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Tam A, Novak J, Ladbury C, Abuali T, Loscalzo M, Sun V, Amini A. Perception and Utilization of Cannabinoids in Patients Undergoing Radiation Treatment: Our Patients Are Curious. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00353-5. [PMID: 38462019 DOI: 10.1016/j.ijrobp.2024.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE Limited studies have described the utilization of cannabinoids among patients with cancer. This survey study aimed to characterize utilization patterns and perceptions of cannabinoid use for treatment-related side effects among patients receiving radiation treatment. METHODS AND MATERIALS This was an anonymous survey study of patients who were undergoing or recently completed radiation treatment at a comprehensive cancer center. Data on cannabinoid use during cancer treatment, reasons for the use of cannabinoids, perceived effects of cannabinoids, and formulations of usage were collected and summarized using descriptive statistics. RESULTS Of the 431 respondents, 111 (25.8%) patients reported cannabinoid use since their cancer diagnosis. Among the cannabinoid users, a majority (73.9%) experienced improvement in symptoms; 38.7% had better relief of cancer-treatment symptoms from cannabinoids in comparison to their prescription medications, and 16.2% lowered the amount of prescription pain medications needed after using cannabinoids. Cannabinoids appeared to be most effective in helping patients manage sleep (76.6%) and anxiety (72.1%). When asked about whether physicians should be discussing cannabinoid use, 45.1% of cannabinoid users wanted to speak with their doctors regarding its utilization. For patients who did not report cannabinoid use, a large majority (83.1%) never had discussions with their doctors regarding its utilization as part of their cancer care, and 34.8% wanted to learn more about cannabinoids from their doctors. CONCLUSIONS About 1 in 4 patients with cancer reported cannabinoid use to assist in symptom control. A majority had subjective alleviation of treatment-related symptoms from cannabinoid use. Regardless of cannabinoid use, a sizable percentage of patients never had any discussions about cannabinoids with their oncologists, with some expressing interest in learning more. Guidelines are needed to assist radiation oncologists on how cannabinoids may play a role in caring for patients.
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Affiliation(s)
- Andrew Tam
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Jennifer Novak
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Colton Ladbury
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Tariq Abuali
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope National Cancer Center, Duarte, California
| | - Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope National Cancer Center, Duarte, California
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California.
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Prateeksha P, Sharma VK, Singh SM, Sharma M, Diwan D, Hesham AEL, Guleria S, Nguyen QD, Gupta VK, Singh BN. Tetrahydrocannabinols: potential cannabimimetic agents for cancer therapy. Cancer Metastasis Rev 2023; 42:823-845. [PMID: 36696005 DOI: 10.1007/s10555-023-10078-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/31/2022] [Indexed: 01/26/2023]
Abstract
Tetrahydrocannabinols (THCs) antagonize the CB1 and CB2 cannabinoid receptors, whose signaling to the endocannabinoid system is essential for controlling cell survival and proliferation as well as psychoactive effects. Most tumor cells express a much higher level of CB1 and CB2; THCs have been investigated as potential cancer therapeutic due to their cannabimimetic properties. To date, THCs have been prescribed as palliative medicine to cancer patients but not as an anticancer modality. Growing evidence of preclinical research demonstrates that THCs reduce tumor progression by stimulating apoptosis and autophagy and inhibiting two significant hallmarks of cancer pathogenesis: metastasis and angiogenesis. However, the degree of their anticancer effects depends on the origin of the tumor site, the expression of cannabinoid receptors on tumor cells, and the dosages and types of THC. This review summarizes the current state of knowledge on the molecular processes that THCs target for their anticancer effects. It also emphasizes the substantial knowledge gaps that should be of concern in future studies. We also discuss the therapeutic effects of THCs and the problems that will need to be addressed in the future. Clarifying unanswered queries is a prerequisite to translating the THCs into an effective anticancer regime.
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Affiliation(s)
- Prateeksha Prateeksha
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, 79410, USA
| | - Vivek K Sharma
- Herbal Nanobiotechnology Lab, Pharmacology Division, CSIR-National Botanical Research Institute, Lucknow, 226001, India
| | - Shiv M Singh
- Department of Botany, Faculty of Science, Banaras Hindu University, Varanasi, 221005, India
| | - Minaxi Sharma
- Haute Ecole Provinciale de Hainaut-Condorcet, Rue de la Sucrerie, 7800, Mons, ATH, Belgium
| | - Deepti Diwan
- Washington University, School of Medicine, Saint Louis, MO 63108, USA
| | - Abd El-Latif Hesham
- Genetics Department, Faculty of Agriculture, Beni-Suef University, Beni-Suef, 62521, Egypt
| | - Sanjay Guleria
- Natural Product-cum-Nano Lab, Division of Biochemistry, Faculty of Basic Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology of Jammu, Main Campus Chatha, Jammu and Kashmir, 180009, India
| | - Quang D Nguyen
- Department of Bioengineering and Alcoholic Drink Technology, Institute of Food Science and Technology, Hungarian University of Agriculture and Life Sciences, Ménesi út 45, Budapest, H-1118, Hungary
| | - Vijai K Gupta
- Biorefining and Advanced Materials Research Center, SRUC, Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
- Center for Safe and Improved Food, SRUC, Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
| | - Brahma N Singh
- Herbal Nanobiotechnology Lab, Pharmacology Division, CSIR-National Botanical Research Institute, Lucknow, 226001, India.
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Sukpiriyagul A, Chartchaiyarerk R, Tabtipwon P, Smanchat B, Prommas S, Bhamarapravatana K, Suwannarurk K. Oral Tetrahydrocannabinol (THC):Cannabinoid (CBD) Cannabis Extract Adjuvant for Reducing Chemotherapy-Induced Nausea and Vomiting (CINV): A Randomized, Double-Blinded, Placebo-Controlled, Crossover Trial. Int J Womens Health 2023; 15:1345-1352. [PMID: 37608911 PMCID: PMC10440684 DOI: 10.2147/ijwh.s401938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023] Open
Abstract
Objective To evaluate the effects of tetrahydrocannabinol (THC):cannabinoid (CBD) (1:1) oil in reducing chemotherapy-induced nausea and vomiting (CINV) in gynecologic cancer patients who received moderate-to-high emetogenic chemotherapy. Material and Method This was a randomized, double-blinded, crossover and placebo-controlled trial. The study was conducted at the Gynecologic Oncology Units, Bhumibol Adulyadej Hospital (BAH), Royal Thai Air Force, Bangkok, Thailand, between August and November 2022. Participants had gynecologic cancer and received moderate-to-high emetogenic chemotherapy. Subjects were randomized and divided into two groups (A and B) based on the block of four randomization method. In the first cycle, groups A and B received THC:CBD extract oil 1:1 (TCEO) and placebo before chemotherapy administration. In the second cycle, groups A and B received placebo and TCEO before chemotherapy administration. Both groups received per protocol antiemetic medication during chemotherapy. Nausea score and side effects were recorded. Results A total of 60 cases were recruited. After exclusion, 54 cases were included in the study. The mean age of participants was 54.4 years. The mean body mass index (BMI) was 26.5 kg/m2. Fifty-nine (21/54) percent cases were the advanced stages of cancer. The nausea score of TCEO and placebo groups were 2.11 and 2.99, respectively (P < 0.05). More than half of the participants (36/54) reported dizziness and sedation side effects. Dry mouth, confusion, anxiety, and palpitation of both groups were comparable. Conclusion The cannabinoid extract (THC:CBD) was an appropriate adjuvant agent to reduce CINV in patients with gynecologic cancer who received high-emetogenic chemotherapy. Dizziness and sedation were the major side effects.
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Affiliation(s)
- Apichaya Sukpiriyagul
- Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air ForceBangkokThailand
| | - Ratiporn Chartchaiyarerk
- Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air ForceBangkokThailand
| | - Paluekpon Tabtipwon
- Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air ForceBangkokThailand
| | - Buppa Smanchat
- Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air ForceBangkokThailand
| | - Sinart Prommas
- Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air ForceBangkokThailand
| | - Kornkarn Bhamarapravatana
- Department of Preclinical Science, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
| | - Komsun Suwannarurk
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
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Poulsen JS, Nielsen CK, Pedersen NA, Wimmer R, Sondergaard TE, de Jonge N, Nielsen JL. Proteomic Changes in Methicillin-Resistant Staphylococcus aureus Exposed to Cannabinoids. JOURNAL OF NATURAL PRODUCTS 2023; 86:1690-1697. [PMID: 37411021 DOI: 10.1021/acs.jnatprod.3c00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a major human pathogen that causes a wide range of infections. Its resistance to β-lactam antibiotics complicates treatment due to the limited number of antibiotics with activity against MRSA. To investigate development of alternative therapeutics, the mechanisms that mediate antibiotic resistance in MRSA need to be fully understood. In this study, MRSA cells were subjected to antibiotic stress from methicillin in combination with three cannabinoid compounds and analyzed using proteomics to assess the changes in physiology. Subjecting MRSA to nonlethal levels of methicillin resulted in an increased production of penicillin-binding protein 2 (PBP2). Exposure to cannabinoids showed antibiotic activity against MRSA, and differential proteomics revealed reduced levels of proteins involved in the energy production as well as PBP2 when used in combination with methicillin.
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Affiliation(s)
- Jan Struckmann Poulsen
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, DK-9220, Aalborg East, Denmark
| | - Christina Kjærager Nielsen
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, DK-9220, Aalborg East, Denmark
| | - Nina Ahrendt Pedersen
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, DK-9220, Aalborg East, Denmark
| | - Reinhard Wimmer
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, DK-9220, Aalborg East, Denmark
| | - Teis Esben Sondergaard
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, DK-9220, Aalborg East, Denmark
| | - Nadieh de Jonge
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, DK-9220, Aalborg East, Denmark
| | - Jeppe Lund Nielsen
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, DK-9220, Aalborg East, Denmark
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Xiao TT, Phillips JC, Macartney G, Stacey D. Recommandation par les infirmières en oncologie concernant la prise de cannabis au Canada pour soulager les nausées et les vomissements induits par la chimiothérapie : étude des facteurs d’influence. Can Oncol Nurs J 2023; 33:310-320. [PMID: 38919899 PMCID: PMC11195795 DOI: 10.5737/23688076333310] [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: 06/27/2024] Open
Abstract
Une étude transversale descriptive a été réalisée pour déterminer les facteurs qui incitent les infirmières canadiennes en oncologie à suggérer la prise de cannabis à leurs patients pour soulager les nausées et vomissements induits par chimiothérapie (NVIC). Au total, 678 membres de l’Association canadienne des infirmières en oncologie (ACIO/CANO) ont reçu, entre le 8 février et le 10 avril 2022, une invitation à répondre au sondage, suivie de trois rappels. Une infirmière enseignante a aussi envoyé l’invitation à 131 autres infirmières en oncologie de l’est de l’Ontario. Le sondage s’appuyait sur le modèle d’utilisation de la recherche d’Ottawa. En tout, 27 personnes ont ouvert le lien du sondage et 25 l’ont rempli. Onze (47,8 %) d’entre elles ont répondu à la question sur l’efficacité du cannabis pour soulager les NVIC. Les trois principaux obstacles à recommander la prise de cannabis étaient la stigmatisation sociale, le manque de connaissances des infirmières et le manque de directives au sein du milieu de travail. Tous les participants ont relevé l’importance de la formation continue et de directives écrites sur le recours au cannabis pour soulager les NVIC. Le sondage a reçu peu de réponses, mais dans l’ensemble, les répondants se disaient mal préparés pour proposer la prise de cannabis en traitement des NVIC.
