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Network-Based Pharmacology Study Reveals Protein Targets for Medical Benefits and Harms of Cannabinoids in Humans. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12042205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This network-based pharmacology study intends to uncover the underlying mechanisms of cannabis leading to a therapeutic benefit and the pathogenesis for a wide range of diseases claimed to benefit from or be caused by the use of the cannabis plant. Cannabis contains more than 600 chemical components. Among these components, cannabinoids are well-known to have multifarious pharmacological activities. In this work, twelve cannabinoids were selected as active compounds through text mining and drug-like properties screening and used for initial protein-target prediction. The disease-associated biological functions and pathways were enriched through GO and KEGG databases. Various biological networks [i.e., protein-protein interaction, target-pathway, pathway-disease, and target-(pathway)-target interaction] were constructed, and the functional modules and essential protein targets were elucidated through the topological analyses of the networks. Our study revealed that eighteen proteins (CAT, COMT, CYP17A1, GSTA2, GSTM3, GSTP1, HMOX1, AKT1, CASP9, PLCG1, PRKCA, PRKCB, CYCS, TNF, CNR1, CNR2, CREB1, GRIN2B) are essential targets of eight cannabinoids (CBD, CBDA, Δ9-THC, CBN, CBC, CBGA, CBG, Δ8-THC), which involve in a variety of pathways resulting in beneficial and adverse effects on the human body. The molecular docking simulation confirmed that these eight cannabinoids bind to their corresponding protein targets with high binding affinities. This study generates a verifiable hypothesis of medical benefits and harms of key cannabinoids with a model which consists of multiple components, multiple targets, and multiple pathways, which provides an important foundation for further deployment of preclinical and clinical studies of cannabis.
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Shorey Fennell B, Magnan RE, Ladd BO, Fales JL. Young Adult Cannabis Users' Perceptions of Cannabis Risks and Benefits by Chronic Pain Status. Subst Use Misuse 2022; 57:1647-1652. [PMID: 35899812 PMCID: PMC10373546 DOI: 10.1080/10826084.2022.2102186] [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: 10/16/2022]
Abstract
Purpose: Young adults experiencing chronic pain may self-medicate with cannabis. We examined perceived risks and benefits of cannabis use among young adult users by chronic pain status, and identified relationships among perceived risks and benefits, physical and mental health, and cannabis-related problems. Methods: Young adults reporting at least weekly cannabis use (N = 176, 50.9% with chronic pain) reported perceptions of lifetime risks and benefits associated with cannabis use, physical and mental health, and cannabis-related problems. Results: Young adults without chronic pain reported better physical and mental health than those with chronic pain. Cannabis use, problems, and risk and benefit perceptions did not differ by pain status. Risk and benefit perceptions were unrelated to physical health, perceiving fewer risks and more benefits was associated with better mental health, and perceiving more risk was associated with cannabis problems. Chronic pain status moderated the relationship between perceived benefits and outcomes, such that perceiving more benefits was associated with better physical health for those without chronic pain. Further, greater perceived benefits were associated with more cannabis-related problems for those without chronic pain but fewer problems for those with chronic pain. Conclusion: This study offers insight into the perceptions of risks and benefits among young adult cannabis users and associations with physical and mental health and cannabis-related problems. The effects of perceived benefits on physical health and cannabis-related problems differs for young adults with and without pain, suggesting assessment and consideration of pain status may be valuable in intervention contexts.
