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Nascimento GC, Escobar-Espinal D, Bálico GG, Silva NR, Del-Bel E. Cannabidiol and pain. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 177:29-63. [PMID: 39029988 DOI: 10.1016/bs.irn.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
Chronic pain presents significant personal, psychological, and socioeconomic hurdles, impacting over 30% of adults worldwide and substantially contributing to disability. Unfortunately, current pharmacotherapy often proves inadequate, leaving fewer than 70% of patients with relief. This shortfall has sparked a drive to seek alternative treatments offering superior safety and efficacy profiles. Cannabinoid-based pharmaceuticals, notably cannabidiol (CBD), hold promise in pain management, driven by their natural origins, versatility, and reduced risk of addiction. As we navigate the opioid crisis, ongoing research plunges into CBD's therapeutic potential, buoyed by animal studies revealing its pain-relieving prowess through various system tweaks. However, the efficacy of cannabis in chronic pain management remains a contentious and stigmatized issue. The International Association for the Study of Pain (IASP) presently refrains from endorsing cannabinoid use for pain relief. Nevertheless, evidence indicates their potential in alleviating cancer-related, neuropathic, arthritis, and musculoskeletal pain, necessitating further investigation. Crucially, our comprehension of CBD's role in pain management is a journey still unfolding, with animal studies illustrating its analgesic effects through interactions with the endocannabinoid, inflammatory, and nociceptive systems. As the plot thickens, it's clear: the saga of chronic pain and CBD's potential offers a compelling narrative ripe for further exploration and understanding.
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Affiliation(s)
- Glauce Crivelaro Nascimento
- Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil.
| | - Daniela Escobar-Espinal
- Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Gabriela Gonçalves Bálico
- Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | | | - Elaine Del-Bel
- Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil; National Institute for Science and Technology, Translational Medicine, University of Sao Paulo, Ribeirao Preto, SP, Brazil; Center for Cannabinoid Research, Mental Health Building, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
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Fraguas-Sánchez AI, Hernán D, Montejo C, Poklis JL, Lichtman AH, Torres-Suárez AI. Polycaprolactone microparticles for the subcutaneous administration of cannabidiol: in vitro and in vivo release. Drug Deliv Transl Res 2024; 14:959-969. [PMID: 37824041 DOI: 10.1007/s13346-023-01444-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
Cannabidiol (CBD) has become a highly attractive entity in therapeutics. However, its low aqueous solubility, instability and handling problems limit the development of effective CBD formulations. Subcutaneously administered CBD-loaded polycaprolactone microparticles (MP) represent an interesting strategy to overcome these challenges. This work focuses on evaluating the pharmacokinetics of CBD formulated in polymer microparticles for subcutaneous administration and characterising its release. The mean release time (MRLT) parameter is used to compare the release of CBD from two microparticle formulations in vitro and in a mouse model. After the administration of CBD in solution, a bicompartmental distribution is observed due to the extensive diffusion to the brain, being the brain/blood AUC ratio 1.29. The blood and brain mean residence time (MRT) are 0.507 ± 0.04 and 0.257 ± 0.0004 days, respectively. MP prepared with two drug/polymer ratios (15/150-MP and 30/150-MP) are designed, showing similar in vitro dissolution profiles (similarity factor (f2) is 63.21), without statistically significant differences between MRLTin vitro values (4.68 ± 0.63 and 4.32 ± 0.05 days). However, considerable differences in blood and brain profiles between both formulations are detected. The blood and brain MRT values of 15/150-MP are 6.44 ± 0.3 days and 6.15 ± 0.25 days, respectively, whereas significantly lower values 3.91 ± 0.29 days and 2.24 ± 0.64 days are obtained with 30/150-MP. The extended release of CBD during 10 days after a single subcutaneous administration is achieved.
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Affiliation(s)
- Ana Isabel Fraguas-Sánchez
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University of Madrid, 28040, Madrid, Spain
- Institute of Industrial Pharmacy, Complutense University of Madrid, 28040, Madrid, Spain
| | - Dolores Hernán
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University of Madrid, 28040, Madrid, Spain
| | - Consuelo Montejo
- Department of Food and Pharmaceutical Sciences, San Pablo CEU University, Madrid, Spain
| | - Justin L Poklis
- Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA
| | - Aron H Lichtman
- Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23298-0613, USA
| | - Ana Isabel Torres-Suárez
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University of Madrid, 28040, Madrid, Spain.
- Institute of Industrial Pharmacy, Complutense University of Madrid, 28040, Madrid, Spain.
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Leinen ZJ, Mohan R, Premadasa LS, Acharya A, Mohan M, Byrareddy SN. Therapeutic Potential of Cannabis: A Comprehensive Review of Current and Future Applications. Biomedicines 2023; 11:2630. [PMID: 37893004 PMCID: PMC10604755 DOI: 10.3390/biomedicines11102630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Historically, cannabis has been valued for its pain-relieving, anti-inflammatory, and calming properties. Ancient civilizations like the Egyptians, Greeks, and Chinese medicines recognized their therapeutic potential. The discovery of the endocannabinoid system, which interacts with cannabis phytoconstituents, has scientifically explained how cannabis affects the human immune system, including the central nervous system (CNS). This review explores the evolving world of cannabis-based treatments, spotlighting its diverse applications. By researching current research and clinical studies, we probe into how cannabinoids like Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) help to manage conditions ranging from chronic pain, persistent inflammation, cancer, inflammatory bowel disease, and neurological disorders to even viral diseases such as Human Immunodeficiency virus (HIV), SARS-CoV-2. and the emerging monkeypox. The long-term recreational use of cannabis can develop into cannabis use disorder (CUD), and therefore, understanding the factors contributing to the development and maintenance of cannabis addiction, including genetic predisposition, neurobiological mechanisms, and environmental influences, will be timely. Shedding light on the adverse impacts of CUD underscores the importance of early intervention, effective treatment approaches, and public health initiatives to address this complex issue in an evolving landscape of cannabis policies and perceptions.
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Affiliation(s)
- Zach J. Leinen
- Department of Pharmacology & Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68182, USA; (Z.J.L.); (R.M.); (A.A.)
| | - Rahul Mohan
- Department of Pharmacology & Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68182, USA; (Z.J.L.); (R.M.); (A.A.)
| | - Lakmini S. Premadasa
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (L.S.P.); (M.M.)
| | - Arpan Acharya
- Department of Pharmacology & Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68182, USA; (Z.J.L.); (R.M.); (A.A.)
| | - Mahesh Mohan
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (L.S.P.); (M.M.)
| | - Siddappa N. Byrareddy
- Department of Pharmacology & Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68182, USA; (Z.J.L.); (R.M.); (A.A.)
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Sulley S, Ndanga M, Saka AK. Prevalence of Cannabis Use and Factors Related to Hospitalizations in the United States: A Population-Based Study Using National Inpatient Sample Between 2012 and 2018. Cureus 2022; 14:e28361. [PMID: 36168355 PMCID: PMC9507936 DOI: 10.7759/cureus.28361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction: Cannabis use has been associated with adverse outcomes among adults and adolescents. As more states legalize or consider legalization, it is imperative to understand cannabis-related hospitalizations among the US population. This study is aimed at understanding the prevalence of cannabis-related hospitalizations using a nationally representative sample. Methods: Using the National Inpatient Sample (NIS) available through the Healthcare Cost and Utilization Project (HCUP), we included all hospitalizations that met the inclusion criteria of documented history of cannabis use and those with any cannabis diagnosis as the reason for hospitalization between 2012 and 2014, and 2016 and 2018 using listwise deletion methods. Cannabis use was identified based on International Classification of Disease (ICD 9 & 10) codes (304.3X, 305.2X) (F12.XXX) for 2012-2014 and 2016-2018, respectively. We included both primary and secondary diagnoses among hospitalized patients. We further analyzed the relationship between cannabis-related diagnoses, race and ethnicity cases, household income, region, age group, rural-urban demographics, and sex. Results: A weighted total of 2,099,665 and 1,023,325 patients with a history of cannabis use were identified for the period of 2012-2014 and 2016-2018, respectively. The primary reason for presentation among a majority of patients was related to mental health, alcohol, HIV, trauma, burns, and toxic effects of drugs for all included years. The rate of the presentation was highest among individuals 12-24-years-old (351, 846) and 25-34-years-old (255 and 563) per 10,000 presentations between 2012-2014 and 2016-2018, respectively. The highest rate of increase by race and ethnicity was observed among Native Americans (227 and 457), Black (287 and 468), and others (125 and 214) during 2012-2014 and 2016-2018, respectively. The highest observations were in the East North Central, West North Central, Mountain, and Pacific Regions of the United States. The highest presentation rates were observed among males with no insurance coverage and populations in the lowest income quartiles. Conclusion: Cannabis-related hospitalization increased significantly over the years, and presentations are not isolated to areas with cannabis legalization. The high presentation rate among individuals with mental and alcohol necessitates the development of strategies to educate and mitigate potential causes of hospitalization among all age groups and races or ethnicity.
