Future Medicine

Should Oncologists Recommend Cannabis?

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.

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Benjamin Caplan, MDShould Oncologists Recommend Cannabis?
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The Art of Medicine – Medical Misinformation and The Internet: A Call to Arms

A Call to Arms: Share Accurate Medical Information on the Internet

In Summary:

 In a piece by Jen Gunter, an OBGYN clinician and pain specialist, she calls on other physicians to help educate the public by sharing accurate medical information and encourages the public to participate by liking well-cited sources. Medical misinformation spreads like wildfire, promoting bogus products to ill-advised patients, or convincing people that their headache is due to cancer. Dr. Gunter was encouraged to write this piece due to her own experience raising her premature children and finding mountains of misinformation.

Help other physicians and foundations like the CED Foundation to spread accurate medical advice and well-sourced evidence-based medical literature by sharing well-cited articles and liking posts that you find helpful. The more popular a post is the more likely it will pop up on other peoples pages due to social media platforms algorithm. Help spread accurate medical information!

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Benjamin Caplan, MDThe Art of Medicine – Medical Misinformation and The Internet: A Call to Arms
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A Flavonol from Sweetscented Marigold Alleviates Pain

Tagetes Lucida as a potential analgesic

In Summary:

Researchers have recently provided evidence that a flavonol extract derived from a common flower has antinociceptive (pain-relieving) properties. Sweet-scented Marigold has been used is frequently used in cooking techniques in South America and has now been found to alleviate pain through serotonin and opioid mechanisms of action. The antinociceptive properties of this flavonol, like those of many other plant-derived compounds, are ripe for testing in a clinical setting to determine their effectiveness in human patients. In this small animal study, it clearly demonstrates promise as a safe alternative to commonly used pain medications. 

Dr. Caplan and the #MDTake:

Modern medicine seems to have largely forgotten its roots. Long before pharmaceutical companies were the source of all medication, the earth served as a resource for medications, and apothecaries, pharmacists, and druggists, as they were known, supported the medical industry with formulations and a deep understanding of natural resources. As the greater scientific arena and dominant culture have lost touch with the earth’s natural medicinal resources, our culture has lost a deeply valuable reservoir of opportunity. As the fast-paced life of modernity demands faster results on an ever-greater, mass-production scale, the construction of sprawling cities, which often demands deforestation and destruction of natural resources, may turn out to be a greater threat to human health than most of us have yet to even understand.

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This paper is also stored here:   http://bit.ly/2Sn1qY9      inside the CED Foundation Archive

Benjamin Caplan, MDA Flavonol from Sweetscented Marigold Alleviates Pain
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Medical Cannabis for Adults Over 50

In Summary:

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.


suggested dose for elderly and cannabis
direction of action for cannabis treatments
bar of significant improvement with cannabis

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Benjamin Caplan, MDMedical Cannabis for Adults Over 50
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An Analysis of Sudden Cardiac Death Exposes the Danger of Tobacco and Cocaine

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.




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This paper is also stored here:   http://bit.ly/2SmffX3      inside the CED Foundation Archive

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Benjamin Caplan, MDAn Analysis of Sudden Cardiac Death Exposes the Danger of Tobacco and Cocaine
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Headache and Migraine Relief Using Cannabis

“Short- and Long-Term Effects of Cannabis on Headache and Migraine “

In Summary:

There are many headache and migraine medications on the market that advertise how they can make you feel better. But what happens when they make you feel worse? Medication overuse headaches occur in 15% of patients taking conventional migraine medication, so it’s no surprise that people are looking for alternatives that bring them relief without reduced risk.

A team of physicians from Washington University wanted to see if cannabis could be a contender. By reviewing data from about 2,000 patients who logged the details of their smoking sessions with the app StrainPrint, researchers were able to see if inhaling cannabis Flower or concentrate could be a solution for headache and migraine relief. They learned that there was, in fact, good reason to be hopeful for the herb.

While concentrates did have a larger reduction in severity rating, there haven’t been enough studies to say it is certainly better than Flower. Overall, inhaled cannabis reduced the severity of migraines and headaches by 50%. Some patients did report needing to use a larger dose for future sessions, indicating the development of tolerance, but the severity of the headaches or migraines wasn’t getting worse or more frequent like what can happen with conventional medications.

