Going specifically into the European case, following the European Monitoring Centre for Drugs and Drug Addiction , this distinction was further refined to perform the analysis: decriminalisation through reforms that remove the prison sentences for minor offences ; depenalisation, where the offence is still criminal, but a reduction of the maximum prison sentence is operated ; depenalisation where the offence is still criminal but the likelihood of sanctions being applied is reduced by facilitating the closure of minor cases ; increase of the penalties, where the possession for personal use is a civil offence but the reform increases the penalties attached to it ; increase of the penalties, where the possession for personal use is a criminal offence and the reform increases the penalties attached to it . To better understand how the European countries included in our study have been categorised and understand each specific policy change, Table 2 provides an overview of the broad category into which the policy changes fall, the specific type of reform and a description of the situation pre- and post-reform in each country.

Seven countries that did not pass any cannabis law in the observed period were used in the analysis as a control group: France, Iceland, Latvia, Malta, the Netherlands, Norway, Sweden. Four additional countries that reformed their cannabis control policies in the observed period were excluded from the analysis because the related ESPAD data were not available for all the considered years: the United Kingdom , Estonia , Luxembourg and Belgium .This paper assessed whether the cannabis policy changes occurred in 13 European countries in the period 2001–2014 were associated with significant outcomes among adolescent students. In particular, to inform discussions about the evaluation of policy developments related to cannabis that might increase the availability of this substance within Europe, we analysed changes in the perceived availability of cannabis. In order to check the possible association with changes in the prevalence of use of this substance among adolescent students, we differentiated between different patterns of use . This has been done in order to account for the fact thatusers are not equal, and that there is a group that, although restricted, is more at risk of developing cannabis-related problems, i.e. frequent users .

This study contributes to clarify the scarce and inconstant literature on European states , providing important information about policy outcomes and efficacy. Moreover, differently from previous studies that simply categorised cannabis control policies into a dichotomous measure , this study takes account of the fact that there is a great diversity of forms that relaxation or increase of prohibition can take in practice , by refining the investigation following the analysis proposed by EMCDDA . In fact, ignoring the significant heterogeneity in these policies, has been highlighted to contribute to what appear to be mixed results from evaluations . In order to better interpret the results, for each country a description of the situation pre- and post-reform has been provided. By combining data from five waves of the ESPAD survey, our data include a timespan of more than 15 years, covering the period before and after the implementation of each of the national drug policy reforms. Results are based on a DiD model. Regarding the availability of cannabis, we find that none of the decriminalisation and depenalisation reforms seem to be linked to an increase in the perception of easy access to this substance by the general population of students, nor it is so among non-frequent and frequent users.

This finding suggests that the common assumption that cannabis availability will increase with the relaxation of prohibition might not apply to the European cases. This means that in a country like Portugal, where the personal possession of cannabis was decriminalised in 2001, the perceived availability of cannabis did not increase as a result of the reform compared to a country like France, where the possibility of incarceration for the possession of cannabis for personal use is still foreseen. Among the policy reforms increasing the penalties for cannabis personal possession, those increasing the administrative penalties attached to this offence are actually associated to a decrease in the rate of students perceiving cannabis as easy to obtain. This result might be a good indication as it has been demonstrated that those who believe they have easy access to cannabis have also a greater risk for uptake, higher consumption frequency, as well as the progression to regular use and abuse . However, the fact that among users this association persists only for the non-frequent ones, suggests that the channels of access to the substance by frequent users, such as domestic production and supply networks , might not have undergone significant modifications.

Light quality and quantity also have a drastic effect on the excitation of PS I and PS II, which is directly interlinked with photosynthesis processes . Light spectral quality considerably affects plant shoots and roots regarding their growth and morphology, and their interaction . In the present experiment, the longest RL was recorded from L1 and L9, and the opposite result was found from L2 and L6 . In a previous study, plant height and weight were found better in red light; RL was longer in red and natural light while shorter in white and blue light undergreenhouse conditions . In the present study, the addition of FR light to R and B increased the LL and LW, while decreasing the LN and NN . It was reported that the cannabis plant attained a higher plant height and leaf area in white light compared to the combination of red and blue light , but we did not find any significant differences in those morphological traits under similar light conditions. In a previous study, the addition of FR to R and B decreased the LL and SL of tomato plants while no signifificant effect was observed for RL and LN .

