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Li A, Erridge S, Holvey C, Coomber R, Barros D, Bhoskar U, Crews M, Donnelly L, Imran M, Korb L, Mwimba G, Sachdeva-Mohan S, Rucker JJ, Sodergren MH. UK Medical Cannabis Registry: a case series analyzing clinical outcomes of medical cannabis therapy for generalized anxiety disorder patients. Int Clin Psychopharmacol 2024:00004850-990000000-00125. [PMID: 38299624 DOI: 10.1097/yic.0000000000000536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
This study aims to analyze changes in health-related quality of life (HRQoL) and safety in patients with generalized anxiety disorder (GAD) prescribed a homogenous selection of cannabis-based medicinal products (CBMPs). Patients prescribed Adven CBMPs (Curaleaf International, UK) for GAD were identified from the UK Medical Cannabis Registry. Primary outcomes were changes in patient-reported outcome measures (PROMs) from baseline up to 12 months, including GAD-7, Single-Item Sleep Quality Scale (SQS), and EQ-5D-5L. Adverse events were recorded using CTCAE version 4.0. A total of 120 patients were identified for inclusion, of which 38 (31.67%), 52 (43.33%), and 30 (25.00%) were prescribed oils, dried flower, and both formulations of CBMP. Associated improvements in GAD-7, SQS, and EQ-5D-5L at 1, 3, 6, and 12 months were observed compared to baseline (P < 0.010). There were 24 (20.00%) patients who reported 442 (368.33%) adverse events, most of which were mild (n = 184, 41.63%) and moderate (n = 197, 44.57%). This study reports an association between initiation of a homogeneous CBMP therapy and improvements in anxiety severity and HRQoL in individuals with GAD. Moreover, therapy was well-tolerated at 12 months follow-up. Further investigation through randomized controlled trials will ultimately be required to determine causation.
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Affiliation(s)
- Adam Li
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London
| | - Simon Erridge
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London
- Sapphire Medical Clinics
| | | | - Ross Coomber
- Sapphire Medical Clinics
- St. George's Hospital NHS Trust
| | | | | | | | | | | | - Laura Korb
- Sapphire Medical Clinics
- North London Mental Health Partnership
| | | | | | - James J Rucker
- Department of Psychological Medicine, Kings College London
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Mikael H Sodergren
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London
- Sapphire Medical Clinics
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Vivek K, Karagozlu Z, Erridge S, Holvey C, Coomber R, Rucker JJ, Weatherall MW, Sodergren MH. UK Medical Cannabis Registry: Assessment of clinical outcomes in patients with insomnia. Brain Behav 2024; 14:e3410. [PMID: 38337193 PMCID: PMC10858318 DOI: 10.1002/brb3.3410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/04/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION The primary aim of this study was to assess changes in sleep-specific health-related quality of life (HRQoL) for those prescribed cannabis-based medicinal products (CBMPs) for insomnia. METHODS A case series of UK patients with insomnia was analyzed. Primary outcomes were changes in the Single-Item Sleep-Quality Scale (SQS), Generalized Anxiety Disorder-7 (GAD-7), and EQ-5D-5L at up to 6 months from baseline. Statistical significance was identified as a p value < .050. RESULTS 61 patients were included in the analysis. There was an improvement in the SQS from baseline at 1, 3, and 6 months (p < .001). There were also improvements in the EQ-5D-5L Index value and GAD-7 at 1, 3, and 6 months (p < .050). There were 28 (45.9%) adverse events recorded by 8 patients (13.1%). There were no life-threatening/disabling adverse events. CONCLUSION Patients with insomnia experienced an improvement in sleep quality following the initiation of CBMPs in this medium-term analysis. Fewer than 15% of participants reported one or more adverse events. However, due to the limitations of the study design, further investigation is required before definitive conclusions can be drawn on the efficacy of CBMPs in treating insomnia.