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Vinette B, Côté J, El-Akhras A, Mrad H, Chicoine G, Bilodeau K. Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review. BMC Cancer 2022; 22:319. [PMID: 35331185 PMCID: PMC8953058 DOI: 10.1186/s12885-022-09378-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/07/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Some patients diagnosed with cancer use medical cannabis to self-manage undesirable symptoms, including nausea and pain. To improve patient safety and oncological care quality, the routes of administration for use of medical cannabis, patients' reasons, and prescribed indications must be better understood. METHODS Based on the Joanna Briggs Institute guidelines, a scoping review was conducted to map the current evidence regarding the use of medical cannabis in oncological settings based on the experiences of patients diagnosed with cancer and their healthcare providers. A search strategy was developed with a scientific librarian which included five databases (CINAHL, Web of Science, Medline, Embase, and PsycINFO) and two grey literature sources (Google Scholar and ProQuest). The inclusion criteria were: 1) population: adults aged 18 and over diagnosed with cancer; 2) phenomena of interest: reasons for cannabis use and/or the prescribed indications for medical cannabis; 3) context: oncological setting. French- or English-language primary empirical studies, knowledge syntheses, and grey literature published between 2000 and 2021 were included. Data were extracted by two independent reviewers and subjected to a thematic analysis. A narrative description approach was used to synthesize and present the findings. RESULTS We identified 5,283 publications, of which 163 met the eligibility criteria. Two main reasons for medical cannabis use emerged from the thematic analysis: limiting the impacts of cancer and its side effects; and staying connected to others. Our results also indicated that medical cannabis is mostly used for three approved indications: to manage refractory nausea and vomiting, to complement pain management, and to improve appetite and food intake. We highlighted 11 routes of administration for medical cannabis, with oils and oral solutions the most frequently reported. CONCLUSION Future studies should consider the multiple routes of administration for medical cannabis, such as inhalation and edibles. Our review highlights that learning opportunities would support the development of healthcare providers' knowledge and skills in assessing the needs and preferences of patients diagnosed with cancer who use medical cannabis.
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Affiliation(s)
- Billy Vinette
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada.
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada.
- Center for Innovation in Nursing Education, Montreal, QC, Canada.
| | - José Côté
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
| | - Ali El-Akhras
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Hazar Mrad
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Gabrielle Chicoine
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Center for Innovation in Nursing Education, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
| | - Karine Bilodeau
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Center for Innovation in Nursing Education, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
- Research Center of the Centre Intégré Universitaire de Santé Et de Services Sociaux de L'Est-de-L'Île-de-Montréal, Montreal, QC, Canada
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Schulze-Schiappacasse C, Durán J, Bravo-Jeria R, Verdugo-Paiva F, Morel M, Rada G. Are Cannabis, Cannabis-Derived Products, and Synthetic Cannabinoids a Therapeutic Tool for Rheumatoid Arthritis? A Friendly Summary of the Body of Evidence. J Clin Rheumatol 2022; 28:e563-e567. [PMID: 33859125 PMCID: PMC8860218 DOI: 10.1097/rhu.0000000000001745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Symptom management in rheumatoid arthritis (RA) remains a complex challenge. Widespread use of cannabis-based medicines for a myriad of symptoms has fostered rheumatology patients' interest. However, their safety and efficacy in RA remain unclear. OBJECTIVE The aim of this study was to perform a structured summary of the body of evidence in order to determine whether cannabis, cannabis-derived products, and synthetic cannabinoids are an effective treatment for rheumatoid arthritis. METHODS An electronic search in Epistemonikos database was performed to identify systematic reviews and their primary studies that addressed our clinical question. The body of evidence was collected in a pivot table in Epistemonikos. Information and data from the primary studies were extracted from the identified reviews. Finally, extracted data were reanalyzed, and a summary of findings table was generated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Twenty-six systematic reviews were identified which included in total only 1 randomized trial assessing our clinical question. CONCLUSIONS Cannabis, cannabis-derived products and synthetic cannabinoids may slightly reduce disease activity in patients with RA. Its use may result in little to no difference in pain reduction and may slightly increase nervous system adverse events. The evidence is very uncertain about the effect of cannabis, cannabis-derived products, and synthetic cannabinoids on serious adverse events risk.
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Affiliation(s)
| | - Josefina Durán
- Internal Medicine Department
- Clinical Immunology and Rheumatology Department, Faculty of Medicine
| | - Rocío Bravo-Jeria
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile
| | - Francisca Verdugo-Paiva
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile
- Epistemonikos Foundation, Santiago, Chile
| | - Macarena Morel
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile
| | - Gabriel Rada
- Internal Medicine Department
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile
- Epistemonikos Foundation, Santiago, Chile
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Lalsare S. Cannabinoids: Legal aspects, pharmacology, phytochemistry, probable targets from biological system, and therapeutic potential. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Karğılı U, Aytaç E. Supercritical fluid extraction of cannabinoids (THC and CBD) from four different strains of cannabis grown in different regions. J Supercrit Fluids 2022. [DOI: 10.1016/j.supflu.2021.105410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mahmud MS, Hossain MS, Ahmed ATMF, Islam MZ, Sarker ME, Islam MR. Antimicrobial and Antiviral (SARS-CoV-2) Potential of Cannabinoids and Cannabis sativa: A Comprehensive Review. Molecules 2021; 26:7216. [PMID: 34885798 PMCID: PMC8658882 DOI: 10.3390/molecules26237216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 12/26/2022] Open
Abstract
Antimicrobial resistance has emerged as a global health crisis and, therefore, new drug discovery is a paramount need. Cannabis sativa contains hundreds of chemical constituents produced by secondary metabolism, exerting outstanding antimicrobial, antiviral, and therapeutic properties. This paper comprehensively reviews the antimicrobial and antiviral (particularly against SARS-CoV-2) properties of C. sativa with the potential for new antibiotic drug and/or natural antimicrobial agents for industrial or agricultural use, and their therapeutic potential against the newly emerged coronavirus disease (COVID-19). Cannabis compounds have good potential as drug candidates for new antibiotics, even for some of the WHO's current priority list of resistant pathogens. Recent studies revealed that cannabinoids seem to have stable conformations with the binding pocket of the Mpro enzyme of SARS-CoV-2, which has a pivotal role in viral replication and transcription. They are found to be suppressive of viral entry and viral activation by downregulating the ACE2 receptor and TMPRSS2 enzymes in the host cellular system. The therapeutic potential of cannabinoids as anti-inflammatory compounds is hypothesized for the treatment of COVID-19. However, more systemic investigations are warranted to establish the best efficacy and their toxic effects, followed by preclinical trials on a large number of participants.
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Affiliation(s)
- Md Sultan Mahmud
- Faculty of Textile Engineering, Bangladesh University of Textiles, Dhaka 1208, Bangladesh; (M.S.M.); (A.T.M.F.A.); (M.Z.I.)
| | - Mohammad Sorowar Hossain
- Biomedical Research Foundation, Dhaka 1230, Bangladesh;
- School of Environment and Life Sciences, Independent University, Dhaka 1229, Bangladesh
| | - A. T. M. Faiz Ahmed
- Faculty of Textile Engineering, Bangladesh University of Textiles, Dhaka 1208, Bangladesh; (M.S.M.); (A.T.M.F.A.); (M.Z.I.)
| | - Md Zahidul Islam
- Faculty of Textile Engineering, Bangladesh University of Textiles, Dhaka 1208, Bangladesh; (M.S.M.); (A.T.M.F.A.); (M.Z.I.)
| | - Md Emdad Sarker
- Faculty of Textile Engineering, Bangladesh University of Textiles, Dhaka 1208, Bangladesh; (M.S.M.); (A.T.M.F.A.); (M.Z.I.)
| | - Md Reajul Islam
- Faculty of Textile Engineering, Bangladesh University of Textiles, Dhaka 1208, Bangladesh; (M.S.M.); (A.T.M.F.A.); (M.Z.I.)
