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Szejko N, Becher E, Heimann F, Grotenhermen F, Müller-Vahl KR. Medicinal Use of Different Cannabis Strains: Results from a Large Prospective Survey in Germany. PHARMACOPSYCHIATRY 2024; 57:133-140. [PMID: 38471525 DOI: 10.1055/a-2261-2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Up to now, it is unclear whether different medicinal cannabis (MC) strains are differently efficacious across different medical conditions. In this study, the effectiveness of different MC strains was compared depending on the disease to be treated. METHODS This was an online survey conducted in Germany between June 2020 and August 2020. Patients were allowed to participate only if they received a cannabis-based treatment from pharmacies in the form of cannabis flowers prescribed by a physician. RESULTS The survey was completed by n=1,028 participants. Most participants (58%) have used MC for more than 1 year, on average, 5.9 different strains. Bedrocan (pure tetrahydrocannabinol to pure cannabidiol [THC:CBD]=22:<1) was the most frequently prescribed strain, followed by Bakerstreet (THC:CBD=19:<1) and Pedanios 22/1 (THC:CBD=22:1). The most frequent conditions MC was prescribed for were different pain disorders, psychiatric and neurological diseases, and gastrointestinal symptoms. Overall, the mean patient-reported effectiveness was 80.1% (range, 0-100%). A regression model revealed no association between the patient-reported effectiveness and the variety. Furthermore, no influence of the disease on the choice of the MC strain was detected. On average, 2.1 side effects were reported (most commonly dry mouth (19.5%), increased appetite (17.1%), and tiredness (13.0%)). However, 29% of participants did not report any side effects. Only 398 participants (38.7%) indicated that costs for MC were covered by their health insurance. CONCLUSIONS Patients self-reported very good efficacy and tolerability of MC. There was no evidence suggesting that specific MC strains are superior depending on the disease to be treated.
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Affiliation(s)
- Natalia Szejko
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Eva Becher
- Department of Sex- and Gender-specific Medicine, University of Bielefeld, Bielefeld, Germany
| | | | - Franjo Grotenhermen
- International Association for Cannabinoid Medicines, Steinheim, Germany
- Center for Cannabis Medicine, Steinheim, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Fadaee A, Mohammadi FS, Ariaee N, Ahmadi Ghezeldasht S, Valizadeh N, Kheradmand F, Boostani R, Rafatpanah H, Rezaee SA. Cannabinoid receptors as new targets for HTLV-1 associated myelopathy (HAM/TSP) treatment. Mult Scler Relat Disord 2024; 87:105659. [PMID: 38704874 DOI: 10.1016/j.msard.2024.105659] [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: 07/09/2023] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND/AIM The roles of endocannabinoids are described in immune modulation and neuroprotection. HTLV-1-associated myelopathy (HAM/TSP) is an inflammatory neurodegenerative disease. Therefore, in this study, the interactions of HTLV-1 regulatory factors and host cannabinoid receptors (CBRs) were evaluated in HAM/TSP. METHODS Nineteen HAM/TSPs, 22 asymptomatic carriers (ACs), and 18 healthy controls (HCs) were enrolled. RNA was extracted from PBMCs and then reverse-transcribed to cDNA. The gene expression of CB1R and CB2R, as well as HTLV-1 proviral load (PVL), Tax and HTLV-1 basic leucine zipper factor (HBZ) were assessed by RT-qPCR. RESULTS The mean expression of CB1R in ACs (8.51 ± 2.76) was significantly higher than HAMTSPs (1.593 ± 0.74, p = 0.05) and also HCs (0.10 ± 0.039, p = 0.001). The CB2R gene expression level in ACs (2.62±0.44) was significantly higher than HAM/TSPs (0.59 ± 0.15, p = 0.001) and HCs (1.00 ± 0.2, p = 0.006). Meanwhile there was a strong correlation between CB1R and CB2R gene expression levels in the HCs and HAM/TSPs (p = 0.001). HTLV-1-Tax expression in HAM/TSPs (386 ± 104) was higher than ACs (75 ± 32) and statistically significant (p = 0.003). While HTLV-1-HBZ was only expressed in three AC subjects and five HAM/TSPs, thus it cannot be analyzed. CONCLUSION The up-regulation of CB2R has immunomodulatory effects in inflammatory reactions. While CB1R as a neuroprotective agent may suppress inflammatory reactions in ACs, preventing HAM/TSP. It seems that, like multiple sclerosis (MS), cannabinoid medications are beneficial in HAM/TSP.
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Affiliation(s)
- Afsane Fadaee
- Faculty of Medicine, Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Azadi-Square, Medical Campus, Mashhad 9177948564, Iran; HTLV-1 Foundation, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmad Abad Bolv., Mashhad, Iran
| | - Fatemeh Sadat Mohammadi
- Faculty of Medicine, Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Azadi-Square, Medical Campus, Mashhad 9177948564, Iran
| | - Nazila Ariaee
- Faculty of Medicine, Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Azadi-Square, Medical Campus, Mashhad 9177948564, Iran
| | - Sanaz Ahmadi Ghezeldasht
- Blood Borne Infections Research Center, Academic Center for Education, Culture, and Research (ACECR), Razavi Khorasan, Mashhad, Iran
| | - Narges Valizadeh
- Faculty of Medicine, Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Azadi-Square, Medical Campus, Mashhad 9177948564, Iran
| | - Fatemeh Kheradmand
- Immunology Research Center, Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Boostani
- HTLV-1 Foundation, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmad Abad Bolv., Mashhad, Iran
| | - Houshang Rafatpanah
- Faculty of Medicine, Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Azadi-Square, Medical Campus, Mashhad 9177948564, Iran; HTLV-1 Foundation, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmad Abad Bolv., Mashhad, Iran
| | - Seyed Abdolrahim Rezaee
- Faculty of Medicine, Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Azadi-Square, Medical Campus, Mashhad 9177948564, Iran; HTLV-1 Foundation, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmad Abad Bolv., Mashhad, Iran.
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De Genna NM, Jacobsen E, Ganguli M. Marijuana use among community-dwelling older adults: A population-based study. Int J Geriatr Psychiatry 2024; 39:e6086. [PMID: 38613138 PMCID: PMC11112682 DOI: 10.1002/gps.6086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES There is a paucity of population-level data on marijuana use and mental health and functioning in older adults. METHODS We analyzed cross-sectional data (n = 910) from a well-characterized cohort, the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. MYHAT is an age-stratified random sample of the population age 65 years and older from a small-town in the USA. Half the sample was female and half were over 75 (Mean age = 77). Most participants were non-Hispanic White. Marijuana use was assessed by self-report and symptoms of mood disorders were screened using the modified Centers for Epidemiological Studies-Depression Scale and the Generalized Anxiety Disorder screener. Cognition was assessed by the Mini-Mental State Examination and a neuropsychological test battery; functioning using the OARS Activities of Daily Living and Instrumental Activities of Daily Living; and overall assessment using the Clinical Dementia Rating (CDR®). RESULTS One in five MYHAT participants had a history of marijuana use and 5% reported recent use, primarily for pain (41%) and recreation/relaxation (37%). Recent use was associated with cigarette and alcohol use, symptoms of depression or anxiety, and impairments in attention. CONCLUSIONS Twenty-percent of community-dwelling older adults living in a US state where recreational marijuana use is illegal had a history of marijuana use. Recent marijuana use was less common but, consistent with prior research, associated with other substance use and poorer mental health.
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Affiliation(s)
- Natacha M. De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Mary Ganguli
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Departments of Psychiatry and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Dahlke S, Butler JI, Hunter KF, Toubiana M, Kalogirou MR, Shrestha S, Devkota R, Law J, Scheuerman M. The Effects of Stigma: Older Persons and Medicinal Cannabis. QUALITATIVE HEALTH RESEARCH 2024:10497323241227419. [PMID: 38305270 DOI: 10.1177/10497323241227419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Cannabis has long been stigmatized as an illicit drug. Since legalization in Canada for both medical and recreational purposes, older adults' cannabis consumption has increased more than any other age group. Yet, it is unclear how the normalization of cannabis has impacted perceptions of stigma for older adults consuming cannabis medicinally. Qualitative description was used to elucidate the experiences of older Canadians aged 60+ related to stigma and their consumption of cannabis for medicinal purposes. Data collection involved semi-structured interviews. Data analysis examined how participants managed stigma related to cannabis use. Perceived stigma was evident in many participants' descriptions of their perceptions of cannabis in the past and present, and influenced how they accessed and consumed cannabis and their comfort in discussing its use with their healthcare providers. Participants employed several distinct strategies for managing stigma-concealing, re-framing, re-focusing, and proselytizing. Findings suggest that while medical cannabis consumption is becoming increasingly normalized among older adults, stigma related to cannabis persists and continues to shape older adults' experiences. A culture shift needs to occur among healthcare providers so that they are educated about cannabis and willing to discuss the possibilities of medicinal cannabis consumption with older adults. Otherwise, older adults may seek advice from recreational or other non-medical sources. Healthcare providers require education about the use of medical cannabis, so they can better advise older adults regarding its consumption for medicinal purposes.
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Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey I Butler
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Madeline Toubiana
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | | | - Shovana Shrestha
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Rashmi Devkota
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Joanna Law
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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Charles AL, Charloux A, Vogel T, Raul JS, Kindo M, Wolff V, Geny B. Cumulative Deleterious Effects of Tetrahydrocannabinoid (THC) and Ethanol on Mitochondrial Respiration and Reactive Oxygen Species Production Are Enhanced in Old Isolated Cardiac Mitochondria. Int J Mol Sci 2024; 25:1835. [PMID: 38339113 PMCID: PMC10855679 DOI: 10.3390/ijms25031835] [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: 12/15/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Delta 9 tetrahydrocannabinol (THC), the main component of cannabis, has adverse effects on the cardiovascular system, but whether concomitant ethanol (EtOH) and aging modulate its toxicity is unknown. We investigated dose responses of THC and its vehicle, EtOH, on mitochondrial respiration and reactive oxygen production in both young and old rat cardiac mitochondria (12 and 90 weeks). THC dose-dependently impaired mitochondrial respiration in both groups, and such impairment was enhanced in aged rats (-97.5 ± 1.4% vs. -75.6 ± 4.0% at 2 × 10-5 M, and IC50: 0.7 ± 0.05 vs. 1.3 ± 0.1 × 10-5 M, p < 0.01, for old and young rats, respectively). The EtOH-induced decrease in mitochondrial respiration was greater in old rats (-50.1 ± 2.4% vs. -19.8 ± 4.4% at 0.9 × 10-5 M, p < 0.0001). Further, mitochondrial hydrogen peroxide (H2O2) production was enhanced in old rats after THC injection (+46.6 ± 5.3 vs. + 17.9 ± 7.8%, p < 0.01, at 2 × 10-5 M). In conclusion, the deleterious cardiac effects of THC were enhanced with concomitant EtOH, particularly in old cardiac mitochondria, showing greater mitochondrial respiration impairment and ROS production. These data improve our knowledge of the mechanisms potentially involved in cannabis toxicity, and likely support additional caution when THC is used by elderly people who consume alcohol.
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Affiliation(s)
- Anne-Laure Charles
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondria, Oxidative Stress and Muscle Plasticity”, University of Strasbourg, 67000 Strasbourg, France; (A.-L.C.); (A.C.); (T.V.); (M.K.); (V.W.)
- Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France;
| | - Anne Charloux
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondria, Oxidative Stress and Muscle Plasticity”, University of Strasbourg, 67000 Strasbourg, France; (A.-L.C.); (A.C.); (T.V.); (M.K.); (V.W.)
- Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France;
- Department of Physiology and Functional Explorations, University Hospital of Strasbourg, 67091 Strasbourg, France
| | - Thomas Vogel
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondria, Oxidative Stress and Muscle Plasticity”, University of Strasbourg, 67000 Strasbourg, France; (A.-L.C.); (A.C.); (T.V.); (M.K.); (V.W.)
- Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France;
- Geriatrics Department, University Hospital of Strasbourg, 67091 Strasbourg, France
| | - Jean-Sébastien Raul
- Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France;
- Toxicology Laboratory, Institute of Legal Medicine, Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France
| | - Michel Kindo
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondria, Oxidative Stress and Muscle Plasticity”, University of Strasbourg, 67000 Strasbourg, France; (A.-L.C.); (A.C.); (T.V.); (M.K.); (V.W.)
- Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France;
- Cardiovascular Surgery Department, University Hospital of Strasbourg, 67091 Strasbourg, France
| | - Valérie Wolff
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondria, Oxidative Stress and Muscle Plasticity”, University of Strasbourg, 67000 Strasbourg, France; (A.-L.C.); (A.C.); (T.V.); (M.K.); (V.W.)
- Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France;
- Neuro-Vascular Department, University Hospital of Strasbourg, 67098 Strasbourg, France
| | - Bernard Geny
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondria, Oxidative Stress and Muscle Plasticity”, University of Strasbourg, 67000 Strasbourg, France; (A.-L.C.); (A.C.); (T.V.); (M.K.); (V.W.)
- Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France;
- Department of Physiology and Functional Explorations, University Hospital of Strasbourg, 67091 Strasbourg, France
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Hachem Y, Moride Y, Castilloux AM, Castillon G, Kalaba M, Néron A, Gamaoun R, Martel MO, Beaulieu P, Ware M, Vigano A. A Descriptive Analysis of Adverse Event Reports from the Quebec Cannabis Registry. Drug Saf 2024; 47:161-171. [PMID: 37996777 DOI: 10.1007/s40264-023-01379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Published data on the safety of natural medical cannabis (MC) when used in the real-world clinical practice setting are lacking. This study aimed to describe adverse events (AEs) reported across three years following MC initiation. METHODS The Quebec Cannabis Registry (QCR) was a prospective registry of adults enrolled through participating physicians when they initiated MC between May 2015 and October 2018. Follow-up ended at MC discontinuation, loss to follow-up, three years, or end of data collection (May 2019). Data were collected at baseline and at follow-up visits every three months for the first two years, then once in the third year. Physicians filled adverse event (AE) reports, which were coded using MedDRA® preferred terms (PTs), and descriptive analyses were conducted. RESULTS A total of 2991 patients were enrolled (mean age 50.9 years, 50.2% females). During follow-up, 108 patients (3.6%) experienced moderate or severe AEs, yielding 111 AE reports (three patients had two reports) and 214 AEs (average 1.9 AEs per report). Mild AEs were recorded as a reason for MC discontinuation for nine patients, but no AE reports were available. The most common PTs for ingested MC (62 reports) were dizziness (12.9%), nausea (11.3%), somnolence (9.7%), and vomiting (8.1%), and for inhaled MC (23 reports), headache (13.0%) was the most common. The most frequent PTs associated with tetrahydrocannabinol (THC)-dominant MC (25 reports) were dizziness and somnolence (12.0% each); for cannabidiol (CBD)-dominant MC (20 reports), vomiting (20.0%) was most common; and dizziness (17.2%), nausea (13.8%), somnolence (10.3%), and headache (8.6%) were the most frequent for balanced MC (58 reports). CONCLUSION No new safety concerns were identified relative to the published literature, although notable differences in AE profile between modes of administration and cannabinoid content ratios should be considered by health professionals. Further work identifying and managing risk factors for AEs is warranted to maintain a favorable benefit-risk balance for MC.
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Affiliation(s)
- Yasmina Hachem
- Medical Cannabis Program in Oncology, McGill University Health Center, Montréal, QC, Canada
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Yola Moride
- Center for PharmacoEpidemiology and Treatment Science, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
- YolaRX Consultants, Montréal, QC, Canada.
| | | | | | - Maja Kalaba
- Canopy Growth Corporation, Smiths Falls, ON, Canada
| | - Andrée Néron
- Bureau d'évaluation médicale (Consultant on request in medical cannabis-related pharmacological assessments and needs for injured workers), Québec City, QC, Canada
| | - Rihab Gamaoun
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Marc O Martel
- Department of Anesthesiology, Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montréal, QC, Canada
| | - Pierre Beaulieu
- Département de pharmacologie et physiologie/Département d'anesthésiologie et de médecine de la douleur, Faculté de médecine de l'Université de Montréal, Montréal, QC, Canada
| | - Mark Ware
- Alan Edwards Pain Management Unit, McGill University Health Center, Montréal, QC, Canada
| | - Antonio Vigano
- Medical Cannabis Program in Oncology, McGill University Health Center, Montréal, QC, Canada
- Division of Palliative and Supportive Care, McGill University Health Center, Montréal, QC, Canada
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Scott JR, Williams DA, Harte SE, Harris RE, Litinas E, Sisley S, Clauw DJ, Boehnke KF. Relationship Between Nociplastic Pain Involvement and Medication Use, Symptom Relief, and Adverse Effects Among People Using Medical Cannabis for Chronic Pain. Clin J Pain 2024; 40:1-9. [PMID: 37823303 DOI: 10.1097/ajp.0000000000001164] [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: 03/13/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Cannabis is increasingly being used for chronic pain management, but cannabis' effects remain poorly characterized in chronic nociplastic pain (NPP), which is posited to be caused by disturbances in nervous system pain processing. In this cross-sectional study (n=1213), we used the 2011 Fibromyalgia (FM) Survey Criteria as a surrogate measure for degree of NPP among individuals using medical cannabis for chronic pain. METHODS Using a quartile-split, we investigated associations between the degree of NPP and medication use, cannabis use characteristics, and symptom relief. Continuous variables were assessed using one-way analysis of variance and categorical variables with Pearson χ 2 test and binomial logistic regression for calculation of odds ratios. RESULTS Participants were predominately female (59%), with a mean ± SD age of 49.4±13.6 years. Higher FM scores were associated with less self-reported improvement in pain and health since initiating medical cannabis use, as well as more cannabis-related side effects. Paradoxically, higher FM scores were also associated with higher usage of concomitant medication use (including opioids and benzodiazepines) but also with substituting cannabis for significantly more medication classes, including opioids and benzodiazepines. DISCUSSION This article presents evidence that individuals in higher NPP quartiles have higher analgesic intake, higher odds of substituting cannabis for medications, higher side effect burden, and lower therapeutic effect from cannabis. These seemingly contradictory findings may reflect higher symptom burden, polypharmacy at baseline, or that NPP may be challenging to treat with cannabis. Further research is necessary to further explain cannabinoid effects in NPP.
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Affiliation(s)
- J Ryan Scott
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | | | | | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Kevin F Boehnke
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
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Wang Y, Robinson KR, Fechtel H, Hartog A. Medical Cannabis Use and Its Impact on Health Among Older Adults: Recent Research Findings and Future Directions. CURRENT ADDICTION REPORTS 2023; 10:837-843. [PMID: 38586531 PMCID: PMC10997349 DOI: 10.1007/s40429-023-00519-x] [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] [Accepted: 09/06/2023] [Indexed: 04/09/2024]
Abstract
Purpose of Review With the rapidly changing landscape of state level legalization of cannabis, older adults have become one of the fastest growing populations seeking medical cannabis (MC). However, research evidence on the risks and benefits of MC use in this population remains limited. This review aims to synthesize recent literature on the impacts of MC use in older adults and identify critical knowledge gaps to be addressed in future research. Recent Findings Recent literature showed that older adults often face financial and/or educational barriers and stigma associated with MC access. Emerging data showed that MC may have therapeutic effects on symptoms of conditions such as chronic pain, insomnia, anxiety/depression, dementia, nausea, and vomiting. However, available evidence is inconsistent and tends to rely on self-report and uncontrolled studies. While some adverse events associated with MC use were reported, it is generally well tolerated in older adults. Neurocognitive and psychological consequences and cardiovascular risks have been reported but again only in limited studies with inconsistent findings. Summary There is a need for more systematic and rigorous research on MC in older adults to determine its safety and efficacy. Research on dosing procedures and product characteristics, as well as how these may impact health outcomes, is crucial. More consistent evidence is needed to inform policy changes and patient/physician education to minimize potential risks and optimize benefits among older adults seeking MC as an alternative treatment.
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Affiliation(s)
- Yan Wang
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Kendall R. Robinson
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Hannah Fechtel
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Alexis Hartog
- Department of Biology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
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Aviram J, Glezerman M, Hayam E, Belobrov R, Procaccia S, Meiri D, Eisenberg E. Evaluating Sex Differences in Efficacy, Safety and Pharmacokinetics in Patients Treated with Cannabis by a Metered-Dose Inhaler. Pharmaceuticals (Basel) 2023; 16:1426. [PMID: 37895897 PMCID: PMC10610259 DOI: 10.3390/ph16101426] [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: 09/19/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Clinical studies on medical cannabis (MC) treatment have shown sex-related differences, including higher susceptibility to adverse events among women and greater analgesia among men. Here, we used the Syqe metered-dose inhaler (MDI) and a single chemovar to analyze sex differences. METHODS A total of 1249 Israeli chronic pain patients were assessed for pain intensity, sleep and adverse events (AEs) over 240 days. RESULTS Following the first two weeks, no significant sex differences were found in the effectiveness or safety of MC treatment (p > 0.05). Inhaled Δ9-THC doses did not vary significantly between sexes (p > 0.05) except in the first month of treatment. Pain reduction and sleep improvement were similar for both sexes (p > 0.05). The overall rate of AEs was equal and relatively low at 10% (n = 65, 10% of women and n = 60, 10% of men; χ2 (1) = 0.05, p = 0.820). A secondary analysis of pharmacokinetic data showed no significant differences between sexes in Δ9-THC and its metabolite pharmacokinetics, cardiovascular measures, or AE severity (p > 0.05). CONCLUSIONS Uniform MC treatment via the Syqe MDI showed no sex differences in short-term effectiveness, safety and pharmacokinetics, nor in long-term effects, under "real-life" conditions. These findings provide insights into MC treatment which may inform clinical practice and policy-making in the field.
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Affiliation(s)
| | - Marek Glezerman
- Faculty of Medicine and Head, Gender- and Sex Conscious Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | | | | | - Shiri Procaccia
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - David Meiri
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Elon Eisenberg
- Rappaport Faculty of Medicine-Technion, Israel Institute of Technology, Haifa 3525433, Israel
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Abuhasira R, Schwartz L, Novack V. Medical Cannabis Is Not Associated with a Decrease in Activities of Daily Living in Older Adults. Biomedicines 2023; 11:2697. [PMID: 37893071 PMCID: PMC10604566 DOI: 10.3390/biomedicines11102697] [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: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
The proportion of older adults using medical cannabis is rising. Therefore, we aimed to assess the effects of herbal medical cannabis on the functional status of older adults. We conducted a prospective observational study of patients aged 65 years or older that initiated cannabis treatment for different indications, mostly chronic non-cancer pain, during 2018-2020 in a specialized geriatric clinic. The outcomes assessed were activities of daily living (ADL), instrumental activities of daily living (IADL), pain intensity, geriatric depression scale, chronic medication use, and adverse events at six months. A cohort of 119 patients began cannabis treatment: the mean age was 79.3 ± 8.5 and 74 (62.2%) were female. Of the cohort, 43 (36.1%) experienced adverse effects due to cannabis use and 2 (1.7%) required medical attention. The mean ADL scores before and after treatment were 4.4 ± 1.8 and 4.5 ± 1.8, respectively (p = 0.27), and the mean IADL scores before and after treatment were 4.1 ± 2.6 and 4.7 ± 3, respectively (p = 0.02). We concluded that medical cannabis in older adults has a number of serious adverse events, but was not associated with a decrease in functional status, as illustrated by ADL and IADL scores after six months of continuous treatment.
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Affiliation(s)
- Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, Be’er-Sheva 8410501, Israel;
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva 8410501, Israel
| | - Lihi Schwartz
- Clalit Health Services, Department of Family Medicine, Dan-Petah Tikva District, Petah Tikva 5239530, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6139001, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Be’er-Sheva 8410501, Israel;
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva 8410501, Israel
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11
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Trojan V, Landa L, Šulcová A, Slíva J, Hřib R. The Main Therapeutic Applications of Cannabidiol (CBD) and Its Potential Effects on Aging with Respect to Alzheimer's Disease. Biomolecules 2023; 13:1446. [PMID: 37892128 PMCID: PMC10604144 DOI: 10.3390/biom13101446] [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: 06/27/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/29/2023] Open
Abstract
The use of cannabinoids (substances contained specifically in hemp plants) for therapeutic purposes has received increased attention in recent years. Presently, attention is paid to two main cannabinoids: delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). With respect to the psychotropic effects and dependence potential of THC (though it is very mild), its use is associated with certain restrictions, and thus the therapeutic properties of CBD are frequently emphasized because there are no limitations associated with the risk of dependence. Therefore, this review covers the main pharmacodynamic and pharmacokinetic features of CBD (including characteristics of endocannabinoidome) with respect to its possible beneficial effects on selected diseases in clinical practice. A substantial part of the text deals with the main effects of CBD on aging, including Alzheimer's disease and related underlying mechanisms.
