Science/Medical

The Battle Between Pharma and Cannabis
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by Dr. Nicola Davies

Despite sweeping legal victories, cannabis remains stigmatized as an illegal drug, listed by the Drug Enforcement Administration as a Schedule 1 drug, along with heroin and lysergic acid diethylamide (LSD). For the battle between pharma and cannabis to be resolved, a separation must be made between the scientific use of cannabis in easing the plight of patients with various conditions and its recreational use. Attitudes in the U.S. have been entrenched since the flower child generation of the 1960s, which saw cannabis as a symbol of rebellion against societal values.

Israel, meanwhile, has established itself as a leader in medical cannabis technology. With the medical cannabis market set to explode, Israel is attracting international investors keen to take advantage of the government’s enlightened approach to these products, cutting edge researchers in the field of medical cannabis, as well as the agricultural expertise of local growers. In turn, international pharma companies are taking advantage of opportunities to conduct research in Israel.

Israel is no pushover, however, in allowing the use of medical cannabis. The supply chain is carefully monitored, from grower to pharmacy, to ensure protocol is followed correctly in order to give patients access to quality products. Indeed, the Israeli Ministry of Health’s Medical Cannabis Unit (IMCA) is authorized to issue permits to those who could benefit from medical cannabis.1

“Israel's federally legal clinical research ability has allowed them to forge ahead of many other countries who have not allowed the research to be conducted. This gave Israel a 10-year head start,” says Australian expatriate Saul Kaye, founder and CEO of Israel Cannabis (iCAN), a leading developer of cannabis-based formulations and pharmaceuticals. Kaye serves as an advisor to the Knesset, Israel’s unicameral parliament, on medical cannabis reform and is a sought-after international speaker on the Israeli regulatory environment, the international cannabis market and cannabis science.

 

Can pharma afford to ignore medical cannabis?

With estimates that the global medical cannabis market could reach $50 billion by 2025, pharma cannot afford to miss out. According to Kaye, Big Pharma does see a chance to cash in on medical cannabis. “GW Pharma and Zynerba are already in cannabis research, with multibillion dollar collective market caps,” he says. “Teva signed a distribution agreement with the Syqe device [selective-dose cannabis inhaler]. They are still on the sidelines but they are actively making acquisitions.”

To explain, Teva Pharmaceuticals, a multinational Israeli company, is working with a government-backed start-up called Syqe, which has developed an inhaler that delivers precise doses of vaporized cannabis via a disposable cartridge.2 After initially being used in a Haifa hospital, the inhaler accurately delivered metered doses for pain relief in hospital patients.

There is also the Israeli medical company, Breath of Life Pharma (BOL), that has developed a range of inhalers and tablets that dissolve under the tongue as a method of administering cannabis medication. The company has more than 12 phase-two clinical trials being conducted or in the planning stages. These trials use cannabis to treat conditions ranging from Parkinson’s disease and Tourette’s syndrome to autism and chronic liver disease. In addition, BOL is building a factory in Jerusalem to purify and separate cannabinoids, with plans to open this facility to European and other companies that need to conduct clinical trials.

 

Patients prefer non-pharma products

Kaye believes that the US is falling behind on cannabis research, “given that it's a federally illegal substance and that pharma companies are more conservative than their younger entrepreneurial upstarts.” He also believes that the opioid crisis may have made pharma companies a bit wary. In the US, some pharma companies are still supporting anti-legalization campaigns for purported safety concerns.

When asked how artificial cannabis medications developed by pharma companies   compare in quality to products derived from the cannabis plant, Kaye says they can rival quality and safety, but that he believes in the power of the combination of molecules in the plant, or the entourage effect.

The entourage effect is how the various cannabinoids, terpenes and flavonoids found in the plant work to enhance its medicinal properties. Pharma’s synthetic renderings extract only one ingredient, like THC or CBD, to use in medications. Cesamet (nabilone) and Marinol (dronabinol) are medicines usually prescribed for nausea in patients undergoing cancer treatment. However, in a study involving 953 participants from 31 countries, patients generally preferred natural cannabis-based medicines rather than the pharmaceutical products.3 Patients claimed the natural products worked faster and were more effective.

 

Can pharma afford to ignore the signs?

A father and daughter team at the University of Georgia, David and Ashley Bradford, analyzed prescriptions filled by enrollees on Medicare Part D between 2010 and 2013. They found that once a state had a medical cannabis law in place, the use of prescription drugs fell significantly if it was possible for patients to use cannabis for the condition.4 The nine categories they chose to investigate were nausea, anxiety, pain, depression, glaucoma, seizures, psychosis, spasticity and sleep disorders. All prescription medication in the categories went down, except for glaucoma. In the case of glaucoma, the use of cannabis only provides relief for around an hour, so patients stayed with the prescription medication. Overall, the researchers found that using medical cannabis reduced the amount spent on prescription drugs significantly.

So, what if pharma could provide approved cannabis medication for the hundreds of conditions that respond well to medicinal cannabis?

Although legal in several states, cannabis is still subject to various restrictions — patients can’t get a cannabis prescription filled at a pharmacy. In this type of situation, it is no wonder that pharma companies are concerned — each drug needs a known pharmacological action to be considered safe. It has to have undergone rigorous clinical trials and only then can it be brought to market. Buying packets of cannabis goes against all medical safety procedures.

Perhaps once the US catches up with Israel and reaches a compromise where everyone wins – the government, patients, and pharma companies – then medical cannabis may be able to reach its true potential through rigorous research in state-approved research facilities. “In my opinion, big pharma will remain on the sidelines, but I predict that within 24 months, they will start to make some acquisitions into this space,” concludes Kaye. ♦


References:

1. State of Israel Ministry of Health (2017). Medical cannabis unit. [Online].

Available at:

https://www.health.gov.il/English/MinistryUnits/HealthDivision/cannabis/Pages/default.aspx

 

2. Syqe Medical (2017) The World's First Selective-Dose Pharmaceutical Grade Medicinal Plants Inhaler [Online].

Available at: http://www.syqemedical.com/

 

3,Hazekamp, A., Ware, M.A., Muller-Vahl, K.R., Abrams, D. and Grotenhermen, F. (2013). The medicinal use of cannabis and cannabinoids – an international cross-sectional survey on administration forms. J Psychoactive Drugs, Jul- Aug 45(3) pp.199-210.

 

4. Bradford, A. and Bradford, W.D. (July, 2016). Medical Marijuana Laws Reduce Prescription Medication Use in Medicare Part D Health Affairs, Vol. 35 (7), pp. 1230-1236.

 

 

 

 

 

Can Cannabis Treat Addiction?
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by Dr Nicola Davies

Drug addiction involves the physical and/or psychological dependence on a habit-forming substance, usually with negative health effects. Overcoming addiction is a huge challenge, but several behavioral and pharmaceutical therapies have been developed to ease the battle. In recent years, there has been an increased interest in the potential for cannabis to treat addiction.1 Both tetrahydrocannabinol (THC) and cannabidiol (CBD) have shown potential to reduce addictive behaviors even when administered in small doses. However, cannabis itself is considered a substance of addiction and, therefore, its efficacy as a treatment for addiction is still under great scrutiny.

 

Cannabis as a substitute for addictive substances

The use of cannabis in exchange for more addictive substances such as opioids and heroin is based on the framework of harm reduction.1 Cannabis has a better safety profile than narcotic drugs, alcohol, and tobacco. It is also less addictive and has not been associated with any reported deaths from overdose.2 Indeed, Dr. Amanda Reiman of the University of California, Berkley, recommends the use of cannabis as a substitute for alcohol and other addictive drugs due to its safety profile, low addiction potential, and level of acceptance.2 CBD, in particular, is emerging as an effective treatment for addictive behaviors, including addiction to tobacco, cocaine and opioids.3

In one study on the effects of CBD and THC as potential treatments for cocaine and amphetamine addiction, low doses of CBD and THC were effective in reducing learned behavior associated with amphetamine and cocaine exposure in rodents.4 The rodents had earlier been conditioned to respond by seeking amphetamine and cocaine as rewards, but after a low dose treatment with THC and CBD, they showed less inclination for their learned behavior.

In another study on the use of cannabis as a substitute for alcohol and other drugs, it was found that cannabis is increasingly being used as a substitute for substances that are known to cause addiction, such as prescription drugs, opioids, alcohol, benzodiazepines, antidepressants, tobacco and illicit drugs.5

A similar study by researchers from the University of Michigan highlighted the effectiveness of cannabis in conjunction with, or as a substitute for, opioid analgesics treatment for chronic pain.6 A combination of cannabinoids and opiates produced greater pain relief, enabling patients to reduce their usage of opiates while at the same time reducing their risk of addiction. Cannabinoids can also prevent opiate withdrawal and the development of tolerance for opiates. Indeed, Dr. Esther Choo and her colleagues from the University of Michigan have reported that the legalization of cannabis in some American states has contributed to a decrease in opioid addiction and deaths from opioid overdose.6 The country has been suffering a nationwide epidemic of opioid abuse, dependence and related deaths, and so Dr. Choo recommends further investigation into the possibility of cannabis treatment for this addiction.

