The following medical conditions are most recognized by states that have laws to allow for the use of medical cannabis.
Post Traumatic Stress Disorder
PTSD is a serious psychological disorder characterized by re-living the emotional response to a deeply disturbing (traumatic) event or multiple events. Traumatic events that may trigger PTSD in some people include war experiences, natural disasters, sexual assault, traffic accidents, witnessing or experiencing violence or serious injury, and an unexpected death of a loved one. Generally, these types of events are out of a person’s control and anyone at any age may develop PTSD.
It is important to understand the mechanism of daily stress as it underlies the manifestation of PTSD. When we are put under stress the “fight-or-flight” response kicks in that is actually a protective, built-in human survival feature. Under these conditions, our bodies increase the production of adrenaline– a stimulating neurotransmitter which in turn increases the hormone cortisol (the bodies stress-management hormone). This creates a cascade of effects that result in producing a state of physical and emotional readiness with virtually every system of the body in self-preservation mode (think survival—could be wartime experiences or if thinking of evolution–having to defend against the attack of a saber-toothed tiger). Once the stress ends, the body typically restores balance and returns to normal functioning—not so with the presence of PTSD, however. With PTSD the traumatic scenario is persistently re-experienced, potentially resulting in a series of negative effects such as anger, sleep problems, chronic pain, depression, substance abuse (alcohol), self-harm and suicide. To learn more about PTSD you may check here.
Use of Medical Cannabis in PTSD
Cannabis is ideally suited to treat many of the symptoms of PTSD, and generally, is an effective remedy for most stress-related issues. Cannabinoids affect many biological processes including appetite regulation, pain (including headaches), anxiety, mood, sleep and blood pressure. The endocannabinoid system (ECS) also plays an important role in the regulation of learning and emotional responses, particularly those related to traumatic experiences. For example, one study examined anandamide, an endocannabinoid that animals and humans make in response to stress. When anandamide remains in the system longer, it acts as an antianxiety and antidepressant. THC is a “analog” of anandamide, meaning the molecule is structurally similar and acts at the CB1 receptor in a similar manner as anandamide—which is one of the reasons it appears to be is helpful in PTSD. Additionally, THC has been found to aid sleep, reducing the frequency of nightmares. Patients taking 5mg of sublingual THC twice a day, showed significant improvement in global symptom severity, sleep quality, frequency of nightmares, and PTSD hyperarousal symptoms (when a person’s body suddenly is in a high alert state as a result of thinking about their trauma).1 Interestingly, CBD also appears to play a role in trauma relief. Another study found that CBD, given immediately following trauma, was found to facilitate the “extinction” (elimination from memory) of the traumatic event, but only when administered immediately after, and not before the process.2 Additionally, CBD is effective in reducing both the cardiovascular responses and anxiety inducing effects caused by PTSD. In comparing veterans’ cannabis use, a survey found that relative to recreational users, medical cannabis users reported significantly greater motivation for using cannabis to cope with sleep disturbance and has also been reported that cannabis increases sleep quality and reduces nightmares. Medical cannabis patients with PTSD also reported a lower frequency of alcohol use.3 Relaxation is the key to stress management and should guide the approach to cannabis therapy. Strain selection is an important aspect in treating the various symptoms of PTSD and is an individualized preference. Hybrid strains of cannabis (a combination of indica and sativa) are found by most to be both relaxing and stimulating, respectively, and appear to offer the best results along with the combination of CBD and THC products.
Cannabis and Future PTSD Research
Research in PTSD with cannabis holds great interest–and much promise. Many clinicians view cannabis as a very important option for individuals suffering from PTSD. Recently, one important study of 76 US Veterans was completed. The study evaluated the use of three types of smoked flower in PTSD suffers; 1) High THC, 2) High CBD and 3) High THC/High CBD ratio flower versus 4) Placebo—this study’s finding has yet to be reported upon.
Traditional approaches for the treatment and management of PTSD
Psychotherapy is a mainstay of PTSD treatment. Two types of psychotherapy are considered most useful include EMDR (Eye movement desensitization and reprocessing) and DBT (Dialectical behavior therapy), both of which help one acknowledge that they are no longer in danger. Some patients can find relief with just one type of therapy, but unfortunately, others struggle to achieve significant long-term relief from their symptoms. If needed, pharmaceutical products will be added, including those from the broad classes of antidepressants and anxiolytics, having associated toxicities and challenges.
1Roitman P, Mechoulam R, Cooper-Kazaz R, Shalev A. 2014. Preliminary, open-label, pilot study of add-on oral Δ9-tetrahydrocannabinol in chronic post-traumatic stress disorder. Clin Drug Investig. (8):587-91.
2Das RK, Kamboj SK, Ramadas M, et al. 2013. Cannabidiol enhances consolidation of explicit fear extinction in humans. Psychopharmacology. 226:781–792.
3Metrik J, Bassett SS, Aston ER, Jackson KM, Borsari B. 2018. Medicinal Versus Recreational Cannabis Use Among Returning Veterans. Transl Issues Psychol Sci. 4(1):6-20.
Multiple sclerosis is an autoimmune disease that causes the body’s immune system to attack the central nervous system (CNS)–the brain and spinal cord. The CNS is composed of neurons (nervous tissue cells) that communicate with each other, transmitting information throughout the brain and spinal cord. These nerve cells create thought and perception and allow the brain to control the body. MS causes the immune system to attack the protective, fatty coating called “myelin” that exists around the nerve cells and assists neurons in carrying electrical signals. This attack creates damaged areas or “lesions” within the CNS which inhibits the nerve cells from communicating as intended, resulting in CNS dysfunction. MS inhibits proper signaling from one part of the brain to another—and from the brain to the rest of the body. This impaired communication leads to changes in both cognitive and physical processes. MS is typically known to be “relapsing and remitting” also known as secondary progressive disease that may result in episodes of numbness, muscle weakness, dizziness, fatigue, changes in mobility, vision disturbances, changes in speech, and bowel and bladder dysfunction. Another type of MS disease, “primary-progressive” is less common with similar symptoms but the disease course is different in that symptoms are consistent. Regardless of the disease course, MS frequently results in not only pain but also in “spasticity”, defined as a condition in which certain muscles are continuously contracted causing interference with normal movement, speech and gait. You may read further information here, to learn more about MS.
Use of Medical Cannabis in MS
One recent study conducted by the National Multiple Sclerosis Society estimated that approximately 66% of MS suffers use cannabis to reduce their symptoms.1 Other work reported on a reduction in opioid deaths indicating that cannabis has been substituted for opioids analgesics for use in pain, anxiety and sleep resulting in the reduction of accidental overdoses. Following this logic, some patients have found they are able to decrease or eliminate their need for pharmaceuticals when including cannabinoids in their daily regimens. Findings of several placebo-controlled studies through 2010, indicated that cannabinoids resulted in significant improvement in patient-reported spasticity with the combination of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Sativex, a balanced cannabis-based medicine (1:1 ratio containing 27 milligrams/ml, THC and 25mg/ml, CBD) for use in the treatment of neuropathic pain in Multiple Sclerosis, is approved in Great Britain and several other European countries.2 At this time THC and CBD have been found to benefit individuals with MS, particularly regarding pain and spasticity.
A recent review stated, “…the effects of cannabinoids on cells of the immune system, on the blood-brain barrier (BBB), microglia, astrocytes, oligodendrocytes and neurons, potentially open the way for a plethora of therapeutic actions on different targets that could aid the management of MS”.3 The multitude of potential therapeutic targets summarized by these authors may provide an indication as to why many MS patients find benefit with inclusion of cannabinoids in their daily regimens. Many clinicians who work with cannabinoids and MS patients frequently recommend a 1:1 THC:CBD preparation, starting with a very low dose with slow, gradual upward titration to desired effect.
Cannabis and future MS research
There have been numerous pharmaceutical products developed and marketed over the past several years for MS, however, due to the toxicities associated with available pharmaceuticals, there has been increased interest in the use of cannabinoids for the management and treatment of MS. Several pre-clinical studies (typically in animals or bench-research) have indicated the endocannabinoid system’s (ECS) key involvement with MS, including protection and preservation of the nervous system and repair or “re-myelination”. It is anticipated this will be an important direction for future MS research—specifically to gain a better understanding of inflammatory mechanisms associated with neurological deterioration and repair.