Results indicated that a higher number of leaves and branches will make the hemp plants shorter in size with narrow leaves and vice versa. Importantly, LN and NN were closely associated with the treatments L9, L10, and L11, whereas LL and LW manifested an opposite relationship with them . This may be due to the inflfluence of UV-A, which reduced the leaf area but increased the leaf number and branching. Generally, UV radiation impacts the phytohormone auxin levels higher in leaf regions with high division activity and lower in areas of cell expansion , resulting in a decrease in adaxial pavement cell expansion . Furthermore, compared to white light, PFW, PGR, and NN increased in most LED composition. The results indicate the incapability of monochromatic white light for plant growth and development, as it also resulted in lower TSC and sucrose accumulation in most cases. The PCA analysis indicated a negative relationship between the L2 treatment and NN, PFW, PGR, TSC, and sucrose, which also had a positive correlation with the parameters. An earlier study showed that the Chl a and Chl b contents increased in lettuce, basil, spinach, kale, and pepper under different combinations of R and B .

In our study, the Chl a and b of hemp plants were significantly increased, but the chlorophyll a/b ratio and Car drastically decreased in the L3 treatment compared to L1 . Besides this, Chl a and b significantly increased, and the Chl a/b ratio significantly decreased in all treatments, while the carotenoid concentration was found decreased in the L2, L3, L4, L6, and L9 treatments compared to L1 . Similar results from a previous study described that a high ratio of both R:B and R:B:W manifested higher chlorophyll compared to natural light in Silene capitate Kom. . Each of the plant pigments has been characterized by an absorbance pattern in wavelength called the absorbance spectrum, where the blue and red regions are absorbed strongly by Chl a and b, with less absorbance of other wavelengths . It is also known that the Chl and Car pigments absorb 400– 500 nm and 630–680 nm in the light spectrum in plants with the help of light-harvesting antenna . The positive influence of red and blue light on Chl synthesis in the present study complies with these findings . Furthermore, the accumulation of Car and the Chl a/b ratio were increased, whereas Chl b was decreased significantly under the spectra composed with green light when compared to the red and blue spectra . Since red and blue light are absorbed by photosynthetic pigments more strongly, their influence is predominant in the upper cell layers, while green light can penetrate deeper into leaf tissues and excite the photosystem in the deeper cell layer .

On the other hand, Car are lipid-soluble colored pigments that mostly consist of carotenes and xanthophylls , whose absorbance range extend into the green region , effectively cover the poorest region of chlorophyll absorbance . Thus, the addition of green light along with others in the present study might increase the concentration of Car. The photochemical activity of photosystem II is expressed by Fv/Fm, which characterizes the maximum efficiency of the photochemical activity under PS II , where Fv , Fm, and F0 denotes the maximal variable flfluorescence, maximal fluorescence intensity, and fluorescence intensity at 50 µs, respectively. The photosynthetic fluorescence is a byproduct of the photosynthetic process created by trapping light energy at the reaction center within a photosynthetic membrane and after being used in photochemistry that dissipates along with heat energy . A decreasing trend in Fv/Fm was observed in the treatments L1, L6, L7, and L10 in the present study . A lower Fv/Fm may be a consequence of decreasing Fm, since F0 does not change too much in light stress .Proline is an important compound as its synthesis and catabolism play an important role in the stress adaptation of plants by keeping in balance the redox reaction . Under stress conditions, ROS-mediated regulation, including H2O2, can upregulate P5CS and downregulate PRODH activity in the plant, which can trigger the biosynthesis of proline .

The second interpretation is that a perception of anxiolytic and relaxation benefits in hemp food is attributed to a direct association with THC and purported side effects of illicit and “medicinal” use of marijuana. However, while this would explain the relationship between each of the negative attitudes and the CBD construct, it would only account for the increase in intention to consume hemp food if consumers were hopeful of and actively seeking THC in hemp food. While this may potentially apply to a particular subset of the population it is less likely to be discerned in a sample that has been deemed representative of the Australian population. The third interpretation may simply be that for at least some consumers, there is confusion surrounding the differences between CBD oil, THC, and hemp oil and food which results in the anomalies in the way that the CBD related survey items were interpreted by the consumer, the perception of it as a positive or negative aspect dependent upon whether the two entities are viewed as having different or similar properties.

The more likely explanation might be somewhat a combination of the first and third scenarios and suggests the challenge for the hemp food industry to separate hemp food from any association with either CBD oil or THC, whether this is through increased consumer education or the development of strains of Cannabis sativa which are guaranteed completely void of THC. Knowledge of the processes of varietal development is beyond the scope of this research and the authors acknowledge that the latter may not even be possible.That is, despite a belief in the physical and psychological benefits of hemp food, a positive attitude toward hemp food did not play a significant role in intention to consume it. The factor which provided the greatest contribution to intention to consume hemp food was consumers’ normative beliefs. Subjective norms focused on consumers’ perceptions of what family, friends, peers and doctors would think of them consuming hemp food and whether they felt others like them would consume it as well.

