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Mick G, Douek P. Clinical Benefits and Safety of Medical Cannabis Products: A Narrative Review on Natural Extracts. Pain Ther 2024:10.1007/s40122-024-00643-0. [PMID: 39096481 DOI: 10.1007/s40122-024-00643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024] Open
Abstract
Interest in medical cannabis and cannabis-based medicinal products (CBMPs) has increased greatly in recent years. Two cannabinoids are of principal importance; delta-9-tetrahydrocannabinol (∆9-THC), the primary psychoactive component, and also cannabidiol (CBD), considered non-intoxicating. Each has distinct mechanisms of action and different therapeutic potentials. CBMPs differ in their ∆9-THC and CBD components; predominantly ∆9-THC, balanced formulations with equivalent ∆9-THC and CBD elements, and CBD-predominant products. In this narrative review, we evaluate the published evidence for the clinical benefits of CBMPs and overall benefits in well-being. We also review the overall safety profile and discuss the potential for dependence with CBMPs. Evidence can be drawn from a wide range of randomized and other controlled studies and from observational real-world studies. Most data from observational registry studies are supportive of ∆9-THC-based products (∆9-THC-predominant or balanced CBMPs) in the management of chronic neuropathic pain. Balanced products are also effective in reducing spasticity in multiple sclerosis. Most CBMPs show benefit in providing symptomatic benefits in reducing anxiety, nausea, and in improving sleep, but the place of specific products is more subtle, and choice guided by specific circumstances. Symptomatic improvements are accompanied by improved quality of life and well-being. Safety data indicate that CBMPs are generally well tolerated in most patients without specific contraindications. The majority of adverse effects are non-serious, and transient; most are principally associated with ∆9-THC and are dose-dependent. In contrast to recreational cannabis use, there is little evidence from clinical studies that CBMPs have any potential for dependence.
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Affiliation(s)
- Gérard Mick
- Pain Center, Voiron Hospital, CHU Grenoble-Alpes-Voiron, Voiron, 38500, Grenoble, France.
- CETD, Hôpital Neurologique Pierre Wertheimer, CHU de Lyon-Hospices Civils de Lyon (HCL), 69500, Bron, France.
- Health Systemic Process (P2S) Laboratory, Research Unit 4129, Université Claude Bernard Lyon 1, 69008, Lyon, France.
- THEMAS Team, TIMC Laboratory, Université Grenoble Alpes, 38000, Grenoble, France.
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Jiménez JH, Oña G, Alcázar-Córcoles MÁ, Bouso JC. Cannabis and Public Health: A Study Assessing Regular Cannabis Users Through Health Indicators. Cannabis Cannabinoid Res 2024; 9:659-668. [PMID: 36637397 DOI: 10.1089/can.2022.0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background and Objective: An increasing number of countries are deciding to regulate the medicinal and/or recreational use of cannabis (Cannabis sativa L.). However, there is a lack of information on the impact of regular consumption of this substance on public health. In this study, for the first time, regular cannabis consumers in Spain were assessed using health indicators, comparing these data with the general population. Methods: Various items of the Enquesta de Salut de Catalunya (ESCA) and other items related to cannabis use were selected to build a survey and administer it to a representative sample of regular cannabis users in Catalonia. Results: Most of the indicators did not show any deterioration in the health of regular cannabis users compared with the general population. It was observed that users suffered from more sleep problems and about 40% of the sample would like to discontinue cannabis use, suggesting a dependence pattern. About 30% of the sample was able to discontinue the use of prescription medications because of cannabis. Social support and sleep problems, and not cannabis use, were predictors of depression and well-being scores. Conclusions: It seems that regular cannabis use, despite contributing to problems related to sleep quality or dependence, does not have a negative impact on public health in a manner detectable using health indicators.
