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Poudel S, Quinonez J, Choudhari J, Au ZT, Paesani S, Thiess AK, Ruxmohan S, Hosameddin M, Ferrer GF, Michel J. Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature. Cureus 2021; 13:e17407. [PMID: 34589318 PMCID: PMC8459575 DOI: 10.7759/cureus.17407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/12/2022] Open
Abstract
Cannabis has been long used since ancient times for both medical and recreational use. Past research has shown that cannabis can be indicated for symptom management disorders, including cancer, chronic pain, headaches, migraines, and psychological disorders (anxiety, depression, and post-traumatic stress disorder). Active ingredients in cannabis that modulate patients' perceptions of their conditions include Δ9‐tetrahydrocannabinol (THC), cannabidiol (CBD), flavonoids, and terpenes. These compounds work to produce effects within the endocannabinoid system to decrease nociception and decrease symptom frequency. Research within the United States of America is limited to date due to cannabis being classified as a schedule one drug per the Drug Enforcement Agency. Few anecdotal studies have found a limited relationship between cannabis use and migraine frequency. The purpose of the review article is to document the validity of how medical cannabis can be utilized as an alternative therapy for migraine management. Thirty-four relevant articles were selected after a thorough screening process using PubMed and Google Scholar databases. The following keywords were used: "Cannabis," "Medical Marijuana," "Headache," "Cannabis and Migraine," "Cannabis and Headache." This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin. Patients suffering from migraines and related conditions may benefit from medical cannabis therapy due to its convenience and efficacy.
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Affiliation(s)
- Sujan Poudel
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Jonathan Quinonez
- Neurology/Osteopathic Neuromuscular Medicine, Larkin Community Hospital, Miami, USA
| | - Jinal Choudhari
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Zachary T Au
- Family and Community Medicine, Larkin Community Hospital, Miami, Florida, USA
| | - Sylvia Paesani
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Armond K Thiess
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Samir Ruxmohan
- Neurology, Larkin Community Hospital, Miami, Florida, USA
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Kogan NM, Peters M, Mechoulam R. Cannabinoid Quinones-A Review and Novel Observations. Molecules 2021; 26:molecules26061761. [PMID: 33801057 PMCID: PMC8003933 DOI: 10.3390/molecules26061761] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/11/2022] Open
Abstract
A cannabinoid anticancer para-quinone, HU-331, which was synthesized by our group five decades ago, was shown to have very high efficacy against human cancer cell lines in-vitro and against in-vivo grafts of human tumors in nude mice. The main mechanism was topoisomerase IIα catalytic inhibition. Later, several groups synthesized related compounds. In the present presentation, we review the publications on compounds synthesized on the basis of HU-331, summarize their published activities and mechanisms of action and report the synthesis and action of novel quinones, thus expanding the structure-activity relationship in these series.
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Kogan M, Sexton M. Medical Cannabis: A New Old Tool for Palliative Care. J Altern Complement Med 2020; 26:776-778. [PMID: 32924552 DOI: 10.1089/acm.2019.0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Mikhail Kogan
- Division of Geriatrics and Palliative Care, Department of Medicine, George Washington University, Washington, DC, USA.,GW Center for Integrative Medicine, Washington, DC, USA
| | - Michelle Sexton
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
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Exploring cancer survivors’ attitudes, perceptions, and concerns about using medical cannabis for symptom and side effect management: A qualitative focus group study. Complement Ther Med 2019; 47:102204. [DOI: 10.1016/j.ctim.2019.102204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/24/2019] [Accepted: 09/29/2019] [Indexed: 01/28/2023] Open
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Bayer G. The Case Against. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Glen Bayer
- Medicines Information Pharmacist; Pharmacy Department; Royal Hobart Hospital; Hobart Australia
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Cancer cachexia: Diagnosis, assessment, and treatment. Crit Rev Oncol Hematol 2018; 127:91-104. [PMID: 29891116 DOI: 10.1016/j.critrevonc.2018.05.006] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 04/16/2018] [Accepted: 05/09/2018] [Indexed: 02/07/2023] Open
Abstract
Cancer cachexia is a multi-factorial syndrome, which negatively affects quality of life, responsiveness to chemotherapy, and survival in advanced cancer patients. Our understanding of cachexia has grown greatly in recent years and the roles of many tumor-derived and host-derived compounds have been elucidated as mediators of cancer cachexia. However, cancer cachexia remains an unmet medical need and attempts towards a standard treatment guideline have been unsuccessful. This review covers the diagnosis, assessment, and treatment of cancer cachexia; the elements impeding the formulation of a standard management guideline; and future directions of research for the improvement and standardization of current treatment procedures.