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Affiliation(s)
| | - Renee E Magnan
- Washington State University Vancouver, Vancouver, Washington, USA
| | - Benjamin O Ladd
- Washington State University Vancouver, Vancouver, Washington, USA
| | - Jessica L Fales
- Washington State University Vancouver, Vancouver, Washington, USA
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3
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Ng JY, Abrams A, Pathak A, Tahir U, Jomy J. What are the experiences of patients using cannabis for pain? A systematic review of qualitative studies. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2021.102098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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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5
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Furrer D, Kröger E, Marcotte M, Jauvin N, Bélanger R, Ware M, Foldes-Busque G, Aubin M, Pluye P, Dionne CE. Cannabis against chronic musculoskeletal pain: a scoping review on users and their perceptions. J Cannabis Res 2021; 3:41. [PMID: 34481519 PMCID: PMC8418709 DOI: 10.1186/s42238-021-00096-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background Chronic musculoskeletal pain (CMP) may lead to reduced physical function and is the most common cause of chronic non-cancer pain. Currently, the pharmacotherapeutic options against CMP are limited and frequently consist of pain management with non-steroidal anti-inflammatories, gabapentinoids, or opioids, which carry major adverse effects. Although the effectiveness of medical cannabis (MC) for CMP still lacks solid evidence, several patients suffering from it are exploring this therapeutic option with their physicians. Objectives Little is known about patients’ perceptions of their MC treatment for CMP. We aimed to increase this knowledge, useful for healthcare professionals and patients considering this treatment, by conducting a scoping literature review, following guidance by Arksey and O’Malley, to describe the views and perceptions of adult patients who had consumed MC to relieve chronic CMP. Methods Databases (PUBMED, EMBASE, Web of Science) and websites were searched using combinations of controlled and free vocabulary. All studies and study designs reporting on patients’ perceptions regarding MC against CMP were considered. Studies had to include adult patients reporting qualitatively or quantitatively, i.e., through questionnaires, on MC use to treat CMP or other non-cancer pain, since studies reporting exclusively on perceptions regarding CMP were very rare. Study characteristics were extracted and limitations of the study quality were assessed. The review includes patients’ demographic characteristics, patterns of MC use, perceived positive and negative effects, use of alcohol or other drugs, reported barriers to CM use, and funding sources of the studies. Results Participants of the 49 included studies reported that MC use helped them to reduce CMP and other chronic non-cancer pain, with only minor adverse effects, and some reported improved psychological well-being. In the included studies, men represent between 18 and 88% of the subjects. The mean age of participants in these studies (42/49) varied between 28.4 and 62.8 years old. The most common route of administration is inhalation. Conclusion MC users suffering from CMP or other chronic non-cancer pain perceived more benefits than harms. However, the information from these studies has several methodological limitations and results are exploratory. These user-reported experiences must thus be examined by well-designed and methodologically sound clinical or observational studies, particularly regarding CMP, where reports are very scarce. Supplementary Information The online version contains supplementary material available at 10.1186/s42238-021-00096-8.
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Affiliation(s)
- Daniela Furrer
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada. .,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada. .,Faculty of Pharmacy, Université Laval, Québec, QC, Canada. .,Hôpital du Saint-Sacrement, 1050 Chemin Ste-Foy, room L2-30, Québec, QC, G1S 4L8, Canada.
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada
| | - Nathalie Jauvin
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada
| | - Richard Bélanger
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada.,Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Mark Ware
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, QC, Canada.,Research Centre of the Centre Intégré de Santé et de Services Sociaux (CISSS) de Chaudière-Appalaches, Lévis, QC, Canada
| | - Michèle Aubin
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Pierre Pluye
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Clermont E Dionne
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Faculty of Medicine, Université Laval, Québec, QC, Canada
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Adams D, Ofei-Tenkorang NA, Connell P, Owens A, Gothard A, Souza D, Narouze S. Interests and concerns regarding medical marijuana among chronic pain patients in Ohio: an online survey. J Cannabis Res 2021; 3:37. [PMID: 34399845 PMCID: PMC8366739 DOI: 10.1186/s42238-021-00092-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background Since the legalization of medical marijuana (MMJ) in Ohio in 2018, many chronic pain (CP) patients have become interested in it as an alternative or adjunct to prescription opioids. This has not only created a need for pain management specialists to learn about this potential indication for MMJ but also for them to have more detailed knowledge of patient attitudes and willingness to comply with providers’ recommendations regarding its safe use with other pain medications. For this purpose, we surveyed CP patients in a region severely affected by the opioid crisis in order to provide better education, formulate treatment plans, and develop clinical policies. Methods We designed and administered the Medical Marijuana Interest Questionnaire (MMIQ) online to patients of the Western Reserve Hospital Center for Pain Medicine (CPM) with a diagnosis of CP who were not yet using MMJ. Questions addressed demographic and clinical characteristics, willingness to consider MMJ, and compliance with treatment plans and concerns. We then carried out a statistical analysis including Pearson chi-square, Spearman’s rho and Kendall’s tau tests to measure associations between variables to identify factors that may influence willingness to use MMJ. Results After sending 1047 email invitations to complete the MMIQ, 242 (23.1%) completed questionnaires were returned. The average age range of all respondents was 51-60 years, 171 (70.7%) were female and 147 (60.7%) were current opioid users. The 204 (84.3%) respondents who were willing to consider using MMJ were given access to the entire questionnaire. Of these, 138 (67.6%) reported wanting to use less opioids after starting MMJ and 191 (93.6%) were amenable to following their pain specialists’ recommendations about using MMJ concurrently with opioids. Their greatest concern on a 0-5 scale was affordability (2.98) and there was a statistically significant negative correlation between older age and preference for inhaled forms (p = 0.023). Conclusion The MMIQ was successful in eliciting important data regarding patients’ attitudes about MMJ for opioid titration and potential compliance. Our study was limited by being administered online rather than in-person, which skewed the demographic makeup of the sample. The MMIQ can be used to study similar populations or adapted to patients already using MMJ. Similar surveys of MMJ-experienced patients could be combined with chart reviews to study the success of these products for pain control and opioid substitution.
