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Mick G, Douek P. Clinical Benefits and Safety of Medical Cannabis Products: A Narrative Review on Natural Extracts. Pain Ther 2024:10.1007/s40122-024-00643-0. [PMID: 39096481 DOI: 10.1007/s40122-024-00643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024] Open
Abstract
Interest in medical cannabis and cannabis-based medicinal products (CBMPs) has increased greatly in recent years. Two cannabinoids are of principal importance; delta-9-tetrahydrocannabinol (∆9-THC), the primary psychoactive component, and also cannabidiol (CBD), considered non-intoxicating. Each has distinct mechanisms of action and different therapeutic potentials. CBMPs differ in their ∆9-THC and CBD components; predominantly ∆9-THC, balanced formulations with equivalent ∆9-THC and CBD elements, and CBD-predominant products. In this narrative review, we evaluate the published evidence for the clinical benefits of CBMPs and overall benefits in well-being. We also review the overall safety profile and discuss the potential for dependence with CBMPs. Evidence can be drawn from a wide range of randomized and other controlled studies and from observational real-world studies. Most data from observational registry studies are supportive of ∆9-THC-based products (∆9-THC-predominant or balanced CBMPs) in the management of chronic neuropathic pain. Balanced products are also effective in reducing spasticity in multiple sclerosis. Most CBMPs show benefit in providing symptomatic benefits in reducing anxiety, nausea, and in improving sleep, but the place of specific products is more subtle, and choice guided by specific circumstances. Symptomatic improvements are accompanied by improved quality of life and well-being. Safety data indicate that CBMPs are generally well tolerated in most patients without specific contraindications. The majority of adverse effects are non-serious, and transient; most are principally associated with ∆9-THC and are dose-dependent. In contrast to recreational cannabis use, there is little evidence from clinical studies that CBMPs have any potential for dependence.
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Affiliation(s)
- Gérard Mick
- Pain Center, Voiron Hospital, CHU Grenoble-Alpes-Voiron, Voiron, 38500, Grenoble, France.
- CETD, Hôpital Neurologique Pierre Wertheimer, CHU de Lyon-Hospices Civils de Lyon (HCL), 69500, Bron, France.
- Health Systemic Process (P2S) Laboratory, Research Unit 4129, Université Claude Bernard Lyon 1, 69008, Lyon, France.
- THEMAS Team, TIMC Laboratory, Université Grenoble Alpes, 38000, Grenoble, France.
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Dubois C, Bobitt J, Ding L, Eurich DT, Knapp AA, Jordan N. The Association of Medical Cannabis Use with Pain Levels and Opioid Use in Illinois' Opioid Alternative Pilot Program. Subst Use Misuse 2024:1-12. [PMID: 39069737 DOI: 10.1080/10826084.2024.2383585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE The state of Illinois' Opioid Alternative Pilot Program (OAPP) is the first and only official harm-reduction program in the US to address the opioid crisis via facilitation of safe and legal access to medical cannabis. This study evaluates the association of medical cannabis use with pain level and frequency of opioid use in the first cohort of OAPP participants in 2019. METHODS A survey was sent OAPP enrollees between February and July 2019. Cannabis users (n = 626) were compared to non-users (n = 234) to determine whether there was an association between cannabis use and self-reported (a) pain level and (b) frequency of opioid use. Backward stepwise regression models were used. RESULTS A total of 860 participants was included in the analysis. Overall, 75% of the study sample reported pain as their primary medical symptom, and 67% of cannabis users reported having a disability. The mean difference in pain level between cannabis users and non-users was 4.5 units (on a 100-point scale) higher among cannabis users than non-users (p = 0.03); and cannabis use was statistically associated with pain level. High-frequency opioid users had lower odds of reporting cannabis use within the past year than low/no opioid users. CONCLUSIONS Although there was a statistical association between cannabis use and pain, the difference of 4.5 points in pain level between users and non-users was too small to reflect a clinically meaningful relative difference. This study may provide useful information to providers and clinicians about how the OAPP and similar programs may reduce opioid use and improve health outcomes.