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Affiliation(s)
- Javier Hidalgo Jiménez
- International Center for Ethnobotanical Education, Research, and Service (ICEERS), Barcelona, España
| | - Genís Oña
- International Center for Ethnobotanical Education, Research, and Service (ICEERS), Barcelona, España
- Department of Anthropology, Philosophy and Social Work, Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, España
| | - Miguel Ángel Alcázar-Córcoles
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - José Carlos Bouso
- International Center for Ethnobotanical Education, Research, and Service (ICEERS), Barcelona, España
- Department of Anthropology, Philosophy and Social Work, Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, España
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Manning B, Arkell TR, Hayley AC, Downey LA. A semi-naturalistic open-label study examining the effect of prescribed medical cannabis use on simulated driving performance. J Psychopharmacol 2024; 38:247-257. [PMID: 38332655 PMCID: PMC10944578 DOI: 10.1177/02698811241229524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Despite increasing medical cannabis use, research has yet to establish whether and to what extent products containing delta-9-tetrahydrocannabinol (THC) impact driving performance among patients. Stable doses of prescribed cannabinoid products during long-term treatment may alleviate clinical symptoms affecting cognitive and psychomotor performance. AIM To examine the effects of open-label prescribed medical cannabis use on simulated driving performance among patients. METHODS In a semi-naturalistic laboratory study, 40 adults (55% male) aged between 23 and 80 years, consumed their own prescribed medical cannabis product. Driving performance outcomes including standard deviation of lateral position (SDLP), the standard deviation of speed (SDS), mean speed and steering variability were evaluated using the Forum8 driving simulator at baseline (pre-dosing), 2.5 h and 5 -h (post-dosing). Perceived driving effort (PDE) was self-reported after each drive. Oral fluid and whole blood samples were collected at multiple timepoints and analysed for THC via liquid chromatography-mass spectrometry. RESULTS A significant main effect of time was observed for mean speed (p = 0.014) and PDE (p = 0.020), with patients displaying modest stabilisation of vehicle control, increased adherence to speed limits and reductions in PDE post-dosing, relative to baseline. SDLP (p = 0.015) and PDE (p = 0.043) were elevated for those who consumed oil relative to flower-based products. Detectable THC concentrations were observed in oral fluid at 6-h post-dosing (range = 0-24 ng/mL). CONCLUSIONS This semi-naturalistic study suggests that the consumption of medical cannabis containing THC (1.13-39.18 mg/dose) has a negligible impact on driving performance when used as prescribed.
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Affiliation(s)
- Brooke Manning
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Thomas R Arkell
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Amie C Hayley
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Institute for Breathing and Sleep (IBAS), Austin Health, Melbourne, VIC, Australia
| | - Luke A Downey
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Institute for Breathing and Sleep (IBAS), Austin Health, Melbourne, VIC, Australia
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Strube C, Comazzi RD, Löwinger D, Auer R, Moggi F, Pfeifer P. Attitudes of Swiss psychiatrists towards cannabis regulation and medical use in psychiatry: a cross-sectional study. J Cannabis Res 2023; 5:40. [PMID: 38057933 DOI: 10.1186/s42238-023-00210-y] [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: 05/16/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Changes in regulation for cannabis for nonmedical use (CNMU) are underway worldwide. Switzerland amended the law in 2021 allowing pilot trials evaluating regulative models for cannabis production and distribution. Simultaneously, cannabis for medical use (CMU) in psychiatry is a growing issue, asked for by patients and being discussed by medical professionals. METHODS From December 2021 to February 2022, we conducted an online survey of psychiatrists in Switzerland. The survey comprised questions on attitudes towards regulative models for CNMU and towards prescribing CMU for mental disorders. RESULTS We contacted 2010 psychiatrists in Switzerland. A total of 274 (14%) participated in the survey. Sixty-four percent agreed to a regulated legalization of CNMU, and 89% would welcome pilot trials in Switzerland assessing models for regulating CNMU with those from a French-speaking region being more skeptical. Forty-nine percent of psychiatrists agree that CMU might have a therapeutic effect in mental disorders, but 50% agree that there is not enough scientific evidence yet. Participants working in an inpatient setting or in a French-speaking region as well as those with a longer duration of practice were more skeptical on CMU for mental health. CONCLUSIONS Most surveyed Swiss psychiatrists favor the regulation of CNMU and the conduct of pilot trials. Despite little evidence and potential negative consequences, many participating Swiss psychiatrists agreed that cannabis could be efficacious in the treatment of some mental disorders advocating for more research in this topic.
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Affiliation(s)
- Constantin Strube
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Renato Davide Comazzi
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Dimitri Löwinger
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland
| | - Reto Auer
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Philippe Pfeifer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Korb L, Tromans S, Perera B, Khan N, Burrows L, Laugharne R, Hassiotis A, Allgar V, Efron D, Maidment I, Shankar R. The potential for medicinal cannabis to help manage challenging behaviour in people with intellectual disability: A perspective review. J Psychopharmacol 2023; 37:1201-1208. [PMID: 37937428 PMCID: PMC10714688 DOI: 10.1177/02698811231209192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Around 2% of the population have intellectual disabilities. Over one-third people with intellectual disabilities (PwID) present with 'challenging behaviour', which nosologically and diagnostically is an abstract concept. Challenging behaviour is influenced by a range of bio-psycho-social factors in a population, which is unable to suitably comprehend and/or communicate concerns. This predisposes to poor health and social outcomes. There is no evidence-based treatments for managing challenging behaviour. Cannabidiol (CBD) and tetrahydrocannabinol (THC) are being trialled for a range of disorders, which are over-represented in PwID and provoke challenging behaviours, such as severe epilepsy, spasticity, post-traumatic stress disorder, social phobia, pain, etc. METHODS This perspective review explores the different conditions, which benefit from medicinal CBD/THC preparations, by analysing recent literature from neurobiological, pre-clinical and clinical studies related to the topic. The evidence is synthesised to build an argument of the therapeutic benefits and challenges of medicinal cannabis to manage severe challenging behaviour in PwID. RESULTS There is developing evidence of medicinal CBD/THC improving psychiatric and behavioural presentations in general. In particular, there is emergent proof in certain key areas of influence of medicinal CBD/THC positively supporting challenging behaviour, for example in children with neurodevelopmental disorders. However, there are significant challenges in employing such treatments in vulnerable populations such as PwID. CONCLUSION Further clinical research for the considered use of medicinal CBD/THC for challenging behaviour management in PwID is needed. Strong co-production with experts with lived experience is needed for further testing to be done in this exciting new area.
