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.

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.

 

Survey of Current Cannabidiol Use in Pediatric Treatment-Resistant Epilepsy

Severe childhood epilepsies are characterized by a high seizure burden and are often associated with neuro-developmental delays. When traditional medications fail to control a child’s seizures, families look to alternative treatments to help their children. One of these alternative treatments that has become more widespread involves the use of a compound from the Cannabis plant, Cannabidiol (CBD). CBD is a non-psychoactive compound that has been shown to have anticonvulsive properties in a number of animal models of epilepsy. In limited human adult trials, CBD has shown promise as an anticonvulsant with very few negative side effects. The purpose of this survey was to understand current use of CBD in children with treatment-resistant epilepsy.

Clinical Trials, Studies and Publications:

Survey of Current Cannabidiol Use in Pediatric Treatment-Resistant Epilepsy

Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey

Abstract

Objective: To determine the association between diabetes mellitus (DM) and marijuana use. Design: Cross-sectional study. Setting: Data from the National Health and Nutrition Examination Survey (NHANES III, 1988e1994) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention.

Clinical Trials, Studies and Publications:

Decreased prevalence of diabetes in marijuana users

Cannabis use was highly prevalent in the study population (57.4%) and was statistically associated with lower body mass index (BMI), lower % fat mass, lower fasting insulin

Abstract

To ascertain the relationship between cannabis use, obesity, and insulin resistance.

Clinical Trials, Studies and Publications:

Cannabis use in relation to obesity and insulin resistance in the Inuit population

Cannabis in Cancer Care

“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 predominatly in cells involved with immune function. Delta-9-tetrahydrocannabinol, the main bio-active 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.”

“Unfortunately, most physicians currently practicing medicine…have little or no knowledge of the biological actions of (endo)cannabinoids and the medicinal qualities of cannabis. Much of the discussion is dominated by addiction medicine specialists who have a skewed view of the health consequences of cannabis use by virtue of their specialty. Certainly a practicing oncologist is likely to have a much different perception of the risk:benefits of cannabis compared to the addiction medicine specialist. (http://ww.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/).”

Clinical Trials, Studies and Publications:

Cannabis in Cancer Care

 

Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010

Since the late 1990s, the number of people dying from opioid painkiller overdoses has steadily risen — with more than 16,000 deaths reported in 2013. And one study in JAMA (Journal of the American Medical Association) Psychiatry found opioid painkiller use has contributed to the rising use of heroin, another opioid, which is even deadlier and more addictive than painkillers.

As of July 2014, a total of 23 states have enacted laws establishing medical cannabis programs and chronic or severe pain is the primary indication in most states. Medical cannabis laws are associated with increased cannabis use among adults. This increased access to medical cannabis may reduce opioid analgesic use by patients with chronic pain, and therefore reduce opioid analgesic overdoses.

Clinical Trials, Studies and Publications:

Medical Cannabis Laws and Opioid Mortality

 

Medical Benefits of Marijuana Can Be Separated from Its Side Effects: Study

study published online on July 9th 2015 in the journal PLOS Biology has demonstrated how the medical benefits of marijuana can be separated from its unwanted side effects.

The recent findings revealed a separated pathway that can alone trigger the beneficial effects of delta9-tetrahydrocannabinol (THC) as a pain reliever for users without affecting their mood, perception or memory.

According to the study, THC is the main psychoactive ingredient in medical marijuana that has been shown to reduce tumour growth in cancer patients as supported by the previous researches conducted by the scientists at the University of East Anglia and University Pompeu Fabra in Barcelona.

With the purpose of separating the medical benefits of marijuana from its side effects, the researchers focused on understanding the molecular mechanism of THC. Behavioral analysis was carried out on mice to determine how pathways in their brains operate with the treatment of THC. Researchers then controlled certain cell receptors – called the cannabinoid receptor and serotonin receptor…they found out that when a particular serotonin receptor (5HT2AR) was blocked, the mice manifested a reduced amnesic effect of THC – in other words, the animal’s memory was slightly impaired – while the effects in terms of pain relief were not altered.

Clinical Trials, Studies and Publications:

Cognitive Impairment Induced by Delta9-tetrahydrocannabinol Occurs through Heteromers between Cannabinoid CB1 and Serotonin 5-HT2A Receptors