Addiction

Reducing Cannabis Use Equally Effective as Abstinence in Treating Cannabis Use Disorder

Reduction in Cannabis Use and Functional Status in Physical Health, Mental Health, and Cognition

In a survey of 111 cannabis use disorder (CUD) patients with abstinent, low use, or heavy use of cannabis, similar benefits were experienced by patients who reduced their use to zero or low use. Both groups exhibited significantly better outcomes than the heavy use group with respect to overall health, appetite, and depression. According to the study, CUD patients “who used cannabis at a low level did not differ from the abstinent individuals in any of the functional outcome measures.” With a relatively small subject population, it is challenging to know if this is applicable to broader audiences, but regardless, It is likely to open up some new treatment option for CUD patients.

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Benjamin Caplan, MDReducing Cannabis Use Equally Effective as Abstinence in Treating Cannabis Use Disorder
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Cannabinoid Receptors Regulating the Function of Opioid Receptors

Constitutive Activity of the Cannabinoid CB1 Receptor Regulates the Function of Co-expressed Mu Opioid Receptors

Summary info:

Cannabinoid receptors have been found to regulate the function of co-expressed mu-opioid receptors. Researchers have found data that indicates the constitutive activity within the cannabinoid system reduced the capacity of expressed mu-opioid receptor functions. This research brings to light the possible benefits of modulating opioid consumption with  cannabis-based medicines. 

Dr Caplan Discussion Points:

One of the interesting discussion points in this paper is a close look at the effects of the CB1 receptor and its capacity to reduce the function of some mu-opioid receptors, through a mechanism different than naloxone. This suggests some appropriate optimism for cannabinoid-based tools in the battle against the worldwide opioid epidemic.

Learn more at http://bit.ly/2wRsbbt 

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Benjamin Caplan, MDCannabinoid Receptors Regulating the Function of Opioid Receptors
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Video: Controversial Questions in Cannabis Today

As cannabis finds its place back into modern human culture quickly, there is much still to be learned. As the science grows and adapts to modern need and expectations, the “can we” may be out-pacing the “should we.” On the other hand, there are circumstances where modern culture really “should be” and is handicapped by years of misinformed stigma.

Here, a few controversial questions about cannabis:

Should teachers be allowed to use cannabis around children? 

Should spiritual leaders be allowed to use cannabis, as they have for millennia?

Should taxi drivers be allowed to use cannabis on the job?

Should pilots be allowed to use cannabis?

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Benjamin Caplan, MDVideo: Controversial Questions in Cannabis Today
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The Effect of Chronic Cannabis Use on Volumetric Alterations in Brain Regions

Title: Neuroanatomical alterations in people with high and low cannabis dependence

A recent article has been published revealing some volumetric alterations in specific brain regions in people who report dependence on cannabis. Magnetic resonance imaging revealed that the volume of certain regions, including the hippocampus, the cerebellum, and the caudate, in cannabis dependent users, were all reduced in size, relative to recreational cannabis users who did not use cannabis chronically. Future research will likely focus on the effects of the structural alterations on patients’ reward, stress, and addiction-relevant circuitry to examine the possible relevance of cannabis dependance on those circuits. 

There are certainly possibilities that suggest this volume difference could be of concern, but there are also a great number of explanations (more than likely) whereby this is related to another variable that we have not yet fully appreciated.

Currently, cannabis use is thought to have a little-to-no risk of addiction (beyond any “normal” product of medical value, such as coffee or eyeglasses), because it does not act directly on the reward circuit. Opioids have a high risk of addiction, and therefore a concerning safety profile, in part because of the direct effect of the opioid system on the reward pathway of the central and peripheral nervous systems. While the endocannabinoid system has been observed to act directly up the reward circuit, it does so in subtle, soft ways, making it an ideal adjunct therapy for opioids to help with pain management. Current research provides inconsistent results and appropriately emphasizes a need for more testing to validate the possibility of cannabis as a recommended pain medication. 

