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Saadeh CE, Rustem DR. Medical Marijuana Use in a Community Cancer Center. J Oncol Pract 2018; 14:e566-e578. [DOI: 10.1200/jop.18.00057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: The primary purpose of this study was to compare the incidence of marijuana use between patients with early- versus advanced-stage cancers. Differences in adverse effects, drug-drug interactions, and drug-disease interactions between those who use marijuana and those who do not were also compared. Methods: Patients age 18 years and older who were receiving chemotherapy were asked to complete an electronic self-reported questionnaire. In addition to questions about patient demographics, current adverse effects, cancer type and stage, comorbidities, performance status, treatment regimen, and general marijuana use, those patients who used marijuana within the last 30 days (current marijuana users) were asked additional questions about the route and frequency of marijuana administration, about reason(s) for use, about possession of a marijuana card, and if they had received any counseling about marijuana. Drug-drug and drug-disease interactions were also analyzed. Results: The overall incidence of marijuana use was 18.3% (32 of 175 patients). The incidence of marijuana use in patients with early- versus advanced-stage cancers was 19.6% (11 of 56 patients) versus 17.6% (21 of 119 patients; P = .75). Patients who use marijuana reported more pain, nausea, appetite issues, and anxiety. There were more drug-drug interactions associated with marijuana use, primarily with concurrent CNS depressants. The frequency of drug-disease interactions between those who use marijuana versus those who do not was similar. Conclusion: Approximately one in five patients with cancer who were receiving chemotherapy were using marijuana, and the frequency was equal in early- and advanced-stage cancer groups. The risks versus benefits should be discussed with all patients who use marijuana.
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Affiliation(s)
- Claire E. Saadeh
- Ferris State University College of Pharmacy, Big Rapids; and Herbert Herman Cancer Center, Lansing, MI
| | - Danielle R. Rustem
- Ferris State University College of Pharmacy, Big Rapids; and Herbert Herman Cancer Center, Lansing, MI
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Cohen N, Fedewa S, Chen AY. Epidemiology and Demographics of the Head and Neck Cancer Population. Oral Maxillofac Surg Clin North Am 2018; 30:381-395. [PMID: 30078696 DOI: 10.1016/j.coms.2018.06.001] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Head and neck malignancies comprise a heterogeneous group of malignancies that cause significant morbidity to those affected. These malignancies are associated with specific risk factors and exposures, some of which impact prognosis. The most common risk factors for developing head and neck cancers are tobacco and alcohol use. Marijuana and e-cigarettes, occupational exposures, and use of topical substances have also been linked to head and neck cancers. Human papilloma virus has been associated with oropharyngeal cancer. Such measures as oral hygiene, screening, smoking cessation, and vaccination are measures taken to decrease the incidence and morbidity of head and neck cancers.
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Affiliation(s)
- Natasha Cohen
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, 550 Peachtree Street. MOT 1135, Atlanta, GA 30308, USA
| | - Stacey Fedewa
- American Cancer Society, 250 Williams Street. NW, Atlanta, GA 30303, USA
| | - Amy Y Chen
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, 550 Peachtree Street. MOT 1135, Atlanta, GA 30308, USA.
