51
|
Clark M, Gritsenko V, Bonnici JS, Marinova T, Reznik A, Isralowitz R. Psychology Student Attitudes and Beliefs Toward Cannabis for Mental Health Purposes: a Cross National Comparison. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00280-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
|
52
|
Timler A, Bulsara C, Bulsara M, Vickery A, Smith J, Codde J. Use of cannabinoid-based medicine among older residential care recipients diagnosed with dementia: study protocol for a double-blind randomised crossover trial. Trials 2020; 21:188. [PMID: 32059690 PMCID: PMC7023743 DOI: 10.1186/s13063-020-4085-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 01/18/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Dementia is a neurological condition that affects the cognitive and functional ability of the brain and is the leading cause of disability among those aged 65 years and above. More effective ways to manage dementia symptoms are needed because current treatment options (antidepressants and antipsychotics) can be ineffective and are associated with substantial side effects, including increased rate of mortality. Cannabinoid-based medicine (CBM) has shown an ability to inhibit some symptoms associated with dementia, and the adverse effects are often minimal; yet, little research has explored the use of CBM among this population. AIM To monitor the safety of a purified dose of CBM oil (3:2 delta-9-tetrahydrocannabinol:cannabidiol) on behaviour symptoms, quality of life and discomfort caused by pain. METHODS/DESIGN We will carry out an 18-week, randomised, double-blind crossover trial that consists of a 2-week eligibility period, two 6-week treatment cycles, and two 2-week washout periods (between both cycles and after the second treatment cycle). We aim to recruit 50 participants with dementia who are living in residential aged-care facilities. The participants will be randomised into two groups and will receive a dose of either CBM oil or placebo for the first treatment cycle and the opposite medication for the second. Data will be collected using the Neuropsychiatric Inventory Questionnaire, the Cohen-Mansfield Agitation Inventory, the Quality of Life in Alzheimer's Disease questionnaire, and the Abbey Pain Scale on seven occasions. These will be completed by the participants, aged-care staff, and nominated next of kin or family members. The participants' heart rate and blood pressure will be monitored weekly, and their body composition and weight will be monitored fortnightly by a research nurse, to assess individual dose response and frailty. In addition, pre- and post-surveys will be administered to aged-care staff and family members to understand their perceptions of CBM and to inform proposed focus groups consisting of the aged-care staff and next of kin. DISCUSSION The study design has been informed by medical professionals and key stakeholders, including those working in the residential aged-care industry to ensure patient safety, collection of non-invasive measures, and methodological rigor and study feasibility. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12619000474156. Registered on 21 March 2019.
Collapse
Affiliation(s)
- Amanda Timler
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia.
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | | | - Jill Smith
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| |
Collapse
|
53
|
Vulfsons S, Minerbi A, Sahar T. Cannabis and Pain Treatment-A Review of the Clinical Utility and a Practical Approach in Light of Uncertainty. Rambam Maimonides Med J 2020; 11:RMMJ.10385. [PMID: 32017678 PMCID: PMC7000155 DOI: 10.5041/rmmj.10385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Over the past decade the phenomenon of cannabis as a legitimate form of treatment for pain has overwhelmed the medical community, especially in the field of pain. From a status of a schedule 1 substance having no currently accepted medical use and being considered to have high potential for abuse, its use has mushroomed to over 50,000 legal medical users per year in Israel alone. There appear to be many reasons behind this phenomenon-medical, sociological, and economical. Thus, what is cannabis? An abusive substance or a medication? Should it be incorporated into current biomedical practice, and how should it be administered? Finally, what is the evidence for the beneficial and detrimental effects of cannabis? This article reviews and discusses the current literature regarding the beneficial and the detrimental effects of medical cannabis in the treatment of pain. We further discuss the problems and challenges facing the medical community in this domain and offer a practical approach to deal with these challenges.
Collapse
Affiliation(s)
- Simon Vulfsons
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel
- Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Amir Minerbi
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel
- Alan Edwards Centre for Research on Pain, Montreal, Quebec, Canada
| | - Tali Sahar
- Pain Relief Unit, Department of Anesthesia, Hadassah Medical Center, Jerusalem, Israel
- Supportive Care & Pain Relief Clinic, Clalit Health Services, Jerusalem District, Israel
- Department of Family Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
54
|
Cifelli P, Ruffolo G, De Felice E, Alfano V, van Vliet EA, Aronica E, Palma E. Phytocannabinoids in Neurological Diseases: Could They Restore a Physiological GABAergic Transmission? Int J Mol Sci 2020; 21:E723. [PMID: 31979108 PMCID: PMC7038116 DOI: 10.3390/ijms21030723] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 01/19/2023] Open
Abstract
γ-Aminobutyric acid type A receptors (GABAARs) are the main inhibitory mediators in the central nervous system (CNS). GABAARs are pentameric ligand gated ion channels, and the main subunit composition is usually 2α2βγ, with various isotypes assembled within a set of 19 different subunits. The inhibitory function is mediated by chloride ion movement across the GABAARs, activated by synaptic GABA release, reducing neuronal excitability in the adult CNS. Several studies highlighted the importance of GABA-mediated transmission during neuro-development, and its involvement in different neurological and neurodevelopmental diseases, from anxiety to epilepsy. However, while it is well known how different classes of drugs are able to modulate the GABAARs function (benzodiazepines, barbiturates, neurosteroids, alcohol), up to now little is known about GABAARs and cannabinoids interaction in the CNS. Endocannabinoids and phytocannabinoids are lately emerging as a new class of promising drugs for a wide range of neurological conditions, but their safety as medication, and their mechanisms of action are still to be fully elucidated. In this review, we will focus our attention on two of the most promising molecules (Δ9-tetrahydrocannabinol; Δ9-THC and cannabidiol; CBD) of this new class of drugs and their possible mechanism of action on GABAARs.
Collapse
Affiliation(s)
| | - Gabriele Ruffolo
- IRCCS San Raffaele Pisana, 00163 Rome, Italy; (G.R.); (E.D.F.)
- Department of Physiology and Pharmacology, laboratory affiliated to Istituto Pasteur Italia, University of Rome Sapienza, 00185 Rome, Italy;
| | | | - Veronica Alfano
- Department of Physiology and Pharmacology, laboratory affiliated to Istituto Pasteur Italia, University of Rome Sapienza, 00185 Rome, Italy;
| | - Erwin Alexander van Vliet
- Amsterdam UMC, University of Amsterdam, Department of (Neuro) Pathology, 1105 Amsterdam, The Netherlands; (E.A.v.V.); (E.A.)
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, 1090 Amsterdam, The Netherlands
| | - Eleonora Aronica
- Amsterdam UMC, University of Amsterdam, Department of (Neuro) Pathology, 1105 Amsterdam, The Netherlands; (E.A.v.V.); (E.A.)
- Stichting Epilepsie Instellingen Nederland (SEIN), 0397 Heemstede, The Netherlands
| | - Eleonora Palma
- Department of Physiology and Pharmacology, laboratory affiliated to Istituto Pasteur Italia, University of Rome Sapienza, 00185 Rome, Italy;
| |
Collapse
|
55
|
Montero-Oleas N, Arevalo-Rodriguez I, Nuñez-González S, Viteri-García A, Simancas-Racines D. Therapeutic use of cannabis and cannabinoids: an evidence mapping and appraisal of systematic reviews. BMC Complement Med Ther 2020; 20:12. [PMID: 32020875 PMCID: PMC7076827 DOI: 10.1186/s12906-019-2803-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 12/22/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although cannabis and cannabinoids are widely used with therapeutic purposes, their claimed efficacy is highly controversial. For this reason, medical cannabis use is a broad field of research that is rapidly expanding. Our objectives are to identify, characterize, appraise, and organize the current available evidence surrounding therapeutic use of cannabis and cannabinoids, using evidence maps. METHODS We searched PubMed, EMBASE, The Cochrane Library and CINAHL, to identify systematic reviews (SRs) published from their inception up to December 2017. Two authors assessed eligibility and extracted data independently. We assessed methodological quality of the included SRs using the AMSTAR tool. To illustrate the extent of use of medical cannabis, we organized the results according to identified PICO questions using bubble plots corresponding to different clinical scenarios. RESULTS A total of 44 SRs published between 2001 and 2017 were included in this evidence mapping with data from 158 individual studies. We extracted 96 PICO questions in the following medical conditions: multiple sclerosis, movement disorders (e.g. Tourette Syndrome, Parkinson Disease), psychiatry conditions, Alzheimer disease, epilepsy, acute and chronic pain, cancer, neuropathic pain, symptoms related to cancer (e.g. emesis and anorexia related with chemotherapy), rheumatic disorders, HIV-related symptoms, glaucoma, and COPD. The evidence about these conditions is heterogeneous regarding the conclusions and the quality of the individual primary studies. The quality of the SRs was moderate to high according to AMSTAR scores. CONCLUSIONS Evidence on medical uses of cannabis is broad. However, due to methodological limitations, conclusions were weak in most of the assessed comparisons. Evidence mapping methodology is useful to perform an overview of available research, since it is possible to systematically describe the extent and distribution of evidence, and to organize scattered data.
