30 April 2015

Cannabis for Seizure Disorders

Many drugs are developed not because there's a great medical need, but rather there's big money to be made from them. In many cases, holistic therapies and medicines already exist that can take the place of any number of synthetic pharmaceuticals. Cannabis is one such therapy and it's time to ask questions and look at a new way of thinking about this plant, Dr Margaret Gedde, MD, PhD, Gedde Whole Health, Colorado, US, and the Clinicians' Institute of Cannabis Medicine, said. A wealth of research shows cannabis does indeed have outstanding promise as a medicinal plant, largely due to its cannabidiol (CBD) content. Cannabinoids interact with your body by way of naturally occurring cannabinoid receptors embedded in cell membranes throughout your body. There are cannabinoid receptors in your brain, lungs, liver, kidneys, immune system and more. Both the therapeutic and psychoactive properties of cannabis occur when a cannabinoid activates a cannabinoid receptor. About two years ago, Dr Gedde received her first request from a parent who wanted to use the high-CBD, low-Δ9-tetrahydrocannabinol (THC) form of cannabis for her child's epileptic seizures.

"I went ahead with that and started to learn about what this could do. Now, two years later, the news that cannabis is a therapy for epilepsy has reached the world. We're very committed to gather ongoing information about what's happening with these children and to get this information out to other physicians in a way that they can use and understand. We want to generate high-quality, publishable data from practice and our experience. We want to help people understand the background and the scientific basis of what cannabis can do and really start to understand that it's a medicine and bring it into what we have as medicine," she says.
THC and CBD molecules, showing their extremely close resemblance

The cannabis plant contains many cannabinoids including CBD and THC. Both have medicinal properties; THC can cause psychotropic effects (feeling 'stoned'), CBD cannot. The whole plant contains a variety of terpenes that have varying medicinal properties too. Through traditional plant breeding and seed exchanges, growers have produced cannabis plants for medical use that have higher levels of CBD and lower levels of THC. Dr Allan Frankel, MD, one of the world’s leading authorities on dosed cannabis medicine (board-certified in California) who treats patients with medical cannabis, works with a number of CBD-rich strains.

In the US, CBD is currently a Schedule 1 controlled substance, (in Australia it is Schedule 9) which means, in the US:
- the 'drug' or other substance has a high potential for abuse,
- the 'drug' or other substance has no currently accepted medical use in treatment in the US,
- there is a lack of accepted safety for use of the 'drug' or other substance under medical supervision.

In Australia it means, under the Scheduling of Medicines and Poisons, Therapeutic Goods Administration (TGA):
- As a constituent of cannabis, the substance would be captured by the entry for cannabis in Schedule 9 (Prohibited Substance).
- CBD may also be a constituent of hemp seed oil ... defined as oil obtained by cold expression from ripened fruits (seeds) of Cannabis sativa and exempted from scheduling provided the oil contains 50 mg/kg or less of THC and is labelled with the warning statement: "Not for internal use" or "Not to be taken".
- CBD is mentioned in Schedule 8 (Controlled Drug) entry for 'nabiximols'* (defined as containing a range of cannabinoids including both THC and CBD).

Across the US there's no doubt that CBD needs to be rescheduled, as current scheduling is blatantly wrong. In Australia, an
interim decision (on matters referred to an expert advisory committee, November 2014) to reschedule CBD (Schedule 4 - Prescription Only Medicine and Schedule 8 - Controlled Drug) was recommended by the Therapeutic Goods Administration (TGA) to be implemented 1 June 2015.

How Does Cannabis Compare to Prescription Drugs?
A number of prescription drugs are well known to be dangerous. Pharmaceuticals in general are among the leading causes of death in the US and some drugs have killed tens of thousands of individuals. The painkiller Vioxx is one classic example that killed over 60,000 before being pulled off the market. In Australia the Royal Australian College of General Practitioners (RACGP) and the Pharmaceutical Society of Australia (PSA) had called upon Federal and State governments to implement a national Electronic Recording and Reporting of Controlled Drugs (ERRCD) system, after a Victorian coroner warned legal drugs were killing more people than illicit drugs or alcohol.

