'Immigration detainer holds tied to lower Medicaid, SNAP enrollment among eligible adults'

 Millions of eligible adults may not be signing up for medical and nutrition support programs because they live in areas where friends and neighbors are detained due to their immigration status.

According to a study published this month in Health Affairs by researchers at Drexel's Dornsife School of Public Health, people living in counties with the highest number of "detainer requests"—formal requests from the U.S. Immigration and Customs Enforcement agency for local authorities to take an individual into custody on suspicion that they are illegally residing in the United States—are less likely to enroll in Medicaid and the Supplemental Nutrition Assistance Program (SNAP).

"There are millions of legal residents of the United States eligible for these beneficial programs who are not enrolling for fear that signing up for a government program will put their household on the government's radar and put their loved ones at risk of deportation," said senior author Brent Langellier, Ph.D., an associate professor in the Dornsife School of Public Health. "A particular concern is the over five million U.S.-born children living with at least one unauthorized immigrant parent."

During a detainer request, or "immigration hold," local law enforcement may hold immigrants suspected to be unlawfully residing in the United States in custody until they can be released to federal immigration agents for possible deportation. The rate of these requests and compliance by local officials varies throughout the country, which enabled researchers to look more closely at the effects of these detentions on communities.

The researchers looked at the number of detainer requests issued in each U.S. county, as well as households' enrollment in Medicaid and SNAP in 2011, 2016 and 2019. The researchers found a statistically significant association between detainer requests and lower enrollment in both government programs in both U.S.-born and immigrant households, with a stronger association among adults in households with at least one immigrant in the household, compared to U.S.-born households.

The authors suggest that some eligible immigrants might forgo benefits for fear of jeopardizing their own legal status or that of a family member or friend.

"Although detainer requests happen behind-the-scenes, they can be indicative of an overall climate of enforcement that impacts the daily lives of immigrants and their neighbors as well," said lead author Caroline Kravitz, a doctoral student in the Dornsife School of Public Health. "This enforcement may instill fear among immigrants and their family members and friends who may fear that any interaction with law enforcement officers could increase deportation risk for someone who is undocumented."

Many studies on SNAP and Medicaid found the programs provide measurable benefits for enrollees. Among other benefits, SNAP is associated with decreased health care costs and better current and long-term health among its millions of participants nationwide, including decreased risk of heart disease and obesity, according to the Center on Budget and Policy Priorities. Funded by federal and state governments, and operated at the state level, Medicaid provides comprehensive health insurance for roughly 90 million low-income and disabled adults and children—totaling one in five Americans.

Despite these benefits, only about half of U.S.-born eligible households and 47% of eligible immigrant households participate in SNAP.

"This surprising link between detainer requests and program enrollment among US-born citizens speaks to the external consequences of local immigration enforcement activities," said Kravitz. "Even people in U.S.-born households but who may have grown up with parents or grandparents who are immigrants or who come from neighborhoods with a large immigrant population may experience residual fear of immigration enforcement."

Although those residing in the United States without legal permission are not eligible for federal funding for Medicaid or SNAP, six states and Washington D.C. fully fund health coverage to some low-income adults who would otherwise not be eligible due to immigration status.

The authors suggest that more investment in outreach programs that communicate to immigrant communities that personal information is not shared between either SNAP or Medicaid and ICE, may help rebuild immigrant communities' trust of government agencies and improve enrollment numbers.

The Drexel researchers found a stronger association in 2011 and 2019 than they found in 2016. The number of detainer requests was lowest in 2016, as the Secure Communities program—a Department of Homeland Security Program aimed to identify immigrants for deportation that are in the custody of local law enforcement agencies—was suspended from 2015 until January 2017.

Notably, they found a statistically significant difference in Medicaid enrollment between those living in the quarter of areas experiencing the most ICE detainer requests, compared to those residing in the quarter of areas that experienced the fewest detainer requests in 2019. In all years, among immigrant households, as the number of ICE requests increased, SNAP enrollment decreased.

