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Medical Marijuana

uses & benefits

Definitions & medications

THC is the acronym for tetrahydrocannabinol. When not otherwise specified, THC is used to refer to the naturally occurring (-)-trans isomer of delta-9-tetrahydrocannabinol from the cannabis plant (Cannabis sativa L.). It is responsible for most of the pharmacological actions of cannabis, including the psychoactive effects.

Dronabinol is the international non-proprietary name (INN) for (-)-trans-delta-9-tetrahydrocannabinol and is used synonymously with THC.

CBD or cannabidiol is the most important non-psychotropic cannabinoid found in the cannabis plant. It is not a cannabinoid receptor agonist.

Nabilone is a synthetic derivative of THC. In some countries, it is licensed for the treatment of nausea in chemotherapy. A quantity of 1 mg nabilone has about the same effect as 7–8 mg dronabinol.

Cannabis extract nabiximols. An alcoholic cannabis extract that is standardized to contain dronabinol and CBD in a ratio of 1:1 and is sprayed under the tongue using a dose pump for the treatment of spasticity in MS. Spraying once delivers 2.7 mg THC and 2.5 mg CBD.

Further reference

Herbal cannabis contains over 400 compounds including over 60 cannabinoids. Cannabinoids are defined, chemically, as aryl-substituted meroterpenes derived unique to the plant genus Cannabis. The pharmacology of most of the cannabinoids is largely unknown but the most potent of these cannabinoids is ▵ 9-tetrahydrocannabinol (▵9-THC, or THC), has been isolated, synthesised and the most studied cannabinoid. Other plant cannabinoids include ▵ 8-THC, cannabinol and cannabidiol along with other cannabinoids produce a complex pharmacological interaction when herbal cannabis is smoked. Cannabinoids are present in stalks, leaves, flowers and seeds of the plants and in the resin secreted by the female plant.

Tetrahydrocannabinol-like derivatives such as dronabinol and nabilone have been synthesized and prescribed in some countries to treat symptoms associated with cancer, Parkinson’s Disease, Multiple Sclerosis, seizures and more.

Pharmacokinetics of cannabinoids
About 50% of the THC in a joint is absorbed by the lungs, enters the bloodstream and reach the brain within minutes. Effects are felt within seconds and fully realized in a few minutes. Oral ingestion effects require more time due to the first-pass metabolism in the liver. Effect is delayed by .5-2 hours but effect is prolonged due to slow absorption from the gut.

Pharmacodynamics of cannabinoids
Cannabinoids interacts with neuronal cannabinoid receptors called CB1 and CB2. The body naturally produces a endogenous cannabinoid called anandamide, also known as N-arachidonoylethanolamine (or bliss molecule) to bind to cannabinoid receptors. Anandamide has very similar molecular structure to tetrahydrocannabinol (THC) – the main psychoactive compound in cannabis. This similarity in chemical structure THC is able to attach to molecules called cannabinoid receptors on neurons in the brain area and activate them.

Cannabis has been shown to be able to alleviate pain of various etiologies and it has shown to have an effect on motor symptoms and pain parameters in patients with Parkinson’s Disease (PD).  A 3 months standardized interview study recently published in Clinical Neuropharmacology to assess the effects of medical cannabis on symptoms of Parkinson disease found improved symptoms of PD in the initial stages of treatment and did not cause major adverse effects. In another study published in European Journal of Pain, results showed a significant decrease from baseline to 30 minutes after cannabis consumption in patients – suggesting treatment with cannabis may lessen motor symptoms and subjective pain in patients with PD and central parkinsonian pain.

Pain is a complex sensation affected by physiological, psychological, genetics and environmental factors but multiple studies have shown pain regulation occurs at the level of spinal cord, periaqueductal gray, thalamus and cortext and cannabinoid receptors are spread throughout all pain pathways. It is plausible that heat and cold pain then are regulated differently following use of cannabis, it may also be that cannabis use causes a TRPV1-mediated release of P and calcitonin gene-related protein leading to excitation of central root ganglion neurons. There needs to be more research to demonstrate and verify the role of cannabis in the therapeutic treatment of PD but for now, there are strong results showing cannabis does improve motor function and lessens the subjective perception of pain in patients with PD.