According to Dr Gedde, cannabis is certainly far safer than most prescription drugs and there's enough information to compare it against the known toxicities of many drugs currently in use. This includes liver and kidney toxicity, gastrointestinal damage, nerve damage and, of course, death. Moreover, CBD and other cannabis products often work when other medications fail, so not only are they generally safer, cannabis preparations also tend to provide greater efficacy. As noted by Dr Gedde:

"There's an ongoing death rate from use of pain medications as prescribed. So, even as prescribed, they're highly dangerous and they are open to abuse. As far as medications used in the paediatric population to control seizures, there are also severe toxicities to organs. Many of them are very sedating. The children become unable to function or really to interact because of the sedating effects. Other medications have a side effect of rage and behavioural problems. Unprovoked rage is actually a known side effect of some of the anti-seizure medications. Cannabis and in particular cannabidiol has none of these issues. No toxicities. The main side effect of cannabidiol is sleepiness. As a child gets accustomed to it, that does wear off and the child can be very alert and functional on the cannabis oil once they have worked into the dosing. Once you put them against each other, there really is no comparison in terms of safety."

Anti-epileptic Drugs (AEDs)
Epilepsy Action Australia defines anti-epileptic drugs (AEDs) as medications used in the management of seizures. Some forms of these medications are also used to treat neuropathic pain, bi-polar disorder and anxiety. Also called anti-convulsants and AEDs (please see list at the end of this article of current AEDs and some of their side-effects).

Cannabis for Seizure Control in Children
In Dr Gedde's experience, about 25% of children experience a rapid reduction in seizures when given cannabis oil, sometimes within days, or weeks. But results do vary, and not every child will respond well in the immediate term. She notes that some children are so sensitised to medications that they need to start at a very low dose, and give it plenty of time to work.

"We are working out in the clinical practice the protocols that seem to give the best benefit the most quickly to the most children, but we do find that some children get results very quickly. For others, it takes more time, up to a number of months," she says.

There's limited information on using cannabis in children for issues other than epilepsy. However, in January 2015, the American Academy of Paediatrics (AAP) updated their policy statement on cannabis, acknowledging that cannabinoids "may currently be an option for … children with life-limiting or severely debilitating conditions and for whom current therapies are inadequate".

The main objection of paediatricians at the Children's Hospital in Denver to using CBD in children, even for conditions like uncontrolled seizures, is that there are no studies in children of potential harms of long-term use of CBD. There might be long term adverse effects of CBD and other cannabinoids that we will only come to discover later.

"This is a good point in my view, and a reason not to suggest use of CBD as a dietary supplement or as a general 'health tonic' for children", Dr Gedde says. "In my view, it is important to weigh the use of a therapy, including potential risks not known, against the risks of the uncontrolled illness itself and of other therapies in use. For many patients, even with incomplete information about CBD, weighing those risks including known toxic effects of their current therapies does point to at least a therapeutic trial with CBD being a good choice."

The Joint Epilepsy Council of Australia released a position statement at the end of October, 2014, on 'medical marijuana' endorsed by Epilepsy Australia stating ..."Basic research studies have provided strong evidence for safety and anti-convulsant properties of CBD. However, the lack of pure, pharmacologically active compounds and legal restrictions have prevented clinical research and confined data on efficacy and safety to anecdotal reports.

Potential Side Effects of Medical Cannabis
According to Dr Gedde the main side effect you need to watch out for is the psychotropic effects of THC. However, she also stresses that THC actually has many valuable medical benefits, so depending on your problem, you may want higher or lower levels of THC. For example, in patients who suffer with severe pain, where the perception of pain causes great distress, the psychotropic effects of THC allows the patient to shift their perception of the pain in their mind and body.

