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Research Corner

The Association Between Cannabis Product Characteristics and Symptom Relief

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An app-based survey of real-world cannabis use by researchers at the University of New Mexico

Link: https://www.nature.com/articles/s41598-019-39462-1
Date of study: June 6, 2016 – March 5, 2018
Date of publication: February 25, 2019
How many people: 3,341 patients over 19,910 cannabis sessions

STUDY FACTS

Survey:

● 3,341 people used ReleafApp (MoreBetter, Ltd.) on a mobile device

● Symptoms and side effects were recorded before and after 19,910 cannabis sessions

● Symptom severity rated on a scale from 0 (none) to 10 (severe)

Relief and side effects were broken down by:

● Cannabis cultivar: C. indica, C. sativa, hybrid

● THC and CBD levels in the cannabis cultivar

● Cannabis form: dried flower, concentrate, edible, tincture

● Inhalation by: vape, pipe, joint

Most common symptoms and side effects:

● Symptoms being treated: anxiety (16% of users), depression (10%), back pain (8%)

● Positive side effects: relaxed (63%), peaceful (54%), comfy (39%), chill (38%)

● Negative side effects: dry mouth (26%), foggy (23%), unmotivated (14%)

● Side effects that could be good or bad depending on context: high (37%), thirsty (27%)

Federal laws all but prohibit scientists from studying cannabis cultivars that have high enough potency and quality to represent the medical cannabis market. In this study, researchers used an app to crowdsource the cultivars of medical cannabis people were using, how they consumed it, for what symptoms, how well cannabis treated their symptoms, and what the side effects were.


Was cannabis effective for symptom relief?

● On average, people initially reported their symptom severity as a 6 out of 10

● Symptom severity decreased to 2.5 after cannabis use, a 60% improvement

What was the most common type of cannabis?

● 48% hybrid, 30% C. indica, 22% C. sativa

● 74% dried flower, 17% concentrate, 5% edibles, 4% tincture

● 45% vaped, 43% used a pipe, 13% smoked joints

What were the most effective cultivars and forms of cannabis for symptom relief?

● C. indica was associated with better symptom relief but more negative
side effects

● Dried flower provided the best symptom relief and side effect profile

● All methods of inhalation provided similar symptom relief, but vapers
reported fewer negative side effects

How much THC was in medical cannabis, and were THC levels important?

● Medical cannabis had 28% THC on average

● Cannabis with more than 10–19% THC did not provide better symptom relief,
except for depression

● Higher THC levels were associated with more side effects, both positive
and negative

What about CBD levels?

● 25% of medical cannabis had <1% CBD, 67% had 1–34% CBD, and 8%
had >35% CBD

● CBD levels were not associated with different symptom relief or side effects

What are the most important points of this study?

● The National Institute on Drug Abuse (NIDA) federally regulates cannabis for
clinical research studies

● NIDA’s most potent cannabis cultivar has 12.5% THC, most of NIDA’s
“high-dose” cultivars have 5–10% THC

● In this study, medical cannabis with <10% THC was uncommon (16% of users)
and least effective for symptom relief

● Crowdsourced studies can provide data to bridge the growing gap between
science and the medical cannabis market

There is a mismatch between the potency of cannabis that the federal government provides for research and the commonly available cultivars of medical cannabis. This type of study fills a knowledge gap in the cannabis cultivars that people are actually using for symptom relief.

Research Corner

When Combined, THC and CBD Reduced the Progression of Multiple Sclerosis (MS) in an Experimental Mouse Model

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Research from the University of South Carolina School of Medicine, published in the Frontiers in Immunology journal in August 2019


STUDY DESIGN

● Researchers injected mice with compounds that caused brain inflammation and symptoms of MS, which began progressing about 8–10 days later. At that point, mice were treated with combined THC and CBD (THC+CBD) over the next week, each at 10 mg per kg body weight.

● Researchers rated MS progression from zero to five: zero (no symptoms), one (limp tail), two (weak hind legs), three (paralyzed hind legs), four (partially paralyzed front legs), then five (complete paralysis).

● Mice are typically euthanized if they maintain level four or reach level five, after which researchers examined brain tissue to understand how treatments affected neurological inflammation.

Both THC+CBD Were Required to Prevent MS Progression, Not Just One or the Other

● THC+CBD treatments prevented about 80% of the mice from developing any symptoms of MS (level 0). This was a drastic improvement compared with treatments using only THC or CBD (but not both) and no treatment at all, where MS progressed the same in all cases, with 60% developing level 3–5 symptoms.

● The researchers repeated these experiments with mice specifically bred to genetically lack the cannabinoid receptors CB1 and CB2, and the THC+CBD treatments were no longer effective. This and other data showed THC+CBD activated the endocannabinoid system to prevent MS progression.

What Was the Biological Basis for Such Astounding Results?

● MS is an autoimmune disorder where immune cells (specifically T-cells) cross into the brain, cause inflammation, and damage the brain tissue to cause symptoms of MS.

● When researchers examined tissue after THC+CBD treatments, they found fewer molecules that trigger inflammation, fewer T-cells infiltrating the brain, and less brain damage.

● The researchers connected the effectiveness of THC+CBD treatments with changes in genetic molecules called micro-RNAs, which prevented inflammation by causing T-cells to enter a process of controlled cell death.