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Bellnier TJ, Brown GW, Ortega T, Janda M, Miskowitz K. Description of collaborative, fee-for-service, office-based, pharmacist-directed medical cannabis therapy management service for patients with chronic pain. J Am Pharm Assoc (2003) 2021; 62:889-896. [PMID: 34887189 DOI: 10.1016/j.japh.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Treatment with medical cannabis (MC) in the United States tends to be patient-driven in nature despite evidence that suggests that patients have remarkably poor knowledge on the medical use of this treatment modality. OBJECTIVE To develop and pilot a collaborative, fee-for-service (FFS), office-based, pharmacist-directed MC therapy management (MCTM) service for patients suffering chronic pain. PRACTICE DESCRIPTION A collaborative, FFS, office-based, pharmacist-directed MCTM service where patients are seen after a physician deems them suitable for treatment with MC. The pharmacist designs the initial treatment regimen by selecting a formulation, dose, route, and frequency of administration and then manages ongoing therapy by making regimen changes based on the patient's response, adverse effects, and financial concerns. PRACTICE INNOVATION The creation of a specialized service where a registered MC pharmacist is positioned in a collaborating provider's office and sees patients face-to-face for the provision of MCTM services. EVALUATION METHODS Patient retention, revenue generated, and ability to replicate the service were evaluated. Patient satisfaction was assessed by collecting subjective feedback on the service. RESULTS The pilot site that developed the service has seen 133 patients from 2016 to 2021 and has retained 89% of patients after 5 years of quarterly appointments. Patients appear willing to pay out of pocket for the service, and the revenue generated covers the pharmacist's and collaborating physician's time as well as additional overhead. The service has been replicated at 2 additional sites, and patient feedback has been positive. CONCLUSIONS MCTM is another useful pharmacist service that patients are willing to pay for. MCTM services decrease the collaborating provider's workload while still allowing them to offer their patients personalized treatment with MC. In our experience, the service retains patients, generates enough revenue to cover costs, can be replicated, and is well received by patients.
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Saulino PA, Greenwald BD, Gordon DJ. The changing landscape of the use of medical marijuana after traumatic brain injury: a narrative review. Brain Inj 2021; 35:1510-1520. [PMID: 34632896 DOI: 10.1080/02699052.2021.1978548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To summarize the potential therapeutic benefits of medical marijuana for patients with traumatic brain injury (TBI). METHODS A systematic search was conducted using PubMed and Cochran's library for information regard the safety and efficacy of medical marijuana as a therapeutic agent. We investigated, in depth, articles specifically evaluating medical marijuana's use in TBI, as well as articles that summarized the effects of marijuana in general. Articles from the year 2000-2020 were included. RESULTS A total of 37 articles met our inclusion criteria. An additional 3 articles were obtained from reference lists. CONCLUSION Studies have shown that medical marijuana can potentially aid the recovery from TBI by modulating the endocannabinoid system, reducing inflammation and secondary injury. Adverse cognitive and physiological effects have been observed in the acute setting as well as chronically, though more research is necessitated. There is also the concern of significant drug-drug interactions that have not been thoroughly studied. Thus, while there is evidence that medical marijuana can be beneficial in the treatment of TBI, more research is necessitated to fully explore the long-term efficacy and adverse effects.
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Affiliation(s)
- Patrick A Saulino
- Rutgers Robert Wood Johnson Medical School, Ringgold Standard Institution, Piscataway, New Jersey, USA
| | - Brian D Greenwald
- Center for Brain Injuries, JFK Johnson Rehabilitation Institute, Ringgold Standard Institution - Physical Medicine and Rehabilitation, Edison, New Jersey, USA.,Rutgers Robert Wood Johnson Medical School New Brunswick, - Physical Medicine and Rehabilitation, Edison, New Jersey, USA
| | - Dustin J Gordon
- Rehabilitation Specialists, Ringgold Standard Institution, Fairleigh Dickinson University, Fair Lawn, New Jersey, USA.,Fairleigh Dickinson University in Teaneck, New Jersey, USA
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Abstract
PURPOSE OF REVIEW Public acceptance of Cannabis sativa L. (cannabis) as a therapeutic option grows despite lags in both research and clinician familiarity. Cannabis-whether as a medical, recreational, or illicit substance-is and has been commonly used by patients. With ongoing decriminalization efforts, decreased perception of harms, and increased use of cannabis in the treatment of symptoms and disease, it is critical for clinicians to understand the rationale for specific therapies and their medical and practical implications for patients. In view of the opioid crisis, overall patient dissatisfaction, and lack of adherence to current chronic pain and headache therapies, this review provides up-to-date knowledge on cannabis as a potential treatment option for headache pain. RECENT FINDINGS Research into the use of cannabinoids for disease treatment have led to FDA-approved drugs for seizures, nausea, and vomiting caused by cancer chemotherapy; and for decreased appetite and weight loss in people with HIV/AIDS. For a wide variety of conditions and symptoms (including chronic pain), cannabis has gained increasing acceptance in society. The effects of cannabidiol (CBD) and tetrahydrocannabinol (THC) in pain pathways have been significantly elucidated. An increasing number of retrospective studies have shown a decrease in pain scores after administration of cannabinoids, as well as long-term benefits such as reduced opiate use. Yet, there is no FDA-approved cannabis product for headache or other chronic pain disorders. More is being done to determine who is likely to benefit from cannabis as well as to understand the long-term effects and limitations of the treatment. Cannabis can refer to a number of products derived from the plant Cannabis sativa L. Relatively well-tolerated, these products come in different configurations, types, and delivery forms. Specific formulations of the plant have been shown to be an effective treatment modality for chronic pain, including headache. It is important for clinicians to know which product is being discussed as well as the harms, benefits, contraindications, interactions, and unknowns in order to provide the best counsel for patients.
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Key Words
- CBD,
- Cannabidiol,
- Cannabis sativa,
- Chronic migraine,
- Chronic pain,
- Dispensary
- Endocannabinoid system,
- Legislation,
- Medical marijuana,
- Migraine treatment,
- Opioid crisis,
- Opioids,
- THC,
- Tetrahydrocannabinol,
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Moustafa B, Testai FD. Cerebrovascular Complications Associated with Marijuana Use. Curr Neurol Neurosci Rep 2021; 21:25. [PMID: 33825077 DOI: 10.1007/s11910-021-01113-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW In the last few years, the attitude toward marijuana in many parts of the world has shifted from illicit to legalized for medical use and to decriminalized. In parallel, there has been a gradual increase in the consumption of this product in the general population, particularly among adolescents and young adults. Marijuana is generally perceived as a harmless drug. However, data obtained in observational studies and preclinical models have established associations between cannabis use and cardiovascular events. In addition, there is emerging evidence linking marijuana use to cerebrovascular complications. Here we provide a critical review of the literature with special emphasis on the association of cannabinoids with stroke and the possible pathogenic mechanisms involved. RECENT FINDINGS Ischemic and hemorrhagic stroke have been described in association with cannabis use, particularly in young individuals. Cerebral infarction remains the most commonly reported stroke subtype seen in marijuana users. Several pathogenic mechanisms have been proposed to explain this association, including multifocal intracranial stenosis, reversible cerebral vasoconstriction syndrome, and coexisting vascular risk factors. Cannabis use is increasingly recognized in young individuals presenting with acute stroke. Our understanding of the pathogenic mechanisms associated with cannabis use and stroke is limited but rapidly evolving. Healthcare providers should educate patients about the potential cardiovascular and cerebrovascular complications related to marijuana or cannabinoids use.
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Affiliation(s)
- Bayan Moustafa
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, College of Medicine, 912 S Wood St, Chicago, IL, USA.