 

Cannabis to facilitate withdrawal from heroin or meth

Cannabis has even been found to help treat addiction to the so-called ‘harder’ drugs, such as heroin and crystal meth. For example, in a study on the interaction between THC and heroin, the administration of a THC-heroin combination to monkeys reduced the addictive potential of either drug.7 In the experiment, monkeys self-administered less heroin following the combination treatment.

Cannabis has also been proposed for the treatment of crystal meth withdrawal symptoms for people undergoing detoxification. These symptoms include irritability, sleeping problems, elevated body temperature, fatigue, anxiety and depression, sweating and a strong craving for the drug. The unpleasant feelings during withdrawal are responsible for some people going back to the drug despite their strong intentions to quit. Medical cannabis can be used to alleviate some of these symptoms.8

Cannabis treatment can facilitate the treatment of crystal meth withdrawal in several ways. For example, it can help relieve anxiety and depression by producing a calming effect for many users. It can also help aid relaxation and better sleep. Furthermore, cannabis improves the user’s mood and creates a pleasurable feeling. All of these effects can make a huge difference in the recovery process of someone who is addicted to meth, especially those experiencing feelings of deep depression. Feelings of irritability and cravings for crystal meth are also reduced when addicts take cannabis.8

 

A holistic approach to addiction treatment

The above studies are an indication that cannabinoid treatment may be helpful for certain types of addiction. However, successful application of cannabinoids in addiction treatment requires consideration of relevant physical, psychological and sociocultural factors. If the factors that fuel the addiction are not addressed, cannabis treatment may only be effective in the short-term.1

Treatment of addiction requires all aspects of health and wellness to be addressed in order to be successful. Often, traumatic experiences and life stressors have contributed to the addiction, and when this is the case, cannabis treatment may be more effective in combination with counseling and behavioral therapy. Indeed, CBD has been shown to have anti-anxiety properties, which could help facilitate therapy sessions.

 

Criticism of cannabis treatment for addiction

The harm-reduction approach used to promote cannabis treatment for addiction has received considerable criticism, as it is seen as simply replacing one habit-forming substance with another.1 The argument is that cannabis is a mind-altering substance that can simply create another dependence.9 Questions have also been raised about the effectiveness of going through addiction treatment while in a different state of mind. Since treatment for addiction often includes counseling, there is doubt whether an individual on cannabis will get the most out of the counseling program.2

Critics also hold the idea that cannabis is a gateway drug, with many believing that marijuana use may lead to the use of other illegal substances. People who have developed a tolerance for marijuana may look for more-powerful illegal substances, such as cocaine and heroin, to get the “high” that they are seeking. Furthermore, a person could be introduced to other drugs by fellow cannabis users who take other illegal substances.

It is also feared that marijuana use as addiction treatment may make some symptoms of addiction worse. For example, crystal meth addicts experience significant paranoia, and the use of medical cannabis may worsen their paranoia, leading to more erratic and even harmful behavior.9

 

A potential preventative and treatment aid to addiction

Despite considerable doubts, the use of cannabis as a replacement for more dangerous addictive substances is gaining increasing acceptance. This is reinforced by emerging evidence supporting the perceived health and medical benefits of cannabis, including pain relief, anti-nausea, and anti-anxiety properties. Currently, the best potential for cannabis use in treating addictive behavior lies in pain management, with the substance already being used in conjunction or as a replacement for opioid painkillers. In this instance, cannabis could even act as a preventative for addiction.

Overall, the role of cannabis in the treatment and prevention of addiction is looking promising. The challenge remains in tackling the myths and fears surrounding substance. ♦


References:

  1. Butterfield, D. (2017). ‘The Complete Guide to Using Cannabis for Addiction Treatment’, HERB [Online]. Available at: http://herb.co/2017/06/25/cannabis-treat-addiction/
  2. Van Wormer, K. and Davis, D. R. (2016). Addiction Treatment. Cengage Learning.
  3. Prud’homme, M., Cata, R. and Jutras-Aswad, D. (2015). ‘Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence’, Substance Abuse: Research and Treatment, 9, pp. 33–38.
  4. Parker, L. et al (2004). ‘Effect of low doses of D9-tetrahydrocannabinol and cannabidiol on the extinction of cocaine-induced and amphetamine-induced conditioned place preference learning in rats’, Psychopharmacology, 175, pp. 360–366.
  5. Lucas, P., Reiman, A., Earleywine, M., McGowan, S. K., Oleson, M., Coward, M. P. and Thomas, B. (2014). ‘Cannabis as a substitute for alcohol and other drugs: A dispensary-based survey of substitution effect in Canadian medical cannabis patients’, Addiction Research & Theory, 21 (5), pp. 435-442.
  6. Choo, E. K., Feldstein Ewing, S. W. and Lovejoy, T. I. (2016). ‘Opioids Out, Cannabis In: Negotiating the Unknowns in Patient Care for Chronic Pain’, Journal for the American Medical Association, 316 (17), pp. 1763-1764.
  7. Li, J., Koek, W. and France, C. P. (2012). ‘Interactions between delta9-tetrahydrocannabinol and heroin: self-administration in rhesus monkeys’, Behavioral Pharmacology, 23 (8), pp. 754–761
  8. Dru, D. (2017). ‘Medical Marijuana: A Treatment for Meth Addiction?’, Medical Marijuana [Online]. Available at: https://www.medicalmarijuana.com/medical-marijuana-treatments-cannabis-uses/medical-marijuana-can-help-overcome-methamphetamine-addiction/
  9. Herman, M. A. and Roberto, M. (2015). ‘The addicted brain: understanding the neurophysiological mechanisms of addictive disorders’, Frontiers in Integrative Neuroscience, 9, p. 18

 

 

The Cannabis Alcohol-Combination: Is It Worth the Risk?
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by Dr. Nicola Davies

 

Cannabis and alcohol are among the most popular recreational drugs, and so it is common for people to consume the two together. The intention of combining the two is to create a positive feeling, but this isn’t always the outcome. In fact, the outcome can be the complete opposite. Many people who consume these two drugs together are not aware of their limits, which can lead to excessive consumption of one or both. The consequence of this can be serious side-effects and, in extreme cases, even death.

 

The effect of alcohol on blood THC levels

 Alcohol consumption can significantly increase cannabinoid levels in the blood. This has been shown by several studies investigating the interaction of the two drugs in the body. In one study, it was shown that alcohol and marijuana consumption results in significantly higher blood concentration of THC.1 The study comprised 19 adults who were given either low-dose alcohol or a placebo 10 minutes before inhaling vaporized cannabis. The level of THC in participants who took alcohol was significantly higher than in those who did not take alcohol.

A study on the dose-dependent effects of cannabis and alcohol on driving impairment also showed that alcohol increases the effects of THC. 2 Comparisons were made between three groups of participants: those who consumed THC only, those who took alcohol and THC, and those who did not consume any of the two substances. It was found that the impact of cannabis on driving ability impairment is dose-dependent. This means that higher blood THC levels lead to further impairment of the consumer’s driving ability. However, results also showed that impairment in driving ability is further increased when intake of alcohol and cannabis are combined, as compared to cannabis or alcohol alone.

People who consume too much alcohol before smoking cannabis may experience the “greening out effect” — an unpleasant sensation characterized by nausea, dizziness, sweating, vomiting, disorientation, and. a strong desire to lie down. These effects result from having too much THC in the blood. In addition to increased blood THC levels, alcohol also causes decreased behavioral inhibition, possibly leading a person to take excess cannabis when drunk.3

 

The effect of cannabis on alcohol levels

Cannabis has been found to lower blood alcohol levels when taken in combination with alcohol.4 This is attributed to THC’s ability to alter gastrointestinal tract motility (the contraction of the muscles that mix the contents of the gastrointestinal tract), slowing down the absorption of alcohol and leading to lower blood alcohol levels. THC may also have the effect of reducing people’s desire to consume alcohol. A study examining the combined effects of the two drugs in human volunteers showed that participants exhibited a decreased desire to consume alcohol after taking the THC-alcohol combination.4 This suggests that THC may dampen the effects of alcohol, or replace the desire for more alcohol.

 

The benefits of the cannabis-alcohol combination

Separately, the two substances have certain benefits when taken in moderation. Alcohol can reduce the risk of cardiovascular disease and type 2 diabetes,5 and cannabis has beneficial effects against pain, nausea and anxiety.6 Nonetheless, there have been no major benefits associated with combining the two substances. Most people combine them in search of a unique ‘high’ from their mixed effects, which may be realized at low-to-moderate doses of the two drugs. However, this is still overshadowed by the discomfort it produces when taken in large doses, such as nausea, dizziness, sweats, and vomiting.7 Cannabis’ ability to also slow down alcohol absorption in the body, leading to lower blood alcohol levels, is not a recommended remedy due to its associated negative effects when taken as part of a combination.

