Could marijuana be an effective pain alternative to prescription medications?
July 1, 2019
Science Daily/Taylor & Francis Group
A new study has shown how cannabis could be an effective treatment option for both pain relief and insomnia, for those looking to avoid prescription and over the counter pain and sleep medications -- including opioids.
The study, published in the Journal of Psychoactive Drugs, which looked at 1,000 people taking legalized marijuana in an American state found that among the 65% of people taking cannabis for pain, 80% found it was very or extremely helpful.
This led to 82% of these people being able to reduce, or stop taking over the counter pain medications, and 88% being able to stop taking opioid painkillers.
74% of the 1,000 interviewees bought it to help them sleep -- 84% of whom said the marijuana had helped them, and over 83% said that they had since reduced or stopped taking over-the-counter or prescription sleep aids.
The study suggests that cannabis could lower opioid use. However, the researchers caution that more needs to be done to understand the potential therapeutic benefits of cannabis.
"Approximately 20% of American adults suffer from chronic pain, and one in three adults do not get enough sleep," says Dr Gwen Wurm, Assistant Professor of Clinical Pediatrics at the University of Miami Miller School of Medicine.
Traditional over the counter medications and painkillers can help, however they may have serious side effects. Opioids depress the respiratory system, meaning that overdoses may be fatal.
"People develop tolerance to opioids, which means that they require higher doses to achieve the same effect," says Dr. Julia Arnsten, Professor of Medicine at Albert Einstein College of Medicine. "This means that chronic pain patients often increase their dose of opioid medications over time, which in turn increases their risk of overdose."
Although less common, sleeping pills can lead to dependence, and can also cause grogginess the next day, interfering with people's work and social lives.
As a consequence, some people are looking to marijuana to help with their symptoms.
To find out more about these users, Wurm and her colleagues used survey data from people who purchased cannabis from two retail stores in Colorado, US, where it is legal for both medical and recreational use -- meaning any adult over 21 with a valid government ID may purchase product.
"In states where adult use of cannabis is legal, our research suggests that many individuals bypass the medical cannabis route (which requires registering with the state) and are instead opting for the privacy of a legal adult use dispensary," says Wurm.
Although the survey was conducted among customers willing to participate -- meaning the results may not reflect the overall population of dispensary customers -- other national survey data, and data from medical patients at medical cannabis dispensaries, also demonstrate that people who use cannabis to treat symptoms both decrease and stop their use of prescription medications.
The study adds weight to the theory that widening access to medical cannabis could lower the use of prescription painkillers, allowing more people to manage and treat their pain without relying on opioid prescription drugs that have dangerous side effects.
This is backed up with other research that shows that states with medical cannabis laws have a 6.38% lower rate of opioid prescribing, and that Colorado's adult-use cannabis law is associated with a relative reduction in opioid overdose death rate from 1999 to 2010.
Wurm adds: "Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen cause GI bleeding or kidney damage with chronic use. Paracetemol (Acetaminophen) toxicity is the second most common cause of liver transplantation worldwide, and is responsible for 56,000 ER visits, 2600 hospitalizations, and 500 deaths per year in the U.S."
However, the researchers caution that more research is needed to understand the health benefits and side effects of cannabis.
"The challenge is that health providers are far behind in knowing which cannabis products work and which do not. Until there is more research into which cannabis products work for which symptoms, patients will do their own "trial and error," experiments, getting advice from friends, social media and dispensary employees," says Wurm.
https://www.sciencedaily.com/releases/2019/07/190701224523.htm
Pain relief without the high
January 4, 2017
Science Daily/Leiden, Universiteit
Researchers at Leiden University led by Mario van der Stelt (Leiden Institute for Chemistry) have set ‘gold standards’ for developing new painkillers based on the medicinal effects of cannabis.
Medicinal marijuana
Medicinal marijuana is in frequent use as a painkiller, but its psycho-active side-effects are a major disadvantage. The pharmaceutical industry is desperately seeking a synthetic form of cannabis that inhibits inflammation and pain, but without the high. Leiden researchers have now brought the development of such drugs a step closer. In an article in Nature Communications they set out 'gold standards' for the use of reference substances, to improve trials with synthetic cannabis.
