Whole-Plant Extract Outperforms THC on Glycemia

 You obviously can't do this until 50 years from now when your doctor has a brain transplant and gets human testing going!

Whole-Plant Extract Outperforms THC on Glycemia

Regular cannabis users have long shown lower rates of obesity and type 2 diabetes despite the appetite-boosting "munchies" effect, a paradox that a new mouse study helps explain. Whole-plant cannabis extract improved glucose control and fat-pancreas signaling more than THC alone in obese, hyperglycemic mice. The data are preclinical and don't support cannabis use for weight or metabolic health.

1. A Curious Metabolic Signal

Cannabis triggers the “munchies”, yet regular users show lower rates of obesity and type 2 diabetes. The mouse study published in The Journal of Physiology points to a possible mechanism: disrupted "cross talk" between fat tissue and the pancreas, suggesting nonpsychoactive plant compounds, not delta-9-tetrahydrocannabinol (THC), may be doing the metabolic work.

2. Whole-Plant Outperforms THC Alone

Obese, hyperglycemic mice received either pure THC or a whole-plant extract, both dosed at 5 mg/kg THC to mimic blood levels after smoking cannabis. Both groups lost weight and fat, but only the extract group showed meaningfully better glucose regulation, glucose clearance approaching lean-mouse levels, and normalized adipokine activity. Per the study author, extract-treated mice showed reversal of type 2 diabetes markers that THC alone didn't match.

3. A Possible Fix for the Adipoinsular Axis

In obesity, signaling between fat cells and the pancreas, known as the adipoinsular axis, breaks down, driving blood sugar up. Cannabis compounds may help restore that communication line. The study author suspects CB1 receptors, present in the central nervous system, fat tissue, liver, and pancreas, are involved, though the exact mechanism is still unmapped.

4. Why the Munchies Fade

Acute THC activates CB1 receptors, boosting appetite and impairing short-term glucose tolerance. With repeated exposure, CB1 signaling downregulates, and effects often flip. Intake drops, and at the extreme end, chronic heavy use can produce cannabis hyperemesis syndrome.

5. What to Tell Patients

Further preclinical work is needed before this moves to human trials. Don't recommend recreational cannabis for weight or glycemic control. If patients ask about cannabis-based therapies, the message worth giving is that the target is the endocannabinoid receptor system itself, not cannabis use, and that long-term cardiometabolic risk with chronic use and aging still isn't well understood.

BOTTOM LINE:

In obese mice, whole-plant extract improved glycemic control and adipokine activity more than THC alone, likely by restoring fat-pancreas signaling. This finding does not support recommending cannabis for weight loss or diabetes management today. If patients ask, clinicians should clarify that the therapeutic target is the receptor system, not cannabis itself. They should also specify that human trials and long-term cardiometabolic risk remain unresolved.

This article is based on a recent Medscape article titled " How Cannabis Compounds May Help Create Weight-Loss Drugs" and was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Study finds long-term brain effect on Cannabis users

 But don't you want better oxygen delivery? Ask your competent? doctor to justify their stance on marijuana.

And this goes totally against what this aging research says:

chronic cannabis users have higher cerebral blood flow and extract more oxygen from brain blood flow than nonusers. August 2017

But this: 

Pot Smoking Baby Boomers Are On The Rise, Why Are Scientists So Happy For Them? Hint: Benefits For The Aging Brain

And this:

The Experiments Revealing How Marijuana Could Treat Dementia

And this;

Cannabis Use Linked to Lower Dementia Risk

The latest here:

Study finds long-term brain effect on Cannabis users

Prominence

Heavy lifetime cannabis use is associated with slightly lower brain activation during working memory tasks in young adults, with a Cohen effect size of -0.28. Recent cannabis use was also associated with lower performance and lower brain activation in working memory and motor tasks, although these associations did not remain significant after correcting for false discovery rate.

Context

• Cannabis use has increased globally, but its effects on brain function are not fully known, which highlights the need to better determine the results of recent and long-term brain activation from cannabis use.

• The legalization of the production and sale of cannabis for recreational and medical use has been associated with an increase in the potency of cannabinoid products, use rates, and the prevalence of cannabis use disorder.

• Greater accessibility to cannabis has also been linked to higher rates of traffic accidents, and frequent use is associated with a higher risk of hyperemesis syndrome and cardiovascular disease.

• Meta-analytic evidence indicates that the short-term effects of cannabis include decreases in cognitive performance, but these reductions may not persist after 72 hours of abstinence.

• Given the disruption of the endocannabinoid system by tetrahydrocannabinol (THC), brain regions with high density of cannabinoid receptors 1 (CB1) can be altered by cannabis use.

Methodology

• Researchers analyzed data from 1,003 young adults (mean age 28.7 years; 46.9% men) with magnetic resonance imaging, urinary toxicology, and data on cannabis use from the Human Connectome Project, collected between August 2012 and 2015.

• Participants were classified as heavy users (>1,000 uses, n=88), moderate (10-999 uses, n=179), or non-users (<10 uses, n=736) of cannabis, based on the Semi-Structured Assessment for the Genetics of Alcoholism.

• Brain activation was assessed during seven distinct tasks administered during the functional MRI session, including working memory, reward, emotion, language, motor function, relational assessment, and theory of mind.

A linear mixed-effects regression model was used to examine the association between lifetime history of cannabis use and recent use, with the mean value of brain activation on each task. Key Information Lifetime heavy cannabis use was significantly associated with lower activation during the working memory task (Cohen's d, -0.28; 95% confidence interval, -0.5 to -0.06; P = 0.02), with more pronounced effects on the anterior insula, medial prefrontal cortex, and dorsolateral prefrontal cortex. The association between heavy cannabis use and lower brain activation during the working memory task remained significant even after excluding individuals with recent cannabis use. Recent cannabis use was associated with lower performance and lower brain activation in working and motor memory tasks, although these associations did not remain significant after correcting for false discovery rate. No other task demonstrated a significant association with a history of heavy use, recent use, or diagnosis of cannabis dependence. In practice These results suggest that cannabis use is associated with both short- and long-term brain function outcomes, especially during working memory tasks. These findings identify "negative outcomes associated with lifetime heavy cannabis use and working memory in healthy young adults that may be long-lasting," the study authors wrote. The most affected brain regions have a relatively high density of CB1 receptors and constitute the area where receptor availability has been found reduced in association with daily exposure to cannabis. Similarly, studies in rodents have shown that exposure to THC reduced the density and sensitivity of CB1 receptors in these brain regions, providing evidence that heavy cannabis use can cause neural adaptation. This reduction mechanism could explain the findings that cannabis use is associated with lower cortical thickness in the dorsomedial and dorsolateral prefrontal cortex

Source

The study was led by Joshua L. Gowin, PhD, of the Department of Radiology at the University of Colorado's Anschutz Medical Campus. It was published online on January 28 in JAMA Network Open.

