1
|
Ibrahim EA, Radwan MM, Gul W, Majumdar CG, Hadad GM, Abdel Salam RA, Ibrahim AK, Ahmed SA, Chandra S, Lata H, ElSohly MA, Wanas AS. Quantitative Determination of Cannabis Terpenes Using Gas Chromatography-Flame Ionization Detector. Cannabis Cannabinoid Res 2023; 8:899-910. [PMID: 36322895 PMCID: PMC10589468 DOI: 10.1089/can.2022.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Background: Cannabis has a long history of being credited with centuries of healing powers for millennia. The cannabis plant is a rich source of cannabinoids and terpenes. Each cannabis chemovar exhibits a different flavor and aroma, which are determined by its terpene content. Methods: In this study, a gas chromatography-flame ionization detector method was developed and validated for the determination of the 10 major terpenes in the main three chemovars of Cannabis sativa L. with n-tridecane used as the internal standard following the standard addition method. The 10 major terpenes (monoterpenes and sesquiterpenes) are α-pinene, β-pinene, β-myrcene, limonene, terpinolene, linalool, α-terpineol, β-caryophyllene, α-humulene, and caryophyllene oxide. The method was validated according to Association of Official Analytical Chemists guidelines. Spike recovery studies for all terpenes were carried out on placebo cannabis material and indoor-growing high THC chemovar with authentic standards. Results: The method was linear over the calibration range of 1-100 μg/mL with r2>0.99 for all terpenes. The limit of detection and limit of quantification were calculated to be 0.3 and 1.0 μg/mL, respectively, for all terpenes. The accuracy (%recovery) at all levels ranged from 89% to 104% and 90% to 111% for placebo and indoor-growing high THC chemovar, respectively. The repeatability and intermediate precision of the method were evaluated by the quantification of target terpenes in the three different C. sativa chemovars, resulting in acceptable relative standard deviations (less than 10%). Conclusions: The developed method is simple, sensitive, reproducible, and suitable for the detection and quantification of monoterpenes and sesquiterpenes in C. sativa biomass.
Collapse
Affiliation(s)
- Elsayed A. Ibrahim
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi, USA
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Mohamed M. Radwan
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi, USA
| | - Waseem Gul
- ElSohly Laboratories, Inc., Oxford, Mississippi, USA
| | - Chandrani G. Majumdar
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi, USA
| | - Ghada M. Hadad
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Randa A. Abdel Salam
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Amany K. Ibrahim
- Department of Pharmacognosy, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Safwat A. Ahmed
- Department of Pharmacognosy, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Suman Chandra
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi, USA
| | - Hemant Lata
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi, USA
| | - Mahmoud A. ElSohly
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi, USA
- ElSohly Laboratories, Inc., Oxford, Mississippi, USA
- Department of Pharmaceutical and Drug Delivery, School of Pharmacy, The University of Mississippi, University, Mississippi, USA
| | - Amira S. Wanas
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, Mississippi, USA
- Department of Pharmacognosy, Faculty of Pharmacy, Minia University, Minia, Egypt
| |
Collapse
|
2
|
Burillo-Putze G, Richards JR, Rodríguez-Jiménez C, Sanchez-Agüera A. Pharmacological management of cannabinoid hyperemesis syndrome: an update of the clinical literature. Expert Opin Pharmacother 2022; 23:693-702. [DOI: 10.1080/14656566.2022.2049237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - John R. Richards
- Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Consuelo Rodríguez-Jiménez
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain
- Clinical Pharmacology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | |
Collapse
|
3
|
Zylla D, Steele G, Eklund J, Mettner J, Arneson T. Oncology Clinicians and the Minnesota Medical Cannabis Program: A Survey on Medical Cannabis Practice Patterns, Barriers to Enrollment, and Educational Needs. Cannabis Cannabinoid Res 2018; 3:195-202. [PMID: 30426072 PMCID: PMC6225592 DOI: 10.1089/can.2018.0029] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Medical cannabis has been available in the State of Minnesota since July 2015 through the Minnesota Medical Cannabis Program (MMCP). Objectives: Our study aimed to delineate oncology providers' views on medical cannabis, identify barriers to patient enrollment, and assess clinicians' interest in a clinical trial of medical cannabis in patients with stage IV cancer. Methods: From June to August 2017, we distributed a 14-question survey to Minnesota oncology physicians, advanced practice nurses, and physician assistants who care for adults and children with cancer. Descriptive analyses for each question were provided for all survey respondents. Results: Of the 529 eligible survey participants, 153 (29%) responded to our survey; 68 respondents were registered with the MMCP. Most identified themselves as a medical oncologist or medical oncology nurse practitioner/physician assistant (n=125, 82%), and most practiced in a community setting (n=102, 67%). Overall, 65% of respondents supported the use of medical cannabis. Perceived cost and inadequate research were the highest barriers to MMCP patient enrollment. The lowest barriers included lack of health group support for allowing certification of patients and risk of social stigma. Of all respondents, 36% lacked confidence in discussing the risks and benefits of medical cannabis, and 85% wanted more education. Conclusions: Although support for cannabis use in the cancer setting is growing, significant barriers remain. This study illustrates a clear need to give clinicians both data and education to guide their discussions about the benefits, risks, and cost considerations of using medical cannabis for cancer-related symptoms.
