Medical Cannabis and Cannabinoids最新文献

Introduction: Multiple sclerosis (MS) is a neurodegenerative disease presenting with a wide range of motor, sensory, and psychiatric symptoms. Although nabiximols is licensed for MS-induced spasticity, cannabis-based medicinal products (CBMPs) have also displayed promising therapeutic potential for managing pain, sleep, and anxiety. Therefore, further evaluation of CBMP treatment for MS is warranted. This study aimed to assess the efficacy and tolerability of CBMP treatment in patients with MS by investigating changes in MS-specific and general health-related patient-reported outcome measures and adverse events.

Methods: This was a prospective case series including patients with MS enrolled on the UK Medical Cannabis Registry. Changes in MS Quality of Life-54 (MSQOL-54), Generalised Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), and EQ-5D-5L scores were assessed from baseline up to 24 months. The prevalence and severity of all adverse events were also assessed.

Results: This study included 203 patients, of whom 47.29% (n = 96) were female and 80.79% (n = 164) had prior cannabis exposure. Improvements in the MSQOL-54 subscales: change in health, energy, health distress, pain, physical function, and physical role limitations, along with improvements in SQS and EQ-5D-5L scores, were seen at all follow-up times compared to baseline (p < 0.050). A total of 278 adverse events were reported by 26 patients (12.81%). Most adverse events were mild (n = 91, 32.73%) or moderate (n = 138, 49.64%) in severity, with fatigue (n = 27, 13.30%) and spasticity (n = 17, 8.37%) being the most common.

Conclusion: CBMP treatment over 24 months was associated with improvements in health-related quality of life and was well tolerated in patients with MS. Future randomised controlled trials with more representative study populations are needed to establish causal relationships.

Background: At least 60% of individuals with anxiety disorders report sleep disturbances, which might be explained by shared physiological mechanisms, including cortisol dysregulation and executive function skills disruption. The scientific literature regarding medical cannabis as a potential therapeutic candidate for these conditions increased about 15 times in the last 10 years. However, assessments of cannabinoid exposure, anxiety, and sleep are inconsistent across studies, and the quality of the evidence is not often assessed.

Summary: We conducted a scoping review to examine the current knowledge on cannabinoid use for anxiety and sleep disturbances. We applied our search strategy to PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, LILACS, and PsycINFO. Papers were selected by duplicate using PRISMA guidelines. Quality assessment was conducted for included studies, and data extraction was performed according to our predefined protocol. Of 1,132 retrieved documents, 29 studies met the inclusion criteria, encompassing randomized clinical trials, observational studies, and case series. Cannabinoids, particularly cannabidiol (CBD), showed potential efficacy in improving anxiety symptoms and sleep disturbances. However, substantial heterogeneity in study design, cannabinoid types, and dosing regimens limited generalizability. Approximately 45% of studies reported positive effects on both outcomes, yet few provided standardized dosing protocols or effect sizes.

Key messages: Cannabinoids, especially CBD, may improve anxiety and sleep disturbances, but methodological limitations and the lack of standardized dosing hinder definitive conclusions. Future research should prioritize dose-response relationships and standardized methodologies to better inform clinical practice.

Introduction: Chronic pain is the most common qualifying condition found in states with legal (certified) access to medical cannabis (MC). We assessed the geographic distribution of MC certifications for severe chronic or intractable pain in Pennsylvania (PA) between 2018 and 2024, identifying relationships between community variables with the percentage of adults with an MC certification for pain.

Methods: Using data from the PA Department of Health (PDOH) from 2018 to 2024 (N = 44,645 to 165,740 certifications for pain/year), we mapped zip codes associated with MC certifications for pain to counties and zip code tabulation areas (ZCTAs), geographic areas that approximate a standardized representation of zip codes for statistical purposes. The difference between the highest and lowest counties was determined. A linear regression evaluated correlations between community variables and the percentage of adults in geographical areas with an MC certification for pain in 2024.