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Affiliation(s)
- Cerina Dubois
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Julie Bobitt
- Center for Dissemination and Implementation Science, University of Illinois College of Medicine, Chicago, IL, USA
| | - Lei Ding
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Ashley A Knapp
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Neil Jordan
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center of of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
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Spampinato G, Candeliere F, Amaretti A, Paris R, Montanari M, Virzì N, Strani L, Citti C, Cannazza G, Rossi M, Raimondi S. A three-years survey of microbial contaminants in industrial hemp inflorescences from two Italian cultivation sites. J Cannabis Res 2024; 6:31. [PMID: 39020444 PMCID: PMC11253326 DOI: 10.1186/s42238-024-00241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/07/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND The use of industrial Cannabis sativa L. for recreational, cosmeceutical, nutraceutical, and medicinal purposes has gained momentum due to its rich content of valuable phytochemicals, such as cannabidiol (CBD) and cannabigerol (CBG). However, there are concerns regarding the risk of microbial contamination in plants grown outside controlled environments. Microbes associated with hemp can be either epiphytes or endophytes and may pose a risk of infectious illness for humans. METHODS Seven Italian hemp genotypes, including Bernabeo, Carmagnola, Carmaleonte, Codimono, CS, Eletta Campana, and Fibranova, were cultivated in two distinct geographic locations, Catania and Rovigo, for three consecutive years from 2019 to 2021. Total aerobic microbes (TAMC), total combined yeasts/moulds (TYMC), the presence of bile-tolerant Gram-negative bacteria, and the absence of Escherichia coli and Salmonella spp. were evaluated and compared. The main phytocannabinoid content was measured and correlated with microbial contamination. RESULTS Most samples analyzed in this study did not meet the European Pharmacopoeia microbiological limits. The detection of potential pathogens, such as E. coli and Salmonella spp., in the samples indicates that the use of inflorescences may represent a possible source of infection. Microbial contamination varied among harvesting seasons and production sites, with agroclimatic conditions influencing microbial load and composition. The presence of potentially pathogenic bacteria was less associated with seasonal climate variability and more likely affected by sporadic contamination from external sources. CBD concentration exhibited a negative correlation with bile-tolerant Gram-negative bacteria and total yeasts/moulds levels. Samples with lower CBD content were more contaminated than those with higher CBD levels, suggesting a potential protective effect of this phytochemical on the plant. CONCLUSIONS The threshing residues (inflorescences, floral bracts, and leaves) of industrial hemp varieties represent a valuable product and a source of beneficial phytochemicals that warrants further exploration. While post-harvest sterilization methods may reduce microbiological risks, they may also degrade heat- and light-sensitive bioactive phytochemicals. The most promising strategy involves implementing best agronomic practices to maintain healthy and uncontaminated cultures. Rigorous monitoring and quality certification protocols are essential to mitigate the microbiological risk associated with the consumption of hemp-derived products.
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Affiliation(s)
- Gloria Spampinato
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
| | - Francesco Candeliere
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
| | - Alberto Amaretti
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
- Biogest-Siteia, University of Modena and Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Roberta Paris
- CREA Research Centre for Cereal and Industrial Crops, Via Di Corticella 133, 40128, Bologna, Italy
| | - Massimo Montanari
- CREA Research Centre for Cereal and Industrial Crops, Via Di Corticella 133, 40128, Bologna, Italy
| | - Nino Virzì
- CREA Research Centre for Cereal and Industrial Crops, C.So Savoia 190, 95024, Acireale, CT, Italy
| | - Lorenzo Strani
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
| | - Cinzia Citti
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
| | - Giuseppe Cannazza
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
| | - Maddalena Rossi
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
- Biogest-Siteia, University of Modena and Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Stefano Raimondi
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy.
- Biogest-Siteia, University of Modena and Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.
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Søgaard TF, Brummer JE, Wilkins C, Sznitman SR, Sevigny EL, Frank VA, Potter G, Hakkarainen P, Barratt MJ, Werse B, Grigg J, Fortin D, Bear D, Lenton S, Jauffret-Roustide M, Kirtadze I. Global patterns in small-scale cannabis growers' distribution practices: Exploring the grower-distributor nexus. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104463. [PMID: 38834441 DOI: 10.1016/j.drugpo.2024.104463] [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: 08/28/2023] [Revised: 05/01/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND While the supply of cannabis is commonly assumed to be dominated by criminal gangs, a sizable share of the domestic cannabis supply is provided by small-scale growers. This article examines the nature and scope of small-scale growers' distribution practices, with a particular focus on cross-country differences and variations between different types of grower-distributors, i.e., "non-suppliers", "exclusive social suppliers", "sharers and sellers" and "exclusive sellers". METHODS Based on a large convenience web survey sample of predominantly small-scale cannabis growers from 18 countries, this article draws on data from two subsamples. The first subsample includes past-year growers in all 18 countries who answered questions regarding their market participation (n = 8,812). The second subsample includes past-year growers in 13 countries, who answered additional questions about their supply practices (n = 2,296). RESULTS The majority of the cannabis growers engaged in distribution of surplus products, making them in effect "grower-distributors". Importantly, many did so as a secondary consequence of growing, and social supply (e.g., sharing and gifting) is much more common than selling. While growers who both shared and sold ("sharers and sellers"), and especially those who only sold ("exclusive sellers"), grew a higher number of plants and were most likely to grow due to a wish to sell for profits, the majority of these are best described as small-scale sellers. That is, the profit motive for growing was often secondary to non-financial motives and most sold to a limited number of persons in their close social network. CONCLUSION We discuss the implications of the findings on the structural process of import-substitution in low-end cannabis markets, including a growing normalization of cannabis supply.
