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Cannabis for the Treatment of Attention Deficit Hyperactivity Disorder: A Report of 3 Cases. 大麻治疗注意缺陷多动障碍3例报告
Q1 Medicine Pub Date : 2022-01-01 DOI: 10.1159/000521370
Holly Mansell, Declan Quinn, Lauren E Kelly, Jane Alcorn

Attention deficit hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder that is highly prevalent in children and adults. An increasing number of patients with ADHD are self-medicating with cannabis, despite a lack of evidence on efficacy and safety. This case report describes 3 males (ages 18, 22, and 23) who have integrated cannabis into their treatment regimen with positive results. Semistructured interviews conducted with the patients describe subjective improvements in symptoms and on quality of life. Improvements on validated rating scales conducted post-cannabis initiation, compared to pre-cannabis initiation obtained from the medical chart, corroborated their personal accounts. Scores on the PHQ-9 (measuring depression) improved by 8-22 points (30-81%), and the SCARED (measuring anxiety) ranged from 0 to 27 points (up to 33%). Improvements on the CEER-9 scale (measuring regulation) ranged from 2 to 7 points (22-78%), and the 9-item SNAP scale (measuring inattention) showed improvements of 2-8 points (7-30%). Mild adverse events including short-term memory problems, dry mouth, and sleepiness were reported. Blood samples were also collected from the patients to determine the plasma concentrations of the cannabinoids and relevant metabolites before and after a cannabis administration. After cannabis use, the plasma levels for CBD and THC ranged from 0 to 15.29 ng/mL and 1.32 to 13.76 ng/mL, respectively. Cannabinoids, however, were not detected prior to dosing, suggesting that cannabis played a complimentary role in the therapeutic regimen of these 3 patients. Clinical trials are recommended to confirm the efficacy of cannabis in the treatment of ADHD.

注意缺陷多动障碍(ADHD)是一种慢性神经行为障碍,在儿童和成人中非常普遍。尽管缺乏有效性和安全性的证据,但越来越多的ADHD患者使用大麻进行自我治疗。本病例报告描述了3名男性(18岁、22岁和23岁)将大麻纳入其治疗方案并取得积极结果。与患者进行的半结构化访谈描述了症状和生活质量的主观改善。与从医疗图表中获得的大麻开始使用前相比,在大麻开始使用后进行的有效评分量表的改进证实了他们的个人说法。PHQ-9(测量抑郁)的得分提高了8-22分(30% -81%),而SCARED(测量焦虑)的得分从0到27分(高达33%)不等。CEER-9量表(测量调节)改善2-7分(22-78%),9项SNAP量表(测量注意力不集中)改善2-8分(7-30%)。轻度不良事件包括短期记忆问题、口干和嗜睡。还收集了患者的血液样本,以确定大麻给药前后大麻素和相关代谢物的血浆浓度。使用大麻后,血浆中CBD和THC的水平分别为0至15.29 ng/mL和1.32至13.76 ng/mL。然而,在给药前未检测到大麻素,这表明大麻在这3名患者的治疗方案中发挥了补充作用。建议进行临床试验以证实大麻治疗ADHD的有效性。
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引用次数: 7
Erratum. 勘误表。
Q1 Medicine Pub Date : 2022-01-01 DOI: 10.1159/000527071

[This corrects the article DOI: 10.1159/000521370.].

[这更正了文章DOI: 10.1159/000521370]。
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引用次数: 0
Clinical Considerations for Cannabis Use and Cardiovascular Health. 大麻使用和心血管健康的临床考虑。
Q1 Medicine Pub Date : 2022-01-01 DOI: 10.1159/000526731
Ruba Sajdeya, Sebastian Jugl, Robert Cook, Joshua D Brown, Amie Goodin
aConsortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, FL, USA; bDepartment of Epidemiology, University of Florida, Gainesville, FL, USA; cCenter for Drug Evaluation and Safety (CoDES), Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL, USA Received: June 14, 2022 Accepted: August 13, 2022 Published online: September 28, 2022
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引用次数: 1
Effects of Cannabis on Cardiovascular System: The Good, the Bad, and the Many Unknowns 大麻对心血管系统的影响:好,坏,和许多未知
Q1 Medicine Pub Date : 2021-11-12 DOI: 10.1159/000519775
A. E. Dabiri, G. Kassab
Cannabis is currently the most consumed illicit substance in the world, and gradual legalization in the USA makes it important to understand the health consequences of the use of this substance. With growing body of evidence that some cannabis ingredients may be beneficial in various aspects of hemostasis, additional research is clearly needed in various clinical areas. In addition to understanding the efficacy, research efforts should also include studies that address any harmful effects of the compounds or administration methods that may result in adverse effects. This review is focused on the cardiometabolic effects of cannabis use. Cardiometabolic diseases are among the leading causes of death in the USA and around the world. The purpose of this review was to provide an overview of the known medicinal benefits of selected cannabis cannabinoids and the known side effects or contraindications. More importantly, we have proposed new questions and signposts in cannabis research to uncover additional medicinal benefits and identify the health hazards with focus on cardiovascular disease.