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Affiliation(s)
- Václav Trojan
- International Clinical Research Centre, Cannabis Facility, St. Anne’s University Hospital, Pekařská 53, 602 00 Brno, Czech Republic
| | - Leoš Landa
- International Clinical Research Centre, Cannabis Facility, St. Anne’s University Hospital, Pekařská 53, 602 00 Brno, Czech Republic
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Alexandra Šulcová
- International Clinical Research Centre, Cannabis Facility, St. Anne’s University Hospital, Pekařská 53, 602 00 Brno, Czech Republic
| | - Jiří Slíva
- Department of Pharmacology, Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague, Czech Republic
| | - Radovan Hřib
- International Clinical Research Centre, Cannabis Facility, St. Anne’s University Hospital, Pekařská 53, 602 00 Brno, Czech Republic
- Centre for Pain Management, Department of Anesthesiology and Intensive Care, St. Anne’s University Hospital, Pekařská 53, 602 00 Brno, Czech Republic
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12
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O’Neill V, Karanikas N, Sav A, Murphy P. Medicinal Cannabis and Implications for Workplace Health and Safety: Scoping Review of Systematic Reviews. Workplace Health Saf 2023; 71:400-410. [PMID: 37077169 PMCID: PMC10467002 DOI: 10.1177/21650799231157086] [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: 04/21/2023]
Abstract
PURPOSE Although medicinal cannabis is prescribed for conditions such as pain, epilepsy, nausea and vomiting during cancer treatment, evidence about associated adverse side effects is still evolving. Because adverse events (AEs) might impact the performance of workers, it is important to consider their implications on workplace health and safety (WHS). This study aimed to map the types and prevalence of the AEs associated with medical cannabis and articulate how those events could impact WHS. METHODS A scoping review of systematic reviews and/or meta-analyses published between 2015 and March 2021 was performed to identify the AEs of medicinal cannabis in adults. Publications in English and full text available online were collected from Embase, MEDLINE, PsychINFO, PubMed, Scopus, and Web of Science. RESULTS Of 1,326 papers identified from the initial search, 31 met the inclusion criteria and were analyzed. The studies reported various AEs with the most predominant being sedation, nausea/vomiting, dizziness, and euphoria. Acute and chronic pain was the most prevalent disorder under review. CONCLUSIONS Adverse events associated with the use of medicinal cannabis could increase workplace risks, including decreased alertness and reaction times, increased absenteeism, reduced ability to safely drive or operate machinery and an increased probability of falling. Focused research into the risk to workers and workplaces from the use of medical cannabis and related human performance impairment is urgently warranted.
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Affiliation(s)
| | | | - Adem Sav
- Queensland University of Technology
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13
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Butler JI, Dahlke S, Devkota R, Shrestha S, Hunter KF, Toubiana M, Kalogirou MR, Law J, Scheuerman M. The Information-Seeking Behavior and Unmet Knowledge Needs of Older Medicinal Cannabis Consumers in Canada: A Qualitative Descriptive Study. Drugs Aging 2023; 40:427-438. [PMID: 37147415 PMCID: PMC10162651 DOI: 10.1007/s40266-023-01030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Older Canadians (age 60+) are increasingly using cannabis to treat their health problems, but little is known regarding how they learn about medicinal cannabis. This study explored the perspectives of older cannabis consumers, prospective consumers, healthcare professionals, and cannabis retailers on older adults' information-seeking behavior and unmet knowledge needs. METHODS A qualitative descriptive design was used. Semi-structured telephone interviews were conducted with a purposeful sample of 36 older cannabis consumers and prospective consumers, as well as 4 healthcare professionals and 5 cannabis retailers from across Canada, for a total sample of 45 participants. Data were thematically analyzed. RESULTS Three main themes characterizing older cannabis consumers' information-seeking were identified: (1) knowledge sources, (2) types of information sought, and (3) unmet knowledge needs. Participants accessed a variety of knowledge sources to inform themselves about medicinal cannabis. Cannabis retailers were identified as providing medical information to many older adults, despite regulations to the contrary. Cannabis-specialized healthcare professionals were also viewed as key knowledge sources, while primary care providers were perceived as both knowledge sources and gatekeepers limiting access to information. The types of information participants sought included the effects and potential benefits of medicinal cannabis, the side effects and risks involved, and guidance regarding suitable cannabis products. Participants' most salient unmet knowledge needs focused on dosing and use of cannabis to treat specific health conditions. DISCUSSION Findings suggest that barriers to learning about medical cannabis among older consumers identified in prior research remain pervasive and cut across jurisdictions. To address these barriers, there is a need for better knowledge products tailored to older cannabis consumers and their information needs, and further education for primary healthcare providers on medicinal cannabis and its therapeutic applications with older patients.
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Affiliation(s)
- Jeffrey I Butler
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
| | - Rashmi Devkota
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada
| | - Shovana Shrestha
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada
| | - Madeline Toubiana
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Maya R Kalogirou
- Faculty of Nursing, MacEwan University, 11405-87th Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Joanna Law
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada
| | - Melissa Scheuerman
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada
- Medical Cannabis Manager, Avant Brands Inc., 335-1632 Dickson Avenue, Kelowna, BC, V1Y 7T2, Canada
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14
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Aliya S, Farani MR, Kim E, Kim S, Gupta VK, Kumar K, Huh YS. Therapeutic targeting of the tumor microenvironments with cannabinoids and their analogs: Update on clinical trials. ENVIRONMENTAL RESEARCH 2023; 231:115862. [PMID: 37146933 DOI: 10.1016/j.envres.2023.115862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/07/2023]
Abstract
Cancer is a major global public health concern that affects both industrialized and developing nations. Current cancer chemotherapeutic options are limited by side effects, but plant-derived alternatives and their derivatives offer the possibilities of enhanced treatment response and reduced side effects. A plethora of recently published articles have focused on treatments based on cannabinoids and cannabinoid analogs and reported that they positively affect healthy cell growth and reverse cancer-related abnormalities by targeting aberrant tumor microenvironments (TMEs), lowering tumorigenesis, preventing metastasis, and/or boosting the effectiveness of chemotherapy and radiotherapy. Furthermore, TME modulating systems are receiving much interest in the cancer immunotherapy field because it has been shown that TMEs have significant impacts on tumor progression, angiogenesis, invasion, migration, epithelial to mesenchymal transition, metastasis and development of drug resistance. Here, we have reviewed the effective role of cannabinoids, their analogs and cannabinoid nano formulations on the cellular components of TME (endothelial cells, pericytes, fibroblast and immune cells) and how efficiently it retards the progression of carcinogenesis is discussed. The article summarizes the existing research on the molecular mechanisms of cannabinoids regulation of the TME and finally highlights the human studies on cannabinoids' active interventional clinical trials. The conclusion outlines the need for future research involving clinical trials of cannabinoids to demonstrate their efficacy and activity as a treatment/prevention for various types of human malignancies.
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Affiliation(s)
- Sheik Aliya
- Department of Biological Engineering, Inha University, Incheon, 22212, Republic of Korea
| | | | - Eunsu Kim
- Department of Biological Engineering, Inha University, Incheon, 22212, Republic of Korea
| | - Suheon Kim
- Department of Biological Engineering, Inha University, Incheon, 22212, Republic of Korea
| | - Vivek Kumar Gupta
- Department of Biological Engineering, Inha University, Incheon, 22212, Republic of Korea
| | - Krishan Kumar
- Department of Biological Engineering, Inha University, Incheon, 22212, Republic of Korea
| | - Yun Suk Huh
- Department of Biological Engineering, Inha University, Incheon, 22212, Republic of Korea.
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15
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Horgas AL, Bruckenthal P, Chen S, Herr KA, Young HM, Fishman S. Assessing Pain in Older Adults: Caregivers play a key role in recognizing and documenting pain at home. Home Healthc Now 2023; 41:128-134. [PMID: 37144927 DOI: 10.1097/nhh.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Horgas, A.L., et al. Assessing Pain in Older Adults. Am J Nurs 2022; 122 (12): 42-48.
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Affiliation(s)
- Ann L Horgas
- Ann L. Horgas is an associate professor and chair of the Department of Biobehavioral Nursing Science at the University of Florida College of Nursing in Gainesville. Patricia Bruckenthal is a professor, associate dean for nursing research and innovation, and chair of doctoral studies in the School of Nursing at Stony Brook University in Stony Brook, NY. Shaoshuai Chen is a doctoral student in the College of Nursing at the University of Iowa in Iowa City, where Keela A. Herr is the Kelting Professor in Nursing, associate dean for faculty, and codirector of the Csomay Center for Gerontological Excellence. Heather M. Young is a professor and founding dean emerita in the Betty Irene Moore School of Nursing at the University of California Davis in Sacramento, and national director of the Betty Irene Moore Fellowship for Nurse Leaders and Innovators. Scott Fishman is a professor, the Fullerton Endowed Chair in Pain Medicine, and executive vice chair in the Department of Anesthesiology and Pain Medicine at the University of California Davis School of Medicine in Sacramento, where he is also director of the Center for Advancing Pain Relief. This article was funded by the Mayday Fund and the Ralph C. Wilson, Jr. Foundation. Contact author: Ann L. Horgas, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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16
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Moussa MK, Hall MAK, Akwe J. Cannabis-Induced Acute Encephalopathy in a 94-Year-Old Woman Due to Family Administration of Cannabidiol (CBD) Products: A Case Report. Cureus 2023; 15:e37927. [PMID: 37223146 PMCID: PMC10202677 DOI: 10.7759/cureus.37927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
In the United States, cannabis use is rising, including among older adults, as is unintentional ingestion. We describe the case of a 94-year-old woman admitted with altered mental status, diarrhea, and hallucinations. She lived with her family, who had noticed recent confusion with weakness, poor oral intake, and loose bowel movements. In the emergency room, her vital signs revealed mild tachycardia and hypotension. She was lethargic, disoriented, confused, and anxious but could answer simple questions. The attending hospitalist administered the Mini-Cog dementia screening and found that the patient was oriented to herself only and was unable to perform word recall tests or complete a clock drawing. The rest of her physical exam was within normal limits for her age. Despite a workup including urine culture, chest X-ray, and computed tomography scan of her head, no organic source for her mental change was found. After five days of admission, a close relative confessed that they had given the patient cannabis oil (marketed as "pure CBD," i.e., cannabidiol, a nonpsychoactive cannabis derivative widely touted as a remedy for pain, anxiety, and anorexia) in the form of edible brownies to help her with her persistent back pain and poor appetite. We performed a urine drug screen for tetrahydrocannabinol (THC), the psychoactive component of cannabis, which verified cannabis use, as well as exposure to THC. The patient recovered to baseline with supportive care. Currently, there is no governing body or framework for the regulation of cannabis products in the United States. Nonprescription CBD products are not regulated by the US Food and Drug Administration, and these products are not tested for safety, efficacy, or quality. Some producers voluntarily conduct such testing, but there is no regulatory oversight, and consumers may be unaware of the need for testing and/or which testing bodies are credible. Given the rapidly increasing proportion of older adults who are cannabis users, physicians should inquire about outpatient use of cannabis in general and CBD in particular during discussions with patients, even the most elderly.
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Affiliation(s)
- Mohamad K Moussa
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA
- Hospital Medicine, Emory Johns Creek Hospital, Johns Creek, USA
| | | | - Joyce Akwe
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA
- Hospital Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, USA
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17
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Ang SP, Sidharthan S, Lai W, Hussain N, Patel KV, Gulati A, Henry O, Kaye AD, Orhurhu V. Cannabinoids as a Potential Alternative to Opioids in the Management of Various Pain Subtypes: Benefits, Limitations, and Risks. Pain Ther 2023; 12:355-375. [PMID: 36639601 PMCID: PMC10036719 DOI: 10.1007/s40122-022-00465-y] [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: 10/03/2022] [Accepted: 11/22/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Pain is a global phenomenon encompassing many subtypes that include neuropathic, musculoskeletal, acute postoperative, cancer, and geriatric pain. Traditionally, opioids have been a mainstay pharmacological agent for managing many types of pain. However, opioids have been a subject of controversy with increased addiction, fatality rates, and cost burden on the US healthcare system. Cannabinoids have emerged as a potentially favorable alternative or adjunctive treatment for various types of acute and chronic pain. This narrative review seeks to describe the efficacy, risks, and benefits of cannabinoids as an adjunct or even potential replacement for opioids in the treatment of various subtypes of pain. METHODS In June of 2022, we performed a comprehensive search across multiple databases for English-language studies related to the use of cannabinoids in the treatment of various types pain: neuropathic pain, musculoskeletal pain, acute postoperative pain, cancer pain, and geriatric pain. Data from meta-analyses, systematic reviews, and randomized control trials (RCTs) were prioritized for reporting. We sought to focus our reported analysis on more recent literature as well as include older relevant studies with particularly notable findings. RESULTS There is conflicting evidence for the use of cannabinoids in the management of pain. While cannabinoids have shown efficacy in treating specific chronic pain subtypes such as neuropathic pain, fibromyalgia pain, and geriatric pain, they do not show as clear benefit in acute postoperative and the majority of musculoskeletal pain syndromes. Data trends towards cannabinoids having a positive effect in treating cancer pain, but results are not as conclusive. To date, there is a paucity of data comparing cannabinoids directly to opioids for pain relief. Overall, the side effects of cannabinoids appear to be relatively mild. However, there is still potential for addiction, altered brain development, psychiatric comorbidities, and drug-drug interactions. CONCLUSION Cannabinoids may be effective in specific subtypes of pain, but current evidence and guidelines do not yet support its use as the first-line treatment for any type of acute or chronic pain. Rather, it may be considered a good adjunct or alternative for patients who have failed more typical or conservative measures. Additional studies are needed with standardized forms of cannabinoids, route of delivery, and dosing for greater-powered analysis. Providers must weigh the individualized patient risks, benefits, and concurrent medication list in order to determine whether cannabinoids are appropriate for a patient's pain treatment plan.
