Synthetic Cannabinoids

Synthetic Cannabis Use in a Psychiatric Inpatient Unit in Australia

Synthetic cannabinoid use in an acute psychiatric inpatient unit

In Summary

Over half of the patients at a psychiatric inpatient unit in Australia reported using synthetic cannabis before their admission to the acute treatment clinic. Although synthetic cannabinoids have been banned from retail centers in Australia patients reported that legality, availability, and the feeling of intoxication were the main motivation for their use of synthetic cannabinoids. There is a high prevalence of new psychoactive substances available and the data from the clinic causes some in the healthcare field to suggest that clinicians should routinely screen for substances during the admission process. 

This article mentions the flurry of new synthetic psychoactive substances, including cannabinoids but also extending beyond just those, which highlights the issue of readily available designer drugs. It can be difficult to keep track of illicit designer drugs as illegal manufacturers are often able to quickly modify their product before the previous form is even determined to be an illegal substance. By routinely checking for new drug variants the legal and medical systems would be better able to maintain and keep a record of such substances for future use, tracking, and treatment protocols.

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Benjamin Caplan, MDSynthetic Cannabis Use in a Psychiatric Inpatient Unit in Australia
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The Characterization of Synthetic Cannabinoids Psychoses

Clinical characteristics of synthetic cannabinoidinduced psychotic disorders- a single-center analysis of hospitalized patients

In Summary

A recent clinical study in Russia has documented four clinical variants of cannabis-induced psychoses, as well as the signs to recognize them. The researchers limited their study to males, so it is uncertain if these psychotic disorders can also be seen in women. Patients admitted to the emergency room who claimed to have ingested synthetic cannabinoids or tested positive for synthetic cannabinoids during urinalysis and were then asked to give consent. After all of the participants were confirmed to be suffering from psychoses the researchers separated patients into four distinct groups defined by their characteristics and highlighted predominant symptoms so that others may efficiently identify the specific psychoses when a new patient is identified. The data provides a basis for future diagnostic techniques and management. 

The featured report emphasizes the importance of micro-dosing. The dose of cannabis is not reported in the article but is likely to include patients who overindulged in tetrahydrocannabinol (THC) which can have alarming effects. Microdosing prevents excess consumption by suggesting that patients start low and go slow when self-dosing their cannabis. It is also a good idea to keep a product that features cannabidiol (CBD) which mitigates the psychotic effects of THC. Patients should take care to minimize the amount of cannabis they consume so that any pain or other symptoms are treated but psychoactive effects are minimal.


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Benjamin Caplan, MDThe Characterization of Synthetic Cannabinoids Psychoses
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A Synthetic Flavonoid Derivative May Treat Triple-Negative Breast Cancer

Regulators and mechanisms of anoikis in triple-negative breast cancer (TNBC)- a review

In Summary:

Researchers are always exploring new methods to treat highly aggressive forms of breast cancer. As the scientific culture opens up to cannabis as a natural pharmaceutical factory, eyes have been drawn to the individual chemical components born inside cannabis, namely cannabinoids, terpenoids, and flavonoid compounds. Recently, a group stumbled upon a promising synthetic flavonoid derivative. This derivative, named GL-V9, has been found to have an inhibitory effect on the growth of triple-negative breast cancer (TNBC) tumors and has shown other anti-metastatic properties. The growth-stopping and anti-spreading effects would address two of the central aspects of TNBC that have thus far made it difficult to treat. The growing understanding of flavonoids and their potential therapeutic benefits seem all but sure to enshrine its place among future research regarding cancer treatments. 

Dr. Caplan and the #MDTake:

In scientific and medical circles, it’s not uncommon to hear the phrase, “everything causes cancer.” It’s often repeated contemptuously, a tongue-in-cheek expression that calls attention to unknowns associated with the spawning and growth of cancers but also bends to the hurricane force of nature’s impact on living organisms. As living biology, cancers are born and thrive while provided sustenance by particular inputs and supports. Because of this fact, there are also innumerable opportunities to stifle or prevent the birth of tumors and many avenues to interrupt its growth or end the life of cancer cells.