Collapse
Affiliation(s)
- Dylan Zylla
- Park Nicollet Oncology Research, HealthPartners Institute, Frauenshuh Cancer Center, Minneapolis, Minnesota.,HealthPartners Institute, HealthPartners, Minneapolis, Minnesota
| | - Grant Steele
- Park Nicollet Oncology Research, HealthPartners Institute, Frauenshuh Cancer Center, Minneapolis, Minnesota.,HealthPartners Institute, HealthPartners, Minneapolis, Minnesota
| | - Justin Eklund
- Park Nicollet Oncology Research, HealthPartners Institute, Frauenshuh Cancer Center, Minneapolis, Minnesota.,HealthPartners Institute, HealthPartners, Minneapolis, Minnesota
| | - Jeanne Mettner
- HealthPartners Institute, HealthPartners, Minneapolis, Minnesota
| | - Tom Arneson
- Minnesota Department of Health, St. Paul, Minnesota
| |
Collapse
|
4
|
Rochford C, Edgeworth D, Hashim M, Harmon D. Attitudes of Irish patients with chronic pain towards medicinal cannabis. Ir J Med Sci 2018; 188:267-272. [PMID: 29423824 DOI: 10.1007/s11845-018-1761-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medicinal cannabis use is topical in the media in Ireland. A recent Health Products Regulatory Authority review, however, has recommended against its use for patients with chronic pain. This is despite evidence for its effectiveness in this patient's cohort and the inadequate pain management of these patients. AIM The aim of this study was to evaluate the attitudes of Irish patients with chronic pain towards medicinal cannabis. METHODS After institutional ethics committee approval, a 12-item questionnaire (excluding demographics) was randomly assigned to patients attending a chronic pain clinic (University Hospital Limerick). The questionnaire was designed to incorporate patient's attitudes on a variety of medicinal cannabis related topics. RESULTS Ninety-six adult patients were surveyed. 88.54% agreed that cannabis should be legalised for chronic pain medicinal purposes. 80.21% believed it would have health benefits for them and 73.96% agreed it would be socially acceptable to use cannabis for this purpose. 33.33% perceived cannabis to be addictive while 68.75% would be willing to try it if prescribed by a medical professional. CONCLUSIONS The study highlights the attitudes of chronic pain patients in Ireland towards medicinal cannabis. It shows their desire to have medical cannabis legalised for chronic pain and that they view it as a reasonable pain management option.