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Merkle S, Tavernier S. Cannabis Use and Bleomycin: An Overview and Case Study of Pulmonary Toxicity. Clin J Oncol Nurs 2018; 22:438-443. [DOI: 10.1188/18.cjon.438-443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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PTL401, a New Formulation Based on Pro-Nano Dispersion Technology, Improves Oral Cannabinoids Bioavailability in Healthy Volunteers. J Pharm Sci 2018; 107:1423-1429. [DOI: 10.1016/j.xphs.2017.12.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 02/07/2023]
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Amen DG, Darmal B, Raji CA, Bao W, Jorandby L, Meysami S, Raghavendra CS. Discriminative Properties of Hippocampal Hypoperfusion in Marijuana Users Compared to Healthy Controls: Implications for Marijuana Administration in Alzheimer's Dementia. J Alzheimers Dis 2018; 56:261-273. [PMID: 27886010 DOI: 10.3233/jad-160833] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few studies have evaluated the impact of marijuana use on regional cerebral blood flow. OBJECTIVE To determine whether perfusion in specific brain regions on functional neuroimaging, including those affected by Alzheimer's disease pathology, are abnormal in marijuana users compared to controls. METHOD Persons with a diagnosis of cannabis use disorder by DSM-IV and DSM-V criteria (n = 982) were compared to controls (n = 92) with perfusion neuroimaging with SPECT at rest and at a concentration task. Perfusion estimates were quantified using a standard atlas. Cerebral perfusion differences were calculated using one-way ANOVA. Diagnostic separation was determined with discriminant analysis of all subjects. Feature selection with a minimum redundancy maximum relevancy (mRMR) identified predictive regions in a subset of marijuana users (n = 436) with reduced psychiatric co-morbidities. RESULTS Marijuana users showed lower cerebral perfusion on average (p < 0.05). Discriminant analysis distinguished marijuana users from controls with correct classification of 96% and leave one out cross-validation of 92%. With concentration SPECT regions, there was correct classification of 95% with a leave-one-out cross validation of 90%. AUC analysis for concentration SPECT regions showed 95% accuracy, 90% sensitivity, and 83% specificity. The mRMR analysis showed right hippocampal hypoperfusion on concentration SPECT imaging was the most predictive in separating marijuana subjects from controls. CONCLUSION Multiple brain regions show low perfusion on SPECT in marijuana users. The most predictive region distinguishing marijuana users from healthy controls, the hippocampus, is a key target of Alzheimer's disease pathology. This study raises the possibility of deleterious brain effects of marijuana use.
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Affiliation(s)
| | | | - Cyrus A Raji
- University of California San Francisco, San Francisco, CA, USA
| | - Weining Bao
- Department of Electrical Engineering, University of Southern California, Los Angeles, CA, USA
| | | | | | - Cauligi S Raghavendra
- Department of Electrical Engineering, University of Southern California, Los Angeles, CA, USA
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Chen K, Farrar MA, Cardamone M, Lawson JA. Cannabis for paediatric epilepsy: challenges and conundrums. Med J Aust 2018; 208:132-136. [DOI: 10.5694/mja17.00699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/30/2017] [Indexed: 01/15/2023]
Affiliation(s)
| | - Michelle A Farrar
- Sydney Children's Hospital, Randwick, Sydney, NSW
- UNSW Sydney, Sydney, NSW
| | - Michael Cardamone
- Sydney Children's Hospital, Randwick, Sydney, NSW
- UNSW Sydney, Sydney, NSW
| | - John A Lawson
- Sydney Children's Hospital, Randwick, Sydney, NSW
- UNSW Sydney, Sydney, NSW
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Clark CS. Medical Cannabis: The Oncology Nurse's Role in Patient Education About the Effects of Marijuana on Cancer Palliation
. Clin J Oncol Nurs 2018; 22:E1-E6. [PMID: 29350699 DOI: 10.1188/18.cjon.e1-e6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cannabis, also known as marijuana, is legal either medicinally or recreationally in 29 states and the District of Columbia, with a majority of the U.S. adult population now living in states where cannabis is legal for medicinal use. As an advocate for patient autonomy and informed choice, the oncology nurse has an ethical responsibility to educate patients about and support their use of cannabis for palliation.
. OBJECTIVES This article aims to discuss the human endocannabinoid system as a basis for better understanding the palliative and curative nature of cannabis as a medicine, as well as review cannabis delivery methods and the emerging role of the oncology nurse in this realm.
. METHODS This article examines the literature and uses a theoretical-conceptual method to explore the oncology nurse's role in supporting the use of medicinal cannabis by patients with cancer.
. FINDINGS The oncology nurse can play a pivotal role in supporting patients' use of cannabis for palliation.
