Lost in the Haze- The Physician’s Role in Cannabinoid Prescribing and Advising
In Summary
A recent publication has come out providing commentary on physicians uncertainty of their role in medical cannabis. Providers have to be appropriately licensed and can find the federal legal status of cannabis intimidating, limiting the number of physicians who are comfortable recommending medical cannabis. Considering the number of local governments approving medical cannabis, the author suggests that physicians and pharmacists familiarize themselves with the pharmacological properties of the different cannabinoids and how various consumption methods alter the effects of those cannabinoids.
This article highlights the difficulties in obtaining medical cannabis from affordable and trusted sources. As medical cannabis is not yet supported by the federal government it can be daunting to find a prescription for medical cannabis, a physician willing to discuss the effects and knowledgeable enough to know all of the current research and to afford cannabis once a medical license is obtained. Insurance is unable to help and cannabis is expensive due to the cultivation process and private funding.
The study is available for review or download here
Integration of screening, assessment, and treatment for cannabis and other drug use disorders in primary care- an evaluation in three pilot sites
In Summary
A recent study has revealed that by implementing care for cannabis into primary care practices diagnoses for cannabis use disorder. The implementation of these practices also led to an increase of screening for cannabis and other drug use, the diagnosis of other substance use disorders, and treatment for substance use disorders. The continued evaluation of these new practices may aid other primary care practices to develop their own methods to more accurately diagnose and treat substance use disorders.
By implementing such diagnostic practices and awareness into physicians offices we begin to normalize cannabis use. Normalizing cannabis within our society will hopefully decrease the current stigma enough to allow patients to be more forthcoming about their cannabis use and allow for better treatment methods and research to be conducted. Misdiagnosis or issues with treatment and sedation often arise due to unknown cannabis use so allowing patients to feel more comfortable when discussing drug use with their physicians should improve diagnostic practices and treatment.
The study is available for review or download here
Although cannabis was used medically decades ago for its proven therapeutic abilities, concerns of abuse led to restrictions of its use in the 1930s and 1940s in the US. But, hemp in the form of medical cannabis, popularly known as cannabidiol or CBD, has again been a subject of research and clinical trials in the medical sciences ever since the groundbreaking research of Dr. Rafael Mechoulam.
Dr. Mechoulam discovered the Endo-Cannabinoid System in human physiognomy, which showed that human beings have CBD receptors present in the body, which creates a cascade of homeostasis (stability of health) throughout the entire central nervous system and the immune System.
Hemp has more than one hundred active chemical components, and the two most crucial ones are THC or tetrahydrocannabinol, and CBD. While THC is psychoactive and gives a high, CBD works as a nutritional supplement, which is very healthy for humans and is not psychoactive. The CBD dominant strains of marijuana have very little or nil THC, thereby being non-addictive for patients.
In this article, we will discuss how medical cannabis helps improve several diseases that are often crippling and can be potentially fatal.
Diseases and Conditions That Can Be Improved With Hemp
Right from the time medical cannabis got legalized in several states in the US and has been administered in patients clinically, it is a miracle drug in treating several acute symptoms of some major diseases plaguing millions of people. Some of them are-
1. Insomnia: Research shows that CBD helps improve sleep, mainly when induced by anxiety
2. Nausea: Nausea primarily caused as a side-effect of chemotherapy and cancer-related treatments.
3. Anxiety and depression: CBD oil has shown miraculous effects on the treatment of depression, anxiety, panic attacks. CBD has an excellent ability to act on the receptors of our brain to release the serotonin neurotransmitter, which becomes severely low in patients suffering from mental illnesses, which makes them feel “low” and enervated. (1)
4. PTSD: One of the most promising areas of research on medical marijuana is in the treatment of war veterans who have PTSD showing miraculous and drastic improvements after the administration of hemp.(2)
Whereas pharmaceutical drugs like benzodiazepines are highly addictive and can even lead to substance abuse, CBD doesn’t lead to addiction.
5. Glaucoma: It has also been reported to help treat Glaucoma, eye conditions that can lead to blindness, but the results are disputed.
6. Epilepsy: One particular type of epilepsy in kids, known as the Dravet Syndrome, is practically impossible to manage but responds to CBD miraculously. This CBD-dominant strain is also popularly known as Charlotte’s Web. (3)Epilepsy also comes with muscle spasms, stiffness, and chronic pain, all of which are significantly reduced with the use of cannabidiol.