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Affiliation(s)
- Kavyesh Vivek
- Imperial College Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
| | - Zekiye Karagozlu
- Imperial College Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
| | - Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
- Department of MedicineCuraleaf ClinicLondonUK
| | - Carl Holvey
- Department of MedicineCuraleaf ClinicLondonUK
| | - Ross Coomber
- Department of MedicineCuraleaf ClinicLondonUK
- Department of Trauma and OrthopaedicsSt. George's Hospital NHS TrustLondonUK
| | - James J. Rucker
- Department of MedicineCuraleaf ClinicLondonUK
- Department of Psychological MedicineKings College LondonLondonUK
- National and Specialist Tertiary Referrals Affective Disorders ServiceSouth London & Maudsley NHS Foundation TrustLondonUK
| | - Mark W. Weatherall
- Department of MedicineCuraleaf ClinicLondonUK
- Department of NeurologyBuckinghamshire Healthcare NHS TrustAmershamUK
| | - Mikael H Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and CancerImperial College LondonLondonUK
- Department of MedicineCuraleaf ClinicLondonUK
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Amaral C, Carvalho C, Scaranelo A, Chapman K, Chatkin J, Ferreira I. Cannabis and sleep disorders: not ready for prime time? A qualitative scoping review. J Clin Sleep Med 2023; 19:975-990. [PMID: 36692176 PMCID: PMC10152356 DOI: 10.5664/jcsm.10428] [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: 08/16/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES To perform a qualitative scoping literature review for studies involving the effects of cannabis on sleep and sleep disorders. METHODS Two electronic databases, MEDLINE and EMBASE, searched for comprehensive published abstracted studies that involved human participants. Inclusion criteria were article of any type, published in English, a target population of cannabis users, and reported data on cannabis effect on sleep and sleep disorders. The Joanna Briggs Institute's (JBI) approach was elected as the methodology framework guidance in the scoping review process. RESULTS A total of 40 unique publications were found. The majority (82.5%) were from the Americas with 60% published in the last decade. Of the 40 studies, only 25% were randomized control trials, and the sleep outcome measurements were similar and comparable in only 20%. Cannabis users studied were reported either 73% frequent users or 27% sporadic users. The utilization of cannabis showed improved sleep (21%), worse sleep (48%), mixed results (14%), or no impact at all (17%) in the studies published in the last 5 decades. CONCLUSIONS Our findings summarize the lack of robust evidence to support the use of cannabis for sleep disorders. The varied cannabis user-related characteristics may account for the inconsistent results identified. Further studies assessing cannabis and sleep are needed to discern what works in what context, how it works, and for whom. CITATION Amaral C, Carvalho C, Scaranelo A, Chapman K, Chatkin J, Ferreira I. Cannabis and sleep disorders: not ready for prime time? A qualitative scoping review. J Clin Sleep Med. 2023;19(5):975-990.
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Affiliation(s)
- Caio Amaral
- Department of Medicine, University Centre of the Americas, São Paulo, São Paulo, Brazil
| | - Carolina Carvalho
- KITE-Toronto Rehabilitation Institute, University Health Network and Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Anabel Scaranelo
- Medical Imaging Department, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth Chapman
- Department of Medicine, Respiratory Division, University of Toronto, Toronto, Ontario, Canada
- Asthma & Airway Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jose Chatkin
- Division of Respiratory Diseases, School of Medicine Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ivone Ferreira
- Department of Medicine, Respiratory Division, University of Toronto, Toronto, Ontario, Canada
- Asthma & Airway Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Respiratory Division of McMaster University, Hamilton, Ontario, Canada
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Ona G, Balant M, Bouso JC, Gras A, Vallès J, Vitales D, Garnatje T. The Use of Cannabis sativa L. for Pest Control: From the Ethnobotanical Knowledge to a Systematic Review of Experimental Studies. Cannabis Cannabinoid Res 2022; 7:365-387. [PMID: 34612729 PMCID: PMC9418361 DOI: 10.1089/can.2021.0095] [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: 11/12/2022] Open
Abstract
Background: Despite the benefits that synthetic pesticides have provided in terms of pest and disease control, they cause serious long-term consequences for both the environment and living organisms. Interest in eco-friendly products has subsequently increased in recent years. Methods: This article briefly analyzes the available ethnobotanical evidence regarding the use of Cannabis sativa as a pesticide and offers a systematic review of experimental studies. Results: Our findings indicate that both ethnobotanical and experimental procedures support the use of C. sativa as a pesticide, as remarkable toxicity has been observed against pest organisms. The results included in the systematic review of experimental studies (n=30) show a high degree of heterogeneity, but certain conclusions can be extracted to guide further research. For instance, promising pesticide properties were reported for most of the groups of species tested, especially Arachnida and Insecta; the efficacy of C. sativa as a pesticide can be derived from a wide variety of compounds that it contains and possible synergistic effects; it is crucial to standardize the phytochemical profile of C. sativa plants used as well as to obtain easily reproducible results; appropriate extraction methods should be explored; and upper inflorescences of the plant may be preferred for the production of the essential oil, but further studies should explore better other parts of the plant. Conclusion: In the coming years, as new findings are produced, the promising potential of C. sativa as a pesticide will be elucidated, and reviews such as the present one constitute useful basic tools to make these processes easier.
