Screening older patients for cannabis use; cannabinoid delivery through skin; potential peptides to medical marijuana pain relief free from side effects
Cannabis side-effects, related research of note and innovative findings for Wednesday, May 19, 2021 (1,035 words, 5 minutes)
While cannabis may have certain medical applications, there are many cognitive side effects that physicians must watch for when prescribing or screening patients. How can these side effects be minimized or even avoided?
This edition of CJMC Fortnightly looks at recent research that considers side effects in screening patients for cannabis history, delivery vehicles that might minimize side effects, and even the potential of avoiding side effects entirely.
Covering your biweekly bioscience bullet points, I’m Jeremy Visser, editorial assistant for the Canadian Journal of Medical Cannabis (CJMC), a publication for physicians produced in Toronto, Canada. We also host the Real World Medicannabis symposia. But enough about me, let’s get to your medical cannabis news.
Peptides found to reduce cognitive side effects from medical marijuana in mice
Researchers at the University of Barcelona have built upon existing research involving mice receiving peptide injections to minimize cognitive side effects of THC.
Rafael Maldonado and his team improved the peptides, making them smaller, more stable and orally deliverable. They gave THC injections to one group of mice and gave another group THC injections with the peptide administered orally.
Findings
Mice that received the peptide and THC had the same pain relief benefits as mice that only received THC
Mice that received the peptide and THC showed improved memory over mice who only received THC
Mice that received the peptide and THC did not show an immunogenic response
Bottom line
A peptide taken orally to reduce or potentially minimize side effects from THC would have massive implications for promoting the use of cannabis for pain relief. Medical cannabis could be a more widely accepted form of pain relief by reducing or removing memory problems and other cognitive side effects.
Research shows patients over 50 years typically do not share their cannabis use with physicians
An article published in The American Journal of Drug and Alcohol Abuse has analyzed cannabis usage and procurement among men and women aged 50 and older in the US. The study included 17,685 participants from the 2018 and 2019 National Survey on Drug Use and Health (NSDUH) data.
Data breakdown
Medical cannabis users (20%) were more likely than recreational users (5%) to buy at a medical dispensary
Recreational users (46%) were more likely than medical cannabis users (25%) to get cannabis for free
Recreational users (56%) were more likely than medical cannabis users (49%) to obtain from other sources such as people at parties
9% of participants used cannabis in the last year
19% of those using cannabis for medical purposes such as treating chronic pain, arthritis, or depression
The other 81% were used for non-medical purposes
Medical cannabis users are 4x more likely than recreational users to discuss their cannabis use with healthcare professionals
Key take-aways
Physicians should screen older patients regularly for cannabis use
Unreported cannabis use can mask mental health diagnoses
Many medical cannabis users may be self-treating without physician consultation
Insights from the world of medical cannabis research
“We know the number of drugs being prescribed to seniors is the number one cause of hospitalizations related to adverse drug reactions.
If you’re on more medications, 10+, you’re five times more likely to be hospitalized for an adverse reaction
We want to reduce polypharmacy.
It makes sense to be thinking about cannabinoid medicine in this patient population”
-- Dr. Blake Pearson, Primary Care Lead, Erie St. Clair Local Health Integration Network’s Opioid Reduction Strategy, Real World Medicannabis Symposium 2020
Lifetime cannabis users with first-episode schizophrenia (FES) disorder may have superior neurocognitive performance
Researchers have analyzed cognitive impairment among FES patients who use cannabis and FES patients who are non-users. The study compared FES patients (cannabis users and non-users) against a healthy control group (cannabis users and non-users). Participants underwent a neurocognitive assessment and filled out cannabis questionnaires.
Study participants
30 lifetime cannabis users with FES
53 non-users with FES
20 cannabis users without FES
49 non-users without FES
Findings
Cannabis users without FES and non-users without FES had no sizable differences in cognitive performance
Lifetime cannabis users with FES and non-users with FES had no sizable difference in psychopathology, medication, nor positive and negative symptoms
Lifetime cannabis users with FES showed less impaired cognitive functioning than non-users with FES, specifically in visual memory
Bottom line
While cannabis abuse can cause cognitive decline in healthy individuals, the evidence suggests that FES patients with lifetime cannabis use had superior neurocognitive performance over non-using patients.
Insights from the world of medical cannabis research
“Why treat skin conditions with cannabis? The answers are fairly obvious.
The skin is the largest organ in the body, it can provide powerful testing ground for a range of cannabinoids and a range of personal care products as well
The skin is accessible, the interventions can be standardized, we can use screens, gels, lotions, all kinds of vehicles. And the outcomes can be measured objectively by a number of modalities.
The important reasons that preclinical and clinical research is ongoing is because the skin is there for us to all use.”
--Dr. Sheldon Pollack, Toronto, Real World Medicannabis Symposium 2020
In defence of transcutaneous delivery of cannabinoids
A review of current and potential cannabinoid delivery forms was published in the Journal of Controlled Release. The researchers reviewed the downsides of traditional delivery forms and proposed emerging topical and transdermal options that could deliver cannabinoids with decreased psychotropic side effects.
Limitations of conventional cannabinoid delivery
Low oral bioavailability
Gastric instability
Poor water solubility
Various psychotropic side effects
Delivery strategies proposed for further study
Microneedling
Electroporation
Liposomal delivery
Ethosomes and nanocryogels
Benefits of more drug delivery options
Besides the potential for fewer psychotropic side effects, more convenient delivery options could benefit those requiring long-term cannabinoid use or chronic indications where more tolerability is needed.
The next edition of CJMC Fortnightly will be distributed on Wednesday, June 2. Sign up for a free subscription by clicking the link below.
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