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Carrascosa AJ, Navarrete F, Saldaña R, García-Gutiérrez MS, Montalbán B, Navarro D, Gómez-Guijarro FM, Gasparyan A, Murcia-Sánchez E, Torregrosa AB, Pérez-Doblado P, Gutiérrez L, Manzanares J. Cannabinoid Analgesia in Postoperative Pain Management: From Molecular Mechanisms to Clinical Reality. Int J Mol Sci 2024; 25:6268. [PMID: 38892456 PMCID: PMC11172912 DOI: 10.3390/ijms25116268] [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: 04/26/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Postoperative pain (POP) is a challenging clinical phenomenon that affects the majority of surgical patients and demands effective management to mitigate adverse outcomes such as persistent pain. The primary goal of POP management is to alleviate suffering and facilitate a seamless return to normal function for the patient. Despite compelling evidence of its drawbacks, opioid analgesia remains the basis of POP treatment. Novel therapeutic approaches rely on multimodal analgesia, integrating different pharmacological strategies to optimize efficacy while minimizing adverse effects. The recognition of the imperative role of the endocannabinoid system in pain regulation has prompted the investigation of cannabinoid compounds as a new therapeutic avenue. Cannabinoids may serve as adjuvants, enhancing the analgesic effects of other drugs and potentially replacing or at least reducing the dependence on other long-term analgesics in pain management. This narrative review succinctly summarizes pertinent information on the molecular mechanisms, clinical therapeutic benefits, and considerations associated with the plausible use of various cannabinoid compounds in treating POP. According to the available evidence, cannabinoid compounds modulate specific molecular mechanisms intimately involved in POP. However, only two of the eleven clinical trials that evaluated the efficacy of different cannabinoid interventions showed positive results.
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Affiliation(s)
- Antonio J. Carrascosa
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - Francisco Navarrete
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Raquel Saldaña
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - María S. García-Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Belinda Montalbán
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - Daniela Navarro
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Fernando M. Gómez-Guijarro
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - Ani Gasparyan
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Elena Murcia-Sánchez
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - Abraham B. Torregrosa
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Paloma Pérez-Doblado
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - Luisa Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Jorge Manzanares
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
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Boujenoui F, Nkambeu B, Salem JB, Castano Uruena JD, Beaudry F. Cannabidiol and Tetrahydrocannabinol Antinociceptive Activity is Mediated by Distinct Receptors in Caenorhabditis elegans. Neurochem Res 2024; 49:935-948. [PMID: 38141130 DOI: 10.1007/s11064-023-04069-6] [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: 07/01/2023] [Revised: 10/05/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023]
Abstract
Cannabis has gained popularity in recent years as a substitute treatment for pain following the risks of typical treatments uncovered by the opioid crisis. The active ingredients frequently associated with pain-relieving effects are the phytocannabinoids Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), but their effectiveness and mechanisms of action are still under research. In this study, we used Caenorhabditis elegans, an ideal model organism for the study of nociception that expresses mammal ortholog cannabinoid (NPR-19 and NPR-32) and vanilloid (OSM-9 and OCR-2) receptors. Here, we evaluated the antinociceptive activity of THC and CBD, identifying receptor targets and several metabolic pathways activated following exposure to these molecules. The thermal avoidance index was used to phenotype each tested C. elegans experimental group. The data revealed for the first time that THC and CBD decreases the nocifensive response of C. elegans to noxious heat (32-35 °C). The effect was reversed 6 h post- CBD exposure but not for THC. Further investigations using specific mutants revealed CBD and THC are targeting different systems, namely the vanilloid and cannabinoid systems, respectively. Proteomic analysis revealed differences following Reactome pathways and gene ontology biological process database enrichment analyses between CBD or THC-treated nematodes and provided insights into potential targets for future drug development.
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Affiliation(s)
- Fatma Boujenoui
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, 3200 Sicotte, Saint-Hyacinthe, Québec, J2S 2M2, Canada
- Centre de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, Québec, Canada
| | - Bruno Nkambeu
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, 3200 Sicotte, Saint-Hyacinthe, Québec, J2S 2M2, Canada
- Centre de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, Québec, Canada
| | - Jennifer Ben Salem
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, 3200 Sicotte, Saint-Hyacinthe, Québec, J2S 2M2, Canada
- Centre de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, Québec, Canada
| | - Jesus David Castano Uruena
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, 3200 Sicotte, Saint-Hyacinthe, Québec, J2S 2M2, Canada
- Centre de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, Québec, Canada
| | - Francis Beaudry
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, 3200 Sicotte, Saint-Hyacinthe, Québec, J2S 2M2, Canada.
- Centre de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, Québec, Canada.
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Morris JN, Loyer J, Blunt J. Stigma, risks, and benefits of medicinal cannabis use among Australians with cancer. Support Care Cancer 2024; 32:252. [PMID: 38532234 DOI: 10.1007/s00520-024-08439-w] [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: 10/01/2023] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE People with cancer who use medicinal cannabis do so despite risks associated with limited clinical evidence, legalities, and stigma. This study investigated how Australians with cancer rationalise their medicinal cannabis use despite its risks. METHODS Ten adults (5 males and 5 females; mean age of 53.3) who used cannabis medicinally for their cancer were interviewed in 2021-2022 about how they used and accessed the substance, attitudes and beliefs underpinning their use, and conversations with others about medicinal cannabis. RESULTS Participants had cancer of the bowel, skin, oesophagus, stomach, thyroid, breast, and Hodgkin lymphoma for which they were receiving treatment (n = 5) or under surveillance (n = 5), with most (n = 6) encountering metastatic disease. Cannabis was used to treat a variety of cancer-related symptoms such as pain, poor sleep, and low mood. Cannabis was perceived as natural and thus less risky than pharmaceuticals. Participants legitimised their medicinal cannabis use by emphasising its natural qualities and distancing themselves from problematic users or riskier substances. Cost barriers and a lack of healthcare professional communication impeded prescription access. Similarly, participants navigated medicinal cannabis use independently due to a lack of guidance from healthcare professionals. CONCLUSION Findings highlight the need for robust data regarding the harms and efficacy of medicinal cannabis and dissemination of such information among healthcare professionals and to patients who choose to use the substance. Ensuring healthcare professionals are equipped to provide non-judgmental and evidence-based guidance may mitigate potential safety and legal risks.
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Affiliation(s)
- Julia N Morris
- Cancer Council SA, 202 Greenhill Road, Eastwood, SA, 5063, Australia.
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MacCallum CA, Lo LA, Pistawka CA, Christiansen A, Boivin M. Cannabis vaporisation: Understanding products, devices and risks. Drug Alcohol Rev 2024; 43:732-745. [PMID: 38124429 DOI: 10.1111/dar.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
ISSUES Vaporisation is a common method of cannabis administration. Inconsistent terminology and jargon regarding vaporisation has led to confusion. The increasing public interest and access to cannabis, combined with possible safety concerns associated with certain cannabis vaping products, warrants improved consumer and public and health care professional knowledge. APPROACH To improve this knowledge, we conducted a review of the common terminology, regulatory status, products and device types related to cannabis vaporisation. KEY FINDINGS Cannabis vaporisation devices can be separated into nine types. While vaporisation reduces respiratory risks associated with cannabis combustion, not all vaping products and device types carry the same level of safety. Metered dose inhalers and dried product vaporisers present the lowest safety risk due to a lower risk of toxin exposure and the use of lower tetrahydrocannabinol potency products. IMPLICATIONS As both vaping and cannabis use increase in popularity, focusing on accurate health education will help facilitate health promotion to encourage lower risk use. The current lack of understanding on risk differences between types of cannabis vaporisation is a missed opportunity for harm reduction. Increased opportunities for public health and health care professional education on different cannabis vaporisation devices and associated risks are warranted. Improvements to health warning labelling may also be beneficial. CONCLUSION Not all cannabis vaporisation devices and products carry the same level of risk. A better understanding of risk differentiation is needed among consumers and health professionals. Continued research, policy development and health education can lead to safer cannabis vaporisation.
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Affiliation(s)
- Caroline A MacCallum
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lindsay A Lo
- Department of Public Health Science, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carly A Pistawka
- Faculty of Science, University of British Columbia, Vancouver, Canada
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MacCallum CA, Lo LA, Boivin M. Clinical Application of Cannabis Vaporization: Examining Safety and Best Practices. Cannabis Cannabinoid Res 2024. [PMID: 38394323 DOI: 10.1089/can.2023.0219] [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: 02/25/2024] Open
Abstract
Introduction: Cannabis vaporization is useful for individuals requiring fast-acting method of cannabis administration and for individuals using smoked cannabis as a harm reduction tool. There is a need for guidance on how to assess if a patient is a vaporization candidate and how to safely initiate and monitor cannabis vaporization. Methods: An overview of safe cannabis vaporization, including practical guidance and tactics to promote the lowest-risk use, is provided. This review was developed through a combination of expert clinical opinion and reviewing the available literature. Results: Dried cannabis vaporizers and metered-dose inhalers are recommended to be used over other vaporization devices. Assessing the benefit versus risks of vaporized cannabis and providing guidance for choosing a vaporization device, choosing a cannabis chemovar, and employing a mindful vaping technique are important steps in the safe utilization of vaporized cannabis. Dosing optimization and monitoring to limit adverse events and improve symptom control are essential. Discussion: The utilization of cannabis vaporization presents an important opportunity for clinicians and other health professionals to help facilitate safer cannabis administration and reduce the prevalence of smoked cannabis.
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Affiliation(s)
- Caroline A MacCallum
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lindsay A Lo
- Department of Public Health Science, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Trevitt BT, Bailey S, Mills L, Arkell TR, Suraev A, McGregor IS, Lintzeris N. Differences in prescribed medicinal cannabis use by cannabinoid product composition: Findings from the cannabis as medicine survey 2020 (CAMS-20) Australia-wide study. PLoS One 2024; 19:e0297092. [PMID: 38354169 PMCID: PMC10866492 DOI: 10.1371/journal.pone.0297092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/22/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Prescribed medicinal cannabis (MC) is an increasingly common prescription in Australia for treating pain, anxiety, and sleep disorders. Prescribed MC products generally contain tetrahydrocannabinol (THC) and/or cannabidiol (CBD) in a variety of dose levels and forms. It is unclear whether THC and CBD products are used by patients with different characteristics and for different conditions. OBJECTIVES To examine consumer experiences of using THC- and CBD-containing prescribed MC products to better understand how they are being used within the Australian context. METHODS We utilised data collected from an online anonymous cross-sectional survey of individuals (CAMS-20 survey), consisting of Australian residents using cannabis for therapeutic reasons. We focused on a subgroup of participants (N = 546) receiving prescribed MC products. We utilised linear, logistic, and multinomial regression modelling to analyse responses to survey questions based on the cannabinoid profile of the prescribed product. RESULTS Participants prescribed THC-dominant MC products were statistically more likely to be younger, male, and to prefer inhaled routes of administration than participants using CBD-dominant products who were older, female, and preferred oral routes of administration. Pain and mental health were the most common reasons for all types of prescribed MC, but were more likely to be treated with THC than CBD despite the significantly higher risk of mild to severe drowsiness, dry mouth and eye irritation. Consumer reported effectiveness of prescribed MC was very positive, particularly for THC-containing products. Consumers on opioids and antipsychotics were statistically more likely to be prescribed THC-containing products than products containing CBD only, despite the greater risk of impairment. CONCLUSIONS This Australia-wide study found clear differences in consumer-reported experiences of prescribed THC- and CBD-containing products. Current prescriptions of these products do not always align with relevant clinical guidance. Educating prescribers around cannabinoid products is essential to ensure optimal prescribing practices and to prevent avoidable drug side effects and interactions.
