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Farshad F, Sahebzad ES, Kheirkhah M, Khani MS, Azmoude E. Comparison of the Effect of Cumin Cyminum and Nettle Oral Drops on the Breast Milk Sufficiency Indicators in New Mothers. Sultan Qaboos Univ Med J 2024; 24:209-215. [PMID: 38828258 PMCID: PMC11139373 DOI: 10.18295/squmj.3.2024.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/09/2023] [Accepted: 01/02/2024] [Indexed: 06/05/2024] Open
Abstract
Objectives This study aimed to compare the effects of green cumin (Cuminum cyminum) and nettle (Urtica dioica L.) oral drops on the indicators of breast milk adequacy in lactating mothers. Due to the presence of phytoestrogens in the combinations of cumin and nettle, it is stipulated that they may have milk-increasing properties. Methods A triple-blind, randomised, controlled clinical trial was conducted on 117 lactating mothers who had given birth to healthy infants aged 10-15 days and who received cumin oral drops (n = 39), nettle oral drops (n = 39) or placebo (n = 39) from August 2020 to March 2021. The participants were recruited from a regional public health care centre affiliated with Iran University of Medical Sciences of Tehran, Tehran, Iran. The 3 study groups received 15 drops thrice a day for 4 weeks. Infant weight, breastfeeding frequency, number of wet diapers, diaper weight and frequency of infant defecation were evaluated before and after the intervention. Results At the beginning of the trial, no statistically significant differences were observed between the 3 groups for infant weight (P = 0.891), breastfeeding frequency (P = 0.921), number of wet diapers (P = 0.783), diaper weight (P = 0.841) and frequency of infant defecation (P = 0.898). However, following the intervention, the mean scores of all indicators were significantly higher in the experimental groups than in the placebo group (P <0.001). In addition, all the indicators in the cumin group increased significantly compared to those in the nettle group (P <0.001). Conclusion Considering the effectiveness of cumin and nettle drops in increasing milk and the availability of these native plants in Iran, it is suggested that they, especially cumin, be used postpartum to increase breast milk production.
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Affiliation(s)
- Fatemeh Farshad
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Sadeghi Sahebzad
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Midwifery & Reproductive Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Kheirkhah
- Midwifery & Reproductive Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Shafi Khani
- Midwifery & Reproductive Health, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Azmoude
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
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Sukpiriyagul A, Chartchaiyarerk R, Tabtipwon P, Smanchat B, Prommas S, Bhamarapravatana K, Suwannarurk K. Oral Tetrahydrocannabinol (THC):Cannabinoid (CBD) Cannabis Extract Adjuvant for Reducing Chemotherapy-Induced Nausea and Vomiting (CINV): A Randomized, Double-Blinded, Placebo-Controlled, Crossover Trial. Int J Womens Health 2023; 15:1345-1352. [PMID: 37608911 PMCID: PMC10440684 DOI: 10.2147/ijwh.s401938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023] Open
Abstract
Objective To evaluate the effects of tetrahydrocannabinol (THC):cannabinoid (CBD) (1:1) oil in reducing chemotherapy-induced nausea and vomiting (CINV) in gynecologic cancer patients who received moderate-to-high emetogenic chemotherapy. Material and Method This was a randomized, double-blinded, crossover and placebo-controlled trial. The study was conducted at the Gynecologic Oncology Units, Bhumibol Adulyadej Hospital (BAH), Royal Thai Air Force, Bangkok, Thailand, between August and November 2022. Participants had gynecologic cancer and received moderate-to-high emetogenic chemotherapy. Subjects were randomized and divided into two groups (A and B) based on the block of four randomization method. In the first cycle, groups A and B received THC:CBD extract oil 1:1 (TCEO) and placebo before chemotherapy administration. In the second cycle, groups A and B received placebo and TCEO before chemotherapy administration. Both groups received per protocol antiemetic medication during chemotherapy. Nausea score and side effects were recorded. Results A total of 60 cases were recruited. After exclusion, 54 cases were included in the study. The mean age of participants was 54.4 years. The mean body mass index (BMI) was 26.5 kg/m2. Fifty-nine (21/54) percent cases were the advanced stages of cancer. The nausea score of TCEO and placebo groups were 2.11 and 2.99, respectively (P < 0.05). More than half of the participants (36/54) reported dizziness and sedation side effects. Dry mouth, confusion, anxiety, and palpitation of both groups were comparable. Conclusion The cannabinoid extract (THC:CBD) was an appropriate adjuvant agent to reduce CINV in patients with gynecologic cancer who received high-emetogenic chemotherapy. Dizziness and sedation were the major side effects.
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Affiliation(s)
- Apichaya Sukpiriyagul
- Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air ForceBangkokThailand
| | - Ratiporn Chartchaiyarerk
- Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air ForceBangkokThailand
| | - Paluekpon Tabtipwon
- Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air ForceBangkokThailand
| | - Buppa Smanchat
- Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air ForceBangkokThailand
| | - Sinart Prommas
- Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air ForceBangkokThailand
| | - Kornkarn Bhamarapravatana
- Department of Preclinical Science, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
| | - Komsun Suwannarurk
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
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Kayode A, Adrish S, Muhammad A, Amin R, Muhammad D, Rida Z, Alabi G, Okumede G, Kayode O. Therapeutic Uses of Medical Cannabis: An Overview of its Functions in Disease Management. JOURNAL OF MEDICAL SCIENCES 2023. [DOI: 10.3923/jms.2023.32.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
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Neurogenetic and Epigenetic Aspects of Cannabinoids. EPIGENOMES 2022; 6:epigenomes6030027. [PMID: 36135314 PMCID: PMC9498086 DOI: 10.3390/epigenomes6030027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
Cannabis is one of the most commonly used and abused illicit drugs in the world today. The United States (US) currently has the highest annual prevalence rate of cannabis consumption in the world, 17.9% in individuals aged 12 or older, and it is on the rise. With increasing cannabis use comes the potential for an increase in abuse, and according to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 5.1% of Americans had Cannabis Use Disorder (CUD) in 2020. Research has shown that genetics and epigenetics play a significant role in cannabis use and CUD. In fact, approximately 50–70% of liability to CUD and 40–48% of cannabis use initiation have been found to be the result of genetic factors. Cannabis usage and CUD have also been linked to an increased risk of psychiatric disorders and Reward Deficiency Syndrome (RDS) subsets like schizophrenia, depression, anxiety, and substance use disorder. Comprehension of the genetic and epigenetic aspects of cannabinoids is necessary for future research, treatment plans, and the production of pure cannabinoid compounds, which will be essential for FDA approval. In conclusion, having a better understanding of the epigenetic and genetic underpinnings of cannabis use, CUD, and the endocannabinoid system as a whole will aid in the development of effective FDA-approved treatment therapies and the advancement of personalized medicine.