"That's an example where the psychoactivity is needed, but there are other areas where it's not. Selection of the type of product, the actual cannabinoids in it and the mode of using it is very helpful for dealing with that side effect," she says. "Beyond that and the kind of distress that excessive psychoactivity can cause if somebody gets too much, cannabis is very safe. There are no known deaths linked with it. That cannot be said about virtually anything else on the planet, including water. You can overdose on water and die. You can't get enough cannabis in your body to kill you."

In Australia, Dr Andrew Katelaris, MD, UNSW, wrote in his submission to the Legal and Constitutional Affairs Committee with regard to the Inquiry into the Regulator of Medicinal Cannabis Bill 2014;

"I am one of a very few clinically trained medical professionals in Australia with experience in growing, extracting and administering cannabis medicines. Cultivars (cultivated varieties) of cannabis that are dominant in the non-psychotropic cannabinoid, CBD, have demonstrated dramatic effects in a subgroup of children with intractable epilepsy in overseas studies. Intractable epilepsy is, by definition, epilepsy that has not been controlled despite maximal combination therapy, leading to cumulative brain damage and early death of the afflicted child. Given the severity of their predicament and the impotence of the medical profession to assist, I prepared standardised extracts of a CBD dominant cannabis in medium chain triglyceride oil at a concentration of 5mg/ml and received volunteers requesting their child be included in this pilot study. Twenty children were administered this treatment, half the group being diagnosed with Dravet syndrome and the remainder having congenital, post infectious and post hypoxic aetiologies for their seizures. Approximately 80% of the recipients received benefit and all wished to continue with the medicine. No significant side effects were reported. In about half of the recipients, the benefit was nothing less than transformational. Not only was seizure activity reduced to a minimum or abolished, but the child's capacity for learning and skill acquisition, as well as social interaction was increased, in some instances dramatically. Repeated approaches have been made to the New South Wales (NSW) state government to reclassify CBD dominant cannabis as a medical herb, subject only to purity and potency control, without any reply or even acknowledgement being received. One can only hope that those considering this bill exercise their social conscience to a higher degree and take urgent action to enact this reclassification at a federal level. Not only does CBD have no psychotropic effect but it also negates the psychotropic effect of THC. Therefore, diversion is not an issue and cannot be used as an excuse to delay taking this necessary step."

Cannabis use in Australia is illegal no matter where you reside. State governments have promised trials of medical cannabis before the current plethora of purported 'medical cannabis' trials. The NSW Legislative Council, General Purpose Standing Committee No. 4 on 'The use of cannabis for medical purposes' recommended in May 2013

"... in general terms medical cannabis has potential as an effective treatment for some medical conditions with appropriate safeguards in place [and] cannabis products are emerging as a promising area of medicine ..."

But for parents of children with intractable epilepsy it could be a case of too little too late and what parent could be blamed for risking that? One such parent, David Stevens writes;

"You should already know how strongly and passionately I feel about medicinal cannabis, especially what it has done for Deisha and many others. Now from the start I want to say that it may or may not work as well on your child as it has for Deisha, but every child with refractory epilepsy should have the opportunity to have access to medicinal cannabis and quite possibly give them and their families quality of life as well as possibly saving the child's life. It doesn't matter what level of government it is, nothing happens overnight and I applaud the governments in Australia who have taken positive action. Unfortunately with all the media attention that medicinal cannabis has been receiving this has led to limited supply and some unscrupulous people selling snake oil to desperate families. Now this is not acceptable and I don't want to see any child or family put at risk. The only answer I see for families to help their child now is to take control themselves.