Medical cannabis laws are associated significantly lowering opioid overdose mortality rate but there are few studies on how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose. The working hypothesis is that the increased access to medical cannabis may reduce opioid analgesic use by patients with chronic pain therefore reducing opioid analgesic overdose.

A recent study published in Neuroscience Forefront Review showed cannabinoid through opioid receptor mechanism increase dopamine concentrations in nucleus accumbens like heroine and cocaine. Clinically cannabis use is associated with modest reductions in opioid withdrawal symptoms for some people and therefore demonstrate potentials for reduction for opioid use. In a double-blinded placebo-controlled studies with THC, significant pain relief was experienced compared with placebo. Another controlled study also reported significant pain relief compared with placebo by patients with postoperative pain. For more chronic pain management, the efficacy of THC appears to be approximately equivalent to codeine and an adjunctive role seems to be the most promising use of cannabinoids in the management of pain.  Cannabinoids and opioids share similar pharmacologic properties, including antinociception; and has shown synergistic interaction that allows for opioid treatment at lower doses with fewer side-effects. The administration of low doses of THC in conjunction with low doses of morphine in one experiment seems to be an alternative regimen that reduces need to escalate opioid dose while increasing opioid potency.

Research from Dalhousie University in Canada found cannabinoids block pain responses in virtually every laboratory pain model tested, cannabinoid has been found to be highly effective against thermal, mechanical and chemical pain and are comparable to opioid in potency and efficacy. National of Academies of Science Engineering Science published a comprehensive studies of recent and relevant research published since 1999 to investigate the health effects of recreational and therapeutic cannabis use, in the report they found conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment for chronic pain in adults.

The proportion of patients with noncancer pain receiving prescription for opioids has almost doubled over the last decade. According to Centers for Disease Control and Prevention (CDC), overdose deaths involving opioid pain relievers have increased and now exceed deaths involving heroine and cocaine combined. Escalating rates of prescription opioid use and abuse have occurred in the context of efforts to improve treatment of non-cancer pain. While escalating opioid utilization has been well described and documented, there is not a similar increase in prescribing of alternative analgesic or other therapies that may serve as alternatives to prescription opioids. Approximately 60% of all opioid overdose occur among patients who have legitimate prescription from a single provider.  This finding by CDC has important implications for patients, providers and policy-makers to explore non-opioid therapies – and that may include easier access to medical cannabis.

There is evidence supporting the potential role for the cannabinoid system as therapeutic treatment of Alzheimer’s Disease, however, much more studies are needed. According to the Advancing Alzheimer’s Research Center, a 2008 investigator-initiated research grant was given to Dr Jung from University of California to confirm earlier research finding of less anandamine, a type of endocannabinoid, in the brains of people with Alzheimer’s disease than in healthy brain. Endocannabinoids are naturally occurring brain chemicals similar to active ingredients in marijuana – these chemicals can protect brain cells from injury and degeneration. The study will also examine whether alterations in the endocannabinoid system affect levels of beta-amyloid in the brain – beta-amyloid is a protein fragment that is a key suspect in Alzheimer’s disease. This fragment is suspected of damaging synapses and disrupting cell-to-cell communication within the Alzheimer brain. The results of Dr Jung’s research could lead to new strategies to preventing and treating Alzheimer.

In a paper presented by multiple institutions together published in Frontiers in Pharmacology to summarize studies of Alzheimer’s Disease to encourage progress toward a clinical trial. While data has been scarce, the paper points out significant findings of recent studies showing cannabinoids exhibiting pleiotropic activites in targeting several processes that play key roles in Alzheimer’s Disease. Cannabinoids has been able to target Aβ and tau aberrant processing, neuroinflammation, excitotoxicity, mitochondrial dysfunction, oxidative stress and at the same time improve behavioral disturbances (see graphic below).  Cannabinoid demonstrate great potentials to be a safe, low-cost, natural origin therapeutic option with low side-effects profile for treating Alzheimer Disease but more research is required.

The limited effectiveness of current therapies against Alzheimer’s disease (AD) highlights the need for intensifying research efforts devoted to developing new agents for preventing or retarding the disease process.

