Gabriel Kaplan

Cannabis: The never-ending, nefarious nepenthe of the 21st century: What should the clinician know?

Cannabis (marijuana or pot) remains a controversial plant in the 21st century. This discussion considers a number of issues regarding cannabis including a historical perspective, description of the Cannabis sativa/indica plant, means of consumption, prevalence of use, links to polydrug use, cannabis lab testing, and cannabis pharmacology (Table 1). Also considered are the many potential adverse medical and psychiatric effects found with smoking cannabis. The issue of “medical marijuana” is then presented, which is a hotly discussed topic in nationaland state-level politics, the criminal justice system, and now in medicine across the board. As such, there are entanglements in the discussion of marijuana as medicine that need to be dissected out in order to clearly examine its potential medicinal legitimacy. This article reviews concerns regarding smoked marijuana, physician liability issues, and The American Society of Addiction Medicine’s recommendations regarding medical marijuana. The information provided will help physicians assess a situation inwhich the risk–benefit ratio to the patient and the doctor as well should be carefully weighed. Finally, it reviews what primary care clinicians can do in identifying and facilitating treatment for an increasing number of persons who develop cannabis-related disorders. This discussion reviews the main characteristics of a robust program termed Screening, Brief Intervention, and Referral to Treatment (SBIRT) and offers a “how to” basic implementation guide for the primary care office. Other available behavioral and pharmacological options are also reviewed to familiarize clinicians with the type of care patients receive when the severity of the condition requires referral to specialists.

Pharmacology of Autism Spectrum Disorder

ASD is a complex and common neurobehavioral disorder with no identified single specific biologic etiology. Instead there appear to be diverse abnormalities of brain networks with cellular, biochemical, and genetic factors. Though behavioral therapy is a major component to management of individuals with ASD, psychopharmacology has emerged as an important therapeutic tool. Pharmacology is targeted at associated disorders such as sleep disorders, aggression, anxiety, depression, repetitive behaviors, and hyperactivity. This chapter reviews current agents noted by research trials to be of benefit. Additional medications under current research are also briefly noted.