About

Sebastian Jugl, Ph.D., is a Research Assistant Professor in the Department of Pharmaceutical Outcomes & Policy at the College of Pharmacy, University of Florida. His research focuses on healthcare quality, medication safety, and population health, with active projects such as the cardiovascular safety of medical cannabis, where he serves as the principal investigator. Dr. Jugl has received several awards, including the Graduate Student Mentoring Award in 2024, the University of Florida Emerging Leader Award in 2023, and the International Society for Pharmacoepidemiology Grinter Fellowship from 2019 to 2022. He has also been recognized with the University of Florida Research Scholarship in 2018 and the Deutschlandstipendium from Goethe University in Frankfurt am Main between 2015 and 2017. In addition to his research, Dr. Jugl is involved in teaching courses related to drug safety, evidence-based practice, and selected topics in pharmacy at the College of Pharmacy. His academic contributions include publications and grants that advance understanding in pharmacoepidemiology, safety sciences, and outcomes research. His work aims to turn safety signals into actionable, risk-stratified evidence to improve medication safety and healthcare outcomes.

Research topics

• Psychiatry
• Medicine
• Psychology
• Pathology
• Family medicine
• Pharmacology

Selected publications

• Risk of intracranial meningioma requiring surgical intervention among recent hormonal contraceptives users

  Journal of Neuro-Oncology · 2026-01-01 · 1 citations

  article
  PublisherDOI

• Abstract 4370259: Medical Cannabis and Acute Myocardial Infarction Risk: A Case-Time-Control Analysis

  Circulation · 2025-11-03

  article

  Introduction/Background: Medical cannabis (MC) appears to have multiple effects on the cardiovascular system via sympathomimetic effects and parasympathetic effects, and there is concern that MC may potentiate major adverse cardiovascular events, such as acute myocardial infarction (AMI). However, few epidemiologic studies have evaluated cardiovascular risk associated with real-world MC use. Research Questions/Hypothesis: Does transient MC exposure increase short-term risk for AMI? Goals/Aims: We aimed to evaluate the association between MC and AMI risk, using a self-controlled case-time-control study design. Methods/Approach: This case-time-control study used Medical Marijuana clinical Outcomes RepositorY (MEMORY) data, which contains OMMU Medical Marijuana Use Registry (MMUR) data linked to Medicaid claims. We included Medicaid beneficiaries with a hospitalization for AMI measured by ICD-10-CM diagnosis codes as cases. These individuals were matched 1:1 with a control (no AMI) on exact age, sex, and calendar time, where each control has at least as much follow-up time as their matched case and did not become a case themselves subsequently. Patients with medical cannabis exposure up to 30 days before AMI (or matched calendar date) were considered exposed during the hazard period, and those with exposure 90–60 days before AMI (or matched calendar date) were considered exposed during the referent period. For cases and controls, odds ratios (ORs) were calculated using multivariable conditional logistic regression by comparing MC exposure ratios between hazard period and referent period within individuals. The overall OR of the case-time-control study was estimated by dividing the OR among cases by the OR among controls. Results: We identified 18,287 patients with an AMI (47.9% female; mean age (SD): 51.8 years old (10.3)); and 333 (0.9%) were receiving MC treatment at the time of AMI. Among cases and controls, we did not find an increase in odds of MC exposure within 30 days before AMI (case OR, 95% CI: 1.34, 0.93-1.93; control OR, 95% CI: 1.29, 0.93-1.79). Moreover, the case-time-control analysis revealed no increased in odds of MC exposure within 30 days before AMI (OR, 95% CI: 1.04, 0.64–1.71), after adjusting for background exposure trends. Conclusion(s): Our findings suggest that medical cannabis use was not associated with an increase in AMI risk within 30 days of use. However, more research is needed to more fully characterize risk among relevant subgroups.