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Affiliation(s)
- Genís Ona
- International Center for Ethnobotanical Education, Research, and Service (ICEERS), Barcelona, Catalonia, Spain
- Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
- Department of Psychology and Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
- Institut Botànic de Barcelona (IBB, CSIC-Ajuntament de Barcelona), Barcelona, Catalonia, Spain
| | - Manica Balant
- Institut Botànic de Barcelona (IBB, CSIC-Ajuntament de Barcelona), 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, Barcelona, Catalonia, Spain
| | - José Carlos Bouso
- International Center for Ethnobotanical Education, Research, and Service (ICEERS), Barcelona, Catalonia, Spain
- Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Airy Gras
- Institut Botànic de Barcelona (IBB, CSIC-Ajuntament de Barcelona), 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, Barcelona, Catalonia, Spain
| | - Daniel Vitales
- Institut Botànic de Barcelona (IBB, CSIC-Ajuntament de Barcelona), 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, Barcelona, Catalonia, Spain
| | - Teresa Garnatje
- Institut Botànic de Barcelona (IBB, CSIC-Ajuntament de Barcelona), Barcelona, Catalonia, Spain
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Kuhathasan N, Minuzzi L, MacKillop J, Frey BN. The Use of Cannabinoids for Insomnia in Daily Life: Naturalistic Study. J Med Internet Res 2021; 23:e25730. [PMID: 34704957 PMCID: PMC8581757 DOI: 10.2196/25730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 01/01/2023] Open
Abstract
Background Insomnia is a prevalent condition that presents itself at both the symptom and diagnostic levels. Although insomnia is one of the main reasons individuals seek medicinal cannabis, little is known about the profile of cannabinoid use or the perceived benefit of the use of cannabinoids in daily life. Objective We conducted a retrospective study of medicinal cannabis users to investigate the use profile and perceived efficacy of cannabinoids for the management of insomnia. Methods Data were collected using the Strainprint app, which allows medicinal cannabis users to log conditions and symptoms, track cannabis use, and monitor symptom severity pre- and postcannabis use. Our analyses examined 991 medicinal cannabis users with insomnia across 24,189 tracked cannabis use sessions. Sessions were analyzed, and both descriptive statistics and linear mixed-effects modeling were completed to examine use patterns and perceived efficacy. Results Overall, cannabinoids were perceived to be efficacious across all genders and ages, and no significant differences were found among product forms, ingestion methods, or gender groups. Although all strain categories were perceived as efficacious, predominant indica strains were found to reduce insomnia symptomology more than cannabidiol (CBD) strains (estimated mean difference 0.59, SE 0.11; 95% CI 0.36-0.81; adjusted P<.001) and predominant sativa strains (estimated mean difference 0.74, SE 0.16; 95% CI 0.43-1.06; adjusted P<.001). Indica hybrid strains also presented a greater reduction in insomnia symptomology than CBD strains (mean difference 0.52, SE 0.12; 95% CI 0.29-0.74; adjusted P<.001) and predominant sativa strains (mean difference 0.67, SE 0.16; 95% CI 0.34-1.00; adjusted P=.002). Conclusions Medicinal cannabis users perceive a significant improvement in insomnia with cannabinoid use, and this study suggests a possible advantage with the use of predominant indica strains compared with predominant sativa strains and exclusively CBD in this population. This study emphasizes the need for randomized placebo-controlled trials assessing the efficacy and safety profile of cannabinoids for the treatment of insomnia.
