Clinicians in a recently published case study have concluded that cannabis was the likely culprit behind a 32-year-old man’s persistent, painful erections. It’s a rare and curious example of marijuana being associated with what’s known in medical jargon as priapism—an erection lasting more than four hours that’s not related to sexual activity.
Priapism can have serious consequences, the report notes, including “damage to the penile tissue, with notable destruction obvious at twelve hours” and “over 90% of those remaining erect for 24 h losing sexual function.” The effects can be permanent.
The patient in the case study, published this month in the Journal of Cannabis Research, had been previously treated at the hospital for an erection lasting 12 hours. In a second incident described in the report, he arrived at the emergency department with an erection that had persisted for six hours. He told doctors that he had been smoking marijuana several nights a week for the past six months and during that period experienced “four or more episodes of a persistent erection lasting close to four hours.” In each case, he had smoked within a two-hour period before the erection began.
The case study’s authors, a team at Coliseum Medical Centers in Georgia, call it “the first known case of cannabis-associated priapism in a patient where all other known causes of priapism have been excluded.”
“The abstinence and subsequent use of cannabis were the only appreciable factors in this patient’s battle with recurrent unwanted erections.”
Cannabis doesn’t appear often in published case studies involving unwanted erections. When it does, it’s often in cases where the erections have other, more likely causes. The team conducted a literature review and “was only able to identify four distinct cases of cannabis use coinciding with priapism,” the report says, “none of which were convincingly able to prove cannabis was the sole cause.”
Two of the past cases involved patients with sickle-cell disease, a leading cause of priapism. Another showed concurrent use of MDMA, or ecstasy, which the report says is another proven cause. The fourth involved a patient with diabetes—another known cause—who had also used a number of other substances, including cocaine—yet another cause—and anabolic steroids.
The new patient’s case is unique. “He had no medical history other than mild hypertension, he took no medications, and used only cannabis, supported by his urinary drug screen,” the report says. “Further, his history exhibited a convincing correlation between his cannabis use and his episodes of recurrent priapism.”
“On physical exam, the patient was mildly hypertensive with an erect, swollen, and tender penis.”
The man had smoked marijuana off and on over his life, he told doctors. The periods during which he consumed cannabis seem to align with past episodes of uncomfortable erections. “He admitted a history of cannabis use at age sixteen and seventeen, during which time he had recurrent priapism lasting less than four hours and never requiring medical treatment,” the report says. “He quit cannabis use in his twenties, and during this period did not have any episodes of priapism.”
The report’s authors were left to speculate about how cannabis could have actually caused the patient’s sustained erections. Among the possibilities they identified was that cannabinoids were affecting regulatory mechanisms that would otherwise signal an erection to end. Another explanation has to do with increased blood-platelet activation, which is associated with cannabis and increased chance of heart attack for 60 minutes after consumption.
Cannabis also has direct effects of its own on the vascular system, causing blood vessels to dilate. Researchers said that effect, too, “could potentiate the unrelenting erection notable in priapism.”
As with many areas of marijuana research, the drug’s classification as a federally controlled substance has historically stymied research. “There is a paucity of studies investigating human erections and marijuana,” researchers wrote in a separate 2008 study, “and as a result there is insufficient evidence to suggest that marijuana will cause priapism in humans.” Little progress has been made since then.
A case study published in 2018 examined a patient with priapism who had consumed not marijuana but lab-created synthetic cannabinoids. Authors of the new report call that case study “supporting evidence” for the theory that cannabis caused their patient’s lasting erection, although they note that synthetic cannabinoids are “100 times more potent activators” of the body’s cannabis receptors.
“If synthetic cannabinoids can cause priapism, plant cannabis, affecting the same [cannabinoid receptors], would also be capable to potentiate this reaction,” the report says.
Of what little research does exist on cannabis and sex, most has focused on more desirable results: making sex better. According to self-reported anonymous surveys—some more scientific than others—many people, especially women, report having more frequent and satisfying sex after consuming marijuana.