So I've made a short video to show you how to make high CBD Medicinal Cannabis Oil for Paediatric Epilepsy to show families how easy and safe it is to make. No more meeting people late at night down dark lane-ways. You will now know exactly what you are giving your child. Please share to your hearts content." YouTube

As reported in The US National Library of Medicine (type the words 'cannabis epilepsy' in the search field and it will return nearly 800 very current results), one scientific study from 2010, Cannabidiol Displays Antiepileptiform and Antiseizure Properties In Vitro and In Vivo, states;

"Plant-derived cannabinoids (phytocannabinoids) are compounds with emerging therapeutic potential. Early studies suggested that cannabidiol (CBD) has anti-convulsant properties in animal models and reduced seizure frequency in limited human trials. CBD (100 mg/kg) exerted clear anti-convulsant effects with significant decreases in incidence of severe seizures and mortality ... Finally, CBD acted with only low affinity at cannabinoid CB1 receptors and displayed no agonist activity. These findings suggest that CBD acts, potentially in a CB1 receptor-independent manner, to inhibit epileptiform activity in vitro and seizure severity in vivo. Thus, we demonstrate the potential of CBD as a novel anti-epileptic drug in the unmet clinical need associated with generalised seizures".

Another study from 2013, Cannabidivarin (CBDV) suppresses pentylenetetrazole (PTZ)-induced increases in epilepsy-related gene expression, states;
"To date, anti-convulsant effects of the plant cannabinoid, CBDV, have been reported in several animal models of seizure. To examine changes to epilepsy-related gene expression following chemical convulsant treatment and their subsequent control by phytocannabinoid administration, we behaviourally evaluated effects of CBDV. Consistent with previous findings, CBDV significantly decreased PTZ-induced seizure severity and increased latency to the first sign of seizure. These results provide the first molecular confirmation of behaviourally observed effects of the non-psychoactive, anti-convulsant, cannabinoid, CBDV, upon chemically-induced seizures and serve to underscore its suitability for clinical development".

Severe childhood epilepsies are characterised by frequent seizures, neuro-developmental delays and impaired quality of life. In these treatment-resistant epilepsies, families often seek alternative treatments. This survey explored the use of cannabidiol-enriched cannabis in children with treatment-resistant epilepsy. The survey was presented to parents belonging to a Facebook group dedicated to sharing information about the use of cannabidiol-enriched cannabis to treat their child's seizures. Nineteen responses met the following inclusion criteria for the study: a diagnosis of epilepsy and current use of cannabidiol-enriched cannabis. Thirteen children had Dravet syndrome, four had Doose syndrome and one each had Lennox-Gastaut syndrome and idiopathic epilepsy. The average number of antiepileptic drugs (AEDs) tried before using cannabidiol-enriched cannabis was twelve. Sixteen (84%) of the nineteen parents reported a reduction in their child's seizure frequency while taking cannabidiol-enriched cannabis. Of these, two (11%) reported complete seizure freedom, eight (42%) reported a greater than 80% reduction in seizure frequency and six (32%) reported a 25-60% seizure reduction. Other beneficial effects included increased alertness, better mood and improved sleep. Side effects included drowsiness and fatigue. Our survey shows that parents are using cannabidiol-enriched cannabis as a treatment for their children with treatment-resistant epilepsy. Because of the increasing number of (US) states that allow access to medical cannabis, its use will likely be a growing concern for the epilepsy community. Safety and tolerability data for cannabidiol-enriched cannabis use among children are not available. Objective measurements of a standardised preparation of pure cannabidiol are needed to determine whether it is safe, well tolerated, and efficacious at controlling seizures in this paediatric population with difficult-to-treat seizures.

My personal opinion as an outsider looking in (I don't have a child with intractable epilepsy, thankfully) is that I would move mountains to help my child and these parents should never be criminalised for helping their sick and suffering children, never - the law is wrong in Australia and needs changed, now, not later, as later will be too late for some; and who would want that on their conscience? Exactly how much unnecessary paediatric poly pharmacy is involved with this disease alone is anyone's guess, but read on to learn just some of the nasty side-effects these real drugs have ...