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Mæland R, Lien L, Leonhardt M. Association between cannabis use and physical health problems in Norwegian adolescents: a cross-sectional study from the youth survey Ungdata. BMC Public Health 2022; 22:661. [PMID: 35382834 PMCID: PMC8985321 DOI: 10.1186/s12889-022-13136-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Cannabis use is increasing among young Norwegians and several studies show a high incidence of common physical health problems. An association has previously been found between cannabis use and mental health problems. Since physical and mental health problems often co-occur, the aim of this study is to explore the relationship between cannabis use and physical health problems. Methods In 2017–2019, the Norwegian youth survey Ungdata collected data from 249,100 Norwegian adolescents, which equalled around 80% of all lower secondary school pupils (13–15 years) and about 50% of upper secondary pupils (16–19 years) in Norway. Descriptive analysis was used to calculate the prevalence of cannabis use and bi- and multivariate logistic regression analysis to examine the association between cannabis use and physical health problems, controlled for sociodemographics and mental health problems. Results Almost 10% of Norwegian adolescents had used cannabis once or more in the previous 12 months. The use of cannabis increased with age and it was more prevalent among boys. There is a clear connection between physical health problems and cannabis use (OR = 1.582 (CI: 1.527–1.638)) even after adjusting for sociodemographic variables and mental health problems (OR = 1.366 (CI: 1.312–1.423)). Conclusion More studies are needed to explore if there might a bidirectional relationship between cannabis use and physical health problems where physical problems increase cannabis use and cannabis use increases the risk of physical health problems. More knowledge on the effect of and motivation for cannabis use are important for policy makers and health care professionals involved in young people.
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Affiliation(s)
- Ragnhild Mæland
- Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post Box 104, 2381, Brumunddal, Norway.,Department of Health and Social Science, Inland Norway University of Applied Science, Elverum, Norway
| | - Marja Leonhardt
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post Box 104, 2381, Brumunddal, Norway. .,Faculty of Health Studies, VID Specialized University, Oslo, Norway.
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Vinette B, Côté J, El-Akhras A, Mrad H, Chicoine G, Bilodeau K. Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review. BMC Cancer 2022; 22:319. [PMID: 35331185 PMCID: PMC8953058 DOI: 10.1186/s12885-022-09378-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/07/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Some patients diagnosed with cancer use medical cannabis to self-manage undesirable symptoms, including nausea and pain. To improve patient safety and oncological care quality, the routes of administration for use of medical cannabis, patients' reasons, and prescribed indications must be better understood. METHODS Based on the Joanna Briggs Institute guidelines, a scoping review was conducted to map the current evidence regarding the use of medical cannabis in oncological settings based on the experiences of patients diagnosed with cancer and their healthcare providers. A search strategy was developed with a scientific librarian which included five databases (CINAHL, Web of Science, Medline, Embase, and PsycINFO) and two grey literature sources (Google Scholar and ProQuest). The inclusion criteria were: 1) population: adults aged 18 and over diagnosed with cancer; 2) phenomena of interest: reasons for cannabis use and/or the prescribed indications for medical cannabis; 3) context: oncological setting. French- or English-language primary empirical studies, knowledge syntheses, and grey literature published between 2000 and 2021 were included. Data were extracted by two independent reviewers and subjected to a thematic analysis. A narrative description approach was used to synthesize and present the findings. RESULTS We identified 5,283 publications, of which 163 met the eligibility criteria. Two main reasons for medical cannabis use emerged from the thematic analysis: limiting the impacts of cancer and its side effects; and staying connected to others. Our results also indicated that medical cannabis is mostly used for three approved indications: to manage refractory nausea and vomiting, to complement pain management, and to improve appetite and food intake. We highlighted 11 routes of administration for medical cannabis, with oils and oral solutions the most frequently reported. CONCLUSION Future studies should consider the multiple routes of administration for medical cannabis, such as inhalation and edibles. Our review highlights that learning opportunities would support the development of healthcare providers' knowledge and skills in assessing the needs and preferences of patients diagnosed with cancer who use medical cannabis.
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Affiliation(s)
- Billy Vinette
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada.
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada.
- Center for Innovation in Nursing Education, Montreal, QC, Canada.
| | - José Côté
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
| | - Ali El-Akhras
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Hazar Mrad
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Gabrielle Chicoine
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Center for Innovation in Nursing Education, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
| | - Karine Bilodeau
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Center for Innovation in Nursing Education, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
- Research Center of the Centre Intégré Universitaire de Santé Et de Services Sociaux de L'Est-de-L'Île-de-Montréal, Montreal, QC, Canada
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Abstract
As medical cannabis becomes legal in more states, cancer patients are
increasingly interested in the potential utility of the ancient
botanical in their treatment regimen. Although eager to discuss
cannabis use with their oncologist, patients often find that their
provider reports that they do not have adequate information to be
helpful. Oncologists, so dependent on evidence-based data to guide
their treatment plans, are dismayed by the lack of published
literature on the benefits of medical cannabis. This results largely
from the significant barriers that have existed to effectively thwart
the ability to conduct trials investigating the potential therapeutic
efficacy of the plant. This is a narrative review aimed at clinicians,
summarizing cannabis phytochemistry, trials in the areas of nausea and
vomiting, appetite, pain and anticancer activity, including assessment
of case reports of antitumor use, with reflective assessments of the
quality and quantity of evidence. Despite preclinical evidence and
social media claims, the utility of cannabis, cannabinoids or
cannabis-based medicines in the treatment of cancer remains to be
convincingly demonstrated. With an acceptable safety profile, cannabis
and its congeners may be useful in managing symptoms related to cancer
or its treatment. Further clinical trials should be conducted to
evaluate whether the preclinical antitumor effects translate into
benefit for cancer patients. Oncologists should familiarize themselves
with the available database to be able to better advise their patients
on the potential uses of this complementary botanical therapy.
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Braun IM, Abrams DI, Blansky SE, Pergam SA. Cannabis and the Cancer Patient. J Natl Cancer Inst Monogr 2021; 2021:68-77. [PMID: 34850899 DOI: 10.1093/jncimonographs/lgab012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
Session 2 of the National Cancer Institute's Cannabis, Cannabinoids, and Cancer Research Workshop opened with testimony from a lymphoma survivor who detailed medicinal cannabis-related improvements in nausea, low appetite, insomnia, and mental health and the limited clinical counsel she received regarding cannabis use. Discussion next turned to the evolution of the legal landscape of cannabis in the United States, one in which state and federal laws frequently conflict and the Controlled Substance Act renders cannabis Schedule I. This legal climate creates conundrums for US medicinal cannabis researchers who contend with limited funding opportunities, avenues to source trial drug, and procedural red tape and for oncology clinicians who recommend medicinal cannabis to patients with some frequency while perceiving themselves as ill equipped to make such clinical recommendations. Ultimately, it creates challenges for cancer patients who find themselves turning to nonmedical and anecdotal information sources. The risks of cannabis use by the cancer patient were discussed next. These include infection, pharmacodynamic and pharmacokinetic drug-botanical interactions, cyclic nausea and vomiting, e-cigarette or vaping product use-associated illness, legal issues, and high cost. The session concluded with a broad survey of the research supporting oncologic cannabinoid use, conclusive evidence for chemotherapy-induced nausea and vomiting, and suggestive evidence for cancer-related pain.