Collapse
Affiliation(s)
- Nadia Montero-Oleas
- Centro de investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud "Eugenio Espejo", Universidad UTE, Quito, Ecuador.
| | - Ingrid Arevalo-Rodriguez
- Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Solange Nuñez-González
- Centro de investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud "Eugenio Espejo", Universidad UTE, Quito, Ecuador
| | - Andrés Viteri-García
- Centro de investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud "Eugenio Espejo", Universidad UTE, Quito, Ecuador
| | - Daniel Simancas-Racines
- Centro de investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud "Eugenio Espejo", Universidad UTE, Quito, Ecuador
| |
Collapse
|
56
|
Pratt M, Stevens A, Thuku M, Butler C, Skidmore B, Wieland LS, Clemons M, Kanji S, Hutton B. Benefits and harms of medical cannabis: a scoping review of systematic reviews. Syst Rev 2019; 8:320. [PMID: 31823819 PMCID: PMC6905063 DOI: 10.1186/s13643-019-1243-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/24/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There has been increased interest in the role of cannabis for treating medical conditions. The availability of different cannabis-based products can make the side effects of exposure unpredictable. We sought to conduct a scoping review of systematic reviews assessing benefits and harms of cannabis-based medicines for any condition. METHODS A protocol was followed throughout the conduct of this scoping review. A protocol-guided scoping review conduct. Searches of bibliographic databases (e.g., MEDLINE®, Embase, PsycINFO, the Cochrane Library) and gray literature were performed. Two people selected and charted data from systematic reviews. Categorizations emerged during data synthesis. The reporting of results from systematic reviews was performed at a high level appropriate for a scoping review. RESULTS After screening 1975 citations, 72 systematic reviews were included. The reviews covered many conditions, the most common being pain management. Several reviews focused on management of pain as a symptom of conditions such as multiple sclerosis (MS), injury, and cancer. After pain, the most common symptoms treated were spasticity in MS, movement disturbances, nausea/vomiting, and mental health symptoms. An assessment of review findings lends to the understanding that, although in a small number of reviews results showed a benefit for reducing pain, the analysis approach and reporting in other reviews was sub-optimal, making it difficult to know how consistent findings are when considering pain in general. Adverse effects were reported in most reviews comparing cannabis with placebo (49/59, 83%) and in 20/24 (83%) of the reviews comparing cannabis to active drugs. Minor adverse effects (e.g., drowsiness, dizziness) were common and reported in over half of the reviews. Serious harms were not as common, but were reported in 21/59 (36%) reviews that reported on adverse effects. Overall, safety data was generally reported study-by-study, with few reviews synthesizing data. Only one review was rated as high quality, while the remaining were rated of moderate (n = 36) or low/critically low (n = 35) quality. CONCLUSIONS Results from the included reviews were mixed, with most reporting an inability to draw conclusions due to inconsistent findings and a lack of rigorous evidence. Mild harms were frequently reported, and it is possible the harms of cannabis-based medicines may outweigh benefits. SYSTEMATIC REVIEW REGISTRATION The protocol for this scoping review was posted in the Open Access (https://ruor.uottawa.ca/handle/10393/37247).
Collapse
Affiliation(s)
- Misty Pratt
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8 L6 Canada
| | - Adrienne Stevens
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8 L6 Canada
- TRIBE Graduate Program, University of Split School of Medicine, Split, Croatia
| | - Micere Thuku
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8 L6 Canada
| | - Claire Butler
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8 L6 Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec H3A 2B4 Canada
| | | | - L. Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD USA
| | - Mark Clemons
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8 M5 Canada
- Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Salmaan Kanji
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8 M5 Canada
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8 L6 Canada
- School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8 M5 Canada
| |
Collapse
|
57
|
Sarzi-Puttini P, Ablin J, Trabelsi A, Fitzcharles MA, Marotto D, Häuser W. Cannabinoids in the treatment of rheumatic diseases: Pros and cons. Autoimmun Rev 2019; 18:102409. [PMID: 31648042 DOI: 10.1016/j.autrev.2019.102409] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 12/23/2022]
Abstract
Medical cannabis is being increasingly used in the treatment of rheumatic diseases because, despite the paucity of evidence regarding its safety and efficacy, a growing number of countries are legalising its use for medical purposes in response to social pressure. Cannabinoids may be useful in the management of rheumatic disorders for two broad reasons: their anti-inflammatory and immunomodulatory activity, and their effects on pain and associated symptoms. It is interesting to note that, although a wide range of medications are available for the treatment of inflammation, including an ever-lengthening list of biological medications, the same is not true of the treatment of chronic pain, a cardinal symptom of many rheumatological disorders. The publication of systematic reviews (SR) concerning the use of cannabis-based medicines for chronic pain (with and without meta-analyses) is outpacing that of randomised controlled trials. Furthermore, narrative reviews of public institution are largely based on these SRs, which often reach different conclusions regarding the efficacy and safety of cannabis-based medicines because of the lack of high-quality evidence of efficacy and the presence of indications that they may be harmful for patients. Societal safety concerns about medical cannabis (e.g. driving risks, workplace safety and pediatric intoxication) must always be borne in mind, and will probably not be addressed by clinical studies. Medical cannabis and cannabis-based medicines have often been legalised as therapeutic products by legislative bodies without going through the usual process of regulatory approval founded on the results of traditional evidence-based studies. This review discusses the advantages and limitations of using cannabis to treat rheumatic conditions.
Collapse
Affiliation(s)
- Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, University of Milan School of Medicine, Milan, Italy.
| | - Jacob Ablin
- Department of Internal Medicine H, Tel Aviv Sourasky Medical Center & Sackler School of Medicine, Tel Aviv University, Israel
| | - Adva Trabelsi
- Department of Internal Medicine H, Tel Aviv Sourasky Medical Center & Sackler School of Medicine, Tel Aviv University, Israel
| | - Mary-Ann Fitzcharles
- Alan Edwards Pain Management Unit, McGill University Health Centre, Quebec, Canada; Division of Rheumatology, McGill University Health Centre, Quebec, Canada
| | - Daniela Marotto
- Rheumatology Unit, P.Dettori Hospital, Tempio Pausania, Italy
| | - Winfried Häuser
- Internal Medicine Department I, Klinikum Saarbrücken, Saarbrücken, Germany; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
| |
Collapse
|
58
|
The endocannabinoid system: Novel targets for treating cancer induced bone pain. Biomed Pharmacother 2019; 120:109504. [PMID: 31627091 DOI: 10.1016/j.biopha.2019.109504] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/16/2019] [Accepted: 09/26/2019] [Indexed: 02/08/2023] Open
Abstract
Treating Cancer-induced bone pain (CIBP) continues to be a major clinical challenge and underlying mechanisms of CIBP remain unclear. Recently, emerging body of evidence suggested the endocannabinoid system (ECS) may play essential roles in CIBP. Here, we summarized the current understanding of the antinociceptive mechanisms of endocannabinoids in CIBP and discussed the beneficial effects of endocannabinoid for CIBP treatment. Targeting non-selective cannabinoid 1 receptors or selective cannabinoid 2 receptors, and modulation of peripheral AEA and 2-AG, as well as the inhibition the function of fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL) have produced analgesic effects in animal models of CIBP. Management of ECS therefore appears to be a promising way for the treatment of CIBP in terms of efficacy and safety. Further clinical studies are encouraged to confirm the possible translation to humans of the very promising results already obtained in the preclinical studies.
Collapse
|
59
|
Howell K, Washington A, Williams PM, Mathis AL, Luque JS. Medical Marijuana Policy Reform Reaches Florida: A Scoping Review. FLORIDA PUBLIC HEALTH REVIEW 2019; 16:128-136. [PMID: 31891164 PMCID: PMC6936729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Florida became the first state in the U.S. South to legalize the use of medical marijuana to treat a variety of health conditions including chronic pain, epilepsy, and spasticity symptoms from multiple sclerosis. While there are over 200,000 medical marijuana patients in Florida, there remain financial, psychological, and insurance coverage barriers which reduce access for many patients. PURPOSE This scoping review, with a focus on state health policy, first describes some clinical studies examining the therapeutic benefits of medical marijuana. Next, there is a discussion of the Florida regulatory environment and major legislation. Also, the review describes how the current Florida policy landscape presents challenges for physicians and patients. METHODS A scoping review of the literature was conducted in PubMed and Google Scholar using the search terms, "medical marijuana" and "medical cannabis" to identify research articles, newspaper reports, and government documents. The purpose of the review was to identify research investigating the therapeutic efficacy of medical marijuana and state policies affecting physician practice. RESULTS The review concluded there was general scientific consensus of therapeutic benefits for patients, especially for chronic pain, from the use of medical marijuana. The review also identified several barriers for physicians and patients around cost, stigma, and lack of insurance coverage which constrains use and access. DISCUSSION The review discusses several directions for future medical marijuana policy and research with the aim to improve therapeutic benefits for Florida patients.