Collapse
Affiliation(s)
- Ciaran Rochford
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Deirdre Edgeworth
- Department of Anesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland
| | - Mohammad Hashim
- Department of Anesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland
| | - Dominic Harmon
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| |
Collapse
|
5
|
Affiliation(s)
- Aniruddh P Behere
- Pediatric Behavioral Medicine, Helen DeVos Children's Hospital, Michigan State University, MI, USA
| | - Prakash B Behere
- Department of Psychiatry, D. Y. Patil Medical College and University, Kolhapur, Maharashtra, India
| | - T S Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore, Karnataka, India
| |
Collapse
|
6
|
Kaskie B, Ayyagari P, Milavetz G, Shane D, Arora K. The Increasing Use of Cannabis Among Older Americans: A Public Health Crisis or Viable Policy Alternative? THE GERONTOLOGIST 2017; 57:1166-1172. [DOI: 10.1093/geront/gnw166] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/06/2017] [Indexed: 11/15/2022] Open
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Kolena B, Petrovičová I, Trnovec T, Pilka T, Bičanová G. Marijuana: Views on Its Medical Use Recorded at the Slovak Social Network. JOURNAL OF DRUG EDUCATION 2016; 46:3-14. [PMID: 27282988 DOI: 10.1177/0047237916646442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We describe opinions on medical use of Cannabis sativa L under conditions of Slovakia (n = 717). Personal experience with marijuana was detected in 77.42% (n = 553) in age categories younger than 20 years (n = 96) and in 77.06% (n = 457) of adults. Almost 86% of respondents (n = 618) agreed with legal use of marijuana for medical purposes. Furthermore, respondents' views on legal usage of marijuana for medical purposes could be affected by availability of information (r = .12) and personal experience (r = .23). Negative impact of substance abuse in younger age-groups was recognized as threat (r = .47), but knowledge about harmful effect of marijuana use did not affect personal opinion for decriminalization (r = .38).
Collapse
Affiliation(s)
| | | | | | - Tomáš Pilka
- Constantine the Philosopher University in Nitra, Slovakia
| | | |
Collapse
|
9
|
Medical marijuana use in head and neck squamous cell carcinoma patients treated with radiotherapy. Support Care Cancer 2016; 24:3517-24. [PMID: 27005465 DOI: 10.1007/s00520-016-3180-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/11/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE The purpose of the study was to better understand why patients with history of head and neck cancer (HNC) treated with radiotherapy are using medical marijuana (MM). METHODS Established HNC quality of life questionnaires and our own MM quality of life questionnaire were sent to 15 HNC patients treated at our institution who reported using MM. Patients are clinically disease free and currently using MM to manage long-term side effects after curative HNC treatment. RESULTS There was a 100 % response rate. Median time from treatment was 45 months (21-136 months). Most patients smoked marijuana (12 patients), while others reported ingestion (4 patients), vaporizing (3 patients), and use of homemade concentrated oil (1 patient). Six patients reported prior recreational marijuana use before diagnosis. MM provided benefit in altered sense, weight maintenance, depression, pain, appetite, dysphagia, xerostomia, muscle spasm, and sticky saliva. CONCLUSIONS HNC patients report MM use to help with long-term side effects of radiotherapy.
Collapse
|
10
|
Abstract
Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal use. For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia. Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects.
Collapse
Affiliation(s)
- D I Abrams
- Hematology-Oncology, San Francisco General Hospital; Integrative Oncology, UCSF Osher Center for Integrative Medicine; and University of California-San Francisco, San Francisco, CA, U.S.A
| |
Collapse
|
11
|
Andreae MH, Carter GM, Shaparin N, Suslov K, Ellis RJ, Ware MA, Abrams DI, Prasad H, Wilsey B, Indyk D, Johnson M, Sacks HS. Inhaled Cannabis for Chronic Neuropathic Pain: A Meta-analysis of Individual Patient Data. THE JOURNAL OF PAIN 2015; 16:1221-1232. [PMID: 26362106 PMCID: PMC4666747 DOI: 10.1016/j.jpain.2015.07.009] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/20/2015] [Accepted: 07/28/2015] [Indexed: 12/21/2022]
Abstract
UNLABELLED Chronic neuropathic pain, the most frequent condition affecting the peripheral nervous system, remains underdiagnosed and difficult to treat. Inhaled cannabis may alleviate chronic neuropathic pain. Our objective was to synthesize the evidence on the use of inhaled cannabis for chronic neuropathic pain. We performed a systematic review and a meta-analysis of individual patient data. We registered our protocol with PROSPERO CRD42011001182. We searched in Cochrane Central, PubMed, EMBASE, and AMED. We considered all randomized controlled trials investigating chronic painful neuropathy and comparing inhaled cannabis with placebo. We pooled treatment effects following a hierarchical random-effects Bayesian responder model for the population-averaged subject-specific effect. Our evidence synthesis of individual patient data from 178 participants with 405 observed responses in 5 randomized controlled trials following patients for days to weeks provides evidence that inhaled cannabis results in short-term reductions in chronic neuropathic pain for 1 in every 5 to 6 patients treated (number needed to treat = 5.6 with a Bayesian 95% credible interval ranging between 3.4 and 14). Our inferences were insensitive to model assumptions, priors, and parameter choices. We caution that the small number of studies and participants, the short follow-up, shortcomings in allocation concealment, and considerable attrition limit the conclusions that can be drawn from the review. The Bayes factor is 332, corresponding to a posterior probability of effect of 99.7%. PERSPECTIVE This novel Bayesian meta-analysis of individual patient data from 5 randomized trials suggests that inhaled cannabis may provide short-term relief for 1 in 5 to 6 patients with neuropathic pain. Pragmatic trials are needed to evaluate the long-term benefits and risks of this treatment.