 Limitations

This was an uncontrolled cross-sectional study, so the observed associations between cannabis and brain function outcomes should not be considered causal. The participants were young adults, so these findings may not be generalizable to other age groups. History of heavy cannabis use was defined as more than 1,000 uses or diagnosis of cannabis dependence, but the sample was recruited from the community, which may represent a relatively low level of severity of dependence. Data were lacking to determine when the most recent use occurred or to quantify the concentration of THC metabolites.The study was supported by grants from the U.S. National Institutes of Health (NIH) and funded by 16 NIH institutes and centers that support NIH Blueprint Neuroscience Research. The study also received support from the McDonnell Center for Systems Neuroscience at the University of Washington and grants DAO54212, DA054096, and DA056408 from the National Institute on Drug Abuse.

Cannabis Is Interfering With the Heart

 I look at this and see that smoking is the problem, not necessarily the cannabis.

 I'm doing it after my next stroke. Unless you have a stick in the mud doctor who still believes in 'Reefer Madness'.

My 13 reasons for marijuana use post-stroke.  

Don't follow me, I'm not medically trained and I don't have a Dr. in front of my name.

This: 

Pot Smoking Baby Boomers Are On The Rise, Why Are Scientists So Happy For Them? Hint: Benefits For The Aging Brain

And this:

The Experiments Revealing How Marijuana Could Treat Dementia

The latest here:

Cannabis Is Interfering With the Heart

New research suggests clinicians should warn patients about the potential of cannabis to harm cardiovascular health. But how big a risk cannabis presents depends on the amount used and how much stock should be placed in observational studies.

The link between cannabinoids and cardiovascular disease, which used to be limited to evidence from preclinical studies, case reports, and case series, is now evident in epidemiological studies, researchers from Stanford reported in a recent paper in Nature Reviews Cardiology.

A large-scale US study from 2024 relied on survey data from more than 430,000 respondents and found the 4% of respondents who reported using cannabis daily had a 49% increased risk for myocardial infarction and a twofold increased risk for stroke. The added risk from cannabis was similar among those who also smoked tobacco and those who never used tobacco.

The effect was also dose dependent. Among weekly users, cannabis was associated with a 3% increased likelihood of heart attack and a 5% increased risk for stroke.

Heart Attack and Stroke

The findings echo another Stanford University study from 2022, which analyzed UK Biobank data from 500,000 participants aged 40 years, and found those who reported smoking cannabis were significantly more likely to have a heart attack than compared with nonusers (53% vs 45%).

Several studies have found an association between arrhythmia, especially atrial fibrillation, and cannabis use. A study published last year in the European Heart Journal showed the risk for new onset arrhythmia in the first 180 days was 0.8% among more than 5000 patients who had filled a cannabis prescription vs 0.4% for control participants, matched according to age, sex, and the use of other pain medications.

Although cannabis contains 100t cannabinoids, research from cell culture and mouse models suggest tetrahydrocannabinol (THC) can cause inflammation and oxidative stress inside the vasculature, explained Mark Chandy, MD, PhD, a cardiologist scientist and assistant professor at Western University in London, Ontario, Canada. He is a co-author on the Stanford study as well as the Nature Reviews Cardiology paper.

THC binds to the CB1 receptor, found in the brain, but also in the myocardium, vascular endothelial, and smooth muscle cells. The CB1 receptor promotes atherosclerotic changes, Chandy explained, adding mouse models have found that cannabis increases atherosclerotic plaques. Scientists also theorize that cannabis might have a prothrombotic effect increasing the risk for heart attacks and strokes.

When it comes to arrhythmia, the activation of CB1 and CB2 receptors can also lead to enzyme inhibition that could ultimately affect the heart’s electrical conduction system.

Disturbing the Heart’s Electrical Conduction

Chip Lavie, MD, medical director at the John Ochsner Heart and Vascular Institute in New Orleans, Louisiana, said that “vasospasm and constriction of blood vessels combined with high platelet aggregation” is the most probable mechanism explaining the association between cannabis and cardiovascular disease. However, he also said that studies show that cannabis can increase the heart rate. “ Many studies show the benefits of a low resting heart rate,” he explained.

Lavie said that considering the evidence, he recommends patients avoid cannabis. If that is not possible, he advises patients to reduce their cannabis use and consume edible cannabis or oils, rather than smoking. Although there isn’t enough evidence to show that consuming cannabis by edibles or oils is safer for the heart, burning cannabis adds toxins.

Chandy suggested cardiologists inform patients who use cannabis about the potential long-term cardiovascular side effects. “I would advise them not to use cannabis. At least, they should be able to make an informed decision about it and know the potential consequences of it.” 

Despite the emerging association between cardiovascular disease and cannabis use, “there isn’t super strong evidence of causal effects,” said Anders Holt, MD, a cardiologist at Copenhagen University Hospital, Copenhagen, Denmark, who led the study that found higher rates of arrythmia among medical cannabis users. Mouse models frequently don’t translate to human physiology, he said.

Weighing the Evidence

As long-term randomized controlled trials studying cannabis and the heart are not feasible or ethical, evidence comes from observational studies, which are prone to confounders. For example, those who consume cannabis recreationally may be more likely to engage in other activities, like alcohol consumption or high-caloric diets, which can have an impact on cardiovascular results.

Much of the evidence linking cannabis use with coronary artery disease is based on studies of participants being asked about recent cannabis use. Patients may misremember previous use, focus only on their use in the last week, or hide their cannabis use from doctors.

Holt’s study was less prone to recall bias, as it relied on medical prescriptions, rather than self-reported data. Still, there could be important differences between patients who fill medical cannabis prescriptions and those who don’t.

Big picture, however, it may not matter whether the association between cannabis and an increased cardiovascular disease risk “is due to the lifestyle, or the selection of these patients, or the active components,” suggested Holt. “We know that people who use cannabis are at an elevated risk, so maybe they should be getting a more vigilant approach.” 

