1
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Barker H, Ferraro MJ. Exploring the versatile roles of the endocannabinoid system and phytocannabinoids in modulating bacterial infections. Infect Immun 2024; 92:e0002024. [PMID: 38775488 DOI: 10.1128/iai.00020-24] [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] [Indexed: 06/12/2024] Open
Abstract
The endocannabinoid system (ECS), initially identified for its role in maintaining homeostasis, particularly in regulating brain function, has evolved into a complex orchestrator influencing various physiological processes beyond its original association with the nervous system. Notably, an expanding body of evidence emphasizes the ECS's crucial involvement in regulating immune responses. While the specific role of the ECS in bacterial infections remains under ongoing investigation, compelling indications suggest its active participation in host-pathogen interactions. Incorporating the ECS into the framework of bacterial pathogen infections introduces a layer of complexity to our understanding of its functions. While some studies propose the potential of cannabinoids to modulate bacterial function and immune responses, the outcomes inherently hinge on the specific infection and cannabinoid under consideration. Moreover, the bidirectional relationship between the ECS and the gut microbiota underscores the intricate interplay among diverse physiological processes. The ECS extends its influence far beyond its initial discovery, emerging as a promising therapeutic target across a spectrum of medical conditions, encompassing bacterial infections, dysbiosis, and sepsis. This review comprehensively explores the complex roles of the ECS in the modulation of bacteria, the host's response to bacterial infections, and the dynamics of the microbiome. Special emphasis is placed on the roles of cannabinoid receptor types 1 and 2, whose signaling intricately influences immune cell function in microbe-host interactions.
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Affiliation(s)
- Hailey Barker
- Microbiology and Cell Science Department, IFAS, University of Florida, Gainesville, Florida, USA
| | - Mariola J Ferraro
- Microbiology and Cell Science Department, IFAS, University of Florida, Gainesville, Florida, USA
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2
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Madhubala D, Patra A, Khan MR, Mukherjee AK. Phytomedicine for neurodegenerative diseases: The road ahead. Phytother Res 2024; 38:2993-3019. [PMID: 38600725 DOI: 10.1002/ptr.8192] [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: 12/06/2023] [Revised: 02/14/2024] [Accepted: 03/10/2024] [Indexed: 04/12/2024]
Abstract
Neurodegenerative disorders (NDs) are among the most common causes of death across the globe. NDs are characterized by progressive damage to CNS neurons, leading to defects in specific brain functions such as memory, cognition, and movement. The most common NDs are Parkinson's, Alzheimer's, Huntington's, and amyotrophic lateral sclerosis (ALS). Despite extensive research, no therapeutics or medications against NDs have been proven to be effective. The current treatment of NDs involving symptom-based targeting of the disease pathogenesis has certain limitations, such as drug resistance, adverse side effects, poor blood-brain barrier permeability, and poor bioavailability of drugs. Some studies have shown that plant-derived natural compounds hold tremendous promise for treating and preventing NDs. Therefore, the primary objective of this review article is to critically analyze the properties and potency of some of the most studied phytomedicines, such as quercetin, curcumin, epigallocatechin gallate (EGCG), apigenin, and cannabinoids, and highlight their advantages and limitations for developing next-generation alternative treatments against NDs. Further extensive research on pre-clinical and clinical studies for developing plant-based drugs against NDs from bench to bedside is warranted.
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Affiliation(s)
- Dev Madhubala
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
- Division of Life Sciences, Institute of Advanced Study in Science and Technology, Guwahati, Assam, India
| | - Aparup Patra
- Division of Life Sciences, Institute of Advanced Study in Science and Technology, Guwahati, Assam, India
| | - Mojibur R Khan
- Division of Life Sciences, Institute of Advanced Study in Science and Technology, Guwahati, Assam, India
| | - Ashis K Mukherjee
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
- Division of Life Sciences, Institute of Advanced Study in Science and Technology, Guwahati, Assam, India
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3
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Arthur P, Kalvala AK, Surapaneni SK, Singh MS. Applications of Cannabinoids in Neuropathic Pain: An Updated Review. Crit Rev Ther Drug Carrier Syst 2024; 41:1-33. [PMID: 37824417 DOI: 10.1615/critrevtherdrugcarriersyst.2022038592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neuropathic pain is experienced due to injury to the nerves, underlying disease conditions or toxicity induced by chemotherapeutics. Multiple factors can contribute to neuropathic pain such as central nervous system (CNS)-related autoimmune and metabolic disorders, nerve injury, multiple sclerosis and diabetes. Hence, development of pharmacological interventions to reduce the drawbacks of existing chemotherapeutics and counter neuropathic pain is an urgent unmet clinical need. Cannabinoid treatment has been reported to be beneficial for several disease conditions including neuropathic pain. Cannabinoids act by inhibiting the release of neurotransmitters from presynaptic nerve endings, modulating the excitation of postsynaptic neurons, activating descending inhibitory pain pathways, reducing neural inflammation and oxidative stress and also correcting autophagy defects. This review provides insights on the various preclinical and clinical therapeutic applications of cannabidiol (CBD), cannabigerol (CBG), and cannabinol (CBN) in various diseases and the ongoing clinical trials for the treatment of chronic and acute pain with cannabinoids. Pharmacological and genetic experimental strategies have well demonstrated the potential neuroprotective effects of cannabinoids and also elaborated their mechanism of action for the therapy of neuropathic pain.
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Affiliation(s)
- Peggy Arthur
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA
| | - Anil Kumar Kalvala
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA
| | - Sunil Kumar Surapaneni
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA
| | - Mandip Sachdeva Singh
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA
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4
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Lee BH, Sideris A, Ladha KS, Johnson RL, Wu CL. Cannabis and Cannabinoids in the Perioperative Period. Anesth Analg 2024; 138:16-30. [PMID: 35551150 DOI: 10.1213/ane.0000000000006070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cannabis use is increasingly common, and with a growing number of jurisdictions implementing legalization frameworks, it is likely that providers will encounter more patients who use cannabis. Therefore, it is important for providers to understand the implications of cannabis use and practical considerations for the perioperative period. Cannabis affects multiple organ systems and may influence intraoperative anesthesia, as well as postoperative pain management. The effects of cannabis and key anesthetic considerations are reviewed here.
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Affiliation(s)
- Bradley H Lee
- From the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Alexandra Sideris
- From the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Karim S Ladha
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christopher L Wu
- From the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
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5
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Batinic A, Curkovic A, Bukic J, Žuntar I, Kuret S, Mimica B, Kalajzic N, Dujic G, Glavaš-Obrovac L, Soldo A, Včeva A, Dujic Z, Sutlovic D. Knowledge and Attitudes of Cannabidiol in Croatia among Students, Physicians, and Pharmacists. PHARMACY 2023; 12:2. [PMID: 38251396 PMCID: PMC10801513 DOI: 10.3390/pharmacy12010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Due to cannabidiol's health benefits and absence of serious side effects, its use is constantly growing. This is a survey-based cross-sectional study that was conducted to determine Croatian pharmacists', physicians', and students' knowledge and attitudes about cannabidiol (CBD). Two questionnaires were created, one for students and the other for physicians and pharmacists. Our participants (in total 874: 473 students and 401 physicians and pharmacists) generally had positive attitudes towards CBD therapy as approximately 60% of them believe that CBD treatment is generally efficacious. Participants had positive attitudes toward the therapeutic value of CBD, especially pharmacists and pharmacy students (63.8% and 72.2%, respectively). Pharmacists were significantly more convinced that CBD could reduce the use of opioids prescribed for chronic pain (p < 0.05). Only 17.5% of students had read scientific papers about CBD, compared to a significantly higher percentage of physicians and pharmacists (43.0% and 47.8%, respectively) (p < 0.05). This study revealed a gap in knowledge regarding CBD, since 89.3% of pharmacists and physicians, as well as 84.8% of students, believe they need more education about CBD. We conclude that it is important to improve the educational curricula so that medical professionals can recommend CBD use to their patients when needed.
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Affiliation(s)
- Ana Batinic
- Pharmacy of Split-Dalmatia County, 21000 Split, Croatia
| | - Ana Curkovic
- Department of Health Studies, University of Split, 21000 Split, Croatia; (A.C.); (S.K.); (N.K.); (D.S.)
| | - Josipa Bukic
- Department of Pharmacy, University of Split School of Medicine, 21000 Split, Croatia;
| | - Irena Žuntar
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia;
| | - Sendi Kuret
- Department of Health Studies, University of Split, 21000 Split, Croatia; (A.C.); (S.K.); (N.K.); (D.S.)
| | - Bianka Mimica
- School of Medicine, University of Split School of Medicine, 21000 Split, Croatia
| | - Nina Kalajzic
- Department of Health Studies, University of Split, 21000 Split, Croatia; (A.C.); (S.K.); (N.K.); (D.S.)
| | - Goran Dujic
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia;
| | - Ljubica Glavaš-Obrovac
- Department of Medicinal Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Ana Soldo
- Croatian Chamber for Pharmacists, 10000 Zagreb, Croatia;
| | - Andrijana Včeva
- Department of Otorhinolaryngology and Maxillofacial Surgery, Medical Faculty, University of Osijek, J. Huttlera 4, 31000 Osijek, Croatia;
- Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Osijek, J. Huttlera 4, 31000 Osijek, Croatia
| | - Zeljko Dujic
- Department of Integrative Physiology, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Davorka Sutlovic
- Department of Health Studies, University of Split, 21000 Split, Croatia; (A.C.); (S.K.); (N.K.); (D.S.)
