Using CBD in early phases of psychosis; medical cannabis for treating the side effects of gynecologic cancer treatments; and more
Research regarding the safety and acute effects of cannabis, for Wed., July 28, 2021 (1420 words, 7 minutes)
As medical cannabis becomes legal in more places around the world, questions regarding safety and tolerability emerge. At the same time, legalization does allow for further exploration of the substance as an alternative treatment for several medical conditions, including different types of cancer and psychosis.
This edition of CJMC Fortnightly examines the use of cannabidiol (CBD) as a novel treatment in the early phases of psychosis, from a study conducted at King’s College London in London, UK. This edition also explores recent research that studies the utilization of medical cannabis in gynecologic cancer patients for symptom management. Today’s edition also summarizes a study regarding the safety and tolerability of natural and synthetic cannabinoids in older adults. On a similar note, this issue highlights research conducted by Washington State University that aims to determine the effects of high-potency cannabis flower and cannabis concentrates on everyday memory and decision-making.
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:
Cannabidiol (CBD) as a novel treatment in the early phases of psychosis
A team of researchers from King’s College London has completed a critical literature review on the use of CBD as a treatment in the early stages of psychosis.
The study authors note that psychosis is generally treated with antipsychotic medications. While these therapies work well for some patients, they do not relieve psychotic symptoms in about one-third of patients. They can also cause serious side effects that make some people reluctant to take them, which is problematic, especially in the early phases of psychosis. Consequently, the study’s investigators examined whether CBD could provide a treatment alternative.
Study framework
Relevant articles and systematic reviews were retrieved through targeted searches on international databases such as PubMed and Google Scholar.
Experts in the fields of cannabinoid psychopharmacology and psychosis were consulted.
The review did not follow a systematic literature search, data extraction or reporting approach.
Findings
There have been only three clinical trials of CBD in patients with psychosis.
Two trials have evaluated CBD as an additional treatment to antipsychotic medication.
Compared to placebo, CBD treatment was associated with improvements in psychotic symptom severity.
CBD may have significant effects on psychotic symptoms in patients with psychosis.
Bottom line
The researchers conclude there is a clear need for larger-scale trials because all of the completed trials have involved small sample sizes. Additionally, all of the studies were of relatively short durations of treatment (four to six weeks). As a result, it is not known if improved results could be obtained with longer treatment.
The researchers also conclude that if larger-scale clinical trials confirm that CBD is effective in treating psychosis, it may benefit those who do not respond well to conventional antipsychotic medication. Finally, they state that future trials should also investigate the molecular mechanism of action of CBD through neuroimaging and blood tests.
Insights from the world of medical cannabis research
“I believe that cannabis is helpful for managing a variety of symptoms [in palliative care] whether pain, anxiety, nausea, or loss of appetite. One of the difficulties we face is not quite understanding the appropriate doses needed to manage each of the symptoms and what the appropriate combinations of THC and CBD might be.”
-- Dr. Marissa Slaven, palliative care physician at McMaster University in Hamilton, Ont. (CJMC 2019; 1:20).
Medical marijuana utilization in gynecologic cancer patients
A group of researchers from New York University (NYU) conducted a study that evaluated the effects of medical cannabis for symptom management in patients with gynecologic cancer at NYU Langone Health. They write that medical cannabis use is common among cancer patients, but little is known about the usage patterns and efficacy, specifically among gynecologic cancer patients.
As published in the online journal Gynecologic Oncology Reports, researchers conducted the study to further explore the feasibility of medical cannabis as a possible treatment aid in gynecologic cancer.
Study framework
Researchers collected demographic and clinical data from gynecologic cancer patients prescribed medical cannabis between May 2016 and February 2019.
Researchers also searched the hospital's electronic medical records for information about medical cannabis formulation prescribed, usage patterns, length of use, symptom relief, and side effect profile.
