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Medical Cannabis Treats Multiple Sclerosis and Associated Neuropathic Pain

Therapeutic impact of orally administered cannabinoid oil extracts in an experimental autoimmune encephalomyelitis animal model of multiple sclerosis

In Summary

A recent study has revealed the validity of treating multiple sclerosis (MS) and associated neuropathic pain (NNP) with medical cannabis. The therapeutic benefits of cannabis for MS and NNP was demonstrated by treating an experimental autoimmune encephalomyelitis animal model with cannabis which revealed an improved score on a neurological disability assessment and behavioral assessment. The authors describe this study as a critical step in advancing the literature describing the therapeutic effects of medical cannabis by validating the merit of such therapeutic effects. 

Highlighted in this study is the importance of the ratio of cannabinoids when treating various ailments. The vast array of cannabinoids has a myriad of effects on the body depending on how which receptor of the endocannabinoid they act on, how they act on that receptor, and how they interact with other cannabinoids that were taken simultaneously. Cannabidiol (CBD) is frequently recommended to help minimize feelings of anxiety, whereas tetrahydrocannabinol (THC) can actually worsen anxiety at higher doses. When consuming cannabis a patient should always be careful to note the ratio and effect of each cannabinoid.

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Benjamin Caplan, MDMedical Cannabis Treats Multiple Sclerosis and Associated Neuropathic Pain
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The impact of cannabis on surgical patients is uncertain

The impact of recreational cannabinoids on peri-operative outcomes

In Summary

A recent op-ed from a plastic surgeon discusses the uncertainty of how recreational cannabis effects peri-operative outcomes. Recreational cannabis does not always follow the same standardization requirements as medical cannabis depending on state laws. Multiple studies have reported their findings from patients who have reported using cannabis before their surgery but as peri-operative screening for cannabis is not routine and stigma prevents many from self-reporting, data is uncertain. Cannabis has been shown to affect anesthesia, post-operative hemostasis, drug metabolism, and pain control. Further research is needed to provide definitive evidence for the exact effect of cannabis on peri-operative outcomes. 

This study highlights the need for inclusion of self-reported cannabis use on national databases so larger studies are able to analyze the impact of cannabis on surgical outcomes, but also general patient outcomes. The stigma surrounding recreational cannabis use should be removed, not necessarily for legalization, but to provide researchers an way around national legalization. Allowing naturalistic studies where statisticians can find trends among recreational cannabis use and healthcare would provide a cost-efficient way to support research without federal funding. Removing stigma will help provide researchers the tools to further our knowledge so that we can better treat those using cannabis. 

The study is available for review or download here

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Benjamin Caplan, MDThe impact of cannabis on surgical patients is uncertain
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Cannabinoids prevent cardiotoxicity caused by popular anti-psychotic

Quetiapine induces myocardial necroptotic cell death through bidirectional regulation of cannabinoid receptors

In Summary

Researchers have recently revealed that cannabinoids are able to inhibit cardiotoxicity caused by the antipsychotic Quetiapine, both in mice and during bench testing. Quetiapine is a popular atypical antipsychotic that has recently been come under fire for causing myocardial injury by inducing necroptosis. The featured study has elucidated the mechanism behind Quetiapine’s cardiotoxicity and identified the combination of cannabinoid receptor 1 (CB1) antagonists and cannabinoid receptor 2 (CB2) agonists as a novel therapy. CB1 antagonists and CB2 agonists are able to inhibit the necroptosis induced by Quetiapine which should still make it a viable antipsychotic for those with access to medical cannabis. 

This article highlights the negative side effects associated with antipsychotics. There is still no cure for schizophrenia or bipolar disorder and the current treatment of antipsychotics and antidepressants often have horrendous side-effects that often deter patients from taking their medications. Better medications need to be developed to treat psychiatric disorders in general, but if we are able to develop therapies that assist patient compliance rates it would also be a huge step forward for the psychiatric community. Further research should be conducted to determine if cannabinoids can aid in other side-effects of antipsychotics that patients find difficult to cope with. 