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Affiliation(s)
- Ilana M Braun
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Donald I Abrams
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Stacey E Blansky
- School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
| | - Steven A Pergam
- University of Washington School of Medicine, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
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Lee C, Round JM, Klarenbach S, Hanlon JG, Hyshka E, Dyck JRB, Eurich DT. Gaps in evidence for the use of medically authorized cannabis: Ontario and Alberta, Canada. Harm Reduct J 2021; 18:61. [PMID: 34103058 PMCID: PMC8186125 DOI: 10.1186/s12954-021-00509-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With legal access to medical cannabis in Canada since 2001, there is a need to fully characterize its use at both the individual and population levels. We draw on data from Canada's largest cohort study of medical cannabis to identify the primary reasons for medical cannabis authorization in Canada from 2014 to 2019 in two major provinces: Alberta (AB) and Ontario (ON), and review the extent that evidence supports each indication. METHODS Self-reported baseline assessments were collected from adult patients in ON (n = 61,835) and AB (n = 3410) who were authorized medical cannabis. At baseline, sociodemographic, primary medical information, and validated clinical questionnaires were completed by patients as part of an individual assessment. Patients' reasons for seeking medical cannabis were compared to published reviews and guidelines to assess the level of evidence supporting medical cannabis use for each condition. RESULTS Medical cannabis use in both AB and ON was similar in both demographic and reason for authorization. The most common reasons for medical cannabis authorization were: (1) pain (AB = 77%, ON = 76%) primarily due to chronic musculoskeletal, arthritic, and neuropathic pain, (2) mental health concerns (AB = 32.9%, ON = 38.7%) due to anxiety and depression, and (3) sleep problems (AB = 28%, ON = 25%). More than 50 other conditions were identified as reasons for obtaining authorization. CONCLUSION In both AB and ON, the majority of reasons for medical cannabis authorization are not substantiated by clinical evidence to fully support its efficacy for long-term use. Ongoing epidemiological studies on medical cannabis on these treatments are warranted to fully outline its treatment benefits or risks.
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Affiliation(s)
- Cerina Lee
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Jessica M Round
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Scott Klarenbach
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada.
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10
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Therapeutic potential of cannabinoids in combination cancer therapy. Adv Biol Regul 2021; 79:100774. [PMID: 33422460 DOI: 10.1016/j.jbior.2020.100774] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
Derivatives of the plant Cannabis sativa have been used for centuries for both medical and recreational purposes, as well as industrial. The first proof of its medicinal use comes from ancient China, although there is evidence of its earlier utilization in Europe and Asia. In the 19th century, European practitioners started to employ cannabis extracts to treat tetanus, convulsions, and mental diseases and, in 1851, cannabis made its appearance in the Pharmacopoeia of the United States as an analgesic, hypnotic and anticonvulsant. It was only in 1937 that the Marijuana Tax Act prohibited the use of this drug in the USA. The general term Cannabis is commonly used by the scientific and scholar community to indicate derivatives of the plant Cannabis sativa. The word cannabinoid is a term describing chemical compounds that are either derivate of Cannabis (phytocannabinoids) or artificial analogues (synthetic) or are produced endogenously by the body (endocannabinoids). A more casual term "marijuana" or "weed", a compound derived from dried Cannabis flower tops and leaves, has progressively superseded the term cannabis when referred to its recreational use. The 2018 World health organisation (WHO) data suggest that nearly 2.5% of the global population (147 million) uses marijuana and some countries, such as Canada and Uruguay, have already legalised it. Due to its controversial history, the medicinal use of cannabinoids has always been a centre of debate. The isolation and characterisation of Δ9 tetrahydrocannabinol (THC), the major psychoactive component of cannabis and the detection of two human cannabinoid receptor (CBRs) molecules renewed interest in the medical use of cannabinoids, boosting research and commercial heed in this sector. Some cannabinoid-based drugs have been approved as medications, mainly as antiemetic, antianorexic, anti-seizure remedies and in cancer and multiple sclerosis patients' palliative care. Nevertheless, due to the stigma commonly associated with these compounds, cannabinoids' potential in the treatment of conditions such as cancer is still largely unknown and therefore underestimated.
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Cubillos Sánchez PA. Cannabis for medical and scientific purposes: the Colombian landscape. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Colombian government, through Law 1787 of 2016, has created a regulatory framework that allows its citizens to have a safe and informed access to cannabis and its derivatives for medical and scientific purposes. Our country joins others in their efforts to legalize cannabis-derived substances for therapeutic purposes, as many jurisdictions have recognized the potential these products have in the treatment of certain medical conditions. This paper describes the current medical cannabis outlook in Colombia, compares the different medical cannabis supply systems in other parts of the world, summarizes the evidence related to the potential therapeutic benefits and potential risks of using cannabis for medical purposes.
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Ni J, Zhang L. Cancer Cachexia: Definition, Staging, and Emerging Treatments. Cancer Manag Res 2020; 12:5597-5605. [PMID: 32753972 PMCID: PMC7358070 DOI: 10.2147/cmar.s261585] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/26/2020] [Indexed: 12/26/2022] Open
Abstract
Cachexia is a multifactorial disease characterized by weight loss via skeletal muscle and adipose tissue loss, an imbalance in metabolic regulation, and reduced food intake. It is caused by factors of catabolism produced by tumors in the systemic circulation as well as physiological factors such as the imbalanced inflammatory activation, proteolysis, autophagy, and lipolysis that may occur with gastric, pancreatic, esophageal, lung cancer, liver, and bowel cancer. Cancer cachexia not only negatively affects the quality of life of patients with cancer but also reduces the effectiveness of anti-cancer chemotherapy and increases its toxicity, leading to increased cancer-related mortality and expenditure of medical resources. Currently, there are no effective medical interventions to completely reverse cachexia and no approved drugs. Adequate nutritional support is the main method of cachexia treatment, while drugs that target the inhibition of catabolism, cell damage, and excessive activation of inflammation are under study. This article reviews recent advances in the diagnosis, staging, and evaluation of cancer cachexia.