 

The implications of the cannabis-alcohol combination

Cannabis and alcohol have different physiological pathways, but when consumed together can have overlapping effects. In a study measuring the intensity and performance impairment of participants given alcohol and marijuana separately and in combination, findings showed that the combination of alcohol and THC produced the most intense effects and caused the greatest performance impairment.8

Another study measuring the effects of cannabis and alcohol on simulated driving ability revealed that regular cannabis consumers committed more driving errors than non-regular consumers.9 Researchers at the Monash University Accident Research Centre in Australia tested the dose-dependent effects of alcohol and cannabis among novice and experienced drivers. The findings confirmed the dose-dependent effects of cannabis and alcohol on driving performance and also suggested the effects were more pronounced in inexperienced drivers. 10

The results of these studies could explain the increased performance impairment seen in people who consume alcohol and cannabis simultaneously, as well as highlighting the differences in impairment when the two drugs are consumed separately. The implications of these findings could inform new traffic laws and regulations as alcohol-cannabis combinations are frequently detected in drivers involved in car accidents. Presently, 29 States and the District of Columbia have legalized marijuana and with the increased availability of cannabis, there are concerns that this could lead to more car accidents.

 

A dose-related phenomenon

The detrimental effects of cannabis consumption are dose-related and are more pronounced during automatic functions compared to more complex tasks requiring conscious control. On the other hand, alcohol seems to produce an opposite pattern of impairment, where users struggle with more complex tasks compared with automatic functions. A possible explanation is that cannabis consumers tend to compensate effectively while driving by using different behavioral strategies.11 They are likely to drive slower and more carefully because they are conscious of possible impairment from taking cannabis. When cannabis is consumed in combination with alcohol, users lose this compensatory behavioral strategic ability, thus decreasing inhibitions and increasing safety risks as well as the likelihood of vehicular accidents.

 

Is it worth combining?

While cannabis and alcohol taken separately and in moderation may have some benefits, when consumed together the physiological and behavioral risks associated with cannabis and alcohol interactions are too great. The effects are dose-dependent and can be seen through task performance impairment. This has major implications for road safety and overall general population safety, especially given the increasing number of people consuming the two drugs in combination following marijuana legalizations. Driving or operating machinery after taking a cannabis-alcohol combination is not recommended for the sake of personal safety and the safety of others. ♦


References: 

  1. Hartman, R. L., Brown, T. L., Milavetz, G., Spurgin, A., Gorelick, D. A., Gaffney, G. and Huestis, M. A. (2015). Controlled Cannabis Vaporizer Administration: Blood and Plasma Cannabinoids with and without Alcohol, Clinical Chemistry, 63 (9).
  2. Bramness, J. G., Khiabani, H. Z. and Mørland, J. (2010). Impairment due to cannabis and ethanol: clinical signs and additive effects, Addiction, 105(6), 1080-1087.
  3. Smith, M. (2017). Greening Out: Combining Cannabis and Alcohol, Pot Guide [Online]. Available at: https://potguide.com/pot-guide-marijuana-news/article/greening-out-combining-cannabis-and-alcohol/ [Accessed 17 September 2017]
  4. Ballard, M. E. and de Wit, H. (2011). Combined effects of acute, very-low-dose ethanol and delta (9)-tetrahydrocannabinol in healthy human volunteers, Pharmacology Biochemistry and Behavior, 97(4), 627-631.
  5. Nova, E., Baccan, G. C., Veses, A., Zapatera, B. and Marcos, A. (2012). Potential health benefits of moderate alcohol consumption: current perspectives in research, Proceedings of the Nutrition Society, 71(2), 307-315.
  6. Webb, C. W. and Webb, S. M. (2014). Therapeutic benefits of cannabis: a patient survey, Hawai'i Journal of Medicine & Public Health, 73(4), 109.
  7. Dovey, D. (2014). Drunk and High: Science Explains Some Of The Side Effects That Come From Mixing Alcohol And Marijuana, Medical Daily [Online]. Available at: http://www.medicaldaily.com/drunk-and-high-science-explains-some-side-effects-come-mixing-alcohol-and-marijuana-278486 [Accessed 17 September, 2017]
  8. Ronen, A., Chassidim, H. S., Gershon, P., Parmet, Y., Rabinovich, A., Bar-Hamburger, R. and Shinar, D. (2010). The effect of alcohol, THC and their combination on perceived effects, willingness to drive and performance of driving and non-driving tasks, Accident Analysis & Prevention, 42(6), 1855-1865.
  9. Downey, L. A., King, R., Papafotiou, K., Swann, P., Ogden, E., Boorman, M. and Stough, C. (2013). The effects of cannabis and alcohol on simulated driving: influences of dose and experience, Accident Analysis & Prevention, 50, 879-886.
  10. Lenné, M. G., Dietze, P. M., Triggs, T. J., Walmsley, S., Murphy, B. and Redman, J. R. (2010). The effects of cannabis and alcohol on simulated arterial driving: influences of driving experience and task demand, Accident Analysis & Prevention42(3), 859-866.
  11. Sewell, R. A., Poling, J. and Sofuoglu, M. (2009). The effect of cannabis compared with alcohol on driving, The American Journal on Addictions, 18(3), 185-193.

 

 

 

Cannabis for Pediatric Care
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by Dr. Nicola Davies

 

While the use of cannabis for medical purposes by adults has become common in states where medical marijuana is legal, there has been a more cautious approach to the use of cannabis in pediatric care, due partly to lack of sufficient scientific evidence to support its efficacy and concern regarding potential side-effects in children.1 However, the use of cannabis for pediatric care is steadily gaining support, as fueled by recent reports of positive outcomes from the use of cannabis medications to treat various health conditions such as epilepsy, psychiatric conditions and movement disorders in children.2

 

The medical potential of cannabis

 When marijuana is consumed, the cannabinoids contained in it produce their effects by binding to cannabinoid receptors in the central nervous system. Due to its non-psychoactive nature, CBD represents a better prospect for use in commercial medical formulations, especially in pediatric care.2

Indeed, increasing reports of the potential efficacy of medical marijuana have led many families to the possibility of using cannabis for pediatric and adolescent conditions. Some families that have tried cannabis to treat children with conditions such as epilepsy and autism have reported improved outcomes.3 To date, most of the reported therapeutic effects are based on subjective accounts, and it is therefore important to note that one of the reasons parents may report improvement in their child’s behavior when marijuana is used for conditions such as autism may be due to the sedating effect of cannabis.4 However, there is no substantiated evidence on how the effects of marijuana, apart from sedation, are beneficial in pediatric autism.

 

Reported cases of efficacy

A systematic review of studies on the use of cannabinoids for pediatric epilepsy indicates that there is a lack of high quality medical evidence to support claims about therapeutic benefits.5 Most research has focused on multiple animal models of epilepsy, where substantial efficacy has been demonstrated. These results may provide hope for the therapeutic potential of cannabinoids for the treatment of epilepsy in humans, though more reliable studies are needed to confirm this.

GW Pharmaceuticals has developed a CBD product known as Epidiolex as a potential treatment for childhood epilepsy.6 The US Food and Drug Administration (FDA) approved investigation into new drug applications for the use of Epidiolex in 213 children averaging 11 years of age for the treatment of severe, intractable epilepsy. After three months of treatment, all children experienced a reduction of seizure frequency by an average of 54 percent — nine percent of patients were completely seizure free. In total, 22 children suffered severe adverse effects while the rest reported modest adverse effects such as fatigue, diarrhea, somnolence and decreased appetite.6 Data from the Epidiolex trial was based on self-reported seizure frequencies; nevertheless, the outcomes indicate significant potential for use of the drug in the treatment of pediatric epilepsy.

Many parents of children with epilepsy are willing to try cannabis treatments despite the lack of strong medical evidence. A wide range of preparations with high CBD and low THC are being offered to treat pediatric epilepsy and other medical conditions. In a study conducted in Colorado involving 75 pediatric patients with epilepsy, 57 percent of families reported positive results — yet the electroencephalogram patterns for the participants did not indicate evidence of improvement.7 Additionally, significant adverse effects were reported, such as increased seizures in 13 percent of participants, status epilepticus (where epileptic fits follow one another with no recovery time), and death. The authors also suspected a placebo-effect since data on seizure outcomes was self-reported and families who moved to Colorado to access the preparations were more likely to report therapeutic benefits compared to those already living in the state.7

Parents of pediatric cancer patients have also sought cannabis treatments for relief of symptoms for their children undergoing chemotherapy or radiation treatment. Most reports of cannabis efficacy as a treatment for cancer are anecdotal. Many parents believe that the use of cannabis as part of the child’s treatment has led to a reduction in disease-related symptoms.3 However, there is no credible medical explanation as to how cannabis may have led to this reduction. In addition, most families in such situations are desperate for a cure, and therefore their judgment may be clouded.