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Benjamin Caplan, MDCannabinoids prevent cardiotoxicity caused by popular anti-psychotic
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The Effect of Cannabis Use During Preconception and Pregnancy Outcomes

In Summary

 A recent study has revealed that women who used cannabis during preconception had lower fecundability but cannabis had no effect on pregnancy outcomes. Researchers screened women attempting to get pregnant for previous cannabis use through urine testing and self-reporting. Women who tested or reported positive for cannabis use were less likely to conceive during the primary menstrual cycle when attempting to get pregnant but the use of cannabis had no effect on the rate of live births or loss of pregnancy. The authors call for further research as some women may not report cannabis use due to stigma despite the importance of gathering data for possible effects of cannabis use on conception. 

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Benjamin Caplan, MDThe Effect of Cannabis Use During Preconception and Pregnancy Outcomes
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Volume of Lateral Orbitofrontal Cortex Predicts Drug Use

Orbitofrontal cortex volume prospectively predicts cannabis and other substance use onset in adolescents

In Summary:

 Researchers have recently unveiled that the volume of the lateral orbitofrontal cortex (OFC) is able to predict future substance use in adolescents. Individuals were followed for 13 years after undergoing magnetic functional resonance imaging and surveyed for cannabis and alcohol use. Interesting the authors chose to utilize those who had used cannabis, but in limited quantities, as a control group instead of including them in their cannabis users group. Similarly, the alcohol only group of participants also included those who used cannabis multiple times within the past year. Nevertheless, the authors conclude that the size of the lateral OFC is able to predict drug use in adolescents although not without admitting the need for replication and validity. 

This paper is a perfect example of biased information within the medical community. Bias is inherent, there is no way around it, but it is the duty of researchers to publish their findings while remaining as objective as possible. The grouping and subsequent statistical analysis of this data mentioned in the featured article are rather odd considering their terminology and broad claims. This may be due to the views of the organization funding the research, or the bias of the research team, but the limitations of this study should have been a larger factor, such as the odd groupings and the fact that this research took place in a state where cannabis use is legal for recreational and medical use. Scientists have an obligation to pursue the truth and not extrapolate their findings to fit their personal agenda. A slew of articles out there suffer from cherry-picking statistics and the extrapolation of data; readers and media outlets who popularize findings should take care to nitpick the methodology and demographics of studies. 

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Benjamin Caplan, MDVolume of Lateral Orbitofrontal Cortex Predicts Drug Use
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Pediatric Oncology Center Justifies the Use of Medical Cannabis

In Summary

Pediatric oncologists from Minnesota recently published an article justifying their use of medical cannabis as palliative care for their patients. The majority of patients at the oncology center were approved for medical cannabis use during their first round of treatment in order to immediately address the negative side effects of chemotherapy such as nausea, pain, and cancer cachexia. The data provided from the center described much higher chemotherapy compliance rates among patients, and that patients have a much better quality of life when utilizing cannabis.

This article highlights a few promising trends and issues with using medical cannabis; one promising trend being the hope for cannabis to provide antitumor effects. Cannabis has been looked into for antitumor effects and has shown promising results but there are many limitations to the few studies that had been published, leading the authors to hold off on overarching conclusions. The center in Minnesota noted that many of the patients diagnosed with brain tumors were especially hopeful that cannabis would aid in curing them of cancer, second to utilizing the drug for nausea. This is a promising trend because it means the greater public is showing interest in the therapeutic possibilities of cannabis and their support and call for research will aid the drive for the federal rescheduling of marijuana. 