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Cabeza C, Corsi O, Pérez-Cruz P. Are cannabinoids an alternative for cachexia-anorexia syndrome in patients with advanced cancer? Medwave 2017; 17:e7130. [DOI: 10.5867/medwave.2017.09.7130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/20/2017] [Indexed: 11/27/2022] Open
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Corsi O, Peña J. Are cannabinoids effective for the management of chemotherapy induced nausea and vomiting? Medwave 2017; 17:e7119. [DOI: 10.5867/medwave.2017.09.7119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/20/2017] [Indexed: 11/27/2022] Open
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Abstract
The use of cannabinoids has been proposed as an analgesic for different painful conditions, especially for chronic pain refractory to usual treatment. However, its real efficacy and safety remains controversial. We sought to determine whether cannabinoids are an effective treatment for chronic non-cancer pain. To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We identified 37 systematic reviews including 41 studies overall, of which 32 were randomized trials relevant for the question of interest. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded it is not clear whether cannabinoids decrease pain in patients with chronic non-cancer pain because the certainty of available evidence is very low. On the other hand, they are associated with significant adverse effects.
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Affiliation(s)
- Rubén F Allende-Salazar
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile. . Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago Centro, Chile
| | - Gabriel Rada
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro de Evidencia UC, Pontificia Universidad Católica de Chile, Santiago, Chile; GRADE working group; The Cochrane Collaboration
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Mudge EM, Murch SJ, Brown PN. Leaner and greener analysis of cannabinoids. Anal Bioanal Chem 2017; 409:3153-3163. [PMID: 28233028 PMCID: PMC5395585 DOI: 10.1007/s00216-017-0256-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/23/2017] [Accepted: 02/10/2017] [Indexed: 11/24/2022]
Abstract
There is an explosion in the number of labs analyzing cannabinoids in marijuana (Cannabis sativa L., Cannabaceae) but existing methods are inefficient, require expert analysts, and use large volumes of potentially environmentally damaging solvents. The objective of this work was to develop and validate an accurate method for analyzing cannabinoids in cannabis raw materials and finished products that is more efficient and uses fewer toxic solvents. An HPLC-DAD method was developed for eight cannabinoids in cannabis flowers and oils using a statistically guided optimization plan based on the principles of green chemistry. A single-laboratory validation determined the linearity, selectivity, accuracy, repeatability, intermediate precision, limit of detection, and limit of quantitation of the method. Amounts of individual cannabinoids above the limit of quantitation in the flowers ranged from 0.02 to 14.9% w/w, with repeatability ranging from 0.78 to 10.08% relative standard deviation. The intermediate precision determined using HorRat ratios ranged from 0.3 to 2.0. The LOQs for individual cannabinoids in flowers ranged from 0.02 to 0.17% w/w. This is a significant improvement over previous methods and is suitable for a wide range of applications including regulatory compliance, clinical studies, direct patient medical services, and commercial suppliers.
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Affiliation(s)
- Elizabeth M Mudge
- Natural Health & Food Products Research, British Columbia Institute of Technology, 3700 Willingdon Ave, Burnaby, British Columbia, V5G 3H2, Canada.,Department of Chemistry, University of British Columbia, 3247 University Way, Kelowna, British Columbia, V1V 1V7, Canada
| | - Susan J Murch
- Department of Chemistry, University of British Columbia, 3247 University Way, Kelowna, British Columbia, V1V 1V7, Canada
| | - Paula N Brown
- Natural Health & Food Products Research, British Columbia Institute of Technology, 3700 Willingdon Ave, Burnaby, British Columbia, V5G 3H2, Canada.