Clinical evidence has, however, emerged regarding the possible efficacy of cannabis treatment for certain cancers. A case study of a 14-year-old Canadian girl diagnosed with acute lymphoblastic leukemia (ALL) showed significant dose-dependent disease control.8 The girl had undergone standard treatments in the form of bone marrow transplant, chemotherapy, and radiotherapy, which had all failed after 34 months. The family administered oral cannabis oil over 78 days, and results showed a dose-response curve with marked reduction in blast count (immature cells in the bone marrow).8 This outcome is promising, although a single case is not sufficient evidence of cannabis efficacy in the treatment of ALL and other cancers.

 

More research is needed

There is some evidence of potential benefits for the use of cannabis treatment in pediatric care. Results from animal studies have indicated substantial efficacy in conditions such as epilepsy and certain cancers. Furthermore, anecdotal reports on the efficacy of cannabis treatment for some pediatric conditions are on the rise. Despite the growing use and interest in cannabis for pediatric care, there is a lack of clinical evidence to sufficiently support claims of efficacy. Furthermore, there are concerns about the potential side-effects of cannabis intake in children. Nevertheless, the non-psychoactive CBD has shown better promise as a therapeutic agent. More research is expected to generate medical evidence for the therapeutic use of cannabis within this vulnerable population. ♦


References:  

  1. Filloux, F. M. (2015). Cannabinoids for pediatric epilepsy? Up in smoke or real science? Translational pediatrics, 4(4), 271. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729003/
  2. Canadian Paediatric Society (2016). Is the medical use of cannabis a therapeutic option for children? Available at: http://www.cps.ca/en/documents/position/medical-use-of-cannabis
  3. Goldstein, B. (2017). Cannabis Use for Pediatric Cancers. Available at: https://www.marijuana.com/news/2017/01/cannabis-use-for-pediatric-cancers/
  4. Murphy, C. (2017). The Compelling Case for Treating Autism with Marijuana. Tonic. Available at: https://tonic.vice.com/en_us/article/785v5d/the-compelling-case-for-treating-autism-with-marijuana
  5. Koppel B.S., Brust J.C., Fife T., et al. (2014) Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82:1556-63.
  6. Devinsky O., Sullivan J., Friedman D., et al. (2015). Epidiolex (Cannabidiol) in Treatment Resistant Epilepsy. AAN 67th annual meeting. Available at: http://ir.gwpharm.com/releasedetail.cfm?releaseid=908097
  7. Press C.A., Knupp, K.G., Chapman, K.E. (2015). Parental reporting of response to oral cannabis extracts for treatment of refractory epilepsy. Epilepsy Behavior. 45(4):49-52. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25845492
  8. Singh, Y., Bali, C. (2013). Cannabis extract treatment for terminal acute lymphoblastic leukemia with a Philadelphia chromosome mutation. Case reports in oncology, 6(3), 585-592. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901602/
Cannabis Use Disorder: What It is and How to Prevent It
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by Dr. Nicola Davies

 

Cannabis Use Disorder (CUD) is a pattern of compulsive cannabis use that harms mental, physical and social well being, and can potentially lead to psychological dependence. It can also be associated with the development of physical tolerance and withdrawal symptoms when prolonged use of high doses is diminished or ceases.1,2

It has been determined that the prevalence of CUD across a range of demographic subgroups in the U.S. population was 1.5 percent in 2001–2002 and 2.9 percent in 2012–2013.3 During the same period, the number of cannabis users more than doubled. Among users in 2012–2013, 30.6 percent were identified as meeting a diagnosis of CUD.

 

Diagnosing Cannabis Use Disorder (CUD)

Cannabis Use Disorder is a form of substance abuse that results in acute intoxication, demonstrated by:

  • -specific physical symptoms occurring within two hours of consuming cannabis, including: increased appetite, dry mouth, bloodshot-eyes, and tachycardia (a faster than normal heart rate while at rest);
  • -significant and problematic changes in perception, cognition, mood, and behavior, including: impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment, and social withdrawal.1,2

While rooted in substance abuse leading to acute intoxication, CUD is mainly characterized by problematic or disordered use persisting for at least one month, or recurring over a 12-month period. The focus for diagnosis of CUD is on psychological dependence, where a person loses control over their use of cannabis and develops a compulsive pattern that persists despite the person’s awareness of the negative outcomes.

To be diagnosed as having CUD, an individual must, at a minimum, display two of the following behavioral patterns within a 12-month period:1,2

  • -a strong urge or compulsion to use cannabis;
  • -frequent consumption of cannabis in larger amounts or for longer periods than was initially intended;
  • -a persistent desire to end or reduce cannabis consumption, or previous unsuccessful efforts;
  • -an excessive amount of time spent obtaining, using, or recovering from cannabis;
  • -continued use of cannabis despite having interpersonal problems caused or exacerbated by the effects of cannabis;
  • -reduction or abandonment of important professional, recreational or social activities (including maintenance of personal hygiene) due to cannabis use;
  • -failure to fulfill important responsibilities at work, school, or home as a result of cannabis use;
  • -recurrent use of cannabis in situations that are potentially hazardous, such as driving a car or operating machinery;
  • -continued use of cannabis despite awareness of persistent or recurrent physical and/or psychological problems associated with that use;
  • -development of tolerance to the effects of cannabis, including increased consumption to achieve desired effects; and,
  • -the experience of withdrawal symptoms, including the use of cannabis to relieve or avoid those symptoms.

 

For a diagnosis of CUD, any physical and psychosocial changes must be directly related to recent use of cannabis, and not due to some other medical condition or better explained by a pre-existing mental disorder.

 

Tolerance and Withdrawal

While included as diagnostic indicators of CUD, neither evidence of tolerance nor withdrawal symptoms are necessarily an outcome of cannabis dependence. Diagnosis for CUD is primarily characterized by a pattern of compulsive use since dependence is primarily psychological, not physical. Nevertheless, heavy users do develop tolerance to the pharmacological effects of cannabis, and experience withdrawal symptoms following reduction or cessation of use.4,5

Tolerance has been primarily demonstrated for the effects of delta9-tetrahydrocannabinol (THC).These include changes in mood, perception, motor skills, the control of nausea and the promotion of sleep.6-9 At the same time, two long-term clinical studies of the role of nabiximols (a synthetic preparation with a 1:1 ratio of THC and cannabidiol) to treat symptoms of multiple sclerosis and central neuropathic pain reported that participants did not develop pharmacological tolerance to nabiximols, suggesting cannabidiol may play a role in moderating tolerance to THC.8

Clinical evidence for the development of withdrawal symptoms among frequent and heavy users of cannabis is fairly well established. Typical symptoms of withdrawal include anxiety, irritability, insomnia, gastrointestinal disturbance, decreased appetite, sweating, muscle aches, tremor of the outstretched hands, and depression.10,11 Typically, these symptoms begin in the first week of abstinence and resolve after a few weeks. Development of tolerance and experience of withdrawal are significant contributors to CUD in that they may lead to increased use. Specifically, tolerance may be a factor in the development of cannabis dependence by encouraging greater use to receive the desired effects. Withdrawal may also be a factor in discouraging the reduction or cessation of cannabis use.

 

Prevention of CUD

In general, the frequency and duration of cannabis use is related to the likelihood of a diagnosis of dependence,8 tolerance12 and withdrawal.13 Therefore, the chronic, heavy user is most at risk for CUD.

There are no specific guidelines for levels of cannabis consumption that might lead to dependence (or withdrawal) or for identifying what kinds of usage would be considered heavy or chronic. A general guideline can be: “daily or almost daily use over a period of at least a few months.”1 Adults seeking treatment for cannabis abuse or dependence usually have a history of roughly ten years of near-daily use and have made more than six previous attempts to quit.14

Similar to other substance abuse disorders, additional risk factors for developing CUD include but are not limited to the following: pre-existing psychiatric disorders, other substance abuse problems (especially alcohol and tobacco abuse), gender (men are 1.6 times more likely to develop CUD), age, and genetics (which affects whether or not people enjoy the psychotropic effects of cannabis).4 Young people between the ages of 18 and 25–29 are identified as the most frequent users of cannabis and are also the most at risk for developing CUD.3

In terms of prevention, any person in an at-risk group or who smokes cannabis regularly over extended periods needs to exercise additional caution and attention to their consumption habits. Unfortunately, dependence can be difficult to address when combined with mental health problems or other health concerns (e.g., sleep problems, chronic pain, anxiety, and trauma). These are often the very reasons cannabis is being used, and cessation or reduction of use can result in a worsening of symptoms, leading to relapse.

