51
|
Kaplan JS, Wagner JK, Reid K, McGuinness F, Arvila S, Brooks M, Stevenson H, Jones J, Risch B, McGillis T, Budinich R, Gambell E, Predovich B. Cannabidiol Exposure During the Mouse Adolescent Period Is Without Harmful Behavioral Effects on Locomotor Activity, Anxiety, and Spatial Memory. Front Behav Neurosci 2021; 15:711639. [PMID: 34512286 PMCID: PMC8426900 DOI: 10.3389/fnbeh.2021.711639] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/03/2021] [Indexed: 12/22/2022] Open
Abstract
Cannabidiol (CBD) is a non-intoxicating phytocannabinoid whose purported therapeutic benefits and impression of a high safety profile has promoted its increasing popularity. CBD’s popularity is also increasing among children and adolescents who are being administered CBD, off label, for the treatment of numerous symptoms associated with autism spectrum disorder, attention deficit hyperactivity disorder, anxiety, and depression. The relative recency of its use in the adolescent population has precluded investigation of its impact on the developing brain and the potential consequences that may present in adulthood. Therefore, there’s an urgency to identify whether prolonged adolescent CBD exposure has substantive impacts on the developing brain that impact behavioral and cognitive processes in adulthood. Here, we tested the effect of twice-daily intraperitoneal administrations of CBD (20 mg/kg) in male and female C57BL/6J mice during the adolescent period of 25–45 days on weight gain, and assays for locomotor behavior, anxiety, and spatial memory. Prolonged adolescent CBD exposure had no detrimental effects on locomotor activity in the open field, anxiety behavior on the elevated plus maze, or spatial memory in the Barnes Maze compared to vehicle-treated mice. Interestingly, CBD-treated mice had a faster rate of learning in the Barnes Maze. However, CBD-treated females had reduced weight gain during the exposure period. We conclude that prolonged adolescent CBD exposure in mice does not have substantive negative impacts on a range of behaviors in adulthood, may improve the rate of learning under certain conditions, and impacts weight gain in a sex-specific manner.
Collapse
Affiliation(s)
- J S Kaplan
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | - J K Wagner
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | - K Reid
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | - F McGuinness
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | - S Arvila
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | - M Brooks
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | - H Stevenson
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | - J Jones
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | - B Risch
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States.,Department of Psychology, Experimental Psychology Graduate Program, Western Washington University, Bellingham, WA, United States
| | - T McGillis
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | - R Budinich
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | - E Gambell
- Department of Psychology, Behavioral Neuroscience Program, Western Washington University, Bellingham, WA, United States
| | | |
Collapse
|
52
|
Feng W, Qin C, Cipolla E, Lee JB, Zgair A, Chu Y, Ortori CA, Stocks MJ, Constantinescu CS, Barrett DA, Fischer PM, Gershkovich P. Inclusion of Medium-Chain Triglyceride in Lipid-Based Formulation of Cannabidiol Facilitates Micellar Solubilization In Vitro, but In Vivo Performance Remains Superior with Pure Sesame Oil Vehicle. Pharmaceutics 2021; 13:1349. [PMID: 34575426 PMCID: PMC8472830 DOI: 10.3390/pharmaceutics13091349] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022] Open
Abstract
Oral sesame oil-based formulation facilitates the delivery of poorly water-soluble drug cannabidiol (CBD) to the lymphatic system and blood circulation. However, this natural oil-based formulation also leads to considerable variability in absorption of CBD. In this work, the performance of lipid-based formulations with the addition of medium-chain triglyceride (MCT) or surfactants to the sesame oil vehicle has been tested in vitro and in vivo using CBD as a model drug. The in vitro lipolysis has shown that addition of the MCT leads to a higher distribution of CBD into the micellar phase. Further addition of surfactants to MCT-containing formulations did not improve distribution of the drug into the micellar phase. In vivo, formulations containing MCT led to lower or similar concentrations of CBD in serum, lymph and MLNs, but with reduced variability. MCT improves the emulsification and micellar solubilization of CBD, but surfactants did not facilitate further the rate and extent of lipolysis. Even though addition of MCT reduces the variability, the in vivo performance for the extent of both lymphatic transport and systemic bioavailability remains superior with a pure natural oil vehicle.
