30 March 2015

Medical Cannabis

There are marked differences in the knowledge on the medical uses of cannabis and cannabinoids in different diseases. For nausea and vomiting associated with cancer chemotherapy, anorexia and cachexia (weight-loss) in HIV/AIDS, chronic, especially neuropathic pain, spasticity in Multiple Sclerosis (MS) and spinal cord injury there is strong evidence for medical benefits. For many other indications, such as epilepsy, pruritus and depression there is much less available data. However, the scientific evidence for a specific indication does not necessarily reflect the actual therapeutic potential for a given disease.

Clinical studies with single cannabinoids or whole plant preparations have often been inspired by positive anecdotal experiences of patients employing crude cannabis products. The anti-emetic, the appetite enhancing, relaxing effects, analgesia and therapeutic use in Tourette syndrome (aka Tourette's syndrome) were discovered in this manner.

Incidental observations have also revealed therapeutically useful effects. This occurred in a study of patients with Alzheimer's disease wherein the primary issue was an examination of the appetite-stimulating effects of Δ-9-Tetrahydrocannabinol (THC). Not only appetite and body weight increased, but disturbed behaviour among the patients decreased. The discovery of decreased intra-ocular pressure with THC administration in the beginning of the 1970's was also serendipitous. Additional interesting indications that have not been scientifically investigated, but remain common problems in modern medicine may benefit from treatment with cannabis or cannabinoids. For this reason, surveys have been conducted questioning individuals that use cannabis therapeutically. They were conducted either as oral non-standardised interviews in the course of investigations of state or scientific institutions (House of Lords Select Committee on Science and Technology in the UK, Institute of Medicine in the USA) on the therapeutic potential of cannabis or as anonymous surveys using standardised questionnaires. In Australia, such information is garnered from the likes of the University of New South Wales, Australia (UNSW Australia) which is involved in cannabis related research in association with the National Drug and Alcohol Research Centre (NDARC). A survey involving 1,500 chronic pain sufferers showed there was a high rate of medicinal cannabis use in Australia. Australians suffering from chronic pain may get more relief from their symptoms using cannabis than they do from conventional medications, researchers found.

A positive influence on body weight was reported in patients with Alzheimer's disease who were previously refusing food. Clinical studies have shown that cannabis may not only increase appetite in patients with Alzheimer's disease but also reduce disturbed behaviour and agitation.

An appetite enhancing effect of THC is observed with daily divided doses totalling 5 mg. When required, the daily dose may be increased to 20 mg. In longer-term studies (for example) of AIDS patients, the appetite-stimulating effect of THC continued for months, confirming the appetite enhancement noted in a shorter 6 week study. THC doubled appetite on a visual analogue scale in comparison to placebo. Patients tended to retain a stable body weight. In addition, cannabis products can improve appetite in cancer patients and in Chronic Obstructive Pulmonary Disease (COPD).

Experiments examining the anti-asthmatic effect of THC or cannabis date mainly from the 1970's, and are all acute studies. The effects of a cannabis cigarette (2% THC) or oral THC (15 mg), respectively, approximately correspond to those obtained with therapeutic doses of common bronchodilator drugs (for example, salbutamol). Since inhalation of cannabis products may irritate the mucous membranes, oral administration or another alternative delivery system would be preferable. Very few patients developed bronchoconstriction after inhalation of THC.

Autoimmune Diseases, Inflammation and Allergies
In a number of painful syndromes secondary to inflammatory processes (e.g. ulcerative colitis, arthritis), cannabis products may act not only as analgesics but also demonstrate anti-inflammatory potential. For example, some patients employing cannabis report a decrease in their need for steroidal and non-steroidal anti-inflammatory drugs. Moreover there are some reports of positive effects of cannabis self-medication in allergic conditions. It is as yet unclear whether cannabis products may have a relevant effect on causative processes of autoimmune diseases.

Dependency and Withdrawal
According to historical and modern case reports, cannabis is a good remedy to combat withdrawal in dependency on benzodiazepines, opiates and alcohol. For this reason, some have referred to it as a gateway drug back. In this context, both the reduction of physical withdrawal symptoms and stress connected with discontinuance of drug abuse may play a role in its observed benefits.

