cannabis

Posted on Pain Management

Positive media coverage of cannabis pain studies, regardless of therapeutic effect


In cannabis trials against pain, people who take placebos report feeling largely the same level of pain relief as those who consume the active cannabinoid substance. Still, these studies receive significant media coverage regardless of the clinical outcome, report researchers from Karolinska Institutet in Sweden in a study published in JAMA Network Open.

“We see that cannabis studies are often described in positive terms in the media regardless of their results,” says the study’s first author Filip Gedin, postdoc researcher at the Department of Clinical Neuroscience, Karolinska Institutet. “This is problematic and can influence expectations when it comes to the effects of cannabis therapy on pain. The greater the benefit a treatment is assumed to have, the more potential harms can be tolerated.”

The study is based on an analysis of published clinical studies in which cannabis has been compared with placebo for the treatment of clinical pain. The change in pain intensity before and after treatment were the study’s primary outcome measurement.

The analysis drew on 20 studies published up to September 2021 involving almost 1,500 individuals.

The results of the study show that pain is rated as being significantly less intense after treatment with placebo, with a moderate to large effect. The researchers also observed no difference in pain reduction between cannabis and placebo, which corroborates results from another recently published meta-analysis. 

“There is a distinct and clinically relevant placebo response in studies of cannabis for pain,” says Dr Gedin.

The researchers also examined a possible connection between the magnitude of the therapeutic effect shown by the cannabis studies and the coverage they receive in the media and in academic journals. Media presence was measured through Altmetric, which is a method of evaluating mentions in the media, in blogs and on social media. Academic impact was measured in terms of citations by other researchers.

The analysis of media presence included a total of 136 news items in traditional media and in blogs and was categorised as positive, negative or neutral, depending on how the results were presented concerning the effectiveness of cannabis as a treatment for pain.

The researchers found that the cannabis studies received much greater media attention than other published studies. The coverage was substantial regardless of the magnitude of the placebo response and regardless of the therapeutic effect of cannabis. They also observed no link between the proportion of positively described news about a study and the effect it reported. 

The researchers add the caveat that their study combined trials of varying designs and quality and therefore the results should be interpreted with caution.

This research was financed by Riksbankens Jubileumsfond (Karin Jensen). The researchers report no potential conflicts of interest.

Posted on Patient Talk

A new study shows patient preference for medical cannabis products in the absence of clinical guidelines

Due to a lack of publicly available data, understanding what products medical cannabis patients use for various conditions has mostly come from survey responses. In a new study, USC Schaeffer Center researchers established a clearer picture by analyzing point-of-sale data from nearly 17,000 patients who made more than 80,000 purchases as part of the New York state medical cannabis program.

The researchers found considerable variation in the products chosen for most medical conditions, and high variability in labeled doses of THC.

“While the medical cannabis market is not new, there is still relatively little research on patient purchasing behavior,” says Alexandra Kritikos, a postdoctoral research fellow in the USC Schaeffer Center and the USC Institute for Addiction Science. “Unfortunately, our analysis suggests that patients may not be getting consistent guidance from clinicians and pharmacists and, in many disease areas, there seems to be a lack of clear clinical data on appropriate dosing.”

The results, published in JAMA Network Open, rely on purchases made between 2016 and 2019 when cannabis flower and edibles could not be sold in the medical market. Cannabis card holders could purchase vape cartridges and pens, capsules and tablets, tinctures, lotions and suppositories.

Medical cannabis users purchase a range of products with varying potencies

Since its inception in 2014, New York’s medical cannabis program has grown to 150,000 participants, making it one of the largest in the nation.

Using data from an integrated single system of dispensaries, the researchers found that the top three conditions patients recorded on their medical card were chronic pain (52%), neuropathy (22%) and cancer (13%). In addition to a qualifying condition, patients also needed a qualifying symptom to register. The top qualifying symptoms were severe pain (82%), severe muscle spasms (21%) and severe nausea (8%).