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Affiliation(s)
| | | | - Chris Wilkins
- SHORE & Whariki Research Centre, Massey University, Auckland, New Zealand
| | | | - Eric L Sevigny
- Department of Criminal Justice and Criminology, Georgia State University, 55 Park Place NE, Atlanta, GA 30303, USA
| | - Vibeke Asmussen Frank
- Research Centre for Management, Organisation and Social Sciences, VIA University College, Denmark
| | | | - Pekka Hakkarainen
- Alcohol, Drugs and Tobacco Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Monica J Barratt
- Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, Vic, Australia; National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia
| | - Bernd Werse
- Dept. of Education, Centre for Drug Research, Goethe University, Frankfurt, Germany
| | - Jodie Grigg
- National Drug Research Institute, enAble Institute, Curtin University, Perth, WA, Australia
| | - Davide Fortin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Daniel Bear
- Humber College, Faculty of Social and Community Services, Toronto, Canada
| | - Simon Lenton
- National Drug Research Institute, enAble Institute, Curtin University, Perth, WA, Australia
| | - Marie Jauffret-Roustide
- Centre d'Études des Mouvements Sociaux (Inserm U1276/CNRS UMR8044/EHESS), France; Baldy Center on Law and Social Policy, Buffalo University, NY, USA; British Columbia Center on Substance Use, Vancouver, Canada; Institut Interuniversitaire sur les Dépendances, Montréal, Canada
| | - Irma Kirtadze
- School of Arts and Sciences, Ilia State University, Tbilisi, Georgia
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Lintzeris N, Mills L, Abelev SV, Suraev A, Arnold JC, McGregor IS. Medical cannabis use in Australia: consumer experiences from the online cannabis as medicine survey 2020 (CAMS-20). Harm Reduct J 2022; 19:88. [PMID: 35907959 PMCID: PMC9338505 DOI: 10.1186/s12954-022-00666-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/19/2022] [Indexed: 11/28/2022] Open
Abstract
Background Australia has had a framework for legal medicinal cannabis since 2016, yet prior online surveys in 2016 and 2018 indicated that most consumers continued to use illicit medical cannabis products. Regulatory data indicate an increase in the prescription of medicinal cannabis since 2019, and this survey examines consumer experiences of prescribed and illicit medical cannabis (MC) use in Australia. Methods A cross-sectional anonymous online survey was administered September 2020 to January 2021. Recruitment via social media, professional and consumer forums, and medical practices. Participant eligibility: ≥ 18 years; used a cannabis product for self-identified medical reason(s) in the past year, and resident in Australia. Outcome measures included consumer characteristics, conditions treated, source and patterns of MC use, and perspectives on accessing MC. Results Of the 1600 participants (mean age 46.4 ± 14.3 years, 53% male), 62.4% (n = 999) reported using only illicit and 37.6% (n = 601) used prescribed MC in the past year. MC was used on a median of 28 (IQR: 12, 28) of the past 28 days and cost $AUD 74 ± 72 weekly (median = $40, IQR: $7, $100). Prescribed participants were more likely to treat pain conditions than those using illicit MC (52% v 40%, OR = 1.7, 1.3–2.1) and less likely to treat sleep conditions (6% v 11%, OR = 0.5, 0.3–0.8), with mental health conditions also a common indication in both groups (26%, 31%). Prescribed MC was consumed predominately by oral routes (72%), whereas illicit MC was most commonly smoked (41%). Prescribed MC was ‘mainly THC’ (26%), ‘equal THC/CBD’ (40%), ‘mainly CBD’ (31%) and ‘uncertain’ (3%), while 34% of those using illicit MC were ‘uncertain’ of the cannabinoid profile. Cost and difficulties finding medical practitioners to prescribe remain significant barriers to accessing prescribed MC, and few (10.8%) described the existing model for accessing prescribed MC as ‘straightforward or easy’. Conclusions There has been a notable shift from illicit to prescribed MC by many consumers compared to prior surveys. Consumers using prescribed MC reported a range of advantages compared to illicit MC, including safer routes of administration, and greater certainty regarding access and composition of products. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00666-w.
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Affiliation(s)
- Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, NSW, Australia. .,Department of Addiction Medicine, Faculty Medicine and Health, University of Sydney, 591 South Dowling Street, Surry Hills, NSW, 2010, Australia.
| | - Llewellyn Mills
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, NSW, Australia.,Department of Addiction Medicine, Faculty Medicine and Health, University of Sydney, 591 South Dowling Street, Surry Hills, NSW, 2010, Australia
| | - Sarah V Abelev
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
| | - Anastasia Suraev
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jonathon C Arnold
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia.,Department of Pharmacology, Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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