CBD & its surprising effect on psychosis

CBD is one of the phytocannabinoids that interacts with the endocannabinoid system (ECS) – which consists of cannabinoid receptors, endogenous cannabinoids and several enzymes controlling activation and availability of these endocennabinoids. The ECS plays a role in memory, appetite and stress response. Two cannabinoid receptors CB1 and CB2 – CB1 receptor is most prominent in the central nervous system and CB2 is most prominent in the immune system. In multiple studies exploring the roles of endogeneous cannabinoids in the neurobiology of schizophrenia, studies have reveals that levels of endocannabinoids are markedly increased in cerebrospinal fluid and peripheral blood of schizophrenia patients. Further studies establish a link between schizophrenia and expression of cannabinoid receptors in different brain area, endocannabinoid system may play an important role in the immune system and its pathogenesis of psychotic disorders. A recent genetic association study in two independent populations suggests an increased risk of schizophrenia in people with single nucleotide polymorphism leading to low CB2 receptor function.

In a 2012 study, Lewweke et al reported the first double-blind control clinical trial in 42 acute paranoid schizophrenia or schizophreniform disorder patients comparing CBD with amisulpride in treatment during 4 weeks. Trial found CBD has the therapeutic effect of reducing psychotic symptoms – similar to amisulpride but with significant less extrapyrmidal side effects, prolactine increase and weight gain than amisulpride.  In one of the first placebo-controlled trial using CBD to treat patients with psychosis, during the six-week trials 88 patients with schozophrenia were divided into two groups – one treated with 1,000 milligrams of CBD and control group received a placebo drug. CBD was found to significantly reduce psychotic symptoms. Patients in the CBD groups were more likely to be rated as improved by their psychiatrist and reported lower levels of positive psychotic symptoms to the researchers. The results, which was recently published in American Journal of Psychiatry, provide hopeful potentials for the world’s three percent of population diagnosed with psychotic disorders – as many of whom are reluctant to take antipsychotic drugs because of the nasty side effects and CBD’s effects do not appear to depend on dopamine receptor antagonism.

Chronic pain can be an incredibly debilitating condition. It can become so overwhelming that it leads feelings of hopelessness and, eventually, depression. For many who live with it on a daily basis, the condition can be so oppressive. It affects other parts of their lives, impacting their mood, health, and overall well-being. Unfortunately, many treatment options are only nominally effective. No wonder a growing number of the estimated one in five Americans who suffer from chronic pain are turning to cannabis as an alternative.

The reduction of chronic pain is one of the most common reasons practitioners prescribe medical cannabis. It has been proven to reduce inflammation, swelling, tension and sore muscles, making it a no brainer for those who suffer from debilitating pain. With a new study from official journal from American Pain Society. that reinforces the truth behind cannabis as a treatment for pain management, American scientists have once again shown the importance of medical cannabis in treating chronic pain.

Cannabis is highly effective in treating pain and inflammation. It does this by working with the endocannabinoid system, which controls pain and inflammation. The brain naturally ramps up the production of endocannabinoids in response to stimuli, such as an injury. However, the body isn’t generally able to create the cannabinoids necessary to manage serious or chronic pain. In these situations, increasing the cannabinoids present in the body can help manage pain. When a person consumes cannabis, it basically helps with the body’s natural pain management system. It wasn’t just helping the physical pain, it was alleviating every symptom the pain caused, even psychological ones.

For decades, harsh chemical drugs have been the only options available to help treat chronic pain. However, as medical cannabis becomes more widespread and now became a substitute for Opioid based pain medication, researchers and patients are finding the answers they’ve been searching for in the treatment of this illness. Using cannabis for pain management is a field of research that is only going to grow and we can only wait and wonder what uses will be discovered next.
The use of cannabis will enable millions of people who are suffering from chronic pain to manage their conditions in a much safer way than through opioid prescriptions. Without the risk of overdose and addiction, medical cannabis oil can make pain treatment safer.

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system)  with MS – the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, MS can cause the nerves themselves to deteriorate or become permanently damaged. There’s no cure for multiple sclerosis.

