Continuing the Conversation: Medical Cannabis in Long-Term Care

I wanted to continue the conversation about cannabinoid therapy in long term care this week by sharing some insights from my colleague Kim Van Dam, Administrator at Steeves & Rozema’s Trillium Villa.

Here she talks about the outcomes we’ve seen in successfully reducing narcotic and antipsychotic use amongst residents living with chronic pain and dementia.

Trillium Villa is one of Ontario’s first LTC residences to introduce cannabinoid therapy and the first home that I worked in several years ago. I continue to work with Kim and the forward-thinking & dedicated S&R team to this day and have been excited by the number of like-minded long term care organizations and in-house physicians who have reached out to learn more about whether it could benefit their residents/patients.

Medical Cannabis and Cognitive Performance in Middle to Old Adults Treated For Chronic Pain

A new study assessing the relationship between long term medical cannabis use and cognitive function amongst middle-aged and older chronic pain patients has shown no association with declines in cognitive performance.

Researchers assessed psychomotor reaction, attention, working memory and new learning. Dosage, concentrations, length of time using medical cannabis and frequency of use were also assessed.

These results are extremely encouraging and should support patients and practitioners alike in their risk-benefit analysis when determining whether medical cannabis is a suitable treatment option.

Read the full research paper here.

September marks World Alzheimer's Month

September marks World Alzheimer’s Month and this year, the Alzheimer’s community is facing more significant challenges than ever.

Nearly 750,000 Canadians are living with Alzheimer’s or another dementia. Due to the significant and prolonged changes brought about by the Coronavirus pandemic, many patients are experiencing increases in symptoms including increased agitation, depression, insomnia and aggressive, and sometimes violent, behaviours.

Current pharmaceutical therapies, including antipsychotic medications, may provide some reduction in behavioural symptoms but carry an increased risk of severe side-effects including stroke and death. As a result, many families are proactively asking for safer alternatives.

There is a growing body of evidence for the use of cannabinoid-based medicines in the treatment of dementia-related symptoms and clinically, we’ve been seeing some outstanding outcomes since beginning therapy. I hope you’ll have a quick watch of this video to learn more.

Patient Testimonial - Jim | Chronic Pain

“I tried a little bit...and there’s just no looking back. It was probably one of the smartest things I ever did.” -- Jim

I’d like to introduce you to another one of my amazing patients who was kind enough to share his story to help educate others about the role cannabinoid therapy can play in managing chronic pain.

When Jim was referred to me, his pain was so severe that he wasn’t comfortable doing anything. Even sitting for a period of time was painful, so needless to say his quality of life was significantly affected.

Cannabinoid therapy has been the only treatment that has made a difference in managing his chronic, severe pain.

Pregabalin and the Risk for Opioid-Related Death

Pregabalin and Gabapentin are anticonvulsants, that are increasingly prescribed as an adjunct for chronic pain. Recent research published in the Annals of Internal Medicine, found that patients prescribed both opioids and either pregabalin or gabapentin concurrently had an increased risk of opioid-related deaths.

Here’s what can happen: When used together, both drugs can suppress the central nervous system, affecting breathing, which can be life threatening. Opioid use can also increase the amount of gabapentin absorbed by the body, which can further increase risks when used together.

“Physicians should carefully consider whether to prescribe this combination of products and if deemed necessary, patients should be closely monitored and adjust opioid doses accordingly.”

Another important point: Current warning labels on gabapentin contain information about the serious adverse effects when combined with opioids; shockingly, labels on pregabalin do not.

A significant part of my work is focused on opioid reduction and improving quality of life. Studies such as this highlight the growing and urgent need for practitioners to familiarize themselves with safer, alternate, methods of treatment for chronic pain, like cannabinoid medicine.

Full article available here.

The Effectiveness of Topical Cannabidiol (CBD) Oil in Symptomatic Relief of Peripheral Neuropathy

For patients suffering from peripheral neuropathy, symptom relief can be challenging with many treatments falling short. In a recent randomized, placebo-controlled trial investigating the efficacy of topically delivered CBD oil in the management of neuropathic chronic pain, researchers found “a statistically significant reduction in intense pain, sharp pain, and cold and itchy sensations in the CBD group when compared to the placebo group.” Additionally, no adverse events were reported in this study.

Read the full article here.

Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain

A recent study has revealed that cannabis may serve as an adjunct to or substitution for illicit opioid use among people who use drugs with chronic pain in Vancouver, British Columbia. The findings of this study have particular implications for healthcare and harm reduction service providers.

View full article here.

Not all research is created equal: Cannabis and chronic pain

Not all research is created equal. A new study published in The Lancet medical journal suggests that cannabis is not effective at treating chronic, non-cancer pain. This study is flawed on a number of levels.

Take a look at what I, and other physicians treating patients with cannabinoid medicine across North America, have to say in the article here.

From a clinical perspective, I have successfully treated hundreds of patients with non-cancer, chronic pain with cannabis therapy. It does not work for everyone and it is not a panacea, but for many, many patients it can be life-changing and is the only medicine that works to relieve their pain.

However, until we have more prospective, randomized controlled trials that can prove causality, we will continue to go around in circles with the cannabis as medicine debate. To legitimize cannabis as medicine and improve access for patients around the world who could benefit, more quality research is imperative.

New Jersey Governor, Phil Murphy expands medical marijuana program: NBC

A renaissance is coming to New Jersey’s long embattled medical marijuana program. 

Democratic Gov. Phil Murphy announced a long list of reforms this morning, including lowering fees for patients and caregivers, adding five approved medical conditions and proposing legislation to increase monthly product limit for patients.

Patients receiving hospice care would be eligible for an unlimited supply of cannabis. Effective immediately, patients suffering from anxiety, migraines, Tourette’s syndrome, chronic pain related to musculoskeletal disorders, and chronic visceral pain will be eligible for the medical cannabis program.

Murphy added that he would like to eventually see opioid addiction added to the growing list of approved conditions. He called cannabis “an offensive weapon” to the growing crisis.

Full article