What Was the Biological Basis for Such Astounding Results?

● This study did not involve humans, but the researchers pointed to Sativex, a pharmaceutical cannabis extract that also has an equal ratio of THC+CBD and is approved in over 25 countries outside the U.S. for treating muscle spasticity in MS.

Both THC+CBD Were Required to Prevent MS Progression, Not Just One or the Other


REFERENCES:

1. Al-Ghezi Z, et al. Frontiers in Immunology. 2019;10:1921. doi:10.3389/fimmu.2019.01921

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Research Corner

Pills to Pot: Observational Analyses of Cannabis Substitution Among Medical Cannabis Users With Chronic Pain

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A survey of patients using medical cannabis to manage chronic pain and how medical use is changing prescription drug use, from the University of Michigan Medical School and published in The Journal of Pain in July 2019.

https://www.jpain.org/article/S1526-5900(18)30735-1/fulltext#sec0018


STUDY FACTS

Survey design:
● Dispensaries and cannabis certification clinics distributed an anonymous, online survey to medical cannabis patients through their databases and social media.
● Researchers asked patients with chronic pain about their health conditions and history using prescription drugs and cannabis.
● 1,321 medical cannabis patients from across the U.S. completed the survey, a nationwide expansion of a smaller 2016 study that surveyed 185 patients in Michigan.1

Demographic breakdown:
● On average, patients were 50 years of age, 59% were female, 86% had a college degree, and 49% were married.
● 63% had used medical cannabis for over 1 year, and 62% also used prescription pain medicines.
● 20% were from California, 18% from Maine, 10% from Arizona, and 9% from New Hampshire.

In 2016, researchers surveyed 185 medical cannabis patients with chronic pain who visited one dispensary in Michigan. These patients reported that after starting to use medical cannabis, they decreased their opioid use by 64%.1 In 2019, the researchers expanded the study to a nationwide survey of more than 1,000 medical cannabis patients. They found that medical cannabis patients were decreasing prescription drug use or replacing their prescriptions with cannabis altogether. Patients also reported decreased pain levels and improved overall health.


All patients in the study used medical cannabis for chronic pain.
● Back pain was most common (58% of patients), followed by migraines (21%), osteoarthritis (20%), and fibromyalgia (15%)
● Patients reported multiple health conditions (4.5 on average), which included conditions besides pain: anxiety (52%), depression (40%), and PTSD (25%).

62% of medical cannabis patients also reported using a prescription drug for pain management.
● NSAIDs (nonsteroidal anti-inflammatory drugs, such as aspirin) were most common (31% of patients), then opioids (16%), benzodiazepines (13%), and gabapentanoids (12%).
● Patients also used SSRIs (12%) and SNRIs (9%), drugs generally used to treat depression and anxiety.

80% of patients reported using medical cannabis to replace an average of two prescription drugs.
● About 40% of patients stopped using NSAIDs, and another 40% decreased use “a lot.”
● 70–80% stopped using other drugs, including opioids, and 10–20% decreased use “a lot.”
● Patients said cannabis provided better symptom management with fewer side effects.
● Those who substituted prescriptions were also more likely to say that their pain levels
decreased or that their overall health improved.

How do these results stack up with the rest of the scientific evidence?
● This survey closely matches at least seven surveys and clinical studies from the U.S., Canada,
and Israel, all reporting that medical cannabis patients are reducing or stopping opioid use.
● The researchers pointed to additional scientific evidence that indicates that THC and opioids
likely work together to increase pain tolerance and that CBD might help reduce opioid
cravings.
● Patients can often achieve similar pain relief by supplementing smaller opioid
doses with cannabis.

On the heels of the opioid epidemic, patients are reporting astounding success using medical cannabis to moderate or stop their opioid use, all while reporting improved pain management and overall better quality of life.

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Research Corner

Real life Experience of Medical Cannabis Treatment in Autism

Analysis of Safety and Efficacy

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What is most remarkable to me is good quality of life was reported by 31.3% of patients at the beginning of the study, and by the end of the 6-month study, 66.8% of the patients reported having a good quality of life.

  • In a study of 188 patients, 30.1% of those in treatment had significant improvement. 53.7% saw moderate improvement.
  • While in the study, the majority of the patients were treated with 30% CBD and 1.5% THC.
  • After the first month, 179 patients continued treatments. At the 6-month follow-up, 155 patients remained in ongoing treatments using the CBD enriched cannabis oil.
  • Rage attacks were improved by 90.3% in the 6 months of treatment.
  • “In our study we have shown that a CBD enriched treatment of ASD patients can potentially lead to an improvement of behavioural symptoms. These findings are consistent with the findings of two double-blind, placebo-controlled crossover studies,” direct quote from study.
  • 34.3% of patients in the study reported a reduction in medications in the following families: antipsychotics, antiepileptics, antidepressants, hypnotics, and sedatives.

PMID:  30655581 (pubmed ID can be typed into the pubmed search bar) 

Lihi Bar-Lev Schleider, Raphael Mechoulam, Naama Saban, Gal Meiri, and Victor Novack

Sci Rep. 2019; 9: 200. Published online January 17, 2019. doi: 10.1038/s41598-018-37570-y

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336869/

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