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Vadivelu N, Kai AM, Kodumudi G, Sramcik J, Kaye AD. Medical Marijuana: Current Concepts, Pharmacological Actions of Cannabinoid Receptor Mediated Activation, and Societal Implications. Curr Pain Headache Rep 2018; 22:3. [PMID: 29349551 DOI: 10.1007/s11916-018-0656-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW The purpose of the following review is to summarize the history and current policies related to marijuana use and prevalence, basic and clinical science pharmacological literature regarding efficacy, subpopulations of concern, and varying policies regarding its use at present. RECENT FINDINGS With the increasingly widespread utilization of marijuana, there is also a growing complexity of public health policy, regulation, and necessity to further assess the medical indications and adverse long-term effects of marijuana use. Health care providers as well as the general public must be prepared to become familiar and up-to-date with medical literature, legislation, and educational material regarding medical marijuana.
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Affiliation(s)
- Nalini Vadivelu
- Department of Anesthesiology, Yale University, TMP3 333, Cedar Street, New Haven, CT, 06520, USA.
| | - Alice M Kai
- Department of Internal Medicine, NYU Winthrop Hospital, 259 First Street, Mineola, NY, 11501, USA
| | - Gopal Kodumudi
- California Northstate University College of Medicine, 9700 West Taron Drive, Elk Grove, CA, 95757, USA
| | - Julie Sramcik
- Department of Anesthesiology, Yale University, TMP3 333, Cedar Street, New Haven, CT, 06520, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Ave, Suite 656, New Orleans, LA, 70112, USA
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Abstract
INTRODUCTION Substance use disorders are a group of chronic relapsing disorders of the brain, which have massive public health and societal impact. In some disorders (e.g., heroin/prescription opioid addictions) approved medications have a major long-term benefit. For other substances (e.g., cocaine, amphetamines and cannabis) there are no approved medications, and for alcohol there are approved treatments, which are not in wide usage. Approved treatments for tobacco use disorders are available, and novel medications are also under study. Areas covered: Medication-based approaches which are in advanced preclinical stages, or which have reached proof-of concept clinical laboratory studies, as well as clinical trials. Expert opinion: Current challenges involve optimizing translation between preclinical and clinical development, and between clinical laboratory studies to therapeutic clinical trials. Comorbidities including depression or anxiety are challenges for study design and analysis. Improved pharmacogenomics, biomarker and phenotyping approaches are areas of interest. Pharmacological mechanisms currently under investigation include modulation of glutamatergic, GABA, vasopressin and κ-receptor function, as well as inhibition of monoamine re-uptake. Other factors that affect potential market size for emerging medications include stigma, availability of treatment settings, adoption by clinicians, and the prevalence of persons with SUD who are not actively treatment-seeking.
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Affiliation(s)
- Eduardo R Butelman
- a Laboratory in the Biology of Addictive Diseases , The Rockefeller University , New York , NY , USA
| | - Mary Jeanne Kreek
- a Laboratory in the Biology of Addictive Diseases , The Rockefeller University , New York , NY , USA
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Endocannabinoid-Specific Impairment in Synaptic Plasticity in Striatum of Huntington's Disease Mouse Model. J Neurosci 2017; 38:544-554. [PMID: 29192125 DOI: 10.1523/jneurosci.1739-17.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/27/2017] [Accepted: 11/12/2017] [Indexed: 01/12/2023] Open
Abstract
Huntington's disease (HD) is an inherited neurodegenerative disease affecting predominantly striatum and cortex that results in motor and cognitive disorders. Before a motor phenotype, animal models of HD show aberrant cortical-striatal glutamate signaling. Here, we tested synaptic plasticity of cortical excitatory synapses onto striatal spiny projection neurons (SPNs) early in the YAC128 mouse model of HD. High-frequency stimulation-induced long-term depression, mediated by the endocannabinoid anandamide and cannabinoid receptor 1 (CB1), was significantly attenuated in male and female YAC128 SPNs. Indirect pathway SPNs, which are more vulnerable in HD, were most affected. Our experiments show metabotropic glutamate receptor and endocannabinoid 2-arachidonoylglycerol-dependent plasticity, as well as direct CB1 activation by agonists, was similar in YAC128 and FVB/N wild-type SPNs suggesting that presynaptic CB1 is functioning normally. These results are consistent with a specific impairment in postsynaptic anandamide synthesis in YAC128 SPN. Strikingly, although suppression of degradation of anandamide was not effective, elevating 2-arachidonoylglycerol levels restored long-term depression in YAC128 striatal neurons. Together, these results have potential implications for neuroprotection and ameliorating early cognitive and motor deficits in HD.SIGNIFICANCE STATEMENT Huntington's disease (HD) is an inherited neurodegenerative disease with no cure. Recent studies find impairment of the endocannabinoid system in animal models but the functional implication for synaptic plasticity in HD remains unclear. Sepers et al. show a selective deficit in synaptic plasticity mediated by the endocannabinoid anandamide, but not 2-arachidonoylglycerol in a mouse model of HD. The deficit is rescued by selectively elevating levels of 2-arachidonoylglycerol produced on-demand. This mechanism could be targeted in the development of future therapeutics for HD.
