Search Results (365)

Background/Objectives: Patient access to cannabinoid-based therapies in Brazil has expanded with the availability of regulated Cannabis-derived products (CDPs). This study explored CDP prescribing practices among Brazilian physicians. Methods: Between September 2024 and March 2025, a national online survey assessed physician characteristics, prescribing status, and reasons for non-prescription. Among prescribers, we analyzed CDP formulations, brands, indications, patient age groups, and time to therapeutic response. Bivariate and multivariable analyses identified factors associated with CDP prescribing. Results: A total of 333 physicians participated in the study, including 305 prescribers and 28 non-prescribers. Most CDP prescribers worked in private practice settings (67.9%). Specific training in CDP prescribing was the factor most strongly associated with a higher likelihood of prescribing (adjusted OR, 100.73; 95% CI, 12.77–794.72; p < 0.001), while lack of knowledge was the main reason for non-prescription. Although some physicians reported prescribing national products, imported products remained predominant (75.8% vs. 24.2%). Products provided through patient associations were also frequently mentioned. Predominant indications included mental and behavioral disorders, neurological diseases, and pain. Oil-based cannabidiol (CBD) formulations were the most frequently prescribed and were generally administered orally or sublingually. Older patients were the most frequently reported recipients of CDP prescriptions, and most physicians reported observing therapeutic effects within 30 days. Conclusions: Despite an evolving regulatory framework, clinical practice remains challenged by gaps in clinical training and disparities in patient access. Full article

Cannabis use has increased substantially in the United States, driven by broader legalization, decriminalization, and expanding medical and recreational availability. For facial plastic surgeons, the clinical implications remain difficult to define because “cannabis use” encompasses heterogeneous products and routes, including smoked flower, vaping, concentrates, edibles, pharmaceutical cannabinoids, topical cannabidiol (CBD), and frequent co-use with tobacco or nicotine. Current evidence suggests that systemic cannabis use, particularly inhaled or heavy perioperative use, may be associated with increased surgical complications in selected populations; however, existing studies are limited by retrospective design, inconsistent exposure definitions, inadequate dose and route characterization, and confounding by tobacco use and comorbidities. Cannabinoids exert biologic effects through the endocannabinoid system, particularly CB1 and CB2 receptors, which are expressed in the central nervous system, immune cells, vasculature, and skin. These pathways influence inflammation, keratinocyte proliferation, fibroblast activity, angiogenesis, immune surveillance, pain signaling, and tissue remodeling. The net effect of cannabinoid exposure on wound healing is likely context dependent, varying based on receptor expression, wound-healing phase, route of administration, cannabinoid composition, local tissue environment, and patient-specific risk factors. Preclinical and early dermatologic literature suggests potential therapeutic roles for topical cannabinoids, especially CBD, in modulating inflammation and epithelial repair. In contrast, systemic perioperative cannabis use has been associated in several surgical cohorts with infection, delayed healing, hematoma, nonunion, and reoperation. Evidence specific to facial plastic surgery remains sparse. The most directly relevant study evaluated cannabis and tobacco use in patients undergoing operative mandibular fracture repair. Cannabis-only use was not associated with increased complications, although the cohort was small; concurrent cannabis and tobacco use was associated with higher rates of surgical site infection, facial nonunion, abscess, debridement, and malocclusion. To date, no published studies address cannabis-associated outcomes in rhinoplasty, rhytidectomy, blepharoplasty, browlift, or facial rejuvenation. This review summarizes the biologic rationale, available surgical evidence, and clinical considerations for incorporating cannabis use into individualized perioperative risk assessment in facial plastic surgery. Full article