A study led by Becky Lynn, an associate professor of obstetrics and gynecology at Saint Louis University in Missouri, last year found that more than two-thirds of women (68.5 percent) who said they’ve consumed marijuana before sex “stated that the overall sexual experience was more pleasurable.” Respondents also said they had an increased sex drive (60.6 percent) and more satisfying orgasms (52.8 percent).
Another study last year, by an Eastern Carolina University graduate student, also found that “participants perceived that cannabis use increased their sexual functioning and satisfaction,” associating cannabis consumption with “increased desire, orgasm intensity, and masturbation pleasure.”
A literature review published this past September in the journal Sexual Medicines Review evaluated decades of evidence and concluded a link between cannabis and libido seems to exist, but effects depend heavily on dose.
“Several studies have evaluated the effects of marijuana on libido, and it seems that changes in desire may be dose dependent,” the review found. “Studies support that lower doses improve desire but higher doses either lower desire or do not affect desire at all.”
Even less research has been published on marijuana and erections. Anecdotal evidence suggests that some men find that consuming cannabis is helpful in achieving and maintaining erections, but consuming too much can impede arousal. It’s not clear the degree to which those effects are physiological and to what degree they are related to psychological factors like stress and anxiety.
As for the man with the 12-hour erection, it’s not clear how he’s fared. According to the case study, he was referred to urology and internal medicine specialists for further diagnosis, “however he was lost to follow-up in this period.”
Photo by Sharon McCutcheon on Unsplash
Epilepsy Patients Who Use ‘Artisanal CBD’ Have Higher Quality Of Life, Study Finds
Epilepsy patients who used nonprescription CBD products reported a higher quality of life and better sleep than patients who did not take the cannabinoid, according to the results of a newly published study in the peer-reviewed journal Epilepsy & Behavior.
Patients who used CBD products also better tolerated epilepsy medications, used fewer prescription medications overall and experienced reduced psychiatric symptoms such as anxiety, the study found.
No significant differences in seizure control were observed between patients who used CBD and those who did not, but the study’s authors noted that “both groups included a high number of individuals with no past month seizures.”
“These findings further emphasize the need for controlled research to determine optimal CBD product types, doses, and concomitant use of other medications that maximize possible clinical benefit while minimizing potential risks,” the report says.
The study, “Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy,” was published Tuesday. It focuses specifically on what authors call “artisanal CBD”—alternatives to the prescription drug Epidiolex, which the U.S. Food and Drug Administration approved in 2018 to treat certain rare types of epilepsy.
“Pharmaceutical CBD is currently a restricted prescription medication, and insurance coverage is often limited to only those patients with the specific approved indications,” the report says. “As a result, a large number of patients with epilepsy elect to use alternative CBD products sold widely as dietary supplements by commercial vendors.”
The research was funded by Realm of Caring, a nonprofit foundation devoted to cannabinoid therapies that is sponsored by companies that make CBD products. The group conducted the study in collaboration with researchers at the Johns Hopkins University School of Medicine.
“Despite the widespread availability and variety of these alternative cannabinoid products—here referred to as artisanal CBD in contrast to pharmaceutical CBD—controlled studies evaluating their safety or efficacy are rare,” the authors write, “making conclusions about the clinical utility of these products uncertain.”
To arrive at their conclusions, researchers analyzed the results of surveys returned by 280 epilepsy patients who said they used so-called artisanal CBD products and 138 patients who used no cannabis products. The participants were selected using Realm of Caring patient registries and social media posts, and follow-up surveys were collected from a subset of 190 participants.
Most patients (74 percent) were white, and roughly half (55 percent) were female. The average age was 21 years old, and most (90 percent) reported no history of non-medical or recreational cannabis use. A majority (93 percent) reported epilepsy as their primary condition, while the other 7 percent developed epilepsy related to cancer, autoimmune or neuropsychiatric conditions, sleep disorders or other conditions.
Although those who took CBD products reported fewer seizures than those who did not, the difference was not statistically significant and may be due to random chance.
Other measures of well being, however, were higher in patients who took CBD. Participants filled out standardized questionnaires on quality of life, pain, anxiety and depression and sleep.