In a time when plant-based and all-natural medicines are becoming more sought out, it’s exciting to see medical cannabis is being considered more seriously as a contender. With the positive results from this study, and similar related work will hopefully encourage more physicians (and patients) to explore this centuries-old option.

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Benjamin Caplan, MDHeadache and Migraine Relief Using Cannabis
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SENIORS, CBD, AND THE LAWS OF ATTRACTION

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!

Infused Beauty Cover Image
Seniors, CBD, and the laws of attraction article substance

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Benjamin Caplan, MDSENIORS, CBD, AND THE LAWS OF ATTRACTION
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Participants in Cannabis for Chronic Pain Study Describe Life-Changing Results

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.”

different types of  pain
Discussion  from text of research  doc
Sample of text discussing lack of adverse  side effects of cannabis

This paper is also stored here:     http://bit.ly/32FZkUU    inside the CED Foundation Archive

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Benjamin Caplan, MDParticipants in Cannabis for Chronic Pain Study Describe Life-Changing Results
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Cannabinoids Further Demonstrate Therapeutic Potential in Interactions with Adrenaline and Serotonin Systems

Regulation of noradrenergic and serotonergic systems by cannabinoids: relevance to cannabinoid-induced effects

In Summary:

Among many system-wide interactive effects, the noradrenergic and serotonergic hormone/signaling systems are responsible for pain, mood, arousal, wakefulness, learning, anxiety, and feelings of reward. A recent review dives deeper into the interactions between cannabinoids and these two systems: cannabinoids play roles in exciting, inhibiting, and regulating the nerve activity and feedback of both the noradrenergic and serotonergic systems. This data further underscores the therapeutic potential of cannabis for conditions such as depression, chronic pain, and insomnia, all of which are mediated, at least in part, by these systems. Further research may uncover more specific therapies targeted toward the noradrenergic and serotonergic systems and their interactions with cannabinoids.

Dr. Caplan and the #MDTake:

It would be shocking to imagine that, in addition to the usual fruits and vegetables on display at supermarkets, all of a sudden, there was a new category of healthy food. Similarly, the recognition that cannabinoids play a central role in animal physiology is embarrassingly recent. Surveying a sea of illnesses that have become increasingly common, over the last hundred years, before which cannabis was a common household product, also begs the question about a relationship between the circumstances. Might some of the common maladies of modern medicine be attributable to a cannabinoid deficiency syndrome?

A Schematic overview for regulation of NA/LC and 5-HT/DRN cells by the CB1 receptor
Neurochemical Evidence for cannabinoid-induced effects
Electrophysiological evidence for acute effects of cannabinoids on neuronal activity
Neurochemical evidence for cannabinoid-induced effects in the locus coeruleus
Functional evidence fo cannabinoid-induced effects
Electrophysiological evidence for acute effects of cannabinoids

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Benjamin Caplan, MDCannabinoids Further Demonstrate Therapeutic Potential in Interactions with Adrenaline and Serotonin Systems
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Pre- and Post-natal Tobacco and Cannabis Exposure Impacts Children in a Sex-Specific Manner

Pre- and postnatal tobacco and cannabis exposure and child behavior problems: Bidirectional associations, joint effects, and sex differences

Summary Info:

Prenatal maternal cannabis and tobacco use is predictive of behavioral problems among toddlers. Resulting differences from control groups include anxiety, depression, and attention problems. Female children of mom’s consuming substances, in particular, seem to be more susceptible to problems relating to internalization, attention, and sleep. Additionally, the behavioral problems induced by prenatal cannabis and tobacco consumption often lead to further maternal substance consumption, which frequently exacerbates existing behavioral problems. 

Highlights of study of mother's prenatal and postnatal consumption of  cannabis
Highlights of interplay of mother's prenatal and postnatal consumption of  cannabis with children
Highlights of interplay of mother's prenatal and postnatal consumption of  cannabis with toddlers

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Benjamin Caplan, MDPre- and Post-natal Tobacco and Cannabis Exposure Impacts Children in a Sex-Specific Manner
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