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Szejko N, Becher E, Heimann F, Grotenhermen F, Müller-Vahl KR. Medicinal Use of Different Cannabis Strains: Results from a Large Prospective Survey in Germany. PHARMACOPSYCHIATRY 2024; 57:133-140. [PMID: 38471525 DOI: 10.1055/a-2261-2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Up to now, it is unclear whether different medicinal cannabis (MC) strains are differently efficacious across different medical conditions. In this study, the effectiveness of different MC strains was compared depending on the disease to be treated. METHODS This was an online survey conducted in Germany between June 2020 and August 2020. Patients were allowed to participate only if they received a cannabis-based treatment from pharmacies in the form of cannabis flowers prescribed by a physician. RESULTS The survey was completed by n=1,028 participants. Most participants (58%) have used MC for more than 1 year, on average, 5.9 different strains. Bedrocan (pure tetrahydrocannabinol to pure cannabidiol [THC:CBD]=22:<1) was the most frequently prescribed strain, followed by Bakerstreet (THC:CBD=19:<1) and Pedanios 22/1 (THC:CBD=22:1). The most frequent conditions MC was prescribed for were different pain disorders, psychiatric and neurological diseases, and gastrointestinal symptoms. Overall, the mean patient-reported effectiveness was 80.1% (range, 0-100%). A regression model revealed no association between the patient-reported effectiveness and the variety. Furthermore, no influence of the disease on the choice of the MC strain was detected. On average, 2.1 side effects were reported (most commonly dry mouth (19.5%), increased appetite (17.1%), and tiredness (13.0%)). However, 29% of participants did not report any side effects. Only 398 participants (38.7%) indicated that costs for MC were covered by their health insurance. CONCLUSIONS Patients self-reported very good efficacy and tolerability of MC. There was no evidence suggesting that specific MC strains are superior depending on the disease to be treated.
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Affiliation(s)
- Natalia Szejko
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Eva Becher
- Department of Sex- and Gender-specific Medicine, University of Bielefeld, Bielefeld, Germany
| | | | - Franjo Grotenhermen
- International Association for Cannabinoid Medicines, Steinheim, Germany
- Center for Cannabis Medicine, Steinheim, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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D’Angelo M, Steardo L. Cannabinoids and Sleep: Exploring Biological Mechanisms and Therapeutic Potentials. Int J Mol Sci 2024; 25:3603. [PMID: 38612415 PMCID: PMC11011314 DOI: 10.3390/ijms25073603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
The endogenous cannabinoid system (ECS) plays a critical role in the regulation of various physiological functions, including sleep, mood, and neuroinflammation. Phytocannabinoids such as Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), cannabinomimimetics, and some N-acylethanolamides, particularly palmitoyethanolamide, have emerged as potential therapeutic agents for the management of sleep disorders. THC, the psychoactive component of cannabis, may initially promote sleep, but, in the long term, alters sleep architecture, while CBD shows promise in improving sleep quality without psychoactive effects. Clinical studies suggest that CBD modulates endocannabinoid signaling through several receptor sites, offering a multifaceted approach to sleep regulation. Similarly, palmitoylethanolamide (PEA), in addition to interacting with the endocannabinoid system, acts as an agonist on peroxisome proliferator-activated receptors (PPARs). The favorable safety profile of CBD and PEA and the potential for long-term use make them an attractive alternative to conventional pharmacotherapy. The integration of the latter two compounds into comprehensive treatment strategies, together with cognitive-behavioral therapy for insomnia (CBT-I), represents a holistic approach to address the multifactorial nature of sleep disorders. Further research is needed to establish the optimal dosage, safety, and efficacy in different patient populations, but the therapeutic potential of CBD and PEA offers hope for improved sleep quality and general well-being.
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Affiliation(s)
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy;
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Miranda A, Peek E, Ancoli-Israel S, Young JW, Perry W, Minassian A. The Role of Cannabis and The Endocannabinoid System in Sleep Regulation and Cognition: A Review of Human and Animal Studies. Behav Sleep Med 2024; 22:217-233. [PMID: 37401160 PMCID: PMC10761597 DOI: 10.1080/15402002.2023.2232497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVES Both sleep and cognition are partially modulated by the endocannabinoid (ECB) system. Cannabis has been reported to have effects on sleep and cognition. This review aims to summarize the recent literature on the ECB system, the role of cannabis and the ECB system on sleep regulation and cognition. Further, this review will identify existing gaps in knowledge and suggest potential targets for future research. METHODS We performed this review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reports were identified by searching PubMed/MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO for articles published through September 2021 for studies with data available on aspects of cognition, cannabis, or the ECB system, and sleep or circadian rhythms (CRs). RESULTS We identified 6 human and 6 animal studies to be eligible for inclusion in this review. Several human studies found that cannabis use is not associated with changes in sleep quality or cognitive function. However, individual cannabinoids appeared to have independent effects on cognition and sleep; THC alone decreased cognitive performance and increased daytime sleepiness, whereas CBD alone had no effect on sleep or cognition. Animal studies demonstrated that manipulation of the ECB system altered activity and cognitive function, some of which appeared to be dependent on the light/dark cycle. CONCLUSION The sleep-wake cycle and CRs are both likely modulated by the ECB system, potentially resulting in effects on cognition, however this area is critically understudied.
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Affiliation(s)
- Alannah Miranda
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Elizabeth Peek
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center for Circadian Biology, University of California San Diego, San Diego, CA, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - William Perry
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center for Excellence on Stress and Mental Health, Veterans Affairs San Diego Health System, San Diego, CA, USA
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Bidwell LC, Sznitman SR, Martin-Willett R, Hitchcock LH. Daily associations with cannabis use and sleep quality in anxious cannabis users. Behav Sleep Med 2024; 22:150-167. [PMID: 37255232 PMCID: PMC10687319 DOI: 10.1080/15402002.2023.2217969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Cannabis is increasingly used to self-treat anxiety and related sleep problems, without clear evidence of either supporting or refuting its anxiolytic or sleep aid effects. In addition, different forms of cannabis and primary cannabinoids ∆9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have differing pharmacological effects. METHODS Thirty days of daily data on sleep quality and cannabis use were collected in individuals who use cannabis for mild-to-moderate anxiety (n = 347; 36% male, 64% female; mean age = 33 years). Participants self-reported both the form (flower or edible) and the ratio of THC to CBD in the cannabis used during the observation period. RESULTS Individuals who reported cannabis use on a particular day also reported better sleep quality the following night. Moderation analyses showed that better perceived sleep after cannabis use days was stronger for respondents with higher baseline affective symptoms. Further, respondents who used cannabis edibles with high CBD concentration reported the highest perceived quality of sleep. CONCLUSIONS Among individuals with affective symptoms, naturalistic use of cannabis was associated with better sleep quality, particularly for those using edible and CBD dominant products.
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Affiliation(s)
- L C Bidwell
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - S R Sznitman
- School of Public Health, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
| | - R Martin-Willett
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - L H Hitchcock
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
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Gething K, Erku D, Scuffham P. Stakeholders' Decisions and Preferences for the Provision and Use of Medicinal Cannabis: A Scoping Review. Cannabis Cannabinoid Res 2023; 8:986-998. [PMID: 36888538 DOI: 10.1089/can.2022.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background: The aim of this scoping review was to examine the extent that stakeholder's decisions about and preferences for the provision and use of medicinal cannabis (MC) had been investigated. We sought to identify which populations were examined, the methods used for eliciting preferences and exploring decisions, and the reported outcomes of studies. Methods: Electronic databases (PubMed, CINAHL, Embase, BSC and PsycINFO) and the reference lists of relevant articles were searched for studies published up to March 2022. Studies were included if stakeholder preferences for MC were (1) the primary focus of the research, or (2) an aspect of a larger preference focus. Studies that (3) described the decisions to use MC were also included. Results: Thirteen studies were reviewed. The population focus of these was primarily patient, with seven studies focused on general patient populations and five studies targeting specific patient populations such as cancer survivors, and people experiencing depression. Methods included health economics preference methods, qualitative interviews, and a single multicriteria decision-making study. Four categories of outcomes were defined and included comparisons of MC with a therapeutic alternative (n=5), preferences for MC attributes (n=5), administration preferences (n=4), and the decision process of users (n=2). Motivation differences in preference were found. Purely medicinal users and novice users place more importance on cannabidiol (CBD) than tetrahydrocannabinol. Overall, inhalation methods of administration were preferred due to quick onset of symptom relief. Price was the greatest influence on choice for recreational/medicinal users, whereas purely medicinal users were less price sensitive for products with higher CBD content. Conclusion: Studies examining public preferences for the provision and use of MC were absent. Revealed preference methods are a useful technique for understanding preferences for characteristics that are difficult to visibly assess such as cannabinoid or strain. The outcomes of symptom-specific multicriteria decision method studies that compare the benefit-safety profiles of commonly used treatments and MC may be a useful decision support tool for health practitioners. Studies with representative samples are needed to understand the impact of age, gender, and race on preferences for MC.