Collapse
Affiliation(s)
- Khadesia Howell
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - Alexandria Washington
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - Paula M Williams
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - Arlesia L Mathis
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| | - John S Luque
- Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health. Tallahassee, FL
| |
Collapse
|
60
|
Evans M, Ogeil RP, Phillips JG. Cannabis, Decision-Making, and Online Assistance Seeking. Am J Addict 2019; 28:473-479. [PMID: 31532567 DOI: 10.1111/ajad.12960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/11/2019] [Accepted: 09/01/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Maladaptive decision-making strategies could contribute to cannabis-related problems, as some individuals may neither select safe patterns of cannabis use, nor seek treatment. METHODS To explore decision-making styles and their relationship to cannabis-related harm, 153 respondents completed the Cannabis Use Disorders Identification Test-Revised (CUDIT-R), the Melbourne Decision Making Questionnaire (MDMQ), and answered questions about their willingness to seek online: (1) further information or (2) treatment for cannabis-related issues. RESULTS Multiple regression considered relationships between problematic cannabis use, decision-making style, and cannabis use within the past month. Subscales of the CUDIT-R revealed that: (1) hazardous use was associated with higher hypervigilance and higher decisional self-esteem; (2) dependence symptoms were associated with lower vigilance and higher procrastination; and (3) harmful use was associated with higher procrastination. People with symptoms of CUD were less likely to seek further help or support online if prone to procrastination or buckpasssing. DISCUSSION AND CONCLUSIONS Decisional style influenced cannabis use and symptoms. Those people with cannabis-related problems that did not seek online assistance were defensively avoidant. SCIENTIFIC SIGNIFICANCE Procrastination is a feature of problematic cannabis use. Online offers of assistance may be ignored by defensively avoidant CUD clients. (Am J Addict 2019;00:1-7).
Collapse
Affiliation(s)
- Mark Evans
- Department of Psychology, Auckland University of Technology, Akoranga Campus, Auckland, New Zealand
| | - Rowan P Ogeil
- Population Health, Eastern Health Clinical School, Monash University and Turning Point, Melbourne, Victoria, Australia
| | - James G Phillips
- Department of Psychology, Auckland University of Technology, Akoranga Campus, Auckland, New Zealand
| |
Collapse
|
61
|
Zolotov Y, Vulfsons S, Sznitman S. Predicting Physicians' Intentions to Recommend Medical Cannabis. J Pain Symptom Manage 2019; 58:400-407. [PMID: 31145978 DOI: 10.1016/j.jpainsymman.2019.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/16/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Although medical cannabis (MC) policies continue to evolve around the world, the integration of MC into clinical practice remains highly debated within the medical community. OBJECTIVES Relying on the Theory of Planned Behavior (TPB), this study aim was to identify underlying factors that influence physicians' intentions to recommend MC to patients and to examine whether there are differences in the strength of these associations across three medical specialties (family medicine, oncology, and pain medicine). METHODS 247 physicians completed questionnaires including measures of TPB constructs (attitudes, subjective norms, and perceived behavioral control) and intentions to recommend MC to two clinical vignettes describing medical background of a cancer and a chronic pain patient. Regression models were used to measure the extent to which perceived knowledge and TPB constructs predict physicians' intentions to recommend MC. RESULTS Physicians' intentions to recommend MC to the cancer patient vignette was higher than their intentions to recommend to the chronic pain patient vignette. Intentions to recommend MC to the patient with cancer were associated with more favorable attitudes toward MC, whereas intentions to recommend MC to the patient with chronic pain were associated with more favorable attitudes, higher levels of perceived control, and lower levels of perceived knowledge. CONCLUSION Clinical practices related to MC may be influenced by nonmedical factors, and this may be particularly prevailing in the field of chronic pain, suggesting that MC may be particularly contentious in this field.
Collapse
Affiliation(s)
- Yuval Zolotov
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Simon Vulfsons
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sharon Sznitman
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
62
|
Welling MT, Liu L, Hazekamp A, Dowell A, King GJ. Developing Robust Standardised Analytical Procedures for Cannabinoid Quantification: Laying the Foundations for an Emerging Cannabis-Based Pharmaceutical Industry. Med Cannabis Cannabinoids 2019; 2:1-13. [PMID: 34676328 PMCID: PMC8489335 DOI: 10.1159/000496868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/12/2019] [Indexed: 04/04/2024] Open
Abstract
The plant genus Cannabis is a prolific producer of unique pharmaceutically relevant metabolites, commonly referred to as cannabinoids. Robust and standardised methods for the quantification of cannabinoids within botanical and drug forms is a critical step forward for an emerging Cannabis-based pharmaceutical industry, which is poised for rapid expansion. Despite a growing body of analytical methods for the quantification of cannabinoids, few have been validated using internationally accredited guidelines. Moreover, standardised methods have yet to be developed for application at various stages of manufacture as well as for different levels of processing and refinement. Validation parameters for establishing robust standardised methods for cannabinoid quantification within Cannabis-based drug forms are critically discussed. Determining an appropriate level of specificity (discrimination) among heterogeneous botanical matrices as well as evaluating accuracy (recovery) and inter-laboratory precision (reproducibility) within strict and volatile regulatory environments are potential obstacles to the establishment of robust analytical procedures. We argue that while some of these challenges remain unique to Cannabis, others are common to botanical-based drug development and manufacture. In order to address potential barriers to analytical method standardisation, a collaborative research initiative inclusive of academic and commercial stakeholders is proposed.
Collapse
Affiliation(s)
- Matthew T. Welling
- Southern Cross Plant Science, Southern Cross University, Lismore, New South Wales, Australia
| | - Lei Liu
- Southern Cross Plant Science, Southern Cross University, Lismore, New South Wales, Australia
| | - Arno Hazekamp
- Hazekamp Herbal Consulting BV, Leiden, The Netherlands
| | - Ashley Dowell
- Southern Cross Plant Science, Southern Cross University, Lismore, New South Wales, Australia
| | - Graham J. King
- Southern Cross Plant Science, Southern Cross University, Lismore, New South Wales, Australia
| |
Collapse
|
63
|
Treister-Goltzman Y, Freud T, Press Y, Peleg R. Trends in Publications on Medical Cannabis from the Year 2000. Popul Health Manag 2019; 22:362-368. [DOI: 10.1089/pop.2018.0113] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yulia Treister-Goltzman
- Clalit Health Services, Southern District, Israel
- The Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Freud
- The Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yan Press
- Clalit Health Services, Southern District, Israel
- The Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roni Peleg
- Clalit Health Services, Southern District, Israel
- The Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
64
|
Shah A, Hayes CJ, Lakkad M, Martin BC. Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use. J Gen Intern Med 2019; 34:1419-1426. [PMID: 30684198 PMCID: PMC6667507 DOI: 10.1007/s11606-018-4782-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/11/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the association of medical marijuana legalization with prescription opioid utilization. METHODS A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006-2014. Adults with pharmacy and medical benefits for the entire calendar year were included in the population for that year. Multilevel logistic regression analysis, controlling for patient, person-year, and state-level factors, were used to determine the impact of medical marijuana legalization on the three opioid use measures. Sub-group analysis among cancer-free adults and cancer-free adults with at least one chronic non-cancer pain condition in the particular year were conducted. Alternate regression models were used to test the robustness of our results including a fixed effects model, an alternate definition for start date for medical marijuana legalization, a person-level analysis, and a falsification test. RESULTS The final sample included a total of 4,840,562 persons translating into 15,705,562 person years. Medical marijuana legalization was found to be associated with a lower odds of any opioid use: OR = 0.95 (0.94-0.96), chronic opioid use: OR = 0.93 (0.91-0.95), and high-risk opioid use: OR = 0.96 (0.94-0.98). The findings were similar in both the sub-group analyses and all the sensitivity analyses. The falsification tests showed no association between medical marijuana legalization and prescriptions for antihyperlipidemics (OR = 1.00; CI 0.99-1.01) or antihypertensives (OR = 1.00; CI 0.99-1.01). CONCLUSIONS In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed. Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use. However, further research assessing risk versus benefits of medical marijuana legalization and head to head comparisons of marijuana versus opioids for pain management is required.
Collapse
Affiliation(s)
- Anuj Shah
- Pharmerit International, Bethesda, MD, USA
| | - Corey J Hayes
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Division of Health Services Research, Psychiatric Research Institute, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mrinmayee Lakkad
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bradley C Martin
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| |
Collapse
|
65
|
Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J 2019; 23:18-041. [PMID: 30624194 DOI: 10.7812/tpp/18-041] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Cannabidiol (CBD) is one of many cannabinoid compounds found in cannabis. It does not appear to alter consciousness or trigger a "high." A recent surge in scientific publications has found preclinical and clinical evidence documenting value for CBD in some neuropsychiatric disorders, including epilepsy, anxiety, and schizophrenia. Evidence points toward a calming effect for CBD in the central nervous system. Interest in CBD as a treatment of a wide range of disorders has exploded, yet few clinical studies of CBD exist in the psychiatric literature. OBJECTIVE To determine whether CBD helps improve sleep and/or anxiety in a clinical population. DESIGN A large retrospective case series at a psychiatric clinic involving clinical application of CBD for anxiety and sleep complaints as an adjunct to usual treatment. The retrospective chart review included monthly documentation of anxiety and sleep quality in 103 adult patients. MAIN OUTCOME MEASURES Sleep and anxiety scores, using validated instruments, at baseline and after CBD treatment. RESULTS The final sample consisted of 72 adults presenting with primary concerns of anxiety (n = 47) or poor sleep (n = 25). Anxiety scores decreased within the first month in 57 patients (79.2%) and remained decreased during the study duration. Sleep scores improved within the first month in 48 patients (66.7%) but fluctuated over time. In this chart review, CBD was well tolerated in all but 3 patients. CONCLUSION Cannabidiol may hold benefit for anxiety-related disorders. Controlled clinical studies are needed.