大麻是目前世界上消费量最大的非法物质,在美国逐渐合法化使得了解使用这种物质对健康的影响变得重要。随着越来越多的证据表明,一些大麻成分可能对止血的各个方面有益,显然需要在各个临床领域进行更多的研究。除了了解疗效外,研究工作还应包括解决化合物的任何有害影响或可能导致不良影响的给药方法的研究。这篇综述的重点是大麻使用对心脏代谢的影响。心脏代谢性疾病是美国和世界各地死亡的主要原因之一。本综述的目的是概述所选大麻大麻素的已知药用益处以及已知的副作用或禁忌症。更重要的是,我们在大麻研究中提出了新的问题和路标,以揭示额外的药用益处,并确定健康危害,重点关注心血管疾病。
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引用次数: 7
Abstracts of the 2021 Cannabis Clinical Outcomes Research Conference 2021年大麻临床结果研究会议摘要
Q1 Medicine Pub Date : 2021-09-21 DOI: 10.1159/000519038
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引用次数: 0
Proceedings of the 2021 Cannabis Clinical Outcomes Research Conference 2021年大麻临床结果研究会议论文集
Q1 Medicine Pub Date : 2021-09-10 DOI: 10.1159/000519037
A. Goodin, Debbie L. Wilson, Robert L. Cook, Yan Wang, Joshua D. Brown, A. Winterstein
The Cannabis Clinical Outcomes Research Conference (CCORC) 2021 was held virtually on April 8 and 9, 2021. The conference was hosted by the Consortium for Medical Marijuana Clinical Outcomes Research, a research organization instituted by the state legislature of Florida in the United States. The inaugural annual CCORC 2021 was organized as a scientific meeting to foster and disseminate research on medical marijuana (MM) clinical outcomes, while promoting engagement among MM researchers, patients, clinicians, policymakers, and industry partners. Key conference themes included: (a) the disconnect between policy, practice, and evidence and steps towards reconciliation, (b) approaches to overcome common barriers to MM research, and (c) the use of focused translational approaches utilizing both mechanistic and clinical research methodology to tackle the complexities of MM outcomes. CCORC 2022 is planned for spring 2022 in Orlando, Florida, United States.
2021年大麻临床结果研究会议(CCORC)于2021年4月8日和9日举行。该会议由美国佛罗里达州立法机构成立的研究组织大麻临床结果研究联合会主办。首届年度CCORC 2021是一次科学会议,旨在促进和传播医用大麻(MM)临床结果的研究,同时促进MM研究人员、患者、临床医生、政策制定者和行业合作伙伴的参与。会议的主要主题包括:(a)政策、实践和证据之间的脱节以及和解步骤,(b)克服MM研究常见障碍的方法,以及(c)利用机制和临床研究方法,使用重点转化方法来解决MM结果的复杂性。CCORC2022计划于2022年春季在美国佛罗里达州奥兰多举行。
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引用次数: 1
Measuring the Change in Health-Related Quality of Life in Patients Using Marijuana for Pain Relief 测量使用大麻止痛患者健康相关生活质量的变化
Q1 Medicine Pub Date : 2021-08-12 DOI: 10.1159/000517857
A. Peterson, Christine Le, Tyler Dautrich
Introduction: Current evidence suggests that cannabinoids are safe with minimal side effects and are effective in managing chronic pain. Data also show that medical marijuana (MM) may improve quality of life (QoL) among patients. However, there are little data showing the health-related QoL (HRQoL) benefit in MM patients using it for pain. The purpose of this study was to determine if there is a relationship between HRQol and MM use in patients using it to relieve pain. Methods: All pain patients aged 18 years or older enrolled in the Pennsylvania MM program were eligible for inclusion. Recruited subjects completed 4 surveys – at enrollment (baseline) then 2, 4, and 8 weeks post-enrollment. We used the EQ-5D survey tool for measuring HRQoL. The primary outcome measure was the change in the EQ-5D Index Score from survey 2 to survey 4 (6 week difference). Secondary outcomes included self-reported pain and health scores. Data were analyzed using a paired t test and repeated-measures multivariable analysis to control for both gender and length of time between surveys. Results: 1,762 people responded to the screening request, and 1,393 (79%) met screening criteria. Of those, 353 (25.3%) agreed to participate and 51% completed all 4 surveys, for a final sample of 181 with 85 male and 95 female and one nonbinary subject. The average age was 41.21 (SD = 