Talking to Patients

Holt said it would be reasonable “to bring up emerging evidence that puts into question whether medical cannabis is entirely safe for the heart” when talking to patients about lifestyle changes, they can make to reduce their risk for cardiovascular complications.

Despite the increased risk for arrhythmia, Holt said his study doesn’t imply that medical cannabis shouldn’t be used for chronic pain, however. For one, the overall absolute risk for arrhythmia remains low. For another, treating pain allows patients to engage in activities that are good for their overall health, and cannabis could be safer than alternatives. “There is very good evidence that nonsteroidal anti-inflammatory drugs (NSAIDs), antiepileptic drugs, and opioids are not ideal for the heart either.” 

In addition to discussing why patients use cannabis, Chandy suggested cardiologists discuss with their patients how much cannabis they consume and the route of administration. “One of the good things about legalization is that we now have labels to indicate approximately how much THC is inside,” said Chandy.

Chandy is especially concerned about synthetic cannabinoids, created in labs to bind more tightly to the CB1 receptor and create more intense psychedelic effects. “The data is more limited on the synthetic cannabis but given that it’s binding so tightly to the CB1 receptor, I would expect that it would cause more cardiovascular disease.” 

He also worries that the effects of cannabis will become more pronounced in the coming decades as research shows more young people are using cannabis. “Just like with cigarettes, it’s not just how much, but how long you’re exposed to it.”

Cannabis Use Linked to Lower Dementia Risk

Didn't your competent? doctor prescribe marijuana years ago to help your stroke recovery?  Oh, you don't have a functioning stroke doctor, do you? 

• 13 reasons for marijuana (132 posts to April 2014)

• marijuana (150 posts to April 2011)

But this: 

Pot Smoking Baby Boomers Are On The Rise, Why Are Scientists So Happy For Them? Hint: Benefits For The Aging Brain

And this:

The Experiments Revealing How Marijuana Could Treat Dementia

The latest here:

Cannabis Use Linked to Lower Dementia Risk

Summary: Recreational cannabis use may be associated with a significant decrease in the odds of experiencing subjective cognitive decline (SCD) in adults over 45. Analyzing data from the CDC’s 2021 Behavioral Risk Factor Surveillance System, researchers found that recreational users had 96% lower odds of reporting SCD compared to non-users.

This intriguing finding suggests potential protective effects of cannabis on cognition, although the study’s authors emphasize the need for longitudinal research to understand the long-term impacts. Despite its limitations, the study contributes to the evolving conversation around cannabis use and cognitive health, highlighting the importance of differentiating between medical and recreational use in research.

Key Facts:

1. Recreational cannabis use was associated with a significantly lower risk of subjective cognitive decline in adults over 45.
2. The study is unique in its examination of cannabis use’s type, frequency, and method, focusing on an older population.
3. There was no significant difference in the odds of SCD related to cannabis consumption frequency and method, suggesting the potential role of THC content in protective effects against cognitive decline.

Source: Bentham Science Publishers

A new study by Upstate Medical University researchers shows that recreational cannabis use may offer protection against cognitive decline.

The study, done by Master of Public Health (MPH) student Zhi Chen and Professor Roger Wong, Ph.D., MPH, MSW, analyzed a large data set from the CDC and found that compared to non-users, non-medical cannabis use, such as for recreational purposes, was significantly associated with 96 percent decreased odds of subjective cognitive decline (SCD).

Wong said he was surprised that mode and frequency had no bearing on SCD since other studies involving younger participants found a negative connection between brain health and cannabis use, indicating perhaps that the age of the participants plays a role in the different results. Credit: Neuroscience News

Medical and dual (medical and non-medical) use were also associated with decreased odds of SCD, although not significant. Cannabis consumption frequency and method were also not significantly associated with SCD.

SCD is an important outcome of interest as prior research shows individuals with SCD have a 2 times higher risk for dementia, which currently has no cure or definitive prevention approaches.

Wong said that previous studies have found negative associations between cannabis use and cognitive decline, so the results were surprising, though he is quick to point out the study had several limitations and that these results are just a snapshot of one year.

“The main takeaway is that cannabis might be protective for our cognition, but it is really crucial to have longitudinal studies because this is just a snapshot of 2021,” said Wong, assistant professor Department of Public Health & Preventive Medicine.

“We do not know if non-medical cannabis leads to better cognition or the other way around if those with better cognition are more likely to use non-medical cannabis.

“We need longitudinal studies to see long term if non-medical cannabis use is protecting our cognition over time. That’s something we don’t know yet, but that research is hindered since cannabis remains illegal federally.”

Data for this study was obtained from 4,744 U.S. adults aged 45 and older in the 2021 Behavioral Risk Factor Surveillance System (BRFSS). SCD was a self-reported increase in confusion or memory loss in the past year.

Odds of SCD by cannabis use reason, frequency, and method were examined after imputing missing data, applying sampling weights, and adjusting for sociodemographic, health, and substance use factors.

The study differs from previous research in that it focuses on middle-aged and older adults, and it uniquely considers the three facets of cannabis use: type of use (medical or non-medical), frequency of use, and mode of use (smoking, vaping, eating or dabbing).

“The reason I think this study is so great is we looked at all the different dimensions of cannabis use,” he said. “The fact that we included all three is a huge contribution to the research because I do not believe such a study has been done before.”

Wong said he was surprised that mode and frequency had no bearing on SCD since other studies involving younger participants found a negative connection between brain health and cannabis use, indicating perhaps that the age of the participants plays a role in the different results.

The study, which was published in Current Alzheimer Research was Chen’s final project in the Advanced Biostatistics course in the MPH program taught by Wong. 

“I applied the knowledge and analytical skills learned from the courses in the Public Health Methods concentration to this study,” Chen said.

“Dr. Wong guided me through the process, from formulating a research question to preparing a full manuscript. I feel fortunate to have incredible professors in our program who train us to become well-rounded public health professionals with the skills for epidemiology and biostatistics work.”

The authors did note some limitations with the study, including the inability to consider state-by-state cannabis regulations; thus, potential selection bias could arise if the population of certain states is either over or underrepresented due to varying measures of cannabis use.

Strengths of the study include using a national data set, which increases the generalizability of the findings. Wong said the difference in protection between medical and non-medical use comes down to the compounds that make up cannabis. Medical-grade cannabis has higher concentrations of CBD whereas non-medical has higher concentrations of THC.