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Affiliation(s)
- Tianhao Tiffany Xiao
- École des sciences, infirmières, Université d'Ottawa, 451, route Smyth, Ottawa, (Ontario) K1H 8M5,
| | - J Craig Phillips
- École des sciences infirmières, Université d'Ottawa, 451, route, Smyth, Ottawa (Ontario) K1H 8M5,
| | - Gail Macartney
- Faculté des sciences infirmières, Université de l'Île-du-Prince-Édouard, 45 Paramount Dr, Charlottetown (Î.-P.-É.) C1E 0C6,
| | - Dawn Stacey
- École des sciences infirmières, Université d'Ottawa, 451, route, Smyth, Ottawa (Ontario) K1H 8M5,
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Xiao TT, Phillips JC, Macartney G, Stacey D. Factors influencing Canadian oncology nurses discussing cannabis use with patients experiencing chemotherapy-induced nausea. Can Oncol Nurs J 2023; 33:300-309. [PMID: 38919903 PMCID: PMC11195786 DOI: 10.5737/23688076333300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
A descriptive, cross-sectional study was conducted to determine factors influencing Canadian oncology nurses discussing cannabis use with patients experiencing chemotherapy-induced nausea (CIN). A survey invitation and three reminders were sent to 678 members of the Canadian Association of Nurses in Oncology (CANO) between February 8 and April 10, 2022. An educator sent an extra invitation to 131 oncology nurses in Eastern Ontario. The survey was based on the Ottawa Model of Research Use. Twenty-seven opened the link to the survey and 25 responded. Of 25 nurses, 11 (47.8%) correctly answered the knowledge question about the effectiveness of cannabis for CIN. The top three barriers to discussing cannabis use were social stigma, nurses' lack of knowledge, and lack of guidance within the workplace. All participants identified needing continuing education and written guidance about use of cannabis for CIN. Although few oncology nurses responded to the survey, most indicated feeling inadequately prepared to discuss cannabis use with patients experiencing CIN.
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Affiliation(s)
| | - J Craig Phillips
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5,
| | - Gail Macartney
- Faculty of Nursing, University of Prince, Edward Island, 45 Paramount Drive, Charlottetown, PE C1E 0C6,
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5,
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To J, Davis M, Sbrana A, Alderman B, Hui D, Mukhopadhyay S, Bouleuc C, Case AA, Amano K, Crawford GB, de Feo G, Tanco K, Garsed J. MASCC guideline: cannabis for cancer-related pain and risk of harms and adverse events. Support Care Cancer 2023; 31:202. [PMID: 36872397 DOI: 10.1007/s00520-023-07662-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Approximately 18% of patients with cancer use cannabis at one time as palliation or treatment for their cancer. We performed a systematic review of randomized cannabis cancer trials to establish a guideline for its use in pain and to summarize the risk of harm and adverse events when used for any indication in cancer patients. METHODS A systematic review of randomized trials with or without meta-analysis was carried out from MEDLINE, CCTR, Embase, and PsychINFO. The search involved randomized trials of cannabis in cancer patients. The search ended on November 12, 2021. The Jadad grading system was used for grading quality. Inclusion criteria for articles were randomized trials or systematic reviews of randomized trials of cannabinoids versus either placebo or active comparator explicitly in adult patients with cancer. RESULTS Thirty-four systematic reviews and randomized trials met the eligibility criteria for cancer pain. Seven were randomized trials involving patients with cancer pain. Two trials had positive primary endpoints, which could not be reproduced in similarly designed trials. High-quality systematic reviews with meta-analyses found little evidence that cannabinoids are an effective adjuvant or analgesic to cancer pain. Seven systematic reviews and randomized trials related to harms and adverse events were included. There was inconsistent evidence about the types and levels of harm patients may experience when using cannabinoids. CONCLUSION The MASCC panel recommends against the use of cannabinoids as an adjuvant analgesic for cancer pain and suggests that the potential risk of harm and adverse events be carefully considered for all cancer patients, particularly with treatment with a checkpoint inhibitor.
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Affiliation(s)
- Josephine To
- Division of Aged Care, Rehabilitation and Palliative Care, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Mellar Davis
- Palliative Care Department, Geisinger Medical System, Danville, USA.
| | | | | | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Carole Bouleuc
- Department of Supportive and Palliative Care, P.S.L. University, Institut Curie, Paris, France
| | - Amy A Case
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Division of Geriatrics and Palliative Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Gregory B Crawford
- Northern Adelaide Local Health Network, South Australia, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | | | - Kimberson Tanco
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Nukitram J, Kumarnsit E, Cheaha D. A 1:1 ratio of cannabidiol: tetrahydrocannabinol attenuates methamphetamine conditioned place preference in mice: A prospective study of antidopaminergic mechanism. Brain Res Bull 2023; 192:47-55. [PMID: 36336144 DOI: 10.1016/j.brainresbull.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022]
Abstract
A 1:1 ratio of cannabidiol to tetrahydrocannabinol (CT) was suggested to be safer for therapeutic purposes in many illnesses. However, CT effects on methamphetamine (METH) conditioned place preference (CPP) remained largely unexplored. This study aimed to examine the effects of CT on METH CPP mice evaluated by animal behaviors accompanied by local field potential (LFP) signals analysis. Male ICR mice were implanted with the LFP electrode in the ventral tegmental area (VTA) and the nucleus accumbens (NAc). Animals were next subjected to induce METH CPP by peritoneal injection with 1 mg/kg METH and 0.9 % NaCl on an alternate day for ten sessions and confined to the corresponding compartment for 30 min meanwhile control mice were given normal saline all day for both compartments. On testing day, either 10 mg/kg CT or 20 mg/kg bupropion (BP), a dopamine reuptake inhibitor, and VTA GABAergic suppressor were orally administered before CPP testing. The results revealed that CPP scores elevation was observed in the METH+vehicle and METH+BP mice, but this was reversed by CT treatment. Although both METH+vehicle and METH+BP enhanced the VTA delta power, NAc gamma I power, NAc delta-gamma coupling, and VTA-NAc gamma I coherence, changes in opposite trends of all mentioned parameters were seen by CT application. These improvements were postulated to involve the antidopaminergic effects of CT via modulations of neural signaling in the VTA and NAc. Altogether, the evidence-based study may suggest the use of CT as alternative drug for METH-seeking and craving therapy.
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Affiliation(s)
- Jakkrit Nukitram
- Physiology Program, Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla 90110, Thailand; Biosignal Research Center for Health, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla 90110, Thailand
| | - Ekkasit Kumarnsit
- Physiology Program, Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla 90110, Thailand; Biosignal Research Center for Health, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla 90110, Thailand.
| | - Dania Cheaha
- Biology Program, Division of Biological Science, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla 90110, Thailand; Biosignal Research Center for Health, Faculty of Science, Prince of Songkla University, Hatyai Campus, Hatyai, Songkhla 90110, Thailand
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Alderman B, Hui D, Mukhopadhyay S, Bouleuc C, Case AA, Amano K, Crawford GB, de Feo G, Sbrana A, Tanco K, To J, Garsed J, Davis M. Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/consensus guidance on the use of cannabinoids for gastrointestinal symptoms in patients with cancer. Support Care Cancer 2023; 31:39. [DOI: 10.1007/s00520-022-07480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
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Fernandes CE, Dolci JEL, Navarro LS, Allevato M, Constantino CF, Pereira RPA, Rieder CRDM, Torino F, Bernardo WM. Cannabis products: medical use. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:358-364. [PMID: 36921194 PMCID: PMC10004278 DOI: 10.1590/1806-9282.2023d693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 03/12/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Flávia Torino
- Ordem dos Advogados do Brasil – São Paulo (SP), Brazil
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Burkhard-Meier A, Rémi C, Lindner LH, von Bergwelt-Baildon M. Cannabis in der Onkologie – viel Rauch um nichts? Laryngorhinootologie 2022. [PMID: 36543223 DOI: 10.1055/a-1949-3296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ZusammenfassungDie medizinische Verwendung von Cannabis hat in den letzten Jahren in Europa und Nordamerika an Popularität gewonnen. Cannabinoide sind sowohl als Fertigarzneimittel als auch in Blüten- und Extraktform verfügbar. Der vorliegende Artikel legt den Fokus auf die supportive Therapie onkologischer Patienten. Mögliche Indikationen sind Schmerzen, Chemotherapie-bedingte Übelkeit und Erbrechen, Appetitlosigkeit und Geschmacksveränderungen. Trotz des enormen Hypes um Cannabis als Medizin ist die Evidenz für dessen Anwendung bei onkologischen Patienten unzureichend. Palliativpatienten mit refraktären Symptomen könnten jedoch geeignete Kandidaten für einen Therapieversuch darstellen. Der entscheidende Parameter für die Auswahl eines Cannabis-Arzneimittels ist die THC/CBD-Ratio. Orale Einnahmeformen bieten sich gerade für Cannabis-naive und ältere Patienten an. Psychische und kardiovaskuläre Nebenwirkungen sind nicht zu unterschätzen.
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Affiliation(s)
- Anton Burkhard-Meier
- Klinikum Grosshadern: Klinikum der Universitat Munchen Standort Grosshadern, München, GERMANY
| | - Constanze Rémi
- Klinik und Poliklinik für Palliativmedizin am Klinikum der LMU München, GERMANY
| | - Lars H. Lindner
- Medizinische Klinik und Poliklinik III am Klinikum der LMU München, GERMANY
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The Therapeutic Potential of the Endocannabinoid System in Age-Related Diseases. Biomedicines 2022; 10:biomedicines10102492. [PMID: 36289755 PMCID: PMC9599275 DOI: 10.3390/biomedicines10102492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/24/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022] Open
Abstract
The endocannabinoid system (ECS) dynamically regulates many aspects of mammalian physiology. ECS has gained substantial interest since growing evidence suggests that it also plays a major role in several pathophysiological conditions due to its ability to modulate various underlying mechanisms. Furthermore, cannabinoids, as components of the cannabinoid system (CS), have proven beneficial effects such as anti-inflammatory, immunomodulatory, neuromodulatory, antioxidative, and cardioprotective effects. In this comprehensive review, we aimed to describe the complex interaction between CS and most common age-related diseases such as neuro-degenerative, oncological, skeletal, and cardiovascular disorders, together with the potential of various cannabinoids to ameliorate the progression of these disorders. Since chronic inflammation is postulated as the pillar of all the above-mentioned medical conditions, we also discuss in this paper the potential of CS to ameliorate aging-associated immune system dysregulation.