Cancer remains a highly complex and heterogeneous disease, causing major morbidity and mortality worldwide despite advances in diagnosis and treatment. The hallmarks of cancer enlighten the biological mechanisms supporting tumourigenesis and malignant evolution, while helping to identify potential therapeutic targets. Medical cannabis has mostly been used in oncology for supportive care, but increasing preclinical evidence suggests interference with cancer-related signalling pathways. This narrative review summarizes the current evidence on cannabinoids, in particular the phytocannabinoids cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC), framing their prospective anticancer effects in the hallmarks of cancer. Preclinical studies imply that CBD exerts antiproliferative effects by modulating oncogenic signalling pathways, including EGFR, PI3K/AKT, RAS/RAF/ERK, mTOR and Wnt/β-catenin, while also influencing tumour suppressor pathways involving p53, p21 and p27, causing cell cycle arrest. CBD has additionally been shown to promote programmed cell death via mitochondrial dysfunction and autophagy, altering cancer metabolism as well. Furthermore, CBD has shown anti-invasive and antiangiogenic properties and also appears to modulate immune responses and interactions with the tumour microenvironment, including emerging links with the microbiome. Overall, cannabinoids exhibit biologically plausible antitumour activity across multiple cancer hallmarks and may present promising candidates for combination therapeutic strategies. Nonetheless, the current evidence remains predominantly preclinical, and robust translational studies and clinical trials are needed to clarify their pharmacokinetic and pharmacodynamic profiles, determine their clinical efficacy and safety while assessing their potential integration into multimodal cancer treatment. Full article

A novel method was applied to account for representation bias in U.S. cannabis prevalence estimates derived from the 2016–2024 Behavioral Risk Factor Surveillance System (BRFSS). Although the BRFSS provides national coverage, the cannabis module was only included in areas comprising about 19% (n = 961,366) of the total respondents. To account for differential module adoption across states, we combined observed cannabis prevalence by legal status from module-adopting areas with the distribution of legal status in non-module areas to generate adjusted national estimates. Areas that adopted the cannabis module were more likely to have legalized both recreational and medical cannabis use and less likely to have prohibited cannabis entirely. Specifically, they were 40% more likely to have recreational and medical legalization and 43% less likely to have total prohibition. Cannabis prevalence was substantially higher in legalized settings, with differences ranging from 91% (2016) to 40% (2024) compared to illegal states. Corresponding differences for medical-only legalization were 6% and 10%, respectively. Based on model-derived estimates, prevalence estimates derived from BRFSS cannabis-module data were approximately 7–8% higher than the corresponding model-based national estimates. This upward bias was more pronounced among older adults, women, Hispanics, and individuals with chronic diseases. However, temporal trends and subgroup patterns remained consistent between adjusted and unadjusted estimates. These findings suggest that while BRFSS cannabis module data may overestimate absolute national prevalence due to differential state adoption, they remain useful for tracking trends over time and across population subgroups. Adjusted estimates provide an alternative model-based framework for interpreting prevalence under different assumptions about jurisdictional composition. Full article

Cannabidiol (CBD) has attracted growing scientific and clinical interest due to its potential therapeutic applications and increasing availability across Europe. This narrative review examined the regulatory status, market availability, and clinical use of CBD in Croatia in relation to selected European Union countries and international reference models (Canada and Australia). A literature search was conducted using PubMed, Scopus, and Web of Science, complemented by official regulatory and governmental sources. The analysis included Croatia, Germany, the Netherlands, Slovenia, Italy, France, and Finland, while Canada and Australia were discussed as international reference models. Considerable differences were identified regarding the regulation of CBD-containing products, access to medical cannabis, reimbursement policies, clinical implementation, and the role of pharmacists. Germany and the Netherlands have established well-developed systems for medical cannabis use, whereas Finland represents a more restrictive regulatory model. In Croatia, CBD-containing products are widely available, but their integration into routine clinical practice remains limited. Regulatory uncertainty, insufficient professional training, and the lack of standardised clinical guidance were identified as important barriers. The findings suggest that the expansion of the consumer CBD market has generally outpaced the integration of cannabinoid-based therapies into healthcare practice across the countries included in this review. Improved professional training and clearer clinical guidance may facilitate their evidence-based implementation in clinical practice. Full article