Use in Epilepsy is among the historically oldest indications of cannabis. Animal experiments provide evidence of the anti-epileptic effects of some cannabinoids. The anti-convulsant activity of some epilepsy medications have been potentiated by THC. According to case reports, many epileptic patients utilise cannabis to control otherwise unmanageable seizure disorders.

review published in Current Gastroenterology Reports in February 2015 examined the role of cannabinoids in the treatment of gastrointestinal symptoms like nausea, vomiting, and visceral pain (pain that originates from in/around organs) and found that certain targeted cannabinoid therapies may be useful in GI disorder/disease management. Read details of a clinical trial from Israel on Cannabidiol (CBD) for Inflammatory Bowel Disease.

In 1971, during a systematic investigation of its effects in healthy cannabis users, it was observed that cannabis reduces intra-ocular pressure. In the following 12 years a number of studies in healthy individuals and glaucoma patients with cannabis and several natural and synthetic cannabinoids were conducted. Cannabis decreases intra-ocular pressure by an average 25-30%, occasionally up to 50%. Some non-psychotropic cannabinoids and to a lesser extent, some non-cannabinoid constituents of the hemp plant also decrease intra-ocular pressure.

Cannabis may be beneficial in patients suffering from ADHD (attention deficit hyperactivity disorder).

Miscellaneous, Mixed Syndromes
There are a number of positive patient reports on medical conditions that cannot be easily assigned to the above categories, such as hiccup, high blood pressure, tinnitus, chronic fatigue syndrome, restless leg syndrome and others. Several hundred possible indications for cannabis and THC have been described by different authors. One example is the successful treatment of a chronic hiccup that developed after a surgery. No medication was effective, but smoking of a cannabis cigarette completely abolished the symptoms. Cannabis products often show very good effects in diseases with multiple symptoms that encompassed within the spectrum of THC effects, for example, in painful conditions that have an inflammatory origin (e.g. arthritis), or are accompanied by increased muscle tone (e.g. menstrual cramps, spinal cord injury), or in diseases with nausea and anorexia accompanied by pain, anxiety and depression, respectively (e.g. AIDS, cancer, hepatitis C).

Large clinical studies have proven analgesic properties of cannabis. Among possible indications are neuropathic pain due to MS, damage of the brachial plexus and HIV infection, pain in Rheumatoid Arthritis, cancer pain, headache, menstrual pain, chronic bowel inflammation and neuralgias. Combination with opioids is possible.

According to small clinical studies cannabinoids taken internally or externally as ointment ameliorate pruritus by different causes, for example severe pruritus in the course of liver diseases.

Psychiatric Symptoms
An improvement of mood in reactive depression has been observed in several clinical studies with THC. There are additional case reports claiming benefit of cannabinoids in other psychiatric symptoms and diseases, such as sleep disorders, anxiety and bipolar disorders, schizophrenic psychosis and dysthymia. According to some case reports THC was effective in otherwise treatment refractory heavy compulsive disorders. Cannabinoids may also reduce symptoms of post-traumatic stress disorders. Various authors have expressed different viewpoints concerning psychiatric syndromes and cannabis. While some emphasise the problems caused by cannabis, others promote the therapeutic possibilities. Quite possibly cannabis products may be either beneficial or harmful, depending on the particular case.

Treatment of side effects associated with anti-neoplastic (anti-tumour) therapy is the indication for cannabinoids which has been most documented, with about 40 cannabis studies. Most trials were conducted in the 1980's. THC has to be dosed relatively highly, so that resultant side effects may occur comparatively frequently. Some recent investigations have shown that THC in low doses improves the efficacy of other anti-emetic drugs if given together. There is evidence from clinical studies that cannabinoids are also effective in nausea and vomiting due to radiotherapy and after surgery. In folk or 'alternative' medicine, cannabinoids are popular and are often used in other causes of nausea including AIDShepatitis and nausea in pregnancy.
United Kingdom Medical Cannabis Activist Clark French

In many clinical trials of cannabis, a beneficial effect on spasticity caused by MS or spinal cord injury has been observed. Among other positively influenced symptoms were pain, paraesthesia, tremor and ataxia. In some studies improved bladder control was observed. There is also anecdotal evidence of a benefit of cannabis in spasticity due to lesions on the brain.

