The administration of a single dose of whole-plant cannabis via a thermal-metered inhaler is effective and well tolerated among patients suffering from neuropathy (nerve pain), according to clinical trial data published online ahead of print in the Journal of Pain and Palliative Care Pharmacotherapy.
Israeli investigators assessed the efficacy of a novel, portable metered-dose cannabis inhaler in eight subjects diagnosed with chronic neuropathic pain. Researchers reported that the device administered an efficient, consistent, and therapeutically effective dosage of cannabinoids to all participants.
They concluded, “This trial suggests the potential use of the Syqe Inhaler device as a smokeless delivery system of medicinal cannabis, producing a delta-9-THC pharmacokinetic profile with low inter-individual variation of (maximum drug/plasma concentrations), achieving pharmaceutical standards for inhaled drugs.”
A series of clinical trials conducted by investigators affiliated with the Center for Medicinal Cannabis Research at the University of California, San Diego previously determined that the inhalation of whole-plant cannabis is efficacious in the treatment of neuropathic pain.
Full text of the study, “The pharmacokinetics, efficacy, safety, and ease of use of a novel portable metered-dose cannabis inhaler in patients with chronic neuropathic pain: A phase 1a study,” will appear in the Journal of Pain and Palliative Care Pharmacotherapy.
The administration of oral THC mitigates symptoms of post-traumatic stress syndrome (PTSD), according to clinical trial data published online ahead of print in the journal Clinical Drug Investigation.
Investigators at the Hebrew University Medical Center in Jerusalem assessed the safety and efficacy of oral THC as an adjunct treatment in ten subjects with chronic PTSD.
Researchers reported, “The intervention caused a statistically significant improvement in global symptom severity, sleep quality, frequency of nightmares, and PTSD hyperarousal symptoms.”
They concluded, “Orally absorbable delta-9-THC was safe and well tolerated by patients with chronic PTSD.”
Separate clinical trial data has previously reported that the administration of nabilone, a synthetic endocannabinoid agonist, can reduce the severity and frequency of nightmares in patients with PTSD.
In 2013, researchers at the New York University School of Medicine published findings indicating that PTSD subjects experience a decrease in their natural production of anandamide, an endogenous cannabinoid neurotransmitter. They hypothesized that an increase in the body’s production of cannabinoids would likely restore subjects’ natural brain chemistry and psychological balance. “[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.
Full text of the study, “Preliminary, open-label, pilot study of add-on oral delta-9-tetrahydrocannabinol in chronic post-traumatic stress disorder,” will appear in Clinical Drug Investigation.
Inhaling whole-plant cannabis provides symptomatic relief in patients with Parkinson’s disease (PD), according to observational trial data published in the March/April edition of the journal Clinical Neuropharmacology. Parkinson’s is a progressive disorder of the central nervous system that results in tremor, slowed movement, and muscle rigidity.
Investigators at Tel Aviv University, Department of Neurology evaluated Parkinson’s disease symptoms in 22 patients at baseline and 30-minutes after inhaling cannabis.
Researchers reported that inhaled cannabis was associated with “significant improvement after treatment in tremor, rigidity, and bradykinsea (slowness of movement). There was also significant improvement of sleep and pain scores. No significant adverse effects of the drug were observed.”
They concluded: “[T]his observational study is the first to report an amelioration of both motor and non–motor symptoms in patients with PD treated with cannabis. The study opens new venues for treatment strategies in PD especially in patients refractory to current medications.”
Israel has formally allowed for the licensed production and distribution of the substance for therapeutic purposes since 2011.
An abstract of the study, “Cannabis (Medical Marijuana) Treatment for Motor and Non–Motor Symptoms of Parkinson Disease: An Open-Label Observational Study,” is online here.
Inhaling cannabis reduces symptoms of Crohn’s disease compared to placebo in patients non-responsive to traditional therapies, according to clinical trial data published online ahead of print in the journal Clinical Gastroenterology and Hepatology.
Researchers at the Meir Medical Center, Department of Gastroenterology and Hepatology in Israel assessed the safety and efficacy of inhaled cannabis versus placebo in 21 subjects with Crohn’s disease who were nonresponsive to conventional treatments.