Vaporizers were the most popular product purchased (40%), followed by tinctures (38%) and tablets (22%). In terms of potency, the majority of products purchased (52%) were high-THC, low-CBD products. High- THC products contained between 2 and 10 mg of THC per dose, depending on the product.

Given this variation, when patients chose different products, they presumably favored different dosing. For example, 41% of patients with chronic pain preferred a high-THC vaporizer, which delivered 2 mg of THC/0.1 mg of CBD per dose, while 33% of chronic pain patients chose tinctures and 25% chose tablets, both of which delivered 10 mg of THC per dose. Another quarter of chronic pain patients chose a product containing 5 mg of both THC and CBD.

In contrast, the majority of patients suffering from cancer, HIV/AIDS and epilepsy purchased the same product, suggesting similar dosing.

Physicians need to take a more active role in patients using medical cannabis products

Earlier research found that electronic medical records frequently underreport the number of medical cannabis users. Combined with findings in the new Schaeffer Center study, the researchers suggest improving medical guidance and oversight of dosing.

“We suspect the lack of clinical guidelines on dosing of cannabinoids for particular medical conditions has made medical providers uncomfortable talking to their patients about their medical cannabis use,” says Rosalie Liccardo Pacula, senior author on both studies. “It is imperative that this change, as drug interactions with other prescribed medications are likely but impossible to identify if medical cannabis use is not considered or recorded in the medical record.” Pacula is a senior fellow at the Schaeffer Center and the Elizabeth Garrett Chair in Health Policy, Economics & Law at the USC Price School of Public Policy.

Pacula and Kritikos hope that their study provides a basis for conversations between providers and patients about cannabis use, including dosing levels.

Calls for caps in the recreational market will not limit access for medical cannabis patients

According to the labeled dosing, none of the most popular products analyzed for any of the conditions had dosing of more than 10 mg of THC, something policymakers should consider, say the researchers.

“We’ve seen the industry and media make the claim that putting caps on potency would limit access to necessary medicine,” Pacula says. “But our research in New York state suggests that medical cannabis users are consuming products that are less potent than what recreational users take.”

Posted on Pain Management

Cannabis-related products demonstrate a short-term reduction in chronic pain


The evidence behind the effectiveness of cannabis-related products to treat chronic pain is surprisingly thin, according to a new systematic evidence review by researchers at Oregon Health & Science University.

The federally funded review, which will be updated on an ongoing basis, was published today in the Annals of Internal Medicine.

Researchers did find evidence to support a short-term benefit in treating neuropathic pain – caused by damage to peripheral nerves, such as diabetic neuropathy resulting in pain described as burning and tingling, involving two FDA-approved synthetic products with 100% tetrahydrocannabinol, or THC: dronabinol (under the trade name Marinol) and nabilone (Cesamet). Both products also lead to notable side effects including sedation and dizziness, according to the review.

Another product, a sublingual spray of equal parts THC and cannabidiol, or CBD, extracted from the cannabis plant, known as nabiximols, also showed evidence of some clinical benefit for neuropathic pain, although that product is not available in the U.S. This product also led to side effects, such as nausea, sedation and dizziness.

“In general, the limited amount of evidence surprised all of us,” said lead author Marian S. McDonagh, Pharm.D., emeritus professor of medical informatics and clinical epidemiology in the OHSU School of Medicine. “With so much buzz around cannabis-related products, and the easy availability of recreational and medical marijuana in many states, consumers and patients might assume there would be more evidence about the benefits and side effects.

“Unfortunately, there is very little scientifically valid research into most of these products,” she said. “We saw only a small group of observational cohort studies on cannabis products that would be easily available in states that allow it, and these were not designed to answer the important questions on treating chronic pain.”

Voters in Oregon, Washington and 20 other states have legalized medical and recreational marijuana, however, the researchers found many of the products now available at U.S. dispensaries have not been well studied.

“For some cannabis products, such as whole-plant products, the data are sparse with imprecise estimates of effect and studies had methodological limitations,” the authors write.

This situation makes it difficult to guide patients.

