RESEARCH

‘Extreme’ Exposure to Secondhand Cannabis Smoke Causes Mild Intoxication

Nonsmokers sharing an unvented area with heavy marijuana smokers in some cases may not have passed a drug screen
Secondhand exposure to cannabis smoke under “extreme conditions,” such as an unventilated room or enclosed vehicle, can cause nonsmokers to feel the effects of the drug, have minor problems with memory and coordination, and in some cases test positive for the drug in a urinalysis. Those are the findings of a Johns Hopkins University School of Medicine study, reported online this month in the journal Drug and Alcohol Dependence.

Cannabis is the most widely used illicit drug in the world. “Many people are exposed to secondhand cannabis smoke,” says lead author Evan S. Herrmann, Ph.D., a postdoctoral fellow in psychiatry and behavioral sciences at Johns Hopkins. “The scenario we looked at was almost a worst-case scenario. It could happen in the real world, but it couldn’t happen to someone without him or her being aware of it.”

“We found positive drug effects in the first few hours, a mild sense of intoxication and mild impairment on measures of cognitive performance,” says senior author Ryan Vandrey, Ph.D., an associate professor of psychiatry and behavioral sciences at Johns Hopkins. “These were relatively slight effects, but even so, some participants did not pass the equivalent of a workplace drug test.”

The new research is the most comprehensive study of secondhand cannabis smoke and its effects since the 1980s, when researchers found the drug’s active ingredient, tetrahydrocannabinol, or THC, and other cannabis byproducts could turn up in nonsmokers’ bodies after an hour or more spent in extreme conditions with heavy smokers in an enclosed space. That finding needed updating, since the average potency of street cannabis has tripled since the 1980s, the Johns Hopkins researchers wrote. Additionally, many earlier studies did not look at whether the nonsmokers reported feeling the drug’s effects, or whether their behavior and thinking were affected by secondhand smoke, as the new study did.

Researchers recruited seven people ages 18 to 45 who said they smoked cannabis at least twice per week and tested positive for THC, but who tested negative for other drugs, and 12 others in the same age range who said they had not used cannabis in the past six months and tested negative for cannabis, other drugs, and alcohol. None of the participants were pregnant, and none of the nonsmokers took part in more than one session.

Six smokers and six nonsmokers spent an hour sitting side by side in a 10-by-13-foot, acrylic-walled room in two different experimental sessions. Each smoker was given 10 high-potency cannabis cigarettes to smoke. In one session, the room’s ventilation fans were turned on. In another session, the fans were turned off, and the room became smoke-filled. This was a realistic simulation of home ventilation conditions. At the end of the exposures, smokers’ and nonsmokers’ blood, urine, saliva and hair were tested at regular intervals for THC.

All six nonsmokers who spent an hour exposed to secondhand smoke in the unventilated room under extreme conditions had detectable amounts of THC in their urine and blood. THC in blood was observed immediately after exposure and for up to three hours afterwards.

Four hours after the experiment ended, one nonsmoker tested positive for THC on a urine test with the same cutoff (50 nanograms per milliliter) used in the Federal Workplace Drug Testing Program. At intervals between two and 22 hours after the experiment, four of the six nonsmokers tested positive for THC in their urine at a lower cutoff (20 nanograms per milliliter) sometimes used in commercial drug testing programs.

None of the nonsmokers exposed to secondhand smoke in the ventilated room tested positive for THC on either the more sensitive or the less sensitive urinalysis. (All the cannabis smokers tested positive for THC afterward.)

Nonsmokers exposed to secondhand smoke with fans running reported no effects other than being hungry. Those who were exposed in the unventilated experiment reported feeling “pleasant,” more tired and less alert. When the nonsmokers were asked to duplicate grid patterns they saw on a computer monitor or perform a basic numbers drill, those in the unventilated study responded faster but made more mistakes than they did before they were exposed to the cannabis smoke, the researchers found.

“The behavioral and cognitive effects were minor and consistent with a mild cannabis effect,” Herrmann says.

“This study is a significant update in our knowledge of cannabis smoke effect on nonsmokers and has implications in many arenas, including drugs and driving,” says co-author Edward J. Cone, Ph.D., a Johns Hopkins adjunct professor of psychiatry and behavioral sciences who performed the early passive inhalation studies in the 1980s.

The study’s limitations included its small size and the lack of a placebo trial using cannabis that contained no THC. The study was supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency in the U.S. Department of Health and Human Services that sets standards for federal workplace drug testing. Information about the effects of secondhand smoke on drug test results were being sought to support different ways of measuring drug use or drug exposure, Vandrey says. Funding came from SAMHSA and the National Center for Research Resources of the National Institutes of Health. The cannabis used in the experiment was provided by the National Institute on Drug Abuse.

Other authors included George E. Bigelow of the Johns Hopkins University School of Medicine; John M. Mitchell of the Research Triangle Institute; and Charles LoDico and Ron Flegel of the Substance Abuse and Mental Health Services Administration.

Rice students create app connecting heart pump to doc

By Mike Williams

Rice University seniors create smartphone app to connect heart patient, pump, doctor
A smartphone app created by students at Rice University may someday serve as the ultimate remote to help control the flow of blood through human hearts.
The Flowtastic team of Rice senior engineering students created a combined software-hardware interface that works with an Android app to monitor and even control a high-tech pump that resides in the aorta and regulates the flow of blood.

The circulatory assist pump called Aortix was invented by Houston-based Procyrion, which is seeking approval from the Food and Drug Administration to use it as a minimally invasive solution for heart-failure patients.