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Affiliation(s)
- Jun Ni
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, People's Republic of China
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13
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Wooldridge LM, Ji L, Liu Y, Nikas SP, Makriyannis A, Bergman J, Kangas BD. Antiemetic Effects of Cannabinoid Agonists in Nonhuman Primates. J Pharmacol Exp Ther 2020; 374:462-468. [PMID: 32561684 DOI: 10.1124/jpet.120.265710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/18/2020] [Indexed: 02/06/2023] Open
Abstract
Attenuating emesis elicited by both disease and medical treatments of disease remains a critical public health challenge. Although cannabinergic medications have been used in certain treatment-resistant populations, Food and Drug Administration-approved cannabinoid antiemetics are associated with undesirable side effects, including cognitive disruption, that limit their prescription. Previous studies have shown that a metabolically stable analog of the endocannabinoid anandamide, methanandamide (mAEA), may produce lesser cognitive disruption than that associated with the primary psychoactive constituent in cannabis, Δ9-tetrahydrocannabinol (Δ9-THC), raising the possibility that endocannabinoids may offer a therapeutic advantage over currently used medications. The present studies were conducted to evaluate this possibility by comparing the antiemetic effects of Δ9-THC (0.032-0.1 mg/kg) and mAEA (3.2-10.0 mg/kg) against nicotine- and lithium chloride (LiCl)-induced emesis and prodromal hypersalivation in squirrel monkeys. Pretreatment with 0.1 mg/kg Δ9-THC blocked nicotine-induced emesis and reduced hypersalivation in all subjects and blocked LiCl-induced emesis and reduced hypersalivation in three of four subjects. Pretreatment with 10 mg/kg mAEA blocked nicotine-induced emesis in three of four subjects and LiCl-induced emesis in one of four subjects and reduced both nicotine- and LiCl-induced hypersalivation. Antiemetic effects of Δ9-THC and mAEA were reversed by rimonabant pretreatment, providing verification of cannabinoid receptor type 1 mediation. These studies systematically demonstrate for the first time the antiemetic effects of cannabinoid agonists in nonhuman primates. Importantly, although Δ9-THC produced superior antiemetic effects, the milder cognitive effects of mAEA demonstrated in previous studies suggest that it may provide a favorable treatment option under clinical circumstances in which antiemetic efficacy must be balanced against side effect liability. SIGNIFICANCE STATEMENT: Emesis has significant evolutionary value as a defense mechanism against ingested toxins; however, it is also one of the most common adverse symptoms associated with both disease and medical treatments of disease. The development of improved antiemetic pharmacotherapies has been impeded by a paucity of animal models. The present studies systematically demonstrate for the first time the antiemetic effects of the phytocannabinoid Δ9-tetrahydrocannabinol and endocannabinoid analog methanandamide in nonhuman primates.
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Affiliation(s)
- Lisa M Wooldridge
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (J.B., B.D.K.); Behavioral Biology Program, McLean Hospital, Belmont, Massachusetts (L.M.W., J.B., B.D.K.); and Center for Drug Discovery, Northeastern University, Boston, Massachusetts (L.J., Y.L., S.P.N., A.M.)
| | - Lipin Ji
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (J.B., B.D.K.); Behavioral Biology Program, McLean Hospital, Belmont, Massachusetts (L.M.W., J.B., B.D.K.); and Center for Drug Discovery, Northeastern University, Boston, Massachusetts (L.J., Y.L., S.P.N., A.M.)
| | - Yingpeng Liu
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (J.B., B.D.K.); Behavioral Biology Program, McLean Hospital, Belmont, Massachusetts (L.M.W., J.B., B.D.K.); and Center for Drug Discovery, Northeastern University, Boston, Massachusetts (L.J., Y.L., S.P.N., A.M.)
| | - Spyros P Nikas
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (J.B., B.D.K.); Behavioral Biology Program, McLean Hospital, Belmont, Massachusetts (L.M.W., J.B., B.D.K.); and Center for Drug Discovery, Northeastern University, Boston, Massachusetts (L.J., Y.L., S.P.N., A.M.)
| | - Alexandros Makriyannis
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (J.B., B.D.K.); Behavioral Biology Program, McLean Hospital, Belmont, Massachusetts (L.M.W., J.B., B.D.K.); and Center for Drug Discovery, Northeastern University, Boston, Massachusetts (L.J., Y.L., S.P.N., A.M.)
| | - Jack Bergman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (J.B., B.D.K.); Behavioral Biology Program, McLean Hospital, Belmont, Massachusetts (L.M.W., J.B., B.D.K.); and Center for Drug Discovery, Northeastern University, Boston, Massachusetts (L.J., Y.L., S.P.N., A.M.)
| | - Brian D Kangas
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (J.B., B.D.K.); Behavioral Biology Program, McLean Hospital, Belmont, Massachusetts (L.M.W., J.B., B.D.K.); and Center for Drug Discovery, Northeastern University, Boston, Massachusetts (L.J., Y.L., S.P.N., A.M.)
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14
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Inglet S, Winter B, Yost SE, Entringer S, Lian A, Biksacky M, Pitt RD, Mortensen W. Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature. Ann Pharmacother 2020; 54:1109-1143. [DOI: 10.1177/1060028020930189] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To compile and synthesize the available literature describing medical cannabis use across various disease states. Data Sources: PubMed, EBSCO, and Google Scholar searches were conducted using MeSH and/or keywords. Study Selection and Data Extraction: Studies were included if they described the use of cannabis-based products and medications in the treatment of a predefined list of disease states in humans and were published in English. The extraction period had no historical limit and spanned through April 2019. Data Synthesis: Evidence was compiled and summarized for the following medical conditions: Alzheimer disease, amyotrophic lateral sclerosis, autism, cancer and cancer-associated adverse effects, seizure disorders, human immunodeficiency virus, inflammatory bowel disease, multiple sclerosis (MS), nausea, pain, posttraumatic stress disorder, and hospice care. Relevance to Patient Care and Clinical Practice: Based on identified data, the most robust evidence suggests that medical cannabis may be effective in the treatment of chemotherapy-induced nausea and vomiting, seizure disorders, MS-related spasticity, and pain (excluding diabetic neuropathy). Overall, the evidence is inconsistent and generally limited by poor quality. The large variation in cannabis-based products evaluated in studies limits the ability to make direct comparisons. Regardless of the product, a gradual dose titration was utilized in most studies. Cannabis-based therapies were typically well tolerated, with the most common adverse effects being dizziness, somnolence, dry mouth, nausea, and euphoria. Conclusions: As more states authorize medical cannabis use, there is an increasing need for high-quality clinical evidence describing its efficacy and safety. This review is intended to serve as a reference for clinicians, so that the risks and realistic benefits of medical cannabis are better understood.