“Cannabis products vary quite a bit in terms of their chemical composition, and this could have important effects in terms of benefits and harm to patients,” said co-author Roger Chou, M.D., director of OHSU’s Pacific Northwest Evidence-based Practice Center. “That makes it tough for patients and clinicians since the evidence for one cannabis-based product may not be the same for another.”

The living review, including a visual abstract summary of the findings, will also be shared on a new web-based tool launched by OHSU and VA Portland Health Care System early this year to help clinicians and researchers evaluate the latest evidence around the health effects of cannabis. Known as Systematically Testing the Evidence on Marijuana, or STEM, the project includes “clinician briefs” to help health care workers translate the clinical implications.

“This new living evidence review is exactly the type of resource clinicians need to clarify for patients the areas of potential promise, the cannabis formulations that have been studied and, importantly, the major gaps in knowledge,” said co-author Devan Kansagara, M.D., M.C.R., professor of medicine in the OHSU School of Medicine and a staff physician at the VA Portland.

Reviewers searched more than 3,000 studies in the scientific literature as of January of this year and landed on a total of 25 with scientifically valid evidence – 18 randomized controlled studies and seven observational studies of at least four weeks.

The effects of cannabis and related products are based on their ability to mimic the body’s own endocannabinoid system. The system is comprised of receptors and enzymes in the nervous system that regulate bodily functions and can affect the sensation of pain.  In the evidence review, researchers sorted the types of product into high, comparable and low ratios of THC to CBD and compared their reported benefits and side effects.

Dronabinol and nabilone fit into the high THC to CBD ratio category, with 100% THC (no CBD), showing   the most benefit among the products studied, with meta-analysis of the six randomized controlled studies demonstrating statistically valid benefits for easing neuropathic pain compared to a placebo.

“Honestly, the best advice is to talk to your primary care physician about possible treatments for chronic pain,” McDonagh said. “If you want to consider cannabis, you need to talk to your doctor.”

Posted on Patient Talk

Could medical marijuana help grandma and grandpa with their ailments?

Could medical marijuana help grandma and grandpa with their ailments?
Could medical marijuana help grandma and grandpa with their ailments?


Medical marijuana may bring relief to older people who have symptoms like pain, sleep disorders or anxiety due to chronic conditions including amyotrophic lateral sclerosis, Parkinson’s disease, neuropathy, spinal cord damage and multiple sclerosis, according to a preliminary study released today that will be presented at the American Academy of Neurology’s 71st Annual Meeting in Philadelphia, May 4 to 10, 2019. The study not only found medical marijuana may be safe and effective, it also found that one-third of participants reduced their use of opioids. However, the study was retrospective and relied on participants reporting whether they experienced symptom relief, so it is possible that the placebo effect may have played a role. Additional randomized, placebo-controlled studies are needed.

According to the Centers for Disease Control and Prevention, approximately 80 per cent of older adults have at least one chronic health condition.

“With legalization in many states, medical marijuana has become a popular treatment option among people with chronic diseases and disorders, yet there is limited research, especially in older people,” said study author Laszlo Mechtler, MD, of Dent Neurologic Institute in Buffalo, N.Y., and a Fellow of the American Academy of Neurology. “Our findings are promising and can help fuel further research into medical marijuana as an additional option for this group of people who often have chronic conditions.”

The study involved 204 people with an average age of 81 who were enrolled in New York State’s Medical Marijuana Program. Participants took various ratios of tetrahydrocannabinol (THC) to cannabidiol (CBD), the main active chemicals in medical marijuana, for an average of four months and had regular checkups. The medical marijuana was taken by mouth as a liquid extract tincture, capsule or in an electronic vaporizer.

Initially, 34 percent of participants had side effects from the medical marijuana. After an adjustment in dosage, only 21 percent reported side effects. The most common side effects were sleepiness in 13 percent of patients, balance problems in 7 percent and gastrointestinal disturbances in 7 percent. Three percent of the participants stopped taking the medical marijuana due to the side effects. Researchers said a ratio of one-to-one THC to CBD was the most common ratio among people who reported no side effects.

