Aggressive Behavior Reduced By Oral THC

According to the findings of four case reports published in the November issue of the Journal of Clinical Psychiatry, the administration of oral synthetic THC is linked with improved symptoms of psychosis in patients with refractory schizophrenia.

Investigators at the Rockland Psychiatric Center in Orangeburg, New York, the Columbia University Medical Center, and the New York University School of Medicine evaluated the efficiency of oral THC (dronabinol) on eight patients with refractory psychosis.

The trial subjects had a history of symptomatic improvement when making use of cannabis and had been unresponsive to conventional medical treatments. It was reported by the researchers that there was significant improvement in four of the eight patients after oral THC treatment. The authors reported, in particular, that administration of cannabinoid produced a significant reduction in subjects’ aggressive tendencies. No patients in the study experienced significant adverse side effects from THC.

“It appears that a predisposed subset of patients with schizophrenia may actually improve with cannabinoid stimulation,” investigators concluded.

The study, “Improvement in refractory psychosis with dronabinol: four case reports,” appeared in the Journal of Clinical Psychiatry.

Cannabinoids Demonstrate Benefits For MS Patients

Administration of oral THC and/or natural cannabis extracts in the long-term has the ability to minimize MS-associated pain and improves mobility compared to placebo, according to clinical trial data to be published in the Journal of Neurology, Neurosurgery, and Psychiatry.
Results of the initial fifteen-week, double-blind, placebo controlled trial, appeared in the British medical journal The Lancet and the study findings are based on the results of a 52-week follow-up trial of more than 500 multiple sclerosis patients.

The investigators though found evidence of a “small treatment effect” in the control of patients’ spasticity noted that subjects achieved greater symptomatic relief in other areas – including pain relief, sleep quality, and mobility – the longer they made use of cannabinoids. These results “suggest a wider symptomatic benefit with time,” researchers concluded.
Researchers from Britain are expected to initiate recruitment of patients for participating in a three-year clinical trial to further investigate whether the long-term use of cannabinoids alters the progression of MS.

Cannabinoids inhibited the progression of diseases such as MS, Parkinson’s disease, and Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease), according to previous studies investigating the impact of cannabinoids on animal models.

Marijuana And Multiple Sclerosis

A chronic degenerative disease of the central nervous system, multiple sclerosis (MS), causes inflammation, muscular weakness, and a loss of motor coordination. Over a period of time, patients afflicted with the disease typically become permanently disabled and the disease could be fatal in some cases. According to the US National Multiple Sclerosis Society, nearly 200 people are diagnosed every week with the disease that often strikes those 20 to 40 years of age.

Clinical and anecdotal reports of the ability of cannabinoids to minimize MS-related symptoms such as pain, spasticity, depression, fatigue, and incontinence are plentiful in the scientific literature. In 2008, investigators at the University of California at San Diego reported inhaled cannabis significantly reduced objective measures of pain intensity and spasticity in patients with MS in a placebo-controlled, randomized clinical trial. Investigators concluded that “smoked cannabis was superior to placebo in reducing spasticity and pain in patients with multiple sclerosis and provided some benefit beyond currently prescribed treatment.”

It should therefore comes as no surprise that patients with multiple sclerosis typically report engaging in cannabis therapy, with one survey indicating that almost one in two MS patients use the drug therapeutically.

Investigators at the University College of London’s Institute of Neurology, writing in the July 2003 issue of the journal Brain, reported that administration of the synthetic cannabinoid agonist WIN 55,212-2 provided “significant neuroprotection” in an animal model of multiple sclerosis. “The results of this study are important because they suggest that in addition to symptom management, … cannabis may also slow the neurodegenerative processes that ultimately lead to chronic disability in multiple sclerosis and probably other disease,” researchers concluded.

Investigators at the Netherland’s Vrije University Medical Center, Department of Neurology, also reported that oral THC could boost immune function in patients with multiple sclerosis.

