[Cannabis – therapy for the future?]

“Despite all the progress achieved in the treatment of chronic gastrointestinal diseases, in some patients the treatment does not reach long-term optimum effectiveness. Therefore a number of patients have turned to complementary and alternative medicine (CAM).

Of the different types of CAM patients with GIT diseases tend to prefer in particular homeopathy, acupuncture and not least phytotherapy, where therapeutic use of cannabis may also be included.

The pathophysiological basis of therapeutic effect of curative cannabis has not been fully clarified so far.

Many scientists in many fields of medicine and pharmacology have been engaged in the study of effects of cannabinoids on the body since the beginning of the 20th century with the interest significantly increasing in the 1980s.

The discovery of CB receptors (1988) and endogenous molecules which activate these receptors (1992) led to the discovery of the endocannabinoid system.

Pharmacological modulation of the endogenous cannabinoid system offers new therapeutic possibilities of treatment of many illnesses and symptoms including the GIT disorders, including of nausea, vomiting, cachexia, IBS, Crohns disease and some other disorders.

Cannabinoids are attractive due to their therapeutic potential – they affect a lot of symptoms with minimum side effects.

Experience of patients with GIT disorders show that the use of cannabis is effective and helps in cases where the standard therapy fails.”

http://www.ncbi.nlm.nih.gov/pubmed/26375695

The effects of endocannabinoid receptor agonist anandamide and antagonist rimonabant on opioid analgesia and tolerance in rats.

“The role of the cannabinoid (CB) system in the tolerance to analgesic effect of opioid remains obscure. The aim of the present study was to evaluate the effects of the endocannabinoid nonselective receptor agonist anandamide (AEA) and CB1 receptor antagonist rimonabant (SR141716) on morphine analgesia and tolerance in rats.

The findings suggested that AEA in combination with morphine produced a significant increase in expression of analgesic tolerance to morphine.

Conversely, cannabinoid receptor antagonist SR141716 attenuated morphine analgesic tolerance.

In addition, administration of AEA with morphine increased morphine analgesia.

In conclusion, we observed that the cannabinoid receptor agonist anandamide and CB1 receptor antagonist SR141716 plays a significant role in the opioid analgesia and tolerance.”

http://www.ncbi.nlm.nih.gov/pubmed/26374993

New insights on the role of the endocannabinoid system in the regulation of energy balance.

“Within the last 15 years, the endocannabinoid system (ECS) has emerged as a lipid signaling system critically involved in the regulation of energy balance, since it exerts a regulatory control on every aspect related to the search, the intake, the metabolism and the storage of calories.

An overactive endocannabinoid-cannabinoid type 1 (CB1) receptor signaling promotes the development of obesity, insulin resistance and dyslipidemia, representing a valuable pharmacotherapeutic target for obesity and metabolic disorders.

However, due to psychiatric side effects, the first generation of brain-penetrant CB1 receptor blockers developed as anti-obesity treatment was removed from the European market in late 2008.

Since then, recent studies have identified new mechanisms of action of the ECS in energy balance and metabolism, as well as novel ways of targeting the system that may be efficacious for the treatment of obesity and metabolic disorders.”

http://www.ncbi.nlm.nih.gov/pubmed/26374449

Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial.

“Multiple sclerosis is associated with muscle stiffness, spasms, pain, and tremor. Much anecdotal evidence suggests that cannabinoids could help these symptoms.

Our aim was to test the notion that cannabinoids have a beneficial effect on spasticity and other symptoms related to multiple sclerosis.

There was evidence of a treatment effect on patient-reported spasticity and pain, with improvement in spasticity…

INTERPRETATION:

Treatment with cannabinoids did not have a beneficial effect on spasticity when assessed with the Ashworth scale. However… objective improvement in mobility and patients’ opinion of an improvement in pain suggest cannabinoids might be clinically useful.”

http://www.ncbi.nlm.nih.gov/pubmed/14615106

Cannabinoids in multiple sclerosis (CAMS) study: safety and efficacy data for 12 months follow up

Logo of jnnpsyc

“To test the effectiveness and long term safety of cannabinoids in multiple sclerosis (MS), in a follow up to the main Cannabinoids in Multiple Sclerosis (CAMS) study.

