As lung inflammation is a critical malfunction in case of COVID-19. Therefore, the reduction of lung inflammation has been tested in the mice animal model. Interestingly, cannabinoids isolates such as CBD and THC has also been tested in human as well even long before the onset of global pandemic owing to the spread of severe acute respiratory syndrome coronavirus type 2 infection . Immune responses during severe cases of COVID-19 trigger the inflammation of human lung tissue resulting in acute respiratory distress and failure. This immune response for the overproduction of the pro-inflammatory cytokines is known as a cytokine storm . Respiratory distress from the COVID-19 induced lung inflammation is the leading cause of high mortality rate. Phyto-cannabinoids especially CBD have exhibited a remarkable anti-inflammatory effect through CB2 inhibitory activity and agonistic effect on the peroxisome proliferator-activated receptor g reviewed in . Additionally, CBD, CBN, and THC have also been shown to exhibit anti-viral effect against COVID-19 in cell-based assay with the same potency as the standard clinical references. However, the complete antiviral mechanism of cannabinoids against SAR-CoV2 infection is still unknown. Therefore, detailed pharmacological research studies are urgently needed to explore the immunotherapy potential of cannabis against SARS-CoV2 infection.Cannabis legalization fueled the scientific research in cannabinoid compounds for potential in medicinal, pharmaceutical, and neurological applications. However, with recent developments in sequencing technologies, there has been a paradigm shift in cannabis research toward the genetical genomics of fiberand drug-type plants. Remarkable growth in genomic data combined with fast-paced development of artificial intelligence -based data analysis tools have made it possible to explore cannabis plant at the genetic and molecular levels. Integrated omics studies combining genomic and expression data with metabolite profiles are now beginning to understand the genetical regulation of the cannabinoid biosynthesis pathway.

Especially, by unraveling the association between the expression of cannabinoid genes with THC:CBD ratio and cannabinoid content. The knowledge could be further applied to genetically modify cannabis with optimized pathways for preferred metabolite yield and composition. Advanced biotechnology methods could be further extended for recombinant production of cannabinoids in metabolically engineered hosts such as yeasts or bacteria. Currently,grow tent hydroponic the recombinant production of THC in yeast is challenging owing to unstable THCA and CBGA expression and high amounts of side products. However, in the future, the combination of genetic technologies to obtain enhanced expression rates will lead to enhanced cannabinoid yields in an economically feasible manner. In addition, cannabinoids have been recently shown to exhibit anti-inflammatory and immunosuppressing effects against the COVID-19 immune response. However, further evidence-based clinical studies are needed to determine the efficacy and safe dosage of cannabis extracts for treatment or prevention of COVID-19. Pharmacological research coupled with rapidly evolving genome-based biotechnology will further facilitate exploring cannabis plants for tremendous potential in drug-discovery.Pain management remains a major challenge in orthopedics. Surgeons employ a multitude of strategies to combat this challenge, including multi-modal pain regimens and preoperative opioid counseling.A recent review of medical cannabis in orthopedic surgery proposed that MC may provide an additional pain management option for patients with chronic pain.Chronic pain, defined as pain that fails to respond to traditional pain control regimens and lasts greater than 3 to 6 months, is one of the most widely recognized indications for MC use and has been reported to be the primary indication for MC use in two-thirds of patients presenting to MC dispensaries in the northeast.MC use has become more widespread in recent years and is currently legal in 36 states and 4 United Sates territories.

This has been paralleled by a decreased perceived risk of cannabis use reported in a nationwide survey of United States citizens from 2002 to 2014.However, limited evidence exists on MC use in orthopedic surgery and on patient perspectives of this novel therapeutic. One descriptive qualitative study of spinal cord injury patients found that patients used MC when other pain management strategies failed and when they had both initiative and connections to educate themselves on MC use.Heng et al investigated musculoskeletal trauma patients’ opinions on MC and found that most patients thought it could be effective in treating musculoskeletal pain.However, there is an overall paucity of research on hand and upper-extremity patient perspectives on MC. This patient population may differ from other orthopedic conditions in that many present electively, it includes conditions with a mix of acute and chronic pain and includes patients of a wide age range. Many other orthopedic sub-specialties include a predominantly older population or see patients in the acute trauma setting. The purpose of this study was to evaluate hand and upperextremity patient perspectives of MC and its use in treating common hand and upper-extremity musculoskeletal conditions. We further sought to identify the prevalence of patients already using MC in this patient population, perceived barriers to MC use, and opinions on the legality of cannabis. We hypothesized that most patients would consider using MC for common orthopedic conditions, and that older patients would be more reluctant to use MC compared to younger patients.Institutional review board approval was obtained prior to initiation of this anonymous cross-sectional survey study. From October 2020 to January 2021, all patients who were at least 18 years old and presenting for an office visit at a metropolitan academic institution with clinic sites across New Jersey and Pennsylvania were asked to participate in this study.

