VANCOUVER — People who have never smoked marijuana could be most at risk of overdosing on cannabis-infused edibles that will soon be on store shelves across the country, warns a public health physician who says first-time users may keep noshing away while expecting a high, only to experience a racing heart, anxiety and panic attacks.
Dr. Lawrence Loh, adjunct professor at the Dalla Lana School of Public Health at the University of Toronto, said overdose from overconsumption often means a trip to the emergency room for those who are unaware that feeling the mellow effects of pot from edibles can take several hours because of the time needed to digest and absorb food into the small intestine versus quickly inhaling the drug through the lungs.
Seniors are especially at risk because of a slower metabolism, Loh said of non-lethal overdose from edibles, which federal regulations limit to an individual serving size of a 10-milligram dose of THC, the psychoactive ingredient in marijuana.
However, someone who eats an entire package of cannabis-infused product could be taking in a whopping 100 milligrams of THC and putting themselves at risk, even though regulations require products to be individually wrapped in 10-milligram serving sizes.
“I think the big thing for anyone in the public, especially cannabis-naive individuals or people who have edibles around with children at home, is to first and foremost avoid overdosing,” Loh said.
“There’s psychotic reactions so people may lose touch with reality, sometimes in the form of hallucinations or delusions and also anxiety or panic attacks along with decreased judgment.”
Loh is co-author of a commentary published Monday in the Canadian Medical Association Journal on the health risks of cannabis edibles.
Short-term effects of edibles are not the only issue of concern, he said.
“There are still those longer term, chronic risks around edibles, particularly around addiction and also the risk of exacerbation of existing mental-health issues that we might be worried about in the longer run with cannabis edibles as well as any form of cannabis,” he said.
Regulations governing edibles, beverages, vapes and topical forms of cannabis came into effect last October, a year after Canada legalized fresh or dried bud, oil, plants and seeds.
Cannabis edibles such as cookies, chocolate and gummies were available for sale starting in December in all provinces except Ontario, Quebec and Alberta, where consumers can access them in mid-January.
In Ontario, for example, edibles will be available as of this week in stores, and then online in mid-January through the provincial distributor as a part of a slow rollout over the next few months.
A University of Colorado School of Medicine study published last March in the Annals of Internal Medicine says an increase in emergency-room visits related to edibles prompted health experts to issue warnings about cardiac and psychiatric issues in the state that began selling recreational marijuana in 2014. Packaging, potency and labelling restrictions on edibles did not come into effect until a year later before being tightened to require labels to prominently display the potency of psychoactive ingredients.
Loh said there’s a lack of data on edibles in general but consumers should also beware that illicit, unregulated products still exist and could be problematic because of issues such as mould.
The Canadian Centre on Substance Use and Addiction recommended last July that anyone who has never smoked or vaped cannabis should not consume more than 2.5 milligrams of THC in a product and wait to feel the effects before taking more.
Dr. Jeff Finkler, an emergency-room physician at St. Paul’s Hospital in Vancouver, said he sees plenty of patients, mostly females in their late teens and early 20s, who come in having panic attacks or anxiety from eating too much of a cannabis-infused food and sometimes mixing it with alcohol or other substances.
“The thing that people forget is that there’s a delayed response,” he said, adding users often think the recommended dosage couldn’t possibly pack a buzz. They are sometimes given a benzodiazepine to counteract the effects of an overdose before being sent home.
“Don’t cut off more than the actual dose just because it looks so small. You don’t want to eat the whole thing. That little thing’s got eight doses or 10 doses,” he said of a package.
“It’s not like smoking. When you start to feel weird you can stop inhaling. But when you ingest it, man, it’s on board.”
While 10 milligrams of THC is the recommended dosage, the psychoactive ingredient of marijuana in a food is hard to measure, he said.
“It requires very sophisticated analytical equipment and it’s even more complicated when they use chocolate because people think it enhances the viability of the THC but chocolate interferes with the measurement of the actual amount.”
“Start low, go slow, and wait. Be patient if you’re going to take the edibles.”
This report by The Canadian Press was first published Jan. 6, 2020.