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Affiliation(s)
| | | | | | | | - Anh Lian
- Intermountain Healthcare, Taylorsville, UT, USA
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15
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Is Percutaneous Adhesiolysis Effective in Managing Chronic Low Back and Lower Extremity Pain in Post-surgery Syndrome: a Systematic Review and Meta-analysis. Curr Pain Headache Rep 2020; 24:30. [PMID: 32468418 DOI: 10.1007/s11916-020-00862-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The growing prevalence of spinal pain in the USA continues to produce substantial economic impact and strain on health-related quality of life. Percutaneous adhesiolysis is utilized for recalcitrant, resistant conditions involving spinal pain when epidural injections have failed to provide adequate improvement, especially low back and lower extremity pain, specifically in post-lumbar surgery syndrome. Despite multiple publications and systematic reviews, the debate continues in reference to effectiveness, safety, appropriate utilization, and medical necessity of percutaneous adhesiolysis in chronic pain. This systematic review, therefore, was undertaken to evaluate and to update effectiveness of percutaneous adhesiolysis to treat chronic refractory low back and lower extremity pain, post-surgical patients of the lumbar spine. RECENT FINDINGS From 2009 to 2016, there was a decline of 53.2% utilization of percutaneous adhesiolysis with an annual decline of 10.3% per 100,000 fee-for-service (FFS) Medicare population. Multiple insurers, including Medicare, with Medicare area contractors of Noridian and Palmetto have issued noncoverage policies for percutaneous adhesiolysis resulting in these steep declines and continued noncoverage by Medicare Advantage plans, Managed Care plans of Medicaid, and other insurers. Since 2005, 4 systematic reviews of percutaneous adhesiolysis were published with 3 of them showing proper methodology and appropriate results with effectiveness of adhesiolysis, whereas one poorly performed systematic review showed negative results. In addition, there were only 4 randomized controlled trials (RCTs) to be included in the previous systematic reviews of post-surgery syndrome, whereas now, the RCTs and other studies have increased. This systematic review shows level I or strong evidence for the effectiveness of percutaneous adhesiolysis in managing chronic low back and lower extremity pain related to post-lumbar surgery syndrome.
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16
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Beedham W, Sbai M, Allison I, Coary R, Shipway D. Cannabinoids in the Older Person: A Literature Review. Geriatrics (Basel) 2020; 5:E2. [PMID: 31941020 PMCID: PMC7151062 DOI: 10.3390/geriatrics5010002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/03/2020] [Accepted: 01/09/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Medical cannabinoids have received significant mainstream media attention in recent times due to an evolving political and clinical landscape. Whilst the efficacy of cannabinoids in the treatment of some childhood epilepsy syndromes is increasingly recognized, medical cannabinoids may also have potential clinical roles in the treatment of older adults. Prescribing restrictions for medical cannabinoids in certain jurisdictions (including the UK) has recently been relaxed. However, few geriatricians have the detailed knowledge or awareness of the potential risks or rewards of utilizing cannabinoids in the older person; even fewer geriatricians have direct experience of using these drugs in their own clinical practice. Older persons are more likely to suffer from medical illness representing potential indications for medical cannabinoids (e.g., pain); equally they may be more vulnerable to any adverse effects. AIM This narrative literature review aims to provide a brief introduction for the geriatrician to the potential indications, evidence-base, contra-indications and side effects of medical cannabinoids in older people. METHODS A search was conducted of CENTRAL, Medline, Embase, CINAHL and psycINFO, Cochrane and Web of Science databases. Reference lists were hand searched. Abstracts and titles were screened, followed by a full text reading of relevant articles. RESULTS 35 studies were identified as relevant for this narrative review. CONCLUSIONS Cannabinoids demonstrate some efficacy in the treatment of pain and chemotherapy-related nausea; limited data suggest potential benefits in the treatment of spasticity and anxiety. Risks of cannabinoids in older patients appear to be moderate, and their frequency comparable to other analgesic drug classes. However, the quality of research is weak, and few older patients have been enrolled in cannabinoid studies. Dedicated research is needed to determine the efficiency and safety of cannabinoids in older patients.
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Affiliation(s)
- William Beedham
- Medical Student, University of Birmingham Medical School, Birmingham B15 2SG, UK; (W.B.); (I.A.)
| | - Magda Sbai
- Consultant Physician and Perioperative Geriatrician, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK;
| | - Isabel Allison
- Medical Student, University of Birmingham Medical School, Birmingham B15 2SG, UK; (W.B.); (I.A.)
| | - Roisin Coary
- Specialist Registrar in Geriatric and General Medicine, St James’s Hospital, P.O. Box 580 Dublin, Ireland;
| | - David Shipway
- Consultant Physician and Perioperative Geriatrician, North Bristol NHS Trust, BS10 5NB& Honorary Senior Clinical Lecturer, University of Bristol, Bristol BS8 2PL, UK
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17
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Charoenkwan K, Srisomboon J. The Annual Meeting of the Thai Gynecologic Cancer Society 2019: Meeting report. J Gynecol Oncol 2019; 30:e118. [PMID: 31576703 PMCID: PMC6779612 DOI: 10.3802/jgo.2019.30.e118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jatupol Srisomboon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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18
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Hoch E, Friemel C, Schneider M, Pogarell O, Hasan A, Preuss UW. [Efficacy and safety of medicinal cannabis: results of the CaPRis study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:825-829. [PMID: 31214723 DOI: 10.1007/s00103-019-02965-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the 1990s, the endocannabinoid system was discovered as part of the human physiology. Since then, the effects of cannabis as a medicine have been researched more systematically. To summarize the scientific knowledge, the German Federal Ministry of Health commissioned an expertise.The project "Cannabis: Potential and Risks: a Scientific Analysis" (CaPRis), which started in 2016, aimed at analyzing the potential of medicinal cannabis and the risks of recreational cannabis use. A search of systematic reviews (SRs) and randomized-controlled trials (RCTs) were conducted in five international databases (publication date: 2006-2017). For the medical use of cannabis 16 SRs (of 186 RCTs) were included from a global search and nine further RCTs were comprised from a de novo search. All studies were methodologically assessed.Evidence for the efficacy of cannabis medicine (given as an adjunct to other medication) was found in patients with chronic pain and spasticity due to multiple sclerosis. Benefits were also found for appetite stimulation, improvement of nausea, and weight gain in patients with cancer, HIV/AIDS or in palliative care. Effects were often small. For other physical or mental disorders, only few or no controlled human studies are available. Adverse effects of cannabis medicine are often reported; severe adverse effects were mentioned in single cases only.To provide reliable treatment recommendations for clinicians and patients, more large-sized RCTs with follow-up assessments, consistent outcome measures, and active comparisons are needed.