Many of the clinical trials carried out to date with with synthetic cannabis have failed, with no measurable effect being recorded in patients. One of the causes of these failures can be found in the pre-clinical lab, during testing with animals. Substances are often used in these tests whose biochemical and molecular-pharmaceutical effects have never been properly characterised. As a result, there have been a lot of contradictory publications on research findings, the results of which cannot be reproduced. This is having a major effect on the allocation of research funding, the use of animal testing and the exposure of patients to non-active substances.
International and public-private collaboration
Marjolein Soethoudt, a PhD candidate in Van der Stelt's research group, studied together with 12 international academic groups, the National Institute of Health (US) and pharmaceuticals concern Hoffman-LaRoche (Switzerland), the 18 most commonly used reference substances, including the psychoactive ingredient in marijuana, Δ9-THC. They carried out their studies under standardised conditions in 36 different tests, to analyse the molecular pharmacological characteristics of the substances. They hoped to be able to identify the most suitable reference sustances for the research on synthetic cannabis. The research led to three 'gold standards' that should make it possible to give an impetus to the development of new painkillers and anti-inflammatories.
Cannabinoid CB2 receptor
Δ9-THC binds to two types of proteins in the human body: the cannabinoid CB1 receptor in the brain and the cannabinoid CB2 receptor in the immune system. Activating the CB1 receptor in the brain makes you high, while activating the CB2 receptor has an anti-inflammatory effect. The three 'gold standards' are molecules that are highly selective in activating only the CB2 receptor and ignoring the CB1 receptor. These three gold standards also appeared to cause the fewest side-effects, nor did they give the mice a high. Earlier studies have shown that these substances do have an analgesic and anti-inflammatory effect. The researchers advise that these three gold standards should be used in future in research on new medicines that rely on the activation of the cannabinoid CB2 receptor for their effectiveness.
Medical marijuana laws linked to health and labor supply benefits in older adults
Findings show that pain declines, assessments of health improve and Americans remain in the workforce
March 19, 2019
Science Daily/Johns Hopkins University Bloomberg School of Public Health
A study that examined older Americans' well-being before and after medical marijuana laws were passed in their state found reductions in reported pain and increased hours worked. The study suggests medical marijuana laws could be improving older Americans' health.
The paper analyzed more than 100,000 responses from survey participants age 51 and older from 1992 to 2012. Researchers found a 4.8 percent decrease in reported pain and a 6.6 percent increase in reported very good or excellent health among respondents with a health condition that would qualify for medical marijuana after their states passed medical marijuana laws relative to similar respondents whose states did not pass a law.
The study appears in the Spring 2019 issue of the Journal of Policy Analysis and Management.
"Our study is important because of the limited availability of clinical trial data on the effects of medical marijuana," says Lauren Hersch Nicholas, PhD, assistant professor in the Bloomberg School's Department of Health Policy and Management. "While several studies point to improved pain control with medical marijuana, research has largely ignored older adults even though they experience the highest rates of medical issues that could be treated with medical marijuana."
Medical marijuana remains controversial as national support for it surges. Opponents continue to argue that legalizing medical marijuana would promote illegal use of the drug and increase misuse of related substances. Supporters highlight the potential health benefits of medical marijuana for pain management and other conditions. By the end of 2018, 33 states and Washington, D.C. had passed laws legalizing medical use of marijuana.
For their study, researchers used data from the 1992-2012 Health and Retirement Study (HRS), the largest nationally representative survey to have track health and labor market outcomes among older Americans. The researchers examined survey responses about symptoms that have a plausible link to one's ability to work: frequency of pain, whether health limits work, overall health assessment and depressive symptoms. At the time of the analysis, 20 states had medical marijuana laws in place.
The analysis matched medical marijuana law effective dates to the HRS interview responses, based on month and year, to track the possible effects of these policy changes. The analysis used 100,921 participant responses that represented individuals with one or more of four health conditions that would qualify for medical marijuana treatment under most state laws (arthritis, cancer, glaucoma and pain). The paper found that 55 percent of the study sample were suffering from one or more of these diagnoses.
The study found that medical marijuana laws lead to increases in full-time work in both samples.
In the sample that would qualify for medical marijuana treatment, the researchers found a greater increase in full-time work after medical marijuana laws were passed. In the full sample, researchers found a 5 percent increase in full-time work versus a 7.3 percent in the sample that qualified for medical marijuana. These results suggest that any decline in productivity resulting from medical marijuana usage -- such as not being able to work at capacity while under treatment -- is outweighed by increased capacity to work.
