Currently we have a chronic pain and mental health epidemic with excessive prescriptions for ssri benzos and opioids. People are unable to feel and process pain. Chronic stress can lead to chronic pain. Pain is a warning signal. patients should be assessed using a bio psycho social assessment and should become a participant in their own healthcare by understanding the brain and body and in communication. Ketamine and psychedelics are a catalyst to help one change perspective, shift out of old narratives, heal trauma and decrease emotional and physical pain by creating neuroplasticity. Ketamine When used in a supportive setting with a therapeutic alliance can correct the misalignment of signals in the body and brain. pain reprocessing therapy and group therapy such as MORE extends the effects of the medicine.

Learning Objectives: 

1. Discuss the impact of chronic stress and central sensitization on chronic pain and mental health.

2. Differentiate ketamine and classic psychedelics in terms of mechanism of action, glutamate v serotonin.

3. Discuss therapies to extend the effects of ketamine such as MORE and pain reprocessing therapy.

Cannabinoid hyperemesis syndrome (CHS) is a constellation of intractable vomiting, abdominal pain and hot bathing behavior that solely occurs in the context of heavy chronic use of THC-predominant cannabis or CB1 agonists. It is associated with frequent emergency visits with high associated expense ($30-90K USD). Considerable morbidity and even some fatalities have been reported. The definitive treatment is abstention from cannabis usage, but parenteral haloperidol and cutaneous application of capsaicin ointment can provide symptomatic relief. The etiology of CHS may relate to biphasic dose responses to THC, a paradoxical shift of THC from partial agonist to antagonist of CB1, or effects on the TRPV1 receptor. After ethics approval, a screening questionnaire was posted online. Kits were sent to assess the DNA of patients fulfilling CHS criteria to assess single nucleotide polymorphisms (SNPs) or other mutations as compared to controls without this disorder. 585 people took the survey. Most were high frequency users of cannabis flower or concentrates (93%), using multiple grams/d of THC-predominant material. 15.6% carried diagnoses of cannabis dependency of addiction, and 56.6% experienced withdrawal symptoms. 87.7% of patients with diagnosis or symptoms indicative of CHS were improved after cannabis cessation, most suffering recurrence rapidly after resumption of use. 40 patients returned kits for genomic analysis, 28 CHS patients who carried formal CHS diagnosis and had consistent symptom profiles, and 12 controls with heavy cannabis usage and no CHS symptoms. Findings included mutations in genes coding COMT (p=0.0009), TRPV1 (p=0.021), CYP2C9 (p=0.0414), DRD2 (p=0.027) and ABCA1 (p=0.008), relating to CHS pathophysiology and clinical manifestations. These results shed light on CHS pathophysiology and additional risk factors of this important emerging public health issue.

Learning Objectives: 

1. Define cannabinoid hyperemesis syndrome (CHS) as a condition affecting chronic cannabis users with nausea, vomiting, abdominal pain and hot bathing behavior.

2. Identify CHS pathophysiology.

3. Review the genomic susceptibilities related to a CHS diagnosis.

Join this year's poster presenters in the Poster Hall during the Poster Discussion, Wednesday, April 17th, from 10:00 AM –11:00 AM PST, to chat live about their posters and latest research and findings.

Autism spectrum disorder is a group of neurodevelopmental conditions that impact behavior, communication, social interaction, and learning abilities. There has been great interest in using medical cannabis to reduce the severity of certain behavioral aspects, however results remain difficult to assess as there are no laboratory tools available for this emerging treatment modality. Using Cannabis Responsive biomarkers obtained in saliva, we were able to measure physiologic levels of numerous metabolites before and after medical cannabis treatment. We discovered 23 potential Cannabis Response biomarkers that exhibited change towards the mean established by our typically developing participants. These biomarkers reflect chemical pathways involved in inflammation, neurotransmission, endocannabinoid signaling and other neurologic processes. We also used machine learning to determine which biomarkers were associated with specific phytocannabinoid compounds (THC, CBD and CBG), non-cannabinoid cannabis plant molecules with synergistic effects, and any compounds that might distinguish autism from typically developing participants.

