Safety and efficacy of medical cannabis in autistic patients; impact of early life exposure to cannabis; and more
Research regarding cannabis use among veterans, and a study to determine changes in quality of life in patients using cannabis for pain relief. Our report for Wed., Sept. 8, 2021 (1490 words, 7 mins.)
Medical cannabis research keeps advancing at great speed, with questions arising regarding the substance's safety in different populations such as veterans and pregnant women. At the same time, more research opens the door for studies involving the viability of medical cannabis use for conditions such as autism spectrum disorder.
This edition of CJMC Fortnightly explores research involving the safety and efficacy of medical cannabis compared to traditional medications in people diagnosed with an autism spectrum disorder. It also examines a recent study conducted to determine the prevalence of medical and non-medical cannabis use among veterans in primary care in the United States. Today, we also summarize a review that aims to explore current evidence regarding the impact of early life exposure to cannabis and the endocannabinoid system's role during pregnancy. On a different note, this issue highlights a study that measures the change in health-related quality of life in patients using cannabis for pain relief.
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:
Safety and efficacy of medical cannabis in autism spectrum disorder compared to commonly used medications
A study conducted by the Colorado Department of Public Health and Environment in Denver found that cannabidiol appears to be viable and effective when treating autism spectrum disorder (ASD) symptoms. The researchers evaluated the safety and efficacy of medications commonly used in ASD and compared them to medical cannabis.
Study framework
The researchers searched online for information about medications currently used in ASD and their safety and efficacy profiles.
The researchers also searched for studies detailing cannabis’ safety and efficacy profile for use in the ASD population.
The results were used to compare medications to cannabis as an alternative treatment.
Findings
Commonly prescribed medications display varying levels of efficacy, safety, and tolerability.
Some of the most common side effects include aggression, anxiety, irritability, and negative cognitive impact.
Many patients discontinue medication use due to side effects.
Recent research has shown the potential efficacy, safety, and tolerability of CBD-rich medical cannabis for treating symptoms of ASD.
Studies have identified circulating endocannabinoids as a possible biomarker for ASD.
Bottom line
The study concludes that currently, there are no approved medications for the core symptoms of ASD, and the FDA has approved only two to treat associated irritability. The authors also state that while there are no published placebo-controlled trials of medical cannabis for ASD at the time of this study’s publication, CBD-rich medical cannabis seems to be effective, tolerable and relatively safe for many of the symptoms of ASD. More research needs to be conducted to determine the long-term safety of medical cannabis in this population.
Insights from the world of medical cannabis research
“Glioblastoma brain tumours have been shown to have receptors to cannabinoids on their cell surfaces, and laboratory studies on glioblastoma cells have shown these drugs may slow tumour growth and work particularly well when used with temozolomide.”
-- Professor Susan Short, Professor of Clinical Oncology and Neuro-Oncology at the University of Leeds and principal investigator of a new phase II trial testing cannabis on brain tumours, in a press release from the University of Leeds on August 3, 2021.
The impact of early life exposure to cannabis: The role of the endocannabinoid system
A group of researchers from McMaster University in Hamilton, Ont. found that some cannabis components may disrupt the fetal endocannabinoid system (ECS) and have long-term negative effects on the offspring. The researchers conducted a review study to explore the evidence surrounding the effects of prenatal exposure to cannabinoids and the role of the ECS in both the placenta and the developing fetus.
The study’s abstract notes that cannabis use during pregnancy has risen. According to previous research, animal and human studies have shown that prenatal exposure to cannabis can increase the number of stillbirths, low birth weight, decreased organ to body weight ratio and neurobehavioural abnormalities.
Study framework
This study was a review of existing research and data.
Findings
The ECS is present at early stages of fetus development and is a potential target for external cannabinoids.
In females, ECS components have been found in reproductive tissues.
The ECS plays a key role in early human development, regulation of placental development and overall pregnancy.