The study found no evidence that medical marijuana laws were associated with changes in daily activities such as getting dressed, going to the bathroom or walking.
"These findings underscore the close relationship between health policy and labor supply within older adults," says Nicholas. "When we're doing policy evaluations, we have to think not only about whether the policy is changing health outcomes, but also whether it does it in a way that supports labor force participation."
The results can help inform policy decisions about medical marijuana policy and broaden clinical support for additional research on marijuana as an effective medical treatment. This is important, the authors say, because marijuana is still illegal and classified as a schedule 1 drug at the federal level, and there remains limited clinical evidence available to inform medical marijuana policies and treatment options for many patients, especially older adults.
The study was supported by the National Institute on Aging.
https://www.sciencedaily.com/releases/2019/03/190319121750.htm
Could medical marijuana help older people with their ailments?
New study shows it may be safe and effective for symptoms of chronic disease
February 28, 2019
Science Daily/American Academy of Neurology
Medical marijuana may bring relief to older people who have symptoms like pain, sleep disorders or anxiety due to chronic conditions including amyotrophic lateral sclerosis, Parkinson's disease, neuropathy, spinal cord damage and multiple sclerosis, according to a preliminary study released today that will be presented at the American Academy of Neurology's 71st Annual Meeting in Philadelphia, May 4 to 10, 2019. The study not only found medical marijuana may be safe and effective, it also found that one-third of participants reduced their use of opioids. However, the study was retrospective and relied on participants reporting whether they experienced symptom relief, so it is possible that the placebo effect may have played a role. Additional randomized, placebo-controlled studies are needed.
According to the Centers for Disease Control and Prevention, approximately 80 percent of older adults have at least one chronic health condition.
"With legalization in many states, medical marijuana has become a popular treatment option among people with chronic diseases and disorders, yet there is limited research, especially in older people," said study author Laszlo Mechtler, MD, of Dent Neurologic Institute in Buffalo, N.Y., and a Fellow of the American Academy of Neurology. "Our findings are promising and can help fuel further research into medical marijuana as an additional option for this group of people who often have chronic conditions."
The study involved 204 people with an average age of 81 who were enrolled in New York State's Medical Marijuana Program. Participants took various ratios of tetrahydrocannabinol (THC) to cannabidiol (CBD), the main active chemicals in medical marijuana, for an average of four months and had regular checkups. The medical marijuana was taken by mouth as a liquid extract tincture, capsule or in an electronic vaporizer.
Initially, 34 percent of participants had side effects from the medical marijuana. After an adjustment in dosage, only 21 percent reported side effects. The most common side effects were sleepiness in 13 percent of patients, balance problems in 7 percent and gastrointestinal disturbances in 7 percent. Three percent of the participants stopped taking the medical marijuana due to the side effects. Researchers said a ratio of one-to-one THC to CBD was the most common ratio among people who reported no side effects.
Researchers found that 69 percent of participants experienced some symptom relief. Of those, the most common conditions that improved were pain with 49 percent experiencing relief, sleep symptoms with 18 percent experiencing relief, neuropathy improving in 15 percent and anxiety improving in 10 percent.
Opioid pain medication was reduced in 32 percent of participants.
"Our findings show that medical marijuana is well-tolerated in people age 75 and older and may improve symptoms like chronic pain and anxiety," said Mechtler. "Future research should focus on symptoms like sleepiness and balance problems, as well as efficacy and optimal dosing."
The study was supported by the Dent Family Foundation.
https://www.sciencedaily.com/releases/2019/02/190228164023.htm
Nerve pain in the legs? Medical marijuana may alter brain connections, bring relief
September 5, 2018
Science Daily/American Academy of Neurology
When medical marijuana is taken for chronic nerve pain, it may provide pain relief by reducing connections between the areas of the brain that process emotions and sensory signals, according to a study published in the September 5, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study looked specifically at radicular pain, a type of nerve pain that radiates from the spine into the legs. Sciatica is a common form of radicular pain.
The component of marijuana examined in this study was tetrahydrocannabinol (THC), one of many cannabinoids found in marijuana and the one most commonly associated with producing a high.
"Pain is a complex experience that involves both the senses and emotions," said study author Haggai Sharon, MD, of the Sagol Brain Institute, Tel Aviv Medical Center in Israel. "Our study results link pain relief from THC with a reduction in the connections between areas of the brain otherwise heavily connected, suggesting that THC may alleviate pain by disrupting signals between these pain processing pathways."