Background/Objectives: Mental and neurological disorders contribute substantially to the global burden of disease, affecting people of all ages and backgrounds. As their prevalence increases with age, their overall impact is expected to grow in the coming decades. Although psychological and pharmacological treatments are available, many patients fail to achieve satisfactory outcomes, underscoring the need for improved therapeutic strategies. Cannabis sativa L. has been used for medicinal purposes for centuries, and cannabidiol (CBD) has attracted increasing attention because of its broad therapeutic potential. Scientific studies indicate that CBD may be beneficial in several mental and neurological disorders. Methods: A comprehensive literature search was conducted to identify articles investigating the therapeutic potential of CBD and cannabis in selected disorders. Results: Evidence from preclinical and clinical studies, together with findings from the broader cannabis literature, indicates that CBD may offer therapeutic benefits in a range of conditions, including Alzheimer’s and Parkinson’s disease, anxiety disorders, and epilepsy. Emerging data also support its potential use as an adjunctive therapy for COVID-19. Current research has improved understanding of the neurobiological mechanisms underlying these disorders and the molecular pathways through which CBD may exert its effects. CBD has demonstrated good tolerability, with predominantly mild adverse effects and a favorable safety profile. Conclusions: Despite promising findings, many available studies are preclinical or involve small patient cohorts, and the mechanisms underlying the therapeutic effects of CBD remain incompletely understood. Further well-designed, randomized, controlled, multicenter trials are needed to establish the efficacy and safety of CBD and support its integration into clinical practice. Full article

Introduction: Epidemiological data indicate that over half of people who consume cannabis report anxiety reduction as a reason for use. Anxiety is frequently cited as a primary motivation for cannabis use among both medical and recreational consumers. The lifetime prevalence of anxiety disorders in the United States is approximately 34% with more recent data suggesting that the figure may be as high as 43%. Methods: Using a mixed methods design, we collected quantitative data through psychosocial assessment tools and demographic questionnaires from a sample of adult cannabis consumers (n = 30). These data were integrated with qualitative findings from semi structured interviews to contextualize consumers’ experiences and perceptions related to anxiety and cannabis use. Results: Medical cannabis consumers (n = 19) reported significantly more frequent consumption, averaging 28.95 days per month, as compared to recreational consumers (n = 11), averaging 23.55 days per month. Scores on the State-Trait Anxiety Inventory indicated clinically significant anxiety symptoms in both groups (39.95 for medical; 38.55 for recreational), with medical consumers more likely to endorse elevated anxiety. Qualitative analyses revealed nuanced and individualized interpretations of anxiety that extended beyond traditional binary diagnostic criteria revealing the Research Domain Criteria (RDoC) as a framework to better understand the relationship between anxiety and cannabis use. Discussion: The value of this work is its use of the RDoC framework to provide a new way to examine the relationship between anxiety and cannabis consumption. Currently the diagnosis of anxiety is binary based on DSM-5-TR criteria. This limitation makes it challenging to study the complex range of outcomes that occur when examining anxiety and cannabis use. Therefore, the opportunity to understand anxiety from a transdiagnostic framework such as RDoC enables researchers to study for whom and under what circumstances cannabis induces and/or reduces anxiety. Full article