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, College of Medicine, 912 S Wood St, Chicago, IL, USA
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Sempio C, Almaraz-Quinones N, Jackson M, Zhao W, Wang GS, Liu Y, Leehey M, Knupp K, Klawitter J, Christians U, Klawitter J. Simultaneous Quantification of 17 Cannabinoids bY LC-MS-MS in Human Plasma. J Anal Toxicol 2021; 46:383-392. [PMID: 33754154 DOI: 10.1093/jat/bkab030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In recent years, the surge in use and of clinical trials involving tetrahydrocannabinol (THC) and cannabidiol (CBD) has increased the need for sensitive and specific analytical assays to measure said compounds in patients, to establish dose-effect relationships and to gain knowledge of their pharmacokinetics and metabolism. We developed and validated an online extraction high-performance liquid chromatography- tandem mass spectrometry (LC-MS/MS) method for simultaneous quantification of 17 cannabinoids and metabolites including THC and its metabolites, CBD and its metabolites and other minor cannabinoids in human plasma. METHODS CBD-glucuronide (CBD-gluc) standard was produced in-house by isolation of CBD-gluc from urine of patients using pure CBD oil. For calibration standards and quality control samples, human plasma was spiked with cannabinoids at varying concentrations within the working range of the respective compound and 200 µL was extracted using a simple one-step protein precipitation procedure. The extracts were analyzed using online trapping LC/LC-atmospheric pressure chemical ionization (APCI)-MS/MS running in the positive multiple reaction monitoring (MRM) mode. RESULTS The lower limit of quantification ranged from 0.78 ng/mL to 7.8 ng/mL and the upper limits of quantification were between 100 ng/mL and 2000 ng/mL. Inter-day analytical accuracy and imprecision ranged from 90.4 to 111% and from 3.1 to 17.4%, respectively. The analysis of plasma samples collected during clinical studies showed that (3R-trans)-Cannabidiol-7-oic Acid (7-CBD-COOH) was the major human metabolite with 5960% of CBD followed by 7-hydroxy-CBD (177%), CBD-gluc (157%) and 6α-hydroxy-CBD (39.8%); 6β-hydroxy-CBD was not detected in any of the samples. CONCLUSIONS In the present study, we developed and validated a robust LC-MS/MS assay for the simultaneous quantification of cannabinoids and their metabolites, which has been used to measure >5,000 samples in clinical studies. Moreover, we were able to quantify CBD-gluc and showed that 7-CBD-COOH, 7-hydroxy-CBD and CBD-gluc are the major CBD metabolites in human plasma.
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Affiliation(s)
- Cristina Sempio
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Nohemi Almaraz-Quinones
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew Jackson
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Wanzhu Zhao
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - George Sam Wang
- Section of Emergency Medicine and Medical Toxicology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Ying Liu
- Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Maureen Leehey
- Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kelly Knupp
- Department of Neurology and Pediatrics, University of Colorado, Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Jelena Klawitter
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Uwe Christians
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Jost Klawitter
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Gressler LE, Baltz AP, Costantino RC, Slejko JF, Onukwugha E. Exploring the Use of State Medical Cannabis Legislation as a Proxy for Medical Cannabis Use Among Patients Receiving Chemotherapy. Curr Treat Options Oncol 2020; 22:1. [PMID: 33215230 DOI: 10.1007/s11864-020-00803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
OPINION STATEMENT The use of medical cannabis is expanding in the USA. Due to conflicting, low-quality evidence, many oncologists may not feel confident to recommend it to patients. Given the potential for legal and financial risks when conducting clinical trials with medical cannabis, the use of observational data should be explored. Observational data that directly capture medical cannabis use in relation to prescription medications and track the prevalence and patterns of cannabis use is sparse. To gain insights into the role medical cannabis plays in the pharmaceutical landscape, proxies such as cannabis legislation need to be explored. In the context of recommendation-nonadherent antiemetic prescribing among patients experiencing chemotherapy-induced nausea and vomiting, medical cannabis may be a suitable alternative to an antiemetic in states that allow medical cannabis. Findings suggest that legislation may impact the use of certain antiemetics in states with cannabis legislation in place. The presence or absence of legislation regarding medical cannabis use may serve as an early, observable surrogate marker of medical cannabis use in the community. In light of the paucity of clinical trials and observational datasets that capture cannabis use, there remains a tremendous need for the development of methodologies or standardized datasets that appropriately and reliably capture the use of medical cannabis to facilitate research into its clinical application and effect on prescription medication use. Standardizing the reporting and destigmatizing use could eliminate the dependence upon proxy measures as a substitute for more extensive data and go a long way in improving data capture, thus allowing us to generate knowledge and hypotheses from observational data until research conditions improve and allow for expanded clinical trials involving medical cannabis.
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Affiliation(s)
- Laura E Gressler
- School of Pharmacy, Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, 21201, USA.
| | - Alan P Baltz
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ryan C Costantino
- USA MEDCOM Pharmacy Service Line, Defense Health Agency, San Antonio, TX, USA
| | - Julia F Slejko
- School of Pharmacy, Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, 21201, USA
| | - Eberechukwu Onukwugha
- School of Pharmacy, Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, 21201, USA
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Patel S, Doroudgar S, Ip EJ. Community pharmacists' lack of knowledge and confidence in non-prescription cannabidiol products. Res Social Adm Pharm 2020; 17:1356-1360. [PMID: 33041209 DOI: 10.1016/j.sapharm.2020.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Non-prescription cannabidiol (CBD) products have recently been available in community pharmacies. However, there is only limited data to support its use, placing community pharmacists in a challenging position to provide evidence-based information to patients. OBJECTIVE The objective of this study was to assess knowledge, experience, and confidence of non-prescription CBD products among community pharmacists. METHODS A 38-question pen-and-paper survey pertaining to knowledge, experience, and confidence of non-prescription CBD products was administered to community pharmacists in the California Bay Area. Inclusion criteria consisted of registered pharmacists at community pharmacies during regular business hours. Participants were excluded if they were under 18 years old or unwilling to participate. RESULTS Of 128 pharmacists, 103 took part and completed the survey (response rate 80.4%). The majority (78.5%) were unable to answer at least 80% of the non-prescription CBD knowledge-based questions. Over 50% have received patient questions and 20.4% recommended non-prescription CBD products in the last 12 months. More than half were "not confident" answering questions about non-prescription CBD products, and 14.5% received formal training on the topic. CONCLUSION Despite patients commonly asking about non-prescription CBD products, the majority of pharmacists lack clinical knowledge and confidence on the topic. There is a need to provide formal training and educational resources on non-prescription CBD products.
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Affiliation(s)
- Shivani Patel
- Department of Clinical Sciences, Touro University California College of Pharmacy, 1310 Club Drive, Vallejo, CA, 94592, USA.
| | - Shadi Doroudgar
- Department of Clinical Sciences, Touro University California College of Pharmacy, 1310 Club Drive, Vallejo, CA, 94592, USA; Division of Primary Care and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
| | - Eric J Ip
- Department of Clinical Sciences, Touro University California College of Pharmacy, 1310 Club Drive, Vallejo, CA, 94592, USA; Department of Internal Medicine, Kaiser Permanente Mountain View Medical Offices, 555 Castro Street, Mountain View, CA, 94041, USA; Division of Primary Care and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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17
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Parihar V, Katz L, Siyam MA, Rogers A, Patterson L, Zacharias R. Mandatory pharmacist-led education session for patients seeking medical cannabis. Pharm Pract (Granada) 2020; 18:2088. [PMID: 33343771 PMCID: PMC7732211 DOI: 10.18549/pharmpract.2020.4.2088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/15/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: The primary objectives of this pre-post session study, was to evaluate the impact of a pharmacist-led education session on the perceived benefits and safety of cannabis among patients with chronic pain, as well as determine the influence of pharmacist education on the selection of safer cannabis products and dosage forms for medical use among patients. Methods: A retrospective analysis of completed pre-post session questionnaires was conducted among chronic pain patients attending a mandatory education session led by a pharmacist, prior to being authorized cannabis in clinic. All questionnaire data was analyzed using SPSS v. 25. Demographic and sample characteristics were reviewed using univariate analyses. Chi-Square tests were employed to determine if the group-based education significantly affected knowledge, perception of efficacy and safety of cannabis. Results: Of the 260 session participants, 203 completed pre-post session questionnaires. After the session, a majority of current cannabis users (33.8%) and cannabis naïve/past users (56.9%) reported they would use a low THC product in the future, and a majority of current users (54.5%) would use a high CBD product in the future. After education, participants were more likely to report cannabis as having the potential for addiction (chi-square =42.6, p <0.0001) and harm (chi-square =34.0, p <0.0001). Conclusions: Pharmacist counselling and education has the potential to influence patient selection and use of cannabis, from more harmful to safer products, as well as moderate the potential perceived benefits of use.
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Affiliation(s)
- Vikas Parihar
- BSc(Pharm), PharmD. Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, & Department of Anesthesia, McMaster University. Hamilton, ON (Canada).
| | - Laura Katz
- PhD, CPsych. Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, & Department of Psychology, Neuroscience and Behavior, McMaster University. Hamilton, ON (Canada).
| | - Mahmoud A Siyam
- BSc. Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, & School of Pharmacy, University of Waterloo. Waterloo, ON (Canada).
| | - Anna Rogers
- BSc(Pharm). Michael G. DeGroote Pain Clinic, Hamilton Health Sciences. Hamilton, ON (Canada).
| | - Lisa Patterson
- BA. Michael G. DeGroote Pain Clinic, Hamilton Health Sciences. Hamilton, ON (Canada).
| | - Ramesh Zacharias
- MD, FRSC, DAAPM, CMD. Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, & Department of Anesthesia, McMaster University. Hamilton, ON (Canada).