“It’s for that in-between phase when medication might not be enough and you don’t want to go and get a super-invasive surgery where they have to cut your chest open,” said Rice bioengineering student Benjamin Lopez. “We don’t want you to get to that very severe state and there’s nothing really out there for you right now.” As many as 2.6 million patients could benefit from such a device, according to the company.

The six-member Rice team also includes bioengineering students Alex Bisberg and Joshua Choi and electrical engineering students Tracy Fu, Navaneeth Ravindranath and Ernest Chan. Their advisers are Gary Woods, a professor in the practice of computer technology and electrical and computer engineering, and Eric Richardson, a lecturer in bioengineering. They are also working with Tanner Songkakul, a product development engineer at Procyrion who earned a bachelor’s degree in electrical engineering from Rice in 2014.

The students have been working at Rice’s Oshman Engineering Design Kitchen with a Procyrion prototype, a stent attached to a tiny but powerful pump that can be inserted into the patient’s aortic vessel to assure that blood keeps flowing at the proper rate to the heart. The Rice team’s contribution gives doctors a way to monitor the device’s performance and make adjustments when necessary, reducing the heart’s workload and helping it heal.

“Our goal has been to make a holistic and integrated system that allows the patient to connect with the doctor and also connect with their device,” Bisberg said. The Rice team built hardware that plugs into the Procyrion controller and also communicates wirelessly with the Android app. They expect the company will combine the hardware components into a single unit that the patient will carry.
Bisberg said patients will be asked to enter their weight into the app every day. That information will automatically go to the doctor’s database. “Weight is a key factor in managing heart failure,” he said. “When the heart isn’t working well, the patient’s body tends to retain fluid.

“We want to be able to get a higher fluid-clearance rate from their bodies by accelerating blood flow to the kidneys and getting the liquid out of their systems.”

If a patient gains too much weight too quickly, the app would notify the doctor, according to team members. They expect the doctor will be able to adjust the pump as necessary either remotely or by plugging directly into the external electronics.

“A change in weight would trigger an email to tell the doctor what’s going on,” Chan said. “That way the doctor only has to look at that data when needed.”
“We spoke to a lot of cardiologists at the Texas Heart Institute and a lot of them said this technology’s great, but it would be really nice if they could only be notified when there’s really a need for them to go in and check,” Choi said.

The system should be a great help to people who can still lead an active lifestyle, he said. “They’re not sedentary,” Chan said. “They can go out and live their lives and we can hold back the progression of the disease and prevent bad things from happening.”

While the team members will leave their project behind when they graduate in May, they said what they’ve invented may be adapted to work with hardware that monitors glucose levels or pacemakers.

WHO calls for urgent fight against antibiotic resistance

By Nina Larson

Geneva (AFP), April 29 – The world is doing far too little to combat the misuse of antibiotics which is fuelling drug resistance and allowing long-treatable diseases to become killers, the World Health Organization said Wednesday. In its first ever analysis of how countries are responding to the problem of antimicrobial resistance — when bugs become immune to existing drugs — the UN health agency revealed “major gaps” in all six regions of the world.

“This is the single greatest challenge in infectious diseases today,” Keiji Fukuda, WHO’s assistant director general for health security, said in a statement. “All types of microbes, including many viruses and parasites, are becoming resistant to medicines,” he warned, voicing particular concern over “bacteria that are progressively less treatable by available antibiotics.”

“This is happening in all parts of the world, so all countries must do their part to tackle this global threat,” he said.

A year ago, WHO issued a hard-hitting study on the phenomenon, cautioning that without significant action the world would be headed for “a post-antibiotic era”. In such an era, “common infections and minor injuries that have been treatable for decades, may once again kill”, Charles Penn, WHO coordinator on antimicrobial resistance, told reporters.
“We will lose the ability to treat a range of serious conditions such as blood stream infections, pneumonia, tuberculosis, malaria and HIV, and the benefits of advanced medical treatment, such as cancer chemotherapy and major surgery will also become much riskier and may well be lost,” he warned.
The UN agency has since conducted a survey of 133 countries asking governments to assess their response to resistance to antimicrobial medicines. Sixty WHO member states did not take part in the survey, including the United States and China.
– Situation ‘alarming’ –

Wednesday’s report — which breaks down the data on a regional basis and does not provide country-specific information — shows the global response is dangerously lacking. Only a quarter of countries that answered the survey had comprehensive national plans in place to fight resistance to antibiotics and other antimicrobial medicines, which is far too few, according to Penn.
One major concern is that sales of such drugs without prescription remain widespread around the world. Counterfeit and low-quality drugs have also been reported in many regions, causing headaches since such medicines often do not contain the right amount of the active ingredient, “resulting in sub-optimal dosing”, the report said.

This was of particular concern in the African region, where it was a “general problem”, the report found, with only only eight of the 47 WHO member states in Africa responding to the survey. Many countries also lack standard treatment guidelines, raising the possibility of overuse of the drugs, it warned.
Monitoring of the use of such drugs was also “infrequent” in most regions, although European countries had made progress in this area, WHO said. The lack of oversight is especially worrying since public awareness about the dangers of misusing antibiotics remains low in all regions. It also added that many people still believe antibiotics can be used to fight viral infections, which is not true.

Even in Europe, where public information campaigns are common, half the population believes viruses can be fought with antibiotics, it found. WHO has drafted a Global Action Plan for addressing antimicrobial resistance and plans to ask all member states to approve it at its annual meeting in Geneva next month. By doing so, countries will agree to draw up their own national plans within two years.

“The world needs to do much more,” Penn said.