FDA approved medications for MS
Currently, many medications developed by the pharmaceutical industry are identified as disease-modifying medicines yet many patients have issues with even the common adverse effects of the various regimens, ranging from injection site pain to fatigue, . The term “disease-modifying” specifically indicates these medicines are able to limit the number of relapses, delay progression of the disability, and limit new disease activity (as seen on MRI). A comprehensive listing of these medications is included here. Additionally, an extensive listing of adjunctive pharmaceuticals used to address the symptoms of MS are also included.
1 Kindred JH, Li K, Ketelhut NB, Proessl F, et al. Cannabis use in people with Parkinson’s disease and multiple sclerosis: a web-based investigation. Complement Ther Med. 2017; 33:99-104.
2 Rog DJ et al. Oromucosal δ9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension. Clinical Therapeutics. 2007, 29: 2068-2079.
3 Mecha M, et. al., Perspectives on Cannabis-Based Therapy of Multiple Sclerosis: A Mini-Review. Front Cell Neurosci (2020); 14:1-7. https://doi.org/10.3389/fncel. 2020; 34:1-7.
Cancer is actually many diseases that result from uncontrolled growth of abnormal cells in the body. Many cancers form solid tumors while others (such as leukemias and lymphomas) form “liquid tumors”. Chemotherapy or “chemo” is a standard pharmaceutical approach to killing cancer cells. Unfortunately, chemo also affects normal, non-cancerous cells in your body. It may cause several serious, challenging symptoms including severe nausea, vomiting, loss of appetite (anorexia) fatigue, and depression.
Radiation therapy may be used alone or frequently in conjunction with chemo and is a treatment that is limited to the local/tumor area but can cause damage to the surrounding tissues near the cancer cells. Radiation may result in pain and other types of physical dysfunction. Frequently the side effects include nausea, headache, anorexia, difficulty swallowing, poor absorption of foods which may lead to poor nutrition and ultimately may result in malnutrition — leading to weight loss and insomnia. Oftentimes, due to these effects, patients may suffer from anxiety and depression. For further information on various cancers and their common symptoms and effects, you may check here.
Cancer and Cannabis
Many cancer patients who use cannabis for symptom relief find it beneficial. It’s commonly acknowledged that cannabis helps to relieve many side-effects associated with traditional cancer treatments including nausea, vomiting, loss of appetite (anorexia), and depression. Dronabinol/Marinol ® , a synthetic form of THC that is federally approved, has been prescribed for symptoms associated with chemo or radiation. In addition, cannabis may be used to treat the chronic pain and depression that often accompanies cancer and cancer therapies. Increasingly, cannabis use for chronic pain, chemo-induced nausea and vomiting and as a sleep-aid may be preferred over pharmaceutical options. Also, recent research has found that cannabinoids can affect tumor growth.
Research has shown the use of cannabis for the treatment of nausea and vomiting to be as effective, if not more so than available conventional pharmaceuticals. Many years of research has also shown that cannabis works well to relieve pain without the serious side effects of conventional (opioid-type) painkillers. Patients in the advanced stages of cancer suffering from severe pain may safely use cannabis in conjunction with opioid pain killers. The synergistic effect of cannabis and opioids typically allows for the reduction in opioid doses. Using cannabis and opioids in this manner decreases pain while reducing problems like constipation (often associated with the opioid), nausea or loss of appetite. 1 The risk of accidental opioid overdoes is also well addressed with this approach to pain management.
Cannabis impedes the growth of tumors. For example, it is well documented in animal studies of gliomas (cancerous brain tumors) that cannabinoids have been shown to inhibit tumor growth. 2 In 2006, researchers conducted a pilot study in humans using THC to shrink recurrent brain tumors–we learned there was tumor shrinkage among a portion of the patients. In a 2011 study, two youth who were routinely using inhaled cannabis and received no conventional treatment experienced regression (or shrinking) of brain tumors.
Currently, research is evaluating cannabidiol (CBD) as a potential treatment for certain types of ggressive breast cancer. 3,4 Researchers learned that CBD inhibits a gene that is thought to direct the spread (metastasis) of cancer cells from the original tumor to invade new areas of the body. Additional information was gained in separate research studies that found cannabinoids inhibit the metastasis and growth of several types of cancer cell lines including breast, prostate, and colorectal, lung and skin carcinomas. Additionally, study findings show that CBD has a similar effect on gastric adenocarcinoma, neuroblastoma, leukemia and others.
As early as 1975, the National Cancer Institute reported on the work of a group of researchers’ findings from a study conducted in a pre-clinical model, “Animals treated for 10 consecutive days with 9 -THC, beginning the day after tumor implantation, demonstrated a dose-dependent action of retarded tumor growth. Mice treated for 20 consecutive days with 8 -THC and CBD had reduced primary tumor size. 5 Numerous confirmatory studies have been conducted since the 1975 work was completed. In the practice of integrative oncology, the health care provider may recommend medicinal cannabis not only for symptom management but also for its possible direct anti-tumor effects. The dosing approach to target cancer cells and treat cancer with cannabis is individualized and should be guided by a professional. Both CBD and THC have anti-cancer effects for specific types of cancer, so there is not a single answer. One should be aware that anti-cancer regimens involve high-dose cannabis, up to 500 mg to 1000 mg of cannabinoids/day or higher. This is delivered by concentrated oil and can be costly due to the high amounts typically used.
Another arena that cannabis is useful for is as an adjuvant therapy for cancer, in conjunction with whatever else your treatment specifies such as a traditional pharmaceutical regimen. In this case, lower doses of cannabinoids will likely be used – more in the range of 100 to 300 mg of cannabinoids/day.
1 Abrams DI, Couey P, Shade SB, et al.: Cannabinoid-opioid interaction in chronic pain. Clinical
Pharmacol Therapy 2011, 90 (6): 844-51.
2 Massi P, et al. Antitumor effects of cannabidiol, a non-psychotropic cannabinoid, on human
glioma cell lines. Journal of Pharmacology and Experimental Therapeutics Fast Forward. 2004,
3 Ligresti A, et al. Anti-tumor activity of plant cannabinoids with emphasis on the effect of
cannabidiol on human breast carcinoma. Journal of Pharmacology and Experimental
Therapeutics Fast Forward. 2006, 318:1375-1387.
4 McAllister et al. Cannabidiol as a novel inhibitor of Id-1 gene expression in aggressive breast
cancer cells. Molecular Cancer Therapeutics. 2007, 6: 2921-2927.
5 A. E. Munson, L. S. Harris, et. al.: Antineoplastic Activity of Cannabinoids
JNCI: Journal of the National Cancer Institute, 1975, 55 (3): 597–602.
As of 2016, the Centers of Disease Control and Prevention estimated that about 2.4 million people in the US have chronic HCV. Of patients acutely infected, approximately 75% progress to “chronic” HCV meaning the infection is present for greater than six months. The most common form of HCV accounts for 70-80% of the chronic HCV cases in the US. Of those patients, about 20-30% are thought to progresses to cirrhosis which often takes decades to appear. In some cases, liver cancers are caused by viral infections– some result from HCV-induced cirrhosis. Due to the lengthy timeline for the effects of chronic HCV to manifest there are many tell-tale health issues that could serve to alert patients with this infection. Testing is important because symptoms may not develop until the HCV has resulted in extensive liver damage, possibly years after the initial infection. To learn more about the risk factors, signs, symptoms and testing for HCV, you may click here.
Use of Medical Cannabis in HCV
Cannabis alone doesn’t treat the HCV infection, nor does it treat the complications that lead to liver disease and cirrhosis. However, many people with HCV use cannabis to ease their general symptoms from the virus or to reduce the nausea associated with HCV pharmaceutical treatments. Cannabis can be inhaled, taken as a pill, liquid or edible, or be absorbed under the tongue. It’s unclear if there are any overall risks as research results have been mixed. Cannabis does affect your liver and mostly has to do with the duration of HCV infection or “disease stage”. In one study, using cannabis didn’t influence liver biopsies or show a negative effect with antiviral treatment so taking the drug didn’t interfere or further damage the liver. Furthermore, this study did not find any evidence that smoking or taking cannabis pills does any additional damage to the liver, despite what previous research had suggested. 1
Some scientists have reported results from a few studies that credit marijuana use with stricter adherence to treatment protocols, due to reduced adverse drug effects experienced by the patient when using cannabis. Researchers found that more people finished the full course of treatment and in turn, people experience better outcomes. However, research in this area has also had mixed outcomes– Another study found that many HCV patients use cannabis routinely and that people who included the drug in their therapy plan didn’t necessarily stick to the plan more closely than their counterparts who didn’t take the drug.
