Cannabis Use Associated With Reduced Intake Of Prescription Drugs

Survey data collected from the members of prominent Berkeley, California medical marijuana collective indicates that most patients minimize their intake of conventional medications following their initiation of cannabis therapy.

Sixty-six percent of respondents said that they consumed cannabis as a prescription drug substitute, according to the results of an anonymous survey. Many respondents said they preferred cannabis as it possesses fewer health side effects than conventional medications.

Some 70 percent of the respondents said they made use of cannabis for treating a chronic condition, such as diabetes or arthritis. Just over half said that they used marijuana for pain relief, including arthritis, migraines, and accident-related injuries. Nearly three-quarters of respondents said that they possessed health insurance coverage.

Reference:
Berkeley Patients Group

Synthetic THC reduces motility In Patients With Irritable Bowel Syndrome

According to clinical trial data to be published in the journal Gastroenterology, the administration of synthetic THC (aka dronabinol) decreases colonic motility compared to placebo in patients with irritable bowel syndrome (IBS).

The impact of oral THC versus placebo in a randomized trial of 75 patients with IBS was assessed by investigators at the Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER) in Rochester, Minnesota.

It was reported by researchers that active THC reduced motility of the large intestine during fasting compared to placebo in all of the study’s participants. The administration of dronabinol yielded the most significant results in IBS patients with diarrhea and in subjects with alternating diarrhea and constipation.

“Dronabinol may provide potential benefit to those [IBS patients] with accelerated transit,” researchers concluded.

Dronabinol is presently a schedule III controlled substance that is approved by the US Food and Drug Administration for the treatment of severe nausea and cachexia (wasting syndrome).

Earlier this month, survey results published online in the European Journal of Gastroenterology and Hepatology reported that patients with IBD commonly use cannabis therapeutically.

Reference:
Pharmacogenetic Trial of a Cannabinoid Agonist Shows Reduced Fasting Colonic Motility in Patients with Non-Constipated Irritable Bowel Syndrome-Gastroenterology

Cannabinoid and Acute Alcohol Withdrawal

According to data published online in the journal of the Public Library of Science (PLoS ONE), the administration of the synthetic cannabinoid agonist HU-211 decreases nerve cell death in an in vitro model of ethanol withdrawal.

The anti-excitotoxic effects of the synthetic cannabinoid HU-211 in culture were assessed by an international team of investigators from the INSERM medical research center in Caen, France, and Complutense University in Madrid, Spain. It was demonstrated by researchers that administration of cannabinoid protects neurons from cell death in an experimental model of ethanol withdrawal. By contrast, the administration of a cannabinoid antagonist (rimonabant) during ethanol withdrawal greatly increased the likelihood of cell death.

“These observations show, for the first time, that the stimulation of the endocannabinoid system could be protective against the hyper-excitability developed during alcohol withdrawal,” investigators concluded. “By contrast, the blockade of the endocannabinoid system seems to be counterproductive during alcohol withdrawal.”
Separate pre-clinical studies have previously documented that the administration of the non-psychotropic organic cannabinoid cannabidiol (CBD) in lab animals is neuroprotective against cerebral infarction and ethanol-induced neurotoxicity (alcohol poisoning).

Reference:
Pharmacological Activation/Inhibition of the Cannabinoid System Affects Alcohol Withdrawal-Induced Neuronal Hypersensitivity to Excitotoxic Insults- PLoS ONE.

Alcohol Is More Dangerous Than Cannabis

The consumption of alcohol causes far greater harms to the individual user and to society than does the use of cannabis.

The finding was made in a review published online in the Journal of Psychopharmacology, the journal of the British Association of Psychopharmacology. Investigators at the Imperial College of London assessed “the relative physical, psychological, and social harms of cannabis and alcohol.”

