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Szejko N, Becher E, Heimann F, Grotenhermen F, Müller-Vahl KR. Medicinal Use of Different Cannabis Strains: Results from a Large Prospective Survey in Germany. PHARMACOPSYCHIATRY 2024; 57:133-140. [PMID: 38471525 DOI: 10.1055/a-2261-2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Up to now, it is unclear whether different medicinal cannabis (MC) strains are differently efficacious across different medical conditions. In this study, the effectiveness of different MC strains was compared depending on the disease to be treated. METHODS This was an online survey conducted in Germany between June 2020 and August 2020. Patients were allowed to participate only if they received a cannabis-based treatment from pharmacies in the form of cannabis flowers prescribed by a physician. RESULTS The survey was completed by n=1,028 participants. Most participants (58%) have used MC for more than 1 year, on average, 5.9 different strains. Bedrocan (pure tetrahydrocannabinol to pure cannabidiol [THC:CBD]=22:<1) was the most frequently prescribed strain, followed by Bakerstreet (THC:CBD=19:<1) and Pedanios 22/1 (THC:CBD=22:1). The most frequent conditions MC was prescribed for were different pain disorders, psychiatric and neurological diseases, and gastrointestinal symptoms. Overall, the mean patient-reported effectiveness was 80.1% (range, 0-100%). A regression model revealed no association between the patient-reported effectiveness and the variety. Furthermore, no influence of the disease on the choice of the MC strain was detected. On average, 2.1 side effects were reported (most commonly dry mouth (19.5%), increased appetite (17.1%), and tiredness (13.0%)). However, 29% of participants did not report any side effects. Only 398 participants (38.7%) indicated that costs for MC were covered by their health insurance. CONCLUSIONS Patients self-reported very good efficacy and tolerability of MC. There was no evidence suggesting that specific MC strains are superior depending on the disease to be treated.
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Affiliation(s)
- Natalia Szejko
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Eva Becher
- Department of Sex- and Gender-specific Medicine, University of Bielefeld, Bielefeld, Germany
| | | | - Franjo Grotenhermen
- International Association for Cannabinoid Medicines, Steinheim, Germany
- Center for Cannabis Medicine, Steinheim, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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2
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Mercer AH, MacDuffie KE, Weiss EM, Johnson A, Dager SR, Kleinhans N. Interpersonal Influences on the Choice to Treat Nausea during Pregnancy with Medication or Cannabis. Am J Perinatol 2024; 41:e2941-e2951. [PMID: 37774747 DOI: 10.1055/a-2183-9013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
OBJECTIVE This study aimed to better understand the interpersonal influences on a pregnant individual's decision of how to treat nausea and vomiting during pregnancy using a qualitative approach. STUDY DESIGN A semistructured interview guide was developed to assess pregnancy symptoms, decision-making regarding treating nausea, and interpersonal influences on treatment decisions. Interviews were conducted with 17 individuals enrolled in a neuroimaging and behavioral study of prenatal exposure to cannabis who used medication and/or cannabis to treat symptoms associated with pregnancy. RESULTS Interviews revealed four groups of stakeholders who influenced participant decision-making: medical providers, partners, family, and friends. Influence was categorized as either positive, negative, neutral, or absent (if not discussed or participant chose not to disclose). Those in the medication group reported only positive or neutral feedback from friends, family, partners, and providers. In contrast, the cannabis group participants reported positive feedback from friends, mixed feedback from family and partners, and negative feedback from providers, which was often felt to be stigmatizing. Many in the cannabis group also reported varying feedback from different medical providers. While the cannabis group frequently reported eliciting feedback from friends, family, and partners, the medication group often did not. CONCLUSION Medication group participants reported entirely positive feedback from providers and often did not mention any feedback at all from partners, family, and friends. Cannabis group participants reported much more varied feedback, both positive and negative, from a variety of interpersonal contacts and sometimes decided to conceal their treatment choice after receiving or fearing negative feedback. We recommend further research into the health outcomes of pregnant patients who chose not to discuss their treatment decisions with providers, family, partners, or friends. We also suggest further study of possible reasons behind a lack of disclosure, including fear of stigma and/or legal consequences. KEY POINTS · Providers, partners, family, friends gave feedback.. · Medication group got positive feedback.. · Cannabis group stigmatized by providers.. · Cannabis group got mixed feedback..
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Affiliation(s)
- Amanda H Mercer
- Counselor Education Department, Portland State University, Portland, Oregon
| | - Katherine E MacDuffie
- Department of Pediatrics, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, University of Washington, Seattle, Washington
| | - Elliott M Weiss
- Department of Pediatrics, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, University of Washington, Seattle, Washington
| | - Allegra Johnson
- Department of Radiology, University of Washington, Seattle, Washington
| | - Stephen R Dager
- Department of Radiology, University of Washington, Seattle, Washington
| | - Natalia Kleinhans
- Department of Radiology, University of Washington, Seattle, Washington
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3
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Karst M. Overview: Chronic Pain and Cannabis-Based Medicines. PHARMACOPSYCHIATRY 2024; 57:152-159. [PMID: 38198809 PMCID: PMC11076105 DOI: 10.1055/a-2231-6630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
Chronic pain is primarily conceptualized as a disease in its own right when it is associated with emotional distress and functional impairment. Pathophysiologically, dysfunction of the cortico-mesolimbic connectome is of major importance, with overlapping signals in the nociceptive and stress systems. The endocannabinoid system plays an important role in the central processing of nociceptive signals and regulates the central stress response. Clinically, there is moderate evidence that cannabis-based medicines (CBM) can contribute to a significant reduction in pain, especially the associated pain affect, and improvement in physical function and sleep quality in a proportion of patients with chronic pain. The analgesic effect appears to be largely independent of the cause of pain. In this context, CBM preferentially regulates stress-associated pain processing.
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Affiliation(s)
- Matthias Karst
- Anesthesiology, Pain Clinic, Hannover Medical School, Hannover,
Germany
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4
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Papoutsis I, Hatzidouka V, Ntoupa SP, Angelis A, Dona A, Sakelliadis E, Spiliopoulou C. Determination of Δ 9-tetrahydrocannabinol, 11-nor-carboxy-Δ 9-tetrahydrocannabinol and cannabidiol in human plasma and urine after a commercial cannabidiol oil product intake. Forensic Toxicol 2024:10.1007/s11419-024-00686-0. [PMID: 38592642 DOI: 10.1007/s11419-024-00686-0] [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: 12/22/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Cannabidiol (CBD) products are widely used for pain relief, sleep improvement, management of seizures etc. Although the concentrations of Δ9-tetrahydrocannabinol (Δ9-THC) in these products are low (≤0.3% w/w), it is important to investigate if its presence and/or that of its metabolite 11-nor-carboxy-Δ9-THC, is traceable in plasma and urine samples of individuals who take CBD oil products. METHODS A sensitive GC/MS method for the determination of Δ9-THC, 11-nor-carboxy-Δ9-THC and CBD in plasma and urine samples was developed and validated. The sample preparation procedure included protein precipitation for plasma samples and hydrolysis for urine samples, solid-phase extraction and finally derivatization with N,O-bis(trimethylsilyl)trifluoroacetamide) with 1% trimethylchlorosilane. RESULTS For all analytes, the LOD and LOQ were 0.06 and 0.20 ng/mL, respectively. The calibration curves were linear (R2 ≥ 0.992), and absolute recoveries were ≥91.7%. Accuracy and precision were within the accepted range. From the analysis of biologic samples of 10 human participants who were taking CBD oil, it was realized that Δ9-THC was not detected in urine, while 11-nor-carboxy-Δ9-THC (0.69-23.06 ng/mL) and CBD (0.29-96.78 ng/mL) were found in all urine samples. Regarding plasma samples, Δ9-THC (0.21-0.62 ng/mL) was detected in 10, 11-nor-carboxy-Δ9-THC (0.20-2.44 ng/mL) in 35, while CBD (0.20-1.58 ng/mL) in 25 out of 38 samples, respectively. CONCLUSION The results showed that Δ9-THC is likely to be found in plasma although at low concentrations. In addition, the detection of 11-nor-carboxy-Δ9-THC in both urine and plasma samples raises questions and concerns for the proper interpretation of toxicological results, especially considering Greece's zero tolerance law applied in DUID and workplace cases.
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Affiliation(s)
- Ioannis Papoutsis
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Vasiliki Hatzidouka
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Division of Pharmaceutical Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatina-Panagoula Ntoupa
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolis Angelis
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Artemisia Dona
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Sakelliadis
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Spindle TR, Zamarripa CA, Russo E, Pollak L, Bigelow G, Ward AM, Tompson B, Sempio C, Shokati T, Klawitter J, Christians U, Vandrey R. Vaporized D-limonene selectively mitigates the acute anxiogenic effects of Δ9-tetrahydrocannabinol in healthy adults who intermittently use cannabis. Drug Alcohol Depend 2024; 257:111267. [PMID: 38498958 PMCID: PMC11031290 DOI: 10.1016/j.drugalcdep.2024.111267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 03/02/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Cannabis contains hundreds of chemical constituents beyond delta-9-tetrahydrocannabinol (THC), which is believed to drive most of its acute pharmacodynamic effects. The entourage effect theory asserts that non-THC constituents can impact acute cannabis effects, but few empirical studies have systematically evaluated this theory in humans. This study assessed whether the cannabis terpenoid d-limonene mitigates the acute anxiogenic effects of THC. METHODS Twenty healthy adults completed nine, double-blind outpatient sessions in which they inhaled vaporized THC alone (15mg or 30mg), d-limonene alone (1mg or 5mg), the same doses of THC and d-limonene together, or placebo; a subset of participants (n=12) completed a tenth session in which 30mg THC+15mg d-limonene was administered. Outcomes included subjective drug effects, cognitive/psychomotor performance, vital signs, and plasma THC and d-limonene concentrations. RESULTS When d-limonene was administered alone, pharmacodynamic outcomes did not differ from placebo. Administration of 15mg and 30mg THC alone produced subjective, cognitive, and physiological effects typical of acute cannabis exposure. Ratings of anxiety-like subjective effects qualitatively decreased as d-limonene dose increased and concurrent administration of 30mg THC+15mg d-limonene significantly reduced ratings of "anxious/nervous" and "paranoid" compared with 30mg THC alone. Other pharmacodynamic effects were unchanged by d-limonene. D-limonene plasma concentrations were dose orderly, and concurrent administration of d-limonene did not alter THC pharmacokinetics. CONCLUSIONS D-limonene selectively attenuated THC-induced anxiogenic effects, suggesting this terpenoid could increase the therapeutic index of THC. Future research should determine whether this effect extends to oral dose formulations and evaluate the interactions between other cannabis terpenoids or cannabinoids and THC.
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Affiliation(s)
- Tory R Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr, Baltimore, MD 21224, USA
| | - C Austin Zamarripa
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr, Baltimore, MD 21224, USA
| | - Ethan Russo
- CReDO Science, 20402 81st Avenue SW, Vashon, WA 98070, USA
| | - Lauren Pollak
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr, Baltimore, MD 21224, USA
| | - George Bigelow
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr, Baltimore, MD 21224, USA
| | - Alexandra M Ward
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bridget Tompson
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Cristina Sempio
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Touraj Shokati
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jost Klawitter
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Uwe Christians
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr, Baltimore, MD 21224, USA.