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Affiliation(s)
- Samuel P Ang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Shawn Sidharthan
- Department of Neurology, Northwell Health-Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA
| | - Wilson Lai
- Department of Anesthesiology and Pain Medicine, Northwell Health-Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA
| | - Nasir Hussain
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kiran V Patel
- Department of Anesthesiology, New York University Langone Medical Center, New York, NY, USA
- Department of Anesthesiology and Pain Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Onyeaka Henry
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan D Kaye
- Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU School of Medicine, Shreveport, LA, USA
- Anesthesiology and Pharmacology, LSU School of Medicine, New Orleans, LA, USA
- Anesthesiology and Pharmacology, Tulane School of Medicine, New Orleans, LA, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA.
- MVM Health, East Stroudsburg, PA, USA.
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18
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Nathan R, Mupamombe CT, Elibol J, Case AA, Smith D, Hyland A, Attwood K, Hansen ED. Assessing Efficacy and Use Patterns of Medical Cannabis for Symptom Management in Elderly Cancer Patients. Am J Hosp Palliat Care 2023; 40:368-373. [PMID: 35749740 DOI: 10.1177/10499091221110217] [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: 11/17/2022] Open
Abstract
OBJECTIVES Our study sought to further characterize patterns of medical cannabis use in elderly cancer patients. Furthermore, we sought to assess efficacy of medical cannabis for the treatment of pain, nausea, anorexia, insomnia and anxiety in elderly cancer patients. BACKGROUND Medical cannabis use is growing for symptom management in cancer patients, but limited data exists on the safety or efficacy of use in elderly patients. METHODS A retrospective chart review assessing changes in numerical symptom scores reported at clinic visits before and after medical cannabis initiation. RESULTS There was no statistically significant difference in pain, nausea, appetite, insomnia or anxiety scores reported before and after initiation of medical cannabis. Oil was the most common form used, followed by vape, and the most common ratios used were high tetrahydrocannabinol (THC) to cannabidiol (CBD) and equal parts THC/CBD products. CONCLUSION This study did not find a statistically significant change in symptom scores with medical cannabis use, although further study is warranted given the limitations of the present study. Elderly patients most commonly are using equal parts THC/CBD or high THC ratio products initially.
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Affiliation(s)
- Rachel Nathan
- Division of Gerontology, Geriatrics, and Palliative Medicine, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Charles T Mupamombe
- 53422West Virginia University School of Medicine, Ruby Memorial Hospital, Buffalo, NY, USA
| | - John Elibol
- 12291Palliative Care Fellowship,University of Buffalo Jacobs School of Medicine, Buffalo, NY, USA
| | - Amy A Case
- Department of Supportive and Palliative Care, 2074Roswell Park Comprehensive Cancer Center, Jacobs School of Medicine at the University of Buffalo, Buffalo, NY, USA
| | - Danielle Smith
- Department of Health Behavior, 2074Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, 2074Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, 2074Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Eric D Hansen
- Department of Supportive and Palliative Care, 2074Roswell Park Comprehensive Cancer Center, Jacobs School of Medicine at the University of Buffalo, Buffalo, NY, USA
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Olsson F, Erridge S, Tait J, Holvey C, Coomber R, Beri S, Hoare J, Khan S, Weatherall MW, Platt M, Rucker JJ, Sodergren MH. An observational study of safety and clinical outcome measures across patient groups in the United Kingdom Medical Cannabis Registry. Expert Rev Clin Pharmacol 2023; 16:257-266. [PMID: 36848456 DOI: 10.1080/17512433.2023.2183841] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND There is a paucity of high-quality data on patient outcomes and safety after initiating treatment with cannabis-based medicinal products (CBMPs). The aim of this study was to assess the clinical outcomes and safety of CBMPs by analyzing patient-reported outcome measures and adverse events across a broad spectrum of chronic conditions. RESEARCH DESIGN AND METHODS This study analyzed patients enrolled in the UK Medical Cannabis Registry. Participants completed the EQ-5D-5L to assess health-related quality of life, Generalized Anxiety Disorder-7 (GAD-7) questionnaire to measure anxiety severity, and the Single-item Sleep Quality Scale (SQS) to rate sleep quality at baseline and follow-up after 1, 3, 6, and 12 months. RESULTS A total of 2833 participants met inclusion criteria. The EQ-5D-5L index value, GAD-7, and SQS all improved at each follow-up (p < 0.001). There was no difference in EQ-5D-5L index values between former or current illicit cannabis consumers and naïve patients (p > 0.050). Adverse events were reported by 474 (16.73%) participants. CONCLUSIONS This study suggests that CBMPs are associated with an improvement in health-related quality of life in UK patients with chronic diseases. Treatment was tolerated well by most participants, but adverse events were more common in female and cannabis-naïve patients.
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Affiliation(s)
- Fabian Olsson
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simon Erridge
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| | - James Tait
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Carl Holvey
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Ross Coomber
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Trauma & Orthopaedics, St. George's Hospital NHS Trust, London, UK
| | - Sushil Beri
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Jonathan Hoare
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Shaheen Khan
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Palliative Medicine, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Mark W Weatherall
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Neurology, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Michael Platt
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| | - James J Rucker
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Centre for Affective Disorders, South London & Maudsley NHS Foundation Trust, London, UK
| | - Mikael H Sodergren
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
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20
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Wolfe D, Corace K, Butler C, Rice D, Skidmore B, Patel Y, Thayaparan P, Michaud A, Hamel C, Smith A, Garber G, Porath A, Conn D, Willows M, Abramovici H, Thavorn K, Kanji S, Hutton B. Impacts of medical and non-medical cannabis on the health of older adults: Findings from a scoping review of the literature. PLoS One 2023; 18:e0281826. [PMID: 36800328 PMCID: PMC9937508 DOI: 10.1371/journal.pone.0281826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Cannabis legalization has enabled increased consumption in older adults. Age-related mental, physical, and physiological changes may lead to differences in effects of cannabis in older adults compared to younger individuals. OBJECTIVE To perform a scoping review to map the evidence regarding the health effects of cannabis use for medical and non-medical purposes in older adults. METHODS Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched for systematic reviews (SRs), randomized controlled trials (RCTs) and non-randomized/observational studies (NRSs) assessing the health effects and associations of cannabis use (medical or non-medical) in adults ≥ 50 years of age. Included studies met age-related inclusion criteria or involved a priori identified health conditions common among older adults. Records were screened using a liberal accelerated approach and data charting was performed independently by two reviewers. Descriptive summaries, structured tables, effect direction plots and bubble plots were used to synthesize study findings. FINDINGS From 31,393 citations, 133 publications describing 134 unique studies (26 SRs, 36 RCTs, 72 NRSs) were included. Medical cannabis had inconsistent therapeutic effects in specific patient conditions (e.g., end-stage cancer, dementia), with a number of studies suggesting possible benefits while others found no benefit. For medical cannabis, harmful associations outnumbered beneficial, and RCTs reported more negative effects than NRSs. Cannabis use was associated with greater frequencies of depression, anxiety, cognitive impairment, substance use and problematic substance use, accidents/injuries, and acute healthcare use. Studies often were small, did not consistently assess harms, and did not adjust for confounding. DISCUSSION The effects of medical cannabis are inconsistent within specific patient conditions. For older adults, generally, the available evidence suggests cannabis use may be associated with greater frequencies of mental health issues, substance use, and acute healthcare use, and the benefit-to-risk ratio is unclear. Studies with a balanced assessment of benefits and harms may guide appropriate public health messaging to balance the marketing pressures of cannabis to older adults.
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Affiliation(s)
- Dianna Wolfe
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kim Corace
- Institute of Mental Health Research at The Royal, University of Ottawa, Ottawa, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | | | | | - Alan Michaud
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Andra Smith
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Gary Garber
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Amy Porath
- Canadian Center for Substance Use and Addiction, Ottawa, Canada
| | - David Conn
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Baycrest Health Sciences, Toronto, Canada
| | - Melanie Willows
- Institute of Mental Health Research at The Royal, University of Ottawa, Ottawa, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Hanan Abramovici
- Health Canada, Office of Cannabis Science and Surveillance, Ottawa, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Salmaan Kanji
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- * E-mail:
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Gershoni T, Pud D, Aviram J, Eisenberg E. Wellness of patients with chronic pain is not only about pain intensity. Pain Pract 2023; 23:145-154. [PMID: 36181347 PMCID: PMC10092262 DOI: 10.1111/papr.13168] [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: 03/15/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Attaining good outcomes in the management of chronic pain remains a clinical challenge. This study aimed to investigate the relationships between - and the contribution of - pain and related conditions to the wellness of these patients. DESIGN A secondary analysis of database of patients with chronic pain treated with medical cannabis (MC) to carry out a one-year prospective follow-up study was conducted. Questionnaires were completed before (T0 ), six (T6 ), and twelve (T12 ) months after MC initiation. Data included patients' demographics and questionnaires related to three latent factors: pain intensity measures, related conditions (catastrophizing, sleep disturbance, anxiety, and depression), and wellness parameters (quality-of-life, disability, subjective-health-state). Weighted average of the observed variables (WOBs) were calculated for each latent factor. Longitudinal structural equation modeling (SEM) and mediation analyses were performed to identify predictors and interrelations between the WOBs, respectively. RESULTS Participants included 510 patients. All variables were significantly improved from T0 to T6 and T12 . SEM revealed that related conditions, and to a lesser extent pain, predicted wellness at T0 , T6 , and T12 (related conditions: β0 = 0.55, p < 0.001; β6 = 0.54, p < 0.001; and β12 = 0.51, p < 0.001; pain: β0 = 0.42, p < 0.001; β6 = 0.18, p < 0.001; and β12 = 0.25, p < 0.001). Mediation analyses demonstrated that the effect of WOB-related conditions was greater than WOB-pain on wellness. CONCLUSION Wellness of patients with chronic pain can be determined not only by pain itself but even more so by the severity of related conditions. Thus, considering a broad spectrum of pain measures and related conditions seems relevant for improving the wellness of patients with chronic pain.
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Affiliation(s)
- Tamar Gershoni
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Dorit Pud
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Joshua Aviram
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel
| | - Elon Eisenberg
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Patil N, Chandel V, Rana A, Jain M, Kaushik P. Investigation of Cannabis sativa Phytochemicals as Anti-Alzheimer's Agents: An In Silico Study. PLANTS (BASEL, SWITZERLAND) 2023; 12:plants12030510. [PMID: 36771595 PMCID: PMC9919841 DOI: 10.3390/plants12030510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 05/27/2023]
Abstract
Cannabis sativa is a medicinal plant that has been known for years and is used as an Ayurvedic medicine. This plant has great potential in treating various types of brain diseases. Phytochemicals present in this plant act as antioxidants by maintaining synaptic plasticity and preventing neuronal loss. Cannabidiol (CBD) and Tetrahydrocannabinol (THC) are both beneficial in treating Alzheimer's disease by increasing the solubility of Aβ42 amyloid and Tau aggregation. Apart from these therapeutic effects, there are certain unknown functions of these phytochemicals in Alzheimer's disease that we want to elucidate through this study. In this research, our approach is to analyze the effect of phytochemicals in Cannabis sativa on multiple culprit enzymes in Alzheimer's disease, such as AChE (Acetylcholinesterase), BChE (Butyrylcholinesterase), γ-secretase, and BACE-1. In this study, the compounds were selected by Lipinski's rule, ADMET, and ProTox based on toxicity. Molecular docking between the selected compounds (THCV, Cannabinol C2, and Cannabidiorcol) and enzymes mentioned above was obtained by various software programs including AutoDock Vina 4.2, AutoDock, and iGEMDOCK. In comparison to Donepezil (BA = -8.4 kcal/mol, Ki = 1.46 mM), Rivastigmine (BA = -7.0 kcal/mol, Ki = 0.02 mM), and Galantamine (BA = -7.1, Ki = 2.1 mM), Cannabidiorcol (BA = -9.4 kcal/mol, Ki = 4.61 mM) shows significant inhibition of AChE. On the other hand, Cannabinol C2 (BA = -9.2 kcal/mol, Ki = 4.32 mM) significantly inhibits Butyrylcholinesterase (BuChE) in comparison to Memantine (BA = -6.8 kcal/mol, Ki = 0.54 mM). This study sheds new light and opens new avenues for elucidating the role of bioactive compounds present in Cannabis sativa in treating Alzheimer's disease.