Due to the complexity of cannabis’ effects on the liver, one should never attempt to self-manage HCV—Check with your cannabinoid doctor or pharmacist, if you think cannabis might be helpful to add to your treatment plan.
Cannabis and Future HCV Research
Due to the lack of effectiveness associated with cannabinoids in the treatment of HCV, there are no known clinical trials in this area.
FDA approved medications for HCV
Antiviral medications are typically a first line of defense against HCV. Older products may give you flu-like symptoms and anemia. Newer pharmaceuticals require shorter courses of therapy than more traditional therapies (from 24-72 weeks, now to 12 weeks) and have reduced adverse effects, however an associated risk is reactivation of the latent virus. Most often pharmaceuticals will be prescribed for management of nausea and these drugs may be associated with their own adverse effects.
1 Lui T, Howell GT, Turner L., et al., Marijuana use in hepatitis C infection does not affect liver biopsy histology or treatment outcomes. Can J Gastroenterol Hepatol 2014;28(7):381-384.
The term “chronic” typically refers to pain that lasts from three – 12 months, though some health professionals define chronic as “pain that extends beyond the expected period of healing.” A recent report by the Center for Disease Control estimated that over 50 million Americans are currently living with chronic pain and most are under-treated. This number of people represents around 20% of the US population.
Numerous health conditions are associated with chronic pain which may explain the large number of patients effected. There are two major types of pain including neuropathic (which is discussed in greater detail, under the Neuropathy content and nociceptive. Nociceptive is further sub-divided into visceral and somatic pain. With nociceptive pain, the receptors in your nervous system (nociceptors) are activated only when one is injured. An injury may occur, and the nociceptors may malfunction and never turn off, continuing to send pain signals even after healing has occurred. Many clinicians suggest that cannabis reduces the perception of pain and in effect, actually reduces patient “suffering.”
Chronic pain has far reaching effects on our health and is associated with higher rates of depression, anxiety, sleep disturbance and decreased physical activity than patients not experiencing chronic pain. Conventional types of pain medications [non-steroidal (NSAID), opioid, antispasmodic] are commonly used as treatments—these may lead to serious complications due to side-effects such as stomach upset, bleeding in the gut, nausea, constipation, decreased appetite, drowsiness, dizziness and addiction.
Awareness has been raised in the past several years as to the serious risks, such as addiction, associated with opioid pain killers. Additionally, many individuals don’t feel these medications provide adequate relief, and with all the negative side-effects, some believe these treatments are not worth the risks involved in taking them.
Use of Medical Cannabis in Chronic Pain
For years, a synthetic cannabinoid (dronabinol/Marinol® ) was all that was available by prescription. Anecdotally, many patients did not feel it was as effective as natural cannabis in pain relief. Recently studies have shown that using only one isolated cannabinoid compound gave limited relief of pain as compared to using all of the cannabinoids found in the whole flower together. In 2016, research from McGill University found that smoking cannabis significantly reduced pain, improved quality of sleep and lessened anxiety in patients who had not responded to conventional pain therapies. It is believed that not only the cannabinoids (THC, CBD, etc.,) are responsible for the analgesic (pain relieving) effects but also this effect may be an “entourage” or cumulative effect at reducing suffering from chronic pain by the synergy of other components of the full plant – namely terpenes.1
Increasingly, evidence has mounted to support the benefits of medical cannabis use clinically, in conjunction with or as a substitute, for prescription opiates in the treatment of chronic pain.2-4 This research finding has been confirmed by many patients who eliminated or reduced their use of opiates, NSAIDS, and muscle relaxers through the use of cannabis for pain. Consistently, patients report meaningful relief of pain, improved sleep outcomes, and have better relationships at home and in the work environments because they are not coping with the negative mood effects of chronic pain.
Cannabinoids also appear to improve the problems that occur with opiate withdrawal, as well as the gradual acquisition of tolerance. Often after a period of use, an opiate dosage will become ineffective. It appears that cannabis may “revitalize” the pain relief properties of prescription opiates and help them to be effective again. One reviewer stated, “Many patients in a palliative care setting who are currently on long-term opioids for chronic pain could potentially be treated with either cannabis alone or in combination with a lower dose of opioids. From a pharmacological perspective, cannabinoids are considerably safer than opioids and have broad applicability in palliative care.”5
The dosage regimen for replacing opiates with cannabis is individualized and should be done under professional supervision.
Cannabis and Future Pain Research
Over the past several years, due to the limited effectiveness and toxicities associated with pharmaceuticals, there has been increased interest in the use of cannabinoids for the management and treatment of chronic pain. There is a considerable body of work on the usage of cannabinoid products for many medical conditions, including the treatment of chronic pain.
FDA approved medications for Chronic Pain
Currently, the medications developed by the pharmaceutical industry for chronic pain generally include members of the classes of drugs known as NSAIDS, opioids, and antispasmodics. Oftentimes, traditional medical treatment for resistant, difficult to treat pain will include the addition of other types of medications, such as anticonvulsant, used in conjunction with the more traditional approaches. Many of these medications alone and in combination are associated with harmful side-effects, particularly with long-term usage.
1Piomelli D (2019) Waiting for the entourage, Cannabis and Cannabinoid Research 4:3, 137–138, DOI: 10.1089/ can.2019.29014.dpi.
2 KM Takakawa, et.al., The impact of medical cannabis on intermittent and chronic opioid users with back pain: How cannabis diminished prescription opioid usage. Cannabis and Cannabinoid Research X:X, 1–8, DOI: 10.1089/can.2019.0039.
3 Lynch ME, Campbell F. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. Br J Clin Pharmacol. 2011, 72(5): 735–744.
4 Abrams DI, et al. Cannabinoid–opioid interaction in chronic pain. Clinical Pharmacology & Therapeutics. 2011, 90(6): 844-851.
5 Carter, GT, Flanagan, AM, Earleywine, M, Abrams, DI, Agarwal, SK, Grinspoon, L. Cannabis in palliative medicine: Improving care and reducing opioid-related morbidity. American Journal of Hospice & Palliative Medicine, 2011, 000(00): 1-7.
Crohn’s patients seek cannabinoid approvals because they have already found that it changes the course of their disease. After seeing the first several patients reporting marked improvement in their conditions with the use of cannabinoids other groups began reporting the same significant change.
All surveyed patients with Crohn’s disease report statistically significant improvement in signs and symptoms in all categories: pain in the gut, anorexia, nausea, vomiting, fatigue, depressed mood, and activity level. Based on a recent Israeli clinical study cannabinoids reduced pain in the gut more so than the pharmaceuticals that were provided. The number of stools per day was reduced, the body weight increased, and all patients reported the frequency and severity of flare-ups were reduced. Through the use of hemp many have seen these side effects reduce or completely become eliminated as the patient begins to embrace cannabinoid therapeutics.
It is now known that biopsy specimens from Crohn’s patients had large quantities of cannabinoid receptors. Activating these receptors with cannabinoids promoted healing of the gastrointestinal membrane. This could offer therapeutic relief to patients suffering from inflammatory disorders such as Crohn’s disease and ulcerative colitis.
Cannabinoid types of products that are available for Crohn’s disease patients credits raw cannabinoid juice, vaporizing and eating GMO free medible foods.
Cachexia is a complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass1 and is observed in more than 80% of seriously ill patients. Frequently seen in chronic obstructive pulmonary disease, chronic kidney disease, rheumatoid arthritis and congestive heart failure, cachexia is commonly seen in the later stages of acquired immune deficiency syndrome (AIDS) and cancer. The cause of cachexia is not well understood an may be the result of inflammation, changes in metabolism and a decrease in calories in their diet, typically due to the loss of appetite. This can lead to malnutrition and other dietary deficiency problems.
Cachexia can be observed as a syndrome in about 50% of patients affected by cancer.2 Often loss of appetite is associated with nausea, an unpleasant side effect of chemotherapy. To learn more about the symptoms of cancer cachexia you may read here.
Involuntary weight loss resulting from severe protein energy malnutrition is a frequent complication of AIDS. Malnutrition may contribute to the progression of AIDS itself. To learn more about the symptoms of HIV-related cachexia you may read here.
Use of medical cannabis in cachexia
THC-rich cannabis has long been established as increasing appetite and is the most effective cannabinoid for treating cachexia. 3 Furthermore, as an anti-inflammatory, its role in cachexia is fairly clear. Cannabis appears to help patients with pain, relaxation, and to promote general well-being, which can improve the quality of life for people suffering from different types of diseases that lead to wasting. Oral and sublingual dosing is a good choice for those having difficulty eating or keeping food down. Starting with a low dose and increase slowly with use of the minimal amount of cannabis to achieve the desired effects is always the best approach.