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Baron EP. Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It's Been …. Headache 2015; 55:885-916. [PMID: 26015168 DOI: 10.1111/head.12570] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of cannabis, or marijuana, for medicinal purposes is deeply rooted though history, dating back to ancient times. It once held a prominent position in the history of medicine, recommended by many eminent physicians for numerous diseases, particularly headache and migraine. Through the decades, this plant has taken a fascinating journey from a legal and frequently prescribed status to illegal, driven by political and social factors rather than by science. However, with an abundance of growing support for its multitude of medicinal uses, the misguided stigma of cannabis is fading, and there has been a dramatic push for legalizing medicinal cannabis and research. Almost half of the United States has now legalized medicinal cannabis, several states have legalized recreational use, and others have legalized cannabidiol-only use, which is one of many therapeutic cannabinoids extracted from cannabis. Physicians need to be educated on the history, pharmacology, clinical indications, and proper clinical use of cannabis, as patients will inevitably inquire about it for many diseases, including chronic pain and headache disorders for which there is some intriguing supportive evidence. OBJECTIVE To review the history of medicinal cannabis use, discuss the pharmacology and physiology of the endocannabinoid system and cannabis-derived cannabinoids, perform a comprehensive literature review of the clinical uses of medicinal cannabis and cannabinoids with a focus on migraine and other headache disorders, and outline general clinical practice guidelines. CONCLUSION The literature suggests that the medicinal use of cannabis may have a therapeutic role for a multitude of diseases, particularly chronic pain disorders including headache. Supporting literature suggests a role for medicinal cannabis and cannabinoids in several types of headache disorders including migraine and cluster headache, although it is primarily limited to case based, anecdotal, or laboratory-based scientific research. Cannabis contains an extensive number of pharmacological and biochemical compounds, of which only a minority are understood, so many potential therapeutic uses likely remain undiscovered. Cannabinoids appear to modulate and interact at many pathways inherent to migraine, triptan mechanisms ofaction, and opiate pathways, suggesting potential synergistic or similar benefits. Modulation of the endocannabinoid system through agonism or antagonism of its receptors, targeting its metabolic pathways, or combining cannabinoids with other analgesics for synergistic effects, may provide the foundation for many new classes of medications. Despite the limited evidence and research suggesting a role for cannabis and cannabinoids in some headache disorders, randomized clinical trials are lacking and necessary for confirmation and further evaluation.
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Affiliation(s)
- Eric P Baron
- Department of Neurology, Headache Center, Cleveland Clinic Neurological Institute, Cleveland, OH, USA
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Abstract
BACKGROUND Pain is common in advanced malignancy but also prevalent in other non-malignant life-limiting diseases such as advanced heart disease; end stage renal failure and multiple sclerosis. Patients with renal or liver impairment need specific consideration, as most analgesics rely on either or both for their metabolism and excretion. SOURCES OF DATA Recent evidence-based guidelines and the systematic reviews that have informed their recommendations. AREAS OF AGREEMENT The principles of the WHO (World Health Organisation) analgesic ladder are commonly endorsed as a structured approach to the management of pain. For neuropathic pain, the efficacy of different agents is similar and choice of drug more guided by side effects, drug interactions and cost. AREAS OF CONTROVERSY Evidence supporting the WHO analgesic ladder is disputed and alternatives suggested, but no overwhelming evidence for an alternative approach exists to date. GROWING POINTS Alternative approaches to the WHO analgesic ladder, new analgesic agents, e.g. rapid onset oral/intranasal fentanyl.
