Tag Archives: marijuana

Self-Reported Effectiveness and Safety of Trokie® Lozenges: A Standardized Formulation for the Buccal Delivery of Cannabis Extracts.

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“Therapeutic use of cannabinoids, the main active ingredients of Cannabissativa L., is often hindered by their limited bioavailability and undesirable psychoactivity. We conducted an observational study in December 2016 and another one in February 2018 to investigate respectively: (i) the effectiveness of Trokie® lozenges, a standardized formulation containing cannabis extracts, to deliver cannabinoids via buccal absorption and (ii) its long-term safety.

Participants were members of the Palliative Care Corporation health clinic, registered California cannabis patients, and had a diagnosis of chronic non-cancer pain. For the effectiveness study, 49 participants were asked to self-report pain perception before and after 1-12 weeks of taking Trokie® lozenges, using an 11-point pain intensity numeric rating scale (PI-NRS).

A mean reduction in PI-NRS score of 4.9 ± 2.0 points was observed. Onset of analgesia typically varied between 5 and 40 min, which seems consistent with, at least partial, buccal absorption. In the safety study, 35 participants were asked to complete a questionnaire about adverse events (AEs) associated with Trokie® lozenges. AEs were reported by 16 subjects (46%), the most common being dizziness/unsteadiness (N = 7), bad taste (N = 5), and throat irritation/dry mouth (N = 4). None of the self-reported AEs resulted in a serious medical situation and most of them had limited impact on daily functions.

Despite the AEs, 90% of participants reported being “satisfied” or “very satisfied” with the product. These observations suggest that buccal administration of standardized extracts via Trokie® lozenges may represent an efficacious and safe approach to cannabis administration.”

https://www.ncbi.nlm.nih.gov/pubmed/30154694

https://www.frontiersin.org/articles/10.3389/fnins.2018.00564/full 

Cannabis and the Health and Performance of the Elite Athlete.

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“Cannabis (marijuana) is undergoing extensive regulatory review in many global jurisdictions for medical and nonmedical access. Cannabis has potential impact on the health of athletes as well as on performance in both training and in competition. The aim of this general review is to identify and highlight the challenges in interpreting information with respect to elite athletic performance, and to point to important research areas that need to be addressed.

MAIN RESULTS:

Cannabis may be primarily inhaled or ingested orally for a range of medical and nonmedical reasons; evidence for efficacy is limited but promising for chronic pain management. Although evidence for serious harms from cannabis use on health of athletes is limited, one should be cognizant of the potential for abuse and mental health issues. Although the prevalence of cannabis use among elite athletes is not well-known, use is associated with certain high-risk sports. There is no evidence for cannabis use as a performance-enhancing drug.

CONCLUSIONS:

Medical and nonmedical cannabis use among athletes reflects changing societal and cultural norms and experiences. Although cannabis use is more prevalent in some athletes engaged in high-risk sports, there is no direct evidence of performance-enhancing effects in athletes. The potential beneficial effects of cannabis as part of a pain management protocol, including reducing concussion-related symptoms, deserve further attention.”

https://www.ncbi.nlm.nih.gov/pubmed/30153174

https://insights.ovid.com/crossref?an=00042752-201809000-00009

Orthopaedic surgery patients who use recreational marijuana have less pre-operative pain.

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“To determine the baseline clinical characteristics of recreational marijuana users undergoing outpatient orthopaedic surgery.

We hypothesized that patients who report marijuana use would have worse pain, function, and general health status.

The results do not support our hypothesis, as marijuana use was associated with less pain and better lower extremity activity rating scale scores when compared to non-users.”

https://www.ncbi.nlm.nih.gov/pubmed/30135987

https://link.springer.com/article/10.1007%2Fs00264-018-4101-x

Efficacy and Safety of Adjunctive Cannabidiol in Patients with Lennox-Gastaut Syndrome: A Systematic Review and Meta-Analysis.

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“Lennox-Gastaut syndrome (LGS) is a severe developmental epileptic encephalopathy, and available interventions fail to control seizures in most patients. Cannabidiol (CBD) is a major chemical of marijuana, which has anti-seizure properties and different mechanisms of action compared with other approved antiepileptic drugs (AEDs).

