Medical cannabis for chronic pain; cannabis and inflammation in HIV; and more
Research regarding cannabis and chronic pain, a study to determine the viability of CBD gels in children and a review of cannabis and sleep for Wednesday, September 22, 2021 (1435 words, 7 minutes)
Medical cannabis research keeps advancing at a significant pace. Certain conditions such as chronic pain and epilepsy are under study by many groups, but research regarding viruses, such as HIV, is also gaining recognition. At the same time, the legalization of cannabis in certain countries has contributed to the narrative that builds around its alleged benefits. For example, when it comes to the ability of cannabis to promote sleep, it can be challenging to distinguish scientific facts from myths.
This edition of CJMC Fortnightly explores a study led by McMaster University that examines the use of medical cannabis or cannabinoids for chronic pain. This report also highlights a review of human and animal studies regarding cannabis and inflammation in patients with HIV. Today, we also summarize a narrative review exploring the relationship between cannabis and sleep to separate facts from popular beliefs. On a different note, this issue examines research conducted to determine the viability of transdermal cannabidiol gel in children with developmental and epileptic disorders.
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:
Medical cannabis or cannabinoids for chronic non-cancer and cancer-related pain: A systematic review and meta-analysis of randomized clinical trials
A study led by McMaster University in Hamilton, Ont. showed some pain relief in medical cannabis users. According to the study’s introduction, medical cannabis is increasingly used to manage chronic pain, but the current guideline recommendations around the use of the substance are inconsistent and variable.
The main objective of this systematic review was to determine the benefits and harms of medical cannabis and cannabinoids for chronic pain.
Study framework
The researchers searched online for randomized clinical trials of medical cannabis or cannabinoids versus non-cannabis control for chronic pain.
The used sources included: MEDLINE, EMBASE, AMED, PsycInfo, CENTRAL, CINAHL, PubMed, Web of Science, Cannabis-Med, Epistemonikos, and trial registries up to January 2021.
Findings
Data from 32 randomized controlled trials showed that the use of oral and topical cannabis resulted in minor improvements in pain relief.
The data also showed small benefits in physical functioning and sleep.
There were minor side effects reported, including dizziness, drowsiness, impaired attention and nausea.
Bottom line
The study concludes that evidence shows that non-inhaled medical cannabis or cannabinoids result in some improvement in pain relief and sleep quality among patients with chronic pain. The researchers also suggest that the treatment guidelines surrounding the substance are too inconsistent. As a result, they have created a clinical practice guideline.
Insights from the world of medical cannabis research
“There are a lot of harms that people talk about with cannabis, such as early-onset psychosis affecting teens and adults, or becoming addicted, but this evidence has been based on recreational cannabis use. Future research should compare long-term and serious harms of medical cannabis with other management options for chronic pain, including opioids.”
-- Professor Jason Busse, associate director of McMaster University’s Michael G. DeGroote Centre for Medicinal Cannabis Research and associate professor, in a report from Global News (Sept. 9, 2021).
Cannabis and inflammation in HIV: A review of human and animal studies
A group of researchers from California found that some cannabis components have anti-inflammatory properties that could benefit people diagnosed with the human immunodeficiency virus (HIV).
According to the study’s abstract, persistent inflammation occurs in people with HIV and has many adverse effects, including myocardial infarction, neurocognitive impairment and even death. The researchers emphasize that cannabidiol (CBD) may be particularly effective as anti-inflammatory therapy.
Study framework:
This study was a selective, non-exhaustive review of the literature on the effects of cannabis on inflammation in people with HIV (PWH).
Findings
The proportion of PWH who use cannabis is two to three times higher than in the general population.
Many PWH use cannabis to manage nausea, sleep disorders, pain, anxiety and depression.
Evidence shows that cannabinoids, primarily THC and CBD, have anti-inflammatory effects.
In many cases, CBD protects against the damaging effects of inflammation.
Many anti-inflammatory actions of cannabinoids may be regulated through the gut, mainly through stabilizing the gut barrier.