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Maillet MA. Individual differences in legal and illicit cannabis purchasing behaviour in British Columbia, Canada: Findings from a 2021 cross-sectional survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104363. [PMID: 38401174 DOI: 10.1016/j.drugpo.2024.104363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Despite thousands of licensed cannabis retail stores operating across Canada, there remains a significant illicit cannabis market. Some cannabis users continue to buy cannabis from dealers, illicit stores, and/or illicit online retailers. METHODS Data are from the 2021 British Columbia Cannabis Use Survey. Respondents (n = 8473) were 19 years or older, lived in British Columbia at the time of the survey, and reported using cannabis in the past 12 months. RESULTS Buying cannabis from all types of illicit sources was more common among younger cannabis users, those who use cannabis more frequently and started using cannabis before the age of 17 (vs. 19 or older), and among those who co-use cannabis with other drugs. Specifically, buying cannabis from a dealer was more common among men, those with lower educational attainment, and those who seek the lowest prices when buying cannabis. In contrast, those using cannabis for medical (vs. non-medical) purposes were more likely to report getting cannabis from illicit retail stores, while buying cannabis from illicit websites was more common among people who use edible cannabis products. CONCLUSION Consistent with other studies, younger and more frequent cannabis users were more likely to report buying cannabis from illicit sources. However, these findings suggest there is significant heterogeneity among those who buy cannabis from different types of illicit sources, which should be carefully considered when developing policies and strategies aimed at encouraging consumers to transition to legal sources.
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Affiliation(s)
- Myles A Maillet
- B.C. Ministry of Public Safety and Solicitor General, Canada
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7
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Schuhmacher S, Gaid D, Bishop LD, Fleming L, Donnan J. Planting the seeds for success: A qualitative study exploring primary healthcare providers' perceptions about medical cannabis. PLoS One 2024; 19:e0295858. [PMID: 38451984 PMCID: PMC10919677 DOI: 10.1371/journal.pone.0295858] [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] [Received: 07/14/2023] [Accepted: 11/30/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND In Canada, cannabis legalization altered the way that the public can access cannabis for medical purposes. However, Canadians still struggle with finding healthcare professionals (HCPs) who are involved in medical cannabis counselling and authorization. This raises questions about the barriers that are causing this breakdown in care. Our study explored the perceptions of primary care providers regarding cannabis in their practice. METHODS Semi-structured interviews were conducted by Zoom with HCPs in Newfoundland and Labrador (NL) to discuss their experiences with medical and non-medical cannabis in practice. Family physicians and nurse practitioners who were practicing in primary care in NL were included. The interview guide and coding template were developed using the Theoretical Domains Framework (TDF). A thematic analysis across the TDF was then conducted. RESULTS Twelve participants with diverse demographic backgrounds and experience levels were interviewed. Five main themes emerged including, knowledge acquisition, internal influences, patient influences, external HCP influences, and systemic influences. The TDF domain resulting in the greatest representation of codes was environmental context and resources. INTERPRETATION The findings suggested that HCPs have significant knowledge gaps in authorizing medical cannabis, which limited their practice competence and confidence in this area. Referring patients to cannabis clinics, while enforcing harm-reduction strategies, was an interim option for patients to access cannabis for medical purposes. However, developing practice guidelines and educational resources were suggested as prominent facilitators to promote medical cannabis authorization within the healthcare system.
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Affiliation(s)
- Sandi Schuhmacher
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Dina Gaid
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Lisa D. Bishop
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Laura Fleming
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
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Scott JR, Williams DA, Harte SE, Harris RE, Litinas E, Sisley S, Clauw DJ, Boehnke KF. Relationship Between Nociplastic Pain Involvement and Medication Use, Symptom Relief, and Adverse Effects Among People Using Medical Cannabis for Chronic Pain. Clin J Pain 2024; 40:1-9. [PMID: 37823303 DOI: 10.1097/ajp.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Cannabis is increasingly being used for chronic pain management, but cannabis' effects remain poorly characterized in chronic nociplastic pain (NPP), which is posited to be caused by disturbances in nervous system pain processing. In this cross-sectional study (n=1213), we used the 2011 Fibromyalgia (FM) Survey Criteria as a surrogate measure for degree of NPP among individuals using medical cannabis for chronic pain. METHODS Using a quartile-split, we investigated associations between the degree of NPP and medication use, cannabis use characteristics, and symptom relief. Continuous variables were assessed using one-way analysis of variance and categorical variables with Pearson χ 2 test and binomial logistic regression for calculation of odds ratios. RESULTS Participants were predominately female (59%), with a mean ± SD age of 49.4±13.6 years. Higher FM scores were associated with less self-reported improvement in pain and health since initiating medical cannabis use, as well as more cannabis-related side effects. Paradoxically, higher FM scores were also associated with higher usage of concomitant medication use (including opioids and benzodiazepines) but also with substituting cannabis for significantly more medication classes, including opioids and benzodiazepines. DISCUSSION This article presents evidence that individuals in higher NPP quartiles have higher analgesic intake, higher odds of substituting cannabis for medications, higher side effect burden, and lower therapeutic effect from cannabis. These seemingly contradictory findings may reflect higher symptom burden, polypharmacy at baseline, or that NPP may be challenging to treat with cannabis. Further research is necessary to further explain cannabinoid effects in NPP.
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Affiliation(s)
- J Ryan Scott
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | | | | | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Kevin F Boehnke
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
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Boehnke KF, Wu CL, Clauw DJ. Thoughtfully Integrating Cannabis Products Into Chronic Pain Treatment. Anesth Analg 2024; 138:5-15. [PMID: 38100797 PMCID: PMC10730114 DOI: 10.1213/ane.0000000000005904] [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: 12/17/2023]
Abstract
Cannabis products (CPs) and cannabis-based medicines (CBMs) are becoming increasingly available and are commonly used for pain management. The growing societal acceptance of cannabis and liberalization of cannabis laws allows patients to access CPs with minimal clinical oversight. While there is mechanistic plausibility that CPs and CBMs may be useful for pain management, the clinical trial literature is limited and does not refute or support the use of CBMs for pain management. Complicating matters, a large and growing body of observational literature shows that many people use CPs for pain management and in place of other medications. However, products and dosing regimens in existing trials are not generalizable to the current cannabis market, making it difficult to compare and reconcile these 2 bodies of literature. Given this complexity, clinicians need clear, pragmatic guidance on how to appropriately educate and work with patients who are using CBMs for pain management. In this review, we narratively synthesize the evidence to enable a clear view of current landscape and provide pragmatic advice for clinicians to use when working with patients. This advice revolves around 3 principles: (1) maintaining the therapeutic alliance; (2) harm reduction and benefit maximization; and (3) pragmatism, principles of patient-centered care, and use of best clinical judgment in the face of uncertainty. Despite the lack of certainty CPs and chronic pain management use, we believe that following these principles can make most of the clinical opportunity presented by discussions around CPs and also enhance the likelihood of clinical benefit from CPs.
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Affiliation(s)
- Kevin F. Boehnke
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher L. Wu
- Department of Anesthesiology, Pain Medicine and Critical Care; Hospital for Special Surgery; New York, NY, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel J. Clauw
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
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Gething K, Erku D, Scuffham P. Stakeholders' Decisions and Preferences for the Provision and Use of Medicinal Cannabis: A Scoping Review. Cannabis Cannabinoid Res 2023; 8:986-998. [PMID: 36888538 DOI: 10.1089/can.2022.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background: The aim of this scoping review was to examine the extent that stakeholder's decisions about and preferences for the provision and use of medicinal cannabis (MC) had been investigated. We sought to identify which populations were examined, the methods used for eliciting preferences and exploring decisions, and the reported outcomes of studies. Methods: Electronic databases (PubMed, CINAHL, Embase, BSC and PsycINFO) and the reference lists of relevant articles were searched for studies published up to March 2022. Studies were included if stakeholder preferences for MC were (1) the primary focus of the research, or (2) an aspect of a larger preference focus. Studies that (3) described the decisions to use MC were also included. Results: Thirteen studies were reviewed. The population focus of these was primarily patient, with seven studies focused on general patient populations and five studies targeting specific patient populations such as cancer survivors, and people experiencing depression. Methods included health economics preference methods, qualitative interviews, and a single multicriteria decision-making study. Four categories of outcomes were defined and included comparisons of MC with a therapeutic alternative (n=5), preferences for MC attributes (n=5), administration preferences (n=4), and the decision process of users (n=2). Motivation differences in preference were found. Purely medicinal users and novice users place more importance on cannabidiol (CBD) than tetrahydrocannabinol. Overall, inhalation methods of administration were preferred due to quick onset of symptom relief. Price was the greatest influence on choice for recreational/medicinal users, whereas purely medicinal users were less price sensitive for products with higher CBD content. Conclusion: Studies examining public preferences for the provision and use of MC were absent. Revealed preference methods are a useful technique for understanding preferences for characteristics that are difficult to visibly assess such as cannabinoid or strain. The outcomes of symptom-specific multicriteria decision method studies that compare the benefit-safety profiles of commonly used treatments and MC may be a useful decision support tool for health practitioners. Studies with representative samples are needed to understand the impact of age, gender, and race on preferences for MC.
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Affiliation(s)
- Katrina Gething
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Daniel Erku
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Paul Scuffham
- Center for Applied Health Economics, School of Medicine, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Sallam NA, Peterson CS, Baglot SL, Kohro Y, Trang T, Hill MN, Borgland SL. Sex Differences in Plasma, Adipose Tissue, and Central Accumulation of Cannabinoids, and Behavioral Effects of Oral Cannabis Consumption in Male and Female C57BL/6 Mice. Int J Neuropsychopharmacol 2023; 26:773-783. [PMID: 37715955 PMCID: PMC10674081 DOI: 10.1093/ijnp/pyad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/13/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Cannabis edibles are an increasingly popular form of cannabis consumption. Oral consumption of cannabis has distinct physiological and behavioral effects compared with injection or inhalation. An animal model is needed to understand the pharmacokinetics and physiological effects of oral cannabis consumption in rodents as a model for human cannabis edible use. METHODS Adult male and female C57BL/6 mice received a single dose of commercially available cannabis oil (5 mg/kg Δ⁹-tetrahydrocannabinol [THC]) by oral gavage. At 0.5, 1, 2, 3, and 6 hours post exposure, plasma, hippocampus, and adipose tissue were collected for THC, 11-OH-THC, and THC-COOH measures. RESULTS We report delayed time to peak THC and 11-OH-THC concentrations in plasma, brain, and adipose tissue, which is consistent with human pharmacokinetics studies. We also found sex differences in the cannabis tetrad: (1) female mice had a delayed hypothermic effect 6 hours post consumption, which was not present in males; (2) females had stronger catalepsy than males; (3) males were less mobile following cannabis exposure, whereas female mice showed no difference in locomotion but an anxiogenic effect at 3 hours post exposure; and (4) male mice displayed a longer-lasting antinociceptive effect of oral cannabis. CONCLUSIONS Oral cannabis consumption is a translationally relevant form of administration that produces similar physiological effects as injection or vaping administration and thus should be considered as a viable approach for examining the physiological effects of cannabis moving forward. Furthermore, given the strong sex differences in metabolism of oral cannabis, these factors should be carefully considered when designing animal studies on the effects of cannabis.