Previous studies found associations between immigration enforcement and avoidance of services, or safety net programs, among immigrants and mixed immigration-status households, but the current study offers data on the role that "behind-the-scenes" administrative enforcement actions—in the form of detainer requests—has on safety net program enrollment.

In addition to Kravitz and Langellier, other authors contributing to this paper include Amy H. Auchincloss, Sofia Argibay, and Alexandra Eastus from Drexel and M. Pia Chaparro from the University of Washington.

In a related paper published this month in the Journal of Urban Health, the research team found that ICE detainer requests were also linked to poorer health among Latine adults. Latine adults living in areas with the highest quartile of requests reported 24% higher odds of fair/poor health, compared to respondents in areas with the fewest detainer requests.

"Our work marks the latest data point among others that show negative health impacts from ICE activities that extend to a broader Latine population—regardless of their socioeconomic status—than just those who are undocumented," said the paper's lead author Alexandra Eastus, a doctoral student in the Dornsife School of Public Health. "These findings suggest that some police departments might better support the health of their Latine community members by setting limits on when to coordinate with federal immigration agencies."

More information: Caroline Kravitz et al, ICE Detainer Requests Were Associated With Lower Medicaid And SNAP Enrollment Among Eligible Adults, 2011–19, Health Affairs (2024). DOI: 10.1377/hlthaff.2023.01547 Alexandra Eastus et al, Detainer Requests Issued by ICE and Fair/Poor Self-Rated Health among Latines in the U.S., 2017–2020, Journal of Urban Health (2024). DOI: 10.1007/s11524-024-00908-1

https://medicalxpress.com/news/2024-09-immigration-detainer-linked-medicaid-snap.html

DNA organization during embryonic development

 Researchers from the Kind Group have gained new insights into the mechanism behind the spatial organization of DNA within the cells of early embryos. When an embryo is first formed after fertilization, each cell has the potential to become any cell type of the body.

The researchers have studied the spatial organization of DNA that is so particular to these early developmental stages. The paper, "Antagonism between H3K27me3 and genome–lamina association drives atypical spatial genome organization in the totipotent embryo," was published in Nature Genetics on September 16, 2024.

Every cell in our body contains the same DNA. This DNA contains the genetic information that serves as a blueprint for making the proteins necessary for the functioning of the cell. Although all cells have the same DNA, they activate only specific parts of it.

As a result, cells develop into different cell types and perform a variety of functions. This is especially relevant during embryo development. When the embryo is first formed after fertilization, each cell can become any type of cell, including brain cells or even placenta cells.

DNA organization in the nucleus

DNA is located in the cell nucleus where it is folded into active and inactive compartments. Regions of the DNA that are located at the edge of the cell nucleus are normally more densely packed and inactive. This spatial DNA organization is important because it determines which parts of DNA are active. This varies per cell type, such as between blood cells and brain cells.

In cells with different functions, specific parts of the DNA change their packaging and spatial organization within the nucleus. This results in different genes being turned "off" and "on."

These changes determine which genes are active and give the cell its identity. Such processes that affect the activity of genes without changing the DNA itself are the epigenome of the cell. Although scientists have investigated the spatial organization of DNA at length, much is still unclear about how this organization is first established during embryonic development.

Unique DNA organization in early embryos

To understand embryo development better, the researchers wanted to know how the epigenome regulates the organization of DNA. In an earlier study, researchers from the Kind group have shown that positioning of DNA regions near the nuclear edge during the first days of embryo development is highly unusual during early embryo development. This might explain how those first cells can be so flexible in what they can become.

Isabel Guerreiro, co-first author of the study, explains, "With this work we aimed to understand what causes the unusual positioning of DNA regions at the edge of the nucleus during early mammalian development. This is often difficult to study, because we can only collect a few cells from early embryos."

To study these cells, the researchers used techniques they had previously developed. These techniques enabled them to analyze the spatial DNA organization in individual cells from early embryos.