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Affiliation(s)
- Benjamin T. Trevitt
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
| | - Sasha Bailey
- Faculty of Medicine and Health, The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, Australia
| | - Llewellyn Mills
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia
- Speciality Addiction Medicine, Faculty Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Drug and Alcohol Clinical Research and Improvement Network, St Leonards, NSW, Australia
| | - Thomas R. Arkell
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Anastasia Suraev
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
| | - Iain S. McGregor
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia
- Speciality Addiction Medicine, Faculty Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Drug and Alcohol Clinical Research and Improvement Network, St Leonards, NSW, Australia
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Boehnke KF, Wu CL, Clauw DJ. Thoughtfully Integrating Cannabis Products Into Chronic Pain Treatment. Anesth Analg 2024; 138:5-15. [PMID: 38100797 PMCID: PMC10730114 DOI: 10.1213/ane.0000000000005904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Cannabis products (CPs) and cannabis-based medicines (CBMs) are becoming increasingly available and are commonly used for pain management. The growing societal acceptance of cannabis and liberalization of cannabis laws allows patients to access CPs with minimal clinical oversight. While there is mechanistic plausibility that CPs and CBMs may be useful for pain management, the clinical trial literature is limited and does not refute or support the use of CBMs for pain management. Complicating matters, a large and growing body of observational literature shows that many people use CPs for pain management and in place of other medications. However, products and dosing regimens in existing trials are not generalizable to the current cannabis market, making it difficult to compare and reconcile these 2 bodies of literature. Given this complexity, clinicians need clear, pragmatic guidance on how to appropriately educate and work with patients who are using CBMs for pain management. In this review, we narratively synthesize the evidence to enable a clear view of current landscape and provide pragmatic advice for clinicians to use when working with patients. This advice revolves around 3 principles: (1) maintaining the therapeutic alliance; (2) harm reduction and benefit maximization; and (3) pragmatism, principles of patient-centered care, and use of best clinical judgment in the face of uncertainty. Despite the lack of certainty CPs and chronic pain management use, we believe that following these principles can make most of the clinical opportunity presented by discussions around CPs and also enhance the likelihood of clinical benefit from CPs.
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Affiliation(s)
- Kevin F. Boehnke
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher L. Wu
- Department of Anesthesiology, Pain Medicine and Critical Care; Hospital for Special Surgery; New York, NY, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel J. Clauw
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
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Iannotti FA. Cannabinoids, Endocannabinoids, and Synthetic Cannabimimetic Molecules in Neuromuscular Disorders. Int J Mol Sci 2023; 25:238. [PMID: 38203407 PMCID: PMC10779239 DOI: 10.3390/ijms25010238] [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: 11/24/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Neuromuscular disorders (NMDs) encompass a large heterogeneous group of hereditary and acquired diseases primarily affecting motor neurons, peripheral nerves, and the skeletal muscle system. The symptoms of NMDs may vary depending on the specific condition, but some of the most common ones include muscle weakness, pain, paresthesias, and hyporeflexia, as well as difficulties with swallowing and breathing. NMDs are currently untreatable. Therapeutic options include symptomatic and experimental medications aimed at delaying and alleviating symptoms, in some cases supplemented by surgical and physical interventions. To address this unmet medical need, ongoing research is being conducted on new treatments, including studies on medical cannabis, endocannabinoids, and related molecules with cannabimimetic properties. In this context, a significant amount of knowledge about the safety and effectiveness of cannabinoids in NMDs has been obtained from studies involving patients with multiple sclerosis experiencing pain and spasticity. In recent decades, numerous other preclinical and clinical studies have been conducted to determine the potential benefits of cannabinoids in NMDs. This review article aims to summarize and provide an unbiased point of view on the current knowledge about the use of cannabinoids, endocannabinoids, and synthetic analogs in NMDs, drawing from an array of compelling studies.
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Affiliation(s)
- Fabio Arturo Iannotti
- Institute of Biomolecular Chemistry (ICB), National Research Council of Italy (CNR), 80078 Pozzuoli, NA, Italy
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Fernandes JAB, Filev R, Fidalgo TM. Cannabinoids for Substance Use Disorder Treatment: What Does the Current Evidence Say? Cannabis Cannabinoid Res 2023; 8:703-715. [PMID: 37262132 DOI: 10.1089/can.2023.0065] [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: 06/03/2023] Open
Abstract
Background: The prevalence of Substance Use Disorder (SUD) is increasing along with the need to develop approaches to reduce the harm associated with substance use, including investigating alternatives such as cannabinoids, which show promising results, although the current evidence is limited. This scoping review focuses on the limitations and potentials of cannabinoid-based treatments for SUDs. Methods: We examined between-subject randomized controlled trials (RCTs) investigating the use of CBD and THC as pharmacological treatment for SUDs in adults, with the procedures attending the expectations of the Preferred Reporting Items for Scoping reviews and Meta-Analyses (PRISMA) for Scoping Reviews guidelines and assessed risk of bias using the Cochrane Risk of Bias Assessment Tool 2. Results: Ten RCTs were included, with six demonstrating low risk of bias, and positive results were found for treating Cannabis Use Disorder, while contradictory results were found for Opioid Use Disorder, and inconclusive results for treating Cocaine Use Disorder. Conclusions: CBD and THC demonstrate potential for treating some SUDs, but evidence is limited. Robust RCTs with larger samples and longer follow-up periods are necessary to assess carefully developed outcomes for different SUD patients. New cannabinoid-based medications and scientific-based policies may advance SUD treatment. A comprehensive approach to treatment and careful methodological choices may benefit patients with SUD.
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Affiliation(s)
- João Ariel Bonar Fernandes
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato Filev
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thiago M Fidalgo
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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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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Bianchi F, Pautex S, Wampfler J, Curtin F, Daali Y, Desmeules JA, Broers B. Medical cannabinoids for painful symptoms in patients with severe dementia: a randomized, double-blind cross-over placebo-controlled trial protocol. FRONTIERS IN PAIN RESEARCH 2023; 4:1108832. [PMID: 37293434 PMCID: PMC10244760 DOI: 10.3389/fpain.2023.1108832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/04/2023] [Indexed: 06/10/2023] Open
Abstract
Background In an observational study in Geneva (Switzerland), we found that administering a standardized THC/CBD oil was feasible, safe, and beneficial in an elderly polymedicated population with severe dementia, behavioral troubles, and pain. Those findings need to be confirmed in a randomized clinical trial. Objectives The MedCanDem trial is a randomized, double-blind cross-over placebo-controlled trial to study the efficacy of cannabinoids in improving painful symptoms during severe dementia disorders in patients living in long-term care facilities in Geneva. This manuscript describes the MedCanDem trial protocol. Materials and methods Participants will be patients suffering from severe dementia associated with pain and behavioral troubles and living in long-term care facilities. We selected five facilities specialized in caring for severely demented patients in Geneva (Switzerland). A total of 24 subjects will be randomized 1:1 to the sequence study intervention/placebo or the sequence placebo/study intervention. Patients will receive study intervention treatment or placebo for eight weeks, and then after a one-week wash-out, treatments will be inversed for another eight weeks. The intervention will be a standardized THC/CBD 1:2 oil extract, and the placebo will be a hemp seed oil. The primary outcome is the reduction from the baseline of the Cohen-Mansfield score; secondary outcomes include the reduction in the Doloplus scale, the reduction of rigidity, the monitoring of concomitant drugs prescription and de-prescription, the safety assessment, and a pharmacokinetic evaluation. The primary and secondary outcomes will be assessed at the baseline, after 28 days, and at the end of both study periods. In addition, safety laboratory analysis, pharmacokinetic evaluation, and therapeutic drug monitoring for the cannabinoids will be evaluated through a blood sample analysis conducted at the beginning and the end of both study periods. Discussion and conclusion This study will allow us to confirm the clinical results observed during the observational study. It represents one of the few studies aiming to prove natural medical cannabis efficacy in a population of non-communicating patients with severe dementia, experimenting with behavioral troubles, pain, and rigidity. Trial registration The trial has Swissethics authorization (BASEC 2022-00999), and it is registered on clinicaltrials.gov (NCT05432206) and the SNCTP (000005168).
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Affiliation(s)
- Federica Bianchi
- Fondation pour l’accueil et l’hébergement de personnes âgées, Long-term Care Home “les Tilleuls”, Geneva, Switzerland
- Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Pautex
- Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - James Wampfler
- Fondation pour l’accueil et l’hébergement de personnes âgées, Long-term Care Home “les Tilleuls”, Geneva, Switzerland
| | - François Curtin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Clinical Pharmacology and Toxicology Division, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Youssef Daali
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Clinical Pharmacology and Toxicology Division, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Geneva, Switzerland
| | - Jules Alexandre Desmeules
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Geneva, Switzerland
| | - Barbara Broers
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
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12
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Withanarachchie V, Rychert M, Wilkins C. The role of cannabis clinics in the health system: a qualitative study of physicians' views in New Zealand. BMC Health Serv Res 2023; 23:10. [PMID: 36600251 DOI: 10.1186/s12913-022-09021-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Privately-owned cannabis clinics have sprung up in many jurisdictions where medicinal cannabis has been legalised and provide an alternative pathway for patients who are unable or unwilling to access a prescription for cannabis-based medicinal products from their usual healthcare providers. AIMS This study aimed to explore physicians' views on cannabis clinics, including their perceptions of the role cannabis clinics play in the wider health system. METHODS A qualitative study using in-depth, semi-structured interviews with thirty-one physicians affiliated with private and community clinics in New Zealand (including cannabis clinicians, GPs, and specialist doctors). The interviews were conducted from July to December 2021. Data were transcribed and analysed using inductive thematic analysis. RESULTS Cannabis clinicians positioned themselves as (1) "service providers", facilitating consumer access to cannabis prescriptions and products, and (2) "educators", providing advice to patients and the wider physician community. While general practitioners and specialists recognised the benefits of specialised cannabis clinics (i.e., knowledge of products and a non-judgmental environment), they questioned the limited evidence of clinical efficacy for cannabis, potential financial conflicts of interests of cannabis clinicians that may blur their clinical judgement, and the risk of compartmentalising patients' healthcare. CONCLUSIONS Our paper raises a number of challenges with attempting to integrate cannabis clinics into the wider health system.