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Affiliation(s)
- Nada A Sallam
- Department of Physiology and Pharmacology, The University of Calgary, Calgary, Canada
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Colleen S Peterson
- Department of Physiology and Pharmacology, The University of Calgary, Calgary, Canada
| | - Samantha L Baglot
- Department of Cell Biology and Anatomy, The University of Calgary, Calgary, Canada
| | - Yuta Kohro
- Department of Physiology and Pharmacology, The University of Calgary, Calgary, Canada
- Department of Molecular and System Pharmacology, Graduate School of Pharmaceutical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Tuan Trang
- Department of Physiology and Pharmacology, The University of Calgary, Calgary, Canada
| | - Matthew N Hill
- Department of Cell Biology and Anatomy, The University of Calgary, Calgary, Canada (Dr Hill and Ms Baglot)
| | - Stephanie L Borgland
- Department of Physiology and Pharmacology, The University of Calgary, Calgary, Canada
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Tanco K, Olson A, Fellman B, Jankowski M, Lai SY, Shete S, Harbison K, Scheid J, Bruera E. Analysis of Dispensing and Utilization Patterns of Medical Cannabis Products in State Licensed Cannabis Dispensaries. J Palliat Med 2023; 26:1482-1487. [PMID: 37285183 DOI: 10.1089/jpm.2023.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Background: To understand real-world dispensing and utilization patterns of medical cannabis (MC) and its financial impact on patients, we analyzed the database of a cannabis company licensed in New York state. Objectives: To evaluate the tetrahydrocannabinol (THC)/cannabidiol (CBD) dose ratios, association of various medical conditions to THC/CBD dose, and the cost of products in registered patients receiving MC from four licensed state dispensaries. Design: Retrospective analysis conducted on anonymized data between January 1, 2016 and December 31, 2020 listing 422,201 dispensed products from 32,845 individuals aged 18 years and older. Setting/Subjects: Adult patients with medical certification for cannabis use in New York, USA. Measurements: The database included patient's age, gender, qualifying medical condition, type and dose of product, medication directions, and amount of product dispensed. Results: Findings showed a median age of 53 years with 52% of patients female. Males were found to use more products than females (1.06:1). Pain (85%) was the most common medical condition and inhalation (57%) the most common route except when used for cancer-directed treatment and neurological conditions. Individuals received a median of six prescriptions costing a median of $50/product. Average THC:CBD ratios were 28:0.5 mg/day and 12:0.25 mg/dose. Neurological conditions demonstrated the highest average cost [mean (95% confidence interval {CI}): $73 ($71-$75)] and average CBD/dose per product [mean (95% CI): 5.89 (5.38-6.40)]. Individuals with a history of substance use disorder utilizing MC as an alternative substance displayed the highest average THC/dose [mean (95% CI): 14.25 (13.36-15.14)]. Conclusion: MC was utilized for various medical conditions with variability in THC:CBD ratio seen depending on the condition. Cost variation was also observed based on the individual's medical condition.
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Affiliation(s)
- Kimberson Tanco
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amanda Olson
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mika Jankowski
- Hematology Affairs Department, Lilly LLC, Hematology Medical Science Liaison, Indianapolis, Indiana, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kevin Harbison
- Training and Development Department, PharmaCann, Lead Retail Pharmacist, Amherst, New York, USA
| | - Jennifer Scheid
- Department of Physical Therapy, Daemen University, Amherst, New York, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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13
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Valikhanova G, Kato Y, Fitzcharles MA, Ware M, Da Costa D, Lowensteyn I, Cheung HS, Grover S. Medical Cannabis Use Among Canadian Veterans and Non-Veterans: A National Survey. INTEGRATIVE MEDICINE REPORTS 2023; 2:120-128. [PMID: 37920683 PMCID: PMC10619467 DOI: 10.1089/imr.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 11/04/2023]
Abstract
Background Medical cannabis (MC) is used by Canadian Veterans to manage a wide range of health issues. However, there is little information comparing the reasons for MC use and its perceived effectiveness between Veterans and non-Veterans. Objects We compared MC use among a convenience sample of Canadian Veterans and with non-Veteran controls, including demographics, reasons and patterns of use, and perceived effectiveness. Methods Between November and December 2021, Canadian Veterans using cannabis were invited to participate in a survey using a national press release, social media, and announcements on online platform dedicated to promoting health among Canadian Veterans and non-Veterans during the pandemic (www.MissionVav.com). The survey was also mentioned in a monthly newsletter from Veteran Affairs Canada. Self-reported effectiveness was evaluated using a 0 to 10 visual analogue scale (0 being not all effective, 10 being the most effective). Results The survey was completed by 157 people, including 108 (69%) males and 49 (31%) females. The mean age was 57 years (range 19 to 84). Among responders, 90 (63%) identified as Veterans. The most common reasons for MC use among Veterans included: insomnia (80%), anxiety (73%), and depression (52%). Veterans reported medical conditions such as chronic pain (88%) and arthritis (51%). Compared with non-Veterans, Veterans were significantly more likely to be male (83% vs. 49%), have a higher BMI (35.2 vs. 30.9), to report problems with sleep, anxiety, depression, and PTSD, and to use cannabis in edible form (51% vs. 22%). Self-reported mean effectiveness scores for MC were highest for PTSD (8.4), insomnia (8.2), anxiety (8.1), depression (8.0), and chronic pain (7.6). Conclusions We found important differences in user characteristics and cannabis use patterns between Canadian Veterans and non-Veterans. Further controlled studies are required to validate these findings, but these data suggest that orally administered cannabis products may be worth further study.
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Affiliation(s)
| | - Yuka Kato
- Department of Mathematics & Statistics, Concordia University, Montreal, Canada
| | - Mary-Ann Fitzcharles
- Department of Rheumatology, McGill University, Montreal, Canada
- Alan Edwards Pain Management Unit, McGill University, Montreal, Canada
| | - Mark Ware
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Deborah Da Costa
- Division of Clinical Epidemiology, McGill University, Montreal, Canada
| | - Ilka Lowensteyn
- McGill Comprehensive Health Improvement Program, Faculty of Medicine, McGill University, Montréal, Canada
| | - Ho Sum Cheung
- McGill Comprehensive Health Improvement Program, Faculty of Medicine, McGill University, Montréal, Canada
| | - Steven Grover
- Department of Medicine, McGill University, Montreal, Canada
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14
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Dassieu L, Paul-Savoie E, Develay É, Villela Guilhon AC, Guénette L, Perreault K, Beaudry H, Dupuis L, Audet C, Lacasse A. Experiences and Perceptions of Medical Cannabis among People Living with Chronic Pain and Community Pharmacists: A Qualitative Study in Canada. Can J Pain 2023; 7:2258537. [PMID: 38027232 PMCID: PMC10653616 DOI: 10.1080/24740527.2023.2258537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/10/2023] [Indexed: 12/01/2023]
Abstract
Background The use of cannabis to treat chronic pain is under debate despite high expectations from patients. Qualitative data obtained by exploring both patients' and health professionals' perspectives are scarce. Aims This study aimed to understand the experiences and perceptions of people living with chronic pain and community pharmacists regarding the role of cannabis in chronic pain treatment in the Canadian context where both medical and recreational cannabis are legal. Methods We conducted 12 online focus groups (July 2020-February 2021) with 26 patients and 19 community pharmacists using semistructured discussion guides. All discussions were audio recorded and transcribed verbatim were analyzed using a reflexive thematic approach. Results We developed three themes related to patients' perspectives and three themes related to pharmacists' perspectives. Patients' perspectives included (1) cannabis as an alternative to other pain medications, (2) a new treatment with potential health-related risks, and (3) a therapy rather than a recreational drug. Pharmacists' perspectives included (1) challenges in monitoring drug interactions with cannabis in the context of scarce research data, (2) informing and treating patients self-medicating with cannabis amid its growing popularity, and (3) financial costs and legal constraints for patients. Conclusions This study highlights patients' and pharmacists' urgent need for reliable information regarding the benefits and risks of cannabis. Training tailored to pharmacists' needs and evidence-based information for patients should be developed to support pharmacists' practice, improve patients' experiences, and promote safe cannabis use.
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Affiliation(s)
- Lise Dassieu
- Research Center of the Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
| | - Emilie Paul-Savoie
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
- School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Élise Develay
- Research Center of the Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Ana Cecilia Villela Guilhon
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Line Guénette
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHU de Québec, Université Laval, Axe Santé des populations et pratiques optimales en santé, Quebec City, Quebec, Canada
| | - Kadija Perreault
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Hélène Beaudry
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
| | - Laurent Dupuis
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
| | - Claudie Audet
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Anaïs Lacasse
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
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15
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Boehnke KF, Martel MO, Smith T, He Y, Bergmans RS, Kruger DJ, Andwele M, Bevan S, Williams DA, Fitzcharles M. Medicinal Cannabis Use for Rheumatic Conditions in the US Versus Canada: Rationale for Use and Patient-Health Care Provider Interactions. ACR Open Rheumatol 2023; 5:443-453. [PMID: 37519131 PMCID: PMC10502834 DOI: 10.1002/acr2.11592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE Understanding how medical cannabis (MC) use is integrated into medical practice for rheumatic disease management is essential. We characterized rationale for MC use, patient-physician interactions around MC, and MC use patterns among people with rheumatic conditions in the US and Canada. METHODS We surveyed 3406 participants with rheumatic conditions in the US and Canada, with 1727 completing the survey (50.7% response rate). We assessed disclosure of MC use to health care providers, MC authorization by health care providers, and MC use patterns and investigated factors associated with MC disclosure to health care providers in the US versus Canada. RESULTS Overall, 54.9% of US respondents and 78.0% of Canadians reported past or current MC use, typically because of inadequate symptom relief from other medications. Compared to those in Canada, fewer US participants obtained MC licenses, disclosed MC use to their health care providers, or asked advice on how to use MC (all P values <0.001). Overall, 47.4% of Canadian versus 28.2% of US participants rated their medical professionals as their most trusted information source. MC legality in state of residence was associated with 2.49 greater odds of disclosing MC use to health care providers (95% confidence interval: 1.49-4.16, P < 0.001) in the US, whereas there were no factors associated with MC disclosure in Canada. Our study is limited by our convenience sampling strategy and cross-sectional design. CONCLUSION Despite widespread availability, MC is poorly integrated into rheumatic disease care, with most patients self-directing use with minimal or no clinical oversight. Concerted efforts to integrate MC into education and clinical policy is critical.
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Affiliation(s)
| | | | | | - Ying He
- University of MichiganAnn Arbor
| | | | | | | | - Sian Bevan
- Arthritis Society CanadaTorontoOntarioCanada
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16
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Craft RM, Gogulski HY, Freels TG, Glodosky NC, McLaughlin RJ. Vaporized cannabis extract-induced antinociception in male vs female rats with persistent inflammatory pain. Pain 2023; 164:2036-2047. [PMID: 37027147 DOI: 10.1097/j.pain.0000000000002902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/24/2023] [Indexed: 04/08/2023]
Abstract
ABSTRACT Although preclinical studies generally report robust antinociceptive effects of cannabinoids in rodent persistent pain models, randomized controlled trials in chronic pain patients report limited pain relief from cannabis/cannabinoids. Differences between animal and human studies that may contribute to these discrepant findings include route of cannabis/cannabinoid administration, type of cannabis/cannabinoid, and how pain is measured. To address these factors, rats with complete Freund adjuvant (CFA)-induced hind paw inflammation were exposed acutely or repeatedly to vaporized cannabis extract that was either tetrahydrocannabinol (THC) or cannabidiol (CBD)dominant. One measure of evoked pain (mechanical threshold), 2 functional measures of pain (hind paw weight-bearing, and locomotor activity), and hind paw edema were assessed for up to 2 hours after vapor exposure. Acute exposure to vaporized THC-dominant extract (200 or 400 mg/mL) decreased mechanical allodynia and hind paw edema and increased hind paw weight-bearing and locomotor activity, with no sex differences. After repeated exposure to vaporized THC-dominant extract (twice daily for 3 days), only the antiallodynic effect was significant. Acute exposure to vaporized CBD-dominant cannabis extract (200 mg/mL) did not produce any effects in either sex; repeated exposure to this extract (100, 200, or 400 mg/mL) decreased mechanical allodynia in male rats only. Sex differences (or lack thereof) in the effects of vaporized cannabis extracts were not explained by sex differences in plasma levels of THC, CBD, or their major metabolites. These results suggest that although vaporized THC-dominant extract is likely to be modestly effective against inflammatory pain in both male and female rats, tolerance may develop, and the CBD-dominant extract may be effective only in male rats.