Collapse
Affiliation(s)
- Scott Shannon
- Department of Psychiatry, University of Colorado, Denver
| | - Nicole Lewis
- Department of Naturopathic Medicine, Wholeness Center, Fort Collins, CO
| | | | - Shannon Hughes
- School of Social Work, Colorado State University College of Health and Human Sciences, Fort Collins
| |
Collapse
|
66
|
Marijuana's Effects on Brain Structure and Function: What Do We Know and What Should We Do? A Brief Review and Commentary. Am J Med 2019; 132:281-285. [PMID: 30240677 DOI: 10.1016/j.amjmed.2018.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 01/15/2023]
Abstract
The recent US Food and Drug Administration approval of the marijuana constituent cannabidiol as safe and effective for treatment of 2 rare forms of epilepsy has raised hopes that others of the 500 chemicals in marijuana will be found to be therapeutic. However, the long-term consequences of street marijuana use are unclear, and recent studies raise red flags about its effects. Changes in brain maturation and intellectual function, including decreases in intelligence quotient, have been noted in chronic users and appear permanent in early users in most but not all studies. These studies suggest that at a minimum, regular marijuana use should be discouraged in individuals under the age of 21.
Collapse
|
67
|
Subramaniam VN, Menezes AR, DeSchutter A, Lavie CJ. The Cardiovascular Effects of Marijuana: Are the Potential Adverse Effects Worth the High? MISSOURI MEDICINE 2019; 116:146-153. [PMID: 31040502 PMCID: PMC6461323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Marijuana is the most commonly abused illicit drug in the United States (US) and much of the Westernized World with a steadily increasing prevalence in usage and abuse over the past decade, especially among adolescents. Much of the available data on 9-tetrahydrocannabinol (THC), the main psychoactive ingredient in marijuana, relates to its neurological effects and anti-emetic properties, with very little on the cardiovascular (CV) effects of THC. Available literature shows that THC has three major effects on the CV and the peripheral vasculature in the form of "cannabis arteritis," cannabis-induced vasospasms, and platelet aggregation, with an unknown verdict on the relationship between marijuana use and atherosclerosis progression. This manuscript reviews these effects and possible mechanisms of action. Moreover, limitations on current views of marijuana and indirect causes of CV toxicity will be investigated, such as concurrent drug use, lifestyle, and mental health. The effects of marijuana on the CV system are extremely worrisome and likely need more attention due to the growing legalization of cannabis for medicinal and recreational use across the US. As a result, awareness among health care professionals about potential side effects and toxicities associated with acute and chronic exposure of cannabis will increase in importance.
Collapse
Affiliation(s)
- Venkat N Subramaniam
- Venkat N. Subramaniam, MD, MS, was previously a medical student, and Arthur R. Menezes, MD, and Alban DeSchutter, MD, were previously cardiovascular fellows at Ochsner, and Carl J. Lavie, MD, currently works in the Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana. Dr. Subramaniam is currently affiliated with the Banner University Medical Center, Phoenix, Arizona
| | - Arthur R Menezes
- Venkat N. Subramaniam, MD, MS, was previously a medical student, and Arthur R. Menezes, MD, and Alban DeSchutter, MD, were previously cardiovascular fellows at Ochsner, and Carl J. Lavie, MD, currently works in the Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana. Dr. Subramaniam is currently affiliated with the Banner University Medical Center, Phoenix, Arizona
| | - Alban DeSchutter
- Venkat N. Subramaniam, MD, MS, was previously a medical student, and Arthur R. Menezes, MD, and Alban DeSchutter, MD, were previously cardiovascular fellows at Ochsner, and Carl J. Lavie, MD, currently works in the Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana. Dr. Subramaniam is currently affiliated with the Banner University Medical Center, Phoenix, Arizona
| | - Carl J Lavie
- Venkat N. Subramaniam, MD, MS, was previously a medical student, and Arthur R. Menezes, MD, and Alban DeSchutter, MD, were previously cardiovascular fellows at Ochsner, and Carl J. Lavie, MD, currently works in the Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana. Dr. Subramaniam is currently affiliated with the Banner University Medical Center, Phoenix, Arizona
| |
Collapse
|
68
|
Ho C, Martinusen D, Lo C. A Review of Cannabis in Chronic Kidney Disease Symptom Management. Can J Kidney Health Dis 2019; 6:2054358119828391. [PMID: 30828459 PMCID: PMC6388458 DOI: 10.1177/2054358119828391] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/16/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE OF REVIEW Physical and psychological symptom burden in patients with advanced chronic kidney disease (CKD) is significantly debilitating; yet, it is often inadequately treated. Legalization of cannabis in Canada may attract increasing interest from patients for its medical use in refractory symptom management, but its indications and long-term adverse health impacts are poorly established, creating a challenge for clinicians to support its use. In this review, we summarize key clinical studies and the level of evidence for nonsynthetic cannabinoids in the treatment of common symptoms encountered in advanced stages of CKD, including chronic pain, nausea and vomiting, anorexia, pruritus, and insomnia. SOURCES OF INFORMATION Medline and Embase. METHODS A search was conducted in MEDLINE and EMBASE (inception to March 1, 2018) on cannabis and CKD symptoms of interest, complemented with a manual review of bibliographies. Studies that examined synthetic cannabinoids that are manufactured to mimic the effects of ∆9-tetrahydrocannabinol such as dronabinol, levonantradol, nabilone, and ajulemic acid were excluded. We focused on studies with higher level of evidence where available, and quality of studies was graded based on the Oxford Centre for Evidence-based Medicine Levels of Evidence (1a to 5). FINDINGS Based on studies conducted in patients without renal impairment, those treated with nonsynthetic cannabinoids were 43% to 300% more likely to report a ≥30% reduction in chronic neuropathic pain compared with placebo. However, there is currently insufficient evidence to recommend nonsynthetic cannabinoids for other medical indications, although preliminary investigation into topical endocannabinoids for uremia-induced pruritus in end-stage renal disease is promising. Finally, any benefits of cannabis may be offset by potential harms in the form of cognitive impairment, increased risk of mortality post-myocardial infarction, orthostatic hypotension, respiratory irritation, and malignancies (with smoked cannabis). LIMITATIONS Nonsynthetic cannabinoid preparations were highly variable between studies, sample sizes were small, and study durations were short. Due to an absence of studies conducted in CKD, recommendations were primarily extrapolated from the general population. IMPLICATIONS Until further studies are conducted, the role of nonsynthetic cannabinoids for symptom management in patients with CKD should be limited to the treatment of chronic neuropathic pain. Clinicians need to be cognizant that nonsynthetic cannabinoid preparations, particularly smoked cannabis, can pose significant health risks and these must be cautiously weighed against the limited substantiated therapeutic benefits of cannabis in patients with CKD.
Collapse
Affiliation(s)
- Claudia Ho
- Fraser Health Renal Program, Surrey, BC, Canada
- University of British Columbia, Vancouver, Canada
| | - Dan Martinusen
- University of British Columbia, Vancouver, Canada
- Royal Jubilee Hospital, Island Health Authority, Victoria, BC, Canada
- BC Renal Agency, Vancouver, Canada
| | - Clifford Lo
- University of British Columbia, Vancouver, Canada
- BC Renal Agency, Vancouver, Canada
- Lower Mainland Pharmacy Services, Langley, BC, Canada
| |
Collapse
|
69
|
Abstract
Ohio's first medical marijuana dispensaries will open in the fall of 2018, so physicians, then, must decide whether they will participate. But is medical marijuana really medical? No, at best, it is an unproven botanical. Medicine today is progressively moving away from traditional understandings of health according to formal and final causation and toward wellness as an expanding, subjective ideal. Whereas patients are healthy if the doctor says so, patients are well if they say so. Pitched as a wellness product, cannabis presents itself as an existential palliative, part of an imminent cult of the body. Consequently, people often use cannabis to escape reality according to a new age mythos. Physicians can play their part by choosing not to certify for "medical" marijuana and seek to rediscover the body as more than mere dead matter in motion rather than insulating ourselves from the difficult questions of suffering, meaning, and purpose. SUMMARY Despite state-level legality, medical marijuana is not medical. Rather, it is often touted as part of a cult of the body to escape suffering and death.
Collapse
|
70
|
Loo JSE, Emtage A, Murali L, Lee SS, Kueh ALW, Alexander SPH. Ligand discrimination during virtual screening of the CB1 cannabinoid receptor crystal structures following cross-docking and microsecond molecular dynamics simulations. RSC Adv 2019; 9:15949-15956. [PMID: 35521393 PMCID: PMC9064321 DOI: 10.1039/c9ra01095e] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/16/2019] [Indexed: 01/04/2023] Open
Abstract
Ligands of inactive and active-state CB1 receptor crystal structures were swapped and virtual screening performance assessed after molecular dynamics simulations.