It was reported by the authors that cannabis inhalation, particularly long-term, contributes to some potential adverse health effects — including harms to the lungs, circulatory system, as well as the exacerbation of certain mental health risks. By contrast, alcohol was described by the authors as “a toxic substance” that is responsible for an estimated five percent “of the total global disease burden.”

Researchers determined, “A direct comparison of alcohol and cannabis showed that alcohol was considered to be more than twice as harmful as cannabis to [individual] users, and five times more harmful as cannabis to others (society). … As there are few areas of harm that each drug can produce where cannabis scores more [dangerous to health] than alcohol, we suggest that even if there were no legal impediment to cannabis use, it would be unlikely to be more harmful than alcohol.”

They concluded, “The findings underline the need for a coherent, evidence-based drugs policy that enables individuals to make informed decisions about the consequences of their drug use.”

Reference:

Popular intoxicants: what lessons can be learned from the last 40 years of alcohol and cannabis regulation-Journal of Psychopharmacology

Cannabis Improves Symptoms Of Inflammatory Bowel Disease

According to a pilot prospective study, inhaled cannabis improves quality of life measurements, disease activity index, and causes weight gain and rise in body mass index in long-standing inflammatory bowel disease (IBD) patients.

Thirteen patients with IBD were included in a pilot prospective study conducted at a Department of Gastroenterology belonging to Tel Aviv University, Israel. The study was conducted for investigating the effects of a treatment with inhaled cannabis.

Several parameters were assessed before treatment and after three months of treatment including the Harvey-Bradshaw index that offers information on disease activity in Crohn’s disease, including general well-being, abdominal pain, number of liquid stools and complications. Patients, after three months of treatment, reported improvement in general health perception, social functioning, ability to work, physical pain, and depression.

A schematic scale of health perception showed an improved average score from 4.1 to 7. The patients experienced an average weight gain of 4.3 kg and an average rise in BMI (body mass index) of 1.4, while the average Harvey-Bradshaw index was reduced from 11.36 to 5.72.

It was concluded by authors that “three months’ treatment with inhaled cannabis improves quality of life measurements, disease activity index, and causes weight gain and rise in BMI in long-standing IBD patients.”

Reference:

Lahat A, Lang A, Ben-Horin S. Impact of Cannabis Treatment on the Quality of Life, Weight and Clinical Disease Activity in Inflammatory Bowel Disease Patients: A Pilot Prospective Study. Digestion. 2011;85(1):1-8.)

Medical Marijuana And Hepatitis C

Hepatitis C is a viral disease of the liver that afflicts an estimated four million in the United States alone. Chronic hepatitis C is typically associated with depression, fatigue, joint pain and liver impairment, including cirrhosis and liver cancer. Patients diagnosed with the disease frequently report using cannabis for treating both symptoms of the disease and the nausea associated with antiviral therapy.

An observational study by investigators at the University of California at San Francisco (UCSF) revealed that patients afflicted with hepatitis C who used cannabis were significantly more likely to adhere to their treatment regimen than patients who did not use it. However, no clinical trials assessing cannabinoid use for this indication are available in the scientific literature.

It is indicated by preclinical data that endocannabinoid system could moderate aspects of chronic liver disease and inflammation could be reduced by cannabinoids in experimental models of hepatitis. Nevertheless, other clinical reviews have reported a positive association between cannabis use on a daily basis and the progression of liver fibrosis (excessive tissue build up) and steatosis (excessive fat build up) in select hepatitis C patients.

Investigators from Canada and Germany, writing in the October 2006 issue of the European Journal of Gastroenterology, concluded that cannabis’ “potential benefits of a higher likelihood of treatment success [for hepatitis c patients] appear to outweigh [its] risks.”