- Department of Toxicology and Pharmacogenetics, School of Medicine, University of Split, 21000 Split, Croatia
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6
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Wysota CN, Henriksen L, Romm KF, Duan Z, Wang Y, Huang J, Berg CJ. Cannabidiol Knowledge, Perceptions, and Use Among Young Adults in 6 U.S. Metropolitan Areas. Cannabis Cannabinoid Res 2023; 8:1140-1149. [PMID: 35878060 PMCID: PMC10714108 DOI: 10.1089/can.2022.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Cannabidiol (CBD) has gained popularity in the United States, particularly among certain populations, including young adults. Thus, we examined (1) CBD product knowledge, perceptions, use, and use intentions among young adults and (2) correlates of use and use intentions. Methods: We analyzed data from a Fall 2020 survey regarding tobacco and other substance use among 2464 young adults in 6 U.S. cities (Mage=24.67; 57.4% female; 28.7% racial/ethnic minority). We used multinomial regression to identify correlates of use status (i.e., former [ever but no past 6 months] use vs. current [past 6 months] and never use, respectively), and linear regression to examine use intentions among never users. Results: Around 51.4% reported ever use, and 32.0% reported current use. On average, participants perceived CBD as safe and effective for addressing pain, anxiety, and sleep (also prominent use motives: ∼40% to 60%, respectively). Use intentions were relatively high, particularly for edibles and topicals (also the most common use modes). Roughly one-fourth mistakenly believed that CBD products were required to be approved by U.S. Food and Drug Administration (24.9%), tested/proven safe (28.8%), and proven effective to be marketed for pain, anxiety, sleep, and so on. (27.2%). Compared to former users, never users perceived greater CBD-related risk (p<0.001), less social acceptability (p<0.001), and greater difficulty accessing CBD (p=0.004); current users perceived more health benefits (p<0.001). Among never users, greater use intentions were associated with greater perceived social acceptability (p<0.001), health benefits (p<0.001), and difficulty accessing CBD (p=0.005). Conclusions: Given misperceptions about CBD, surveillance of young adults' knowledge, perceptions, and use of CBD is critical as its market expands.
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Affiliation(s)
- Christina N. Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Lisa Henriksen
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - Katelyn F. Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Jidong Huang
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
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7
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Berg CJ, Schauer GL, Cavazos-Rehg P, Romm KF, Wang Y, Wysota CN, Duan Z, Henriksen L. Cannabidiol Marketing Strategies in the United States: An Analysis of Three Prominent Companies. Cannabis Cannabinoid Res 2023; 8:1150-1160. [PMID: 36169594 PMCID: PMC10714115 DOI: 10.1089/can.2022.0080] [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] [Indexed: 12/30/2022] Open
Abstract
Introduction: The popularity and market for cannabidiol (CBD) products have expanded. Materials and Methods: Using Numerator advertising data from 2017 to 2021 regarding three popular CBD companies in the United States (Charlotte's Web, Green Roads, Medterra), we examined (1) general advertising characteristics (e.g., media channel, year); (2) ad content (i.e., themes of headlines and imagery); (3) themes of prominent sources (i.e., specific websites, magazines, etc.); and (4) ad expenditures. Results: Across companies during the study timeframe, there were 475 unique ads (i.e., unique content), 4767 ad occurrences, and $1,471,944 total expenditures. Charlotte's Web accounted for the greatest proportion of unique ads, ad occurrences, and expenditures (53.3%, 62.8%, and 70.3%, respectively), followed by Medterra (40.4%, 33.9%, and 28.5%) and Green Roads (6.3%, 3.3%, and 1.2%). The largest proportion of occurrences and expenditures were via online display (83.5%, 54.8%), followed by mobile (15.9%, 24.8%) and print (0.4%, 20.1%). Per ad occurrences and expenditures, ads prominently featured headline themes focused on brand/trust/quality (27.5%, 18.3%, respectively), wellness (17.5%, 17.7%), pain/sport (9.9%, 20.0%), and promotions (13.2%, 11.6%), in addition to visual themes of the product itself (74.3%, 78.5%) or with women (5.3%, 10.0%). The most prominent source themes were focused on health/wellness (21.0% of ad occurrences, 18.1% of expenditures), followed by other websites and search engines (18.3%, 11.2%), news/weather (12.9%, 21.3%), and entertainment/lifestyle/culture (12.6%, 28.0%). Despite some distinctions between companies, ad and source themes were similar. Conclusions: Regulatory efforts must be informed by ongoing surveillance of CBD marketing and how specific consumer subgroups are impacted by marketing exposure.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Gillian L Schauer
- Addictions, Drug & Alcohol Institute, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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8
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Alvarez E, Queirolo R, Sotto B. Conflicting forces in the implementation of medicinal cannabis regulation in Uruguay. J Cannabis Res 2023; 5:26. [PMID: 37434242 DOI: 10.1186/s42238-023-00189-6] [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: 11/01/2021] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Uruguay is widely known as a pioneer country regarding cannabis regulation policies, as it was the first state to regulate the cannabis market for both recreational and medicinal purposes in 2013. However, not all aspects of the regulation have moved forward at the same speed. Medicinal uses keep facing several challenges that undermine patients' effective access to treatments and products. What are those persistent challenges for the medicinal cannabis policy in Uruguay? This paper aims to describe and understand the current state of medicinal cannabis in the country and identify the most critical challenges and conflicting forces for its proper implementation. METHODS To do so, we conduct twelve in-depth interviews with key informants, including governments officials, activists, entrepreneurs, researchers, and doctors. These interviews are complemented with information from the congressional committees' public records and other documentary sources. RESULTS This research shows that the legal framework was thought to assure quality products over access. The main challenges of medicinal cannabis in Uruguay are related to three issues: (i) the timid development of the industry, (ii) a limited and expensive supply, and (iii) the emergence of an informal productive sector. CONCLUSIONS The political decisions regarding medicinal cannabis made in the last seven years have derived from a halfway policy that fails to guarantee patient access or promote the growth of a vibrant national industry. Positively, the several actors involved are aware of the extent of these challenges and new decisions have been made to overcome them, meaning that monitoring the future of the policy is very much needed.
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Affiliation(s)
- Eliana Alvarez
- Department of Social Sciences, Universidad Católica del Uruguay, Montevideo, Uruguay.
| | - Rosario Queirolo
- Department of Social Sciences, Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Belen Sotto
- Department of Social Sciences, Universidad Católica del Uruguay, Montevideo, Uruguay
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9
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Strand NH, Maloney J, Kraus M, Wie C, Turkiewicz M, Gomez DA, Adeleye O, Harbell MW. Cannabis for the Treatment of Fibromyalgia: A Systematic Review. Biomedicines 2023; 11:1621. [PMID: 37371716 DOI: 10.3390/biomedicines11061621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Fibromyalgia is a common disease syndrome characterized by chronic pain and fatigue in conjunction with cognitive dysfunction such as memory difficulties. Patients currently face a difficult prognosis with limited treatment options and a diminished quality of life. Given its widespread use and potential efficacy in treating other types of pain, cannabis may prove to be an effective treatment for fibromyalgia. This review aims to examine and discuss current clinical evidence regarding the use of cannabis for the treatment of fibromyalgia. An electronic search was conducted on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus using Medical Subject Heading (MeSH) terms on all literature published up to October 2022. A follow-up manual search included a complete verification of relevant studies. The results of four randomized controlled trials (RCTs) and five observational studies (a total of 564 patients) that investigated the effects of cannabis on fibromyalgia symptoms were included in this review. Of the RCTs, only one demonstrated that cannabinoids did not have a different effect than placebo on pain responses. Overall, this analysis shows low-quality evidence supporting short-term pain reduction in people with fibromyalgia treated with cannabinoid therapeutics. Although current evidence is limited, medical cannabis appears to be a safe alternative for treating fibromyalgia.
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Affiliation(s)
- Natalie H Strand
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ 85050, USA
| | - Jillian Maloney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ 85050, USA
| | - Molly Kraus
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ 85050, USA
| | - Christopher Wie
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ 85050, USA
| | | | - Diego A Gomez
- Mayo Clinic Alix School of Medicine, Phoenix, AZ 85050, USA
| | | | - Monica W Harbell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ 85050, USA
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10
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Chung T, Steinberg ML, Bridgeman MB. Recommendation for Cannabis Use Disorder Diagnosis in a Context of Cannabis for Therapeutic Purposes. JAMA Psychiatry 2023; 80:409-410. [PMID: 36920375 DOI: 10.1001/jamapsychiatry.2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
This Viewpoint proposes a model of cannabis use disorder diagnosis in the context of cannabis for therapeutic purposes that is based on DSM-5 model of diagnosing substance use disorder in the context of prescribed medication use
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Affiliation(s)
- Tammy Chung
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick.,Department of Psychiatry, Rutgers, The State University of New Jersey, New Brunswick
| | - Marc L Steinberg
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mary Barna Bridgeman
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, New Brunswick
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11
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Abstract
PURPOSE OF REVIEW Cannabis has been used since ancient times for medical and recreational research. This review article will document the validity of how medical cannabis can be utilized for chronic nonmalignant pain management. RECENT FINDINGS Current cannabis research has shown that medical cannabis is indicated for symptom management for many conditions not limited to cancer, chronic pain, headaches, migraines, and psychological disorders (anxiety and post-traumatic stress disorder). Δ9-Tetrahydrocannabinol (THC) and cannabidiol (CBD) are active ingredients in cannabis that modulate a patient's symptoms. These compounds work to decrease nociception and symptom frequency via the endocannabinoid system. Research regarding pain management is limited within the USA as the Drug Enforcement Agency (DEA) classifies it as a schedule one drug. Few studies have found a limited relationship between chronic pain and medical cannabis use. A total of 77 articles were selected after a thorough screening process using PubMed and Google Scholar. This paper demonstrates that medical cannabis use provides adequate pain management. Patients suffering from chronic nonmalignant pain may benefit from medical cannabis due to its convenience and efficacy.
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12
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Alvarez LD, Alves NRC. Molecular determinants of tetrahydrocannabinol binding to the glycine receptor. Proteins 2023; 91:400-411. [PMID: 36271319 DOI: 10.1002/prot.26438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 02/03/2023]
Abstract
The recognition of Cannabis as a source of new compounds suitable for medical use has attracted strong interest from the scientific community in its research, and substantial progress has accumulated regarding cannabinoids' activity; however, a thorough description of their molecular mechanisms of action remains a task to complete. Highlighting their complex pharmacology, the list of cannabinoids' interactors has vastly expanded beyond the canonical cannabinoid receptors. Among those, we have focused our study on the glycine receptor (GlyR), an ion channel involved in the modulation of nervous system responses, including, to our interest, sensitivity to peripheral pain. Here, we report the use of computational methods to investigate possible binding modes between the GlyR and Δ9 -tetrahydrocannabinol (THC). After obtaining a first pose for the THC binding from a biased molecular docking simulation and subsequently evaluating it by molecular dynamic simulations, we found a dynamic system with an identifiable representative binding mode characterized by the specific interaction with two transmembrane residues (Phe293 and Ser296). Complementarily, we assessed the role of membrane cholesterol in this interaction and positively established its relevance for THC binding to GlyR. Lastly, the use of restrained molecular dynamics simulations allowed us to refine the description of the binding mode and of the cholesterol effect. Altogether, our findings contribute to the current knowledge about the GlyR-THC mode of binding and propose a new starting point for future research on how cannabinoids in general, and THC in particular, modulate pain perception in view of its possible clinical applications.