• Siani-Rose, M., Cox, S., Goldstein, B., Abrams, D., Taylor, M., & Kurek, I. (2023). Cannabis-Responsive Biomarkers: A Pharmacometabolomics-Based Application to Evaluate the Impact of Medical Cannabis Treatment on Children with Autism Spectrum Disorder. Cannabis and Cannabinoid Research, 8(1), 126-137.
• Quillet, J. C., Siani-Rose, M., McKee, R., Goldstein, B., Taylor, M., & Kurek, I. (2023). A machine learning approach for understanding the metabolomics response of children with autism spectrum disorder to medical cannabis treatment. Scientific Reports, 13(1), 13022.
• Siani-Rose, M., McKee, R., Cox, S., Goldstein, B., Abrams, D., Taylor, M., & Kurek, I. (2023). The potential of salivary lipid-based Cannabis-responsive biomarkers to evaluate medical cannabis treatment in children with autism spectrum disorder. Cannabis and Cannabinoid Research, 8(4), 642-656.

Learning Objectives:

1. Define pharmacometabolomics and its potential to objectively measure impact of cannabis therapy.

2. Discuss pharmacometabolomics applications, including predictive, responsive, dosing guidance and monitoring and diagnostic.

3. Explain how identification of biomarkers by machine learning may lead to better understanding of the uses and impact of medical cannabis.

The cannabis plant contains a complex mixture of dozens of known active ingredients, such as phytocannabinoids, terpenes, and flavonoids. The two most prevalent and famed cannabinoids in cannabis are delta 9 tetrahydrocannabinol (Δ9-THC) and non-psychotropic cannabidiol (CBD), which are biosynthesized in the plant as acids - Δ9-THCA and CBDA. The acidic cannabinoids commonly undergo non-enzymatic decarboxylation into their neutral forms during extraction, storage, or heating processes. Δ9-THCA, Δ9-THC, CBDA, and CBD are the major cannabinoids, but there are many minor cannabinoids, produced by plants to a lesser extent, at different times during the plant growth cycle. In addition to phytocannabinoids, our own bodies and brains synthesize endocannabinoid molecules. Both endocannabinoids and phytocannabinoids target cannabinoid receptors widely expressed throughout the body and the brain, but they can also interact with other receptors and neurotransmitter systems, exerting various biological and therapeutic effects. However, the current cannabinoid market is fraught with unvalidated claims and synthetic cannabinoids masquerading as natural compounds. This causes chaos for consumers and regulators, and can lead to adverse effects and experiences. To solve this problem, there is a need for new standards and a universal cannabis product system. Previous attempts at cannabis taxonomy focused on plant morphology and content and ratio of just THC and CBD, but failed to consider other important active compounds in the finished products, like terpenes. Standardization efforts are underway to address market complexities, but a comprehensive taxonomy based on active ingredients is needed to guide consumers and businesses toward informed choices in the cannabis market. One can envision future cannabis markets where products are categorized, scored, and represented based on the active ingredients in the products, rather than broad plant taxonomy segmentations (indica vs sativa) or unvalidated claims. In the near future, healthcare practitioners and consumers will be empowered with clarity regarding the sources and attributes of the ingredients in their cannabis products. This will further facilitate individualized, yet consumer-friendly approaches to cannabinoid health and recreation.

Learning Objectives: 

1. Review the complexity of the cannabis plant: Learn about the diverse array of active ingredients present in the cannabis plant, including cannabinoids, terpenes, and flavonoids, and their potential effects on the body.

2. Recognize the challenges in the current cannabinoid market: Identify the issues surrounding unvalidated claims and the proliferation of synthetic cannabinoids, and understand how these challenges impact consumers and regulators.

3. Recognize the importance of establishing new standards and a universal product system to address market complexities, and understand the significance of a comprehensive taxonomy based on active ingredients in guiding informed choices for healthcare practitioners, consumers and businesses in the cannabis market.

