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A Phase I, double blind, three-way crossover study to assess the pharmacokinetic profile of cannabis based medicine extract CBME administered sublingually in variant cannabinoid ratios in normal healthy male volunteers GWPK Journal of Cannabis Therapeutics.
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Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: Cannabinoid influence on cytokine profile in multiple sclerosis. Cannabis potency in Europe. Local administration of delta9-tetrahydrocannabinol attenuates capsaicin-induced thermal nociception in rhesus monkeys: Psychopharmacology Berl ; Mini Rev Med Chem. Pharmacokinetics, metabolism and drug-abuse potential of nabilone. The cannabinoid receptor agonist WIN 55, mesylate blocks the development of hyperalgesia produced by capsaicin in rats.
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Although treatment of some specific body areas abdomen, chest, whole brain with radiotherapy can induce nausea, very few reports of cannabinoid use in those situations have been published, and the reports that exist have used mainly pharmaceutical cannabinoids A recently published placebo-controlled study demonstrated that quality of life for patients with head-and-neck cancers undergoing radiotherapy is not improved with the use of nabilone The authors postulated that nabilone on its own is not potent enough to affect symptoms.
Another recently published study surveyed 15 patients with previously treated head-and-neck cancer about their use of medical cannabis, and all respondents endorsed the benefits of cannabis in the treatment of the long-term residual effects of radiation The data supporting cannabis and cannabinoid use in appetite stimulation is less conclusive than it is in pain or nausea. When used in cancer patients with cachexia, cannabinoids appear to be only modestly effective.
A study from the North Central Cancer Trial Group compared the use of an oral cannabinoid dronabinol with oral megestrol acetate and with the two drugs together. Final results did not show any statistical improvement in weight with dronabinol, either alone or in combination A Swiss-led study using cannabis extract in cancer patients also did not show benefit in terms of appetite or weight gain, and the trial was closed early after a mandated review A small Canadian study using oral dronabinol in advanced cancer patients demonstrated improved sense of taste and subsequent increased protein consumption.
That change did not translate to weight gain, but patients did express improvement in quality of life measurements More promising results were seen in studies of the non-cancer population. A study of response to smoked cannabis, dronabinol, or placebo in patients with aids demonstrated that the patients using smoked cannabis experienced the greatest weight gain 3. An earlier study in patients with dementia treated with either dronabinol or placebo documented an increase in appetite, increased weight gain, and modulated aggressive behaviour Although the main use of cannabinoids in patients with cancer and palliative patients has been symptom management, there could be other roles for these molecules in the treatment of malignancies.
In one of the first reports of cannabinoids having antitumour effects, extracts of cannabis were shown to inhibit the growth of lung adenocarcinoma cells in vitro An in vivo mouse model produced similar results. Preclinical studies have investigated cannabinoid activity in several malignancies lung, glioma, thyroid, lymphoma, skin, pancreas, endometrium, breast, prostate 59 — 61 , demonstrating antiproliferative, anti-metastatic, antiangiogenic, and proapoptotic effects reviewed by Velasco et al.
Cannabis has not been studied clinically as a treatment for malignancy. The only clinical study published to date that used cannabinoids enrolled patients with glioblastoma multiforme and was based on extensive preclinical work by the same investigators Their small study 9 patients showed the safety of intracranial administration of thc and demonstrated antiproliferative effects in some of the patients.
All patients eventually progressed and died, but not because of any effects of the extract. The investigators are actively continuing their clinical and research work, focusing on tumours of the central nervous system Oncologists might be concerned that cannabinoids could reduce the effectiveness of established chemotherapy agents. Several authors have investigated cannabis extracts used in tandem with a variety of chemotherapy agents in vitro and in animal models, showing synergism in reducing cell numbers, and no negative effect on anticancer function.
Cell cultures from pancreatic 64 , glioma 65 , gastric 66 , lung 67 , and colon 68 cancers have been investigated using a range of antineoplastic agents, including gemcitabine, temozolomide, paclitaxel, and 5-fluorouracil.
Synergism in inducing cancer cell death is a common finding, which bodes well for the possibility of human clinical trials in future Despite the emerging evidence of antineoplastic activity, some older in vitro studies demonstrated cancer cell proliferation and loss of immune-mediated cancer suppressor activity after treatment with cannabinoid preparations 58 , Some studies have even shown discordant results depending on the concentration of cannabinoids: Thus, conflicting evidence points to the need for sober second thought before outright recommendations of cannabinoids for cancer patients can be made.
But again, mice and rats are not people, and what is observed in vitro does not necessarily translate into clinical medicine. The preclinical evidence that cannabinoids might have direct anticancer activity is provocative as well, but more research is warranted. Currently, several clinical studies using cannabinoids in cancer therapy are registered at http: When a patient is referred to our outpatient clinic with a request for medical cannabis, several questions come to mind:.
Most of our patients have either tried medical cannabis or read about its role in symptom control. Those who have tried it recreationally or for medical purposes can accurately reflect on the benefits or the adverse effects experienced, which makes the discussion somewhat easier.
Those who have little knowledge and less experience require a complete discussion with respect to the benefits, the possible adverse effects, the process of application and authorization, and the cost which is borne by the patient, because it is not covered by provincial or private medical insurance.
Table iii lists our contraindications to authorization, which are similar to those published by Health Canada 70 , the College of Family Physicians of Canada 71 , and the Canadian Medical Protective Association It should be noted that no special license or additional certification is necessary to authorize the use of medical cannabis, but a working knowledge of cannabis as already presented is helpful for oncology professionals who are considering a patient request.