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Affiliation(s)
- Nil Patil
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara 391760, Gujarat, India
- Laboratory 209, Cell & Developmental Biology Laboratory, Centre of Research for Development, Parul University, Vadodara 391760, Gujarat, India
| | - Vaishnavi Chandel
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara 391760, Gujarat, India
| | - Aarzu Rana
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara 391760, Gujarat, India
| | - Mukul Jain
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Vadodara 391760, Gujarat, India
- Laboratory 209, Cell & Developmental Biology Laboratory, Centre of Research for Development, Parul University, Vadodara 391760, Gujarat, India
| | - Prashant Kaushik
- Instituto de Conservacióny Mejora de la Agrodiversidad Valenciana, Universitat Politècnica de València, 46022 Valencia, Spain
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23
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Endocannabinoid System: Chemical Characteristics and Biological Activity. Pharmaceuticals (Basel) 2023; 16:ph16020148. [PMID: 37017445 PMCID: PMC9966761 DOI: 10.3390/ph16020148] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
The endocannabinoid system (eCB) has been studied to identify the molecular structures present in Cannabis sativa. eCB consists of cannabinoid receptors, endogenous ligands, and the associated enzymatic apparatus responsible for maintaining energy homeostasis and cognitive processes. Several physiological effects of cannabinoids are exerted through interactions with various receptors, such as CB1 and CB2 receptors, vanilloid receptors, and the recently discovered G-protein-coupled receptors (GPR55, GPR3, GPR6, GPR12, and GPR19). Anandamide (AEA) and 2-arachidoylglycerol (2-AG), two small lipids derived from arachidonic acid, showed high-affinity binding to both CB1 and CB2 receptors. eCB plays a critical role in chronic pain and mood disorders and has been extensively studied because of its wide therapeutic potential and because it is a promising target for the development of new drugs. Phytocannabinoids and synthetic cannabinoids have shown varied affinities for eCB and are relevant to the treatment of several neurological diseases. This review provides a description of eCB components and discusses how phytocannabinoids and other exogenous compounds may regulate the eCB balance. Furthermore, we show the hypo- or hyperfunctionality of eCB in the body and how eCB is related to chronic pain and mood disorders, even with integrative and complementary health practices (ICHP) harmonizing the eCB.
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Clarke H, Fitzcharles M. The evolving culture of medical cannabis in Canada for the management of chronic pain. Front Pharmacol 2023; 14:1153584. [PMID: 37089954 PMCID: PMC10119390 DOI: 10.3389/fphar.2023.1153584] [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: 01/29/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
Although used therapeutically for millennia, cannabis has been a prohibited substance worldwide for most of the 20th Century. With revision of prohibitive regulations in many jurisdictions during the past 2 decades, cannabis is increasingly available to patients as a potential treatment option for various symptoms. Pain relief, sleep promotion and alleviation of distress, depression and anxiety are the most common reasons for cannabis use. Canada has been at the forefront of medical cannabis (MC) legislation revisions to enable and facilitate access for therapeutic use. Although initially viewed with caution and stigma, attitudes to cannabis in general have changed. Medical cannabis is identified as the herbal plant product sourced from a grower/producer and is not at present a regulated pharmaceutical product. Medical cannabis use is currently prevalent in Canada but has bypassed the rigorous study required for usual drug approval. Although uptake has been enthusiastic by patients, the medical community has voiced cautions and concerns. Access to medical cannabis is fairly easy once an approval document is obtained from a healthcare professional, but without obligation for medical or pharmacy oversight. The greatest concern is a dearth of sound clinical evidence for effects and harms. Emerging concerns include prevalent patient self-management with information based on personal research, an abundance of on-line information which may not always be accurate, the emergence of designated "cannabis clinics," potential risks to society due to accidents, and high cost of the legal medical product leading to access via the recreational market. With cannabis now entrenched in Canadian healthcare, physicians must be sufficiently knowledgeable to provide guidance that is evidence-based and will ensure personal and societal harm reduction. Examination of the changing culture of medical cannabis in Canada will provide insight for countries that may be anticipating similar revisions of cannabis regulations to allow cannabis access for their patient population and learn from the issues created by recreational legalization.
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Affiliation(s)
- H. Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, ON, Canada
| | - M. Fitzcharles
- Department of Rheumatology, McGill University, Montreal, QC, Canada
- Alan Edwards Pain Management Unit, McGill University, Montreal, QC, Canada
- *Correspondence: M. Fitzcharles,
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25
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Wise K, Phan N, Selby-Pham J, Simovich T, Gill H. Utilisation of QSPR ODT modelling and odour vector modelling to predict Cannabis sativa odour. PLoS One 2023; 18:e0284842. [PMID: 37098051 PMCID: PMC10128932 DOI: 10.1371/journal.pone.0284842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023] Open
Abstract
Cannabis flower odour is an important aspect of product quality as it impacts the sensory experience when administered, which can affect therapeutic outcomes in paediatric patient populations who may reject unpalatable products. However, the cannabis industry has a reputation for having products with inconsistent odour descriptions and misattributed strain names due to the costly and laborious nature of sensory testing. Herein, we evaluate the potential of using odour vector modelling for predicting the odour intensity of cannabis products. Odour vector modelling is proposed as a process for transforming routinely produced volatile profiles into odour intensity (OI) profiles which are hypothesised to be more informative to the overall product odour (sensory descriptor; SD). However, the calculation of OI requires compound odour detection thresholds (ODT), which are not available for many of the compounds present in natural volatile profiles. Accordingly, to apply the odour vector modelling process to cannabis, a QSPR statistical model was first produced to predict ODT from physicochemical properties. The model presented herein was produced by polynomial regression with 10-fold cross-validation from 1,274 median ODT values to produce a model with R2 = 0.6892 and a 10-fold R2 = 0.6484. This model was then applied to terpenes which lacked experimentally determined ODT values to facilitate vector modelling of cannabis OI profiles. Logistic regression and k-means unsupervised cluster analysis was applied to both the raw terpene data and the transformed OI profiles to predict the SD of 265 cannabis samples and the accuracy of the predictions across the two datasets was compared. Out of the 13 SD categories modelled, OI profiles performed equally well or better than the volatile profiles for 11 of the SD, and across all SD the OI data was on average 21.9% more accurate (p = 0.031). The work herein is the first example of the application of odour vector modelling to complex volatile profiles of natural products and demonstrates the utility of OI profiles for the prediction of cannabis odour. These findings advance both the understanding of the odour modelling process which has previously only been applied to simple mixtures, and the cannabis industry which can utilise this process for more accurate prediction of cannabis odour and thereby reduce unpleasant patient experiences.
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Affiliation(s)
- Kimber Wise
- School of Science, RMIT University, Bundoora, Victoria, Australia
- Nutrifield, Sunshine West, Victoria, Australia
| | - Nicholas Phan
- Faculty of Science, Monash University, Clayton, Victoria, Australia
| | - Jamie Selby-Pham
- School of Science, RMIT University, Bundoora, Victoria, Australia
- Nutrifield, Sunshine West, Victoria, Australia
| | - Tomer Simovich
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
- PerkinElmer Inc., Glen Waverley, Victoria, Australia
| | - Harsharn Gill
- School of Science, RMIT University, Bundoora, Victoria, Australia
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26
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Hallinan CM, Gunn JM, Bonomo YA. Use of electronic medical records to monitor the safe and effective prescribing of medicinal cannabis: is it feasible? Aust J Prim Health 2022; 28:564-572. [PMID: 35927928 DOI: 10.1071/py22054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND General practitioners are well positioned to contribute to the pharmacovigilance of medical cannabis via the general practice electronic medical record (EMR). The aim of this research is to interrogate de-identified patient data from the Patron primary care data repository for reports of medicinal cannabis to ascertain the feasibility of using EMRs to monitor medicinal cannabis prescribing in Australia. METHODS EMR rule-based digital phenotyping of 1 164 846 active patients from 109 practices was undertaken to investigate reports of medicinal cannabis use from September 2017 to September 2020. RESULTS Eighty patients with 170 prescriptions of medicinal cannabis were identified in the Patron repository. Reasons for prescription included anxiety, multiple sclerosis, cancer, nausea, and Crohn's disease. Nine patients showed symptoms of a possible adverse event, including depression, motor vehicle accident, gastrointestinal symptoms, and anxiety. CONCLUSIONS The recording of medicinal cannabis effects in the patient EMR provides potential for medicinal cannabis monitoring in the community. This is especially feasible if monitoring were to be embedded into general practitioner workflow.
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Affiliation(s)
- Christine M Hallinan
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences of the University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia; and Faculty of Medicine, Dentistry and Health Sciences of the University of Melbourne, Level 2, Alan Gilbert Building, Grattan Street, Parkville, Vic. 3010, Australia; and Health and Biomedical Research Information Technology Unit (HaBIC R2), Faculty of Medicine, Dentistry and Health Sciences of the University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
| | - Jane M Gunn
- Faculty of Medicine, Dentistry and Health Sciences of the University of Melbourne, Level 2, Alan Gilbert Building, Grattan Street, Parkville, Vic. 3010, Australia
| | - Yvonne A Bonomo
- Faculty of Medicine, Dentistry and Health Sciences of the University of Melbourne, Level 2, Alan Gilbert Building, Grattan Street, Parkville, Vic. 3010, Australia; and Department of Addiction Medicine, St Vincent's Hospital, Fitzroy, Vic. 3065, Australia
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27
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Horgas AL, Bruckenthal P, Chen S, Herr KA, Young HM, Fishman S. Assessing Pain in Older Adults. Am J Nurs 2022; 122:42-48. [PMID: 36384795 DOI: 10.1097/01.naj.0000904092.01070.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Ann L Horgas
- Ann L. Horgas is an associate professor and chair of the Department of Biobehavioral Nursing Science at the University of Florida College of Nursing in Gainesville. Patricia Bruckenthal is a professor, associate dean for nursing research and innovation, and chair of doctoral studies in the School of Nursing at Stony Brook University in Stony Brook, NY. Shaoshuai Chen is a doctoral student in the College of Nursing at the University of Iowa in Iowa City, where Keela A. Herr is the Kelting Professor in Nursing, associate dean for faculty, and codirector of the Csomay Center for Gerontological Excellence. Heather M. Young is a professor and founding dean emerita in the Betty Irene Moore School of Nursing at the University of California Davis in Sacramento, and national director of the Betty Irene Moore Fellowship for Nurse Leaders and Innovators. Scott Fishman is a professor, the Fullerton Endowed Chair in Pain Medicine, and executive vice chair in the Department of Anesthesiology and Pain Medicine at the University of California Davis School of Medicine in Sacramento, where he is also director of the Center for Advancing Pain Relief. This article was funded by the Mayday Fund and the Ralph C. Wilson, Jr. Foundation. Contact author: Ann L. Horgas, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Costa AC, Joaquim HPG, Pedrazzi JFC, Pain ADO, Duque G, Aprahamian I. Cannabinoids in Late Life Parkinson's Disease and Dementia: Biological Pathways and Clinical Challenges. Brain Sci 2022; 12:brainsci12121596. [PMID: 36552056 PMCID: PMC9775654 DOI: 10.3390/brainsci12121596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
The use of cannabinoids as therapeutic drugs has increased among aging populations recently. Age-related changes in the endogenous cannabinoid system could influence the effects of therapies that target the cannabinoid system. At the preclinical level, cannabidiol (CBD) induces anti-amyloidogenic, antioxidative, anti-apoptotic, anti-inflammatory, and neuroprotective effects. These findings suggest a potential therapeutic role of cannabinoids to neurodegenerative disorders such as Parkinson's disease (PD) and Alzheimer. Emerging evidence suggests that CBD and tetrahydrocannabinol have neuroprotective therapeutic-like effects on dementias. In clinical practice, cannabinoids are being used off-label to relieve symptoms of PD and AD. In fact, patients are using cannabis compounds for the treatment of tremor, non-motor symptoms, anxiety, and sleep assistance in PD, and managing responsive behaviors of dementia such as agitation. However, strong evidence from clinical trials is scarce for most indications. Some clinicians consider cannabinoids an alternative for older adults bearing Parkinson's disease and Alzheimer's dementia with a poor response to first-line treatments. In our concept and experience, cannabinoids should never be considered a first-line treatment but could be regarded as an adjuvant therapy in specific situations commonly seen in clinical practice. To mitigate the risk of adverse events, the traditional dogma of geriatric medicine, starting with a low dose and proceeding with a slow titration regime, should also be employed with cannabinoids. In this review, we aimed to address preclinical evidence of cannabinoids in neurodegenerative disorders such as PD and AD and discuss potential off-label use of cannabinoids in clinical practice of these disorders.