Common Seizure Medication Side Effects
Seizure medications work on the central nervous system. Most cause some degree of drowsiness or dizziness, at least at the beginning of therapy. Also, most anti-seizure medications can induce suicidal thoughts or actions and/or bring on or worsen depression. Seizure medications have a variety of possible side effects. The following is a list of potential side effects of different classes of seizure medications.
Acetazolamide (Diamox): Kidney stonesIncreased urination, Loss of potassium
Benzodiazepines (Valium, Ativan, Klonopin, Onfi): Dependence, Possible severe seizures on sudden withdrawal, Respiratory depression, Increased risk of glaucomaLiver injury

Carbamazepine (Tegretol) and related drugs: Upset stomach, Serious (even fatal) skin reactions, Serious blood disorders, Reduced sodium levels (oxcarbazepine)
Ethosuximide (Zarontin) and derivatives: Serious blood disorders
Ezogabine/Retigabine (Potiga): Potentially irreversible eye damage, Potentially irreversible skin discolouration
Felbamate (Felbalol): Liver failure, Potentially fatal anaemia (aplastic anaemia)
Gabapentin (Neurontin): Weight gain, Behavioural changes including hyperactivity

Lacosamide (Vimpat): Skin rashChanges in heartbeat with possible faintingDrug dependence
Lamotrigine (Lamictal): Serious rash, Stomach problems, Difficulty sleeping
Levetiracetam (Keppra, Keppra XR): HeadacheFlu-like symptoms, Weight lossChanges in behaviour, Changes in blood count
Perampanel (Fycompa): Severe changes in mood and behavior, including hostility, aggression, suicidal thoughts, Weight gain, Drug dependence
Phenobarbital and derivatives: Birth defectsMemory loss, Depression

Phenytoin (Dilantin): Body hair growth, Birth defects, Gum disease, Seizures with higher doses
Pregabalin (Lyrica): Swelling of hands and feet, Trouble concentrating, Weight gain
Rufinamide (Banzel): EKG changes, Interference with oral contraceptives
Tiagabine (Gabitril): Tremour, Agitation, Seizures in non-epilepsy patients
Topiramate (Topamax): Increased risk for glaucoma, Trouble concentrating, Decreased sweating, Increase in body temperature
Valproic acid and derivatives (Depakene, Depakote): Stomach upset, Temporary loss or thinning of hair, PancreatitisToxicity to liver, Weight gain, Birth defects
Vigabatrin (Sabril): Irreversible visual problems, including reductions in acuity and colour differentiation
Zonisamide (Zonegran): Kidney stones, Rise in body temperature, Metabolic acidosis

expanded from Cannabis for the Treatment of Epilepsy and More
with additional information from Granny Storm Crow's List 2015, Google Scholar
Anti-epileptic medications
funded NPS MedicineWise


27 April 2015

What is Vaping?

An alternative to smoking, vaping, vaporisation, or using a vaporiser as a means of inhaling cannabis or other herbal material, has been around in various forms since the 1960's, but has recently really caught on in popular culture. Combining new (and some old) technology while providing a healthier alternative to enjoying cannabis, the hype behind vaporisers is not overblown.

Vaporisers (sometimes advertised and sold as aromatherapy devices) heat any herbal material (cannabis, various dried herbal mixes and some concentrates) to a certain temperature to form a light mist (vapour) which you then inhale. In simple terms it's the process of gently heating herbs or concentrates with hot air to release active ingredients, which are boiled off and inhaled in the form of vapour. Most vaporisers these days use convection to heat the herb, this method heats much more evenly and effectively than conduction.

When it comes to vaporisation there are a variety of substances that can be used, including dry herb, concentrates and e-juices*. The material being vaporised will affect which vaporiser you'll want to use, as not all vapes work with every substance. It is easier to decide on a vape when you know what you plan to vaporise most frequently.