Causes of unique DNA organization in early embryos

Using these techniques, called scDam&T-seq and EpiDamID, the researchers found that DNA regions that are not located near the nuclear edge have high levels of a specific modification in the proteins around which the DNA is wrapped.

"This suggests that the presence of this modification repels the DNA regions from the nuclear edge," Guerreiro explains.

"However, it is not only the presence of this protein modification that decides where DNA regions are located. We found that the balance between the 'repellent' protein modification and an intrinsic attraction of the DNA sequence to the nuclear edge, determines the unusual organization of DNA regions in the cell nucleus of early embryos."

Understanding embryo development

The researchers have found a major cause for the atypical spatial DNA organization inside the nucleus of early embryo cells. These findings represent a major step toward understanding healthy embryo development and uncovering the mechanisms that enable these cells to differentiate into a wide variety of cell types.

Guerreiro says, "Uncovering the mechanism behind the unusual nuclear organization that characterizes the early embryo has the potential to improve regenerative medicine strategies and human in vitro fertilization outcomes."

More information: Isabel Guerreiro et al, Antagonism between H3K27me3 and genome–lamina association drives atypical spatial genome organization in the totipotent embryo, Nature Genetics (2024). DOI: 10.1038/s41588-024-01902-8

https://medicalxpress.com/news/2024-09-insights-dna-embryonic.html

Trump’s policies are far more popular than Harris’s, and it’s as simple as that

 

The choice gets easier every day.

President Trump’s common-sense policies are much more popular (and help people of all races and income levels) than Kamala Harris’s, the latter of whom believes that the government is the solution to everything.

Trump wants a smaller government, while Harris wants a much bigger government which greedily confiscates an ever-increasing share of the money we earn.

On tackling inflation, Trump says we should “drill, drill, drill,” have fewer regulations, lower taxes, and close the border. When Kamala is asked how to lower prices, she responds by saying she was raised middle-class, and that her neighbors liked nice lawns. Her answer on inflation is the same word salad we always get; it is as if she is a wooden puppet whose string has been pulled. The only suggestions she has made on lowering costs are more government handouts, which do not lower prices, and government price controls, which will destroy America. It is a shame that so many Democrats consider profit to be a dirty word.

On health care, Trump believes people should have the freedom of choice on what policies to buy. Democrats believe the government should dictate what you buy. The Affordable Care Act made costs skyrocket because they took away choice, added mandates, and massively reduced competition with price controls. They told companies they had to spend 80% to 85% of premiums on direct health care, which meant small- and medium-sized companies couldn’t survive. Democrats only pretend to care about small companies.

Trump wants fewer government employees; Democrats want a lot more, as it gives them devoted bureaucrats. 87,000 additional IRS agents are not necessary, and the Education department has not improved results, only making things worse, no matter how much money they spend, or how many bureaucrats they hire.

Trump wants poor and minority children to have a choice to go to better schools. Democrats want to dictatorially force poor and minority children to attend government-run schools no matter how poor the results are. They don’t mind the children ending up on the government dole.

Trump understands that the climate has always changed cyclically and naturally. He is not a climate change denier, no matter how many times the media and other Democrats repeat that lie. Kamala and the Democrats seem to falsely believe that the earth did not have warming or cooling prior to humans using natural resources, which have  greatly improved our quality and length of life. No matter how many dire predictions on the climate have been 100% wrong, the media and other Democrats repeat the mantra that the science is settled. They lie!

Trump wants people to have the freedom of choice to buy whatever cars, trucks, and appliances they want. Democrats want to dictatorially force the public to spend massive amounts of money to buy cars, trucks, and appliances powered by the highly flammable pollutant lithium.

Trump believes people should pay back the student loans they willingly borrowed. Democrats believe that a president can dictatorially and unconstitutionally force taxpayers from this, and future generations, to pay off these loans as they seek to buy votes.