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Affiliation(s)
- Laura Korb
- Haringey Learning Disability Partnership, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Samuel Tromans
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- Adult Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Bhathika Perera
- North East London NHS Foundation Trust, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Nagina Khan
- Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Richard Laugharne
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
| | | | - Victoria Allgar
- Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Truro, UK
| | - Daryl Efron
- Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Ian Maidment
- College of Life and Health Sciences, Aston School of Pharmacy, Aston University, Birmingham, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
- Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Truro, UK
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Azizoddin DR, Cohn AM, Ulahannan SV, Henson CE, Alexander AC, Moore KN, Holman LL, Boozary LK, Sifat MS, Kendzor DE. Cannabis use among adults undergoing cancer treatment. Cancer 2023; 129:3498-3508. [PMID: 37354093 PMCID: PMC11070130 DOI: 10.1002/cncr.34922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/06/2023] [Accepted: 03/14/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Little is known about the risks and benefits of cannabis use in the context of cancer care. This study characterized the prevalence, reasons for use, and perceived benefits of cannabis and compared symptoms and perceived risks between those who reported past 30-day cannabis use and those who did not. METHODS Adults undergoing cancer treatment at a National Cancer Institute-designated cancer center completed measures of sociodemographic characteristics, cannabis use, use modalities, reasons for use, perceived harms/benefits of use, physical and psychological symptoms, and other substance/medication use. Analyses compared patients who used or did not use cannabis in the past 30 days. RESULTS Participants (N = 267) were 58 years old on average, primarily female (70%), and predominantly White (88%). Over a quarter of respondents (26%) reported past 30-day cannabis use, and among those, 4.5% screened positive for cannabis use disorder. Participants who used cannabis most often used edibles (65%) or smoked cannabis (51%), and they were younger and more likely to be male, Black, and disabled, and to have lower income and Medicaid insurance than participants who did not use cannabis. Those who used cannabis reported more severe symptoms and perceived cannabis as less harmful than those who did not use cannabis. The most common medical reasons for cannabis use were pain, cancer, sleep problems, anxiety, nausea/vomiting, and poor appetite. Participants reported the greatest cannabis-related symptom relief from sleep problems, nausea/vomiting, headaches, pain, muscle spasms, and anxiety. CONCLUSIONS Patients with cancer who used cannabis perceived benefits for many symptoms, although they showed worse overall symptomatology. PLAIN LANGUAGE SUMMARY Among adults undergoing cancer treatment, 26% reported cannabis use in the past 30 days. Those who used cannabis were more likely to be male and disabled and to have lower income and Medicaid insurance than those who did not use cannabis. Participants most commonly reported using cannabis for pain, cancer, sleep, anxiety, and nausea/vomiting and reported the greatest perceived benefits for sleep, nausea/vomiting, headaches, pain, muscle spasms, and anxiety, yet participants who used cannabis also reported feeling worse physically and psychologically compared to those who did not use cannabis. Participants who used cannabis were more likely to report that cannabis was less risky to their health than alcohol, smoking, and opioids than those who did not use cannabis.