Researchers found that 69 percent of participants experienced some symptom relief. Of those, the most common conditions that improved were pain with 49 percent experiencing relief, sleep symptoms with 18 percent experiencing relief, neuropathy improving in 15 percent and anxiety improving in 10 percent.

Opioid pain medication was reduced in 32 percent of participants.

“Our findings show that medical marijuana is well-tolerated in people age 75 and older and may improve symptoms like chronic pain and anxiety,” said Mechtler. “Future research should focus on symptoms like sleepiness and balance problems, as well as efficacy and optimal dosing.”

Posted on Pain Management

Later hit: Does cannabis ease pain, speed recovery in injured athletes?

Revolutionary mmj patch successfully treats fibromyalgia and diabetics nerve pain

Increasingly, professional athletes in sports ranging from football to bicycling to long-distance running have turned to using cannabis to reduce pain from post-game injuries and to help speed recovery.

Anecdotal reports of cannabis’ purported benefits abound, but empirical evidence is scant. Today, the National Football League announced funding of a novel clinical trial that will assess the therapeutic efficacy (and any possible adverse effects) of delta-9-tetrahydrocannabinol (THC), the primary psychoactive compound in cannabis; cannabidiol (CBD), the second most prevalent active ingredient in cannabis but not psychoactive; and a combination of the two for treating post-competition pain caused by soft tissue injury, compared to a placebo.

Co-led by Mark Wallace, MD, a pain management specialist and director of the Center for Pain Medicine at UC San Diego Health, and Thomas Marcotte, PhD, professor of psychiatry at University of California School of Medicine and co-director of the Center for Medicinal Cannabis Research (CMCR) at UC San Diego, the randomized, double-blind trial will involve testing and monitoring of professional rugby players.

Professional rugby was chosen for the first trial because it approximates the types of injuries also experienced by NFL players, the researchers said, and was logistically more feasible.

“An innovation of this research is using a ‘real-world model’ of the NFL’s competitive injury burden with a group of elite athletes who experience similar injuries,” said Marcotte. “It’s a first-of-its-kind randomized trial to examine the possible practical efficacy of cannabinoids on post-competition pain.”

The primary goal of the trial will be to evaluate pain relief and recovery. Secondary goals include assessment of any effects on physical function, sleep, cognition and mood.

Participating athletes who report post-game pain that meets a specific threshold will have a blood sample drawn and be assigned to vaporize either 4 percent THC, 12 percent CBD, a combination of THC and CBD at those percentages or a placebo for up to four times per day over the following 48 hours. They will be asked to self-report pain scores via a cell phone application at regular intervals during those 48 hours. A second blood draw will be taken the day after each game.

Practicing, competing and living with pain are unavoidable elements of a professional athlete’s life. As a result, efforts to ameliorate the negative effects of pain are long-standing, and include the use of prescription pain medications, including opioids.

Cannabis has been used for medical purposes for centuries around the world. Increasingly, there are efforts to develop and promote it as a safer pharmacological alternative to other forms of pain relief and there is some scientific research suggesting that THC is effective in relieving certain types of pain.

Wallace, a professor of anesthesiology and chief of the Division of Pain Medicine at UC San Diego School of Medicine, has integrated the use of medical cannabis into clinical practice.

“Much of the knowledge we used for dosing medical cannabis in our pain clinic came from the studies supported by CMCR, which showed there is a therapeutic window of analgesia with low doses of THC reducing pain and high doses worsening pain.

“We will build on the CMCR research and our clinical experience to translate efficacy and safety for sports injury recovery.”

The trial will be conducted following regulatory reviews by the Food and Drug Administration, the Drug Enforcement Administration, the UC San Diego Institutional Review Board and the Research Advisory Panel of California.

Though no conclusions can be drawn until the study is completed and data analyzed, investigators hypothesize that THC and THC/CBD combinations will prove superior to CBD and placebo for pain reduction; and CBD alone will prove superior to placebo.