Medical Cannabis and Cannabinoids最新文献

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.

Introduction: Cannabinoids, a class of compounds found in Cannabis sativa L., possess a wide range of pharmacological properties. While Δ⁹-tetrahydrocannabinol (Δ⁹-THC) is strictly regulated owing to its psychoactive effects, cannabidiol (CBD), a nonpsychoactive compound, is permitted in certain countries. This study aimed to optimize the preparation of ethanolic cannabis extracts using response surface methodology (RSM) and develop an effective system for removing Δ⁹-THC through centrifugal partition chromatography (CPC) to produce broad-spectrum CBD (hemp extract containing CBD and other compounds with minimal or no Δ⁹-THC).

Methods: Three variables and six responses were assessed to optimize extraction conditions. Predictions were made using Design-Expert^® software, and the experimental conditions were identified using the Box-Behnken design (BBD). The extracts were analyzed using high-performance liquid chromatography and a chromameter. Optimal conditions were used for pilot-scale extraction, and the CPC process was optimized by determining the partition coefficient of the target cannabinoids in various solvent systems and maximum sample load.

Results: The optimal extraction conditions were -31°C for 33 min and a sample-to-solvent ratio of 1:8% w/v, with a desirability value of 0.576. Temperature was the most influential factor. Although the total yield decreased, this condition provided the highest concentration of light-colored cannabinoids and was successfully scaled up for the three other cannabis samples. The optimal CPC solvent system, consisting of hexane/0.1% FA in ACN/20 mm ammonium formate at a ratio of 10/6.5/3.5 v/v/v, demonstrated a yield recovery of 89.3 ± 0.21% w/w with a maximum load of 5 g of sample per run. The resulting broad-spectrum CBD extract had a high CBD content (73.3 ± 0.37% w/w) and minimal Δ⁹-THC content (0.2 ± 0.00% w/w).

Conclusion: BBD-RSM optimization of ethanolic cannabis extraction provided the highest cannabinoid concentration with a short extraction time and desirable appearance. The CPC process successfully separated Δ⁹-THC, yielding a high-purity broad-spectrum CBD extract.

Introduction: Cannabis as a therapeutic agent is accessible to a growing number of people, though research suggests that many medical cannabis (MC) users undertake their cannabinoid therapy independently, without collaborating with a cannabis clinician or informing their primary care provider (PCP). The effects of medical collaboration or disclosure to PCP on outcomes of cannabinoid therapy are unknown. Researchers anticipate that those who collaborate with a cannabis clinician or disclose their medical cannabis use to their PCP will find MC to be more effective, use less delta-9-tetrahydrocannabinol (THC) and more cannabidiol (CBD), and experience fewer side effects.

Methods: Through an online survey, medical cannabis users reported their cannabis usage patterns, health outcomes, PCP awareness, and collaboration with cannabis clinicians. These responses were analyzed using a variety of statistical tests to search for differences in reported efficacy, specific cannabinoid, and side effects between different levels of medical professional involvement (n = 988).

Results: Patients who either worked with a cannabis clinician or reported their use of their PCP reported significantly higher efficacy (p < 0.001), and in the case of working specifically with a cannabis clinician, higher daily doses of cannabidiol were used (p < 0.001). CBD doses did not vary between those who had disclosed their MC use to their PCP and those who had not. There were no significant differences in THC doses or side effects identified between groups.

Conclusion: The results indicated that undertaking cannabinoid therapy with PCP awareness or guidance from a cannabis clinician is associated with better outcomes.