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Affiliation(s)
- Katrina Gething
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Daniel Erku
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Paul Scuffham
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Lee RM, Donnan J, Harris N, Garland SN. A cross-sectional survey of the prevalence and patterns of using cannabis as a sleep aid in Canadian cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01474-2. [PMID: 37837502 DOI: 10.1007/s11764-023-01474-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Poor sleep is one of the most common side effects of cancer. It can persist for years beyond treatment and negatively impact quality of life and health. Cannabis is increasingly used to manage cancer treatment-related symptoms, including sleep. This study investigated the use and perceived effects of cannabis as a sleep aid in Canadian cancer survivors. METHODS Adult Canadian cancer survivors (N = 1464) were recruited via the Angus Reid Institute and completed an online, cross-sectional survey including the Insomnia Severity Index and questions about cannabis use for sleep. Standard descriptive statistics, such as means, standard deviations, and ranges were produced for measured variables to assess the ways cancer survivors use cannabis for sleep. Frequencies were tabulated for categorical and ordinal variables. RESULTS On average, participants (Mage = 61.1 years; Women = 50%: Men = 48%) received their cancer diagnosis 12.5 years prior. Of participants, 23.5% (n = 344) currently use cannabis as a sleep aid, with reported benefits including relaxation, reduced time to fall asleep, fewer nocturnal awakenings and improved sleep quality. Two thirds (68.3%, n = 235) only began using cannabis for sleep after their cancer diagnosis. Over a third of participants (36.3%, n = 125) use cannabis as a sleep aid every day. Among the 344, the most common other reasons for using cannabis were pain (31.4%, n = 108), recreational use (24.4%, n = 84), and anxiety (12.5%, n = 43). CONCLUSIONS Given the prevalence and potential impact, research is needed to examine the actual efficacy of cannabis as a sleep aid. IMPLICATIONS FOR CANCER SURVIVORS It is important that cancer survivors have information on methods to help their sleep to avoid impairments to quality of life and health.
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Affiliation(s)
- Rachel M Lee
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University, St. John's, NL, Canada
| | - Nick Harris
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada.
- Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada.
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
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Kolobaric A, Hewlings SJ, Bryant C, Colwell CS, R. D’Adamo C, Rosner B, Chen J, Pauli EK. A Randomized, Double-Blind, Placebo-Controlled Decentralized Trial to Assess Sleep, Health Outcomes, and Overall Well-Being in Healthy Adults Reporting Disturbed Sleep, Taking a Melatonin-Free Supplement. Nutrients 2023; 15:3788. [PMID: 37686820 PMCID: PMC10490534 DOI: 10.3390/nu15173788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Inadequate sleep is a global health concern. Sleep is multidimensional and complex; new multi-ingredient agents are needed. This study assessed the comparative effects of two multi-ingredient supplements on sleep relative to placebo. Adults (N = 620) seeking better sleep were randomly assigned to receive one of three study products. Sleep A (contained lower (0.35 mg THC and higher levels of botanicals (75 mg each hops oil and valerian oil), Sleep B (contained higher THC (0.85 mg) and lower botanicals (20 mg each hops oil and valerian oil) or placebo) for 4 weeks. Sleep disturbance was assessed at baseline and weekly using NIH's Patient-Reported Outcomes Measurement Information System (PROMIS™) Sleep Disturbance SF 8A survey. Anxiety, stress, pain, and well-being were assessed using validated measures at baseline and weekly. A linear mixed-effects regression model was used to assess the change in health outcome score between active product groups and the placebo. There was a significant difference in sleep disturbance, anxiety, stress, and well-being between Sleep A and placebo. There was no significant difference in any health parameter between Sleep B and placebo. Side effects were mild or moderate. There were no significant differences in the frequency of side effects between the study groups. A botanical blend containing a low concentration of THC improved sleep disturbance, anxiety, stress, and well-being in healthy individuals that reported better sleep as a primary health concern.
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Affiliation(s)
- Antonija Kolobaric
- Radicle Science, Inc., Del Mar, CA 92014, USA; (A.K.); (C.B.); (J.C.); (E.K.P.)
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Susan J. Hewlings
- Radicle Science, Inc., Del Mar, CA 92014, USA; (A.K.); (C.B.); (J.C.); (E.K.P.)
| | - Corey Bryant
- Radicle Science, Inc., Del Mar, CA 92014, USA; (A.K.); (C.B.); (J.C.); (E.K.P.)
| | - Christopher S. Colwell
- Department of Psychiatry & Biobehavioral Sciences, University of California–Los Angeles, Los Angeles, CA 90095, USA;
| | - Christopher R. D’Adamo
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Bernard Rosner
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Jeff Chen
- Radicle Science, Inc., Del Mar, CA 92014, USA; (A.K.); (C.B.); (J.C.); (E.K.P.)
| | - Emily K. Pauli
- Radicle Science, Inc., Del Mar, CA 92014, USA; (A.K.); (C.B.); (J.C.); (E.K.P.)
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Fernández N, Cappello MG, Quiroga PN. An assessment of qualitative and quantitative cannabinoids analysis in selected commercially available cannabis oils in Argentina. Forensic Sci Int 2023; 349:111762. [PMID: 37392612 DOI: 10.1016/j.forsciint.2023.111762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/08/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023]
Abstract
In recent years, the therapeutic use of cannabis products, especially cannabis oils, has increased significantly, due to the pharmacological potential of their cannabinoids, for the treatment of conditions, such as pain management, cancer, and epilepsy. In Argentina, patients with medical prescriptions can access to cannabis oil, through self-cultivation, a third-person (grower or importer), or a civil organization authorized for that purpose. However, these products remain largely unregulated in Argentina, and information available regarding labeling accuracy, especially cannabidiol (CBD)/ Δ9-tetrahydrocannabinol (Δ9-THC) concentrations are inconsistent or nonexistent, nor long-term product stability, and lot to lot variability. Understanding these properties is fundamental if these products are to be used in patients with a determinate pathology. Therefore, we analyzed commercially available cannabis oils (n: 500) in Argentina for qualitative and quantitative cannabinoids content. In order to provide a detailed overview of their cannabinoids profiles, and determine Δ9-THC, CBD, and cannabinol (CBN) concentrations, samples were diluted and analyzed by gas chromatography- mass spectrometry (GC/MS). Most of the samples tested positive for cannabinoids (n: 469) with Δ9-THC and CBD as the predominant cannabinoids. Among products tested, only 29.8% (n: 149) gave specific CBD label claims, and testing indicated a CBD tested positive of 70.5% (n: 105). For products (n: 17) with a THC-free label claim, testing indicated 76.5% (n: 13) of Δ9-THC positive, and cannabinoids were not detected in four products. Δ9-THC concentrations ranged from 0.1 to 143.0 mg/mL, CBD concentrations from 0.1 to 125.3 mg/mL, and CBN concentrations from 0.04 to 60.10 mg/mL; CBN/ Δ9-THC ratios ranged from 0.0012 to 2.31, and CBD/ Δ9-THC ratios from 0.0008 to 178.87. Furthermore, the (Δ9-THC + CBN)/CBD ratio of most samples was greater than one. In summary, our results indicate that cannabis oil products show wide variability in cannabinoids content, purity, and labeling.
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Affiliation(s)
- Nicolás Fernández
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Toxicología y Química Legal, Laboratorio de Asesoramiento Toxicológico Analítico (CENATOXA), Ciudad Autónoma de Buenos Aires (CABA), Buenos Aires, Argentina.
| | - Marcello Gian Cappello
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Toxicología y Química Legal, Laboratorio de Asesoramiento Toxicológico Analítico (CENATOXA), Ciudad Autónoma de Buenos Aires (CABA), Buenos Aires, Argentina
| | - Patricia Noemí Quiroga
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Toxicología y Química Legal, Laboratorio de Asesoramiento Toxicológico Analítico (CENATOXA), Ciudad Autónoma de Buenos Aires (CABA), Buenos Aires, Argentina
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Amaral C, Carvalho C, Scaranelo A, Chapman K, Chatkin J, Ferreira I. Cannabis and sleep disorders: not ready for prime time? A qualitative scoping review. J Clin Sleep Med 2023; 19:975-990. [PMID: 36692176 PMCID: PMC10152356 DOI: 10.5664/jcsm.10428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES To perform a qualitative scoping literature review for studies involving the effects of cannabis on sleep and sleep disorders. METHODS Two electronic databases, MEDLINE and EMBASE, searched for comprehensive published abstracted studies that involved human participants. Inclusion criteria were article of any type, published in English, a target population of cannabis users, and reported data on cannabis effect on sleep and sleep disorders. The Joanna Briggs Institute's (JBI) approach was elected as the methodology framework guidance in the scoping review process. RESULTS A total of 40 unique publications were found. The majority (82.5%) were from the Americas with 60% published in the last decade. Of the 40 studies, only 25% were randomized control trials, and the sleep outcome measurements were similar and comparable in only 20%. Cannabis users studied were reported either 73% frequent users or 27% sporadic users. The utilization of cannabis showed improved sleep (21%), worse sleep (48%), mixed results (14%), or no impact at all (17%) in the studies published in the last 5 decades. CONCLUSIONS Our findings summarize the lack of robust evidence to support the use of cannabis for sleep disorders. The varied cannabis user-related characteristics may account for the inconsistent results identified. Further studies assessing cannabis and sleep are needed to discern what works in what context, how it works, and for whom. CITATION Amaral C, Carvalho C, Scaranelo A, Chapman K, Chatkin J, Ferreira I. Cannabis and sleep disorders: not ready for prime time? A qualitative scoping review. J Clin Sleep Med. 2023;19(5):975-990.