The impact of cannabis on physiological aspects of pregnancy other than childbirth and reproductive health has not been studied extensively.
Bottom line
The authors conclude that most studies focus on THC and synthetic cannabinoid receptors, with little research focusing on the effects of CBD. These facts lead them to express the need for studies and trials examining the effects of CBD and other cannabis components on fetal health.
Prevalence of medical and non-medical cannabis use among veterans in primary care
In a study published in the journal Psychology of Addictive Behaviors, researchers in Virginia found that veterans who reside in states with legalized cannabis may be more likely to use cannabis.
Study framework
The researchers examined past-year cannabis use prevalence in 1,072 predominantly white and male participants.
The participants were Veterans Health Administration (VHA) primary care patients enrolled in a drug screening validation study between 2012 and 2014.
Multiple regression models estimated cannabis use prevalence and clinical similarities among recreational and medical users.
Findings
Nearly 18.7% of the veterans reported past-year cannabis use, with 14.1% of the total sample reporting any recreational use and 7.0% reported any medical use.
Veterans using only medical cannabis reported having more cannabis use days. Still, they had lower odds of other drug use, alcohol or drug-related disorders than veterans reporting only recreation use.
Differences between recreational only users and those using medical and recreational cannabis were minimal.
Bottom line
The study concluded that veterans enrolled in VHA in states where cannabis is legal are more likely to use cannabis. The authors also note that veterans who identify as recreational users are at a higher risk of adverse clinical outcomes than medical cannabis users. They also state that prevalence monitoring, intervention services and regular assessments should be considered for this population, especially in states with legalized cannabis.
Insights from the world of medical cannabis research
“By reducing anxiety levels, CBD may also improve other associated symptoms and improve sleep patterns and quality of life. There is also growing evidence about the ability of CBD to address different substance-use disorders and to reduce the risks associated with the consumption of opiates, alcohol, tobacco and other substances.”
--Dr. Guillermo Moreno Sanz, Scientific and Medical Director (Europe) at Khiron Life Sciences Corp speaking at the Medical Cannabis Clinicians Society webinar “Clinical experience with CBD: dried flower and oral extracts” in June 2021.
Measuring the change in health-related quality of life in patients using marijuana for pain relief
In research conducted by the University of the Sciences in Philadelphia, researchers aimed to determine a relationship between health-related quality of life changes and medical cannabis (MC) use in patients using the substance to relieve pain.
According to the paper’s abstract, current research suggests that cannabinoids are safe and effective in treating chronic pain with minimal side effects. The authors also note that existing data shows that MC can improve quality of life among users but that there is little data available regarding the health-related quality of life benefits in patients using MC for pain management.
Study framework
All pain patients who were 18 years or older enrolled in the Pennsylvania MC program were eligible for inclusion.
1,762 people responded to the screening request, and 1,393 (79%) met the screening criteria.
Of those, 353 (25.3%) agreed to participate, and 51% completed all four surveys, for a final sample of 181.
The participants completed four surveys: at enrollment and two, four, and eight weeks.
The primary outcome measure was the change in the EQ-5D Index Score from the second to the final survey. Secondary outcomes included self-reported pain and health scores.
Findings
MC patients experienced significant improvements on measures of executive function and clinical state over the course of 12 months.
The health-related quality of life score improved from the second survey to the final survey and the self-reported pain and health scores.
The EQ-5D scale revealed significant improvement in anxiety and pain and a significant worsening in self-care.
Bottom line
The authors conclude that the survey’s results show a significant improvement in health-related quality of life among patients using MC for pain management. They specify that the scale used validates the pain improvement and shows a significant improvement in anxiety levels. Overall, there seems to be a positive relationship between MC use and health-related quality of life in this population. However, the decrease in self-care suggests that further research into which aspects of self-care are affected by medical cannabis is necessary.
The next edition of CJMC Fortnightly will be distributed on Wednesday, September 22. Sign up for a free subscription by clicking the link below.
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