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Chang YD, Jung JW, Oberoi-Jassal R, Kim J, Rajasekhara S, Haas M, Smith J, Desai V, Donovan KA, Portman D. Edmonton Symptom Assessment Scale and Clinical Characteristics Associated With Cannabinoid Use in Oncology Supportive Care Outpatients. J Natl Compr Canc Netw 2020; 17:1059-1064. [PMID: 31487688 DOI: 10.6004/jnccn.2019.7301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Information about the frequency of cannabinoid use and the clinical characteristics of its users in oncology supportive care is limited. This study explored associations between cannabinoid use and cancer-related clinical characteristics in a cancer population. PATIENTS AND METHODS This retrospective review included 332 patients who had a urine drug test (UDT) for tetrahydrocannabinol (THC) together with completion of an Edmonton Symptom Assessment Scale (ESAS) and cannabinoid history questionnaire on the same day that urine was obtained during 1 year in the supportive care clinic. RESULTS The frequency of positive results for THC in a UDT was 22.9% (n=76). Significant statistical differences were seen between THC-positive and THC-negative patients for age (median of 52 [lower quartile, 44; upper quartile, 56] vs 58 [48; 67] years; P<.001), male sex (53.9% vs 39.5%; P=.034), and past or current cannabinoid use (65.8% vs 26.2%; P<.001). Statistical significance was observed in ESAS items between the THC-positive and THC-negative groups for pain (7 [lower quartile, 5; upper quartile; 8] vs 5 [3; 7]; P=.001), nausea (1 [0; 3] vs 0 [0; 3]; P=.049), appetite (4 [2; 7] vs 3 [0; 5.75]; P=.015), overall well-being (5.5 [4; 7] vs 5 [3; 6]; P=.002), spiritual well-being (5 [2; 6] vs 3 [1; 3]; P=.015), insomnia (7 [5; 9] vs 4 [2; 7]; P<.001), and total ESAS (52 [34; 66] vs 44 [29; 54]; P=.001). Among patients who reported current or past cannabinoid use, THC-positive patients had higher total scores and scores for pain, appetite, overall well-being, spiritual well-being, and insomnia than THC-negative patients. CONCLUSIONS Patients with cancer receiving outpatient supportive care who had positive UDT results for THC had higher symptom severity scores for pain, nausea, appetite, overall and spiritual well-being, and insomnia compared with their THC-negative counterparts. These results highlight potential opportunities to improve palliative care.
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Affiliation(s)
- Young D Chang
- Department of Supportive Care Medicine, Moffitt Cancer Center, and.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Jae-Woo Jung
- Department of Supportive Care Medicine, Moffitt Cancer Center, and.,Department of Internal Medicine, Chung-Ang University, College of Medicine, Seoul, Korea; and
| | | | - Jongphil Kim
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Sahana Rajasekhara
- Department of Supportive Care Medicine, Moffitt Cancer Center, and.,Department of Internal Medicine, Chung-Ang University, College of Medicine, Seoul, Korea; and
| | - Meghan Haas
- Department of Supportive Care Medicine, Moffitt Cancer Center, and.,Department of Internal Medicine, Chung-Ang University, College of Medicine, Seoul, Korea; and
| | - Joshua Smith
- Department of Supportive Care Medicine, Moffitt Cancer Center, and
| | - Vijay Desai
- Department of Supportive Care Medicine, Moffitt Cancer Center, and
| | | | - Diane Portman
- Department of Supportive Care Medicine, Moffitt Cancer Center, and.,Department of Internal Medicine, Chung-Ang University, College of Medicine, Seoul, Korea; and
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Szyliowicz D, Hilsenrath P. Medical Marijuana Knowledge and Attitudes: A Survey of the California Pharmacists Association. J Prim Care Community Health 2020; 10:2150132719831871. [PMID: 30795717 PMCID: PMC6388448 DOI: 10.1177/2150132719831871] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Views on the medical efficacy and acceptability of marijuana have changed over the years. California was the first state permitting individuals to use medical marijuana. Even with a long history of use and widespread agreement around the effectiveness of medical marijuana, the literature is sparse about the role health care providers, including pharmacists, play in this interaction. The purpose of this article is to shed light on knowledge and attitudes of pharmacists regarding medical marijuana. We developed a survey for pharmacists about their level of knowledge and attitudes toward medical marijuana. The survey was distributed using SurveyMonkey. It consisted of 44 questions and an opportunity to provide comments. We collaborated with the California Pharmacists Association who provided a link to the survey in October 2017 to their members. Results from 474 responses indicate a majority of providers believe that marijuana has medical efficacy. Yet most providers report that they neither have much information about medical marijuana nor do they know where to get such information. One area of particular concern is the potential for drug interactions. Pharmacists would feel more comfortable discussing medical marijuana if it was approved by the Food and Drug Administration. Moreover, they believe more research needs to occur. The variance between California and federal policy leads to dysfunction among pharmacists providing information to patients. We believe federal policy should change.
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20
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DeVuono MV, Parker LA. Cannabinoid Hyperemesis Syndrome: A Review of Potential Mechanisms. Cannabis Cannabinoid Res 2020; 5:132-144. [PMID: 32656345 PMCID: PMC7347072 DOI: 10.1089/can.2019.0059] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: Cannabinoids have long been known for their ability to treat nausea and vomiting. Recent reports, however, have highlighted the paradoxical proemetic effects of cannabinoids. Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclical episodes of nausea and vomiting, accompanied by abdominal pain following prolonged, high-dose cannabis use, which is alleviated by hot baths and showers. Little is known about the cause of this syndrome. Discussion: Cannabinoids produce a biphasic effect on nausea and vomiting, with low doses having an antiemetic effect and high doses producing emesis. Presentation and treatment of CHS are similar to cyclical vomiting syndrome as well as chemotherapy-related anticipatory nausea and vomiting, suggesting that these phenomena may share mechanisms. The prevalence of CHS is not known because of the symptomatic overlap with other disorders and the lack of knowledge of the syndrome by the public and physicians. Treatment with typical antiemetic drugs is ineffective for CHS, but anxiolytic and sedative drugs, along with hot showers, seem to be consistently effective at reducing symptoms. The only known way to permanently end CHS, however, is abstinence from cannabinoids. Case studies and limited pre-clinical data on CHS indicate that prolonged high doses of the main psychotropic compound in cannabis, Δ9-tetrahydrocannabinol (THC), result in changes to the endocannabinoid system by acting on the cannabinoid 1 (CB1) receptor. These endocannabinoid system changes can dysregulate stress and anxiety responses, thermoregulation, the transient receptor potential vanilloid system, and several neurotransmitters systems, and are thus potential candidates for mediating the pathophysiology of CHS. Conclusions: Excessive cannabinoid administration disrupts the normal functioning of the endocannabinoid system, which may cause CHS. More clinical and pre-clinical research is needed to fully understand the underlying pathophysiology of this disorder and the negative consequences of prolonged high-dose cannabis use.
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Affiliation(s)
- Marieka V. DeVuono
- Department of Psychology and Collabortive Neuroscience Program, University of Guelph, Guelph, Canada
| | - Linda A. Parker
- Department of Psychology and Collabortive Neuroscience Program, University of Guelph, Guelph, Canada
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Rodriguez-Almaraz JE, Chang S, Clarke J, Oberheim-Bush NA, Taylor J, Buerki R, Berger M, Zablotska L, Lobach I, Butowski N. A systematic review and meta-analysis examining the effects of cannabis and its derivatives in adults with malignant CNS tumors. Neurooncol Pract 2020; 7:376-383. [PMID: 32765889 DOI: 10.1093/nop/npaa013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Primary CNS tumors constitute a heterogeneous group of neoplasms that share a considerable morbidity and mortality rate. To help control tumor growth and clinical outcomes (overall survival, progression-free survival, quality of life) symptoms, patients often resort to alternative therapies, including the use of cannabis. Despite rapidly growing popularity, cannabis and its impact on patients with primary malignant CNS tumors is understudied. Methods To shed light on the lack of scientific evidence in this field, in November 2018 we conducted a search and examination of cannabis in neuro-oncology in major journal databases and bibliographies of selected articles, and through abstracts of annual meetings using prespecified criteria in line with the Cochrane Collaboration guidelines. Results We identified 45 publications, of which 9 were selected. Five studies were included. Publication dates ranged from 2004 to 2018 and included varying histologies of primary brain tumors. The average survival at 1 year was 56.09% (95% CI: 48.28-63.9). There was no difference in risk ratio (RR) for death at 1 year between groups (RR: 1.069 [95% CI: 0.139-8.25]). We found strong evidence of heterogeneity (Q = 74.0%; P = .021). We found no statistical evidence of publication bias (P = .117; SD = 1.91). Conclusions There was limited moderate-quality evidence that supports the use of cannabinoids as adjuvant to the standard of care in the treatment of brain and CNS tumors. There was very low-quality evidence suggesting that cannabinoids were associated with adult-onset gliomas. Further prospective clinical trials are necessary to adequately evaluate the impact of cannabinoids on CNS tumors, specifically on survival and quality of life.