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Affiliation(s)
- Vinuli Withanarachchie
- Shore & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand.
| | - Marta Rychert
- Shore & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Chris Wilkins
- Shore & Whāriki Research Centre, College of Health, Massey University, Auckland, New Zealand
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13
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Lo LA, MacCallum CA, Yau JC, Barr AM. Differences in those who prefer smoking cannabis to other consumption forms for mental health: what can be learned to promote safer methods of consumption? J Addict Dis 2022:1-5. [PMID: 35975780 DOI: 10.1080/10550887.2022.2107332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Smoking cannabis in medical users is associated with exposure to harmful toxins. It is important to characterize cannabis-use profiles and risk-factors for medical cannabis users who smoke cannabis. 100 members of a medical cannabis dispensary with mental health concerns were interviewed in detail about their cannabis use. Forty seven percent of participants preferred smoking only, 18% preferred vaporizing, 25% preferred both smoking and vaping, and 10% preferred oral ingestion methods. Smokers differed from other users in multiple ways, including a greater preference for THC-dominant chemovars, and more frequent and greater amount of cannabis consumption. Smoking was also associated with greater rates of alcohol use disorder. These results may inform harm-reduction approaches to decrease the number of individuals smoking cannabis and use less harmful methods of medical cannabis ingestion.
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Affiliation(s)
- Lindsay A Lo
- Department of Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Caroline A MacCallum
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, Faculty of Medicine, Division of Palliative Care, UBC, Vancouver, BC, Canada.,Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, Canada
| | - Jade C Yau
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
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de Souza MR, Henriques AT, Limberger RP. Medical cannabis regulation: an overview of models around the world with emphasis on the Brazilian scenario. J Cannabis Res 2022; 4:33. [PMID: 35710586 PMCID: PMC9202119 DOI: 10.1186/s42238-022-00142-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Cannabis sativa has accompanied humankind since ancient times, permeating the most diverse aspects of its existence, among which the search for health promotion and well-being stands out. Nevertheless, during the twentieth century, a series of restrictions and controls have been adopted internationally to prevent the abusive use of this species. Despite that, there has been an increased demand for the medical use of cannabis and its derivatives in the last few decades, especially among patients with debilitating conditions for which the existing therapeutic alternatives are limited. Accordingly, several countries have adopted regulatory strategies to allow access to cannabis-based products. This study aimed to overview the existing regulatory frameworks for medical cannabis around the world, focusing on the current Brazilian scenario. In addition to supply and access regulation aspects, some quality-related issues regarding cannabis-based pharmaceutical products were addressed, with emphasis on risks to patients. The literature research was performed between October 2020 and March 2021. According to the retrieved information, by the time the data collection was completed, thirty-six countries had already implemented regulatory frameworks regarding medical cannabis, and sixteen countries had models under development or in the process of implementation. The characteristics of the assessed regulatory strategies vary considerably from country to country, reflecting sociocultural, historical, and political aspects. Among the key aspects that differed between the assessed models, one can highlight the type of cannabis products that are made available and the technical requirements applied to them, as well as the possible access mechanisms. Different supply regulation strategies were also observed regarding cannabis cultivation, production licensing, and distribution mechanisms. In Brazil, an evolution of the regulatory framework has been noticeable since 2015, even though pending points are still to be addressed, among which are the species’ cultivation and the access to it for scientific research purposes. Constructing a regulatory model which provides access to good quality cannabis-based medicines that may meet the patient’s needs is still a challenge in the coming years, requiring the engagement of various stakeholders, including regulators, members of the academic community, prescribing professionals, and patients.
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Affiliation(s)
- Maíra Ribeiro de Souza
- Laboratório de Análises e Pesquisas em Toxicologia, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90610-000, Brazil. .,Laboratório de Farmacognosia e Controle da Qualidade de Fitoterápicos, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90610-000, Brazil. .,Agência Nacional de Vigilância Sanitária (ANVISA), Brasília, DF, 71205-050, Brazil.
| | - Amélia Teresinha Henriques
- Laboratório de Farmacognosia e Controle da Qualidade de Fitoterápicos, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90610-000, Brazil
| | - Renata Pereira Limberger
- Laboratório de Análises e Pesquisas em Toxicologia, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90610-000, Brazil
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15
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Kebede L, Masoomi Dezfooli S, Seyfoddin A. Medicinal Cannabis Pharmacokinetics and Potential Methods of Delivery. Pharm Dev Technol 2022; 27:202-214. [PMID: 35084279 DOI: 10.1080/10837450.2022.2035748] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The evidence of cannabis exhibiting polypharmacological properties has been accumulating for the past few decades, particularly for its analgesic and anti-inflammatory abilities. However, inconsistent dosage forms and erratic absorption levels prevent medicinal cannabis products from becoming mainstream recommendations for pain management. Current cannabis products fail to address the undesirable characteristics associated with cannabinoids such as low solubility, poor bioavailability, and lack of specificity, all of which contribute to low therapeutic effect. In this narrative view, the pharmacokinetics of cannabis products and possible methods of drug delivery, in the form of carrier systems, will be explored. The incorporation of cannabinoids into carrier systems provides an opportunity to improve absorption levels, increase bioavailability and reduce adverse events allowing for a greater therapeutic effect.
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Affiliation(s)
- Lidya Kebede
- Drug Delivery Research Group, School of Science, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Seyedehsara Masoomi Dezfooli
- Drug Delivery Research Group, School of Science, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Ali Seyfoddin
- Drug Delivery Research Group, School of Science, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
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16
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MacCallum CA, Lo LA, Pistawka CA, Boivin M. A Clinical Framework for Evaluating Cannabis Product Quality and Safety. Cannabis Cannabinoid Res 2022. [PMID: 35049330 DOI: 10.1089/can.2021.0137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Increase in medical cannabis use, along with available products, warrants the need for clinicians to be knowledgeable in evaluating the quality of any cannabis product presented in clinical practice. Determining whether a product is regulated within the region is key in assessing overall quality and safety. Regulated products are held to a higher standard including independent testing, contamination mitigation, and concentration limits. Here, we present a clinical framework in evaluating cannabis products to ascertain the quality and regulation level of the product. Evaluation includes assessing the source company, reviewing product details (e.g., type, cannabinoid content, and labeling), and assessing quality control variables such as manufacturing and decontamination processes. The quality of products patients use is an important part of mitigating cannabis-related harms, especially in medically vulnerable patients. Currently, there is a great need to implement widespread standardization and regulations to ensure product quality and safety.
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Affiliation(s)
- Caroline A MacCallum
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay A Lo
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Carly A Pistawka
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Hillebrands L, Lamshoeft M, Lagojda A, Stork A, Kayser O. In vitro metabolism of tebuconazole, flurtamone, fenhexamid, metalaxyl-M and spirodiclofen in Cannabis sativa L. (hemp) callus cultures. PEST MANAGEMENT SCIENCE 2021; 77:5356-5366. [PMID: 34309997 PMCID: PMC9292707 DOI: 10.1002/ps.6575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cannabis sativa L. (hemp) is a medicinal plant producing various cannabinoids. Its consumption is legalized for medical use due to the alleged positive health effects of these cannabinoids. To satisfy the demand, C. sativa plants are propagated in contained growth chambers. During indoor propagation, pesticides usually are used to ensure efficient production. However, pesticide registration and safe application in C. sativa has not been investigated in detail. RESULTS With this study the metabolic degradation of pesticides in recently established C. sativa callus cultures was examined. Tebuconazole, metalaxyl-M fenhexamid, flurtamone and spirodiclofen were applied at 10 μm for 21 days. Results were compared with metabolism data obtained from Brassica napus L., Glycine max (L.) Merr., Zea mays L. and Tritium aestivum L. callus cultures as well as in metabolism guideline studies. The successfully established C. sativa callus cultures were able to degrade pesticides by oxidation, demethylation, and cleavage of ester bonds in phase I, as well as glycosylation and conjugation with malonic acid in phase II and III. Initial metabolites were detected after Day (D)7 and were traced at D21. CONCLUSION The resulting pathways demonstrate the same main degradation strategies as crop plants. Because metabolites could be the main residue, the exposure of consumers to these residues will be of high importance. We present here an in vitro assay for a first estimation of pesticide metabolism in C. sativa. © 2021 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
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Affiliation(s)
- Leonie Hillebrands
- Faculty of Biochemical and Chemical Engineering, Chair of Technical BiochemistryTU Dortmund UniversityDortmundGermany
- Bayer AG Division Crop ScienceMonheimGermany
| | | | | | | | - Oliver Kayser
- Faculty of Biochemical and Chemical Engineering, Chair of Technical BiochemistryTU Dortmund UniversityDortmundGermany
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18
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Balant M, Gras A, Ruz M, Vallès J, Vitales D, Garnatje T. Traditional uses of Cannabis: An analysis of the CANNUSE database. JOURNAL OF ETHNOPHARMACOLOGY 2021; 279:114362. [PMID: 34171396 DOI: 10.1016/j.jep.2021.114362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/31/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Cannabis is one of the most versatile genera in terms of plant use and has been exploited by humans for millennia. Nowadays, Cannabis is the centre of many scientific studies, most of them focusing on chemical composition and medicinal values. While new and varied applications are continuously being developed, the knowledge surrounding less common uses of the plant is slowly disappearing. AIM OF THE REVIEW We have analysed diversity of global data of Cannabis traditional uses, to investigate if certain plant parts are significantly associated with particular Cannabis use. We wanted to uncover potential associations between the plant parts used for the treatment of different body systems and ailments. MATERIALS AND METHODS We have analysed the extensive database of Cannabis traditional uses (CANNUSE). This database contains 2330 data entries of Cannabis ethnobotanical uses from over 40 countries across the world. The dataset was divided into five general groups based on the type of use: medicinal, alimentary, psychoactive, fibre and other uses. Given the abundance of human medicinal uses, detailed analysis was done on the subset of 1167 data entries. We analysed the relationship between 16 body system categories and ailments treated with Cannabis plant parts. We used a Pearson's chi-square and Fisher's exact test, to determine which Cannabis parts are characteristic of treatment for specific ailments. RESULTS In this dataset, the majority of reports were represented by medicinal (75.41%), followed by psychoactive (8.35%) and alimentary (7.29%) use. The most commonly used plant parts were leaf (50.51%), seed (15.38%) and inflorescence (11.35%). We found that different Cannabis plant parts were significantly associated with different uses; the leaf was typically used for medicinal, seed for alimentary and inflorescence for psychoactive use. Regarding the human medicinal uses, most common were reports for treatments of the digestive system and nutritional disorders (17.66%), nervous system and mental disorders (16.24%), followed by pain and inflammations (12.21%). We found a significant relationship between the use of certain Cannabis parts and treatment of ailments and body systems categories; leaf was significantly associated with treatment of two categories: skin and subcutaneous tissue disorders and circulatory system and blood disorders; seed use was associated with musculoskeletal system disorders and traumas; while inflorescence use shows a statistical support for treatment of nervous system and mental disorders. CONCLUSION Several pharmaceutical companies are intensely working on developing new drugs with isolated chemical compounds or crude extracts, almost exclusively from Cannabis inflorescences. However, our review revealed that use of leaf or seed in traditional medicine is often more important than use of inflorescence for the treatment of certain ailments. A review of traditional medicine provides a body of knowledge and an initial pathway to identify landraces and plant parts that could have an important role in future medicinal research. We are confident that traditional medicine still has a large potential for modern medicine. As more information on Cannabis diversity (genetics, biochemistry, and clinical studies) becomes available, ethnobotanical data are poised to be of much greater significance.