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Affiliation(s)
- Desiree R. Azizoddin
- Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amy M. Cohn
- Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Susanna V. Ulahannan
- Hematology‐Oncology Section, Department of Internal Medicine, Stephenson Cancer Center, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Christina E. Henson
- Department of Radiation Oncology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Adam C. Alexander
- Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kathleen N. Moore
- Gynecologic Oncology Section, Department of Obstetrics and Gynecology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Laura L. Holman
- Gynecologic Oncology Section, Department of Obstetrics and Gynecology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Laili Kharazi Boozary
- Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
- Cellular and Behavioral Neurobiology, Department of Psychology, The University of Oklahoma, Norman, Oklahoma, USA
| | - Munjireen S. Sifat
- Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Darla E. Kendzor
- Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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7
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Gliksberg O, Kushnir T, Sznitman SR, Lev-Ran S, Brill S, Amit BH, Feingold D. Negative experiences of patients using medicinal cannabis: A systematic review of qualitative studies. J Clin Nurs 2023; 32:5607-5618. [PMID: 36807590 DOI: 10.1111/jocn.16653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Abstract
AIMS AND OBJECTIVES In this study, we systematically reviewed qualitative studies concerning patients' experience with medicinal cannabis (MC) use, to gain insight into the negative effects of MC. BACKGROUND Over the past decades, the use of MC for therapeutic purposes has increased. However, there is conflicting and insufficient data on possible negative physiological and psychological effects of MC treatment. DESIGN A systematic review was conducted and the PRISMA guidelines were adopted. Literature searches were conducted using PubMed, PsycINFO and EMBASE. Critical Appraisal Skills Programme (CASP) qualitative checklist used to assess risk of bias in the included studies. METHODS We included studies focusing on conventional medical treatment using cannabis-based products, approved by a physician for a particular health issue. RESULTS Of the 1230 articles identified in the initial search, eight articles were included in the review. Following the compilation of themes in the eligible studies, six themes were identified: (1) MC approval; (2) administrative barriers; (3) social perception; (4) MC misuse/widespread effect; (5) adverse effects; and (6) dependence or addiction. These were grouped into two meta-themes: (1) administrative and social aspects of MC use; and (2) experiences of the effects of medicinal cannabis. CONCLUSIONS Our findings call for specific attention to unique consequences associated with MC use. Further research is needed in order to assess the degree to which negative experiences associated with MC use may affect various aspects of patients' medical condition. RELEVANCE TO CLINICAL PRACTICE Describing the complex experience of MC treatment and its spectrum of consequences for patients may enable physicians, therapists and researchers to provide more attentive and accurate MC treatment to their patients. PATIENT OR PUBLIC CONTRIBUTION In this review, patients' narratives were explored, yet the research methods did not directly involve patients or the public.
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Affiliation(s)
- Or Gliksberg
- Doctoral Program, Department of Psychology, Ariel University, Ariel, Israel
| | - Talma Kushnir
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Psychology, Ariel University, Ariel, Israel
| | | | - Shaul Lev-Ran
- Israel Center on Addiction, Netanya, Israel
- Lev Hasharon Medical Center, Netanya, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silviu Brill
- Institute of Pain Medicine, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ben H Amit
- Cannabis Clinic, Reuth Rehabilitation Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ney LJ, Akosile W, Davey C, Pitcher L, Felmingham KL, Mayo LM, Hill MN, Strodl E. Challenges and considerations for treating PTSD with medicinal cannabis: the Australian clinician's perspective. Expert Rev Clin Pharmacol 2023; 16:1093-1108. [PMID: 37885234 DOI: 10.1080/17512433.2023.2276309] [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: 06/29/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Preclinical and experimental research have provided promising evidence that medicinal cannabis may be efficacious in the treatment of posttraumatic stress disorder (PTSD). However, implementation of medicinal cannabis into routine clinical therapies may not be straightforward. AREAS COVERED In this review, we describe some of the clinical, practical, and safety challenges that must be addressed for cannabis-based treatment of PTSD to be feasible in a real-world setting. These issues are especially prevalent if medicinal cannabis is to be combined with trauma-focused psychotherapy. EXPERT OPINION Future consideration of the clinical and practical considerations of cannabis use in PTSD therapy will be essential to both the efficacy and safety of the treatment protocols that are being developed. These issues include dose timing and titration, potential for addiction, product formulation, windows of intervention, and route of administration. In particular, exposure therapy for PTSD involves recall of intense emotions, and the interaction between cannabis use and reliving of trauma memories must be explored in terms of patient safety and impact on therapeutic outcomes.
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Affiliation(s)
- Luke J Ney
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Wole Akosile
- Greater Brisbane Clinical School, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Chris Davey
- Department of Psychiatry, Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | | | - Kim L Felmingham
- School of Psychological Sciences, Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Leah M Mayo
- Department of Psychiatry, Mathison Centre for Mental Health Research, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Matthew N Hill
- Department of Psychiatry, Mathison Centre for Mental Health Research, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Esben Strodl
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Bialas P, Böttge-Wolpers C, Fitzcharles MA, Gottschling S, Konietzke D, Juckenhöfel S, Madlinger A, Welsch P, Häuser W. Cannabis use disorder in patients with chronic pain: overestimation and underestimation in a cross-sectional observational study in 3 German pain management centres. Pain 2023; 164:1303-1311. [PMID: 36327134 DOI: 10.1097/j.pain.0000000000002817] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
ABSTRACT There are concerns that cannabis use disorder (CUD) may develop in patients with chronic pain prescribed medical cannabis (MC). The criteria for CUD according to the Statistical Manual for Mental Disorders Version 5 (DSM-5) were not developed for the identification of patients using cannabis for therapeutic reasons. In addition, some items of CUD might be attributed to the desire of the patient to relieve the pain. Therefore, alternative strategies are needed to identify the true prevalence of CUD in persons with chronic pain being treated with MC. The prevalence of CUD in patients with chronic pain according to the DSM-5 criteria was assessed using an anonymous questionnaire in 187 consecutive patients attending 3 German pain centres in 2021. Questionnaires were rated as follows: (1) all criteria included, (2) removal of items addressing tolerance and withdrawal, and (3) removal of positive items if associated with the desire to relieve pain. Abuse was assessed by self-report (use of illegal drugs and diversion and illegal acquisition of MC) and urine tests for illegal drugs. Physicians recorded any observation of abuse. Cannabis use disorder according to the DSM-5 criteria was present in 29.9%, in 13.9% when items of tolerance and withdrawal were removed, and in 2.1% when positive behaviour items were removed. In 10.7%, at least 1 signal of abuse was noted. Urine tests were positive for nonprescribed drugs (amphetamines and tranquilizer) in 4.8% of subjects. Physicians identified abuse in 1 patient. In this study, the DSM-5 criteria overestimated and physicians underestimated the prevalence of CUD in patients prescribed MC for chronic pain.