Results: There was almost a four-fold difference in the percent of adults with an MC certification for pain in the highest (Perry = 2.3%) versus lowest (Tioga = 0.6%) counties in 2024. Bradford and Tioga County had a significantly (p < 0.05) lower percentage certified relative to the county-wide average. There was a significantly higher proportion of certifications for pain in counties with larger population densities of adults (1.76 ± 0.12%) than counties with smaller population densities (1.38% ± 0.14%) of adults (t(65) = 4.66, p < 0.001, d = 1.14). At the county level, higher median household income (r(65) = +0.335, p < 0.01), lower median age (r(65) = -0.241, p = 0.0499), and higher rural-urban continuum code (r(65) = +0.644, p < 0.001) were associated with a greater percentage of adults with an MC certification for pain using simple linear regression. Using a multiple regression model, only rural-urban continuum code was significantly associated with the percent of adults with an MC certification for pain (p < 0.001). At the ZCTA level, the proportion of non-white individuals, including Hispanics, showed a significant inverse association with the percent of adults with an MC certification for pain (r(1,722) = -0.07, p < 0.01).

Conclusions: This study identified four-fold county-level disparities in MC certifications for pain. The association between median household income and MC pain certifications may indicate differences in accessibility of MC based on financial status. Further research may be warranted pending any changes to the legal status or demand for MC.

Introduction: The endocannabinoid system plays a role in sleep-wake regulation. In clinical practice, people with central disorders of hypersomnolence (CDH) frequently report use of cannabis.

Methods: We compared lifetime and current use of cannabis of people with CDH to the Dutch general population. Additionally, we assessed cannabis use in relation to hypersomnolence symptoms.

Results: In total, 76 (out of 88) patients completed the online questionnaire. Lifetime cannabis use (42% vs. 23%, p < 0.001) and current use (18% vs. 4%, p < 0.001) were higher in people with CDH compared to the Dutch general population. For 57% of patients currently using cannabis, improvements of at least one CDH symptom were the motivation for use. Additionally, 79% of current cannabis users reported cannabis-related effects on a symptom, which were mostly positive (43%), some negative (7%), or mixed effects (29%). Patients that stopped using mostly started using cannabis before symptom onset and for recreational purposes. The most reported reasons to stop using were disadvantages of using or changes in the social environment.

Conclusion: This study provides a rationale for future research on the potential benefits of cannabis in CDH.

Background: Despite significant gaps in the research literature, the integration of cannabidiols into chewing gum as a drug delivery system is a novel and promising approach for various cannabinoid therapeutic applications. Chewing gum offers a unique delivery mechanism that may promote both local and systemic effects through the oral mucosa, enhancing the bioavailability and efficacy of cannabinoid medications.

Summary: This commentary explores and delves into the potential of cannabinoid-infused chewing gum, highlighting its putative benefits for managing an array of conditions, including oral health, anxiety, and pain. The therapeutic potential of cannabinoids is explored in the context of their anti-inflammatory, antimicrobial, analgesic, and anxiolytic properties that may be especially impactful in the oral cavity and at the oral-pharyngeal mucosa. Additionally, we reviewed the advantages of using chewing gum for discrete self-medication and rapid onset of salutary effects.

Key messages: Despite a long-standing widespread history of chewing gum use in general, there is sparse experience and even less clinical research on the effects and possible clinical value of incorporating cannabidiol or any other cannabinoid in a chewing gum product. Despite promising reports, research gaps remain, particularly in understanding the absorption mechanisms, dosing precision, and long-term safety of cannabinoid-based chewing gum. Addressing these challenges will position cannabinoid-infused chewing gum as a versatile and effective drug delivery system for a range of health conditions.

Introduction: Cannabis contains hundreds of chemical constituents beyond delta-9-tetrahydrocannabinol (Δ9-THC), which is thought to be the primary driver of most of its acute pharmacodynamic effects. The entourage effect theory asserts that the pharmacological and therapeutic effects of cannabis are not solely attributable to Δ9-THC but are influenced by other constituents, such as minor cannabinoids and terpenes, through distinct pharmacological action. However, empirical studies that have systematically evaluated this theory in humans remain limited. This study tested the hypothesis that the terpene α-pinene can attenuate the acute memory-impairing effects of inhaled Δ9-THC in humans.