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Affiliation(s)
| | | | - Timothy G Freels
- Integrative Physiology and Neuroscience, Washington State University, Pullman, WA, United States
| | | | - Ryan J McLaughlin
- Integrative Physiology and Neuroscience, Washington State University, Pullman, WA, United States
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17
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Carnide N, Nadalin V, Mustard C, Severin CN, Furlan AD, Smith PM. Cannabis use among workers with work-related injuries and illnesses: results from a cross-sectional study of workers' compensation claimants in Ontario, Canada. BMJ Open 2023; 13:e072994. [PMID: 37463805 PMCID: PMC10357653 DOI: 10.1136/bmjopen-2023-072994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES Little is known about how workers use cannabis following a work-related injury/illness, including whether they receive clinical guidance. The objective was to compare characteristics of workers using and not using cannabis after a work-related injury/illness and describe use patterns. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Workers who experienced a work-related physical injury/illness resulting in one or more days of lost time compensated by the workers' compensation authority in Ontario, Canada (n=1196). METHODS Participants were interviewed 18 or 36 months after their injury/illness. Participants were asked about their past-year cannabis use, including whether use was for the treatment of their work-related condition. Sociodemographic, work and health characteristics were compared across cannabis groups: no past-year use; use for the work-related condition; use unrelated to the work-related condition. Cannabis use reasons, patterns, perceived impact and healthcare provider engagement were described. RESULTS In total, 27.4% of the sample reported using cannabis (14.1% for their work-related condition). Workers using cannabis for their condition were less likely to be working (58.0%) and more likely to have quite a bit/extreme pain interference (48.5%), psychological distress (26.0%) and sleep problems most/all the time (62.1%) compared with those not using cannabis (74.3%, 26.3%, 12.0% and 38.0%, respectively) and those using cannabis for other reasons (74.2%, 19.5%, 12.0% and 37.1%, respectively) (all p<0.0001). No significant differences were observed in medical authorisations for use among those using cannabis for their condition (20.4%) or unrelated to their condition (15.7%) (p=0.3021). Healthcare provider guidance was more common among those using cannabis for their condition (32.7%) compared with those using for other reasons (17.1%) (p=0.0024); however, two-thirds of this group did not receive guidance. CONCLUSIONS Cannabis may be used to manage the consequences of work-related injuries/illnesses, yet most do not receive clinical guidance. It is important that healthcare providers speak with injured workers about their cannabis use.
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Affiliation(s)
- Nancy Carnide
- Institute for Work and Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Cameron Mustard
- Institute for Work and Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrea D Furlan
- Institute for Work and Health, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter M Smith
- Institute for Work and Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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18
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Slawek DE, Althouse AD, Feldman R, Arnsten JH, Bulls HW, Liebschutz JM, Nugent SM, Orris SR, Rohac R, Starrels JL, Morasco BJ, Kansagara D, Merlin JS. Cannabis dispensary staff approaches to counseling on potential contraindications to cannabis use: insights from a national self-report survey. BMC PRIMARY CARE 2023; 24:145. [PMID: 37442944 PMCID: PMC10347704 DOI: 10.1186/s12875-023-02095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Legal cannabis is available in more than half of the United States. Health care professionals (HCPs) rarely give recommendations on dosing or safety of cannabis due to limits imposed by policy and lack of knowledge. Customer-facing cannabis dispensary staff, including clinicians (pharmacists, nurses, physician's assistants), communicate these recommendations in the absence of HCP recommendations. Little is known about how dispensary staff approach individuals with complex medical and psychiatric comorbidities. Using responses from a national survey, we describe how cannabis dispensary staff counsel customers with medical and psychiatric comorbidities on cannabis use and examine whether state-specific cannabis policy is associated with advice given to customers. METHODS National, cross-sectional online survey study from February 13, 2020 to October 2, 2020 of dispensary staff at dispensaries that sell delta-9-tetrahydrocannabinol containing products. Measures include responses to survey questions about how they approach customers with medical and psychiatric comorbidities; state medicalization score (scale 0-100; higher score indicates more similarity to regulation of traditional pharmacies); legalized adult-use cannabis (yes/no). We conducted multiple mixed effects multivariable logistic regression analyses to understand relationships between state medicalization and dispensary employees' perspectives. RESULTS Of 434 eligible respondents, most were budtenders (40%) or managers (32%), and a minority were clinicians (18%). State medicalization score was not associated with responses to most survey questions. It was associated with increased odds of encouraging customers with medical comorbidities to inform their traditional HCP of cannabis use (Odds ratio [OR]=1.2, 95% confidence interval [CI] 1.0-1.4, p=0.03) and reduced odds of recommending cannabis for individuals with cannabis use disorder (CUD) (OR=0.8, 95% CI 0.7-1.0, p=0.04). Working in a state with legalized adult-use cannabis was associated with recommending traditional health care instead of cannabis in those with serious mental illness (OR 2.2, 95% CI 1.1-4.7, p=0.04). Less than half of respondents believed they had encountered CUD (49%), and over a quarter did not believe cannabis is addictive (26%). CONCLUSIONS When managing cannabis dosing and safety in customers with medical and psychiatric comorbidity, dispensary staff preferred involving individuals' traditional HCPs. Dispensary staff were skeptical of cannabis being addictive. While state regulations of dispensaries may impact the products individuals have access to, they were not associated with recommendations that dispensary staff gave to customers. Alternative explanations for dispensary recommendations may include regional or store-level variation not captured in this analysis.
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Affiliation(s)
- Deepika E Slawek
- Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA.
| | - Andrew D Althouse
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Feldman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Hailey W Bulls
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
- CHAllenges in Managing and Preventing Pain (CHAMPP) Clinical Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shannon M Nugent
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Steven R Orris
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca Rohac
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joanna L Starrels
- Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Benjamin J Morasco
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Devan Kansagara
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
- CHAllenges in Managing and Preventing Pain (CHAMPP) Clinical Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Kruger DJ, Gerlach J, Kruger JS, Mokbel MA, Clauw DJ, Boehnke KF. Physicians' Attitudes and Practices Regarding Cannabis and Recommending Medical Cannabis Use. Cannabis Cannabinoid Res 2023. [PMID: 37098170 DOI: 10.1089/can.2022.0324] [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] [Indexed: 04/27/2023] Open
Abstract
Introduction: Medical cannabis users tend not to trust or rely on health care providers regarding cannabis advice. Previous surveys of physicians have focused on favorability toward medical cannabis. The current study assesses how physicians interact with patients regarding cannabis in their day-to-day practice, and whether and how they address important topics such as use patterns and substituting cannabis for medications. We predicted that physicians would generally perceive cannabis dispensary staff and caretakers as not competent in addressing patient health needs and would not be likely to use their recommendations. Methods: Physicians in a university-affiliated health system completed an anonymous online survey. The survey assessed physicians' cannabis related education experiences, perceptions of their knowledge of and competence regarding medical cannabis, and the content of cannabis related discussions with patients. We also examined perceptions of the sources of influence on patients regarding cannabis and physicians' attitudes toward medical cannabis dispensary staff and medical cannabis caregivers (MCCs). Results: A few physicians (10%) had ever signed a medical cannabis authorization form for their patients, consistent with their perceptions of low knowledge and competence in this area. Discussions on cannabis primarily focus on risks (63%) rather than dosage (6%) and harm reduction (25%). Physicians see their influence on patients as weak compared with other information sources and have generally unfavorable attitudes toward medical cannabis dispensary staff and MCCs. Conclusion: Greater integration of medical cannabis knowledge is needed at all levels of medical and clinical education to address the potential harm to patients if they receive no guidance. Continued research is needed to provide a strong scientific basis for developing treatment guidelines and standardized medical education for medical cannabis use.
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Affiliation(s)
- Daniel J Kruger
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph Gerlach
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jessica S Kruger
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Majd A Mokbel
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J Clauw
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin F Boehnke
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
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20
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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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21
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Greis A, Larsen E, Liu C, Renslo B, Radakrishnan A, Wilson-Poe AR. Perceived Efficacy, Reduced Prescription Drug Use, and Minimal Side Effects of Cannabis in Patients with Chronic Orthopedic Pain. Cannabis Cannabinoid Res 2022; 7:865-875. [PMID: 34767730 PMCID: PMC9784606 DOI: 10.1089/can.2021.0088] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Introduction: Although cannabis is widely used for the treatment of chronic pain, most research relies on patient self-report and few studies have objectively quantified its efficacy and side effects. Extant inventories for measuring cannabis use were not designed to capture the medically relevant features of cannabis use, but rather were designed to detect problematic use or cannabis use disorder. Thus, we sought to capture the medically relevant features of cannabis use in a population of patients with orthopedic pain and pair these data with objective measures of pain and prescription drug use. Materials and Methods: In this prospective observational study, orthopedic pain patients were enrolled in Pennsylvania's medical cannabis program by their treating pain management physician, received cannabis education from their physician at the time of certification, and purchased products from state-licensed cannabis retailers. Results: Medical cannabis use was associated with clinical improvements in pain, function, and quality of life with reductions in prescription drug use; 73% either ceased or decreased opioid consumption and 31% discontinued benzodiazepines. Importantly, 52% of patients did not experience intoxication as a side effect of cannabis therapy. Significant clinical benefits of cannabis occurred within 3 months of initiating cannabis therapy and plateaued at the subsequent follow-ups. Conclusions: This work provides a direct relationship between the initiation of cannabis therapy and objectively fewer opioid and benzodiazepine prescriptions. Our work also identifies specific subpopulations of patients for whom cannabis may be most efficacious in reducing opioid consumption, and it highlights the importance of both physician involvement and patient self-titration in symptom management with cannabis.
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Affiliation(s)
- Ari Greis
- Department of Physical Medicine and Rehabilitation, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eric Larsen
- Department of Physical Medicine and Rehabilitation, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Conan Liu
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bryan Renslo
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anjithaa Radakrishnan
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adrianne R. Wilson-Poe
- Dow Neurobiology, Legacy Research Institute, Portland, Oregon, USA.,Address correspondence to: Adrianne R. Wilson-Poe, PhD, Dow Neurobiology, Legacy Research Institute, 1225 NE 2nd Avenue Ste. 249, Portland, OR 97232, USA,
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22
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Schwabe AL, Naibauer SK, McGlaughlin ME, Gilbert AN. Human olfactory discrimination of genetic variation within Cannabis strains. Front Psychol 2022; 13:942694. [PMID: 36389460 PMCID: PMC9651054 DOI: 10.3389/fpsyg.2022.942694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Cannabis sativa L. is grown and marketed under a large number of named strains. Strains are often associated with phenotypic traits of interest to consumers, such as aroma and cannabinoid content. Yet genetic inconsistencies have been noted within named strains. We asked whether genetically inconsistent samples of a commercial strain also display inconsistent aroma profiles. We genotyped 32 samples using variable microsatellite regions to determine a consensus strain genotype and identify genetic outliers (if any) for four strains. Results were used to select 15 samples for olfactory testing. A genetic outlier sample was available for all but one strain. Aroma profiles were obtained by 55 sniff panelists using quantitative sensory evaluation of 40 odor descriptors. Within a strain, aroma descriptor frequencies for the genetic outlier were frequently at odds with those of the consensus samples. It appears that within-strain genetic differences are associated with differences in aroma profile. Because these differences were perceptible to untrained panelists, they may also be noticed by retail consumers. Our results could help the cannabis industry achieve better control of product consistency.