12.9) years, with no difference between genders. The adjusted HRQoL score improved from 0.722 to 0.747 (p = 0.011) from survey 2 to survey 4, as did the self-reported pain and health scores. The EQ-5D subscales revealed no change in mobility or usual activities, significant improvement in anxiety and pain, and a significant worsening in self-care. Conclusion: The results show a significant improvement in HRQoL among patients using MM for pain. The EQ-5D subscales validated the pain improvement and also showed an improvement in anxiety. However, the decline in the self-care subscale may have tempered the overall improvement in HRQoL, and further research into which aspects of self-care are impacted by MM use in this population is warranted. Overall, there is a positive relationship between MM use and HRQoL in patients using it for pain.
目前的证据表明,大麻素是安全的,副作用最小,对治疗慢性疼痛有效。数据还显示,医用大麻(MM)可以改善患者的生活质量(QoL)。然而,很少有数据显示使用它治疗疼痛的MM患者的健康相关生活质量(HRQoL)受益。本研究的目的是确定使用MM缓解疼痛的患者的HRQol与使用MM之间是否存在关系。方法:所有参加宾夕法尼亚MM项目的18岁及以上疼痛患者均符合入选条件。招募的受试者在入组时(基线)、入组后2周、4周和8周完成了4项调查。我们使用EQ-5D测量工具来测量HRQoL。主要结局指标是调查2至调查4期间EQ-5D指数得分的变化(6周差异)。次要结果包括自我报告的疼痛和健康评分。使用配对t检验和重复测量多变量分析对数据进行分析,以控制性别和两次调查之间的时间长度。结果:1762人响应了筛查请求,1393人(79%)符合筛查标准。其中353人(25.3%)同意参与,51%的人完成了所有4项调查,最终样本为181人,其中85名男性,95名女性和1名非二元受试者。平均年龄为41.21岁(SD = 12.9),性别差异无统计学意义。从调查2到调查4,调整后的HRQoL评分从0.722提高到0.747 (p = 0.011),自我报告的疼痛和健康评分也是如此。EQ-5D量表显示,在行动能力和日常活动方面没有变化,焦虑和疼痛方面有显著改善,自我照顾方面有显著恶化。结论:使用MM治疗疼痛患者的HRQoL有明显改善。EQ-5D量表证实了疼痛的改善,也显示了焦虑的改善。然而,自我护理量表的下降可能已经缓和了HRQoL的整体改善,并且进一步研究自我护理的哪些方面受到该人群使用MM的影响是有必要的。总体而言,在使用MM治疗疼痛的患者中,MM的使用与HRQoL呈正相关。
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引用次数: 5
Priorities for Medical Marijuana Research from the Perspective of Physicians, Dispensary Owners/Staff, and Patients: A Survey Study 从医生、药房老板/工作人员和患者的角度看医用大麻研究的优先事项:一项调查研究
Q1 Medicine Pub Date : 2021-08-02 DOI: 10.1159/000518105
J. Jean-Jacques, Robert Cook, A. Winterstein, A. Goodin, Joshua D. Brown, S. Jugl, Yan Wang
Objective: More patients are turning to medical marijuana as an alternative treatment, yet there are apparent knowledge gaps on the risk benefit of medical marijuana for a variety of indications. This study aimed to determine the priorities for medical marijuana research from the perspective of multiple stakeholders including patients, clinicians, and industry representatives. Methods: An anonymous survey was administered to attendees of the 2019 American Medical Marijuana Physicians Association annual meeting in Orlando, Florida. Respondents completed the survey on paper or smartphone via Qualtrics. The survey included questions on demographics and medical marijuana research priorities under the following broad categories: clinical conditions, safety issues, marijuana types, populations, and others. Results: Forty-six participants (56.5% female, mean age = 51.6 ± 14.1) responded to the survey. A majority were medical marijuana qualified physicians in Florida (56.5%), 30.5% other physicians or clinicians, and 21.7% medical marijuana patients (multiple choices allowed). The top conditions prioritized for research by this group were chronic pain, cancer, and anxiety, and the top priority safety issues were dosing/product choice, complications from smoking/vaping, and drug interactions. Regarding marijuana types, the group prioritized research on THC/CBD ratios, different modes of consumption, and terpenes. Conclusions: Findings from this survey indicate that medical marijuana stakeholders perceived a broad range of research topics as priorities. More research is needed to advance the evidence in these areas and provide guidance to patients, physicians, and the medical marijuana industry.