Recent studies have shown that between 20-60% of people with multiple sclerosis are currently using cannabis, reflecting wide acceptance of cannabis within the MS community. The cannabis plant contains up to 110 cannabinoids, however the two that have been the primary focus of medical investigations are  Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Certain strains containing CBD levels equal or higher than THC have positive effects on muscle spasticity and pain for people with MS.  The positive effects of cannabis on spasticity and pain have been emphasized by the American Academy of Neurology after a systematic review of medical marijuana (1948-November 2013) to address treatment of symptoms of MS, epilepsy and movement disorders.

Medical Research Council of UK funded a multicentre randomized placebo-controlled trial to look at cannabinoids for treatment of spasticity and other symptoms related to MS and they found that cannabinoid might be clinically useful in the treatment of pain in MS.

Cannabis is also known as medical marijuana. It is a plant that naturally exists and the pharmaceutical sector in many ways is dependent on it to facilitate patients in a better way. It helps in relieving pain, nausea, depression, poor appetite, dementia, stress, and HIV/AIDS. It is also helpful in preventing cancers and tumors (Mary Lynn Mathre, 1997). According to a presented detail by SAMHSA (Substance Abuse and Mental Health Services Administration), there has been no death reported ever due to cannabis; it is completely safe for human beings in the United States as stated in Drug Awareness Warning Network Annual Report (Centers for Disease Control and Prevention, 2017).

Cannabis is being utilized as herbal medicine back since it was a part of the pharmaceutical industry by the people of the old era. But since the 19th century, it is officially a part of pharmaceutical industry officially. Cannabis was first tested on animals then it was tested on humans, and since then it has been used for human beings as well. Due to extensive benefits of cannabis, various states have agreed to make the availability legal under certain laws.

The use of cannabis is common in people with every age, and nowadays it is getting very popular among seniors. Elder patients are also significantly utilizing cannabis, and it is making their quality of life better. Many people around the world suffer from age-related illness. It has been estimated that around 92% of elders have as a minimum as one chronic disease and 77 percent experience two. The older citizens commonly suffer from anxiety disorders, depression, and dementia which would double by the year 2030. Alzheimer’s Disease, Chronic Pain, Depression, Fibromyalgia, Anxiety, Cardiovascular Disease, Cancer, Arthritis, Glaucoma, Sleep Disorders, Diabetes, and Osteoporosis are some of the disorders which are experienced by elder people. Elder people require such drugs that have less side effects and health professionals prescribe them such treatments which leave out fewer side effects. Cannabis is getting very popular in curing various diseases and symptoms related to various diseases without any side effects.

A review regarding geriatric care reported that there had been a lot of studies suggest that medical marijuana is very safe and a lot of nurses are utilizing medical marijuana with old patients, and nurses claim that cannabis is replacing various drugs. Education regarding cannabis is vital for more aged patients and its safety for human bodies (Mahvan, Hilaire, Mann, Brown, & Linn, 2017).

There have been a lot of news regarding adverse effects of opioids and that it will increase in future. Opioids are highly prescribed medicine globally, and its side effects are reported. 2.8 million Elders are noted to have abused prescription drugs since last few years, according to SAMHSA it will increase more by the year 2020. Cannabis has efficiently replaced the over usage of opioid which has lowered the incidence of its adverse effects (Kramer, 2015).

Alzheimer disease is a prominent disorder that is faced by elders it is also termed as an age-related disease characterized by memory and cognitive impairment. It has various neuropathological markers comprising of neurofibrillary tangles and neuritic plaques. Cannabis is very useful in Alzheimer disease and with symptoms related to it (Belendiuk, Baldini, & Bonn-Miller, 2015). Dronabinol was reported to enhance the food intake and lower the disturbed behavior in a study of elderly patients with recognized Alzheimer disease (Kramer, 2015).