There are some clinical treatment options for symptoms of cannabis abuse and withdrawal, but not for development of CUD itself. Outpatient treatment services, as well as behavioral treatments such as motivational enhancement therapy and cognitive-behavioral therapy, among others, have been shown to be effective in enabling people with CUD to gain control over their use of cannabis.14

 

Overall, most people who experiment with cannabis when they are young, greatly diminish or end their use in their late twenties; it is the long-term, frequent users who have tried and failed to quit who are most likely to develop CUD.15  


References:

  1. 1. American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C.: American Psychiatric Association, p. 182.
  2. 2. World Health Organization (WHO). (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization, pp. 56-57.
  3. 3. Hasin, D.S., Saha, T.D., Kerridge, B.T., Goldstein, R.B., Chou, S.P., Zhang, H., Jung, J., Pickering, R.P., Ruan, W.J., Smith, S.M., Huang, B., & Grant, B.F. (2015). “Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013,” JAMA Psychiatry, 72(12): 1235–42.
  4. 4. Joy, J.E., Watson, S.J., & Benson, J.A. (Eds). (1999). Marijuana and Medicine: Assessing the Science Base. Washington, D.C.: National Academies Press.
  5. 5. Lichtman, A.H. & Martin, B.R. (2005). “Cannabinoid tolerance and dependence,” In Cannabinoids, Roger G. Pertwee (Ed.). Handbook of Experimental Pharmacology, volume 168, pp. 691–717. Berlin Heidelberg: Springer-Verlag.
  6. 6. Angarita, G.A., Emadi, N., Hodges, S., & Morgan, P.T. (2016). “Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: A comprehensive review,” Addiction Science & Clinical Practice, 11, 9.
  7. 7. D'Souza, D.C., Ranganathan, M., Braley, G., Gueorguieva, R., Zimolo, Z., Cooper, T., Perry, E., & Krystal, J. (2008). “Blunted psychotomimetic and amnestic effects of delta-9-tetrahydrocannabinol in frequent users of cannabis,” Neuropsychopharmacology, 33(10): 2505–16.
  8. 8. Health Canada. (2013). Information for Health Care Professionals: Cannabis (Marihuana, Marijuana) and the Cannabinoids. Ottawa: Health Canada.
  9. 9. Schierenbeck, T., Riemann, D., Berger, M., & Hornyak, M. (2008). “Effect of illicit recreational drugs upon sleep: Cocaine, ecstasy and marijuana,” Sleep Medicine Reviews, 12(5): 381–9.
  10. 10. Babson, K. A., Sottile, J., & Morabito, D. (2017). Cannabis, cannabinoids, and sleep: A review of the literature. Current Psychiatry Reports, 19: 23.
  11. 11. Danovitch, I. & Gorelick, D.A. (2012). “State of the art treatments for cannabis dependence,” The Psychiatric Clinics of North America, 35(2): 309–26.
  12. 12. Levin, K.H., Copersino, M.L., Heishman, S.J., Liu, F., Kelly, D.L., Boggs, D.L., & Gorelick, D.A. (2010). “Cannabis withdrawal symptoms in non-treatment-seeking adult cannabis smokers,” Drug and Alcohol Dependence, 111: 120–27.
  13. 13. Bonnet, U. & Preuss, U.W. (2017). “The cannabis withdrawal syndrome: Current insights,” Substance Abuse and Rehabilitation, 8: 9–37.
  14. 14. Budney, A.J., Roffman, R., Stephens, R.S., & Walker, D. (2007). “Marijuana dependence and its treatment,” Addiction Science & Clinical Practice, 4(1): 4–16.
  15. 15. Hall, W., Renström, M., & Poznyak, V. (Eds.). (2016). The Health and Social Effects of Nonmedical Cannabis Use. Geneva, Switzerland: World Health Organization.

 

Does Cannabis Really Increase Your Creativity?
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by Dr. Nicola Davies

For decades, artists and entertainers (among others) have extolled the creative benefits of cannabis. Bob Marley believed that “music and herb go together.” Lady Gaga has said she uses cannabis when she writes her songs. Steve Jobs claimed that cannabis made him feel creative. The astronomer Carl Sagan even wrote an essay in 1969 for a book by Dr. Lester Grinspoon titled “Marihuana Reconsidered,” in which he wrote that cannabis increased his appreciation of art, music and food.

To test the hypothesis that cannabis increases creativity, researchers from various fields are conducting studies to establish a reliable link . However, what has emerged is that the link to creativity is more complex than previously thought and hinges on many factors, including the dose of cannabis, its quality and the user’s personality. Researchers who have collated their evidence from properly controlled studies do not necessarily agree with the well-publicized perceptions of many famous users.  So, who is right?

 

In pursuit of the definition of creativity

While creativity is commonly defined as the ability to interpret traditional thinking in new and innovative ways, it is not necessarily confined to artists and performers; a person may be able to use their creativity to make more friends or to find fifty uses for a paperclip. In other words, the definition of creativity can refer either to a person’s output or their personality type.

 

Divergent and convergent thinking

During tests designed to understand how cannabis can affect creativity, scientists measured two types of thinking involved in creativity. There is divergent thinking, where a person arrives at a number of solutions to a problem through brainstorming many different ideas — the more alternate and innovative ideas, the more creative they are. Guildford’s Alternative Uses Task is used to measure this ability.

In convergent thinking, scientists measure a person’s ability to find the most appropriate solution to a defined problem using the Remote Associates Task. In a 2015 Dutch study, the researchers found that if they gave their participants high doses of delta-9-tetrahydrocannabinol (THC) (22mg) versus a low dose (5.5mg) in vaporized cannabis, those on the high dose experienced a drop in creativity, when compared to participants in the  low dose and placebo groups.1 Specifically, high THC doses impaired divergent thinking. On a lower dose, participants scored better on verbal fluency tests, an important aspect of divergent thinking. The study found that the THC content in cannabis, the regularity of how much the person smokes, and the personality type influenced the results. It cited a study in which scores on the Torrance Test of Creative Thinking (TTCT) went down after smoking a joint for those who smoked cannabis regularly; but, for first time users, the TTCT scores increased.2

When less potent cannabis was smoked, users reported feeling that their artistic inhibitions were relaxed. But the question still remained: Did it really allow for better creativity? Scientists looked to neurotransmitters in the brain for answers.

 

It all comes down to dopamine

Dopamine is a neurotransmitter that can increase communication between the neurons and is commonly responsible for activating hormones to produce a “feel good” effect. In a University College of London study, researchers found that low doses of THC allowed neurons in the brain to fire with less inhibition.3 This meant that everyday thoughts were more united rather than random, allowing for deeper concentration. Many studies have documented that cannabis can increase the cerebral blood flow, allowing frontal lobe activation and increased neuron activity, thereby allowing artists to live in the moment and, as Carl Sagan mentioned, increase their appreciation of whatever is in that moment.

At the Karolinska Institute in Sweden, researchers looked at the dopamine receptors of people termed ‘highly creative.’4 They found that a low density of these dopamine receptors in the thalamus allowed many thoughts to get through without the dopamine performing its usual filtering task. This process could be responsible for the divergent thinking of highly creative people, as well as individuals with schizophrenia. But, what effect does cannabis have on individuals at risk of schizophrenia?

 

Psychotic symptoms

According to Rebecca Kuepper of the Department of Psychiatry and Psychology at Maastricht University in the Netherlands, those who take large doses of cannabis to enhance creativity run the risk of psychotic symptoms that could persist long-term.5 Although the researchers involved in Kuepper’s study were cautious, they did say that the natural endocannabinoid system has an important role to play, which could explain why THC affected neurotransmission in people whose dopamine levels were not well regulated, such as those with a psychotic disorder. It would seem from various studies that healthy individuals can cope with low doses of THC, even helping them to focus on their creative output. On the other hand, those at risk of schizophrenia can internalize this creativity in the form of paranoia and delusions.

 

Cannabis might help those low on creativity

In research conducted by Gráinne Schafer and her team from the Clinical Psychopharmacology Unit at University College London, two groups were identified — one with high-trait creativity and one with low-trait creativity.3 Researchers measured scores of various functions on a day when there was no cannabis use and again on a day when cannabis was administered. They found that verbal fluency scores for the group with low-trait creativity increased on the days they had cannabis. In fact, the scores matched the levels of those in the creative group, which they believed might be due to the increased dopamine release reducing inhibitions. They also found that THC seemed to have a disruptive effect on convergent thinking when searching for and converging on a single solution to a problem.