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Affiliation(s)
- Alana C. Costa
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-903, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo 05403-010, Brazil
| | - Helena P. G. Joaquim
- Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - João F. C. Pedrazzi
- Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo 05403-903, Brazil
| | - Andreia de O. Pain
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Department of Internal Medicine, Jundiaí Medical School, Jundiaí 13202-550, Brazil
| | - Gustavo Duque
- Division of Geriatric Medicine, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Department of Internal Medicine, Jundiaí Medical School, Jundiaí 13202-550, Brazil
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, 9712 Groningen, The Netherlands
- Correspondence:
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MacNair L, Kalaba M, Peters EN, Feldner MT, Eglit GML, Rapin L, El Hage C, Prosk E, Ware MA. Medical cannabis authorization patterns, safety, and associated effects in older adults. J Cannabis Res 2022; 4:50. [PMID: 36131299 PMCID: PMC9494878 DOI: 10.1186/s42238-022-00158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 08/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background Use of medical cannabis is increasing among older adults. However, few investigations have examined cannabis use in this population. Methods We assessed the authorization patterns, safety, and effects of medical cannabis in a sub-analysis of 201 older adults (aged ≥ 65 years) who completed a 3-month follow-up during this observational study of patients who were legally authorized a medical cannabis product (N = 67). Cannabis authorization patterns, adverse events (AEs), Edmonton Symptom Assessment Scale-revised (ESAS-r), and Brief Pain Inventory Short Form (BPI-SF) data were collected. Results The most common symptoms for which medical cannabis was authorized were pain (159, 85.0%) and insomnia (9, 4.8%). At baseline and at the 3-month follow-up, cannabidiol (CBD)-dominant products were authorized most frequently (99, 54%), followed by balanced products (76, 42%), and then delta-9-tetrahydrocannabinol (THC)-dominant products (8, 4.4%). The most frequent AEs were dizziness (18.2%), nausea (9.1%), dry mouth (9.1%), and tinnitus (9.1%). Significant reductions in ESAS-r scores were observed over time in the domains of drowsiness (p = .013) and tiredness (p = .031), but not pain (p = .106) or well-being (p = .274). Significant reductions in BPI-SF scores over time were observed for worst pain (p = .010), average pain (p = .012), and overall pain severity (p = 0.009), but not pain right now (p = .052) or least pain (p = .141). Conclusions Overall, results suggest medical cannabis was safe, well-tolerated, and associated with clinically meaningful reductions in pain in this sample of older adults. However, the potential bias introduced by the high subject attrition rate means that all findings should be interpreted cautiously and confirmed by more rigorous studies.
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Hermush V, Ore L, Stern N, Mizrahi N, Fried M, Krivoshey M, Staghon E, Lederman VE, Bar-Lev Schleider L. Effects of rich cannabidiol oil on behavioral disturbances in patients with dementia: A placebo controlled randomized clinical trial. Front Med (Lausanne) 2022; 9:951889. [PMID: 36148467 PMCID: PMC9486160 DOI: 10.3389/fmed.2022.951889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAlmost 90% of patients with dementia suffer from some type of neurobehavioral symptom, and there are no approved medications to address these symptoms.ObjectiveTo evaluate the safety and efficacy of the medical cannabis oil “Avidekel” for the reduction of behavioral disturbances among patients with dementia.Materials and methodsIn this randomized, double-blind, single-cite, placebo-controlled trial conducted in Israel (ClinicalTrials.gov: NCT03328676), patients aged at least 60, with a diagnosis of major neurocognitive disorder and associated behavioral disturbances were randomized 2:1 to receive either “Avidekel,” a broad-spectrum cannabis oil (30% cannabidiol and 1% tetrahydrocannabinol: 295 mg and 12.5 mg per ml, respectively; n = 40) or a placebo oil (n = 20) three times a day for 16 weeks. The primary outcome was a decrease, as compared to baseline, of four or more points on the Cohen-Mansfield Agitation Inventory score by week 16.ResultsFrom 60 randomized patients [mean age, 79.4 years; 36 women (60.0%)], 52 (86.7%) completed the trial (all eight patients who discontinued treatment were from the investigational group). There was a statistically significant difference in the proportion of subjects who had a Cohen-Mansfield Agitation Inventory score reduction of ≥ 4 points at week 16: 24/40 (60.0%) and 6/20 (30.0%) for investigational and control groups, respectively (χ2 = 4.80, P = 0.03). There was a statistically significant difference in the proportion of subjects who had a Cohen-Mansfield Agitation Inventory score reduction of ≥ 8 points at week 16: 20/40 (50%) and 3/20 (15%), respectively (χ2 = 6.42, P = 0.011). The ANOVA repeated measures analysis demonstrated significantly more improvement in the investigational group compared to the control group at weeks 14 and 16 (F = 3.18, P = 0.02). Treatment was mostly safe, with no significant differences in the occurrence of adverse events between the two groups.ConclusionIn this randomized controlled trial, ‘Avidekel’ oil significantly reduced agitation over placebo in patients suffering from behavioral disturbances related to dementia, with non-serious side-effects. Further research is required with a larger sample size.
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Affiliation(s)
- Vered Hermush
- Geriatric Wing, Laniado Hospital, Netanya, Israel
- Technion School of Medicine, Haifa, Israel
- *Correspondence: Vered Hermush,
| | - Liora Ore
- Department of Graduate Studies in Health Systems Management, The Max Stern Yezreel Valley College, Jezreel Valley, Israel
| | - Noa Stern
- Geriatric Wing, Laniado Hospital, Netanya, Israel
- Technion School of Medicine, Haifa, Israel
| | | | - Malki Fried
- Geriatric Wing, Laniado Hospital, Netanya, Israel
| | | | - Ella Staghon
- Geriatric Wing, Laniado Hospital, Netanya, Israel
| | | | - Lihi Bar-Lev Schleider
- Research Department, Tikun-Olam Cannbit Pharmaceuticals, Tel Aviv, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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Kalonji P, Revol A, Broers B, Ljuslin M, Pautex S. Patient-Related Barriers to the Prescription of Cannabinoid-Based Medicines in Palliative Care: A Qualitative Approach. Palliat Med Rep 2022; 3:200-205. [PMID: 36203714 PMCID: PMC9531874 DOI: 10.1089/pmr.2022.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pauline Kalonji
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Aurélie Revol
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
| | - Barbara Broers
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
- Primary Care Division, University Hospital Geneva, Geneva, Switzerland
| | - Michael Ljuslin
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
| | - Sophie Pautex
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
- Palliative Medicine Division and University Hospital Geneva, Geneva, Switzerland
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32
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Baumbusch J, Sloan Yip I. Older adults experiences of using recreational cannabis for medicinal purposes following legalization. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103812. [PMID: 35930902 DOI: 10.1016/j.drugpo.2022.103812] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Legalization of recreational, or non-medical, cannabis in Canada in 2018 was followed by significant increase in use among older adults. Non-medical cannabis is often used medicinally in this population for issues such as pain, insomnia, and appetite stimulation. The purpose of this study was to explore new cannabis use among older adults within an evolving socio-legal context. RESEARCH DESIGN AND METHODS Normalization theory provided the theoretical foundation and qualitative description was the guiding methodology. A convenience sample of twelve participants (ten women, two men) aged 71 to 85 years old was recruited. Data were collected using semi-structured interviews and analyzed thematically. RESULTS Findings illustrate factors that influenced participants' beliefs and contributed to their decisions to begin using cannabis in later life. The most important factor was legalization, which sparked a shift in beliefs around using cannabis and shaped the beginning of de-stigmatization around using this substance. Increasing acceptance in their social networks and visibility of cannabis in the media also informed decision-making. However, using cannabis for non-medicinal or social reasons remained stigmatized. DISCUSSION AND IMPLICATIONS This research indicates that older adults' beliefs about cannabis use are shifting and this is likely related to legalization and broader social acceptance of cannabis. As a consequence, increased public health education is needed to improve health literacy about cannabis use during this stage of the life-course.
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Affiliation(s)
| | - Isabel Sloan Yip
- School of Nursing, University of British Columbia, Vancouver, Canada
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33
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Zongo A, Lee C, El-Mourad J, Dyck JRB, Hyshka E, Hanlon JG, Eurich DT. Substance Use Disorders and Psychoactive Drug Poisoning in Medically Authorized Cannabis Patients: Longitudinal Cohort Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:544-552. [PMID: 34806435 PMCID: PMC9234898 DOI: 10.1177/07067437211060597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Poisoning from psychoactive drugs and substance use disorders (SUD) have been reported among non-medical cannabis users. However, little is known about medical cannabis users and their risk for poisoning and/or development of SUD. This study assessed the risk of emergency department (ED) visits or hospitalization for 1) poisoning by psychoactive drugs and 2) mental/behavioural disorders due to the use of psychoactive drugs and other substances, in medically authorized cannabis patients in Ontario, Canada from 2014-2017. METHODS A cohort study of adult patients authorized for medical cannabis that were matched to population-based controls. ED visit/hospitalization were assessed with a main diagnostic code for: 1) poisoning by psychoactive drugs; 2) mental and behavioural disorder due to psychoactive drugs or other substance use. Conditional Cox proportional hazards regressions were conducted. RESULTS 18,653 cannabis patients were matched to 51,243 controls. During a median follow-up of 243 days, the incidence rate for poisoning was 4.71 per 1,000 person-years (95%CI: 3.71-5.99) for cases and 1.73 per 1,000 person-years (95% CI: 1.36-2.19) for controls. The adjusted hazard ratio (aHR) was 2.45 (95%CI: 1.56-3.84). For mental/behavioural disorders, the incident rates were 8.89 (95% CI: 7.47-10.57) and 5.01 (95% CI: 4.36-5.76) in the cannabis and the controls group. The aHR was 2.27 (95%CI: 1.66-3.11). No difference was observed between males and females (P-value for interaction > 0.05). CONCLUSIONS Our study observed a short-term increased risk of ED visit/hospitalization for poisoning or for mental/behavioural disorders (from use of psychoactive drugs and other substances)- in medically authorized cannabis patients.
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Affiliation(s)
- Arsène Zongo
- Faculty of Pharmacy, 4440Université Laval, Quebec City, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, Canada
| | - Cerina Lee
- School of Public Health, 3158University of Alberta, Edmonton, Canada
| | - Jihane El-Mourad
- Faculty of Pharmacy, 4440Université Laval, Quebec City, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, 3158University of Alberta, Edmonton, Canada
| | - Elaine Hyshka
- School of Public Health, 3158University of Alberta, Edmonton, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, 177410University of Toronto, Ontario, Canada.,Department of Anaesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Dean T Eurich
- School of Public Health, 3158University of Alberta, Edmonton, Canada
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34
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Clary KL, Kang H, Quintero Silva L, Bobitt J. Weeding Out the Stigma: Older Veterans in Illinois Share Their Experiences Using Medical Cannabis. J Psychoactive Drugs 2022:1-8. [PMID: 35640046 DOI: 10.1080/02791072.2022.2082901] [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: 10/18/2022]
Abstract
Many U.S. Veterans are using cannabis for medical purposes. Modern research findings continue to point to medical cannabis as a potentially effective alternative to prescription medications for treating a range of medical conditions. While research exists on the use levels of cannabis, limited research can be found on the perceived stigma of using cannabis, especially among older Veterans. We surveyed 121 older U.S. Veterans who were enrolled in the Illinois Medical Cannabis Patient Program during Fall 2020. We then used maximum variation sampling to select a subset of 32 Veterans to partake in a phone interview. Two researchers conducted and qualitatively coded 30-minute audiotaped semi-structured interviews. Interview topics included (1) the use of cannabis, opioids, and benzodiazepines; (2) interactions with medical providers; (3) stigma regarding cannabis use; and (4) educational materials. We share findings from stigma. We identified three themes: (1) stereotypes regarding people who use cannabis, (2) media portrayal of cannabis users, and (3) hesitation in disclosing cannabis use. Stigma creates situations in which older Veterans may be hesitant to disclose their use of cannabis with physicians and friends/family, which can be dangerous and socially isolating. Additional research is needed to expand upon our findings with more generalizable methods.
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Affiliation(s)
- Kelly Lynn Clary
- School of Social Work, Texas State University, San Marcos, TX, USA
| | - Hyojung Kang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Laura Quintero Silva
- Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Julie Bobitt
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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35
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Charoenporn V, Charernboon T, Mackie CJ. Medical Cannabis as a Substitute for Prescription Agents: A Systematic Review and Meta-analysis. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2070870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Veevarin Charoenporn
- Department of Psychiatry, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- National Addictions Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Thammanard Charernboon
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand
| | - Clare J Mackie
- National Addictions Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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36
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Long-term effectiveness and safety of medical cannabis administered through the metered-dose Syqe Inhaler. Pain Rep 2022; 7:e1011. [PMID: 35620248 PMCID: PMC9116950 DOI: 10.1097/pr9.0000000000001011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Administration of low-dose medical cannabis through the metered-dose Syqe Inhaler demonstrates similar effectiveness on pain reduction and superior safety compared with other higher-dose administration routes. Introduction: Objectives: Methods: Results: Conclusions:
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37
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Kaufmann CN, Kim A, Miyoshi M, Han BH. Patterns of Medical Cannabis Use Among Older Adults from a Cannabis Dispensary in New York State. Cannabis Cannabinoid Res 2022; 7:224-230. [PMID: 33998868 PMCID: PMC9070740 DOI: 10.1089/can.2020.0064] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Cannabis use has increased among older adults. Few epidemiological studies have examined the medical diseases reported for cannabis use, routes of cannabis administration, and methods of consumption among older adults, and how they differ from younger adults. Methods: We analyzed invoice data on purchases of cannabis products from a large medical cannabis dispensary in New York State between January 1, 2016 and December 31, 2017. Data came from n=11,590 patients stratified by ages 18-49 (n=4,606), 50-64 (n=3,993), and ≥65 years (n=2,991). We assessed differences in groups by demographic characteristics of patients, qualifying conditions and symptoms for cannabis use, cannabis product dosing of THC and CBD, THC:CBD ratios, and cannabis delivery methods. Results: Among cannabis patients, 25.8% were aged ≥65 years, and 34.5% were ages 50-64. Across all age groups, severe or chronic pain was the predominant symptom for cannabis use, although older patients were more likely to use cannabis for cancer and Parkinson's disease among other conditions. Older adults were more likely to use sublingual tincture versus other consumption methods, to use products with a lower THC:CBD ratio, and to begin cannabis treatment with a lower THC and higher CBD dose compared with younger age groups. However, all age groups demonstrated a similar increase in THC dosing over time. Conclusion: Analysis of medical cannabis invoices from a dispensary in New York State showed that although there are similarities in patterns of cannabis use across all groups, there are key characteristics unique to the older adult medical cannabis user.
