We read with interest the recent review of medical use of cannabinoids (1). As the authors attempt to emphasize, they focus on a heterogeneous collection of experiments that employed a range of treatments, including synthetic THC, CBD, and THC-mimicking drugs.
Lay readers might inappropriately generalize these results specifically to whole plant medical cannabis But few (only two) of these experiments were conducted using medical cannabis; most of the studies reviewed focused on outcome measures that do not address the plant’s potential advantages over a single, compound agent in pill form.
For example, the authors conclude that evidence of individual, synthetic cannabinoids to help nausea and vomiting due to chemotherapy was low in quality. Within hours of the publication of the paper, mainstream media coverage applied these conclusions to medical cannabis per se, not just medical cannabinoids (2). In fact, as the authors emphasize, only 6 of the 28 studies assessing nausea and vomiting used THC, and none of these actually employed vaporized or inhaled botanical cannabis. The dependent measures were also not sensitive to the key advantage of medical cannabis for nausea: speed of onset. (Inhaled medicines can work within seconds. Sprayed extracts require at least a half hour while cannabinoids in pill form can take multiple hours.) The authors were generally careful about these caveats, but the disparate and inaccurate media coverage suggests that flagship journals in all fields now have to be even more diligent when cautioning readers about the inappropriate generalization of results. Despite increasing popularity, medical cannabis remains controversial and, apparently, newsworthy. As reviews of the effects of cannabinoids proliferate, authors, editors, journal staff, and journalists might welcome a reminder that cautions about interpretation need to be spelled out in more effusive, detailed, and thorough ways.
Mitch Earleywine, Ph.D.
University at Albany
Department of Psychology
Chair, NORML Board of Directors
National Organization for the Reform of Marijuana Laws (NORML)
Amanda Reiman, Ph.D.
Drug Policy Alliance
1) Whiting PF, Wolff RF, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA, 2015: 313(24):2456-2473
2) Seaman, AM. Medical marijuana: good evidence for some diseases, weak for others. Reuters. June 24, 2015. http://www.reuters.com/article/2015/06/23/us-marijuana-medical-evidence-idUSKBN0P31WT20150623
Brain imaging research published this month in the journal Molecular Psychiatry provides physiological evidence as to why cannabis may mitigate certain symptoms of post-traumatic stress disorder (PTSD)
Post-traumatic stress syndrome is an anxiety disorder that is estimated to impact some eight million Americans annually. Yet, to date, there are no pharmaceutical treatments specifically designed or approved to target symptoms of PTSD.
Investigators at the New York University School of Medicine and the New York University Langone Medical Center, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury reported that subjects diagnosed with PTSD typically possess elevated quantities of endogenous cannabinoid receptors in regions of the brain associated with fear and anxiety. Investigators also determined that many of these subjects experience a decrease in their natural production of anandamide, an endogenous cannabinoid neurotransmitter, resulting in an imbalanced endocannibinoid regulatory system.
Researchers speculated that an increase in the body’s production of cannabinoids would likely restore subjects’ natural brain chemistry and psychological balance. They affirmed, “[Our] findings substantiate, at least in part, emerging evidence that … plant-derived cannabinoids such as marijuana may possess some benefits in individuals with PTSD by helping relieve haunting nightmares and other symptoms of PTSD.”
They concluded: “The data reported herein are the first of which we are aware of to demonstrate the critical role of CB1 (cannabinoid) receptors and endocannabinoids in the etiology of PTSD in humans. As such, they provide a foundation upon which to develop and validate informative biomarkers of PTSD vulnerability, as well as to guide the rational development of the next generation of evidence-based treatments for PTSD.”
Anecdotal evidence and case study reports have increasingly indicated that cannabis may mitigate traumatic memories and anxiety. However, clinical trial data remains unavailable, in large part because US federal officials have blocked investigators’ efforts to study cannabis in PTSD subjects. In 2011 federal administrators halted efforts by investigators at the University of Arizona to complete an FDA-approved, placebo-controlled clinical trial to evaluate the use of cannabis in 50 veterans with treatment-resistant PTSD.
PTSD is also seldom identified as a qualifying condition in states that allow for the physician authorized use of cannabis therapy. (To date, only New Mexico explicitly cites PTSD as a qualifying condition for cannabis treatment, although a handful of other states, like California, allow doctors the discretion to legally recommend marijuana for post-trauma subjects.) In Oregon, lawmakers in the House are considering Senate-approved legislation, SB 281, that would allow PTSD patients to legally consume cannabis under the state’s nearly 15-year-old medical marijuana program.
Tremendous PBS Video Explains Why Medical Cannabis Works — And How Big Pharma Is Planning To Cash In On ItAugust 25, 2011
PBS is to be commended for producing this excellent video summarizing the science behind the use of cannabis as a medicine.