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Affiliation(s)
- Manica Balant
- Institut Botànic de Barcelona (IBB, CSIC - Ajuntament de Barcelona), Passeig del Migdia s/n, 08038, Barcelona, Catalonia, Spain.
| | - Airy Gras
- Institut Botànic de Barcelona (IBB, CSIC - Ajuntament de Barcelona), Passeig del Migdia s/n, 08038, Barcelona, Catalonia, Spain.
| | - Mario Ruz
- Laboratori de Botànica (UB), Unitat Associada Al CSIC, Facultat de Farmàcia i Ciències de l'Alimentació - Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona, Av. Joan XXIII 27-31, 08028, Barcelona, Catalonia, Spain.
| | - Joan Vallès
- Laboratori de Botànica (UB), Unitat Associada Al CSIC, Facultat de Farmàcia i Ciències de l'Alimentació - Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona, Av. Joan XXIII 27-31, 08028, Barcelona, Catalonia, Spain; Institut d'Estudis Catalans (IEC), Carrer del Carme, 47, 08001, Barcelona, Catalonia, Spain.
| | - Daniel Vitales
- Institut Botànic de Barcelona (IBB, CSIC - Ajuntament de Barcelona), Passeig del Migdia s/n, 08038, Barcelona, Catalonia, Spain; Laboratori de Botànica (UB), Unitat Associada Al CSIC, Facultat de Farmàcia i Ciències de l'Alimentació - Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona, Av. Joan XXIII 27-31, 08028, Barcelona, Catalonia, Spain.
| | - Teresa Garnatje
- Institut Botànic de Barcelona (IBB, CSIC - Ajuntament de Barcelona), Passeig del Migdia s/n, 08038, Barcelona, Catalonia, Spain.
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R C Coelho MP, de O P Leme F, A Moreira F, E M T Branco S, M Melo M, G de Melo E. Current review of hemp-based medicines in dogs. J Vet Pharmacol Ther 2021; 44:870-882. [PMID: 34605042 DOI: 10.1111/jvp.13016] [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: 04/30/2021] [Revised: 08/30/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Medical use of Cannabis (or hemp) began thousands of years ago. In the 20th century, mechanisms of action were demonstrated with the discovery of its active substances, the phytocannabinoids, and its pharmacological targets, the endocannabinoid system. This system is composed of receptors, endogenous substances, and enzymes, and it participates in the modulation of physiological mechanisms in several species, including dogs. Studies indicate that changes in this system may contribute to the genesis of some diseases. Therefore, the use of substances that act on its components may help in the treatment of these diseases. The main phytocannabinoids described are Δ9- tetrahydrocannabinol (THC) and cannabidiol (CBD). In humans, the benefits of using CBD in several diseases have been demonstrated. The popularization of this type of treatment has also reached veterinary medicine, which on one hand was related to an increase in adverse event records, but on the other also allowed reports of anecdotal evidences of its effectiveness and safety in animals. Clinical studies published so far indicate that the use of CBD in dogs can be safe at given doses and can contribute to osteoarthritis and idiopathic epilepsy treatments. Clinical and pre-clinical studies and case reports were reviewed in this report to identify the main characteristics of hemp-based therapies in dogs, including its pharmacokinetics, pharmacodynamics, safety, and efficacy in the treatment of diseases.
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Affiliation(s)
- Maria Paula R C Coelho
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fabiola de O P Leme
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fabricio A Moreira
- Departamento de Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Stephanie E M T Branco
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marilia M Melo
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Eliane G de Melo
- Departamento de Clínica e Cirurgia Veterinárias, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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20
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Russo EB. Myth busting cannabinoid hyperemesis syndrome. Am J Emerg Med 2021; 56:342-343. [PMID: 34607735 DOI: 10.1016/j.ajem.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ethan B Russo
- CReDO Science 20402 81st Avenue SW Vashon, WA 98070, USA..
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21
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Schräder NHB, Gorell ES, Stewart RE, Duipmans JC, Harris N, Perez VA, Tang JY, Wolff AP, Bolling MC. Cannabinoid use and effects in patients with epidermolysis bullosa: an international cross-sectional survey study. Orphanet J Rare Dis 2021; 16:377. [PMID: 34488820 PMCID: PMC8419930 DOI: 10.1186/s13023-021-02010-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/24/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Epidermolysis bullosa (EB) patient anecdotes and case reports indicate that cannabinoid-based medicines (CBMs) may alleviate pain and pruritus and improve wound healing. CBM use has not been characterized in the EB patient population. OBJECTIVES To evaluate CBM use among EB patients, including CBM types, effects on symptoms (e.g., pain and pruritus), disease process (e.g., blistering, wounds, and inflammation), well-being (e.g., sleep, appetite) and concomitant medications. METHODS English-speaking EB patients or caregivers completed an online international, anonymous, cross-sectional survey regarding CBM use. Respondents reported the types of CBMs, subsequent effects including perceived EB symptom alteration, changes in medication use, and side effects. RESULTS Seventy-one EB patients from five continents reported using or having used CBMs to treat their EB. Missing question responses ranged between 0 (0%) and 33 (46%). Most used more than one CBM preparation (mean: 2.4 ± 1.5) and route of administration (mean: 2.1 ± 1.1). Topical and ingested were the most common routes. Pain and pruritus were reported retrospectively to decrease by 3 points (scale: 0-10; p < 0.001 for both) after CBM use. Most reported that CBM use improved their overall EB symptoms (95%), pain (94%), pruritus (91%) and wound healing (81%). Most participants (79%) reported decreased use of pain medications. The most common side-effect was dry mouth (44%). CONCLUSIONS CBMs improve the perception of pain, pruritus, wound healing, and well-being in EB patients and reduced concomitant medication use. Nevertheless, a direct relation between the use of CBMs and reduction of the above-mentioned symptoms cannot be proven by these data. Therefore, future controlled studies using pharmaceutically standardised CBM preparations in EB are warranted to delineate the risks and benefits of CBMs.
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Affiliation(s)
- Nicholas H. B. Schräder
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Emily S. Gorell
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH USA
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA USA
| | - Roy E. Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - José C. Duipmans
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Nicole Harris
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA USA
| | | | - Jean Y. Tang
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA USA
| | - André P. Wolff
- Anaesthesiology Pain Centre, Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke C. Bolling
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Societal issues and policy implications related to the use of cannabinoids, cannabis, and cannabis-based medicines for pain management. Pain 2021; 162:S110-S116. [PMID: 33009248 DOI: 10.1097/j.pain.0000000000002001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
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Abstract
Introduction: CBD is a major phytocannabinoid in hemp (Cannabis sativa containing less than 0.3% THC). Hemp cigarettes are a combustible form of hemp consisting of dried and smokable flowers, which represent 2% of the overall CBD market, and the market is expected to grow. Combustion and pyrolysis of organic material are associated with the production of carbonyl compounds, which are known toxicants and are associated with adverse health outcomes. Concentrations of carbonyl compounds in mainstream hemp cigarette smoke are unknown. Materials and Methods: We analyzed and compared carbonyl concentrations in the mainstream smoke produced by a hemp cigarette (Brand B), a premium hemp cigarette (Brand A), Marlboro Red tobacco cigarette, and a research reference tobacco cigarette using high-performance liquid chromatography. We measured carbonyl concentrations in μg per puff and mg per cigarette. Carbonyls investigated were formaldehyde, acetaldehyde, acetone, acrolein, propionaldehyde, crotonaldehyde, 2-butanone, and butyraldehyde. Significance was determined using Tukey's test. Results: We observed that Brand B had significantly higher butyraldehyde than any cigarette. No significant differences were observed in crotonaldehyde concentration in the cigarettes. For the remaining carbonyls, Brand A had consistently lower concentrations in mainstream smoke than tobacco cigarettes. Hemp cigarettes emit carbonyls in a lower concentration in μg/puff than tobacco cigarettes, but the magnitude of significance generally decreases when normalized to mg/cigarette. Conclusions: Smoke from hemp cigarettes contains carbonyls at biologically significant concentrations. Opportunities may exist to reduce carbonyl production in these products, and identified potential risks must be considered when balancing the harms and benefits of hemp cigarettes when used for therapeutic purposes.