There was suggestive evidence for treatment effects of Δ9-THC on some aspects of disability.

There were no major safety concerns.

Overall, patients felt that these drugs were helpful in treating their disease.

These data provide limited evidence for a longer term treatment effect of cannabinoids.”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1739436/

The adverse effects of cannabinoids: implications for use of medical marijuana

Logo of cmaj

“Wang and colleagues present a systematic review of the research on adverse effects of medical cannabis use.

The authors found that most of the adverse events reported in the randomized clinical trials were not serious; dizziness was the most common.

These findings support the conclusions of the Institute of Medicine, that short-term use of cannabinoids for medical purposes has an acceptable safety profile.

This provides reassurance on the safety of prescribing cannabinoids and the newer cannabis extract for the short-term symptomatic relief…” 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2413322/

Endocannabinoid regulation of amyloid-induced neuroinflammation.

“The modulation of endocannabinoid (EC) levels and the activation of cannabinoid receptors are seen as promising therapeutic strategies in a variety of diseases, including Alzheimer’s disease (AD).

These data reinforce the notion of a role for the EC system in neuroinflammation and open new perspectives on the relevance of modulating EC levels in the inflammed brain.”

http://www.ncbi.nlm.nih.gov/pubmed/26362942

Tetrahydrocannabivarin (THCv) reduces Default Mode Network and increases Executive Control Network Resting State Functional Connectivity in Healthy Volunteers.

“The cannabinoid CB1 Neutral Antagonist Tetrahydrocannabivarin (THCv) has been suggested as a possible treatment for obesity but without the depressogenic side-effects of inverse antagonists such as Rimonabant.

Our findings are the first to show that treatment with the CB1 neutral antagonist THCv decreases resting state functional connectivity in the Default Mode network and increases connectivity in the Cognitive Control network and Dorsal Visual Stream network.

This effect profile suggests possible therapeutic activity of THCv for obesity where functional connectivity has been found to be altered in these regions.”

http://www.ncbi.nlm.nih.gov/pubmed/26362774

Combination cannabinoid and opioid receptor antagonists improves metabolic outcomes in obese mice.

“This study demonstrates that the combination of rimonabant, naloxone and norBNI is effective at producing weight loss over a sustained period of time without altering performance in standardised mouse behaviour tests. Fos expression patterns offer insight into the neuroanatomical substrates subserving these physiological and behavioural changes.

These results indicate that CB1-targeted drugs for weight loss may still be feasible.”

http://www.ncbi.nlm.nih.gov/pubmed/26360587

Assessment of Israeli Physicians’ Knowledge, Experience and Attitudes towards Medical Cannabis: A Pilot Study.

“Cannabis has been used throughout history for different purposes but was outlawed in the United States in 1937; many countries followed suit. Although recently reintroduced as a medical treatment in several countries, the use of cannabis in Israel is permitted for some medical purposes but is still controversial, eliciting heated public and professional debate. The few published studies on physicians’ attitudes to medical cannabis found them to be generally unsupportive.

OBJECTIVES:

To examine, for the first time, the experience, knowledge and attitudes of Israeli physicians towards medical cannabis (MC)…

Physicians generally agreed that MC treatment could be helpful for chronic and for terminally ill patients. Oncologists and pain specialists did not agree unanimously that MC can undermine mental health, whereas other physicians did. Physicians who recommended MC in the past (once or more) agreed, more than physicians who did not, with the statement “MC treatment in Israel is accessible to patients who need it”.

CONCLUSIONS:

In contrast to other studies we found partial acceptance of MC as a therapeutic agent. Further in-depth studies are needed to address regulatory and educational needs.”

http://www.ncbi.nlm.nih.gov/pubmed/26357721