Dosing

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.

View this review (yellow link) or download:

This paper is also stored here:   http://bit.ly/2MTBOAm      inside the CED Foundation Archive

To explore related information, click the keywords below:

Benjamin Caplan, MDReducing Cannabis Use Equally Effective as Abstinence in Treating Cannabis Use Disorder
read more

A case of an abnormal heart rhythm. Is cannabis to blame?

Article title: Atrioventricular Nodal Reentrant Tachycardia Triggered by Marijuana Use: A case report and review of the literature

Summary:

The effect of cannabis on the heart is not yet well-understood. This report highlights a case of one 40-year-old patient who had, an hour after smoking cannabis, a specific type of cardiac rhythm abnormality (arrhythmia) called atrioventricular nodal reentrant tachycardia (AVNRT).  There is a physical component of this abnormality, an errant track where aberrant rhythms re-enter the heart and can cause rapid heartbeats (tachycardia.) In the discussion, the authors suggest that cannabis use, at higher doses, may stimulate the parasympathetic system, which happens to be involved in electrical current tracks in our heart. The authors further hypothesize that in susceptible people, as in this case, cannabis may affect this electrical pathway in the heart, and may disrupt a stable rhythm.

Dr Caplan and the #MDTake:

Abnormal heart rhythm disorders can be life-concerning conditions, however, there have only been 17 or so reported cases (see Table 1) of life-threatening cases in the medical literature. As it is exceedingly rare, it can be difficult to determine if cannabis is implicated or not.

Clinical Impressions:

Including rare, serious heart conditions, relatively benign circumstances, and conditions related to structural heart disease, arrhythmias are a relatively uncommon condition. Nevertheless, CED Clinic has seen many patients who have atrial fibrillation, a smaller but significant number of patients who have stable low or elevated heart rates, and a rare few with irregularly irregular abnormalities. Some patients have embraced cannabis while anticoagulated (helpful to reduce the risks of potentially dangerous clots), and some who are engaging with cannabis have been treated surgically. The approach to cannabis that most seem to prefer is a slow, gradually increasing dosage routine, where one can become accustomed to low doses, prior to advancing to something which may be more therapeutic, while minimizing the potential cardiac impact. Fortunately, to date, we have observed no grave repercussions that seemed caused, correlated or attributable to cannabis.

ECG showing AVNRT at the time of presentation.

View this review (yellow link) or download:

This paper is also stored here:    http://bit.ly/2MPc7Rl     inside the CED Foundation Archive

To explore related information, click the keywords below:


Benjamin Caplan, MDA case of an abnormal heart rhythm. Is cannabis to blame?
read more

Does Cannabis affect blood pressure, heart rate, brain blood flow?

Article title: Acute Cardiovascular Effects of Marijuana Use

The Review:

The authors of this systematic review combed through multiple previously published studies, looking at the short-term cardiovascular effects of THC on the body. The cardiovascular effects they covered included: changes in blood pressure, heart rate, and blood flow to the brain (cerebrovascular circulation).

This review showed that for blood pressure, the results were undecided, as some studied showed a drop in blood pressure, while others did not. For heart rate, the studies showed an increase after consuming marijuana, but quantity and duration were not mentioned. As for blood flow to the brain, only one study showed a potential decrease while the others found no change. The THC percentage of the products used (mainly inhaled ones) ranged from 1.2% to 17.5%.

Dr Caplan and the #MDTake:

This limited review aims to evaluate the effects of THC on blood pressure, heart rate and blood flow to the brain, but it has important limitations. In terms of how the changes were recorded in the studies and the relevant amounts (of what is changing) were not mentioned. For instance, while the study did show that THC may increase heart rate in the short term, it is not clear what the relevance is, what risk this may poses to consumers if any. Past literature has shown that heart muscle can respond to specific cannabinoids, both in the lab and in animals trails. Several case studies have reported individuals with grave reactions, although these concerns have yet to be replicated in a controlled manner, nor correlated with any specific circumstances or components of cannabis. Toward a goal of maximizing safety, caution is likely warranted for those consuming cannabis with known cardiac risk factors (including heart dysfunction, blood pressure concerns, rhythm abnormalities, and others) particularly with regard to the consumption of high THC products.