Collapse
Affiliation(s)
- Michael H Andreae
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - George M Carter
- Foundation for Integrative AIDS Research, Brooklyn, New York
| | - Naum Shaparin
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kathryn Suslov
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, California
| | - Mark A Ware
- Department of Anesthesia and Family Medicine, McGill University, Montréal, Québec, Canada
| | - Donald I Abrams
- AIDS Program, San Francisco General Hospital, University of California, San Francisco, California
| | - Hannah Prasad
- Department of Physical Medicine and Rehabilitation, VA Northern California and University of California Davis Medical Center, Sacramento, California
| | - Barth Wilsey
- Department of Physical Medicine and Rehabilitation, VA Northern California and University of California Davis Medical Center, Sacramento, California
| | - Debbie Indyk
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Henry S Sacks
- Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
12
|
Systematic Review of the Use of Phytochemicals for Management of Pain in Cancer Therapy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:506327. [PMID: 26576425 PMCID: PMC4630373 DOI: 10.1155/2015/506327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/01/2015] [Indexed: 12/23/2022]
Abstract
Pain in cancer therapy is a common condition and there is a need for new options in therapeutic management. While phytochemicals have been proposed as one pain management solution, knowledge of their utility is limited. The objective of this study was to perform a systematic review of the biomedical literature for the use of phytochemicals for management of cancer therapy pain in human subjects. Of an initial database search of 1,603 abstracts, 32 full-text articles were eligible for further assessment. Only 7 of these articles met all inclusion criteria for this systematic review. The average relative risk of phytochemical versus control was 1.03 [95% CI 0.59 to 2.06]. In other words (although not statistically significant), patients treated with phytochemicals were slightly more likely than patients treated with control to obtain successful management of pain in cancer therapy. We identified a lack of quality research literature on this subject and thus were unable to demonstrate a clear therapeutic benefit for either general or specific use of phytochemicals in the management of cancer pain. This lack of data is especially apparent for psychotropic phytochemicals, such as the Cannabis plant (marijuana). Additional implications of our findings are also explored.