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Affiliation(s)
- Caio Amaral
- Department of Medicine, University Centre of the Americas, São Paulo, São Paulo, Brazil
| | - Carolina Carvalho
- KITE-Toronto Rehabilitation Institute, University Health Network and Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Anabel Scaranelo
- Medical Imaging Department, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth Chapman
- Department of Medicine, Respiratory Division, University of Toronto, Toronto, Ontario, Canada
- Asthma & Airway Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jose Chatkin
- Division of Respiratory Diseases, School of Medicine Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ivone Ferreira
- Department of Medicine, Respiratory Division, University of Toronto, Toronto, Ontario, Canada
- Asthma & Airway Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Respiratory Division of McMaster University, Hamilton, Ontario, Canada
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Stella N. THC and CBD: Similarities and differences between siblings. Neuron 2023; 111:302-327. [PMID: 36638804 PMCID: PMC9898277 DOI: 10.1016/j.neuron.2022.12.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/14/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
Δ9-tetrahydrocannabinol (THC) and its sibling, cannabidiol (CBD), are produced by the same Cannabis plant and have similar chemical structures but differ dramatically in their mechanisms of action and effects on brain functions. Both THC and CBD exhibit promising therapeutic properties; however, impairments and increased incidence of mental health diseases are associated with acute and chronic THC use, respectively, and significant side effects are associated with chronic use of high-dose CBD. This review covers recent molecular and preclinical discoveries concerning the distinct mechanisms of action and bioactivities of THC and CBD and their impact on human behavior and diseases. These discoveries provide a foundation for the development of cannabinoid-based therapeutics for multiple devastating diseases and to assure their safe use in the growing legal market of Cannabis-based products.
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Affiliation(s)
- Nephi Stella
- Department of Pharmacology, Department Psychiatry and Behavioral Sciences, Center for Cannabis Research, Center for the Neurobiology of Addiction, Pain, and Emotion, University of Washington School of Medicine, Seattle, WA 98195, USA
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Kalaba M, Ware MA. Cannabinoid Profiles in Medical Cannabis Users: Effects of Age, Gender, Symptoms, and Duration of Use. Cannabis Cannabinoid Res 2022; 7:840-851. [PMID: 33999649 PMCID: PMC9784598 DOI: 10.1089/can.2020.0120] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Introduction: Clinical trials remain the gold standard for evaluating efficacy, but there is increasing interest in using real-world evidence (RWE) to inform health care decision making. The aims of this observational study were to describe patterns of medical cannabis use, associated changes in symptom severity over time, and to evaluate change in cannabis dose over time for pain-related symptoms. Methods: Data were collected by Strainprint™, an application that is HIPAA, PIPEDA, and PHIPA compliant. A total of 629 participants recorded data between May 2017 and August 2019. A total of 65 symptoms were grouped as Pain, Mental Health, Physical Symptoms, Seizures, Headaches/Migraines, and Other. Descriptive statistics and mixed-effects modeling were applied. Results: THC-dominant products were more frequently consumed for symptoms of pain and sleep, while CBD-dominant products were more frequently consumed for anxiety and depression. Male and female participants demonstrated significant differences in the type of cannabis they consumed. Females more frequently consumed CBD-dominant products, and males more frequently consumed balanced (THC:CBD) products. Oil use was more prominent among females, while vaping was more common among males. Product use also varied by age tertiles (<31; 31-39; >40 years). CBD-dominant products were more common among younger participants, <31 years, THC-dominant products were more common among the 31-39 years category and balanced (THC:CBD) products were common among older participants >41 years. Dosages of CBD-dominant and balanced (THC:CBD) products increased over time irrespective of symptom response. THC-dominant products demonstrated a significant relationship between dose and symptom reduction over time. Conclusions: Recognizing that RWE has important methodological limitations, we observed cannabis product preferences based on demographic characteristics, such as gender and age and the primary symptom treated such as pain and anxiety. Our study offers real-world insights into how participants use and respond to cannabis products and suggests important avenues and methodologies for future research.
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Affiliation(s)
- Maja Kalaba
- Canopy Growth Corporation, Smiths Falls, Ontario, Canada.,Address correspondence to: Maja Kalaba, MPH, Canopy Growth Corporation, 1 Hershey Drive, Smiths Falls, ON K7A 0A8, Canada,
| | - Mark A. Ware
- Canopy Growth Corporation, Smiths Falls, Ontario, Canada
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Clinical Management of Sleep and Sleep Disorders With Cannabis and Cannabinoids. Clin Neuropharmacol 2022; 45:27-31. [DOI: 10.1097/wnf.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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O’Brien K. Cannabidiol (CBD) in Cancer Management. Cancers (Basel) 2022; 14:cancers14040885. [PMID: 35205633 PMCID: PMC8869992 DOI: 10.3390/cancers14040885] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/28/2022] [Accepted: 02/05/2022] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Cannabidiol (CBD) is one of the main constituents of the plant Cannabis sativa. Surveys suggest that medicinal cannabis is popular amongst people diagnosed with cancer. CBD is one of the key constituents of cannabis, and does not have the potentially intoxicating effects that tetrahydrocannabinol (THC), the other key phytocannabinoid has. Research indicates the CBD may have potential for the treatment of cancer, including the symptoms and signs associated with cancer and its treatment. Preclinical research suggests CBD may address many of the pathways involved in the pathogenesis of cancers. Preclinical and clinical research also suggests some evidence of efficacy, alone or in some cases in conjunction with tetrahydrocannabinol (THC, the other key phytocannabinoid in cannabis), in treating cancer-associated pain, anxiety and depression, sleep problems, nausea and vomiting, and oral mucositis that are associated with cancer and/or its treatment. Studies also suggest that CBD may enhance orthodox treatments with chemotherapeutic agents and radiation therapy and protect against neural and organ damage. CBD shows promise as part of an integrative approach to the management of cancer. Abstract The plant Cannabis sativa has been in use medicinally for several thousand years. It has over 540 metabolites thought to be responsible for its therapeutic effects. Two of the key phytocannabinoids are cannabidiol (CBD) and tetrahydrocannabinol (THC). Unlike THC, CBD does not have potentially intoxicating effects. Preclinical and clinical research indicates that CBD has a wide range of therapeutic effects, and many of them are relevant to the management of cancer. In this article, we explore some of the potential mechanisms of action of CBD in cancer, and evidence of its efficacy in the integrative management of cancer including the side effects associated with its treatment, demonstrating its potential for integration with orthodox cancer care.
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Affiliation(s)
- Kylie O’Brien
- Adelaide Campus, Torrens University, Adelaide, SA 5000, Australia;
- NICM Health Research Centre, Western Sydney University, Westmead, Sydney, NSW 2145, Australia
- Releaf Group Ltd., St Kilda, VIC 3182, Australia
- International College of Cannabinoid Medicine, iccm.co, London N1 7GU, UK
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14
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Kuhathasan N, Minuzzi L, MacKillop J, Frey BN. The Use of Cannabinoids for Insomnia in Daily Life: Naturalistic Study. J Med Internet Res 2021; 23:e25730. [PMID: 34704957 PMCID: PMC8581757 DOI: 10.2196/25730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 01/01/2023] Open
Abstract
Background Insomnia is a prevalent condition that presents itself at both the symptom and diagnostic levels. Although insomnia is one of the main reasons individuals seek medicinal cannabis, little is known about the profile of cannabinoid use or the perceived benefit of the use of cannabinoids in daily life. Objective We conducted a retrospective study of medicinal cannabis users to investigate the use profile and perceived efficacy of cannabinoids for the management of insomnia. Methods Data were collected using the Strainprint app, which allows medicinal cannabis users to log conditions and symptoms, track cannabis use, and monitor symptom severity pre- and postcannabis use. Our analyses examined 991 medicinal cannabis users with insomnia across 24,189 tracked cannabis use sessions. Sessions were analyzed, and both descriptive statistics and linear mixed-effects modeling were completed to examine use patterns and perceived efficacy. Results Overall, cannabinoids were perceived to be efficacious across all genders and ages, and no significant differences were found among product forms, ingestion methods, or gender groups. Although all strain categories were perceived as efficacious, predominant indica strains were found to reduce insomnia symptomology more than cannabidiol (CBD) strains (estimated mean difference 0.59, SE 0.11; 95% CI 0.36-0.81; adjusted P<.001) and predominant sativa strains (estimated mean difference 0.74, SE 0.16; 95% CI 0.43-1.06; adjusted P<.001). Indica hybrid strains also presented a greater reduction in insomnia symptomology than CBD strains (mean difference 0.52, SE 0.12; 95% CI 0.29-0.74; adjusted P<.001) and predominant sativa strains (mean difference 0.67, SE 0.16; 95% CI 0.34-1.00; adjusted P=.002). Conclusions Medicinal cannabis users perceive a significant improvement in insomnia with cannabinoid use, and this study suggests a possible advantage with the use of predominant indica strains compared with predominant sativa strains and exclusively CBD in this population. This study emphasizes the need for randomized placebo-controlled trials assessing the efficacy and safety profile of cannabinoids for the treatment of insomnia.