Medical cannabis use is steadily increasing worldwide, including among pregnant and breastfeeding women. This Perspective provides an overview of current evidence regarding cannabis exposure during pregnancy and lactation and its implications for clinical decision-making. The available literature indicates relatively consistent evidence linking prenatal Δ⁹-tetrahydrocannabinol (THC) exposure with adverse perinatal outcomes, including reduced birth weight, increased risk of preterm delivery, and potential neurodevelopmental effects, although the findings remain heterogeneous and often confounded. In contrast, evidence regarding cannabis exposure during breastfeeding is sparse, and long-term infant outcomes associated with postnatal exposure through breast milk remain insufficiently characterized. Data on isolated cannabidiol (CBD) exposure during pregnancy and lactation are particularly limited, and most available evidence derives from preclinical studies or pharmacokinetic modeling rather than clinical outcome studies. Current recommendations from major health organizations uniformly advise avoiding cannabis and cannabinoid use during pregnancy and breastfeeding. This Perspective highlights the need to interpret the evidence according to cannabinoid type, exposure period, route and pattern of use, and the distinction between recreational exposure and regulated medical use. Such distinctions are particularly important because evidence is relatively stronger for prenatal THC exposure, whereas data on CBD and lactational exposure remain limited and are derived largely from indirect clinical, pharmacokinetic, and preclinical sources. Within this evidence landscape, individualized clinical interpretation may be needed when exposure has already occurred, cessation is not immediately feasible, or maternal treatment decisions remain complex, while remaining anchored in current avoidance recommendations. Full article

Background: Poor appetite, a major contributor to malnutrition, is highly prevalent among older adults and associated with adverse clinical outcomes. Nevertheless, there are currently no widely accepted or consistently effective pharmacological treatments targeting appetite that are routinely recommended alongside nutritional interventions. Medical cannabis has been proposed as a potential appetite stimulant in older adults with poor appetite through modulation of appetite-regulating hormones such as glucagon-like peptide-1 (GLP-1) and total ghrelin, but the evidence remains limited. Aims: To investigate the effects of Sativex^® versus placebo on postprandial GLP-1 and total ghrelin concentrations following a single dose (8.1 mg Δ9-tetrahydrocannabinol (THC) and 7.5 mg cannabidiol (CBD)), and on subjective appetite following two separated doses, in older adults with poor appetite, and to investigate the associations between plasma concentrations of THC and its metabolites on these outcomes. Methods: This protocolized secondary analysis included 17 participants (≥65 years) with poor appetite from a double-blind, randomized, placebo-controlled crossover trial. Participants received Sativex^® or placebo on two separate study days. GLP-1 and total ghrelin were measured following one dose of Sativex^®/placebo and a standardized breakfast, and subjective appetite was assessed repeatedly using visual analog scales throughout the administration of two separate doses of Sativex^®/placebo, the consumption of a standardized breakfast, and an ad libitum lunch meal. Effects/associations were analyzed using linear mixed-effects models. Results: Compared with placebo, Sativex^® produced an estimated 2.38 pmol/L (95% confidence intervals (CI): −0.71 to 5.46; Bonferroni-corrected p = 0.274) reduction in mean GLP-1 and time-dependent changes in mean total ghrelin (Bonferroni-corrected p = 0.054). Compared with placebo, Sativex^® produced minimal changes in separate subjective appetite sensations (all Bonferroni-corrected p = 1.00) and a slightly lower combined appetite score (−5.2 mm; 95% CI: −24.4 to 4.0; Bonferroni-corrected p = 1.00). Increased plasma concentrations of THC and metabolites were associated with reduced estimates of mean GLP-1 concentrations and subjective appetite, as well as increased mean total ghrelin concentrations. However, no statistically significant differences were detected for any analyses, and estimates had wide CIs, warranting cautious interpretation. Conclusions: In conclusion, no statistically significant differences were detected between Sativex^® and placebo in postprandial GLP-1, total ghrelin, or subjective appetite over time in older adults with poor appetite. Similarly, no statistically significant associations were observed between plasma concentrations of THC and its metabolites and GLP-1, total ghrelin, or subjective appetite. Trial registration: ClinicalTrials.gov ID: NCT05503147; EudraCT nr.: 2021-002318-15. Full article