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Affiliation(s)
- Nirushi Kuhathasan
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - James MacKillop
- Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Benicio N Frey
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Fedorova EV, Wong CF, Ataiants J, Iverson E, Conn B, Lankenau SE. Cannabidiol (CBD) and other drug use among young adults who use cannabis in Los Angeles. Drug Alcohol Depend 2021; 221:108648. [PMID: 33676073 PMCID: PMC8462788 DOI: 10.1016/j.drugalcdep.2021.108648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cannabidiol (CBD) is purportedly a promising therapeutic agent to provide relief for a variety of medical conditions with mild or no psychoactive effects. However, little is known about young adults who use cannabis and CBD-dominant products, and associations between CBD use and other drug use. METHODS Young adults (aged 24-32) who currently used cannabis (n = 239) were surveyed in Los Angeles in March 2019 through March 2020. The sample was divided into CBD-dominant (at least 1:1 CBD:THC ratio) and THC-dominant product users. We described CBD forms, reasons and conditions for CBD use and examined between-group differences in sociodemographic characteristics, cannabis practices, health and other drug use. RESULTS CBD-dominant users were more likely to be female, use cannabis at lower frequency and amount (except for edible/drinkable/oral products), self-report medical motivation for cannabis use, use cannabis for pain and report more health problems. Oil, flower, topicals and sprays/drops/tinctures were the most prevalent CBD forms. Psychological problems and pain were commonly reported conditions and medical reasons for CBD use. CBD-dominant users were more likely to report illicit drug use, where psilocybin use was markedly different between the two groups. CONCLUSIONS CBD use was associated with health histories and motivations linked to pain and psychological problems. Positive association between CBD use and illicit drug use may indicate self-medication for psychological conditions. Future studies should evaluate the effectiveness of various CBD forms and dose regimens for treatment of pain and psychological problems, and as a potential intervention for decreasing other drug use and associated harms.
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Affiliation(s)
- Ekaterina V. Fedorova
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
| | - Carolyn F. Wong
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Research on Children, Youth, & Families, 4650 Sunset Blvd., MS #2, Los Angeles,
CA 90027, United States
| | - Janna Ataiants
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
| | - Ellen Iverson
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States,Children’s Hospital Los Angeles, Division of
Adolescent Medicine, 4650 Sunset Blvd., MS #2, Los Angeles, CA 90027, United
States
| | - Bridgid Conn
- University of Southern California, Keck School of Medicine,
Department of Pediatrics, 4650 Sunset Blvd., Los Angeles, CA 90027, United
States
| | - Stephen E. Lankenau
- Drexel University, Dornsife School of Public Health,
Department of Community Health and Prevention, 3215 Market Street, Philadelphia, PA
19104, United States
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7
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Medicinal applications of cannabis/cannabinoids. Curr Opin Psychol 2021; 38:1-10. [DOI: 10.1016/j.copsyc.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 01/08/2023]
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Shakil SSM, Gowan M, Hughes K, Azam MNK, Ahmed MN. A narrative review of the ethnomedicinal usage of Cannabis sativa Linnaeus as traditional phytomedicine by folk medicine practitioners of Bangladesh. J Cannabis Res 2021; 3:8. [PMID: 33741060 PMCID: PMC7980557 DOI: 10.1186/s42238-021-00063-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a worldwide interest in the use of Cannabis sativa for biomedicine purposes. Cannabis has ethnomedicinal usage as a natural medicine in Bangladesh and cultivated during the British Empire period for revenues. OBJECTIVE Folk medicine practitioners (FMPs) from different districts of Bangladesh have been using Cannabis sativa, but until now there have not been any compiled studies particularly regarding this practice. Hence, this review is an effort to retrieve the traditional usage of Cannabis sativa as a phytomedicine from published ethnomedicinal studies. METHODS AND MATERIALS Information was searched by