 

Non-users versus regular users

People who smoke cannabis regularly were found to have a fairly low level of dopamine functioning, and with the increase in dopamine activity they would perform better on a divergent thinking task, as long as the THC dose was not too strong. In contrast, for healthy people who have never smoked cannabis and who have no dopamine imbalances, a low dose of THC could stimulate dopamine production to such an extent that they could not perform at optimum levels, therefore reducing their creative ability.

Among highly creative individuals, whether or not they used cannabis regularly, a low dose of THC did not have a negative impact on their creative thinking. It would seem that very creative people have built-in protective systems prevent their brains from being overloaded with neuron activity and an excess of dopamine production.

Overall, it has been established that low doses of cannabis allow most people to focus — in other words, they become more productive rather than creative when they are writing, composing, or painting. In their relaxed state, it seems that cannabis users are able to embrace the ideas normally floating around in their heads and spend the time needed to transform them into a product. So, creative people are right in the  sense that moderate cannabis use allows them to concentrate long enough to sit down and come up with the product that proves their innate creative ability. However, whether using cannabis actually makes a person more creative is still under investigation. ♦   


1.  Kowal, M. A., Hazekamp, A., Colzato, L. S., van Steenbergen, H., van der Wee, N. J. A., Durieux, J., … Hommel, B. (2015). Cannabis and creativity: highly potent cannabis impairs divergent thinking in regular cannabis users. Psychopharmacology232(6), 1123–1134.

2.  Bourassa M, Vaugeois P (2001) Effects of marijuana use on divergent thinking. Creat Res J 13:411–416.

3.  Schafer, G., Feilding, A., Morgan, C. J. A., Agathangelou, M., Freeman, T. P., & Valerie Curran, H. (2012). Investigating the interaction between schizotypy, divergent thinking and cannabis use. Consciousness and Cognition21(1), 292–298.

4.  de Manzano Ö, Cervenka S, Karabanov A, Farde L, Ullén F (2010) Thinking Outside a Less Intact Box: Thalamic Dopamine D2 Receptor Densities Are Negatively Related to Psychometric Creativity in Healthy Individuals. PLoS ONE 5(5): e10670. 

5.  Kuepper R, Ceccarini J, Lataster J, van Os J, van Kroonenburgh M, van Gerven JMA, et al. (2013) Delta-9-Tetrahydrocannabinol-Induced Dopamine Release as a Function of Psychosis Risk: 18F-Fallypride Positron Emission Tomography Study. PLoS ONE 8(7): e70378.

 

Dr. D's Easy Access to Medical Marijuana
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by Amanda Pampuro, photos courtesy of Dr. Donald Davidson

Dr D's Van advertising online cannabis cards

You usually don’t want to hear “doctor” and “virus” in the same sentence, but Dr. D. is taking medical marijuana viral. Earlier this year, Dr. Donald Davidson launched the first tele-medicine platform for cannabis. Now individuals in California with pre-existing conditions can apply for a medical marijuana card from anywhere with WiFi.

“There’s always this buzzword in medicine, which is access, right? And tele-medicine creates access for people that wouldn’t actually have it, whether it’s too big of an inconvenience or they’re elderly or immobile or whatever,” Davidson said. 

Since Davidson partnered with Ease, a California-based cannabis delivery company, his patients can be approved for a referral card and obtain medicine all from within the comfort of their home.

“The way it works is this is a specialized medicine. People are coming in with chronic conditions that have been going on for years and years … so they fill out an intake form and you ask them questions, so you already know what’s going on,” Davidson said. “Our job is to educate people and to screen out people who are unstable, have mental illnesses, and screen out people with new issues. So we wouldn’t give a recommendation just seeing someone online with a new onset, like knee-pain or redness or swelling over the last few weeks or months.”

Dr. D's fleet of smart cars

Harboring an entrepreneurial spirit, Davidson’s other business ventures have included the milk and cookie delivery service. Campus Cookies, running a fishing and kayaking tour service, and being a dating coach. Describing himself as a “typical smart guy,” Davidson was first exposed to the work of Dr. Sue Sisley — famous for her extended struggle to test the efficacy of cannabis in the treatment of PTSD — during his residency at the University of Arizona where he studied emergency medicine.

“The far majority of these [cannabis] doctors [in LA] were total weirdos,” Davidson said. “They had horrible malpractice and were hiding in the cannabis industry, folks prescribing narcotics, over-prescribing Adderall, and giving out fake doctor’s notes. And once we saw that, we were like, ‘Wow, okay, we have a huge opportunity to create this portal to make it safe and normal.’”

“I always loved the business stuff, promoting it, building the business, running the ad campaign, social media, all that stuff,” Davidson said, adding that he personally vets all of the doctors he works with, ensuring his staff maintains both certification and professional appearance.

While he declined to disclose who is launching it, Davidson said, “The Dr. D product line, named in my honor for all my work in the field, is being launched by a friend of mine who has licensed and legal cultivation and manufacturing operations.” While Davidson said he has no financial interest in the product line, he is giving both his name and knowledge to its development.

Dr. Davidson vape pen

“I think the greatest challenge, but it’s also the most fun, is educating people about cannabis,” Davidson said, adding that cannabis is still off the radar for most medical schools. “So me, with an MD behind my name, anything I say publicly must have science behind it. You know, I’m not a stupid staff writer … or any of that bullshit where they fill up these big articles with a bunch of spammy links that’s all fluff, meant to drive traffic to their website. I’m a doctor. What I specialize in is taking massive amounts of information fed to me fire-hose style and finding the need-to-know take away points that people can actually use in a clinically relevant way.”

In addition to using his website as an educational resource for patients, Davidson is about to take a mobile clinic on a road trip across the Golden State to retirement homes and country clubs.

By “educating people that most of these budtenders are 18-year-olds who know nothing of [the] pharmacology of cannabis,” Dr. D. hopes his consultation services will keep the ethos of medical marijuana strong. ♦

Mysterious Marijuana: Myths and Realities
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by Dr. Nicola Davies

Weed, pot, grass, hashish, cannabis, marijuana — whatever you call it, unarguably no other plant in history has been so controversial. Is marijuana an adverse substance that has corrupted users over time? Or does it hold secrets that could change the way it is perceived? Let’s delve into the myths, realities, and possible benefits of this infamous substance.

 
Myth #1: Marijuana is a  gateway to addiction

For decades, marijuana has been nicknamed the “gateway drug” since it is often the first drug people try. In the U.S. and Canada it is the most commonly used illicit drug. According to a survey conducted by Yahoo and The Marist Institute, 55 million Americans have tried the drug at least once in their lifetime.1 Due to its wide use, it may be a gateway drug for some.2 However, the idea that it tempts users to progress to harder substances is mere speculation. There is little evidence to prove that marijuana drives dependence on other drugs. Dr. Karen van Gundy, researcher at the University of New Hampshire, says, “There seems to be this idea that we can prevent later drug problems by making sure kids never smoke pot. But whether marijuana smokers go on to use other illicit drugs depends more on social factors like being exposed to stress and being unemployed — not so much whether they smoked a joint in the eighth grade.”3

 

Myth #2: Marijuana is more addictive than tobacco and alcohol

Marijuana may lead to substance abuse. Research suggests that people who start using marijuana before they turn 18 are more susceptible to substance abuse than those who start using as adults.4 However, many studies over the years have proven that alcohol and tobacco are more addictive than marijuana. For example, Ruben Baler, health scientist administrator for the National Institute on Drug Abuse, said in an interview for a Live Science article, that the adverse effects of alcohol are far more direct and immediate compared to marijuana use. Gary Murray from the National Institute on Alcohol Abuse and Alcoholism also believes that alcohol is often more dangerous than marijuana as it is more likely to react with other drugs.5

 

Myth #3: Marijuana is an herb, so it cannot be harmful

As marijuana is natural, people think it isn’t harmful. While its effects may not be instant, studies have shown correlations between its use and negative health effects. For example, depending on consumption levels, it can interfere with the brain’s ability to process information, which can impact the ability to drive. In 2016, scientists at The National Institutes of Health cited the widespread use of marijuana by American teenagers, with symptoms including slowed cerebral development, depression, and insomnia. 6 According to the World Health Organization (WHO), cannabis can also result in chronic bronchitis.7 Thus, while data on marijuana’s negative effects are not enough to make a conclusive connection, it is by no means harmless.

 

Myth #4: Marijuana has only short-term physical effects

Marijuana, like any illicit drug or even prescription medicine, can have adverse repercussions. However, it boils down to the question of how much is too much. For some, marijuana serves as a rite of passage in their youth. It is unlikely that such users would suffer any long-term consequences. Short-term symptoms can include altered vision and impaired movement and thinking. In contrast, those who become dependent on marijuana and turn into chronic users are likely to have far greater problems, just like an alcoholic or a chain smoker.8 However, to say that marijuana is a killer is a gross exaggeration.