Background: Online communities such as Reddit can reveal critical information needs (CINs) among people who discuss opioid use for chronic or acute pain under conditions of stigma and uncertainty. Methods: We used a mixed-method design to analyze 3428 unique Reddit posts from 1 January to 31 December 2022. Sentence-BERT embeddings and K-means clustering identified eight dominant themes, followed by qualitative analysis of a random subsample of 400 posts. Results: The most prevalent theme was seeking alternatives to opioids for pain relief (28.00%), followed by medications for chronic pain (19.84%) and kratom use experiences (14.64%). Qualitative findings showed recurrent concerns about addiction, stigma in clinical encounters, withdrawal, treatment access, and peer-to-peer discussion of kratom, tianeptine, cannabis, and other substitute substances. Conclusions: The study suggests an unmet need for accessible, nonstigmatizing, and clinically grounded information on pain management, tapering, and lower-risk alternatives to opioid use. These results have implications for addiction prevention, harm reduction, and patient-facing communication strategies for clinical practice and community health. Full article

Background: Adolescence is a sensitive period for brain maturation during which exposure to Δ⁹-tetrahydrocannabinol (THC) can induce long-lasting neurobehavioral alterations. Yet, preclinical and clinical studies report inconsistent long-term outcomes of adolescent THC exposure, ranging from clear impairments to apparently normalizing effects. We hypothesize that these discrepancies reflect stable individual differences in stress-coping abilities. Methods: To test this, selectively bred Dominant (Dom; stress-resilient, risk-prone) and Submissive (Sub; stress-vulnerable, depressive-like) Sabra mice received THC or vehicle during adolescence and were assessed in adulthood. Results: Anxiety-like and exploratory behavior, measured in the hole-board test, were differentially affected by THC as a function of stress vulnerability: in Sub mice, THC increased exploration and reduced anxiety-like behavior, whereas in Dom mice THC produced the opposite pattern. Recognition memory, evaluated by the novel object recognition test, showed modest, line-dependent alterations. Sensitivity to N-methyl-D-aspartate (NMDA) receptor hypofunction, a widely used index of vulnerability to schizophrenia-like symptoms, was examined using MK-801-induced locomotion. Adolescent THC potentiated MK-801-evoked hyperlocomotion in Dom mice but attenuated it in Sub mice. Conclusions: In the context of increasing medical and recreational cannabis exposure, these in vivo findings suggest that stress-vulnerability-related traits may be an important variable to consider in future preclinical and translational studies of adolescent THC exposure. Full article

Introduction: Medical cannabis is increasingly used to manage post-traumatic stress disorder (PTSD), a condition frequently linked to high healthcare utilization, particularly for acute services. Methods: We conducted a retrospective cohort study using data from Leafwell among patients with PTSD who either used medical cannabis for at least one year (treated group) or were cannabis-naïve (untreated group). The primary outcomes were urgent care, emergency department (ED), or hospitalization visits in the past six months. We applied inverse probability weighting with regression adjustment (IPWRA) to estimate the average treatment effect (ATE) of medical cannabis exposure, adjusting for demographics, PTSD severity, and other health factors. Sensitivity analyses were performed to assess robustness. Results: Out of 1946 participants, 1261 were in the treated group and 685 in the untreated group. The treated group had a 35.6% lower probability of urgent care visits (coefficient = −0.024, SE = 0.0117) and a 35.1% lower probability of ED visits (coefficient = −0.027, SE = 0.0124). Although hospitalization rates were 26.3% lower, this difference was not statistically significant. Findings remained consistent across multiple ATE estimation methods, and adjusting the IPWRA model’s tolerance levels strengthened these associations. Fewer than 2% of the treated group reported adverse events. Conclusions: Medical cannabis use among patients with PTSD was associated with reduced urgent care and ED visits. These results were robust across analytical methods, supporting the potential role of medical cannabis in lowering acute healthcare needs. Further longitudinal research is warranted to assess causality and clarify effects on hospitalization. Full article

Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population and is a leading cause of years lived with disability. Long-term, real-world evidence for inhaled cannabis in patients refractory to conventional multimodal therapy remains scarce. We assessed the five-year efficacy and safety of inhaled cannabis in CLBP patients who had documented failure of ≥1 year of opioid analgesics, anticonvulsants, antidepressants, NSAIDs, and physiotherapy, with each patient serving as their own historical control. Methods: We analyzed prospectively collected clinical data from 241 consecutive adults with treatment-refractory CLBP (mean age 49.3 ± 14.9 years; 37.8% female; mean pain duration 15.1 years) initiated on inhaled medical cannabis (predominantly smoking, THC 4–22%, CBD 2–22%) in a single-center tertiary orthopedic clinic between 2020 and 2025 (Hasharon Hospital, Rabin Medical Center, Israel; IRB protocols 0807-21-RMC and 0634-25-RMC). Year-0 outcomes during conventional therapy were compared with outcomes at Years 1–5 on cannabis. Primary outcomes were the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory severity/interference (BPI-S/BPI-I). Concomitant-medication trajectories were a secondary outcome. The primary analysis was a mixed model for repeated measures (MMRM) with random intercept and slope, REML estimation, and time as a categorical fixed effect. Multiple imputation (MAR, m = 20, Rubin’s rules) was the primary missing-data approach; complete-case and tipping-point pattern-mixture sensitivity analyses were used. A multivariate Hotelling T² provided a joint test across the four correlated PROMs. Concomitant-medication discontinuation was modeled with GEE logistic regression and exact McNemar tests. Time to discontinuation was estimated by Kaplan–Meier and Cox regression. The Bonferroni-adjusted significance threshold for the four primary outcomes was α = 0.0125. BioWell gas-discharge-visualization (GDV) parameters were exploratory only. Results: Of 241 patients, 238 (98.8%) provided Year-5 data and 224 (92.9%) remained on cannabis at Year 5; only five patients (2.1%) discontinued for adverse events or inefficacy. All four primary PROMs improved markedly and durably. MMRM-estimated Year-5 minus Year-0 changes were: NRS −5.36 (95% CI −5.65, −5.07), ODI −17.68 (95% CI −19.73, −15.63), BPI-S −6.73 (95% CI −6.99, −6.47), and BPI-I −3.41 (95% CI −3.65, −3.16); all four contrasts had |z| ≥ 16.9 and p < 10⁻²⁰. MI-pooled estimates were within 0.05 of MMRM (FMI < 0.03 for all outcomes). Hotelling T² was F(4, 232) = 872.8, p < 10⁻²⁰. At Year 5, 89.2% achieved ≥30% NRS reduction, 77.2% ≥ 50%, and 93.4% met the NRS minimum clinically important difference (MCID); ODI MCID 65.6%, BPI-S MCID (≥1 pt) 98.3%, BPI-I MCID (≥1 pt) 91.3%. Concomitant opioid use fell from 100% at baseline to 4.6% at Year 5 (within-patient absolute risk reduction 95.4%, McNemar exact p = 1.16 × 10⁻⁶⁹), NSAID from 100% to 7.1%, SSRI/SNRI from 80.5% to 5.4%, and gabapentinoid from 38.6% to 2.5%. The ARR-derived NNT for opioid discontinuation was 1.05; this NNT is referenced to each patient’s own documented maximal-conventional-therapy state and is not equivalent to a between-arm randomized-trial NNT. Cannabis dose × time interaction was consistent with no pharmacological tolerance (β = −0.0044 per gram-month per year, p = 0.074). Across 1205 patient-years of cannabis exposure (calculated as 241 patients × 5 follow-up years from Year 1 through Year 5; baseline Year 0 represents pre-cannabis state and is not included in person-time on cannabis), 1338 organ-system AE events were recorded at 1.110/patient-year (Poisson 95% CI 1.05–1.17); 99.8% of graded events were mild (grade 1), with ocular (476 events, 0.40/PY), cognitive (460, 0.38/PY), and gastrointestinal (368, 0.31/PY) reactions predominating. The Year-3 retention dip reflected a documented telemedicine-clinic phenomenon during 2022–2024, with patients returning to in-person follow-up by Year 4–5. BioWell GDV discriminated NRS ≥ 4 only at chance level (BWS AUC 0.574, 95% CI 0.54–0.60; BWV AUC 0.51). Conclusions: In a treatment-refractory CLBP cohort with five-year longitudinal follow-up, inhaled cannabis was associated with large, sustained, and statistically robust improvements in pain, disability, and pain interference, accompanied by near-total displacement of opioids, NSAIDs, antidepressants, and gabapentinoids. These observational associations, although mechanically less susceptible to bias for the binary medication-discontinuation outcomes than for self-reported PROMs, cannot be interpreted causally in the absence of a concurrent randomized control arm and may reflect a combination of pharmacological effect, regression to the mean from a high pre-treatment baseline, expectancy and self-selection effects intrinsic to an actively chosen open-label therapy, and secular trends in pain reporting. The within-patient benefit-risk profile—ARR-derived NNT ≈ 1 for opioid sparing against a predominantly mild adverse-event burden—supports consideration of cannabis as a potentially clinically meaningful, opioid-sparing option in patients who have failed multimodal conventional therapy, pending confirmation in randomized comparative trials. Full article