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Affiliation(s)
- Patric Bialas
- Medical Practice for Pain Medicine Saarlouis, Saarlouis, Germany
- Department of Anesthesiology, Intensive Care and Pain Medicine, Saarland University Medical Center, Homburg, Germany
| | | | - Mary-Ann Fitzcharles
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC, Canada
- Division of Rheumatology, McGill University Health Centre, Montreal, QC, Canada
| | - Sven Gottschling
- Centre of Palliative Care and Pediatric Pain, Saarland University Medical Center, Homburg, Germany
| | - Dieter Konietzke
- Center for Pain Medicine and Mental Health Saarbrücken, Saarbrücken, Germany
| | | | - Albrecht Madlinger
- Center for Pain Medicine and Mental Health Saarbrücken, Saarbrücken, Germany
| | - Patrick Welsch
- Center for Pain Medicine and Mental Health Saarbrücken, Saarbrücken, Germany
| | - Winfried Häuser
- Center for Pain Medicine and Mental Health Saarbrücken, Saarbrücken, Germany
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
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10
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Kvillemo P, Strandberg AK, Gripenberg J. Attitudes to Cannabis Use and Public Prevention Information Among Young Adults: A Qualitative Interview Study With Implications for Prevention Practice. Front Public Health 2022; 10:830201. [PMID: 35812509 PMCID: PMC9261461 DOI: 10.3389/fpubh.2022.830201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cannabis use carries an increased risk of ill health and social problems, especially when initiated at a young age. Drug use is influenced by individual beliefs, knowledge, and attitudes, which are, in turn, governed by social and environmental factors. In recent years, a less restrictive attitude toward cannabis has been observed in many countries, with concerns about increased cannabis use among young people. The aim of the current study was to gain a deeper understanding of young adults' attitudes toward cannabis use and public prevention information about cannabis. Methods A qualitative interview study was conducted among 32 anonymous informants aged 18-29 years in the Stockholm region. Participants were recruited through purposeful sampling, and semi-structured in-depth interviews were conducted using a digital video calling platform. A qualitative content analysis of the interviews was performed to generate categories and codes for cannabis use and attitudes toward prevention information. Results Both cannabis users and abstainers perceived some risks with cannabis; however, for many users, the positive effects appeared to outweigh any expected harm. Furthermore, the existing public information was perceived as less credible because of an excessive focus on harm. The informants expressed a desire for neutral facts about the effects of cannabis, delivered by credible senders. Moreover, they felt that prevention information should be delivered by individuals whom young people look up to or with whom they can identify, for example, people with authority or famous people such as influencers. The informants also underlined the importance of dialogue with the target group and taking young people's experiences into account when providing information about cannabis. Conclusion Current risk awareness associated with cannabis use among young adults is insufficient to prevent them from using cannabis. Public prevention information should preferably combine a fact-based focus on risks with recognition of cannabis' short-term desired effects, delivered by credible senders with authority or those with whom young people can identify.
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Affiliation(s)
- Pia Kvillemo
- Stockholm Prevents Alcohol and Drug Problems (STAD), Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
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Jacobs RJ, Kane MN. Exploratory Factor Analysis of Medical Students’ Perceptions of Medical Cannabis Scale. Cureus 2022; 14:e25749. [PMID: 35812569 PMCID: PMC9270071 DOI: 10.7759/cureus.25749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background There are few published research articles investigating medical students’ perceptions of medical cannabis (MC), including their attitudes toward its efficacy and appropriateness in medicine, concerns for potential adverse effects, and their willingness to prescribe it to patients (in future practice). This research investigated the factor structure of a tool to assess medical students’ perceptions of MC for the purpose of curriculum enhancement. Methods Using a voluntary electronic survey, quantitative data were collected between January and March 2022 from 526 medical students enrolled in a large medical school in Florida, United States. A 32-item questionnaire developed by the researchers was used to investigate medical students’ perceptions of MC. The survey was anonymous and took about 10 minutes to complete. Bivariate correlation analyses were conducted prior to performing a principal component analysis with varimax rotation. Results Using principal component analysis with varimax rotation, three factors were identified with eigenvalues greater than 1.0 and a cumulative variance of 59.694%. These factors are perceived knowledge of MC, concern for possible adverse effects of MC (e.g., the potential for misuse/dependence), and attitudes toward MC (e.g., cannabis having an acceptable role in medicine, willingness (as a future physician) to help patients access MC, obtaining training about MC in school and residency training, the physician’s role as a prescriber, and efficacy and benefits of MC for certain health conditions). Conclusions The development of this kind of brief measure may be valuable for defining the future educational needs of medical students and other health professionals as well as a tool for future research.