 

Myth #5: Marijuana leads to crime

Marijuana and crime — this connection is as old as marijuana itself. Negative connotations are typical with anything illicit or socially unacceptable. This is not to say that negative perceptions are entirely baseless. In 2013, a study by the office of National Drug Control Policy suggested a strong connection between drug use and crime.9 In 2016, another study found that the long-term use of cannabis could trigger violent behavior.10 However, it can be argued that conclusions from statistically correlative studies may not consider subjective factors such as socioeconomic circumstances or personality traits.

 

Myth #6: Legalizing marijuana will increase its use

Legalized marijuana is not new. The drug is already fully legal in eight states and Washington D.C., as well as partially legal in countries such as The Netherlands and Germany. According to the writer Austin Smith, legalizing marijuana has its advantages. For instance, it offers social benefits like employment and increased tax revenue.11 A major argument against legalizing marijuana is the risk of encouraging teenagers to use it more. However, a survey of youth behavior in the U.S. indicated that teenage use of marijuana has declined over the past two decades.12 Federal statistics indicate that in Colorado, teenage use of marijuana dropped after legalization.13

 

Myth #7: Marijuana causes mental illness and brain damage

Being an illicit drug, marijuana has been shrouded by speculation driven by prejudice and fear. A study by the National Academies of Sciences showed only moderate evidence of an association between the use of marijuana and cognitive impairment. With respect to mental health, the study did suggest a connection to conditions such as schizophrenia in frequent cannabis users.14 But while heavy doses may potentially trigger mental illness, there is no conclusive data to suggest that marijuana causes brain damage.15

 

Myth #8: Marijuana cannot possibly have medicinal benefits

According to the US National Cancer Institute, the use of marijuana for healing goes back over 3,000 years when it was used to alleviate pain and control seizures.16 It’s not a new trend — prescription drugs such as tetrahydrocannabinol have been legitimately sold in the U.S. for years. Cannabinoids are effective in treating symptoms such as vomiting, pain, and muscular stiffness. In 2012, researchers at the University of Plymouth, UK discovered that marijuana helped ease muscle stiffness in 30 percent of 300 multiple sclerosis patients in their sample group.17 A 2017 National Academies of Sciences report on the health effects of marijuana stated that cannabinoids are effective for treating chronic pain in adults, as well as epileptic seizures.18 Although current research on the medicinal benefits of marijuana remains inadequate, its healing qualities are well known and it has been legalized for medical purposes in many countries.

 

Myth #9: Marijuana works miracles in glaucoma treatment

Glaucoma is an eye condition in which optic nerves are damaged due to high eye pressure, or intraocular pressure (IOP). Glaucoma can be managed by lowering IOP. In this context, studies indicate that smoking marijuana could reduce IOP. However, marijuana can only reduce IOP for a few hours, which is why ophthalmologists do not recommend it as a treatment.19


 Myth #10: Medicinal marijuana reverses cancer

Marijuana can reverse or cure cancer — it’s the buzzword that’s gone viral across social media channels in recent times. However, while it has been proven that medical cannabis provides cancer patients relief from chemotherapy’s side effects and studies in animals have indicated that cannabinoids lower tumor growth, there is not enough research to state definitively that marijuana can cure cancer. 20

 

Marijuana Mysteries: The Journey Continues

The world is in the midst of medical innovation, including heightened speculation on marijuana. In this context, it remains to be seen whether marijuana is exalted to the higher echelons of healthcare or if it simply continues its colorful journey through time. But one thing is certain: The myths and misconceptions will also evolve along the way. ♦


References:

1 Yahoo News & Marist College Institute for Public Opinion. (2017). ‘Yahoo News/Marist Poll: Weed & The American Family’. [pdf] USA: Marist College Institute for Public Opinion. Available at: http://maristpoll.marist.edu/wp-content/misc/Yahoo%20News/20170417_Summary%20Yahoo%20News-Marist%20Poll_Weed%20and%20The%20American%20Family.pdf [Accessed 20/06/2017]

2 Secades-Villa R, Garcia-Rodríguez O, Jin CJ, Wang S, Blanco C. (2015) ‘Probability and predictors of the cannabis gateway effect: a national study,’ International Journal of Drug Policy, 26(2):135-142.

3 Gundy, K. (2010). ‘Sep 07, 2010 Researchers Debunk the Gateway Theory … Again’ [blog] 7 September. Available at: https://blog.mpp.org/tag/karen-van-gundy/ [Accessed 20 June 2017]

4 Winters KC, Lee C-YS. (2008). ‘Likelihood of developing an alcohol and cannabis use disorder during youth: Association with recent use and age.’ Drug Alcohol Depend. 92(1-3):239-247.

5 Brownstein, J. (2014). ‘Marijuana vs. Alcohol: Which Is Really Worse for Your Health?’ [blog] 21 January. Available at: www.livescience.com/42738-marijuana-vs-alcohol-health-effects.html/ [Accessed 21 June 2017]

6 Zajicek JP, Hobart JC, Slade A, et al. (2012). ‘Multiple Sclerosis and Extract of Cannabis: results of the MUSEC trial.’ Journal of Neurology, Neurosurgery & Psychiatry. 83:1125-1132.

7 World Health Organization (2017). ‘Management of substance abuse: Cannabis Facts and Figures.’ Available at: www.who.int/substance_abuse/facts/cannabis/en [Accessed 21 June 2017]8

 9 Executive Office of the President of the United States. (2013). ‘National Drug Control Strategy’. [pdf] The White House. Available at: https://obamawhitehouse.archives.gov/sites/default/files/ondcp/policy-and-research/ndcs_2013.pdf [Accessed 21/06/2017]

 10 Schoeler, T et al. (2016) ‘Continuity of cannabis use and violent offending over the life course’ Cambridge Core; Psychological Medicine, 46(8):1663-77.

11 Smith, A. (2016). ‘4 marijuana stats that will blow you away’ [blog] 17 May. Available at: www.usatoday.com/story/sponsor-story/motley-fool/2016/05/17/motley-fool-marijuana-stats/84326712/ [Accessed 21/06/2017]

12 Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Service. (2016). ‘MMWR Series: Youth Risk Behavior Surveillance - United States, 2015. [pdf] USA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Available at: www.cdc.gov/healthyyouth/data/yrbs/pdf/2015/ss6506_updated.pdf [Accessed 22/06/2017]

13 SAMHDA—the Substance Abuse and Mental Health Data Archive (2015). ‘National Survey on Drug Use and Health: Comparison of 2013-2014 and 2014-2015 Population Percentages

(50 States and the District of Columbia).’ [pdf] USA: SAMHDA. Available at: http://samhda.s3-us-gov-west-1.amazonaws.com/s3fs-public/field-uploads/2k15StateFiles/NSDUHsaeShortTermCHG2015.htm [Accessed 22/06/2017]

14 National Academy of Science (2017). ‘The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research’ [pdf] USA: National Academy of Science. Available at: www.drugabuse.gov/publications/marijuana/what-are-marijuanas-long-term-effects-brain [Accessed 22/06/2017]

 15 National Institute on Drug Abuse (NIDA) (2017). ‘Marijuana’ [pdf] USA: NIDA. Available at: http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-report-highlights.pdf [Accessed 22/06/2017]

 16 National Cancer Institute (2017). ‘Cannabis and Cannabinoids (PDQ®)–Patient Version’ [blog] 13 April. Available at: www.cancer.gov/about-cancer/treatment/cam/patient/cannabis-pdq#link/_7 [Accessed 20/06/2017]

17 Zajicek, J.P. et al (MUSEC Research Group) (2012). ‘MUltiple Sclerosis and Extract of Cannabis: results of the MUSEC trial’ [pdf] UK: University of Plymouth. Available at: http://jnnp.bmj.com/content/83/11/1125 [Accessed 21/06/2017]

 18 National Academy of Science (2017). ‘The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research’ [pdf] USA: National Academy of Science. Available at: www.drugabuse.gov/publications/marijuana/what-are-marijuanas-long-term-effects-brain [Accessed 22/06/2017]

19 Turbert, D. (2014). ‘Does Marijuana Help Treat Glaucoma?’, EyeSmart, American Academy of Ophthalmology, 27 June [online]. Available at: www.aao.org/eye-health/tips-prevention/medical-marijuana-glaucoma-treament [Accessed 21/06/2017]

20 Kossen, J. (2016). ‘Can Cannabis Cure Cancer?’ [blog] 27 March. Available at: www.leafly.com/news/health/can-cannabis-cure-cancer [Accessed 21/06/2017]

Cannabis Treatment for Hypertension
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By Dr. Nicola Davies

What Is Hypertension?