7. Muscle Spasticity: Spasticity resulting from multiple sclerosis, or arthritis, and some neurological disorders, which also causes chronic pain, and tremors work miraculously on CBD. The most common drug, Sativex, an oral spray consisting of both CBD and THC, has been proven to be effective and safe in reducing these symptoms.
Marijuana is excellent in dulling nerve pain and multiple sclerosis. While there are several medical drugs present to treat these conditions- such as Lyrica and Neurontin, they have highly sedating effects on the patients. While patients using CBD report getting back to their daily activities feel much more relaxed.
8. Parkinson’s disease: CBD also acts as an excellent muscle relaxant and is unique in treating tremors caused by Parkinson’s disease. (4)
9. Chronic pain: CBD impacts the Endocannabinoid receptors to interact with and release neurotransmitters naturally present in the human body to reduce acute pain and inflammation.
10. Alzheimer’s disease: Inflammation, one of the biggest causes of Alzheimer’s symptoms, can be effectively reduced by CBD oil administration. Clinical trials have also shown CBD’s ability in reversing, delaying, and often preventing the negative impacts of Alzheimer’s disease.
11. ALS: ALS can be managed with CBD oil very efficiently as it delays the progression of its symptoms such as spasticity and prolongs the survival of patients, owing to its neuroprotective abilities.
12. Appetite loss, and severe anorexia: Anorexia Nervosa is a critical eating and psychiatric disorder. While many anorexics are given anti-depressants and anti-anxiety medication, they come with enormous side effects rendering patients drowsy, while research shows that CBD possesses orexigenic (an appetite stimulant/hormone) which can regulate and enhances the appetite.
13. AIDS and Cancer symptoms: While many people are plagued by the agony of weight gain or obesity, gaining weight becomes extremely difficult for many people, especially those with AIDS or cancer. (5) Dronabinol, a synthetic THC commonly known as Marinol, is medically approved to be used for treatment in patients, and the effect of it has always been on the positive with the consistent improvement of appetite, lessens nausea, and vomiting in cancer and patients of AIDS.
Wasting Syndrome, a condition associated with AIDS, a slow, painful process involving loss of muscle mass and a gradual decrease in health, has also shown excellent results in reducing the symptoms.
14. Endometriosis, Fibromyalgia, Migraine, Interstitial cystitis (all these conditions cause chronic pain and inflammation), are also certain critical illnesses whose symptoms are also found to be expertly moderated by the use of hemp seed oil.
Medical marijuana is most commonly used to manage chronic pain. It is very safe as there are no chances of an overdose and is non-addictive. It can replace the NSAIDs (Non-steroidal anti-inflammatory drug(s)), which patients with kidney problems, GERD, or ulcers cannot consume. While pharmaceutical drugs work at the level of the symptoms, they do not work at the level of the system, thereby not providing a “cure,” and that causes enormous strain on the human physiognomy.
The list is not all-inclusive but rather a survey of several types of conditions that medical marijuana can be administered on, and has already proven its effectiveness.
In the larger picture, no one living in the urban society today is exempted from an inflamed immune and central nervous system, due to environmental toxins and our inflammatory diet (containing way too much sugar), reasons that lead to an inflamed immune system and symptoms of brain inflammation.
The ability of CBD to control and to provide relief to these symptoms is undeniable, and hence, more use and awareness of cannabinoids are necessary.
Author Bio: Vishal Vivek, Co-founded Hemp Foundation to increase awareness about hemp which is the most misunderstood plant on the planet. He believes that we can fight climate change, water crisis and plastic pollution with Hemp. Times Group recognized him as a legendary entrepreneur and published his biography in “I Did IT- Vol 2” at the age of 30
Oncologists Should Recommend Cannabis-Based Medicine for Palliative Care
In Summary:
Earlier this June a review was published that encourages oncologists to recommend cannabis products to their patients as a safe and effective method of palliative care. The opinion piece highlights how cannabis is a useful treatment for a variety of illnesses (nausea, vomiting, sleep, mood, anxiety), and encourages practitioners to prescribe cannabis for their patients so that they can appreciate the safety and effectiveness of the product.