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Affiliation(s)
- Eva Hoch
- Forschungsgruppe Cannabinoide, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Ludwig-Maximilians-Universität, Nußbaumstr. 7, 80336, München, Deutschland.
| | - Chris Friemel
- Forschungsgruppe Cannabinoide, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Ludwig-Maximilians-Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - Miriam Schneider
- University of Agriculture, Martin-Luther-University, Morogoro, Tanzania
| | - Oliver Pogarell
- Forschungsgruppe Cannabinoide, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Ludwig-Maximilians-Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - Alkomiet Hasan
- Forschungsgruppe Cannabinoide, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Ludwig-Maximilians-Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - Ulrich W Preuss
- Vitos Klinik Psychiatrie und Psychotherapie, Herborn, Deutschland
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland
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19
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Kiefer A, Eckert-Lill C, Bussick D, Hörnig M, Reimann H. [Cannabis for medical purposes and its prescription]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:811-817. [PMID: 31187182 DOI: 10.1007/s00103-019-02970-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Since 10 March 2017, physicians have been allowed to prescribe cannabis to patients with serious illnesses and in the absence of alternative therapies. Patients can obtain it as dried flowers or extracts in standardised pharmaceutical quality by prescription (narcotic prescription, except for cannabidiol) in pharmacies. When prescribing, physicians have to take a few things into account. The first step is to decide which therapeutic effects are to be achieved and which is the most suitable cannabis product.Cannabis for medical use must meet the requirements for pharmaceutical quality. An identity check must be carried out in the pharmacy on the basis of the monographs of the German Pharmacopoeia (DAB) or the German Pharmaceutical Codex/New Prescription Form (DAC/NRF). For the production of prescription drugs, e.g. capsules, drops or inhalates, there are also corresponding monographs for the preparation of prescription drugs. These standardised, quality-assured prescription formulas should be given preference in the case of a medical prescription.When prescribing an oral or inhalative form of application, it should be noted that the onset and duration of action are very different. Also, due to the complex pharmacology of cannabinoids, interindividual genetic differences in the metabolisation of ∆9-tetrahydrocannabinol (THC), the individual structure and function of the cannabinoid receptors, as well as differences in receptor density and distribution, the dosage and frequency of application must be individually determined. Last but not least, the dosage also depends on the type of disease and individual susceptibility to side effects. When prescribed for the first time, a creeping dosage with a very low initial dose is recommended.
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Affiliation(s)
| | | | - Daniela Bussick
- ABDA - Bundesvereinigung Deutscher Apothekerverbände e. V., 10117, Berlin, Deutschland
| | - Michael Hörnig
- AVOXA - Mediengruppe Deutscher Apotheker GmbH, Eschborn, Deutschland
| | - Holger Reimann
- AVOXA - Mediengruppe Deutscher Apotheker GmbH, Eschborn, Deutschland
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20
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Prospects for the Use of Cannabinoids in Oncology and Palliative Care Practice: A Review of the Evidence. Cancers (Basel) 2019; 11:cancers11020129. [PMID: 30678303 PMCID: PMC6406915 DOI: 10.3390/cancers11020129] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/20/2019] [Accepted: 01/20/2019] [Indexed: 01/15/2023] Open
Abstract
There is an increased interest in the use of cannabinoids in the treatment of symptoms in cancer and palliative care patients. Their multimodal action, in spite of limited efficacy, may make them an attractive alternative, particularly in patients with multiple concomitant symptoms of mild and moderate intensity. There is evidence to indicate cannabis in the treatment of pain, spasticity, seizures, sleep disorders, nausea and vomiting, and Tourette syndrome. Although the effectiveness of cannabinoids is limited, it was confirmed in neuropathic pain management and combination with opioids. A relatively favorable adverse effects profile, including no depressive effect on the respiratory system, may make cannabis complement a rather narrow armamentarium that is in the disposition of a palliative care professional.
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Bonini SA, Premoli M, Tambaro S, Kumar A, Maccarinelli G, Memo M, Mastinu A. Cannabis sativa: A comprehensive ethnopharmacological review of a medicinal plant with a long history. JOURNAL OF ETHNOPHARMACOLOGY 2018; 227:300-315. [PMID: 30205181 DOI: 10.1016/j.jep.2018.09.004] [Citation(s) in RCA: 265] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/02/2018] [Accepted: 09/03/2018] [Indexed: 05/21/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Cannabis sativa L. (C. sativa) is an annual dioecious plant, which shares its origins with the inception of the first agricultural human societies in Asia. Over the course of time different parts of the plant have been utilized for therapeutic and recreational purposes, for instance, extraction of healing oils from seed, or the use of inflorescences for their psychoactive effects. The key psychoactive constituent in C. sativa is called Δ-9-tetrahydrocannabinol (D9-THC). The endocannabinoid system seems to be phylogenetically ancient, as it was present in the most primitive vertebrates with a neuronal network. N-arachidonoylethanolamine (AEA) and 2-arachidonoyl glycerol (2-AG) are the main endocannabinoids ligands present in the animal kingdom, and the main endocannabinoid receptors are cannabinoid type-1 (CB1) receptor and cannabinoid type-2 (CB2) receptor. AIM OF THE STUDY The review aims to provide a critical and comprehensive evaluation, from the ancient times to our days, of the ethnological, botanical, chemical and pharmacological aspects of C. sativa, with a vision for promoting further pharmaceutical research to explore its complete potential as a therapeutic agent. MATERIALS AND METHODS This study was performed by reviewing in extensive details the studies on historical significance and ethnopharmacological applications of C. sativa by using international scientific databases, books, Master's and Ph.D. dissertations and government reports. In addition, we also try to gather relevant information from large regional as well as global unpublished resources. In addition, the plant taxonomy was validated using certified databases such as Medicinal Plant Names Services (MPNS) and The Plant List. RESULTS AND CONCLUSIONS A detailed comparative analysis of the available resources for C. sativa confirmed its origin and traditional spiritual, household and therapeutic uses and most importantly its popularity as a recreational drug. The result of several studies suggested a deeper involvement of phytocannabinoids (the key compounds in C. sativa) in several others central and peripheral pathophysiological mechanisms such as food intake, inflammation, pain, colitis, sleep disorders, neurological and psychiatric illness. However, despite their numerous medicinal benefits, they are still considered as a menace to the society and banned throughout the world, except for few countries. We believe that this review will help lay the foundation for promoting exhaustive pharmacological and pharmaceutical studies in order to better understand the clinical relevance and applications of non-psychoactive cannabinoids in the prevention and treatment of life-threatening diseases and help to improve the legal status of C. sativa.
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Affiliation(s)
- Sara Anna Bonini
- Department of Molecular and Translational Medicine, Division of Pharmacology, University of Brescia, Brescia, Italy
| | - Marika Premoli
- Department of Molecular and Translational Medicine, Division of Pharmacology, University of Brescia, Brescia, Italy
| | - Simone Tambaro
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden
| | - Amit Kumar
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden
| | - Giuseppina Maccarinelli
- Department of Molecular and Translational Medicine, Division of Pharmacology, University of Brescia, Brescia, Italy
| | - Maurizio Memo
- Department of Molecular and Translational Medicine, Division of Pharmacology, University of Brescia, Brescia, Italy
| | - Andrea Mastinu
- Department of Molecular and Translational Medicine, Division of Pharmacology, University of Brescia, Brescia, Italy.