目的:越来越多的患者将医用大麻作为一种替代治疗方法,但对医用大麻在各种适应症中的风险效益存在明显的知识差距。本研究旨在从包括患者、临床医生和行业代表在内的多个利益相关者的角度确定医用大麻研究的优先级。方法:对在佛罗里达州奥兰多举行的2019年美国医用大麻医师协会年会上的与会者进行了一项匿名调查。受访者通过Qualtrics在纸上或智能手机上完成调查。该调查的问题包括人口统计学和医用大麻研究优先事项,分为以下大类:临床条件、安全问题、大麻类型、人口等。结果:共46人接受调查,其中女性56.5%,平均年龄51.6±14.1岁。大多数是佛罗里达州的医用大麻合格医生(56.5%),30.5%是其他医生或临床医生,21.7%是医用大麻患者(允许多选)。该组优先考虑的首要问题是慢性疼痛、癌症和焦虑,首要的安全问题是剂量/产品选择、吸烟/电子烟并发症和药物相互作用。在大麻类型方面,该小组优先研究了THC/CBD比例、不同的消费方式和萜烯。结论:本调查结果表明,医用大麻利益相关者将广泛的研究主题视为优先事项。需要更多的研究来推进这些领域的证据,并为患者、医生和医用大麻行业提供指导。
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引用次数: 5
The Pharmacological Effects of Plant-Derived versus Synthetic Cannabidiol in Human Cell Lines 植物来源与合成大麻二酚在人体细胞系中的药理作用
Q1 Medicine Pub Date : 2021-07-29 DOI: 10.1159/000517120
Ryan. Maguire, D. J. Wilkinson, T. England, S. O’Sullivan
Introduction: Cannabidiol (CBD) can be isolated from Cannabis sativa L. or synthetically produced. The aim of this study was to compare the in vitro effects of purified natural and synthetic CBD to establish any pharmacological differences or superiority between sources. Methods: Six purified samples of CBD were obtained, 4 of these were natural and 2 synthetic. The anticancer effects of CBD were assessed in a human ovarian cancer cell line (SKOV-3 cells). The neuroprotective effects of CBD were assessed in human pericytes in a model of stroke (oxygen glucose deprivation [OGD]). The ability of CBD to restore inflammation-induced intestinal permeability was assessed in differentiated human Caco-2 cells (a model of enterocytes). Results: (1) In proliferating and confluent SKOV-3 cells, all CBD samples similarly reduced resazurin metabolism as a marker of cell viability in a concentration-dependent manner (p < 0.001). (2) In pericytes exposed to OGD, all CBD samples similarly reduced cellular damage (measured by lactate dehydrogenase) at 24 h by 31–48% and reduced inflammation (measured by IL-6 secretion) by 30–53%. Attenuation of IL-6 was inhibited by 5HT1A receptor antagonism for all CBD sources. (3) In differentiated Caco-2 cells exposed to inflammation (TNFα and IFNγ, 10 ng/mL for 24 h), each CBD sample increased the speed of recovery of epithelial permeability compared to control (p < 0.05–0.001), which was inhibited by a CB1 receptor antagonist. Conclusion: Our results suggest that there is no pharmacological difference in vitro in the antiproliferative, anti-inflammatory, or permeability effects of purified natural versus synthetic CBD. The purity and reliability of CBD samples, as well as the ultimate pharmaceutical preparation, should all be considered above the starting source of CBD in the development of new CBD medicines.