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Affiliation(s)
- Lautaro D Alvarez
- Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, UMYMFOR, Buenos Aires, Argentina
| | - N R Carina Alves
- Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, IFIBYNE, Buenos Aires, Argentina
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13
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Ding H, Kiguchi N, Mabry KM, Kishioka S, Ko MC. Functional consequences of short-term exposure to opioids versus cannabinoids in nonhuman primates. Neuropharmacology 2023; 223:109328. [PMID: 36356937 PMCID: PMC9742330 DOI: 10.1016/j.neuropharm.2022.109328] [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: 03/30/2022] [Revised: 10/12/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
Opioids provide pain relief but are associated with several adverse effects. Researchers are exploring cannabis-based medicine as an alternative. However, little is known about the tendency for physical dependence on cannabinoids in comparison with that on opioids in primates. The aim of this study was to compare the potency of heroin and delta-9-tetrahydrocannabinol (THC) in eliciting analgesic effects and the development of physical dependence between opioids and cannabinoids in both male and female rhesus monkeys. Systemic administration of either heroin (0.03-0.18 mg/kg) or THC (0.3-1.8 mg/kg) in a dose-dependent manner produced antinociceptive effects against an acute thermal nociceptive stimulus. The μ-opioid receptor antagonist naltrexone (0.01 mg/kg) and the cannabinoid receptor antagonist SR141716A (0.3 mg/kg) produced the same degree of rightward shift in the dose-response curves for heroin- and THC-induced antinociception, respectively. Monkeys implanted with telemetry devices were subjected to short-term repeated administrations (two injections per day for 1-3 days) of either heroin (0.18 mg/kg), morphine (1.8 mg/kg), THC (1.8 mg/kg), or CP 55,940 (0.032 mg/kg). Administration of naltrexone (0.01 mg/kg) increased respiration, heart rate, and blood pressure in heroin- or morphine-treated monkeys. In contrast, administration of SR141716A (0.3 mg/kg) did not cause a significant change in these physiological parameters in THC- or CP 55,940-treated monkeys. Additionally, morphine, but not CP 55,940, enhanced the monkeys' hypersensitivity to the algogen capsaicin. Collectively, these results demonstrate that in nonhuman primates, both opioids and cannabinoids exert comparable antinociception; however, physical dependence on opioids, but not cannabinoids, at their antinociceptive doses, occurs following short-term exposures.
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Affiliation(s)
- Huiping Ding
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, 27157, USA.
| | - Norikazu Kiguchi
- Department of Physiological Sciences, School of Pharmaceutical Sciences, Wakayama Medical University, Wakayama, 640-8156, Japan
| | - Kelsey M Mabry
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, 27157, USA
| | - Shiroh Kishioka
- Faculty of Wakayama Health Care Sciences, Takarazuka University of Medical and Health Care, Wakayama, 640-8392, Japan
| | - Mei-Chuan Ko
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, 27157, USA
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14
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Klatzkow S, Davis G, Shmalberg J, Gallastegui A, Miscioscia E, Tarricone J, Elam L, Johnson MD, Leonard KM, Wakshlag JJ. Evaluation of the efficacy of a cannabidiol and cannabidiolic acid rich hemp extract for pain in dogs following a tibial plateau leveling osteotomy. Front Vet Sci 2023; 9:1036056. [PMID: 36686184 PMCID: PMC9846637 DOI: 10.3389/fvets.2022.1036056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
Objective To determine the impact of a cannabidiol (CBD) and cannabidiolic acid (CBDA) rich hemp product on acute post-operative pain in dogs following a tibial plateau leveling osteotomy (TPLO), and to evaluate for changes in early bone healing, serum chemistry profiles, and complete blood counts. Methods In this randomized, placebo controlled, blinded clinical trial, 44 client-owned dogs were assigned to receive either a CBD/CBDA product dosed at 2-2.5 mg/kg PO every 12 h or a placebo for 4 weeks following a TPLO. Variables evaluated before (week 0), and at 2 and 4 weeks post-operatively included standardized veterinary assessments for pain score, weight-bearing, and lameness, the Canine Brief Pain Inventory (pain interference score-PIS, pain severity score-PSS), and serum biochemistry. Complete blood counts were performed at weeks 0 and 4. Additionally, orthogonal radiographs evaluating the degree of healing were taken at week 4. A mixed model analysis, analyzing changes of variables of interest from enrollment baseline to all other time points was utilized, with a p-value ≤ 0.05 considered significant. Results Of the 44 enrolled patients, 3 were lost to follow up and excluded from analysis. No significant differences were noted between placebo (n = 19) and CBD/CBDA (n = 22) groups at any point in pain score, degree of lameness, degree of weight-bearing, PIS, PSS, or radiographic healing of the osteotomy. A significant finding of elevation of ALP above normal reference range in the treatment group was identified (p = 0.02) and eosinophil count was affected by treatment (p = 0.01), increasing from baseline in placebo and decreasing in treatment groups. Finally, a significant difference (p = 0.03) was noted at 2 weeks post-operatively where 4 patients in the placebo group and no treatment patients received trazodone to facilitate activity restrictions. Clinical significance Use of a CBD/CBDA rich hemp product dosed at 2-2.5 mg/kg PO every 12 h did not have a significant impact on pain or delay early bone healing. A statistically significant increase in ALP, decrease in eosinophils, and reduced use of trazodone was identified in the treatment group.
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Affiliation(s)
- Sarah Klatzkow
- Department of Small Animal Surgery, Red Bank Veterinary Hospital, Tinton Falls, NJ, United States,*Correspondence: Sarah Klatzkow
| | - Garrett Davis
- Department of Small Animal Surgery, Red Bank Veterinary Hospital, Tinton Falls, NJ, United States
| | - Justin Shmalberg
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Aitor Gallastegui
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Erin Miscioscia
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Jason Tarricone
- Department of Small Animal Surgery, Red Bank Veterinary Hospital, Tinton Falls, NJ, United States
| | - Lindsay Elam
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Matthew D. Johnson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Katelyn M. Leonard
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Joseph J. Wakshlag
- Department of Clinical Sciences, Cornell College of Veterinary Medicine, Ithaca, NY, United States
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15
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Boyacıoğlu Ö, Korkusuz P. Cannabinoids as Prospective Anti-Cancer Drugs: Mechanism of Action in Healthy and Cancer Cells. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1410:145-169. [PMID: 36396926 DOI: 10.1007/5584_2022_748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Endogenous and exogenous cannabinoids modulate many physiological and pathological processes by binding classical cannabinoid receptors 1 (CB1) or 2 (CB2) or non-cannabinoid receptors. Cannabinoids are known to exert antiproliferative, apoptotic, anti-migratory and anti-invasive effect on cancer cells by inducing or inhibiting various signaling cascades. In this chapter, we specifically emphasize the latest research works about the alterations in endocannabinoid system (ECS) components in malignancies and cancer cell proliferation, migration, invasion, angiogenesis, autophagy, and death by cannabinoid administration, emphasizing their mechanism of action, and give a future perspective for clinical use.
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Affiliation(s)
- Özge Boyacıoğlu
- Department of Bioengineering, Graduate School of Science and Engineering, Hacettepe University, Ankara, Turkey
- Department of Medical Biochemistry, Faculty of Medicine, Atılım University, Ankara, Turkey
| | - Petek Korkusuz
- Department of Histology and Embryology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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16
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Kaufmann R, Bozer AH, Jotte AK, Aqua K. Long-Term, Self-Dosing CBD Users: Indications, Dosage, and Self-Perceptions on General Health/Symptoms and Drug Use. Med Cannabis Cannabinoids 2023; 6:77-88. [PMID: 37900894 PMCID: PMC10601936 DOI: 10.1159/000531666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/31/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Self-dosing of off-the-shelf cannabidiol (CBD) for a myriad of health conditions is common in the USA. These CBD products are often mislabeled, suggesting that much less or much more CBD is being consumed than indicated on the label. This study examined the relationship between long-term self-dosing of CBD and (a) indications and, when a verified concentration of CBD is being consumed, (b) the daily CBD dosage, (c) the impact on general health and symptoms, and (d) over-the-counter (OTC) and prescription (Rx) drug usage. Methods US adults 18-75 years of age who had used unverified CBD products for >1 month were recruited to participate in this decentralized, observational, IRB-approved study and provided a concentration-verified CBD product of their choice from 15 different vendors for 4 weeks. Prior to receiving product, they were queried on their primary reason for use (PRfU), primary symptom for use (PSfU), general health score (GHS), symptom score (SS), OTC and Rx drug use, and daily CBD dose. Individuals were queried daily on OTC and Rx drug use and CBD dose and weekly on SS and GHS prior to (pre-CBD) and after (post-CBD) ingestion of CBD on that day. Results The PRfU included chronic pain, mental health, general health and wellness, sleep disorders, the central nervous system, digestive health, and others, while the PSfU included anxiety, back and/or joint pain, sleep, inflammation, and others. The mean daily dose was normally distributed, with a mean, median, and range of 53.1, 40.8, 8-390 mg/day, respectively. For both GHS and SS, the post-CBD was significantly higher than the pre-CBD score for each category of PRfU. The GHS scores did not change over the study, but pre- and post-CBD SS improved over time, with pre-improving more than post-CBD SS. The percentage of individuals decreasing or completely stopping OTC drugs or Rx drugs over the 4 weeks was 31.2% and 19.2%, respectively, with those taking CBD for chronic pain, decreasing drug use the most. OTC and Rx drug usage decreased when the CBD dose was changed and when GHS and SS improved. Conclusion Pain, mental health (primarily anxiety/stress), and sleep are the most common reasons for CBD use. Self-administration of CBD reduced OTC and Rx drug usage at daily doses less than those reported in controlled studies. CBD self-administration significantly improves self-perception of general health and decreases symptom severity, and as these improve, fewer OTC and Rx drugs are used.