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Affiliation(s)
- Nirushi Kuhathasan
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - James MacKillop
- Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Benicio N Frey
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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15
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Graupensperger S, Fairlie AM, Vitiello MV, Kilmer JR, Larimer ME, Patrick ME, Lee CM. Daily-level effects of alcohol, marijuana, and simultaneous use on young adults' perceived sleep health. Sleep 2021; 44:6325450. [PMID: 34291803 DOI: 10.1093/sleep/zsab187] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Simultaneous alcohol and marijuana (SAM) use is increasingly prevalent among young adults but has adverse health consequences. The current study examined daily-level associations between perceived sleep health and SAM use, relative to non-substance-use days and alcohol- or marijuana-only days. We also estimated linear associations between alcohol/marijuana use and perceived sleep health and explored whether effects were moderated by combined use of alcohol and marijuana. METHODS A community sample of SAM-using young adults (N=409; Mage=21.61, SD=2.17; 50.9% female; 48.2% White; 48.9% college students) completed twice-daily surveys for five 14-day sampling bursts. Daily measurements assessed substance use and perceived sleep health in terms of subjective sleep quality, negative impact of sleep on functioning, and symptoms of insomnia. RESULTS Multilevel models indicated that, relative to non-substance-use days, participants reported poorer perceived sleep health on alcohol-only days, better perceived sleep health on marijuana-only days, and mixed evidence regarding SAM use (i.e., fewer perceived symptoms of insomnia, but poorer perceived next day functioning attributed to sleep). Daily-level estimates showed increased alcohol use was associated with poorer perceived sleep health, while stronger effects from marijuana were associated with better perceived sleep health. Across all indices of sleep health, only one linear association was moderated by combined use: The adverse association between alcohol and next day functioning was weaker on days alcohol was combined with marijuana. CONCLUSIONS Findings provide additional evidence for daily-level effects of alcohol and marijuana use on perceived sleep health and address an important literature gap regarding potential adverse effects of SAM use.
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Affiliation(s)
- Scott Graupensperger
- Department of Psychiatry and Behavioral Sciences, University of Washington - Seattle, WA, USA
| | - Anne M Fairlie
- Department of Psychiatry and Behavioral Sciences, University of Washington - Seattle, WA, USA
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington - Seattle, WA, USA
| | - Jason R Kilmer
- Department of Psychiatry and Behavioral Sciences, University of Washington - Seattle, WA, USA
| | - Mary E Larimer
- Department of Psychiatry and Behavioral Sciences, University of Washington - Seattle, WA, USA
| | - Megan E Patrick
- Institute for Social Research, University of Michigan - Ann Arbor, MI, USA
| | - Christine M Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington - Seattle, WA, USA
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16
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Zhou ES, Nayak MM, Chai PR, Braun IM. Cancer patient's attitudes of using medicinal cannabis for sleep. J Psychosoc Oncol 2021; 40:397-403. [PMID: 33847549 DOI: 10.1080/07347332.2021.1910396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Poor sleep is one of the most common side effects of cancer treatment. One increasingly popular approach to manage side effects of cancer treatment is use of medicinal cannabis (MC). DESIGN Cancer patients using MC participated in semi-structured interviews to assess their experiences with MC (n = 24). A multi-stage thematic analysis was applied to interview transcripts. Themes related to use of MC for sleep were extracted. FINDINGS The majority reported MC use for sleep. These participants reported that MC improved sleep initiation and continuity, resulted in decreased use of sleep medications, and that improved sleep led to better health. No participant reported MC was ineffectual for sleep or caused undesirable side effects when used for sleep. CONCLUSIONS Cancer patients often utilize MC to specifically manage poor sleep. There is a need for rigorous studies assessing prevalence of use for this indication and clinical trials to assess comparative efficacy and safety.
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Affiliation(s)
- Eric S Zhou
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Manan M Nayak
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peter R Chai
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Medical Toxicology, Brigham and Women's Hospital, Boston, MA, USA
| | - 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
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Carnero Contentti E, López PA, Criniti J, Pettinicchi JP, Tavolini D, Mainella C, Tizio S, Tkachuk V, Silva B, Caride A, Rojas JI, Alonso R. Use of cannabis in patients with multiple sclerosis from Argentina. Mult Scler Relat Disord 2021; 51:102932. [PMID: 33848817 DOI: 10.1016/j.msard.2021.102932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of cannabis to treat some symptoms of neurological diseases, including multiple sclerosis (MS), has increased worldwide. We aimed to assess the use of cannabis in patients with MS (PwMS) from Argentina, its reasons and patients' perceptions on the management of MS symptoms. Additionally, we assessed their association with socio-demographic and clinical aspects. METHODS A cross-sectional online survey that included 281 PwMS from Argentina was conducted. Screening instruments: Demographics and clinical data, health-related QoL (MS Impact Scale-29), Fatigue Severity Scale, The Hospital Anxiety and Depression Scale, sleep disorders, physical disability (self-administrated Expanded Disability Status Scale) and medical or recreational cannabis use were evaluated. A logistic regression model was carried out. RESULTS Current users (cannabis was used within the past year) was reported in 34.2% and former users (had tried cannabis but not used it within the past year) in 22.7%. Daily cannabis use was reported in 31.3% (current + former users) of the studied cohort, 41.9% started their use after MS diagnosis and 54.3% of them had never discussed about cannabis use with their neurologist. Recreational use was reported in 47.5%. Younger (age below 30 years) PwMS (OR = 2.39, p = 0.03), presence of chronic pain (OR = 2.42, p = 0.002) and current alcohol intake (OR = 3.33, p = 0.001) were predictors of current cannabis use in our multivariate model. CONCLUSION A high prevalence of use of cannabis in PwMS from Argentina was observed. Demographic, symptoms and lifestyle factors predict cannabis use. Identifying the presence and severity of these conditions would contribute to a better MS management and treatment.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Internal medicine Department, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Santiago Tizio
- Neurology Department, Hospital Italiano y Español de La Plata, Argentina
| | - Verónica Tkachuk
- Neuroimmunology Section, Neurology Department, Hospital de Clínicas "José de San Martín", University of Buenos Aires, Buenos Aires, Argentina
| | - Berenice Silva
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
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18
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Abstract
Despite the fact that medical properties of Cannabis have been recognized for more than 5000 years, the use of Cannabis for medical purposes have recently reemerged and became more accessible. Cannabis is usually employed as a self-medication for the treatment of insomnia disorder. However, the effects of Cannabis on sleep depend on multiple factors such as metabolomic composition of the plant, dosage and route of administration. In the present chapter, we reviewed the main effect Cannabis on sleep. We focused on the effect of "crude or whole plant" Cannabis consumption (i.e., smoked, oral or vaporized) both in humans and experimental animal models.The data reviewed establish that Cannabis modifies sleep. Furthermore, a recent experimental study in animals suggests that vaporization (which is a recommended route for medical purposes) of Cannabis with high THC and negligible CBD, promotes NREM sleep. However, it is imperative to perform new clinical studies in order to confirm if the administration of Cannabis could be a beneficial therapy for the treatment of sleep disorders.
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19
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Ek J, Jacobs W, Kaylor B, McCall WV. Addiction and Sleep Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1297:163-171. [PMID: 33537944 DOI: 10.1007/978-3-030-61663-2_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Shared neurophysiology of addiction and sleep disorders results in a bidirectional interplay. Diagnosing and treating primary sleep disorders, particularly in adolescents, can prevent the development of addiction in susceptible individuals. Addressing sleep issues in early recovery, and throughout maintenance, can prevent relapse. Cannabis use for insomnia shows mixed results; assisting with onset sleep latency in early use, this subsides with chronic use and holds addiction risk. Insomnia is a primary complaint of cannabis withdrawal syndrome and a primary cause of relapse in cannabis use disorder. An ideal sleep aid would prevent relapse and have low abuse potential. Pharmaceutical and behavioral options include suvorexant, mirtazapine, trazodone, and aerobic exercise, but clinical trials are lacking to demonstrate efficacy.
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Affiliation(s)
- Jonathan Ek
- Division of Addiction Medicine, Augusta University-Medical College of Georgia, Augusta, GA, USA.
| | - William Jacobs
- Division of Addiction Medicine, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | - Brett Kaylor
- Division of Addiction Medicine, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | - W Vaughn McCall
- Division of Addiction Medicine, Augusta University-Medical College of Georgia, Augusta, GA, USA
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20
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Drazdowski TK, Kliewer WL, Marzell M. College students' using marijuana to sleep relates to frequency, problematic use, and sleep problems. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:103-112. [PMID: 31498749 PMCID: PMC7061072 DOI: 10.1080/07448481.2019.1656634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/01/2019] [Accepted: 08/11/2019] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Given the rising rates of insufficient sleep and the popularity of marijuana, we investigated using marijuana as a sleep aid, marijuana use frequency, problematic marijuana use, and sleep problems. Participants: Participants included a convenience sample of college students who endorsed using marijuana in the past year from May to December 2013 (N = 354; 68% female, 57% White). Methods: Path analyses investigated if using marijuana to sleep predicted: (1) marijuana use outcomes and (2) sleep problems; and if sleep problems predicted marijuana use outcomes. Results: Using marijuana to sleep was related to increased use and problematic use, as well as worse sleep efficiency. Daytime dysfunction related to sleepiness was associated with elevated levels of marijuana use and problematic use. Similar associations were found across sex and race. Conclusions: College students should be informed of the potential misconceptions between marijuana and improved sleep and provided with evidence-based alternatives to improve their sleep.