  PublisherDOI

• Legalization of Smokable Medical Cannabis and Changes in the Dispensed Amount of Δ-9 Tetrahydrocannabinol Per Patient

  Cannabis and Cannabinoid Research · 2024-04-02

  article1st author

  Introduction: Florida’s medical cannabis (marijuana) program is among the largest in the United States. Smokable cannabis forms were not legally available in this program until 2019, and five years after other forms of cannabis were available. This study assessed changes in Δ-9 tetrahydrocannabinol (THC) dispensed per patient following legalization of smokable cannabis in Florida. Materials and Methods: This quasi-experimental study used data from the Florida Department of Health Office of Medical Marijuana Use Reports on THC dispensing from April 6, 2018, through March 13, 2020. Certified medical cannabis user during the study period was included. The exposure was the dispensed amount of THC from legalized smokable forms of medical cannabis (statute identified as SB182), effective as of March 2019. Changes in level and trend of average milligram (mg) of dispensed THC per certified patient with 95% confidence intervals (CIs), before and after SB182, were calculated by fitting a generalized least squares linear model and allowing a 17-week phase-in period. Results: The number of certified patients increased by 24.8% from 197,107 (March 22, 2019) to 246,079 (July 19, 2019) and to 325,868 by March 13, 2020. Assuming that a 20% THC concentration in smokable products, there was a significant level increase in the mean weekly dispensed THC amount per certified patient of 138.45 mg (95% CI: 102.69–174.20), translating to a 42.18% increase (95% CI: 33.14–50.28), from the pre-policy period. We noted a continuous increase of 5.62 mg per certified patient per week (95% CI: 4.35–6.89) throughout the 35 weeks following the policy, when compared with the period before. Assuming 10% THC concentration in smokable products, we observed a significant level increase of 35.10 mg (95% CI: 5.31–64.88), corresponding to an increase of 10.70% (95% CI: 1.70–18.89), and a trend increase of 2.23 mg per certified patient per week (95% CI: 1.18–3.29). Discussion: The expansion of the Florida medical cannabis program to include smokable cannabis forms was associated with a significant increase in the mean amount of weekly dispensed THC per certified patient. Findings suggest that the dispensed amount of THC after legalization of smokable medical cannabis far exceeds the maximum recommended daily dose, based on extrapolation from oral cannabis product dosing recommendations from one expert consensus statement, raising questions about the safety, and need for consumer education.

  PublisherDOI

• Reasons for Use and Perceived Effects of Medical Cannabis: A Cross-Sectional Statewide Survey

  Medical Cannabis and Cannabinoids · 2024-07-30 · 1 citations

  articleOpen access

  Introduction: Medical cannabis (MC) is available upon certification for one of several qualifying conditions in Florida, USA. Previous studies suggested that some people seek cannabis for medical conditions/symptoms beyond those legally permitted. Yet, data remains limited on patient motives for seeking MC and their experiences around its impact on their health. We aimed to compare reported qualifying conditions for MC certification with the most frequently self-reported reasons for using MC while assessing the alignment between the two and understand the perceived impacts of MC on self-reported conditions and symptoms. Methods: We conducted a cross-sectional study using survey data from the Medical Marijuana & Me (M3) Databank of individuals receiving MC in Florida, USA, in 2022. Participants were recruited via convenience sampling from nine MC clinics/clinic networks across Florida and were asked to fill out an online survey. The study measures included sociodemographic variables, self-reported health conditions, self-reported main reasons for using MC, self-reported qualifying conditions for MC certification, and self-reported perceived impact of MC on health conditions. We cross-tabulated reported qualifying conditions and reasons for MC use and reported the perceived impact per condition. Results: A total of 632 participants completed the survey, of whom 396 (62.66%) were female, and 471 (74.53%) were non-Hispanic White. The median (IQR) age was 45 (35, 58). The most frequently reported qualifying conditions were post-traumatic stress disorder (PTSD) (n=187, 29.59%), a condition not on the qualifying conditions list (n=175, 27.69%), medical conditions of the same kind/comparable to those listed (n=140, 22.15%), and chronic nonmalignant pain (n=62, 25.63%). The top ten most frequently reported reasons for using MC were anxiety (n=383, 60.60%), chronic pain (n=278, 43.99%), depression (n=252, 39.87%), PTSD (n=220, 34.81%), headaches/migraine (n=134, 21.20%), fibromyalgia (n=67, 10.60%), attention-deficit/hyperactivity disorder (ADHD) (n=59, 9.34%), bipolar disorder (n=53, 8.39%), high blood pressure (n=41, 6.49%), and cancer, (n=18,2.85%). Of respondents, 70-90% with each qualifying condition reported it as one of the main reasons for using MC. Most respondents reported improvement of anxiety (n=430/451, 95.34%), depression (n=381/392, 97.20%), chronic pain (n=305/310, 98.39%), insomnia/ sleeping problems (n=225/295, 86.44%), PTSD (n=247/270, 91.48%), headaches/ migraine (n=172/218, 78.90%), ADHD (n=82/123, 66.67%), bipolar disorder (n=79/89, 88.76%), and fibromyalgia (n=77/82, 93.90%). Most respondents were unsure/reported no change in blood pressure (n=93/162, 57.41%). A small percentage reported perceived worsening impacts on their conditions. Conclusion: Qualifying conditions and self-reported reasons for using MC aligned for most respondents. Yet, a notable proportion of respondents sought MC for broader treatment effects beyond those delineated by the officially recognized qualifying conditions in Florida, USA. Most patients perceived positive effects, including those with limited available evidence on efficacy.

