Cannabinoids are safe and effective in the treatment of chronic pain conditions, according to a review of recent clinical trials published online ahead of print in the Canadian Journal of Anesthesia.
Investigators at the University of Montreal, Department of Anesthesiology evaluated the results of 26 clinical trials “of good or excellent quality” involving 1,364 subjects. Trials assessed the use of various types of cannabinoid preparations, including herbal cannabis, liquid and oral cannabis extracts, and synthetic cannabinoid agents in pain treatment.
Authors reported that cannabinoids were efficacious in alleviating various types of pain, including pain due to neuropathy, musculoskeletal disorders, fibromyalgia, HIV, and other chronic pain conditions.
They concluded, “Overall, the recent literature supports the idea that currently available cannabinoids are modestly effective analgesics that provide a safe, reasonable therapeutic option for managing chronic non-cancer-related pain and possibly cancer-related pain.”
Their conclusion mimics that of a 2015 systematic review published in the Journal of Neuroimmune Pharmacology that reported, “[C]annabinoids are safe, demonstrate a modest analgesic effect, and provide a reasonable treatment option for treatment of chronic non-cancer pain.”
An abstract of the study, “Medical cannabis: considerations for the anesthesiologist and pain physician,” appears online here.
The administration of cannabis oil extracts high in cannabidiol reduces seizure frequency in children with intractable epilepsy, according to clinical data published online ahead of print in the journal Seizure.
Israeli researchers retrospectively evaluated the effects of CBD oil in a multicenter cohort of 74 patients with intractable epilepsy. Participants in the trial were resistant to conventional epilepsy treatment and were treated with CBD extracts for a period of at least three months. Extracts in the study were provided by a pair of Israeli-licensed growers and were standardized to possess a CBD to THC ratio of 20 to 1.
Investigators reported: “CBD treatment yielded a significant positive effect on seizure load. Most of the children (89 percent) reported reduction in seizure frequency. … In addition, we observed improvement in behavior and alertness, language, communication, motor skills and sleep.”
They concluded, “The results of this multicenter study on CBD treatment for intractable epilepsy in a population of children and adolescents are highly promising. Further prospective, well-designed clinical trials using enriched CBD medical cannabis are warranted.”
In 2013, the United States Food and Drug Administration granted orphan drug status to imported, pharmaceutically standardized CBD (aka Epidiolex) extracts for use in experimental pediatric treatment. Open-label safety trial data published online in December 2015 in the journal Lancet Neurology reported a median reduction in seizures in adolescent patient treated with Epidiolex that approached 40 percent. Authors concluded, “Our findings suggest that cannabidiol might reduce seizure frequency and might have an adequate safety profile in children and young adults with highly treatment-resistant epilepsy.”
An abstract of the study, “CBD-enriched medical cannabis for intractable pediatric epilepsy: The current Israeli experience,” appears online here.
Electronically driven vaporizers deliver cannabinoids in a relatively safe and reliable manner, according to data published in the journal PLOS ONE.
Swiss investigators evaluated the ability of various types of vaporizer technologies to safely and effectively release THC and CBD (cannabidiol) in vapor. Researchers reported that electronically driven devices, which allow for precise temperature control, were able to provide for relatively safe and uniform dosing. By contrast, gas-powered devices performed in a more unreliable manner and “cannot be recommended for therapeutic purposes.”
Authors concluded, “[T]he four electrically-driven and temperature-controlled vaporizers investigated in this study efficiently decarboxylate acidic cannabinoids and release reliably the corresponding neutral cannabinoids into the vapor. Therefore, they can be considered as a promising application mode for the safe and efficient administration of medicinal cannabis and cannabinoids.”
Vaporizer technology seeks to heat marijuana to a point where cannabinoid vapors form, but below the point of combustion. In clinical trials, investigators have concluded that vaporization “does not result in exposure to combustion gases” and produces higher plasma concentrations of THC compared to smoked cannabis.
The full text of the study, Medicinal Cannabis: “In vitro validation of vaporizers for the smoke-free inhalation of cannabis,” appears online here.
The administration of liquid cannabis extracts containing THC is associated with the mitigation of various symptoms of Alzheimer’s-related agitation and dementia, according to observational trial data published online ahead of print in The Journal of Alzheimer’s Disease.
Israeli investigators assessed the use of cannabis oil as an adjunct pharmacotherapy treatment in ten Alzheimer’s disease patients over a period of several weeks. Researchers reported that drug administration was associated with a significant reduction in patients’ symptom severity scores. Specifically, cannabis oil ingestion corresponded with decreased levels of aggression, irritability, apathy, and delusions.
Investigators concluded, “Adding medical cannabis oil to Alzheimer’s disease patients pharmacotherapy is safe and a promising treatment option.”
The administration of dronabinol (oral synthetic THC in pill form) has previously been reported to reduce Alzheimer’s-induced agitation and improve weight gain, while preclinical studies have theorized that cannabinoids may be neuroprotective against the onset of the disease.
An abstract of the study, “Safety and efficacy of medical cannabis oil for behavioral and psychological symptoms of dementia: An open label, add-on, pilot study,” appears online here.
Investigators at the University of California, Los Angeles and the University of Minnesota evaluated whether marijuana use was associated with changes in intellectual performance in two longitudinal cohorts of adolescent twins. Participants were assessed for intelligence at ages 9 to 12, before marijuana involvement, and again at ages 17 to 20.
Researchers reported no dose-response relationship between cannabis use and IQ decline. They also found no significant differences in performance among marijuana using subjects when compared to their non-using twins.
Investigators concluded: “In the largest longitudinal examination of marijuana use and IQ change, … we find little evidence to suggest that adolescent marijuana use has a direct effect on intellectual decline. … [T]he lack of a dose–response relationship, and an absence of meaningful differences between discordant siblings lead us to conclude that the deficits observed in marijuana users are attributable to confounding factors that influence both substance initiation and IQ rather than a neurotoxic effect of marijuana.”
The findings follow the publication of a separate longitudinal study in the Journal of Pharmacology which concluded that cumulative adolescent marijuana use is not associated with lower IQ or poorer educational performance once adjustments are made for potential confounders, specifically cigarette smoking.
An abstract of the study, “Impact of adolescent marijuana use on intelligence: Results from two longitudinal twin studies,” is online here.