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Affiliation(s)
- Tess K. Drazdowski
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd., Eugene, OR 97401
| | - Wendy L. Kliewer
- Virginia Commonwealth University, Department of Psychology, PO Box 842018, Richmond VA 23284
| | - Miesha Marzell
- Binghamton University, Department of Social Work, PO Box 6000, Binghamton, NY 13902-6000
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21
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Sznitman SR, Vulfsons S, Meiri D, Weinstein G. Medical cannabis and insomnia in older adults with chronic pain: a cross-sectional study. BMJ Support Palliat Care 2020; 10:415-420. [PMID: 31959585 DOI: 10.1136/bmjspcare-2019-001938] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Medical cannabis (MC) is increasingly being used for treatment of chronic pain symptoms. Among patients there is also a growing preference for the use of MC to manage sleep problems. The aim of the current study was to examine the associations between use of whole plant cannabis and sleep problems among chronic pain patients. METHODS A total of 128 individuals with chronic pain over the age of 50 years were recruited from the Rambam Institute for Pain Medicine in Haifa, Israel. Of them, 66 were MC users and 62 were non-users. Regression models tested the differences in sleep problems between the two groups. Furthermore, Pearson correlations between MC use measures (dose, length and frequency of use, number of strains used, tetrahydrocannabinol/cannabidiol levels) and sleep problems were assessed among MC users. RESULTS After adjustment for age, sex, pain level and use of sleep and anti-depressant medications, MC use was associated with less problems with waking up at night compared with non-MC use. No group differences were found for problems with falling asleep or waking up early without managing to fall back asleep. Frequent MC use was associated with more problems waking up at night and falling asleep. CONCLUSIONS MC use may have an overall positive effect on maintaining sleep throughout the night in chronic pain patients. At the same time, tolerance towards potential sleep-inducing properties of MC may occur with frequent use. More research based on randomised control trials and other longitudinal designs is warranted.
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Affiliation(s)
- Sharon R Sznitman
- School of Public Health, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
| | - Simon Vulfsons
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel
| | - David Meiri
- Department of Biology, Technion Israel Institute of Technology, Haifa, Israel
| | - Galit Weinstein
- School of Public Health, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
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22
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Kesner AJ, Lovinger DM. Cannabinoids, Endocannabinoids and Sleep. Front Mol Neurosci 2020; 13:125. [PMID: 32774241 PMCID: PMC7388834 DOI: 10.3389/fnmol.2020.00125] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/22/2020] [Indexed: 12/21/2022] Open
Abstract
Sleep is a vital function of the nervous system that contributes to brain and bodily homeostasis, energy levels, cognitive ability, and other key functions of a variety of organisms. Dysfunctional sleep induces neural problems and is a key part of almost all human psychiatric disorders including substance abuse disorders. The hypnotic effects of cannabis have long been known and there is increasing use of phytocannabinoids and other formulations as sleep aids. Thus, it is crucial to gain a better understanding of the neurobiological basis of cannabis drug effects on sleep, as well as the role of the endogenous cannabinoid system in sleep physiology. In this review article, we summarize the current state of knowledge concerning sleep-related endogenous cannabinoid function derived from research on humans and rodent models. We also review information on acute and chronic cannabinoid drug effects on sleep in these organisms, and molecular mechanisms that may contribute to these effects. We point out the potential benefits of acute cannabinoids for sleep improvement, but also the potential sleep-disruptive effects of withdrawal following chronic cannabinoid drug use. Prescriptions for future research in this burgeoning field are also provided.
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Affiliation(s)
- Andrew J Kesner
- Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute of Health (NIH), Bethesda, MD, United States
- Center on Compulsive Behaviors, Intramural Research Program, National Institute of Health (NIH), Bethesda, MD, United States
| | - David M Lovinger
- Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute of Health (NIH), Bethesda, MD, United States
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23
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Suraev A, Grunstein RR, Marshall NS, D'Rozario AL, Gordon CJ, Bartlett DJ, Wong K, Yee BJ, Vandrey R, Irwin C, Arnold JC, McGregor IS, Hoyos CM. Cannabidiol (CBD) and Δ 9-tetrahydrocannabinol (THC) for chronic insomnia disorder ('CANSLEEP' trial): protocol for a randomised, placebo-controlled, double-blinded, proof-of-concept trial. BMJ Open 2020; 10:e034421. [PMID: 32430450 PMCID: PMC7239553 DOI: 10.1136/bmjopen-2019-034421] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/06/2020] [Accepted: 03/11/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Insomnia is a highly prevalent and costly condition that is associated with increased health risks and healthcare utilisation. Anecdotally, cannabis use is frequently reported by consumers to promote sleep. However, there is limited research on the effects of cannabis on sleep and daytime function in people with insomnia disorder using objective measures. This proof-of-concept study will evaluate the effects of a single dose of an oral cannabis-based medicine on sleep and daytime function in participants with chronic insomnia disorder. METHODS AND ANALYSIS A randomised, crossover, placebo-controlled, single-dose study design will be used to test the safety and efficacy of an oral oil solution ('ETC120') containing 10 mg Δ9-tetrahydrocannabinol (THC) and 200 mg cannabidiol (CBD) in 20 participants diagnosed with chronic insomnia disorder. Participants aged 35-60 years will be recruited over an 18-month period commencing August 2019. Each participant will receive both the active drug and matched placebo, in a counterbalanced order, during two overnight study assessment visits, with at least a 1-week washout period between each visit. The primary outcomes are total sleep time and wake after sleep onset assessed via polysomnography. In addition, 256-channel high-density electroencephalography and source modelling using structural brain MRI will be used to comprehensively examine brain activation during sleep and wake periods on ETC120 versus placebo. Next-day cognitive function, alertness and simulated driving performance will also be investigated. ETHICS AND DISSEMINATION Ethics approval was received from Bellberry Human Research Ethics Committee (2018-04-284). The findings will be disseminated in a peer-reviewed open-access journal and at academic conferences. TRIAL REGISTRATION NUMBER ANZCTRN12619000714189.
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Affiliation(s)
- Anastasia Suraev
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nathaniel S Marshall
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia
| | - Angela L D'Rozario
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
| | - Christopher J Gordon
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia
| | - Delwyn J Bartlett
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
| | - Keith Wong
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Brendon J Yee
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chris Irwin
- Menzies Health Institute Queensland, School Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Jonathon C Arnold
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Discipline of Pharmacology, Sydney, New South Wales, Australia
| | - Iain S McGregor
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
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24
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Evaluation and management of insomnia in women with breast cancer. Breast Cancer Res Treat 2020; 181:269-277. [PMID: 32314110 DOI: 10.1007/s10549-020-05635-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/07/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Insomnia is a common issue among patients with breast cancer with a potentially devastating impact on quality of life. It can be caused or exacerbated by multiple disease and treatment-related factors. Despite the prevalence and impact of insomnia, it is rarely addressed systematically in the oncology clinic. We conducted a comprehensive review of insomnia to guide clinical care of patient's with breast cancer and insomnia. METHODS This manuscript reviews the prevalence, etiology, emerging science and both non-pharmacologic and pharmacologic options for treatment of insomnia among patients with breast cancer. RESULTS Multiple factors contribute to insomnia among patients with breast cancer including endocrine therapy and hotflashes, pain and discomfort from local therapy, and fear of recurrence. If we do identify insomnia, there are treatment options and strategies available to help patients. In particular, there is now a considerable body of evidence supporting the use of psychosocial interventions and behavioral treatments, such as cognitive behavioral therapy for insomnia (CBT-I), yoga, and mind-body programs. It is also important for oncology providers to be educated regarding available pharmacologic therapies and emerging data for cannabis-based therapy. CONCLUSION This manuscript provides an up-to-date and comprehensive review of the prevalence, etiology, and treatment approaches available for insomnia for clinicians treating patients with breast cancer. We also address strategies and goals for cancer care delivery and future research.