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Affiliation(s)
| | - Amber Harris Bozer
- Department of Psychological Sciences, Tarleton State University, Stephenville, TX, USA
| | | | - Keith Aqua
- Syzygy Research Solutions, LLC, Wellington, FL, USA
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17
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Ragnhildstveit A, Kaiyo M, Snyder MB, Jackson LK, Lopez A, Mayo C, Miranda AC, August RJ, Seli P, Robison R, Averill LA. Cannabis-assisted psychotherapy for complex dissociative posttraumatic stress disorder: A case report. Front Psychiatry 2023; 14:1051542. [PMID: 36846226 PMCID: PMC9947284 DOI: 10.3389/fpsyt.2023.1051542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND A dissociative subtype of posttraumatic stress disorder, known as "D-PTSD", has been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In addition to meeting criteria for PTSD, patients endorse prominent dissociative symptoms, namely depersonalization and derealization, or detachment from one's self and surroundings. At present, this population is supported by a highly heterogeneous and undeveloped literature. Targeted interventions are therefore lacking, and those indicated for PTSD are limited by poor efficacy, delayed onset of action, and low patient engagement. Here, we introduce cannabis-assisted psychotherapy (CAP) as a novel treatment for D-PTSD, drawing parallels to psychedelic therapy. CASE PRESENTATION A 28-year-old female presented with complex D-PTSD. In a naturalistic setting, she underwent 10 sessions of CAP, scheduled twice monthly over 5 months, coupled with integrative cognitive behavioral therapy. An autonomic and relational approach to CAP was leveraged, specifically psychedelic somatic interactional psychotherapy. Acute effects included oceanic boundlessness, ego dissolution, and emotional breakthrough. From baseline to post-treatment, the patient showed a 98.5% reduction in pathological dissociation, as measured by the Multidimensional Inventory of Dissociation, no longer meeting criteria for D-PTSD. This was accompanied by decreased cognitive distractibility and emotional suffering, as well as increased psychosocial functioning. Anecdotally, the patient has sustained improvements for over 2 years to date. CONCLUSIONS There is urgency to identify treatments for D-PTSD. The present case, while inherently limited, underscores the potential of CAP as a therapeutic option, leading to robust and sustained improvement. Subjective effects were comparable to those produced by classic and non-classic psychedelics, such as psilocybin and ketamine. Further research is warranted to explore, establish, and optimize CAP in D-PTSD, and to characterize its role in the pharmacological landscape.
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Affiliation(s)
- Anya Ragnhildstveit
- Integrated Research Literacy Group, Draper, UT, United States.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Miriam Kaiyo
- Integrated Research Literacy Group, Draper, UT, United States.,Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | | | | | - Alex Lopez
- Integrated Research Literacy Group, Draper, UT, United States
| | - Chasity Mayo
- Integrated Research Literacy Group, Draper, UT, United States
| | - Alyssa Claire Miranda
- Integrated Research Literacy Group, Draper, UT, United States.,Consciousness and Transformative Studies, National University, San Diego, CA, United States
| | - River Jude August
- Integrated Research Literacy Group, Draper, UT, United States.,Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | - Paul Seli
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Reid Robison
- Numinus Wellness, Draper, UT, United States.,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Lynnette Astrid Averill
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Department of Veterans Affairs, Clinical Neuroscience Division, National Center for PTSD, West Haven, CT, United States
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18
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Li K, Lai C, Hei S, Liu C, Li Z, Xu K. Identification of a potential structure-based GPCR drug for interstitial cystitis/bladder pain syndrome: in silico protein structure analysis and molecular docking. Int Urogynecol J 2022:10.1007/s00192-022-05424-x. [PMID: 36576541 DOI: 10.1007/s00192-022-05424-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/12/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is currently no effective treatment for interstitial cystitis / bladder pain syndrome (IC/BPS) and thus seriously reduces the quality of life of patients. The purpose of this study is to analyze the structure and function of G protein coupled receptors related to IC/BPS by integrating bioinformatics and provide basis for the development of new drugs for IC/BPS. METHODS We used ProtParam and DNAMAN to analyze the physical and chemical properties of GPR18 and GPR183 proteins. The secondary and tertiary structure, conservative domain, phosphorylation site of both proteins were predicted by ProtScale, PredictProtein, SWISS-MODEL and GPS5.0 respectively. Multiple sequence alignment of the proteins were carried out by DNAMAN and the phylogenetic tree was constructed by MEGA. Further, the molecular docking verification of cannabidiol and both proteins were carried out by using AutoDock Vin. RESULTS GPR18 and GPR183 proteins were composed of 331 and 361 amino acids respectively. α-helix is the highest in the secondary structure of the two proteins. Both proteins contain seven transmembrane domains specific to G protein coupled receptors. And homology analysis showed that the two proteins had high homology. In terms of molecular docking, cannabidiol, a non psychoactive component extracted from the cannabis, can form effective molecular binding with GPR18 and GPR183 proteins. CONCLUSIONS We identified the structures of GPR18 and GPR183 proteins and their highly homologous evolutionary properties. Furthermore, both proteins can form effective binding with cannabidiol which provides new insights for the development of IC/BPS drugs by targeting G protein coupled receptors.
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Affiliation(s)
- Kuiqing Li
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yan Jiang West Road, Guangzhou, 510120, China
| | - Cong Lai
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yan Jiang West Road, Guangzhou, 510120, China
| | - Shangyan Hei
- Traditional Chinese Medicine Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cheng Liu
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yan Jiang West Road, Guangzhou, 510120, China
| | - Zhuohang Li
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yan Jiang West Road, Guangzhou, 510120, China
| | - Kewei Xu
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yan Jiang West Road, Guangzhou, 510120, China.
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19
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Lichenstein SD. THC, CBD, and Anxiety: A review of recent findings on the anxiolytic and anxiogenic effects of cannabis' primary cannabinoids. CURRENT ADDICTION REPORTS 2022; 9:473-485. [PMID: 38106452 PMCID: PMC10722902 DOI: 10.1007/s40429-022-00450-7] [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] [Accepted: 10/11/2022] [Indexed: 11/29/2022]
Abstract
Purpose of review In the context of ongoing decriminalization and legalization of cannabis, a better understanding of how THC and CBD impact anxiety is critical to elucidate the risks of recreational cannabis use as well as to establish the therapeutic potential of cannabis products for anxiety-related applications. Recent findings Recent literature supports anxiogenic effects of THC administration, which may be attenuated among regular cannabis users. Data regarding anxiolytic effects of CBD administration are mixed. Most newer studies contradict earlier findings in reporting no effects of CBD on anxiety in healthy participants, whereas inconsistent results have been reported among individuals with anxiety disorders, substance use disorders, and other clinical populations. Summary Future research is needed to reconcile heterogenous findings, explore sex differences in the effects of THC and CBD on anxiety, as well as to assess how effects change with extended exposure, the impact of different CBD doses, and interactions between THC, CBD, and other cannabis compounds.
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20
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Wysota CN, Le D, Clausen ME, Ciceron AC, Fuss C, Bennett B, Romm KF, Duan Z, Berg CJ. Young adults' knowledge, perceptions and use of cannabidiol products: a mixed-methods study. HEALTH EDUCATION RESEARCH 2022; 37:379-392. [PMID: 36217613 PMCID: PMC9677236 DOI: 10.1093/her/cyac030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 06/07/2023]
Abstract
Cannabidiol (CBD) product regulatory efforts must be informed by research regarding consumer perceptions. This mixed-methods study examined CBD product information sources, knowledge, perceptions, use and use intentions among young adults. This study analyzed (i) Fall 2020 survey data from 2464 US young adults (Mage = 24.67, 51.4% ever users, 32.0% past 6-month users) and (ii) Spring 2021 qualitative interviews among 40 survey participants (27.5% past-month users). Overall, 97.9% of survey participants reported having heard of CBD, 51.4% ever/lifetime use and 32.0% past 6-month use. Survey participants learned about CBD from friends/family (58.9%), products/ads at retailers (36.4%), online content/ads (34.8%), CBD stores (27.5%) and social media (26.7%). One-fourth believed that CBD products were required to be US Food and Drug Administration-approved (24.9%), tested for safety (28.8%) and proven effective to be marketed for pain, anxiety, sleep, etc. (27.2%). Survey and interview participants perceived CBD as safe, socially acceptable and effective for addressing pain, anxiety and sleep. Interview findings expanded on prominent sources of marketing and product exposure, including online and specialty retailers (e.g. vape shops), and on participants' concerns regarding limited regulation and/or evidence regarding CBD's effectiveness/risks. Given young adults' misperceptions about CBD, surveillance of CBD knowledge, perceptions and use is critical as the CBD market expands.
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Affiliation(s)
- Christina N Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, DC, USA
| | - Daisy Le
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, DC, USA
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, 1919 Pennsylvania Ave. NW, Washington, DC 20006, USA
- George Washington Cancer Center, George Washington University, 800 22nd St. NW, Washington, DC, USA
| | - Michelle Elise Clausen
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, 1919 Pennsylvania Ave. NW, Washington, DC 20006, USA
| | - Annie Coriolan Ciceron
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, 1919 Pennsylvania Ave. NW, Washington, DC 20006, USA
| | - Caroline Fuss
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, DC 20052, USA
| | - Breesa Bennett
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, DC 20052, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, DC, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, DC, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, DC, USA
- George Washington Cancer Center, George Washington University, 800 22nd St. NW, Washington, DC, USA
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Use of X-ray irradiation for inactivation of Aspergillus in cannabis flower. PLoS One 2022; 17:e0277649. [PMID: 36378669 PMCID: PMC9665375 DOI: 10.1371/journal.pone.0277649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
California cannabis regulations require testing for four pathogenic species of Aspergillus-A. niger, A. flavus, A. fumigatus and A. terreus in cannabis flower and cannabis inhalable products. These four pathogenic species of Aspergillus are important human pathogens and their presence in cannabis flower and cannabis products may pose a threat to human health. In this study, we examined the potential of X-ray irradiation for inactivation of cannabis flower contaminated with any of the four pathogenic species of Aspergillus. We determined that X-ray irradiation at a dose of 2.5 kGy is capable of rendering Aspergillus cells non-viable at low (102 spores/g dried flower), medium (103 spores/g dried flower) and high (104 spores/g dried flower) levels of inoculation. We also showed that X-ray treatment of cannabis flower did not significantly alter the cannabinoid or the terpene profiles of the flower samples. Therefore, X-ray irradiation may be a feasible method for Aspergillus decontamination of cannabis flower. More work is required to determine the consumer safety of irradiated cannabis flower and cannabis products.
