Cannabinoids in Medical Practice

Abstract
Many patients with chronic medical illnesses use cannabinoids. There are two FDA-approved cannabinoid products,whereas medical marijuana purchased at legal dispensaries is not FDA regulated and may contain uncertain concentrations of various compounds. Cannabinoids have shown efficacy in treating chemotherapy-related nausea and vomiting, poor appetite in advanced HIV, some pain states, and multiple sclerosis-associated spasticity. Recreational cannabinoid use has many known potential serious harms. Physicians should be knowledgeable
about cannabinoids and should inquire with their patients about cannabinoid use. Practical suggestions for clinical approaches are included.

Author:  TB Strouse

Cannabis and Cannabinoid Research (2016) 1:38

Clinical Trials, Studies and Publications (click to access):

Cannabinoids in Medical Practice

 

Cannabis and the Management of Chronic Pain

This review will provide the reader with the foundational basic and clinical science linking the endocannabinoid system and the phytocannabinoids with their potentially therapeutic role in the management of chronic pain.

Abstract

The endocannabinoid system is involved in a host of homeostatic and physiologic functions, including modulation of pain and inflammation. The specific roles of currently identified endocannabinoids that act as ligands at endogenous cannabinoid receptors within the central nervous system (primarily but not exclusively CB 1 receptors) and in the periphery (primarily but not exclusively CB 2 receptors) are only partially elucidated, but they do exert an influence on nociception. Exogenous plant-based cannabinoids (phytocannabinoids) and chemically related compounds, like the terpenes, commonly found in many foods, have been found to exert significant analgesic effects in various chronic pain conditions. Currently, the use of Δ9-tetrahydrocannabinol is limited by its psychoactive effects and predominant delivery route (smoking), as well as regulatory or legal constraints. However, other phytocannabinoids in combination, especially cannabidiol and β-caryophyllene, delivered by the oral route appear to be promising candidates for the treatment of chronic pain due to their high safety and low adverse effects profiles. This review will provide the reader with the foundational basic and clinical science linking the endocannabinoid system and the phytocannabinoids with their potentially therapeutic role in the management of chronic pain.

Authors: PG Fine, MJ Rosenfeld

Rambam Maimonides Medical Journal (2013) 4:1

Clinical Trials, Studies and Publications (click to access):

The endocannabinoid system, cannabinoids, and pain.

Cannabis Decreases Neuropathic Pain

Abstract

A randomized, placebo-controlled crossover trial utilizing vaporized cannabis containing placebo and 6.7% and 2.9% delta-9-tetrahydrocannabinol (THC) was performed in 42 subjects with central neuropathic pain related to spinal cord injury and disease. Subjects received two administrations of the study medication in a 4-hour interval. Blood samples for pharmacokinetic evaluation were collected, and pain assessment tests were performed immediately after the second administration and 3 hours later. Pharmacokinetic data, although limited, were consistent with literature reports, namely dose-dependent increase in systemic exposure followed by rapid disappearance of THC. Dose-dependent improvement in pain score was evident across all pain scale elements. Using mixed model regression, an evaluation of the relationship between plasma concentrations of selected cannabinoids and percent change in items from the Neuropathic Pain Scale was conducted. Changes in the concentration of THC and its nonpsychotropic metabolite, 11-nor-9-carboxy-THC, were related to percent change from baseline of several descriptors (eg, itching, burning, and deep pain). However, given the large number of multiple comparisons, false-discovery-rate-adjusted P-values were not significant. Plans for future work are outlined to explore the relationship of plasma concentrations with the analgesic response to different cannabinoids. Such an appraisal of descriptors might contribute to the identification of distinct pathophysiologic mechanisms and, ultimately, the development of mechanism-based treatment approaches for neuropathic pain, a condition that remains difficult to treat.

Authors: BL Wilsey, R Deutsch, E Samara, TD Marcotte, AJ Barnes, MA Huestis, D Le

Journal of Pain Research (2016) 9:587

Clinical Trials, Studies and Publications (click to access):

A preliminary evaluation of the relationship of cannabinoid blood concentrations with the analgesic response to vaporized cannabis.

Cannabis in Cancer Care

Abstract

Cannabis has been used in medicine for thousands of years prior to achieving its current illicit substance status. Cannabinoids, the active components of Cannabis sativa, mimic the effects of the endogenous cannabinoids (endocannabinoids), activating specific cannabinoid receptors, particularly CB1 found predominantly in the central nervous system and CB2 found predominantly in cells involved with immune function. Delta-9-tetrahydrocannabinol, the main bioactive cannabinoid in the plant, has been available as a prescription medication approved for treatment of cancer chemotherapy-induced nausea and vomiting and anorexia associated with the AIDS wasting syndrome. Cannabinoids may be of benefit in the treatment of cancer-related pain, possibly synergistic with opioid analgesics. Cannabinoids have been shown to be of benefit in the treatment of HIV-related peripheral neuropathy, suggesting that they may be worthy of study in patients with other neuropathic symptoms. Cannabinoids have a favorable drug safety profile, but their medical use is predominantly limited by their psychoactive effects and their limited bioavailability.
Authnors: DI Abrams, M Guzman
Clinical Pharmacology and Therapeutics (2015) 97:575

Clinical Trials, Studies and Publications (click to access):

Cannabis in Cancer Care

Use of cannabinoids in cancer care – palliative care

Commentary by Dr. SK Aggarwal on Cannabinoid Integrative Medicine (CIM) in oncologic palliative care.

Summary:

“Integrating CIM into oncologic palliative care promises to improve overall health-related quality of life, to provide further relief from distressing symptoms and spiritual suffering, and to bring hope to patients and families facing terminal illness.”

Author: SK Aggarwal

Current Oncology (2016) 23:S33-S36

Clinical Trials, Studies and Publications (click to access):

Use of cannabinoids in cancer care: palliative care.

Integrating Cannabis Into Clinical Cancer Care

Abstract

Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal use.

For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combating anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia.

Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects.

Authors: DJ Abrams

Current Oncology (2016) 23:S8-S14

Clinical Trials, Studies and Publications (click to access):

Integrating cannabis into clinical cancer care.

 

Endocannabinoid signaling mediates oxytocin-driven social reward

Evidence that an oxytocin-dependent endocannabinoid
signal contributes to the regulation of social reward.
The results provide insights into the functions of oxytocin, a
neuropeptide crucial for social behavior, and its interactions
with other modulatory systems that regulate the rewarding
properties of social behavior. They further suggest that oxytocin-
driven anandamide signaling may be defective in autism
spectrum disorders, and that correcting such deficits might offer a
strategy to treat these conditions.

Authors: D Wei, D Dinh, D Lee, A Anguren, G Moreno-Sanz, C Gall, D Piomelli

Cannabis and Cannabinoid Research (2016)1:81-89

Clinical Trials, Studies and Publications (click to access):

Enhancement of Anandamide-Mediated Endocannabinoid Signalling Corrects Autism-Related Social Impairment