  PublisherDOI

• Prenatal Exposure to Valproic Acid Across Various Indications for Use

  JAMA Network Open · 2024-05-22 · 19 citations

  articleOpen access

  Importance: Teratogenic outcomes associated with valproic acid use represent a substantial concern for persons of childbearing age. Regulatory agencies worldwide have enhanced warnings or implemented risk minimization programs to reduce exposure during pregnancy. Objectives: To determine pregnancy rates during valproic acid use and concomitant contraception use across indications. Design, Setting, and Participants: This retrospective cohort study used data from the Merative MarketScan commercial claims databases from January 1, 2005, to December 31, 2020, to identify female patients aged 12 to 44 years who initiated valproic acid treatment and had continuous insurance enrollment 6 months before initiation and 9 months after treatment end. A treatment episode included consecutive prescription fills that occurred within 7 days from the end of the days' supply of the previous dispensing. Data were analyzed from March 1 to September 10, 2023. Main Outcomes and Measures: Treatment episodes were categorized by inferred indication using diagnoses preceding treatment initiation, including epilepsy, migraine or headache, mood disorders, and unknown or off-label uses. Pregnancy incidence rate ratios (IRRs) were calculated and were adjusted for age and calendar year. Contraceptive use (prescription contraceptives, intrauterine devices, and implants) during treatment was examined. Results: The cohort included 165 772 valproic acid treatment episodes among 69 390 women (mean [SD] age, 29.8 [10.0] years). Mood disorders (42.5%) were the most common indication, followed by migraine or headache (20.1%), with epilepsy playing a minor role (14.9%). Pregnancy incidence rates during valproic acid use remained unchanged, with a rate of 1.74 (95% CI, 1.14-2.53) per 100 person-years in 2005 and a rate of 1.90 (95% CI, 1.16-3.12) per 100 person-years in 2019. Compared with epilepsy, pregnancy rates were more than double for mood disorder (IRR, 2.16 [95% CI, 1.93-2.42]) and migraine or headache (IRR, 2.01 [95% CI, 1.92-2.09]). Few treatment episodes coincided with contraceptive use (37 012 [22.3%]), and oral dosage forms were the most common (27 069 [73.1%]). Conclusions and Relevance: In this cohort study of patients of childbearing age who used valproic acid, pregnancy rates during valproic acid use did not decrease despite enhanced US Food and Drug Administration safety communications, and contraception use remained low. Patients with migraine and mood disorders accounted for the largest proportion of valproic acid use and had the highest pregnancy rates, while patients with epilepsy had the lowest. These findings suggest a need to enhance efforts to mitigate prenatal exposure to valproic acid, especially for indications where the risk of use during pregnancy outweighs the benefit.

