Opiates

Informing Doctors and Patients on Cannabis Use for Pain

Paper Title: Cannabis and Pain: A Clinical Review

Although results from many bench-scientific and preclinical animal trials support the use of medical cannabis for pain management, there is not yet an equal body of evidence in human clinical trials. However, this is, in part, due to the fact that, despite millennia of accounts supporting the use of cannabis to treat a large number of medical concerns, in the shorter history of cannabis research, the number of controlled, double-blind, placebo studies are limited, and to some points of view, may not even be possible. Additionally, in an era where increasingly more patients request cannabis therapy from their clinicians, health professionals are catastrophically undereducated on the topic. Furthermore, given the status of the modern opioid crisis, there is a growing need for alternative pain management strategies: states with medical marijuana laws experience significantly fewer opioid-related deaths than states lacking them. Additional research could reduce these deaths further and provide viable alternatives for patients seeking pain management when other therapies have failed. 

Below are interesting clippings from this article, points that are either described eloquently or bring a welcome addition to the ongoing discussion:

Benjamin Caplan, MDInforming Doctors and Patients on Cannabis Use for Pain
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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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This paper is also stored here:   http://bit.ly/2Hqu8Bn      inside the CED Foundation Archive

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Benjamin Caplan, MDCannabinoid Receptors Regulating the Function of Opioid Receptors
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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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This paper is also stored here:    http://bit.ly/2K7bbVX     inside the CED Foundation Archive

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Benjamin Caplan, MDNew Developments of Cannabinoid-Based Drugs
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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!

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Benjamin Caplan, MDVideo: Do-It-Yourself Cannabis Tinctures
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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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This paper is also stored here:    http://bit.ly/2Xh5PQl     inside the CED Foundation Archive


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Benjamin Caplan, MDCannabinoids have Opioid-Sparing Effects on Morphine Analgesia
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80%: Cannabis extremely helpful for pain; 82%: helped reduce or stop over-the-counter medications; 88% able to stop taking opioid painkillers

“The study, published in the Journal of Psychoactive Drugs, which looked at 1,000 people taking legalized marijuana in an American state found that among the 65% of people taking cannabis for pain, 80% found it was very or extremely helpful.”

“82% of these people being able to reduce, or stop taking over the counter pain medications, and 88% being able to stop taking opioid painkillers.”

“74% of the 1,000 interviewees bought it to help them sleep – 84% of whom said the marijuana had helped them, and over 83% said that they had since reduced or stopped taking over-the-counter or prescription sleep aids.”

“The study adds weight to the theory that widening access to medical cannabis could lower the use of prescription painkillers, allowing more people to manage and treat their pain without relying on opioid prescription drugs that have dangerous side effects.”

“This is backed up with other research that shows that states with medical cannabis laws have a 6.38% lower rate of opioid prescribing and that Colorado’s adult-use cannabis law is associated with a relative reduction in opioid overdose death rate from 1999 to 2010.”

“”Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen cause GI bleeding or kidney damage with chronic use. Paracetemol (Acetaminophen) toxicity is the second most common cause of liver transplantation worldwide, and is responsible for 56,000 ER visits, 2600 hospitalizations, and 500 deaths per year in the U.S.”

Link to news brief: https://eurekalert.org/pub_releases/2019-07/tfg-cmb062819.php

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This paper is also stored here:    http://bit.ly/2JmB7Lv     inside the CED Foundation Archive

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Benjamin Caplan, MD80%: Cannabis extremely helpful for pain; 82%: helped reduce or stop over-the-counter medications; 88% able to stop taking opioid painkillers
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The Cannabinoid System is a Promising Source of Targets for Treating Pain

A Budding Source of Targets for Treating Inflammatory and Neuropathic Pain ECS

The cannabinoid system provides momentum to develop cannabinoid-based medications to treat inflammatory and neuropathic pain as researchers continue to find promising therapeutic targets. These new targets may lead to the formation of novel pain-relief medications that may serve well to alleviate pain for those suffering from cancer, multiple sclerosis, and fibromyalgia. Cannabis-based pain medicine is also being researched for opioid-sparing effects and effectiveness in reducing the necessary dose of opioids.

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

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Benjamin Caplan, MDThe Cannabinoid System is a Promising Source of Targets for Treating Pain
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Cannabinoids + opioid pain relief: subjective effects in healthy humans

Human study finds that, when taken with opioids, dronabinol (THC) may increase impairment and decrease, or not affect, pain relief. Researchers conclude that THC might NOT protect the body from the adverse effects of opioids. However, the study examined only 10 participants, and such a small sample size should give pause to the validity and applicability of the findings. 

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

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Benjamin Caplan, MDCannabinoids + opioid pain relief: subjective effects in healthy humans
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Cannabinoid Receptors Working with Opioid Receptors

The locus coeruleus is a spot in the human brainstem that is integral to our responses to stress, panic, wakefulness, and sleep-wake transitions. Both the cannabinoid receptors and opioid receptors in the locus coeruleus have a synergistic relationship that, once the medical system begins to incorporate more education about cannabinoids, just might change how physicians prescribe pain medication. The interactions of the two receptor types provide a mechanism that could easily and conveniently improve pain control, provide treatments for addiction, and will likely aid those experiencing symptoms of withdrawal. Research focusing on the treatment of opioid addiction with cannabis is ongoing… but hindered by the legal status of cannabis.

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

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Benjamin Caplan, MDCannabinoid Receptors Working with Opioid Receptors
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New Study Finds Cannabis May Be “Unsafe” For Pregnant Women

https://www.wbur.org/commonhealth/2019/06/18/cannabis-unsafe-pregnant-women

In a study of 661, 617 pregnant women, researchers found that cannabis use was significantly associated with an increased risk of preterm birth. But these findings may be limited due to other risk factors like tobacco, alcohol, and opioid use. 

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This paper is also stored here:    http://bit.ly/2L0vTaY     inside the CED Foundation Archive

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Benjamin Caplan, MDNew Study Finds Cannabis May Be “Unsafe” For Pregnant Women
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