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Jacobs RJ, Colon J, Kane MN. Medical Students’ Attitudes, Knowledge, and Beliefs about Medical Cannabis: A Qualitative Descriptive Study. Cureus 2022; 14:e28336. [PMID: 36168342 PMCID: PMC9502535 DOI: 10.7759/cureus.28336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background There has been increased attention given to understanding the uses of medical cannabis (MC) for symptom management of various medical conditions. Physicians receive minimal training in medical school and rely mostly on anecdotal evidence; by proxy, medical students generally do receive formal training in MC. It is unknown how medical students perceive MC, including its efficacy, appropriateness in medicine, its possible adverse effects, and its value for patients. This study investigated medical students’ perceived knowledge, beliefs, and attitudes toward MC to better understand their knowledge about and attitudes toward MC. Method Using a semi-structured interview guide, eight focus groups were conducted with 83 medical students via Zoom virtual meeting platform (Zoom Video Communications, Inc., San Jose, California, United States) in June 2022. The interviews were guided by the following content areas: (1) beliefs about cannabis' therapeutic utility, (2) perceived knowledge about MC, (3) the role of the physician regarding MC, (4) concern for cannabis’ adverse effects, and (5) MC education in the school curriculum. Data were analyzed using thematic analysis, an iterative, systematic process of coding patterns, and emerged themes in the interview data to explore medical students’ perceptions about MC. Themes were validated based on whether each theme captured distinct parts of the interview data and whether their content cohered meaningfully. Results Four themes emerged from the focus group interviews investigating medical students’ perceptions of MC: (1) erroneous beliefs about MC, (2) unreliable sources of information, (3) mixed attitudes toward legalization, and (4) desire for MC education while in medical school. Attitudes regarding MC in general, including legalization, varied by United States state of origin of the student and exposure to MC (e.g., use by family member). Conclusion MC seems to be a significant issue for medical trainees who might be required to recommend it to patients and manage coexisting therapies. Cultivating new knowledge about students’ perceptions and perceived knowledge about medicinal options and dosing of MC is critical for medical educators as they design undergraduate curricular initiatives for future physicians.
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14
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Bilbao A, Spanagel R. Medical cannabinoids: a pharmacology-based systematic review and meta-analysis for all relevant medical indications. BMC Med 2022; 20:259. [PMID: 35982439 PMCID: PMC9389720 DOI: 10.1186/s12916-022-02459-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Medical cannabinoids differ in their pharmacology and may have different treatment effects. We aimed to conduct a pharmacology-based systematic review (SR) and meta-analyses of medical cannabinoids for efficacy, retention and adverse events. METHODS We systematically reviewed (registered at PROSPERO: CRD42021229932) eight databases for randomized controlled trials (RCTs) of dronabinol, nabilone, cannabidiol and nabiximols for chronic pain, spasticity, nausea /vomiting, appetite, ALS, irritable bowel syndrome, MS, Chorea Huntington, epilepsy, dystonia, Parkinsonism, glaucoma, ADHD, anorexia nervosa, anxiety, dementia, depression, schizophrenia, PTSD, sleeping disorders, SUD and Tourette. Main outcomes and measures included patient-relevant/disease-specific outcomes, retention and adverse events. Data were calculated as standardized mean difference (SMD) and ORs with confidence intervals (CI) via random effects. Evidence quality was assessed by the Cochrane Risk of Bias and GRADE tools. RESULTS In total, 152 RCTs (12,123 participants) were analysed according to the type of the cannabinoid, outcome and comparator used, resulting in 84 comparisons. Significant therapeutic effects of medical cannabinoids show a large variability in the grade of evidence that depends on the type of cannabinoid. CBD has a significant therapeutic effect for epilepsy (SMD - 0.5[CI - 0.62, - 0.38] high grade) and Parkinsonism (- 0.41[CI - 0.75, - 0.08] moderate grade). There is moderate evidence for dronabinol for chronic pain (- 0.31[CI - 0.46, - 0.15]), appetite (- 0.51[CI - 0.87, - 0.15]) and Tourette (- 1.01[CI - 1.58, - 0.44]) and moderate evidence for nabiximols on chronic pain (- 0.25[- 0.37, - 0.14]), spasticity (- 0.36[CI - 0.54, - 0.19]), sleep (- 0.24[CI - 0.35, - 0.14]) and SUDs (- 0.48[CI - 0.92, - 0.04]). All other significant therapeutic effects have either low, very low, or even no grade of evidence. Cannabinoids produce different adverse events, and there is low to moderate grade of evidence for this conclusion depending on the type of cannabinoid. CONCLUSIONS Cannabinoids are effective therapeutics for several medical indications if their specific pharmacological properties are considered. We suggest that future systematic studies in the cannabinoid field should be based upon their specific pharmacology.
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Affiliation(s)
- Ainhoa Bilbao
- Behavioral Genetics Research Group, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
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15
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Rajabalizadeh R, Ghasemzadeh Rahbardar M, Hosseinzadeh H. Medicinal herbs in treating chemotherapy-induced nausea and vomiting: A review. Phytother Res 2022; 36:3691-3708. [PMID: 35841194 DOI: 10.1002/ptr.7563] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 12/22/2022]
Abstract
Cancer development entangles with mutation and selection for cells that progressively increase capacity for proliferation and metastasis at the cellular level. Surgery, chemotherapy, and radiotherapy are the standard treatments to manage several types of cancer. Chemotherapy is toxic for both normal and cancer cells and can induce unfavorable conditions, such as chemotherapy-induced nausea and vomiting (CINV), that reduce patients' quality of life. Emesis after chemotherapy is categorized into two classes acute and delayed. Since ancient times, herbal medicines have been used in various cultures to manage stomachache, vomiting, and nausea. In this manuscript, the antiemetic mechanisms of several herbal medicines and their preparations such as Zingiber officinale (5-HT, NK-1 receptor and muscarinic antagonist activity), Mentha spicata (5-HT antagonist activity), Scutellaria baicalensis (antioxidant activity), Persumac (useful in delayed phase through antioxidant, anti-inflammatory, and anti-contractile properties) and Rikkunshito (supportive in acute and delayed phase through 5-HT receptor antagonist activity) have been reviewed to show their potential effects on decreasing CINV and attract scientists attention to formulate more herbal medicine to alleviate CINV in cancer patients. However, it is crucial to say that additional high-quality investigations are required to firmly verify the clinical effectiveness and safety of each plant/compound.
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Affiliation(s)
- Reza Rajabalizadeh
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hossein Hosseinzadeh
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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16
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Burkhard-Meier A, Rémi C, Lindner LH, von Bergwelt-Baildon M. [Cannabis in oncology - much ado about nothing?]. Dtsch Med Wochenschr 2022; 147:916-922. [PMID: 35868317 DOI: 10.1055/a-1872-2749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The medical use of Cannabis has gained popularity in Europe and Northern America in recent years. Cannabinoids are available as finished pharmaceuticals, flowers and extracts. This article focuses on supportive medicine for oncological patients. Possible indications are pain, chemotherapy-induced nausea and vomiting, loss of appetite and altered taste perception. Despite the enormous cannabis hype in medicine, the evidence for its use in oncology patients is insufficient. However, palliative patients with refractory symptoms could be candidates for a therapeutic trial. The key parameter for choosing a cannabis medicinal product is the THC/CBD ratio. Oral forms of administration are particularly suitable for cannabis-naive and older patients. Mental and cardiovascular side effects should not be underestimated.
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Affiliation(s)
| | - Constanze Rémi
- Klinik und Poliklinik für Palliativmedizin am Klinikum der LMU München
| | - Lars H Lindner
- Medizinische Klinik und Poliklinik III am Klinikum der LMU München
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17
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Sex differences exist in the perceived relief of cancer symptoms with medical cannabis: results from the Quebec Cannabis Registry. Support Care Cancer 2022; 30:7863-7871. [PMID: 35723729 DOI: 10.1007/s00520-022-07193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study explored whether symptom relief differs by sex in patients with cancer receiving medical cannabis (MC) therapy. METHODS This is an analysis of data collected from patients with cancer enrolled in the Quebec Cannabis Registry. MC was initiated for the therapeutic management of cancer symptoms. Patients completed the revised Edmonton Symptom Assessment System (ESAS-r) questionnaire at baseline and 3-month follow-up. We examined the interaction between sex and time on each ESAS-r symptom and the interaction between time and tetrahydrocannabinol:cannabidiol (THC:CBD) ratios for each sex on total symptom burden. RESULTS The analysis included 358 patients (M: 171). There were no sex differences in baseline ESAS-r scores. Three months of MC therapy led to significant improvements in pain (M: - 1.4 ± 0.3, p < 0.001; F: - 1.1 ± 0.3, p < 0.01), tiredness (M: - 1.7 ± 0.4, p < 0.001; F: - 1.2 ± 0.4, p < 0.05), anxiety (M: - 1.1 ± 0.4, p < 0.05; F: - 1.2 ± 0.4, p < 0.001), and well-being (M: - 1.2 ± 0.4, p < 0.05; F: - 1.4 ± 0.4, p < 0.01) in both sexes. Only F perceived improved drowsiness (- 1.1 ± 0.4, p < 0.05), nausea (- 0.9 ± 0.3, p < 0.05), lack of appetite (- 1.7 ± 0.4, p < 0.001), and shortness of breath (- 0.9 ± 0.3, p < 0.05). From baseline to 3-month follow-up, THC-dominant MC significantly reduced pain (- 1.52 ± 0.52, p < 0.05) in M, whereas in F it diminished nausea (- 2.52 ± 0.70, p < 0.01) and improved well-being (- 2.41 ± 0.79, p < 0.05). THC:CBD-balanced products significantly reduced pain (- 1.48 ± 0.49, p < 0.05), tiredness (- 1.82 ± 0.62, p < 0.05), anxiety (- 1.83 ± 0.54, p < 0.05), and improved well-being (- 2.01 ± 0.56, p < 0.01) in M. CBD-dominant products did not offer significant symptom relief in either sex. CONCLUSION The perceived relief of cancer symptoms from MC differs between sexes. More randomized controlled trials are needed to confirm our findings.
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18
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Bogale K, Raup-Konsavage W, Dalessio S, Vrana K, Coates MD. Cannabis and Cannabis Derivatives for Abdominal Pain Management in Inflammatory Bowel Disease. Med Cannabis Cannabinoids 2022; 4:97-106. [PMID: 35224429 DOI: 10.1159/000517425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/22/2021] [Indexed: 12/15/2022] Open
Abstract
For centuries, cannabis and its components have been used to manage a wide variety of symptoms associated with many illnesses. Gastrointestinal (GI) diseases are no exception in this regard. Individuals suffering from inflammatory bowel disease (IBD) are among those who have sought out the ameliorating properties of this plant. As legal limitations of its use have eased, interest has grown from both patients and their providers regarding the potential of cannabis to be used in the clinical setting. Similarly, a growing number of animal and human studies have been undertaken to evaluate the impact of cannabis and cannabinoid signaling elements on the natural history of IBD and its associated complications. There is little clinical evidence supporting the ability of cannabis or related products to treat the GI inflammation underlying these disorders. However, 1 recurring theme from both animal and human studies is that these agents have a significant impact on several IBD-related symptoms, including abdominal pain. In this review, we discuss the role of cannabis and cannabinoid signaling in visceral pain perception, what is currently known regarding the efficacy of cannabis and its derivatives for managing pain, related symptoms and inflammation in IBD, and what work remains to effectively utilize cannabis and its derivatives in the clinical setting.