Non-medical users often use cannabis to improve sleep and reduce stress. Poor sleep and chronic stress increase the risk for dementia so the protection in SCD could come from better sleep and stress relief that cannabis provides. Medical cannabis is used primarily for pain relief.

“Based on our findings, we don’t see the CBD in medical cannabis being beneficial for cognitive health,” Wong said.

About this cannabis and dementia research news

Author: Noman Akbar
Source: Bentham Science Publishers
Contact: Noman Akbar – Bentham Science Publishers
Image: The image is credited to Neuroscience News

Original Research: Closed access.
“Association Between Cannabis Use and Subjective Cognitive Decline: Findings from the Behavioral Risk Factor Surveillance System (BRFSS)” by Zhi Chen et al. Current Alzheimer’s Research

Cannabis Use Linked to Higher Anxiety Disorder Risk

I'm sure you got this totally backwards. People are self treating their anxiety disorder by using cannabis. You got cause and effect completely wrong! 

Didn't your competent? doctor prescribe marijuana years ago to help your stroke recovery?  Oh, you don't have a functioning stroke doctor, do you? 

• 13 reasons for marijuana (132 posts to April 2014)

• marijuana (150 posts to April 2011)

Cannabis Use Linked to Higher Anxiety Disorder Risk

Summary: A comprehensive study found a significant association between emergency department visits for cannabis use and the development of new anxiety disorders.

Analyzing health data from over 12 million Ontarians, the research revealed that individuals who sought emergency care for cannabis use exhibited a nearly fourfold increase in the risk of being diagnosed with an anxiety disorder within three years, compared to the general population. Additionally, the study highlights the potential for cannabis use to exacerbate existing anxiety symptoms.

These findings underscore the complexities of cannabis use and its impact on mental health, challenging the perception of cannabis as a benign substance and pointing to the need for caution in its medicinal or recreational use.

Key Facts:

1. Individuals requiring emergency care for cannabis use showed a 3.9-fold increased risk of developing new anxiety disorders compared to the general population.
2. The study also found a 3.7-fold increased risk of severe or worsening anxiety disorders following cannabis-related emergency department visits.
3. This extensive research suggests a potential causal relationship between cannabis use and increased anxiety, advocating against its use as a treatment for anxiety symptoms.

Source: ICES

Twenty-seven percent of individuals who had an emergency department visit for cannabis use developed a new anxiety disorder within three years, according to new research.

Led by researchers at the Bruyère Research Institute, University of Ottawa Department of Family Medicine, The Ottawa Hospital, and ICES, this is the largest study of the relationship between cannabis use and anxiety to date.

The current study finds that cannabis use may worsen anxiety and is the largest to date examining this question. Credit: Neuroscience News

Can Cannabis Improve Exercise Experience?

Didn't your competent? doctor prescribe marijuana years ago to help your stroke recovery?  Oh, you don't have a functioning stroke doctor, do you? 

• 13 reasons for marijuana (132 posts to April 2014)

• marijuana (150 posts to April 2011)

Can Cannabis Improve Exercise Experience?

Summary: A study of 42 runners reveals that using cannabis before exercise can boost mood and enjoyment. The study shows that both THC and CBD can enhance exercise experience, with CBD even outperforming THC in some aspects.

However, THC can make exercise feel more effortful due to increased heart rate. While cannabis may improve enjoyment, it’s not considered a performance-enhancing drug, and its use should be approached with caution.

Key Facts:

1. Cannabis, both THC and CBD, can enhance the enjoyment and mood during exercise, potentially making it more enjoyable.
2. CBD, in particular, showed significant benefits in enhancing exercise experience without the impairment associated with THC.
3. THC can increase heart rate, making exercise feel more challenging, and it’s not recommended for performance enhancement.

Source: University of Colorado

A bit of weed before a workout can boost motivation and make exercise more enjoyable. But if performance is the goal, it may be best to skip that joint.

That’s the takeaway of the first ever study to examine how legal, commercially available cannabis shapes how exercise feels.

The study of 42 runners, published Dec. 26 in the journal Sports Medicine, comes almost exactly 10 years after Colorado became the first state to commence legal sales of recreational marijuana, at a time when cannabis-users increasingly report mixing it with workouts.

“The bottom-line finding is that cannabis before exercise seems to increase positive mood and enjoyment during exercise, whether you use THC or CBD. But THC products specifically may make exercise feel more effortful,” said first author Laurel Gibson, a research fellow with the University of Colorado Boulder’s Center for Health and Addiction: Neuroscience, Genes and Environment (CU Change).

The findings, and previous research by the team, seem to defy long-held stereotypes that associate cannabis with “couch-lock” and instead raise an intriguing question: Could the plant play a role in getting people moving?

Cannabis RCT Shows Efficacy in Migraine but Side Effects Too

 In case you are self treating to prevent your stroke risk from migraines. 

If You Can See This, Your Stroke Risk Skyrockets, Study Says - migraine with aura.

The latest here:

Cannabis RCT Shows Efficacy in Migraine but Side Effects Too

AUSTIN, Texas — Self-treatment of migraines using cannabis can be effective but comes at risk of significant side effects, according to results from a randomized, controlled trial of cannabis products in migraine. The study also suggests that typical recreational doses may be higher than needed, and that products with a mixture of THC and CBD might limit adverse effects, according to lead author Nathaniel Schuster, MD.

"Patients are using cannabis on their own, treating themselves without us having known whether this is effective in a placebo-controlled study. Knowing that there's a lot of interest in THC and CBD, [it would be useful to know] whether one or both might be effective, as well as a mix," said Dr. Schuster in an interview. He presented the results at the annual meeting of the American Headache Society.

Dr. Schuster and colleagues tested a cannabis product with 6% THC based on prior studies showing efficacy of that concentration for other pain conditions, according to Dr. Schuster, who is an associate professor and associate clinical director at the University of California, San Diego, center for pain medicine. He added that the study is the first randomized, controlled trial of cannabis in migraine patients that he is aware of. "It's just hard to do this research. It's very regulated. We had to go through a lot of government approvals to do this," he said.

The study produced a key message. "I think one of the really important things for patients to take from this is that recreational doses are probably not necessary. The doses that we studied are lower than people use recreationally. Patients who are self-treating on their own right now are probably using higher doses than they need for the purpose of treating migraine," said Dr. Schuster.