Cannabis edibles and orally administered oils act slowly and unreliably because the incorporated cannabinoids do not dissolve in water. Similar poor performance profiles are observed for other water-insoluble bioactive ingredients as well. Since humans are mostly made of water, water-insoluble ingredients cannot be efficiently absorbed into our bloodstream. Alcohol, on the other hand, is water-soluble and, as a result, absorbs quickly and completely. This presentation will demonstrate how to ultrasonically manufacture liquid and powdered “water-soluble” cannabinoid and alkaloid nanoemulsions that can be readily mixed into and administered as beverages or consumed directly as fast-disintegrating tablets. Similarly to alcohol, cannabinoids, alkaloids, and other bioactive ingredients incorporated in these "water-soluble" formulations are absorbed into the bloodstream without delay, significantly accelerating their onset of action and increasing their bioavailability. Pre-clinical pharmacokinetic study results will be demonstrated.

Learning Objectives:

1. Describe how rapid action and high bioavailability are essential for deriving reliable therapeutic benefits from cannabis extracts and other bioactive ingredients.

2. Summarize why cannabis extracts and many other bioactives are not water-soluble,so their oral/digestive administration is very inefficient and unpredictable.

3. Determine how the delivery efficiency of such bioactive ingredients can be significantly improved by formulating them as “water-soluble” liquid or powdered nanoemulsions.

ISO 17025 accreditation ensures laboratories provide high-quality testing services. However, the path to achieving compliance could be riddled with challenges for new and established labs alike. A Laboratory Information Management System (LIMS) is a strategic framework to seamlessly meet ISO 17025 standards, preventing operational and compliance gaps and setting labs up for success. Often labs use their LIMS for only a fraction of their accreditation activities. This presentation will identify specific LIMS capabilities that can save labs time and money, and help them maintain accreditation more easily. Mastering effective trend analysis is a common challenge for laboratories in relation to meeting clause 7.7.1 of ISO/IEC 17025:2017. With LIMS’ control charting feature, labs can adeptly analyze trends using statistical techniques and promptly identify process variations. Trend analysis charts enable labs to quickly identify random errors and also address less obvious requirements, such as monitoring the competence of staff (ISO/IEC 17025:2017 clause 6.2.5, part (f)). The Quality Control (QC) management functionality enables labs to verify test runs, by comparing the test results of QC samples to set criteria, greatly increasing confidence in data integrity. Furthermore, an artificial intelligence (AI)-powered LIMS enables laboratories to make data-driven decisions and offers a proactive edge in issue identification and corrective action implementation. A LIMS also sends out maintenance or calibration alerts, ensuring timely equipment calibration and preventing failures. It also stores calibration and maintenance results for audits. This proactive approach enhances overall lab performance, reduces analytical errors, and results in significant time and cost savings.

Learning Objectives: 

1. Discuss what ISO 17025 accreditation is, and why it is important for cannabis testing labs.

2. Summarize how labs can fully utilize LIMS to bridge operational gaps and achieve or maintain ISO 17025 compliance.

3. Identify how AI-powered LIMS can boost lab performance and help proactively identify and correct issues, leading to significant savings.

In the rapidly evolving landscape of cannabis production and consumption, ensuring the safety and quality of cannabis products is of paramount importance. Microbial contaminants pose potential health risks to cannabis consumers, necessitating robust testing procedures. This presentation will first introduce the fundamental concepts of cannabis microbiology, emphasizing the significance of accurate and reliable testing methodologies. Secondly, we will break down traditional culture-based techniques utilizing specialized growth media to detect and quantify microbial contaminants while comparing molecular methods that include rapid detection and the ability to differentiate between viable and non-viable microorganisms.

Learning Objectives:

1. Summarize the basics of Microbiology.

2. Review the difference between culture and molecular microbiology.

3. Discuss quality control in Cannabis microbiology.

BACKGROUND: Approximately 4% of the UK population experiences PTSD. Individuals must exhibit symptoms across four clusters to receive a diagnosis: intrusion, avoidance, altered reactivity and altered mood.

OBJECTIVES: Evidence suggests that cannabinoid agonists such as nabilone and tetrahydrocannabinol (THC) may alleviate PTSD symptoms. We investigated the safety and effectiveness of THC-predominant cannabis flowers for inhalation to manage PTSD symptoms.