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Affiliation(s)
- Kaleb Bogale
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Wesley Raup-Konsavage
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Shannon Dalessio
- Division of Gastroenterology & Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Kent Vrana
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Matthew D Coates
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.,Division of Gastroenterology & Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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19
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Abstract
As medical cannabis becomes legal in more states, cancer patients are
increasingly interested in the potential utility of the ancient
botanical in their treatment regimen. Although eager to discuss
cannabis use with their oncologist, patients often find that their
provider reports that they do not have adequate information to be
helpful. Oncologists, so dependent on evidence-based data to guide
their treatment plans, are dismayed by the lack of published
literature on the benefits of medical cannabis. This results largely
from the significant barriers that have existed to effectively thwart
the ability to conduct trials investigating the potential therapeutic
efficacy of the plant. This is a narrative review aimed at clinicians,
summarizing cannabis phytochemistry, trials in the areas of nausea and
vomiting, appetite, pain and anticancer activity, including assessment
of case reports of antitumor use, with reflective assessments of the
quality and quantity of evidence. Despite preclinical evidence and
social media claims, the utility of cannabis, cannabinoids or
cannabis-based medicines in the treatment of cancer remains to be
convincingly demonstrated. With an acceptable safety profile, cannabis
and its congeners may be useful in managing symptoms related to cancer
or its treatment. Further clinical trials should be conducted to
evaluate whether the preclinical antitumor effects translate into
benefit for cancer patients. Oncologists should familiarize themselves
with the available database to be able to better advise their patients
on the potential uses of this complementary botanical therapy.
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20
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Peng J, Fan M, An C, Ni F, Huang W, Luo J. A narrative review of molecular mechanism and therapeutic effect of Cannabidiol (CBD). Basic Clin Pharmacol Toxicol 2022; 130:439-456. [PMID: 35083862 DOI: 10.1111/bcpt.13710] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
Abstract
Cannabidiol (CBD) is an abundant non-psychoactive phytocannabinoid in Cannabis extracts which has high affinity on a series of receptors, including type 1 cannabinoid receptor (CB1), type 2 cannabinoid receptor (CB2), GPR55, transient receptor potential vanilloid (TRPV), and peroxisome proliferator-activated receptor gamma (PPARγ). By modulating the activities of these receptors, CBD exhibits multiple therapeutic effects, including neuroprotective, antiepileptic, anxiolytic, antipsychotic, anti-inflammatory, analgesic and anti-cancer properties. CBD could also be applied to treat or prevent COVID-19 and its complications. Here, we provide a narrative review of CBD's applications in human diseases: from mechanism of action to clinical trials.
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Affiliation(s)
- Jiangling Peng
- Department of Diabetes Complications and Metabolism, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Mingjie Fan
- Department of Diabetes Complications and Metabolism, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Chelsea An
- Department of Diabetes Complications and Metabolism, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Feng Ni
- Institute of Drug Discovery Technology, Ningbo University, Ningbo, Zhejiang, China
| | - Wendong Huang
- Department of Diabetes Complications and Metabolism, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
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21
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Braun IM, Abrams DI, Blansky SE, Pergam SA. Cannabis and the Cancer Patient. J Natl Cancer Inst Monogr 2021; 2021:68-77. [PMID: 34850899 DOI: 10.1093/jncimonographs/lgab012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
Session 2 of the National Cancer Institute's Cannabis, Cannabinoids, and Cancer Research Workshop opened with testimony from a lymphoma survivor who detailed medicinal cannabis-related improvements in nausea, low appetite, insomnia, and mental health and the limited clinical counsel she received regarding cannabis use. Discussion next turned to the evolution of the legal landscape of cannabis in the United States, one in which state and federal laws frequently conflict and the Controlled Substance Act renders cannabis Schedule I. This legal climate creates conundrums for US medicinal cannabis researchers who contend with limited funding opportunities, avenues to source trial drug, and procedural red tape and for oncology clinicians who recommend medicinal cannabis to patients with some frequency while perceiving themselves as ill equipped to make such clinical recommendations. Ultimately, it creates challenges for cancer patients who find themselves turning to nonmedical and anecdotal information sources. The risks of cannabis use by the cancer patient were discussed next. These include infection, pharmacodynamic and pharmacokinetic drug-botanical interactions, cyclic nausea and vomiting, e-cigarette or vaping product use-associated illness, legal issues, and high cost. The session concluded with a broad survey of the research supporting oncologic cannabinoid use, conclusive evidence for chemotherapy-induced nausea and vomiting, and suggestive evidence for cancer-related pain.
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Affiliation(s)
- Ilana M Braun
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Donald I Abrams
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Stacey E Blansky
- School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
| | - Steven A Pergam
- University of Washington School of Medicine, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
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22
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Sexton M, Garcia JM, Jatoi A, Clark CS, Wallace MS. The Management of Cancer Symptoms and Treatment-Induced Side Effects With Cannabis or Cannabinoids. J Natl Cancer Inst Monogr 2021; 2021:86-98. [PMID: 34850897 DOI: 10.1093/jncimonographs/lgab011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/06/2023] Open
Abstract
Cannabis and cannabinoids are increasingly being accessed and used by patients with advanced cancer for various symptoms and general quality of life. Specific symptoms of pain, nausea and vomiting, loss of appetite and cachexia, anxiety, sleep disturbance, and medical trauma are among those that have prompted patients with cancer to use cannabis. This conference report from the National Cancer Institute's "Cannabis, Cannabinoid and Cancer Research Symposium" on the topic of "Cancer Symptom/Treatment Side Effect Management" is an expert perspective of cannabis intervention for cancer and cancer treatment-related symptoms. The purpose of the symposium was to identify research gaps, describe the need for high-quality randomized prospective studies of medical cannabis for palliative care in patients with cancer, and evaluate the impact of medical cannabis on cancer survivors' quality of life. Further, education of clinicians and affiliated health-care providers in guiding cancer patients in using cannabis for cancer care would benefit patients. Together, these steps will further aid in refining the use of cannabis and cannabinoids for symptom palliation and improve safety and efficacy for patients.
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Affiliation(s)
- Michelle Sexton
- Department of Anesthesiology, Division of Pain Management, University of California, San Diego, CA, USA
| | - Jose M Garcia
- Department of Medicine, Division of Geriatrics, University of Washington and Geriatric Research Education and Clinical Center, Puget Sound Veterans Administration Health Care System, Seattle, WA, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Carey S Clark
- Department of Nursing, Pacific College of Health and Science, San Diego, CA, USA
| | - Mark S Wallace
- Department of Anesthesiology, Division of Pain Management, University of California, San Diego, CA, USA
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23
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Malík M, Velechovský J, Tlustoš P. The overview of existing knowledge on medical cannabis plants growing. PLANT, SOIL AND ENVIRONMENT 2021. [PMID: 0 DOI: 10.17221/96/2021-pse] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Optimizing the Process Design of Oil-in-Water Nanoemulsion for Delivering Poorly Soluble Cannabidiol Oil. Processes (Basel) 2021. [DOI: 10.3390/pr9071180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Process approaches and intensification technological processes are integrated parts of available devices, which have a positive effect on the parameters of the obtained products. Nanoemulsions as delivery carriers are becoming more popular and there is a real need to increase the possibilities of formulation designing and engineering. Therefore, preparations of oil-in-water nanoemulsion with encapsulated cannabidiol (CBD) as oil phase were carried out in two ways: sonication method and two-stage high-pressure homogenization. The provided analysis showed spherical morphology and much larger sizes and polydispersity of nanoemulsions obtained by the sonication approach. The size of nanodroplets was from 216 nm up to 1418 nm for sonication, whereas for homogenization 128–880 nm. Additionally, it was observed that a proportionally higher percentage of surfactin resulted in a higher value of the Zeta potential. The formulations were found to be stable for at least 30 days. The in vitro experiments performed on human skin cell lines (HaCaT keratinocytes and normal dermal NHDF fibroblasts), and in vivo topical tests on probants established the biocompatibility of nanoemulsions with CBD. The last stage exhibits reduced discoloration and a higher degree of hydration by the selected systems with CBD and, thus indicating this nanoformulation as useful in cosmetics applications.
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25
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Watanabe AH, Navaravong L, Sirilak T, Prasitwarachot R, Nathisuwan S, Page RL, Chaiyakunapruk N. A systematic review and meta-analysis of randomized controlled trials of cardiovascular toxicity of medical cannabinoids. J Am Pharm Assoc (2003) 2021; 61:e1-e13. [PMID: 33952424 DOI: 10.1016/j.japh.2021.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Several systematic reviews (SRs) have summarized the potential effectiveness of medical cannabinoids, but it is unclear to what extent safety-related outcomes were incorporated. OBJECTIVE The objective of this study was to evaluate the cardiovascular toxicity associated with medical use of cannabinoids. METHODS A 2-stage systematic review (SR) approach was undertaken to assess the current evidence on cannabinoid-associated cardiovascular events reported among randomized controlled trials (RCTs). First, we searched for SRs in multiple sources until June 2019. Second, RCTs identified from the SRs were included if they assessed medical cannabis and reported cardiovascular events. The outcomes of interest were all types of cardiovascular events. Data were extracted by 2 independent reviewers. Study quality was assessed using the Cochrane risk of bias. A statistical test of heterogeneity was performed. The summary risk ratios (RRs) and 95% CIs were calculated using a random-effects model. RESULTS A total of 47 studies involving 2800 patients were included. The median duration of cannabinoid use was 15.8 days (range 1 to 322), and 45% of the studies excluded patients with underlying cardiovascular diseases. Cannabinoid use was significantly associated with increased risks of orthostatic hypotension (RR 3.16 [95% CI 2.27-4.40], I2 = 2.3%) and hypotension (3.55 [1.45-8.71], I2 = 31.8%), with a trend of increased risk of tachycardia (1.94 [0.81-4.64], I2 = 48.6%). No study reported serious cardiovascular events. CONCLUSIONS Cannabinoid use was associated with tachycardia, hypotension, and orthostatic hypotension. There is a paucity of data for other cardiovascular events among medical cannabis users. More data, especially regarding long-term effects among patients with existing cardiovascular diseases, are needed.
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26
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Cancer Initiation, Progression and Resistance: Are Phytocannabinoids from Cannabis sativa L. Promising Compounds? Molecules 2021; 26:molecules26092668. [PMID: 34063214 PMCID: PMC8124362 DOI: 10.3390/molecules26092668] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 12/15/2022] Open
Abstract
Cannabis sativa L. is a source of over 150 active compounds known as phytocannabinoids that are receiving renewed interest due to their diverse pharmacologic activities. Indeed, phytocannabinoids mimic the endogenous bioactive endocannabinoids effects through activation of CB1 and CB2 receptors widely described in the central nervous system and peripheral tissues. All phytocannabinoids have been studied for their protective actions towards different biological mechanisms, including inflammation, immune response, oxidative stress that, altogether, result in an inhibitory activity against the carcinogenesis. The role of the endocannabinoid system is not yet completely clear in cancer, but several studies indicate that cannabinoid receptors and endogenous ligands are overexpressed in different tumor tissues. Recently, in vitro and in vivo evidence support the effectiveness of phytocannabinoids against various cancer types, in terms of proliferation, metastasis, and angiogenesis, actions partially due to their ability to regulate signaling pathways critical for cell growth and survival. The aim of this review was to report the current knowledge about the action of phytocannabinoids from Cannabis sativa L. against cancer initiation and progression with a specific regard to brain, breast, colorectal, and lung cancer as well as their possible use in the therapies. We will also report the known molecular mechanisms responsible for such positive effects. Finally, we will describe the actual therapeutic options for Cannabis sativa L. and the ongoing clinical trials.