Collapse
|
13
|
Abstract
The use of cannabis is currently increasing according to U.S. Department of Health and Human Services (HHS). Surprisingly, cannabis use among burn patients is poorly reported in literature. In this study, rates of cannabis use in burn patients are compared with general population. Data from the National Burn Repository (NBR) were used to investigate incidence, demographics, and outcomes in relation to use of cannabis as evidenced by urine drug screen (UDS). Thousands of patients from the NBR from 2002 to 2011 were included in this retrospective study. Inclusion criteria were patients older than 12 years of age who received a drug screen. Data points analyzed were patients' age, sex, UDS status, mechanism of burn injury, total body surface area, length of stay, ICU days, and insurance characteristics. Incidence of cannabis use in burn patients from the NBR was compared against national general population rates (gathered by Health and Human Services) using chi-square tests. Additionally, the burn patient population was analyzed using bivariate analysis and t-tests to find differences in the characteristics of these patients as well as differences in outcomes. Seventeen thousand eighty out of over 112,000 patients from NBR had information available for UDS. The incidence of cannabis use is increasing among the general population, but the rate is increasing more quickly among patients in the burn patient population (P = .0022). In 2002, 6.0% of patients in burn units had cannabis+ UDS, which was comparable with national incidence of 6.2%. By 2011, 27.0% of burn patients tested cannabis+ while national incidence of cannabis use was 7.0%. Patients who test cannabis+ are generally men (80.1%, P < .0001) and are younger on average (35 years old vs 42, P < .0001). The most common mechanisms of injury among patients who test cannabis+ or cannabis- are similar. Flame injury makes up >60% of injuries, followed by scalds that are >15%. In comparing cannabis+/- patients, cannabis+ patients are more likely to be uninsured (25.2% vs 17.26%, P < .0001). Finally, patients who test cannabis+ have larger burns (TBSA% of 12.94 vs 10.98, P < .0001), have a longer length of stay (13.31 days vs 12.6, P = .16), spend more days in the ICU (7.84 vs 6.39, P = .0006), and have more operations (2.78 vs 2.05, P < .0001). The rate patients testing positive for cannabis in burn units is growing quickly. These patients are younger and are less likely to be insured. These patients also have larger burns, spend more time in ICUs, and have a greater number of operations. The increasing use of cannabis, as expected from legalization of cannabis in multiple states, among burn patient population may lead to increased burden on already tenuous health care resources.
Collapse
|
14
|
Goldsmith RS, Targino MC, Fanciullo GJ, Martin DW, Hartenbaum NP, White JM, Franklin P. Medical marijuana in the workplace: challenges and management options for occupational physicians. J Occup Environ Med 2015; 57:518-25. [PMID: 25951421 PMCID: PMC4410963 DOI: 10.1097/jom.0000000000000454] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although possession and use of marijuana is prohibited by federal law, legalization in four states (Alaska, Colorado, Oregon, and Washington) and allowance for palliation and therapy in 19 others may reposition the drug away from the fringes of society. This evolving legal environment, and growing scientific evidence of its effectiveness for select health conditions, requires assessment of the safety and appropriateness of marijuana within the American workforce. Although studies have suggested that marijuana may be used with reasonable safety in some controlled environments, there are potential consequences to its use that necessitate employer scrutiny and concern. Several drug characteristics must be considered, including Δ-tetrahydrocannabinol (Δ-THC, or THC) concentration, route of administration, dose and frequency, and pharmacokinetics, as well as the risks inherent to particular workplace environments.
Collapse
Affiliation(s)
- Robert S. Goldsmith
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Marcelo C. Targino
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Gilbert J. Fanciullo
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Douglas W. Martin
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Natalie P. Hartenbaum
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Jeremy M. White
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Phillip Franklin
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| |
Collapse
|
15
|
Abrams DI, Guzman M. Cannabis in cancer care. Clin Pharmacol Ther 2015; 97:575-86. [DOI: 10.1002/cpt.108] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/09/2015] [Indexed: 12/16/2022]
Affiliation(s)
- DI Abrams
- Hematology-Oncology, San Francisco General Hospital, Department of Medicine; University of California San Francisco; San Francisco California USA
| | - M Guzman
- Biochemistry and Molecular Biology, School of Biology; Complutense University, and Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Madrid Spain
| |
Collapse
|
16
|
Waissengrin B, Urban D, Leshem Y, Garty M, Wolf I. Patterns of use of medical cannabis among Israeli cancer patients: a single institution experience. J Pain Symptom Manage 2015; 49:223-30. [PMID: 24937161 DOI: 10.1016/j.jpainsymman.2014.05.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/11/2014] [Accepted: 05/28/2014] [Indexed: 01/28/2023]
Abstract
CONTEXT The use of the cannabis plant (Cannabis sativa L.) for the palliative treatment of cancer patients has been legalized in multiple jurisdictions including Israel. Yet, not much is currently known regarding the efficacy and patterns of use of cannabis in this setting. OBJECTIVES To analyze the indications for the administration of cannabis among adult Israeli cancer patients and evaluate its efficacy. METHODS Efficacy and patterns of use of cannabis were evaluated using physician-completed application forms, medical files, and a detailed questionnaire in adult cancer patients treated at a single institution. RESULTS Of approximately 17,000 cancer patients seen, 279 (<1.7%) received a permit for cannabis from an authorized institutional oncologist. The median age of cannabis users was 60 years (range 19-93 years), 160 (57%) were female, and 234 (84%) had metastatic disease. Of 151 (54%) patients alive at six months, 70 (46%) renewed their cannabis permit. Renewal was more common among younger patients and those with metastatic disease. Of 113 patients alive and using cannabis at one month, 69 (61%) responded to the detailed questionnaire. Improvement in pain, general well-being, appetite, and nausea were reported by 70%, 70%, 60%, and 50%, respectively. Side effects were mild and consisted mostly of fatigue and dizziness. CONCLUSION Cannabis use is perceived as highly effective by some patients with advanced cancer and its administration can be regulated, even by local authorities. Additional studies are required to evaluate the efficacy of cannabis as part of the palliative treatment of cancer patients.