Cannabis and Future Cachexia Research
Currently no studies are in progress to further evaluate the role of cannabis in either cancer or HIV-associated cachexia.
Traditional approaches for the management of cachexia
No guidelines or standards of care for the treatment of cancer cachexia have been broadly accepted. Unfortunately, this may indicate the lack of focus placed on this frequent consequence of cancer as compared to chemotherapeutic agents targeting the disease itself. Currently, the interventions most commonly recommended to patients are nutritional interventions, pharmacological interventions including glucocorticoids such as prednisone or dexamethasone. Side effects may include insulin resistance, immune suppression, muscle myopathy, and risk of adrenal insufficiency. Megestrol acetate (see below in HIV-associated cachexia) is also used. Unlike whole-plant THC, dronabinol, (a synthetic THC approved by the FDA) has been used in an attempt to boost appetite, however, results from clinical trials showed negligible effects in this population.
In 1993, Megace® (megestrol acetate), a synthetic form of the hormone progesterone, was approved by the US FDA for the treatment of anorexia, cachexia or unexplained weight loss in patients with AIDS. The mechanism by which MA increases appetite is unknown. While the therapeutic effect of this pharmaceutical product is weight gain, other common adverse include stomach upset, diarrhea, gas, insomnia, vaginal bleeding, decreased sex drive, impotence and difficulty having an orgasm.
1 Evans WJ, Morely JE, Argil ́es J., et. al., Cachexia: A new definition. Clinical Nutrition 2008; 27:793-799
2 Fearon KC . Cancer cachexia: Developing multimodal therapy for a multidimensional problem. Eur J Cancer 2008; 44:1124 – 32.
3 Mattes RD, Engelman IK, Shaw LM, Elsohly MA. Cannabinoids and Appetite Stimulation. Pharma Biochem Behavior, 1994; 49: 187-195.
In the Summer of 1981, The Centers for Disease Control (CDC) first described the disease now known as acquired immune deficiency syndrome (AIDS). AIDS was a significant contributor to illness and death in the United States for several years from the early-1980s to the mid-1990s and once better understood, the pathogen was identified as a human retrovirus then named HIV. Due to the virus’ attack on the immune system, if gone untreated, the individual was left with extremely low defenses to combat several hallmark diseases, now associated with AIDS, including pneumocystis carinii pneumonia, and Kaposi’s sarcoma (a rare type of skin cancer). Additional important complications of the disease include AIDS dementia, HIV neuropathy, wasting syndrome, nausea and vomiting associated with potent antiretroviral medications and depression. You may review details about HIV/AIDS, its transmission, symptoms and associated infections, here
Use of Medical Cannabis in HIV/AIDS
In 2003, research confirmed that use of cannabinoids did not have a negative effect on HIV patients CD4 cell count or viral load (key indicators of patients’ HIV status)1 From the very early days of the epidemic, cannabis was found to be effective in management of the numerous symptoms and complications of the infection or pharmaceutical therapy. “Wasting syndrome” which involves profound, unexplained weight loss, is minimized with THC by stimulating the appetite of suffers.2 Many patients also find cannabis helpful for AIDS-related neuropathic pain3 that may be caused by the virus, opportunistic infection, the antiviral regimen or a combination of these factors. Researchers at UCLA recently published findings indicating that cannabis use in HIV patients is associated with a lower likelihood of cognitive decline than seen in HIV patients not using cannabis. Scientist speculate this may be due to the known anti-inflammatory effects of cannaboids.4 While newer drug regimens have reduced the severity of many of the associated complications of HIV, cannabis is still popularly embraced as a means to alleviate many adverse symptoms and complications that may accompany the infection and antiretroviral treatment. Given the nature of these symptoms, both THC and CBD appear useful in the management of HIV/AIDS. As with other disease areas, patients should start with a low dose and titrate upward until desired effect(s) are achieved.
Cannabis and Future HIV/AIDS Research
Therapies now available for the treatment of HIV/AIDS include pharmaceuticals that are used in various combinations or “cocktails”. While therapeutic advances have been made that have resulted in HIV/AIDS becoming a more manageable, chronic infectious disease (from what was once thought to be a death sentence), the toxicities of these therapies are challenging for patients to endure. Cannabis has offered a source of relief for this population and important, well-designed research continues–such as evaluating cannabis ability to aid in opioid reduction in HIV adults experiencing generalized pain, cognition in a female and risk-reduction in adolescent populations, as well as a deeper dive into the effects of cannabis in HIV-neuropathic pain looking at specific dosing and extract concentrations.
FDA approved medications for HIV/AIDS
Early HIV drugs were often associated with serious and debilitating side effects. Currently, a multiple drug “cocktail” for the treatment of HIV is the standard of care in this infectious disease and appears to have effectively eradicated the virus (to where it is now considered a chronic disease), however, challenging toxicities continue such as nausea, vomiting, rash, fever, fatigue, headache, dizziness, headaches, diarrhea, loss of appetite, and neuropathic pain, to name a few of the most commonly experienced.
1 Abrams, D. I., Hilton, J. F., Leiser, R. J., et al. (2003). Short-term effects of cannabinoids in patients with HIV-1 infection. A randomized, placebo-controlled clinical trial. Ann Intern Med, 139, 258-266.
2 Haney, M., Gunderson, E. W., Rabkin, et. al. (2007). Dronabinol and marijuana in HIV-positive marijuana smokers. Caloric intake, mood, and sleep. J Acquir Immune Defic Syndr, 45(5), 545-554.
3 Ellis, R. J., Toperoff, W., Vaida, F., et al. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology, (2008) 34(3), 672-680.
4 Wei-Ming Watson, C., Paolillo, E, Morgan, E., et. al., Cannabis Exposure is Associated with a Lower Likelihood of Neurocognitive Impairment in People Living With HIV. J Acquir Immune Defic Syndr (2019) 83(1):56-64
Alzheimer’s Disease (AD) is a form of dementia and is recognized as a serious health concern, with the numbers of individuals that are afflicted growing as our population ages. The associated signs and symptoms of AD are easily recognized; however, the cause of the disease is not well understood by research professionals. Genetics are believed to play an important role in the development of the disease. As AD is typically associated with aging, frequently there is a tendency to confuse the signs and symptoms of AD with memory changes associated with the normal aging process. Diagnosis of AD is achieved via a combination of various types of testing and is likely to be successfully diagnosed about 90% of the time by physicians. AD is an area of great research activity as the far-reaching health and economic impacts are recognized by governments and health organizations globally. AD has affected most families and it is believed that in 2015 almost 47 million individuals worldwide lived with AD (that number doubles about every 20 years). In 2020, in the US alone, it is estimated that approximately 6 million people live with AD having an associated per-person cost of around $56,000 annually. By doing the math it is clear that humanistic and economic costs of AD are enormous—and growing. A detailed discussion about the symptoms of AD are available from the National Institute on Aging, here. If you are interested in further information regarding U.S. as well as international perspectives about AD you may click here,
Use of Medical Cannabis in AD
Prevention or Delay of AD
Researchers are seeing indications that the combination of THC and CBD in cannabis, in very low or “micro doses” taken on a daily basis, due to its potent anti-inflammatory nature and ability to cross the blood brain barrier, may prevent or delay the onset of AD. THC is 1,000 times more potent in the brain system than CBD—however, there is evidence that suggests that both compounds working together reduced brain inflammation far more effectively than either THC or CBD working alone.1 The available evidence from research conducted in both humans and animals indicate that beginning in mid-life the long-term, micro-dose daily exposure to the complex blend of compounds found in the marijuana plant appear to slow the brain’s processes underlying AD.
One researcher from The Ohio State University, Dr. Gary Wenk, PhD has conducted numerous studies in animals using a synthetic cannabinoid (often used in research to simulate the actions of THC), the results of which have helped him conclude the value of cannabis.2,3 You may be interested in viewing Wenk’s TED talk here. While his entire video has valuable information that is also relevant to our health, the specific discussion of cannabis effects begins around 10 minutes: 40 seconds.