简介:大麻二酚(CBD)可以从大麻中分离或人工合成。本研究的目的是比较纯化的天然和合成CBD的体外效果,以确定来源之间的任何药理学差异或优势。方法:获得6个CBD纯化样品,其中4个为天然样品,2个为合成样品。在人卵巢癌症细胞系(SKOV-3细胞)中评估CBD的抗癌作用。在中风模型(氧-葡萄糖剥夺[OGD])中评估了CBD在人周细胞中的神经保护作用。在分化的人Caco-2细胞(肠细胞模型)中评估CBD恢复炎症诱导的肠道通透性的能力。结果:(1)在增殖和融合的SKOV-3细胞中,所有CBD样品以浓度依赖的方式类似地降低了作为细胞活力标志的resazulin代谢(p<0.001)。(2)在暴露于OGD的周细胞中,在24小时时,所有CBD样本类似地减少了31-48%的细胞损伤(通过乳酸脱氢酶测量)和30-53%的炎症(通过IL-6分泌测量)。对于所有CBD来源,5HT1A受体拮抗作用抑制IL-6的衰减。(3) 在暴露于炎症(TNFα和IFNγ,10 ng/mL,持续24小时)的分化Caco-2细胞中,与对照组相比,每个CBD样品都提高了上皮通透性的恢复速度(p<0.05–0.001),而对照组被CB1受体拮抗剂抑制。结论:我们的研究结果表明,纯化的天然CBD与合成CBD在体外的抗增殖、抗炎或渗透作用没有药理学差异。在开发新的CBD药物时,CBD样品的纯度和可靠性以及最终的药物制剂都应高于CBD的起始来源。
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引用次数: 6
Cannabis and Cannabis Derivatives for Abdominal Pain Management in Inflammatory Bowel Disease 大麻和大麻衍生物用于炎症性肠病的腹痛管理
Q1 Medicine Pub Date : 2021-06-21 DOI: 10.1159/000517425
K. Bogale, W. Raup-Konsavage, Shannon Dalessio, K. Vrana, M. Coates
For centuries, cannabis and its components have been used to manage a wide variety of symptoms associated with many illnesses. Gastrointestinal (GI) diseases are no exception in this regard. Individuals suffering from inflammatory bowel disease (IBD) are among those who have sought out the ameliorating properties of this plant. As legal limitations of its use have eased, interest has grown from both patients and their providers regarding the potential of cannabis to be used in the clinical setting. Similarly, a growing number of animal and human studies have been undertaken to evaluate the impact of cannabis and cannabinoid signaling elements on the natural history of IBD and its associated complications. There is little clinical evidence supporting the ability of cannabis or related products to treat the GI inflammation underlying these disorders. However, 1 recurring theme from both animal and human studies is that these agents have a significant impact on several IBD-related symptoms, including abdominal pain. In this review, we discuss the role of cannabis and cannabinoid signaling in visceral pain perception, what is currently known regarding the efficacy of cannabis and its derivatives for managing pain, related symptoms and inflammation in IBD, and what work remains to effectively utilize cannabis and its derivatives in the clinical setting.
几个世纪以来,大麻及其成分一直被用来治疗与许多疾病相关的各种症状。在这方面,胃肠道疾病也不例外。患有炎症性肠病(IBD)的人都在寻找这种植物的改善特性。随着对大麻使用的法律限制放宽,患者及其提供者对大麻在临床环境中使用的潜力越来越感兴趣。同样,已经开展了越来越多的动物和人类研究,以评估大麻和大麻素信号因子对IBD自然史及其相关并发症的影响。几乎没有临床证据支持大麻或相关产品治疗这些疾病背后的胃肠道炎症的能力。然而,从动物和人类研究中反复出现的一个主题是,这些药物对几种ibd相关症状有显著影响,包括腹痛。在这篇综述中,我们讨论了大麻和大麻素信号在内脏疼痛感知中的作用,目前已知的大麻及其衍生物对IBD疼痛、相关症状和炎症的疗效,以及在临床环境中有效利用大麻及其衍生物还有哪些工作要做。
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引用次数: 11
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Medical Cannabis and Cannabinoids
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