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12
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Farinha-Ferreira M, Rei N, Fonseca-Gomes J, Miranda-Lourenço C, Serrão P, Vaz SH, Gomes JI, Martins V, de Alves Pereira B, Sebastião AM. Unexpected short- and long-term effects of chronic adolescent HU-210 exposure on emotional behavior. Neuropharmacology 2022; 214:109155. [PMID: 35660545 DOI: 10.1016/j.neuropharm.2022.109155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
Chronic adolescent cannabinoid receptor agonist exposure has been shown to lead to persistent increases in depressive-like behaviors. This has been a key obstacle to the development of cannabinoid-based therapeutics. However, most of the published work has been performed with only three compounds, namely Δ9-tetrahydrocannabinol, CP55,940 and WIN55,212-2. Hypothesizing that different compounds may lead to distinct outcomes, we herein used the highly potent CB1R/CB2R full agonist HU-210, and first aimed at replicating cannabinoid-induced long-lasting effects, by exposing adolescent female Sprague-Dawley rats to increasing doses of HU-210, for 11 days and testing them at adulthood, after a 30-day drug washout. Surprisingly, HU-210 did not significantly impact adult anxious- or depressive-like behaviors. We then tested whether chronic adolescent HU-210 treatment resulted in short-term (24h) alterations in depressive-like behavior. Remarkably, HU-210 treatment simultaneously induced marked antidepressant- and prodepressant-like responses, in the modified forced swim (mFST) and sucrose preference tests (SPT), respectively. Hypothesizing that mFST results were a misleading artifact of HU-210-induced behavioral hyperreactivity to stress, we assessed plasmatic noradrenaline and corticosterone levels, under basal conditions and following an acute swim-stress episode. Notably, we found that while HU-210 did not alter basal noradrenaline or corticosterone levels, it greatly augmented the stress-induced increase in both. Our results show that, contrary to previously studied cannabinoid receptor agonists, HU-210 does not induce persisting depressive-like alterations, despite inducing marked short-term increases in stress-induced reactivity. By showing that not all cannabinoid receptor agonists may induce long-term negative effects, these results hold significant relevance for the development of cannabinoid-based therapeutics.
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Affiliation(s)
- Miguel Farinha-Ferreira
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Nádia Rei
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - João Fonseca-Gomes
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Catarina Miranda-Lourenço
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Paula Serrão
- Departamento de Biomedicina - Unidade de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto. Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal; MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto. Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Sandra H Vaz
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Joana I Gomes
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Valéria Martins
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Beatriz de Alves Pereira
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Ana M Sebastião
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal.
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13
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Deidda R, Dispas A, De Bleye C, Hubert P, Ziemons É. Critical review on recent trends in cannabinoid determination on cannabis herbal samples: From chromatographic to vibrational spectroscopic techniques. Anal Chim Acta 2022; 1209:339184. [DOI: 10.1016/j.aca.2021.339184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 12/13/2022]
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14
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Lazris D, Gaur D, Curseen K, Kavalieratos D, Maxwell M, Quest T, Zarrabi AJ. Integrated Medical Cannabis Consultations in a Palliative Care Program: Policies, Procedures, and Progress after Six Years of Practice. J Palliat Med 2022; 25:802-806. [PMID: 35319304 DOI: 10.1089/jpm.2021.0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Our academic ambulatory palliative care program has counseled, monitored, and certified patients for cannabis as part of routine palliative care practice for six years. Objective: We describe the population certified for cannabis and policies, procedures, and medicolegal challenges in our palliative care clinic. Methods: We performed a retrospective review of patients, qualifying diagnoses for cannabis certification, reasons for referral, and number of annual certifications. Results: Between 2015 and 2021, we certified 1711 patients for cannabis. The most common indications were cancer (64%), pain (24%), and neuropathy (9%). Other three months in 2021, 28% of new referrals to our practice were certified for cannabis and 15% of patients were referred explicitly for cannabis certification. Conclusion: Despite legal and practical challenges to implementing a medical cannabis program, our palliative care program has fully integrated cannabis as part of our standard outpatient clinical practice.