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Camille Bains, The Canadian Press
Over 1.2 million people died from drug-resistant infections in 2019 – study
More than 1.2 million people died in 2019 from infections caused by bacteria resistant to multiple antibiotics, higher than HIV/AIDS or malaria, according to a new report published on Thursday.
Global health officials have repeatedly warned about the rise of drug-resistant bacteria and other microbes due to the misuse and overuse of antibiotics, which encourages microorganisms to evolve into “superbugs”.
The new Global Research on Antimicrobial Resistance report, published in The Lancet, revealed that antimicrobial resistance (AMR) was directly responsible for an estimated 1.27 million deaths and associated with about 4.95 million deaths. The study analysed data from 204 countries and territories.
“These new data reveal the true scale of antimicrobial resistance worldwide… Previous estimates had predicted 10 million annual deaths from AMR by 2050, but we now know for certain that we are already far closer to that figure than we thought,” said Chris Murray, co-author of the study and a professor at the University of Washington.
Last year, the World Health Organization warned that none of the 43 antibiotics in development or recently approved medicines were enough to combat antimicrobial resistance.
Cornelius Clancy, professor of Medicine at the University of Pittsburgh, said one of the ways to tackle AMR is to look at a new treatment model.
“The traditional antibiotic model that we’ve had for past number of decades since penicillin. I think it is tapped out.”
Most of 2019’s deaths were caused by drug resistance in lower respiratory infections such as pneumonia, followed by bloodstream infections and intra-abdominal infections.
AMR’s impact is now most severe in Sub-Saharan Africa and South Asia, while around one in five deaths is in children aged under five years.
There was limited availability of data for some regions, particularly many low and middle-income countries, which may restrict the accuracy of the study’s estimates.
Clancy said the focus has been on COVID-19 for the past two years, but AMR is a “long-term kind of challenge”.
(Reporting by Mrinalika Roy in Bengaluru; Editing by Krishna Chandra Eluri and Devika Syamnath)
Study casts doubt on reliability of rapid antigen tests in kids; COVID transmission through breastmilk unlikely
The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that has yet to be certified by peer review.
Rapid antigen tests may be unreliable in children
When used in children, rapid antigen tests for detecting the coronavirus do not meet accuracy criteria set by the World Health Organization and U.S. and UK device regulators, according to researchers who reviewed 17 studies of the tests.
The trials evaluated six brands of tests in more than 6,300 children and teenagers through May 2021. In all but one study, the tests were administered by trained workers. Overall, compared to PCR tests, the antigen tests failed to detect the virus in 36% of infected children, the researchers reported on Tuesday in BMJ Evidence-Based Medicine. Among children with symptoms, it missed 28% of infections. Among infected kids without symptoms, the tests missed the virus in 44%. Only about 1% of the time did the tests mistakenly diagnose the virus in a child who was not actually infected.
Given that more than 500 antigen tests are available in Europe alone, the authors said, “the performance of most antigen tests under real-life conditions remains unknown.” But the new findings “cast doubt on the effectiveness” of rapid antigen tests for widespread testing in schools, they concluded.
Breastmilk transmission of COVID-19 unlikely
A new study appears to confirm smaller, earlier studies that suggested nursing mothers are unlikely to transmit the coronavirus in breastmilk.
Between March and September 2020, researchers obtained multiple breastmilk samples from 110 lactating women, including 65 with positive COVID-19 tests, 36 with symptoms who had not been tested, and a control group of 9 women with negative COVID-19 tests. Seven women (6%) – six with positive tests and one who had not been tested – had non-infectious genetic material (RNA) from the virus in their breastmilk, but none of the samples had any evidence of active virus, according to a report published on Wednesday in Pediatric Research. Why breastmilk would contain coronavirus RNA but not infectious virus is unclear, said study leader Dr. Paul Krogstad of the David Geffen School of Medicine at UCLA, “Breastmilk is known to contain protective factors against infection, including antibodies that reflect both the mother’s exposure to viruses and other infectious agents and to vaccines she has received,” he noted.
The U.S. Centers for Disease Control and Prevention (CDC) advises that before breastfeeding, bottle-feeding, or expressing milk, women with COVID-19 should wash their hands or use hand sanitizer with at least 60% alcohol. The CDC also recommends that they wear a mask when within 6 feet (1.8 meters) of the baby.
