[From cannabis to selective CB2R agonists: molecules with numerous therapeutical virtues].

“Originally used in Asia for the treatment of pain, spasms, nausea and insomnia, marijuana is the most consumed psychotropic drug worldwide. The interest of medical cannabis has been reconsidered recently, leading to many scientific researches and commercialization of these drugs.

Natural and synthetic cannabinoids display beneficial antiemetic, anti-inflammatory and analgesic effects in numerous diseases, however accompanied with undesirable effects due to the CB1 receptor. Present researches focus on the design of therapeutical molecules targeting the CB2 receptors, and thus avoiding central side effects and therefore psychotropic effects caused by the CB1 receptor.”

http://www.ncbi.nlm.nih.gov/pubmed/23732102

Cannabinoid (CB)1 receptors are critical for the innate immune response to TLR4 stimulation.

“Sickness behaviours are host defence adaptations that arise from integrated autonomic outputs in response to activation of the innate immune system. These behaviours include fever, anorexia, and hyperalgesia intended to promote survival of the host when encountering pathogens. Cannabinoid (CB) receptor activation can induce hypothermia and attenuate lipopolysaccharide (LPS)-evoked fever. The aim of the present study was to examine the role of CB1 receptors in the LPS-evoked febrile response. CB1 receptor-deficient (CB1-/-) mice did not display LPS-evoked fever; likewise pharmacological blockade of CB1 receptors in wild-type mice blocked LPS-evoked fever. This unresponsiveness is not limited to thermogenesis, as the animals were not hyperalgesic after LPS administration. A toll-like receptor (TLR)3 agonist and viral mimetic polyinosinic:polycytidylic acid evoked a robust fever in CB1-/- mice suggesting TLR3-mediated responses are functional. LPS-evoked c-Fos activation in areas of the brain associated with the febrile response was evident in wild-type mice but not in CB1-/- mice. Liver and spleen TLR4 mRNA were significantly lower in CB1-/- mice compared to wild-type, and peritoneal macrophages from CB1-/- mice did not release pro-inflammatory cytokines in response to LPS. These data indicate that CB1 receptors play a critical role in LPS-induced febrile responses through inhibiting TLR4-mediated cytokine production.”

http://www.ncbi.nlm.nih.gov/pubmed/23739343

Medicinal Use of Marijuana — Polling Results – The New England Journal of Medicine

“Readers recently joined in a lively debate about the use of medicinal marijuana. In Clinical Decisions,1 an interactive feature in which experts discuss a controversial topic and readers vote and post comments, we presented the case of Marilyn, a 68-year-old woman with metastatic breast cancer. We asked whether she should be prescribed marijuana to help alleviate her symptoms. To frame this issue, we invited experts to present opposing viewpoints about the medicinal use of marijuana. J. Michael Bostwick, M.D., a professor of psychiatry at Mayo Clinic, proposed the use of marijuana “only when conservative options have failed for fully informed patients treated in ongoing therapeutic relationships.” Gary M. Reisfield, M.D., from the University of Florida, certified in anesthesiology and pain medicine, and Robert L. DuPont, M.D., a clinical professor of psychiatry at Georgetown Medical School, provide a counterpoint, concluding that “there is little scientific basis” for physicians to endorse smoked marijuana as a medical therapy.

We were surprised by the outcome of polling and comments, with 76% of all votes in favor of the use of marijuana for medicinal purposes — even though marijuana use is illegal in most countries. A total of 1446 votes were cast from 72 countries and 56 states and provinces in North America, and 118 comments were posted. However, despite the global participation, the vast majority of votes (1063) came from the United States, Canada, and Mexico. Given that North America represents only a minority of the general online readership of the Journal, this skew in voting suggests that the subject of this particular Clinical Decisions stirs more passion among readers from North America than among those residing elsewhere. Analysis of voting across all regions of North America showed that 76% of voters supported medicinal marijuana. Each state and province with at least 10 participants casting votes had more than 50% support for medicinal marijuana except Utah. In Utah, only 1% of 76 voters supported medicinal marijuana. Pennsylvania represented the opposite extreme, with 96% of 107 votes in support of medicinal marijuana.