Collapse
Affiliation(s)
- Jason S. E. Loo
- School of Pharmacy
- Faculty of Health and Medical Sciences
- Taylor's University
- 47500 Subang Jaya
- Malaysia
| | - Abigail L. Emtage
- School of Pharmacy
- The University of Nottingham Malaysia Campus
- 43500 Semenyih
- Malaysia
| | - Lahari Murali
- School of Pharmacy
- The University of Nottingham Malaysia Campus
- 43500 Semenyih
- Malaysia
| | - Sze Siew Lee
- School of Pharmacy
- Faculty of Health and Medical Sciences
- Taylor's University
- 47500 Subang Jaya
- Malaysia
| | - Alvina L. W. Kueh
- School of Pharmacy
- Faculty of Health and Medical Sciences
- Taylor's University
- 47500 Subang Jaya
- Malaysia
| | | |
Collapse
|
71
|
Carty DR, Miller ZS, Thornton C, Pandelides Z, Kutchma ML, Willett KL. Multigenerational consequences of early-life cannabinoid exposure in zebrafish. Toxicol Appl Pharmacol 2018; 364:133-143. [PMID: 30594692 DOI: 10.1016/j.taap.2018.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022]
Abstract
While Δ9-tetrahydrocannabinol (THC) has been widely studied in the realm of developmental and reproductive toxicology, few studies have investigated potential toxicities from a second widely used cannabis constituent, cannabidiol (CBD). CBD is popularized for its therapeutic potential for reducing seizure frequencies in epilepsy. This study investigated developmental origins of health and disease (DOHaD) via multigenerational gene expression patterns, behavior phenotypes, and reproductive fitness of a subsequent F1 following an F0 developmental exposure of zebrafish (Danio rerio) to THC (0.024, 0.12, 0.6 mg/L; 0.08, 0.4, 2 μM) or CBD (0.006, 0.03, 0.15 mg/L; 0.02, 0.1, 0.5 μM). Embryonic exposure at these concentrations did not cause notable morphological abnormalities in either F0 or F1 generations. However, during key developmental stages (14, 24, 48, 72, and 96 h post fertilization) THC and CBD caused differential expression of c-fos, brain-derived neurotrophic factor (bdnf), and deleted-in-azoospermia like (dazl), while in F1 larvae only CBD differentially expressed dazl. Larval photomotor behavior was reduced (F0) or increased (F1) by THC exposure, while CBD had no effect on F0 larvae, but decreased activity in the unexposed F1 larvae. These results support our hypothesis of cannabinoid-related developmental neurotoxicity. As adults, F0 fecundity was reduced, but it was not in F1 adults. Conversely, in the adult open field test there were no significant effects in F0 fish, but a significant reduction in the time in periphery was seen in F1 fish from the highest THC exposure group. The results highlight the need to consider long-term ramifications of early-life exposure to cannabinoids.
Collapse
Affiliation(s)
- Dennis R Carty
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA; Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Zachary S Miller
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA
| | - Cammi Thornton
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA
| | - Zacharias Pandelides
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA
| | - Marisa L Kutchma
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA
| | - Kristine L Willett
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA.
| |
Collapse
|
72
|
Zarhin D, Negev M, Vulfsons S, Sznitman SR. Rhetorical and regulatory boundary-work: The case of medical cannabis policy-making in Israel. Soc Sci Med 2018; 217:1-9. [DOI: 10.1016/j.socscimed.2018.09.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 11/16/2022]
|
73
|
Wheeler JS, Hagemann TM. Medical marijuana in the United States: Historical perspectives, legal considerations, and professional obligations of the pharmacist. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- James S. Wheeler
- Department of Clinical Pharmacy and Translational Science The University of Tennessee Health Science Center College of Pharmacy Nashville Tennessee
| | - Tracy M. Hagemann
- Department of Clinical Pharmacy and Translational Science The University of Tennessee Health Science Center College of Pharmacy Nashville Tennessee
| |
Collapse
|
74
|
Perioperative Patient Beliefs Regarding Potential Effectiveness of Marijuana (Cannabinoids) for Treatment of Pain: A Prospective Population Survey. Reg Anesth Pain Med 2018; 42:652-659. [PMID: 28796754 DOI: 10.1097/aap.0000000000000654] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Cannabinoids have an expanding presence in medicine. Perioperative patients' perceptions of the effectiveness of these compounds, and acceptance if prescribed for pain, have not been previously described. Our primary objective was to describe patients' beliefs regarding the potential effectiveness of cannabinoids for the treatment of acute and chronic pain, as well as gauge patient acceptance of these compounds if prescribed by a physician. In addition, demographic and pain history data were collected to elucidate the predictors of the aforementioned patient attitudes. Secondarily, we sought to characterize the subgroup of patients who reported marijuana use. Predictors of marijuana use, effectiveness, and adverse effects were also reported for this subgroup. METHODS An anonymous questionnaire was administered to 501 patients in the preoperative registration area at Mount Sinai Hospital, New York, New York. The questionnaire was designed to collect data on patient demographics, presence of pain, pain severity, use of pain medication, history of illicit-drug use, tobacco use, cannabis use, patient beliefs about the potential effectiveness of marijuana for acute and chronic pain and their willingness to use cannabis for pain, if prescribed by a physician. Normality of distributions for continuous variables was assessed with skewness and kurtosis measures. A logistic regression model was used to assess the demographic and medical characteristics of marijuana users compared with nonusers. The effectiveness of marijuana in dealing with pain and adverse effects associated with its use were examined using exploratory principal component analysis. RESULTS More than 80% of this cohort of preoperative patients believed that marijuana could be at least somewhat effective for the treatment of pain after surgery and would be willing to use cannabinoid compounds if prescribed by their physician. Predictors of positive attitudes toward marijuana included history of marijuana use, pain history, and being a marijuana nonuser of white race. Approximately 27% of the respondents reported a history of marijuana use. Younger patients, those with higher levels of pain in the last 24 hours, and those who found standard therapies to be less effective for their pain were more likely to use marijuana. CONCLUSIONS Patients generally believe that marijuana could be at least somewhat effective for the management of pain and are willing to use cannabinoid compounds for this indication, if prescribed by a physician.
Collapse
|
75
|
Huson HB, Granados TM, Rasko Y. Surgical considerations of marijuana use in elective procedures. Heliyon 2018; 4:e00779. [PMID: 30225378 PMCID: PMC6139487 DOI: 10.1016/j.heliyon.2018.e00779] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Marijuana consumption is estimated as upwards of 9.5% of the U.S. adult population. Nevertheless, few trials exist on potential implications for surgical outcomes amongst users. METHODS A current literature review explored marijuana's effects to answer: (I) How is marijuana use screened for in clinical and pre-operative settings? (II) What are potential surgical complications of marijuana use? (III) How should surgeons handle patient marijuana use regarding elective surgery? (IV) Are marijuana's effects the same or different from those of tobacco? RESULTS In acute settings, marijuana's effects peaked at approximately 1 hour post initiation, lasting 2-4 hours. Marijuana increased cardiac workload, myocardial infarctions and strokes in young, chronic users. Cannabis caused similar pulmonary complications to those of a tobacco smoker. Marijuana caused airway obstruction and increased anesthetic dosages needed to place laryngeal airways. Use within 72 hours of general anesthesia was advised against. In vitro and in vivo studies were contradictory regarding prothrombic or antithrombotic effects. CONCLUSIONS Marijuana use is problematic to surgeons, left without evidence-based approaches. In emergency settings, marijuana use may be unavoidable. However, further research would provide much needed information to guide elective procedures.
Collapse
Affiliation(s)
- Henry B. Huson
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Yvonne Rasko
- Division of Plastic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| |
Collapse
|
76
|
Bryant LM, Daniels KE, Cognetti DM, Tassone P, Luginbuhl AJ, Curry JM. Therapeutic Cannabis and Endocannabinoid Signaling System Modulator Use in Otolaryngology Patients. Laryngoscope Investig Otolaryngol 2018; 3:169-177. [PMID: 30062131 PMCID: PMC6057224 DOI: 10.1002/lio2.154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/29/2018] [Accepted: 03/01/2018] [Indexed: 12/13/2022] Open
Abstract
Objectives 1) review benefits and risks of cannabis use, with emphasis on otolaryngic disease processes; 2) define and review the endocannabinoid signaling system (ESS); and 3) review state and federal regulations for the use and research of cannabis and ESS modulators. Methods This manuscript is a review of the current literature relevant to the stated objectives. Results Cannabis (marijuana) use is increasing. It is the most widely used illicit substance in the world. There is increasing interest in its therapeutic potential due to changing perceptions, new research, and legislation changes controlling its use. The legal classification of cannabis is complicated due to varied and conflicting state and federal laws. There are currently two synthetic cannabinoid drugs that are FDA approved. Current indications for use include chemotherapy‐related nausea and vomiting, cachexia, and appetite loss. Research has demonstrated potential benefit for use in many other pathologies including pain, inflammatory states, and malignancy. Data exists demonstrating potential antineoplastic benefit in oral, thyroid, and skin cancers. Conclusions ESS modulators may play both a causal and therapeutic role in several disorders seen in otolaryngology patients. The use of cannabis and cannabinoids is not without risk. There is a need for further research to better understand both the adverse and therapeutic effects of cannabis use. With increasing rates of consumption, elevated public awareness, and rapidly changing legislation, it is helpful for the otolaryngologist to be aware of both the adverse manifestations of use and the potential therapeutic benefits when talking with patients.