The human cultural history has taught all cultures that sleep, exercise, fruits, vegetables, fiber, and water are all required ingredients for sustained, healthy growth. What is it about fruits and veggies that is healthy? They have fiber that is healthy for the human digestive tract, but they also have natural components, terpenes and flavonoids, which support wellness, healing, and the normal cycling (features of both living and dying) of our cells. Cancer represents the inappropriate over-replication of cells. In a sense, the body’s natural ability to end the cells which are not responding to normal signals is lost. If we know that the cannabis factory happens to produce many of the same compounds that are found elsewhere in vegetation and fruits, is it so surprising that we would see cancer-fighting effects?

Breast cancer & flavonoids: current research and treatments
Graphical Abstract: anolkis resistance; breast cancer-related chemsitry

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Benjamin Caplan, MDA Synthetic Flavonoid Derivative May Treat Triple-Negative Breast Cancer
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Is Sativex absorbed in the mouth or gut? To eat or not to eat beforehand?

Article Title: A meta-opinion: cannabinoids delivered to oral mucosa by a spray for systemic absorption are rather ingested into gastro-intestinal tract: the influences of fed/fasting states.

Sativex® spray is made of a 1:1 ratio of THC and CBD. It is marketed for use in the treatment of spasticity in patients with Multiple Sclerosis and is absorbed into the bloodstream through the oral mucosa. This absorption has the benefit of rapid absorption, as it avoids the slow process of digestion which is the typical path of absorption for edibles. This meta-opinion (expert opinion) review argues that Sativex is actually washed down by our saliva and digested through our gastrointestinal tract very much like edibles, and NOT merely absorbed in the mouth via oral mucosa, as the producers suggest. The authors reviewed several research studies which have found that the concentrations of THC and CBD in the body, following administration of Sativex differed if a patient had a meal or not beforehand. This would suggest that Sativex is indeed absorbed in the gastrointestinal tract, rather than merely through the oral mucosa.

How this matters to consumers:

Toward a goal of reproducible dosing and effects, consumers would do well to understand the effects of various methods of absorption. Specifically, it is helpful to know that the effect of Sativex may be delayed if it follows a meal.

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Benjamin Caplan, MDIs Sativex absorbed in the mouth or gut? To eat or not to eat beforehand?
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New Developments of Cannabinoid-Based Drugs

Title: Novel approaches in clinical development of cannabinoid drugs

A pamphlet has recently been published that highlights new approaches in the clinical development of cannabinoid-based therapies. The pamphlet begins with a look into how current cannabinoids affect patients based on gender, stress, physiological variations, and also delves into how cannabis works on the body in general.

A novel therapy that features an oral version of tetrahydrocannabinol (THC) and a synthetic activator of cannabinoid-receptor-1 (CB1) is explored in this piece and frames it to be a promising future therapy. The pharmacological properties of these two novel therapies were optimized during development after various analysis techniques, forming medications that the authors hope to see in future clinical trials. 

Although the authors remain hopeful that their cannabis-based therapies will reach clinical trials soon, trials featuring cannabinoids are difficult to test in a formal setting because of a dire lack of funding. The federal government still lists cannabis as a Schedule I substance, under the Controlled Substances Act, meaning that the federal government does not support the idea that cannabis has any medical use. Considering the legal status of cannabis, only privately-funded studies are able to take place, and unfortunately, that leaves cannabis research in an area of complete bias and prohibitively underfunded. Considering the massive literature supporting a myriad of novel therapeutic benefits, this is a costly reality to the health and well-being of millions.


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Benjamin Caplan, MDNew Developments of Cannabinoid-Based Drugs
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Can specific, isolated Cannabinoids reduce Cannabis Dependency?

Using cannabis to decrease dependency on cannabis? An Australian study shows promise using Nabiximols to target receptors and diminish the rate of relapse. The spray of equal parts CBD and THC had regular smokers smoking 19 fewer days than those on placebo

The News article: http://bit.ly/2YbSrN1

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Benjamin Caplan, MDCan specific, isolated Cannabinoids reduce Cannabis Dependency?
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Cannabinoids Treat Chronic Gastrointestinal Disorders

Title: Nabilone administration in refractory chronic diarrhea- a case series

A new study reveals the efficacy of treating chronic gastrointestinal disorders with cannabinoids, such as Nabilone. Researchers followed case studies in which patients were given nabilone which greatly reduced symptoms of chronic diarrhea and weight gain, over a period of three months.