  PublisherOA PDFDOI

• A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

  UNC Libraries · 2024-01-09

  articleOpen access

  In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

  PublisherDOI

• Cannabis use and acute postoperative pain outcomes in older adults: a propensity matched retrospective cohort study

  Regional Anesthesia & Pain Medicine · 2024-06-30 · 13 citations

  articleOpen access

  INTRODUCTION: Cannabis use is increasing among older adults, but its impact on postoperative pain outcomes remains unclear in this population. We examined the association between cannabis use and postoperative pain levels and opioid doses within 24 hours of surgery. METHODS: We conducted a propensity score-matched retrospective cohort study using electronic health records data of 22 476 older surgical patients with at least 24-hour hospital stays at University of Florida Health between 2018 and 2020. Of the original cohort, 2577 patients were eligible for propensity-score matching (1:3 cannabis user: non-user). Cannabis use status was determined via natural language processing of clinical notes within 60 days of surgery and structured data. The primary outcomes were average Defense and Veterans Pain Rating Scale (DVPRS) score and total oral morphine equivalents (OME) within 24 hours of surgery. RESULTS: 504 patients were included (126 cannabis users and 378 non-users). The median (IQR) age was 69 (65-72) years; 295 (58.53%) were male, and 442 (87.70%) were non-Hispanic white. Baseline characteristics were well balanced. Cannabis users had significantly higher average DVPRS scores (median (IQR): 4.68 (2.71-5.96) vs 3.88 (2.33, 5.17); difference=0.80; 95% confidence limit (CL), 0.19 to 1.36; p=0.01) and total OME (median (IQR): 42.50 (15.00-60.00) mg vs 30.00 (7.50-60.00) mg; difference=12.5 mg; 95% CL, 3.80 mg to 21.20 mg; p=0.02) than non-users within 24 hours of surgery. DISCUSSION: This study showed that cannabis use in older adults was associated with increased postoperative pain levels and opioid doses.

  PublisherOA PDFDOI

• Cannabis Use and Inhalational Anesthesia Administration in Older Adults: A Propensity-matched Retrospective Cohort Study

  Anesthesiology · 2024-07-09 · 3 citations

  articleOpen access

  BACKGROUND: Cannabis use is associated with higher intravenous anesthetic administration. Similar data regarding inhalational anesthetics are limited. With rising cannabis use prevalence, understanding any potential relationship with inhalational anesthetic dosing is crucial. Average intraoperative isoflurane or sevoflurane minimum alveolar concentration equivalents between older adults with and without cannabis use were compared. METHODS: The electronic health records of 22,476 surgical patients 65 yr or older at the University of Florida Health System between 2018 and 2020 were reviewed. The primary exposure was cannabis use within 60 days of surgery, determined via (1) a previously published natural language processing algorithm applied to unstructured notes and (2) structured data, including International Classification of Diseases codes for cannabis use disorders and poisoning by cannabis, laboratory cannabinoids screening results, and RxNorm codes. The primary outcome was the intraoperative time-weighted average of isoflurane or sevoflurane minimum alveolar concentration equivalents at 1-min resolution. No a priori minimally clinically important difference was established. Patients demonstrating cannabis use were matched 4:1 to non-cannabis use controls using a propensity score. RESULTS: Among 5,118 meeting inclusion criteria, 1,340 patients (268 cannabis users and 1,072 nonusers) remained after propensity score matching. The median and interquartile range age was 69 (67 to 73) yr; 872 (65.0%) were male, and 1,143 (85.3%) were non-Hispanic White. The median (interquartile range) anesthesia duration was 175 (118 to 268) min. After matching, all baseline characteristics were well-balanced by exposure. Cannabis users had statistically significantly higher average minimum alveolar concentrations than nonusers (mean ± SD, 0.58 ± 0.23 vs. 0.54 ± 0.22, respectively; mean difference, 0.04; 95% confidence limits, 0.01 to 0.06; P = 0.020). CONCLUSION: Cannabis use was associated with administering statistically significantly higher inhalational anesthetic minimum alveolar concentration equivalents in older adults, but the clinical significance of this difference is unclear. These data do not support the hypothesis that cannabis users require clinically meaningfully higher inhalational anesthetics doses.

  PublisherOA PDFDOI

• Protocol of a Combined Cohort and Cross-Sectional Study of Persons Receiving Medical Cannabis in Florida, USA: The Medical Marijuana and Me (M3) Study