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22
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Dash GF, Holt L, Kenyon EA, Carter EK, Ho D, Hudson KA, Feldstein Ewing SW. Detection of vaping, cannabis use, and hazardous prescription opioid use among adolescents. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:820-828. [PMID: 36030794 PMCID: PMC9588707 DOI: 10.1016/s2352-4642(22)00212-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 05/19/2023]
Abstract
There has been a global surge in adolescents' use of electronic nicotine delivery systems (vaping), cannabis (vaped and edible), and prescription opioids, collectively termed ECPO. The nature of ECPO use can make it difficult to detect due to few obvious immediate physical and behavioural signs, as well as subtle long-term effects that allow adolescents to transition from initial exploration into hazardous ECPO use without easy detection by care providers. Here, we address the nature of the presentation of ECPO use in adolescents (roughly age 13-18 years), including challenges in detecting use and related complications, which affect screening, prevention, and intervention. We begin by reviewing empirical data on these difficult to detect effects in adolescents, including acute effects at cellular and neural levels and long-term neurocognitive and developmental changes that precede outwardly detectable physical signs. We then provide concrete approaches for providers to screen for ECPO use in adolescents even in the absence of overt physical and behavioural symptoms. Finally, we conclude with direct practice recommendations for prevention and intervention.
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Affiliation(s)
- Genevieve F Dash
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA.
| | - Laura Holt
- Department of Psychology, Trinity College, Hartford, CT, USA
| | - Emily A Kenyon
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Emily K Carter
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Diana Ho
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Karen A Hudson
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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Garcia-Romeu A, Elmore J, Mayhugh RE, Schlienz NJ, Martin EL, Strickland JC, Bonn-Miller M, Jackson H, Vandrey R. Online survey of medicinal cannabis users: Qualitative analysis of patient-level data. Front Pharmacol 2022; 13:965535. [PMID: 36147312 PMCID: PMC9485457 DOI: 10.3389/fphar.2022.965535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Aim: To characterize perceived benefits and challenges experienced by medicinal cannabis users. Methods: An anonymous online survey collected demographics, health information, and open-ended responses from medicinal cannabis users regarding perceptions, motivations, and experience of treatment. Qualitative open-ended responses were thematically analyzed. Results: Respondents (N = 808) were predominantly White (79%), female (63%), with a mean (SD) age of 38 (20). Two hundred eighty-four (35%) respondents provided data on a dependent family member (e.g., child; 22% of total sample). Most used cannabidiol (CBD)-dominant products (58%), primarily for neurological disorders (38%) or pain (25%). Primary motivations for medicinal cannabis use were based on beliefs that traditional treatments were ineffective and/or had intolerable side effects (51%), positive scientific or media portrayals of the safety/efficacy of cannabis as a therapeutic (29%), or preference for “natural” treatments over pharmaceuticals (21%). A majority of respondents (77%) attributed positive effects to the medicinal use of cannabis/cannabinoids. These included physical symptom improvements such as reduced pain (28%), improved sleep (18%), and seizure reduction (18%), and mental health improvements including reduced anxiety (22%) and improved mood (11%). Additionally, respondents reported reduced use of other medications (e.g., opioids) (12%), and improved quality of life (14%). Problems associated with use were cited by 41% of respondents, and included unwanted side effects (16%), lack of information or medical support (16%), prohibitive costs (12%), and legal concerns (10%). Conclusion: Most participants reported benefits from cannabis use for a variety of conditions where traditional treatments were ineffective or unacceptable. Concerns regarding cannabis side effects, legality, lack of information, and cost were raised. Data indicate greater research and education on the safety and efficacy of medicinal cannabis/cannabinoid use is warranted.
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Affiliation(s)
- Albert Garcia-Romeu
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Albert Garcia-Romeu,
| | - Joshua Elmore
- University of Colorado Boulder, Boulder, CO, United States
| | | | | | - Erin L. Martin
- Medical University of South Carolina, Charleston, SC, United States
| | | | | | - Heather Jackson
- Realm of Caring Foundation, Colorado Springs, Colorado, CO, United States
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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24
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Bockmann EC, Brito R, Madeira LF, da Silva Sampaio L, de Melo Reis RA, França GR, Calaza KDC. The Role of Cannabinoids in CNS Development: Focus on Proliferation and Cell Death. Cell Mol Neurobiol 2022; 43:1469-1485. [PMID: 35925507 DOI: 10.1007/s10571-022-01263-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
The active principles of Cannabis sativa are potential treatments for several diseases, such as pain, seizures and anorexia. With the increase in the use of cannabis for medicinal purposes, a more careful assessment of the possible impacts on embryonic development becomes necessary. Surveys indicate that approximately 3.9% of pregnant women use cannabis in a recreational and/or medicinal manner. However, although the literature has already described the presence of endocannabinoid system components since the early stages of CNS development, many of their physiological effects during this stage have not yet been established. Moreover, it is still uncertain how the endocannabinoid system can be altered in terms of cell proliferation and cell fate, neural migration, neural differentiation, synaptogenesis and particularly cell death. In relation to cell death in the CNS, knowledge about the effects of cannabinoids is scarce. Thus, the present work aims to review the role of the endocannabinoid system in different aspects of CNS development and discuss possible side effects or even opportunities for treating some conditions in the development of this tissue.
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Affiliation(s)
- Eduardo Cosendey Bockmann
- Instituto de Biologia, Departamento de Neurobiologia, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Rafael Brito
- Departamento de Biologia Celular e Molecular, Instituto de Biologia, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Lucianne Fragel Madeira
- Instituto de Biologia, Departamento de Neurobiologia, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Luzia da Silva Sampaio
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Augusto de Melo Reis
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Guilherme Rapozeiro França
- Departamento de Ciências Fisiológicas, Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Karin da Costa Calaza
- Instituto de Biologia, Departamento de Neurobiologia, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
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25
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Shah RM, Saklecha A, Patel AA, Divi SN. Analyzing the Impact of Cannabinoids on the Treatment of Spinal Disorders. Curr Rev Musculoskelet Med 2022; 15:133-142. [PMID: 35132567 PMCID: PMC9076773 DOI: 10.1007/s12178-022-09743-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Cannabis is among the most used illicit substances globally, with medical applications, increased legalization, and shifting social attitudes leading to increased use in recent years. Cannabinoids are a group of psychoactive substances found within the cannabis plant, with the most common being Δ9-tetrahydrocannabinol and cannabidiol. Due to the high prevalence of use, it is increasingly important to evaluate the effects of cannabis and cannabinoids on spine patients, in both operative and nonoperative settings. RECENT FINDINGS Cannabis and cannabinoids may be effective in treating patients with chronic conditions such as back pain and spinal cord injuries. Longitudinal effects and implications on surgical outcomes and complications are poorly understood. High-quality, outcomes-focused research can inform approaches for clinicians to approach cannabis and cannabinoid use. Studies to elucidate the standardization of cannabis regimens can help develop guidelines for potential therapeutic applications. Cannabis and cannabinoids may be useful alternatives or additions for many spine patients, but future research is needed for recommendations to be determined. Our manuscript reviews the available literature regarding cannabis use and various spinal conditions, organizing our findings into the following narrative themes: (1) the management of chronic lower back pain, (2) perioperative outcomes, (3) cannabis use in general orthopaedic procedures, and (4) spinal cord injuries.
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Affiliation(s)
| | | | - Alpesh A Patel
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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26
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Bogale K, Raup-Konsavage W, Dalessio S, Vrana K, Coates MD. Cannabis and Cannabis Derivatives for Abdominal Pain Management in Inflammatory Bowel Disease. Med Cannabis Cannabinoids 2022; 4:97-106. [PMID: 35224429 DOI: 10.1159/000517425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/22/2021] [Indexed: 12/15/2022] Open
Abstract
For centuries, cannabis and its components have been used to manage a wide variety of symptoms associated with many illnesses. Gastrointestinal (GI) diseases are no exception in this regard. Individuals suffering from inflammatory bowel disease (IBD) are among those who have sought out the ameliorating properties of this plant. As legal limitations of its use have eased, interest has grown from both patients and their providers regarding the potential of cannabis to be used in the clinical setting. Similarly, a growing number of animal and human studies have been undertaken to evaluate the impact of cannabis and cannabinoid signaling elements on the natural history of IBD and its associated complications. There is little clinical evidence supporting the ability of cannabis or related products to treat the GI inflammation underlying these disorders. However, 1 recurring theme from both animal and human studies is that these agents have a significant impact on several IBD-related symptoms, including abdominal pain. In this review, we discuss the role of cannabis and cannabinoid signaling in visceral pain perception, what is currently known regarding the efficacy of cannabis and its derivatives for managing pain, related symptoms and inflammation in IBD, and what work remains to effectively utilize cannabis and its derivatives in the clinical setting.