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22
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Bouquié R, Deslandes G, Mazaré H, Cogné M, Mahé J, Grégoire M, Jolliet P. Cannabis and anticancer drugs: societal usage and expected pharmacological interactions - a review. Fundam Clin Pharmacol 2018; 32:462-484. [DOI: 10.1111/fcp.12373] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Régis Bouquié
- Laboratoire de Biologie Médicale; Centre Hospitalier Léon-Jean Grégory; avenue du Roussillon 66330 Thuir France
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
- EA 4275 Biostatistique; Pharmacoépidémiologie et Mesures Subjectives en Santé; Nantes University Hospital; Nantes France
| | - Guillaume Deslandes
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
| | - Hélène Mazaré
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
| | - Marion Cogné
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
| | - Julien Mahé
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
| | - Matthieu Grégoire
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections; Nantes University Hospital; Nantes France
| | - Pascale Jolliet
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
- EA 4275 Biostatistique; Pharmacoépidémiologie et Mesures Subjectives en Santé; Nantes University Hospital; Nantes France
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23
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Garcia JM, Shamliyan TA. Cannabinoids in Patients with Nausea and Vomiting Associated with Malignancy and Its Treatments. Am J Med 2018; 131:755-759.e2. [PMID: 29909841 DOI: 10.1016/j.amjmed.2017.12.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Jose M Garcia
- Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Wash; Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Wash
| | - Tatyana A Shamliyan
- Quality Assurance, Evidence-Based Medicine Center, Elsevier, Philadelphia, Pa.
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Cancer cachexia: Diagnosis, assessment, and treatment. Crit Rev Oncol Hematol 2018; 127:91-104. [PMID: 29891116 DOI: 10.1016/j.critrevonc.2018.05.006] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 04/16/2018] [Accepted: 05/09/2018] [Indexed: 02/07/2023] Open
Abstract
Cancer cachexia is a multi-factorial syndrome, which negatively affects quality of life, responsiveness to chemotherapy, and survival in advanced cancer patients. Our understanding of cachexia has grown greatly in recent years and the roles of many tumor-derived and host-derived compounds have been elucidated as mediators of cancer cachexia. However, cancer cachexia remains an unmet medical need and attempts towards a standard treatment guideline have been unsuccessful. This review covers the diagnosis, assessment, and treatment of cancer cachexia; the elements impeding the formulation of a standard management guideline; and future directions of research for the improvement and standardization of current treatment procedures.
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Abstract
The chemotherapy-induced nausea and vomiting (CINV) is one of the most frequent side effects in cytostatic therapy and a profound challenge during the therapy of cancer patients. Therefore, standardized guideline-orientated prophylaxis is essential and a fundamental contribution for the success of treatment. This review summarizes the current recommendations for CINV of the Multinational Association of Supportive Care in Cancer (MASCC) and European Society of Medical Oncology (ESMO), the American Society for Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN) and the S3-guideline Supportive Therapie of the Leitlinienprogramm Onkologie and shall facilitate its use in the daily routine.
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26
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Schussel V, Kenzo L, Santos A, Bueno J, Yoshimura E, de Oliveira Cruz Latorraca C, Pachito DV, Riera R. Cannabinoids for nausea and vomiting related to chemotherapy: Overview of systematic reviews. Phytother Res 2017; 32:567-576. [PMID: 29168289 DOI: 10.1002/ptr.5975] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/12/2017] [Accepted: 10/14/2017] [Indexed: 11/12/2022]
Abstract
Nausea and vomiting are common and distressing adverse events of chemotherapy. This review focuses on the findings and quality of systematic reviews (SRs) of cannabinoids for chemotherapy-induced nausea and vomiting (CINV). Review of SRs, a systematic literature search, was conducted in several electronic databases and included SRs evaluating cannabinoids for CINV in cancer patients. Methodological quality and quality of reporting were evaluated by AMSTAR and PRISMA, respectively. Initial search retrieved 2,206 records, and 5 SRs were included. On the basis of findings of the sole SR judged as high methodological quality, cannabinoids seem to be more effective than placebo, equal to prochlorperazine for reducing CINV, and to be preferred by patients. The response to different combinations of antiemetic agents seems to be equal to 1 antiemetic alone. The average of AMSTAR score was 5, and the average of PRISMA score was 13.2. Cannabinoids represent a valuable option for treating CINV, despite the adverse events related to treatment, such as drowsiness and cognitive impairment. There is no good quality evidence to recommend or not the use of cannabinoids for CINV. More studies are still needed to evaluate the effectiveness of cannabinoids when compared with modern antiemetics.
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Affiliation(s)
- Victor Schussel
- Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lucas Kenzo
- Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Andreia Santos
- Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Júlia Bueno
- Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ellen Yoshimura
- Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Daniela Vianna Pachito
- Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Cochrane Brazil, São Paulo, SP, Brazil
| | - Rachel Riera
- Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Cochrane Brazil, São Paulo, SP, Brazil
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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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Manning Meurer M, Chakrala K, Gowda D, Burns C, Kelly R, Schlabritz-Loutsevitch N. A case of cannabinoid hyperemesis syndrome with Heliobacter pylori and preeclampsia during pregnancy. Subst Abus 2017; 39:9-13. [PMID: 28723278 DOI: 10.1080/08897077.2017.1356790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The condition termed cannabinoid hyperemesis syndrome (CHS) was characterized a decade ago by Allen et al. and includes cyclic episodes of nausea and vomiting and the learned behavior of hot bathing in individuals with chronic cannabis abuse. During pregnancy, the differential diagnosis of this syndrome is challenging, since it can be masked by typical symptoms of early pregnancy or by hyperemesis gravidarum, a complication of early pregnancy associated with excessive nausea and vomiting. CASE DESCRIPTION The authors herein describe the case of a 21-year-old primigravida patient diagnosed with hyperemesis gravidarum at 6 weeks of gestation and with preeclampsia at 35 weeks. At 30 weeks of gestation, a drug screen was performed that was positive for cannabis; therefore, a diagnosis of CHS was made. After labor induction, the patient delivered an infant who developed normally and had a negative drug test of the umbilical cord blood. Esophagogastroduodenoscopy was performed 9 days post delivery, with biopsies taken of the duodenal, gastric, and esophageal tissues. Moderate chronic gastritis with lymphoid aggregates and slight acute inflammation were noticed, whereas no malignancy, dysplasia, or goblet cell metaplasia was detected. A number of Helicobacter-like organisms were identified by H. pylori immunostaining. CONCLUSION Presented here is the first case reporting an association of chronic cannabis use with H. pylori colonization and preeclampsia in pregnancy, which brings to light the possible involvement of a cannabinoid-related pathway in the link between pregnancy-specific complications and bacterial colonization.