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Affiliation(s)
- Christopher N. Kaufmann
- Division of Geriatrics and Gerontology, Department of Medicine, University of California San Diego School of Medicine, San Diego, California, USA.,Address correspondence to: Christopher N. Kaufmann, PhD, MHS, Division of Geriatrics and Gerontology, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive, No. 0665, La Jolla, San Diego, CA 92093, USA
| | - Arum Kim
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Mari Miyoshi
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Benjamin H. Han
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, New York, New York, USA
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38
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Bahji A, Breward N, Duff W, Absher N, Patten SB, Alcorn J, Mousseau DD. Cannabinoids in the management of behavioral, psychological, and motor symptoms of neurocognitive disorders: a mixed studies systematic review. J Cannabis Res 2022; 4:11. [PMID: 35287749 PMCID: PMC8922797 DOI: 10.1186/s42238-022-00119-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/07/2022] [Indexed: 12/30/2022] Open
Abstract
Abstract
Aim
We undertook this systematic review to determine the efficacy and safety of cannabis-based medicine as a treatment for behavioral, psychological, and motor symptoms associated with neurocognitive disorders.
Methods
We conducted a PRISMA-guided systematic review to identify studies using cannabis-based medicine to treat behavioral, psychological, and motor symptoms among individuals with Alzheimer's disease (AD) dementia, Parkinson’s disease (PD), and Huntington’s disease (HD). We considered English-language articles providing original data on three or more participants, regardless of design.
Findings
We identified 25 studies spanning 1991 to 2021 comprised of 14 controlled trials, 5 pilot studies, 5 observational studies, and 1 case series. In most cases, the cannabinoids tested were dronabinol, whole cannabis, and cannabidiol, and the diagnoses included AD (n = 11), PD (n = 11), and HD (n = 3). Primary outcomes were motor symptoms (e.g., dyskinesia), sleep disturbance, cognition, balance, body weight, and the occurrence of treatment-emergent adverse events.
Conclusions
A narrative summary of the findings from the limited number of studies in the area highlights an apparent association between cannabidiol-based products and relief from motor symptoms in HD and PD and an apparent association between synthetic cannabinoids and relief from behavioral and psychological symptoms of dementia across AD, PD, and HD. These preliminary conclusions could guide using plant-based versus synthetic cannabinoids as safe, alternative treatments for managing neuropsychiatric symptoms in neurocognitive vulnerable patient populations.
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Bar-Lev Schleider L, Mechoulam R, Sikorin I, Naftali T, Novack V. Adherence, Safety, and Effectiveness of Medical Cannabis and Epidemiological Characteristics of the Patient Population: A Prospective Study. Front Med (Lausanne) 2022; 9:827849. [PMID: 35223923 PMCID: PMC8864967 DOI: 10.3389/fmed.2022.827849] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/10/2022] [Indexed: 12/31/2022] Open
Abstract
Background Despite the absence of rigorous prospective studies, there has been an increase in the use of cannabis-based medicinal products. During the study period, the use of medical cannabis in Israel was tightly regulated by national policy. Through a prospective study of approximately 10,000 patients, we aimed to characterize the medical cannabis patient population as well as to identify treatment adherence, safety, and effectiveness. Methods and Findings In this study of prescribed medical cannabis patients, adherence, safety, and effectiveness were assessed at 6 months. Treatment adherence was assessed by the proportion of patients purchasing the medication out of the total number of patients (excluding deceased cases and patients transferred to another cannabis clinic). Safety was assessed by the frequency of the side-effects, while effectiveness was defined as at least moderate improvement in the patient condition without treatment cessation or serious side-effects. The most frequent primary indications requiring therapy were cancer (49.1%), followed by non-specific pain (29.3%). The average age was 54.6 ± 20.9 years, 51.1% males; 30.2% of the patients reported prior experience with cannabis. During the study follow-up, 1,938 patients died (19.4%) and 1,735 stopped treatment (17.3%). Common side-effects, reported by 1,675 patients (34.2%), were: dizziness (8.2%), dry mouth (6.7%), increased appetite (4.7%), sleepiness (4.4%), and psychoactive effect (4.3%). Overall, 70.6% patients had treatment success at 6 months. Multivariable logistic regression analysis revealed that the following factors were associated with treatment success: cigarette smoking, prior experience with cannabis, active driving, working, and a young age. The main limitation of this study was the lack of data on safety and effectiveness of the treatment for patients who refused to undergo medical assessment even at baseline or died within the first 6 months. Conclusions We observed that supervised medical-cannabis treatment is associated with high adherence, improvement in quality of life, and a decrease in pain level with a low incidence of serious adverse events.
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Affiliation(s)
- Lihi Bar-Lev Schleider
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Research Department, Tikun Olam - Cannbit Pharmaceuticals, Tel Aviv, Israel
| | - Raphael Mechoulam
- Institute for Drug Research, Medical Faculty Hebrew University, Jerusalem, Israel
| | - Inbal Sikorin
- Geriatric Department, Hadarim Nursing Home, Naan, Israel
| | - Timna Naftali
- Department of Gastroenterology and Hepatology, Meir Medical Center, Kfar Saba and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, United States
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40
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Ergisi M, Erridge S, Harris M, Kawka M, Nimalan D, Salazar O, Loupasaki K, Ali R, Holvey C, Coomber R, Usmani A, Sajad M, Beri S, Hoare J, Khan SA, Weatherall MW, Platt M, Rucker JJ, Sodergren MH. An Updated Analysis of Clinical Outcome Measures Across Patients From the UK Medical Cannabis Registry. Cannabis Cannabinoid Res 2022. [DOI: 10.1089/can.2021.0145] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Mehmet Ergisi
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Sapphire Medical Clinics, London, United Kingdom
| | - Michael Harris
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Michal Kawka
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Devaki Nimalan
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Oliver Salazar
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Katerina Loupasaki
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Rayyan Ali
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Carl Holvey
- Sapphire Medical Clinics, London, United Kingdom
| | - Ross Coomber
- Sapphire Medical Clinics, London, United Kingdom
- St. George's Hospital NHS Trust, London, United Kingdom
| | - Azfer Usmani
- Sapphire Medical Clinics, London, United Kingdom
- Dartford and Gravesham NHS Trust, Kent, United Kingdom
| | - Mohammed Sajad
- Sapphire Medical Clinics, London, United Kingdom
- Dudley Group of Hospitals NHS Trust, West Midlands, United Kingdom
| | - Sushil Beri
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Sapphire Medical Clinics, London, United Kingdom
| | - Jonathan Hoare
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Sapphire Medical Clinics, London, United Kingdom
| | - Shaheen A. Khan
- Sapphire Medical Clinics, London, United Kingdom
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark W. Weatherall
- Sapphire Medical Clinics, London, United Kingdom
- Buckinghamshire Healthcare NHS Trust, Amersham, United Kingdom
| | - Michael Platt
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Sapphire Medical Clinics, London, United Kingdom
| | - James J. Rucker
- Sapphire Medical Clinics, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mikael H. Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Sapphire Medical Clinics, London, United Kingdom
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41
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Hoeper S, Crosbie E, Holmes LM, Godoy L, DeFrank V, Hoang C, Ling PM. "The Perfect Formula:" Evaluating Health Claims, Products and Pricing on Cannabis Dispensary Websites in Two Recently Legalized States. Subst Use Misuse 2022; 57:1207-1214. [PMID: 35532143 DOI: 10.1080/10826084.2022.2069267] [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: 10/18/2022]
Abstract
Introduction: Many cannabis dispensaries market and sell their products online through websites designed to attract and maintain customers; often, these websites incorporate a variety of product claims and other marketing tactics. This study evaluated website content, product pricing and discounts on dispensary websites in California and Nevada, states that legalized recreational cannabis in 2016. Methods: We content coded product availability, marketing claims and discounts on cannabis dispensary websites in the San Francisco Bay Area (N = 34) and Reno (N = 15) from March to June 2020 using a web crawler to scrape pricing information for four product types. We conducted bivariate analyses comparing both locations. Results: Prices were significantly lower for flower, edibles, and concentrates in Reno compared to the Bay Area, but not cartridges. In both areas, a range of marketing claims were made regarding the health effects of certain products. The most common were that cannabis products treated pain, nausea/vomiting, spasms, anxiety, insomnia, and depression. Products were also said to promote creativity and euphoria. Other marketing claims related to potency, pleasure enhancement, and improved social interactions. Discounts targeted to senior citizens and veterans were found on over half of all websites. Conclusions: Dispensary websites in the Bay Area and Reno frequently make health-related claims which should not be allowed in absence of scientific evidence. Non-health related claims are similar to those used for selling e-cigarettes and other tobacco products. Monitoring cannabis dispensary websites provides insight into local sales tactics and may help identify subpopulations for research on behavioral impacts of cannabis marketing activities.
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Affiliation(s)
- Samantha Hoeper
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Eric Crosbie
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA.,Ozmen Institute for Global Studies, University of Nevada, Reno, Reno, Nevada, USA
| | - Louisa M Holmes
- Departments of Geography and Demography, Penn State University, University Park, Pennsylvania, USA
| | - Lindsey Godoy
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Vincent DeFrank
- School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Christine Hoang
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, USA.,Division of General Internal Medicine, Dept of Medicine, University of California, San Francisco, San Francisco, California, USA
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42
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Tumati S, Lanctôt KL, Wang R, Li A, Davis A, Herrmann N. Medical Cannabis Use Among Older Adults in Canada: Self-Reported Data on Types and Amount Used, and Perceived Effects. Drugs Aging 2021; 39:153-163. [PMID: 34940961 PMCID: PMC8696251 DOI: 10.1007/s40266-021-00913-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 12/20/2022]
Abstract
Background Medical cannabis use is growing among older adults. In this retrospective study, we aimed to assess the characteristics of older medical cannabis users including the indications, type and amount of cannabis used, perceived changes in symptoms after cannabis use, change in dose of concurrent medications, and adverse effects. Methods Data were collected between October 2014 and October 2020 from patients who were consulting the Canada-wide network of clinics of a medical cannabis provider and who were willing to answer questionnaires based on their medical status. The current study included older adults (≥ 65 years) who completed questionnaires at intake and first follow-up visits. Data were summarized with descriptive statistics, which were compared between men and women with t tests or chi-squared tests. Tests of proportions assessed categorical responses for perceived effects after cannabis use. Logistic regression was used to assess trends in cannabis usage. Results Data included that from 9766 older adult users at intake (mean ± SD age = 73.2 ± 6.8 years, females = 60.0%), among whom 4673 (females = 61.4%) returned for follow-up after 90.6 ± 58 days. The most common primary indication for which medical cannabis was sought was pain (67.7%), which was more common in women, whereas oncological and neurological conditions were more common in men. At follow-up, cannabis oil was used by 81.0% of older adults, among whom compositions containing only or mostly cannabidiol (CBD) had been used by 83.6%. Adverse effects reported by older adults at the follow-up visit included dry mouth (12.8%), drowsiness (8.6%), and dizziness (4.0%). The majority of older adults reported improvements in pain (72.7%, z = 1482.6, p < 0.0001, compared to worsening or no change), sleep (64.5%, z = 549.4, p < 0.0001), and mood (52.8%, z = 16.4, p < 0.0001), with 35.6% reporting use of a reduced dose of opioids and 19.9% a reduced dose of benzodiazepines. Interpretation Among older adults, medical cannabis is used more often by women, with CBD-containing cannabis oils being the most commonly used. Users reported improved pain, sleep, and mood symptoms at follow-up after cannabis use. This study describes the patterns of use of medical cannabis by older adults and highlights the need for research to determine appropriate indications, precise doses of active ingredients, and short- and long-term outcomes among older adults. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00913-y.
