The long-term, daily use of cannabis is associated with improved analgesia and reduced opioid use in patients with treatment-resistant chronic pain conditions, according to clinical trial data reported online ahead of print in The Clinical Journal of Pain.
Investigators with Hebrew University in Israel evaluated the use of cannabis on pain in a cohort of 176 patients, each of whom had been previously unresponsive to all conventional pain medications. Subjects inhaled THC-dominant cannabis daily (up to 20 grams per month) for a period of at least six months.
A majority of participants (66 percent) experienced improvement in their pain symptom scores after cannabis therapy, and most reported “robust” improvements in their quality of life. Subjects’ overall consumption of opioid drugs declined 44 percent by the end of the trial, and a significant percentage of participants discontinued opioid therapy altogether over the course of the study.
Authors concluded, “In summary, this long-term prospective cohort suggests that cannabis treatment in a mixed group of patients with treatment-resistant chronic pain may result in improved pain, sleep and quality of life outcomes, as well as reduced opioid use.”
The Israeli results are similar to those reported in a 2015 Canadian trial which concluded that chronic pain patients who use herbal cannabis daily for one-year experienced reduced discomfort and increased quality of life compared to controls, and did not possess an increased risk of serious side effects.
According to data published in 2014 in The Journal of the American Medical Association, US states with medical marijuana laws experience far fewer opiate-related deaths than do states that prohibit the plant. Investigators from the RAND Corporation and the University of California, Irvine reported similar findings in 2015, concluding, “States permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.” Clinical data published in 2011 in the journal Clinical Pharmacology & Therapeutics previously reported that the administration of vaporized cannabis “safely augments the analgesic effect of opioids.”
A review published earlier this year in the Canadian Journal of Anesthesia assessing the clinical use of cannabinoids for pain in over 1,300 subjects concludes, “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.”
An abstract of the study, “The effect of medicinal cannabis on pain and quality of life outcomes in chronic pain: A prospective open-label study,” appears online here.
A report published last fall claiming that an estimated three in ten consumers of cannabis suffer from a ‘use disorder’ has been dismissed in a new study published in JAMA Psychiatry.
Investigators at the Washington School of Medicine in St. Louis assessed trends in marijuana use and the prevalence of marijuana use disorders during the years 2002 to 2013. Researchers determined that the self-reported use of cannabis by adults increased an estimated 19 percent, but that reports of cannabis-related problems actually declined during this same period.
“We’re certainly seeing some increases in marijuana use,” the lead researcher of the new study said. “But our survey didn’t notice any increase in marijuana-related problems. Certainly, some people are having problems so we should remain vigilant, but the sky is not falling.”
Separate evaluations of self-reported marijuana use by young people have determined that rates of cannabis use by high-school students is significantly lower today than it was 15 years ago.
Full text of the study, “Recent Trends in the Prevalence of Marijuana Use and Associated Disorders in the United States,” appears online in JAMA Psychiatry here.
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.