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Affiliation(s)
- Kaleb Bogale
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Wesley Raup-Konsavage
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Shannon Dalessio
- Division of Gastroenterology & Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Kent Vrana
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Matthew D Coates
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.,Division of Gastroenterology & Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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27
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Hill KP, Gold MS, Nemeroff CB, McDonald W, Grzenda A, Widge AS, Rodriguez C, Kraguljac NV, Krystal JH, Carpenter LL. Risks and Benefits of Cannabis and Cannabinoids in Psychiatry. Am J Psychiatry 2022; 179:98-109. [PMID: 34875873 DOI: 10.1176/appi.ajp.2021.21030320] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The United States is in the midst of rapidly changing laws regarding cannabis. The increasing availability of cannabis for recreational and medical use requires that mental health clinicians be knowledgeable about evidence to be considered when counseling both patients and colleagues. In this review, the authors outline the evidence from randomized double-blind placebo-controlled trials for therapeutic use of cannabinoids for specific medical conditions and the potential side effects associated with acute and chronic cannabis use. METHODS Searches of PubMed and PsycInfo were conducted for articles published through July 2021 reporting on "cannabis" or "cannabinoids" or "medicinal cannabis." Additional articles were identified from the reference lists of published reviews. Articles that did not contain the terms "clinical trial" or "therapy" in the title or abstract were not reviewed. A total of 4,431 articles were screened, and 841 articles that met criteria for inclusion were reviewed by two or more authors. RESULTS There are currently no psychiatric indications approved by the U.S. Food and Drug Administration (FDA) for cannabinoids, and there is limited evidence supporting the therapeutic use of cannabinoids for treatment of psychiatric disorders. To date, evidence supporting cannabinoid prescription beyond the FDA indications is strongest for the management of pain and spasticity. CONCLUSIONS As cannabinoids become more available, the need for an evidence base adequately evaluating their safety and efficacy is increasingly important. There is considerable evidence that cannabinoids have a potential for harm in vulnerable populations such as adolescents and those with psychotic disorders. The current evidence base is insufficient to support the prescription of cannabinoids for the treatment of psychiatric disorders.
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Affiliation(s)
- Kevin P Hill
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Mark S Gold
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Charles B Nemeroff
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - William McDonald
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Adrienne Grzenda
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Alik S Widge
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Carolyn Rodriguez
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Nina V Kraguljac
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - John H Krystal
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
| | - Linda L Carpenter
- Department of Psychiatry, Harvard Medical School, Boston, andBeth Israel Deaconess Medical Center, Boston (Hill);Department of Psychiatry, School of Medicine, Washington University in St. Louis (Gold);Department of Psychiatry, Dell Medical School, University of Texas at Austin (Nemeroff);Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald);Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles (Grzenda);Department of Psychiatry, University of Minnesota, Minneapolis (Widge);Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., andVeterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez);Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Kraguljac);Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal);Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, andButler Hospital, Providence, R.I. (Carpenter)
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28
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Improved cyclobutyl nabilone analogs as potent CB1 receptor agonists. Eur J Med Chem 2022; 230:114027. [DOI: 10.1016/j.ejmech.2021.114027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022]
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29
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Yeoh SY, Roberts E, Scott F, Nicholson TR, David AS, Rogers JP. Catatonic Episodes Related to Substance Use: A Cross-Sectional Study Using Electronic Healthcare Records. J Dual Diagn 2022; 18:52-58. [PMID: 35001837 DOI: 10.1080/15504263.2021.2016342] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Substance use has increasingly been linked to the onset of catatonic episodes; however, no large observational studies have examined this association. This study aimed to identify catatonic episodes temporally associated with acute intoxication, withdrawal or chronic substance use, investigate which substances were involved, and compare clinical characteristics of substance-related and non-substance-related catatonic episodes. Methods: This study retrospectively identified all catatonic episodes recorded in an electronic case register hosted at a large secondary mental health trust in London, UK. Episodes were categorized as substance-related if the clinical record reported either a positive urine drug screen, an ICD-10 diagnosis of a mental or behavioral disorder due to substance use, or documented substance use between two weeks prior to the catatonic episode and the date of the catatonic episode. Results: 108 of 2130 catatonic episodes (5.1%) were deemed substance-related. The number of contemporaneously reported substance-related episodes increased between 2007 and 2016 [r = 0.72, p = 0.02]. Episodes in the context of acute intoxication (n = 54) were most frequently related to cannabis (n = 31) or cocaine (n = 5) use, whilst those in the context of drug withdrawal (n = 8) were most commonly related to alcohol, opioids and benzodiazepines. There were 50 episodes of catatonia associated with chronic substance use without intoxication or withdrawal, of which the majority were related to cannabis use (n = 37). 21 episodes had overlapping intoxication, withdrawal and chronic use of different substances within an episode. Compared to catatonic episodes not related to substance use, episodes of substance-related catatonia occurred in individuals who were younger (mean age 31.3 years [SD 12.2] vs 35.7 years [SD 16.3], p = 0.01) and more likely to be men (74.0% vs 54.3%, p < 0.001). The clinical features of catatonia were similar between the two groups. Conclusions: A relatively small proportion of catatonic episodes were temporally associated with reported substance use within their electronic records. Substance-related catatonic episodes were mostly related to cannabis use, but other substances including cocaine, alcohol, opioids and benzodiazepines were sometimes implicated. This is likely an underestimate of substance-related catatonia use due to issues with documentation and appropriate investigation.
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Affiliation(s)
- Su Ying Yeoh
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emmert Roberts
- South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Fraser Scott
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Jonathan P Rogers
- South London and Maudsley NHS Foundation Trust, London, UK.,Division of Psychiatry, University College London, London, UK
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30
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Pugazhendhi A, Suganthy N, Chau TP, Sharma A, Unpaprom Y, Ramaraj R, Karuppusamy I, Brindhadevi K. Cannabinoids as anticancer and neuroprotective drugs: Structural insights and pharmacological interactions—A review. Process Biochem 2021. [DOI: 10.1016/j.procbio.2021.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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31
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Abstract
Cannabis is the most frequently used illegal psychoactive substance by older adults. With population aging, legalization and medicalization of cannabis, and changes in perceptions of older adults toward its use, recreational and medical cannabis use/misuse is on the rise in seniors. Although there are solid data related to the adverse events of cannabis in older adults, efficacy data are lacking. Older adults are at increased risk of developing cannabis use disorder alongside other medical and psychiatric comorbidities. We review the benefits and risks associated with cannabis use, and screening and management strategies for cannabis use disorder in older adults.
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32
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Cannabinoids-based Medicine Pharmacology, Drug Interactions, and Perioperative Management of Surgical Patients. Adv Anesth 2021; 38:167-188. [PMID: 34106833 DOI: 10.1016/j.aan.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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33
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Shirah BH, Ahmed MM. The Use of Cannabis for Medical Purposes in the Arab World. Med Cannabis Cannabinoids 2021; 4:72-74. [PMID: 34676353 PMCID: PMC8525169 DOI: 10.1159/000510824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/11/2020] [Indexed: 09/28/2023] Open
Abstract
The legal landscape of cannabis (marijuana) has dramatically changed over the past few years in several countries worldwide. Many patients now have legal access to products derived from cannabis. In the Middle East, Lebanon became the first Arab country to legalize cannabis for medical and industrial use recently in 2020. Other Middle Eastern and Arab countries continue to completely ban the use of cannabis and products derived from cannabis. This article is a call to conduct medical research in the use of cannabis for medical purposes to determine the suitability and need for this substance in the Arab world. Based on these studies, evidence-based recommendations can be made to the highest authorities in the Arab countries for legalization or continued prohibition. As the international use of cannabis is increasing, the Arab countries may consider legalization of the substance to cover the unmet medical need and offer an additional treatment option for certain conditions.
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Affiliation(s)
- Bader H. Shirah
- King Abdullah International Medical Research Centre/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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34
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Palma-Álvarez RF, Soriano-Dia A, Ros-Cucurull E, Daigre C, Serrano-Pérez P, Ortega-Hernández G, Perea-Ortueta M, Gurrea Salas D, Ramos-Quiroga JA, Grau-López L. Catatonia Related to Cannabis and Synthetic Cannabinoids: A Review. J Dual Diagn 2021; 17:159-171. [PMID: 33902405 DOI: 10.1080/15504263.2021.1904163] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Cannabis and synthetic cannabinoids (SC) are related to several neuropsychiatric symptoms and disorders, especially psychotic symptoms and disorders. Interestingly, catatonia-like symptoms associated with cannabis and SC have been generally neglected in research and scarcely described despite the clinical repercussions. Hence, this review aims to analyze current clinical publications on catatonia induced by cannabis or SC in a systematized way. Methods: A search using PRISMA guidelines was performed on three databases based on a specific inclusion and exclusion criteria. Results: 11 publications describing 14 patients (10 males; mean age 22.50 ± 6.67 years old) with catatonia apparently precipitated by the use of cannabis (n = 6) or SC (n = 8) were found. Clinical features and treatment are described and discussed. Conclusion: From a clinical perspective, cannabis and SC use may be related to catatonia-like symptoms and catatonia syndrome in the same way these substances (cannabis and SC) are related to induced-psychotic episodes. However, further research will be required to understand the exact nature of that relationship. Additionally, investigations focused on the clinical significance (i.e., prognosis, evolution, and outcomes) of catatonia-like symptoms induced by cannabis and SC use in patients are also needed.
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Affiliation(s)
- Raul Felipe Palma-Álvarez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Albert Soriano-Dia
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Elena Ros-Cucurull
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Constanza Daigre
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Pedro Serrano-Pérez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Germán Ortega-Hernández
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Marta Perea-Ortueta
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Josep-Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Lara Grau-López
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
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Berger AA, Liu Y, Jin K, Kaneb A, Welschmeyer A, Cornett EM, Kaye AD, Imani F, Khademi SH, Varrassi G, Viswanath O, Urits I. Efficacy of Acupuncture in the Treatment of Chronic Abdominal Pain. Anesth Pain Med 2021; 11:e113027. [PMID: 34336622 PMCID: PMC8314076 DOI: 10.5812/aapm.113027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Context Abdominal pain is a widespread complaint and is one of the common reasons leading patients to seek medical care, either in emergency situations or with their primary providers. While acute abdominal pain is a better defined, usually surgical condition, chronic abdominal pain requires longer, typically lifelong, therapy. Chronic abdominal pain may also present with acute flares and complications. Here we review seminal and novel evidence discussing the use of acupuncture in the treatment of abdominal pain, indications, and conditions that may benefit from this approach. Evidence Acquisition Chronic abdominal pain is a common complaint causing significant morbidity and disability and has a hefty price tag attached. Recent studies show it may be prevalent in as much as 25% of the adult population. It is defined as three episodes of severe abdominal pain over the course of three months. Chronic abdominal pain could be the result of chronicity of acute pain or of chronic pain syndromes, most commonly IBD syndromes and IBS. While a plethora of treatments exists for both conditions, these treatments usually fall short of complete symptom control, and there is a need for complementary measures to curb disability and increase the quality of life in these patients. Acupuncture is a form of integrative medicine that has long been used in Chinese and traditional medicine, based on the rebalancing of the patient’s Qi, or Ying/Yang balance. It has been shown to be effective in treating several other conditions, and novel evidence may expand its use into other fields as well. Clinical trials studying acupuncture in chronic pain conditions have been promising, and recent evidence supports the use of abdominal pain in chronic abdominal pain conditions as well. Though not curative, acupuncture is a complementary approach that helps reduce symptoms and improved quality of life. Conclusions Chronic abdominal pain is a widespread condition, mostly affected by the IBS and IBD spectrum. Etiologies are still being studied for these conditions, and while novel treatment approaches are absolute game changers for these patients, many continue to experience some level of symptoms and disability. Acupuncture may provide further alleviation of these symptoms in select patients, thus improving quality of life, reducing disability, and saving healthcare dollars. It is a largely safe and inexpensive method that may significantly contribute to the quality of life of selected patients.