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Prospéro García OE, Ruiz Contreras AE, Cortés Morelos J, Herrera Solís A, Méndez Díaz M. Marihuana: legalización y atención médica. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.22201/fm.24484865e.2019.62.6.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Despite the fact that the use of marihuana is illegal in most countries of the world, it still is one of the most commonly used drugs worldwide. 8.6% of the Mexican population, between 12-65 years old, has smoked marihuana at least once in their lifetime (2017). There has been a significant increase in the number of consumers in the last few years. Fatal cases associated with cannabis use had not been recognized for a long time, however, lately, deaths due to a cannabis hyperemesis syndrome (CHS) and deaths from self-mutilation have been reported. Although marihuana synthesizes several active substances with potential therapeutic properties, nowadays, the greatest use of marihuana in our country and in the world is recreational. This review discusses the consequences of using marihuana for recreational use, the social and health contexts regarding legalization and potential therapeutic uses of compounds isolated from the plant based on the scientific literature. Our contribution is to warn people about the potential negative impact on the health of recreational use marihuana and the urgency of supporting the research of its effects on the brain. Similarly, we aim to identify the active principles with potential therapeutic use.
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Affiliation(s)
- Oscar E. Prospéro García
- Universidad Nacional Autónoma de México (UNAM), Grupo de Neurociencias, Ciudad de México, México; Universidad Nacional Autónoma de México (UNAM), Facultad de Medicina, Departamento de Fisiología, Laboratorio de Canabinoides, Ciudad de México, México
| | - Alejandra E. Ruiz Contreras
- Universidad Nacional Autónoma de México (UNAM), Grupo de Neurociencias, Ciudad de México, México; Universidad Nacional Autónoma de México (UNAM), Facultad de Psicología, Coordinación de Psicobiología y Neurociencias, Laboratorio de Neurogenómica Cognitiva, Ciudad de México, México
| | - Jacqueline Cortés Morelos
- Universidad Nacional Autónoma de México (UNAM), Grupo de Neurociencias, Ciudad de México, México; Universidad Nacional Autónoma de México (UNAM), Facultad de Medicina, Departamento de Psiquiatría y Salud Mental, Ciudad de México, México
| | - Andrea Herrera Solís
- Universidad Nacional Autónoma de México (UNAM), Grupo de Neurociencias, Ciudad de México, México; Hospital General Dr. Manuel Gea González, Subdirección de Investigación Biomédica, Laboratorio Efectos Terapéuticos de los Canabinoides, Ciudad de México, México
| | - Mónica Méndez Díaz
- Universidad Nacional Autónoma de México (UNAM), Grupo de Neurociencias, Ciudad de México, México; Universidad Nacional Autónoma de México (UNAM), Facultad de Medicina, Departamento de Fisiología, Laboratorio de Canabinoides, Ciudad de México, México
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Borgan F, Beck K, Butler E, McCutcheon R, Veronese M, Vernon A, Howes OD. The effects of cannabinoid 1 receptor compounds on memory: a meta-analysis and systematic review across species. Psychopharmacology (Berl) 2019; 236:3257-3270. [PMID: 31165913 PMCID: PMC6828623 DOI: 10.1007/s00213-019-05283-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/20/2019] [Indexed: 01/01/2023]
Abstract
RATIONALE While cannabis-based medicinal products have been shown to be effective for numerous neurological and psychiatric disorders, the evidence base regarding their adverse cognitive effects is poorly understood. The cannabinoid 1 receptor modulates memory performance via intracellular and extracellular mechanisms that alter synaptic transmission and plasticity. While previous literature has consistently shown that chronic cannabis users exhibit marked cognitive impairments, mixed findings have been reported in the context of placebo-controlled experimental trials. It is therefore unclear whether these compounds inherently alter cognitive processes or whether individuals who are genetically predisposed to use cannabis may have underlying cognitive deficits. OBJECTIVE We conducted a meta-analysis to investigate the effects of full and partial cannabinoid 1 receptor (CB1R) agonists, antagonists, and negative allosteric modulators on non-spatial and spatial memory. METHODS In accordance with the PRISMA guidelines, the EMBASE, MEDLINE, and PsycINFO databases were systematically searched for studies examining the effects of CB1R agonists, antagonists, and negative allosteric modulators on memory performance. RESULTS We systematically reviewed 195 studies investigating the effects of cannabinoid compounds on memory. In humans (N = 35 studies, comprising N = 782 subjects), delta-9-tetrahydrocannabinol (THC) (1.5-5 mg/kg) relative to placebo impaired performance on non-spatial memory tests, whereas only high THC doses (67 mg/kg) impaired spatial memory. Similarly, THC (0.2-4 mg/kg) significantly impaired visuospatial memory in monkeys and non-human primates (N = 8 studies, comprising N = 71 subjects). However, acute THC (0.002-10 mg/kg) had no effect on non-spatial (N = 6 studies, comprising 117 subjects; g = 1.72, 95% confidence interval (CI) - 0.18 to 3.63, p = 0.08) or spatial memory (9 studies, comprising 206 subjects; g = 0.75, 95% confidence interval (CI) - 1.09 to 2.58, p = 0.43). However, acute, full CB1R agonists significantly impaired non-spatial memory (N = 23 studies, 519 subjects; g = - 1.39, 95% CI - 2.72 to - 0.06, p = 0.03). By contrast, the chronic administration of CB1R agonists had no effect on non-spatial memory (N = 5 studies, comprising 146 subjects; g = - 0.05, 95% confidence interval (CI) - 1.32 to 1.22, p = 0.94). Moreover, the acute administration of CB1R antagonists had no effect on non-spatial memory in rodents (N = 9 studies, N = 149 subjects; g = 0.40, 95% CI - 0.11 to 0.92, p = 0.12). CONCLUSIONS The acute administration of THC, partial CB1R agonist, significantly impaired non-spatial memory in humans, monkeys, and non-human primates but not rodents. However, full CB1R agonists significantly impaired non-spatial memory in a dose-dependent manner but CB1R antagonists had no effect on non-spatial memory in rodents. Moreover, chronic THC administration did not significantly impair spatial or non-spatial memory in rodents, and there is inconclusive evidence on this in humans. Our findings highlight species differences in the effects of cannabinoid compounds on memory.
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Affiliation(s)
- Faith Borgan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park Road, London, SE5 8AF, UK
| | - Katherine Beck
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park Road, London, SE5 8AF, UK
| | - Emma Butler
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park Road, London, SE5 8AF, UK
| | - Robert McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park Road, London, SE5 8AF, UK
| | - Mattia Veronese
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony Vernon
- Department of Basic and Clinical Neuroscience Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, SE1 1UL, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park Road, London, SE5 8AF, UK.
- Department of Basic and Clinical Neuroscience Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Psychiatric Imaging Group, Faculty of Medicine, MRC London Institute of Medical Sciences (LMS), Imperial College London, London, UK.
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Bonaccorso S, Ricciardi A, Zangani C, Chiappini S, Schifano F. Cannabidiol (CBD) use in psychiatric disorders: A systematic review. Neurotoxicology 2019; 74:282-298. [PMID: 31412258 DOI: 10.1016/j.neuro.2019.08.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/02/2019] [Accepted: 08/04/2019] [Indexed: 12/21/2022]
Abstract
Cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) are the most represented phytocannabinoids in Cannabis sativa plants. However, CBD may present with a different activity compared with the psychotomimetic THC. Most typically, CBD is reported to be used in some medical conditions, including chronic pain. Conversely, the main aim of this systematic review is to assess and summarise the available body of evidence relating to both efficacy and safety of CBD as a treatment for psychiatric disorders, alone and/or in combination with other treatments. Eligible studies included randomized controlled trials (RCT) assessing the effect of CBD in a range of psychopathological conditions, such as substance use; psychosis, anxiety, mood disturbances, and other psychiatric (e.g., cognitive impairment; sleep; personality; eating; obsessive-compulsive; post-traumatic stress/PTSD; dissociative; and somatic) disorders. For data gathering purposes, the PRISMA guidelines were followed. The initial search strategy identified some n = 1301 papers; n = 190 studies were included after the abstract's screening and n = 27 articles met the inclusion criteria. There is currently limited evidence regarding the safety and efficacy of CBD for the treatment of psychiatric disorders. However, available trials reported potential therapeutic effects for specific psychopathological conditions, such as substance use disorders, chronic psychosis, and anxiety. Further large-scale RCTs are required to better evaluate the efficacy of CBD in both acute and chronic illnesses, special categories, as well as to exclude any possible abuse liability.
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Affiliation(s)
| | - Angelo Ricciardi
- Camden and Islington NHS Mental Health Foundation Trust, London, UK; Department of Mental Health, ASL Roma 1, Rome, Italy
| | - Caroline Zangani
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Meffert BN, Morabito DM, Mosich MK, Loflin MJ, Sottile J, Heinz AJ. Navigating Blind in the Green Rush: Clinical Considerations and Harm Reduction Practices for Cannabis. Curr Drug Res Rev 2019; 11:3-11. [PMID: 30793115 DOI: 10.2174/2589977511666181109153958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The United States has recently experienced extensive changes in state policy regarding the use of cannabis for recreational and medicinal purposes. Despite its rapidly increasing accessibility and social acceptance, there is a striking dearth of research on cannabis as a treatment for medical and psychological conditions. Research on cannabis is difficult to conduct as it is classified as a schedule I drug with high potential for abuse and currently no accepted medical use in treatment. As a result, no standard dosing procedures exist and the lack of conclusive scientific evidence has left clinical providers without evidence-based guidelines about if, when, and how to guide clients on using cannabis safely. Objective To (1) provide critical psychoeducational information about cannabis and cannabis problems to guide client-provider conversations about cannabis use and (2) describe common clinical concerns around cannabis use, highlight special considerations for vulnerable populations, and review harm reduction techniques and practical resources that may help clinicians and their clients navigate safer cannabis use. Conclusion The removal of regulatory barriers would enable researchers to address key public health questions about the potential therapeutic and adverse effects of cannabis use. Additionally, funds for research, clinician education, and public health education initiatives are necessary to reduce risk around cannabis use in the United States.