Current research suggests the role of cannabinoids in the prevention and slowing of AD. However, until more research is conducted to clarify and confirm dosing, safety and cannabinoids’ general role in therapy for this devastating illness, we will not know the specifics. What we do know is that cannabis is effective in reducing, if not eliminating, the symptoms of anxiety, depression and aggression in the AD population. For only one example, a recent study conducted by researchers in Switzerland showed that cannabis in a THC and CBD combination, in a ratio of approximately 2:1 (CBD:THC) was well tolerated and greatly improved behavior problems, rigidity, and daily care in severely demented patients.4
Cannabis and Future AD Research
Over the past several years, due to the limited effectiveness and toxicities associated with pharmaceuticals, there has been increased interest in the use of cannabinoids for the management and treatment of AD. Several studies conducted in labs and clinics have indicated that cannabinoids may reduce oxidative stress and neuroinflammation in AD which, may contribute to reductions in neuronal damage and cell loss. Over the past 20 years this hypothesis has gained support in being a possible trigger for the development of AD.4 Due to the myriad of beneficial effects that cannabinoids appear to provide in the aging and AD populations, providing a strong proof of concept, this is a very important research consideration for cannabis and AD for the future.5
FDA Approved Medications for AD
Currently, the medications developed by the pharmaceutical industry treat the outward behaviors (symptoms) and consequent personality changes of AD, with many of them having harmful side-effects such as nausea, vomiting, loss of appetite, muscle cramps and increased frequency of bowel movements. In the case of a newer agent memantine, common adverse effects may include headache, constipation, confusion and dizziness. The five (5) FDA approved medications for treatment in AD all effect the chemical messenger systems in the brain, and include: donepezil, galantamine, rivastigmine, memantine, and more recently the combination of donepezil with memantine has also been marketed.
1 E Aso, I Ferrer. Cannabinoids for Treatment of Alzheimer’s disease: moving toward the clinic. Frontiers in Pharmacology, 2014; 5(37): 1-11.
2 Y Marchalant., et.al., Cannabioid receptor stimulation is anti-inflammatory and improves memory in old rats. Neurobiology of Aging. 2008:29; 1894–1901.
3 Y Marchalant., et.al., Cannabinoids attenuate the effects of aging upon neuroinflammation and neurogenesis
Neurobiology. Dis. (2009), doi:10.1016/j.nbd.2009.01.014
4 B Boers, et. al., Prescription of a THC/CBD-Based Medication to Patients with Dementia: A Pilot Study in Geneva, Med Cannabis and Cannabinoids 2019;2:56–59
5 EA Newcombe., et. al., Inflammation: the link between comorbidities, genetics, and Alzheimer’s disease. J of Neuroinflammation. 2018; 15:276.
Glaucoma is a condition resulting in increased pressure within the eye. The pressure increase may cause damage to the internal blood vessels, nerve endings and may result in impaired vision with damage to the optic nerve. There are two basic types of glaucoma — chronic (open-angle glaucoma) and acute (closed-angle glaucoma). In open-angle glaucoma, pressure slowly increases over time, often resulting in the loss of peripheral vision with difficulty seeing in the dark or driving at night. With acute, closed-angle glaucoma, the pupil becomes dilated and fixed which constitutes an medical emergency situation—immediate consultation with your physician is warranted and frequently surgery is required. The incidence of glaucoma increases with age and is also known to have a genetic component. Treatment for glaucoma typically includes use of a variety of medicated eyedrops. For further information on glaucoma you may check here.
Use of Medical Cannabis in Glaucoma
First observed in 1971 during an investigation of healthy cannabis users, researchers noted that participants had reduced intraocular pressure (IOP).1 It is noted that when taken intravenously, by smoking, or orally, IOP was reduced (but not when cannabis preparations were applied topically to the eye in the form of eye-drops).2 Cannabis decreases IOP by an average of 25-30% and occasionally up to 50%. The specific mechanism in cannabis that causes this is not known.
Cannabis treatments for glaucoma have mostly been in combination with pharmaceutical eye drops, as the IOP lowering effects seem to be additive. In 1980, a non-psychoactive extract of cannabis was tested in combination with Timolol eye-drops in patients with high IOP. They found that the effects of the two medications were complementary and were beneficial in some cases where other medications had failed.
Formerly, it had been thought that inhalation of cannabis, as often as every three hours, was required to treat glaucoma and the ensuing side effects (euphoria) significantly outweighed the benefits, however, clinicians (and researchers) have now observed that with patients who use cannabis to treat glaucoma with chronic use, administration every 3 hours is not necessary for long-lasting eye pressure reduction. THC seems to be more effective than CBD,3 however, more testing is needed to determine how and when cannabinoids are best used in the treatment of glaucoma.
Cannabis and Future Glaucoma Research
At this time research with cannabinoids to address glaucoma is not an area of meaningful activity. x Active research has halted before the information required to support more robust decision-making has been elucidated. The national organizations that provide support and resources for research have officially assumed the position that multiple, frequent dosing (smoking, typically)4 of THC is required for effectiveness in lowering IOP—although other research and clinical observation does not necessarily support this position.
FDA approved medications for Glaucoma
Currently, the medications developed by the pharmaceutical industry to treat glaucoma include several classes of drugs to allow use of multiple products should one product not be adequate to control the IOP–some of these products are available as combinations. These classes of drugs include prostaglandin analogs, beta blockers, alpha agonists, carbonic anhydrase inhibitors, and rho kinase inhibitors.
1 Hepler RS, Frank IR. Marihuana smoking and intraocular pressure. JAMA. 1971, 217: 1392.
2 Tomida I, Pertwee RG, Azuara-Blanco A. Cannabinoids and glaucoma. Br J Ophthalmol. 2004, 88(5): 708-713.
3 Yazulla S. Endocannabinoids in the retina: From marijuana to neuroprotection. Prog Retin Eye Res. 2008, 27(5): 501-526.
4 Green K. The ocular effects of cannabinoids. Curr. Top. Eye Res. 1979, 1: 175–215.
Nail patella syndrome is a genetic disorder which occurs at birth or during early childhood which lead to improper development, underdevelopment of the knee caps, underdevelopment of bones or abnormal projections of either side of the hipbone. Some may have increased pressure in the eyes leading to glaucoma.
Epilepsy & Seizures
Seizure Disorder is a broad term that is given to a variety of seizure-types, the most common of which is epilepsy. Epilepsy is a chronic neurological brain disorder and is the fourth most common neurological disorder that affects both children and adults. A seizure is a brief change in brain activity associated with excessive electrical activation. An epilepsy diagnosis may occur with an individual after having had two or more seizures. Epilepsy may occur as the result of a neurologic injury, infection, toxicity to the brain, or at times the cause may be unknown. A comprehensive summary of various types of seizures, disorders and syndromes including descriptions of their symptoms may be found here.
Use of Medical Cannabis in Seizure Disorder
While some patients will use cannabis to replace one or more of their pharmaceutical preparations, controlling seizures is serious and should always involve collaborative management by a Neurologist in conjunction with a cannabis expert. Patients frequently note that the side-effects of anti-seizure pharmaceuticals are challenging and often, at the right dose and timing, may prefer cannabis due to reduced side effects. It is key to remember to always be consistent with dose and timing of cannabis whether used alone or in conjunction with pharmaceutical preparations. Due to the complexity of seizure disorders, one should always seek professional assistance with management, all the while keeping a journal of daily activities for optimal results.
While both THC and CBD are found to have anti-seizure activity, it is CBD (due to its non-euphoric activity) that has become the cannabis “go to” to address seizure disorder.1 In June, 2019, the US-Food and Drug Administration (FDA) approved the first highly purified, plant derived CBD extract, called Epidiolex®, for the treatment of two pediatric seizure conditions (Dravet’s Syndrome and Lennox-Gastaut syndrome).2 In conjunction with this approval, the Drug Enforcement Agency (DEA) changed the legal status of Epidiolex® by moving it from a Schedule 1 drug (meaning it has no medical value) to a Schedule 5 drug (the lowest/most relaxed classification under the Controlled Substances Act). Many states in the US now allow the use of CBD-rich cannabis due to the activism of parents with children with epilepsy who want access.
It is important to note that the origin and processing of the cannabis preparation is important. With highly purified products, many valuable anti-seizure constituents are removed during this activity. Not only are the cannabinoids (CBD or THC) anticonvulsant, but the terpenes in a full cannabis extract may increase effectiveness. In one study of 272 patients, 86% had some degree of seizure reduction while using whole-plant cannabis.