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Affiliation(s)
- Amnon A. Berger
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
- Corresponding Author: Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Yao Liu
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Kevin Jin
- LSU Health Shreveport School of Medicine, Shreveport, LA, USA
| | - Alicia Kaneb
- Georgetown University School of Medicine, Washington DC, USA
| | | | - Elyse M. Cornett
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Alan David Kaye
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed-Hosein Khademi
- Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran
- Corresponding Author: Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Omar Viswanath
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
- University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
- Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, AZ, USA
| | - Ivan Urits
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
- Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA, USA
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Vannabouathong C, Zhu M, Chang Y, Bhandari M. Can Medical Cannabis Therapies be Cost-Effective in the Non-Surgical Management of Chronic Knee Pain? CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2021; 14:11795441211002492. [PMID: 33795939 PMCID: PMC7970188 DOI: 10.1177/11795441211002492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/18/2021] [Indexed: 11/15/2022]
Abstract
Introduction: Chronic knee pain is a common musculoskeletal condition, which usually leads
to decreased quality of life and a substantial financial burden. Various
non-surgical treatments have been developed to relieve pain, restore
function and delay surgical intervention. Research on the benefits of
medical cannabis (MC) is emerging supporting its use for chronic pain
conditions. The purpose of this study was to evaluate the cost-effectiveness
of MC compared to current non-surgical therapies for chronic knee pain
conditions. Methods: We conducted a cost-utility analysis from a Canadian, single payer
perspective and compared various MC therapies (oils, soft gels and dried
flowers at different daily doses) to bracing, glucosamine,
pharmaceutical-grade chondroitin oral non-steroidal anti-inflammatory drugs
(NSAIDs), and opioids. We estimated the quality-adjusted life years (QALYs)
gained with each treatment over 1 year and calculated incremental
cost-utility ratios (ICURs) using both the mean and median estimates for
costs and utilities gained across the range of reported values. The final
ICURs were compared to willingness-to-pay (WTP) thresholds of $66 714,
$133 428 and $200 141 Canadian dollars (CAD) per QALY gained. Results: Regardless of the estimates used (mean or median), both MC oils and soft gels
at both the minimal and maximal recommended daily doses were cost-effective
compared to all current knee pain therapies at the lowest WTP threshold.
Dried flowers were only cost-effective up to a certain dosage (0.75 and
1 g/day based on mean and median estimates, respectively), but all dosages
were cost-effective when the WTP was increased to $133 428/QALY gained. Conclusion: Our study showed that MC may be a cost-effective strategy in the management
of chronic knee pain; however, the evidence on the medical use of cannabis
is limited and predominantly low-quality. Additional trials on MC are
definitely needed, specifically in patients with chronic knee pain.
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Affiliation(s)
| | - Meng Zhu
- OrthoEvidence, Burlington, ON, Canada
| | | | - Mohit Bhandari
- OrthoEvidence, Burlington, ON, Canada.,Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Mannekote Thippaiah S, Iyengar SS, Vinod KY. Exo- and Endo-cannabinoids in Depressive and Suicidal Behaviors. Front Psychiatry 2021; 12:636228. [PMID: 33967855 PMCID: PMC8102729 DOI: 10.3389/fpsyt.2021.636228] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/19/2021] [Indexed: 12/20/2022] Open
Abstract
Cannabis (marijuana) has been known to humans for thousands of years but its neurophysiological effects were sparsely understood until recently. Preclinical and clinical studies in the past two decades have indisputably supported the clinical proposition that the endocannabinoid system plays an important role in the etiopathogeneses of many neuropsychiatric disorders, including mood and addictive disorders. In this review, we discuss the existing knowledge of exo- and endo-cannabinoids, and role of the endocannabinoid system in depressive and suicidal behavior. A dysfunction in this system, located in brain regions such as prefrontal cortex and limbic structures is implicated in mood regulation, impulsivity and decision-making, may increase the risk of negative mood and cognition as well as suicidality. The literature discussed here also suggests that the endocannabinoid system may be a viable target for treatments of these neuropsychiatric conditions.
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Affiliation(s)
- Srinagesh Mannekote Thippaiah
- Valleywise Behavioral Health, Phoenix, AZ, United States.,Creighton University School of Medicine, Phoenix, AZ, United States
| | - Sloka S Iyengar
- The American Museum of Natural History, New York, NY, United States
| | - K Yaragudri Vinod
- Department of Analytical Psychopharmacology, The Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States.,Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States.,Department of Child & Adolescent Psychiatry, New York University Langone Health, New York, NY, United States
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38
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Dei Cas M, Casagni E, Casiraghi A, Minghetti P, Fornasari DMM, Ferri F, Arnoldi S, Gambaro V, Roda G. Phytocannabinoids Profile in Medicinal Cannabis Oils: The Impact of Plant Varieties and Preparation Methods. Front Pharmacol 2020; 11:570616. [PMID: 33364946 PMCID: PMC7751640 DOI: 10.3389/fphar.2020.570616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
Cannabis (Cannabis sativa L.) is a highly promising medicinal plant with well-documented effectiveness and growing use in the treatment of various medical conditions. Cannabis oils are mostly used in galenic preparations, due to their easy adjustment of the administration dose, together with the enhanced bioavailability of its active compounds. As stated by the Italian Law (9/11/2015, 279 Official Gazette), “to ensure the quality of the oil-based cannabis preparation, the titration of the active substance(s) should be carried out.” This study aims to represent the Italian panorama of cannabis oils, which were analyzed (8,201) to determine their cannabinoids content from 2017 to 2019. After application of the exclusion criteria, 4,774 standardized cannabis oils were included, which belong to different medicinal cannabis varieties and prepared according to different extraction methods. The concentration of the principal cannabinoids was taken into account dividing samples on the basis of the main extraction procedures and cannabis varieties. According to this analysis, the most substantial variations should be attributed to different cannabis varieties rather than to their extraction protocols. This study may be the starting point of preparatory pharmacists to assess the correct implementation of the preparation procedures and the quality of the extracts.
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Affiliation(s)
- Michele Dei Cas
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Eleonora Casagni
- Department of Pharmaceutical Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Antonella Casiraghi
- Department of Pharmaceutical Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Paola Minghetti
- Department of Pharmaceutical Sciences, Università Degli Studi di Milano, Milan, Italy
| | | | - Francesca Ferri
- Department of Pharmaceutical Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Sebastiano Arnoldi
- Department of Pharmaceutical Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Veniero Gambaro
- Department of Pharmaceutical Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Gabriella Roda
- Department of Pharmaceutical Sciences, Università Degli Studi di Milano, Milan, Italy
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Takashina S, Igarashi Y, Takahashi M, Kondo Y, Inoue K. Screening Method for the Quality Evaluation of Cannabidiols in Water-based Products Using Liquid Chromatography Tandem Mass Spectrometry. ANAL SCI 2020; 36:1427-1430. [PMID: 32713900 DOI: 10.2116/analsci.20n015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/15/2020] [Indexed: 08/09/2023]
Abstract
A sensitive, useful and preliminary screening method was proposed to quantitate the containable cannabinoids most commonly included in mineral water and gummi candy products, specifically cannabidiol (CBD), cannabinol (CBN), 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCA), cannabigerol (CBG), and cannabidiolic acid (CBDA), using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) for quality evaluations. Based on the electrospray positive ion mode, the limit of detection and the limit of quantification values were 0.2 to 0.5 ng/mL and 0.8 and 2.0 ng/mL. Samples (0.5 g) were diluted by water/methanol (50/50), to which stable isotope internal standards were added; the recovery results appeared in range from 91.3 to 101.2%. This method was applied to evaluate CBD products (6 kinds) from the Japanese market. Our survey found obvious discrepancies between the labeling and the results were overserved in products. In addition, CBN, THCA, CBG, and CBDA were not detected in full-spectrum products that contained various cannabinoids that naturally occur in the cannabis plant. Thus, it is necessary to be able to verify the accurate concentration and impurity in various CBD products from the Japanese market as quickly as possible.
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Affiliation(s)
- Shiori Takashina
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Yuki Igarashi
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Miki Takahashi
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Yukie Kondo
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Koichi Inoue
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan.
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40
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Howard J, Osborne J. Cannabis and work: Need for more research. Am J Ind Med 2020; 63:963-972. [PMID: 32797692 DOI: 10.1002/ajim.23170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022]
Abstract
Cannabis sativa is one of the oldest and most widely used plants in the world with a variety of industrial, medical, and nonmedical applications. Despite its long history, cannabis-derived products remain a source of controversy across the fields of medicine, law, and occupational safety and health. More favorable public attitudes about cannabis in the US have resulted in greater access to cannabis through legalization by states, leading to more consumption by workers. As more states adopt cannabis access laws, and as more workers choose to consume cannabis products, the implications for existing workplace policies, programs, and practices become more salient. Past workplace practices were grounded in a time when cannabis consumption was always viewed as problematic, considered a moral failing, and was universally illegal. Shifting cultural views and the changing legal status of cannabis indicate a need for research into the implications and challenges relating to cannabis and work. This commentary suggests research needs in the following areas: (a) data about industries and occupations where cannabis consumption among workers is most prevalent; (b) adverse health consequences of cannabis consumption among workers; (c) workplace supported recovery programs; (d) hazards to workers in the emerging cannabis industry; (e) relationship between cannabis consumption and occupational injuries; (f) ways to assess performance deficits and impairment from cannabis consumption; (g) consumption of synthetic cannabinoids to evade detection by drug testing; (h) cannabis consumption and its effect on occupational driving; and (i) ways to craft workplace policies and practices that take into consideration conflicting state and federal laws pertaining to cannabis.