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Affiliation(s)
- Daniel Adams
- Western Reserve Hospital Center for Pain Medicine, 1900 23rd St, Cuyahoga Falls, OH, 44223, USA.
| | | | - Patrick Connell
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Alexa Owens
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | - Dmitri Souza
- Western Reserve Hospital Center for Pain Medicine, 1900 23rd St, Cuyahoga Falls, OH, 44223, USA
| | - Samer Narouze
- Western Reserve Hospital Center for Pain Medicine, 1900 23rd St, Cuyahoga Falls, OH, 44223, USA
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7
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Chang Y, Zhu M, Vannabouathong C, Mundi R, Chou RS, Bhandari M. Medical Cannabis for Chronic Noncancer Pain: A Systematic Review of Health Care Recommendations. Pain Res Manag 2021; 2021:8857948. [PMID: 33613794 PMCID: PMC7878090 DOI: 10.1155/2021/8857948] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
Purpose Medical cannabis for patients with chronic noncancer pain (CNCP) has been the focus of numerous health care recommendations. We conducted a systematic review to identify and summarize the currently available evidence-based recommendations. Methods We searched MEDLINE, EMBASE, PsycINFO, the Cochrane database of systematic reviews, and websites for clinical guidelines and recommendations. We summarized the type of the publications, developers, approach of health care recommendation development, year and country of publication, and conditions that were addressed. We categorized the direction and strength of each recommendation. Results We identified 12 eligible publications. Publication years ranged from 2007 to 2019; four (33.3%) of them were published in 2018. Canada ranked first for the number of publications (n = 4, 33.3%). Most (n = 11, 92%) of the included recommendations were based on both a systematic review of the best evidence and expert consensus. All the included publications provided a recommendation supporting medical cannabis for CNCP in general and for the specific conditions of neuropathic pain, chronic pain in people living with Human Immunodeficiency Virus (HIV), and chronic abdominal pain, with detailed information sharing and comprehensive consideration of a patient's own values and preferences. Conclusion Clinicians can attend to the guidance currently offered, being aware that only weak recommendations are available for medical cannabis in patients with CNCP, as a third- or fourth-line therapy. Detailed discussions with patients regarding the benefits in reducing pain and potential adverse effects are required before its prescription.
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Affiliation(s)
- Yaping Chang
- OrthoEvidence Inc., Burlington, ON, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Meng Zhu
- OrthoEvidence Inc., Burlington, ON, Canada
| | | | - Raman Mundi
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Sunnybrook Holland Orthopaedic and Arthritic Centre, Toronto, ON, Canada
| | - Roland S. Chou
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- OrthoEvidence Inc., Burlington, ON, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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Hergert DC, Robertson-Benta C, Sicard V, Schwotzer D, Hutchison K, Covey DP, Quinn DK, Sadek JR, McDonald J, Mayer AR. Use of Medical Cannabis to Treat Traumatic Brain Injury. J Neurotrauma 2021; 38:1904-1917. [PMID: 33256496 DOI: 10.1089/neu.2020.7148] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is not a single pharmacological agent with demonstrated therapeutic efficacy for traumatic brain injury (TBI). With recent legalization efforts and the growing popularity of medical cannabis, patients with TBI will inevitably consider medical cannabis as a treatment option. Pre-clinical TBI research suggests that cannabinoids have neuroprotective and psychotherapeutic properties. In contrast, recreational cannabis use has consistently shown to have detrimental effects. Our review identified a paucity of high-quality studies examining the beneficial and adverse effects of medical cannabis on TBI, with only a single phase III randomized control trial. However, observational studies demonstrate that TBI patients are using medical and recreational cannabis to treat their symptoms, highlighting inconsistencies between public policy, perception of potential efficacy, and the dearth of empirical evidence. We conclude that randomized controlled trials and prospective studies with appropriate control groups are necessary to fully understand the efficacy and potential adverse effects of medical cannabis for TBI.