The cannabinoid treatment also reduced the abdominal pain felt by patients and improved their overall quality of life. Considering the favorable safety profile of cannabinoids and the effectiveness demonstrated in the patients, cannabinoids were deemed an appropriate and clinically beneficial method for the treatment of chronic gastrointestinal disorders, such as chronic diarrhea. 

Highlighted by this article are the many symptoms cannabis used to treat before the prohibition of cannabis and the scheduling of the medication under the Controlled Substances Act. Cannabis has been used in eastern medicine, for thousands of years, and used to be a prevalent medication in the late 19th and early 20th centuries, and has just recently been re-recognized as an option to treat anorexia associated with human immunodeficiency virus (HIV), nausea and vomiting due to chemotherapy, and various sleep disorders. Cannabis was once a well-recognized medication, but it has been mercilessly slandered by politicians. The rise and fall of cannabis have largely been politically driven pushes, and the plant and its effects deserve further study to examine the scope and efficacy of its therapeutic benefits. 

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Benjamin Caplan, MDCannabinoids Treat Chronic Gastrointestinal Disorders
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Cannabis is a Safe and Effect for the Treatment of Fibromyalgia

Safety and Efficacy of Medical Cannabis in Fibromyalgia 

A recent study has concluded that cannabis is a safe and effective treatment for patients suffering from fibromyalgia symptoms.

Fibromyalgia is a disorder characterized by widespread pain, fatigue, and issues sleeping. Cannabis is well known for its ability to treat pain, especially in lieu of opioids as the side effects are minimal and the risk of addiction minimal. This study found that over 200 patients were greatly benefited by cannabis as it moderated their pain and improved their mood. Future studies should aim to directly compare cannabis-based treatment with the currently accepted methods of fibromyalgia treatment to validate efficacy. 

This study highlights how beneficial cannabis can be for those patients who are treatment-resistant for the general treatment of most disorders, especially when pain is involved. Cannabis has been proven to be much safer than opioids, and yet our lack of complete information, concerning the exact mechanisms of the endocannabinoid system and how different cannabinoids act on those mechanisms severely limits our ability to offer practical, novel therapies. Cannabis has previously been shown to be beneficial for treatment-resistant forms of epilepsy and depression, which holds promise when continuing to look for novel treatments for other disorders that have proven difficult to treat. 

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Benjamin Caplan, MDCannabis is a Safe and Effect for the Treatment of Fibromyalgia
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Cannabinoids have Opioid-Sparing Effects on Morphine Analgesia

Opioid-Sparing Effects of Cannabinoids on Morphine Analgesia- Participation of CB1 and CB2 Receptors

Researchers have recently provided evidence that synthetic cannabinoids are able to work synergistically with morphine to provide maximum pain relief while limiting opioid doses.

In an effort to control the current opioid epidemic researchers have been looking into the possible benefits of cannabinoids due to the interaction of the opioid and endocannabinoid systems. The results of this study showed that various synthetic cannabinoids (WIN and GP1a) were able to work synergistically with morphine in two separate pain models to maximize analgesic effects. Further evidence is still needed to validate these claims before patient use, but this paper provides further evidence that medical cannabis may help put an end to the opioid crisis. 

Highlighted in this paper is the lingering uncertainty of exact mechanisms within the endocannabinoid system. The authors of this article are left without definite answers as to whether or not the analgesic effect is mediated completely through cannabinoid receptor 1 (CB1) or if cannabinoid receptor 2 (CB2) is also involved. Research into cannabinoids is slow within the United States, as there are currently only privately funded studies. This severely limits the medical community from a full understanding. The better a system is understood, the more concrete answers can be found. Critics may never support the rescheduling of cannabis but without moving cannabis to a Schedule II or III, it remains impossible to back even their claims. 

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Benjamin Caplan, MDCannabinoids have Opioid-Sparing Effects on Morphine Analgesia
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Video: Cannabinoid Delivery Systems for Pain and Inflammation Treatment

A 2018 literature review summarizes the various ways patients can consume cannabis (orally, topically, etc.) and the pain reductions associated with each method. The review focuses on the treatment of multiple sclerosis, cancer, anorexia, arthritis, and other painful disorders.

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Benjamin Caplan, MDVideo: Cannabinoid Delivery Systems for Pain and Inflammation Treatment
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