Utilizing cannabis for seizure control requires professional advice and active involvement. One may also use cannabis to help with control of symptoms, like agitation, insomnia or as a general antioxidant. One should never attempt to self-manage in this situation. If used for seizure control, most protocols involve high doses of CBD-rich cannabis. Most often the CBD will be supplied as an oil concentrate or tincture. Dosing of children is calculated by body weight and given in divided daily doses (typically 3 times daily). Adults may take very large daily doses, as well. CBD used for anxiety/agitation associated with seizure disorders requires far lower doses (10 to 25 mg/dose).
Cannabis and Future Seizure Disorder Research
The interest in cannabis preparations in the treatment of seizures, particularly drug refractory childhood epilepsies, has sky-rocketed in recent years. With over 120 phytocannabinoids known to scientist’s, look for research on a couple important lesser known cannabinoid options: THCA (a non-euphoric precursor to THC) and CBDV which is structurally similar to CBD, and is also not intoxicating when isolated.4
FDA approved medications for Seizure Disorder
Currently, the primary treatment approach for epilepsy are anti-seizure medications developed by the pharmaceutical industry. Many of these have challenging side-effects and often two or three medications are required to adequately quell the seizure activity. The typical course of epilepsy is often marked with remission that may include periods of two to five years without a seizure. This may occur while the patient is taking an anti-seizure medicine as well as when the medicine is withdrawn.
Also, sometimes useful in seizure regulation is a ketogenic diet, and control of post-seizure symptoms which may include “brain-fog”, fatigue, and mood-disturbances, addressed by counseling and/or medications. A last resort for seizure control is brain surgery or nerve stimulation.
1 Ames FR, Cridland S. Anticonvulsant effect of cannabidiol. South African Medical Journal. 1985, 69: 14.
2 Morano A., et. al., Cannabinoids in the Treatment of Epilepsy: Current Status and Future Prospects. Neurotherapeutics 2015, 12:747–768 DOI 10.1007/s13311-015-0375-5.
4 Perucca E., Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last? J Epilepsy Research. 2017, 7: 2.
Amyotrophic lateral sclerosis (ALS) is also commonly known as “Lou Gehrig’s Disease”. ALS is a neurodegenerative disease (also known a motor neuron disease) that causes the death of neurons in the brain and spinal cord that control the voluntary muscles in the body. Symptoms include progressive muscle weakness with muscle spasm, and pain. The cause of ALS is not well understood but in about 5-10% of the cases is thought to be genetic with the remaining 90-95% a combination of genetic and environmental factors contributing to the disease. There is no cure or means to slow the progression of ALS. For more information on the disease, its symptoms and management you may read here.
Use of Medical Cannabis in ALS
Cannabinoids and/or cannabis may have therapeutic benefit for ALS, as it does for other neurodegenerative diseases. It may be “disease modifying” or slow the progression of the disease, but in the least, has been found to help with the major symptoms of ALS such as spasticity, excess salivary secretions, appetite improvement and mood depression. In a survey of 131 patients with ALS, those who were able to obtain cannabis found it preferable to prescription medication in managing their symptoms.1 The average dose required for benefit to this patient group is approximately 30 mg/day. Dosing and type of preparation is an important characteristic in interpreting any results—which often are not well documented in existing studies. As found for other neurodegenerative diseases, cannabis extracts seem to perform better than pure or synthetic THC in management of these constellation of symptoms. Whole plant cannabis not only has cannabinoids but also terpenes and flavonoids that may be useful in the management of the symptoms, typically including the anti-inflammatory, anti-spasmodic and pain reduction, neuroprotection and sleep-aid aspects. Characteristically patients also have difficulty swallowing the saliva that is normally produced in the mouth. Cannabis decreases salivation in the mouth and upper airway, making functioning more manageable for the patient.
Cannabis and Future ALS Research
While there is not a cure for ALS, there is a great deal of interest in learning more about the potential therapies in the hope of finding a means of modifying the course of the disease.2 Ongoing studies in the ALS population are looking to evaluate cannabis’ effect on symptoms but also its potential to stall or modify the progression of the disease. Due to the issue of Federal legality in the US, studies appear to be initiating outside the country, namely Australia and Italy.
FDA approved medications for ALS
Currently, the medications developed by the pharmaceutical industry that are approved by the U.S. Food and Drug Administration (FDA) treat ALS include three treatments that specifically aim to slow the progression of the disease, including: riluzole- tablet (Rilutek), riluzole-oral suspension (Tiglutik), and edaravone (Radicava). None of these treatments have been shown to reverse the damage already caused by ALS, but it is thought they might increase patients’ life expectancy. They often are taken in combination with a variety of therapies in the hope of improving the patients’ quality of life.
1Amtmann D, Weydt P, Johnson KL, Jensen MP, Carter GT. 2004. Survey of cannabis use in patients with amyotrophic lateral sclerosis. Am J Hosp Palliat Care. 21:95–104.
2 Carter GT, Abood ME, Aggarwal SK, Weiss MD. 2010. Cannabis and amyotrophic lateral sclerosis: hypothetical and practical applications, and a call for clinical trials. Am J Hosp Palliat Care. 27(5):347-56.
Autism spectrum disorder (ASD) is a neurodevelopment disorder that manifests as a developmental disability that can cause significant social, communication and behavioral challenges. Typically, nothing about the physical appearance of persons with ASD sets them apart from others. Those with ASD often communicate, learn, and problem-solve differently and their abilities may range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives; others need less. The US Center for Disease Control has indicated the numbers of children diagnosed with ASD (primarily boys) has steadily increased over recent years with the impact in 2000 noted to be 1 in 150, and 2014 1 in 59. Several explanations for this phenomenon exist, however, as scientists do not fully understand the complex, causative factors involved in the development of ASD, some speculate one reason may be a change in diagnostic criteria.
A diagnosis of ASD now includes several conditions that used to be diagnosed separately including autistic disorder, pervasive developmental disorder and Asperger syndrome. These conditions are now all called ASD. To date, no behavioral, genetic, brain imaging, or electrophysiological test can specifically validate a clinical diagnosis of ASD. The major characteristics of autism fall in four main areas: impaired social skills, delayed or disordered speech, limits in the range of interests and repetitive behaviors—all of these areas implicate an imbalance in the endocannabinoid system which is involved in their modulation. Most often these impairments are noted in early childhood and last throughout life. Approximately 20-30% (some sources report a greater %) of patients with autism also have seizure disorder. For more information on ASD, its symptoms, diagnosis and screening, you may read more here.
Use of Medical Cannabis in ASD
Since the early 2000s, anecdotes have emerged from the community as to the usefulness of cannabinoids in aiding the management of ASD symptoms. There is not one clear approach in this group: THC vs CBD vs THCA. It is still very early and unclear as to the most effective type of preparation, including specific cannabinoids and ratios. A variety of observational research (not placebo controlled, not allowing conclusions to be developed from resulting information) has been conducted using synthetics as well as naturally occurring cannabinoids. For example, reported in 2019, 180 ASD patients were treated with 20:1, CBD:THC (CBD rich) and results were reported upon by a group of prominent Israeli scientists. The findings concluded that after 6 months of treatment, approximately 80% of patients experienced a significant or moderate improvement.1 Eleven of the 13 ASD patients who also experienced seizures, reported a complete disappearance of symptoms, while the remaining two patients reported improvement. Approximately 13% (23 patients) reported adverse side effects such as sleepiness, restlessness, psychoactive effects, increased appetite and dry mouth. Ultimately, researchers concluded: “Cannabis as a treatment in ASD patients appears to be well-tolerated, safe and seemingly effective option to relieve symptoms, mainly: seizures, tics, depression, restlessness and rage attacks.” Another recent study (2019) reported similar positive findings. With this said, high ratio, CBD-rich cannabis preparations have resulted in positive outcomes in the treatment of symptoms typically experienced by ASD patients in other studies, as well. While these studies hold promise for families with members who suffer from ASD, they remain observational as they are not placebo controlled. Most of the information available for the treatment and management of autism related symptoms is due to observational research— However, parents of some autistic children report that cannabis eases behavioral problems more effectively than conventional pharmaceuticals, without the adverse effects noted with pharmaceutical agents. Regardless of chosen cannabinoids, the strategy should always be very low-dose initiation with slow upward titration (gradual increases in dose) to desired effects.
Cannabis and Future ASD Research
Several early, proof of concept studies were conducted with dronabinol, a synthetic THC. Subsequently, there are currently numerous clinical trials outside of the US (Israel, Australia, Chile) that are either in planning or underway using cannabis to treat autism. An summary describing several new and ongoing studies may be found here.
