Posted on Pain Management

Chronic pain patients are more supportive of cannabis access than doctors

8 in 10 cannabis users report combining marijuana with exercise, saying it boosts motivation and mood, eases pain

Adults with chronic pain are significantly more supportive of policies expanding cannabis access than the physicians who treat them, according to a study from Rutgers Health and other institutions.

The study surveyed over 1,600 individuals with chronic pain and 1,000 physicians in states with medical cannabis programs, including New Jersey. The researchers discovered that 71% of chronic pain patients were in favour of the federal legalization of medical cannabis, while 59% of physicians shared the same viewpoint.

“Cannabis has a unique and complex policy landscape,” noted Elizabeth Stone, a core faculty member at the Rutgers Institute for Health, Health Care Policy and Aging Research and the study’s lead author. “Depending on the state you’re in, medical cannabis may be legal, both medical and recreational use may be legal, neither may be legal, or some aspects may be decriminalized.”

Currently, 38 states and Washington, D.C. have legalized medical cannabis use, and New Jersey and 23 other states, along with D.C., have legalized it for adult recreational use. However, cannabis remains a Schedule I controlled substance under federal law. Schedule I drugs are considered to have the highest risk of abuse with no recognized medical use, according to the National Institutes of Health.

Among those polled for the study, 55% of chronic pain patients but 38% of physicians supported federal legalization of cannabis for adult recreational use. Some 64% of patients, but 51% of physicians, favoured requiring insurance coverage for cannabis treatment of chronic pain.

“Overall, individuals with chronic pain were more supportive of policies that would expand access to medical cannabis, while healthcare providers were more supportive of policies that would restrict access to medical cannabis,” said Stone, who is also an instructor in the Department of Psychiatry at Rutgers Robert Wood Johnson Medical School.

The researchers tapped two separate survey groups for the study data: One contained adults with noncancer pain lasting six months or more, and the other contained primary care providers and various specialty physicians.

Personal experience played a significant role in shaping attitudes for both groups. People who had used cannabis for chronic pain reported the highest levels of support for expanding access. Physicians who hadn’t recommended cannabis for chronic pain management reported the lowest levels of support.

The study also found broad support for increased education for doctors prescribing medical cannabis. About 70% of both patients and physicians favoured requiring medical schools to train future doctors on cannabis treatment for chronic noncancer pain.

“I think it points to the need for future guidance around cannabis use and efficacy,” Stone said. “Is it something they should be recommending? If so, are there different considerations for types of products or modes of use or concentration?”

Posted on Diabetes

A new injectable to prevent and treat hypoglycemia

A new injectable to prevent and treat hypoglycemia

Encapsulated glucagon for insulin-induced hypoglycemia dissolves when sugar levels get seriously low (less than 60 milligrams per deciliter, mg/dL), releasing the hormone into the bloodstream and triggering the liver to release glucose. The micelles remain intact at normal sugar levels (more than 100 mg/dL), keeping glucagon inactive. Credit Adapted from ACS Central Science 2024, DOI: 10.1021/acscentsci.4c00937

People with diabetes take insulin to lower high blood sugar. However, if glucose levels plunge too low — from taking too much insulin or not eating enough sugar — people can experience hypoglycemia, which can lead to dizziness, cognitive impairment, seizures or comas. Researchers in ACS Central Science report encapsulating the hormone glucagon to prevent and treat this condition. In mouse trials, the nanocapsules activated when blood sugar levels dropped dangerously low and quickly restored glucose levels.

Glucagon is a hormone that signals the liver to release glucose into the bloodstream. It’s typically given by injection to counteract severe hypoglycemia in people who have diabetes. While an emergency glucagon injection can correct blood sugar levels in about 30 minutes, formulations can be unstable and insoluble in water. Sometimes, the hormone quickly breaks down when mixed for injections and clumps together to form toxic fibrils. Additionally, many hypoglycemic episodes occur at night, when people with diabetes aren’t likely to test their blood sugar. To improve commercial glucagon stability and prevent hypoglycemia, Andrea Hevener and Heather Maynard looked to micelles: nanoscale, soap-like bubbles that can be customized to assemble or disassemble in different environments and are used for drug delivery. They developed a glucose-responsive micelle that encapsulates and protects glucagon in the bloodstream when sugar levels are normal but dissolve if levels drop dangerously low. To prevent hypoglycemia, the micelles could be injected ahead of time and circulate in the bloodstream until they are needed.

In lab experiments, the researchers observed that the micelles disassembled only in liquid environments mimicking hypoglycemic conditions in human and mice bodies: less than 60 milligrams of glucose per deciliter. Next, when mice experiencing insulin-induced hypoglycemia received an injection of the specialized micelles, they achieved normal blood sugar levels within 40 minutes. The team also determined that glucagon-packed micelles stayed intact in mice and didn’t release the hormone unless blood glucose levels fell below the clinical threshold for severe hypoglycemia. From additional toxicity and biosafety studies in mice, the researchers note that empty micelles didn’t trigger an immune response or induce organ damage.

Posted on Diet

How Sugar & Processed Foods Impact Your Health

“In this episode, my guest is Dr Robert Lustig, M.D., a neuroendocrinologist and professor of paediatrics at the University of California, San Francisco (UCSF). He is also a bestselling author on nutrition and metabolic health. We discuss the “calories in calories out” (CICO) model of metabolism and weight regulation and how specific macronutrients (protein, fat, carbohydrates), fibre, and sugar can modify the CICO equation. We cover the impact of different types of sugars, particularly fructose, sugars found in liquid form, taste intensity, and other factors on insulin levels, liver, kidney, and metabolic health. We also explore how fructose in non-fruit sources can be addictive, similar to drugs of abuse, and how sugar alters brain circuits related to food cravings and satisfaction. Additionally, we discuss the role of sugar in childhood and adult obesity, gut health and disease, and mental health. Furthermore, we delve into how the food industry uses refined sugars to create pseudo foods and their effects on the brain and body. This episode provides actionable information about sugar and metabolism, weight control, brain health, and body composition. It should be of interest to anyone seeking to understand how specific food choices impact the immediate and long-term health of the brain and body.”