Studies show that cannabis has long-term effects on the treatment of elderly patients and due to that use of opioid have been reducing in the treatment plans. (Ratz, Ginosar, Furmanov, Saifi, & Meidan, 2016)

Cannabis is used to cure inflammation in elder people. CBD a component of cannabis act as natural anti-inflammatory medicine for cancers, and intraoral inflammations (Burstein, 2015). CBD is excellent as it is nonpsychoactive and does not induce high feelings. The benefits of CBD was studied in arthritis, and it was suggested due to the anti-inflammatory properties of cannabis, it is very beneficial in curing arthritis (Malfait, Gallily, Sumariwalla, Malik, & Andreakos, 2000).

Another important question that is asked by people and is common in peoples mind that does CBD interacts with other drugs? The answer to this question is no! There was a research carried out to assess the interaction of drugs with CBD; it confirmed the safety outline of CBD and suggested that CBD enhances the treatment whenever it is prescribed to patients with other drugs (Iffland & Grotenhermen, 2017).

In Elder patients, cannabis helps with blood pressure, digestive disorders, headaches, constipation, anxiety, and insomnia and for these issues, cannabis is highly replacing various medicines. Cannabis-induced ointments are very beneficial in alleviating neuropathy and arthritis pain and can never be doubted as to induce getting high effects but give very soothing effect with a pleasant scent. The creams medicated and locally made are famous for sore joints and muscles. They are also very useful for back pain. It is helpful in fast-acting antidepressant, and that is why it is beneficial in psychological issues (Vidal, Linge, Campa, & Fuencisla, 2016).

Conclusion

The discussion above concludes that cannabis is of great importance in medical industry. Adequate education and knowledge should be spread among people so that everyone can avail benefits from cannabis for seniors. Cannabis is a natural plant that has extensive benefits. Its administration and intake are efficient by all means. Cannabis helps in relieving pain, nausea, depression, poor appetite, dementia, stress, and HIV/AIDS Cannabis helps seniors in Alzheimer’s Disease, Chronic Pain, Depression, Fibromyalgia, Anxiety, Cardiovascular Disease, Cancer, Arthritis, Glaucoma, Sleep Disorders, Diabetes, and Osteoporosis. Cannabis is more utilized in geriatric care by health care professions. Cannabis has efficiently replaced the over usage of opioid which has lowered the incidence of its adverse. It helps elder patients with Alzheimer disease. It could be proudly said that cannabis is completely safe for seniors and due to adverse effects of certain drugs seniors are shifting to cannabis due its long-term effects and safety.

References

Belendiuk, K. A., Baldini, L. L., & Bonn-Miller, M. O. (2015). Narrative review of the safety and efficacy of marijuana for the treatment of commonly state-approved medical and psychiatric disorders. Addiction science \& clinical practice, 10(1), 10.

Burstein, S. (2015). Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorganic \& medicinal chemistry, 23(7), 1377-1385.

Centers for Disease Control and Prevention. (2017, June 21). National Estimates of Marijuana Use and Related Indicators — National Survey on Drug Use and Health, United States, 2002–2014. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/mmwr/volumes/65/ss/ss6511a1.htm?s_cid=ss6511a1_w

Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and Cannabinoid Research, 2(1), 139-154.

Kramer, J. L. (2015). Medical marijuana for cancer. CA: a cancer journal for clinicians, 65(2), 109-122.

Mahvan, T. D., Hilaire, M. L., Mann, A., Brown, A., & Linn, B. (2017). Marijuana Use in the Elderly: Implications and Considerations. The Consultant Pharmacist{\textregistered}, 32(6), 341-351.

Malfait, A., Gallily, R., Sumariwalla, P., Malik, A., & Andreakos, E. (2000). The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proceedings of the National Academy of Sciences, 97(71), 9561-9566.

Mary Lynn Mathre, R. (1997). Cannabis in medical practice: A legal, historical and pharmacological overview of the therapeutic use of marijuana. Jefferson, USA: McFarland.

Ratz, Y., Ginosar, Y., Furmanov, K., Saifi, F., & Meidan, R. (2016). The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open-label Study. The Clinical journal of pain, 32(12), 1036-1043.

Vidal, R., Linge, R., Campa, L., & Fuencisla. (2016). Cannabidiol induces rapid-acting antidepressant-like effects and enhances cortical 5-HT/glutamate neurotransmission: role of 5-HT 1A receptors. Neuropharmacology, 103, 16-26.

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