Dry Herb
Waxy Concentrates
  • Dried/cured plant material
  • Extracted from dry herb
  • Beneficial properties released when vaporised
  • Extraction methods include CO2, butane, or high-proof alcohol

While most vaporisers are designed to be specifically compatible with one material, multi-compatible units are becoming more common. These units generally have separate heating chambers for each style of material that will be vaporised. These multi-compatible vaporisers are more commonly found in the pen style version and not the larger portable or desktop vapes.

The heated air is either drawn through the herb (manual whip) or forced through with a fan. The temperature can be varied precisely with analogue or digital controllers, or by the draw speed and strength in the manual mode. It's all in the personal preference of the user. Some people prefer to select their temperature to control which active ingredients are released, and some prefer a single temperature and vary their draws. Different temperatures release different proportions of active ingredients in the herb. This affects the tastes and the experience in general.

They come in desktop sizes for in-home use or various portable ones, including Vape Pens, which are proving very popular with the younger generation in the US, particularly. 

There are several different design factors that determine how a vaporisers heat source receives power. Ultimately, it will be achieved via either electricity or flame. Though power cords or a rechargeable battery are required for the electric variety, they generally perform better due to the consistent stream of power provided.

Electric / Plug In

  • Plugs directly into an outlet
  • Generally used with desktop units, which produce more vapour


  • No need for charger or wires
  • Refill anywhere

Rechargeable Batteries

  • Can be internal or external
  • Generally used with portable vaporisers


  • No electricity required
  • User controls the distance of heat from herb

Vaporisers powered via electricity tend to heat up and maintain temperature more efficiently than the other options. However, with the flame style power source, one is not tethered down by wires, which is optimal for situations where there is no electricity available to recharge a vaporiser. Controlling the temperature of the vaporiser is key to achieving the most efficient vapour production. There is a range in which the herb will begin to release its active ingredients and if the herb is not warm enough, no vapour forms. Alternatively if the temperature rises too far, the herb will burn up and defeat the whole purpose of vaporisation.


  • Most accurate control design
  • Temp readout on display screen


  • Rotating dial operation
  • Allows for very slight increases/decreases in temp

Press Style

  • Heats while button is held down or rechargeable battery inserted
  • Timing plays a big role in proper heating

Monitoring the temperature throughout the process of vaporisation prevents the material from being overheated, which leads to combustion and smoke. The remaining herb should be crispy and a brownish colour, NOT ash. If the leftover product is black or burned up, a lower temperature is required to produce vapour.

Along with choosing the temperature control, it is good to consider how long the vaporiser will take to go from cold to hot and ready to vape. Each vaporiser's heat up time is different, however pen style units are generally the quickest, followed by other portables and then desktop units (which require more power).

10 Seconds or Less

1-2 Minutes

2-4 Minutes

Vaporisers that heat up to and maintain a set temperature are more efficient in terms of vapour production. Units that have a push button control and rapid heat up time are more difficult to control, which can easily lead to combustion if you are not careful.

Though the iconic Volcano Vaporiser is often what comes to mind when people first think of a vaporiser, the technology and implementations of vaping continue to be applied in a variety of forms. As popularity grows, it seems that innovation around this popular consumption method will continue to flourish.

Compared to smoking, vaping is much healthier for you. Your body doesn’t love it when you light things on fire and then suck them into your lungs. Studies show that cannabis vaporisers provide the same level of THC, but fewer toxins. The same study notes that vaping is less bad for you than smoking. In some US states that have legalised medical cannabis, they encourage users to vape or eat cannabis as an alternative to smoking. In many cities around the world, including New York, they’ve disallowed smoking altogether, largely for health reasons.

The word 'vape' became so prevalent in popular culture and language that it was named Oxford English Dictionary’s Word of the Year in 2014, meaning 'to inhale and exhale the vapour produced by an electronic cigarette or similar device'. According to OED, you are about 30 times more likely to come across the word vape - both a verb and a noun - now than only two years ago.