While some indicators, such as pain, did not meaningfully differ between the groups, artisanal CBD users reported greater health satisfaction. Sleep was significantly better among CBD users, and patients who used CBD were also less likely to meet the clinical threshold for anxiety.
Those who used CBD also had lower odds of having gone to the emergency room or calling in sick to work or school during the past month.
“Generally, higher quality of life, lower psychiatric symptom scores and improved sleep were observed among people using an artisanal CBD product based on both cross-sectional and longitudinal comparisons,” the study says. “Artisanal CBD Users reported significantly better epilepsy medication tolerability, a lower odds of prescription medication use and traditional anticonvulsant use, and reduced healthcare utilization compared with Controls.”
“These findings are consistent with research indicating that practitioners recommending CBD in clinical care for epilepsy report integrating the use of CBD both as a means to improve patient quality of life and as well as for seizure reduction,” the researchers noted.
Other patients—about 1 in 5 of the survey participants—reported adverse effects from CBD. These included drowsiness (11 percent), apparent worsening of epilepsy symptoms (4 percent), high or prohibitive cost of CBD products (4 percent), worries over legality (3 percent) and either concerns about or experienced interactions with other drugs.
CBD dosing didn’t seem to significantly impact the outcomes, although higher doses of CBD were associated with higher quality of life scores and lower odds of a past-month outpatient visit. In general, participants reported using a median dose of 1.4 milligrams of CBD per kilogram of body weight, which authors note “is well below the dose commonly associated with pharmaceutical products (e.g., 10 mg/kg/day is the current recommended maintenance dose for pharmaceutical CBD).”
Authors acknowledge there are a number of limitations to the study, for instance the fact that it’s drawn from self-reported data. “These limitations mean that we are not able to directly verify epilepsy characteristics and did not have control over factors like CBD dose or frequency of administration,” they wrote. Moreover, participants were drawn from Realm of Caring’s patient registry, “which may not generalize to the broader population of patients with epilepsy. Of note, the nature of the sample means that there is a possible referral bias and related increases in expectation for clinical benefit.”
Some of the authors also have links to the commercial cannabis industry, according to a study disclaimer. Of the study’s eight named co-authors, one, Ryan Vandrey, has received compensation as a consultant or advisory board member from Canopy Growth, MyMD Pharmaceuticals, WebMD and Syqe Medical. Another, Marcel O. Bonn-Miller, is an employee of Canopy Growth and a past director at AusCann Group Holdings.
Overall, the study says, the findings “highlight real-world evidence for the possible utility of artisanal CBD products in a diverse and heterogenous population of patients with epilepsy. Although the lack of a placebo control group precludes determination of efficacy, the consistent observation of clinically meaningful differences between groups at baseline and with Controls who initiated artisanal CBD product use over time suggests that use of these products can improve health and quality of life for patients with epilepsy.”
Photo by Kimzy Nanney
Surgeon General Says Stop Locking People Up For Marijuana
The nation’s top doctor said on Sunday that it’s time to stop incarcerating people for marijuana use.
“When it comes to decriminalization, I don’t think that there is value to individuals or to society to lock people up for marijuana use,” Surgeon General Vivek Murthy said in a CNN appearance. “I don’t think that serves anybody well.”
Murthy was answering a question about a new draft federal marijuana legalization bill that was circulated last week by Senate Majority Leader Chuck Schumer (D-NY) and other top senators.
While the surgeon general stopped short of endorsing full-scale commercial cannabis legalization, his comments do indicate support for an approach that would at least decriminalize low-level possession.
President Joe Biden, who opposes broad legalization, campaigned on a platform of incremental decriminalization and expunging past records, but has taken no steps to follow through on those promises since taking office.
“When it comes to marijuana, I think we have to let science guide us,” Murthy said in the CNN interview. “And we know that the science tells us that there are some benefits to marijuana from a medical perspective but there are also some harms that we have to consider—and we have to put those together as we think about the right policy.”