using the search terms "ethnomedicinal Cannabis sativa and Bangladesh"; "Bangladesh cannabaceae and ethnomedicinal survey"; "ganja, bhang and folk medicine Bangladesh"; "tetrahydrocannabinol (THC), cannabinoid and therapeutic, clinical trial"; and "cannabis and pharmacological/biological" and retrieved from ethnobotanical articles available on PubMed, Scopus, Science Direct, and Google Scholar databases. A search of the relevant scientific literature also was conducted to assess the efficacy of the ethnomedicinal usage of Cannabis sativa. RESULTS While reviewing over 200 ethnomedicinal plants' survey articles, we found that FMPs of Bangladesh from 12 different districts used Cannabis sativa to treat cited ailments like sleep-associated problems (n=5), neuropsychiatric and CNS problems (n=5), and infections and respiratory problems (n=5) followed by rheumatism, gastrointestinal, gynecological (n=4 each), cancer, sexual, and other ailments including hypertension, headache, itch, increases bile secretion, abortifacient, dandruff, fever, and urinary problems (n=1 each). There are a total of 15 formulations identified from the 11 out of 18 ethnomedicinal plant survey reports. The leaf was the main plant part used (53.8%), followed by root (23%), seed (7.7%) and flower, inflorescence, resin, and all parts 3.8% respectively. CONCLUSIONS Sales and cultivation of Cannabis are illegal at present in Bangladesh, but the use of Cannabis sativa as a natural phytomedicine has been practiced traditionally by folk medicine practitioners of Bangladesh for many years and validated through relevant pharmacological justification. Although Cannabis sativa possesses ethnomedicinal properties in the folk medicine of Bangladesh, it is, furthermore, needed to conduct biological research to consolidate pharmacological justification about the prospects and challenges of Cannabis and cannabinoids' use in Bangladesh as safer biomedicine in the future.
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Affiliation(s)
| | - Matt Gowan
- The Canadian College of Naturopathic Medicine, Toronto, Ontario Canada
| | | | - Md. Nur Kabidul Azam
- Department of Genetic Engineering & Biotechnology, Jashore University of Science & Technology, Jashore, Bangladesh
| | - Md. Nasir Ahmed
- Biotechnology & Natural Medicine Division, TechB Nutrigenomics, Dhaka, Bangladesh
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O'Sullivan SE, Stevenson CW, Laviolette SR. Could Cannabidiol Be a Treatment for Coronavirus Disease-19-Related Anxiety Disorders? Cannabis Cannabinoid Res 2021; 6:7-18. [PMID: 33614948 PMCID: PMC7891214 DOI: 10.1089/can.2020.0102] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease-19 (COVID-19)-related anxiety and post-traumatic stress symptoms (PTSS) or post-traumatic stress disorder (PTSD) are likely to be a significant long-term issue emerging from the current pandemic. We hypothesize that cannabidiol (CBD), a chemical isolated from Cannabis sativa with reported anxiolytic properties, could be a therapeutic option for the treatment of COVID-19-related anxiety disorders. In the global over-the-counter CBD market, anxiety, stress, depression, and sleep disorders are consistently the top reasons people use CBD. In small randomized controlled clinical trials, CBD (300-800 mg) reduces anxiety in healthy volunteers, patients with social anxiety disorder, those at clinical high risk of psychosis, in patients with Parkinson's disease, and in individuals with heroin use disorder. Observational studies and case reports support these findings, extending to patients with anxiety and sleep disorders, Crohn's disease, depression, and in PTSD. Larger ongoing trials in this area continue to add to this evidence base with relevant patient cohorts, sample sizes, and clinical end-points. Pre-clinical studies reveal the molecular targets of CBD in these indications as the cannabinoid receptor type 1 and cannabinoid receptor type 2 (mainly in fear memory processing), serotonin 1A receptor (mainly in anxiolysis) and peroxisome proliferator-activated receptor gamma (mainly in the underpinning anti-inflammatory/antioxidant effects). Observational and pre-clinical data also support CBD's therapeutic value in improving sleep (increased sleep duration/quality and reduction in nightmares) and depression, which are often comorbid with anxiety. Together these features of CBD make it an attractive novel therapeutic option in COVID-related PTSS that merits investigation and testing through appropriately designed randomized controlled trials.