Hypertension, also known as high blood pressure, is a serious, chronic medical issue. It occurs when your blood pumps through your veins with too much power. People with hypertension are more likely to suffer from cardiovascular diseases and premature death.  Blood pressure is measured in two parts: systolic pressure and diastolic pressure. The systolic pressure, the top number in blood pressure readouts, expresses how much pressure your blood applies to your artery walls when your heart beats. Since your heart is pumping, the blood pressure is higher and that is the reason the systolic is the top number. The diastolic pressure expresses how much pressure your blood applies to your artery walls between heartbeats. When your heart is not pumping, the pressure is lower and that is why the diastolic pressure is the bottom number. If your systolic pressure is higher than 140 mmHg or your diastolic pressure is over 90 mmHg, then you have hypertension.1 There are many ways to treat high blood pressure, including diet, exercise and maintaining a healthy weight, and studies now show that use of medical marijuana could be a viable treatment for this condition as well.

 

How Can Cannabis Help with Lowering Blood Pressure?

 

Cannabis as Dietary Supplement

A study on hypertensive rats, conducted by researchers at the Department of Human Nutritional Sciences, University of Manitoba, Canada, presents interesting results on the effects of the hemp seed (Cannabis sativa L.)  on systolic blood pressure.2 In a two-month feeding experiment with spontaneous hypertensive rats, the normal systolic pressure was controlled or even decreased when they were fed with hemp seed protein (HPI) or protein hydrolysate (HMH) compared to a casein-only diet. After the third week of the experiment, the rats that had hemp seed protein hydrolysate added to their diet had statistically significant reduction of their systolic pressure compared to the other groups. In the second experiment with adult rats with established hypertension, the diets containing hemp seed peptides or proteins also had an antihypertensive effect compared to the other diet groups. Based on the findings of this research, hemp seed could potentially be used as a nutritional additive for the prevention and treatment of high blood pressure.

Smoking Marijuana

In an early placebo-controlled study amongst patients with glaucoma, marijuana smoking resulted not only in reduced intraocular pressure but also in decreased blood pressure.3 It has also been shown that five to ten minutes after marijuana consumption, subjects can experience tachycardia (a heart rate that exceeds the normal resting rate) and decreased blood pressure.4 A more recent study comprising US adults found that the marijuana smokers had 69 percent probability of not suffering from hypertension compared to non-smokers.5 Nonetheless, the same study demonstrated that the number of years of marijuana use is an important factor and that in the long-term, marijuana smoking can have negative effects on metabolic health. Indeed, research has shown that the sudden discontinuance of cannabis use in heavy users could increase blood pressure.6 Furthermore, the diastolic pressure of the study participants escalated from a mean (SEM) of 74.8 (0.7) mmHg while smoking marijuana to a mean of 81.8 (0.6) mmHg following cessation. Similarly, the mean systolic pressure raised from 129.6 (0.9) mmHg to 139.8 (0.8) mmHg and the mean arterial pressure was also increased.6

 

Cannabinoids in Vivo

The application of cannabis extracts in vivo has also demonstrated positive effects on blood pressure. Rimonabant, a cannabinoid CB1 receptor antagonist, could potentially lower blood pressure, especially in males. In a study where obese or overweight patients were given 20mg rimonabant as a means of controlling their weight, both their diastolic and systolic blood pressure decreased.7 This reduction was even more evident in patients with pre-existing hypertension. Other cannabinoid extracts, such as the main psychoactive ingredient of marijuana, Δ9-tetrahydrocannabinol (THC) and anandamide, caused low blood pressure in unconscious spontaneous hypertensive rats, and the effects of amandine were still evident even when the rats were conscious.

 

Mechanism of Cannabinoids and their Effects

Sándor Bátkai, PhD, and colleagues explored the relationship between the endocannabinoid system and the cardiovascular system, concluding that “endocannabinoids tonically suppress cardiac contractility in hypertension” and that “enhancing the CB1-mediated cardio depressor and vasodilator effects of endogenous anandamide by blocking its hydrolysis can normalize blood pressure.”8 They also argued that focusing on the endocannabinoid system could potentially lead to novel treatments for hypertension. Furthermore, follow-up research found that, “Functional CB1 receptors are present in vascular tissue as well as the myocardium,” and therefore “cannabinoid agonists and endocannabinoids exert major hypotensive and cardio depressor effects in vivo through the stimulation of CB1 receptors.”9 The authors maintain that pharmaceutical research on the endocannabinoid system could prove beneficial for treating high blood pressure and ischemic heart disease.

 

Indirect Ways of Cannabis Effects to Hypertension

Hypertension has many underlying causes, including smoking, obesity, lack of physical activity, a diet high in salt, excessive consumption of alcohol, stress, sleep apnea, genetics, adrenal and thyroid disorders, chronic kidney disease, genetics, and older age.10 Cannabis could be used to treat some of these conditions and, thus, indirectly treat hypertension.

 

Obesity: In a study of 4,657 US adult males and females, it was demonstrated that current marijuana use resulted in lower levels of fasting insulin and smaller waist circumference.11 Based on a study investigating marijuana use and metabolic syndrome among adults in the U.S., current cannabis users were 45 percent less likely to present with metabolic syndrome compared to those who had never used cannabis. For the middle-aged participants, the findings were more interesting, as both current and past users had lower probabilities of developing metabolic syndrome as opposed to those who had never used marijuana.12

 

Stress: In a review study, in which the author examined the effects of medicinal marijuana and post-traumatic stress disorder (PTSD), it was concluded that marijuana use is associated with lower levels of PTSD.13 Neurobiological studies performed on animals and humans confirm these findings, but more research is needed.

 

What does the Future Hold?

Despite the numerous studies examining the effect of cannabis on blood pressure, there are no cannabinoid-based medicines produced which target hypertension. Even though the use of cannabis has been proven highly beneficial with reducing intraocular pressure and marijuana is legally prescribed to patients with glaucoma, there is still room for improvement to prove its benefits for lowering blood pressure. As there is not yet any study that focuses on the effects of marijuana and its extracts on hypertensive patients, the antihypertensive potential of cannabis is left largely unexplored. Ideally, more studies with hypertensive patients should be considered to provide reliable data which physicians can use to prescribe cannabis-based treatment for this condition.

 

 

References:

  1. Eisenberg, J. M. (2012). Measuring Your Blood Pressure at Home. Center for Clinical Decisions and Communications Science. Retrieved February 21, 2017, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0041082/#conssmbp.s3
  2. Girgih, A. T., Alashi, A., He, R., Malomo, S., & Aluko, R. E. (2014). Preventive and treatment effects of a hemp seed (Cannabis sativa L.) meal protein hydrolysate against high blood pressure in spontaneously hypertensive rats.European journal of nutrition53(5), 1237-1246.
  3. Merritt, J. C., Crawford, W. J., Alexander, P. C., Anduze, A. L., & Gelbart, S. S. (1980). Effect of marijuana on intraocular and blood pressure in glaucoma.Ophthalmology87(3), 222-228.
  4. Merritt, J. C. (1982). Glaucoma, hypertension, and marijuana.Journal of the National Medical Association74(8), 715.
  5. Yankey, B. N., Strasser, S., & Okosun, I. S. (2016). A cross-sectional analysis of the association between marijuana and cigarette smoking with metabolic syndrome among adults in the United States.Diabetes & Metabolic Syndrome: Clinical Research & Reviews10(2), S89-S95.
  6. Vandrey, R., Umbricht, A., & Strain, E. C. (2011). Increased blood pressure following abrupt cessation of daily cannabis use.Journal of addiction medicine5(1), 16.
  7. Pacher, P., Bátkai, S., & Kunos, G. (2006). The endocannabinoid system as an emerging target of pharmacotherapy.Pharmacological reviews58(3), 389-462.
  8. Bátkai, S., Pacher, P., Osei-Hyiaman, D., Radaeva, S., Liu, J., Harvey-White, J., ... & Kunos, G. (2004). Endocannabinoids acting at cannabinoid-1 receptors regulate cardiovascular function in hypertension.Circulation110(14), 1996-2002.
  9. Pacher, P., Bátkai, S., & Kunos, G. (2005). Blood pressure regulation by endocannabinoids and their receptors.Neuropharmacology48(8), 1130-1138.
  10. Klodas,E. (2015).Causes of high blood pressure. (2015). WebMD. Retrieved February 23, 2017, from, http://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causes#1
  11. Penner, E. A., Buettner, H., & Mittleman, M. A. (2013). The impact of marijuana use on glucose, insulin, and insulin resistance among US adults.The American journal of medicine126(7), 583-589.
  12. Vidot, D. C., Prado, G., Hlaing, W. M., Florez, H. J., Arheart, K. L., & Messiah, S. E. (2016). Metabolic Syndrome among marijuana users in the United States: an analysis of National Health and Nutrition Examination Survey data.The American journal of medicine129(2), 173-179.
  13. Yarnell, S. (2014). The Use of Medicinal Marijuana for Posttraumatic Stress Disorder: A Review of the Current Literature.The primary care companion for CNS disorders17(3).

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