Trump believes that capitalism and the private sector have always given people of all races and income levels the ability to move up the economic ladder. It has worked for 250 years. Democrats essentially believe that the way to help people is to have the government handout money to them. This leads to generational poverty, not prosperity. It does not reduce the wealth or income gap no matter where it is tried.

When Harris is asked what she would do differently than Biden, her word salad answer is that basically she would turn the page and move towards an “opportunity economy” to help people prosper. A logical question or retort would be: Why haven’t you and Joe Biden presented these opportunities the last four years, and how do you intend to do this, without mentioning your seemingly nonexistent job at McDonald’s, and how school buses are yellow?

Maybe someone could point out that when Trump and Republicans created opportunity zones in 2017, 100% of Democrats, including Harris, voted against the bill:

An Opportunity Zone is a designation and investment program created by the Tax Cuts and Jobs Act of 2017 allowing for certain investments in lower income areas to have tax advantages.

Harris seems to love to steal Trump’s policies and pretend they are her own.

Always pay attention to what politicians do, not what they pretend they want to do. Trump has a proven record of delivering, and he can do it again.

https://www.americanthinker.com/blog/2024/09/trump_s_policies_are_far_more_popular_than_harris_s_and_it_s_as_simple_as_that.html

'Oregon DMV Mistakenly Registered 306 Non-Citizens To Vote, Officials Say'

 by Jack Phillips via The Epoch Times,

The Oregon Driver and Motor Vehicle Services (DMV) and the Oregon Secretary of State’s Office both confirmed that the DMV has mistakenly registered more than 300 non-U.S. citizens to vote since 2021.

Officials with the Oregon Department of Transportation said on Sept. 14 that a data entry problem occurred when people who were not citizens applied for driver’s licenses.

An initial analysis by the Oregon Department of Transportation, which oversees the state’s DMV, revealed that 306 noncitizens were registered to vote, according to Kevin Glenn, a department spokesperson. Of those, two voted in elections since 2021.

“It’s basically a data entry issue,” Glenn said, explaining that when a DMV worker enters information about a person applying for a driver’s license or state ID, the worker can incorrectly code that the person has a U.S. birth certificate or passport when that person does not.

Responding to the report, the Oregon Secretary of State’s Office said in a statement that Secretary LaVonne Griffin-Valade has ordered an update to 0.01 percent of voter registrations.

“Residents impacted by this issue were noncitizens at the time they were erroneously registered. They will be notified by mail that they will not receive a ballot unless they demonstrate that they are eligible to vote,” her office stated, noting that only two people who were registered to vote have a voting history but that their citizenship status when they cast ballots is not known.

Her office “moved quickly to update the voter rolls,” Griffin-Valade said, noting that the DMV has to “take immediate action” to make sure noncitizens can’t vote.

“Automatic voter registration has been hugely beneficial for thousands of eligible Oregon voters to ensure access to our democracy,” the secretary said in her statement.

“I’m confident the DMV is rectifying this error and improving their process, so it doesn’t happen again.”

The mistake occurred in part because Oregon has allowed noncitizens to obtain driver’s licenses for the past several years, and the DMV automatically registers most people to vote when they obtain a license or other ID, according to Glenn.

A 2019 bill that was passed in the state Legislature allowed people in Oregon to get driver’s licenses without showing proof of citizenship. The law went into effect in 2021.

The administrator for the DMV, Amy Joyce, told The Oregonian that her office is trying to check for possible errors involving any other noncitizens and allowing them to vote.

State and federal laws prohibit non-U.S. citizens from voting in any elections.

Several state and federal lawmakers in Oregon called for further investigations after the issue was revealed.

State Rep. Janelle Bynum, a Democrat, said the U.S. Department of Justice should get involved and probe the issue.

“Any errors in this process are unacceptable, and the office of the Secretary of State must be held responsible for any such lapses. I will relentlessly defend our laws and safeguard the integrity of our elections,” she told the Oregon Capital Chronicle.