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Affiliation(s)
| | - Carl W. Stevenson
- School of Biosciences, University of Nottingham, Loughborough, United Kingdom
| | - Steven R. Laviolette
- Department of Anatomy and Cell Biology and Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
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10
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Oña G, Bouso JC. Therapeutic Potential of Natural Psychoactive Drugs for Central Nervous System Disorders: A Perspective from Polypharmacology. Curr Med Chem 2021; 28:53-68. [PMID: 31830883 DOI: 10.2174/0929867326666191212103330] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/22/2022]
Abstract
In the drug development, the formation of highly selective ligands has been unsuccessful in the treatment of central nervous system disorders. Multi-target ligands, from the polypharmacology paradigm, are being proposed as treatments for these complex disorders, since they offer enhanced efficacy and a strong safety profile. Natural products are the best examples of multi-target compounds, so they are of high interest within this paradigm. Additionally, recent research on psychoactive drugs of natural origin, such as ayahuasca and cannabis, has demonstrated the promising therapeutic potential for the treatment of some psychiatric and neurological disorders. In this text, we describe how research on psychoactive drugs can be effectively combined with the polypharmacology paradigm, providing ayahuasca and cannabis research as examples. The advantages and disadvantages are also discussed.
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Affiliation(s)
- Genís Oña
- International Center for Ethnobotanical Education, Research and Service (ICEERS), Barcelona, Spain
| | - José Carlos Bouso
- International Center for Ethnobotanical Education, Research and Service (ICEERS), Barcelona, Spain
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11
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Stith SS, Li X, Diviant JP, Brockelman FC, Keeling KS, Hall B, Vigil JM. The effectiveness of inhaled Cannabis flower for the treatment of agitation/irritability, anxiety, and common stress. J Cannabis Res 2020; 2:47. [PMID: 33526145 PMCID: PMC7819324 DOI: 10.1186/s42238-020-00051-z] [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: 03/01/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND An observational research design was used to evaluate which types of commonly labeled Cannabis flower product characteristics are associated with changes in momentary feelings of distress-related symptoms. METHODS We used data from 2306 patient-directed cannabis administration sessions among 670 people who used the real-time Cannabis effects recording software, Releaf App, between June 6, 2016, and February 23, 2019, for tracking the effects of Cannabis flower consumption. Fixed effects multivariable panel regression techniques were used to establish overall relief by symptom type and to determine which labeled product characteristics (e.g., subspecies/subtype, inhalation method, and major cannabinoid contents) showed the strongest correlation with changes in momentary feelings of agitation/irritability, anxiety, and stress, along with experienced side effects. RESULTS In total, a decrease in symptom intensity levels was reported in 95.51% of Cannabis usage sessions, an increase in 2.32% of sessions, and no change in 2.16% of sessions. Fixed effects models showed, on average, respondents recorded a maximum symptom intensity reduction of 4.33 points for agitation/irritability (SE = 0.20, p < 0.01), 3.47 points for anxiety (SE = 0.13, p < 0.01), and 3.98 for stress (SE = 0.12, p < 0.01) on an 11-point visual analog scale. Fixed effects regressions showed that, controlling for time-invariant user characteristics, mid and high tetrahydrocannabinol (THC) levels were the primary independent predictor of increased symptom relief, and that when broken out by symptom type, this effect was only statistically significant for our largest sample of users, those reporting anxiety rather than agitation/irritability or stress. Cannabidiol (CBD) levels were generally not associated with changes in symptom intensity levels. In a minority of cannabis use sessions (< 13%), cannabis users reported anxiogenic-related negative side effects (e.g., feeling anxious, irritable, paranoid, rapid pulse, or restless), whereas in a majority of sessions (about 66%), users reported positive anxiolytic side effects (e.g., feeling chill, comfy, happy, optimistic, peaceful, or relaxed). CONCLUSIONS The findings suggest the majority of patients in our sample experienced relief from distress-related symptoms following consumption of Cannabis flower, and that among product characteristics, higher THC levels were the strongest predictors of relief.