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Affiliation(s)
- Brienna N Meffert
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, USA
| | - Danielle M Morabito
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, USA
| | - Michelle K Mosich
- Department of Psychology, Palo Alto University, Pacific Graduate School of Psychology, Palo Alto, USA
| | | | - James Sottile
- Department of Psychology, Palo Alto University, Pacific Graduate School of Psychology, Palo Alto, USA
| | - Adrienne J Heinz
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, USA.,Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, USA
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Morean ME, Lederman IR. Prevalence and correlates of medical cannabis patients' use of cannabis for recreational purposes. Addict Behav 2019; 93:233-239. [PMID: 30772776 DOI: 10.1016/j.addbeh.2019.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/27/2019] [Accepted: 02/01/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Rates of legal medical cannabis (MC) use are increasing, but little is known about the prevalence and correlates of recreational cannabis (RC) use among medical users (MC/R). METHODS 348 MC users who resided in a state in which MC is legal and had medical authorization to use MC legally completed an anonymous survey in Spring 2017 (64.1% female, 82.8% White, mean age 33.03[±10.37] years). Rates of endorsing MC/R and the following potential correlates of MC/R were examined: the legal status of RC in participants' states of residence, sex, age, race, primary medical condition, MC product(s) used, MC expectancies, features of MC sought out (e.g., high tetrahydrocannabinol [THC] content), and negative cannabis use consequences. RESULTS 55.5% of MC users engaged in MC/R. MC/R was associated with residing in a state in which RC is legal, being female, using MC for pain or mental health conditions, vaping MC concentrates, holding positive expectancies for combustible MC, and seeking out MC products with high THC concentrations. Preferring MC products with high cannabidiol (CBD) concentrations protected against MC/R. CONCLUSIONS More than half of MC users endorsed MC/R, which is considerably higher than rates of misuse observed for other prescription medications. Findings raise concerns about circumvention of RC laws in states where RC remains illegal and could be used to inform MC regulatory efforts (e.g., reducing THC content, increasing CBD content). Findings also suggest that prevention/intervention efforts to reduce MC/R are needed, especially among high-risk populations of MC users (e.g., women, pain patients, psychiatric patients).
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Mondino A, Cavelli M, González J, Santana N, Castro-Zaballa S, Mechoso B, Bracesco N, Fernandez S, Garcia-Carnelli C, Castro MJ, Umpierrez E, Murillo-Rodriguez E, Torterolo P, Falconi A. Acute effect of vaporized Cannabis on sleep and electrocortical activity. Pharmacol Biochem Behav 2019; 179:113-123. [DOI: 10.1016/j.pbb.2019.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/04/2019] [Accepted: 02/24/2019] [Indexed: 01/31/2023]
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The Association between Cannabis Product Characteristics and Symptom Relief. Sci Rep 2019; 9:2712. [PMID: 30804402 PMCID: PMC6389973 DOI: 10.1038/s41598-019-39462-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 01/22/2019] [Indexed: 01/17/2023] Open
Abstract
Federal barriers and logistical challenges have hindered measurement of the real time effects from the types of cannabis products used medically by millions of patients in vivo. Between 06/06/2016 and 03/05/2018, 3,341 people completed 19,910 self- administrated cannabis sessions using the mobile device software, ReleafApp to record: type of cannabis product (dried whole natural Cannabis flower, concentrate, edible, tincture, topical), combustion method (joint, pipe, vaporization), Cannabis subspecies (C. indica and C. sativa), and major cannabinoid contents (tetrahydrocannabinol, THC; and cannabidiol, CBD), along with real-time ratings of health symptom severity levels, prior-to and immediately following administration, and reported side effects. A fixed effects panel regression approach was used to model the within-user effects of different product characteristics. Patients showed an average symptom improvement of 3.5 (SD = 2.6) on an 11-point scale across the 27 measured symptom categories. Dried flower was the most commonly used product and generally associated with greater symptom relief than other types of products. Across product characteristics, only higher THC levels were independently associated with greater symptom relief and prevalence of positive and negative side effects. In contrast, CBD potency levels were generally not associated with significant symptom changes or experienced side effects.
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Gonçalves J, Rosado T, Soares S, Simão AY, Caramelo D, Luís Â, Fernández N, Barroso M, Gallardo E, Duarte AP. Cannabis and Its Secondary Metabolites: Their Use as Therapeutic Drugs, Toxicological Aspects, and Analytical Determination. MEDICINES (BASEL, SWITZERLAND) 2019; 6:E31. [PMID: 30813390 PMCID: PMC6473697 DOI: 10.3390/medicines6010031] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 02/08/2023]
Abstract
Although the medicinal properties of Cannabis species have been known for centuries, the interest on its main active secondary metabolites as therapeutic alternatives for several pathologies has grown in recent years. This potential use has been a revolution worldwide concerning public health, production, use and sale of cannabis, and has led inclusively to legislation changes in some countries. The scientific advances and concerns of the scientific community have allowed a better understanding of cannabis derivatives as pharmacological options in several conditions, such as appetite stimulation, pain treatment, skin pathologies, anticonvulsant therapy, neurodegenerative diseases, and infectious diseases. However, there is some controversy regarding the legal and ethical implications of their use and routes of administration, also concerning the adverse health consequences and deaths attributed to marijuana consumption, and these represent some of the complexities associated with the use of these compounds as therapeutic drugs. This review comprehends the main secondary metabolites of Cannabis, approaching their therapeutic potential and applications, as well as their potential risks, in order to differentiate the consumption as recreational drugs. There will be also a focus on the analytical methodologies for their analysis, in order to aid health professionals and toxicologists in cases where these compounds are present.
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Affiliation(s)
- Joana Gonçalves
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Tiago Rosado
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Sofia Soares
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Ana Y Simão
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Débora Caramelo
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Ângelo Luís
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Nicolás Fernández
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Toxicología y Química Legal, Laboratorio de Asesoramiento Toxicológico Analítico (CENATOXA). Junín 956 7mo piso. Ciudad Autónoma de Buenos Aires (CABA), Buenos Aires C1113AAD, Argentina.
| | - Mário Barroso
- Serviço de Química e Toxicologia Forenses, Instituto de Medicina Legal e Ciências Forenses - Delegação do Sul, 1169-201 Lisboa, Portugal.
| | - Eugenia Gallardo
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Ana Paula Duarte
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
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Vigil JM, Stith SS, Diviant JP, Brockelman F, Keeling K, Hall B. Effectiveness of Raw, Natural Medical Cannabis Flower for Treating Insomnia under Naturalistic Conditions. MEDICINES 2018; 5:medicines5030075. [PMID: 29997343 PMCID: PMC6164964 DOI: 10.3390/medicines5030075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 11/16/2022]
Abstract
Background: We use a mobile software application (app) to measure for the first time, which fundamental characteristics of raw, natural medical Cannabis flower are associated with changes in perceived insomnia under naturalistic conditions. Methods: Four hundred and nine people with a specified condition of insomnia completed 1056 medical cannabis administration sessions using the Releaf AppTM educational software during which they recorded real-time ratings of self-perceived insomnia severity levels prior to and following consumption, experienced side effects, and product characteristics, including combustion method, cannabis subtypes, and/or major cannabinoid contents of cannabis consumed. Within-user effects of different flower characteristics were modeled using a fixed effects panel regression approach with standard errors clustered at the user level. Results: Releaf AppTM users showed an average symptom severity reduction of -4.5 points on a 0⁻10 point visual analogue scale (SD = 2.7, d = 2.10, p < 0.001). Use of pipes and vaporizers was associated with greater symptom relief and more positive and context-specific side effects as compared to the use of joints, while vaporization was also associated with lower negative effects. Cannabidiol (CBD) was associated with greater statistically significant symptom relief than tetrahydrocannabinol (THC), but the cannabinoid levels generally were not associated with differential side effects. Flower from C. sativa plants was associated with more negative side effects than flower from C. indica or hybrid plant subtypes. Conclusions: Consumption of medical Cannabis flower is associated with significant improvements in perceived insomnia with differential effectiveness and side effect profiles, depending on the product characteristics.
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Affiliation(s)
- Jacob M Vigil
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Sarah S Stith
- Department of Economics, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Jegason P Diviant
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA.