Collapse
Affiliation(s)
- Wanshan Feng
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Chaolong Qin
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Elena Cipolla
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
- School of Pharmacy, Universita di Roma Tor Vergata, 00173 Rome, Italy
| | - Jong Bong Lee
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Atheer Zgair
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
- College of Pharmacy, University of Anbar, Ramadi 31001, Iraq
| | - Yenju Chu
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
- Tri-Service General Hospital, Medical Supplies and Maintenance Office, National Defense Medical Center, Taipei 114202, Taiwan
| | - Catherine A. Ortori
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Michael J. Stocks
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | | | - David A. Barrett
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Peter M. Fischer
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Pavel Gershkovich
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| |
Collapse
|
53
|
Mucoadhesion and Mucopenetration of Cannabidiol (CBD)-Loaded Mesoporous Carrier Systems for Buccal Drug Delivery. Sci Pharm 2021. [DOI: 10.3390/scipharm89030035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transmucosal drug delivery represents a promising noninvasive option when drugs are employed which have a low oral bioavailability like CBD. However, this concept can only be successful as long as the formulation provides sufficient buccal retention and mucosal penetration. In this study, mucoadhesive carrier systems were evaluated consisting of CBD-loaded silica (Aeroperl 300) carriers, mucoadhesive polymers (Hypromellose (HPMC), chitosan and carbomer) and propylene glycol as a penetration enhancer. Mucoadhesive effect, drug release and penetration ability were evaluated for each carrier system. The results show that the addition of HPMC and carbomer substantially improve mucoadhesion compared to pure CBD, with an increase of 16-fold and 20-fold, respectively. However, due to their strong swelling, HPMC and carbomer hinder the penetration of CBD and rely on co-administration of propylene glycol as an enhancer to achieve sufficient mucosal absorption. Chitosan, on the other hand, achieves an 8-fold increase in mucoadhesion and enhances the amount of CBD absorbed by three times compared to pure CBD. Thus, chitosan represents a promising polymer to combine both effects. Considering the results, the development of silica-based buccal drug delivery systems is a promising approach for the effective delivery of CBD.
Collapse
|
54
|
Crippa JAS, Zuardi AW, Guimarães FS, Campos AC, de Lima Osório F, Loureiro SR, dos Santos RG, Souza JDS, Ushirohira JM, Pacheco JC, Ferreira RR, Mancini Costa KC, Scomparin DS, Scarante FF, Pires-Dos-Santos I, Mechoulam R, Kapczinski F, Fonseca BAL, Esposito DLA, Pereira-Lima K, Sen S, Andraus MH, Hallak JEC. Efficacy and Safety of Cannabidiol Plus Standard Care vs Standard Care Alone for the Treatment of Emotional Exhaustion and Burnout Among Frontline Health Care Workers During the COVID-19 Pandemic: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2120603. [PMID: 34387679 PMCID: PMC8363917 DOI: 10.1001/jamanetworkopen.2021.20603] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Frontline health care professionals who work with patients with COVID-19 have an increased incidence of burnout symptoms. Cannabidiol (CBD) has anxiolytic and antidepressant properties and may be capable of reducing emotional exhaustion and burnout symptoms. OBJECTIVE To investigate the safety and efficacy of CBD therapy for the reduction of emotional exhaustion and burnout symptoms among frontline health care professionals working with patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This prospective open-label single-site randomized clinical trial used a 1:1 block randomization design to examine emotional exhaustion and burnout symptoms among frontline health care professionals (physicians, nurses, and physical therapists) working with patients with COVID-19 at the Ribeirão Preto Medical School University Hospital in São Paulo, Brazil. Participants were enrolled between June 12 and November 12, 2020. A total of 214 health care professionals were recruited and assessed for eligibility, and 120 participants were randomized in a 1:1 ratio by a researcher who was not directly involved with data collection. INTERVENTIONS Cannabidiol, 300 mg (150 mg twice per day), plus standard care or standard care alone for 28 days. MAIN OUTCOMES AND MEASURES The primary outcome was emotional exhaustion and burnout symptoms, which were assessed for 28 days using the emotional exhaustion subscale of the Brazilian version of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. RESULTS A total of 120 participants were randomized to receive either CBD, 300 mg, plus standard care (treatment arm; n = 61) or standard care alone (control arm; n = 59) for 28 days. Of those, 118 participants (59 participants in each arm; 79 women [66.9%]; mean age, 33.6 years [95% CI, 32.3-34.9 years]) received the intervention and were included in the efficacy analysis. In the treatment arm, scores on the emotional exhaustion subscale of the Maslach Burnout Inventory significantly decreased at day 14 (mean difference, 4.14 points; 95% CI, 1.47-6.80 points; partial