OBJECTIVE:

The aim was to evaluate the efficacy and safety of CBD as adjunctive treatment for seizures in patients with LGS using meta-analytical techniques.

METHODS:

Randomized, placebo-controlled, single- or double-blinded trials were identified. Main outcomes included the ≥ 50% reduction in baseline drop and non-drop seizure frequency, and the incidence of treatment withdrawal and adverse events (AEs). Risk ratios (RRs) with 95% confidence intervals (CIs) were estimated through the inverse variance method.

RESULTS:

Two trials were included involving 396 participants. Patients presenting ≥ 50% reduction in drop seizure frequency during the treatment were 40.0% with CBD and 19.3% with placebo [RR 2.12 (95% CI 1.48-3.03); p < 0.001]. The rate of non-drop seizure frequency was reduced by 50% or more in 49.4% of patients in the CBD and 30.4% in the placebo arms [RR 1.62 (95% CI 1.09-2.43); p = 0.018]. The RR for CBD withdrawal was 4.93 (95% CI 1.50-16.22; p = 0.009). The RR to develop any AE during CBD treatment was 1.24 (95% CI 1.11-1.38; p < 0.001). AEs significantly associated with CBD were somnolence, decreased appetite, diarrhea and increased serum aminotransferases.

CONCLUSIONS:

Adjunctive CBD resulted in a greater reduction in seizure frequency and a higher rate of AEs than placebo in patients with LGS presenting seizures uncontrolled by concomitant AEDs.”

 https://www.ncbi.nlm.nih.gov/pubmed/30132269
https://link.springer.com/article/10.1007%2Fs40263-018-0558-9

“Cannabidiol in the Lennox-Gastaut Syndrome.”  https://www.nejm.org/doi/10.1056/NEJMc1807878

Optimization Of A Preclinical Therapy Of Cannabinoids In Combination With Temozolomide Against Glioma.

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 Biochemical Pharmacology “Glioblastoma multiforme (GBM) is the most frequent and aggressive form of brain cancer. These features are explained at least in part by the high resistance exhibited by these tumors to current anticancer therapies. Thus, the development of novel therapeutic approaches is urgently needed to improve the survival of the patients suffering this devastating disease.

Δ9-Tetrahydrocannabinol (THC, the major active ingredient of marijuana), and other cannabinoids have been shown to exert antitumoral actions in animal models of cancer, including glioma. The mechanism of these anticancer actions relies, at least in part, on the ability of these compounds to stimulate autophagy-mediated apoptosis in tumor cells.

Previous observations from our group demonstrated that local administration of THC (or of THC + CBD at a 1:1 ratio, a mixture that resembles the composition of the cannabinoid-based medicine Sativex®) in combination with Temozolomide, the benchmark agent for the treatment of GBM, synergistically reduces the growth of glioma xenografts.

With the aim of optimizing the possible clinical utilization of cannabinoids in anti-GBM therapies, in this work we explored the anticancer efficacy of the systemic administration of cannabinoids in combination with TMZ in preclinical models of glioma.

Our results show that oral administration of THC+CBD (Sativex-like extracts) in combination with TMZ produces a strong antitumoral effect in both subcutaneous and intracranial glioma cell-derived tumor xenografts. In contrast, combined administration of Sativex-like and BCNU (another alkylating agent used for the treatment of GBM which share structural similarities with the TMZ) did not show a stronger effect than individual treatments.

Altogether, our findings support the notion that the combined administration of TMZ and oral cannabinoids could be therapeutically exploited for the management of GBM.”

https://www.ncbi.nlm.nih.gov/pubmed/30125556

https://www.sciencedirect.com/science/article/abs/pii/S0006295218303496

Cannabidiol Attenuates Experimental Autoimmune Encephalomyelitis Model of Multiple Sclerosis Through Induction of Myeloid-Derived Suppressor Cells.