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Affiliation(s)
- Sarah S Stith
- Department of Economics, University of New Mexico, Albuquerque, USA
| | - Xiaoxue Li
- Department of Economics, University of New Mexico, Albuquerque, USA
| | - Jegason P Diviant
- Department of Psychology, University of New Mexico, Albuquerque, USA
| | | | | | | | - Jacob M Vigil
- Department of Psychology, University of New Mexico, Albuquerque, USA.
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Stith SS, Diviant JP, Brockelman F, Keeling K, Hall B, Lucern S, Vigil JM. Alleviative effects of Cannabis flower on migraine and headache. JOURNAL OF INTEGRATIVE MEDICINE 2020; 18:416-424. [PMID: 32758396 DOI: 10.1016/j.joim.2020.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 04/01/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Few studies to date have measured the real-time effects of consumption of common and commercially available Cannabis products for the treatment of headache and migraine under naturalistic conditions. This study examines, for the first time, the effectiveness of using dried Cannabis flower, the most widely used type of Cannabis product in the United States, in actual time for treatment of headache- and migraine-related pain and the associations between different product characteristics and changes in symptom intensity following Cannabis use. METHODS Between 06/10/2016 and 02/12/2019, 699 people used the Releaf Application to record real-time details of their Cannabis use, including product characteristics and symptom intensity levels prior to and following self-administration; data included 1910 session-level attempts to treat headache- (1328 sessions) or migraine-related pain (582 sessions). Changes in headache- or migraine-related pain intensity were measured on a 0-10 scale prior to, and immediately, following Cannabis consumption. RESULTS Ninety-four percent of users experienced symptom relief within a two-hour observation window. The average symptom intensity reduction was 3.3 points on a 0-10 scale (standard deviation = 2.28, Cohen's d = 1.58), with males experiencing greater relief than females (P < 0.001) and a trend that younger users (< 35 years) experience greater relief than older users (P = 0.08). Mixed effects regression models showed that, among the known (i.e., labeled) product characteristics, tetrahydrocannabinol levels 10% and higher are the strongest independent predictors of symptom relief, and this effect is particularly prominent in headache rather than migraine sufferers (P < 0.05), females (P < 0.05) and younger users (P < 0.001). Females and younger users also appear to gain greater symptom relief from flower labeled as "C. indica" rather than "C. sativa" or other hybrid strains. CONCLUSION These results suggest that whole dried Cannabis flower may be an effective medication for treatment of migraine- and headache-related pain, but the effectiveness differs according to characteristics of the Cannabis plant, the combustion methods, and the age and gender of the patient.
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Affiliation(s)
- Sarah S Stith
- Department of Economics, Faculty of Economics, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Jegason P Diviant
- Department of Psychology, Student of Psychology, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Franco Brockelman
- Morebetter Ltd. Software Developer, Hyattsville, Maryland 20781, USA
| | - Keenan Keeling
- Morebetter Ltd. Software Developer, Hyattsville, Maryland 20781, USA
| | - Branden Hall
- Morebetter Ltd. Software Developer, Hyattsville, Maryland 20781, USA
| | - Storri Lucern
- Department of Psychology, Student of Psychology, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Jacob M Vigil
- Department of Psychology, Faculty of Psychology, University of New Mexico, Albuquerque, New Mexico 87131, USA.