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Affiliation(s)
| | - Susan Chang
- University of California, San Francisco, Neuro-Oncology Division
| | - Jennifer Clarke
- University of California, San Francisco, Neuro-Oncology Division
| | | | - Jennie Taylor
- University of California, San Francisco, Neuro-Oncology Division
| | - Robin Buerki
- University of California, San Francisco, Neuro-Oncology Division
| | - Mitchel Berger
- University of California, San Francisco, Neuro-Oncology Division
| | - Lydia Zablotska
- University of California, San Francisco, Department of Epidemiology and Biostatistics
| | - Iryna Lobach
- University of California, San Francisco, Department of Epidemiology and Biostatistics
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22
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Medical students are unprepared to counsel patients about medical cannabis and want to learn more. Complement Ther Med 2020; 48:102237. [DOI: 10.1016/j.ctim.2019.102237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 01/05/2023] Open
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Brown JD, Goodin AJ. The prevalence of drivers under the influence of medical cannabis must be considered within proper context. Res Social Adm Pharm 2019; 15:1372-1373. [DOI: 10.1016/j.sapharm.2019.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 01/26/2019] [Indexed: 02/02/2023]
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Abstract
As medical use of cannabis is increasingly legalized worldwide, a better understanding of the medical and hazardous effects of this drug is imperative. The pain associated with rheumatic diseases is considered a prevalent indication for medicinal cannabis in various countries. Thus far, preliminary clinical trials have explored the effects of cannabis on rheumatoid arthritis, osteoarthritis and fibromyalgia; preliminary evidence has also found an association between the cannabinoid system and other rheumatic conditions, including systemic sclerosis and juvenile idiopathic arthritis. The potential medicinal effects of cannabis could be attributable to its influence on the immune system, as it exerts an immunomodulatory effect on various immune cells, including T cells, B cells and macrophages. However, the available evidence is not yet sufficient to support the recommendation of cannabinoid treatment for rheumatic diseases.
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Makary P, Parmar JR, Mims N, Khanfar NM, Freeman RA. Patient Counseling Guidelines for the Use of Cannabis for the Treatment of Chemotherapy-Induced Nausea/Vomiting and Chronic Pain. J Pain Palliat Care Pharmacother 2019; 32:216-225. [PMID: 31070496 DOI: 10.1080/15360288.2019.1598531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The use of cannabis medications has grown in recent years for the symptomatic relief of chemotherapy-induced nausea/vomiting (CINV) and chronic pain (cancer-related and non-cancer-related). As states legalize the use of cannabis, it is important for pharmacists and other health care professionals to be aware of how to counsel patients receiving prescriptions for cannabis medications. The aim of this study was to develop patient counseling guidelines for the use of cannabis products in treatment of CINV and chronic pain. A literature search was performed using Medline/PubMed resources and Google Scholar between July 2015 and August 2018 using broad search terms, e.g., cannabinoids adverse effects, cannabis, natural cannabinoids, and tetrahydrocannabinol. Using the American Society of Health-System Pharmacists patient counseling guidelines and medical information on cannabis medications gathered from drug databases, a comprehensive counseling guideline was developed. Medical evidence of the use of natural cannabis medications that are smoked or orally ingested have not been studied as extensively as oral therapeutic agents currently available. Cannabis medications have become more prevalent by approval of legislators in several states. Hence, pharmacists and health care professionals should counsel patients effectively on its use. This guideline needs to be tested to assess its utility in patients.
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26
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Extraction, isolation and purification of tetrahydrocannabinol from the Cannabis sativa L. plant using supercritical fluid extraction and solid phase extraction. J Supercrit Fluids 2019. [DOI: 10.1016/j.supflu.2019.01.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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27
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Borgonetti V, Governa P, Montopoli M, Biagi M. Cannabis sativa L. Constituents and Their Role in Neuroinflammation. ACTA ACUST UNITED AC 2019. [DOI: 10.2174/1573407214666180703130525] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The interest in Cannabis sativa L. phytocomplex as a medicinal tool is a recently-emerging topic. Neurodegenerative diseases represent a promising field of application for cannabis and its preparations, as most of this pathologic conditions relies on an inflammatory etiology. Several cannabis constituents display anti-inflammatory effects targeting multiple pathways. In this review, a comprehensive overview of the available literature on C. sativa constituents activities in neuroinflammation is given. On the basis that the anti-inflammatory activity of cannabis is not attributable to only a single constituent, we discuss the possible advantages of administering the whole phytocomplex in order to fully exploit the “entourage effect” in neuroinflammatory-related conditions.
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Affiliation(s)
| | | | | | - Marco Biagi
- SIFITLab, Via Laterina 8, 53100 Siena, Italy
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28
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Cooke AC, Knight KR, Miaskowski C. Patients' and clinicians' perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 63:23-28. [PMID: 30472467 DOI: 10.1016/j.drugpo.2018.09.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prevalence of opioid-associated morbidity and mortality underscores the need for research on non-opioid treatments for chronic non-cancer pain (CNCP). Pain is the most common medical condition for which patients request medical cannabis. Limited research indicates that patients are interested in cannabis as a potential addition to or replacement for opioid medication. This analysis reports on CNCP patient and clinician perceptions about the co-use of cannabis and opioids for CNCP management. METHODS We interviewed 23 clinicians and 46 CNCP patients, using semi-structured interview guides, from six safety-net clinics across the San Francisco Bay Area, and 5 key stakeholders involved in CNCP management. We used a modified grounded theory approach to code and analyze transcripts. RESULTS CNCP patients described potential benefits of co-use of cannabis and opioids for pain management and concerns about dosing and addictive potential. Patients reported seeking cannabis when unable to obtain prescription opioids. Clinicians stated that their patients reported cannabis being helpful in managing pain symptoms. Clinicians expressed concerns about the potential exacerbation of mental health issues resulting from cannabis use. CONCLUSION Clinicians are hampered by a lack of clinically relevant information about cannabis use, efficacy and side-effects. Currently no guidelines exist for clinicians to address opioid and cannabis co-use, or to discuss the risk and benefits of cannabis for CNCP management, including side effects. Cannabis and opioid co-use was commonly reported by patients in our sample, yet rarely addressed during clinical CNCP care. Further research is needed on the risks and benefits of cannabis and opioid co-use.
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Affiliation(s)
- Alexis C Cooke
- Department of Psychiatry, University of California, San Francisco CA, United States.
| | - Kelly R Knight
- Department of Anthropology, History and Social Medicine, University of California, San Francisco CA, United States
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco CA, United States
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Saadeh CE, Rustem DR. Medical Marijuana Use in a Community Cancer Center. J Oncol Pract 2018; 14:e566-e578. [DOI: 10.1200/jop.18.00057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: The primary purpose of this study was to compare the incidence of marijuana use between patients with early- versus advanced-stage cancers. Differences in adverse effects, drug-drug interactions, and drug-disease interactions between those who use marijuana and those who do not were also compared. Methods: Patients age 18 years and older who were receiving chemotherapy were asked to complete an electronic self-reported questionnaire. In addition to questions about patient demographics, current adverse effects, cancer type and stage, comorbidities, performance status, treatment regimen, and general marijuana use, those patients who used marijuana within the last 30 days (current marijuana users) were asked additional questions about the route and frequency of marijuana administration, about reason(s) for use, about possession of a marijuana card, and if they had received any counseling about marijuana. Drug-drug and drug-disease interactions were also analyzed. Results: The overall incidence of marijuana use was 18.3% (32 of 175 patients). The incidence of marijuana use in patients with early- versus advanced-stage cancers was 19.6% (11 of 56 patients) versus 17.6% (21 of 119 patients; P = .75). Patients who use marijuana reported more pain, nausea, appetite issues, and anxiety. There were more drug-drug interactions associated with marijuana use, primarily with concurrent CNS depressants. The frequency of drug-disease interactions between those who use marijuana versus those who do not was similar. Conclusion: Approximately one in five patients with cancer who were receiving chemotherapy were using marijuana, and the frequency was equal in early- and advanced-stage cancer groups. The risks versus benefits should be discussed with all patients who use marijuana.