He also pointed out that the results offer potential insight into reducing side effects. "If [patients] are using THC only, they can hopefully have less of the side effects and tolerate it better by using a THC-CBD mix," said Dr. Schuster.

Four therapies tested

Participants in the study could self-treat up to four migraine attacks. They were instructed to treat each migraine with one of four therapies, which were provided in a randomized, double-blind order: These included a 6% THC formulation; a mix of THC (6%) and CBD (11%); a CBD 11% formulation; and placebo cannabis with THC and CBD removed by alcohol extraction. Participants filled out a questionnaire 2 hours after treatment, and were then allowed to use rescue treatments if needed, but not additional cannabis. The age range was from 21 to 65, and inclusion criteria included 2-23 migraine days per month. Exclusion criteria included a positive urine test for THC, barbiturates, opioids, oxycodone, or methadone prior to enrollment.

The study included 73 patients who treated a migraine during the study period. There were 247 migraine attacks treated. Among participants, the median age was 41, 82.6% were female and 17.4% were male, and the median body mass index was 26.0 kg/m ². Participants experienced a median of 15 headache days per month and 6 migraine days per month, and 27.2% had chronic migraine.

At 2 hours, pain relief occurred in 48.3% of placebo treatments, 54.4% of the CBD treatments, 70.5% of the THC treatments ( P = .007 versus placebo), and 69.0% of the THC/CBD treatments ( P = .014 versus placebo). At 2 hours, pain freedom occurred in 15.5% of the placebo treatments, 24.6% of the CBD treatments, 29.5% of the THC treatments, and 36.2% of the THC/CBD treatments ( P = .010 versus placebo). At 2 hours, freedom from most bothersome symptoms (MBS) occurred in 36.2% of the placebo treatments, 43.9% of the CBD treatments, 49.2% of the THC treatments, and 62.1% of the THC/CBD treatments (P = .004 versus placebo).

To achieve at least a 20% improvement in pain relief, compared with placebo, the number needed to treat (NNT) with THC/CBD was five. For at least a 20% improvement in pain freedom, the NNT was five, and for a 20% improvement in freedom from most bothersome symptoms, the NNT was four.

Treatment with THC was associated with the highest frequency of any adverse event (31.0%), followed by CBD and THC/CBD (19.6% each), and placebo (5.0%). At 2 hours, 18.0% of the THC treatments had an adverse event, compared with 7.0% of the CBD treatments, 6.9% of the THC/CBD treatments, and 5.2% of placebo treatments.

The number needed to treat of five for pain relief was encouraging, according to Dr. Schuster. "It's better than some other things, but at the expense of side effects. The side effects that we see are certainly higher with cannabis than it is with other migraine treatments that patients certainly should be using beforehand. There's also a risk of addiction, which is a concern," said Dr. Schuster.

Useful data but questions remain

Having a clinical trial will be useful for physicians, said Ali Ezzati, MD, who attended the session. "I think it was an impressive study. Obviously, there are some challenges with cannabis studies in the medical world because of the stigma that comes with it and also the possibility of inducing addiction [and] promoting that to patients. But at the end of the day, it's very, very common for our patients to ask us about cannabinoid use, and we really don't have data on it. I'm glad that there are people who are running these studies so we will be able at least to answer our patients," said Dr. Ezzati, who is an associate professor of neurology at University of California, Irvine.

Dr. Ezzati also noted that clinical trials have investigated cannabinoid use for other types of pain, such as arthritic or generalized pain. Although he said that there are some clinical similarities between other types of pain and migraine, the pathophysiology appears to be unique, which means that more work needs to be done. "It will probably take 5 or 10 years to have sufficient data to give patients a direct path for using (cannabinoids)," said Dr. Ezzati.

The study was funded by the Migraine Research Foundation. Dr. Schuster has consulted with Schedule 1 Therapeutics and Vectura Fertin. Dr. Ezzati has no relevant financial disclosures.

 

Patient recruitment underway in phase 2a trial for cannabis oil dementia treatment

 With your elevated risk of dementia post stroke, if your doctor isn't closely following this research you don't have a functioning stroke doctor or hospital. Don't do anything with this until your doctor oks it.

Your risk of dementia, has your doctor told you of this?

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

What is your doctor's EXACT PROTOCOL TO PREVENT DEMENTIA?

The latest here:

Patient recruitment underway in phase 2a trial for cannabis oil dementia treatment 

MediCane Health Inc. announced recruitment of the first patient for its phase 2a study designed to assess the effects of cannabis oil in adults with probable Alzheimer’s disease who have limited or no response to antipsychotic medication.

According to a company release, the trial is being conducted in two leading academic hospitals in Israel — Sheba Medical Center and Sourasky Medical Center. The trial will include 55 participants, who will receive MediCane’s balanced THC:CBD orally administered cannabis oil extracted from MediCane’s proprietary strain and formulated for blinding purposes, in addition to standard care.

MediCane Health Inc. will soon commence a phase 2a clinical trial to test its proprietary oral medical cannabis oil on patients with behavioral and psychological symptoms of dementia. Source: Adobe Stock.

The first part of the study is an open-label phase that will enroll 15 participants for safety and dose-range finding, followed by a randomized, double-blind, placebo-controlled second phase that will include 40 participants to evaluate safety and efficacy, the company stated.

According to the release, agitation and disruptive behaviors, expressed as excessive fidgeting, restlessness, pacing, shouting, screaming, uninhibited behaviors and aggression, are present in over half of patients with dementia at some point during the illness.

“MediCane is proud to collaborate with two of the leading medical centers in Israel in our journey to find a safe and effective cannabis-based medicine for [behavioral and psychological symptoms of dementia] symptom relief,” Nurit Tweezer-Zaks, MD, MBA, CEO of MediCane research and development, said in the release. “Through this joint effort we hope to be able to successfully complete the study during 2024 and launch the product in Israel, Germany and additional EU markets.”

‘There’s a real risk there’: Cannabis use exacerbates depression

 

Are you sure you got cause and effect right?

Vastly more likely that people with mental health problems are self medicating with marijuana. We can't let crap research like this prevent having marijuana available for stroke recovery.  

My 13 reasons for marijuana use post-stroke.  

Don't follow me, I'm not medically trained and I don't have a Dr. in front of my name.