The study involved 15 men with chronic radicular nerve pain with an average age of 33. Women were excluded since hormone fluctuations during menstruation may affect pain sensitivity. All participants had medium to high radicular pain for over six months.
Before treatment, participants rated their pain levels and had brain scans with functional magnetic resonance imaging (fMRI) to look at the connections between various areas of the brain. Participants were then given treatment with THC.
For the first visit, nine participants were given an average of 15 milligrams of THC oil placed under the tongue and six were given placebo oil. One hour after treatment, participants were questioned again, and had another brain scan approximately two hours after treatment.
At least one week later, participants returned for a second visit and those who had the placebo now received the treatment, and vice versa.
Researchers found that THC reduces a person's pain when compared to placebo. On a scale of zero to 100, before taking medication, on average participants rated their pain levels at 53. After taking THC oil, they rated their pain levels at an average of 35 compared to an average of 43 for those who were given the placebo.
In addition, the more pain relief a person experienced, the greater the reduction of connections between the areas of the brain involved in processing pain.
"Interestingly, our results also show that the more connected the areas of the brain that process emotion and sensory prior to treatment, the greater the pain relief experienced when taking THC," said Sharon. "Larger studies are needed to confirm our findings."
Limitations of the study are that women were excluded and the number of participants was small. Also, this study looked only at THC. Future studies are needed to examine how other components of the marijuana plant, like cannabidiol, may be useful in relieving pain in combination with THC.
The study was funded by the Yahel Foundation and the Israeli Ministry of Science, Technology and Space.
https://www.sciencedaily.com/releases/2018/09/180905161942.htm
An alternative to medical marijuana for pain?
March 4, 2015
Science Daily/Elsevier
Medical marijuana is proliferating across the country due to the ability of cannabis ingestion to treat important clinical problems such as chronic pain. However, negative side effects and the development of tolerance limit the widespread therapeutic use of Δ9-tetrahydrocannabinol (Δ9-THC), the major psychoactive ingredient in cannabis.
THC's side effects are produced via its actions at cannabinoid CB1 receptors in the brain. Thus, scientists theorized that an agent with similar mechanistic actions, but that activate CB2 receptors instead, may eliminate the unwanted side effects while maintaining an equivalent level of efficacy.
Dr. Andrea Hohmann and her colleagues at Indiana University tested this strategy and found that, unlike Δ9-THC, repeated dosing with the cannabinoid CB2 agonist AM1710 suppresses chemotherapy-induced pain in mice without producing tolerance, physical withdrawal, motor dysfunction, or hypothermia. Moreover, the therapeutic effects of AM1710 were preserved in mice lacking CB1 receptors but absent in mice lacking CB2 receptors.
Their findings are reported in the current issue of Biological Psychiatry.
"Our study is important because it demonstrates beyond doubt that activation of cannabinoid CB2 receptors suppresses neuropathic pain without producing signs of physical dependence (i.e., a withdrawal syndrome) or other unwanted side effects associated with activation of CB1 receptors in the brain," said Hohmann.
Their studies used animals that were treated with a chemotherapeutic agent (paclitaxel) to produce pain. When animals were given AM1710, a CB2 agonist, its pain-suppressive effects were fully preserved and its therapeutic effects were maintained even after repeated dosing.
Alternatively, and as expected, when animals were given Δ9-THC, they developed complete tolerance to the pain-suppressing effects of THC and with repeated dosing, THC was no longer effective in suppressing neuropathic pain.
When the THC-treated animals were challenged with a drug that blocks CB1 receptors in the brain, the animals showed a prominent withdrawal syndrome, indicating signs of physical dependence following removal of THC. Strikingly, this was not the case with the CB2 agonist; blocking either CB1 or CB2 receptors produced no signs of withdrawal in animals treated chronically with the CB2 agonist.
Hohmann added, "We think our data suggests that CB2 receptors are an important target for suppressing chronic pain without unwanted side effects (e.g. psychoactivity, addiction)."
"It is important to know whether the benefits of cannabis ingestion for pain could be attributed in large part to the stimulation of CB2 receptors," commented Dr. John Krystal, Editor of Biological Psychiatry. "CB2 agonists, in theory, would present less risk regarding addiction and intoxication than the ingestion of cannabis or THC."