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27
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Roychoudhury P, Kapoor AK, Walsh D, Cortes H, Clarke H. State of the science: cannabis and cannabinoids in palliative medicine-the potential. BMJ Support Palliat Care 2021; 11:299-302. [PMID: 33903260 DOI: 10.1136/bmjspcare-2021-002888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
Abstract
Cannabinoids are chemicals derived naturally from the cannabis plant or are synthetically manufactured. They interact directly with cannabinoid receptors or share chemical similarity with endocannabinoids (or both). Within palliative medicine, cannabinoid receptors (CB1 and CB2) may modulate some cancer symptoms: appetite, chemotherapy-induced nausea and vomiting, and mood, pain and sleep disorders. Opioid and cannabinoid receptors have overlapping neuroanatomical receptor distribution, particularly at the dorsal horn, dorsal striatum and locus coeruleus. They have a favourable safety profile compared with opioids, and cannabis-based medicines help chronic pain. While cannabidiol (CBD) has anti-inflammatory properties, tetrahydrocannabinol (THC) is the psychoactive substance for issues such as mood and sleep. Nabiximols (Sativex), a CBD:THC combination, is Food and Drug Administration approved for some multiple sclerosis symptoms and epilepsy. There has been a swift societal evolution in attitudes about use of cannabis and cannabinoid medicines for chronic pain. In the USA, 33 states have now legalised prescription-based medical cannabis for several medical conditions; Canada has had legislation since 2001 authorising medical use. The European Union (EU) recently declared all EU citizens must have access to medical cannabis over the next 4 years. The integration into medicine and routine clinical use of cannabis is fraught with information gaps, regulatory issues and scarcity of research. Each patient should have a comprehensive assessment and risk-benefit discussion before any cannabis-based intervention to avoid possible complications such as hallucinations, psychosis and potential cardiac harm.
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Affiliation(s)
| | | | - Declan Walsh
- Department of Supportive Care and Survivorship, Atrium Health, Charlotte, North Carolina, USA
| | - Henry Cortes
- Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Hance Clarke
- Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada .,Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Cannabinoid Therapeutics, University Health Network, Toronto, Ontario, Canada
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Novak J, Liu J, Zou X, Abuali T, Vazquez J, Kalash R, Evans B, Loscalzo MJ, Sun V, Brower J, Amini A. Radiation oncologist perceptions of therapeutic cannabis use among cancer patients. Support Care Cancer 2021; 29:5991-5997. [PMID: 33768374 DOI: 10.1007/s00520-021-06160-6] [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] [Received: 01/26/2021] [Accepted: 03/16/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Cancer patients are increasingly incorporating medical marijuana into the management of treatment-related side effects. Currently however, data is limited regarding the risks and benefits of therapeutic cannabis for cancer patients. We sought to characterize radiation oncologists' practices and opinions regarding therapeutic cannabis via a nationwide survey. MATERIALS AND METHODS An anonymous survey was distributed via email to 873 radiation oncologists in the American Society for Radiation Oncology member database. Radiation oncologists were asked their opinions and practices regarding the use of therapeutic cannabis for their patients. Bivariate analyses of potential predictors for responses were conducted using standard statistical techniques. RESULTS One hundred seven radiation oncologists completed the survey. According to the survey, 36% of respondents would recommend therapeutic cannabis to their patients to mitigate treatment toxicity. Physicians practicing in states where medical marijuana is legal were more likely to recommend it compared to physicians working in states that have not legalized medical marijuana (OR = 3.79, 1.19-12.1, p = 0.01). Seventy-one percent of respondents reported therapeutic cannabis as being effective at least some of the time for managing treatment-related toxicities. Fifty-eight percent of physicians reported lacking sufficient knowledge to advise patients regarding therapeutic cannabis, while 86% of respondents were interested in learning more about therapeutic cannabis for cancer patients. CONCLUSIONS Although a majority of radiation oncologists believe there are benefits to therapeutic cannabis, many are hesitant to recommend for or against its use. Radiation oncologists appear to be interested in learning more about how therapeutic cannabis may play a role in their patients' care.
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Affiliation(s)
- Jennifer Novak
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Avenue, Duarte, CA, 91010, USA
| | - Jason Liu
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Avenue, Duarte, CA, 91010, USA
| | - Xiaoke Zou
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Tariq Abuali
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Avenue, Duarte, CA, 91010, USA
| | - Jessica Vazquez
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Avenue, Duarte, CA, 91010, USA
| | - Ronny Kalash
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Avenue, Duarte, CA, 91010, USA
| | - Brett Evans
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Matthew J Loscalzo
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Virginia Sun
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Jeffrey Brower
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Avenue, Duarte, CA, 91010, USA.
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Velayudhan L, McGoohan K, Bhattacharyya S. Safety and tolerability of natural and synthetic cannabinoids in adults aged over 50 years: A systematic review and meta-analysis. PLoS Med 2021; 18:e1003524. [PMID: 33780450 PMCID: PMC8007034 DOI: 10.1371/journal.pmed.1003524] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cannabinoid-based medicines (CBMs) are being used widely in the elderly. However, their safety and tolerability in older adults remains unclear. We aimed to conduct a systematic review and meta-analysis of safety and tolerability of CBMs in adults of age ≥50 years. METHODS AND FINDINGS A systematic search was performed using MEDLINE, PubMed, EMBASE, CINAHL PsychInfo, Cochrane Library, and ClinicalTrials.gov (1 January 1990 to 3 October 2020). Randomised clinical trials (RCTs) of CBMs in those with mean age of ≥50 years for all indications, evaluating the safety/tolerability of CBMs where adverse events have been quantified, were included. Study quality was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Two reviewers conducted all review stages independently. Where possible, data were pooled using random-effects meta-analysis. Effect sizes were calculated as incident rate ratio (IRR) for outcome data such as adverse events (AEs), serious AEs (SAEs), and death and risk ratio (RR) for withdrawal from study and reported separately for studies using tetrahydrocannabinol (THC), THC:cannabidiol (CBD) combination, and CBD. A total of 46 RCTs were identified as suitable for inclusion of which 31 (67%) were conducted in the United Kingdom and Europe. There were 6,216 patients (mean age 58.6 ± 7.5 years; 51% male) included in the analysis, with 3,469 receiving CBMs. Compared with controls, delta-9-tetrahydrocannabinol (THC)-containing CBMs significantly increased the incidence of all-cause and treatment-related AEs: THC alone (IRR: 1.42 [95% CI, 1.12 to 1.78]) and (IRR: 1.60 [95% CI, 1.26 to 2.04]); THC:CBD combination (IRR: 1.58 [95% CI,1.26 to 1.98]) and (IRR: 1.70 [95% CI,1.24 to 2.33]), respectively. IRRs of SAEs and deaths were not significantly greater under CBMs containing THC with or without CBD. THC:CBD combination (RR: 1.40 [95% CI, 1.08 to 1.80]) but not THC alone (RR: 1.18 [95% CI, 0.89 to 1.57]) significantly increased risk of AE-related withdrawals. CBD alone did not increase the incidence of all-cause AEs (IRR: 1.02 [95% CI, 0.90 to 1.16]) or other outcomes as per qualitative synthesis. AE-related withdrawals were significantly associated with THC dose in THC only [QM (df = 1) = 4.696, p = 0.03] and THC:CBD combination treatment ([QM (df = 1) = 4.554, p = 0.033]. THC-containing CBMs significantly increased incidence of dry mouth, dizziness/light-headedness, and somnolence/drowsiness. Study limitations include inability to fully exclude data from those <50 years of age in our primary analyses as well as limitations related to weaknesses in the included trials particularly incomplete reporting of outcomes and heterogeneity in included studies. CONCLUSIONS This pooled analysis, using data from RCTs with mean participant age ≥50 years, suggests that although THC-containing CBMs are associated with side effects, CBMs in general are safe and acceptable in older adults. However, THC:CBD combinations may be less acceptable in the dose ranges used and their tolerability may be different in adults over 65 or 75 years of age.
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Affiliation(s)
- Latha Velayudhan
- Department of Old age Psychiatry, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Katie McGoohan
- Department of Old age Psychiatry, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
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30
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Malinowska B, Baranowska-Kuczko M, Kicman A, Schlicker E. Opportunities, Challenges and Pitfalls of Using Cannabidiol as an Adjuvant Drug in COVID-19. Int J Mol Sci 2021; 22:1986. [PMID: 33671463 PMCID: PMC7922403 DOI: 10.3390/ijms22041986] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to coronavirus disease 2019 (COVID-19) which, in turn, may be associated with multiple organ dysfunction. In this review, we present advantages and disadvantages of cannabidiol (CBD), a non-intoxicating phytocannabinoid from the cannabis plant, as a potential agent for the treatment of COVID-19. CBD has been shown to downregulate proteins responsible for viral entry and to inhibit SARS-CoV-2 replication. Preclinical studies have demonstrated its effectiveness against diseases of the respiratory system as well as its cardioprotective, nephroprotective, hepatoprotective, neuroprotective and anti-convulsant properties, that is, effects that may be beneficial for COVID-19. Only the latter two properties have been demonstrated in clinical studies, which also revealed anxiolytic and antinociceptive effects of CBD (given alone or together with Δ9-tetrahydrocannabinol), which may be important for an adjuvant treatment to improve the quality of life in patients with COVID-19 and to limit post-traumatic stress symptoms. However, one should be aware of side effects of CBD (which are rarely serious), drug interactions (also extending to drugs acting against COVID-19) and the proper route of its administration (vaping may be dangerous). Clearly, further clinical studies are necessary to prove the suitability of CBD for the treatment of COVID-19.
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Affiliation(s)
- Barbara Malinowska
- Department of Experimental Physiology and Pathophysiology, Medical University of Białystok, 15-222 Białystok, Poland; (M.B.-K.); (A.K.)
| | - Marta Baranowska-Kuczko
- Department of Experimental Physiology and Pathophysiology, Medical University of Białystok, 15-222 Białystok, Poland; (M.B.-K.); (A.K.)