Collapse
Affiliation(s)
- Lucas M Bryant
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Kelly E Daniels
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| | - David M Cognetti
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Patrick Tassone
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Adam J Luginbuhl
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Joseph M Curry
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| |
Collapse
|
77
|
Sharon H, Goldway N, Goor-Aryeh I, Eisenberg E, Brill S. Personal experience and attitudes of pain medicine specialists in Israel regarding the medical use of cannabis for chronic pain. J Pain Res 2018; 11:1411-1419. [PMID: 30104896 PMCID: PMC6074811 DOI: 10.2147/jpr.s159852] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction The scientific study of the role of cannabis in pain medicine still lags far behind the growing use driven by public approval. Accumulated clinical experience is therefore an important source of knowledge. However, no study to date has targeted physicians who actually use cannabis in their daily practice. Methods Registered, active, board-certified pain specialists in Israel (n=79) were asked to complete a Web-based survey. The survey was developed using the Qualtrics Online Survey Software. Questions were formulated as multiple-choice questions, and these addressed three areas of interest: 1) doctors’ personal experience; 2) the role of cannabis in pain medicine; and 3) cannabis medicalization and legalization. Results Sixty-four percent of all practicing pain specialists in Israel responded. Almost all prescribe cannabis. Among them, 63% find cannabis moderately to highly effective, 56% have encountered mild or no side effects, and only 5% perceive it as significantly harmful. Common indications are neuropathic pain (65%), oncological pain (50%), arthralgias (25%), and any intractable pain (29%). Leading contraindications are schizophrenia (76%), pregnancy/breastfeeding (65%), and age <18 years (59%). Only 12% rated cannabis as more hazardous than opiates. On a personal note, 45% prefer cannabis for themselves or a family member. Lastly, 54% would like to see cannabis legalized in Israel. Conclusion In this survey, pain clinicians experienced in prescribing cannabis over prolonged periods view it as an effective and relatively safe treatment for chronic pain, based on their own experience. Their responses suggest a possible change of paradigm from using cannabis as the last resort.
Collapse
Affiliation(s)
- Haggai Sharon
- Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Center for Brain Functions, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, .,Pain Management and Neuromodulation Centre, Guy's and St Thomas' Hospital, London, UK,
| | - Noam Goldway
- Center for Brain Functions, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
| | | | - Elon Eisenberg
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion Institute for Technology, Haifa, Israel
| | - Silviu Brill
- Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, .,Goldman School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
78
|
Allen LA, Ambardekar AV. Hashing It Out Over Cannabis: Moving Toward a Standard Guideline on Substance Use for Cardiac Transplantation Eligibility That Includes Marijuana. Circ Heart Fail 2018; 9:CIRCHEARTFAILURE.116.003330. [PMID: 27413033 DOI: 10.1161/circheartfailure.116.003330] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Larry A Allen
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora.
| | - Amrut V Ambardekar
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
| |
Collapse
|
79
|
Abstract
PURPOSE OF REVIEW To review the literature on decriminalization of drug use from 2016 to 2017 and suggest the way forward. RECENT FINDINGS The systematic review of the literature on decriminalization resulted in seven articles that discuss decriminalization as compared with 57 published articles on legalization. Decriminalization of drug use did not have an effect on the age of onset of drug use and the prices of drugs did not decrease after the implementation of drug decriminalization. Policy-based studies on decriminalization suggest shifting from criminal sanctions to a public health approach, which was endorsed by the United Nations (UN) that viewed drug addiction as a preventable and treatable health disorder. One study preferred decriminalization only for cannabis and cautioned against regulating cannabis like alcohol. Another study indicated that general medical practitioners in Ireland did not favour the decriminalization of cannabis. SUMMARY Scientific evidence supporting drug addiction as a health disorder and the endorsement by the UN strengthen the case for decriminalization. However, studies reporting on the positive outcomes of decriminalization remain scarce. The evidence needs to be more widespread in order to support the case for decriminalization. Furthermore, the endorsement by the UN needs to be acted upon by individual member states.
Collapse
|
80
|
Abstract
Treatment-resistant mood disorders and anxiety disorders require intensive treatment, but treatment options should balance benefits and adverse effects or other potential detrimental effects on patients, including the risk of developing prescription medication addiction. Some of the newer treatment modalities for mood and anxiety disorders may have similar properties to benzodiazepines. The goal of this review was to identify the potential for developing dependence on the novel treatment approaches to treatment-resistant depression and refractory anxiety disorders. PubMed, MEDLINE, PsycINFO, Ovid, Cochrane Library, and Google Scholar were searched. Ketamine is effective in improving symptoms of major depressive disorder, but with no sustained benefits. Long-term use of oral or intranasal ketamine formulations may be associated with the risk of developing dependence. Augmentation of stimulant medication is usually effective for residual symptoms of depression, but the effects are usually short lasting and there is a potential for abuse. Synthetic cannabinoids and medicinal cannabis are increasingly being prescribed for a number of medical conditions, including anxiety disorders, without enough evidence about their efficacy and with the risk of patients developing dependence. In summary, benzodiazepines, ketamine, stimulant medications, and cannabinoids have some common characteristics, including short-lasting benefits and the risk of developing prescription medication addiction with longer use. All of these treatments may raise ethical dilemmas about the appropriateness of prescribing these medications in the long run for patients with depression and anxiety disorders.
Collapse
Affiliation(s)
- Dusan Kolar
- Mood Disorders Research and Treatment Service, Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
81
|
Gertsch J. The Intricate Influence of the Placebo Effect on Medical Cannabis and Cannabinoids. Med Cannabis Cannabinoids 2018; 1:60-64. [PMID: 34676323 PMCID: PMC8489322 DOI: 10.1159/000489291] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 09/08/2023] Open
Abstract
The botanical drug cannabis flos (inflorescence of Cannabis sativa L.) has a unique popular status as being a potent recreational drug and bona fide universal remedy (panacea). Generally, cannabinoids exert therapeutic effects in a broad range of pathophysiologies related to inflammation, pain, metabolic and stress-related conditions in preclinical animal models. However, the translation of such data to humans still lacks an evidence-based foundation. Motivated by the booming cannabis manufacturing industry and the increasing worldwide self-therapy by patients, there are cumulative accounts about broad therapeutic effects of cannabis and legal cannabinoids like cannabidiol (CBD) beyond statistical evidence. The numerous affirming anecdotal reports by patients pose a challenge to physicians and legal authorities. Moreover, the lack of standardization of cannabis products and widely missing randomized double-blind placebo-controlled clinical trials largely hinder the scientific assessment of medical cannabis in humans. Given the recent insight that the endocannabinoid system is mediating, at least in part, a placebo effect, psychoactive cannabis and cannabinoids could exert complex neuropharmacological actions. As discussed in this commentary, the meaning response may play a role in the broad palliative and therapeutic effects of medical cannabis unprecedented by other phytopharmaceuticals.
Collapse
Affiliation(s)
- Jürg Gertsch
- Institute of Biochemistry and Molecular Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
82
|
Weeding Out the Justification for Marijuana Treatment in Patients with Developmental and Behavioral Conditions. J Dev Behav Pediatr 2018. [PMID: 28622159 DOI: 10.1097/dbp.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alex is a 13-year-old adolescent with high-functioning autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD)-combined type, anxiety, and depression. He has been resistant to engaging in therapy and treatment with various medications has been unsuccessful. Alex's parents are concerned about his anxiety, isolation, oppositional behaviors, academic underachievement, truancy, and substance use. A recent altercation with his stepfather led to a police intervention and a brief removal of Alex from the home. Alex previously used alcohol and other drugs; at present, he reports that his current drug use consists of frequently smoking pot. Alex states that he uses marijuana to relieve his anxiety and does not understand why this is problematic as marijuana is now legal in his state.Kevin is a 24-year-old adult man with diagnoses of autism spectrum disorder, mild intellectual disability, and schizoaffective disorder. He has a long history of challenging and problematic behaviors including aggression toward self and others, property destruction, inappropriate sexual behaviors, elopement, emotional outbursts, anxiety, and suicidal ideation. Past diagnoses include bipolar affective disorder, depression, and intermittent explosive disorder. Kevin is notably obese and somnolent. His current medications include 8 psychotropic medications, 3 antiallergy medications, levothyroxine, and a fish oil supplement. His father reports that medications have gradually been added and dosages increased over time. Two weeks ago, his new psychiatrist initiated a trial of medical marijuana. His father hopes that the marijuana will allow Kevin's other medications to be decreased or discontinued.Linda is an 11-year-old girl with high-functioning autism spectrum disorder, anxiety, and ADHD-inattentive subtype. Anxiety has been her most impairing condition, and Linda has been responding well to a treatment with cognitive behavioral therapy and a selective serotonin reuptake inhibitor. She is also working with her therapist on strategies to address her symptoms of ADHD. Linda has had no side effects from her medication and she and her family have been pleased with her progress. At a follow-up appointment, her mother brings an article from the lay press authored by a parent who claims that marijuana "saved" her autistic son. Linda's mother asks if marijuana should be considered for her daughter.