Also highlighted in this article is that of all the patients certified to use medical cannabis a subset of 24% never actually registered through the state to receive the cannabis. The authors have no real data of etiology behind this phenomena but suspect that the $200 annual fee on top of the fee for each additional dispensed prescription limited patients abilities to afford cannabis. Without the support of the federal government insurance companies are unable to cover medical cannabis leading many unable to afford medical cannabis. With the promising data provided in this article, it is a shame so many patients were unable to benefit from cannabis use due to affordability. 

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Benjamin Caplan, MDPediatric Oncology Center Justifies the Use of Medical Cannabis
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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

In Summary

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 which is severely hindering the medical community from taking full advantage of all it has to offer. The better a system is understood the more definite answers can be found. Critics may never support the rescheduling of cannabis but without moving cannabis to 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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Long-Term Administration of CBD has No Effect on Cognitive Function

Cognitive functioning following long-term cannabidiol use in adults with treatment-resistant epilepsy

In Summary

A recent study has revealed that the cognitive function of adults taking cannabidiol (CBD) to treat their treatment-resistant epilepsy (TRE) was not affected by long-term use. Analysis of the study revealed no correlation between cognitive change scores and CBD dose, nor was there a correlation between change in seizure severity and cognitive test performance. Cognitive dysfunction commonly occurs comorbidly to TRE so it is important to note CBD has yet to show the ability to repair cognitive function but it will not further hinder cognitive function. 

This post highlights the limitations of research for cannabis despite CBD being approved by the FDA to treat rare forms of epilepsy. This is because of a lack of a control group, which would be provided by adults not suffering from TRE but consuming the same dose of CBD or by adults suffering from TRE but not taking medication. If cannabis, or even just CBD, were supported for medical use at the federal level researchers would be able to create much more efficacious treatments within a more rapid time-frame. 

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Benjamin Caplan, MDLong-Term Administration of CBD has No Effect on Cognitive Function
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Cannabinoids Affect Your Sense of Smell

Cannabinoid Receptor-Mediated Modulation of Inhibitory Inputs to Mitral 3 Cells in the Main Olfactory Bulb

In Summary

A recent study has revealed that the endocannabinoid system regulates mitral cell activity in the olfactory bulb, affecting users’ sense of smell. Cannabinoids that agonize and antagonize cannabinoid receptor 1 (CB1) are able to regulate the threshold for odor stimulation and synaptic input, thereby modulating a users ability to smell various stimuli. This may aid people suffering from neuropathic pain caused by sensitivity to an array of odors such as perfume or household cleaners. 

This article highlights how much more our community has to learn about the endocannabinoid system so that we can identify all of the possible therapeutic targets it provides. It is still uncertain whether or not cannabinoid 2 receptors are found within the central nervous system, specifically regions of the brain, which could provide more targets for the non-psychoactive components of cannabis, such as THC, another mechanism to work through. The more we learn about cannabis the more possibilities arise, calling for further research to be done. 

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Benjamin Caplan, MDCannabinoids Affect Your Sense of Smell
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Cannabidiol Shows Promise for Reducing Binge Eating and Development of Obesity

Cannabidiol inhibits sucrose self‐administration by CB1 and CB2 receptor mechanisms in rodents

In Summary

A recent study has uncovered cannabidiol’s (CBD) potential for treating psychiatric disorders characterized by binge eating and preventing the development of obesity. Researchers found that the administration of CBD in rodents reduced the self-administration of sucrose. Although clinical studies are needed to provide further evidence, the current data provide solid evidence for a novel treatment for the reduction of binge eating and development of obesity via a mechanism within the endocannabinoid system. 

This article highlights the lack of treatment for obesity despite its prevalence among American society. Currently, there are no successful pharmacotherapies for obesity so the promising aspects of CBD as treatment warrant further research. CBD lowers the activity of the reward system in response to food, much like how it is thought to interact with opioids, and would, therefore, prevent people from seeking out food to engage in dangerous behavior.

The study is available for review or download here:

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Benjamin Caplan, MDCannabidiol Shows Promise for Reducing Binge Eating and Development of Obesity
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