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Lucas P, Boyd S, Milloy MJ, Walsh Z. The impact of non-medical cannabis legalization and other exposures on retention in longitudinal cannabis research: a survival analysis of a prospective study of Canadian medical cannabis patients. J Cannabis Res 2021; 3:34. [PMID: 34321108 PMCID: PMC8320176 DOI: 10.1186/s42238-021-00089-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite repeated calls by medical associations to gather evidence on the harms and benefits of cannabis, there are ongoing methodological challenges to conducting observational and clinical studies on cannabis, including a high rate of patients that are lost to follow-up (LTFU). This study explores factors potentially associated with retention in a large prospective study of Canadian medical cannabis patients, with the goal of reducing the probability that patients will be lost to follow-up in future cannabis research. METHODS The Tilray Observational Patient Study (TOPS) was a multi-site, prospective study assessing the impact of medical cannabis over 6 months in a broad population of authorized Canadian cannabis patients. The study took place from 2016 to 19, and we conducted a series of exploratory analyses including a Kaplan-Meier survival analysis and logistic regressions to assess the potential association between study retention and variables including patient characteristics, cannabis and prescription drug use, quality of life, and the legalization of non-medical cannabis. RESULTS Overall, 1011 participants were included in this analysis, contributing 287 patient-years of data. Retention was 728 (72%) at 3 months, and 419 (41.4%) at 6 months. Our analyses found significantly lower adjusted odds of retention following legalization (AOR 0.28, 95% CI 0.18-0.41), and in patients that used prescription opioids at baseline (AOR 0.62, 95% CI 0.46-0.85), while increased odds of retention were found in patients with a higher baseline psychological score (AOR 1.43, 95% CI 1.08-1.90) or that used anti-seizure medications at baseline (AOR 1.91, 95% CI 1.30-2.81). DISCUSSION TOPS provided a unique opportunity to examine patient characteristics and other variables that may be associated with retention in prospective medical cannabis studies. Our findings highlight some of the challenges of conducting medical cannabis research at a time when patients have a multitude of cannabis access options, including legal adult dispensaries and a robust illicit market. High LTFU rates can impact the validity of studies, and potentially lead to misestimations of the harms and benefits of medical cannabis use. Despite being a multi-site prospective study, this was a convenience sample, thereby limiting the generalizability of these findings. Additionally, data regarding the use of cannabis was self-reported by patients, so is subject to potential recall bias. CONCLUSION We found evidence that external policy changes that affect access to cannabis such as the legalization of non-medical adult use and patient characteristics associated with patient physical/psychological capacity can impact retention in prospective medical cannabis studies. Evidence-based strategies to reduce study burden on participants, such as minimizing in-person visits by providing digitized internet-based surveys and phone or telemedicine follow-up options as well as ensuring adequate participant compensation could improve retention. Additionally, policy-related changes aimed at improving access to medical cannabis, including increased cost-coverage and community-based distribution, could encourage patients to remain in the federal medical cannabis program and thereby reduce LTFU in associated studies.
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Affiliation(s)
- Philippe Lucas
- Social Dimensions of Health, University of Victoria, 3800 Finnerty Rd, Victoria, B.C V8P 5C2 Canada
- 1100 Maughan Rd, Nanaimo, BC V9X1J2 Canada
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC V8N 5M8 Canada
| | - Susan Boyd
- Faculty of Human and Social Development, School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Rd, Victoria, B.C V8P 5C2 Canada
| | - M.-J. Milloy
- Faculty of Medicine, University of British Columbia, St. Paul’s Hospital, Burrard Street, Vancouver, B.C 806-1081 Canada
- British Columbia Centre On Substance Use, 400-1045 Howe St, Vancouver, B.C V6Z 2A9 Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, 3333 University Way, OkanaganKelowna, B.C V1V 1V7 Canada
- Centre for the Advancement of Psychological Science and Law, University of British Columbia, 3333 University Way, OkanaganKelowna, BC V1V 1V7 Canada
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MacCallum CA, Lo LA, Boivin M. "Is medical cannabis safe for my patients?" A practical review of cannabis safety considerations. Eur J Intern Med 2021; 89:10-18. [PMID: 34083092 DOI: 10.1016/j.ejim.2021.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 02/07/2023]
Abstract
Medical cannabis use is increasing worldwide. Clinicians are commonly asked by patients to provide guidance on its safety and efficacy. Although there has been an increase in research on the role of medical cannabis for a number of different conditions, we found that there was a paucity of clear safety guidance on its use. We aim to address this issue by answering two pertinent clinician safety questions: 1 Can medical cannabis be safely used in this patient? 2. What strategies can be used to ensure that any harms from medical cannabis are mitigated? To address these questions, we reviewed available evidence and provided expert clinical opinion to summarize the fundamental components for evaluating medical cannabis safety and strategies to reduce risk from its use. Our review resulted in a safety-focused framework for medical cannabis initiation and utilization. We provide clear recommendations for patients being considered for cannabis (e.g. precautions, contraindications and drug interactions). Risk mitigation strategies such as appropriate chemovar (strain) selection, routes of administration, and dosing are reviewed. As with any other pharmacotherapy, we review the key components of monitoring and address potential issues that may arise while using medical cannabis. We propose a structured assessment and monitoring strategy that can be used by clinicians recommending cannabis (CRC) to guide patients through each step of their cannabis journey. This framework can be used to ensure that medical cannabis utilization is associated with the lowest possible risk to the patient.
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Affiliation(s)
- Caroline A MacCallum
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Faculty of Medicine, Division of Palliative Care, UBC, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, Canada.
| | - Lindsay A Lo
- Department of Psychology, Queen's University, Kingston, ON, Canada
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Abstract
Previous studies show how time perception can be altered by cannabis consumption, but it is not clear yet whether cannabis produces temporal underproductions or overproductions after acute cannabis intoxication. The present study aimed to analyze a sample of 50 regular cannabis users controlling for cannabis strain (sativa, indica, and hybrid) and to compare their scores in a temporal production task before and after consuming cannabis with a control group of 49 nonusers. Results showed that cannabis intake leads to overproductions, suggesting that regular users' internal tempo slows down after acute intoxication. However, the analyses of main effects showed that indica users, both at baseline levels and after consuming, reported significant underproductions compared to controls, sativa, and hybrid users, and the cannabis-induced effects had a higher magnitude after smoking in the indica-strain group. Results highlight the relevance of including the type of strain consumed in cannabis studies, and they are discussed in terms of short- and long-term alterations in temporal perception under the light of the self-medication theory and the therapeutic uses of cannabis.
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Affiliation(s)
- Anna Muro
- Department of Basic, Developmental and Educational Psychology, Universitat Autònoma de Barcelona, Spain
| | - Ramon Cladellas
- Department of Basic, Developmental and Educational Psychology, Universitat Autònoma de Barcelona, Spain
| | - Judit Castellà
- Department of Basic, Developmental and Educational Psychology, Universitat Autònoma de Barcelona, Spain
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27
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Jugl S, Okpeku A, Costales B, Morris EJ, Alipour-Haris G, Hincapie-Castillo JM, Stetten NE, Sajdeya R, Keshwani S, Joseph V, Zhang Y, Shen Y, Adkins L, Winterstein AG, Goodin A. A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019. Med Cannabis Cannabinoids 2021; 4:21-42. [PMID: 34676348 PMCID: PMC8525213 DOI: 10.1159/000515069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.
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Affiliation(s)
- Sebastian Jugl
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Aimalohi Okpeku
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Brianna Costales
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Earl J. Morris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Golnoosh Alipour-Haris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Juan M. Hincapie-Castillo
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | | | - Ruba Sajdeya
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Verlin Joseph
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yahan Zhang
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Yun Shen
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Lauren Adkins
- Health Sciences Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Almut G. Winterstein
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
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Shulman H, Sewpersaud V, Thirlwell C. Evolving Global Perspectives of Pharmacists: Dispensing Medical Cannabis. Cannabis Cannabinoid Res 2021; 7:126-134. [PMID: 33998897 PMCID: PMC9070745 DOI: 10.1089/can.2020.0144] [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: Different countries have employed a variety of methods for their populace to access medical cannabis. Objectives: The purpose of this literature review was to assess the international literature on pharmacists' beliefs and attitudes towards medical cannabis. Methodology: This literature review summarized the various countries that utilize pharmacies and pharmacists to dispense medical cannabis. The countries included in this review were: Australia, Canada, Denmark, Finland, Germany, Israel, Italy, Netherlands, Poland, Serbia, Switzerland, USA, and Uruguay. Discussion: The pharmacist perspective has been of key importance within the medical landscape, as they are the ones who not only dispense medication but also counsel and monitor patients and it is this perspective that is lacking. Conclusion: Overall, this review found that even though pharmacists are generally comfortable with dispensing medical cannabis; they still require further education to do so as safely and effectively as possible.
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Affiliation(s)
- Holly Shulman
- Sleep Wake Awareness Program, North York, Ontario, Canada
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29
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Kurlyandchik I, Tiralongo E, Schloss J. Safety and Efficacy of Medicinal Cannabis in the Treatment of Fibromyalgia: A Systematic Review. J Altern Complement Med 2021; 27:198-213. [DOI: 10.1089/acm.2020.0331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Inna Kurlyandchik
- Office of Research, Endeavour College of Natural Health, Brisbane, Queensland, Australia
| | - Evelin Tiralongo
- Clinical Trial Unit (Griffith Health), Griffith University Gold Coast, Queensland, Australia
| | - Janet Schloss
- Office of Research, Endeavour College of Natural Health, Brisbane, Queensland, Australia
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
- Fellow at ARCCIM, The University of Technology Sydney, Ultimo, Australia
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30
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Kayser RR, Haney M, Simpson HB. Human Laboratory Models of Cannabis Use: Applications for Clinical and Translational Psychiatry Research. Front Psychiatry 2021; 12:626150. [PMID: 33716825 PMCID: PMC7947318 DOI: 10.3389/fpsyt.2021.626150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
Cannabis is increasingly used by individuals with mental health diagnoses and often purported to treat anxiety and various other psychiatric symptoms. Yet support for using cannabis as a psychiatric treatment is currently limited by a lack of evidence from rigorous placebo-controlled studies. While regulatory hurdles and other barriers make clinical trials of cannabis challenging to conduct, addiction researchers have decades of experience studying cannabis use in human laboratory models. These include methods to control cannabis administration, to delineate clinical and mechanistic aspects of cannabis use, and to evaluate potential treatment applications for cannabis and its constituents. In this paper, we review these human laboratory procedures and describe how each can be applied to study cannabis use in patients with psychiatric disorders. Because anxiety disorders are among the most common psychiatric illnesses affecting American adults, and anxiety relief is also the most commonly-reported reason for medicinal cannabis use, we focus particularly on applying human laboratory models to study cannabis effects in individuals with anxiety and related disorders. Finally, we discuss how these methods can be integrated to study cannabis effects in other psychiatric conditions and guide future research in this area.