At its core, the technology for vaporisers is simple, but stylish. All vaporisers have a power source, coils that heat and vape the ingredients, and an LED light at the tip. Portable vaporisers are super customisable and incredibly discreet, as they leave little smell and residue behind. If you’re looking for a new way to consume your favourite plant, a vaporiser might be for you.

While vaporisers and e-cigs are catching like wildfire amongst tobacco and cannabis lovers across the US, the law is still trying to play catch up (*e-cigs are illegal in Australia because nicotine is classified as a poison). Regulating vaporisers has lead to the creation of 'vaporium' communities for users to buy and inhale vapours. New York has just cracked down on vaporisers by including them in their Public Smoking Ban laws.

As vaporisers continue to become the norm in the cannabis community, we expect the technology will become even more widely used. However, laws are expected try to regulate this method. But as legalisation in the US spreads, vaping obviously stands out as a healthier alternative to smoking - something we can all get on board with. Hopefully lawmakers and officials will agree too!

adapted from The Stoner's Cookbook
with additional information from Vapor Nation and
Australian Vaporizers

23 April 2015

Cannabis and Chronic Pain

Chronic non-malignant pain is pain defined as an "unpleasant sensory and emotional experience associated with actual or potential tissue damage" lasting either 3 months or longer or longer than expected given a certain injury. It can result from trauma, a disease process or an unknown cause. By adding the word “neuropathic” to the disorder name, the definition includes that the cause of pain is a direct result of damage or compression of a nerve. In contrast to “non-malignant” pain, chronic malignant pain is associated with a severe/worsening known disease process, and is often experienced by patients with cancer.

Approximately 11% of individuals residing in the United States (US) experience chronic non-malignant pain and it is therefore the leading cause of disability. Uncontrolled chronic non-malignant neuropathic pain can be severely debilitating, and safe and effective management is essential for maintaining optimised quality of life for patients. Opioids are commonly prescribed for patients with chronic pain, and are a useful and effective therapy for many. However, opioid use can lead to severe side effects, addiction/dependence and death in cases of overdose (accidental or intentional). Although most patients with chronic non-malignant pain who are prescribed opioids do not develop addiction/dependence, many develop abnormal/unhealthy drug-related behaviours (although the likelihood of developing these behaviours is decreased if patients are pre-screened for past addiction/dependence and alcohol/illegal drug use, and decision of whether or not to prescribe is modified given this information). 

Cannabinoid therapies (including whole-plant) may be an effective treatment option for chronic pain, and have the potential to work as an add-on therapies to help reduce patients’ opioid dosages. In some anecdotal cases, whole-plant cannabis has been reported to be able to fully replace opioid use (although these results should not be expected).

In Australia, a large study of people suffering from chronic problems such as back pain, migraine and arthritis has discovered many are turning to cannabis to relieve their symptoms, despite already being prescribed heavy-duty opioid medications such as morphine and oxycodone. In a finding that is likely to further intensify the debate about medical cannabis use, the National Drug and Alcohol Research Centre (NDARC) researchers found people who used the illegal 'drug' (cannabis is an annual, herbal plant) said it was more helpful than the highly addictive and potentially dangerous opioid medications.

Experience of adjunctive cannabis use for chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) study;
•There is increasing debate about the use of cannabis for medical purposes, including chronic non-cancer pain (CNCP)
•In 1,514 people prescribed opioids for CNCP, 16% had used cannabis for pain.
•A quarter reported that if they had access to cannabis, they would use it for pain relief.
•Those using cannabis for pain were younger, with greater pain severity and interference.
•They had been prescribed opioids for longer and were on higher opioid doses.