All patients presented with a hand or upper-extremity complaint to 1 of 3 board certified, fellowship-trained orthopedic hand and upper-extremity surgeons. Medical cannabis is legal in both states where the survey was conducted, with New Jersey legalizing MC in 2010 and Pennsylvania in 2016. Patients completed a survey that was created by the study investigators regarding patient opinions of MC, including opinions of its legality, safety, costs, and potential barriers for use . Medical cannabis was defined in the survey as any publicly available legal MC product, which included topical, inhalational, and oral cannabis products. All survey responses were collected and stored electronically , with no identifying patient information collected as part of the survey. During the study period, 937 clinic patients were solicited to participate in the study.Statistical significance was set at P < .05.The present study identified numerous findings regarding hand surgery patient perspectives of MC. The majority of patients reporting to hand and upper-extremity orthopedic surgery outpatient offices would consider using MC for chronic pain control or for pain associated with many common orthopedic conditions. As MC use increases throughout the United States and as more MC research continues to emerge, it is important for surgeons to understand how patients perceive these substances and what factors may represent barriers to use. Most patients in our study reported that they would consider using MC for a variety of acute and chronic orthopedic pain conditions and believed it could effectively treat musculoskeletal pain. This is consistent with other orthopedic patient populations’ beliefs on the utility of MC. In a survey of orthopedic trauma patients, 81% believed cannabis can be used as a medication, and 78% believed it could be used to treat acute pain.9 In a study of elective surgery patients at a large academic center, inclusive of both orthopedic and nonorthopedic procedures, most patients believed MC could be at least somewhat effective for postoperative pain and chronic pain , and most patients would use MC if prescribed by a physician.

The positive patient response to MC as a potential pain control option brings into question the clinical effectiveness of MC in treating musculoskeletal pain. In multiple prior studies, cannabis users subjectively reported that cannabis provided effective pain relief.Of orthopedic trauma patients who used RC during recovery, 90% believed that it reduced their pain symptoms, and 81% believed it reduced the amount of opioids they required.Similarly, a survey of MC users, most being treated for chronic pain, revealed that 75% believed MC was effective in treating their pain and positively impacted their quality of life.Further, a study of orthopedic surgery patients found that preoperative RC users had lower pain scores and improved lower-extremity activity scores compared to non-cannabis users.Though most orthopedic surgery patients in the literature believe that MC is an effective treatment for pain, multiple review articles conclude that only low to moderate-quality evidence exists to support pain reduction with MC. These reviews also call for additional research on the safety, efficacy, and dosing of MC prior to making definitive conclusions on MC for pain management.To date, cannabis research has been limited by the federal classification of cannabis as a Schedule 1 substance, which has presented many barriers for researchers to perform high quality clinical trials.In our cohort, 74.7% of patients believed MC to be safe for treating orthopedic conditions and 74% of patients agreed or strongly agreed that MC was safer than prescription opioids for common pain conditions. While opioids are associated with many adverse outcomes including overdose and death, cannabis is likely perceived as safer as it is not associated with either of these critical major side effects.Despite this, other side effects of cannabis use must be considered. Cannabis use has been linked to negative mental health illnesses , impaired cognition, and increased rates of cardiovascular and cerebrovascular events. There is also a reported increased risk of motor vehicle collisions, including fatal accidents, in the acute setting following cannabis use.Negative consequences of cannabis use have also been described in total joint arthroplasty, although the evidence is inconsistent. One study reported no difference in short-term outcomes in primary total knee arthroplasty with cannabis use,grow tent for sale while another reported an increased risk of revision associated with cannabis use disorder.However, these studies are limited by the mixed inclusion of both MC and RC use.Lastly, the impact of cannabis use on anesthesia should be considered. A recent review of the perioperative care of cannabis users highlighted increased incidence of hyperreactive airway, intraoperative hypothermia, andcerebrovascular ischemic events. 

These studies are limited by the federal classification of cannabis as a Schedule 1 substance, and further studies are needed to better inform patients on the risks and benefits of MC. Interestingly, despite our cohort’s support for MC use as an alternative to opioids, only 26% believed MC could be used as a treatment for opioid use disorder. There is limited and contradictory evidence on the effects of cannabis on opioid use. One population level study found lower average opioid overdose mortality rates in states with legalized MC. Another study of orthopedic surgeons prescribing opioids to Medicare Part D patients found a decrease in opioid prescriptions in states with legal MC.Most studies on the impact of cannabis on opioid use in postoperative patients focus on the effect of preoperative RC use on perioperative and postoperative opioid requirements. Increased postoperative opioid requirements have been reported for orthopedic trauma patients. and total joint arthroplasty patients who were RC users.In contrast, other studies reported no difference in opioid requirements for RC users among total joint arthroplasty patients and elective surgery patients, inclusive of orthopedic and nonorthopedic procedures.None of these studies reported specifically on the effects of legal MC use on opioid requirements. One study of total hip arthroplasty and total knee arthroplasty patients treated after surgery with dronabinol, a synthetic prescription cannabinoid, in addition to a standard multi-modal pain regimen found a lower mean length of stay and lower averageopioid use.Further studies are required to elucidate the impact of multi-modal pain regimens inclusive of MC on opioid requirements in orthopedic surgery patients. Cost was reported by nearly 50% of our patients as a potential barrier for MC use, and over 70% reported the cost as either “expensive” or “not affordable.” A previous study of MC users also revealed the most common negative aspect of MC use was the associated cost, where patients reported spending over $2,000 per year on MC.The cost of MC varies by state and by specific product and is challenging to study, given the heterogeneity of the required quantity. A recent study by the Minnesota Department of Health found that the average 30-day cost per patient using MC to treat pain was $314 in 2019.35 Over 90% of patients in our cohort, greater than the number of patients that endorsed a willingness to use MC, supported insurance coverage for MC. Currently, no insurance companies cover MC.