More work will be necessary before CB2 receptor agonists could be prescribed for use in humans, but for now, these data support the therapeutic potential of CB2 agonists for managing pain without the adverse effects associated with cannabis.
https://www.sciencedaily.com/releases/2015/03/150304075336.htm
Medical marijuana gets wary welcome from older adults, poll shows
Most accept its use with doctor's recommendation, but want more research
April 3, 2018
Science Daily/Michigan Medicine - University of Michigan
Few older adults use medical marijuana, a new national poll finds, but the majority support its use if a doctor recommends it, and might talk to their own doctor about it if they developed a serious health condition. And two-thirds say the government should do more to study the drug's health effects.
Four out five of poll respondents between the ages of 50 and 80 said they support allowing medical marijuana if it's recommended by a physician. Forty percent support allowing marijuana use for any reason.
And two-thirds say the government should do more to study the drug's health effects, according to the new findings from the National Poll on Healthy Aging.
While more than two-thirds of those polled said they thought that marijuana can ease pain, about half said they believed prescription pain medications were more effective than marijuana.
The poll was conducted in a nationally representative sample of 2,007 Americans between the ages of 50 and 80 by the University of Michigan Institute for Healthcare Policy and Innovation. It was sponsored by AARP and Michigan Medicine, U-M's academic medical center.
"While just six percent of our poll respondents said they'd used marijuana for medical purposes themselves, 18 percent said they know someone who has," says U-M's Preeti Malani, M.D., director of the poll and a specialist in treatment of older patients. "With medical marijuana already legal in 29 states and the District of Columbia, and other states considering legalizing this use or all use, this is an issue of interest to patients, providers and policymakers alike."
She notes that the poll results indicate older Americans have a sense of wariness, rather than wholehearted acceptance, around medical use of marijuana. This may be surprising to those who think of the Baby Boom generation -- who are now in their mid-50s to early 70s -- as embracing marijuana use in their youth in the 1960s and 1970s.
Marijuana and pain
The poll sheds new light on older Americans' attitudes toward the use of marijuana to control pain -- one of the most common conditions cited in state medical marijuana statutes. Just under one-third of respondents said they feel that marijuana definitely provides pain relief, and another 38 percent said it probably does. But only 14 percent thought marijuana was more effective than prescription pain medication, while 48 percent believed the opposite and 38 percent believed the two were equally effective. When it came to controlling dosages for pain relief, though, prescription pain medicine won out: 41 percent thought it would be easier to control dosage with medication.
The poll also asked respondents about negative effects of both substances. In all, 48 percent thought prescription pain medicines are more addictive than marijuana, and 57 said that such medicines have more side effects than marijuana.
"These perceptions of relative safety and efficacy are important for physicians, other providers and public health regulators to understand," says Malani. Marijuana use, particularly long-term use, has been associated with impaired memory, decision making and ability to perform complex tasks.
The widespread support by older Americans for more research on the effects of marijuana is especially significant, she says, given the growing legalization trend in states and the continued federal policy that marijuana use is illegal.
"Although older adults may be a bit wary about marijuana, the majority support more research on it," says Alison Bryant, Ph.D., senior vice president of research for AARP. "This openness to more research likely speaks to a desire to find safe, alternative treatments to control pain."
Research on marijuana's effects and related issues can be done under carefully controlled circumstances, but few studies have included older adults. The new poll results indicate an appetite for further government-sponsored research, including government-standardized dosing.
Malani, a professor of internal medicine at the U-M Medical School who specializes in infectious diseases and geriatrics, notes that providers should be routinely asking older patients about marijuana use.
Only one in five poll respondents said their primary health care provider had asked whether they use marijuana. A slightly lower percentage said they thought their provider was knowledgeable about medical marijuana -- but three-quarters said they simply didn't know how much their provider knows about the topic.
Still, 70 percent of those who answered the poll said they would definitely or probably ask their provider about marijuana if they had a serious medical condition that might respond to it. That means providers need to be ready to answer questions and provide counseling to patients, especially in states where medical marijuana is legal.
The poll results are based on answers from a nationally representative sample of 2,007 people ages 50 to 80. The poll respondents answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.
A full report of the findings and methodology is available at http://www.healthyagingpoll.org, along with past reports on National Poll on Healthy Aging findings.
https://www.sciencedaily.com/releases/2018/04/180403085044.htm