U.S. House Rep. Andrea Salinas (D-Ore.) also called for an investigation, telling the paper that the DMV engaged in “total malpractice.”

“I am calling on the state to act quickly to remove these individuals from the rolls, conduct a full and transparent investigation into how this occurred, and provide concrete steps they are taking to remedy this issue and prevent it from happening again,” she said.

“However, I want to emphasize that this was a bureaucratic error by the Oregon DMV and not a systemic attempt to cheat the system by organizations or individuals.”

In recent weeks, other states have announced purges to voter rolls.

Ohio Secretary of State Frank LaRose said that a recent review found that 597 people were registered to vote despite not being U.S. citizens.

Texas Gov. Greg Abbott announced earlier this year that reviews showed that more than 6,500 possible noncitizens were removed from state voter rolls. More than 1,900 of those people had a history of voting, his office said.

https://www.zerohedge.com/political/oregon-dmv-mistakenly-registered-306-non-citizens-vote-officials-say

AbbVie faulted for misleading ad featuring Serena Williams

 Pharma giant AbbVie has been taken to task by the FDA for running an ad for one of its migraine drugs, featuring tennis star Serena Williams, which the agency says overstates its efficacy.

In the ad for oral CGRP inhibitor Ubrelvy (ubrogepant), Williams is depicted as suffering from a migraine while in a talk show dressing room, which resolves by the time she walks onto the set and allows her to carry out the interview laughing and pain-free.

A voiceover by the star – who has become something of an advocate for migraineurs since revealing she suffers from them several years ago – remarks: "When migraine strikes, you're faced with a choice. Ride it out with the trade-offs or treating? Or push through the pain and symptoms?"

She continues: "With Ubrelvy, there's another option. One dose works fast to eliminate migraine pain."

The FDA has called out that statement, saying in its letter that the ad gives no indication of how long it takes Ubrelvy to work and makes "false or misleading representations" about the drug.

The implication is that "all patients who take Ubrelvy can expect their migraine pain to be eliminated after a single dose of Ubrelvy, when this has not been demonstrated," according to the regulator. "Healthcare providers, patients, and caregivers should not be misled regarding the benefits that can be expected from acute migraine headache treatments."

This is actually a double fault for Ubrelvy advertising in the US, as the FDA previously sent a letter upbraiding Allergan – which was acquired by AbbVie for $63 billion – five years ago, shortly before the takeover went through in 2020. Williams started promoting the drug in the same year.

The FDA says that it is "concerned that AbbVie […] appears to be promoting Ubrelvy using similar claims and presentations in a misleading manner," and asks the drugmaker to stop running the ad immediately or cease Ubrelvy distribution.

The latter isn't going to happen of course. AbbVie recorded sales of more than $1.2 billion for Ubrelvy and partner migraine drug Qulipta for episodic and chronic migraine prevention last year.

AbbVie told Stat that it had stopped airing the ad after the first half of the year and that it is complying with the FDA's investigation.

So-called 'untitled letters' from the FDA for advertising breaches are fairly uncommon, with only four sent so far this year.

Previous warnings were delivered to Novartis for promotion of breast cancer therapy Kisqali (ribociclib), as well as to Kaleo for its epinephrine drug Auvi-Q, and Bristol-Myers Squibb's lung cancer medicine Krazati (adagrasib).

https://pharmaphorum.com/news/abbvie-faulted-misleading-ad-featuring-serena-williams

Florida Hospitals Ask Immigrants About Their Legal Status. Texas Will Try It Next

 For 3 days, the staff of an Orlando medical clinic encouraged a woman with abdominal pain who called the triage line to go to the hospital. She resisted, scared of a 2023 Florida law

opens in a new tab or window that required hospitals to ask whether a patient was in the U.S. with legal permission.

The clinic had worked hard to explain the limits of the law, which was part of Gov. Ron DeSantis' (R) sweeping packageopens in a new tab or window of tighter immigration policiesopens in a new tab or window. The clinic posted signs and counseled patients: They could decline to answer the question and still receive care. Individual, identifying information wouldn't be reported to the state.