- Department of Clinical Pharmacy, Medical University of Białystok, 15-222 Białystok, Poland
| | - Aleksandra Kicman
- Department of Experimental Physiology and Pathophysiology, Medical University of Białystok, 15-222 Białystok, Poland; (M.B.-K.); (A.K.)
| | - Eberhard Schlicker
- Department of Pharmacology and Toxicology, University of Bonn, 53127 Bonn, Germany
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31
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Abu-Amna M, Salti T, Khoury M, Cohen I, Bar-Sela G. Medical Cannabis in Oncology: a Valuable Unappreciated Remedy or an Undesirable Risk? Curr Treat Options Oncol 2021; 22:16. [PMID: 33439370 DOI: 10.1007/s11864-020-00811-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 01/11/2023]
Abstract
OPINION STATEMENT The use of the cannabis plant by cancer patients has been rising significantly in the past few years worldwide, primarily driven by public demand. There is an obvious need for more reliable scientific data, pharmacology information, a better understanding of its mode of action, and available clinical evidence supporting its robust use. Physicians must complete a thorough medical assessment, screening for potential drugs, or treatment contraindications before allowing its consumption. In light of the growing popularity of cannabis usage, it is highly essential that, in the near future, the medical community will be able to provide practical recommendations and explicit guidelines, including doses, and that cannabinoid concentrations in the used products are defined regarding its prescription before any medical procedure involving its usage is authorized. Here, we review and describe the favorable outcomes demonstrating the benefits of cannabis as an adjunctive treatment to conventional medicines for chemotherapy-induced nausea, vomiting, and cancer-related pain (primarily refractory chronic or neuropathic pain). Although not yet substantial enough, the treatment of anorexia, insomnia, depression, and anxiety is also seemingly favorable. To date, reports regarding its anti-neoplastic effects or its potent immunosuppressive properties influencing response to immunotherapy are still very conflicting and controversial. Thus, with the current state of evidence, cannabis use is not advisable as initial treatment, as an adjunct or an advanced line of care. In the coming years, we expect that preclinical data and animal models will shift to the clinical arena, and more patients will be recruited for clinical trials, and their reports will advance the field. Thus, physicians should prescribe cannabis only if careful clarification and consideration is provided together with a follow-up response evaluation.
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Affiliation(s)
- Mahmoud Abu-Amna
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
| | - Talal Salti
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel
| | - Mona Khoury
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel
| | - Idan Cohen
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel. .,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel.
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32
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Gupta K, Walton R, Kataria SP. Chemotherapy-Induced Nausea and Vomiting: Pathogenesis, Recommendations, and New Trends. Cancer Treat Res Commun 2020; 26:100278. [PMID: 33360668 DOI: 10.1016/j.ctarc.2020.100278] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
The significant physical and emotional effects of chemotherapy-induced nausea and vomiting (CINV) are experienced by cancer patients. Severe symptoms decrease the patient's quality of life and potentially deters further treatment. The five main forms of CINV (i.e., acute, delayed, anticipatory, breakthrough, and refractory) require different treatment regimens, which often include 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids. Despite a significant amount of research and development of antiemetic agents, management of CINV remains a great challenge with many needs waiting to be adequately addressed, such as controlling non-acute CINV, developing appropriate CINV treatment protocols for multiple-day chemotherapy patients, and providing options for those prone to CINV despite treatment. Further research is required to optimize CINV management for these patients.
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Affiliation(s)
- Kush Gupta
- Kasturba Medical College, Mangalore, Karnataka 575001, India.
| | | | - S P Kataria
- Vardhaman Mahavir Medical College and Safdurjung Hospital, New Delhi 110029, India
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33
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Cannabis extract nanoemulsions produced by high-intensity ultrasound: Formulation development and scale-up. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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34
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Lal S, Shekher A, Puneet, Narula AS, Abrahamse H, Gupta SC. Cannabis and its constituents for cancer: History, biogenesis, chemistry and pharmacological activities. Pharmacol Res 2020; 163:105302. [PMID: 33246167 DOI: 10.1016/j.phrs.2020.105302] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/03/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022]
Abstract
Cannabis has long been used for healing and recreation in several regions of the world. Over 400 bioactive constituents, including more than 100 phytocannabinoids, have been isolated from this plant. The non-psychoactive cannabidiol (CBD) and the psychoactive Δ9-tetrahydrocannabinol (Δ9-THC) are the major and widely studied constituents from this plant. Cannabinoids exert their effects through the endocannabinoid system (ECS) that comprises cannabinoid receptors (CB1, CB2), endogenous ligands, and metabolizing enzymes. Several preclinical studies have demonstrated the potential of cannabinoids against leukemia, lymphoma, glioblastoma, and cancers of the breast, colorectum, pancreas, cervix and prostate. Cannabis and its constituents can modulate multiple cancer related pathways such as PKB, AMPK, CAMKK-β, mTOR, PDHK, HIF-1α, and PPAR-γ. Cannabinoids can block cell growth, progression of cell cycle and induce apoptosis selectively in tumour cells. Cannabinoids can also enhance the efficacy of cancer therapeutics. These compounds have been used for the management of anorexia, queasiness, and pain in cancer patients. Cannabinoid based products such as dronabinol, nabilone, nabiximols, and epidyolex are now approved for medical use in cancer patients. Cannabinoids are reported to produce a favourable safety profile. However, psychoactive properties and poor bioavailability limit the use of some cannabinoids. The Academic Institutions across the globe are offering training courses on cannabis. How cannabis and its constituents exert anticancer activities is discussed in this article. We also discuss areas that require attention and more extensive research.
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Affiliation(s)
- Samridhi Lal
- Amity Institute of Pharmacy, Amity University, Gurgaon, Haryana, 122413, India
| | - Anusmita Shekher
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, 221 005, India
| | - Puneet
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India
| | | | - Heidi Abrahamse
- Laser Research Centre, University of Johannesburg, Doornfontein, 2028, South Africa
| | - Subash C Gupta
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, 221 005, India.
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Grimison P, Mersiades A, Kirby A, Lintzeris N, Morton R, Haber P, Olver I, Walsh A, McGregor I, Cheung Y, Tognela A, Hahn C, Briscoe K, Aghmesheh M, Fox P, Abdi E, Clarke S, Della-Fiorentina S, Shannon J, Gedye C, Begbie S, Simes J, Stockler M. Oral THC:CBD cannabis extract for refractory chemotherapy-induced nausea and vomiting: a randomised, placebo-controlled, phase II crossover trial. Ann Oncol 2020; 31:1553-1560. [DOI: 10.1016/j.annonc.2020.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
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Nemeškalová A, Hájková K, Mikulů L, Sýkora D, Kuchař M. Combination of UV and MS/MS detection for the LC analysis of cannabidiol-rich products. Talanta 2020; 219:121250. [DOI: 10.1016/j.talanta.2020.121250] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 02/07/2023]
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Abstract
Cannabinoids have been known as the primary component of cannabis for decades, but the characterization of the endocannabinoid system (ECS) in the 1990s opened the doors for cannabis' use in modern medicine. The 2 main receptors of this system, cannabinoid receptors 1 and 2, are found on cells of various tissues, with significant expression in the gastrointestinal (GI) tract. The characterization of the ECS also heralded the understanding of endocannabinoids, naturally occurring compounds synthesized in the human body. Via secondary signaling pathways acting on vagal nerves, nociceptors, and immune cells, cannabinoids have been shown to have both palliative and detrimental effects on the pathophysiology of GI disorders. Although research on the effects of both endogenous and exogenous cannabinoids has been slow due to the complicated legal history of cannabis, discoveries of cannabinoids' treatment potential have been found in various fields of medicine, including the GI world. Medical cannabis has since been offered as a treatment for a myriad of conditions and malignancies, including cancer, human immunodeficiency virus/acquired immunodeficiency syndrome, multiple sclerosis, chronic pain, nausea, posttraumatic stress disorder, amyotrophic lateral sclerosis, cachexia, glaucoma, and epilepsy. This article hopes to create an overview of current research on cannabinoids and the ECS, detail the potential advantages and pitfalls of their use in GI diseases, and explore possible future developments in this field.
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Valentino WL, McKinnon BJ. Cannabis & ENT: State certification-An expanding yet unregulated system. Am J Otolaryngol 2020; 41:102459. [PMID: 32299638 DOI: 10.1016/j.amjoto.2020.102459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES 1) Ascertain the status of cannabis legalization by state, 2) Explore the process required to obtain cannabis credentials for both the patient and the physician, 3) Determine the level of interest of otolaryngologists in the medicinal cannabis, and 4) Explore possible research directions into efficacy and potential complications. STUDY DESIGN Descriptive study. METHODS Internet searches were conducted to identify each state's Medical Cannabis Program website. The qualifying conditions, list of approved-practitioners, process required for both practitioners and patients for approval were noted. Lists of approved practitioners were analyzed to determine the prevalence of board-certified otolaryngologists. RESULTS Of the 33 states that authorize medicinal cannabis, eight provide lists of approved-practitioners, six of which provide specialty information. A total of 24 Otolaryngologists can be found of the 5944 physicians on these six lists. All otolaryngologists were located in highly-populated metropolitan areas with a mean number of 29.9 years in practice. Significant variations exist between each state including legal definitions and qualifying conditions. CONCLUSIONS Lack of consistent regulation across the country drives uncertainty regarding the adoption of medicinal cannabis. Very few otolaryngologists in the country are registered to certify patients for medical cannabis. While the medicinal use of cannabis may currently have limited applications within otolaryngology, many areas that have yet to be explored.
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Affiliation(s)
| | - Brian J McKinnon
- Department of Otolaryngology - Head and Neck Surgery, UTMB Health, United States of America.
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Inglet S, Winter B, Yost SE, Entringer S, Lian A, Biksacky M, Pitt RD, Mortensen W. Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature. Ann Pharmacother 2020; 54:1109-1143. [DOI: 10.1177/1060028020930189] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To compile and synthesize the available literature describing medical cannabis use across various disease states. Data Sources: PubMed, EBSCO, and Google Scholar searches were conducted using MeSH and/or keywords. Study Selection and Data Extraction: Studies were included if they described the use of cannabis-based products and medications in the treatment of a predefined list of disease states in humans and were published in English. The extraction period had no historical limit and spanned through April 2019. Data Synthesis: Evidence was compiled and summarized for the following medical conditions: Alzheimer disease, amyotrophic lateral sclerosis, autism, cancer and cancer-associated adverse effects, seizure disorders, human immunodeficiency virus, inflammatory bowel disease, multiple sclerosis (MS), nausea, pain, posttraumatic stress disorder, and hospice care. Relevance to Patient Care and Clinical Practice: Based on identified data, the most robust evidence suggests that medical cannabis may be effective in the treatment of chemotherapy-induced nausea and vomiting, seizure disorders, MS-related spasticity, and pain (excluding diabetic neuropathy). Overall, the evidence is inconsistent and generally limited by poor quality. The large variation in cannabis-based products evaluated in studies limits the ability to make direct comparisons. Regardless of the product, a gradual dose titration was utilized in most studies. Cannabis-based therapies were typically well tolerated, with the most common adverse effects being dizziness, somnolence, dry mouth, nausea, and euphoria. Conclusions: As more states authorize medical cannabis use, there is an increasing need for high-quality clinical evidence describing its efficacy and safety. This review is intended to serve as a reference for clinicians, so that the risks and realistic benefits of medical cannabis are better understood.