Cannabis sativa L. is a multipurpose crop of increasing agricultural and medical relevance, whose productivity and phytocannabinoid profile are influenced not only by genotype and environmental factors but also by the composition of its microbiota. This review synthesizes current knowledge (2020–2026) on the rhizosphere and endophytic microbiota of hemp, with particular emphasis on plant growth-promoting bacteria (PGPB) and their mechanisms of action. Molecular studies indicate that hemp-associated bacterial communities are dominated by Proteobacteria, Actinobacteriota, Firmicutes and Bacteroidota, with genotype-, tissue- and developmental-stage-dependent variation. PGPB influence plant performance through direct mechanisms, including biological nitrogen fixation, phosphate solubilization, siderophore production and phytohormone synthesis (indole-3-acetic acid (IAA), gibberellins, cytokinins, and 1-aminocyclopropane-1-carboxylate (ACC) deaminase), as well as indirect mechanisms such as antibiosis, enzyme-mediated pathogen inhibition and induction of systemic tolerance to abiotic stress. Experimental studies demonstrate that inoculation with selected strains or consortia can enhance biomass accumulation, improve germination and root architecture, increase resistance to Fusarium oxysporum and modulate cannabinoid and terpene profiles. Importantly, plant responses are cultivar-specific, highlighting the need for genotype-tailored microbial formulations. Full article

The pharmaceutical development of cannabis-based medicinal products is challenged by significant variability in the quality, composition, and standardization of plant-derived active pharmaceutical ingredients (APIs). In Ukraine, despite recent legislative liberalization, a substantial shortage of standardized raw materials continues to limit the development of innovative dosage forms. This study analyses international practices among API manufacturers to identify technological parameters necessary to overcome domestic market barriers and support the implementation of advanced drug delivery systems. Content analysis was conducted on regulatory documentation, professional literature, and manufacturers’ technical specifications. Candidate evaluation followed predefined inclusion and exclusion criteria. The study assessed compliance with Good Manufacturing Practice (GMP) requirements, extraction and purification technologies, the extent of analytical characterization, and batch-to-batch reproducibility. Purposive sampling enabled a comparative analysis of various technological approaches. Marked heterogeneity was observed in API standardization and analytical control indicators among manufacturers. Possession of a GMP certificate was found necessary but may be insufficient to ensure the pharmaceutical equivalence of materials. Differences in extraction methods and purification levels may affect stability profiles, pharmaceutical development strategies, and risk management related to final product quality. The findings demonstrate that manufacturer selection is a critical decision point in pharmaceutical development, with substantiated supplier choice directly influencing dosage form development and regulatory compliance. Full article