Cannabis use among cancer survivors; CBD's efficacy for burnout among Covid-19's frontline workers; and more
Research on cannabis for pain and a study of cannabis and cognition for Wednesday, August 25, 2021 (1590 words, 8 minutes)
As medical cannabis research advances, questions regarding its viability for treating different conditions are always on the rise. This is especially when it comes to pain management and cancer, which seem to be common areas of interest for medical cannabis research. At the same time, the Covid-19 pandemic has affected our lives in every way imaginable. One of the effects of the pandemic was that it opened new areas of medical research. For example, the Covid-19 crisis led to studies of medical cannabis and how it might affect this virus.
This edition of CJMC Fortnightly explores research involving cannabis use among cancer survivors in the United States and also examines a recent study conducted to determine the efficacy and safety of CBD for the treatment of burnout and emotional exhaustion among frontline healthcare workers during the Covid-19 pandemic. Today, we also summarize a cross-sectional survey of the quality of patient information on the internet regarding the use of cannabis for pain. On a different note, this issue provides highlights of an observational study of cognition in medical cannabis patients published in the Journal of the International Neuropsychological Society.
If you are new to our e-newsletter, welcome to our community. We are delighted to have you join us. Every two weeks, CJMC Fortnightly provides readers with an update on new findings regarding medical cannabis. Delivering your cannabis news this week is Cristela Tello Ruiz of the Canadian Journal of Medical Cannabis (CJMC), a publication for physicians produced in Toronto, Canada. Here is this week’s medical cannabis news:
Cannabis use among cancer survivors in the United States: Analysis of a nationally representative sample
A study conducted by Virginia Commonwealth University in Richmond, Va., examined the utilization of cannabis among cancer survivors in the USA and found that cannabis use in this group is increasing slowly. However, according to the study’s abstract, research on cannabis use among those with a history of cancer is still limited.
Study framework
The researchers collected data on the prevalence of past-year cannabis use among individuals with and without a cancer history from the Population Assessment of Tobacco and Health study.
The Population Assessment of Tobacco and Health study is a nationally representative survey conducted in four different waves in the United States between 2013 and 2018.
Findings
In the most recent survey, 8% of cancer survivors reported past-year cannabis use compared to 15% of those without a history of cancer.
Across the four survey waves, an estimated 3.8% of cancer survivors engaged with cannabis, compared to 6.5% of those without a cancer history.
Older age and access to health insurance were associated with a lower likelihood of cannabis use.
Greater levels of pain were associated with a higher likelihood of cannabis use.
Bottom line
The study concludes that while cannabis use is slightly lower among cancer survivors, cannabis use is generally increasing across both populations. The researchers also note that factors related to pain relief seem to be more prevalent in cancer populations and could be contributing to cannabis use among cancer survivors.
Insights from the world of medical cannabis research
“Less than 200 patients with rheumatic diseases have been studied in the evidence-based, randomized clinical trials regarding cannabis. We have a lot of anecdotal evidence, but this is not the scientific evidence we need to make good treatment choices.”
-- Dr. Mary-Ann Fitzcharles, associate professor of medicine in the Division of Rheumatology at McGill University in Montreal (CJMC 2019; 3:10).
Efficacy and safety of cannabidiol plus standard care vs. standard care alone for the treatment of emotional exhaustion and burnout among frontline healthcare workers during the Covid-19 pandemic
A group of researchers from multiple universities around the world, including the University of São Paulo in Brazil and McMaster University in Canada, conducted a randomized clinical trial to evaluate the viability of CBD to treat emotional exhaustion and burnout in healthcare frontline workers during the Covid-19 crisis. The researchers found that CBD can help diminish emotional exhaustion and burnout symptoms in this population.
The study’s abstract notes that frontline health care professionals who work with patients diagnosed with Covid-19 have an increased rate of burnout symptoms. The researchers also hypothesize that because CBD has anxiolytic and antidepressant properties, it may be capable of reducing emotional exhaustion and burnout symptoms in frontline healthcare workers dealing with Covid-19 patients.
Study framework
An open-label, single-site randomized clinical trial.
Randomization used a 1:1 block design.
Participants included frontline healthcare professionals working with Covid-19 patients at the Ribeirão Preto Medical School University Hospital in São Paulo, Brazil
A total of 120 participants were randomized to receive either CBD (300 mg divided into two daily doses of 150 mg each) plus standard care or standard care alone for 28 days.
Emotional exhaustion and burnout symptoms were assessed for 28 days using the emotional exhaustion subscale of the Brazilian version of the Maslach Burnout Inventory–Human Services Survey for Medical Personnel.