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Doremus JM, Stith SS, Vigil JM. Using recreational cannabis to treat insomnia: Evidence from over-the-counter sleep aid sales in Colorado. Complement Ther Med 2019; 47:102207. [DOI: 10.1016/j.ctim.2019.102207] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/20/2019] [Accepted: 09/30/2019] [Indexed: 12/18/2022] Open
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Li X, Vigil JM, Stith SS, Brockelman F, Keeling K, Hall B. The effectiveness of self-directed medical cannabis treatment for pain. Complement Ther Med 2019; 46:123-130. [DOI: 10.1016/j.ctim.2019.07.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 12/23/2022] Open
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Bonaccorso S, Ricciardi A, Zangani C, Chiappini S, Schifano F. Cannabidiol (CBD) use in psychiatric disorders: A systematic review. Neurotoxicology 2019; 74:282-298. [PMID: 31412258 DOI: 10.1016/j.neuro.2019.08.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/02/2019] [Accepted: 08/04/2019] [Indexed: 12/21/2022]
Abstract
Cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) are the most represented phytocannabinoids in Cannabis sativa plants. However, CBD may present with a different activity compared with the psychotomimetic THC. Most typically, CBD is reported to be used in some medical conditions, including chronic pain. Conversely, the main aim of this systematic review is to assess and summarise the available body of evidence relating to both efficacy and safety of CBD as a treatment for psychiatric disorders, alone and/or in combination with other treatments. Eligible studies included randomized controlled trials (RCT) assessing the effect of CBD in a range of psychopathological conditions, such as substance use; psychosis, anxiety, mood disturbances, and other psychiatric (e.g., cognitive impairment; sleep; personality; eating; obsessive-compulsive; post-traumatic stress/PTSD; dissociative; and somatic) disorders. For data gathering purposes, the PRISMA guidelines were followed. The initial search strategy identified some n = 1301 papers; n = 190 studies were included after the abstract's screening and n = 27 articles met the inclusion criteria. There is currently limited evidence regarding the safety and efficacy of CBD for the treatment of psychiatric disorders. However, available trials reported potential therapeutic effects for specific psychopathological conditions, such as substance use disorders, chronic psychosis, and anxiety. Further large-scale RCTs are required to better evaluate the efficacy of CBD in both acute and chronic illnesses, special categories, as well as to exclude any possible abuse liability.
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Affiliation(s)
| | - Angelo Ricciardi
- Camden and Islington NHS Mental Health Foundation Trust, London, UK; Department of Mental Health, ASL Roma 1, Rome, Italy
| | - Caroline Zangani
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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The Association between Cannabis Product Characteristics and Symptom Relief. Sci Rep 2019; 9:2712. [PMID: 30804402 PMCID: PMC6389973 DOI: 10.1038/s41598-019-39462-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 01/22/2019] [Indexed: 01/17/2023] Open
Abstract
Federal barriers and logistical challenges have hindered measurement of the real time effects from the types of cannabis products used medically by millions of patients in vivo. Between 06/06/2016 and 03/05/2018, 3,341 people completed 19,910 self- administrated cannabis sessions using the mobile device software, ReleafApp to record: type of cannabis product (dried whole natural Cannabis flower, concentrate, edible, tincture, topical), combustion method (joint, pipe, vaporization), Cannabis subspecies (C. indica and C. sativa), and major cannabinoid contents (tetrahydrocannabinol, THC; and cannabidiol, CBD), along with real-time ratings of health symptom severity levels, prior-to and immediately following administration, and reported side effects. A fixed effects panel regression approach was used to model the within-user effects of different product characteristics. Patients showed an average symptom improvement of 3.5 (SD = 2.6) on an 11-point scale across the 27 measured symptom categories. Dried flower was the most commonly used product and generally associated with greater symptom relief than other types of products. Across product characteristics, only higher THC levels were independently associated with greater symptom relief and prevalence of positive and negative side effects. In contrast, CBD potency levels were generally not associated with significant symptom changes or experienced side effects.
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