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Affiliation(s)
- Dylan G Harris
- Department of Palliative Care, Prince Charles Hospital, Merthyr Tydfil, South Wales CF479DT, UK
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Abstract
Marijuana is the most commonly used illicit drug around the world. It is most often consumed through smoking, placing the respiratory system in direct contact with the toxic constituents of the drug, which are similar to those of tobacco cigarettes. However, accurate study of the adverse effects of marijuana is difficult to perform, owing to marijuana's illegal status, variation in smoking technique, often short duration of use compared with tobacco and the frequently confounding factor of concomitant consumption of both marijuana and tobacco. Despite this, there is evidence to suggest that marijuana can impair lung function, damage large airway mucosa and possibly contribute to bullous disease, while its carcinogenic potential is controversial.
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Affiliation(s)
- Megan L Howden
- Alfred Hospital and Monash University, Prahran 3181, Australia
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Acheson SK, Moore NLT, Kuhn CM, Wilson WA, Swartzwelder HS. The synthetic cannabinoid WIN 55212-2 differentially modulates thigmotaxis but not spatial learning in adolescent and adult animals. Neurosci Lett 2010; 487:411-4. [PMID: 21055447 DOI: 10.1016/j.neulet.2010.10.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 09/15/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
Abstract
Unlike Δ(9)-THC, the synthetic compound WIN 55212-2 (WIN) is a full agonist of endogenous cannabinoid receptors. Previous work has shown Δ(9)-THC to affect adolescent and adult animals differently on numerous behavioral measures of spatial memory, anxiety, and locomotor activity. However, far less is known about the developmental and neurobehavioral effects of WIN. To address this, we assessed the effect of WIN (1mg/kg) on spatial learning in adolescent and adult rats using the Morris water maze. While all animals demonstrated decreased swim distance across days, WIN affected adolescents and adults differently. It improved performance in adolescents and resulted in a nearly significant performance decrement in adults. However, these effects were significantly related to thigmotaxis, which declined across days in the water maze testing protocol. WIN reduced thigmotaxis on days 1 and 2 (but not days 3-5) only in adolescents. The effect of age, treatment, and the age×treatment interaction was eliminated after controlling for thigmotaxis. These results indicate that WIN affects thigmotaxis rather than spatial reference memory. More importantly, these findings indicate a dissociation between the developmental effects of THC and the synthetic CB1 receptor agonist, WIN 55212-2. We suggest that the role of thigmotaxis be carefully evaluated in future neurodevelopmental studies of spatial learning, especially those investigating the endocannabinoid system.
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Affiliation(s)
- Shawn K Acheson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, United States.
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Green AJ, De-Vries K. Cannabis use in palliative care - an examination of the evidence and the implications for nurses. J Clin Nurs 2010; 19:2454-62. [DOI: 10.1111/j.1365-2702.2010.03274.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Amirjamshidi A, Abbassioun K, Parsa K. Hiccup and neurosurgeons: a report of 4 rare dorsal medullary compressive pathologies and review of the literature. ACTA ACUST UNITED AC 2007; 67:395-402; discussion 402. [PMID: 17350413 DOI: 10.1016/j.surneu.2006.10.070] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 10/22/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to present 4 rare cases of medullary compressive lesions presenting with IH, to discuss the indications for neurosurgical decompression in such cases, and to review the possible etiologies of IH briefly. METHODS The reported cases include (1) a 19-year-old adolescent boy and a 21-year-old man with Chiari I malformation and cervical syrinx compressing or tightening the cervico-medullary junction; (2) a 35-year-old man with ependymoma extending from the lower half of the fourth ventricle to C1/C2 junction and compressing this part of the medulla; and (3) a 16-year-old adolescent boy who was referred to the emergency department in severe distress because of IH, occurring as a result of a distal PICA aneurysm located on the floor of the lower triangle of the fourth ventricle. RESULTS Surgical decompression in all the cases was successful in withholding the hiccups. CONCLUSION The dorsal medullary area is not an unusual location for genesis of hiccup. When encountering a case of IH, appropriate CNS imaging studies should be included in the evaluation protocol.
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Affiliation(s)
- Abbass Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran 19585, Iran.
