its effects because it means that the products available to consumers and researchers are not consistent in strain or dosage. Researchers in the United States are restricted to a limited number of cannabis strains and products controlled by the National Institute on Drug Abuse in their studies, whereas commercially, products and strains are growing exponentially. Our study notes significant interest in cannabinoids within the orthopaedic trauma community. However, without support from federal legislation and adequate research, consensus for the use of cannabinoids in the treatment of a variety of medical conditions will be incredibly difficult to attain. In addition, this survey found that nearly all respondents were unfamiliar with PEA, which is an endogenous cannabinoid classified as a nutraceutical, or a food that has potential health or medicinal benefits. Limitations of this study include an incomplete data set and selection bias. Although the percentage of respondents In particular, 84 respondents did not provide answers to the two questions about whether they would recommend cannabis or CBD to their patients if it were completely legal. Such a loss of responses for two particularly important questions about the sentiment of cannabinoids skews the data and reduces the impact of this specific question. Selection bias is plausible as only orthopaedic traumatologists were invited to participate in the survey. Regardless of these limitations, the findings of this study are invaluable to understanding the knowledge and sentiment of orthopaedic traumatologists regarding cannabis. Attitudes toward cannabinoids among orthopaedic traumatologists are favorable; however, in-depth knowledge of cannabis' mechanism is admittedly poor. This inconsistency is likely due to the illegal federal status of cannabinoids, which has impeded needed clinical research as industry promotion seems to have outstripped medical evidence. However, orthopaedic traumatologists seem to be cautiously aware of this dissonance and have not capitulated to freely recommending cannabinoids without evidence. More clinical research for cannabinoids is needed to help orthopaedic traumatologists provide guidance to their patients seeking advice for this recently popular therapeutic. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Chin, Mr. Etiz, Dr. Nelson, Dr. Lim, and Dr. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Chin, Dr. Nelson , Irvine, Orange, CA. Find articles by Garwin Chin. Find articles by Brent A F Etiz. Find articles by Ariana M Nelson. Find articles by Philip K Lim. Find articles by John A Scolaro. Scolaro: jscolaro hs. Published by Wolters Kluwer Health, Inc. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

Eschen buying marijuana