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Affiliation(s)
- Danielle C Hergert
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Cidney Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Veronik Sicard
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Daniela Schwotzer
- Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Kent Hutchison
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA
| | - Dan P Covey
- Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Davin K Quinn
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Joseph R Sadek
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,New Mexico VA Health Care System, Albuquerque, New Mexico, USA
| | - Jacob McDonald
- Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA.,Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,Psychology Department, University of New Mexico, Albuquerque, New Mexico, USA
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Wilson M, Klein T, Bindler RJ, Kaplan L. Shared Decision-Making for Patients Using Cannabis for Pain Symptom Management in the United States. Pain Manag Nurs 2020; 22:15-20. [PMID: 33139204 DOI: 10.1016/j.pmn.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/14/2020] [Accepted: 09/17/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Gaps in research evidence and inconsistent policies regarding use of cannabis for pain and associated symptoms result in confusion for healthcare providers and patients. The objective of this review was to synthesize information on cannabis use for pain with legal and policy implications to create a shared decision-making model that can be used to guide patient care interactions. APPROACH Current cannabis policies, state laws, research, and patient care practices related to medical and recreational cannabis in the United States were reviewed, along with best practices in shared decision-making. Reviewed literature was then synthesized to create a model that can be used by registered nurses and others to address cannabis use, where legal, for pain and related symptoms. RESULT AND CONCLUSIONS Cannabis is a legal option for many patients with pain. To minimize harms and optimize benefits, nurses can play a key role when authorized by law in assisting with decision-making surrounding cannabis use.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington, USA.
| | - Tracy Klein
- College of Nursing, Washington State University, Vancouver, Washington, USA
| | - Ross J Bindler
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Louise Kaplan
- College of Nursing, Washington State University, Vancouver, Washington, USA
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10
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Kaplan L, Klein T, Wilson M, Graves J. Knowledge, Practices, and Attitudes of Washington State Health Care Professionals Regarding Medical Cannabis. Cannabis Cannabinoid Res 2020; 5:172-182. [PMID: 32656349 DOI: 10.1089/can.2019.0051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Health care providers in Washington State practice in a unique environment where both medical and recreational cannabis use are legal. Five types of health care providers can authorize medical cannabis. State-certified medical cannabis consultants may advise patients in a cannabis retail store regarding use and consumption. Washington State's health care professionals' perspectives about medical cannabis can inform policy-makers nationwide who are navigating challenges posed by legalization of medical and recreational cannabis. Materials and Methods: A cross-sectional mixed-mode survey using a 26-item questionnaire was administered to a random sample of actively licensed health care professionals legally permitted to provide medical cannabis authorizations in Washington State. We describe participant demographics and summarize responses to survey questions. We report comparisons across provider types using Fisher's exact tests with a level of significance of p<0.01. Results: Among the 1440 health care professionals invited to participate in the study, 310 respondents met eligibility criteria (response rate 24%). Only 57 respondents (18.4%) indicated having ever issued a medical cannabis authorization. Among them, 6, all naturopaths, had provided more than 500. Over half (58%) reported that they did not feel they had the knowledge and skills necessary to provide authorizations. Depending on the condition, 29-93% of respondents correctly identified conditions that qualified a patient to receive a medical cannabis authorization. Very few knew that employers are not required to provide accommodations for medical cannabis. Health care professionals (64.8%) served as the most frequent source of information regarding cannabis risks and benefits. Over half (62%) strongly or somewhat agreed that the Drug Enforcement Agency should reschedule cannabis to make it legal at the federal level. Conclusion: A wide range of knowledge was exhibited within our sample of health care professionals regarding qualifying conditions for medical cannabis. As more states adopt comprehensive medical cannabis laws, health care professionals must be prepared to provide information to patients regarding the effects, risks, and benefits of cannabis. Standardized education could ensure that health care professionals are prepared to responsibly promote the use of cannabis when indicated for medically appropriate symptoms and conditions. A rational approach to medical cannabis is needed to assure that unforeseen consequences are mitigated.