‘There’s a real risk there’: Cannabis use exacerbates depression

By Stephanie Viguers

Source/Disclosures

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CHICAGO — Cannabis has been approved by state legislators across the United States for more than 50 medical indications, according to a speaker at the ACP Internal Medicine Meeting.

Kari L. Franson, PharmD, PhD, BCPP, a professor of clinical pharmacy at the University of Southern California, said these indications include Alzheimer’s disease (n = 15 states), epilepsy/seizures (n = 31 states), nausea (n = 20 states), amyotrophic lateral sclerosis (n = 22 states), pain (n = 30 states), autism (n = 14 states), Parkinson’s disease (n = 15 states), cachexia (n = 24 states), hepatitis C (n = 11 states), peripheral neuropathy (n = 11 states), cancer (n = 30 states), HIV/AIDS (n = 31 states), PTSD (n = 30 states), Crohn’s disease (n = 20 states), multiple sclerosis (n = 22 states), Tourette’s syndrome (n = 7 states) and glaucoma (n = 27 states).

Cannabis has been approved by state legislators across the United States for more than 50 medical indications, according to a speaker at the ACP Internal Medicine Meeting. Source: Adobe Stock.

“I’ll tell you right now, [cannabis] doesn’t work for glaucoma,” Franson said during the presentation. “Isn’t it funny that 27 states have it as something that it is legal for? So, it’s not evidence based. It’s based on compassion.”

For the most part, Franson said that she only considers recommending medical cannabis when patients ask about it. Among all the indications, only pediatric seizures, MS and pain have “reasonable data” to suggest cannabis is beneficial, she added.

“The evidence for using THC-type cannabis for pain is quite good,” Franson said.

The short-term effects associated with THC-type cannabis include dizziness, disorientation, euphoria, dry mouth, somnolence, nausea/vomiting, fatigue, depression and anxiety. Less is known about the long-term effects, Franson said. But evidence suggests that it can cause cannabinoid hyperemesis syndrome, stroke, acute myocardial infarction, impaired cognitive functioning and psychiatric effects such as insomnia, anxiety, cannabis use disorder, psychosis and depression.

Although recent research has shown that cannabis can reduce depression in the short term, the symptoms appear to worsen over time. This was demonstrated in a naturalist study conducted in Canada. Most patients (89%) who reported feeling stressed, anxious or depressed had a 50% reduction in depression after 20 minutes of cannabis use, and 94% had a 58% reduction in anxiety, according to Franson. However, baseline symptoms of depression exacerbated gradually.

“This is the thing that I really would love to see imprinted in your brains when you all walk out of here,” Franson told attendees. “I see a lot of patients who use cannabis chronically and really struggle with depression. I can’t stress to you enough how difficult it is to talk to a patient about their depression symptoms when they’re utilizing cannabis and they are convinced how much it makes them feel better.”

The risk for depression — and other poor outcomes — is particularly evident in adolescents, Franson said.

A previous meta-analysis of 11 longitudinal and prospective studies showed that adolescents who used cannabis were more likely than nonusers to attempt suicide (OR = 3.46; 95% CI, 1.53-7.84), experience suicidal ideation (OR = 1.5; 95% CI, 1.11-2.03), and develop depression (OR = 1.37; 95% CI, 1.16-1.62) or anxiety (OR = 1.18; 95% CI, 0.84-1.67).

“There’s a real risk there,” Franson said.

References:

Cuttler C, et al. J Affect Disord. 2018;doi:10.1016/j.jad.2018.04.054.

 

How does cannabis use affect brain health? Caution advised, more research needed

 For kicks ask your doctor about this:

‘Put Ya’ Lighters Up’: New Study Finds Cannabis Could Block COVID-19 From Entering The Body

It is completely up to you to figure out what to do post stroke with marijuana. Your doctor will know nothing concrete. Here are my posts on the subject: But don't listen to me, I'm not medically trained.

• marijuana (142 posts to February 2011)

My 13 reasons for marijuana use post-stroke. 

The latest here:

How does cannabis use affect brain health? Caution advised, more research needed

American Heart Association Scientific Statement

Statement Highlights:

• Although recreational and medicinal marijuana (cannabis) is increasingly available across the U.S., public and professional awareness that cannabis use may adversely affect brain health is critical, according to the American Heart Association’s first scientific statement on the subject.
• Animal studies indicate that marijuana’s psychoactive component, THC, may lead to behavioral and cognitive abnormalities, particularly if exposure occurs prenatally or during adolescence.
• However, studies in humans have had mixed results, with some suggesting a higher risk of cognitive impairment due to marijuana use and further research needed on exact consequences.
• The statement outlines the latest research and the need for future studies to address several open questions about how marijuana may impact brain health.

Embargoed until 6 a.m. CT / 7 a.m. ET Thursday, Feb 10, 2022

DALLAS, Feb. 10, 2022 — Despite the perception that marijuana is harmless, there is some scientific evidence challenging that belief, and there are many unanswered questions about its impact on brain health, according to a new American Heart Association scientific statement published today in the Association’s journal Stroke. This scientific statement will be presented and discussed during a symposium at the Association’s International Stroke Conference in New Orleans, today at 7 a.m. CT/ 8 a.m. ET. An American Heart Association scientific statement is an expert analysis of current research and may inform future clinical practice guidelines.

“There’s a lot of uncertainty in the medical community about the health effects of marijuana. This scientific statement is intended to guide health care professionals in having a balanced and intentional discussion with patients about the potential known and unknown effects of marijuana on brain health,” said writing group Chair Fernando D. Testai, M.D., Ph.D., FAHA, a professor of neurology and rehabilitation at the University of Illinois at Chicago.

This is the Association’s first scientific statement on cannabis and brain health, following a statement on marijuana and cardiovascular health, published in August 2020. Both statements are important since marijuana use in the U.S. is increasing, particularly among adolescents and young adults, with about one-third of 12^th graders and nearly half of college students reporting marijuana use in 2018. In addition, the use of marijuana medicinally and/or recreationally has been legalized or decriminalized in many states across the U.S. in the past 2 decades, and the concentration of tetrahydrocannabinol (THC, the psychoactive component in marijuana) in cannabis products has increased significantly, from about 4% in 1995 to 15% in 2018.

The most studied chemicals in cannabis are THC and CBD. THC is the compound in marijuana that gives the sensation of being high. CBD (cannabidiol) has antioxidant and anti-inflammatory properties but does not have psychoactive effects. The potential therapeutic benefits of CBD continue to be investigated in clinical trials.