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Affiliation(s)
- Claire E. Saadeh
- Ferris State University College of Pharmacy, Big Rapids; and Herbert Herman Cancer Center, Lansing, MI
| | - Danielle R. Rustem
- Ferris State University College of Pharmacy, Big Rapids; and Herbert Herman Cancer Center, Lansing, MI
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Lee G, Yang E, Kim S, Park CS, Park YS, Jin YH. Parapheromones Suppress Chemotherapy Side Effects. J Pharmacol Exp Ther 2018; 367:215-221. [DOI: 10.1124/jpet.118.251363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/17/2018] [Indexed: 02/02/2023] Open
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Bouquié R, Deslandes G, Mazaré H, Cogné M, Mahé J, Grégoire M, Jolliet P. Cannabis and anticancer drugs: societal usage and expected pharmacological interactions - a review. Fundam Clin Pharmacol 2018; 32:462-484. [DOI: 10.1111/fcp.12373] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Régis Bouquié
- Laboratoire de Biologie Médicale; Centre Hospitalier Léon-Jean Grégory; avenue du Roussillon 66330 Thuir France
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
- EA 4275 Biostatistique; Pharmacoépidémiologie et Mesures Subjectives en Santé; Nantes University Hospital; Nantes France
| | - Guillaume Deslandes
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
| | - Hélène Mazaré
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
| | - Marion Cogné
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
| | - Julien Mahé
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
| | - Matthieu Grégoire
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections; Nantes University Hospital; Nantes France
| | - Pascale Jolliet
- Clinical Pharmacology Department; Nantes University Hospital; institut de biologie; 9 quai Moncousu 44093 Nantes Cedex 1 France
- EA 4275 Biostatistique; Pharmacoépidémiologie et Mesures Subjectives en Santé; Nantes University Hospital; Nantes France
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An Atmospheric Pressure Chemical Ionization MS/MS Assay Using Online Extraction for the Analysis of 11 Cannabinoids and Metabolites in Human Plasma and Urine. Ther Drug Monit 2018. [PMID: 28640062 DOI: 10.1097/ftd.0000000000000427] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although, especially in the United States, there has been a recent surge of legalized cannabis for either recreational or medicinal purposes, surprisingly little is known about clinical dose-response relationships, pharmacodynamic and toxicodynamic effects of cannabinoids such as Δ9-tetrahydrocannabinol (THC). Even less is known about other active cannabinoids. METHODS To address this knowledge gap, an online extraction, high-performance liquid chromatography coupled with tandem mass spectrometry method for simultaneous quantification of 11 cannabinoids and metabolites including THC, 11-hydroxy-Δ9-tetrahydrocannabinol, 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid, 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid glucuronide (THC-C-gluc), cannabinol, cannabidiol, cannabigerol, cannabidivarin, Δ9-tetrahydrocannabivarin (THCV), and 11-nor-9-carboxy-Δ9-tetrahydrocannabivarin (THCV-COOH) was developed and validated in human urine and plasma. RESULTS In contrast to atmospheric pressure chemical ionization, electrospray ionization was associated with extensive ion suppression in plasma and urine samples. Thus, the atmospheric pressure chemical ionization assay was validated showing a lower limit of quantification ranging from 0.39 to 3.91 ng/mL depending on study compound and matrix. The upper limit of quantification was 400 ng/mL except for THC-C-gluc with an upper limit of quantification of 2000 ng/mL. The linearity was r > 0.99 for all analyzed calibration curves. Acceptance criteria for intrabatch and interbatch accuracy (85%-115%) and imprecision (<15%) were met for all compounds. In plasma, the only exceptions were THCV (75.3%-121.2% interbatch accuracy) and cannabidivarin (interbatch imprecision, 15.7%-17.2%). In urine, THCV did not meet predefined acceptance criteria for intrabatch accuracy. CONCLUSIONS This assay allows for monitoring not only THC and its major metabolites but also major cannabinoids that are of interest for marijuana research and clinical practice.
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Contreras T, Bravo-Soto G, Rada G. Do cannabinoids constitute a therapeutic alternative for insomnia? Medwave 2018; 18:e7152. [PMID: 29474349 DOI: 10.5867/medwave.2018.01.7151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION It has been suggested that cannabinoids would constitute a therapeutic alternative for patients with insomnia. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified eight systematic reviews including three studies overall, of which two were randomized trials. We concluded it is not clear whether cannabinoids have an effect on insomnia severity or on sleep quality; that they might have no effect on sleep conciliation, sleep awakening or behavior during wakefulness, and are probably associated with frequent adverse effects.
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Affiliation(s)
- Tania Contreras
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Gonzalo Bravo-Soto
- Proyecto Epistemonikos, Santiago, Chile; Centro Evidencia UC, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Rada
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro Evidencia UC, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; The Cochrane Collaboration; GRADE working group. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Centro de Innovación UC Anacleto Angelini, Avda. Vicuña Mackenna 4860, Macul, Santiago, Chile
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Do recreational cannabis users, unlicensed and licensed medical cannabis users form distinct groups? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 42:15-21. [DOI: 10.1016/j.drugpo.2016.11.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/13/2016] [Accepted: 11/20/2016] [Indexed: 01/14/2023]
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Gazibara T, Prpic M, Maric G, Pekmezovic T, Kisic-Tepavcevic D. Medical Cannabis in Serbia: The Survey of Knowledge and Attitudes in an Urban Adult Population. J Psychoactive Drugs 2017. [DOI: 10.1080/02791072.2017.1292434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Tatjana Gazibara
- Teaching Assistant, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Prpic
- Medical Student, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gorica Maric
- Teaching Assistant, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Professor, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Darija Kisic-Tepavcevic
- Associate Professor, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Pergolizzi JV, Taylor R, LeQuang JA, Zampogna G, Raffa RB. Concise review of the management of iatrogenic emesis using cannabinoids: emphasis on nabilone for chemotherapy-induced nausea and vomiting. Cancer Chemother Pharmacol 2017; 79:467-477. [PMID: 28235999 DOI: 10.1007/s00280-017-3257-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 12/11/2022]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a prevalent, distressing, and burdensome side effect of cancer chemotherapy. It is estimated to affect the majority of patients receiving certain anti-cancer drug regimens and can be treatment-limiting, even for life-saving medications. Despite seemingly numerous options, such as antimuscarinic anticholinergics, antihistamines, 5-HT3 receptor antagonists, dopamine receptor antagonists, and neurokinin-1 receptor antagonists, preventative therapies are often inadequately effective, particularly for "delayed CINV"-leaving an important unmet clinical need. Cannabinoid receptor agonists, by virtue of their unique mechanism of action and efficacy and safety data reported in clinical trials, appear to offer a useful additional option. The mechanistic value of cannabinoids has been well known for many years, but these agents may have been underutilized in the past because of the notoriety and legal status of marijuana. While botanical marijuana contains nearly 500 components, including the psychoactive tetrahydrocannabinol (THC), nabilone is an established, single-entity synthetic cannabinoid receptor agonist that has become the focus of renewed interest. We review the basic pharmacology and clinical trial data of nabilone for use in prophylaxis and treatment of CINV.