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Cranford JA, Arnedt JT, Conroy DA, Bohnert KM, Bourque C, Blow FC, Ilgen M. Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain. Drug Alcohol Depend 2017; 180:227-233. [PMID: 28926791 PMCID: PMC5648597 DOI: 10.1016/j.drugalcdep.2017.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/20/2017] [Accepted: 08/18/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To examine the prevalence and correlates of sleep problems in a sample of medical cannabis patients. PROCEDURES Adults ages 21 and older (N=801,M age=45.8) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, sleep, pain, and other related constructs. FINDINGS Over half of the sample (59%) met criteria for past 1-month sleep disturbance, defined as at least one sleep problem occurring on 15 or more nights in the past month. Most participants (86%) reported that sleep problems were due to their current pain. Approximately 80% of participants reported using cannabis in the past 6 months to improve sleep and, among these participants, cannabis was rated as helpful for improving sleep. Sleep-related cannabis side effects were rare (35%), but sleep-related cannabis withdrawal symptoms were relatively common (65%). Statistically significant correlates of past 1-month sleep disturbance included a) being female, b) being white, c) being on disability, d) not having a medical cannabis card, and e) frequency of using cannabis to help sleep. CONCLUSIONS Sleep problems are highly prevalent and frequent in medical cannabis patients and are closely tied to pain. Sleep-related cannabis withdrawal symptoms are relatively common but their clinical relevance is unknown. The association between frequency of cannabis use to help sleep with higher odds of sleep problems will need to be clarified by longitudinal studies.
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Affiliation(s)
- James A. Cranford
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - J. Todd Arnedt
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - Deirdre A. Conroy
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - Kipling M. Bohnert
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States, ,VA Center for Clinical Management Research (CCMR), Veterans Health Administration, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States, ,VA Center for Clinical Management Research (CCMR), Veterans Health Administration, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States
| | - Mark Ilgen
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States, ,VA Center for Clinical Management Research (CCMR), Veterans Health Administration, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States
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Abstract
PURPOSE OF REVIEW The current review aims to summarize the state of research on cannabis and sleep up to 2014 and to review in detail the literature on cannabis and specific sleep disorders from 2014 to the time of publication. RECENT FINDINGS Preliminary research into cannabis and insomnia suggests that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia. Delta-9 tetrahydrocannabinol (THC) may decrease sleep latency but could impair sleep quality long-term. Novel studies investigating cannabinoids and obstructive sleep apnea suggest that synthetic cannabinoids such as nabilone and dronabinol may have short-term benefit for sleep apnea due to their modulatory effects on serotonin-mediated apneas. CBD may hold promise for REM sleep behavior disorder and excessive daytime sleepiness, while nabilone may reduce nightmares associated with PTSD and may improve sleep among patients with chronic pain. Research on cannabis and sleep is in its infancy and has yielded mixed results. Additional controlled and longitudinal research is critical to advance our understanding of research and clinical implications.
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Affiliation(s)
- Kimberly A Babson
- National Center for PTSD-Dissemination & Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
| | | | - Danielle Morabito
- National Center for PTSD-Dissemination & Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
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Aizpurua-Olaizola O, Elezgarai I, Rico-Barrio I, Zarandona I, Etxebarria N, Usobiaga A. Targeting the endocannabinoid system: future therapeutic strategies. Drug Discov Today 2017; 22:105-110. [DOI: 10.1016/j.drudis.2016.08.005] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/07/2016] [Accepted: 08/11/2016] [Indexed: 02/03/2023]
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Germain A, McKeon AB, Campbell RL. Sleep in PTSD: Conceptual model and novel directions in brain-based research and interventions. Curr Opin Psychol 2016; 14:84-89. [PMID: 28813325 DOI: 10.1016/j.copsyc.2016.12.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/07/2016] [Accepted: 12/16/2016] [Indexed: 11/15/2022]
Abstract
Peri-traumatic sleep disturbances are growingly recognized as biologically-relevant and modifiable predisposing, precipitating, and perpetuating factors in posttraumatic stress disorder (PTSD). The exponential growth of the literature on sleep in PTSD over the last two decades has stimulated a paradigm shift in the conceptualization of the relationship between sleep and PTSD. A conceptual framework that captures this paradigm shift is offered. New research on existing and promising sleep-focused treatments for augmenting PTSD treatment outcomes is then summarized. New findings on the neurobiological correlates and underpinnings of the relationship between sleep and PTSD are also discussed. Informed by these recent findings and foundational literature, opportunities for innovation in clinical and experimental research are proposed.
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Affiliation(s)
- Anne Germain
- University of Pittsburgh School of Medicine, Department of Psychiatry, United States.
| | - Ashlee B McKeon
- University of Pittsburgh School of Medicine, Department of Psychiatry, United States
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Prospéro-García O, Amancio-Belmont O, Becerril Meléndez AL, Ruiz-Contreras AE, Méndez-Díaz M. Endocannabinoids and sleep. Neurosci Biobehav Rev 2016; 71:671-679. [DOI: 10.1016/j.neubiorev.2016.10.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 02/08/2023]
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Haug NA, Kieschnick D, Sottile JE, Babson KA, Vandrey R, Bonn-Miller MO. Training and Practices of Cannabis Dispensary Staff. Cannabis Cannabinoid Res 2016; 1:244-251. [PMID: 28861496 PMCID: PMC5531366 DOI: 10.1089/can.2016.0024] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: The proliferation of cannabis dispensaries within the United States has emerged from patient demand for the legalization of cannabis as an alternative treatment for a number of conditions and symptoms. Unfortunately, nothing is known about the practices of dispensary staff with respect to recommendation of cannabis strains/concentrations for specific patient ailments. To address this limitation, the present study assessed the training and practices of cannabis dispensary staff. Materials and Methods: Medical and nonmedical dispensary staff (n=55) were recruited via e-mail and social media to complete an online survey assessing their demographic characteristics, dispensary features, patient characteristics, formal training, and cannabis recommendation practices. Results: Fifty-five percent of dispensary staff reported some formal training for their position, with 20% reporting medical/scientific training. A majority (94%) indicated that they provide specific cannabis advice to patients. In terms of strains, dispensary staff trended toward recommendations of Indica for anxiety, chronic pain, insomnia, nightmares, and Tourette's syndrome. They were more likely to recommend Indica and hybrid plants for post-traumatic stress disorder (PTSD)/trauma and muscle spasms. In contrast, staff were less likely to recommend Indica for depression; hybrid strains were most often recommended for amyotrophic lateral sclerosis (ALS). In terms of cannabinoid concentrations, dispensary staff were most likely to recommend a 1:1 ratio of delta-9-tetrahydrocannabinol (THC):cannabidiol (CBD) for patients suffering from anxiety, Crohn's disease, hepatitis C, and PTSD/trauma, while patients seeking appetite stimulation were most likely to be recommended THC. Staff recommended high CBD for arthritis and Alzheimer's disease and a high CBD or 1:1 ratio for ALS, epilepsy, and muscle spasms. Conclusions: Although many dispensary staff are making recommendations consistent with current evidence, some are recommending cannabis that has either not been shown effective for, or could exacerbate, a patient's condition. Findings underscore the importance of consistent, evidence-based, training of dispensary staff who provide specific recommendations for patient medical conditions.
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Affiliation(s)
- Nancy A. Haug
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Dustin Kieschnick
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California
| | - James E. Sottile
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, California
| | - Kimberly A. Babson
- National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcel O. Bonn-Miller
- National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
- Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VAMC, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Maple KE, McDaniel KA, Shollenbarger SG, Lisdahl KM. Dose-dependent cannabis use, depressive symptoms, and FAAH genotype predict sleep quality in emerging adults: a pilot study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:431-40. [PMID: 27074158 PMCID: PMC5289074 DOI: 10.3109/00952990.2016.1141913] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cannabis has been shown to affect sleep in humans. Findings from animal studies indicate that higher endocannabinoid levels promote sleep, suggesting that chronic use of cannabis, which downregulates endocannabinoid activity, may disrupt sleep. OBJECTIVES This study sought to determine if past-year cannabis use and genes that regulate endocannabinoid signaling, FAAH rs324420 and CNR1 rs2180619, predicted sleep quality. As depression has been previously associated with both cannabis and sleep, the secondary aim was to determine if depressive symptoms moderated or mediated these relationships. METHODS Data were collected from 41 emerging adult (ages 18-25) cannabis users. Exclusion criteria included Axis I disorders (besides SUD) and medical and neurologic disorders. Relationships were tested using multiple regressions, controlling for demographic variables, past-year substance use, and length of cannabis abstinence. RESULTS Greater past-year cannabis use and FAAH C/C genotype were associated with poorer sleep quality. CNR1 genotype did not significantly predict sleep quality. Depressive symptoms moderated the relationship between cannabis use and sleep at a nonsignificant trend level, such that participants with the higher cannabis use and depressive symptoms reported the more impaired sleep. Depressive symptoms mediated the relationship between FAAH genotype and sleep quality. CONCLUSIONS This study demonstrates a dose-dependent relationship between chronic cannabis use and reported sleep quality, independent of abstinence length. Furthermore, it provides novel evidence that depressive symptoms mediate the relationship between FAAH genotype and sleep quality in humans. These findings suggest potential targets to impact sleep disruptions in cannabis users.
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Affiliation(s)
- Kristin E Maple
- a Department of Psychology , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
| | - Kymberly A McDaniel
- a Department of Psychology , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
| | | | - Krista M Lisdahl
- a Department of Psychology , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
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