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Affiliation(s)
- Anna L. Schwabe
- School of Biological Sciences, University of Northern Colorado, Greeley, CO, United States
- *Correspondence: Anna L. Schwabe,
| | - Samantha K. Naibauer
- School of Biological Sciences, University of Northern Colorado, Greeley, CO, United States
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23
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Matheson J, Bourgault Z, Le Foll B. Sex Differences in the Neuropsychiatric Effects and Pharmacokinetics of Cannabidiol: A Scoping Review. Biomolecules 2022; 12:biom12101462. [PMID: 36291671 PMCID: PMC9599539 DOI: 10.3390/biom12101462] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/28/2022] Open
Abstract
Cannabidiol (CBD) is a non-intoxicating cannabinoid compound with diverse molecular targets and potential therapeutic effects, including effects relevant to the treatment of psychiatric disorders. In this scoping review, we sought to determine the extent to which sex and gender have been considered as potential moderators of the neuropsychiatric effects and pharmacokinetics of CBD. In this case, 300 articles were screened, retrieved from searches in PubMed/Medline, Scopus, Google Scholar, PsycInfo and CINAHL, though only 12 met our eligibility criteria: eight studies in preclinical models and four studies in humans. Among the preclinical studies, three suggested that sex may influence long-term effects of gestational or adolescent exposure to CBD; two found no impact of sex on CBD modulation of addiction-relevant effects of Δ⁹-tetrahydrocannabinol (THC); two found antidepressant-like effects of CBD in males only; and one found greater plasma and liver CBD concentrations in females compared to males. Among the human studies, two found no sex difference in CBD pharmacokinetics in patient samples, one found greater plasma CBD concentrations in healthy females compared to males, and one found no evidence of sex differences in the effects of CBD on responses to trauma recall in patients with post-traumatic stress disorder (PTSD). No studies were identified that considered the role of gender in CBD treatment effects. We discuss potential implications and current limitations of the existing literature.
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Affiliation(s)
- Justin Matheson
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada
- Correspondence:
| | - Zoe Bourgault
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5S 1A8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON L9M 1G3, Canada
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24
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Haffar A, Khan IA, Abdelaal MS, Banerjee S, Sharkey PF, Lonner JH. Topical Cannabidiol (CBD) After Total Knee Arthroplasty Does Not Decrease Pain or Opioid Use: A Prospective Randomized Double-Blinded Placebo-Controlled Trial. J Arthroplasty 2022; 37:1763-1770. [PMID: 35390457 DOI: 10.1016/j.arth.2022.03.081] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multimodal analgesia has become the standard of care for pain management following total knee arthroplasty (TKA). Cannabidiol (CBD) is increasingly utilized in the postoperative period. The purpose of this study was to analyze the analgesic benefits of topical CBD following primary TKA. METHODS In this randomized double-blinded placebo-controlled trial, 80 patients undergoing primary unilateral TKA applied topical CBD (CBD; n = 19), essential oil (EO; n = 21), CBD and essential oil (CBD + EO; n = 21), or placebo (PLA; n = 19) thrice daily around the knee for two weeks postoperatively. This supplemented a standardized multimodal analgesic protocol. Outcomes included visual analog scale (VAS) pain and numeric rating scale (NRS) sleep scores (collected on postoperative day [POD] 0, 1, 2, 7, 14, 42), and cumulative postoperative opioid use (42 days). RESULTS Demographic characteristics were similar among the four cohorts. Preoperative VAS and NRS scores were similar among groups. The CBD cohort had a higher mean VAS pain score on POD 2 compared to the EO cohort (CBD: 69.9 ± 19.3 versus. EO: 51.0 ± 18.2; P = .013). No statistically significant differences existed for VAS scores at other times, and no statistically significant differences were observed for postoperative NRS sleep scores or postoperative opioid use at any time point. CONCLUSION Utilization of topical CBD in supplement to multimodal analgesia did not reduce pain or opioid consumption, or improve sleep scores following TKA. These results suggest that the local effects of topical CBD are not beneficial for providing additional pain relief after TKA.
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Affiliation(s)
- Amer Haffar
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Irfan A Khan
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Mohammad S Abdelaal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Samik Banerjee
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Peter F Sharkey
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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25
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Kruger DJ, Mokbel MA, Clauw DJ, Boehnke KF. Assessing Health Care Providers' Knowledge of Medical Cannabis. Cannabis Cannabinoid Res 2022; 7:501-507. [PMID: 34463161 PMCID: PMC9418358 DOI: 10.1089/can.2021.0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: Many health care providers would benefit from greater knowledge and awareness of medical cannabis, even if they choose not to integrate it into their medical practice. Unfortunately, health care providers generally report low knowledge of medical cannabis and cite this lack of knowledge as a barrier to making patient recommendations. It is important to understand health care providers' medical cannabis knowledge and its correlates. However, few studies have rigorously assessed clinically relevant cannabis-related knowledge, instead typically focusing on attitudes toward cannabis and perceived knowledge. Methods: Physicians in a university-affiliated health system completed an anonymous online survey. The survey assessed participants' basic demographics and medical experience, experiences with cannabis education, beliefs about their knowledge of and competency regarding medical cannabis, and knowledge of medical cannabis in relation to the current scientific evidence. Results: The average level of medical cannabis knowledge was 58% correct, with scores ranging from 39% to 78% correct. Perceived cannabis knowledge predicted actual knowledge, and those who pursued self-initiated study or attended a lecture on medical cannabis had higher knowledge levels. Conclusion: Levels of factual knowledge about medical cannabis among physicians were moderate. Our results highlight the mismatch between physician knowledge and cannabis policy. We offer our brief, 10-min assessment as a baseline for characterizing cannabis knowledge, acknowledging that the content and interpretation may change as knowledge advances.
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Affiliation(s)
- Daniel J. Kruger
- Population Studies Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Majd A. Mokbel
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J. Clauw
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin F. Boehnke
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
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26
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Characterizing anxiety, pain, sleep, and quality of life among patients in a state Medical Marijuana Program. Complement Ther Clin Pract 2022; 48:101612. [DOI: 10.1016/j.ctcp.2022.101612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/09/2022] [Accepted: 05/29/2022] [Indexed: 11/17/2022]
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Sotoodeh R, Waldman LE, Vigano A, Moride Y, Canac-Marquis M, Spilak T, Gamaoun R, Kalaba M, Hachem Y, Beaulieu P, Desroches J, Ware MA, Perez J, Shir Y, Fitzcharles MA, Martel MO. Predictors of Pain Reduction Among Fibromyalgia Patients Using Medical Cannabis: A Long-Term Prospective Cohort Study. Arthritis Care Res (Hoboken) 2022. [PMID: 35876631 DOI: 10.1002/acr.24985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/23/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Many patients with fibromyalgia (FM) report using cannabis as a strategy to improve pain. Given that pain often co-occurs with symptoms of anxiety and depression (i.e., negative affect) and sleep problems among patients with FM, improvements in these symptoms might indirectly contribute to reductions in pain intensity following cannabis use. The main objective of the study was to examine whether changes in pain intensity following initiation of medical cannabis among patients with FM could be attributed to concurrent changes (i.e., reductions) in negative affect and sleep problems. METHODS This was a 12-month prospective cohort study among patients with FM (n = 323) initiating medical cannabis under the care of physicians. Patients were assessed at baseline, and follow-up assessment visits occurred every 3 months after initiation of medical cannabis. Patients' levels of pain intensity, negative affect, and sleep problems were assessed across all visits. RESULTS Multilevel mediation analyses indicated that reductions in patients' levels of pain intensity were partly explained by concurrent reductions in sleep problems and negative affect (both P < 0.001). This remained significant even when accounting for patients' baseline characteristics or changes in medical cannabis directives over time (all P > 0.05). CONCLUSION Our findings provide preliminary insight into the potential mechanisms of action underlying pain reductions among patients with FM who are using medical cannabis. Given the high attrition rate (i.e., 75%) observed in the present study at 12 months, our findings cannot be generalized to all patients with FM who are using medical cannabis.
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Affiliation(s)
| | | | | | - Yola Moride
- University of Montreal, Montreal, Quebec, Canada, and Rutgers University, New Brunswick, New Jersey
| | | | | | - Rihab Gamaoun
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Maja Kalaba
- Canopy Growth Corporation, Smith Falls, Ontario, Canada
| | | | | | | | - Mark A Ware
- Canopy Growth Corporation, Smith Falls, Ontario, Canada
| | - Jordi Perez
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Yoram Shir
- McGill University Health Centre, Montreal, Quebec, Canada
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28
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Zylla D. Response to letter to the editor. Support Care Cancer 2022; 30:4581-4582. [PMID: 35348894 DOI: 10.1007/s00520-022-06999-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Dylan Zylla
- Cancer Research Center, HealthPartners, Saint Paul, MN, USA.
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29
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Donnan J, Shogan O, Bishop L, Najafizada M. Drivers of purchase decisions for cannabis products among consumers in a legalized market: a qualitative study. BMC Public Health 2022; 22:368. [PMID: 35189856 PMCID: PMC8860259 DOI: 10.1186/s12889-021-12399-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cannabis was legalized in Canada for non-medical use in 2018. The goal of legalization was to improve health and safety by creating access to regulated products, with accurate product labels and warnings and no risk of contamination. However, more than 2 years post-legalization, a large proportion of purchases are still suspected to be through unlicensed retailers. This study sought to identify the factors that influenced the purchase decisions of cannabis consumers in Newfoundland and Labrador (NL). Methods Semi-structured focus groups and interviews were conducted in NL with individuals who were > 19 and had purchased cannabis within the last 12 months. All sessions were conducted virtually, audio-recorded, and transcribed. A thematic analysis was conducted, and two members of the research team coded the data using NVivo. A combination of deductive and inductive coding was carried out, themes from the literature were identified, and new themes from the transcripts were discovered. A final coding template of the data was agreed upon by the team through discussion and consensus. Results A total of 23 individuals (30% women) participated, with 83% coming from urban areas. While all cannabis product types were discussed, the conversation naturally focused on dried flower products. Participants discussed a variety of considerations when making purchase decisions categorized around five broad themes: 1) price, 2) quality, 3) packaging and warnings, 4) the source of the cannabis, and 5) social influences. The price difference between licensed and un-licensed sources was commonly discussed as a factor that influenced purchase decisions. Product quality characteristics (e.g. size, color, moisture content) and social influences were also considered in purchase decisions. Participants were generally indifferent to packaging and warning labels but expressed concern about the excessive packaging required for regulated products. Conclusion This study explores the many attributes that influence purchase decisions for dried leaf cannabis. Understanding the drivers of purchase decisions can help inform policy reforms to make regulated cannabis products more appealing to consumers. Further research is needed to measure the effect of each attribute on cannabis purchase decisions.
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Affiliation(s)
- Jennifer Donnan
- School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada.
| | - Omar Shogan
- School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Lisa Bishop
- School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Maisam Najafizada
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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30
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Kedzierski N, Hernandez M. Blackout Brownie: A Final Dessert Case Study. J Anal Toxicol 2022; 46:e105-e109. [PMID: 35137122 DOI: 10.1093/jat/bkac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Cannabis products have been becoming more widely accepted as a recreational drug and for medicinal purposes to aid in various ailments. This paper reports a death after acute ingestion of an edible cannabis brownie. The 65-year-old female decedent with a history of chronic pain ingested an edible cannabis brownie after other alternative edibles and prescribed medication produced no desired effects. After consuming the cannabis product with her husband, both began feeling high and nauseated. The decedent was last seen alive by her husband stopped part way up the stairs prior to him going to sleep. She was found expired at the base of the stairs the following morning with no apparent trauma. The autopsy concluded the decedent was obese with severe ischemic cardiovascular disease. The toxicology report detected delta-9-tetrahydrocannabinol present at greater than 5000 ng/mL in the decedent's central blood at the time of sample collection. The final cause of death was ruled as natural due to cardiovascular disease with cannabis present in her system.