Once the decision is made to support authorization, the choice of which licensed producer and product to use can be somewhat difficult for some patients. The more than 30 licensed producers list more than products for sale, which can be a problem for those who do not have experience with cannabis or patients who might be elderly or excessively fatigued. We do not advise that patients smoke the dried product; rather, they should vaporize, which is likely safer in the long run We also advise neophytes to choose a product that has a balanced thc: Cannabinoid proportions can be guided by available efficacy data summarized in Table iv.
Once patients have started to use the product and document the effects, the thc: Conditions potentially responding to cannabinoid therapies 74 — Titration of dose should follow the effect on the symptom in question for example, pain reduction, nausea control. Follow-up with patients is essential to determine benefits and any adverse effects, questions about use or strain selection, and outcomes.
Certainly, if the adverse effects are not tolerable, then an alternative therapy should be considered. If the patient is not getting the desired symptom control, then some dose modification might be necessary. Discontinuation of cannabis should be considered if an adequate trial does not result in the desired outcome as determined by the treating team or the patient.
Inter-professional collaboration is the new paradigm under which modern health care operates Research has demonstrated that inter-professional collaboration is enabled and promoted by inter-professional education, especially at the undergraduate level 79 , Although physicians ultimately authorize and prescribe cannabinoid therapies, valuable insights and inputs about achieving optimal patient outcomes can be derived from other members of the health care team, including nurses, social workers, rehabilitation therapists, and pharmacists.
Furthermore, pharmacies are designed to ensure proper storage and security of medical products. Pharmacists are also well positioned to comprehensively counsel patients and caregivers on the optimal methods of opioid and by extension, cannabis storage and disposal so as to limit diversion and unintentional exposure Moreover, given the emergence of cannabinoids as a novel therapeutic class, cannabinoid education for medical professionals as well as for patients and caregivers should be conducted per the principles of inter-professional education Industrialized countries are experiencing exponential increases in the utilization of opioids 84 , Major public health issues are emerging as a result, not the least of which relate to drug diversion, opioid addiction, and death from opioid overdose 84 , Currently, opioids remain the mainstay of cancer pain management, and increased cancer survival translates into patients using opioids for longer periods of time High-dose and long-term opioid therapy in cancer patients is becoming a concern, given observed risks such as poly-endocrinopathy, osteoporosis, and immunosup-pression Preclinical studies have demonstrated that certain opioids—such as codeine, morphine, methadone, and remifentanil—are associated with increased morbidity and mortality attributable to worsening of cancer and infections Opioid-induced hyperalgesia syndrome is also being reported with increased incidence, especially in patients with advanced cancer and escalating pain Thus, it behooves physicians to explore options that will allow for improved overall pain relief while curbing the overuse of opioids.
Observational studies in advanced cancer cohorts have demonstrated that cannabinoid therapies are associated with opioid-sparing and improved analgesia Published data on the addiction potential for recreational cannabis reflects a risk of 9. Finally, a British study showed that the overall harm score for user and society for recreational cannabis score: Because medical cannabis generally tends to have a higher ratio of cbd to thc , it would be expected to be associated with a lower predilection to diversion, less addiction potential, and lower overall harm scores than those for recreational cannabis The integration and broader utilization of cannabinoid therapies within the domain of oncology including palliation carries the potential not only for improved health care outcomes for patients but also for economic savings and greater safety for society 90 , Patient reports of improvement in quality of life, especially for those undergoing intensive treatment regimens, could be key to patients continuing with lifesaving or life-prolonging therapies.
Cannabinoids might be able to help patients throughout their disease trajectory, but evidence about the ideal timing for cannabinoid initiation is lacking. More research will guide oncology and palliative care teams in their pursuit of excellence in cancer and symptomatic care. VM has presented educational activities supported by Tweed, Bedrocan, and Mettrum. National Center for Biotechnology Information , U.
Journal List Curr Oncol v. Published online Dec Find articles by P. Author information Copyright and License information Disclaimer. Copyright Multimed Inc. This article has been cited by other articles in PMC. The Endocannabinoid System The endogenous opioid and cannabinoid systems are the only chemical systems in the human body that have survived more than million years of human evolution 1 — 4.
Cannabinoid Pharmacology In Canada, more than strains of medical cannabis are available from licensed producers 5. Open in a separate window. Cannabinoids for Medical Use Although the assessment and treatment of pain and other symptoms in patients with advanced cancers has become a standard of care, many patients still have incomplete symptom control Pain Cannabinoids, including herbal cannabis and extracts, have been used for the treatment of pain for centuries.
Nausea and Vomiting Controlling nausea and vomiting was one of the initial uses of cannabinoids documented in the modern scientific literature. Appetite Stimulation The data supporting cannabis and cannabinoid use in appetite stimulation is less conclusive than it is in pain or nausea. The Importance of Inter-professional Collaboration Inter-professional collaboration is the new paradigm under which modern health care operates Cannabinoid Therapies As a Harm Reduction Strategy Industrialized countries are experiencing exponential increases in the utilization of opioids 84 , Oxford University Press; The Medicinal Uses of Cannabis and Cannabinoids.
Grotenhermen F, Russo E, editors. My favorites are the 3: Also, ones with menthol and lemon scents or similar ingredients to Icy Hot can really help as you get both in one go. No one addresses this! How much to be affective? How do I get thc and cbd benefits the whole plant synergy benefit into an oil? This whole time I thought I was smoking thc amd cbd. Erica, would love to help you out with all your CBD questions including how to make your own lotions. Content failed to load. Country United States Canada.
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