Legal marijuana products too strong for pain relief
March 26, 2020
Science Daily/Wake Forest Baptist Medical Center
More than 90% of the legal marijuana products offered in medical dispensaries are much stronger than what clinical studies have shown that doctors recommend for chronic pain relief, according to a study published in the March 26 online edition of the journal PLOS ONE.
To many that may seem like a good thing, but just the opposite is true.
"We know that high-potency products should not have a place in the medical realm because of the high risk of developing cannabis-use disorders, which are related to exposure to high THC-content products," said the study's lead author, Alfonso Edgar Romero-Sandoval, M.D., Ph.D., associate professor of anesthesiology at Wake Forest School of Medicine, part of Wake Forest Baptist Health.
"Several earlier studies showed that levels of up to 5% tetrahydrocannabinol (THC) -- the main psychoactive compound in marijuana that provides pain relief as well as intoxication -- were sufficient to reduce chronic pain with minimal side effects."
The goal of this study was to evaluate the advertised THC and CBD content of legal cannabis products to determine their suitability for medicinal use, and to compare the potency of the products offered in medical and recreational programs.
The researchers recorded the concentrations of THC and cannabidiol (CBD) -- the non-euphoric compound in marijuana -- in all plant cannabis products provided by legal dispensary websites and compared them between or within the states in the study: California, Colorado, Maine, Massachusetts, New Hampshire, New Mexico, Rhode Island, Vermont and Washington. A total of 8,505 cannabis products across 653 dispensaries were sampled.
Romero-Sandoval's team found that most of the products offered in the medical dispensaries in the study had more than 10% THC and that many had 15% or more, the same as what is available in products at recreational dispensaries.
This is problematic because between 60% and 80% of people who use medical marijuana use it for pain relief, Romero-Sandoval said. The higher the concentration of THC the greater risk, not only for developing dependency, but also for developing tolerance more quickly, which means higher and higher concentrations might be needed to get the same level of pain relief.
"It can become a vicious cycle," Romero-Sandoval said.
"Better regulation of the potency of medical marijuana products is critical. The FDA regulates the level of over-the-counter pain medications such as ibuprofen that have dose-specific side effects, so why don't we have policies and regulations for cannabis, something that is far more dangerous?"
This study provides the scientific evidence to help policy makers correct mistakes and to create a better framework to protect patients, he said.
https://www.sciencedaily.com/releases/2020/03/200326144354.htm
Cannabis as painkiller
August 7, 2012
Science Daily/Deutsches Aerzteblatt International
Cannabis-based medications have been demonstrated to relieve pain. Cannabis medications can be used in patients whose symptoms are not adequately alleviated by conventional treatment. The indications are muscle spasms, nausea and vomiting as a result of chemotherapy, loss of appetite in HIV/Aids, and neuropathic pain.
This is the conclusion drawn by Franjo Grotenhermen and Kirsten Müller-Vahl in issue 29-30 of Deutsches Ärzteblatt International.
The clinical effect of the various cannabis-based medications rests primarily on activation of endogenous cannabinoid receptors. Consumption of therapeutic amounts by adults does not lead to irreversible cognitive impairment. The risk is much greater, however, in children and adolescents (particularly before puberty), even at therapeutic doses.
Over 100 controlled trials of the effects of cannabinoids in various indications have been carried out since 1975. The positive results have led to official licensing of cannabis-based medications in many countries. In Germany, a cannabis extract was approved in 2011 for treatment of spasticity in multiple sclerosis. In June 2012 the Federal Joint Committee (the highest decision-making body for the joint self-government of physicians, dentists, hospitals and health insurance funds in Germany) pronounced that the cannabis extract showed a slight additional benefitfor this indication and granted a temporary license until 2015.
https://www.sciencedaily.com/releases/2012/08/120807101232.htm
Cannabis pain relief without the 'high'
Mechanism of cannabidiol for safe pain relief without side effects
October 24, 2018
Science Daily/McGill University Health Centre
In the wake of cannabis legalization, a team of scientists at the Research Institute of the McGill University Health Centre (MUHC) and McGill University have delivered encouraging news for chronic pain sufferers by pinpointing the effective dose of marijuana plant extract cannabidiol (CBD) for safe pain relief without the typical "high" or euphoria produced by the THC. The findings of their study have been published in the journal PAIN (The Journal of the International Association for the Study of Pain).
Cannabis indica and sativa are the two main cannabis strains that produce the pharmacological principles known as tetrahydrocannabinol (THC) and cannabidiol (CBD). Dr. Gabriella Gobbi's team demonstrated that CBD does not act on the CB1 cannabinoid receptors like THC but through the mechanism that binds specific receptors involved in anxiety (serotonin 5-HT1A) and pain (vanilloid TRPV1). Researchers were able to extrapolate the exact dosage of CBD displaying analgesic and antianxiety properties without the risk of addiction and euphoria classically produced by the THC.
"We found in animal models of chronic pain that low doses of CBD administered for seven days alleviate both pain and anxiety, two symptoms often associated in neuropathic or chronic pain," says first author of the study Danilo De Gregorio, a post-doctoral fellow at McGill University in Dr. Gobbi's laboratory.
Lead author Dr. Gobbi, a researcher in the Brain Repair and Integrative Neuroscience (BRaIN) Program of the RI-MUHC, sees this as advancement for the evidence-based application of cannabis in medicine with CBD offering a safe alternative to THC and opioids for chronic pain, such as back pain, sciatica, diabetic, cancer and post-trauma pain.
"Our findings elucidate the mechanism of action of CBD and show that it can be used as medicine without the dangerous side effects of the THC," says Dr. Gobbi, who is also Professor of Psychiatry at the Faculty of Medicine at McGill University and staff psychiatrist at the MUHC. "This research is a new advancement for an evidence-based application of cannabis in medicine."
Despite widespread public usage, little clinical studies exist on CBD, which became legal in Canada on October 17, 2018, following the passage of Canada's Cannabis Act.
"There is some data showing that CBD provides pain relief for humans but more robust clinical trials are needed ," says Dr. Gobbi, a recent grant recipient for her study of the pharmalogical effects of CBD.
https://www.sciencedaily.com/releases/2018/10/181024163625.htm