Collapse
Affiliation(s)
- Barliz Waissengrin
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Damien Urban
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Yasmin Leshem
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Meital Garty
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
17
|
Abstract
Marijuana policy is rapidly evolving in the United States and elsewhere, with cannabis sales fully legalized and regulated in some jurisdictions and use of the drug for medicinal purposes permitted in many others. Amidst this political change, patients and families are increasingly asking whether cannabis and its derivatives may have therapeutic utility for a number of conditions, including developmental and behavioral disorders in children and adolescents. This review examines the epidemiology of cannabis use among children and adolescents, including those with developmental and behavioral diagnoses. It then outlines the increasingly well-recognized neurocognitive changes shown to occur in adolescents who use cannabis regularly, highlighting the unique susceptibility of the developing adolescent brain and describing the role of the endocannabinoid system in normal neurodevelopment. The review then discusses some of the proposed uses of cannabis in developmental and behavioral conditions, including attention-deficit hyperactivity disorder and autism spectrum disorder. Throughout, the review outlines gaps in current knowledge and highlights directions for future research, especially in light of a dearth of studies specifically examining neurocognitive and psychiatric outcomes among children and adolescents with developmental and behavioral concerns exposed to cannabis.
Collapse
|
18
|
Cannabis for Intractable Nausea after Bilateral Cerebellar Stroke. J Am Geriatr Soc 2014; 62:1199. [DOI: 10.1111/jgs.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Jaques SC, Kingsbury A, Henshcke P, Chomchai C, Clews S, Falconer J, Abdel-Latif ME, Feller JM, Oei JL. Cannabis, the pregnant woman and her child: weeding out the myths. J Perinatol 2014; 34:417-24. [PMID: 24457255 DOI: 10.1038/jp.2013.180] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/23/2013] [Accepted: 12/12/2013] [Indexed: 11/09/2022]
Abstract
To review and summarise the literature reporting on cannabis use within western communities with specific reference to patterns of use, the pharmacology of its major psychoactive compounds, including placental and fetal transfer, and the impact of maternal cannabis use on pregnancy, the newborn infant and the developing child. Review of published articles, governmental guidelines and data and book chapters. Although cannabis is one of the most widely used illegal drugs, there is limited data about the prevalence of cannabis use in pregnant women, and it is likely that reported rates of exposure are significantly underestimated. With much of the available literature focusing on the impact of other illicit drugs such as opioids and stimulants, the effects of cannabis use in pregnancy on the developing fetus remain uncertain. Current evidence indicates that cannabis use both during pregnancy and lactation, may adversely affect neurodevelopment, especially during periods of critical brain growth both in the developing fetal brain and during adolescent maturation, with impacts on neuropsychiatric, behavioural and executive functioning. These reported effects may influence future adult productivity and lifetime outcomes. Despite the widespread use of cannabis by young women, there is limited information available about the impact perinatal cannabis use on the developing fetus and child, particularly the effects of cannabis use while breast feeding. Women who are using cannabis while pregnant and breast feeding should be advised of what is known about the potential adverse effects on fetal growth and development and encouraged to either stop using or decrease their use. Long-term follow-up of exposed children is crucial as neurocognitive and behavioural problems may benefit from early intervention aimed to reduce future problems such as delinquency, depression and substance use.