Background: Our objective was to provide an overview of the currently available scientific and clinical data supporting the use of Cannabis and Cannabis-derived products for the treatment of chronic pain disorders. We also provide information for researchers, clinicians, and patients to be better informed and understand the approach behind the recommendation of Cannabis as a potential adjuvant in the treatment/control of chronic pain. Cannabis and its bioactive compounds have sparked interest in the field of pain treatment in spite of its controversial history and status as a controlled substance in many countries. With the increase in chronic pain, physicians and patients have started to look at alternative ways to treat pain aside from traditional treatments. One alternative is the use of cannabis to reduce/treat chronic pain disorders based on anecdotal accounts and the function of its phytocannabinoids. The two main cannabinoids in cannabis, tetrahydrocannabinol (THC) and cannabidiol, act on CB1 and CB2 receptors (in addition to several additional receptors). It is through these pleiotropic receptor interactions that these compounds elicit their biological function including the reduction of chronic pain. In this narrative review, we included the most recent evidence supporting the use of cannabis in the treatment of chronic pain disorders including chronic neuropathic pain, cancer-induced neuropathic pain, chronic musculoskeletal pain, and chronic headaches and migraines.

Summary: Evidence suggests that cannabis and cannabinoids have an analgesic effect that arises from a combination of compounds and various receptor systems. These effects may be maximized with the use of a combination of cannabinoids. At the same time, the combination of cannabinoids helps minimize the undesirable side effects of some cannabinoids such as the psychoactivity of THC. With these findings, further research is necessary to assess the analgesic properties of other cannabinoids like cannabichromene and cannabigerol and their contributions to the reduction of pain.

Key messages: Cannabis and its bioactive compounds show potential in the reduction of chronic pain.

Introduction: Cannabis policy is rapidly changing in the USA and across the globe, with 24 states legalizing cannabis for adult use and 38 states making medical cannabis available for those with qualified conditions. Building on prior evidence, we reviewed the recently published literature (from the past 5 years) focused on the treatment effects of naturally derived medical cannabis products within the pediatric population.

Methods: We conducted a systematic literature review of three electronic databases using MeSH terms and free-text. A study was eligible for inclusion if it investigated the efficacy of medical cannabis for any condition, it was published in 2019 or later, and the mean age of participants was under 21. We excluded studies that tested the effect of pharmaceutical cannabis-derived drug products.

Results: We identified a total of 10 studies that met our inclusion/exclusion criteria. Of the 10, 2 utilized a double-arm randomized control trial (RCT) design, 3 used a single-arm trial design, and the remaining were observational studies, a case series, or a qualitative design. Aside from autism spectrum disorder (ASD) (n = 4), studies focused on cancer, treatment-resistant epilepsy, and Sturge-Weber syndrome (SWS). Four of the five single- or double-arm trials used a CBD:THC compound in a specific ratio as treatment. Both RCTs found significant improvement in ASD-related validated measures. Other studies found general improvements in validated measures of efficacy for SWS and epilepsy. Minimal adverse events were reported.

Conclusion: In the pediatric population, emerging evidence, combined with existing literature, suggests medical cannabis may be beneficial for quality-of-life symptoms related to specific conditions, like cancer, ASD, treatment-resistant epilepsy, and SWS. More clinical trial data are necessary to establish medical cannabis as an addition to established medical guidelines.

Introduction: As medical cannabis becomes more accessible, product quality must be evaluated. Researchers identified a social media community where Florida medical cannabis patients discuss personal experiences. The objective of this study was to analyze posts in this community to understand patient experience with products purchased from Florida medical dispensaries they believed to be contamination, perceptions of product quality, and desired changes to the Florida program.

Methods: Social networking theory acted as the underlying framework, and we employed a qualitative case study design to identify mentions of possible contamination and understand patient perceptions of contamination and the Florida medical cannabis program from the Reddit community FLMedicalTrees. The lead researcher conducted a social media analysis of posts identified as containing discussions relevant to product contamination. Constant comparison methods were used to code data, arrive at themes, and maintain validity and reliability of interpretation of coded themes.