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Affiliation(s)
| | | | | | | | - Anh Lian
- Intermountain Healthcare, Taylorsville, UT, USA
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40
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Suhre W, O'Reilly-Shah V, Van Cleve W. Cannabis use is associated with a small increase in the risk of postoperative nausea and vomiting: a retrospective machine-learning causal analysis. BMC Anesthesiol 2020; 20:115. [PMID: 32423445 PMCID: PMC7236204 DOI: 10.1186/s12871-020-01036-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cannabis legalization may contribute to an increased frequency of chronic use among patients presenting for surgery. At present, it is unknown whether chronic cannabis use modifies the risk of postoperative nausea and vomiting (PONV). METHODS This study was a retrospective cohort study conducted at 2 academic medical centers. Twenty-seven thousand three hundred eighty-eight adult ASA 1-3 patients having general anesthesia for non-obstetric, non-cardiac procedures and receiving postoperative care in the Post Anesthesia Care Unit (PACU) were analyzed in the main dataset, and 16,245 patients in the external validation dataset. The main predictor was patient reported use of cannabis in any form collected during pre-anesthesia evaluation and recorded in the chart. The primary outcome was documented PONV of any severity prior to PACU discharge, including administration of rescue medications in PACU. Relevant clinical covariates (risk factors for PONV, surgical characteristics, administered prophylactic antiemetic drugs) were also recorded. RESULTS 10.0% of patients in the analytic dataset endorsed chronic cannabis use. Using Bayesian Additive Regression Trees (BART), we estimated that the relative risk for PONV associated with daily cannabis use was 1.19 (95 CI% 1.00-1.45). The absolute marginal increase in risk of PONV associated with daily cannabis use was 3.3% (95% CI 0.4-6.4%). We observed a lesser association between current, non-daily use of cannabis (RR 1.07, 95% CI 0.94-1.21). An internal validation analysis conducted using propensity score adjustment and Bayesian logistic modeling indicated a similar size and magnitude of the association between cannabis use and PONV (OR 1.15, 90% CI 0.98-1.33). As an external validation, we used data from another hospital in our care system to create an independent model that demonstrated essentially identical associations between cannabis use and PONV. CONCLUSIONS Cannabis use is associated with an increased relative risk and a small increase in the marginal probability of PONV.
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Affiliation(s)
- Wendy Suhre
- Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Vikas O'Reilly-Shah
- Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Perioperative & Pain Initiatives in Quality, Safety, and Outcome, Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Children's Hospital, 4800 Sand Point Way, Seattle, WA, 98105, USA
| | - Wil Van Cleve
- Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Perioperative & Pain Initiatives in Quality, Safety, and Outcome, Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, 1959 NE Pacific St, Seattle, WA, 98195, USA
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Martínez V, Iriondo De-Hond A, Borrelli F, Capasso R, del Castillo MD, Abalo R. Cannabidiol and Other Non-Psychoactive Cannabinoids for Prevention and Treatment of Gastrointestinal Disorders: Useful Nutraceuticals? Int J Mol Sci 2020; 21:E3067. [PMID: 32357565 PMCID: PMC7246936 DOI: 10.3390/ijms21093067] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023] Open
Abstract
Cannabis sativa is an aromatic annual flowering plant with several botanical varieties, used for different purposes, like the production of fibers, the production of oil from the seeds, and especially for recreational or medical purposes. Phytocannabinoids (terpenophenolic compounds derived from the plant), include the well-known psychoactive cannabinoid Δ9-tetrahydrocannabinol, and many non-psychoactive cannabinoids, like cannabidiol. The endocannabinoid system (ECS) comprises of endocannabinoid ligands, enzymes for synthesis and degradation of such ligands, and receptors. This system is widely distributed in the gastrointestinal tract, where phytocannabinoids exert potent effects, particularly under pathological (i.e., inflammatory) conditions. Herein, we will first look at the hemp plant as a possible source of new functional food ingredients and nutraceuticals that might be eventually useful to treat or even prevent gastrointestinal conditions. Subsequently, we will briefly describe the ECS and the general pharmacology of phytocannabinoids. Finally, we will revise the available data showing that non-psychoactive phytocannabinoids, particularly cannabidiol, may be useful to treat different disorders and diseases of the gastrointestinal tract. With the increasing interest in the development of functional foods for a healthy life, the non-psychoactive phytocannabinoids are hoped to find a place as nutraceuticals and food ingredients also for a healthy gastrointestinal tract function.
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Affiliation(s)
- Vicente Martínez
- Department of Cell Biology, Physiology and Immunology, Neurosciences Institute, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28049 Madrid, Spain
| | - Amaia Iriondo De-Hond
- Instituto de Investigación en Ciencias de la Alimentación (CIAL) (UAM-CSIC), C/Nicolás Cabrera, 9, Campus de la Universidad Autónoma de Madrid, 28049 Madrid, Spain; (A.I.D.-H.); (M.D.d.C.)
| | - Francesca Borrelli
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Via Domenico Montesano 49, 80131 Naples, Italy;
| | - Raffaele Capasso
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 100, 80055 Portici (NA), Italy
| | - María Dolores del Castillo
- Instituto de Investigación en Ciencias de la Alimentación (CIAL) (UAM-CSIC), C/Nicolás Cabrera, 9, Campus de la Universidad Autónoma de Madrid, 28049 Madrid, Spain; (A.I.D.-H.); (M.D.d.C.)
| | - Raquel Abalo
- High Performance Research Group in Physiopathology and Pharmacology of the Digestive System NeuGut-URJC, Department of Basic Health Sciences, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Campus de Alcorcón, Avda. de Atenas s/n, 28022 Madrid, Spain
- Unidad Asociada I+D+i del Instituto de Química Médica (IQM), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain;
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Medical Marijuana: Facts and Questions. Am J Ther 2019; 26:e502-e510. [PMID: 29324465 DOI: 10.1097/mjt.0000000000000716] [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]
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Tavhare SD, Acharya R, Reddy RG, Dhiman KS. Management of chronic pain with Jalaprakshalana (water-wash) Shodhita (processed) Bhanga ( Cannabis sativa L.) in cancer patients with deprived quality of life: An open-label single arm clinical trial. Ayu 2019; 40:34-43. [PMID: 31831967 PMCID: PMC6891996 DOI: 10.4103/ayu.ayu_43_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Pain is a common and complex symptom of cancer having physical, social, spiritual and psychological aspects. Approximately 70%-80% of cancer patients experiences pain, as reported in India. Ayurveda recommends use of Shodhita (Processed) Bhanga (Cannabis) for the management of pain but no research yet carried out on its clinical effectiveness. Objective To assess the analgesic potential of Jala-Prakshalana (Water-wash) processed Cannabis sativa L. leaves powder in cancer patients with deprived quality of life (QOL) through openlabel single arm clinical trial. Materials and Methods Waterwash processed Cannabis leaves powder filled in capsule, was administered in 24 cancer patients with deprived QOL presenting complaints of pain, anxiety or depression; for a period of 4 weeks; in a dose of 250 mg thrice a day; along with 50 ml of cow's milk and 4 g of crystal sugar. Primary outcome i.e. pain was measured by Wong-Bakers FACES Pain Scale (FACES), Objective Pain Assessment (OPA) scale and Neuropathic Pain Scale (NPS). Secondary outcome namely anxiety was quantified by Hospital Anxiety and Depression Scale (HADS), QOL by FACT-G scale, performance score by Eastern Cooperative Oncology Group (ECOG) and Karnofsky score. Results Significant reduction in pain was found on FACES Pain Scale (P < 0.05), OPA (P < 0.05), NPS (P < 0.001), HADS (P < 0.001), FACT-G scale (P < 0.001), performance status score like ECOG (P < 0.05) and Karnofsky score (P < 0.01). Conclusion Jalaprakshalana Shodhita Bhanga powder in a dose of 250 mg thrice per day; relieves cancerinduced pain, anxiety and depression significantly and does not cause any major adverse effect and withdrawal symptoms during trial period.
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Affiliation(s)
- Swagata Dilip Tavhare
- Department of Dravyaguna, GJ Patel Institute of Ayurvedic Studies and Research, New Vallabhvidyanagar, Anand, Jamnagar, Gujarat, India
| | - Rabinarayan Acharya
- Department of Dravyaguna, Institute for Post Graduate Teaching and Research in Ayurved, Gujarat Ayurved University, Jamnagar, Gujarat, India
| | - R Govind Reddy
- Regional Ayurveda Research Institute for Mother and Child Health, CCRAS, Nagpur, Maharashtra, India
| | - Kartar Singh Dhiman
- Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, New Delhi, India
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Bonn-Miller MO, Pollack CV, Casarett D, Dart R, ElSohly M, Good L, Guzmán M, Hanuš L, Hill KP, Huestis MA, Marsh E, Sisley S, Skinner N, Spahr J, Vandrey R, Viscusi E, Ware MA, Abrams D. Priority Considerations for Medicinal Cannabis-Related Research. Cannabis Cannabinoid Res 2019; 4:139-157. [PMID: 31579832 DOI: 10.1089/can.2019.0045] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Marcel O Bonn-Miller
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles V Pollack
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - David Casarett
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Richard Dart
- Rocky Mountain Drug and Poison Control Center, Denver, Colorado
| | - Mahmoud ElSohly
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, Oxford, Mississippi
| | - Larry Good
- Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Manuel Guzmán
- Department of Biochemistry and Molecular Biology, Complutense University of Madrid, Madrid, Spain
| | - Lumír Hanuš
- Department of Medicinal and Natural Products, Institute for Drug Research, The Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kevin P Hill
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eric Marsh
- Departments of Neurology and Pediatrics, Division of Child Neurology, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Sisley
- Colorado State University-Pueblo, Pueblo, Colorado
| | | | | | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eugene Viscusi
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark A Ware
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Donald Abrams
- UCSF Osher Center for Integrative Medicine, University of California-San Francisco, San Francisco, California
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Brown D, Watson M, Schloss J. Pharmacological evidence of medicinal cannabis in oncology: a systematic review. Support Care Cancer 2019; 27:3195-3207. [PMID: 31062109 DOI: 10.1007/s00520-019-04774-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/25/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE This systematic literature review examines research into the use of medicinal cannabis in cancer management. The aim was to identify the gaps in knowledge on the dose, dosing schedule and absorption of the administration routes of medicinal cannabis use in oncology. METHODS A comprehensive search of the literature was conducted across six databases to identify original data reporting the pharmacology of medicinal cannabis in oncology. RESULTS Eighteen articles were selected for review. Of the selected articles, ten were identified as randomised control trials, two experimental studies, two retrospective cohort studies and four case studies. Four articles reported absorption data and one drug interaction study was identified. CONCLUSIONS There is little evidence reported in the literature on the absorption of medicinal cannabis in cancer populations. Various reasons are explored for the lack of pharmacokinetic studies for medicinal cannabis in cancer populations, including the availability of assays to accurately assess cannabinoid levels, lack of clinical biomarkers and patient enrolment for pharmacokinetic studies.