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“Multiple sclerosis (MS) is a chronic debilitating autoimmune disease without a cure. While the use of marijuana cannabinoids for MS has recently been approved in some countries, the precise mechanism of action leading to attenuate neuroinflammation is not clear. We used experimental autoimmune encephalomyelitis (EAE), a murine model of MS, to explore the anti-inflammatory properties of cannabidiol (CBD), a non-psychoactive cannabinoid. Treatment with CBD caused attenuation of EAE disease paradigms as indicated by a significant reduction in clinical scores of paralysis, decreased T cell infiltration in the central nervous system, and reduced levels of IL-17 and IFNγ. Interestingly, CBD treatment led to a profound increase in myeloid-derived suppressor cells (MDSCs) in EAE mice when compared to the vehicle-treated EAE controls. These MDSCs caused robust inhibition of MOG-induced proliferation of T cells in vitro. Moreover, adoptive transfer of CBD-induced MDSCs ameliorated EAE while MDSC depletion reversed the beneficial effects of CBD treatment, thereby conclusively demonstrating that MDSCs played a crucial role in CBD-mediated attenuation of EAE. Together, these studies demonstrate for the first time that CBD treatment may ameliorate EAE through induction of immunosuppressive MDSCs.”

https://www.ncbi.nlm.nih.gov/pubmed/30123217

“In conclusion, we have demonstrated that the mitigation of EAE with CBD comes from its ability to target a range of anti-inflammatory pathways, including (i) induction of anti-inflammatory MDSCs and (ii) decrease in pro-inflammatory and induction of anti-inflammatory cytokines. Because CBD is non-psychoactive, our studies suggest that CBD may constitute an excellent candidate for the treatment of MS and other autoimmune diseases. Our studies provide further evidence of the importance of MDSCs and that manipulation of such cells may constitute novel therapeutic modality to treat MS and other autoimmune diseases.”

https://www.frontiersin.org/articles/10.3389/fimmu.2018.01782/full

Medical marijuana laws and workplace fatalities in the United States

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International Journal of Drug Policy

“The aim of this research was to determine the association between legalizing medical marijuana and workplace fatalities.

To date, 29 states and the District of Columbia have legalized the use of marijuana for medicinal purposes. Although there is increasing concern that legalizing medical marijuana will make workplaces more dangerous, little is known about the relationship between medical marijuana laws (MMLs) and workplace fatalities.

 

Findings

Legalizing medical marijuana was associated with a 19.5% reduction in the expected number of workplace fatalities among workers aged 25–44 (incident rate ratio [IRR], 0.805; 95% CI, .662–.979). The association between legalizing medical marijuana and workplace fatalities among workers aged 16–24, although negative, was not statistically significant at conventional levels. The association between legalizing medical marijuana and workplace fatalities among workers aged 25–44 grew stronger over time. Five years after coming into effect, MMLs were associated with a 33.7% reduction in the expected number of workplace fatalities (IRR, 0.663; 95% CI, .482–.912). MMLs that listed pain as a qualifying condition or allowed collective cultivation were associated with larger reductions in fatalities among workers aged 25–44 than those that did not.

Conclusions

The results provide evidence that legalizing medical marijuana improved workplace safety for workers aged 25–44. Further investigation is required to determine whether this result is attributable to reductions in the consumption of alcohol and other substances that impair cognitive function, memory, and motor skills.”

https://www.sciencedirect.com/science/article/pii/S0955395918301968

“Workplace Deaths Drop After States Legalize Medical Marijuana”  https://www.marijuanamoment.net/workplace-deaths-drop-after-states-legalize-medical-marijuana/

“Medical Marijuana States Have Lower Rates Of Workplace Death, According To New Study” https://www.civilized.life/articles/medical-marijuana-states-have-lower-rates-of-workplace-death-according-to-new-study/

“States with legal medical marijuana have seen a drop in workplace deaths” https://www.businessinsider.com/fatal-work-injuries-decline-in-states-with-medical-marijuana-laws-2019-4

“Legalizing Medical Marijuana Could Make Workplaces Safer.”  https://thefreshtoast.com/cannabis/legalizing-medical-marijuana-could-make-workplaces-safer/

Cannabinoid pharmacology and therapy in gut disorders.