References:

[1] Schnelle et al. 1999. Results of a standardized survey on the medical use of cannabis products in the German-speaking area. Forschende Komplementarmedizin (Germany) 3: 28-36.
[2] David Berstein. 2004. “Hepatitis C – Current state of the art and future directions.” MedScape Today.
[3] Sylvestre et al. 2006. Cannabis use improves retention and virological outcomes in patients treated for hepatitis C. European Journal of Gastroenterology & Hepatology. 18: 1057-1063.
[4] Zamora-Valdes et al. 2005. The endocannabinoid system in chronic liver disease (PDF). Annals of Hepatology 4: 248-254.
[5] Gabbey et al. 2005. Endocannabinoids and liver disease – review. Liver International 25: 921-926.
[6] Lavon et al. 2003. A novel synthetic cannabinoid derivative inhibits inflammatory liver damage via negative cytokine regulation. Molecular Pharmacology 64: 1334-1344.
[7] Hezode et al. 2005. Daily cannabis smoking as a risk factor for progression of fibrosis in chronic hepatitis C. Hepatology 42: 63-71.
[8] Ishida et al. 2008. Influence of cannabis use on severity of hepatitis C disease. Clinical Gastroenterology and Hepatology 6: 69-75.
[9] Parfieniuk and Flisiak. 2008. Role of cannabinoids in liver disease. World Journal of Gastroenterology 14: 6109-6114.
[10] Fischer et al. 2006. Treatment for hepatitis C virus and cannabis use in illicit drug user patients: implications and questions. European Journal of Gastroenterology & Hepatology. 18: 1039-1042.
[11] Schwabe and Siegmund. 2005. op. cit.
[12] Hezode et al. 2005. op. cit.
[13] David Berstein. 2004. op. cit.
[14] Hezode et al. 2008. Daily cannabis use: a novel risk factor of steatosis severity in patients with chronic hepatitis C. Gastroenterology 134: 432-439.
[15] Purohit et al. 2010. Role of cannabinoids in the development of fatty liver (steatosis). The AAPS Journal 12: 233-237.

Medical Marijuana And Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease is a fatal neurodegenerative disorder that is characterized by the selective loss of motor neurons in the brain stem, spinal cord, and motor cortex. It is estimated that around 30,000 Americans are living with the complication that often arises spontaneously and afflicts otherwise healthy adults. More than half of the affected patients die within 2.5 years following the onset of symptoms.

An absence of clinical trials investigating the use of cannabinoids for ALS treatment was revealed by a review of the scientific literature. However, it is indicated by recent preclinical findings that cannabinoids may delay progression of the disease, lending support to anecdotal reports by patients that cannabinoids may be efficacious in moderating the disease’s development and in alleviating certain ALS-related symptoms like depression, drooling, appetite loss, and pain.

Investigators at the California Pacific Medical Center in San Francisco, writing in the March 2004 issue of the journal Amyotrophic Lateral Sclerosis & Other Motor Neuron Disorders, reported that the administration of THC both before and after the onset of ALS symptoms staved disease progression and prolonged survival in animals compared to untreated controls.

The administration of other naturally occurring and synthetic cannabinoids may also moderate disease progression but not necessarily impact survival, according to additional trials in animal models of Amyotrophic Lateral Sclerosis. A recent study has demonstrated that blocking the CB1 cannabinoid receptor did extend life span in an ALS mouse model, indicating that the beneficial effects of cannabinoids on ALS could be mediated by non-CB1 receptor mechanisms.

A team of investigators writing in the American Journal of Hospice & Palliative Medicine in 2010 reported, “Based on the currently available scientific data, it is reasonable to think that cannabis might significantly slow the progression of ALS, potentially extending life expectancy and substantially reducing the overall burden of the disease.” They concluded, “There is an overwhelming amount of preclinical and clinical evidence to warrant initiating a multicenter randomized, double-blind, placebo-controlled trial of cannabis as a disease-modifying compound in ALS.”