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Affiliation(s)
- Danielle Brown
- Endeavour College of Natural Health, Brisbane, Queensland, Australia.
| | - Michael Watson
- Endeavour College of Natural Health, Brisbane, Queensland, Australia
| | - Janet Schloss
- Endeavour College of Natural Health, Brisbane, Queensland, Australia
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Tanco K, Dumlao D, Kreis R, Nguyen K, Dibaj S, Liu D, Marupakula V, Shaikh A, Baile W, Bruera E. Attitudes and Beliefs About Medical Usefulness and Legalization of Marijuana among Cancer Patients in a Legalized and a Nonlegalized State. J Palliat Med 2019; 22:1213-1220. [PMID: 31386595 DOI: 10.1089/jpm.2019.0218] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: There is a growing preference for the use of marijuana for medical purposes, despite limited evidence regarding its benefits and potential safety risks. Legalization status may play a role in the attitudes and preferences toward medical marijuana (MM). Objectives: The attitudes and beliefs of cancer patients in a legalized (Arizona) versus nonlegalized state (Texas) regarding medical and recreational legalization and medical usefulness of marijuana were compared. Settings/Subjects: Two hundred adult cancer patients were enrolled from outpatient Palliative Care centers at Banner MD Anderson Cancer Center in Gilbert, AZ (n = 100) and The University of Texas MD Anderson Cancer Center in Houston, TX (n = 100). Design and Measurements: Adult cancer patients seen by the Palliative Care teams in the outpatient centers were evaluated. Various physical and psychosocial assessments were conducted, including a survey of attitudes and beliefs toward marijuana. Results: The majority of individuals support legalization of marijuana for medical use (Arizona 92% [85-97%] vs. Texas 90% [82-95%]; p = 0.81) and belief in its medical usefulness (Arizona 97% [92-99%] vs. Texas 93% [86-97%]; p = 0.33) in both states. Overall, 181 (91%) patients supported legalization for medical purposes whereas 80 (40%) supported it for recreational purposes (p < 0.0001). Patients preferred marijuana over current standard treatments for anxiety (60% [51-68%]; p = 0.003). Patients found to favor legalizing MM were younger (p = 0.027), had worse fatigue (p = 0.015), appetite (p = 0.004), anxiety (p = 0.017), and were Cut Down, Annoyed, Guilty, and Eye Opener-Adapted to Include Drugs (CAGE-AID) positive for alcohol/drugs (p < 0.0001). Conclusion: Cancer patients from both legalized and nonlegalized states supported legalization of marijuana for medical purposes and believed in its medical use. The support for legalization for medical use was significantly higher than for recreational use in both states.
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Affiliation(s)
- Kimberson Tanco
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donato Dumlao
- Subspecialty Palliative Care in Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Rebecca Kreis
- Subspecialty Palliative Care in Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Kristy Nguyen
- Department of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seyedeh Dibaj
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Liu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Ayesha Shaikh
- Subspecialty Palliative Care in Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Walter Baile
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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Kleckner AS, Kleckner IR, Kamen CS, Tejani MA, Janelsins MC, Morrow GR, Peppone LJ. Opportunities for cannabis in supportive care in cancer. Ther Adv Med Oncol 2019; 11:1758835919866362. [PMID: 31413731 PMCID: PMC6676264 DOI: 10.1177/1758835919866362] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/03/2019] [Indexed: 12/17/2022] Open
Abstract
Cannabis has the potential to modulate some of the most common and debilitating symptoms of cancer and its treatments, including nausea and vomiting, loss of appetite, and pain. However, the dearth of scientific evidence for the effectiveness of cannabis in treating these symptoms in patients with cancer poses a challenge to clinicians in discussing this option with their patients. A review was performed using keywords related to cannabis and important symptoms of cancer and its treatments. Literature was qualitatively reviewed from preclinical models to clinical trials in the fields of cancer, human immunodeficiency virus (HIV), multiple sclerosis, inflammatory bowel disease, post-traumatic stress disorder (PTSD), and others, to prudently inform the use of cannabis in supportive and palliative care in cancer. There is a reasonable amount of evidence to consider cannabis for nausea and vomiting, loss of appetite, and pain as a supplement to first-line treatments. There is promising evidence to treat chemotherapy-induced peripheral neuropathy, gastrointestinal distress, and sleep disorders, but the literature is thus far too limited to recommend cannabis for these symptoms. Scant, yet more controversial, evidence exists in regard to cannabis for cancer- and treatment-related cognitive impairment, anxiety, depression, and fatigue. Adverse effects of cannabis are documented but tend to be mild. Cannabis has multifaceted potential bioactive benefits that appear to outweigh its risks in many situations. Further research is required to elucidate its mechanisms of action and efficacy and to optimize cannabis preparations and doses for specific populations affected by cancer.
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Affiliation(s)
- Amber S Kleckner
- Cancer Control and Survivorship, University of Rochester Medical Center, CU 420658, 265 Crittenden Blvd., Rochester, NY 14642, USA
| | - Ian R Kleckner
- Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA
| | - Charles S Kamen
- Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA
| | - Mohamedtaki A Tejani
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Michelle C Janelsins
- Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA
| | - Gary R Morrow
- Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA
| | - Luke J Peppone
- Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA
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Abstract
OPINION STATEMENT Cannabis is a useful botanical with a wide range of therapeutic potential. Global prohibition over the past century has impeded the ability to study the plant as medicine. However, delta-9-tetrahydrocannabinol (THC) has been developed as a stand-alone pharmaceutical initially approved for the treatment of chemotherapy-related nausea and vomiting in 1986. The indication was expanded in 1992 to include treatment of anorexia in patients with the AIDS wasting syndrome. Hence, if the dominant cannabinoid is available as a schedule III prescription medication, it would seem logical that the parent botanical would likely have similar therapeutic benefits. The system of cannabinoid receptors and endogenous cannabinoids (endocannabinoids) has likely developed to help us modulate our response to noxious stimuli. Phytocannabinoids also complex with these receptors, and the analgesic effects of cannabis are perhaps the best supported by clinical evidence. Cannabis and its constituents have also been reported to be useful in assisting with sleep, mood, and anxiety. Despite significant in vitro and animal model evidence supporting the anti-cancer activity of individual cannabinoids-particularly THC and cannabidiol (CBD)-clinical evidence is absent. A single intervention that can assist with nausea, appetite, pain, mood, and sleep is certainly a valuable addition to the palliative care armamentarium. Although many healthcare providers advise against the inhalation of a botanical as a twenty-first century drug-delivery system, evidence for serious harmful effects of cannabis inhalation is scant and a variety of other methods of ingestion are currently available from dispensaries in locales where patients have access to medicinal cannabis. Oncologists and palliative care providers should recommend this botanical remedy to their patients to gain first-hand evidence of its therapeutic potential despite the paucity of results from randomized placebo-controlled clinical trials to appreciate that it is both safe and effective and really does not require a package insert.
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Affiliation(s)
- Donald I Abrams
- Hematology-Oncology, Zuckerberg San Francisco General, Integrative Oncology, UCSF Osher Center for Integrative Medicine, Professor of Clinical Medicine, University of California San Francisco, Ward 84, 995 Potrero, San Francisco, CA, 94110, USA.
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Ho C, Martinusen D, Lo C. A Review of Cannabis in Chronic Kidney Disease Symptom Management. Can J Kidney Health Dis 2019; 6:2054358119828391. [PMID: 30828459 PMCID: PMC6388458 DOI: 10.1177/2054358119828391] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/16/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose of Review: Physical and psychological symptom burden in patients with advanced chronic kidney disease (CKD) is significantly debilitating; yet, it is often inadequately treated. Legalization of cannabis in Canada may attract increasing interest from patients for its medical use in refractory symptom management, but its indications and long-term adverse health impacts are poorly established, creating a challenge for clinicians to support its use. In this review, we summarize key clinical studies and the level of evidence for nonsynthetic cannabinoids in the treatment of common symptoms encountered in advanced stages of CKD, including chronic pain, nausea and vomiting, anorexia, pruritus, and insomnia. Sources of Information: Medline and Embase Methods: A search was conducted in MEDLINE and EMBASE (inception to March 1, 2018) on cannabis and CKD symptoms of interest, complemented with a manual review of bibliographies. Studies that examined synthetic cannabinoids that are manufactured to mimic the effects of ∆9-tetrahydrocannabinol such as dronabinol, levonantradol, nabilone, and ajulemic acid were excluded. We focused on studies with higher level of evidence where available, and quality of studies was graded based on the Oxford Centre for Evidence-based Medicine Levels of Evidence (1a to 5). Findings: Based on studies conducted in patients without renal impairment, those treated with nonsynthetic cannabinoids were 43% to 300% more likely to report a ≥30% reduction in chronic neuropathic pain compared with placebo. However, there is currently insufficient evidence to recommend nonsynthetic cannabinoids for other medical indications, although preliminary investigation into topical endocannabinoids for uremia-induced pruritus in end-stage renal disease is promising. Finally, any benefits of cannabis may be offset by potential harms in the form of cognitive impairment, increased risk of mortality post-myocardial infarction, orthostatic hypotension, respiratory irritation, and malignancies (with smoked cannabis). Limitations: Nonsynthetic cannabinoid preparations were highly variable between studies, sample sizes were small, and study durations were short. Due to an absence of studies conducted in CKD, recommendations were primarily extrapolated from the general population. Implications: Until further studies are conducted, the role of nonsynthetic cannabinoids for symptom management in patients with CKD should be limited to the treatment of chronic neuropathic pain. Clinicians need to be cognizant that nonsynthetic cannabinoid preparations, particularly smoked cannabis, can pose significant health risks and these must be cautiously weighed against the limited substantiated therapeutic benefits of cannabis in patients with CKD.
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Affiliation(s)
- Claudia Ho
- Fraser Health Renal Program, Surrey, BC, Canada.,University of British Columbia, Vancouver, Canada
| | - Dan Martinusen
- University of British Columbia, Vancouver, Canada.,Royal Jubilee Hospital, Island Health Authority, Victoria, BC, Canada.,BC Renal Agency, Vancouver, Canada
| | - Clifford Lo
- University of British Columbia, Vancouver, Canada.,BC Renal Agency, Vancouver, Canada.,Lower Mainland Pharmacy Services, Langley, BC, Canada
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50
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Mortimer TL, Mabin T, Engelbrecht AM. Cannabinoids: the lows and the highs of chemotherapy-induced nausea and vomiting. Future Oncol 2019; 15:1035-1049. [PMID: 30720344 DOI: 10.2217/fon-2018-0530] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Despite remaining one of the most widely abused drugs worldwide, Cannabis sativa exhibits remarkable medicinal properties. The phytocannabinoids, cannabidiol and Δ-9-tetrahydrocannabinol, reduce nausea and vomiting, particularly during chemotherapy. This is attributed to their ability to reduce the release of serotonin from enterochromaffin cells in the small intestine, which would otherwise orchestrate the vomiting reflex. Although there are many preclinical and clinical studies on the effects of Δ-9-tetrahydrocannabinol during nausea and vomiting, little is known about the role that cannabidiol plays in this scenario. Since cannabidiol does not induce psychotropic effects, in contrast to other cannabinoids, its use as an anti-emetic is of great interest. This review aims to summarize the available literature on cannabinoid use, with a specific focus on the nonpsychotropic drug cannabidiol, as well as the roles that cannabinoids play in preventing several other adverse side effects of chemotherapy including organ toxicity, pain and loss of appetite.
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Affiliation(s)
- Toni Leigh Mortimer
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Tom Mabin
- Department of Medicine, Division of Cardiology, University of Cape Town, Observatory, 7925, South Africa
| | - Anna-Mart Engelbrecht
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, 7600, South Africa
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