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Affiliation(s)
- Nancy Kedzierski
- Toxicology Department, Orange County Crime Laboratory, 320 N. Flower St., Santa Ana, CA 92703 USA
| | - Melanie Hernandez
- Toxicology Department, Orange County Crime Laboratory, 320 N. Flower St., Santa Ana, CA 92703 USA
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31
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Characteristics that influence purchase choice for cannabis products: a systematic review. J Cannabis Res 2022; 4:9. [PMID: 35105374 PMCID: PMC8805380 DOI: 10.1186/s42238-022-00117-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction When non-medical cannabis use became legal, government regulators implemented policies to encourage safer consumption through access to a regulated market. While this market is growing, sales still occur through unregulated channels. This systematic review identifies factors influencing cannabis purchasing to help policymakers understand why consumers still purchase illicit market cannabis (registered with PROSPERO CRD42020176079). Methods A comprehensive search strategy included databases in health, business, and social science fields (inception to June 2020). Studies were eligible for inclusion if they were conducted with persons who purchase cannabis and examine at least one attribute that would influence purchase choice and were published in the English language. Studies could be of any methodological design. Two independent reviewers completed two levels of screening, and all extraction was verified by a second reviewer. A qualitative synthesis of the findings was completed. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Results Of the 4839 citations screened, 96 were eligible for full-text review and 35 were included in the final synthesis. Aspects of price were the most common factors (27 studies). Twenty studies measured price elasticity; most studies found that demand was price inelastic. Many other attributes were identified (e.g., product quality, route of administration, product recommendations, packaging), but none were explored in depth. Eleven studies addressed aspects of product quality including demand elasticity based on quality, potency, and aroma. Studies also explored consumer-perceived “quality” but provided no definition; differences in quality appeared to impact consumer choice. Smoking cannabis appeared to be the preferred route of administration but was only examined in three studies. There was insufficient data to understand in the impact of other attributes on choice. There appeared to be preference heterogeneity for different attributes based on the consumer’s experience, reason for use, and gender. Conclusion While price influences choices, demand is relatively inelastic. This suggests that consumers may be seeking lowest-cost, unregulated cannabis to avoid reducing consumption. Beyond price, there is a significant gap in our understanding of consumer choices. Perceived quality does appear to impact choice; however, more research is needed due to the lack of a recognized definition for cannabis quality. Supplementary Information The online version contains supplementary material available at 10.1186/s42238-022-00117-0.
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32
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Ilan Y. Digital Medical Cannabis as Market Differentiator: Second-Generation Artificial Intelligence Systems to Improve Response. Front Med (Lausanne) 2022; 8:788777. [PMID: 35141242 PMCID: PMC8818992 DOI: 10.3389/fmed.2021.788777] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/20/2021] [Indexed: 12/19/2022] Open
Abstract
Legalized use of cannabis products and the rising interest in their therapeutic benefits have opened up new opportunities for therapy and marketing. However, the marked variability in formulations, administration modes, therapeutic regimens, and inter- and intra-subject responses make the standardization of medical cannabis-based regimens difficult. Legalization has made the cannabis market highly competitive and lowered the revenue margins. This study reviews some of the challenges in medical cannabis use and difficulties in standardizing its therapeutic regimens that hinder maximizing its beneficial effects. The development of tolerance toward cannabis and low adherence to chronic administration further impair its long-term beneficial effects. Digital medical cannabis is a cannabis product controlled by a second-generation artificial intelligence (AI) system that improves patient responses by increasing adherence and dealing with tolerance. Second-generation AI systems focus on a single patient's outcome and deal with the inter- and intra-subject variability in responses. The use of digital medical cannabis is expected to improve product standardization, maximize therapeutic benefits, reduce health care costs, and increase the revenue of companies. Digital medical cannabis offers several market differentiators for cannabis companies. This study presents a model for promoting the use of digital medical cannabis and presents its advantages for patients, clinicians, health care authorities, insurance companies, and cannabis manufacturers. Ongoing trials and real-world data on the use of these systems further support the use of digital medical cannabis for improved global health.
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Affiliation(s)
- Yaron Ilan
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
- *Correspondence: Yaron Ilan
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33
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Boehnke KF, Yakas L, Scott JR, DeJonckheere M, Litinas E, Sisley S, Clauw DJ, Williams DA, McAfee J. A mixed methods analysis of cannabis use routines for chronic pain management. J Cannabis Res 2022; 4:7. [PMID: 35016733 PMCID: PMC8750808 DOI: 10.1186/s42238-021-00116-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 12/26/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The wide heterogeneity of available cannabis products makes it difficult for physicians to appropriately guide patients. In the current study, our objective was to characterize naturalistic cannabis use routines and explore associations between routines and reported benefits from consuming cannabis. METHODS We performed a mixed methods analysis of n=1087 cross-sectional survey responses from adults with self-reported chronic pain using cannabis for symptom management in the USA and Canada. First, we qualitatively analyzed responses to an open-ended question that assessed typical cannabis use routines, including administration routes, cannabinoid content, and timing. We then sub-grouped responses into categories based on inhalation (smoking, vaporizing) vs. non-inhalation (e.g., edibles). Finally, we investigated subgroups perceptions of how cannabis affected pain, overall health, and use of medications (e.g., substituting for opioids, benzodiazepines). Substitutions were treated as a count of medication classes, while responses for both pain and health were analyzed continuously, with - 2 indicating health declining a lot or pain increasing a lot and 2 indicating that health improved a lot or pain decreased a lot. RESULTS Routines varied widely in terms of administration routes, cannabinoid content, and use timing. Overall, 18.8%, 36.2%, and 45% used non-inhalation, inhalation, and non-inhalation + inhalation routes, respectively. Those who used inhalation routes were younger (mean age 46.5 [inhalation] and 49.2 [non-inhalation + inhalation] vs. 56.3 [inhalation], F=36.1, p<0.001), while a higher proportion of those who used non-inhalation routes were female (72.5% non-inhalation vs. 48.3% inhalation and 65.3% non-inhalation + inhalation, X2=59.6, p<0.001). THC-rich products were typically used at night, while CBD-rich products were more often used during the day. While all participants reported similarly decreased pain, participants using non-inhalation + inhalation administration routes reported larger improvements in health than the non-inhalation (mean difference = 0.32, 95% CI: 0.07-0.37, p<0.001) and inhalation subgroups (mean difference = 0.22, 95% CI: 0.07-0.37, p=0.001). Similarly, the non-inhalation + inhalation group had significantly more medication substitutions than those using non-inhalation (mean difference = 0.62, 95% CI: 0.33-0.90, p<0.001) and inhalation administration routes (mean difference = 0.45, 95% CI: 0.22-0.69, p<0.001), respectively. CONCLUSIONS Subgrouping medical cannabis patients based on administration route profile may provide useful categories for future studies examining the risks and benefits of medical cannabis.
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Affiliation(s)
- Kevin F Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Laura Yakas
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Ryan Scott
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Daniel J Clauw
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David A Williams
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jenna McAfee
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
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Boehnke KF, Gagnier JJ, Matallana L, Williams DA. Cannabidiol Product Dosing and Decision-Making in a National Survey of Individuals with Fibromyalgia. THE JOURNAL OF PAIN 2022; 23:45-54. [PMID: 34214700 PMCID: PMC8716664 DOI: 10.1016/j.jpain.2021.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
Many people with fibromyalgia use cannabidiol (CBD) products despite limited rigorous evidence of benefit. In the current study, we conducted a secondary analysis of a cross-sectional survey of N = 878 people with fibromyalgia to investigate naturalistic decision making around CBD product choices, use patterns, and dosing. We subgrouped participants based on use of high-THC cannabis (HTC) in the past year (yes/no) as previous studies have shown that HTC use influences CBD use patterns. The study population was largely female (93.6%), white (91.5%) and 55.5 years old on average. Participants typically purchased CBD products online or at dispensaries, with purchasing driven by personal research (63%) rather than endorsement from medical professionals (16%). Overall, tinctures and topicals were the most common administration routes endorsed. However, participants in the past-year HTC group used inhalation routes far more frequently than those who did not (39.8% vs 7.1%). Among participants using CBD tinctures or edibles, the average dose per session was 16 mg and 24 to 27 mg per day, although approximately one-third of participants did not know what dose of CBD they used. Participants using both inhalation and non-inhalation administration routes reported greater symptom relief than those using non-inhalation routes alone. However, there was no consistent relationship between CBD dose and reported effects, possibly due to expectancy effects around CBD products or interindividual variability. Our granular investigation reveals variability of CBD product dosing practices for fibromyalgia, and how past-year HTC use influences CBD product use. Future clinical trials should investigate the potential benefits of low-dose (<50mg) botanical CBD products. PERSPECTIVE: This article shows that past-year HTC use strongly influences how people with fibromyalgia choose and use CBD products. Participants typically used <50 mg/d of CBD, and there was no relationship between higher CBD dose and reported therapeutic benefit. Future clinical trials should investigate therapeutic benefits of low dose CBD.
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Affiliation(s)
- Kevin F. Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA,Corresponding author: Kevin Boehnke, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48106.
| | - Joel J. Gagnier
- Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - David A. Williams
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
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Affiliation(s)
- Margaret Haney
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York
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Holman A, Boehnke KF. Tackling the taboo: a sensible prescription for appropriate cannabis use in fibromyalgia. Pain Manag 2021; 12:117-122. [PMID: 34743594 DOI: 10.2217/pmt-2021-0096] [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] Open
Affiliation(s)
- Alexis Holman
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kevin F Boehnke
- Anesthesiology Department, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, MI 48106, USA
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Poudel S, Quinonez J, Choudhari J, Au ZT, Paesani S, Thiess AK, Ruxmohan S, Hosameddin M, Ferrer GF, Michel J. Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature. Cureus 2021; 13:e17407. [PMID: 34589318 PMCID: PMC8459575 DOI: 10.7759/cureus.17407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/12/2022] Open
Abstract
Cannabis has been long used since ancient times for both medical and recreational use. Past research has shown that cannabis can be indicated for symptom management disorders, including cancer, chronic pain, headaches, migraines, and psychological disorders (anxiety, depression, and post-traumatic stress disorder). Active ingredients in cannabis that modulate patients' perceptions of their conditions include Δ9‐tetrahydrocannabinol (THC), cannabidiol (CBD), flavonoids, and terpenes. These compounds work to produce effects within the endocannabinoid system to decrease nociception and decrease symptom frequency. Research within the United States of America is limited to date due to cannabis being classified as a schedule one drug per the Drug Enforcement Agency. Few anecdotal studies have found a limited relationship between cannabis use and migraine frequency. The purpose of the review article is to document the validity of how medical cannabis can be utilized as an alternative therapy for migraine management. Thirty-four relevant articles were selected after a thorough screening process using PubMed and Google Scholar databases. The following keywords were used: "Cannabis," "Medical Marijuana," "Headache," "Cannabis and Migraine," "Cannabis and Headache." This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin. Patients suffering from migraines and related conditions may benefit from medical cannabis therapy due to its convenience and efficacy.
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Affiliation(s)
- Sujan Poudel
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Jonathan Quinonez
- Neurology/Osteopathic Neuromuscular Medicine, Larkin Community Hospital, Miami, USA
| | - Jinal Choudhari
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Zachary T Au
- Family and Community Medicine, Larkin Community Hospital, Miami, Florida, USA
| | - Sylvia Paesani
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Armond K Thiess
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Samir Ruxmohan
- Neurology, Larkin Community Hospital, Miami, Florida, USA
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Zeng L, Lytvyn L, Wang X, Kithulegoda N, Agterberg S, Shergill Y, Esfahani MA, Heen AF, Agoritsas T, Guyatt GH, Busse JW. Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review. BMJ Open 2021; 11:e050831. [PMID: 34493521 PMCID: PMC8451285 DOI: 10.1136/bmjopen-2021-050831] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To explore values and preferences towards medical cannabis among people living with chronic pain. DESIGN Mixed-methods systematic review. DATA SOURCES We searched MEDLINE, EMBASE and PsycINFO from inception to 17 March 2020. STUDY SELECTION Pairs of reviewers independently screened search results and included quantitative, qualitative and mixed-methods studies reporting values and preferences towards medical cannabis among people living with chronic pain. REVIEW METHODS We analysed data using meta-narrative synthesis (quantitative findings were qualitised) and tabulated review findings according to identified themes. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence. RESULTS Of 1838 initial records, 15 studies proved eligible for review. High to moderate certainty evidence showed that patient's use of medical cannabis for chronic pain was influenced by both positive (eg, support from friends and family) and negative social factors (eg, stigma surrounding cannabis use). Most patients using medical cannabis favoured products with balanced ratios of tetrahydrocannabinol (THC) and cannabidiol (CBD), or high levels of CBD, but not high THC preparations. Many valued the effectiveness of medical cannabis for symptom management even when experiencing adverse events related to concentration, memory or fatigue. Reducing use of prescription medication was a motivating factor for use of medical cannabis, and concerns regarding addiction, losing control or acting strangely were disincentives. Out-of-pocket costs were a barrier, whereas legalisation of medical cannabis improved access and incentivised use.Low to very low certainty evidence suggested highly variable values towards medical cannabis among people living with chronic pain. Individuals with pain related to life-limiting disease were more willing to use medical cannabis, and preferred oral over inhaled administration. CONCLUSIONS Our findings highlight factors that clinicians should consider when discussing medical cannabis. The variability of patients' values and preferences emphasise the need for shared decision making when considering medical cannabis for chronic pain.