A high level of concern for the opinion of others and the mediating effect of the CBD construct on negative attitudes suggests that for this sample of the Australian population there remains a widespread stigma associated with hemp consumption. This stigma may be difficult to eradicate as it is the artifact of the previous illegal status of hemp food combined with decades of propaganda against cannabis use in any form . Consumers may find it difficult to disassociate hemp food from the more illicit uses of cannabis and seek the approval of others for confirmation of the acceptability of consuming hemp products. The normative beliefs and the mediated influence of negative beliefs through association with CBD oil are the only contributing factors to intention to consume hemp food in this study. A fifinal analysis of the findings from across the two phases of this research consisted of a meta-inference of qualitative with the quantitative findings under a pragmatic framework. Here it was revealed that the application of the theory of planned behavior and SEM in the quantitative phase two of this study was consistent with the outcomes of the initial interviews.

Survey participants in the qualitative phase of the current study generally held positive attitudes toward hemp food and indicated they were likely to consume them at some time in the future, however, they also made contradictory statements indicating their reluctance to consume them at a time when they had to drive a car or attend their workplace, for example, yet denied they believed they would test positive. The issue of an association of hemp food with CBD oil and THC is complex and may not be easily resolved. This research evaluates the acceptance of hemp food in the Australian population and evaluates behavioral and normative beliefs within a population where consumption of cannabis products has been illegal until recent times. The attitudes and beliefs surroundingcannabis may not extrapolate to a population where cannabis is a legal entity, or where hemp foods have been available for longer periods of time.

However, the protocol of assessing negative attitudes as a separate construct under TPB may have utility for future research of alternate novel foods where highly salient negative associations are made to the food from external sources. The findings from the current study suggest some ambiguity may exist within the population between CBD oil and THC, the two more widely known properties of cannabis, and its association with hemp food, specifically hemp seed oil. Despite being highly conspicuous of hemp food, consumers may not be fully versed in their properties, effects, health benefits, etc., or aware of the differences between Cannabis sativa used in hemp food production, and Cannabis indica which is better known as marijuana. This may have contributed to the responses regarding the anxiolytic and relaxation effects of hemp food.

The aim of the report of this highly challenging case is to depict how sudden unexplained deaths can sometimes be associated to many atypical and complex findings, albeit of unknown significance. At the autopsy, the only relevant macroscopic finding was the myocardial bridging of left anterior descending coronary artery in the context of a normal heart. In general terms, MB is a congenital coronary anomaly that usually affects the middle tract of left anterior descending coronary artery and is often found for the first time only at autopsy . According to many authors, when it is particularly thick , it may cause myocardial ischemia, but it is controversial if it can be considered a possible cause of SCD . Myocardial bridging has been also reported in men with no family history of sudden cardiac death in which the first clinical manifestations of BrS were acute chest pain and syncope .

A causal relationship between this coronary anomaly and BrS has never been proved, but Riezebos et al. hypothesized that “interaction between the provoked ischemia and the specific repolarization abnormalities that are caused by the Brugada syndrome could provide an electrophysiological substrate that may increase individual susceptibility to life-threatening ventricular tachyarrhythmias” . Microscopic examination of the atria and ventricles found some interesting and complex features. Starting from the left ventricle, fibrosis and disarray in the myocardial area above the MB were described. These features have already been associated to MB in young cases of SD . In particular, considering the young age, the presence of fibrosis and disarray without ventricular hypertrophy in regions far from the septum is compatible with an early phenotype of HCM . It should be considered that the abnormal weight of the heart is also suggestive of HCM. In our case, there also was a sign suggestive of arrhythmogenic cardiomyopathy : the fatty infiltration of the right ventricle.

However, this feature was only found in the antero-lateral region of the right ventricle, a localization that is typical of physiological conditions . Moreover, the fatty infiltration was clearly separated by the myocardium, and there were no signs of necrosis/atrophy of the myocytes , no fibrous or fibro-fatty infiltration of the myocardium and no inflammatory infiltrates . Finally, NGS found no variant pathogenic for ACM. All these data suggest a physiological condition. However, this finding is atypical, because fatty infiltration of the myocardium generally affects elderly or obese patients, and our case was young and non-obese . Hence, since the absence of signs of cardiomyopathy, a clear pathogenic significance cannot be given to the findings. However, it should be considered that some authors reported that fatty infiltration could cause arrhythmias because it represents a structural barrier to the heart electrical impulse and causes oxidative stress. In particular,previous cases of sudden death in patients with fat of the free wall of the right ventricle have been reported . Another interesting microscopic feature was the fibrosis of the sino-atrial node area.