US Surgeon General Dr. Vivek Murthy says he doesn't think "that there is value to individuals or to society to lock people up for marijuana use" but emphasizes the need to "let science guide our process and policymaking" #CNNSOTU pic.twitter.com/g3gNEDEcQ8
— CNN Politics (@CNNPolitics) July 18, 2021
Murthy, who previously served as surgeon general under the Obama administration, said he is concerned about the effort to change cannabis laws getting ahead of the science.
“In terms of our approach to marijuana, I worry when we don’t let science guide our process and policymaking,” he said in the latest comments. “And as surgeon general that’s my role, is to work with policymakers who work with members in the community and the general public to help people understand what science tells us and where you gaps, to help fill those gaps with research and with honest inquiry.”
Previously, in 2015, Murthy said there is “preliminary data showing that for certain medical conditions and symptoms, that marijuana can be helpful.”
But in 2018, the doctor said he is “concerned about how rapidly states have been legalizing marijuana” because there are a “lot of unknowns” about its effects.
Testing People For Marijuana Impairment Based On THC Levels Is ‘Not Reliable,’ Federally Funded Study Finds
The amount of THC in a person’s system after consuming marijuana is not an accurate predictor of impairment, a federally funded study has determined.
The research, backed by a grant from the National Institute of Justice (NIJ), involved 20 people who either ate or vaporized cannabis with varying levels of THC. They were then tested with basic field sobriety and cognitive tests.
While the groups that received doses higher than 5mg of THC were all “negatively impacted” and experienced observable psychomotor impairment, the RTI International researchers found that “THC levels in biofluids were not reliable indicators of marijuana intoxication for their study participants.”
Researchers investigated how marijuana affects skills required for safe driving and found that biofluid levels of THC did not correlate with field sobriety test performance or marijuana intoxication, regardless of how the cannabis was ingested. Read more: https://t.co/Aqkfvplv9P pic.twitter.com/1mWehGKCHQ
— Natl Inst of Justice (@OJPNIJ) June 3, 2021
“Researchers investigated how marijuana affects skills required for safe driving and found that biofluid levels of THC did not correlate with field sobriety test performance or marijuana intoxication, regardless of how the cannabis was ingested.”
That raises questions about “per se” laws that are in place in several states, barring people from driving if they have more than a certain amount of THC in their blood.
“These important findings come as no surprise,” NORML Deputy Director Paul Armentano said. “Despite a handful of states imposing per se THC thresholds as part of their traffic safety laws, there exists no science demonstrating that these arbitrary limits are reliable predictors of either recent cannabis exposure or impairment.”
The study, which was published last year and promoted by NIJ in a tweet on Thursday, also found that various tests, including standing on one leg, balancing and walking and turning, “were not sensitive to cannabis intoxication for any of the study participants.”
Throughout the tests, participants’ blood, urine and oral fluid were collected and then sent to forensic laboratories.
“Results from the toxicology tests showed that the levels of all three targeted cannabis components (THC, cannabidiol, and cannabinol) in blood, urine, and oral fluid did not correlate with cognitive or psychomotor impairment measures for oral or vaporized cannabis administration,” NIJ said.
“Many of their study participants had significantly decreased cognitive and psychomotor functioning even when their blood, urine, and oral fluid contained low levels of THC,” the federal agency continued. “The researchers also observed that standardized field sobriety tests commonly used to detect driving under the influence of drugs or alcohol were not effective in detecting marijuana intoxication.”
In other words, THC does lead to impairment—but the concentration of that compound in bodily fluids does not accurately correlate with the extent to which a person is impaired. And in low doses, it seems some people are not negatively impacted, at least with respect to the standard tests that the researchers utilized.
Late last year, a different study published in the Journal of the American Medical Association found that low levels of CBD do not appear to have a significant impact on driving, and low-level THC consumption has an impact that is “modest in magnitude and similar to that seen in drivers with a 0.05%” blood alcohol concentration.
A a congressional research body also released a report in 2019 that found that evidence about cannabis’s ability to impair driving is currently inconclusive.
Researchers have found on several occasions that traffic fatalities do not increase after a state legalizes marijuana.
Of course, that doesn’t change the fact that both opponents and supporters of legalization generally caution against driving under the influence.