  Medical Cannabis and Cannabinoids · 2023-05-09 · 4 citations

  articleOpen access

  Significant knowledge gaps regarding the effectiveness and safety of medical cannabis (MC) create clinical challenges for MC physicians, making treatment recommendations and patients choosing treatment among the growing number of options offered in dispensaries. Additionally, data describing the characteristics of people who use MC and the products and doses they receive are lacking. The Medical Marijuana and Me (M3) Study was designed to collect patient-centered data from MC users. We aim to describe preferred MC use patterns that patients report as “most effective” for specific health conditions and symptoms, identify user characteristics associated with such use patterns, characterize adverse effects, including cannabis use disorder, identify products and patient characteristics associated with adverse effects, describe concurrent prescription medication use, and identify concomitant medication use with potential drug-MC interaction risk. Among MC initiators, we also aim to quantify MC use persistence and identify reasons for discontinuation, assess MC utilization pattern trajectories over time, describe outcome trajectories of primary reasons for MC use and determine factors associated with different trajectories, track changes in concomitant substance and medication use after MC initiation, and identify factors associated with such changes. M3 is a combined study comprised of: (1) a prospective cohort of MC initiators completing surveys at enrollment, 3 months, and 9 months after MC initiation and (2) a cross-sectional study of current MC users. A multidisciplinary committee including researchers, physicians, pharmacists, patients, and dispensary personnel designed and planned study protocols, established study measures, and created survey questionnaires. M3 will recruit 1,000–1,200 participants aged ≥18 years, with ∼50% new and ∼50% current MC patients from MC clinics across Florida, USA. Study enrollment started in May 2022 and will continue until the target number of patients is achieved. Survey domains include sociodemographic characteristics, physical and mental health, cannabis use history, reasons for MC use and discontinuation, MC products and use patterns, concurrent use of prescription medications and other substances, and side effects. Data collected in the M3 Study will be available for interested researchers affiliated with the Consortium for Medical Marijuana Clinical Outcomes Research. The M3 Study and Databank will be the largest cohort of current and new MC users in Florida, USA, which will provide data to support MC-related health research necessary to inform policy and clinical practice and ultimately improve patient outcomes.

  PublisherDOI

• Developing and validating a natural language processing algorithm to extract preoperative cannabis use status documentation from unstructured narrative clinical notes

  Journal of the American Medical Informatics Association · 2023-04-26 · 19 citations

  articleOpen access

  OBJECTIVE: This study aimed to develop a natural language processing algorithm (NLP) using machine learning (ML) techniques to identify and classify documentation of preoperative cannabis use status. MATERIALS AND METHODS: We developed and applied a keyword search strategy to identify documentation of preoperative cannabis use status in clinical documentation within 60 days of surgery. We manually reviewed matching notes to classify each documentation into 8 different categories based on context, time, and certainty of cannabis use documentation. We applied 2 conventional ML and 3 deep learning models against manual annotation. We externally validated our model using the MIMIC-III dataset. RESULTS: The tested classifiers achieved classification results close to human performance with up to 93% and 94% precision and 95% recall of preoperative cannabis use status documentation. External validation showed consistent results with up to 94% precision and recall. DISCUSSION: Our NLP model successfully replicated human annotation of preoperative cannabis use documentation, providing a baseline framework for identifying and classifying documentation of cannabis use. We add to NLP methods applied in healthcare for clinical concept extraction and classification, mainly concerning social determinants of health and substance use. Our systematically developed lexicon provides a comprehensive knowledge-based resource covering a wide range of cannabis-related concepts for future NLP applications. CONCLUSION: We demonstrated that documentation of preoperative cannabis use status could be accurately identified using an NLP algorithm. This approach can be employed to identify comparison groups based on cannabis exposure for growing research efforts aiming to guide cannabis-related clinical practices and policies.

  PublisherOA PDFDOI

Frequent coauthors

• Almut G. Winterstein

  Center for Drug Evaluation and Research

  41 shared

• Amie Goodin

  38 shared

• Ruba Sajdeya

  University of Florida

  28 shared

• Joshua D. Brown

  Center for Drug Evaluation and Research

  26 shared

• Robert L. Cook

  University of Alabama at Birmingham

  19 shared

• Earl J. Morris

  University of Florida

  16 shared

• Shailina Keshwani

  University of Florida

  11 shared

• Kimia Zandbiglari

  Center for Drug Evaluation and Research

  9 shared

Awards & honors

• Graduate Student Mentoring Award 2024
• University of Florida Emerging Leader Award 2023
• International Society for Pharmacoepidemiology Grinter Fello…
• University of Florida Research Scholarship 2018
• German Society for International Collaboration (DGIZ) Deutsc…