In sudden death cases, it is important that an expert pathologist carefully examines the conduction system, as recommended, among others, by Ottaviani and Buja and by The Royal College of Pathologists . Indeed, this analysis can help to find the cause of the death but is complicated, for example, by the interindividual anatomical variability. The feature we found in our case is considered physiological since fibrosis has been described as a “modulator of structural and functional integrity” of sino-atrial node.In our case, the found amount of fibrosis in the sino-atrial node area is relatively unusual for the young age of the victim . However, despite the crucial function of this pacemaker and the presence of important structures, such as Nav1.5 channels-in the periphery of its area, according to current evidence, no pathological significance of this feature can be assessed.In conclusion, the autopsy revealed a long and thick MB located in a very proximal tract of the coronary artery and surrounded by signs suggestive of HCM/MB-caused ischemic damage. Moreover, fatty infiltration of the right ventricle and significant fibrosis of the sino-atrial node area were found. These features are relatively common in the general population but are atypical in a young and healthy patient.In our case, the victim was reportedly a habitual cannabis consumer, and the friend who witnessed his death told the police that he had smoked cannabis few tens of minutes before his death. Toxicologic testing was positive for cannabis use. However, THC concentration in peripheral blood was low. Marijuana use has been associated with a wide spectrum of cardiac adverse effects and, in particular, with arrhythmias .

Synthetic cannabinoids WIN55,212-2 and JWH133 were also tested in glioblastoma cells expressing high levels of CB2 receptors by Ellert-Miklaszewska et al. in their research article. These authors used five different glioma cell lines and patients-derived cells that were highly resistant to standard chemotherapy due to a lack of tumour suppressor p53 and/or PTEN. Interestingly, the observed cannabinoid-induced autophagy and apoptotic cell death were enhanced bythe inactivation of specific autophagy genes, suggesting cannabinoid use as a potential new therapeutic strategy for glioblastoma . The latest tumour is the topic of the work by Kolbe et al., who tested the effects of cannabidiol and ∆9 -tetrahydrocannabinol , the main cannabinoids found in the cannabis plant, on patient-derived glioblastoma cells. Cell cycle analysis revealed a decrease in cell cycle marker Ki67 via G protein-coupled orphan GPR55 receptor upon treatment with THC, pointing to the potential therapeutic action of THC in GPR55-expressing glioblastomas .

The review by Andradas et al. takes stock of the situation of cannabinoid’s treatment in paediatric oncology. They report few, and yet only preliminary, results on cannabinoids’ effects on children’s tumours, and unfortunately even less data on their safety and side effects. Remarkably, the few available studies are greatly diversified in terms of methodologies, types of compounds and formulations used, thus leading to controversial observations and a lack of confirmations . Moreover, Andradas et al. reported bad news on this subject in their paper on the role of cannabinoids in the treatment of children’s brain cancers medulloblastoma and ependymoma. Despite positive results in vitro, THC and CBD treatment of mouse models of these tumours failed to have any impact on traditional chemotherapy or on the animals’ survival . Bar-Sela et al. reported unfavourable outcomes for cancer patients, who were cannabis consumers, treated with immunotherapy in their observatory study. Their findings suggest that cannabinoids’ immunomodulatory effects might interfere with immunotherapy and call for caution on their use in those patients . Then, Taylor et al. review the current knowledge of the involvement of endocannabinoid system and its various constituents in reproductive events and in gynaecological cancers.

The latter are malignancies originating from either the reproductive tract or the products of conception, or secondary tumours. The review article highlights how targeting the endocannabinoid system could lead to new approaches to the diagnosis and treatment of these cancers in the female reproductive system . Another review analyses the complex involvement of the various components of the endocannabinoid system in susceptibility to cancer, prognosis, and response to treatment, focusing on the relationship of this lipid signalling system with cancer biology in different paradigms, such as gastrointestinal, gynaecological, prostate, thoracic, thyroid, and brain cancers, as well as melanoma. Interestingly, Moreno et al. noted that the same component of the endocannabinoid system can exert both pro- and anti-tumoural actions in different tumour subtypes . Finally, Afrin et al. discuss the action of non-THC cannabinoids in cancer. In their study, these authors evidenced the paucity of clinical data using cannabinoids, and the need for further preclinical investigations in order to establish the ‘pros’ and ‘cons’ of using whole cannabis extracts . Taken together, we hope to offer the reader at least a compass to navigate the mare magnum of the cannabinoid and endocannabinoid literature in the context of cancer.