Want to know why cannabis is effective at treating multiple symptoms and conditions? Watch this video. Want to know how cannabinoids selectively target and kill cancer cells? Watch this video. Want to know how many patents Big Pharma has taken out on cannabis-derived synthetic drugs? Watch this video.
And then share it with your friends and family.
[Editor’s note: This post is excerpted from this week’s forthcoming NORML weekly media advisory. To have NORML’s media advisories and legislative updates delivered straight to your in-box, sign up for ‘NORML News’ here.]
Cannabis inhalation and the administration of cannabinoids are both associated with “significant analgesic effects” in the treatment of chronic non-cancer pain, according to a systemic review of randomized controlled trials to be published in the British Journal of Clinical Pharmacology.
Investigators from the University of Toronto, Hospital for Sick Children, conducted a literature review regarding the efficacy of cannabinoids in the treatment of chronic pain, including neuropathic pain, fibromyalgia, rheumatoid arthritis, and mixed chronic pain. Eighteen randomized controlled trials published between 2003 and 2010 involving a total of 766 participants met inclusion criteria. Four of the trials assessed inhaled cannabis, while other studies assessed the analgesic properties of either plant-derived cannabinoids or synthetic cannabinoids.
“Overall the quality of trials was excellent,” authors wrote. “Fifteen of the eighteen trials that met inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared to placebo, several reported significant improvements in sleep. There were no serious adverse effects.”
Researchers noted that all four trials involving inhaled cannabis “found a positive effect with no serious adverse side effects.” They added: “Of special importance is the fact that two of the trials examining smoked cannabis demonstrated a significant analgesic effect in HIV neuropathy, a type of pain that has been notoriously resistant to other treatments normally used for neuropathic pain. In the trial examining cannabis based medicines in rheumatoid arthritis a significant reduction in disease activity was also noted, this is consistent with pre-clinical work demonstrating that cannabinoids are anti-inflammatory.”
Investigators concluded, “[C]annabinoids are a modestly effective and safe treatment option for chronic non-cancer (predominantly neuropathic) pain. Given the prevalence of chronic pain, its impact on function and the paucity of effective therapeutic interventions, additional treatment options are urgently needed. More large-scale trials of longer duration reporting on pain and level of function are required.”
NORML has additional information on the analgesic properties of cannabinoids in its handbook, Emerging Clinical Applications for Cannabis and Cannabinoids, here.
NORML has recently posted online the fourth edition of its popular and comprehensive booklet, “Emerging Clinical Applications for Cannabis & Cannabinoids: A Review of the Recent Scientific Literature.”
Updated and revised for 2011, this report reviews approximately 200 newly published scientific studies assessing the safety and efficacy of marijuana and its compounds in the treatment and management of nineteen clinical indications: Alzheimer’s disease, Amyotrophic Lateral Sclerosis (ALS), chronic pain, diabetes mellitus, dystonia, fibromyalgia, gastrointestinal disorders, gliomas and other cancers, hepatitis C, human immunodeficiency virus (HIV), hypertension, incontinence, methicillin-resistant Staphyloccus aureus (MRSA), multiple sclerosis, osteoporosis, pruritus, rheumatoid arthritis, sleep apnea, and Tourette’s syndrome.
Explains the report’s lead author, NORML Deputy Director Paul Armentano: “The conditions profiled in this report were chosen because patients frequently inquire about the therapeutic use of cannabis to treat these disorders. In addition, many of the indications included in this report may be moderated by cannabis therapy. In several cases, preclinical data and clinical data indicates that cannabinoids may halt the progression of these diseases in a more efficacious manner than available pharmaceuticals.”
The updated report also features a new section, authored by osteopath and medical cannabis specialist Dr. Dustin Sulak, highlighting the significance of the endocannabinoid system and its role in maintaining mental and physiological health.
“As we continue to sort through the emerging science of cannabis and cannabinoids, one thing remains clear: a functional cannabinoid system is essential for health,” writes Dr. Sulak. “From embryonic implantation on the wall of our mother’s uterus, to nursing and growth, to responding to injuries, endocannabinoids help us survive in a quickly changing and increasingly hostile environment. As I realized this, I began to wonder: can an individual enhance his/her cannabinoid system by taking supplemental cannabis? Beyond treating symptoms, beyond even curing disease, can cannabis help us prevent disease and promote health by stimulating an ancient system that is hard-wired into all of us? I now believe the answer is yes.”
Full text of the report is now available online here. Hard copies will be available for purchase shortly. Print copies of the third edition of this report will be made available at a reduced rate for those seeking bulk orders. (Please e-mail NORML for further details.)