Of 45 patients prescribed medical cannabis, 89% were receiving chemotherapy at the time of prescription and 56% were undergoing primary treatment.
Findings
Medical cannabis was used for a median of 5.2 months.
More than 70% of patients reported improvement in nausea and vomiting
Only 36% of patients using medical cannabis for pain relief reported improvement.
Of 41 patients with follow-up information, 71% found that cannabis improved at least one symptom.
Bottom line
The study concludes that most of the patients who participated in the trial reported symptom relief without significant side effects. The sample was small, but this initial data can be useful for counselling gynecologic cancer patients on the efficacy and side effects of medical cannabis for symptom management.
Safety and tolerability of natural and synthetic cannabinoids in older adults
In a review published by the journal Drugs & Aging, researchers from King’s College London studied the feasibility of natural and synthetic cannabinoids in older adults. This study was a systematic review and meta-analysis of open-label trials and observational studies.
The purpose of this systematic review was to examine the safety and tolerability of cannabinoid-based medications in individuals with a median age of 50+ years.
Study framework
Researchers conducted a systematic search on PubMed, PsycINFO, MEDLINE, EMBASE and CINHAL.
The research includes studies that:
Were published from 1990 onwards
Included older adults (50+ years)
Provided data on the safety and tolerability of medical cannabinoids.
Separate analyses were conducted based on the cannabinoid-based medication used. They included TCH, CBD and a combination of THC and CBD (THC:CBD).
Findings:
The researchers identified 38 studies that fit the criteria: 23 on THC, six on CBD, and nine on combination THC:CBD.
THC had a very low incidence of all-cause and treatment-related adverse events and no serious adverse events.
CBD and THC had a low risk of treatment-related withdrawals.
THC:CBD treatment had low risk of treatment-related adverse events.
Bottom line
The study concluded that while cannabinoid-based medications were generally safe and acceptable to adults over 50 years of age, these results are limited by the lack of a control group and heterogeneity. However, the results complement and are consistent with comparable evidence from randomized controlled trials.
Insights from the world of medical cannabis research
“In the skin itself, we have been able to localize the cannabinoid receptors to different structures: hair follicles, sebaceous glands, keratinocytes, melanocytes, sweat glands, immune cells and the blood vessels. If we are able to harness or signal through these receptors we may be able to change disease pathology.”
--Dr. Mark Kirchhof, Division Head of Dermatology at the University of Ottawa, speaking at the annual meeting of the Canadian Dermatology Association in June 2021.
Acute effects of high-potency cannabis flower and cannabis concentrates on everyday memory and decision-making
A team of researchers from Washington State University observed a group of cannabis consumers over Zoom while the users smoked high-potency cannabis flower or vaped concentrates. They then gave the participants a series of cognitive tests.
This study is one of the few to investigate cannabis that contains much more than 10% THC. It is just the second study to examine the effects of high-potency cannabis concentrates, according to the authors.
Study framework
The study’s 80 participants were divided into four groups:
One group used cannabis with more than 20% THC and also contained CBD.
The second group also used cannabis with more than 20% THC but without CBD.
The third group vaped cannabis concentrates with more than 60% THC that included CBD.
The fourth group remained sober.
Several cognitive evaluations were conducted, including memory, risk perception and decision-making tests.
Findings
The researchers found no impact on performance on decision-making tests in the cannabis-consuming group compared to the sober control group.
Researchers did find some memory impairments in cannabis-consuming participants related to free recall, source memory and false memories.
Those who vaped the concentrates with more than 60% THC performed similarly to those who smoked cannabis flower.
Bottom line
The study’s authors write that they are cautious about coming to any general conclusion due to the limitations of the small study. However, Carrie Cuttler, psychologist and lead of the study, says it is encouraging to see that high THC concentrates do not increase the harms or negative side effects.
The next edition of CJMC Fortnightly will be distributed on Wednesday, August 11. Sign up for a free subscription by clicking the link below.
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