METHODS: We analysed data from the UK patient registry, T21. Validated questionnaires were used to collect PROMs for health-related quality of life (HRQoL), mood/anxiety, sleep, and PTSD-specific symptoms. Inclusion criteria were i) a confirmed diagnosis of PTSD, ii) completed PROMs questionnaires at baseline and at the 3-month follow-up, and iii) received a prescription for a chemotype 1 (THC-predominant) cannabis flower.

RESULTS: Fifty-eight patients were included, 34 of which also had PROMs recorded at 6 months. Most were males (65.5%) with an average age of 39.2 years who had previously used cannabis illicitly (95.6%). At 3 months, participants reported significant improvements in overall health, mood, and sleep quality (P<0.001) but not in the proxy for HRQoL (P=0.052). Similarly, participants reported substantial benefits in managing intrusion symptoms (P<0.001), mood alterations (P<0.001), and reactivity alterations (P=0.002), which were sustained or further improved at 6 months. Participants did not report any side effects associated with CBMPs.

CONCLUSIONS: Inhalation of THC is well-tolerated and useful for managing symptoms of PTSD in cannabis-experienced individuals. However, further research is needed to evaluate the long-term safety and outcomes of controlled inhalation of CBMP in patients naïve to cannabis.

Learning Objectives:

1. Discuss the basics of the endocannabinoid deficiency observed in PTSD patients.

2. Recognize the limitations encountered so far by randomized clinical trials aimed at assessing the efficacy of cannabis flowers in PTSD patients.

3. Summarize the benefits of an add-on treatment with chemotype-1 cannabis flowers for PTSD patients.

The escalating demands for operational efficiency, precision, and regulatory adherence in analytical laboratories necessitate the adoption of advanced technological solutions. Laboratory Information Management Systems (LIMS) have emerged as pivotal in addressing these requirements, offering comprehensive tools to enhance laboratory operations. This review delineates the functional breadth of LIMS, emphasizing its instrumental role in optimizing productivity, ensuring data integrity, and facilitating compliance with stringent regulatory frameworks. Through an examination of LIMS functionalities, this study highlights the system's capability to automate critical laboratory tasks, streamline workflows, and significantly reduce manual errors, thereby augmenting laboratory efficiency. Additionally, LIMS's contribution to bolstering regulatory compliance is underscored, showcasing its capacity to maintain exhaustive audit trails, manage electronic records, and generate compliance reports efficiently. The review further explores the strategic value of LIMS in fostering informed decision-making through robust data analytics and reporting features, underscoring its adaptability to evolving laboratory needs and technological advancements. This comprehensive overview aims to illuminate the multifaceted benefits of LIMS implementation, asserting its necessity for laboratories striving to meet contemporary operational challenges while positioning themselves for future growth and innovation.

Learning Objectives:

1. Define a LIMS system.

2. Develop an understanding for the critical role of LIMS in Modern Laboratory Operations.

3. Identify the Benefits of Implementing LIMS for Compliance and Efficiency.

Hop latent viroid (HLVd) infection lowers the commercial value of cannabis by reducing flower harvest weight, THC concentration, and terpene production. Unlike other microbial contaminants including yeast, mold, and pathogenic bacteria, HLVd is not subject to regulatory compliance testing due to the absence of known human safety concerns. However, because of the financial losses associated with HLVd infection, cannabis cultivators are advised to adopt a tiered approach to safeguard against HLVd and other microbial contaminants to reduce the risk or spread of infection. These strategies include implementing (in order of increasing complexity and effort): basic biosecurity standard operating procedures, non-burdensome environmental monitoring plans (EMP) and rational Hazard Analysis and Control Point (HACCP) plans. Remarkably, these strategies not only shield against HLVd but also confer enhanced protection against other financially detrimental microbial contaminants such as yeast, mold, and pathogenic bacteria. Consequently, the adoption of these protective measures yields additional benefits, including the production of a higher quality cannabis product that commands premium pricing, a reduction in microbial contaminant test failures without reliance on a kill-step, and the fulfillment of a crucial element for future Good Manufacturing Practices (GMP) certification.