New technique may speed vaccine, antibody drug development
Researchers are working on a way to speed development of vaccines and monoclonal antibody drugs for COVID-19 and other illnesses, shortening the time from collection of volunteers’ blood samples to identification of potentially useful antibodies from months to weeks.
As described in Science Advances on Wednesday, the new technique employs cryo-electron microscopy, or cryoEM, which involves freezing the biological sample to view it with the least possible distortion. Currently, “generation of monoclonal antibodies involves several steps, is expensive, and typically takes somewhere on the order of two to three months, and at the end of that process you still need to perform structural analysis of the antibodies” to figure out where they attach themselves to their target, and how they actually work, explained Andrew Ward of Scripps Research Institute in La Jolla, California.
In experiments using the new approach to look for antibodies to HIV, “we flipped the process on its head… by starting with structure,” Ward said. Because cryoEM affords such high resolution, instead of having to laboriously sort through antibody-producing immune cells one by one to identify promising antibodies, the process of identifying antibodies, mapping their structure and seeing how they are likely to attack viruses and other targets goes much faster, he added. “The ongoing COVID-19 pandemic has highlighted the need for such robust and rapid technologies,” his team concluded.
Click for a Reuters graphic on vaccines in development.
(Reporting by Nancy Lapid; Editing by Bill Berkrot)
Vaccination plus infection offered most protection during Delta surge, U.S. study shows – CBC News
Protection against the previously-dominant Delta variant was highest among people who were both vaccinated and had survived a previous COVID-19 infection, according to a report published Wednesday by the U.S. Centers for Disease Control and Prevention (CDC).
The report also found those who had previously been infected with COVID-19 were better protected against the Delta variant than those who were vaccinated alone, suggesting that natural immunity was a more potent shield than vaccines against that variant, California and New York health officials reported on Wednesday.
Protection against Delta was lowest among those who had never been infected or vaccinated, the CDC report continued.
“The evidence in this report does not change our vaccination recommendations,” Dr. Ben Silk of the CDC and one of the study’s authors told a media briefing.
“We know that vaccination is still the safest way to protect yourself against COVID-19,” he said.
The findings do not apply to the Omicron variant of the virus, which now accounts for 99.5 per cent of COVID-19 cases in the United States.
Study includes data from May to November
For the study, health officials in California and New York gathered data from May through November, which included the period when the Delta variant was dominant.
It showed that people who survived a previous infection had lower rates of COVID-19 than people who were vaccinated alone.
That represented a change from the period when the Alpha variant was dominant, Silk told the briefing.
“Before the Delta variant, COVID-19 vaccination resulted in better protection against a subsequent infection than surviving a previous infection,” he said.
In the summer and fall of 2021, however, when Delta became the predominant circulating iteration of the virus in the United States, “surviving a previous infection now provided greater protection against the subsequent infection than vaccination,” he said.
But acquiring immunity through natural infection carries significant risks. According to the study, by Nov. 30, 2021, roughly 130,781 residents of California and New York had died from COVID-19.
The analysis did not include information on the severity of initial infection, nor does it account for the full range of illness caused by prior infection.
One important limitation to the study was that it ended before administration of vaccine booster doses was widespread.
WATCH | Experts agree the science behind booster shots is sound:
‘Clearly shows’ vaccines provide safest protection
Dr. Erica Pan, state epidemiologist for the California Department of Public Health, said in an email that the study “clearly shows” that vaccines provide the safest protection against COVID-19 and they offer added protection for those with prior infections.
“Outside of this study, recent data on the highly contagious Omicron variant shows that getting a booster provides significant additional protection against infection, hospitalization and death,” Pan said.
Silk said the CDC is studying the impact of vaccination, boosters and prior infection during the Omicron surge and expects to issue further reports when that data becomes available.
So far, Omicron has proven to evade some level of immunity from both vaccination and previous infection, but vaccines are still largely preventing serious illness and death.
An Israeli hospital on Monday also said preliminary research indicates a fourth dose of leading mRNA-based vaccines provides only limited defence against infection from the variant.
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