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Affiliation(s)
- Madeline Manning Meurer
- a Department of Obstetrics and Gynecology , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Kalyan Chakrala
- b Department of Internal Medicine , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Dinesh Gowda
- c Department of Pediatrics , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Charles Burns
- d Department of Pathology , Medical Center Hospital , Odessa , Texas , USA
| | - Randall Kelly
- a Department of Obstetrics and Gynecology , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Natalia Schlabritz-Loutsevitch
- a Department of Obstetrics and Gynecology , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
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Pergolizzi JV, Taylor R, LeQuang JA, Zampogna G, Raffa RB. Concise review of the management of iatrogenic emesis using cannabinoids: emphasis on nabilone for chemotherapy-induced nausea and vomiting. Cancer Chemother Pharmacol 2017; 79:467-477. [PMID: 28235999 DOI: 10.1007/s00280-017-3257-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 12/11/2022]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a prevalent, distressing, and burdensome side effect of cancer chemotherapy. It is estimated to affect the majority of patients receiving certain anti-cancer drug regimens and can be treatment-limiting, even for life-saving medications. Despite seemingly numerous options, such as antimuscarinic anticholinergics, antihistamines, 5-HT3 receptor antagonists, dopamine receptor antagonists, and neurokinin-1 receptor antagonists, preventative therapies are often inadequately effective, particularly for "delayed CINV"-leaving an important unmet clinical need. Cannabinoid receptor agonists, by virtue of their unique mechanism of action and efficacy and safety data reported in clinical trials, appear to offer a useful additional option. The mechanistic value of cannabinoids has been well known for many years, but these agents may have been underutilized in the past because of the notoriety and legal status of marijuana. While botanical marijuana contains nearly 500 components, including the psychoactive tetrahydrocannabinol (THC), nabilone is an established, single-entity synthetic cannabinoid receptor agonist that has become the focus of renewed interest. We review the basic pharmacology and clinical trial data of nabilone for use in prophylaxis and treatment of CINV.
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Affiliation(s)
| | - Robert Taylor
- NEMA Research, Inc., 868 106th Ave North, Naples, FL, 34108, USA
| | - Jo Ann LeQuang
- NEMA Research, Inc., 868 106th Ave North, Naples, FL, 34108, USA.
| | | | - Robert B Raffa
- University of Arizona College of Pharmacy, Tucson, AZ, USA
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30
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Mudge EM, Murch SJ, Brown PN. Leaner and greener analysis of cannabinoids. Anal Bioanal Chem 2017; 409:3153-3163. [PMID: 28233028 PMCID: PMC5395585 DOI: 10.1007/s00216-017-0256-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/23/2017] [Accepted: 02/10/2017] [Indexed: 11/24/2022]
Abstract
There is an explosion in the number of labs analyzing cannabinoids in marijuana (Cannabis sativa L., Cannabaceae) but existing methods are inefficient, require expert analysts, and use large volumes of potentially environmentally damaging solvents. The objective of this work was to develop and validate an accurate method for analyzing cannabinoids in cannabis raw materials and finished products that is more efficient and uses fewer toxic solvents. An HPLC-DAD method was developed for eight cannabinoids in cannabis flowers and oils using a statistically guided optimization plan based on the principles of green chemistry. A single-laboratory validation determined the linearity, selectivity, accuracy, repeatability, intermediate precision, limit of detection, and limit of quantitation of the method. Amounts of individual cannabinoids above the limit of quantitation in the flowers ranged from 0.02 to 14.9% w/w, with repeatability ranging from 0.78 to 10.08% relative standard deviation. The intermediate precision determined using HorRat ratios ranged from 0.3 to 2.0. The LOQs for individual cannabinoids in flowers ranged from 0.02 to 0.17% w/w. This is a significant improvement over previous methods and is suitable for a wide range of applications including regulatory compliance, clinical studies, direct patient medical services, and commercial suppliers.
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Affiliation(s)
- Elizabeth M Mudge
- Natural Health & Food Products Research, British Columbia Institute of Technology, 3700 Willingdon Ave, Burnaby, British Columbia, V5G 3H2, Canada.,Department of Chemistry, University of British Columbia, 3247 University Way, Kelowna, British Columbia, V1V 1V7, Canada
| | - Susan J Murch
- Department of Chemistry, University of British Columbia, 3247 University Way, Kelowna, British Columbia, V1V 1V7, Canada
| | - Paula N Brown
- Natural Health & Food Products Research, British Columbia Institute of Technology, 3700 Willingdon Ave, Burnaby, British Columbia, V5G 3H2, Canada.
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Abstract
Cannabis sativa, a subspecies of the Cannabis plant, contains aromatic hydrocarbon compounds called cannabinoids. [INCREMENT]-Tetrahydrocannabinol is the most abundant cannabinoid and is the main psychotropic constituent. Cannabinoids activate two types of G-protein-coupled cannabinoid receptors: cannabinoid type 1 receptor and cannabinoid type 2 receptor. There has been ongoing interest and development in research to explore the therapeutic potential of cannabis. [INCREMENT]-Tetrahydrocannabinol exerts biological functions on the gastrointestinal (GI) tract. Cannabis has been used for the treatment of GI disorders such as abdominal pain and diarrhea. The endocannabinoid system (i.e. endogenous circulating cannabinoids) performs protective activities in the GI tract and presents a promising therapeutic target against various GI conditions such as inflammatory bowel disease (especially Crohn's disease), irritable bowel syndrome, and secretion and motility-related disorders. The present review sheds light on the role of cannabis in the gut, liver, and pancreas and also on other GI symptoms, such as nausea and vomiting, cannabinoid hyperemesis syndrome, anorexia, weight loss, and chronic abdominal pain. Although the current literature supports the use of marijuana for the treatment of digestive disorders, the clinical efficacy of cannabis and its constituents for various GI disorders remains unclear.
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Zhong W, Picca AJ, Lee AS, Darmani NA. Ca2+ signaling and emesis: Recent progress and new perspectives. Auton Neurosci 2017; 202:18-27. [DOI: 10.1016/j.autneu.2016.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 02/07/2023]
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Affiliation(s)
- L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. .,Deutsche Gesellschaft für Palliativmedizin e. V., Berlin, Deutschland.
| | - M Schäfer
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland.,Deutsche Schmerzgesellschaft e. V., Berlin, Deutschland
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Ablin J, Ste-Marie PA, Schäfer M, Häuser W, Fitzcharles MA. Medical use of cannabis products. Schmerz 2016; 30:3-13. [DOI: 10.1007/s00482-015-0083-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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