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Studies, data, articles

Cannabis

Introduction: The opioid epidemic has become an immense problem in North America, and despite decades of research on the most effective means to treat opioid use disorder (OUD), overdose deaths are at an all-time high, and relapse remains pervasive.
 

Discussion: Although there are a number of FDA-approved opioid replacement therapies and maintenance medications to help ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications are not risk free nor are they successful for all patients. Furthermore, there are legal and logistical bottlenecks to obtaining traditional opioid replacement therapies such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between efficacious OUD treatments and the widespread prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatment therapies is highly warranted. In this article, we review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD. Herein, we highlight knowledge gaps and discuss cannabis' potential to prevent opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse.
 

Conclusion: The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.

  

© Copyright © Beth Wiese and Adrianne R. Wilson-Poe 2018; Published by Mary Ann Liebert, Inc.

Authors:

Beth Wiese  |  Adrianne R. Wilson-Poe

Wiese B, Wilson-Poe AR (2018) Emerging evidence for cannabis' role in opioid use disorder,
Cannabis and Cannabinoid Research 3:1, 179–189, DOI: 10.1089/can.2018.0022.

HIGHLIGHTS:


• Mental health conditions are prominent among the reasons for medical cannabis use.

• Cannabis has potential for treatment of PTSD and substance abuse disorders.

• Cannabis use may influence cognitive assessment, particularly with regard to memory.

• Cannabis use does not appear to increase the risk of harm to self or others.

• More research is needed to characterize the mental health impact of medical cannabis.

  

© Clinical Psychology Review, Volume 51, February 2017, Pages 15-29. 

Authors:

Zach Walsh | Raul Gonzalez | Kim Crosby |  Michelle S. Thiessen | Chris Carroll .| Marcel O.Bonn-Miller

Introduction:
Prescription drug overdoses are the leading cause of accidental death in the United States. Alternatives to opioids for the treatment of pain are necessary to address this issue. Cannabis can be an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to opioid-based medications. Medical cannabis patients report that cannabis is just as effective, if not more, than opioid-based medications for pain.

Materials and Methods: The current study examined the use of cannabis as a substitute for opioid-based pain medication by collecting survey data from 2897 medical cannabis patients.

 

CONCLUSION

Future research should track clinical outcomes where cannabis is offered as a viable substitute for pain treatment and examine the outcomes of using cannabis as a medication assisted treatment for opioid dependence.

 

© 2017 Cannabis and Cannabinoid Research

Authors:

Amanda Reiman,,* Mark Welty, and Perry Solomon

WHAT IS KNOWN AND OBJECTIVE:
Cannabis withdrawal in heavy users is commonly followed by increased anxiety, insomnia, loss of appetite, migraine, irritability, restlessness and other physical and psychological signs. Tolerance to cannabis and cannabis withdrawal symptoms are believed to be the result of the desensitization of CB1 receptors by THC.

 

CASE SUMMARY: 
This report describes the case of a 19-year-old woman with cannabis withdrawal syndrome treated with cannabidiol (CBD) for 10 days. Daily symptom assessments demonstrated the absence of significant withdrawal, anxiety and dissociative symptoms during the treatment.

 

WHAT IS NEW AND CONCLUSION

CBD can be effective for the treatment of cannabis withdrawal syndrome.

 

© 2012 Blackwell Publishing Ltd. 

Authors:

Crippa JA, Hallak JE, Machado-de-Sousa JP, Queiroz RH, Bergamaschi M, Chagas MH, Zuardi AW.

FINDINGS

 

•Cannabis use was associated with 64% lower opioid use in patients with chronic pain.
•Cannabis use was associated with better quality of life in patients with chronic pain.
•Cannabis use was associated with fewer medication side effects and medications used.

Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding.

PERSPECTIVE 
This article suggests that using medical cannabis for CP treatment may benefit some CP patients. The reported improvement in quality of life, better side effect profile, and decreased opioid use should be confirmed by rigorous, longitudinal studies that also assess how CP patients use medical cannabis for pain management.
 
 
Kevin F. Boehnke, Evangelos Litinas, Daniel J. Clauw

HIGHLIGHTS:

November 17, 2017 - A new study conducted by researchers at The University of New Mexico, involving medical cannabis and prescription opioid use among chronic pain patients, found a distinct connection between having the legal ability to use cannabis and significant reductions in opioid use.

The study titled, “Associations between Medical Cannabis and Prescription Opioid Use in Chronic Pain Patients: A Preliminary Cohort Study,” and published in the open access journal PLOS ONE, was conducted by Drs. Jacob Miguel Vigil, associate professor, Department of Psychology and Sarah See Stith, assistant professor, Department of Economics. The results from this preliminary study showed a strong correlation between enrollment in the New Mexico Medical Cannabis Program (MCP) and cessation or reduction of opioid use, and that whole, natural Cannabis sativa and extracts made from the plant may serve as an alternative to opioid-based medications for treating chronic pain.

By the end of the observation period, the data showed MCP enrollment was associated with a 17 times higher age- and gender-adjusted odds of ceasing opioid prescriptions, a 5 times higher odds of reducing daily prescription opioid dosages, and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10 percentage points in the non-enrolled patient group.

Lik to Study: https://www.ncbi.nlm.nih.gov/pubmed/29145417

Abstract


This study sought to determine whether the cannabis constituent cannabidiol attenuates the development of morphine reward in the conditioned place preference paradigm. Separate groups of mice received either saline or morphine in combination with one of four doses of cannabidiol using three sets of drug/no-drug conditioning trials. After drug-place conditioning, morphine mice displayed robust place preference that was attenuated by 10 mg/kg cannabidiol. Further, when administered alone, this dose of cannabidiol was void of rewarding and aversive properties.