"We tried to explain this again and again and again, but the fear was real," Grace Medical Home CEO Stephanie Garris said, adding the woman finally did go to an emergency room for treatment.

Texas will be the next to try a similar law for hospitals enrolled in state health plans, Medicaid, and the Children's Health Insurance Program. It takes effect November 1 -- just before the end of a presidential election in which immigration is a key topicopens in a new tab or window.

"Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants," Texas Gov. Greg Abbott (R) said in a statement announcing his mandate, which differs from Florida's in that providers don't have to tell patients their status won't be shared with authorities.

Both states have high numbers of immigrants, ranging from people who are in the U.S. without legal permission to people who have pending asylum cases or are part of mixed-status families. And while the medically uninsured rate in these two states -- neither of which have expanded Medicaid -- are higher than the national average, research has shown immigrants tend to use less and spend less on healthcareopens in a new tab or window.

Texas and Florida have a long history of challenging the federal government's immigration policies by passing their ownopens in a new tab or window. And their Republican leaders say the hospital laws counter what they see as lax enforcement at the border by the Biden administration -- though Florida's early data are, by its own admission, limited.

Florida State Sen. Blaise Ingoglia (R), who sponsored the hospital bill, said in a written statement that the law is "the strongest, and most comprehensive state-led, anti-ILLEGAL immigration law," but did not respond to the Associated Press' questions about the impact of the law on the immigrant community or on hospital patients.

Immigrant advocate groups in Florida said they sent thousands of text messages and emails and held clinics to help people understand the limitations of the law -- including that law enforcement agencies wouldn't know an individual's status because the data would be reported in aggregate.

But many outreach calls from health workers went unanswered. Some patients said they were leaving Florida, as a result of the law's impact on getting healthcare and on employment; the DeSantis administration tied the hospital mandate to other initiatives that invalidated some driver's licenses, criminalized transportation of migrants lacking permanent status, and changed employment verification policies.

Whatever data Florida and Texas do collect likely will be unreliable for several reasons, researchers suggested. Health economist Paul Keckley, PhD, said the report released by Florida state officials could have "incomplete or inaccurate or misleading" data.

For one, it's self-reported. Anyone can decline to answer, an option chosen by nearly 8% of people admitted to the hospital and about 7% of people who went to the emergency room from June to December 2023, the Florida state report said. Fewer than 1% of people who went to the emergency room or were admitted to the hospital reported being in the U.S. "illegally."

The Florida Agency for Health Care Administration acknowledged large limitations in their analysis, saying it didn't know how much of the care provided to "illegal aliens" went unpaid. It also said it was unable to link high levels of uncompensated care with the level of "illegal aliens" coming to a hospital, saying it's "more associated with rural county status than illegal immigration percentages."

The agency didn't immediately respond to requests for comment and more information. Its report noted that for much of the last decade, the amount of unpaid bills and uncollected debts held by Florida hospitals has declined.

In Florida and in Texas, people who aren't in the U.S. legally can't enroll in Medicaid, which provides health insurance for low-income people -- except in the case of a medical emergency.

Multiple factors can affect the cost of care for people who are in the U.S. without legal permission, experts said, especially the lack of preventive care. That's especially true for people who have progressive diseases like cancer, said James W. Castillo II, MD, the health authority for Cameron County, Texas, which has about 22% of the population uninsured compared to the state average of 16.6%.

https://www.medpagetoday.com/publichealthpolicy/equity-in-medicine/111967

Medical Cannabinoids in Kids Linked to These Adverse Events

 Cannabinoids used for medical purposes in children and adolescents come with a risk of adverse events, a systematic review and meta-analysis of 23 randomized clinical trials showed.

The risk ratio (RR) of developing adverse events was higher in the cannabinoid group than in the control group (1.09, 95% CI 1.02-1.16), Lauren Kelly, PhD, MSc, of the University of Manitoba in Winnipeg in Canada, and colleagues reported in JAMA Pediatricsopens in a new tab or window.

