Australian Study Finds Most Medical Cannabis Obtained Without Prescription

PainRelief.com Interview with:
Janni Leung, PhD
National Health and Medical Research Council Emerging Leadership Fellow
National Centre for Youth Substance Use Research (NCYSUR)
The University of Queensland

PainRelief.com:  What is the background for this study? 

Response: It is important to know the prevalence and source of medical cannabis use because non-prescribed use may put individuals at risk.

Many Young Adults and Adolescents Vape Both Tobacco and Cannabis

PainRelief.com Interview with:
Ruoyan Sun PhD
Assistant Professor
School of Public Health
The University of Alabama at Birmingham

PainRelief.com:  What is the background for this study? 

Response: Many people consider vaping as just nicotine vaping, but these vaping devices can be used to vape cannabis as well. We are curious about how many e-cigarette users are vaping cannabis. Using the Population Assessment of Tobacco and Health (PATH) study from 2018 to 2019, we investigated the proportion of current (past 30-day) e-cigarette users (ages 12-24) who vaped cannabis and their frequency of cannabis vaping.  

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About 1/3 North Americans Self Medicate with Cannabis, Mostly for Pain

PainRelief.com Interview with:
Janni Leung, PhD
Senior Research Fellow
National Centre for Youth Substance Use Research (NCYSUR)
The University of Queensland

Dr. Leung

PainRelief.com:  What is the background for this study? 

Response: There is increasing interest in cannabis use for medical reasons, and we want to find out how many people are using it and for what.

PainRelief.com:  What are the main findings?

Response: Almost 1 in 3 of North Americans self-reported that they have used cannabis for medical reasons, with higher use reported by young adults, although chronic conditions are less prevalent in this group.

Most common reasons were to help with pain, sleep, depression and anxiety, but some reported using it to manage their drug or alcohol use and psychosis.

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More Kids Poisoned by Cannabis Since Legalization

PainRelief.com Interview with:
Daniel Myran, MD, MPH, CCFP, FRCPC
Family and Public Health and Preventive Medicine Physician 
CIHR Fellow, Ottawa Hospital Research Institute 
Department of Family Medicine Innovation Fellow
University of Ottawa 

Dr. Myran

PainRelief.com:  What is the background for this study? 

Response: Canada legalized recreational, or non-medical, cannabis in October 2018. Canada took phased approach to legalization initially only allowing flower-based cannabis products and oils and after one year permitting the sale of commercial cannabis edibles (e.g. THC containing candies, baked goods, and drinks). In this study we took advantage of this phased roll out of legal cannabis to understand the impact of legalization on cannabis exposures or poisonings in children aged 0-9 years and the contribution of different types of cannabis products to these events. 

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Study Finds Physical Exercise Increases Body’s Own Cannabis-Type Substances

PainRelief.com Interview with:
Amrita Vijay PhD
Division of Rheumatology
Orthopedics and Dermatology
School of Medicine
University of Nottingham
Nottingham, UK

Dr. Vijay

PainRelief.com:  What is the background for this study? What are the main findings?

Response: We carried out this research as we wanted to see if exercise had an effect on the levels of anti-inflammatory substances produced by gut microbes and on endocannabinoids (i.e cannabis-like substances) produced by our bodies.  

One of the key findings of the study is that physical exercise increases levels of the body’s own cannabis-type substances and highlights a key link between how substances produced by our gut microbes interact with these cannabis-like substances and reduces inflammation.  

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Survey of Medical Cannabis Effects on Anxiety and Depression

PainRelief.com Interview with:
Erin Martin Ph.D. Candidate
Department of Neuroscience
Medical University of South Carolina
Charleston, SC 29425

Erin Martin

PainRelief.com:  What is the background for this study?
Response: Anxiety and depressive disorders are highly prevalent. People with these disorders are increasingly using cannabis products for symptom management, either as an alternative to or in conjunction with traditional antidepressants.

The goal of this study was to examine the effect of medicinal cannabis product use on symptoms of anxiety and depression in a clinical population, and to assess important correlates of anxiety and depression such as chronic pain and quality of life.  

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Study Finds Medical Cannabis Not Likely to Solve Opioid Crisis for Pain Patients

PainRelief.com Interview with:
Carsten Hjorthøj, senior Researcher
Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Copenhagen University Hospital
University of Copenhagen, Department of Public Health
Section of Epidemiology, Copenhagen, Denmark.