FDA approved approaches for the management of ASD symptoms
Currently the only available pharmaceutical indicated for ASD patients is riluzole, a drug originally developed for amyotrophic lateral sclerosis (ALS). The research study was completed in 2012 with a stated purpose of treating children and adolescents (with or without ASD) who have obsessive-compulsive disorder.
Riluzole, is involved with neuronal signaling and is viewed by many as having limited therapeutic value.2 Other medications frequently used in symptom management include pharmaceuticals such as antiepileptics, antidepressants, anxiolytics, antipsychotics, mood stabilizers and muscle relaxers. Also currently employed for management are a variety of behavior, communication approaches, and dietary interventions.
1 Bar-Lev Schleider L, Mechoulam R, et.al., Real life Experience of Medical Cannabis Treatment in Autism: Analysis of Safety and Efficacy. Nature/Scientific Reports (2019) 9:200 | DOI:10.1038/s41598-018-37570-y
2 Wink LK, et. al. A Randomized Placebo-Controlled Cross-Over Pilot Study of Riluzole for Drug-Refractory Irritability in Autism Spectrum Disorder. J Autism Dev Disord. 2018 Sep;48(9):3051-3060. doi: 10.1007/s10803-018-3562-5.
Chronic inflammatory demyelinating polyneuropathy, also known as CIDP, is an acquired immune-mediated inflammatory disorder closely associated with Guillain-Barre syndrome. Affecting the peripheral nervous system, this condition is a chronic relapsing polyneuropathy.
It is a relapsing and remitting disorder. This means that a patient might suffer a particularly difficult period of symptom intensification, then after time recover completely. At some point within the disease’s progression, that patient will likely suffer relapses and not remit completely, then suffering resulting permanent damage. This is how the disease progresses over time.
Typical symptoms of chronic inflammatory demyelinating polyneuropathy include:
- Numbing of the body
- Tingling sensations, particularly in limbs
- Progressive muscle weakness and atrophy
- Loss of deep tendon reflexes
- Chronic fatigue
- Other abnormal sensations
Cannabis to Alleviate Chronic Inflammatory Demyelinating Polyneuropathy
Research has shown that cannabis helps slow the progression of Huntington’s disease through its interaction with the endocannabinoid system. After studies determined that Huntington’s disease was related to a loss of cannabinoid receptors in the basal ganglia, researchers set out to examine whether increasing endocannabinoid activity could be therapeutically beneficial for treating the disease. Results have been encouraging.
In preclinical trials, the major cannabinoids found in cannabis have been found to be effective at protecting the life of neurons in the brain. Research has shown that through the activation of cannabinoid 2 receptors (CB2), the inflammation and toxicity of microglial cells is reduced, which in turn slows the neurodegeneration caused by Huntington’s disease2. Through the activation of cannabinoid 1 receptors (CB1), cannabinoids have shown to effectively alleviate specific motor symptoms like tremors and movement disorders and reduce the process in which neurons are damaged and killed to slow the progression of the disease.
Additionally, studies examining the effect of cannabis-based medications on Huntington’s disease have proven cannabinoids effective at delaying the progression of the disorder.
Researchers suggest that targeting the cannabinoid system with cannabinoids may have a potential therapeutic benefit for treating basal ganglia disorders like Parkinson’s disease and Huntington’s disease. Cannabinoids are effective at providing neuroprotection through three methods: reducing inflammation by activating CB2 receptors, limiting cell death by activating CB1 receptors, and providing an antioxidant effect through a mechanism independent of cannabinoid receptors. Studies also indicate that cannabinoids are effective at reducing muscle spasms and the inability to concentrate through their direct activation of vanilloid TRPV(1) receptors.
Several types of muscle spasms may occur. Skeletal muscle spasms are the most common, often due to overuse and muscle fatigue, dehydration, and electrolyte abnormalities (also known as “heat cramps”). Prone to this type of spasm are athletes performing strenuous exercise in a hot environment or those who work in labor-intensive occupations and in heated conditions (i.e. construction workers). Usually, spasms occur in the large muscles, which are strained as they do most of the work. Another cause of spasm is due to overuse, typically effecting the neck, shoulders and back. Symptoms occur rapidly and are painful, routinely, however, they may be relieved by gentle stretching and usually resolve quickly.
Smooth muscles, located within the walls of hollow organs (like the gut or GI tract), can also go into spasm causing significant pain. Another example of spasm that may occur is the cardiac muscles of the heart, which results in chest pain. Some diseases of the nervous system, such as amyotrophic lateral sclerosis, multiple sclerosis, or spinal cord injury, may also be associated with muscle spasm or spasticity where the spasm occurs due to abnormal transmission of signals from the brain to the muscles.
Use of Medical Cannabis in muscle spasm
For millennia (prior to written research), use of cannabis has been an herbal approach for the management of muscle spasm. Furthermore, the muscle relaxing properties of cannabis have been noted in the literature dating back hundreds of years1 —therefore, it is perceived by many as a reliable “remedy” for this purpose. Presently, many people suffering from chronic skeletal muscle spasms have turned to medical cannabis to relieve their pain.
Most of the available information about cannabis and cannabinoids in the treatment of muscle spasms has focused on multiple sclerosis (MS) patients. Several studies conducted in an MS population have shown relief from spasms, spasticity and pain. Spasm relief has also been documented across a variety of patients and diseases. While CBD has shown muscle relaxant properties, its effects do not appear to be as robust as those found with THC.
It has been confirmed that both topical and internal cannabis treatment are able to relieve spasms. The use of topical applications of cannabis is generally an effective method of delivery with few to no side effects. Topicals may be applied to the affected area without causing any psychoactive effects. Widespread spasticity often requires internal use (smoking or ingesting), with either CBD or THC or in combination as they are both useful for muscle spasms- and remember CBD helps to reduce side effects associated with THC (euphoria). Often the combination of internal preparations together with topicals provide better relief than either dosage form used alone.
Cannabis and Future Muscle Spasm Research
No new research has been identified studying the use of cannabinoids for the relief of spasms—speculation would have it that no further work is being done due to its long-standing acceptance for this purpose.
FDA approved medications for AD
Currently, the medications developed by the pharmaceutical industry for treatment of MS are discussed elsewhere. (Suggest linking to the MS section) Medications commonly prescribed for general skeletal muscle spasms include, skeletal muscle relaxants, benzodiazepines, and both prescription and over-the-counter anti-inflammatories. Also, often in conjunction with pharmaceuticals, physicians may suggest yoga (stretching), physical therapy, acupuncture, massage and chiropractic care to manage this common condition.
1 Nuutinen T., Medicinal properties of terpenes found in Cannabis sativa and Humulus lupulus. EU J of Med Chem 2018; 157: 198-228.
Severe nausea may occur for a variety of reasons and may be a brief episode or remain ongoing and may occur with or without vomiting. Brief intermittent episodes might be due to pain, stress, overeating, excess alcohol, motion sickness or a reaction to medications. Chronic, severe nausea will typically be the result of infection, liver disorders, food poisoning, pregnancy or possibly brain abnormalities. Additionally, severe nausea often accompanies some cancers, typically in conjunction with chemotherapy. Nausea with vomiting is more likely to occur with food reactions, infection, or when food stops moving through the GI tract. Also, patients may experience Cannabis Hyperemesis Syndrome (CHS). Chronic (typically high dose) cannabis use may result in CHS that causes severe vomiting. This is a rare condition and paradoxical in nature as cannabis has been used since ancient times for it’s antiemetic (nausea treatment) properties.
Use of Medical Cannabis in Severe Nausea
Our stomach and GI contain many endocannabinoid receptors that are naturally occurring and are involved in the regulation of nausea and vomiting in humans (as well as other animals).1 In the late 1970s/early 1980s, inadequate treatment of chemotherapy-induced nausea and vomiting led researchers to seek alternatives to the pharmaceutical products that were in use at the time. These investigations resulted in the 1985 approval and marketing of a synthetic Δ9-Tetrahydrocannabinol (THC) product dronabinol (Marinol®), for the treatment of nausea and vomiting associated with chemotherapy.2 Synthetic THCs effects have been confirmed in a double-blind, placebo-controlled trial versus a strong pharmaceutical antiemetics. Many patients experience adverse effects with the synthetic THC drug and prefer the effects of cannabis.
While THC is associated with very good effectiveness for use in nausea, cannabidiol (CBD) (in animal models) also suppresses nausea and vomiting within a more limited dose range. Sativex® is a prescription product approved for use outside the US, with an approximate 1:1 ratio of CBD:THC, has also been found to decrease chemotherapy-induced nausea and vomiting in preclinical trials.