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Affiliation(s)
- Reilly R. Kayser
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, NY, United States
| | - Margaret Haney
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, NY, United States
| | - Helen Blair Simpson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, NY, United States
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31
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Medical cannabis education among healthcare trainees: A scoping review. Complement Ther Med 2021; 58:102675. [PMID: 33539943 DOI: 10.1016/j.ctim.2021.102675] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/24/2021] [Accepted: 01/24/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES It has been previously demonstrated that healthcare professionals would like additional education on medical cannabis. However, there has not yet been a review of the status of medical cannabis curriculum for medical and allied healthcare trainees worldwide, even though future healthcare workers will be placed on the forefront of patient care and must be prepared to counsel patients. This study was designed to address this gap in knowledge. DESIGN A search syntax was generated and databases PubMed, ERIC, CINAHL, and Web of Science were searched for relevant articles. A grey literature search of Google Scholar, MedEd, Medline, and the Proquest Dissertations and Theses section was also performed. All titles and abstracts were screened. Selected articles were subsequently screened using predetermined inclusion and exclusion criteria. RESULTS Allied healthcare trainees lacked sufficient knowledge about medical cannabis and did not feel prepared to counsel patients on this subject. Additionally, they expressed a growing interest in medical cannabis and would like more standardized education on the topic. Finally, faculty and deans in various institutions agreed on the need to educate students on the subject, and aimed to implement courses on medical cannabis or expand their existing curricula. CONCLUSIONS While the medical cannabis landscape is developing, medical and allied health students are not properly educated and knowledgeable on this emerging field of clinical care. The findings suggest that the implementation of competencies-based curricula on medical cannabis is essential for medical and allied healthcare trainees to have the appropriate level of knowledge to counsel and educate their patients.
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Costales B, van Boemmel-Wegmann S, Winterstein A, Segal R. Clinical Conditions and Prescription Drug Utilization among Early Medical Marijuana Registrants in Florida. J Psychoactive Drugs 2021; 53:185-194. [PMID: 33393877 DOI: 10.1080/02791072.2020.1864069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Initial legalization of medical marijuana (MM) in Florida required providers to submit initial and follow-up treatment plan forms to the University of Florida to support research on MM safety and efficacy. This study retrospectively analyzed all treatment plan forms submitted between program inception (August 2016) through July 2017 and describes early Florida MM registrants by clinical conditions and prescription drug utilization. Among 7,548 unique treatment plans, the initial visit was characterized by registrants who were mostly white (83.7%), 52.3 (SD 16.4) years of age on average, and who were assessed by the provider as at least moderately ill (79.6%). Musculoskeletal and spasticity-related conditions (44.8%), chronic pain (41.9%), and mental health disorders (17.0%) were the most frequent medical complaints for seeking MM treatment with more than one condition per patient possible. One in four (25.9%) patients reported use of prescription opioids and over one-fifth of patients frequently utilized at least one psychotropic medication as well as cardiovascular agents. There were 2,075 unique follow-up plans available which were mostly characterized by clinical improvement and reported reductions in utilization of some drug classes. Further research is needed to guide clinicians on the risks and benefits of MM used concomitantly with prescription drugs.
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Affiliation(s)
- Brianna Costales
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Sascha van Boemmel-Wegmann
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Almut Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA.,Consortium for Medical Marijuana Clinical Outcomes Research, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
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McAfee J, Boehnke KF, Moser SM, Brummett CM, Waljee JF, Bonar EE. Perioperative cannabis use: a longitudinal study of associated clinical characteristics and surgical outcomes. Reg Anesth Pain Med 2020; 46:137-144. [PMID: 33208521 DOI: 10.1136/rapm-2020-101812] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite increases in cannabis use generally and for pain management, data regarding cannabis use in patients undergoing surgery are lacking. This study examined the prevalence of cannabis use among patients undergoing elective surgery and explored differences in clinical characteristics and surgical outcomes between cannabis users and non-cannabis users. METHODS This prospective study included 1335 adults undergoing elective surgery. Participants completed self-report questionnaires preoperative and at 3-month and 6-month postsurgery to assess clinical characteristics and surgical outcomes. RESULTS Overall, 5.9% (n=79) of patients reported cannabis use (53.2% medical, 19.0% recreational and 25.3% medical and recreational). On the day of surgery, cannabis users reported worse pain, more centralized pain symptoms, greater functional impairment, higher fatigue, greater sleep disturbances and more symptoms of anxiety and depression versus non-cannabis users (all p<0.01). Additionally, a larger proportion of cannabis users reported opioid (27.9%) and benzodiazepine use (19.0%) compared with non-cannabis users (17.5% and 9.2%, respectively). At 3 and 6 months, cannabis users continued to report worse clinical symptoms; however, both groups showed improvement across most domains (p≤0.05). At 6 months, the groups did not differ on surgical outcomes, including surgical site pain (p=0.93) or treatment efficacy (p=0.88). CONCLUSIONS Cannabis use is relatively low in this surgical population, yet cannabis users have higher clinical pain, poorer scores on quality of life indicators, and higher opioid use before and after surgery. Cannabis users reported similar surgical outcomes, suggesting that cannabis use did not impede recovery.
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Affiliation(s)
- Jenna McAfee
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin F Boehnke
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephanie M Moser
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
OBJECTIVE To review pharmacology, available dosage forms, efficacy, and safety of cannabis and cannabinoids in cancer patients. DATA SOURCES In PubMed (1965 to June 2020) the search was conducted using the search terms cannabidiol, cannabis, CBD, dronabinol, endocannabinoids, medical marijuana, nabiximols, nabilone, THC, and cancer. Abstracts from article bibliographies were reviewed. STUDY SELECTION AND DATA EXTRACTION Relevant English-language studies conducted in humans evaluating cannabis and cannabinoids for cancer treatment or related symptoms were considered. Reference lists in relevant articles, package inserts, guidance documents, and addditional articles evaluating cannabis and cannabinoids were identified. DATA SYNTHESIS Cannabis and cannabinoid effectiveness can be attributed to active components delta-9-tetrahydrocannabinol and cannabidiol. Multiple dosage forms exist, each with different properties contributing to efficacy and safety differences. No data supports use as anticancer agents, and mixed efficacy results have been reported when used in cancer patients with nausea, pain, and anorexia. Inclusion of medicinal and synthetic products, small sample sizes, varying patient populations, and different dosage forms, doses, and drug combinations. These products are well tolerated, and adverse effects depend on the main active component. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Healthcare professionals need to identify appropriateness, monitor, and document use of cannabis and cannabinoids similar to other drug therapies as well as educate the patients/ caregivers about potential benefits and risks. CONCLUSIONS Current evidence for use of medical cannabis and cannabinoids in cancer patients is weak. However, healthcare professionals are in an ideal role to monitor and educate patients using medical cannabis and cannabinoids.
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Affiliation(s)
| | - Lisa M Holle
- UConn School of Pharmacy, Storrs, CT, USA.,UConn Health Neag Cancer Center, Farmington, CT, USA
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Mantzoukas S, Ntoukas A, Lagogiannis I, Kalyvas N, Eliopoulos P, Poulas K. Larvicidal Action of Cannabidiol Oil and Neem Oil against Three Stored Product Insect Pests: Effect on Survival Time and in Progeny. BIOLOGY 2020; 9:E321. [PMID: 33019756 PMCID: PMC7599800 DOI: 10.3390/biology9100321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/14/2022]
Abstract
SStored product pests can be detrimental to agricultural produce. As much as chemical pesticides are effective control agents, they involve several environmental and health risks. Within the framework of studies on alternative pest management methods, interest has focused on a plethora of plants whose extracts have demonstrated promising action as insecticides. Azadirachta indica and the derived neem oil have been extensively tested against many harmful insect species. In contrast, Cannabis sativa L. and its main compound, CBD, a highly concentrated cannabinoid, have not been investigated much. The present study examined the potential insecticidal activity of CBD and neem oils against 4th instar larvae of Tribolium confusum, Oryzaephilus surinamensis and Plodia interpunctella on wheat, rice and corn seeds. Treatment efficacy was expressed in terms of larval mortality. Mortality was observed in relation to dosage, time exposure intervals and product types. The results showed clear pesticidal activity for both oils, which at high doses induced significant mortality. The treatments produced significantly fewer offspring in the insect species tested than the control. The efficacy of treatment in progeny suppression was, as expected, dose dependent.
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Affiliation(s)
- Spiridon Mantzoukas
- Department of Pharmacy, University of Patras, 26504 Patras, Greece; (A.N.); (I.L.); (N.K.)
| | - Aristeidis Ntoukas
- Department of Pharmacy, University of Patras, 26504 Patras, Greece; (A.N.); (I.L.); (N.K.)
| | - Ioannis Lagogiannis
- Department of Pharmacy, University of Patras, 26504 Patras, Greece; (A.N.); (I.L.); (N.K.)
| | - Nikolaos Kalyvas
- Department of Pharmacy, University of Patras, 26504 Patras, Greece; (A.N.); (I.L.); (N.K.)
| | | | - Konstantinos Poulas
- Department of Pharmacy, University of Patras, 26504 Patras, Greece; (A.N.); (I.L.); (N.K.)
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Montoya Z, Conroy M, Vanden Heuvel BD, Pauli CS, Park SH. Cannabis Contaminants Limit Pharmacological Use of Cannabidiol. Front Pharmacol 2020; 11:571832. [PMID: 33013414 PMCID: PMC7516211 DOI: 10.3389/fphar.2020.571832] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/25/2020] [Indexed: 01/15/2023] Open
Abstract
For nearly a century, Cannabis has been stigmatized and criminalized across the globe, but in recent years, there has been a growing interest in Cannabis due to the therapeutic potential of phytocannabinoids. With this emerging interest in Cannabis, concerns have arisen about the possible contaminations of hemp with pesticides, heavy metals, microbial pathogens, and carcinogenic compounds during the cultivation, manufacturing, and packaging processes. This is of particular concern for those turning to Cannabis for medicinal purposes, especially those with compromised immune systems. This review aims to provide types of contaminants and examples of Cannabis contamination using case studies that elucidate the medical consequences consumers risk when using adulterated Cannabis products. Thus, it is imperative to develop universal standards for cultivation and testing of products to protect those who consume Cannabis.
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Affiliation(s)
- Zackary Montoya
- Institute of Cannabis Research, Colorado State University-Pueblo, Pueblo, CO, United States
| | - Matthieu Conroy
- Institute of Cannabis Research, Colorado State University-Pueblo, Pueblo, CO, United States
| | | | - Christopher S Pauli
- Institute of Cannabis Research, Colorado State University-Pueblo, Pueblo, CO, United States
| | - Sang-Hyuck Park
- Institute of Cannabis Research, Colorado State University-Pueblo, Pueblo, CO, United States
- Department of Biology, Colorado State University-Pueblo, Pueblo, CO, United States
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Marcu J. The legalization of cannabinoid products and standardizing cannabis-drug development in the United States: a brief report
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 22:289-293. [PMID: 33162772 PMCID: PMC7605018 DOI: 10.31887/dcns.2020.22.3/jmarcu] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This brief report covers recent advances in cannabis and cannabinoid regulation and drug approval. The popularity of cannabis and cannabinoid products continues to rise, and these products are available for the majority of the population in the United States to purchase as easily as alcohol. Although many states have approved programs and research licenses, these activities and products all remain federally illegal. The solution may be for the United States to offer multiple pathways for product approval that adapt to the diversity of the products and the needs of the consumer. Multiple pathways for market approval would protect public health, whether the public is using cannabis and cannabinoids as a medicine, a wellness product, or as a recreational substance.