Bottom line
The authors conclude that cannabis as a possible clinical treatment for HIV would significantly contribute to the field. They note that THC and CBD, along with other exogenous cannabis components, are anti-inflammatory and counter oxidative stress, which can be beneficial for PWH when ingested, inhaled or absorbed. However, they also specify that further research is needed to refine the effects of dose, timing and cannabis compound that would benefit this population.
Cannabinol and sleep: Separating fact from fiction
In a study published in the Journal of Cannabis and Cannabinoid Research, researcher Jamie Corroon from The Center for Medical Cannabis Education in California conducted a narrative review to determine whether or not cannabis has sleep-promoting effects. According to the study’s abstract, marketers of cannabis products have been claiming that cannabinol (CBN) and other cannabinoids have unique sleep-promoting effects. However, the author notes that while these could be factual, they may also be rooted in cannabis lore rather than facts.
Study framework
The author evaluated the published evidence regarding CBN and sleep. He prepared a narrative review after a systematic search of PubMed/MEDLINE.
The inclusion criteria for the studies were two-fold: the administration of CBN to human participants and the measurement of outcomes directly related to sleep (fatigue, tiredness, etc.).
The abstracts of 99 human studies were screened for relevance.
The characteristics and principal findings were extracted from eight full-text articles that met inclusion criteria for detailed review.
Findings:
Studies specifically assessing subjective effects associated with sleep, such as sedation or fatigue, are rare.
Published clinical trials investigating associations between CBN and validated sleep questionnaires and/or formal polysomnography were not identified.
Evidence demonstrating that CBN produces cannabis-like effects in humans is mixed.
Bottom line
The study concluded that the current research is too limited to determine a more definitive conclusion. While this particular review did not find studies that support the hypothesis that CBN promotes sleep, it is possible that sleep-related effects have not yet been studied in an appropriately designed clinical trial.
Insights from the world of medical cannabis research
“CBD has agonistic properties on the serotonergic receptors, which may explain its anxiolytic effects and it may inhibit the activity in the threat circuits. It has also been found to activate GABA receptors. GABA is the main calming neurotransmitter in the human brain.”
--Dr. Orit Holtzman, Vice-president of the Australian & New Zealand College of Cannabinoid Practitioners, speaking at the Medical Cannabis Clinicians Society webinar “Anxiety in unprecedented times: non-intoxicating pharmaceutical cannabis treatment (CBD & CBG)” in March 2021.
Safety and tolerability of transdermal cannabidiol gel in children with developmental and epileptic encephalopathies
In a nonrandomized controlled trial conducted by the University of Melbourne in Melbourne, Australia, researchers found that CBD transdermal gel was safe, well-tolerated and reduced symptoms in children with developmental and epileptic encephalopathies.
According to the paper’s abstract, developmental and epileptic encephalopathies (DEEs) are the most severe group of drug-resistant epilepsies. The authors also note that alternatives to oral therapies are needed in this population. This study’s objective was to assess the viability of cannabidiol (CBD) transdermal gel in children with DEEs and evaluate seizure frequency, sleep, and quality of life.
Study framework
This trial was conducted in two centers in Australia and New Zealand from April 2018 to July 2019.
Children and teenagers aged three to 18 years with DEEs receiving a stable regimen of one to four antiseizure medications were eligible.
A total of 48 participants were selected.
Participants received two daily applications of CBD transdermal gel at doses of 125 to 500 mg for six and a half months.
Findings
The transdermal CBD treatment was associated with reductions in seizure frequency of focal impaired awareness seizures (FIAS) and tonic-clonic seizures (TCS) frequency.
The only treatment-related gastrointestinal adverse effect was diarrhea, which one patient reported.
Parents and caregivers noted improvements in social engagement, irritability, alertness, energy, sleep and cognition.
Bottom line
The authors conclude that in children and teenagers with DEEs, CBD transdermal gel was safe and well-tolerated. The treatment was associated with a reduction in FIAS and TCS frequency and caregiver-reported improvements in overall quality of life. However, they also note the study’s limitations, such as its non-randomized and open-label design.
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