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Affiliation(s)
- Linan Zeng
- Pharmacy Department/Evidence-based Pharmacy Center, West China Second University Hospital, Chengdu, Sichuan, China
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Natasha Kithulegoda
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Silvana Agterberg
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA
| | - Yaad Shergill
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Meisam Abdar Esfahani
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anja Fog Heen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
- Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
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Merlin JS, Althouse A, Feldman R, Arnsten JH, Bulls HW, Liebschutz JM, Nugent SM, Orris SR, Rohac R, Starrels JL, Morasco BJ, Kansagara D. Analysis of State Cannabis Laws and Dispensary Staff Recommendations to Adults Purchasing Medical Cannabis. JAMA Netw Open 2021; 4:e2124511. [PMID: 34524435 PMCID: PMC8444019 DOI: 10.1001/jamanetworkopen.2021.24511] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Over the last decade, cannabis has become more accessible through the proliferation of dispensaries in states that have legalized its use. Most patients using cannabis for medical purposes report getting advice from dispensaries, yet there has been little exploration of frontline dispensary staff practices. OBJECTIVE To describe the practices of frontline dispensary workers who interact with customers purchasing cannabis for medical purposes and assess whether dispensary practices are associated with medicalization of state cannabis laws (degree to which they resemble regulation of prescription or over-the-counter drugs) and statewide adult use. DESIGN, SETTING, AND PARTICIPANTS This nationwide cross-sectional survey study was conducted from February 13, 2020, to October 2, 2020, using an online survey tool. Potential respondents were eligible if they reported working in a dispensary that sells tetrahydrocannabinol-containing products and interacting with customers about cannabis purchases. MAIN OUTCOMES AND MEASURES Participant responses to questions about formulating customer recommendations and talking to customers about risks. RESULTS The 434 survey responses from 351 unique dispensaries were most often completed by individuals who identified as budtenders (40%), managers (32%), and pharmacists (13%). Most respondents reported basing customer recommendations on the customer's medical condition (74%), the experiences of other customers (70%), the customer's prior experience with cannabis (67%), and the respondent's personal experience (63%); fewer respondents relied on clinician input (40%), cost (45%), or inventory (12%). Most respondents routinely advised customers about safe storage and common adverse effects, but few counseled customers about cannabis use disorder, withdrawal, motor vehicle collision risk, or psychotic reactions. A higher state medicalization score was significantly associated with using employer training (odds ratio, 1.41; 95% CI, 1.18-1.67) and physician or clinician input (odds ratio, 1.23; 95% CI, 1.05-1.43) as a basis for recommendation. Medicalization score was not associated with counseling about cannabis risks. CONCLUSIONS AND RELEVANCE This survey study provides insight into how frontline dispensary staff base cannabis recommendations and counsel about risks. The findings may have utility for clinicians to counsel patients who purchase cannabis, customers who want to be prepared for a dispensary visit, and policy makers whose decisions affect cannabis laws.
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Affiliation(s)
- Jessica S. Merlin
- Challenges in Managing and Preventing Pain Clinical Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew Althouse
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert Feldman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julia H. Arnsten
- Division of General Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Hailey W. Bulls
- Challenges in Managing and Preventing Pain Clinical Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shannon M. Nugent
- Department of Psychiatry, Oregon Health and Science University, Portland
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Steven R. Orris
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca Rohac
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joanna L. Starrels
- Division of General Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Benjamin J. Morasco
- Department of Psychiatry, Oregon Health and Science University, Portland
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Devan Kansagara
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
- Department of Medicine, Oregon Health and Science University, Portland
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Butler TW, Hande K, Ryan M, Raman R, McDowell MR, Cones B, Jackson HJ, Cortez M, Murphy BA. Cannabidiol: Knowledge, Beliefs, and Experiences of Patients With Cancer. Clin J Oncol Nurs 2021; 25:405-412. [PMID: 34269337 DOI: 10.1188/21.cjon.405-412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cannabidiol (CBD) is purported to work for a variety of therapeutic indications. Interest in CBD products has significantly increased as patients with cancer seek ways to improve symptom control and quality of life. OBJECTIVES The purpose of this study was to explore patients' knowledge of and experience with CBD. METHODS A panel of oncology nurse practitioners, an oncologist, and oncology pharmacy specialists developed a survey to capture information about patient knowledge and use of CBD. The initial survey was pilot tested and further refined, resulting in the final item survey. The final survey was administered to 100 participants undergoing or having completed cancer treatment and being followed in a supportive oncology care clinic at a large academic medical center. FINDINGS Most patients learned about CBD through a family member or friend. The majority of patients had never tried CBD. The most common reported indications were pain, anxiety, and nausea. Of those who had not tried CBD, the most common reasons included lack of knowledge about CBD and providers not recommending CBD.
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41
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Arout CA, Haney M, Herrmann ES, Bedi G, Cooper ZD. A placebo-controlled investigation of the analgesic effects, abuse liability, safety and tolerability of a range of oral cannabidiol doses in healthy humans. Br J Clin Pharmacol 2021; 88:347-355. [PMID: 34223660 DOI: 10.1111/bcp.14973] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Preclinical studies demonstrate that cannabidiol (CBD) elicits an antinociceptive response in animal models of neuropathic pain; in humans, limited data are available to support such analgesic effects. Few studies have examined CBD's analgesic effects when administered without other compounds, and little is known regarding dose-dependent effects in noncannabis users. METHODS This double-blind, placebo-controlled, within-subject outpatient clinical laboratory study sought to determine the analgesic effects, abuse liability, safety and tolerability of acute CBD (0, 200, 400 and 800 mg orally) in healthy noncannabis-using volunteers (n = 17; 8 men, 9 women). Outcomes included experimental pain threshold and pain tolerance using the cold pressor test (CPT), subjective ratings of CPT painfulness and bothersomeness, subjective ratings of abuse liability and mood, and cardiovascular measures, which were assessed at baseline and several time points after drug administration. Data analyses included repeated measures analysis of variance (ANOVA) with planned comparisons. RESULTS CBD failed to consistently affect pain threshold and tolerance in the CPT relative to placebo. All doses of CBD increased ratings of painfulness compared to placebo (P < .01). Further, CBD had dose-dependent, modest effects on mood and subjective drug effects associated with abuse liability. Oral CBD was safe and well tolerated, producing small decreases in blood pressure (P < .01). CONCLUSION CBD did not elicit consistent dose-dependent analgesia and in fact increased pain on some measures. Future studies exploring CBD-induced pain relief should consider using a more extensive pain assessment paradigm in different participant populations.
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Affiliation(s)
- Caroline A Arout
- Division on Substance Use Disorders, New York Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Margaret Haney
- Division on Substance Use Disorders, New York Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Evan S Herrmann
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, USA
| | - Gillinder Bedi
- Centre for Youth Mental Health, The University of Melbourne and Substance Use Research Group, Melbourne, Australia
| | - Ziva D Cooper
- University of California, Los Angeles Cannabis Research Initiative, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA, USA.,Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Jugl S, Okpeku A, Costales B, Morris EJ, Alipour-Haris G, Hincapie-Castillo JM, Stetten NE, Sajdeya R, Keshwani S, Joseph V, Zhang Y, Shen Y, Adkins L, Winterstein AG, Goodin A. A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019. Med Cannabis Cannabinoids 2021; 4:21-42. [PMID: 34676348 PMCID: PMC8525213 DOI: 10.1159/000515069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.
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Affiliation(s)
- Sebastian Jugl
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Aimalohi Okpeku
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Brianna Costales
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Earl J. Morris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Golnoosh Alipour-Haris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Juan M. Hincapie-Castillo
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | | | - Ruba Sajdeya
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Verlin Joseph
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yahan Zhang
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Yun Shen
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Lauren Adkins
- Health Sciences Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Almut G. Winterstein
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
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Fedorova EV, Wong CF, Ataiants J, Iverson E, Conn B, Lankenau SE. Cannabidiol (CBD) and other drug use among young adults who use cannabis in Los Angeles. Drug Alcohol Depend 2021; 221:108648. [PMID: 33676073 PMCID: PMC8462788 DOI: 10.1016/j.drugalcdep.2021.108648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cannabidiol (CBD) is purportedly a promising therapeutic agent to provide relief for a variety of medical conditions with mild or no psychoactive effects. However, little is known about young adults who use cannabis and CBD-dominant products, and associations between CBD use and other drug use. METHODS Young adults (aged 24-32) who currently used cannabis (n = 239) were surveyed in Los Angeles in March 2019 through March 2020. The sample was divided into CBD-dominant (at least 1:1 CBD:THC ratio) and THC-dominant product users. We described CBD forms, reasons and conditions for CBD use and examined between-group differences in sociodemographic characteristics, cannabis practices, health and other drug use. RESULTS CBD-dominant users were more likely to be female, use cannabis at lower frequency and amount (except for edible/drinkable/oral products), self-report medical motivation for cannabis use, use cannabis for pain and report more health problems. Oil, flower, topicals and sprays/drops/tinctures were the most prevalent CBD forms. Psychological problems and pain were commonly reported conditions and medical reasons for CBD use. CBD-dominant users were more likely to report illicit drug use, where psilocybin use was markedly different between the two groups. CONCLUSIONS CBD use was associated with health histories and motivations linked to pain and psychological problems. Positive association between CBD use and illicit drug use may indicate self-medication for psychological conditions. Future studies should evaluate the effectiveness of various CBD forms and dose regimens for treatment of pain and psychological problems, and as a potential intervention for decreasing other drug use and associated harms.
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Affiliation(s)
- Ekaterina V. Fedorova
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
| | - Carolyn F. Wong
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Research on Children, Youth, & Families, 4650 Sunset Blvd., MS #2, Los Angeles,
CA 90027, United States
| | - Janna Ataiants
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
| | - Ellen Iverson
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United
States
| | - Bridgid Conn
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States
| | - Stephen E. Lankenau
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
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Boehnke KF, Gagnier JJ, Matallana L, Williams DA. Cannabidiol Use for Fibromyalgia: Prevalence of Use and Perceptions of Effectiveness in a Large Online Survey. THE JOURNAL OF PAIN 2021; 22:556-566. [PMID: 33400996 DOI: 10.1016/j.jpain.2020.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/20/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022]
Abstract
Cannabidiol (CBD) is widely advertised as helpful for chronic pain management but research is limited. Using a cross-sectional, anonymous survey, we examined patterns of naturalistic CBD use among individuals with fibromyalgia (FM) and other chronic pain conditions. Our objective was to better understand rates of CBD use, reasons for use and discontinuation, communication with healthcare professionals about CBD, and perceptions of CBD effectiveness and safety among people with FM. After excluding incomplete surveys, our study population consisted of N = 2,701 participants with fibromyalgia, primarily in the United States. Overall, 38.1% reported never using CBD, 29.4% reported past CBD use, and 32.4% reported current CBD use. Past-year cannabis use was strongly associated with past or current CBD use. Those using CBD typically did so due to inadequate symptom relief, while those not using CBD typically cited safety concerns as their reason for not using CBD. Two-thirds of participants disclosed CBD use to their physician, although only 33% asked for physician advice on using CBD. Participants used CBD for numerous FM-related symptoms (most commonly pain), and generally reported slight to much improvement across symptom domains. Around half of participants reported side effects, which were typically minor. Our findings are limited by selection bias and our cross-sectional design, which prevents causal associations. In conclusion, CBD use is common among individuals with FM and many individuals using CBD report improvements across numerous FM-related symptoms. Our findings highlight the need for additional rigorous studies to better understand CBD's potential for FM management. PERSPECTIVE: This article indicates that CBD use is common among people with fibromyalgia, and the results suggest that many derive benefit from using CBD across multiple symptoms domains. Clinicians should discuss CBD use with fibromyalgia patients, and future studies are needed to rigorously assess CBD's therapeutic value for fibromyalgia symptoms.
