HSBH PRESENTATION

Cannabinoids for medical use: A systematic review and meta analysis

28 trials

2454 patients

Study 1

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Whiting, P., Wolff, R., Deshpande, S., Di Nisio, M., Duffy, S., Hernandez, A., … Kleijnen, J. (2015). Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA, 313(24), 2456–2473. https://doi.org/10.1001/jama.2015.6358

The Effect of Medicinal Cannabis on Pain and Quality of Life Outcomes in Chronic Pain: A Prospective Open-label Study

https://www.123rf.com/

Cannabis improved pain outcomes

20 gram monthly dose of cannabis

Study 2

206 participants

www.uihere.com

Focus on treatment resistant chronic pain

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Haroutounian, S., Ratz, Y., Ginosar, Y., Furmanov, K., Saifi, F., Meidan, R., & Davidson, E. (2016). The Effect of Medicinal Cannabis on Pain and Quality of Life Outcomes in Chronic Pain: A Prospective Open-label Study. The Clinical Journal of Pain. https://doi.org/10.1097/AJP.0000000000000364

4. Hill, K. (2015). Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review. JAMA, 313(24), 2474–2483. https://doi.org/10.1001/jama.2015.6199

Summary

- Objective was to review the pharmacology, indications, and laws related to medical marijuana use. This use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence.

- The medical literature on medical marijuana was searched from 1948 to March 2015 using MEDLINE. The search terms used included cannabis, cannabinoids, and tetrahydrocannabinol.

- The limits used were “administration and dosage” “adverse effects” “therapeutic use,” or “clinical trial.”

- The MEDLINE search resulted in 562 articles. Articles that discussed cannabinoids as pharmacotherapy in a clinical trial were selected for an initial brief review. After additional citations were obtained from references, a total of 74 articles were reviewed.

Study 4

https://www.nlm.nih.gov/bsd/pmresources.html

3. Baron, E., Lucas, P., Eades, J., & Hogue, O. (2018). Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort. The Journal of Headache and Pain, 19(1), 1–28. https://doi.org/10.1186/s10194-018-0862-2

- Aim was to clinically identify patterns of cannabis treatment in migraine and headache: compared to arthritis and chronic pain.

- Participants were medical cannabis users for pain: headache and arthritis.

- 3405 responses, 2032 in final analysis, representing 12% of those reached. 1271 (62.6%) were male, 758 (37.3%) were female, and 3 (0.15%) did not specify gender. Ages ranged from 9 to 85 years old, with an average age of 40.

- An estimation of migraine prevalence among those surveyed was obtained by incorporating the ID Migraine™ questionnaire into the survey, which is used to predict the probability of migraine.

Study 3

https://www.researchgate.net/figure/Migraine-Screen-Questionnaire-MS-Q_fig1_44655138

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Effectiveness of a Small Dose

Effectiveness

of a Small Dose

- 10% THC concentration is highly effective

- pain reduction and improved moods

- management of insomnia irritability and aggressiveness

- suggests only a small amount may need to be used for effective treatment

Medical Cannabis Over Opioid

Cannabis over Opioid

- 64% decrease in the use of opioids

- cannabis acts as a consistent, long term method

- high use of opioids lead to an "opioid panademic" with a high death toll

- suggests medical cannabis may be a safer way to manage chronic pain

Many Choices of Method

- variety of choice to appeal to user

- commonly taken via inhalation

- many other additional methods

Choice of Method

Medical Limitations

Various medical complications can arise from taking medicinal cannabis

Medical

Access Limitations

ECONOMIC

• Expensive
• Chronic pain = $350/month
• No cover through PBS
• Importation costs

Access

MANUFACTURE

• Limited local producers
• Variable product quality
• THB = expensive
• CBD = cheaper

LEGAL LIMITATIONS

Legal

Views of Society towards users:

• Negative stigma towards cannabis users
• Issues with family, friends and workplace

Negative Stigma

These theories might sound a bit complex... but we'll walk you through it!

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Theory 1

Endocannabinoid System & THC

Theory 1

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• The human body has an endocannabinoid system. It’s roles include regulating pain, memory, sleep and appetite (Murnion, 2015).

• Endocannabinoids are neurotransmitters that bind to receptors such as CB1 and CB2 (Pertwee, 2008). When they bind they act as antagonists to influence pain relief (CB1) and inflammation reduction (CB2) (Pertwee, 2012).

• Cannabinoids are chemicals found in cannabis. There are approximately 100, one of these being Tetrahydrocannabinol (THC) (Boehnke, 2019).

• THC interacts with the body’s endocannabinoid system by binding to CB1 and CB2 receptors (Boehnke, 2019).

• A study conducted on mice showed that the activation of CB1 receptors reduces nociception in visceral pain and the activation of CB1 and CB2 receptors reduces neuropathic and inflammatory pain (Pertwee et al., 2009; Murnion, 2015).
• Limitation: Use of animals. Results may not be applicable to humans.

• The results of a study on human volunteers using functional brain imaging highlighted that THC reduces the unpleasantness of pain (Lee et alk., 2013).
• Limitations: Results were an average, indicating not all participants experienced the same pain relieving effects of THC.

Image from https://www.hemple.com/how-cannabinoids-work/

Theory 2

CBD's Effect

Theory 2

• CBD: Cannabinoid found in cannabis

• CBD does not interact with CB1 & CB2 receptors, instead CBD blocks peripheral nerves which detect pain sensation (Fernández-Ruiz et al., 2013).

• A study on animals has reinforced this CBD mechanism (Mack & Joy, 2001).

• Limitation: Use of animals. Results may not accurately prove the effects CBD has on humans in terms of pain relief.

Image from https://www.zmescience.com/medicine/thc-and-cbd-during-early-pregnancy-might-cause-alcohol-like-fetal-defects/

Image from https://www.healtheuropa.eu/study-cbd-offsets-thc/93855/

Theory 3

Cannabinoids & the Opioid Receptor System

Theory 3

Image from https://neurosciencenews.com/opioid-system-relationships-6793/

• Cannabinoids found in cannabis can have a synergistic effect with the endogenous opioid system.

• Cannabinoids influence opioid receptors, causing endocannabinoids to block pain detection by sensory neurons (Fine & Rosenfeld, 2013).

• Experimental research performed on the molecular basis of cross-talk between co-expressed CB1 receptors and opioid receptors has supported this theory Canals & Milligan, 2008).

• Limitation: Extensive research, however only one trial performed. Therefore, may lack reliability.

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Overall...

• Many theories and mechanisms explain how cannabis can reduce chronic pain.

• Further research is required to determine if other cannabinoids in cannabis have an effect on pain relief.

• Ethical constraints may arise from conducting this research. Human ingestion of cannabis may be required and this could cause adverse side effects for participants.

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