Eleven participants smoked standardized cannabis cigarettes containing 23 percent THC and 0.5 percent CBD (cannabidiol) twice daily over a period of eight weeks. The other ten subjects smoked placebo cigarettes containing no active cannabinoids.
Investigators reported, “Our data show that 8-weeks treatment with THC-rich cannabis, but not placebo, was associated with a significant decrease of 100 points in CDAI (Crohn’s Disease and activity index) scores.” (The CDIA is a research tool used to quantify the symptoms of Crohn’s disease patients.) Five of the eleven patients in the study group also reported achieving disease remission (defined as a reduction in patient CDAI score by more than 150 points).
Researchers also reported that “no significant side effects” were associated with cannabis inhalation. Subjects in the study group reported improvements in appetite and sleep compared to those in the placebo group. Cannabis inhalation was also associated with “significantly less pain” among the participants.
The study is the first placebo-controlled clinical trial to assess the consumption of cannabis for the treatment of Crohn’s.
Israeli researchers had previously published observational trial data reporting that Crohn’s patients require fewer disease-related surgeries following their use of cannabis.
According to survey data published in 2011 in the European Journal of Gastroenterology and Hepatology, some one-half of Crohn’s disease patients acknowledge having used cannabis to mitigate their disease symptoms.
From the International Association for Cannabinoid Medicines
IACM-Bulletin of 8 April 2012
World: Increasing numbers of patients use cannabis for medicinal purposes
An increasing number of patients in the world are using cannabis for therapeutic reasons, with available data from countries, which have installed programs for their citizens. Good data are available for Israel, Canada, the Netherlands and many states of the US with medicinal cannabis laws and registries. In several more countries only a few patients are allowed to use cannabis for medicinal purposes, including Germany, Norway, Finland and Italy. In many other countries such as Spain and some states of the US without a registry such as California the number of medicinal users is estimated to be high, but no detailed data are available.
The numbers in California with hundreds of cannabis dispensaries and clinics that issue medical cannabis recommendations are unclear, since the state does not require residents to register as patients (see below**)
Most of the 16 states that allow the medicinal use of cannabis require a registration. Recently the press agency Associated Press published data on registered patients in different states of the USA based on state agencies responsible for maintaining patient registries:
State: Number of registered patients (per 1,000 of the whole population) –
Colorado: 82,089 (16.3)
Oregon: 57,386 (15.0)
Montana: 14,364 (14.5)
Michigan: 131,483 (13.3)
Hawaii: 11,695 (8.6)
Rhode Island: 4,466 (4.2)
Arizona: 22,037 (3.5)
New Mexico: 4,310 (2.1)
Maine: 2,708 (2.0)
Nevada: 3,388 (1.3)
Vermont: 505 (0.8)
Alaska: 538 (0.8)
Patient registration is mandatory in Delaware, New Jersey and the District of Columbia (Washington D.C.), but their registries are not yet up and running. Washington State has neither voluntary nor mandatory registration.
Data from Israel show that in August 2011 6,000 patients got medicinal cannabis (0.8 patients in 1,000). It is estimated that the number increases to 40,000 in 2016 (5.2 patients in 1,000 citizens).
In Canada 12,116 patients were allowed to use cannabis on 30 September 2011 (0.35 patients in 1,000 citizens).
Numbers of patients using cannabis from the pharmacies in the Netherlands were estimated to be 1,300 in 2010 (0.08 patients in 1,000 citizens). However, many patients in the Netherlands use cannabis from the coffee shops or grow their own.
In Germany about 60 patients are currently allowed to use cannabis for medicinal purposes.
(Sources: Associated Press of 24 March 2012, website of the Israeli Prime Minister of 7 August 2011, UPI of 31 October 2011, Pharmaceutisch Weekblad No. 20, 2011)
**[Editor's note: CA NORML published a white paper last May estimating that California has 750,000 - 1,125,000 citizens who possess a physician's recommendation to use cannabis medicinally.]