Outside North America, we received the greatest participation from countries in Latin America and Europe, and overall results were similar to those of North America, with 78% of voters supporting the use of medicinal marijuana. All countries with 10 or more voters worldwide were at or above 50% in favor. There were only 43 votes from Asia and 7 votes from Africa, suggesting that in those continents, this topic does not resonate as much as other issues.

Where does this strong support for medicinal marijuana come from? Your comments show that individual perspectives were as polarized as the experts’ opinions. Physicians in favor of medicinal marijuana often focused on our responsibility as caregivers to alleviate suffering. Many pointed out the known dangers of prescription narcotics, supported patient choice, or described personal experience with patients who benefited from the use of marijuana. Those who opposed the use of medicinal marijuana targeted the lack of evidence, the lack of provenance, inconsistency of dosage, and concern about side effects, including psychosis. Common in this debate was the question of whether marijuana even belongs within the purview of physicians or whether the substance should be legalized and patients allowed to decide for themselves whether to make use of it.

In sum, the majority of clinicians would recommend the use of medicinal marijuana in certain circumstances. Large numbers of voices from all camps called for more research to move the discussion toward a stronger basis of evidence.”

http://www.nejm.org/doi/full/10.1056/NEJMclde1305159

“New England Journal of Medicine Endorses Medical Marijuana; San Francisco Medical Society Releases Study; New York Times Editorial Welcomes Debate” http://ndsn.org/feb97/nejm.html

Three out of four doctors recommend marijuana in New England Journal of Medicine poll

More than three out of four doctors support medical cannabis for a hypothetical breast cancer patient, New England Journal of Medicine reports“More than three out of four doctors support medical cannabis for a hypothetical breast cancer patient, New England Journal of Medicine reports

In a poll by the well-respected New England Journal of Medicine released today, more than three out of four doctors recommended medical cannabis for a hypothetical late-stage breast cancer patient.

“We were surprised by the outcome of polling and comments, with 76% of all votes in favor of the use of marijuana for medicinal purposes — even though marijuana use is illegal in most countries,” Jonathan N. Adler, M.D., and James A. Colbert, M.D. wrote for the NEJOM May 30th.

Marijuana is a federally illegal – schedule one drug – that the U.S. government claims has no medical value and is more dangerous than heroin or LSD. Yet 19 states have legalized cannabis for medical use, given its 10,000 year history as a safe herbal remedy for nausea, pain and insomnia among other conditions.”

More: http://blog.sfgate.com/smellthetruth/2013/05/30/three-out-of-four-doctors-recommend-marijuana-in-new-england-journal-of-medicine-poll/

Majority Support Medical Pot in New NEJM Poll

“To recommend, or not to recommend, medicinal marijuana? That’s the question recently posed in a New England Journal of Medicine interactive online poll. To get a feel for physicians’ opinions, NEJM presented readers with a fictional clinical situation. Here’s the scenario:

“Marilyn is a 68-year-old woman with breast cancer metastatic to the lungs and the thoracic and lumbar spine. She is currently undergoing chemotherapy with doxorubicin. She reports having very low energy, minimal appetite, and substantial pain in her thoracic and lumbar spine. For relief of nausea, she has taken ondansetron and prochlorperazine, with minimal success. She has been taking 1000 mg of acetaminophen every 8 hours for the pain. Sometimes at night she takes 5 mg or 10 mg of oxycodone to help provide pain relief. During a visit with her primary care physician she asks about the possibility of using marijuana to help alleviate the nausea, pain, and fatigue. She lives in a state that allows marijuana for personal medicinal use, and she says her family could grow the plants. As her physician, what advice would you offer with regard to the use of marijuana to alleviate her current symptoms? Do you believe that the overall medicinal benefits of marijuana outweigh the risks and potential harms?”

Readers weighed in with a variety of impassioned opinions. And the results, the authors said, were  surprising: 76% of respondents said they would recommend medicinal marijuana. Here’s part of the discussion:

“Physicians in favor of medicinal marijuana often focused on our responsibility as caregivers to alleviate suffering. Many pointed out the known dangers of prescription narcotics, supported patient choice, or described personal experience with patients who benefited from the use of marijuana. Those who opposed the use of medicinal marijuana targeted the lack of evidence, the lack of provenance, inconsistency of dosage, and concern about side effects, including psychosis. Common in this debate was the question of whether marijuana even belongs within the purview of physicians or whether the substance should be legalized and patients allowed to decide for themselves whether to make use of it.”” 