Specific adverse events significantly linked to cannabinoid treatment -- cannabidiol (CBD) in about half of the trials -- included:

• Diarrhea (RR 1.82)
• Elevated serum aspartate aminotransferase (RR 5.69)
• Elevated alanine aminotransferase (RR 5.67)
• Somnolence (RR 2.28)

These events led to more trial withdrawals due to adverse events (RR 3.07, 95% CI 1.73-5.43), and serious adverse events were more common with medical cannabinoids than among controls (RR 1.81, 95% CI 1.21-2.71).

"The interest and use of cannabis-based medicines has increased, including in children with complex health concerns like epilepsy, autism, and cancer," Kelly told MedPage Today in an email. At the same time, adverse effects of medical use hadn't been systematically appraised in children, she added.

Her group concluded that "physicians considering cannabinoids for medical purposes in children and adolescents should weigh the risk and benefit profile of cannabinoids and available therapeutic options as well as the individual's underlying disease condition and prognosis."

When used, physicians and caregivers should monitor for somnolence, changes in appetite, dizziness, and other cannabinoid-related adverse events, they suggested.

Also watch for interactions with other drugs, particularly the combination of CBD and epilepsy drugs, like clobazam and valproate, they urged. "Children and adolescents treated with CBD and clobazam should be closely monitored for CNS-related adverse events, such as lethargy, fatigue, and somnolence, secondary to altered clobazam metabolism, and lowering of the clobazam dose accordingly should be considered."

Subgroup analysis suggested that cannabinoids, compared with the control, were associated with a higher risk of serious adverse events in trials of only children and adolescents (RR 1.87, 95% CI 1.30-2.70), with use of purified CBD (RR 2.16, 95% CI 1.55-3.02), with treatment of more than 12 weeks (RR 2.30, 95% CI 1.57-3.38), and among those with epilepsy (RR 2.16, 95% CI 1.55-3.02).

The most common indications for cannabinoids in young participants were drug-resistant epilepsy (nine trials) and chemotherapy-induced nausea and vomiting (seven trials). Additionally, autism spectrum disorder was the indication in three trials, traumatic brain injury in two, spasticity in one, and cannabis use disorder in one.

Overall, the systematic review and meta-analysis consisted of 15 parallel trials, seven crossover trials, and one adaptive dose-finding trial. Eleven trials included only children and adolescents. Interventions included purified cannabidiol in 11 trials, nabilone in four, tetrahydrocannabinol in three, cannabis herbal extract in another three, and dexanabinol in two.

Only some 18% of the 3,612 total participants in the trials were female, although data on gender were not available for two trials.

Limitations of the meta-analysis included heterogeneity in trial designs, indications, interventions, dose, and duration, Kelly and colleagues noted. For instance, duration of most of the trials was short (10-14 weeks or one to two cycles of cancer treatment), and there was a dearth of reports on concomitant medication use.

Additionally, there is no standardized method to capture cannabinoid-related adverse events in children and adolescents, "leading to inconsistencies in definitions and grading," they wrote. There also were discrepancies (based on dose or treatment group) in how serious adverse events were reported.

Furthermore, few trials evaluated cannabis herbal extract, "thus highlighting a need for a pathway for global research efforts to identify the safety and efficacy of these cannabis-based products," they added.

Disclosures

The study was supported by a grant from the Canadian Institutes of Health Research Cannabis Team in partnership with the Canadian Cancer Society.

The authors did not report any conflicts of interest.

Primary Source

JAMA Pediatrics

Source Reference: opens in a new tab or windowChhabra M, et al "Cannabinoids used for medical purposes in children and adolescents: A systematic review and meta-analysis" JAMA Pediatr 2024; DOI: 10.1001/jamapediatrics.2024.3045.

https://www.medpagetoday.com/pediatrics/generalpediatrics/111975