Tourette syndrome and other Movement Disorders 
There are some positive anecdotal reports of therapeutic response to cannabis in Tourette syndrome, dystonia and tardive dyskinesia. The use in Tourette syndrome is being investigated in clinical studies. Many patients achieve a modest improvement, however some show a considerable response or even complete symptom control. In some MS patients, benefits on ataxia and reduction of tremor have been observed following the administration of THC. Authors of a controlled animal study published in the journal Neuropharmacology have found that long-term stimulation of cannabinoid receptors may prevent onset of movement/motor dysfunction symptoms that result from Huntington’s disease. Cannabis products may prove useful in Parkinson's disease without worsening the primary symptoms. In a study published in the Journal of Psychopharmacology in 2014, patients treated with 300 mg/day of cannabidiol (CBD) with Parkinson’s Disease, without dementia or co-morbid psychiatric conditions, experienced increased well-being and quality of life compared to patients who had received a placebo.

Prescribing Patients Medical Cannabis for Pain
In December 2014, the College of Family Physicians of Canada published its preliminary recommendations for physicians recommending/prescribing smoked cannabis for chronic non-cancer pain in the organisation’s journal, Canadian Family Physician. The authors reviewed the information available on cannabis for medical use, utilising mainly level II (“well conducted observational studies”) and level III (“expert opinion”) evidence to create guidelines on the following aspects of medical cannabis use for chronic non-cancer pain: conditions recommended for use; circumstances under which medical cannabis should not be recommended; circumstances under which caution should be taken when recommending medical cannabis use; and, dosing. The number of Canadians authorised to use 'medical marijuana' has been sky-rocketing. In 2002 – a year after the government first permitted access through Health Canada regulations – 500 patients had registered. Today, there are more than 50,000. This has happened despite the official position of the Canadian Medical Association (CMA) that “there is insufficient scientific evidence available to support the use of marijuana for clinical purposes.” The CMA also believes we don’t know enough about its risks and benefits, about the interactions between marijuana and other medications or how to prescribe an appropriate dosage. It advises doctors they are not obligated to write cannabis prescriptions for patients.

Meanwhile the Australian Medical Association (AMA) are not interested in anything but pharmaceutical cannabis which has limited applications. Quoted in the Australian mainstream media, "Medicinal cannabis should be subject to the same safety and efficacy tests as any other 'drug' before being made available on the Australian market", said the AMA. They also warned against the legalisation of the raw 'dope plant', or any oils and tinctures made from it and urged that only fully-tested cannabis-based medicines should be considered for use.

In a significant development for those who argue cannabis is effective in alleviating chronic pain and providing relief from symptoms including nausea and muscle spasms and should be legalised, the NSW government has secured the support of the Commonwealth and its state and territory counterparts to 'trial' the use of cannabis for medicinal purposes. In March 2015 the Australian Broadcasting Commission (ABC) reported that NSW was running three medical trials to allow children with severe epilepsy, adults with a terminal illness and people with nausea and vomiting caused by chemotherapy to use medical cannabis. The Terminal Illness Cannabis Scheme (TICS) was launched with patients and carers allowed to 'register' with the government (NSW) as using medical cannabis but with no support whatsoever from the government; even when law enforcement arrested a 'carer' and confiscated the medicine/s (the scheme notates that law enforcement may use their discretion not to charge).

Australian Epilepsy sufferer Deisha takes cannabis oil which allows her to live seizure free (seen here with Dad, David). 
Deisha was having seizures every five to eight seconds, cannabis stopped them completely.

Big and Not-so-Big 'Pharma' are targeting a very small number of patients to get their pharmaceuticals into as many countries as possible to make their drugs the only preparations available at exorbitant prices, it would seem (pharmaceutical companies care about profits not patients). The Victorian (Australia) government quoted the cost of Sativex, a cannabis-derived pharmaceutical mouth spray, to be $500 per month in New Zealand (NZ), but Fairfax media (NZ) reported that Sativex, classed as a Schedule B drug like cannabis, would cost for a typical yearly prescription, about NZ$20,200. Somewhere in between lies the true cost but the latest research reiterates that the whole, organic cannabis plant is needed for the best medicinal applications (the Entourage Effect).

A San Diego, California Scientist, Igor Grant, said recently "It's now well-established that 'marijuana' can soothe neuropathic pain in patients with diseases like HIV/AIDS. It can reduce spasticity in MS and, perhaps obviously, it can stimulate appetite in underweight patients. More research is needed before reaching conclusions about marijuana's usefulness with other diseases, like epilepsy and schizophrenia." Grant says there's now more than enough evidence to justify rescheduling 'marijuana' in the US. Other scientists agree. The American Academy of Paediatrics recently called for rescheduling. Even US Surgeon General Vivek Murthy has acknowledged 'marijuana' can be helpful in treating certain conditions.

additional medical and scientific references compliments of Granny Storm Crow's List 2015

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