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Affiliation(s)
- John Howard
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention US Department of Health and Human Services Washington DC
| | - Jamie Osborne
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention US Department of Health and Human Services Atlanta Georgia
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Berger AA, Keefe J, Winnick A, Gilbert E, Eskander JP, Yazdi C, Kaye AD, Viswanath O, Urits I. Cannabis and cannabidiol (CBD) for the treatment of fibromyalgia. Best Pract Res Clin Anaesthesiol 2020; 34:617-631. [PMID: 33004171 DOI: 10.1016/j.bpa.2020.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022]
Abstract
Fibromyalgia is a complex disease process that is as prevalent as it is poorly understood. Research into the pathophysiology is ongoing, and findings will likely assist in identifying new therapeutic options to augment those in existence today that are still insufficient for the care of a large population of patients. Recent evidence describes the use of cannabinoids in the treatment of fibromyalgia. This study provides a systematic, thorough review of the evidence alongside a review of the seminal data regarding the pathophysiology, diagnosis, and current treatment options. Fibromyalgia is characterized by widespread chronic pain, fatigue, and depressive episodes without an organic diagnosis, which may be prevalent in up to 10% of the population and carries a significant cost in healthcare utilization, morbidity, a reduced quality of life, and productivity. It is frequently associated with psychiatric comorbidities. The diagnosis is clinical and usually prolonged, and diagnostic criteria continue to evolve. Some therapies have been previously described, including neuropathic medications, milnacipran, and antidepressants. Despite some level of efficacy, only physical exercise has strong evidence to support it. Cannabis has been used historically to treat different pain conditions since ancient times. Recent advances allowed for the isolation of the active substances in cannabis and the production of cannabinoid products that are nearly devoid of psychoactive influence and provide pain relief and alleviation of other symptoms. Many of these, as well as cannabis itself, are approved for use in chronic pain conditions. Evidence supporting cannabis in chronic pain conditions is plentiful; however, in fibromyalgia, they are mostly limited. Only a handful of randomized trials exists, and their objectivity has been questioned. However, many retrospective trials and patient surveys suggest the significant alleviation of pain, improvement in sleep, and abatement of associated symptoms. Evidence supporting the use of cannabis in chronic pain and specifically in fibromyalgia is being gathered as the use of cannabis increases with current global trends. While the current evidence is still limited, emerging data do suggest a positive effect of cannabis in fibromyalgia. Cannabis use is not without risks, including psychiatric, cognitive, and developmental as well as the risks of addiction. As such, clinical judgment is warranted to weigh these risks and prescribe to patients who are more likely to benefit from this treatment. Further research is required to define appropriate patient selection and treatment regimens.
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Affiliation(s)
- Amnon A Berger
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Joseph Keefe
- Ben-Gurion University of the Negev Medical School for International Health, Beer-Sheva, Israel
| | - Ariel Winnick
- Ben-Gurion University of the Negev Medical School for International Health, Beer-Sheva, Israel
| | - Elasaf Gilbert
- Ben-Gurion University of the Negev Medical School for International Health, Beer-Sheva, Israel
| | - Jonathan P Eskander
- Portsmouth Anesthesia Associates, Anesthesiology and Pain Medicine, Portsmouth, VA, USA
| | - Cyrus Yazdi
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Alan D Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA; University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
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Poyatos L, Pérez-Acevedo AP, Papaseit E, Pérez-Mañá C, Martin S, Hladun O, Siles A, Torrens M, Busardo FP, Farré M. Oral Administration of Cannabis and Δ-9-tetrahydrocannabinol (THC) Preparations: A Systematic Review. ACTA ACUST UNITED AC 2020; 56:medicina56060309. [PMID: 32585912 PMCID: PMC7353904 DOI: 10.3390/medicina56060309] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
Abstract
Background and objective: Changes in cannabis legalization regimes in several countries have influenced the diversification of cannabis use. There is an ever-increasing number of cannabis forms available, which are gaining popularity for both recreational and therapeutic use. From a therapeutic perspective, oral cannabis containing Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is a promising route of administration but there is still little information about its pharmacokinetics (PK) effects in humans. The purpose of this systematic review is to provide a general overview of the available PK data on cannabis and THC after oral administration. Materials and Methods: A search of the published literature was conducted using the PubMed database to collect available articles describing the PK data of THC after oral administration in humans. Results: The literature search yielded 363 results, 26 of which met our inclusion criteria. The PK of oral THC has been studied using capsules (including oil content), tablets, baked goods (brownies and cookies), and oil and tea (decoctions). Capsules and tablets, which mainly correspond to pharmaceutical forms, were found to be the oral formulations most commonly studied. Overall, the results reflect the high variability in the THC absorption of oral formulations, with delayed peak plasma concentrations compared to other routes of administration. Conclusions: Oral THC has a highly variable PK profile that differs between formulations, with seemingly higher variability in baked goods and oil forms. Overall, there is limited information available in this field. Therefore, further investigations are required to unravel the unpredictability of oral THC administration to increase the effectiveness and safety of oral formulations in medicinal use.
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Affiliation(s)
- Lourdes Poyatos
- Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias (HUGTiP-IGTP), 08916 Badalona, Spain; (L.P.); (E.P.); (C.P.-M.); (S.M.); (O.H.); (M.F.)
- Departments of Pharmacology, Therapeutics and Toxicology and Department of Psychiatry, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain;
| | - Ana Pilar Pérez-Acevedo
- Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias (HUGTiP-IGTP), 08916 Badalona, Spain; (L.P.); (E.P.); (C.P.-M.); (S.M.); (O.H.); (M.F.)
- Departments of Pharmacology, Therapeutics and Toxicology and Department of Psychiatry, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain;
- Correspondence: ; Tel.: +34-934978865
| | - Esther Papaseit
- Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias (HUGTiP-IGTP), 08916 Badalona, Spain; (L.P.); (E.P.); (C.P.-M.); (S.M.); (O.H.); (M.F.)
- Departments of Pharmacology, Therapeutics and Toxicology and Department of Psychiatry, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain;
| | - Clara Pérez-Mañá
- Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias (HUGTiP-IGTP), 08916 Badalona, Spain; (L.P.); (E.P.); (C.P.-M.); (S.M.); (O.H.); (M.F.)
- Departments of Pharmacology, Therapeutics and Toxicology and Department of Psychiatry, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain;
| | - Soraya Martin
- Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias (HUGTiP-IGTP), 08916 Badalona, Spain; (L.P.); (E.P.); (C.P.-M.); (S.M.); (O.H.); (M.F.)
| | - Olga Hladun
- Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias (HUGTiP-IGTP), 08916 Badalona, Spain; (L.P.); (E.P.); (C.P.-M.); (S.M.); (O.H.); (M.F.)
- Departments of Pharmacology, Therapeutics and Toxicology and Department of Psychiatry, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain;
| | - Adrià Siles
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias (HUGTiP-IGTP), 08916 Badalona, Spain;
| | - Marta Torrens
- Departments of Pharmacology, Therapeutics and Toxicology and Department of Psychiatry, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain;
- Drug Addiction Program, Institut de Neuropsiquiatria, Parc de Salut Mar and Institut Hospital del Mar de Recerca Mèdica (PSMAR-IMIM), 08003 Barcelona, Spain
| | - Francesco Paolo Busardo
- Department of Excellence-Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy;
| | - Magí Farré
- Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias (HUGTiP-IGTP), 08916 Badalona, Spain; (L.P.); (E.P.); (C.P.-M.); (S.M.); (O.H.); (M.F.)
- Departments of Pharmacology, Therapeutics and Toxicology and Department of Psychiatry, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain;
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Zarhin D. The trajectory of "medical cannabis" in Israel: Driving medicalization in different directions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102809. [PMID: 32516686 DOI: 10.1016/j.drugpo.2020.102809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/16/2020] [Accepted: 05/25/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although researchers, laypersons and policymakers have been debating about the "medicalization of cannabis" for years, few have attempted to unpack this phrase and clarify what it actually means. The present qualitative research addresses this issue by tracing the trajectory of "medical cannabis" (MC) in Israel. METHODS This article draws on multiple sources, including in-depth interviews, parliamentary protocols, conference observations, policy documents, and media coverage. RESULTS The analysis shows that while patients, growers, and certain physicians advocated for a more inclusive type of cannabis medicalization, other physicians and sick funds strove to curtail this medicalization; for its part, the Ministry of Health (MoH) attempted to find a pathway that would bridge their conflicting standpoints. In the first phase of medicalization patients' and regulators' trajectories coincided; however, they diverged in the second phase as regulators sought to transform MC into a standardized medication in line with the biomedical model. Patients and physicians criticized the new policy reform and highlighted some of its negative effects on patient care. The trajectories of patients and regulators then intersected in a way that led to some alterations in the MC trajectory. CONCLUSION This study enhances our understanding of how MC was, and is still being, incorporated into medicine in Israel. The study illuminates the plurality of meanings that have been assigned to the concept of medicalization and the contingent nature of MC. Additionally, this study sheds light on the under-investigated role of regulators as drivers of the medicalization of "solutions," and it shows how different engines of medicalization may drive the process in diverging directions.
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Affiliation(s)
- Dana Zarhin
- Department of Sociology, Faculty of Social Sciences, University of Haifa, Israel; Department of Sociology, Brandeis University, Waltham, MA, USA.
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Role of the pharmacist in the care of patients using cannabis. J Am Pharm Assoc (2003) 2020. [DOI: 10.1016/j.japh.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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