Methods: Participants (N = 19; last cannabis use 39 days, on average, prior to first test session [SD = 84; range = 2-365]) completed six double-blind outpatient drug administration sessions during which they inhaled, using a Mighty Medic hand-held vaporizer, α-pinene alone (15 mg), Δ9-THC alone (30 mg), Δ9-THC and α-pinene together (30 mg Δ9-THC + 0.5 mg α-pinene; 30 mg Δ9-THC + 5 mg α-pinene; 30 mg Δ9-THC + 15 mg α-pinene), or placebo (ambient air) in a randomized order. Outcomes, which were collected up to 6 h post-drug exposure, included subjective drug effects, cognitive/psychomotor performance, and vital signs.

Results: Administration of 15 mg α-pinene alone produced no significant pharmacodynamic effects compared to placebo. Administration of 30 mg Δ9-THC alone elicited subjective, cognitive, and physiological effects consistent with acute Δ9-THC-dominant cannabis exposure, including impairment of cognitive performance and working memory ability compared to placebo. The co-administration of α-pinene with Δ9-THC did not mitigate Δ9-THC-induced memory impairment or significantly alter other acute subjective, cognitive, or physiological effects.

Conclusions: Inhaled α-pinene, at doses at and above those naturally found in cannabis flowers, did not mitigate Δ9-THC-induced cognitive impairments as hypothesized or influence other common acute effects of Δ9-THC in this sample of healthy adults. This result is inconsistent with some cannabis industry claims and speculation by some cannabis researchers. By systematically varying both Δ9-THC and terpene exposure and assessing their interaction across multiple pharmacodynamic domains, this work provides a model for future investigations into Δ9-THC-terpene interactions. As cannabis use continues to expand for both medicinal and non-medicinal purposes, more research is needed to better understand the acute effects of lesser studied chemical constituents of the plant and how they interact with predominant phytocannabinoids like Δ9-THC. This can inform cannabinoid drug development and product regulations.

Introduction: The American College of Obstetrics and Gynecology advises against cannabis and cannabidiol (CBD) product use during pregnancy; despite this, recent studies suggest cannabis and CBD use is increasing during pregnancy. The objective of this study is to assess risk perceptions of cannabis and CBD use during pregnancy among pregnant and non-pregnant patients.

Methods: The study design is multi-method; a cross-sectional survey assessing use behaviors and risk perceptions is supplemented with qualitative focus group discussions (FGDs). Recruitment for surveys was from outpatient obstetrics clinics and recruitment for FGDs was from the same clinics and a substance-use treatment clinic, from October 2022 to February 2023. The survey instrument was developed via combining question items from validated instruments that assess cannabis and CBD use and risk perceptions. Comparisons of response frequency distributions for pregnant versus non-pregnant participants were calculated with chi-square analysis for individual risk perception question items. Data from the FGDs were coded and analyzed via a deductive content analysis approach.

Results: There were 261 survey respondents and 5 FGDs (n = 17). Of the surveys, 198 (75.9%) were currently pregnant, 55 (21.1%) were not pregnant, and 8 (3.1%) did not disclose pregnancy status. Approximately 5.0% (n = 13) reported currently breastfeeding. For the question, "How risky is it to use marijuana [cannabis] once or twice a week during pregnancy?", pregnant versus non-pregnant participants responded most frequently with "great risk" (29.2% vs. 27.3%) and "not sure" (40.0% vs. 34.5%), where p = 0.88 (not significant) between pregnant vs. non-pregnant response distribution. For the question, "How risky is it to use CBD once or twice a week during pregnancy?" pregnant vs. non-pregnant participants responded most frequently with: "great risk" (22.1% vs. 20.0%), and "not sure" (52.3% vs. 41.8%), where p = 0.12 (not significant). Ever use of cannabis and CBD differed in pregnant versus non-pregnant patients (cannabis 36.0% pregnant vs. 65.5% non-pregnant; CBD 19.9% pregnant vs. 38.2% non-pregnant). Qualitative findings indicated that participants perceived that legalization of marijuana has resulted in reduction of stigma against users, but participants expressed mixed feelings toward the perception of marijuana safety due to legalization, though several participants described perceived benefits of marijuana use more generally.