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Atsmon J, Heffetz D, Deutsch L, Deutsch F, Sacks H. Single-Dose Pharmacokinetics of Oral Cannabidiol Following Administration of PTL101: A New Formulation Based on Gelatin Matrix Pellets Technology. Clin Pharmacol Drug Dev 2017; 7:751-758. [DOI: 10.1002/cpdd.408] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/24/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Jacob Atsmon
- Tel Aviv Sourasky Medical Center; Tel-Aviv; Israel, and Tel Aviv University Sackler Faculty of Medicine; Tel-Aviv Israel
| | | | - Lisa Deutsch
- BioStats Statistical Consulting Ltd.; Modiin Israel
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Lapham GT, Lee AK, Caldeiro RM, McCarty D, Browne KC, Walker DD, Kivlahan DR, Bradley KA. Frequency of Cannabis Use Among Primary Care Patients in Washington State. J Am Board Fam Med 2017; 30:795-805. [PMID: 29180554 PMCID: PMC5769869 DOI: 10.3122/jabfm.2017.06.170062] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/09/2017] [Accepted: 06/17/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Over 12% of US adults report past-year cannabis use, and among those who use daily, 25% or more have a cannabis use disorder. Use is increasing as legal access expands. Yet, cannabis use is not routinely assessed in primary care, and little is known about use among primary care patients and relevant demographic and behavioral health subgroups. This study describes the prevalence and frequency of past-year cannabis use among primary care patients assessed for use during a primary care visit. METHODS This observational cohort study included adults who made a visit to primary care clinics with annual behavioral health screening, including a single-item question about frequency past-year cannabis use (March 2015 to February 2016; n = 29,857). Depression, alcohol and other drug use were also assessed by behavioral health screening. Screening results, tobacco use, and diagnoses for past-year behavioral health conditions (e.g., mental health and substance use disorders) were obtained from EHRs. RESULTS Among patients who completed the cannabis use question (n = 22,095; 74% of eligible patients), 15.3% (14.8% to 15.8%) reported any past-year use: 12.2% (11.8% to 12.6%) less than daily, and 3.1% (2.9%-3.3%) daily. Among 2228 patients age 18 to 29 years, 36.0% (34.0% to 38.0%) reported any cannabis use and 8.1% (7.0% to 9.3%) daily use. Daily cannabis use was common among men age 18 to 29 years who used tobacco or screened positive for depression or used tobacco: 25.5% (18.8% to 32.1%) and 31.7% (23.3% to 40.0%), respectively. CONCLUSIONS Cannabis use was common in adult primary care patients, especially among younger patients and those with behavioral health conditions. Results highlight the need for primary care approaches to address cannabis use.