References:
[1] Chong et al. 2006. Cannabis use in patients with multiple sclerosis. Multiple Sclerosis 12: 646-651.
[2] Rog et al. 2005. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 65: 812-819.
[3] Wade et al. 2004. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Multiple Sclerosis 10: 434-441.
[4] 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.
[5] Vaney et al. 2004. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Multiple Sclerosis 10: 417-424.
[6] Zajicek et al. 2003. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis: multicentre randomized placebo-controlled trial [PDF]. The Lancet 362: 1517-1526.
[7] Page et al. 2003. Cannabis use as described by people with multiple sclerosis [PDF]. Canadian Journal of Neurological Sciences 30: 201-205.
[8] 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.
[9] Consroe et al. 1997. The perceived effects of smoked cannabis on patients with multiple sclerosis. European Journal of Neurology 38: 44-48.
[10] Meinck et al. 1989. Effects of cannabinoids on spasticity and ataxia in multiple sclerosis. Journal of Neurology 236: 120-122.
[11] Ungerleider et al. 1987. Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. Advances in Alcohol and Substance Abuse 7: 39-50.
[12] Denis Petro. 1980. Marijuana as a therapeutic agent for muscle spasm or spasticity. Psychosomatics 21: 81-85.
[13] Jody Corey-Bloom. 2010. Short-term effects of cannabis therapy on spasticity in multiple sclerosis. In: University of San Diego Health Sciences, Center for Medicinal Cannabis Research. Report to the Legislature and Governor of the State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding. op. cit.
[14] Clark et al. 2004. Patterns of cannabis use among patients with multiple sclerosis. Neurology 62: 2098-2010.
[15] Reuters News Wire. August 19, 2002. “Marijuana helps MS patients alleviate pain, spasms.”
[16] Pryce et al. 2003. Cannabinoids inhibit neurodegeneration in models of multiple sclerosis. Brain 126: 2191-2202.
[17] Killestein et al. 2003. Immunomodulatory effects of orally administered cannabinoids in multiple sclerosis. Journal of Neuroimmunology 137: 140-143.
[18] Wade et al. 2006. Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms of multiple sclerosis. Multiple Sclerosis 12: 639-645.
[19] Rog et al. 2007. Oromucosal delta-9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clinical Therapeutics 29: 2068-2079.
[20] Canada News Wire. June 20, 2005. “Sativex: Novel cannabis derived treatment for MS pain now available in Canada by prescription.”
[21] Daily Finance. June 22, 2010. “U.K. approves pot-based drug.”

[22] GW Pharmaceuticals press release. July 28, 2010. ” Spanish Sativex approval.”

[23] http://www.gwpharm.com/Sativex6.aspx

Marijuana And Gastrointestinal Disorders

Gastrointestinal (GI) disorders, including functional bowel diseases like irritable bowel syndrome (IBS) and inflammatory bowel diseases afflict more than one in five Americans, particularly women. While some of these disorders could be controlled by diet and pharmaceutical medications, others are poorly moderated by conventional treatments. GI disorder symptoms include cramping, abdominal pain, inflammation of the lining of the large and/or small intestine, chronic diarrhea, rectal bleeding, and weight loss.

Virtually no clinical trial work has been performed in this area although several anecdotal reports and a handful of case reports exist in the scientific literature supporting the use of cannabinoids to treat symptoms of GI disorders, aside from a 2007 clinical study assessing the impact of oral THC on colonic motility.

However, many preclinical studies have demonstrated that activation of the CB1 and CB2 cannabinoid receptors exert biological functions on the gastrointestinal tract. Many experts now believe that cannabinoids and/or modulation of the endogenous cannabinoid system represent 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.

Medical Marijuana And Fibromyalgia

Fibromyalgia is a disease characterized by widespread musculoskeletal pain, fatigue and multiple tender points in the neck, spine, shoulders, and hips. It is a chronic pain syndrome of unknown etiology, which is often poorly controlled by standard pain medications, and afflicts an estimated 3 to 6 million Americans.

The patients of Fibromyalgia frequently self-report making the use of cannabis therapeutically for treating the disease symptoms, and physicians – where legal to do so – often recommend the use of cannabis to treat musculoskeletal disorders. There are few clinical trials, to date however, assessing the use of cannabinoids to treat the disease.

Investigators at Germany’s University of Heidelberg, writing in the July 2006 issue of the journal Current Medical Research and Opinion, evaluated the analgesic effects of oral THC in nine patients with fibromyalgia over a period of three months. The trial subjects were administered daily doses of 2.5 to 15 mg of THC and received no other pain medication during the trial. All those participants who completed the trial reported a significant reduction in daily recorded pain and electronically induced pain.

The administration of the synthetic cannabinoid nabilone significantly reduced pain in 40 subjects with fibromyalgia in a randomized, double-blind, placebo-controlled trial, according to a 2008 study published in The Journal of Pain. “As nabilone improved symptoms and was well-tolerated, it may be a useful adjunct for pain management in fibromyalgia,” investigators concluded. A separate 2010 trial performed at McGill University in Montreal disclosed that low doses of nabilone significantly improved sleep quality in patients diagnosed with fibromyalgia.