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Biochemical Pharmacology

“Cannabis sp and their products (marijuana, hashish…), in addition to their recreational, industrial and other uses, have a long history for their use as a remedy for symptoms related with gastrointestinal diseases.

After many reports suggesting these beneficial effects, it was not surprising to discover that the gastrointestinal tract expresses endogenous cannabinoids, their receptors, and enzymes for their synthesis and degradation, comprising the so-called endocannabinoid system.

This system participates in the control of tissue homeostasis and important intestinal functions like motor and sensory activity, nausea, emesis, the maintenance of the epithelial barrier integrity, and the correct cellular microenvironment. Thus, different cannabinoid-related pharmacological agents may be useful to treat the main digestive pathologies.

To name a few examples, in irritable bowel syndrome they may normalize dysmotility and reduce pain, in inflammatory bowel disease they may decrease inflammation, and in colorectal cancer, apart from alleviating some symptoms, they may play a role in the regulation of the cell niche.

This review summarizes the main recent findings on the role of cannabinoid receptors, their synthetic or natural ligands and their metabolizing enzymes in normal gastrointestinal function and in disorders including irritable bowel syndrome, inflammatory bowel disease, colon cancer and gastrointestinal chemotherapy-induced adverse effects (nausea/vomiting, constipation, diarrhea).”

 https://www.ncbi.nlm.nih.gov/pubmed/30076849
https://www.sciencedirect.com/science/article/abs/pii/S0006295218303186

Falling rates of marijuana dependence among heavy users.

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Drug and Alcohol Dependence Home

“Marijuana use has become increasingly popular in the United States since the turn of the century, and typical use patterns among past-month marijuana users have intensified, raising concerns for an increase in cannabis use disorders (CUDs). Yet the population prevalence of CUDs has mostly remained flat. We analyzed trends in DSM-IV marijuana dependence among Daily/Near-Daily (DND) users, both overall and by age and gender, and considered potential explanations.

RESULTS:

Dependence among DND users fell by 39% (26.5%-16.1%; p < .001), with significant trend. No significant change is detected at the population level. Sub-group analysis shows a steep gradient for age but not for gender. Declines are robust to sub-group analysis, except for users over 50 years old. Among dependence symptoms, most showed significant declines: reducing important activities (p < .001); use despite emotional, mental, or physical problems (p < .001); failing attempts to cutback (p < .001); lots of time getting, using, or getting over marijuana (p < .01); and failing to keep limits set on use (p < .05). Reported tolerance showed no significant change.

CONCLUSIONS:

Though it is unclear why, the risk of dependence formation among heavy marijuana users appear to have declined since 2002. Further research is warranted regarding explanations related to state marijuana policies, product forms, or social context.”

https://www.ncbi.nlm.nih.gov/pubmed/30077891

https://www.drugandalcoholdependence.com/article/S0376-8716(18)30389-2/fulltext

Association of Marijuana Use With Psychosocial and Quality of Life Outcomes Among Patients With Head and Neck Cancer

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“Is there a difference in quality of life and psychosocial outcomes between marijuana users and nonusers who have newly diagnosed head and neck cancer?

In this case-matched cohort study, 74 patients with newly diagnosed head and neck cancer who were marijuana users appeared to have quality of life differences compared with 74 who did not use marijuana, including decreased anxiety, pain, and depression and increased appetite and generalized feelings of well-being on the Edmonton Symptom Assessment System and the EuroQol-5D questionnaires.

Recreational marijuana use potentially improves quality of life and psychosocial symptoms among patients with newly diagnosed head and neck cancer.

Recreational use of C sativa potentially alleviates anxiety, depression, pain, and nausea and improves general well-being in patients with newly diagnosed HNC.”

https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2688527

“Cannabis Tied to QOL Benefits in Head and Neck Cancer. Patients on marijuana reported better depression and anxiety scores”  https://www.medpagetoday.com/hematologyoncology/othercancers/74387