Dr. Caplan and the #MDTake:
As Dr Abrams makes abundantly and eloquently clear, the reasons for oncologists to RETURN to recommending cannabis (as clinicians were accustomed to doing in generations past) are many. Weighing the safety profile of cannabinoid medicines and the long list of potential benefits for those battling cancers, against temporary adverse side effects (some of which, like appetite stimulation and sedation, can also be advantages for oncology patients), it is almost unethical for modern clinicians to NOT recommend that patients consider cannabis supplementation. The historical sociopolitical war on drugs was never founded in scientific rationale, nor supported by rigorous inquiry that has borne out half a million scientific reviews on the topic. It is high time that physicians return to a practice style that prioritizes patient well-being first, and emphasizes self-education about areas of medicine about which the providers may be less informed.
As with all elements of the aging process, the human endocannabinoid system loses tone over time. Whether it is a reduction in the numbers of cannabinoid receptors or a slow waning of the machinery used to create the signaling molecules that bind to the receptors or the natural senescence of the system that supports all of these normal signaling processes, the fact remains that adults over 50 are best-suited for external support for the endocannabinoid system.
Indeed, the average age at dispensaries is surprising to most who are not familiar with the modern medical cannabis arena. Baby Boomers, perhaps more than any other age group, tend to dominate the medical cannabis dispensaries. This is no new phenomenon, however. Through the ages, across cultures and around the globe, cannabis has been consumed primarily by older adults. Whether by tribe elders, wise councilmen, spiritual leaders, or the educated elite, cannabis has been an integral part of human aging for as long as we have recorded history.
Here, a review out of Israel followed at 184 patients over 65 (average age was 81.2) beginning cannabis treatment. 63.6% were female. “After six months of treatment, 58.1% were still using cannabis. Of these patients, 33.6% reported adverse events, the most common of which were dizziness (12.1%) and sleepiness and fatigue (11.2%). Of the respondents, 84.8% reported some degree of improvement in their general condition.”
Appropriately, the authors advise caution for older adults related to those adults who may be consuming multiple pharmaceuticals, for potential medication interaction effects, as well as nervous system impairment, and increased cardiovascular risk for those who may quire the concern. Wisely, they recommend that “Medical cannabis should still be considered carefully and individually for each patient after a risk-benefit analysis and followed by frequent monitoring for efficacy and adverse events.”
Dr. Caplan and the #MDTake:
At CED Clinic, we have long seen that the average age of medical patients is over 50. Whether for concerns related to sleep, pain, mental or physical health, it seems as though Baby Boomers have either weathered enough politics to have developed a healthy cynicism for the misinformation campaigns of the 1930s and 1970s, or they have direct or indirect experience with cannabis to have learned of its safety and efficacy. Either way, it is quickly reclaiming its historical place in the care of older adults, although oddly… it seems to be a demographic skipped over by the marketing systems of most establishments in the cannabis arena, at least for now.
Sudden cardiac death associated to substances of abuse and psychotropic drugs consumed by young people- A population study based on forensic autopsies
In Summary:
A recent study out of Spain has revealed alarming trends among cases of sudden cardiac death associated with substances of abuse consumed by young people. Half of the 15-36-year-olds who suffered sudden cardiac death were found with illicit substances in their bodies, primarily cannabis, tobacco, and cocaine. Researchers found that although cannabis was the most common substance found in the deceased systems, cocaine and tobacco are known to have a stronger impact on the cardiovascular system and lead to ischemic heart disease, which is often the more acute causes of sudden death. It was also mentioned here that the duration of cannabis is far longer in the body than that of either tobacco or cocaine, and this duration may easily confuse people to associate it as a trigger for sudden death.
However, on the other hand, there are several tragic cases of young, otherwise heart-healthy individuals who have died with cannabis as the only substance discovered. Fortunately, these cases are extraordinarily rare, but unfortunately, no reproducible association has been established, so the mysterious concerns are not easily relieved or forgotten.
Dr. Caplan and the #MDTake:
While the return of medical cannabis to modern medical care seems to bring with it a return of appreciation for more naturalistic care, it is critical for us all to recognize that we still have much to learn. The tools and high standards of scientific evaluation have only recently been applied to cannabis, and there are reasonable arguments that the usual tools may not actually apply (for example, some are suggesting that the placebo effect, a cornerstone of randomized control trials may be a facet of effects related to the endocannabinoid system.)