References:

[1] Amtmann et al. 2004. Survey of cannabis use in patients with amyotrophic lateral sclerosis. The American Journal of Hospice and Palliative Care 21: 95-104.
[2] Raman et al. 2004. Amyotrophic lateral sclerosis: delayed disease progression in mice by treatment with a cannabinoid. Amyotrophic Lateral Sclerosis & Other Motor Neuron Disorders 5: 33-39.
[3] Weydt et al. 2005. Cannabinol delays symptom onset in SOD1 transgenic mice without affecting survival. Amyotrophic Lateral Sclerosis & Other Motor Neuron Disorders 6: 182-184.
[4] Bilsland et al. 2006. Increasing cannabinoid levels by pharmacological and genetic manipulation delay disease progression in SOD1 mice. The FASEB Journal 20: 1003-1005.
[5] Ibid.
[6]Carter et al. 2010. Cannabis and amyotrophic lateral sclerosis: hypothetical and practical applications, and a call for clinical trials. American Journal of Hospice & Palliative Medicine 27: 347-356.

Cannabis influences blood levels of appetite hormones in HIV patients

Scientists of the Center for Medicinal Cannabis Research (CMCR) of the University of California in San Diego, USA, have investigated among others the effects of cannabis on appetite hormones in the course of a placebo-controlled trial with HIV patients, who suffered from pain.

Twenty-eight patients had been included to investigate the effects of smoked cannabis on their pain in the original already published clinical study. Seven of these patients selected for investigating the blood levels of the hormones leptin, ghrelin, peptide YY, and insulin after exposition with cannabis and placebo in a cross-over design.

Cannabis administration, compared to placebo, was associated with significant increases in plasma levels of ghrelin and leptin, and decreases in peptide YY. It however did not significantly influence insulin levels. Authors stated that “cannabis-related changes in these hormones had a magnitude similar to what has been observed with food intake over the course of a day in normal volunteers, suggesting physiological relevance. “They concluded that “these findings are consistent with modulation of appetite hormones mediated through endogenous cannabinoid receptors, independent of glucose metabolism.”

Reference:

Riggs PK, Vaida F, Rossi SS, Sorkin LS, Gouaux B, Grant I, Ellis RJ. A pilot study of the effects of cannabis on appetite hormones in HIV-infected adult men. Brain Res. 2011 Nov 7. [in press])

Medical Marijuana And Incontinence

Urinary incontinence, defined as a loss of bladder control, may result from many biological factors, including weak bladder muscles and inflammation, as well as from nerve damage associated with diseases such as multiple sclerosis (MS) and Parkinson’s disease. It is believed that more than one in ten Americans over age 65 suffer from incontinence, particularly women.

Several recent clinical trials in the past have indicated that cannabinoid therapy could reduce incidents of incontinence. Investigators at Oxford’s Centre for Enablement in Britain, writing in the February 2003 issue of the journal Clinical Rehabilitation, reported that bladder control was improved by self-administered doses of whole-plant cannabinoid extracts when compared to placebo in patients suffering from MS and spinal cord injury.

These initial findings were followed by investigators at London’s Institute for Neurology in an open-label pilot study of cannabis-based extracts for bladder dysfunction in 15 patients with advanced multiple sclerosis. Investigators determined “urinary urgency, the number of and volume of incontinence episodes, frequency, and nocturia all decreased significantly” following cannabinoid therapy. “Cannabis-based medicinal extracts are a safe and effective treatment for urinary and other problems in patients with advanced MS.”

A multi-center, randomized placebo-controlled trial involving 630 patients administered oral doses of cannabis extracts or THC confirmed these findings in 2006. It was reported by researchers that subjects administered cannabis extracts experienced a 38 percent reduction in incontinence episodes from baseline to the end of treatment, while patients administered THC experienced a 33 percent reduction, suggesting a “clinical effect of cannabis on incontinence episodes.

“In light of these findings, experts have recommended the use of cannabinoids as potential ‘second-line’ agents to treat incontinence.