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Benjamin Caplan, MDThe Effect of Chronic Cannabis Use on Volumetric Alterations in Brain Regions
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Author’s Response to Discrepancies in Medical Cannabis Use

Medical Cannabis Use: The Authors Reply

In yesterday’s blog post, the discrepancies in the number of medical cannabis users were discussed and the suggestion arose that perhaps medical cannabis use may need stricter regulations. The author of the piece that inspired the letter featured in the post responded, highlighting the possibility that recreational cannabis is being used for medical purposes rather than users obtaining cannabis from more nefarious sources. The author points out that renewing medical licenses can be a hassle and in states where recreational cannabis has been legalized patients may just be obtaining their cannabis, used for medical purposes, from recreational dispensaries. Surveys that delve into this issue are needed to confirm the author’s hypothesis. 

Describing the medical process of obtaining a cannabis license as a hassle is, unfortunately, reported by many consumers. State governments are forced to run the regulatory processes, in the absence of federal support, and conservative politicians and opposition groups often create difficulty around opening dispensaries in their districts. On top of the expenses of renewing or obtaining a medical license, it may seem almost less confrontational for people who reside in a state or have access to recreational marijuana (from a state-regulated dispensary) simply to purchase recreational cannabis, rather than take the time to obtain a license. 

Of note, Massachusetts is one of the few states that has anticipated this circumstance and has codified protections and advantages of the medical program, into law. In Massachusetts, medical patients are incentivized through robust discounts (totaling greater than $2000 in discounts, and 20% cost reduction because of the absence of state taxation for medical patients.) Further, there are legal protections available only to medical patients, and the opportunity for delivery, which are not available to recreational consumers.

Benjamin Caplan, MDAuthor’s Response to Discrepancies in Medical Cannabis Use
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The Effect of Cannabis Consumption on Sperm

Impacts of cannabinoid epigenetics on human development- reflections on Murphy et. al. ‘cannabinoid exposure and altered DNA methylation in rat and human sperm’ epigenetics

An op-ed has praised the work published last year which exposed how pre-conception exposure to cannabis in males is related to alterations in epigenetic regulation of the central nervous and immune systems. Murphy et. al.’s paper ‘Cannabinoid exposure and altered DNA methylation in rat and human sperm,’ revealed that the sperm cells of men who have consumed cannabis are a key vector that may affect neuraxis, heart blood vessels, immune stimulation, secondary genomic instability, and carcinogenesis in the fetus offspring. The author of the response piece extrapolates the data collected by Murphy et. al. to conclude the genome-epigenome is extremely sensitive to environmental toxicants and that further research should examine the epigenomic toxicology of multiple cannabinoids. 

The effect of prenatal exposure to cannabis on birth rates, birth outcomes, and the health of the mother is still uncertain. Studies focussing on cannabis use during pregnancy are limited, and what little has been reported, is inconsistent. The featured article now brings to light that both parents may need to be cautious when attempting to conceive or when having unprotected sex as cannabis may affect both germ cells. Currently, governing bodies of obstetricians advise that pregnant mothers cease any cannabis use so if someone who needs cannabis for a medical purpose that improves their quality of life becomes pregnant they need to seek out alternative methods of treatment. Research is needed so that pregnant women can safely continue their medication or so that alternatives can be found so that women do not need to suffer for the duration of their pregnancy and possible breastfeeding period. 

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Benjamin Caplan, MDThe Effect of Cannabis Consumption on Sperm
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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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Hangovers Resulting from Drinking Negatively Impact Everyday Memory

Alcohol Hangover Has Detrimental Impact Upon Both Executive Function and Prospective Memory

A recent study revealed that alcohol hangovers negatively impact everyday memory, specifically executive function (EF) and prospective memory (PM). EF and PM are cognitive functions that underpin everyday memory; things such as remembering an appointment or where you placed your keys. Participants of the study who suffered from hangovers were able to recall significantly fewer items from memory tasks than their peers. The findings of this study may prove useful when looking into how alcohol and cannabis interact with patients.

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Benjamin Caplan, MDHangovers Resulting from Drinking Negatively Impact Everyday Memory
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