Collapse
Affiliation(s)
- S C Jaques
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia
| | - A Kingsbury
- Mater Miseriacordiae Health Service Brisbane, Mater Mothers' Hospital, South Brisbane, QLD, Australia
| | - P Henshcke
- Mercy Women's Hospital, Heidelberg, Melbourne, VIC, Australia
| | | | - S Clews
- The Langton Centre, Surry Hills, NSW, Australia
| | - J Falconer
- The Langton Centre, Surry Hills, NSW, Australia
| | - M E Abdel-Latif
- The Centenary Hospital for Women and Children, Canberra, ACT, Australia
| | - J M Feller
- 1] The Sydney Children's Hospital, Randwick, NSW, Australia [2] School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - J L Oei
- 1] Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia [2] School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| |
Collapse
|
20
|
Olver IN, Eliott JA, Koczwara B. A qualitative study investigating chemotherapy-induced nausea as a symptom cluster. Support Care Cancer 2014; 22:2749-56. [PMID: 24805911 DOI: 10.1007/s00520-014-2276-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The prevention of chemotherapy-induced vomiting has been improved by antiemetics, but nausea remains problematic. This study explores the concept that this is partly because patients use the term nausea to describe a cluster of symptoms. METHODS A total of 42 cancer patients currently being treated (n = 21) or at least 6 months of past treatment (median 3.5 years; n = 21) with experience of chemotherapy-induced nausea consented to semi-structured interviews about nausea, which were transcribed and analysed. There were 24 females and 18 males. RESULTS The nature, number, location, duration and intensity of experiences described as nausea varied. Physical and psychological symptoms included dry retching, vomiting, anorexia, indigestion, change of taste, dizziness, bloating, reflux, inability to concentrate, fatigue and restlessness. Patients located nausea in sites ranging from the head/neck, sternum and mid and lower abdomen to the whole body. Some patients identified symptoms as part of the experience of nausea, and others described symptoms associated with nausea but separate from it. For most, distinguishing features of chemotherapy-induced (as opposed to other) nausea were its constant presence over time, fatigue and emotional associations with the cancer diagnosis. Triggers varied and included food (smells), negative emotions including anxiety, movement, smells (e.g., hand cream, cleaning products), treatment-related events, tooth brushing and mentioning nausea. Prescribed antiemetics were consistently noted as reducing the intensity of, but for many, not completely alleviating, nausea. Distraction and relaxation were preferred management techniques. CONCLUSION Control of nausea will require treating the particular cluster of symptoms which a patient is experiencing as nausea.
Collapse
Affiliation(s)
- Ian N Olver
- Cancer Council Australia, PO Box 4708, Sydney, New South Wales, 2000, Australia,
| | | | | |
Collapse
|
21
|
Ahmed AIA, van den Elsen GAH, van der Marck MA, Olde Rikkert MGM. Medicinal Use of Cannabis and Cannabinoids in Older Adults: Where Is the Evidence? J Am Geriatr Soc 2014; 62:410-1. [DOI: 10.1111/jgs.12661] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Amir I. A. Ahmed
- Department of Elderly; Vincent van Gogh; Venray the Netherlands
- Department of Geriatric Medicine; Radboud Alzheimer Centre; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Pharmacology and Toxicology; Radboud University Medical Center; Nijmegen the Netherlands
| | - Geke A. H. van den Elsen
- Department of Geriatric Medicine; Radboud Alzheimer Centre; Radboud University Medical Center; Nijmegen the Netherlands
| | - Marjolein A. van der Marck
- Department of Geriatric Medicine; Radboud Alzheimer Centre; Radboud University Medical Center; Nijmegen the Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric Medicine; Radboud Alzheimer Centre; Radboud University Medical Center; Nijmegen the Netherlands
| |
Collapse
|
22
|
|