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Affiliation(s)
- Louise Kaplan
- College of Nursing, Washington State University Vancouver, Vancouver, Washington, USA
| | - Tracy Klein
- College of Nursing, Washington State University Vancouver, Vancouver, Washington, USA
| | - Marian Wilson
- College of Nursing, Washington State University Spokane, Spokane, Washington, USA
| | - Janessa Graves
- College of Nursing, Washington State University Spokane, Spokane, Washington, USA
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11
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Altman BR, Mian MN, Slavin M, Earleywine M. Cannabis Expectancies for Sleep. J Psychoactive Drugs 2019; 51:405-412. [PMID: 31319769 PMCID: PMC10446891 DOI: 10.1080/02791072.2019.1643053] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
Up to 35% of adults in the United States suffer from sleep disturbances, which covary with a host of negative mental and physical health outcomes. Previous research suggests that cannabis' sedative effects may be associated with improved sleep. The present study examined the self-reported effect of cannabis use on individual's sleep-related problems. Participants included 311 individuals recruited online, who reported both sleep-related problems and cannabis use. Analyses revealed that participants expected cannabis to decrease the incidence of sleep-related problems, including allowing participants to have an earlier bedtime, to fall asleep more quickly, and to have a longer night's sleep. Moreover, expectancies about the influence of cannabis on sleep negatively covaried with cannabis-related problems. These findings suggest that individuals believe using cannabis might positively influence their sleep quality and believing so may be protective against cannabis problems. Randomized control trials of cannabis for insomnia appear justified.
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Affiliation(s)
- Brianna R Altman
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - M N Mian
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - M Slavin
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - M Earleywine
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
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Wildes M, Bigand TL, Layton ME, Wilson M. Cannabis Use and Cognition in Adults Prescribed Opioids for Persistent Pain. Pain Manag Nurs 2019; 21:94-99. [PMID: 31405787 DOI: 10.1016/j.pmn.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Adults with persistent pain frequently report cannabis use to help manage their symptoms. The impact of cannabis use on cognition in the presence of concurrent symptoms of depression and anxiety is poorly understood. AIMS Our study explored how cannabis use affects relationships among symptoms of depression, anxiety, and cognition. DESIGN A cross-sectional survey study was conducted. SETTINGS Surveys were distributed at outpatient clinics treating adults for pain in the Pacific Northwestern United States. PARTICIPANTS A total of 150 adults prescribed an opioid medicine for persistent pain were recruited. METHODS A pencil and paper survey was used to collect several self-reported ratings of cognition, symptoms of depression and anxiety, and the average potency of cannabis consumed as measured by the percentage of delta-9-tetrahydrocannibinol (THC) and cannabidiol (CBD), as well as frequency of cannabis use. RESULTS Depression, anxiety and cognition significantly worsened as the reported percentage of CBD, THC and overall frequency of cannabis use in the past 30 days increased. Depression and anxiety both significantly predicted worsening cognition in the sample. The relationship between depressive symptoms and cognition was strengthened as reported percentages of CBD use increased. The relationship was the same for anxiety and cognition, although not as strong. CONCLUSIONS More cannabis use, particularly high CBD products, may be linked with increased symptom burdens and may strengthen relationships between negative affect and cognition. Further cannabis research within persistent pain populations is warranted to add evidence that can assist patients in managing mood and mental processes. Nurses should evaluate how negative affective health symptoms may impact cognition among adults with persistent pain using prescription opioid medications, especially in the context of concurrent cannabis use.
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Affiliation(s)
- Megan Wildes
- Multicare Neuroscience Institute, Spokane, Washington; College of Nursing, Gonzaga University, Spokane, Washington
| | - Teresa L Bigand
- College of Nursing, Washington State University, Spokane, Washington
| | - Matthew E Layton
- Program of Excellence in Addictions Research, Washington State University, Spokane, Washington; Translational Addictions Research Center, Washington State University, Pullman, Washington; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington; Program of Excellence in Addictions Research, Washington State University, Spokane, Washington; Translational Addictions Research Center, Washington State University, Pullman, Washington.