Learning Objectives:

1. Review HLVd properties and the biological effects of infection in cannabis.

2. Describe methods of HLVd is detection and its modes of transmission.

3. Outline HLVd biosecurity planning and infection mitigation actions.

Genetics may influence experience with cannabis and CBD. With increased access to legal cannabis and the research community expanding their focus on the medicinal uses of cannabinoids, more and more consumers are seeking cannabis for health and wellness. However, cannabinoids and terpenes are extremely complex and research tells us that users can have vastly different physiological responses to individual strains/chemovars or products. [8] This makes it almost impossible to find a perfectly aligned product through trial and error. The truth is, cannabis is personal, and uncovering true endocompatibility for each individual user can be scientifically validated. Combining genomics with biomarkers and measurable outcomes allows us to develop better predictive inferences. There are statistics of adverse events with delta9 THC consumption and drug to drug interaction resulting in psychotomimetic effects among others. [1] (Sorensen 2017).

In the realm of modern healthcare, the integration of personalized wellness approaches has garnered significant attention for its potential to optimize patient outcomes. DNA emerges as a pioneering force in this paradigm shift, capitalizing on the transformative capabilities of genetic testing to tailor healthcare solutions to individual genetic profiles. This abstract elucidates the multifaceted contributions of that DNA testing and analysis, delving into its foundational pillars of personalized wellness, cutting-edge technology, and comprehensive insights.

Personalized precision therapeutics can be used to support in mitigation of these adverse events looking at Single Nucleotide Polymorphism (SNPs) along with Pharmacogenomics (PGx) for drug to drug interaction and Pharmacokinetics for dosing based on metabolic function.

Methods: A health profile is used along with a buccal swab EndoDNA test to identify genetic patterns in the cohort of significant relevance. In addition, care councilors received protocol efficacy feedback as well as the use of a biometric device.

Results: Findings include mutations in genes coding COMT (p=0.0009), TRPV1 (p=0.021), CYP2C9 (p=0.0414), DRD2 (p=0.027) and ABCA1 (p=0.008) were clustered and analyzed to identify a genetic pattern for this specific adverse event.

[2] COMT – COMT (catechol-o-methyltransferase) is best known for its association with dopamine levels and processing. Studies have shown an association between mutations of the COMT gene and depression, ADHD & OCD. Dopamine imbalances caused by variations in COMT may influence the processing of THC resulting in a higher rate of CHS.

[3] TRPV1 – TRPV1 regulates receptors which respond to heat, ethanol, low pH and are known to interest with CBD and other compounds present in cannabis. TRPV1 has been linked to anxiety and pain responses. Mutations in TRPV1 may be responsible for the hot bathing behavior and abdominal pain present in CHS.

[4] ABCA1 – ABCA1 regulates a protein which affects cholesterol and phospholipid levels. Some studies have shown that ABCB1 may alter alter drug pharmacokinetics, and increased cannabis dependency.

[5] CYP2C9 – CYP2C9 is associated with the metabolism of many pharmaceuticals and is one the primary metabolizer of THC. Variations in the CYP2C9 may result in an altered metabolization of THC, resulting in a higher rate of CHS.

[6] CYP2C19 – CYP2C19 is associated with the metabolism of many pharmaceuticals and is an accessory metabolizer of THC. Variations in the CYP2C19 may result in an altered metabolization of THC, resulting in a higher rate of CHS.

[7] DRD2 - DRD2 is associated with dopamine levels, a neurotransmitter which, in simple terms, controls our brain’s reward system. Due to this, dopamine plays a primary role in addiction, fear memory, depression and anxiety. In the past, drugs which target these transmitters often have an effect on the digestive system. The excessive cannabis consumption and nausea associated with CHS may be explainable by mutations in DRD2.

Conclusion: This is the largest observational study ever conducted on phytocannabinoid effects correlating with a genotyping method. A peer reviewed approved study was published as a partial example of study findings. Western IRB, peer reviewed, and first to note associated mutations in genes affecting the ECS and neurotransmitter systems that may elucidate the pathophysiology of these adverse events.

Learning Objectives: 

1. Discuss the latest research and scientific evidence to evaluate and confidently use cannabinoid therapeutics for individually defined optimal outcomes.

2. Explain the scientifically based, genetically focused resource that consistently and reliably matches individuals with the most compatible cannabinoid products.

3. Review specific clinical applications this method is being used in (Phase 2 Clinical Trial).