Clinical Impressions:

Clinically, there is a distinct trend of people who have found heart rate effects with their cannabis use, mostly increased heart rates at the beginning of use (both when first beginning to consume cannabis as well as early on during an episode of consumption.) There seems to be a tolerance to the heart rate effects because many report that this effect wanes over time. There are a clear group of patients for whom cannabis lowers blood pressure, but also groups for who it either has no effect or increases blood pressure. The long-term trend again seems that tolerance plays a role in bringing all extremes to the middle ground. Regarding blood flow, there seems to be a clear increase in local blood flow with topicals and, at least among CED Clinic patients, no observable relationship between cannabis use and blood flow, from a macroscopic perspective.

View this review (yellow link) or download:

This paper is also stored here:    http://bit.ly/2MLkihz     inside the CED Foundation Archive

To explore related information, click the keywords below:

Benjamin Caplan, MDDoes Cannabis affect blood pressure, heart rate, brain blood flow?
read more

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. 

View this review (yellow link) or download:

This paper is also stored here:    http://bit.ly/2K42H1S     inside the CED Foundation Archive

To explore related information, click the keywords below:

Benjamin Caplan, MDThe Effect of Cannabis Consumption on Sperm
read more

Medical cannabis doctors left to handle “backlash” from patients over lack of availability

Though UK doctors have been able to prescribe cannabis since November 2018, very few prescriptions have been issued, because most forms of medical cannabis have not been approved by the government.

In response to thousands of disappointed patients, the House of Commons Health and Social Care Committee called for immediate clinical trials focusing on the treatment of intractable childhood epilepsy. 

View this review (yellow link) or download:

This paper is also stored here:   http://bit.ly/2XXYrEJ      inside the CED Foundation Archive

To explore related information, click the keywords below:

Benjamin Caplan, MDMedical cannabis doctors left to handle “backlash” from patients over lack of availability
read more

Video: Do-It-Yourself Cannabis Tinctures

One of the terrific realities of modern Cannabis is that it is possible, and often quite simple, to make effective products at home. With suitable education and access to testing facilities, the soil, nutrients, and plant growth can be supported at home, lab-tested for make-up and potency, as well as safety-checked for potential microscopic contaminants, and ultimately, individualized medicine can be created right at home!

Here is a sample instructional for just one way that cannabis tincture can be made at home. There are countless others and hopefully, many that are yet to be discovered!

To explore related information, click the keywords below:

Benjamin Caplan, MDVideo: Do-It-Yourself Cannabis Tinctures
read more

Student-Athletes are at an Increased Risk for Binge Drinking and Substance Use

Title: Psychological correlates and binge drinking behaviours among Canadian youth- a cross-sectional analysis of the mental health pilot data from the COMPASS study

A recent study has examined data from the COMPASS program and found that student-athletes in Canada were more likely to engage in binge-drinking and illicit substance use. Researchers focussed on the measure of flourishing, defined as an overall healthy mental state and emotional connectedness, and how flourishing related to concerning drinking and substance use behavior. Student-athletes were found to be the most at risk for binge-drinking, defined as consuming 5 or more drinks in a single session, and those more likely to binge-drink were also more likely to co-use illicit substances. This research provides evidence for the formation of targeted prevention programs.

Cannabis use is banned among athletes by most sports organizations. Cannabis appeals to athletes considering the many different consumption methods, allowing discreet consumption and personalization with variable potential opportunities for relief. Cannabinoids are generally naturally occurring substances unless clearly manufactured, and have been shown to be beneficial for post-workout recovery, muscle soreness, anxiety, sleep, and relaxation. All of those symptoms, including the emotionally driven ones, are common among student-athletes who often feel an immense amount of pressure to perform in competition. As in most other areas of modern culture, Cannabidiol (CBD) finds itself in a grey area for most sports organizations’ substance regulations given that it is not intoxicating and readily available with a notable safety profile. Even if cannabis is not federally legal, CBD is so widely available that many athletes are embracing it, in lieu of more dangerous, or potentially addictive, medications.

Tweet: A recent study has examined data from the #COMPASS program and found that #studentathletes in Canada were more likely to engage in #binge-drinking and illicit substance use. Read this and other linked studies:

View this review (yellow link) or download:

This paper is also stored here:    http://bit.ly/2XSoIUQ     inside the CED Foundation Archive

To explore related information, click the keywords below:

Benjamin Caplan, MDStudent-Athletes are at an Increased Risk for Binge Drinking and Substance Use
read more