eta squared [ηp2] = 0.08), day 21 (mean difference, 4.34 points; 95% CI, 0.94-7.73 points; ηp2 = 0.05), and day 28 (mean difference, 4.01 points; 95% CI, 0.43-7.59 points; ηp2 = 0.04). However, 5 participants, all of whom were in the treatment group, experienced serious adverse events: 4 cases of elevated liver enzymes (1 critical and 3 mild, with the mild elevations reported at the final 28-day assessment) and 1 case of severe pharmacodermia. In 2 of those cases (1 with critical elevation of liver enzymes and 1 with severe pharmacodermia), CBD therapy was discontinued, and the participants had a full recovery. CONCLUSIONS AND RELEVANCE In this study, CBD therapy reduced symptoms of burnout and emotional exhaustion among health care professionals working with patients during the COVID-19 pandemic. However, it is necessary to balance the benefits of CBD therapy with potential undesired or adverse effects. Future double-blind placebo-controlled clinical trials are needed to confirm the present findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04504877.
Collapse
Affiliation(s)
- José Alexandre S. Crippa
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
| | - Antonio W. Zuardi
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
| | - Francisco S. Guimarães
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alline Cristina Campos
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Flávia de Lima Osório
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
| | - Sonia Regina Loureiro
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rafael G. dos Santos
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
| | - José Diogo S. Souza
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Juliana Mayumi Ushirohira
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Julia Cozar Pacheco
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rafael Rinaldi Ferreira
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karla Cristinne Mancini Costa
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Davi Silveira Scomparin
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Franciele Franco Scarante
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Isabela Pires-Dos-Santos
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Raphael Mechoulam
- Institute for Drug Research, School of Pharmacy, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Flávio Kapczinski
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Benedito A. L. Fonseca
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Danillo L. A. Esposito
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karina Pereira-Lima
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Srijan Sen
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | | | - Jaime E. C. Hallak
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
| |
Collapse
|
55
|
Sholler DJ, Spindle TR, Cone EJ, Goffi E, Kuntz D, Mitchell JM, Winecker RE, Bigelow GE, Flegel RR, Vandrey R. Urinary Pharmacokinetic Profile of Cannabidiol (CBD), Δ9-Tetrahydrocannabinol (THC), and their Metabolites Following Oral and Vaporized CBD and Vaporized CBD-Dominant Cannabis Administration. J Anal Toxicol 2021; 46:494-503. [PMID: 34089060 DOI: 10.1093/jat/bkab059] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/16/2021] [Accepted: 06/04/2021] [Indexed: 11/14/2022] Open
Abstract
The market for products containing cannabidiol (CBD) is booming globally. However, the pharmacokinetics of CBD in different oral formulations and the impact of CBD use on urine drug testing outcomes for cannabis (e.g., 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (∆9-THCCOOH)) are understudied. This study characterized the urinary pharmacokinetics of CBD (100 mg) following vaporization or oral administration (including 3 formulations: gelcap, pharmacy-grade syrup, or Epidiolex) as well as vaporized CBD-dominant cannabis (containing 100 mg CBD and 3.7 mg Δ9-THC) in healthy adults (n=18). A subset of participants (n=6) orally administered CBD syrup following overnight fasting (versus low-fat breakfast). Urine specimens were collected before and for 58 hours after dosing on a residential research unit. Immunoassay (IA) screening (cutoffs: 20, 50, 100 ng/mL) for ∆9-THCCOOH was performed, and quantitation of cannabinoids was completed via LC-MS-MS. Urinary CBD concentrations (ng/mL) were higher after oral (mean Cmax: 734; mean Tmax: 4.7 h, n=18) versus vaporized CBD (mean Cmax: 240; mean Tmax: 1.3 h, n=18), and oral dose formulation significantly impacted mean Cmax (Epidiolex=1274 ng/mL, capsule=776 ng/mL, syrup=151 ng/mL, n=6/group) with little difference in Tmax. Overnight fasting had limited impact on CBD excretion in urine, and there was no evidence of CBD conversion to ∆8- or ∆9-THC in any route or formulation in which pure CBD was administered. Following acute administration of vaporized CBD-dominant cannabis, 3 of 18 participants provided a total of 6 urine samples in which ∆9-THCCOOH concentrations ≥15 ng/mL. All 6 specimens screened positive at a 20 ng/mL IA cutoff, and 2 of 6 screened positive at a 50 ng/mL cutoff. These data show that absorption/elimination of CBD is impacted by drug formulation, route of administration, and gastric contents. Although pure CBD is unlikely to impact drug testing, it is possible that hemp products containing low amounts of ∆9-THC may produce a cannabis-positive urine drug test.