The U.S. Drug Enforcement Agency (DEA) and the Food and Drug Administration (FDA) classify cannabis as a Schedule I controlled substance, on par with heroin and LSD, for having a “high potential for abuse and little to no medical benefit.” In contrast, CBD is legal when derived from hemp, which is the same species of plant as cannabis and contains less than 0.3% THC.

To fully understand the potential impact of marijuana, it’s important to know that the human body naturally produces compounds called endocannabinoids that are similar to those in marijuana. Endocannabinoids are involved in the regulation of many body processes throughout life (including learning, memory, pain control and sleep), and the action of endocannabinoids is essential to prenatal brain development and to brain maturation during adolescence.

Endocannabinoids, as well as THC, can attach to neurons in the brain through molecules called cannabinoid receptors. When THC activates cannabinoid receptors in the brain, it can disrupt the normal actions of endocannabinoids. “These receptors are highly concentrated in brain areas related to cognition,” said Testai.

According to the statement, previous animal studies (in rodents) indicate that prolonged exposure to THC disrupts memory and learning, and impacts brain development and maturation in specific ways if exposed at certain stages of life:

• During prenatal life, an important time for brain development, THC disrupts the normal signaling pathways of the endocannabinoid system and may alter the offspring’s thinking, emotional behavior and response to stress.
• During adolescence, an important time for brain maturation, THC changes the structure and function of brain circuits, particularly in areas involved in cognition, emotional regulation and social behavior (such as the prefrontal cortex and hippocampus).

“Data obtained in these animal studies demonstrate that disruption of endocannabinoid pathways leads to behavioral and cognitive abnormalities, such as poorer memory and learning ability and a heightened sensitivity to stress. Also, there may be vital life periods – gestation and adolescence – when the brain may be particularly vulnerable to the impact of THC,” Testai said.

While the exact timing and amount of marijuana exposure are more easily controlled in animal studies, as well as controlling the animals’ social and environmental conditions, human research studies cannot replicate similar strict parameters. Thus, results from existing studies in humans have been mixed, yet raise similar concerns about the impact of marijuana exposure on brain health. Among the studies in humans summarized in the scientific statement, the findings included:

• While actively using marijuana, people demonstrated worse scores on driving road tests when using THC-dominant marijuana, compared to when they were using CBD-dominant marijuana or no marijuana.
• In young adults who were followed for 25 years as part of a heart disease research project, scores on verbal memory tests declined in correlation to more years of self-reported exposure to marijuana.
• There were more psychological problems and poorer cognitive function in children (average age 9) whose mothers reported using marijuana during pregnancy.
• Marijuana use during adolescence has been associated with thinning in an area of the brain involved in cognition (the prefrontal cortex), with greater exposure to marijuana associated with more thinning. However, other studies detected no difference.
• Structural changes in the brain were visible in some studies comparing marijuana users and non-users. Specifically, there was thinning of brain areas important in orchestrating thoughts and actions, or decreased volume in an area of the brain important for memory.  Other studies that compared cognitive testing and brain imaging found no differences between marijuana users and non-users.
• Cannabis users were found to have an increased risk of clot-caused stroke, with one study finding 17% more and another finding 24% more strokes among cannabis users.

 The statement also highlights numerous open questions on the impact of cannabis on brain health, including:

• Does marijuana’s impact on brain health differ depending on the person’s age?
• How does marijuana interact with other substances such as prescription medications? This is a particular concern in elderly people who may be using multiple medications such as blood thinners, antiarrhythmia or anticonvulsant medications to treat other chronic health conditions.
• Do the effects of marijuana differ whether it is used recreationally or prescribed for the treatment of a specific medical condition?
• How much marijuana is too much? In older research studies conducted when marijuana was illegal in all U.S. states, there may have been significant under-reporting of how frequently marijuana was used.
• Do different types of marijuana (such as higher THC levels or synthetic cannabinoids) impact the brain differently?
• Are there differences in brain health depending on whether marijuana is smoked or consumed in an edible product?

“Our understanding of the effects of marijuana on the brain is imperfect, and human research in this area is a work in progress. Still, the results of recent animal studies challenge the widely accepted idea that cannabinoids are harmless and call for caution when using marijuana, particularly while pregnant or during adolescence,” said Testai.

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Stroke Brain Health Science Subcommittee of the Stroke Council; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Council on Cardiovascular and Stroke Nursing; the Council on Lifestyle and Cardiometabolic Health; and the Council on Peripheral Vascular Disease. The American Academy of Neurology has affirmed this scientific statement as an educational tool for neurologists.   

American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Philip B. Gorelick, M.D., M.P.H.; Hugo J. Aparicio, M.D., M.P.H.; Francesca M. Filbey, Ph.D.; Raul Gonzalez, Ph.D.; Rebecca F. Gottesman, M.D., Ph.D.; Miriam Melis, Ph.D.; Mariann R. Piano, R.N., Ph.D.; Tiziana Rubino, Ph.D.; and Sarah Y. Song, M.D. Authors’ disclosures are listed in the manuscript.

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

• Available multimedia is on right column of release link https://newsroom.heart.org/news/how-does-cannabis-use-affect-brain-health?preview=329ced6977544b97516adddd1ac008f1
• After Feb. 10, 2022, view the manuscript online.
• AHA news release: Marijuana users’ risk of deadly complication doubles after rare type of bleeding stroke (January 2022)
• AHA news release: Marijuana use associated with complications after heart attack or procedures (November 2020)
• AHA news release: Cannabis may be linked to strokes and heart rhythm disturbances in young people (November 2019)
• Follow AHA/ASA news on Twitter @HeartNews

 

Cannabis-Based Products in a Neurological Setting: A Clinical and Pharmacokinetic Survey

I suppose you could ask your doctor to get Sativex from the UK off label for your spasticity.

Sativex, a cannabis based spray, was approved in England in 2019 for use in moderate to severe spasticity(only MS) when other treatments haven’t worked.

Currently, Sativex is not approved for any indication in the US, so you are totally screwed unless you are in a legal marijuana state and want to experiment on your own. But you can't, that would only be allowed if prescribed by your doctor. And your doctor will never prescribe marijuana.