References:

[1] Wade et al. 2003. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clinical Rehabilitation 17: 21-29.
[2] Brady et al. 2004. An open label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Multiple Sclerosis 10: 425-433.
[3] Freeman et al. 2006. The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomized placebo-controlled trial. The International Urogynecology Journal 17: 636-641.
[4] University of Pittsburgh Medical Center Press Release. May 21, 2006. ” Marijuana-derived drug suppresses bladder pain in animal models.”
[5] Kalsi and Fowler. 2005. Therapy insight: bladder dysfunction associated with multiple sclerosis. Nature Clinical Practice Neurology 2: 492-501.

Medical Marijuana And Gastrointestinal Disorders

Gastrointestinal (GI) disorders, including functional bowel diseases such as inflammatory bowel diseases (Crohn’s disease and colitis) and irritable bowel syndrome (IBS) afflict more than one in five Americans, particularly women. While some of the disorders could be prevented by diet and pharmaceutical medications, others are poorly moderated by conventional treatments.

 The symptoms of gastrointestinal disorders often include cramping, abdominal pain, inflammation of the lining of the large and/or small intestine, rectal bleeding, chronic diarrhea, and weight loss.

Though several anecdotal reports and a handful of case reports exist in the scientific literature supporting the use of cannabinoids for treating symptoms of this disorder, virtually no clinical trial work has been performed in this area, aside from a 2007 clinical study assessing the impact of oral THC on colonic motility.

Nevertheless, it has been demonstrated by numerous preclinical studies that activation of the CB1 and CB2 cannabinoid receptors exert biological functions on the gastrointestinal tract. In animals, effects of their activation include suppression of gastrointestinal motility, reduced acid reflux, inhibition of intestinal secretion, protection from inflammation, and promotion of epithelial wound healing in human tissue.

As a result, it is believed by many experts that cannabinoids and/or modulation of the endogenous cannabinoid system represents a novel therapeutic approach for the treatment of numerous GI disorders — including inflammatory bowel diseases, functional bowel diseases, gastro-oesophagael reflux conditions, secretory diarrhea, gastric ulcers, and colon cancer.

References:
[1] Gahlinger, Paul M. 1984. Gastrointestinal illness and cannabis use in a rural Canadian community. Journal of Psychoactive Drugs 16: 263-265.
[2] Swift et al. 2005. Survey of Australians using cannabis for medical purposes. Harm Reduction Journal 4: 2-18.
[3] Baron et al. 1990. Ulcerative colitis and marijuana. Annals of Internal Medicine 112: 471.
[4] Jeff Hergenrather. 2005. Cannabis alleviates symptoms of Crohn’s Disease. O’Shaughnessy’s 2: 3.
[5] Esfandyari et al. 2007. Effects of a cannabinoid receptor agonist on colonic motor and sensory functions in humans: a randomized, placebo-controlled study. American Journal of Physiology, Gastrointestinal and Liver Physiology 293: 137-145.
[6] Massa and Monory. 2006. Endocannabinoids and the gastrointestinal tract. Journal of Endocrinological Investigation 29 (Suppl): 47-57.
[7] Roger Pertwee. 2001. Cannabinoids and the gastrointestinal tract. Gut 48: 859-867.
[8] DiCarlo and Izzo. 2003. Cannabinoids for gastrointestinal diseases: potential therapeutic applications. Expert Opinion on Investigational Drugs 12: 39-49.
[9] Lehmann et al. 2002. Cannabinoid receptor agonism inhibits transient lower esophageal sphincter relaxations and reflux in dogs. Gastroenterology 123: 1129-1134.
[10] Massa et al. 2005. The endocannabinoid system in the physiology and pathophysiology of the gastrointestinal tract. Journal of Molecular Medicine 12: 944-954.
[11] Wright et al. 2005. Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing. Gastroenterology 129: 437-453.
[12] Massa and Monory. 2006. op. cit.
[13] Izzo and Coutts. 2005. Cannabinoids and the digestive tract. Handbook of Experimental Pharmacology 168: 573-598.
[14] Izzo et al. 2009. Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb. Trends in Pharmacological Sciences 30: 515-527.