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Ben Amar M. Cannabinoids in medicine: A review of their therapeutic potential. JOURNAL OF ETHNOPHARMACOLOGY 2006; 105:1-25. [PMID: 16540272 DOI: 10.1016/j.jep.2006.02.001] [Citation(s) in RCA: 280] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 01/30/2006] [Accepted: 02/02/2006] [Indexed: 05/07/2023]
Abstract
In order to assess the current knowledge on the therapeutic potential of cannabinoids, a meta-analysis was performed through Medline and PubMed up to July 1, 2005. The key words used were cannabis, marijuana, marihuana, hashish, hashich, haschich, cannabinoids, tetrahydrocannabinol, THC, dronabinol, nabilone, levonantradol, randomised, randomized, double-blind, simple blind, placebo-controlled, and human. The research also included the reports and reviews published in English, French and Spanish. For the final selection, only properly controlled clinical trials were retained, thus open-label studies were excluded. Seventy-two controlled studies evaluating the therapeutic effects of cannabinoids were identified. For each clinical trial, the country where the project was held, the number of patients assessed, the type of study and comparisons done, the products and the dosages used, their efficacy and their adverse effects are described. Cannabinoids present an interesting therapeutic potential as antiemetics, appetite stimulants in debilitating diseases (cancer and AIDS), analgesics, and in the treatment of multiple sclerosis, spinal cord injuries, Tourette's syndrome, epilepsy and glaucoma.
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Affiliation(s)
- Mohamed Ben Amar
- Substance Abuse Program, Faculties of Continuing Education and Graduate Studies, University of Montreal, C.P. 6128, succursale Centre-ville, Montreal, Que. H3C 3J7, Canada.
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Shmist YA, Goncharov I, Eichler M, Shneyvays V, Isaac A, Vogel Z, Shainberg A. Delta-9-tetrahydrocannabinol protects cardiac cells from hypoxia via CB2 receptor activation and nitric oxide production. Mol Cell Biochem 2006; 283:75-83. [PMID: 16444588 DOI: 10.1007/s11010-006-2346-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2004] [Accepted: 08/22/2005] [Indexed: 10/25/2022]
Abstract
Delta-9-tetrahydrocannabinol (THC), the major active component of marijuana, has a beneficial effect on the cardiovascular system during stress conditions, but the defence mechanism is still unclear. The present study was designed to investigate the central (CB1) and the peripheral (CB2) cannabinoid receptor expression in neonatal cardiomyoctes and possible function in the cardioprotection of THC from hypoxia. Pre-treatment of cardiomyocytes that were grown in vitro with 0.1 - 10 microM THC for 24 h prevented hypoxia-induced lactate dehydrogenase (LDH) leakage and preserved the morphological distribution of alpha-sarcomeric actin. The antagonist for the CB2 (10 microM), but not CB1 receptor antagonist (10 microM) abolished the protective effect of THC. In agreement with these results using RT-PCR, it was shown that neonatal cardiac cells express CB2, but not CB1 receptors. Involvement of NO in the signal transduction pathway activated by THC through CB2 was examined. It was found that THC induces nitric oxide (NO) production by induction of NO synthase (iNOS) via CB2 receptors. L-NAME (NOS inhibitor, 100 microM) prevented the cardioprotection provided by THC. Taken together, our findings suggest that THC protects cardiac cells against hypoxia via CB2 receptor activation by induction of NO production. An NO mechanism occurs also in the classical pre-conditioning process; therefore, THC probably pre-trains the cardiomyocytes to hypoxic conditions.