Collapse
Affiliation(s)
- Dennis J Sholler
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - Tory R Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - Edward J Cone
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - Elia Goffi
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - David Kuntz
- Clinical Reference Laboratory, 8433 Quivira Rd, Lenexa, KS 66214, USA
| | - John M Mitchell
- RTI International, 3040 East Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Ruth E Winecker
- RTI International, 3040 East Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - George E Bigelow
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - Ronald R Flegel
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| |
Collapse
|
56
|
MacCallum CA, Eadie L, Barr AM, Boivin M, Lu S. Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain. Front Pharmacol 2021; 12:633168. [PMID: 33995035 PMCID: PMC8120104 DOI: 10.3389/fphar.2021.633168] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/08/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Chronic non-cancer pain (CNCP) is estimated to affect 20% of the adult population. Current United States and Canadian Chronic non-cancer pain guidelines recommend careful reassessment of the risk-benefit ratio for doses greater than 90 mg morphine equivalent dose (MED), due to low evidence for improved pain efficacy at higher morphine equivalent dose and a significant increase in morbidity and mortality. There are a number of human studies demonstrating cannabis opioid synergy. This preliminary evidence suggests a potential role of cannabis as an adjunctive therapy with or without opioids to optimize pain control. Methods: In 2017, the Canadian Opioid Guidelines Clinical Tool was created to encourage judicious opioid prescribing for CNCP patients and to reevaluate those who have been chronically using high MED. Mirroring this approach, we draw on our clinical experiences and available evidence to create a clinical tool to serve as a foundational clinical guideline for the initiation of medical cannabis in the management of CNCP patients using chronic opioid therapy. Findings: Following principles of harm reduction and risk minimization, we suggest cannabis be introduced in appropriately selected CNCP patients, using a stepwise approach, with the intent of pain management optimization. We use a structured approach to focus on low dose cannabis (namely, THC) initiation, slow titration, dose optimization and frequent monitoring. Conclusion: When low dose THC is introduced as an adjunctive therapy, we observe better pain control clinically with lower doses of opioids, improved pain related outcomes and reduced opioid related harm.
Collapse
Affiliation(s)
- Caroline A MacCallum
- Department of Medicine, Faculty of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, Faculty of Medicine, Division of Palliative Care, UBC, Vancouver, BC, Canada.,Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, Canada
| | - Lauren Eadie
- Department of Medicine, Faculty of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, UBC, Vancouver, BC, Canada
| | | | - Shaohua Lu
- Department of Medicine, Faculty of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
57
|
Fedorova EV, Wong CF, Ataiants J, Iverson E, Conn B, Lankenau SE. Cannabidiol (CBD) and other drug use among young adults who use cannabis in Los Angeles. Drug Alcohol Depend 2021; 221:108648. [PMID: 33676073 PMCID: PMC8462788 DOI: 10.1016/j.drugalcdep.2021.108648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cannabidiol (CBD) is purportedly a promising therapeutic agent to provide relief for a variety of medical conditions with mild or no psychoactive effects. However, little is known about young adults who use cannabis and CBD-dominant products, and associations between CBD use and other drug use. METHODS Young adults (aged 24-32) who currently used cannabis (n = 239) were surveyed in Los Angeles in March 2019 through March 2020. The sample was divided into CBD-dominant (at least 1:1 CBD:THC ratio) and THC-dominant product users. We described CBD forms, reasons and conditions for CBD use and examined between-group differences in sociodemographic characteristics, cannabis practices, health and other drug use. RESULTS CBD-dominant users were more likely to be female, use cannabis at lower frequency and amount (except for edible/drinkable/oral products), self-report medical motivation for cannabis use, use cannabis for pain and report more health problems. Oil, flower, topicals and sprays/drops/tinctures were the most prevalent CBD forms. Psychological problems and pain were commonly reported conditions and medical reasons for CBD use. CBD-dominant users were more likely to report illicit drug use, where psilocybin use was markedly different between the two groups. CONCLUSIONS CBD use was associated with health histories and motivations linked to pain and psychological problems. Positive association between CBD use and illicit drug use may indicate self-medication for psychological conditions. Future studies should evaluate the effectiveness of various CBD forms and dose regimens for treatment of pain and psychological problems, and as a potential intervention for decreasing other drug use and associated harms.