Findings
In the CBD group, scores on the emotional exhaustion subscale significantly decreased at day 14, day 21 and day 28 compared to the standard care group.
Five participants in the CBD group experienced serious adverse events: four cases of elevated liver enzymes and one case of severe pharmacodermia.
Bottom line
The study concludes that overall, CBD therapy reduced symptoms of burnout and emotional exhaustion among healthcare professionals during the Covid-19 pandemic. However, the researchers specify that it is necessary to balance the benefits of CBD therapy with its potential adverse effects. Future double-blind placebo-controlled clinical trials are needed to confirm the findings.
Cannabis for pain: A cross-sectional survey of the patient information quality on the internet
In a study published by the Journal of Cannabis Research, researchers from McMaster University in Hamilton, Ont., found that most of the information regarding the utilization of cannabis for pain management available online is somewhat biased.
The study’s abstract notes that patients thinking about using cannabis for pain relief often see information online but may not be able to identify trustworthy and accurate sources. For this reason, the researchers emphasized the importance of healthcare practitioners playing a role in assisting them in discerning the quality of information.
Study framework
A cross-sectional quality assessment of website information was conducted.
Websites from three countries were searched on Google: Canada, the Netherlands, and the United States. Only websites in English were included.
The first three pages of generated websites were used.
Eligible websites contained consumer health information on cannabis for pain management.
Encyclopedias, forums, academic journals, general news websites, major e-commerce websites, websites not publicly available, books, and video platforms were excluded.
The information presented on eligible websites was assessed using the DISCERN instrument.
The DISCERN instrument consists of three sections:
The reliability of the publication.
The individual aspects of the publication.
An overall averaged score.
Findings:
Of 270 websites, 216 were duplicates, and 18 were excluded based on eligibility criteria, resulting in 36 eligible websites.
Websites selling cannabis products/services scored the lowest on the DISCERN score, while health portals scored the highest.
Bottom line
The study concluded that online cannabis consumer health information for the treatment and management of pain presents biases to readers. These biases included websites that selectively cited studies that supported the benefits associated with cannabis use while neglecting to mention those studies discussing its risks. Another bias was the promotion of cannabis as a natural product with the implication that this means the substance is inherently safe.
The researchers conclude by noting that it is important for healthcare providers to be involved with their patients’ quests for information to ensure that they find the right resources online.
Insights from the world of medical cannabis research
“I believe that medical cannabis should be considered for the treatment of PTSD, not as a monotherapy but rather as an alternative treatment modality that is part of an individualized comprehensive, holistic care plan.”
--Lisa Ducharme, Nurse Practitioner at Canadian Nurse Practitioner Services in Toronto (CJMC 2019; 3:12).
An observational, longitudinal study of cognition in medical cannabis patients over the course of 12 months of treatment: Preliminary results
In research recently published by the Journal of the International Neuropsychological Society, researchers from McLean Hospital Imaging Center in Boston assessed cognitive and clinical measures in medical cannabis patients over one year finding that medical cannabis can enhance cognition.
According to the paper’s abstract, few studies have assessed the long-term impact of medical cannabis use on cognition but studies examining recreational cannabis users generally do report cognitive decrements.
Because medical cannabis patients are different from recreational consumers relating to reasons for use and product selection, the researchers assessed cognitive and clinical measures in this population. Based on previous findings, they hypothesized that medical cannabis patients would not show decrements and might instead demonstrate improvements in cognition over time.
Study framework
Patients completed a baseline visit prior to initiating medical cannabis and completed evaluations after three, six and 12 months of treatment.
At each visit, patients completed a neurocognitive test assessing executive function, verbal learning and memory.
Clinical scales assessed mood, anxiety and quality of sleep.
Exposure to THC and CBD was quantified.
Findings
Relative to baseline, medical cannabis patients demonstrated significant improvements on measures of executive function and clinical state over the course of 12 months.
Verbal learning and memory performance generally remained stable.
Improved cognitive performance was not correlated with medical cannabis use but clinical improvement was associated with higher CBD use.
The analysis also suggested that cognitive improvements were associated with clinical improvement.
Bottom line
The study concludes that the results build on previous findings that indicate medical cannabis patients may exhibit enhanced executive function over time. The researchers express that future studies should examine distinctions between recreational and medical cannabis use to identify potential mechanisms related to cognitive changes.
The next edition of CJMC Fortnightly will be distributed on Wednesday, September 8. Sign up for a free subscription by clicking the link below.
If you are a healthcare provider and you found this newsletter valuable, you may wish to request a subscription to the Canadian Journal of Medical Cannabis, our quarterly Medical Cannabis research publication, at www.cjmc.ca