Cannabis was used during the Han Chinese dynasty to treat inflammatory disorders and malaria . Other ancient people used Cannabis for healing and recreation in several regions of the world . In the western world, the importance of Cannabis was recognized in the mid-19th century, when an Irish physician, William B. O’Shaughnessy, and a French psychiatrist, Jacques-Joseph Moreau, reported that Cannabis had some beneficial effects . Cannabis was also used for religious and textile purposes . More recently, Cannabis was used as a recreational drug and the emergent problem of opiate dependency caused legal restrictions in 1925. In 1941, the American National Formulary and Pharmacopoeia included these compounds among illicit drugs . In recent years, there have been legislative changes to allow the use of Cannabis for some medical and/or recreational purposes . In this review we describe the interplay between endocannabinoids and immune systems in the cancer context.These compounds can also be stored in intracellular vesicles or organelles .

Data collection and management occurred within REDCap software hosted at the University of Miami. Data for this analysis included 158 responses from 21 March 2020 to 23 March 2021 from participants mostly residing in the United States . Thirteen participants were from other countries including Canada, Colombia, France, Israel, Kenya, Malaysia, Mexico, and New Zealand. Participants were categorized as cancer survivors along with age-matched medicinal cannabis users without a history of cancer . This study summarizes differences by cancer history in cannabis use patterns, changes in the method of delivery, reports of physical and mental health symptoms managed by cannabis, and COVID-19-related fears among an age-matched sample of respondents from the COVID-19 cannabis health study. Findings from the study suggest that cancer survivors are frequently reporting the use of cannabis to manage both physical and mental health symptoms associated with their cancer diagnosis, which is consistent with studies of cannabis use among cancer survivors before the COVID-19 pandemic .

Specifically, self-reported symptoms most frequently managed by medicinal cannabis among respondents included anxiety and pain. While no differences in frequency of cannabis use or method of delivery were observed between those with and without a cancer diagnosis, cancer survivors were more likely to have an advanced supply of cannabis. However, most cancer survivors reported an advanced supply of less than one month. Similar to our fifindings, other studies have also identified anxiety and sleep problems as primary symptoms managed by cancer patients using medicinal cannabis . Opportunities exist for cannabis use as a form of palliative care and non-curative treatment among cancer patients. Early intervention with palliative care among cancer patients can increase overall survival and improve quality of life of both cancer patients and their caregivers . Integrating medicinal cannabis into palliative care can address disparities and underuse of palliative care among cancer patients due to poor effective-ness of current palliative treatment options, as indicated by poor symptom control and intolerable adverse effects attributed to palliative treatment options such as opioids .

Anxiety and depression are common mental health symptoms experienced by cancer patients. These mental health symptoms can manifest as worry and poor sleep quality, and about one-third of cancer patients experience psychological distress that requires clinical treatment, although this proportion varies greatly by cancer type and prognosis . As the endocannabinoid system is involved in mood regulation, cannabis-derived treatment could improve mental health symptoms, as has been shown in mice models . Curative cancer treatment can also cause physical symptoms such as nausea, vomiting, pain, and neuropathy. Modern antiemetic regimens are less effective at controlling nausea with 40–70% of patients reporting nausea while receiving highly or moderately emetogenic chemotherapy. Chemotherapeutic agents induce nausea and vomiting through elevated release of serotonin which bind to the 5-hydroxytryptmaine 3 receptors, which send information of excess chemicals to the brain and directly promote emesis . Cannabinoids can directly inhibit these receptors and are thought to act as modulators and indirect agonists on the autoreceptors of the 5-HT3 . The bioactive benefits of cannabis may outweigh its risks, particularly in the context of palliative care. Future research should focus on providing further evidence on the mechanistic pathways and effectiveness to optimize medicinal cannabis applications and dosage. The COVID-19 pandemic has led to added stress and anxiety among cancer patients .

We observed that cancer survivors were more likely to fear a COVID-19 diagnosis compared to those without a history of cancer. Higher levels of fear of contracting COVID-19 among cancer survivors are likely due to both early and more recent reports of increased risk of COVID-19 morbidity and mortality among adults with pre-existing conditions, including cancer . To cope with the psychological impacts of the pandemic, cancer patients are exhibiting several coping strategies. For example, US-based ovarian cancer patients reported using emotional support, self-care, hobbies, planning, positing reframing, and religion as coping strategies . Older cancer patients in the US reported to engage in physical activities such as gardening, walking, fitness regimes, tai chi, yoga, and fishing to stay busy or active during the pandemic . Similarly, respondents to our survey reported physical activity as a common coping mechanism.