Collapse
|
83
|
Charlebois S, Somogyi S, Sterling B. Cannabis-infused food and Canadian consumers’ willingness to consider “recreational” cannabis as a food ingredient. Trends Food Sci Technol 2018. [DOI: 10.1016/j.tifs.2018.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
84
|
Shishko I, Oliveira R, Moore TA, Almeida K. A review of medical marijuana for the treatment of posttraumatic stress disorder: Real symptom re-leaf or just high hopes? Ment Health Clin 2018; 8:86-94. [PMID: 29955551 PMCID: PMC6007739 DOI: 10.9740/mhc.2018.03.086] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction: The incidence of posttraumatic stress disorder (PTSD) is common within the population and even more so among veterans. Current medication treatment is limited primarily to antidepressants. Such medicines have shown to produce low remission rates and may require 9 patients to be treated for 1 to have a response. Aside from the Veterans Affairs/Department of Defense guidelines, other guidelines do not recommend pharmacotherapy as a first-line option, particularly in the veteran population. Marijuana has been evaluated as an alternative and novel treatment option with 16 states legalizing its use for PTSD. Methods: A systematic search was conducted to evaluate the evidence for the use of marijuana for PTSD. Studies for the review were included based on a literature search from Ovid MEDLINE and Google Scholar. Results: Five studies were identified that evaluated the use of marijuana for PTSD. One trial was conducted in Israel and actively used marijuana. Three studies did not use marijuana in the treatment arm but instead evaluated the effects postuse. A retrospective chart review from New Mexico relied on patients to recall their change in PTSD symptoms when using marijuana. Three studies concluded there might be a benefit, but two discouraged its use. Although the two negative studies show a statistical difference in worse PTSD outcomes, clinical significance is unclear. Discussion: Conflicting data exist for the use of marijuana for PTSD; however, current evidence is limited to anecdotal experiences, case reports, and observational studies, making it difficult to make clinical recommendations.
Collapse
Affiliation(s)
- Ilona Shishko
- Clinical Pharmacy Specialist-Psychiatry, South Texas Veterans Health Care System, San Antonio, Texas; The University of Texas at Austin, Austin, Texas; UT Health Science Center San Antonio, San Antonio, Texas,
| | - Rosana Oliveira
- Clinical Pharmacy Specialist-Psychiatry, South Texas Veterans Health Care System, San Antonio, Texas; The University of Texas at Austin, Austin, Texas; UT Health Science Center San Antonio, San Antonio, Texas
| | - Troy A Moore
- Clinical Pharmacy Specialist-Psychiatry, Director, ASHP-Accredited PGY-2 Psychiatric Pharmacy Residency Program, Co-Director, Interprofessional Advanced Fellowship in Addiction Treatment, South Texas Veterans Health Care System, Assistant Professor, UTHSCSA Department of Psychiatry-Division of Community Recovery, Research and Training, South Texas Veterans Health Care System, San Antonio, Texas; The University of Texas at Austin, Austin, Texas; UT Health Science Center San Antonio, San Antonio, Texas
| | - Kenneth Almeida
- Clinical Pharmacy Specialist-Hepatology, Texas Liver Institute, San Antonio, Texas
| |
Collapse
|
85
|
Keyhani S, Vali M, Cohen B, Woodbridge A, Arenson M, Eilkhani E, Aivadyan C, Hasin D. A search algorithm for identifying likely users and non-users of marijuana from the free text of the electronic medical record. PLoS One 2018; 13:e0193706. [PMID: 29509775 PMCID: PMC5839555 DOI: 10.1371/journal.pone.0193706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/19/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The harmful effects of marijuana on health and in particular cardiovascular health are understudied. To develop such knowledge, an efficient method of developing an informative cohort of marijuana users and non-users is needed. METHODS We identified patients with a diagnosis of coronary artery disease using ICD-9 codes who were seen in the San Francisco VA in 2015. We imported these patients' medical record notes into an informatics platform that facilitated text searches. We categorized patients into those with evidence of marijuana use in the past 12 months and patients with no such evidence, using the following text strings: "marijuana", "mjx", and "cannabis". We randomly selected 51 users and 51 non-users based on this preliminary classification, and sent a recruitment letter to 97 of these patients who had contact information available. Patients were interviewed on marijuana use and domains related to cardiovascular health. Data on marijuana use collected from the medical record was compared to data collected as part of the interview. RESULTS The interview completion rate was 71%. Among the 35 patients identified by text strings as having used marijuana in the previous year, 15 had used marijuana in the past 30 days (positive predictive value = 42.9%). The probability of use in the past month increased from 8.8% to 42.9% in people who have these keywords in their medical record compared to those who did not have these terms in their medical record. CONCLUSION Methods that combine text search strategies for participant recruitment with health interviews provide an efficient approach to developing prospective cohorts that can be used to study the health effects of marijuana.
Collapse
Affiliation(s)
- Salomeh Keyhani
- San Francisco VA Medical Center, San Francisco, CA, United States of America
- University of California San Francisco, Department of Medicine, San Francisco, CA, United States of America
- * E-mail:
| | - Marzieh Vali
- San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Beth Cohen
- San Francisco VA Medical Center, San Francisco, CA, United States of America
- University of California San Francisco, Department of Medicine, San Francisco, CA, United States of America
| | - Alexandra Woodbridge
- Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Melanie Arenson
- University of Maryland, Department of Psychology, College Park, Maryland, United States of America
| | - Elnaz Eilkhani
- University of California San Francisco, Department of Medicine, San Francisco, CA, United States of America
| | - Christina Aivadyan
- New York State Psychiatric Institute, New York, NY, United States of America
| | - Deborah Hasin
- New York State Psychiatric Institute, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| |
Collapse
|
86
|
Liszewski W, Stoff BK, Farah RS. The ethics of medical marijuana in dermatology. J Am Acad Dermatol 2018; 78:634-636. [PMID: 29447683 DOI: 10.1016/j.jaad.2017.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Walter Liszewski
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.
| | - Benjamin K Stoff
- Department of Dermatology, Emory University, Atlanta, Georgia; Emory Center for Ethics, Emory University, Atlanta, Georgia
| | - Ronda S Farah
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
87
|
Rochford C, Edgeworth D, Hashim M, Harmon D. Attitudes of Irish patients with chronic pain towards medicinal cannabis. Ir J Med Sci 2018; 188:267-272. [PMID: 29423824 DOI: 10.1007/s11845-018-1761-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medicinal cannabis use is topical in the media in Ireland. A recent Health Products Regulatory Authority review, however, has recommended against its use for patients with chronic pain. This is despite evidence for its effectiveness in this patient's cohort and the inadequate pain management of these patients. AIM The aim of this study was to evaluate the attitudes of Irish patients with chronic pain towards medicinal cannabis. METHODS After institutional ethics committee approval, a 12-item questionnaire (excluding demographics) was randomly assigned to patients attending a chronic pain clinic (University Hospital Limerick). The questionnaire was designed to incorporate patient's attitudes on a variety of medicinal cannabis related topics. RESULTS Ninety-six adult patients were surveyed. 88.54% agreed that cannabis should be legalised for chronic pain medicinal purposes. 80.21% believed it would have health benefits for them and 73.96% agreed it would be socially acceptable to use cannabis for this purpose. 33.33% perceived cannabis to be addictive while 68.75% would be willing to try it if prescribed by a medical professional. CONCLUSIONS The study highlights the attitudes of chronic pain patients in Ireland towards medicinal cannabis. It shows their desire to have medical cannabis legalised for chronic pain and that they view it as a reasonable pain management option.
Collapse
Affiliation(s)
- Ciaran Rochford
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Deirdre Edgeworth
- Department of Anesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland
| | - Mohammad Hashim
- Department of Anesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland
| | - Dominic Harmon
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| |
Collapse
|
88
|
Hsu G, Koçak Ö, Kovács B. Co-Opt or Coexist? A Study of Medical Cannabis Dispensaries’ Identity-Based Responses to Recreational-Use Legalization in Colorado and Washington. ORGANIZATION SCIENCE 2018. [DOI: 10.1287/orsc.2017.1167] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Greta Hsu
- Graduate School of Management, University of California–Davis, Davis, California 95616
| | - Özgecan Koçak
- Goizueta Business School, Emory University, Atlanta, Georgia 30322
| | - Balázs Kovács
- School of Management, Yale University, New Haven, Connecticut 06520
| |
Collapse
|
89
|
Prather PL. Preface to DMR special edition 'Cannabinoid receptors and ligands: therapeutic drug development and abuse potential'. Drug Metab Rev 2018; 50:1-2. [PMID: 29378464 DOI: 10.1080/03602532.2018.1431657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paul L Prather
- a Department of Pharmacology and Toxicology, College of Medicine , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| |
Collapse
|
90
|
Freisthler B, Cooke A. Do characteristics of marijuana use correspond to overall health levels for medical marijuana patients? JOURNAL OF SUBSTANCE USE 2018; 23:307-311. [PMID: 30881220 DOI: 10.1080/14659891.2017.1394383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The current study assesses how characteristics of medical marijuana use are related to general health status and past year change in health. An analytic sample of 312 patients were recruited from 16 medical marijuana dispensaries across Los Angeles, California. Patients completed a short intercept survey and a longer patient survey. Surveys asked information about health, marijuana use behaviors, preferred ways to use marijuana, marijuana recommendation, and sociodemographic information. Data were analyzed using hierarchical linear modeling of patients nested within dispensaries. For general health status, patients who smoke marijuana, have more medical conditions for which they received their medical marijuana recommendation, and use marijuana more times per day report lower levels of general health. The number of days using marijuana per month was related to worse health in the past year. Medical marijuana use does not appear to improve overall health status according to the results presented here, but is limited by the cross-sectional nature of the study. As the legalization of medical marijuana use continues to grow across the United States, identifying how marijuana is related to health will allow physicians to better determine who may benefit from its use.
