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 Studies, references and findings

Cannabidiol for the treatment of cannabis withdrawal syndrome:
a case report

WHAT IS KNOWN AND OBJECTIVE:
Cannabis withdrawal in heavy users is commonly followed by increased anxiety, insomnia, loss of appetite, migraine, irritability, restlessness and other physical and psychological signs. Tolerance to cannabis and cannabis withdrawal symptoms are believed to be the result of the desensitization of CB1 receptors by THC.

 

CASE SUMMARY: 
This report describes the case of a 19-year-old woman with cannabis withdrawal syndrome treated with cannabidiol (CBD) for 10 days. Daily symptom assessments demonstrated the absence of significant withdrawal, anxiety and dissociative symptoms during the treatment.

 

WHAT IS NEW AND CONCLUSION: 

CBD can be effective for the treatment of cannabis withdrawal syndrome.

 

© 2012 Blackwell Publishing Ltd. 

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J Clin Pharm Ther. 2013 Apr;38(2):162-4. doi: 10.1111/jcpt.12018. Epub 2012 Oct 24.

Impact of cannabis use during stabilization on methadone maintenance treatment

BACKGROUND AND OBJECTIVES: 

Illicit drug use, particularly of cannabis, is common among opiate-dependent individuals and has the potential to impact treatment in a negative manner.

 

METHODS: 

To examine this, patterns of cannabis use prior to and during methadone maintenance treatment (MMT) were examined to assess possible cannabis-related effects on MMT, particularly during methadone stabilization. Retrospective chart analysis was used to examine outpatient records of patients undergoing MMT (n = 91), focusing specifically on past and present cannabis use and its association with opiate abstinence, methadone dose stabilization, and treatment compliance.

 

RESULTS: 

Objective rates of cannabis use were high during methadone induction, dropping significantly following dose stabilization. History of cannabis use correlated with cannabis use during MMT but did not negatively impact the methadone induction process. Pilot data also suggested that objective ratings of opiate withdrawal decrease in MMT patients using cannabis during stabilization.

 

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: 

The present findings may point to novel interventions to be employed during treatment for opiate dependence that specifically target cannabinoid-opioid system interactions.

 

Copyright © American Academy of Addiction Psychiatry.

 

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Am J Addict. 2013 Jul-Aug;22(4):344-51. doi: 10.1111/j.1521-0391.2013.12044.x.

Cannabidiol inhibits the reward-facilitating effect of morphine: involvement of 5-HT1A receptors in the dorsal raphe nucleus

Unlike hospice, long-term drug safety is an important issue in palliative medicine. Opioids may produce significant morbidity. Cannabis is a safer alternative with broad applicability for palliative care. Yet the Drug Enforcement Agency (DEA) classifies cannabis as Schedule I (dangerous, without medical uses). Dronabinol, a Schedule III prescription drug, is 100% tetrahydrocannabinol (THC), the most psychoactive ingredient in cannabis. Cannabis contains 20% THC or less but has other therapeutic cannabinoids, all working together to produce therapeutic effects. As palliative medicine grows, so does the need to reclassify cannabis. This article provides an evidence-based overview and comparison of cannabis and opioids. Using this foundation, an argument is made for reclassifying cannabis in the context of improving palliative care and reducing opioid-related morbidity.

 

Am J Hosp Palliat Care. 2011 Aug;28(5):297-303. doi: 10.1177/1049909111402318. Epub 2011 Mar 28.

 

Carter GT1Flanagan AMEarleywine MAbrams DIAggarwal SKGrinspoon L.

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

OBJECTIVES 
The objective of this prospective, open-label study was to determine the long-term effect of medicinal cannabis treatment on pain and functional outcomes in subjects with treatment-resistant chronic pain.  


METHODS 
The primary outcome was change in pain symptom score on the S-TOPS (Treatment Outcomes in Pain Survey – Short Form) questionnaire at 6 months follow-up in intent-to-treat (ITT) population. The secondary outcomes included change in S-TOPS physical, social and emotional disability scales, pain severity and pain interference on brief pain inventory (BPI), sleep problems, and change in opioid consumption.  