Conclusion: Findings indicate uncertainty of risk related to cannabis and CBD use during pregnancy regardless of current pregnancy or lactation status, despite prevalent ever use of cannabis and CBD in those who were pregnant. This suggests an urgent need for clearer risk communication about cannabis and CBD use in pregnancy.

Introduction: On May 21, 2024, the Drug Enforcement Administration (DEA) published a proposed rule to reschedule marijuana from schedule I to III under the Controlled Substance Act (CSA), followed by a 60-day open comment period. The purpose of this study was to analyze the public attitudes regarding the proposed rule and identify trends based on time of comment submission and recurring arguments throughout the comments.

Methods: This was an observational, cross-sectional, mixed-methods study. Comments from the proposal were stratified according to the submission date as early (May 21 to June 11), mid- (June 12 to July 2), and late (July 3-22) respondents. Investigators were assigned an equal number of comments to code as in favor of, against, or no clear position on rescheduling. Comments were further coded based on type of comment (form letters, personal anecdotes), rationale for comment (racism, decriminalization, safety, and economic factors), and whether descheduling was favored. Chi-square tests were used to analyze categorical data. A random sample of comments was selected to assure a 5% margin of error.

Results: More than 42,000 comments were submitted. Of these, 380 comments were selected and coded, with 42% (n = 158) in support of rescheduling, 55% (n = 211) against rescheduling, and 2.9% (n = 11) with no clear position. Of all comments coded, 71% wanted to go further and were in support of descheduling. The early responses consisted of a majority in favor of rescheduling, while the mid- and late responses consisted of more comments against rescheduling (X ² [2, N = 369] = 35.8, p < 0.00001). Of the comments against rescheduling, a large majority supported descheduling (X ² [2, N = 265] = 32.0, p < 0.0001). As for comment structure, 69% (n = 263) of all comments coded were form letters, while 8.4% (n = 32) were personal anecdotes.

Conclusion: The number of comments in support of rescheduling decreased with time, only dominating the early respondent wave. Despite a larger number of negative attitudes toward the DEA's proposed rule of rescheduling marijuana from schedule I to III, a majority of comments supported taking a step further to deschedule marijuana all together.

Introduction: As legalization of medical cannabis (MC) in the USA expands, there remains uncertainty in clinical guidance. Healthcare professionals remain unprepared to communicate to patients the therapeutic outcomes and possible adverse effects of MC utilization. There is limited training provided at all levels of medical education, even for professionals with many years of clinical practice. Additionally, there is minimal scientific research, which delays the development of evidence-based guidelines.

Methods: This review followed established methodological approaches for scoping reviews according to PRISMA-ScR guidelines. Studies were included if they addressed the attitudes and beliefs of medical practitioners in the USA and were published after the year 2000.

Results: There were forty-one studies from January 2013 to February 2025 included in the format of both electronic surveys and qualitative interviews. Participants included US physicians, other healthcare professionals, and medical trainees, representing multiple clinical specialties. Physicians reported lack of confidence in counseling patients or managing their use of MC. Oncologists, emergency medicine physicians, pain management specialists, and primary care physicians perceived that MC is beneficial for managing chronic pain, nausea, loss of appetite, depression, and other symptoms. Obstetric providers had unfavorable perceptions about perinatal use of MC. Physicians practicing in states where the drug has been legalized and those with greater years of practice were more comfortable recommending MC and counseling patients.

Conclusions: US physicians and medical trainees perceived significant knowledge barriers to recommending MC and counseling patients on its therapeutic use. Implementing clear clinical practice guidelines, further education on these drugs in clinical curriculums, and enhancing continuing education offerings would improve prescriber confidence. Increased research could also assist medical professionals in appropriate clinical decision making.