Previous clinical and preclinical trials have demonstrated that both naturally occurring and endogenous cannabinoids hold analgesic qualities, especially in the treatment of pain resistant to conventional pain therapies. As a result, some experts have suggested that cannabinoids are applicable for treating chronic pain conditions such as fibromyalgia, and have theorized that the disease may be associated with an underlying clinical deficiency of the endocannabinoid system.

References:
[1] Swift et al. 2005. Survey of Australians using cannabis for medical purposes. Harm Reduction Journal 4: 2-18.
[2] Ware et al. 2005. The medicinal use of cannabis in the UK: results of a nationwide survey. International Journal of Clinical Practice 59: 291-295.
[3] Dale Gieringer. 2001. Medical use of cannabis: experience in California. In: Grotenhermen and Russo (Eds). Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential. New York: Haworth Press: 153-170.
[4] Gorter et al. 2005. Medical use of cannabis in the Netherlands. Neurology 64: 917-919.
[5] Schley et al. 2006. Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Current Medical Research and Opinion 22: 1269-1276.
[6] Skrabek et al. 2008. Nabilone for the treatment of pain in fibromyalgia. The Journal of Pain 9: 164-173.
[7] Ware et al. 2010. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesthesia and Analgesia 110: 604-610.
[8] Burns and Ineck. 2006. Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain. The Annals of Pharmacotherapy 40: 251-260.
[9] David Secko. 2005. Analgesia through endogenous cannabinoids. CMAJ 173:
[10] Wallace et al. 2007. Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology 107:785-96.
[11] Cox et al. 2007. Synergy between delta9-tetrahydrocannabinol and morphine in the arthritic rat. European Journal of Pharmacology 567: 125-130.
[12] Ethan Russo. 2004. Clinical endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocrinology Letters 25: 31-39.

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

Spasticity In Multiple Sclerosis Marijuana Treatment

Multiple-Sclerosis-MarijuanaAccording to recent clinical and anecdotal reports, cannabinoids have the ability to minimize symptoms of multiple sclerosis like pain, depression, fatigue, spasticity and incontinence.

The benefits of cannabis in treating multiple sclerosis (MS) are thoroughly discussed in the scientific literature since the last two decades. According to investigators at the University of California at San Diego, inhaled cannabis was useful in significantly reducing objective measures of pain intensity and spasticity in patients with multiple sclerosis in a placebo-controlled, randomized clinical trial.

It was concluded by the involved researchers that “smoked cannabis was superior to placebo in reducing spasticity and pain in patients with multiple sclerosis and provided some benefit beyond currently prescribed treatment.” The fact that patients with multiple sclerosis typically report engaging in cannabis therapy is therefore not surprising by any standards.

Multiple sclerosis (MS) is a chronic degenerative disease of the central nervous system that leads to muscular weakness, inflammation, and loss of motor coordination. Patients suffering from this complication usually become permanently disabled and the disease can be fatal in some cases. It is worth a mention that about 200 people (mostly in the age group of 20-40 years) are diagnosed every week with the disease, according to the US National Multiple Sclerosis Society.

Investigators at the University College of London’s Institute of Neurology reported in an issue of the journal Brain that cannabinoids could inhibit progression of the disease in addition to offering symptom management. Administration of the synthetic cannabinoid agonist WIN 55,212-2 provided “significant neuroprotection” in an animal model of multiple sclerosis. “The results of this study are important because they suggest that in addition to symptom management, … cannabis may also slow the neurodegenerative processes that ultimately lead to chronic disability in multiple sclerosis and probably other disease,” researchers concluded.

The administration of oral THC can boost immune function in patients with MS, according to investigators at the Netherland’s Vrije University Medical Center, Department of Neurology. “These results suggest pro-inflammatory disease-modifying potential of cannabinoids [for] MS,” they concluded.

Health regulators in Canada, the United Kingdom, Spain, and New Zealand have approved the prescription use of plant cannabis extracts in recent years for treating symptoms of multiple sclerosis.

Reference:

  • Chong et al. 2006. Cannabis use in patients with multiple sclerosis. Multiple Sclerosis 12: 646-651.
  • Rog et al. 2005. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 65: 812-819.
  • Wade et al. 2004. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Multiple Sclerosis 10: 434-441.
  • 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.
  • Vaney et al. 2004. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Multiple Sclerosis 10: 417-424.
  • Vaney et al. 2004. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Multiple Sclerosis 10: 417-424.