For these, and a great many other unknowns, it is important for the discerning consumer to consult with trusted resources, including friends, family, scientists, and where possible, doctors, to ensure the appropriateness of use on an individual basis.
Recommendations for the medical management of chronic venous disease- The role of Micronized Purified Flavonoid Fraction (MPFF)
In Summary:
A recent review has affirmed that treating chronic venous disease with Micronized Purified Flavonoid Fraction (MPFF) therapy is safe and effective. After reviewing 250 papers, the authors have found a large body of supportive evidence that the MPFF treatment, known as Diosmiplex, is effective for healing venous ulcers on its own or in combination with compression therapy. Diosmiplex, the only MPFF prescribed in the United States, as of 2017, is derived from orange rinds and favorable among patients due to its high safety rating.
Dr. Caplan and the #MDTake:
Flavonoids are one of the categories of natural compounds produced in nature, including within the innate production system of the cannabis plant. Several patients have reported using strong cannabis topical agents to help venous insufficiency and disease, including conditions such as varicose veins, phlebitis, and post-surgical venous incompetence.
Plant-derived coumarins shape the composition of an Arabidopsis synthetic root microbiome
In Summary:
While investigating plant molecules that inhibit parasitic growth, researchers have uncovered a new method for improving crop growth and overall yield. Small molecules, such as flavonoids and coumarins, improve the microbiome of plant roots in order to help them grow and maintain their health. While investigating how the absence of coumarins and flavonoids affect the growth of a common weed the authors stumbled upon a molecular mechanism that will facilitate efforts to grow crops in iron-deficient soils.
Dr. Caplan and the #MDTake:
The natural machinery of Cannabis supports the production of tremendous numbers of flavonoids, coumarins, and microbiome-supporting compounds. Over millennia, cannabis has evolved fastidious attention to detail, and an integral role in the animal ecosystem. Although this natural role has historically been disagreeable to many oppressive movements (religious and cultural), it is nonetheless, self-evident as modern society returns to embrace the science of cannabis. The scientific, medical, textile, farming, nutrition, recreational, and materials construction industries are all wishing only that they had come back to cannabis sooner.
Kudos @abbierosner for this moving piece in CBD Today, “SENIORS, CBD, AND THE LAWS OF ATTRACTION” The article reviews an evolving #CBD playing field, the fears, the market, and a few sprinkled quotes by Dr Laurie Vollen, @JamiePaz, and me!
Restored Self: A Phenomenological Study of Pain Relief by Cannabis
In Summary:
In an Israeli qualitative study investigating the impact of cannabis use on chronic pain patients, all but one of the nineteen study participants experienced pain relief after cannabis use. Participants explained how cannabis allowed them to not just discontinue medications treating their pain, but also medications treating secondary outcomes of their pain, such as poor sleep and anxiety. Patients described feeling “a sigh of relief,” being “reborn” or being saved by cannabis use after years of debilitating pain and medication side effects.
Dr. Caplan and the #MDTake:
The pathway through which cannabis works to combat pain is different from the usual pathways doctors have used for the last 90 years. Prior to the 1930s, cannabis was used routinely, just about everywhere, but political and social agendas kidnapped the medicine and hid it away from most of the mainstream and from routine medical education.
Patients often describe typical pain relievers as adjusting the impact of the pain. Reducing or quieting the pain, softening discomfort, allowing the sufferer to perform previously typical tasks without debilitation or dysfunction. Cannabis, on the other hand, is sometimes described as “taking the sufferer away from the pain,” rather than the other way around. The effects that cannabis can have on the reduction of inflammation, attention, memory, and relaxation, provide a new type of opportunity for relief.
Still, other patients describe the effects of cannabis through a lens of mental focus. Whereas in daily use we typically open a standard set of drawers, some have said, the use of cannabis allows the consumer to open up a different set of draws, and through this adjusted lens, to see discomfort from a different perspective.
For those suffering with chronic pain, years upon years of discomfort, suffering that, when paired with modern medicines, has only met frustration and further discomfort, cannabis is frequently seen as a welcome “sigh of relief.”