Collapse
Affiliation(s)
- Ekaterina V. Fedorova
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
| | - Carolyn F. Wong
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Research on Children, Youth, & Families, 4650 Sunset Blvd., MS #2, Los Angeles,
CA 90027, United States
| | - Janna Ataiants
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
| | - Ellen Iverson
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United
States
| | - Bridgid Conn
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States
| | - Stephen E. Lankenau
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
| |
Collapse
|
58
|
Shakil SSM, Gowan M, Hughes K, Azam MNK, Ahmed MN. A narrative review of the ethnomedicinal usage of Cannabis sativa Linnaeus as traditional phytomedicine by folk medicine practitioners of Bangladesh. J Cannabis Res 2021; 3:8. [PMID: 33741060 PMCID: PMC7980557 DOI: 10.1186/s42238-021-00063-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a worldwide interest in the use of Cannabis sativa for biomedicine purposes. Cannabis has ethnomedicinal usage as a natural medicine in Bangladesh and cultivated during the British Empire period for revenues. OBJECTIVE Folk medicine practitioners (FMPs) from different districts of Bangladesh have been using Cannabis sativa, but until now there have not been any compiled studies particularly regarding this practice. Hence, this review is an effort to retrieve the traditional usage of Cannabis sativa as a phytomedicine from published ethnomedicinal studies. METHODS AND MATERIALS Information was searched by using the search terms "ethnomedicinal Cannabis sativa and Bangladesh"; "Bangladesh cannabaceae and ethnomedicinal survey"; "ganja, bhang and folk medicine Bangladesh"; "tetrahydrocannabinol (THC), cannabinoid and therapeutic, clinical trial"; and "cannabis and pharmacological/biological" and retrieved from ethnobotanical articles available on PubMed, Scopus, Science Direct, and Google Scholar databases. A search of the relevant scientific literature also was conducted to assess the efficacy of the ethnomedicinal usage of Cannabis sativa. RESULTS While reviewing over 200 ethnomedicinal plants' survey articles, we found that FMPs of Bangladesh from 12 different districts used Cannabis sativa to treat cited ailments like sleep-associated problems (n=5), neuropsychiatric and CNS problems (n=5), and infections and respiratory problems (n=5) followed by rheumatism, gastrointestinal, gynecological (n=4 each), cancer, sexual, and other ailments including hypertension, headache, itch, increases bile secretion, abortifacient, dandruff, fever, and urinary problems (n=1 each). There are a total of 15 formulations identified from the 11 out of 18 ethnomedicinal plant survey reports. The leaf was the main plant part used (53.8%), followed by root (23%), seed (7.7%) and flower, inflorescence, resin, and all parts 3.8% respectively. CONCLUSIONS Sales and cultivation of Cannabis are illegal at present in Bangladesh, but the use of Cannabis sativa as a natural phytomedicine has been practiced traditionally by folk medicine practitioners of Bangladesh for many years and validated through relevant pharmacological justification. Although Cannabis sativa possesses ethnomedicinal properties in the folk medicine of Bangladesh, it is, furthermore, needed to conduct biological research to consolidate pharmacological justification about the prospects and challenges of Cannabis and cannabinoids' use in Bangladesh as safer biomedicine in the future.
Collapse
Affiliation(s)
| | - Matt Gowan
- The Canadian College of Naturopathic Medicine, Toronto, Ontario Canada
| | | | - Md. Nur Kabidul Azam
- Department of Genetic Engineering & Biotechnology, Jashore University of Science & Technology, Jashore, Bangladesh
| | - Md. Nasir Ahmed
- Biotechnology & Natural Medicine Division, TechB Nutrigenomics, Dhaka, Bangladesh
| |
Collapse
|