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Affiliation(s)
- Yelena A Shmist
- Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
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Kogan NM, Rabinowitz R, Levi P, Gibson D, Sandor P, Schlesinger M, Mechoulam R. Synthesis and Antitumor Activity of Quinonoid Derivatives of Cannabinoids. J Med Chem 2004; 47:3800-6. [PMID: 15239658 DOI: 10.1021/jm040042o] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Three cannabis constituents, cannabidiol (1), Delta(8)-tetrahydrocannabinol (3), and cannabinol (5), were oxidized to their respective para-quinones 2, 4, and 6. In the 1960s, the oxidized product 4 had been assigned a para-quinone structure, which was later modified to an ortho-quinone. To distinguish between the two possible quinone structures, a detailed NMR investigation was undertaken. The original para-quinone structure was confirmed. X-ray crystallography elucidated the structures of the crystalline 2 and 6. All three compounds displayed antiproliferative activity in several human cancer cell lines in vitro, and quinone 2 significantly reduced cancer growth of HT-29 cancer in nude mice.
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Affiliation(s)
- Natalya M Kogan
- Department of Medicinal Chemistry and Natural Products, School of Pharmacy, The Hebrew University, Jerusalem 91120, Israel
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Abstract
The principal constituent of cannabis, Delta(9)-tetrahydrocannabinol (THC), is moderately effective in treating nausea and vomiting, appetite loss, and acute and chronic pain. Oral THC (dronabinol) and the synthetic cannabinoid, nabilone, have been registered for medical use in the US and UK, but they have not been widely used because patients find it difficult to titrate doses of these drugs. Advocates for the medical use of cannabis argue that patients should be allowed to smoke cannabis to relieve these above-mentioned symptoms. Some US state governments have legislated to allow the medical prescription of cannabis, but the US federal government has tried to prevent patients from obtaining cannabis and threatened physicians who prescribe it with criminal prosecution or loss of their licence to practise. In the UK and Australia, committees of inquiry have recommended medical prescription (UK) and exemption from criminal prosecution (New South Wales, Australia), but governments have not accepted these recommendations. The Canadian government allows an exemption from criminal prosecution to patients with specified medical conditions. It has recently legislated to provide cannabis on medical prescription to registered patients, but this scheme so far has not been implemented. Some advocates argue that legalising cannabis is the only way to ensure that patients can use it for medical purposes. However, this would be contrary to international drug control treaties and is electorally unpopular. The best prospects for the medical use of cannabinoids lie in finding ways to deliver THC that do not involve smoking and in developing synthetic cannabinoids that produce therapeutic effects with a minimum of psychoactive effects. While awaiting these developments, patients with specified medical conditions could be given exemptions from criminal prosecution to grow cannabis for their own use, at their own risk.
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Affiliation(s)
- Wayne Hall
- Office of Public Policy and Ethics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia.
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Abstract
PURPOSE OF REVIEW Drug abuse, especially with designer drugs, continues to grow, involving a wide demographic range. Consequently, anesthesiologists may be involved in the care of patients under the acute and chronic influence of a myriad of substances. In addition to the usual physiological damage to vital organs (heart, lungs, kidneys, and immune system) new evidence of permanent damage in regions of the brain responsible for memory and pain mediation is emerging. As drug use continues to increase, anesthesiologists must learn to detect drug abusing patients and avoid known interactions. This article will attempt to review the recent literature on this subject. RECENT FINDINGS Cocaine, marijuana, ethanol, and heroin top the list of abused drugs, alone and in combination. The combined effects of these drugs can be synergistic in creating cardiovascular instability and toxicity. Because combinations create synergy in dopamine and serotonin transmission, addiction is possibly faster, more entrenched, and more difficult to treat. Anesthesiologists are now becoming involved in many of the rapid detoxification procedures to combat/treat addiction. Only limited research has addressed the newer designer drugs, but case reports regarding hyperthermia, cerebral edema, cerebral vasospasm, and lethal interactions with commonly used medications such as beta-blockers implicate the need for awareness in anesthesia personnel. SUMMARY Drug abuse continues to be a major problem facing our society. Anesthesiologists encounter emergency cases in which 'party drugs' have clearly been used, and may also be anesthetizing patients in whom abuse is present but unrecognized. Understanding how illicit drugs interact with anesthetic agents is of paramount importance.
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Affiliation(s)
- Joy L Steadman
- University of Miami School of Medicine, Miami, Florida, USA
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