Finding:

The finding that cannabidiol blocks opioid reward suggests that this compound may be useful in addiction treatment settings.

Abstract


Neuropathic pain affects between 5% and 10% of the US population and can be refractory to treatment. Opioids may be recommended as a second-line pharmacotherapy but have risks including overdose and death. Cannabis has been shown to be effective for treating nerve pain without the risk of fatal poisoning. The author suggests that physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. This harm reduction strategy may reduce the morbidity and mortality rates associated with prescription pain medications.

Keywords: cannabis, cannabinoids, opioids, neuropathic pain, chronic pain, harm reduction, ethics

Conclusion:

Prescribing cannabis in place of opioids for neuropathic pain may reduce the morbidity and mortality rates associated with prescription pain medications and may be an effective harm reduction strategy.

 

Mindfulness

HIGHLIGHTS:

In “Mindfulness Training and Stress Reactivity in Substance Abuse: Results from a Randomized, Controlled Stage 1 Pilot Study,” Brewer and colleagues compared a manualized version of mindfulness training to cognitive behavior therapy (CBT) for individuals in community-based outpatient addiction treatment. This study, which combined a laboratory-based behavioral experiment with psychological and physiological measures, suggested a reduction in stress-related indices in the mindfulness group compared to the CBT group.

Authors:

Marianne T. Marcus, EdD, RN, FAAN and Aleksandra Zgierska, MD, PhD

 

Contemporary Clinical Trial: 2016-2019

Abstract

Although therapeutic treatments exist for substance use disorder (SUD), about half of individuals who enter treatment leave early and relapse to substance use. Early dropout from residential treatment places individuals at risk of relapse, and women in SUD residential treatment represent a vulnerable population. Evidence gaps persist for the use of mindfulness-based interventions (MBIs) among racially and ethnically diverse women with SUDs, especially regarding the efficacy of MBIs adapted to prevent residential dropout and relapse. We previously developed and pilot tested an MBI, Moment-by-Moment in Women’s Recovery (MMWR), adapted to support women with SUD during residential treatment. The 12-session MMWR program tested in the present study integrates relapse prevention, addresses literacy level and trauma experiences and mental health problems, and is relevant to issues surrounding treatment- and relapse-related stressors among women. The primary objective of the current Phase II randomized controlled trial is to adequately test the efficacy of MMWR on residential treatment retention and substance use relapse and determine psychosocial and neural mechanisms of action underlying MMWR. Participants are women in residential SUD treatment from a community-based residential site that serves mainly women who are low-income and racially and ethnically diverse. A subgroup of participants from each treatment group also completes functional and structural neuroimaging assessments before and after the intervention to explore possible structural and functional brain correlates of change associated with participation in the MMWR program. Findings are expected to inform the utility of adapting MBIs to improve treatment success among vulnerable women in SUD residential treatment.

 

Authors:

Hortensia Amaroa, and David S. Black

Kratom

Summary

What is known and objective

Advances in pain research have led to an understanding that many pains are driven by more than one underlying (patho)physiologic cause (ie, they are “multimechanistic”) and that better pain relief is obtained with fewer adverse effects when an analgesic is correspondingly multimechanistic. At least two of the more‐modern analgesics combine opioid and non‐opioid mechanisms, and have become known as “atypical opioids.” Less well known is that just as Nature evolved opioids, it also evolved atypical opioids, presaging modern drug discovery efforts.

Comment

Traditional (typical) opioids are extracts or analogs of substances derived from the poppy plant. They produce their analgesic and adverse effects primarily through a single, opioid mechanism (albeit with individual differences). Two most recent analgesics were developed to have both an opioid mechanism and, a second, non‐opioid mechanism of action (inhibition of monoamine neurotransmitter reuptake). Little known is that Nature had already evolved a plant source of compounds with the same properties.

What is new and conclusion

As debate about the use and abuse potential of kratom swirls, conflicting, often contradicting, opinions are expressed. A review of the basic pharmacology of kratom reveals the explanation for the bifurcation in viewpoints: kratom has both opioid and non‐opioid properties. Fascinatingly, just as the poppy plant (Papaver) evolved the typical opioids, Mitragyna evolved the mitragynines—Nature's “atypical opioids.”

Authors:

R. B. Raffa PhD  J. V. Pergolizzi Jr, MD  R. Taylor Jr, PhD  M. H. Ossipov PhD  NEMA Research Group

Abstract

BACKGROUND:

Kratom (Mitragyna speciosa) is a psychoactive plant native to Southeastern Asia that is receiving increased international attention as a potential therapeutic agent. While much of the limited scientific research on kratom is focused on its analgesic potential, kratom use also has important risks and benefits in the domain of mental health.

METHODS:

We conducted a comprehensive systematic review of all studies on kratom use and mental health published between January 1960 and July 2017.

RESULTS:

Findings indicate kratom's potential as a harm reduction tool, most notably as a substitute for opioids among people who are addicted. Kratom also enhances mood and relieves anxiety among many users. For many, kratom's negative mental health effects - primarily withdrawal symptoms - appear to be mild relative to those of opioids. For some users, however, withdrawal is highly uncomfortable and maintaining abstinence becomes difficult.

CONCLUSION:

Results inform clinicians working in the mental health and substance use fields, policy-makers, and researchers about the mental health effects of this plant.

Copyright © 2017 Elsevier B.V. All rights reserved.

Swogger MTWalsh Z

Article: Wiley Online Library

Authors:

Oliver Grundmann  Paula N. Brown  Jack Henningfield  Marc Swogger  Zach Walsh