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Affiliation(s)
| | - Robert Taylor
- NEMA Research, Inc., 868 106th Ave North, Naples, FL, 34108, USA
| | - Jo Ann LeQuang
- NEMA Research, Inc., 868 106th Ave North, Naples, FL, 34108, USA.
| | | | - Robert B Raffa
- University of Arizona College of Pharmacy, Tucson, AZ, USA
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Medical Marijuana: Just the Beginning of a Long, Strange Trip? Phys Ther 2017; 97:239-248. [PMID: 27660328 DOI: 10.2522/ptj.20160367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/16/2016] [Indexed: 12/12/2022]
Abstract
Medical marijuana continues to gain acceptance and become legalized in many states. Various species of the marijuana plant have been cultivated, and this plant can contain up to 100 active compounds known as cannabinoids. Two cannabinoids seem the most clinically relevant: Δ9-tetrahydrocannabinol (THC), which tends to produce the psychotropic effects commonly associated with marijuana, and cannabidiol (CBD), which may produce therapeutic effects without appreciable psychoactive properties. Smoking marijuana, or ingesting extracts from the whole plant orally (in baked goods, teas, and so forth), introduces variable amounts of THC, CBD, and other minor cannabinoids into the systemic circulation, where they ultimately reach the central and peripheral nervous systems. Alternatively, products containing THC, CBD, or a combination of both compounds, can be ingested as oral tablets or via sprays applied to the oral mucosal membranes. These products may provide a more predictable method for delivering a known amount of specific cannabinoids into the body. Although there is still a need for randomized controlled trials, preliminary studies have suggested that medical marijuana and related cannabinoids may be beneficial in treating people with chronic pain, inflammation, spasticity, and other conditions seen commonly in physical therapist practice. Physical therapists, therefore, should be aware of the options that are available for patients considering medical marijuana and should be ready to provide information for these patients. Clinicians also should be aware that marijuana can produce untoward effects on cognition, coordination, balance, and cardiovascular and pulmonary function and should be vigilant for any problems that may arise if patients are using cannabinoids during physical rehabilitation.
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Vin-Raviv N, Akinyemiju T, Meng Q, Sakhuja S, Hayward R. Marijuana use and inpatient outcomes among hospitalized patients: analysis of the nationwide inpatient sample database. Cancer Med 2016; 6:320-329. [PMID: 27891823 PMCID: PMC5269570 DOI: 10.1002/cam4.968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/18/2016] [Accepted: 10/21/2016] [Indexed: 12/30/2022] Open
Abstract
The purpose of this paper is to examine the relationship between marijuana use and health outcomes among hospitalized patients, including those hospitalized with a diagnosis of cancer. A total of 387,608 current marijuana users were identified based on ICD‐9 codes for marijuana use among hospitalized patients in the Nationwide Inpatient Sample database between 2007 and 2011. Logistic regression analysis was performed to determine the association between marijuana use and heart failure, cardiac disease, stroke, and in‐hospital mortality. All models were adjusted for age, gender, race, residential income, insurance, residential region, pain, and number of comorbidities. Among hospitalized patients, marijuana use was associated with a 60% increased odds of stroke (OR: 1.60, 95% CI: 1.44–1.77) compared with non‐users, but significantly reduced odds of heart failure (OR: 0.78, 95% CI: 0.75–0.82), cardiac disease (OR: 0.86, 95% CI: 0.82–0.91), or in‐hospital mortality (OR: 0.41, 95% CI: 0.38–0.44). Among cancer patients, odds of in‐hospital mortality was significantly reduced among marijuana users compared with non‐users (OR: 0.44, 95% CI: 0.35–0.55). Hospitalized marijuana users were more likely to experience a stroke compared with non‐users, but less likely to experience in‐hospital mortality. Prospective studies will be needed to better characterize the health effects of marijuana use, especially among older, sicker, and/or hospitalized patients. In the meantime, conversations regarding marijuana use/misuse may be warranted in the clinical setting in order for patients and healthcare providers to adequately weigh the anticipated benefits of marijuana use with potentially significant health risks.
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Affiliation(s)
- Neomi Vin-Raviv
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado.,School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama.,Comprehensive Cancer Center, University of Alabama School of Public Health, Birmingham, Alabama
| | - Qingrui Meng
- Department of Biostatistics, University of Alabama School of Public Health, Birmingham, Alabama
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama
| | - Reid Hayward
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado.,School of Sport and Exercise Science, University of Northern Colorado, Greeley, Colorado
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Sznitman SR, Goldberg V, Sheinman-Yuffe H, Flechter E, Bar-Sela G. Storage and disposal of medical cannabis among patients with cancer: Assessing the risk of diversion and unintentional digestion. Cancer 2016; 122:3363-3370. [DOI: 10.1002/cncr.30185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Sharon R. Sznitman
- Department of Health Promotion, School of Public Health; University of Haifa; Haifa Israel
| | | | | | | | - Gil Bar-Sela
- Division of Oncology; Rambam Health Care Campus; Haifa Israel
- Integrated Oncology and Palliative Care Unit, Rambam Health Care Campus; Technion-Israel Institute of Technology; Haifa Israel
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Fraguas-Sánchez AI, Fernández-Carballido A, Torres-Suárez AI. Phyto-, endo- and synthetic cannabinoids: promising chemotherapeutic agents in the treatment of breast and prostate carcinomas. Expert Opin Investig Drugs 2016; 25:1311-1323. [PMID: 27633508 DOI: 10.1080/13543784.2016.1236913] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The term 'cannabinoids' designates a family of compounds with activity upon cannabinoid receptors. Cannabinoids are classified in three groups: phytocannabinoids, endocannabinoids, and the synthetic analogues of both groups. They have become a promising tool in the treatment of cancer disease, not only as palliative agents, but also as antitumor drugs, due to their ability to inhibit the proliferation, adhesion, migration, invasion, and angiogenesis of tumour cells. Two of the cancers where they have shown high anticancer activity are breast and prostate tumours. Despite this potential clinical interest, several studies have also reported that cannabinoids can stimulate the proliferation of cancer cells at very low concentrations. Areas covered: The aim of this review is to evaluate the promising chemotherapeutic utility of phytocannabinoids, endocannabinoids, and synthetic cannabinoids in breast and prostate cancer. Expert opinion: Cannabinoids, in particular the non-psychoactive CBD, may be promising tools in combination therapy for breast and prostate cancer, due to their direct antitumor effects, their ability to improve the efficacy of conventional antitumor drugs and their usefulness as palliative treatment. Nevertheless, deeper studies to fully establish the mechanisms responsible for their antitumour and pro-tumour properties and their formulation in efficient delivery systems remain to be established.
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Affiliation(s)
- A I Fraguas-Sánchez
- a Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy , Complutense University of Madrid , Madrid , Spain
| | - A Fernández-Carballido
- a Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy , Complutense University of Madrid , Madrid , Spain.,b Institute of Industrial Pharmacy , Complutense University of Madrid , Madrid , Spain
| | - A I Torres-Suárez
- a Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy , Complutense University of Madrid , Madrid , Spain.,b Institute of Industrial Pharmacy , Complutense University of Madrid , Madrid , Spain
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Sznitman SR, Bretteville-Jensen AL. Public opinion and medical cannabis policies: examining the role of underlying beliefs and national medical cannabis policies. Harm Reduct J 2015; 12:46. [PMID: 26467203 PMCID: PMC4606899 DOI: 10.1186/s12954-015-0082-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/07/2015] [Indexed: 12/30/2022] Open
Abstract
Background Debate about medical cannabis legalization are typically informed by three beliefs: (1) cannabis has medical effects, (2) medical cannabis is addictive and (3) medical cannabis legalization leads to increased used of cannabis for recreational purposes (spillover effects). We examined how strongly these beliefs are associated with public support for medical cannabis legalization and whether this association differs across divergent medical cannabis policy regimes. Methods Robust regression analysis was used to analyse data derived from two nationally representative samples of adults participating in comparable cross-sectional online surveys in one country where medical cannabis smoking is illegal (Norway, n = 2175, 51 % male) and in one country where medical cannabis smoking is legal (Israel, n = 648, 49 % male). Results The belief that cannabis has medical benefits was more strongly related to support for medical cannabis legalization than were beliefs about addiction and spillover effects. While the support for medical cannabis legalization was stronger in Israel than in Norway (78 vs. 51 %, p < 0.01), the belief variables had, in general, more impact on the policy stand in Norway. Conclusion The belief that cannabis has medical benefits is particularly salient for support for medical cannabis legalization. It is possible that the recent surge in evidence supporting the medical benefits of cannabis will increase the belief about medical benefits of cannabis in the general population which may in turn increase public support for medical cannabis legalization. Results also suggest that once medical cannabis is legalized, factors beyond cannabis-specific beliefs will increasingly influence medical cannabis legalization support. These conclusions are, however, only suggestive as the current study is based on cross-sectional data. Hopefully, future research will be able to capitalize on changes in medical cannabis policies and conduct longitudinal studies that enable an examination of the causal relation between public opinion and medical cannabis policy changes.
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Affiliation(s)
- Sharon R Sznitman
- School of Public Health, University of Haifa, Eshkol Tower, room 705, Mt. Carmel, 3190501, Haifa, Israel.
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