Results: Of 300 post mentions of contamination, 98 posts were identified as relevant following review. Key results were as follows: (1) multiple mentions of possible contamination of products from medical cannabis dispensaries reported by Florida program patients; (2) patients sought second opinions when concerned about possible contamination and shared personal experiences as well as advice on what concerned patients should do if they believe they have contaminated products; (3) some patients expressed feelings of anxiety and worry about health, safety, and quality control, while others that described possible product contamination did not express concern; and (4) patients wanted changes regarding vertical integration, company accountability, state oversight, and home grow law.

Conclusions: Medical cannabis patients and providers could benefit from education on responding to possible contamination within medical cannabis products. Policymakers should consider these findings when setting regulations around contamination testing thresholds, dispensary oversight, and other regulations that directly impact patient safety, like allowing patients to see products before purchase.

Introduction: Diabetic peripheral neuropathy (DPN) represents a prevalent neurological complication affecting millions of patients globally. This clinical investigation evaluated the therapeutic efficacy and safety profile of a novel transdermal medical cannabis formulation (THC:CBD:CBN) in treating painful DPN of the lower extremities.

Methods: This phase III, double-blind, placebo-controlled, randomized clinical trial was conducted at Don Chan Hospital, Thailand, enrolling 100 participants over a 12-week intervention period. Using a computer-generated randomization sequence, participants were allocated to receive either the standardized cannabis formulation or a matched placebo. The primary outcome measure comprised pain intensity assessment using the validated Thai version of the Neuropathic Pain Symptom Inventory (NPSI-T). Secondary outcomes encompassed treatment-emergent adverse events and dermatological manifestations. Statistical analyses were performed using SPSS Version 28.0, incorporating generalized estimating equation (GEE) modeling and Analysis of Covariance (ANCOVA). The study protocol received approval from the Institutional Review Board of Khon Kaen University and the Kalasin Provincial Public Health Office Ethics Committee, with trial registration in the Thai Clinical Trials Registry.

Results: The intervention group demonstrated statistically significant reductions in NPSI-T scores across all measured dimensions (p < 0.001). Mean total NPSI-T scores decreased markedly from 25.60 to 5.57 in the treatment cohort, contrasting with minimal reduction from 25.24 to 22.85 in the placebo group. GEE analysis revealed significant pain amelioration at weeks 4, 8, and 12 (p < 0.001). The cannabis formulation exhibited an excellent safety profile, with only 10% of participants reporting mild adverse events, comparable to placebo group outcomes.

Conclusion: This novel transdermal medical cannabis formulation (THC:CBD:CBN) demonstrated significant therapeutic efficacy in ameliorating painful DPN symptoms while maintaining a favorable safety profile. These findings provide robust clinical evidence supporting its potential as an innovative therapeutic option for managing painful DPN.

Background: Medical cannabis (MC) use is increasing across the USA, with functional MC programs now operating in 38 states. While program policies and practices vary widely, little is known about whether and how states evaluate their programs. Better characterization of state MC program evaluation to date could inform states, program officials, and providers about best practices and provide a roadmap for future program evaluation.

Summary: We conducted a narrative review of state MC program evaluations, including peer-reviewed literature and reports produced by independent state-based and non-state-based evaluators. Among 304 abstracts initially screened, seven evaluations met inclusion criteria. Within these evaluations, we report results according to three overarching themes: (1) evaluation characteristics, including comparison across evaluations; (2) program experience, including perceptions of providers and patients; and (3) assessment of cannabis use, including self-reported efficacy for qualifying medical conditions, patterns of medical and nonmedical cannabis use, and assessment of risk factors relevant to MC use. Additionally, we found that while goals and methods for state MC evaluations varied widely, evaluations that relied on independent, non-state entities tended to have more comprehensive and quantitatively rigorous results.

Key messages: Few states operating MC programs have completed a formal evaluation of their program. Among states that have completed an evaluation, approaches varied widely; however, common themes were also present, which may inform future state evaluation efforts. Evaluation through independent, non-state partners may provide an optimal strategy to ensure high-quality data and meaningful results.