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Affiliation(s)
- David Lazris
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dhruv Gaur
- Brown University, Providence, Rhode Island, USA
| | - Kimberly Curseen
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dio Kavalieratos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Meredith Maxwell
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tammie Quest
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ali John Zarrabi
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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15
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Nutt D. Why doctors have a moral imperative to prescribe and support medical cannabis—an essay by David Nutt. BMJ : BRITISH MEDICAL JOURNAL 2022. [DOI: 10.1136/bmj.n3114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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16
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Ilan Y. Digital Medical Cannabis as Market Differentiator: Second-Generation Artificial Intelligence Systems to Improve Response. Front Med (Lausanne) 2022; 8:788777. [PMID: 35141242 PMCID: PMC8818992 DOI: 10.3389/fmed.2021.788777] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/20/2021] [Indexed: 12/19/2022] Open
Abstract
Legalized use of cannabis products and the rising interest in their therapeutic benefits have opened up new opportunities for therapy and marketing. However, the marked variability in formulations, administration modes, therapeutic regimens, and inter- and intra-subject responses make the standardization of medical cannabis-based regimens difficult. Legalization has made the cannabis market highly competitive and lowered the revenue margins. This study reviews some of the challenges in medical cannabis use and difficulties in standardizing its therapeutic regimens that hinder maximizing its beneficial effects. The development of tolerance toward cannabis and low adherence to chronic administration further impair its long-term beneficial effects. Digital medical cannabis is a cannabis product controlled by a second-generation artificial intelligence (AI) system that improves patient responses by increasing adherence and dealing with tolerance. Second-generation AI systems focus on a single patient's outcome and deal with the inter- and intra-subject variability in responses. The use of digital medical cannabis is expected to improve product standardization, maximize therapeutic benefits, reduce health care costs, and increase the revenue of companies. Digital medical cannabis offers several market differentiators for cannabis companies. This study presents a model for promoting the use of digital medical cannabis and presents its advantages for patients, clinicians, health care authorities, insurance companies, and cannabis manufacturers. Ongoing trials and real-world data on the use of these systems further support the use of digital medical cannabis for improved global health.
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Affiliation(s)
- Yaron Ilan
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
- *Correspondence: Yaron Ilan
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17
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Rubin-Kahana DS, Hassan AN, Sanches M, Le Foll B. Medical Cannabis and Past-Year Cannabis Use Disorder Among Adult Recreational Users in the United States: Results From a Nationally Representative Sample. Front Psychiatry 2022; 13:836908. [PMID: 35432009 PMCID: PMC9012583 DOI: 10.3389/fpsyt.2022.836908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION With the increasing number of cannabis users and more jurisdictions allowing medical cannabis, more evidence-based knowledge about the prevalence of cannabis use disorder (CUD) among medical users is greatly needed. OBJECTIVES To examine and compare the prevalence and severity of CUD and the prevalence of different CUD criteria among two groups: those who combine recreational and medical use vs. those who exclusively use cannabis recreationally. To examine the association between CUD and sociodemographic characteristics, medical conditions, and psychiatric comorbidities between these two groups. METHODS The National Epidemiological Survey on Alcohol and Related Conditions III data were used, a US nationally representative in-person interview of 36,309 adults aged ≥18 years collected in 2012-2013. The statistical examination included proportion comparison hypothesis testing and linear regressions, all using complex survey design analysis procedures. RESULTS Recreational users who used cannabis also for medical purposes had a higher prevalence of CUD in general, as well as mild and moderate CUD than users who used cannabis only for recreational purposes. CUD is more prevalent in recreational, medical users with the following characteristics: young, male, non-white, living in the Midwest, using a greater amount of cannabis, having a concurrent mental disorder, and had CUD before the past year. CONCLUSION Recreational, medical cannabis users have a higher likelihood of having CUD. Although the results should be taken with caution, given the lack of established validity of CUD among medical users, health care professionals who prescribe or recommend the use of cannabis for medical purposes should take this into consideration while evaluating the risks/benefits ratio of cannabis. They need to assess patients' recreational cannabis use, screen for CUD, and educate users about the possible complications caused by cannabis use.
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Affiliation(s)
- Dafna Sara Rubin-Kahana
- Child, Youth, and Family Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahmed Nabeel Hassan
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, King Abdul-Aziz University, Jeddah, Saudi Arabia.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Marcos Sanches
- Biostatistical Consulting Service, Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bernard Le Foll
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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18
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Rømer Thomsen K, Thylstrup B, Kenyon EA, Lees R, Baandrup L, Feldstein Ewing SW, Freeman TP. Cannabinoids for the treatment of cannabis use disorder: New avenues for reaching and helping youth? Neurosci Biobehav Rev 2021; 132:169-180. [PMID: 34822876 DOI: 10.1016/j.neubiorev.2021.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/16/2022]
Abstract
Cannabis use peaks during adolescence and emerging adulthood, and cannabis use disorder (CUD) is associated with a wide range of adverse outcomes. This is particularly pertinent in youth, because the developing brain may be more vulnerable to adverse effects of frequent cannabis use. Combining evidence-based psychosocial interventions with safe and effective pharmacotherapy is a potential avenue to improve youth outcomes, but we lack approved CUD pharmacotherapies. Here, we review new potential avenues for helping youth with CUD, with a particular focus on cannabinoid-based treatments. Evidence from placebo-controlled RCTs suggests synthetic delta-9-tetrahydrocannabinol (THC) decreases withdrawal symptoms, but not cannabis use, in adults with daily cannabis use/CUD, while findings regarding formulations containing THC combined with cannabidiol (CBD) are mixed. Preliminary evidence from two placebo-controlled RCTs in adults with CUD suggests that both Fatty Acid Amide Hydrolase inhibitors and CBD can reduce cannabis use. However, larger trials are needed to strengthen the evidence. Findings from adults point to cannabinoid-based treatments as a potential strategy that should be examined in youth with CUD.