Collapse
Affiliation(s)
- Bridget Freisthler
- Ohio State University, College of Social Work, 1947 College Road, Columbus, Ohio 43210,
| | - Alexis Cooke
- University of California, Los Angeles, Fielding School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA 90095,
| |
Collapse
|
91
|
Azizi SAA, Omer AA, Mufaddel AA. Cannabis Use among People with Mental Illness: Clinical and Socio-Demographic Characteristics. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojpsych.2018.83021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
92
|
Abstract
Nearly half of all states have legalized medical marijuana or recreational-use marijuana. As more states move toward legalization, the effects on injured patients must be evaluated. This study sought to determine effects of cannabis positivity at the time of severe injury on hospital outcomes compared with individuals negative for illicit substances and those who were users of other illicit substances. A Level I trauma center performed a retrospective chart review covering subjects over a 2-year period with toxicology performed and an Injury Severity Score (ISS) of more than 16. These individuals were divided into the negative and positive toxicology groups, further divided into the marijuana-only, other drugs-only, and mixed-use groups. Differences in presenting characteristics, hospital length of stay, intensive care unit (ICU) stays, ventilator days, and death were compared. A total of 8,441 subjects presented during the study period; 2,134 (25%) of these had toxicology performed; 843 (40%) had an ISS of more than 16, with 347 having negative tests (NEG); 70 (8.3%) substance users tested positive only for marijuana (MO), 323 (38.3%) for other drugs-only, excluding marijuana (OD), and 103 (12.2%) subjects showed positivity for mixed-use (MU). The ISS was similar for all groups. No differences were identified in Glasgow Coma Scale (GCS), ventilator days, blood administration, or ICU/hospital length of stay when comparing the MO group with the NEG group. Significant differences occurred between the OD group and the NEG/MO/MU groups for GCS, ICU length of stay, and hospital charges. Cannabis users suffering from severe injury demonstrated no detrimental outcomes in this study compared with nondrug users.
Collapse
|
93
|
Affiliation(s)
- Nicholas Athey
- School of Criminology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Neil Boyd
- School of Criminology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Elysha Cohen
- School of Criminology, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
94
|
Abstract
Cancer pain remains a significant clinical problem worldwide. Causes of cancer pain are multifactorial and complex and are likely to vary with an array of tumor-related and host-related factors and processes. Pathophysiology is poorly understood; however, new laboratory research points to cross-talk between cancer cells and host’s immune and neural systems as an important potential mechanism that may be broadly relevant to many cancer pain syndromes. Opioids remain the most effective pharmaceuticals used in the treatment of cancer pain. However, their role has been evolving due to emerging awareness of risks of chronic opioid therapy. Despite extensive research efforts, no new class of analgesics has been developed. However, many potential therapeutic targets that may lead to the establishment of new pharmaceuticals have been identified in recent years. It is also expected that the role of non-pharmacological modalities of treatment will grow in prominence. Specifically, neuromodulation, a rapidly expanding field, may play a major role in the treatment of neuropathic cancer pain provided that further technological progress permits the development of non-invasive and inexpensive neuromodulation techniques.
Collapse
Affiliation(s)
- Marcin Chwistek
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center/Temple Health, Philadelphia, PA, USA
| |
Collapse
|
95
|
Henning AD, Dimeo P. The new front in the war on doping: Amateur athletes. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 51:128-136. [PMID: 28619395 DOI: 10.1016/j.drugpo.2017.05.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 11/24/2022]
Abstract
The war on drugs is usually associated with criminal policies aimed at stemming consumption of drugs such as heroin, cocaine, and cannabis, less so with enhancement drugs like those used in sport. As drug use in sport, or doping, has become more visibly widespread, policies aimed at combating the issue have become more restrictive, intrusive, and harsh. In this article we draw new comparisons between the wider war on drugs and recent developments in sports anti-doping. We identify a growing trend towards criminalisation of traffickers and users, and associate that with another growing trend: the testing of amateur athletes. This article reviews the current anti-doping system, including the recent amateur policies, then considers of the results of one such program in amateur cycling. We then shift to consider the possible implications for amateurs of criminal doping laws and the recent debates about allowing medical exemptions for therapeutic use of banned substances. We show that drug use in sport can be understood as a new front in the war on drugs, with some extreme measures and many negative unintended consequences. To remedy this, we argue that amateur athletes require a separate anti-doping policy focused on minimising harms of use.
Collapse
Affiliation(s)
- April D Henning
- Brooklyn College, 2900 Bedford Avenue, Brooklyn, NY 11210, USA.
| | - Paul Dimeo
- University of Stirling, Stirling, FK9 4LA, Scotland, UK.
| |
Collapse
|
96
|
Nader DA, Sanchez ZM. Effects of regular cannabis use on neurocognition, brain structure, and function: a systematic review of findings in adults. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:4-18. [DOI: 10.1080/00952990.2017.1306746] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Danilo A. Nader
- Departmento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Zila M. Sanchez
- Departmento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil
| |
Collapse
|
97
|
Lieberman MF. "Recredicinal" Marijuana. Am J Ophthalmol 2017; 177:xv-xviii. [PMID: 28342528 DOI: 10.1016/j.ajo.2017.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 11/25/2022]
|
98
|
Szaflarski M, Sirven JI. Social factors in marijuana use for medical and recreational purposes. Epilepsy Behav 2017; 70:280-287. [PMID: 28132734 DOI: 10.1016/j.yebeh.2016.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/04/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
Abstract
Of all the various treatment options for epilepsy, no other therapy comes close to the polarity that cannabis engenders. The rationale for this reaction is firmly rooted in the social factors that enshroud the use of marijuana for both medical and recreational purposes. In order to best understand how to approach this controversial treatment, it is essential to explore the social, demographic, and historical variables that have led to the current opinions on cannabis therapy and how this has converged on epilepsy treatment. Utilizing a sociological conceptual framework, this review discusses in depth the social, cultural, and historical dimensions of cannabis use in the US for medical purposes and its impact on epilepsy treatment. Moreover, it posits that cannabis therapy and the opinions surrounding its use are products of history and assesses this treatment option through the lens of our current times. This article is part of a Special Issue titled Cannabinoids and Epilepsy.
Collapse
Affiliation(s)
- Magdalena Szaflarski
- Department of Sociology, University of Alabama at Birmingham, HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152, USA.
| | - Joseph I Sirven
- Department of Neurology, Division of Epilepsy, Mayo Clinic College of Medicine, Mayo Clinic in Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| |
Collapse
|
99
|
Abstract
PURPOSE There is increasing use of marijuana among young adults and more states in the United States are legalizing medical marijuana use. A number of studies have revealed both the beneficial and harmful effects of marijuana to the human system. Despite some beneficial effects, studies have shown marijuana to have a lot of deleterious effects on the visual system, which subsequently reduces the quality of eyesight. The aim of this study was to investigate if heavy marijuana smoking is associated with a poor quality of eyesight compared with light/no use of marijuana. METHODS The National Longitudinal Survey of Youths (NLSY79), a nationally representative sample of 12,686 young men and women surveyed in 1979 to 2010 was used for this study. The quality of eyesight of 1304 heavy marijuana users was compared with 1304 respondents with light or no marijuana use. The t test, multivariate and weighted logistic regression were used in the data analysis. RESULTS There was no statistically significant difference in the self-reported quality of eyesight among heavy marijuana smokers compared with youths who never used marijuana or are light marijuana users. Among heavy marijuana smokers, males and high school graduates have decreased odds of reporting a poor quality of eyesight, whereas blacks have increased odds of reporting a poor quality of eyesight. CONCLUSIONS The self-reported quality of eyesight among marijuana users can aid clinicians and other health practitioners facilitate the development of sex-, racial/ethnic-, and educational level-informed prevention and early intervention programs and also help characterize public opinions regarding cannabis, which are particularly relevant given the ongoing debate concerning the medicalization and legalization of cannabis in the United States.
Collapse
|
100
|
Fine C, Kishel B, O'Glasser AY, Desai SS. A Greener Oregon: Acute Inpatient Delirium. Am J Med 2017; 130:423-425. [PMID: 27908791 DOI: 10.1016/j.amjmed.2016.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher Fine
- Department of Medicine, Oregon Health & Science University, Portland
| | - Brittany Kishel
- Department of Medicine, Oregon Health & Science University, Portland
| | - Avital Y O'Glasser
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland.
| | - Sima S Desai
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland
| |
Collapse
|