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Affiliation(s)
- Jahan Marcu
- American Journal of Endocannabinoid Medicine, Little Falls, New Jersey, US
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Dunbar MS, Davis JP, Tucker JS, Seelam R, Shih RA, D'Amico EJ. Developmental Trajectories of Tobacco/Nicotine and Cannabis Use and Patterns of Product Co-use in Young Adulthood. Tob Use Insights 2020; 13:1179173X20949271. [PMID: 32922109 PMCID: PMC7446261 DOI: 10.1177/1179173x20949271] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/08/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Concurrent co-use of tobacco/nicotine and cannabis (T/C) products is common among young people and may increase risks for negative health and psychosocial outcomes, but little is known about developmental patterns of T/C co-use. This study aimed to identify distinct trajectory classes of concurrent T/C co-use from ages 16 to 21 and compare groups on T/C co-use behaviors in young adulthood. Methods Participants (n = 2497) reported T/C use on annual online surveys from 2015 to 2019 (ages 16-22). We used parallel process growth mixture models to model simultaneous trajectories of past-month cigarette, e-cigarette, smokeless tobacco, and cannabis use and identify latent classes of T/C trajectories. Classes were then compared on types and number of T/C products used and types of T/C co-use in young adulthood. Results Models revealed 4 T/C classes: Low/No T/C Use, Early Concurrent T/C Co-use, Late Concurrent T/C Co-use, and Tobacco Quitters/Cannabis Maintainers. Compared to other classes, the Early Concurrent T/C Co-use group-individuals with rapid progression to concurrent T/C co-use during adolescence-were more likely to report poly-tobacco use, poly-cannabis use, same-occasion sequential T/C co-use and T/C co-administration (ie, mixing T/C) of both combustible and vaping products in young adulthood. Conclusion Early progression to concurrent T/C co-use in adolescence is prospectively linked to poly-product use and co-use of T/C products in young adulthood. Prevention efforts targeting co-use of T/C products in adolescence may help to reduce riskier patterns of T/C use and co-use in young adulthood.
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Cameron EC, Hemingway SL. Cannabinoids for fibromyalgia pain: a critical review of recent studies (2015-2019). J Cannabis Res 2020; 2:19. [PMID: 33526114 PMCID: PMC7819299 DOI: 10.1186/s42238-020-00024-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/02/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Fibromyalgia is a chronic health condition characterized by widespread, severe musculoskeletal pain that affects an estimated 5-7% of the global population. Due to the highly comorbid nature of fibromyalgia, patients with the disorder often respond poorly to traditional pain treatments. Recent studies suggest that patient response may be more favorable to alternative analgesics, such as cannabis. However, the therapeutic potential of cannabis-based pain treatment for fibromyalgia remains unclear. The present study examined the most recent cannabis literature (2015-2019) and provides a critical review of current research on the safety and efficacy of medical cannabis treatments for fibromyalgia. METHODS We followed Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines in searching the PubMed and Medline databases using the search terms "cannabis + fibromyalgia" and then "cannabinoids + fibromyalgia." Inclusion criteria were a) English language, b) published in peer review journals, c) published from 2015 to 2019, d) all study designs except for systematic reviews and meta-analyses, and e) all cannabis preparations. RESULTS The search identified five applicable studies involving 827 participants that used six different treatments. Review suggested several methodological problems pertaining to generalizability and validity. CONCLUSION Although the critically reviewed studies superficially suggest that medical cannabis is a safe and effective treatment for fibromyalgia pain, serious methodological limitations prevent a definitive conclusion regarding the use of cannabinoids for pain management in fibromyalgia patients at this time.
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Affiliation(s)
- Erinn C Cameron
- School of Psychology, Fielding Graduate University, 2020 De La Vina St, Santa Barbara, CA, 93105, USA.
| | - Samantha L Hemingway
- School of Psychology, Fielding Graduate University, 2020 De La Vina St, Santa Barbara, CA, 93105, USA
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Abstract
Tourette syndrome is a complex neuropsychiatric disorder with a wide phenotypic spectrum, including tics and psychiatric comorbidities, such as obsessive-compulsive disorder and attention-deficit disorder. Often considered a neurodevelopmental disorder, it is most prevalent during childhood and treatment strategies can vary according to degree of severity and patient-specific symptom manifestations. This review focuses on established and emerging management options for tics, including behavioral interventions and nonpharmacologic therapies, medication management, and promising surgical approaches.
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Affiliation(s)
- Joohi Jimenez-Shahed
- Movement Disorders Neuromodulation & Brain Circuit Therapeutics, Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, 1000 10th Avenue, Suite 10C, New York, NY 10019, USA.
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Szejko N, Fichna JP, Safranow K, Dziuba T, Żekanowski C, Janik P. Association of a Variant of CNR1 Gene Encoding Cannabinoid Receptor 1 With Gilles de la Tourette Syndrome. Front Genet 2020; 11:125. [PMID: 32194619 PMCID: PMC7065033 DOI: 10.3389/fgene.2020.00125] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
Background Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder of unknown etiology, although a major role of genetic factors has been established. Cannabis-based medicines may alleviate GTS-associated tics and variants of CNR1 gene encoding central cannabinoid receptor (CB1) are believed to be a risk factor for the development of some neurodevelopmental diseases. Our aim was to test the association of selected CNR1 gene variants with GTS. Material and Methods The cohort of GTS cases comprised 262 unrelated patients aged 3–53 years (mean age: 18.3 ± 9.1 years; 204 males (77.9%), 126 (48.1%) adults defined as ≥18 years). As a control group we enrolled 279 unrelated, ethnically and gender matched individuals with no diagnosed mental, neurological or general disorder, aged 13–54 years (mean age: 22.5 ± 3.0 years; 200 males, (74.1%). Both study and control groups were selected from Polish population, which is ethnically homogenous subgroup of Caucasian population. Four single nucleotide polymorphisms (SNPs) in CNR1 were selected: rs2023239, rs2180619, rs806379, and rs1049353 based on minor allele frequency in general population >15%. These variants were genotyped using a real-time quantitative polymerase chain reaction system (TaqMan SNP genotyping assay). Results We found significant association of GTS clinical phenotype with rs2023239 variant. Minor allele C and CT+CC genotypes were found significantly more often in GTS patients compared to controls (17.4 vs 11.1%, p=0.003 and 32.8 vs 20.4%, p=0.001, respectively), and the difference remained significant after correction for multiple testing. C allele of rs2023239 polymorphism of the CNR1 gene was associated with the occurrence of tics. There were no statistically significant associations for rs806379, rs1049353 or rs2180619 variants. Conclusion Our findings suggest that C allele of rs2023239 polymorphism of the CNR1 gene is a risk factor of GTS in Polish population. The variant can be potentially associated with abnormal endocannabinoid transmission, which is suspected to be one of the causes of GTS.
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Affiliation(s)
- Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland.,Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Piotr Fichna
- Laboratory of Neurogenetics, Department of Neurodegenerative Disorders, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Dziuba
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Cezary Żekanowski
- Laboratory of Neurogenetics, Department of Neurodegenerative Disorders, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Janik
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
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Cogan PS. The 'entourage effect' or 'hodge-podge hashish': the questionable rebranding, marketing, and expectations of cannabis polypharmacy. Expert Rev Clin Pharmacol 2020; 13:835-845. [PMID: 32116073 DOI: 10.1080/17512433.2020.1721281] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The concept of a cannabis 'entourage effect' was first coined as a hypothetical afterthought in 1998. Since then, multiple scientific reviews, lay articles, and marketing campaigns have promoted the effect as a wholly beneficial manifestation of polypharmacy expected to modulate the therapeutic effects of cannabis and its derivatives. There is reason to wonder at the authenticity of such claims. AREAS COVERED A broad definition of the entourage effect is presented, followed by brief summaries of the nature of cannabis polypharmacy and the commonly cited contributing phytochemicals, with special attention to their attendant adverse effects. A critical analysis is then offered of the primary literature that is often portrayed as suggestive of the effect in existing reviews, with further studies being drawn from PubMed and Google Scholar searches. A final discussion questions the therapeutic value of the entourage effect and offers alternate perspectives on how it might be better interpreted. EXPERT OPINION Claims of a cannabis entourage effect invoke ill-defined and unsubstantiated pharmacological activities which are commonly leveraged toward the popularization and sale of ostensible therapeutic products. Overestimation of such claims in the scientific and lay literature has fostered their misrepresentation and abuse by a poorly regulated industry.
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Affiliation(s)
- Peter S Cogan
- Department of Pharmaceutical Sciences, Regis University School of Pharmacy , Denver, CO, USA
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Rocha L, Frías‐Soria CL, Ortiz JG, Auzmendi J, Lazarowski A. Is cannabidiol a drug acting on unconventional targets to control drug-resistant epilepsy? Epilepsia Open 2020; 5:36-49. [PMID: 32140642 PMCID: PMC7049809 DOI: 10.1002/epi4.12376] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022] Open
Abstract
Cannabis has been considered as a therapeutic strategy to control intractable epilepsy. Several cannabis components, especially cannabidiol (CBD), induce antiseizure effects. However, additional information is necessary to identify the types of epilepsies that can be controlled by these components and the mechanisms involved in these effects. This review presents a summary of the discussion carried out during the 2nd Latin American Workshop on Neurobiology of Epilepsy entitled "Cannabinoid and epilepsy: myths and realities." This event was carried out during the 10th Latin American Epilepsy Congress in San José de Costa Rica (September 28, 2018). The review focuses to discuss the use of CBD as a new therapeutic strategy to control drug-resistant epilepsy. It also indicates the necessity to consider the evaluation of unconventional targets such as P-glycoprotein, to explain the effects of CBD in drug-resistant epilepsy.