One must consider the nausea (and possible vomiting) that may occur and select the best approach for administering cannabis under these circumstances. For this purpose, the preferred methods of cannabis delivery include the use of inhaled, or sublingual (under the tongue) products. Doses of 5-10 mg are usually effective, or alternatively, 1-2 puffs of a smoked or vaporized product.
Cannabis and Future Nausea Research
Currently, cannabis research focused on nausea (with or without vomiting) is not a priority, likely because of its long history of use and that it is established as a good choice for the management of this issue.
FDA approved medications for Nausea
Currently, the medications developed by the pharmaceutical industry to treat nausea include a variety of classes/types of drugs, prescribed dependent upon the underlying cause of the nausea. For example, frequently antihistamines will be prescribed for motion sickness. For post-surgery, a serotonin or dopamine receptor-blocker or even corticosteroid may be prescribed. There are several pharmaceutical options available for the treatment of nausea—typically having adverse effects and potential complications. More information may be learned about these options and consequent side-effects here.
1 Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol. 2011, 163(7):1411-22.
2Meiri E, et al. Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Curr Med Res Opin. 2007, 23: 533-543.
Neuropathy results from damage to or the dysfunction of the nervous system. Typically, this occurs in the peripheral nervous system, which lies beyond the spine and brain, although brain injury, such as the result of a stroke, may also result in neuropathic symptoms. This damage may occur a the result of trauma, infections, disorders of the nervous system, or even exposure to certain pharmaceuticals–chemotherapy, for example. Most patients have noted the associated pain feels more intense than a typical injury to the skin. The most common syndromes associated with neuropathy include: postherpetic neuralgia, root avulsions, painful traumatic mononeuropathy, painful polyneuropathy (particularly due to diabetes), central pain syndromes (potentially caused by an injury at any level of the nervous system), postsurgical pain syndromes, phantom limb syndrome, chemotherapy-induced peripheral neuropathy (CIPN), and complex regional pain syndrome (CRPS).
Neuropathic pain is described as numbing or burning along with sensations of tingling, electric shock, crawling, itching, or shooting. The pain may increase to include larger and larger areas of the body. This condition is difficult to treat and often requires a combination of medicine, counseling and often some form of alternative therapy.
Peripheral neuropathy (PN) is a disturbance in the function of a nerve or a group of nerves outside of the brain and spinal cord (called the peripheral nerves). Numbness, tingling, a burning sensation or a feeling of itching or crawling in the affected area are the typical symptoms associated with PN. The nerves that are furthest from the heart, such as those in the hands and feet, are the most likely be affected and healing is a challenge with poorer circulation to the extremities. People with diabetes may suffer with PN because of circulatory problems caused by the illness. For individuals with PN, often mild stimuli (such as gentle touch or even bedsheets touching the extremities) may be perceived as very painful.
Use of Medical Cannabis in Neuropathy
The treatment of pain, particularly NP, is one of the major therapeutic applications of cannabis that is currently under ongoing investigation. FDA-sanctioned research has shown that inhaled cannabis can significantly alleviate NP. One study design showed that volunteers given injections followed by moderate doses of cannabis, found significant reductions in the discomfort caused by the shot.1 Yet another study found patients, not responsive to standard pain therapies, experienced NP reduction when using inhaled cannabis.2
Some patients find they are able to decrease or eliminate their need for pharmaceuticals when including cannabinoids in their regimens. Sativex, a balanced cannabis-based medicine (1:1 ratio of CBD:THC) for use in the treatment of NP in Multiple Sclerosis is approved in Great Britain and several other European countries.3 With increased research around this topic, cannabis is likely to become accepted as an effective option in the treatment of NP.
Neuropathy has proven to be a treatment challenge using both conventional as well as integrative approaches. For the best results using cannabis for neuropathy and NP, patients should follow a constant daily regimen for weeks or even months. For example, post-herpetic neuralgia may last for months, but over time, with cannabis therapy, the pain reduces. CBD and THC are both useful for neuropathy as the combined effects are synergistic in the management of neuropathy and resulting pain that frequently occurs. CBD may be most effective in this syndrome for its anti-inflammatory and neuroprotective effects coupled with THC that is thought to be more effective for pain reduction, also countering inflammation, of course with the inclusion of associated terpenes and flavonoids. Doses may range up to 25 -30 mg of cannabinoids daily, in balanced combination, divided and take at three times. Greater doses may result in the development of tolerance and require “tolerance breaks” which prove challenging for some.
Cannabis and Future Neuropathy Research
Over the past several years, due to the limited effectiveness and toxicities associated with available pharmaceuticals, there has been increased interest in the use of cannabinoids for the management and treatment of neuropathy and NP. Several studies are currently underway, in a variety of neuropathic types of conditions, utilizing CBD, from hemp (THC < 0.3%). Given what we currently understand regarding the mechanisms of THC and CBD, the exclusion of THC from these studies and resulting regimens, may only be addressing a component of the issues of neuropathy, NP and its management and may not be useful over the longer term.
FDA approved medications for Neuropathy
Currently, the medications developed by the pharmaceutical industry may treat the symptoms of neuropathic-related pain syndromes. Most commonly these medications are gabapentin (Neurontin®— several other brand-name versions are also marketed) and pregabalin (Lyrica®) with both agents considered to be classical anti-seizure medications and are thought to affect the chemical messenger systems in the brain that ultimately effect aspects of nerve conduction. These agents have some common side-effects that many patients consider problematic. More information on these two FDA approved medications are available here.
1 Wilsey B, et al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain. 2008, 9(6): 506-21.
2 Wilsey, B, Marcotte, T, Deutsch, R, Gouaux, B, Sakai, S, Donaghe, H. Low-dose vaporized cannabis significantly improves neuropathic pain. J Pain. 2013, 14(2): 136-48.
3 Rog DJ et al. Oromucosal δ9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension. Clinical Therapeutics. 2007, 29: 2068-2079.
What is the science and pharmacology behind marijuana, and can it be used to treat Parkinson’s symptoms?
The endocannabinoid system is located in the brain and made up of cannabinoid receptors (a receptor is molecular switch on the outside of a cell that makes something happen inside a cell when activated) that are linked to neurons (brain cells) that regulate thinking and some body functions.
Researchers began to show enthusiasm to study cannabis in relation to PD after people with PD gave anecdotal reports and posted on social media as to how cannabis allegedly reduced their tremors. Some researchers think that cannabis might be neuroprotective — saving neurons from damage caused by PD.
Cannabinoids (the drug molecules in marijuana) have also been studied for use in treating other symptoms, like bradykinesia (slowness caused by PD) and dyskinesia (excess movement caused by levodopa). Despite some promising preclinical findings, researchers have not found any meaningful or conclusive benefits of cannabis for people with PD.
Researchers issue caution for people with PD who use cannabis because of its effect on thinking. PD can impair the executive function — the ability to make plans and limit risky behavior. People with a medical condition that impairs executive function should be cautious about using any medication that can compound this effect.
Sickle Cell Anemia
Sickle cell anemia is a blood disease. Healthy blood cells are shaped like donuts without a hole. These disc-shaped organisms are small, but contain our genetic code and, more importantly, our oxygen. Oxygen, as I’m sure you know, is what we breathe, and most times when our oxygen supply is put in jeopardy, so are our lives.
As the name suggests, sickle cell disease changes the shape of these once disc-like cells into that of crescent moons (or sickles). This reshaping makes it very difficult for blood cells’ hemoglobin to hold on to and circulate oxygen, and can also cause blockages in the circulatory system that can have fatal results.
Common symptoms of sickle cell anemia include:
- Shortage of red blood cells, causing anemia
- Bouts of “sickle pain” where congested parts of the circulatory system become swollen and inflamed, eliciting a throbbing/stabbing pain that is only abated by taking medication and/or increasing circulation
- Swelling of hands and feet
- Spleen and internal organ inflammation and damage, which can lead to frequent infections
- Slowed growth and delayed puberty
- Vision problems
- Risk of stroke
Cannabis may not be a panacea for everyone, but its usefulness and versatility cater to many, including those suffering from sickle cell disease. Alongside the mood enhancing, uplifting, and euphoric effects, cannabis also has analgesic (pain relief) and anti-inflammatory (anti-swelling) properties that are particularly useful for sickle cell patients. These attributes lend themselves to people surviving sickle cell disease.