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Denmark introduced a pilot program of medical cannabis in 2018. Medical cannabis, and cannabis-based medicine, has gained a lot of both attention and controversy as a possible way to treat pain disorders, but the evidence base is still sparse. The Danish nationwide unselected registers allow us to perform a high quality pharmacoepidemiologic study with propensity score matched controls.

The main findings are that medical cannabis and cannabis-based medicine did not reduce the use of opioids in pain patients, and might actually lead to an increase in use of opioids. However, patients with neuropathic pain disorders appeared to reduce their use of gabapentin, their use of overall medication (but not opioids!), and the number of days spent in hospital, compared with controls.

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Medical Cannabis May Be Helpful For Pain Relief in a Minority of People with Chronic Pain, But Will Not Be Effective For Most

PainRelief.com Interview with:
JASON BUSSE DC, PhD
Associate Professor
Associate Director
Michael G. DeGroote Centre for Medicinal Cannabis Research
McMaster University Medical Centre
Ontario, Canada

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Our focused clinical practice guideline was informed by 4 systematic reviews exploring benefits and harms of medical cannabis for chronic pain, the potential for cannabis to help people who live with pain to reduce their use of opioids, and patients values & preferences regarding medical cannabis for chronic pain. We found that non-inhaled medical cannabis provided small to very small improvements in pain relief, physical functioning and sleep quality compared to placebo, but did not improve mental functioning, role functioning or social functioning. Use of medical cannabis, versus placebo, also caused small increases in the risk of several transient, moderate, side effects, such as impaired attention, nausea, and drowsiness, and a larger increase in the risk of dizziness.

There was insufficient evidence to inform the risk of serious adverse events, such as motor vehicle accidents, cannabis use disorder (addiction), or suicide. We also found that patients’ attitudes towards medical cannabis show considerable variation, meaning that when presented with the same evidence different patients are likely to make different decisions about embarking on a trial of medical cannabis. Due to the close balance between modest benefits and harms, and high variability among patients’ attitudes, we made a weak recommendation to consider a trial of medical cannabis for people living with chronic pain who had not achieved sufficient relief with standard care.

A weak recommendation means that clinicians should provide chronic pain patients with the evidence for benefits and harms and help them to make a decision consistent with their patient’s values and preferences.

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Medlab Clinical Developing New Buccal Spray for Chronic Cancer Pain Relief

PainRelief.com Interview with:
Dr.  Jeremy Henson
Director of Medical Affairs
Medlab Clinical Ltd

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: THC and CBD combination medicines have the potential to provide a non-opioid option for chronic pain that does not have the GIT or respiratory adverse reactions of opioids and allows better cognitive functioning.

Delivery across the oro-buccal membrane appears to be best method of administration of cannabinoids for chronic pain. Oro-buccal delivery has pharmacokinetics appropriate for 6-8 hourly maintenance dosing and avoids first pass metabolism and the slow erratic onset of ingestion; and the high serum THC peaks, frequent redosing and toxic oxidation products of vaping.

The problems with using a 50% ethanol vehicle to deliver cannabinoids across the oro-buccal membrane include local irritation, incomplete absorption and significant systemic ethanol levels. These issues could be solved by using a micellular nanoparticle to solubilise the cannabinoids and deliver them across the oro-buccal mucous membrane.

This study was a first in human study of a micellular nanoparticle formulation of 1:1 THC and CBD delivered as an oro-buccal spray for chronic cancer pain.

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Study Identifies Three Patterns of Medical Cannabis Use for Pain

Dr. Deepika Slawek,

PainRelief.com Interview with:
Deepika Slawek, MD, MS, MPH 
(she/hers)
Assistant Professor of Medicine, Division of General Internal Medicine
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, NY 10467

PainRelief.com:  What is the background for this study?

Response: Medical cannabis has become increasingly available in the United States over the past 25 years and is commonly used for the management of pain. Little is known about the patterns of medical cannabis use by patients with chronic pain. This information could help providers anticipate patients’ needs and identify potential disparities in access.

We followed 99 adults in New York State who were newly certified for medical cannabis use and who were prescribed opioids over the course of 1 year. Using a latent class trajectory analysis, we identified clusters of participants based on 14-day frequency of medical cannabis use. We used logistic regression to determine factors associated with cluster membership including sociodemographic characteristics, pain, substance use, and mental health symptoms.

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