More: http://ripr.org/post/majority-support-medical-pot-new-nejm-poll 

Most Docs Would Prescribe Marijuana to Cancer Patient

“The vast majority of doctors would prescribe medical marijuana to ease the pain of an older woman suffering from advanced breast cancer, according to a survey conducted by the New England Journal of Medicine (NEJM).

In its February edition, the NEJM presented its readers with a hypothetical scenario of 68-year old patient named “Marilyn” whose breast cancer had metastasized to her lung and spine. Marilyn, who lives in a state where medical marijuana is legal, asked her primary care doctor if using marijuana would alleviate her chronic pain, nausea and fatigue.

The results of the online survey, published in the May 30 edition of the NEJM, found that 76 percent of the 1,446 doctors who responded would give Marilyn a prescription for medical marijuana.”

More: http://americannewsreport.com/nationalpainreport/most-docs-would-prescribe-marijuana-to-cancer-patient-8820152.html

Most Docs OK With Medical Marijuana: Survey – MedlinePlus

“Majority would give a prescription to an advanced cancer patient in pain.Three-quarters of doctors who responded to a survey about medical marijuana said they would approve the use of the drug to help ease pain in an older woman with advanced breast cancer.

….there are two FDA-approved prescription cannabinoid pills — dronabinol (Marinol) and nabilone (Cesamet) — that don’t begin working as quickly as smoked marijuana, but provide longer symptom relief without the high of marijuana.

 They also don’t appear to have any addictive properties, he said.

What many doctors would like to see, according to the survey, is more evidence on the use of marijuana as medicine, so they could make a better-informed decision one way or the other.”

More: http://www.nlm.nih.gov/medlineplus/news/fullstory_137301.html

Medical Marijuana: 76% Of Doctors Would Prescribe It, Poll Finds – HUFFPOST

“Three out of four doctors would prescribe marijuana to a patient who was experiencing pain from cancer, according to the results of a poll published in the New England Journal of Medicine.”

Doctors Medical Marijuana

Most docs OK with medical marijuana, survey says – MedicalXpress

“Majority would give a prescription to an advanced cancer patient in pain.”

Most docs OK with medical marijuana: survey

 

 

 

 

“(HealthDay)—Three-quarters of doctors who responded to a survey about medical marijuana said they would approve the use of the drug to help ease pain in an older woman with advanced breast cancer.

In a February issue of the New England Journal of Medicine, doctors were presented with a case vignette, as well as arguments both for and against the use of medical marijuana. Doctors were then asked to decide whether or not they would approve such a prescription for this patient.

The results now appear in the May 30 edition of the journal.

Seventy-six percent of the 1,446 doctors who responded said they would give the woman a prescription for medical marijuana. Many cited the possibility of alleviating the woman’s symptoms as a reason for approving the prescription.”

More: http://medicalxpress.com/news/2013-05-docs-medical-marijuana-survey.html

A Brief History of Medical Marijuana – TIME

“Should Professors Cheech and Chong ever receive university tenure teaching the medical history of their favorite subject, the course pack would be surprisingly thick.

As early as 2737 B.C., the mystical Emperor Shen Neng of China was prescribing marijuana tea for the treatment of gout, rheumatism, malaria and, oddly enough, poor memory. The drug’s popularity as a medicine spread throughout Asia, the Middle East and down the eastern coast of Africa, and certain Hindu sects in India used marijuana for religious purposes and stress relief. Ancient physicians prescribed marijuana for everything from pain relief to earache to childbirth…

By the late 18th century, early editions of American medical journals recommend hemp seeds and roots for the treatment of inflamed skin, incontinence and venereal disease. Irish doctor William O’Shaughnessy first popularized marijuana’s medical use in England and America. As a physician with the British East India Company, he found marijuana eased the pain of rheumatism and was helpful against discomfort and nausea in cases of rabies, cholera and tetanus.”

http://content.time.com/time/health/article/0,8599,1931247,00.html