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Clem SN, Bigand TL, Wilson M. Cannabis Use Motivations among Adults Prescribed Opioids for Pain versus Opioid Addiction. Pain Manag Nurs 2019; 21:43-47. [PMID: 31375419 DOI: 10.1016/j.pmn.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/15/2019] [Accepted: 06/16/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cannabis has been linked to reduced opioid use, although reasons for cannabis use among adults prescribed opioids are unclear. AIMS The purpose of this study was to determine whether motivations for cannabis use differ between adults prescribed opioids for persistent pain versus those receiving opioids as medication-assisted treatment for opioid use disorder. DESIGN A cross-sectional survey design was used. PARTICIPANTS Adults prescribed opioids for persistent pain (n = 104) or opioid use disorder (n = 139) were recruited from outpatient settings. METHODS Data were collected on surveys asking about cannabis use and compared the two populations. A series of regression models examined population characteristics and cannabis use motivations using validated measures of the Marijuana Motives Measure scale. RESULTS More than half the sample (n = 122) reported current, daily cannabis use and 63% reported pain as a motivation for use. Adults with persistent pain were more likely to be older, female, and have higher levels of education (p < .05). Adults with opioid use disorder were more likely to report "enhancement" (p < .01) and relief of drug withdrawal symptoms (p < .001) as motivations for cannabis use. The most common reasons for cannabis use in both populations were social and recreational use and pain relief. CONCLUSIONS Both studied populations have unmet health needs motivating them to use cannabis and commonly use cannabis for pain. Persistent pain participants were less likely to use cannabis for euphoric effects or withdrawal purposes. Nurses should assess for cannabis use, provide education on known risks and benefits, and offer options for holistic symptom management.
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Affiliation(s)
- Selena N Clem
- College of Nursing, Washington State University, Spokane, Washington
| | - Teresa L Bigand
- College of Nursing, Washington State University, Spokane, Washington
| | - Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington.
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Gonçalves J, Rosado T, Soares S, Simão AY, Caramelo D, Luís Â, Fernández N, Barroso M, Gallardo E, Duarte AP. Cannabis and Its Secondary Metabolites: Their Use as Therapeutic Drugs, Toxicological Aspects, and Analytical Determination. MEDICINES (BASEL, SWITZERLAND) 2019; 6:E31. [PMID: 30813390 PMCID: PMC6473697 DOI: 10.3390/medicines6010031] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 02/08/2023]
Abstract
Although the medicinal properties of Cannabis species have been known for centuries, the interest on its main active secondary metabolites as therapeutic alternatives for several pathologies has grown in recent years. This potential use has been a revolution worldwide concerning public health, production, use and sale of cannabis, and has led inclusively to legislation changes in some countries. The scientific advances and concerns of the scientific community have allowed a better understanding of cannabis derivatives as pharmacological options in several conditions, such as appetite stimulation, pain treatment, skin pathologies, anticonvulsant therapy, neurodegenerative diseases, and infectious diseases. However, there is some controversy regarding the legal and ethical implications of their use and routes of administration, also concerning the adverse health consequences and deaths attributed to marijuana consumption, and these represent some of the complexities associated with the use of these compounds as therapeutic drugs. This review comprehends the main secondary metabolites of Cannabis, approaching their therapeutic potential and applications, as well as their potential risks, in order to differentiate the consumption as recreational drugs. There will be also a focus on the analytical methodologies for their analysis, in order to aid health professionals and toxicologists in cases where these compounds are present.
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Affiliation(s)
- Joana Gonçalves
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Tiago Rosado
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Sofia Soares
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Ana Y Simão
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Débora Caramelo
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Ângelo Luís
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Nicolás Fernández
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Toxicología y Química Legal, Laboratorio de Asesoramiento Toxicológico Analítico (CENATOXA). Junín 956 7mo piso. Ciudad Autónoma de Buenos Aires (CABA), Buenos Aires C1113AAD, Argentina.
| | - Mário Barroso
- Serviço de Química e Toxicologia Forenses, Instituto de Medicina Legal e Ciências Forenses - Delegação do Sul, 1169-201 Lisboa, Portugal.
| | - Eugenia Gallardo
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
| | - Ana Paula Duarte
- Centro de Investigação em Ciências da Saúde, Faculdade de Ciências da Saúde da Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
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