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Affiliation(s)
- Gwen T Lapham
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB).
| | - Amy K Lee
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Ryan M Caldeiro
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Dennis McCarty
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Kendall C Browne
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Denise D Walker
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Daniel R Kivlahan
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
| | - Katharine A Bradley
- From the Kaiser Permanent Washington Health Research Institute (formerly Group Health Research Institute) (GTL, AKL, KAB); Department of Health Services, University of Washington, Seattle, WA (GTL, KAB); Behavioral Health Support Services, Kaiser Permanente Washington (formerly Group Health Cooperative), Seattle (RMC); Oregon Health & Science University (OHSU) - Portland State University School of Public Health, OHSU, Portland, OR (DM); Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle (KCB, DRK); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (KCB, DRK); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (DDW); Health Services Research & Development VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle (DRK); Department of Medicine, University of Washington, Seattle (KAB)
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Butler S. A glimpse into a neglected population – Emerging adults. Scand J Pain 2017; 17:230-232. [DOI: 10.1016/j.sjpain.2017.08.005] [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)
- Stephen Butler
- Department of Public Health and Caring Sciences , Uppsala University , Uppsala , Sweden
- Multidisciplinary Pain Center, Academic Hospital of Uppsala , Uppsala , Sweden
- National Center for Complex Disorders , St. Olav’s Hospital , Trondheim , Norway
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Agabio R, Sanna F, Lobina C, Monduzzi M, Nairi V, Cugia F, Mameli S, Pisanu GM, Gessa GL, Melis MR. Is 2-Hydroxypropyl-β-cyclodextrin a Suitable Carrier for Central Administration of Δ 9 -Tetrahydrocannabinol? Preclinical Evidence. Drug Dev Res 2017; 78:411-419. [PMID: 28921601 DOI: 10.1002/ddr.21413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 09/04/2017] [Indexed: 11/11/2022]
Abstract
Preclinical Research Δ9 -Tetrahydrocannabinol (THC) is a hydrophobic compound that has a potent antinociceptive effect in animals after intrathecal (IT) or intracerebroventricular (ICV) administration. The lack of a suitable solvent precludes its IT administration in humans. 2-Hydroxypropyl-β-cyclodextrin (HPβCD) increases the water solubility of hydrophobic drugs and is approved for IT administration in humans. To investigate whether HPβCD might be a suitable carrier for ICV administration of THC in rats, two formulations containing THC complexed with HPβCD (30 and 135 μg of THC per animal) and vehicle were administered to Wistar rats. The antinociceptive effect (using the tail flick test), locomotor activity, and body temperature were evaluated. ICV injection of 135 μg of THC/HPβCD complex increased tail flick latency, reduced locomotor activity, and had a dual effect on body temperature. The 30 μg THC/HPβCD formulation only produced a hyperthermic effect. All animals appeared healthy, with no difference between the groups. These results were similar to those obtained in other preclinical studies in which THC was administered centrally using solvents that are unsuitable for IT administration in humans because of their toxicity. Our findings suggest that HPβCD may be a useful carrier for IT administration of THC in humans. Drug Dev Res 78 : 411-419, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- R Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - F Sanna
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - C Lobina
- Neuroscience Institute, National Research Council of Italy, Section of Cagliari, Cagliari, Italy
| | - M Monduzzi
- Department of Chemistral and Geological Sciences, University of Cagliari, Cagliari, Italy
| | - V Nairi
- Department of Chemistral and Geological Sciences, University of Cagliari, Cagliari, Italy
| | - F Cugia
- Department of Chemistral and Geological Sciences, University of Cagliari, Cagliari, Italy
| | - S Mameli
- Pain Therapy Unit, Azienda Ospedaliera "Brotzu," ASL 8, Cagliari, Italy
| | - G M Pisanu
- Pain Therapy Unit, Azienda Ospedaliera "Brotzu," ASL 8, Cagliari, Italy
| | - G L Gessa
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.,Neuroscience Institute, National Research Council of Italy, Section of Cagliari, Cagliari, Italy
| | - M R Melis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
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Ballas SK. The Use of Cannabis by Patients with Sickle Cell Disease Increased the Frequency of Hospitalization due to Vaso-Occlusive Crises. Cannabis Cannabinoid Res 2017; 2:197-201. [PMID: 29082316 PMCID: PMC5627667 DOI: 10.1089/can.2017.0011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction: The objective of this study was to determine if patients with sickle cell disease using cannabis had decreased frequency of acute vaso-occlusive crises (VOCs) that required hospitalization. Method: This was a retrospective study in which 270 urine drug screen tests were done on 72 patients: 40 males and 32 females. Results: Cannabinoids were found in 144 urine tests from 37 patients and were negative in 126 tests from 35 patients. Males who used cannabis were significantly younger (p<0.001) than males who did not. Patients who tested positive used benzodiazepines, cocaine, and phencyclidine significantly more often than patients who tested negative. There was no significant difference in the amounts of opioids consumed by users and nonusers of cannabis. The cannabis cohort was seen in the clinic significantly (p<0.05) less often than controls, but hospital admissions were significantly greater in the cannabis group than controls (p<0.05). Conclusion: These data show an unexpected negative effect of cannabis on the frequency of VOCs. This may be due to the effect of cannabis on the brain and/or the severity of the disease in the cannabis users. More controlled studies are needed to clarify these findings.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation for Hematologic Research, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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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.