 

Cannabis-Based Products in a Neurological Setting: A Clinical and Pharmacokinetic Survey

Susan Mohamed¹, Giovanna Lopane¹, Loredana Sabattini¹, Cinzia Scandellari¹, Diletta Zardi², Vincenzo Donadio¹, Giovanni Rizzo¹, Alessandro Perrone¹, Alessandra Lugaresi^1,2† and Manuela Contin^1,2*†

• ¹IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
• ²Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

Background and Aim: Limited data are available in clinical settings on the pharmacokinetics of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). We investigated the use of cannabis-based products in neurological practice, monitoring patients' steady-state cannabinoids (CBs) plasma concentrations matched with different preparations.

Methods: This was a prospective, single-center, observational study. Patients underwent venous blood withdrawal before the CBs' morning dose and then 2.5 h post-dosing. Spasticity or pain were patient self-assessed by the Numeric Rating Scale (NRS) before the morning CB's administration and 2.5 h post-dosing.

Results: Thirty-three patients were enrolled. Main indications for CBs were spasticity and chronic pain. Sixteen patients were treated with oromucosal spray formulation Sativex^® and 17 with oil-based solutions. Both CBs trough plasma concentrations were ≤ limit of detection (0.1 ng/ml) in 45% of patients. Intrasubject CB's plasma levels significantly increased over baseline values in patients treated with Bediol^® oil (p < 0.05) and Sativex^® (p < 0.01). Post-dosing CB's bioavailability did not significantly differ between oral oil and oromucosal spray. NRS scores decreased (p < 0.01), matching the increase (p < 0.01) in CB's plasma concentrations.

Conclusion: This is the first study investigating CB's plasma concentrations of oral and oromucosal preparations in real-world neurological practice. Findings of similar bioavailability for both CBD and THC after galenic oil compared with oromucosal spray dosing may be clinically relevant and deserve additional research in larger cohorts.

Introduction

The cannabis plant contains several substances, such as more than one hundred cannabinoids (CBs) (1). There is great interest in the use of cannabis for the management of many diseases and symptoms (2) and the attention has been focused in particular on the two CBs, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) (3).

Two types of CB receptors have been identified, CB1 and CB2, which are parts of the human endocannabinoid system, involved in various functions, such as muscle spasticity, analgesic activity, anticonvulsant properties, vasodilatory and hypotensive action, and appetite (3).

THC is a partial agonist of CB1 and CB2 receptors. The main pharmacological effects of THC are psychoactivity, analgesia, muscle relaxation, anti-vomiting, and stimulation of appetite (3). Muscle relaxant effects are also recognized for hyper-reflexic bladder (4, 5).

Cannabidiol does not have a direct effect on the CB1 or CB2 receptors responsible for cannabis psychoactivity but it has been shown to have a negative allosteric activity on CB1 (6). From experimental models of epilepsies, different CBD mechanisms have emerged, such as antagonism of G protein-coupled receptor 55 (GPR55), desensitization of transient receptor potential of vanilloid type 1 (TRPV1) channels, and interactions with voltage-gated sodium and potassium channels (7). Other mechanisms associated with anti-inflammatory pathways include direct agonistic activity on serotonin 1A and adenosine A2A receptors (8). The main pharmacological effects of CBD are antiseizure, muscle relaxant, anxiolytic, and anti-inflammatory (1).

In the literature, several works have examined the efficacy and safety of CB's preparations in the treatment of a series of symptoms associated with neurological diseases, such as multiple sclerosis (MS), epilepsies, Huntington's disease, Parkinson's disease, cervical dystonia, and Tourette's syndrome. These applications were reviewed by an ad hoc guideline development subcommittee of the American Academy of Neurology (9). Chronic pain is another field of use of therapeutic cannabis, although few rigorous studies have evaluated its effectiveness (10).

Available data on CB's safety from clinical trials and real-world experience show that the most common adverse effects (AEs) associated with THC are dizziness, drowsiness, dry mouth, nausea/vomiting, impairment in cognitive function (perception disorders, euphoria, and confusion) and psychomotor skills, balance, and coordination problems (11). Studies on recreational cannabis have suggested a link between early, frequent use of high potency THC, and earlier onset of psychosis in subjects with a personal or family history of schizophrenia or psychotic disorders (12). CBD's common AEs include diarrhea, somnolence, pyrexia, decreased appetite, vomiting, and upper respiratory tract infection (11).

In Italy, two cannabis medicinal products are authorized: one based on THC and CBD, in the approximate 1:1 dose ratio (2.7 mg THC and 2.5 mg for CBD), in a spray for oral mucosa (Sativex^®, GW Pharmaceuticals, UK), indicated to relieve symptoms in adult patients who suffer from moderate to severe spasticity due to MS. The other, marketed from the end of June 2021, is based on purified plant-based CBD, in an oil oral formulation (Epidiolex, GW Pharmaceuticals, UK), indicated as an adjunct treatment of seizures associated with two rare, severe forms of epilepsy with childhood onset, the Lennox-Gastaut and Dravet syndromes. Furthermore, there are several available cannabis galenical preparations (i.e., oil extracts, decoctions) characterized by different percentages of THC and CBD (Supplementary Table 1), which can be prescribed by physicians to users registered on the Italian Ministry of Health database (13). Eligible indications of medical cannabis include the management of the chronic pain associated with MS and spinal cord injury, the control of nausea and vomiting due to chemotherapy, radiotherapy, or HIV therapy, the handling of appetite loss in oncologic and HIV-positive patients. Medical cannabis is also indicated for its appetite stimulant effect in cachexia and anorexia, its hypotensive effect in glaucoma, and as antispasmodic in Tourette's syndrome (14).

Despite the substantial number of published studies, data on the pharmacokinetics of THC and CBD are limited (15, 16). In particular, the pharmacokinetics of CBs from oral galenical preparations has not been extensively studied in clinical settings (17). CB's posological protocols for physicians are missing (14), thus, currently the management of dosing is largely empirical, based on a balance between the desired therapeutic effects and the prevention of the adverse ones. Knowledge of CB's pharmacokinetics from different available formulations could help the prescribers in optimizing therapeutic regimens.

The purpose of this study was to investigate the use of cannabis-based products at the Institute of Neurological Sciences of Bologna (ISNB), such as indications, type of patients treated, formulations, dosages, evidence of efficacy, and AEs, and to monitor steady-state CB's plasma concentrations matched with different cannabis-based products.

More at link.