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Affiliation(s)
- Kevin F Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Joel J Gagnier
- Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Lynne Matallana
- National Fibromyalgia Association, Newport Beach, California; Community Health Focus Inc., Ann Arbor, Michigan
| | - David A Williams
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, Michigan
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Takakuwa KM, Sulak D. A Survey on the Effect That Medical Cannabis Has on Prescription Opioid Medication Usage for the Treatment of Chronic Pain at Three Medical Cannabis Practice Sites. Cureus 2020; 12:e11848. [PMID: 33409086 PMCID: PMC7781576 DOI: 10.7759/cureus.11848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: The opioid epidemic continues to claim thousands of lives every year without an effective strategy useful in mitigating mortality. The use of medical cannabis has been proposed as a potential strategy to decrease opioid usage. The objective of this study was to determine how the use of medical cannabis affects prescribed opioid usage in chronic pain patients. Methods: We conducted an online convenience sample survey of patients from three medical cannabis practice sites who had reported using opioids. A total of 1181 patients responded, 656 were excluded for not using medical cannabis in combination with opioid use or not meeting the definition of chronic pain, leaving 525 patients who had used prescription opioid medications continuously for at least three months to treat chronic pain and were using medical cannabis in combination with their prescribed opioid use. Results: Overall, 40.4% (n=204) reported that they stopped all opioids, 45.2% (n=228) reported some decrease in their opioid usage, 13.3% (n=67) reported no change in opioid usage, and 1.1% (n=6) reported an increase in opioid usage. The majority (65.3%, n=299) reported that they sustained the opioid change for over a year. Almost half (48.2%, n=241) reported a 40-100% decrease in pain while 8.6% (n=43) had no change in pain and 2.6% (n=13) had worsening pain. The majority reported improved ability to function (80.0%, n=420) and improved quality of life (87.0%, n=457) with medical cannabis. The majority (62.8%, n=323) did not want to take opioids in the future. While the change in pain level was not affected by age and gender, the younger age group had improved ability to function compared with the middle and older age groups. Conclusions: Patients in this study reported that cannabis was a useful adjunct and substitute for prescription opioids in treating their chronic pain and had the added benefit of improving the ability to function and quality of life.
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Affiliation(s)
- Kevin M Takakuwa
- Emergency Medicine, Society of Cannabis Clinicians, Sebastopol, USA
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46
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Pérez-Acevedo AP, Pacifici R, Mannocchi G, Gottardi M, Poyatos L, Papaseit E, Pérez-Mañá C, Martin S, Busardò FP, Pichini S, Farré M. Disposition of cannabinoids and their metabolites in serum, oral fluid, sweat patch and urine from healthy individuals treated with pharmaceutical preparations of medical cannabis. Phytother Res 2020; 35:1646-1657. [PMID: 33155722 DOI: 10.1002/ptr.6931] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/07/2022]
Abstract
Recently, several countries authorized the use of cannabis flowering tops (dried inflorescences) with a standardized amount of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD) and their acidic precursors [Δ-9-tetrahydrocannabinolic acid A (THCA-A) and cannabidiolic acid (CBDA)] to treat neurogenic pain. We studied the acute pharmacological effects and disposition of cannabinoids and their metabolites in serum, oral fluid, sweat patch and urine of 13 healthy individuals treated with medical cannabis decoction and oil. Cannabinoids and their metabolites were quantified by ultrahigh performance tandem mass spectrometry. Even if the oil contained a significantly higher amount of THC, the absorption of THC and its metabolites were similar in both herbal preparations. Conversely, whereas oil contained a significantly higher amount of CBD and a lower amount of CBDA, absorption was significantly higher after decoction intake. Only cannabinoids present in both herbal preparations (THC, CBD, THCA-A and CBDA) were found in oral fluid, due to the higher acidity compared with that of serum. THC metabolites urinary excretion was always higher after decoction administration. Decoction induced greater feeling of hunger and drowsiness than oil preparation. Pharmacokinetics of cannabinoids, their precursors and their metabolites in biological fluids of individuals treated with cannabis decoction and oil showed a high interindividual variability. The aqueous preparation was generally better absorbed than the oil, even if it contained a minor amount of THC, THCA-A and CBD.
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Affiliation(s)
- Ana P Pérez-Acevedo
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roberta Pacifici
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Lourdes Poyatos
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Papaseit
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clara Pérez-Mañá
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Soraya Martin
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesco P Busardò
- Department of Excellence - Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Magí Farré
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), Badalona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
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47
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Bruce D, Grove TJ, Foster E, Shattell M. Gender Differences in Medical Cannabis Use: Symptoms Treated, Physician Support for Use, and Prescription Medication Discontinuation. J Womens Health (Larchmt) 2020; 30:857-863. [PMID: 33090932 DOI: 10.1089/jwh.2020.8437] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Medical cannabis (MC) utilization continues to expand in the United States, as a growing body of evidence supports the use of cannabis and cannabinoids in the treatment of a range of chronic conditions. To date, gender-related differences in MC use are not widely reported, and little is known regarding physicians' support of patients' use of MC to address symptoms associated with chronic conditions. Materials and Methods: We conducted a cross-sectional online survey of MC users in Illinois (n = 361). We summarized participants' qualifying conditions, symptoms treated with MC, perceived physician support for MC use, use of MC and prescription medications, then analyzed differences by participant gender. Results: Bivariate analyses indicate that men report higher levels of support for MC use from both specialist and primary care physicians. Women were significantly more likely to increase use of cannabis after acquiring an MC card, and to discontinue prescription medications through MC use. Multivariable analyses indicate that being a woman, using MC to treat multiple symptoms, and reporting higher levels of support for MC use from a primary care provider significantly increased the likelihood of discontinuing prescription medication through MC use. Discussion: Women are more likely to report decreased use of prescription medications to treat symptoms, and report lower levels of support from physicians for MC use. Future research on gender differences in this population may benefit from more detailed data related to symptomology, utilization, dosing, and outcomes associated with MC, and interactions with the health care system to extend these findings.
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Affiliation(s)
- Douglas Bruce
- Department of Health Sciences, DePaul University, Chicago, Illinois, USA
| | - Thomas J Grove
- Department of Health Sciences, DePaul University, Chicago, Illinois, USA
| | - Elissa Foster
- College of Communication, DePaul University, Chicago, Illinois, USA
| | - Mona Shattell
- Johns Hopkins School of Nursing, Baltimore, Maryland, 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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Lintzeris N, Mills L, Suraev A, Bravo M, Arkell T, Arnold JC, Benson MJ, McGregor IS. Medical cannabis use in the Australian community following introduction of legal access: the 2018-2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18). Harm Reduct J 2020; 17:37. [PMID: 32513180 PMCID: PMC7278204 DOI: 10.1186/s12954-020-00377-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In 2016, the Australian federal government passed legislation enabling a range of cannabis-based products to be prescribed to patients by registered healthcare professionals. An online survey conducted immediately prior to these legislative changes found that the vast majority of respondents at the time were illicitly sourcing cannabis plant matter, smoking was the preferred route of administration and mental health, chronic pain, and sleep conditions were the most frequently cited reasons for medical cannabis use. This manuscript reports the results of a follow-up survey conducted in 2018-2019, the Cannabis As Medicine Survey (CAMS-18). The goal of this second questionnaire was to examine patterns of use and consumer perspectives regarding medical cannabis use in Australia, 2 years after the introduction of legal access pathways. METHODS Anonymous online cross-sectional survey with convenience sample, recruited mainly through online media between September 2018 and March 2019. Participants were adults (18 years or over) residing in Australia who reported using a cannabis product for self-identified therapeutic reasons during the preceding 12 months. The survey measured consumer characteristics, indications and patterns of medical cannabis use, routes and frequency of administration, perceived benefits and harms, experiences and preferred models of access to medical cannabis. RESULTS Data were available for 1388 respondents. The main categories of condition being treated with medical cannabis were pain (36.4%), mental health (32.8%), sleep (9.2%), neurological (5.2%) and cancer (3.8%). Respondents reported using medical cannabis on 15.8 (11.2) days in the past 28, by inhaled (71.4%) or oral (26.5%) routes and spending AUD$82.27 ($101.27) per week. There were high levels of self-reported effectiveness, but also high rates of side effects. There was uncertainty regarding the composition of illicit cannabinoid products and concerns regarding their possible contamination. Few respondents (2.7%) had accessed legally prescribed medical cannabis, with the main perceived barriers being cost, disinterest from the medical profession and stigma regarding cannabis use. CONCLUSIONS Chronic pain, mental health and sleep remain the main clinical conditions for which consumers report using medical cannabis. Despite 2 years of legal availability, most consumers in Australia reported accessing illicit cannabis products, with uncertainty regarding the quality or composition of cannabis products.
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Affiliation(s)
- Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Kogarah, NSW, Australia.
- Discipline of Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Llewellyn Mills
- Drug and Alcohol Services, South East Sydney Local Health District, Kogarah, NSW, Australia
- Discipline of Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anastasia Suraev
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Maria Bravo
- Drug and Alcohol Services, South East Sydney Local Health District, Kogarah, NSW, Australia
- Discipline of Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas Arkell
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Jonathon C Arnold
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Melissa J Benson
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Iain S McGregor
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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50
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Kansagara D, Becker WC, Ayers C, Tetrault JM. Priming primary care providers to engage in evidence-based discussions about cannabis with patients. Addict Sci Clin Pract 2019; 14:42. [PMID: 31787111 PMCID: PMC6886188 DOI: 10.1186/s13722-019-0171-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 11/09/2019] [Indexed: 12/17/2022] Open
Abstract
Cannabis use has become increasingly common in the U.S. in recent years, with legalization for medical and recreational purposes expanding to more states. With this increase in use and access, providers should be prepared to have more conversations with patients about use. This review provides an overview of cannabis terminology, pharmacology, benefits, harms, and risk mitigation strategies to help providers engage in these discussions with their patients. Current evidence for the medical use of cannabis, cannabis-related diagnoses including cannabis use disorder (CUD) and withdrawal syndromes, and the co-use of opioids and cannabis are discussed. It is crucial that providers have the tools and information they need to deliver consistent, evidence-based assessment, treatment, prevention and harm-reduction, and we offer practical guidance in these areas.
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Affiliation(s)
- Devan Kansagara
- VA Evidence Synthesis Program, VA Portland Healthcare System, Mail Code R&D 71, 3710 SW US Veterans Hospital Road, Portland, OR, 97239-2999, USA. .,Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - William C Becker
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.,VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Chelsea Ayers
- VA Evidence Synthesis Program, VA Portland Healthcare System, Mail Code R&D 71, 3710 SW US Veterans Hospital Road, Portland, OR, 97239-2999, USA
| | - Jeanette M Tetrault
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
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