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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.
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Kelly MEM, Lehmann C, Zhou J. The Endocannabinoid System in Local and Systemic Inflammation. ACTA ACUST UNITED AC 2017. [DOI: 10.4199/c00151ed1v01y201702isp074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Medical Marijuana: Just the Beginning of a Long, Strange Trip? Phys Ther 2017; 97:239-248. [PMID: 27660328 DOI: 10.2522/ptj.20160367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/16/2016] [Indexed: 12/12/2022]
Abstract
Medical marijuana continues to gain acceptance and become legalized in many states. Various species of the marijuana plant have been cultivated, and this plant can contain up to 100 active compounds known as cannabinoids. Two cannabinoids seem the most clinically relevant: Δ9-tetrahydrocannabinol (THC), which tends to produce the psychotropic effects commonly associated with marijuana, and cannabidiol (CBD), which may produce therapeutic effects without appreciable psychoactive properties. Smoking marijuana, or ingesting extracts from the whole plant orally (in baked goods, teas, and so forth), introduces variable amounts of THC, CBD, and other minor cannabinoids into the systemic circulation, where they ultimately reach the central and peripheral nervous systems. Alternatively, products containing THC, CBD, or a combination of both compounds, can be ingested as oral tablets or via sprays applied to the oral mucosal membranes. These products may provide a more predictable method for delivering a known amount of specific cannabinoids into the body. Although there is still a need for randomized controlled trials, preliminary studies have suggested that medical marijuana and related cannabinoids may be beneficial in treating people with chronic pain, inflammation, spasticity, and other conditions seen commonly in physical therapist practice. Physical therapists, therefore, should be aware of the options that are available for patients considering medical marijuana and should be ready to provide information for these patients. Clinicians also should be aware that marijuana can produce untoward effects on cognition, coordination, balance, and cardiovascular and pulmonary function and should be vigilant for any problems that may arise if patients are using cannabinoids during physical rehabilitation.
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Katz D, Katz I, Porat-Katz BS, Shoenfeld Y. Medical cannabis: Another piece in the mosaic of autoimmunity? Clin Pharmacol Ther 2016; 101:230-238. [DOI: 10.1002/cpt.568] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/09/2016] [Indexed: 02/07/2023]
Affiliation(s)
- D Katz
- The Zabludowicz Center for Autoimmune Diseases; Chaim Sheba Medical Center; Tel-Hashomer Israel
- Faculty of Medicine; The Hebrew University of Jerusalem; Israel
| | - I Katz
- The Zabludowicz Center for Autoimmune Diseases; Chaim Sheba Medical Center; Tel-Hashomer Israel
- Faculty of Medicine; The Hebrew University of Jerusalem; Israel
| | - BS Porat-Katz
- The Robert H. Smith Faculty of Agriculture, Food and Environment School of Nutritional Sciences; The Hebrew University of Jerusalem; Rehovot Israel
| | - Y Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases; Chaim Sheba Medical Center; Tel-Hashomer Israel
- Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine; Tel-Aviv University; Israel
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