RESULTS 
274 subjects were approved for treatment; complete baseline data were available for 206 (ITT), and complete follow-up data for 176 subjects. At follow-up, pain symptom score improved from median 83.3 (95% CI 79.2-87.5) to 75.0 (95% CI 70.8-79.2), P<0.001. Pain severity score (7.50 [95% CI 6.75-7.75] to 6.25 [95% CI 5.75-6.75] and pain interference score (8.14 [95% CI 7.28-8.43] to 6.71 [95% CI 6.14-7.14]) improved (both P<0.001), together with most social and emotional disability scores. Opioid consumption at follow-up decreased by 44% (P<0.001). Serious adverse effects led to treatment discontinuation in two subjects.


DISCUSSION 
The treatment of chronic pain with medicinal cannabis in this open-label, prospective cohort resulted in improved pain and functional outcomes, and significant reduction in opioid use. The results suggest long-term benefit of cannabis treatment in this group of patients, but the study’s non-controlled nature should be  considered when extrapolating the results.
 

Am J Hosp Palliat Care. 2011 Aug;28(5):297-303. doi: 10.1177/1049909111402318. Epub 2011 Mar 28.

 

Carter GT1Flanagan AMEarleywine MAbrams DIAggarwal SKGrinspoon L.

Medical cannabis laws and
opioid analgesic overdose mortality in the United States, 1999-2010

IMPORTANCE
Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them.

 

OBJECTIVE
To determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality.

 

DESIGN, SETTINGS AND PARTICIPANTS
A time-series analysis was conducted of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included.

 

EXPOSURES
Presence of a law establishing a medical cannabis program in the state.

 

MAIN OUTCOMES AND MEASURES
Age-adjusted opioid analgesic overdose death rate per 100 000 population in each state. Regression models were developed including state and year fixed effects, the presence of 3 different policies regarding opioid analgesics, and the state-specific unemployment rate.

 

RESULTS
Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, −37.5% to −9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (−19.9%; 95% CI, −30.6% to −7.7%; P = .002), year 2 (−25.2%; 95% CI, −40.6% to −5.9%; P = .01), year 3 (−23.6%; 95% CI, −41.1% to −1.0%; P = .04), year 4 (−20.2%; 95% CI, −33.6% to −4.0%; P = .02), year 5 (−33.7%; 95% CI, −50.9% to −10.4%; P = .008), and year 6 (−33.3%; 95% CI, −44.7% to −19.6%; P < .001). In secondary analyses, the findings remained similar.

 

CONCLUSIONS AND RELEVANCE

Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.

 

Bachhuber, Marcus A., Brendan Saloner, Chinazo O. Cunningham, and Colleen L. Barry. 

JAMA internal medicine 174, no. 10 (2014): 1668-1673.

 

Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain

FINDINGS

•Cannabis use was associated with 64% lower opioid use in patients with chronic pain.

•Cannabis use was associated with better quality of life in patients with chronic pain.

•Cannabis use was associated with fewer medication side effects and medications used.

Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding.

PERSPECTIVE 
This article suggests that using medical cannabis for CP treatment may benefit some CP patients. The reported improvement in quality of life, better side effect profile, and decreased opioid use should be confirmed by rigorous, longitudinal sutides that also assess how CP patients use medical cannabis for pain management.

 

 

Kevin F. Boehnke, Evangelos Litinas, Daniel J. Clauw

 

Front Psychiatry. 2013 Sep 23;4:109. doi: 10.3389/fpsyt.2013.00109.

Modulation of the endocannabinoid
system: vulnerability factor and new treatment target for stimulant addiction

Cannabis is one of the most widely used illicit substance among users of stimulants such as cocaine and amphetamines. Interestingly, increasing recent evidence points toward the involvement of the endocannabinoid system (ECBS) in the neurobiological processes related to stimulant addiction. This article presents an up-to-date review with deep insights into the pivotal role of the ECBS in the neurobiology of stimulant addiction and the effects of its modulation on addictive behaviors. This article aims to: (1) review the role of cannabis use and ECBS modulation in the neurobiological substrates of psychostimulant addiction and (2) evaluate the potential of cannabinoid-based pharmacological strategies to treat stimulant addiction. A growing number of studies support a critical role of the ECBS and its modulation by synthetic or natural cannabinoids in various neurobiological and behavioral aspects of stimulants addiction. Thus, cannabinoids modulate brain reward systems closely involved in stimulants addiction, and provide further evidence that the cannabinoid system could be explored as a potential drug discovery target for treating addiction across different classes of stimulants.

Olière S1Joliette-Riopel APotvin SJutras-Aswad D.

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