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Affiliation(s)
- Shankar Tumati
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
| | - RuoDing Wang
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Abby Li
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Andrew Davis
- Department of Economics, Acadia University, Wolfville, NS, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Abstract
Cannabis is the most frequently used illegal psychoactive substance by older adults. With population aging, legalization and medicalization of cannabis, and changes in perceptions of older adults toward its use, recreational and medical cannabis use/misuse is on the rise in seniors. Although there are solid data related to the adverse events of cannabis in older adults, efficacy data are lacking. Older adults are at increased risk of developing cannabis use disorder alongside other medical and psychiatric comorbidities. We review the benefits and risks associated with cannabis use, and screening and management strategies for cannabis use disorder in older adults.
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Senderovich H, Wagman H, Zhang D, Vinoraj D, Waicus S. The Effectiveness of Cannabis and Cannabis Derivatives in Treating Lower Back Pain in the Aged Population: A Systematic Review. Gerontology 2021; 68:612-624. [PMID: 34515130 DOI: 10.1159/000518269] [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: 02/12/2021] [Accepted: 06/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Cannabis is increasingly used in the management of pain, though minimal research exists to support its use since approval. Reduction in stigma has led to a growing interest in pharmaceutical cannabinoids as a possible treatment for lower back pain (LBP). The objective of this review was to assess the role and efficacy of cannabis and its derivatives in the management of LBP and compile global data related to the role of cannabis in the management of LBP in an aging population. METHODS A systematic review was conducted using predetermined keywords by 3 independent researchers. Predetermined inclusion and exclusion criteria were applied, and 23 articles were selected for further analysis. RESULTS Studies identified both significant and insignificant impacts of cannabis on LBP. Contradicting evidence was noted on the role of cannabis in the management of anxiety and insomnia, 2 common comorbidities with LBP. The existing literature suggests that cannabis may be used in the management of LBP and comorbid symptoms. CONCLUSIONS Further research is needed to consider cannabis as an independent management option. There is a lack of evidence pertaining to the benefits of cannabis in an aged population, and thus, additional research is warranted to support its use in the aged population.
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Affiliation(s)
- Helen Senderovich
- Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Geriatrics, Palliative Care, Pain Medicine, Baycrest, Toronto, Ontario, Canada
| | - Hayley Wagman
- Wilfred Laurier University, Waterloo, Ontario, Canada
| | - Dennis Zhang
- Department of Family Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Danusha Vinoraj
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Waicus
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Zolotov Y, Gruber SA. Cannabis and aging: research remains in its infancy. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:523-526. [PMID: 34376078 DOI: 10.1080/00952990.2021.1949334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yuval Zolotov
- Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Staci A Gruber
- Cognitive and Clinical Neuroimaging Core, McLean Hospital Imaging Center, Belmont, MA, USA.,Marijuana Investigations for Neuroscientific Discovery (MIND) Program, McLean Hospital Imaging Center, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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46
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Sihota A, Smith BK, Ahmed S, Bell A, Blain A, Clarke H, Cooper ZD, Cyr C, Daeninck P, Deshpande A, Ethans K, Flusk D, Le Foll B, Milloy M, Moulin DE, Naidoo V, Ong M, Perez J, Rod K, Sealey R, Sulak D, Walsh Z, O’Connell C. Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control. Int J Clin Pract 2021; 75:e13871. [PMID: 33249713 PMCID: PMC8365704 DOI: 10.1111/ijcp.13871] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/24/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Opioid misuse and overuse have contributed to a widespread overdose crisis and many patients and physicians are considering medical cannabis to support opioid tapering and chronic pain control. Using a five-step modified Delphi process, we aimed to develop consensus-based recommendations on: 1) when and how to safely initiate and titrate cannabinoids in the presence of opioids, 2) when and how to safely taper opioids in the presence of cannabinoids and 3) how to monitor patients and evaluate outcomes when treating with opioids and cannabinoids. RESULTS In patients with chronic pain taking opioids not reaching treatment goals, there was consensus that cannabinoids may be considered for patients experiencing or displaying opioid-related complications, despite psychological or physical interventions. There was consensus observed to initiate with a cannabidiol (CBD)-predominant oral extract in the daytime and consider adding tetrahydrocannabinol (THC). When adding THC, start with 0.5-3 mg, and increase by 1-2 mg once or twice weekly up to 30-40 mg/day. Initiate opioid tapering when the patient reports a minor/major improvement in function, seeks less as-needed medication to control pain and/or the cannabis dose has been optimised. The opioid tapering schedule may be 5%-10% of the morphine equivalent dose (MED) every 1 to 4 weeks. Clinical success could be defined by an improvement in function/quality of life, a ≥30% reduction in pain intensity, a ≥25% reduction in opioid dose, a reduction in opioid dose to <90 mg MED and/or reduction in opioid-related adverse events. CONCLUSIONS This five-stage modified Delphi process led to the development of consensus-based recommendations surrounding the safe introduction and titration of cannabinoids in concert with tapering opioids.
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Affiliation(s)
- Aaron Sihota
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
| | | | - Sana‐Ara Ahmed
- Medical Director, Anesthesiology and Interventional Chronic PainAhmed Institute for Pain and Cannabinoid ResearchCalgaryABCanada
| | - Alan Bell
- Department of Family and Community MedicineUniversity of TorontoTorontoONCanada
| | - Allison Blain
- Department of AnesthesiaMichael G DeGroote Pain ClinicHamilton Health SciencesMcMaster UniversityHamiltonONCanada
| | - Hance Clarke
- Department of Anesthesia and Pain MedicineToronto General HospitalUniversity Health NetworkUniversity of TorontoTorontoONCanada
| | - Ziva D. Cooper
- Department of Psychiatry and Biobehavioral ScienceUCLA Cannabis Research InitiativeJane and Terry Semel Institute for Neuroscience and Human Behavior University of CaliforniaLos AngelesCAUSA
| | - Claude Cyr
- Department of Family MedicineMcGill UniversityMontrealQCCanada
| | - Paul Daeninck
- Max Rady College of MedicineRady Faculty of Health SciencesUniversity of Manitoba, and CancerCare ManitobaWinnipegMBCanada
| | - Amol Deshpande
- Comprehensive Interdisciplinary Pain ProgramDivision of Physical MedicineToronto Rehabilitation InstituteTorontoONCanada
| | - Karen Ethans
- Department of MedicineSection of Physical Medicine and RehabilitationUniversity of ManitobaWinnipegMBCanada
| | - David Flusk
- Faculty of MedicineMemorial University of NewfoundlandSt John’s NLCanada
| | - Bernard Le Foll
- Translational Addiction Research LaboratoryCentre for Addiction and Mental HealthTorontoONCanada
- Alcohol Research and Treatment ClinicAcute Care ProgramCentre for Addiction and Mental HealthTorontoONCanada
- Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthTorontoONCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoONCanada
- Department of PsychiatryUniversity of TorontoTorontoONCanada
- Institute of Medical SciencesUniversity of TorontoTorontoONCanada
- British Columbia Centre on Substance UseVancouverBCCanada
| | - M‐J Milloy
- British Columbia Centre on Substance UseVancouverBCCanada
- Department of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Dwight E. Moulin
- Departments of Clinical Neurological Sciences and OncologyEarl Russell Chair in Pain MedicineWestern UniversityLondonONCanada
| | | | - May Ong
- Department of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Jordi Perez
- Department of AnesthesiaMcGill UniversityMontrealQCCanada
| | - Kevin Rod
- FCFP Director Toronto Poly ClinicLecturer DFCM University of TorontoTorontoONCanada
| | | | | | - Zachary Walsh
- Department of PsychologyUniversity of British ColumbiaVancouverBCCanada
| | - Colleen O’Connell
- Department of Physical Medicine and RehabilitationStan Cassidy Centre for RehabilitationFrederictonNBCanada
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47
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Bhaskar A, Bell A, Boivin M, Briques W, Brown M, Clarke H, Cyr C, Eisenberg E, de Oliveira Silva RF, Frohlich E, Georgius P, Hogg M, Horsted TI, MacCallum CA, Müller-Vahl KR, O'Connell C, Sealey R, Seibolt M, Sihota A, Smith BK, Sulak D, Vigano A, Moulin DE. Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process. J Cannabis Res 2021; 3:22. [PMID: 34215346 PMCID: PMC8252988 DOI: 10.1186/s42238-021-00073-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed. METHODS Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain. RESULTS There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5-5 mg of each cannabinoid once or twice daily and titrates by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day. CONCLUSIONS In summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.
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Affiliation(s)
- Arun Bhaskar
- Pain Management Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Alan Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Matthew Brown
- Department of Pain Medicine, The Royal Marsden Hospital, London, UK
- The Institute of Cancer Research, London, UK
| | - Hance Clarke
- Department of Anesthesia and Pain Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Claude Cyr
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Elon Eisenberg
- Institute of Pain Medicine, Rambam Health Care Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Eva Frohlich
- Department of Anaesthesiology and Pain Management, Helen Joseph Hospital, Johannesburg, South Africa
| | | | - Malcolm Hogg
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | | | | | - Kirsten R Müller-Vahl
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Colleen O'Connell
- Department of Physical Medicine and Rehabilitation, Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada
| | - Robert Sealey
- Cannabinoid Medicine Specialist, Victoria, BC, Canada
| | - Marc Seibolt
- Algesiologikum- Centers for Pain Medicine, Day Clinic for Pain Medicine, Munich, Germany
| | - Aaron Sihota
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Brennan K Smith
- CTC Communications, Medical Division, Mississauga, ON, Canada
| | | | - Antonio Vigano
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Dwight E Moulin
- Departments of Clinical Neurological Sciences and Oncology, Earl Russell Chair of Pain Medicine, Western University, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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Mohiuddin M, Blyth FM, Degenhardt L, Di Forti M, Eccleston C, Haroutounian S, Moore A, Rice ASC, Wallace M, Park R, Gilron I. General risks of harm with cannabinoids, cannabis, and cannabis-based medicine possibly relevant to patients receiving these for pain management: an overview of systematic reviews. Pain 2021; 162:S80-S96. [PMID: 32941319 DOI: 10.1097/j.pain.0000000000002000] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022]
Abstract
ABSTRACT The growing demand for improved pain treatments together with expanding legalization of, and access to, cannabinoids, cannabis, and cannabis-based medicines has intensified the focus on risk-benefit considerations in pain management. Given limited harms data from analgesic clinical trials, we conducted an overview of systematic reviews focused on all harms possibly relevant to patients receiving cannabinoids for pain management. This PROSPERO-registered, PRISMA-compliant systematic overview identified 79 reviews, encompassing over 2200 individual reports about psychiatric and psychosocial harms, cognitive/behavioral effects, motor vehicle accidents, cardiovascular, respiratory, cancer-related, maternal/fetal, and general harms. Reviews, and their included studies, were of variable quality. Available evidence suggests variable associations between cannabis exposure (ranging from monthly to daily use based largely on self-report) and psychosis, motor vehicle accidents, respiratory problems, and other harms. Most evidence comes from settings other than that of pain management (eg, nonmedicinal and experimental) but does signal a need for caution and more robust harms evaluation in future studies. Given partial overlap between patients receiving cannabinoids for pain management and individuals using cannabinoids for other reasons, lessons from the crisis of oversupply and overuse of opioids in some parts of the world emphasize the need to broadly consider harms evidence from real-world settings. The advancement of research on cannabinoid harms will serve to guide optimal approaches to the use of cannabinoids for pain management. In the meantime, this evidence should be carefully examined when making risk-benefit considerations about the use of cannabinoids, cannabis, and cannabis-based medicine for chronic pain.
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Affiliation(s)
- Mohammed Mohiuddin
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Fiona M Blyth
- University of Sydney Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London, Maudsley NHS Foundation Trust, King's College, London, United Kingdom
- South London and Maudsley NHS Mental Health Foundation Trust, London, United Kingdom
| | | | - Simon Haroutounian
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University Pain Center, Washington University School of Medicine, St Louis, MO, United States
| | | | - Andrew S C Rice
- Department Surgery and Cancer, Pain Research Group, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Mark Wallace
- Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Rex Park
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- School of Policy Studies, Queen's University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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49
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Porter B, St. Marie B, Milavetz G, Herr K. Cannabidiol (CBD) Use by Older Adults for Acute and Chronic Pain. J Gerontol Nurs 2021; 47:6-15. [PMID: 34191653 PMCID: PMC8344100 DOI: 10.3928/00989134-20210610-02] [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] [Indexed: 11/20/2022]
Abstract
Legalization of cannabidiol (CBD) products has ignited interest in clinical practice and research. One desired indication includes possible pain-relieving effects of CBD. The purposes of the current article are to (1) clarify terminology relevant to cannabinoids; (2) explain and understand the pharmacotherapeutics of CBD; (3) examine research of the current use of CBD by older adults for treating pain; (4) discuss safety considerations with using CBD products; and (5) provide best practice recommendations for clinicians as they advise their older adult patients. A review of the literature demonstrated mixed results on the efficacy of CBD in relieving pain in older adults. There is inconsistency in the labeling of over-the-counter CBD products that can result in safety issues and will require more federal quality control. Likewise, gaps in knowledge regarding safety and efficacy of CBD use in older adults are vast and require further research. [Journal of Gerontological Nursing, 47(7), 6-15.].
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50
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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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