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Affiliation(s)
- Kristine Rømer Thomsen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark.
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
| | - Emily A Kenyon
- Department of Psychology, University of Rhode Island, USA
| | - Rachel Lees
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Lone Baandrup
- Mental Health Centre Copenhagen and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Sarah W Feldstein Ewing
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark; Department of Psychology, University of Rhode Island, USA
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
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19
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ONAY A, ERTAŞ A, SÜZERER V, YENER İ, YILMAZ MA, AYAZ-TİLKAT E, EKİNCİ R, BOZHAN N, İRTEGÜN-KANDEMİR S. Cannabinoids for SARS-CoV-2 and is there evidence of their therapeutic efficacy? Turk J Biol 2021; 45:570-587. [PMID: 34803455 PMCID: PMC8573844 DOI: 10.3906/biy-2105-73] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/02/2021] [Indexed: 01/08/2023] Open
Abstract
To combat the coronaviruses and their novel variants, therapeutic drugs and the development of vaccines that are to be effective throughout human life are urgently needed. The endocannabinoid system (ECS) acts as a modulator in the activation of the microcirculation, immune system, and autonomic nervous system, along with controlling pharmacological functions such as emotional responses, homeostasis, motor functions, cognition, and motivation. The ECS contains endogenous cannabinoids, cannabinoid receptor (CBRs), and enzymes that regulate their biosynthesis, transport, and degradation. Moreover, phytocannabinoids and synthetic cannabinoids that mimic the action of endocannabinoids also play an essential role in the modulation of the ECS. Cannabinoids, the main constituents of cannabis (Cannabis sativa L.), are therapeutic compounds that have received international attention in the health field due to their therapeutic properties. Recently, they have been tested for the treatment of COVID-19 due to their antiviral properties. Indeed, cannabinoid-type compounds, and in particular cannabidiol (CBD), isolated from glandular trichomes found in the calyx of cannabis flowers with reported antiviral properties is hypothesized to be a therapeutic option in the ministration of SARS-CoV-2 consorted with COVID-19 disease. The relevant articles were determined from the database search published mainly in Web of Science, Google scholar, PubMed, Crossref, and ClinicalTrials.gov database during the pandemic period. The articles were evaluated for the therapeutic potentials, mechanisms of action of cannabinoids, the roles of the ECS in the immune system, impact of cannabinoids in SARS-CoV-2 septic, especially if they address the application of cannabinoids as drugs for the curability and management of SARS-CoV-2 and its novel variants. Although the evidence needed to be considered using cannabinoids in the control and treatment of viral diseases is currently in its infancy, they already offer an opportunity for clinicians due to their effects in relieving pain, improving appetite, and improving childhood epilepsy, especially in cancer and human immunodeficiency virus (HIV/AIDS) patients. In addition to these, the most recent scientific evidence emphasizes their use in the treatment of the coronavirus infected patients. In brief, all preclinic and clinic studies that have been reported show that, through the cannabinoid system, cannabinoids, particularly CBD, have many mechanisms that are effective in the treatment of patients infected by SARS-CoV-2. Thus, more extensive studies are necessary in this area to fully identify the effects of cannabinoids on SARS-CoV-2.
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Affiliation(s)
- Ahmet ONAY
- Department of Biology, Faculty of Science, Dicle University, DiyarbakırTurkey
| | - Abdulselam ERTAŞ
- Department of Pharmacognosy, Faculty of Pharmacy, Dicle University, DiyarbakırTurkey
| | - Veysel SÜZERER
- Department of Pharmacy Services, Vocational School of Health, Bingöl University, BingölTurkey
| | - İsmail YENER
- Department of Analytical Chemistry, Faculty of Pharmacy, Dicle University, DiyarbakırTurkey
| | | | - Emine AYAZ-TİLKAT
- Department of Biology, Faculty of Science and Literature, Batman University, BatmanTurkey
| | - Remzi EKİNCİ
- Department of Field Crops, Faculty of Agriculture, Dicle University, DiyarbakırTurkey
| | - Nesrin BOZHAN
- Department of Biology, Faculty of Science, Dicle University, DiyarbakırTurkey
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20
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Affiliation(s)
- Allan H Young
- Academic Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David J Nutt
- Neuropsychopharmacology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
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