Millions of Australians suffer from chronic pain - a problem set to increase as the population ages. Yet there are few effective and safe long-term treatments, and accidental overdose deaths from prescribed pain drugs are now more common than deaths from heroin. Study leader Louisa Degenhardt found nearly 13% of 1,500 chronic pain patients, who were mainly aged in their late 40's and early 50's, had used cannabis in the past year despite being prescribed opioids. This compared to only 4.7% of the rest of the population, she wrote in the journal Drug and Alcohol Dependence. "One in three said they found it very effective to relieve their pain, that's a score of ten out of ten," she said. "Now these are all subjective scores but it means there is definitely a group of people who think that taking it was very beneficial." Professor Degenhardt, from NDARC and the University of Melbourne said the study raised important questions about whether the benefits of cannabis for pain should be more seriously explored, but also about the negative effects of drugs, such as patient dependence. "The people who were also trying cannabis for pain, they were younger but they had also been living with pain for longer," she said. "Their pain was so severe it had been interfering with their lives."

A study published in October 2014 in JAMA Internal Medicine found that opioid-related deaths were 25% lower in US states where medical cannabis is legal. Although this study found an association, rather than a cause-effect relationship, given cannabis’ highly favourable safety profile (especially in comparison to opioids) the results warrant further research.

A systematic review of 13 studies on the topic of cannabinoid therapy use for chronic neuropathic pain, published in the Winter 2015 volume of Journal of Oral & Facial Pain and Headache, found that “evaluation of these studies suggests that cannabinoids may provide effective analgesia (i.e. pain relief) in chronic neuropathic pain conditions that are refractory (i.e. not fully responsive) to other treatments.” 

To gather a sample of papers to review, the researchers used several online databases, as well as print sources dating back to 1950. Termed used in the searches included: marijuana; marihuana; cannabis; cannabinoids (endogenous, phytocannabinoids found in cannabis, synthetic cannabinoids); nabilone (a synthetic cannabinoid that functions like delta-9-tetrahydrocannabinol (THC) currently Food & Drug Administration (FDA) approved for the treatment of chemotherapy-induced nausea and vomiting); dronabinol (synthetic THC, currently FDA-approved for the treatment of chemotherapy-induced nausea and vomiting); THC, a phytocannabinoid; cannabidiol (CBD) a phytocannabinoid; ajulemic acid (a synthetic cannabinoid that is a breakdown product of THC, has demonstrated an ability to provide pain and inflammation relief without producing psychoactive effects); pain; chronic disease; neuropathic. The researchers limited the search to randomised placebo-controlled trials (the gold standard for clinical trials, allows for an examination of cause-effect relationships) and reduction in pain intensity and harmful events were compared among the studies. While 24 studies using the terms noted above were found, 11 did not fit the criteria. The remaining 13 studies that were analysed were rated using the Jadad Scale, which is used to assess the quality of clinical trials and, as noted by the researchers, “to measure bias in pain research”.

The researchers found that, “cannabis-based medicinal extracts used in different populations of chronic non-malignant neuropathic pain patients may provide effective analgesia in conditions that are refractory [i.e. not fully responsive] to other treatments” and that “the vast majority of adverse events listed were considered minor in nature”. Overall, improvements in “sleep quality, appetite, nausea, and anxiety” were also noted.

This review, conducted on studies that have examined the use of cannabinoid therapies for chronic non-malignant neuropathic pain, provides important details for the consideration of the place for cannabinoid use in symptom/disease/disorder treatment. While unable to draw new cause-effect relationships from systematic reviews, these types of studies help to answer a broad question, while limiting bias that is often found in individual papers. Given that this review was conducted in accordance with appropriate scientific methodology, and that a benefit to the use of cannabinoid therapies was found (with minimal adverse side effects), this study adds to growing evidence that cannabinoid therapies (including phytocannabinoids and isolated/synthetic cannabinoids) may be safe and clinically useful therapies in the management of chronic non-malignant neuropathic pain.

According to the authors, increased research will help to determine optimal specific cannabinoids (e.g. phytocannabinoid, synthetic, endogenous modulation), delivery methods, and length of treatment.

Granny Storm Crows List 2015
Google Scholar