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Affiliation(s)
- Luisa Rocha
- Departamento de FarmacobiologíaCentro de Investigación y de Estudios AvanzadosMéxico CityMéxico
| | | | - José G. Ortiz
- Department of Pharmacology and ToxicologySchool of MedicineUniversity of Puerto RicoSan JuanPuerto Rico
| | - Jerónimo Auzmendi
- Departamento de Bioquímica ClínicaFacultad de Farmacia y BioquímicaInstituto de Investigaciones en Fisiopatología y Bioquímica Clínica (INFIBIOC)Universidad de Buenos AiresBuenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
| | - Alberto Lazarowski
- Departamento de Bioquímica ClínicaFacultad de Farmacia y BioquímicaInstituto de Investigaciones en Fisiopatología y Bioquímica Clínica (INFIBIOC)Universidad de Buenos AiresBuenos AiresArgentina
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Tetrahydrocannabinol (THC) cartridge ingestion. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Duffy B, Li L, Lu S, Durocher L, Dittmar M, Delaney-Baldwin E, Panawennage D, LeMaster D, Navarette K, Spink D. Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent. TOXICS 2020; 8:E8. [PMID: 31991538 PMCID: PMC7151740 DOI: 10.3390/toxics8010008] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 01/25/2023]
Abstract
Beginning in June of 2019, there was a marked increase in reported cases of serious pulmonary injury associated with vaping. The condition, referred to as e-cigarette or vaping product use-associated lung injury (EVALI), does not appear to involve an infectious agent; rather, a chemical adulterant or contaminant in vaping fluids is suspected. In August of 2019, the Wadsworth Center began receiving vaporizer cartridges recovered from patients with EVALI for analysis. Having no a priori information of what might be in the cartridges, we employed untargeted analyses using gas chromatography-mass spectrometry and high-resolution mass spectrometry to identify components of concern. Additionally, we employed targeted analyses used for New York medical marijuana products. Here, we report on the analyses of 38 samples from the first 10 New York cases of EVALI for which we obtained cartridges. The illicit fluids had relatively low cannabinoid content, sometimes with unusual Δ9-/Δ8-tetrahydrocannabinol ratios, sometimes containing pesticides and many containing diluents. A notable diluent was α-tocopheryl acetate (vitamin E acetate; VEA), which was found in 64% of the cannabinoid-containing fluids. To investigate potential sources of the VEA, we analyzed six commercial cannabis-oil diluents/thickeners. Three were found to be >95% VEA, two were found to be primarily squalane, and one was primarily α-bisabolol. The cause(s) of EVALI is unknown. VEA and squalane are components of some personal care products; however, there is growing concern that vaping large amounts of these compounds is not safe.
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Affiliation(s)
- Bryan Duffy
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Lingyun Li
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Shijun Lu
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Lorie Durocher
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Mark Dittmar
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Emily Delaney-Baldwin
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Deepika Panawennage
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - David LeMaster
- Laboratory of Molecular Diagnostics, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA;
| | - Kristen Navarette
- Center for Environmental Health, New York State Department of Health, Albany, NY 12201, USA;
- Albany Medical Center, Department of Pediatrics, Albany, NY 12208, USA
| | - David Spink
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA
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Zeyl V, Sawyer K, Wightman RS. What Do You Know About Maryjane? A Systematic Review of the Current Data on the THC:CBD Ratio. Subst Use Misuse 2020; 55:1223-1227. [PMID: 32124675 DOI: 10.1080/10826084.2020.1731547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Ratios of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) impact metabolism and therapeutic effects of cannabis. Currently, no states with legalized medical or recreational cannabis consider ratios THC:CBD in regulations. Objective: Determine what THC:CBD ratios are selected for use in clinical cannabis trials and what is the rationale. Methods: This is a systematic literature review of Central, CINAHL, Embase, PsycInfo, and PubMed of the last 10 years of English language medical cannabis publications highlighting THC:CBD ratios. Included were clinical studies of products containing and listing both THC and CBD ratios, percentages, or weighted amounts. Case reports and series, abstracts, reviews, and meta-analysis were excluded. Non-human, non-therapeutic, or studies examining approved cannabis pharmaceuticals were excluded. Results: Four hundred and seventy-nine (479) unique references were found, of which 11 met inclusion criteria. THC:CBD ratios listed and/or calculated: 1:0, 22:1, 2:1, 1:1, 1:2, 1:6, 1:9, 1:20, 1:33, 1:50, and 0:1. Rationale for ratios selected was often not listed, or simply trivialized as the ratios available to patients in the area, or ratios that were pharmaceutically available throughout the study country. One study compared ratios of high and low THC:CBD, but did not specify the ratios. Conclusion: The medical and scientific communities have not drawn substantive conclusions nor thoroughly explored THC:CBD ratios for "best practice" treatment of different disease processes and their sequelae. While there is evidence that cannabis provides medical benefits, research is lacking on standardization of medical cannabis use in modern medical practices.
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Affiliation(s)
- Victoria Zeyl
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Rachel S Wightman
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Urbi B, Broadley S, Bedlack R, Russo E, Sabet A. Study protocol for a randomised, double-blind, placebo-controlled study evaluating the Efficacy of cannabis-based Medicine Extract in slowing the disease pRogression of Amyotrophic Lateral sclerosis or motor neurone Disease: the EMERALD trial. BMJ Open 2019; 9:e029449. [PMID: 31719072 PMCID: PMC6858175 DOI: 10.1136/bmjopen-2019-029449] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with no known cure and with an average life expectancy of 3-5 years post diagnosis. The use of complementary medicine such as medicinal cannabis in search for a potential treatment or cure is common in ALS. Preclinical studies have demonstrated the efficacy of cannabinoids in extending the survival and slowing of disease progression in animal models with ALS. There are anecdotal reports of cannabis slowing disease progression in persons with ALS (pALS) and that cannabis alleviated the symptoms of spasticity and pain. However, a clinical trial in pALS with these objectives has not been conducted. METHODS AND ANALYSIS The Efficacy of cannabis-based Medicine Extract in slowing the disease pRogression of Amyotrophic Lateral sclerosis or motor neurone Disease trial is a randomised, double-blind, placebo-controlled cannabis trial in pALS conducted at the Gold Coast University Hospital, Australia. The investigational product will be a cannabis-based medicine extract (CBME) supplied by CannTrust Inc., Canada, with a high-cannabidiol-low-tetrahydrocannabinol concentration. A total of 30 pALS with probable or definite ALS diagnosis based on the El Escorial criteria, with a symptom duration of <2 years, age between 25 and 75years and with at least 70% forced vital capacity (FVC) will be treated for 6 months. The primary objective of the study is to evaluate the efficacy of CBME compared with placebo in slowing the disease progression measured by differences in mean ALS Functional Rating Scale-Revised and FVC score between the groups at the end of treatment. The secondary objectives are to evaluate the safety and tolerability of CBME by summarising adverse events, the effects of CBME on spasticity, pain, weight loss and quality of life assessed by the differences in mean Numeric Rating Scale for spasticity and Numeric Rating Scale for pain, percentage of total weight loss and ALS specific quality of life-Revised questionnaire. ETHICS AND DISSEMINATION The study has been approved by the local Institutional Review Board. The results of this study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03690791.
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Affiliation(s)
- Berzenn Urbi
- Neurology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Simon Broadley
- Neurology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Richard Bedlack
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Ethan Russo
- International Cannabis and Cannabinoids Institute, Prague, Czech Republic
| | - Arman Sabet
- Neurology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Slawek D, Meenrajan SR, Alois MR, Comstock Barker P, Estores IM, Cook R. Medical Cannabis for the Primary Care Physician. J Prim Care Community Health 2019; 10:2150132719884838. [PMID: 31646929 PMCID: PMC6820188 DOI: 10.1177/2150132719884838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Medical cannabis use is common in the United States and increasingly more socially acceptable. As more patients seek out and acquire medical cannabis, primary care physicians will be faced with a growing number of patients seeking information on the indications, efficacy, and safety of medical cannabis. We present a case of a patient with several chronic health conditions who asks her primary care provider whether she should try medical cannabis. We provide a review of the pharmacology of medical cannabis, the state of evidence regarding the efficacy of medical cannabis, variations in the types of medical cannabis, and safety monitoring considerations for the primary care physician.
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Affiliation(s)
- Deepika Slawek
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | | | | | | | - Robert Cook
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Boehnke KF, Scott JR, Litinas E, Sisley S, Williams DA, Clauw DJ. High-Frequency Medical Cannabis Use Is Associated With Worse Pain Among Individuals With Chronic Pain. THE JOURNAL OF PAIN 2019; 21:570-581. [PMID: 31560957 DOI: 10.1016/j.jpain.2019.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 12/25/2022]
Abstract
Cannabis is widely used for chronic pain. However, there is some evidence of an inverse dose-response relationship between cannabis effects and pain relief that may negatively affect analgesic outcomes. In this cross-sectional survey, we examined whether daily cannabis use frequency was associated with pain severity and interference, quality of life measures relevant to pain (eg, anxiety and depressive symptoms), and cannabis use preferences (administration routes and cannabinoid ratio). Our analysis included 989 adults who used cannabis every day for chronic pain. Participant use was designated as light, moderate, and heavy (1-2, 3-4, and 5 or more cannabis uses per day, respectively). The sample was also subgrouped by self-reported medical-only use (designated MED, n = 531, 54%) versus medical use concomitant with a past-year history of recreational use (designated MEDREC, n = 458, 46%). In the whole sample, increased frequency of use was significantly associated with worse pain intensity and interference, and worse negative affect, although high-frequency users also reported improved positive affect. Subgroup analyses showed that these effects were driven by MED participants. Heavy MED participant consumption patterns showed greater preference for smoking, vaporizing, and high tetrahydrocannabinol products. In contrast, light MED participants had greater preference for tinctures and high cannabidiol products. Selection bias, our focus on chronic pain, and our cross-sectional design likely limit the generalizability of our results. Our findings suggest that lower daily cannabis use frequency is associated with better clinical profile as well as lower risk cannabis use behaviors among MED participants. Future longitudinal studies are needed to examine how high frequency of cannabis use interacts with potential therapeutic benefits. PERSPECTIVE: Our findings suggest that lower daily cannabis use frequency is associated with better clinical profile as well as safer use behaviors (eg, preference for cannabidiol and noninhalation administration routes). These trends highlight the need for developing cannabis use guidelines for clinicians to better protect patients using cannabis.
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Affiliation(s)
- Kevin F Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, Michigan.
| | - J Ryan Scott
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | - David A Williams
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, Michigan
| | - Daniel J Clauw
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, Michigan
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Seltenrich N. Cannabis Contaminants: Regulating Solvents, Microbes, and Metals in Legal Weed. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:82001. [PMID: 31430176 PMCID: PMC6791536 DOI: 10.1289/ehp5785] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/28/2019] [Indexed: 05/30/2023]
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