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.

New Warnings About Benzodiazepine Use and Dementia Risk

There have been several studies that have indicated that have linked benzodiazepine use to an increased risk for Alzheimer's disease (AD).

This is one out of Finland is one of the largest.

Lead author Vesa Tapiainen, MD, PhD, said: “These drugs are often used to treat sleep problems, but their efficacy for this indication diminishes over time, whereas the risks for adverse events remain.”

In addition to insomnia, benzodiazepines and other so-called "Z" drugs, such as zolpidem (multiple brands) and zopiclone (Lunesta, Sunovion), are used to treat other neuropsychiatric symptoms of dementia, such as anxiety.

Commenting on the study’s findings, David S. Knopman, MD (Mayo Clinic, Alzheimer's Association Medical and Scientific Advisory Council), noted that many studies have suggested that patients who are exposed to certain psychoactive drugs, such as those with cholinomimetic properties, are at increased risk for dementia.

"I therefore find it plausible that benzodiazepines and related drugs could carry the same risks," he said.

The "bottom line" for Knopman is that use of certain psychoactive drugs seems to increase the risk for dementia. However, it is unclear whether the drugs are temporarily worsening cognition or symptoms are being treated with these drugs, said Knopman.

"In other words, the direction of causality from drugs to dementia could go in either direction, and this study that used administrative data can't determine the direction of causality," he said.

Nevertheless, a take-home message is that benzodiazepines and related sleep medications should be avoided "if at all possible" in older individuals, said Knopman.

Similar to benzodiazepines and “Z” drugs, cannabinoid-based medicines have anxiolytic, anticonvulsive and relaxing effects. When dosed low and slow by an experienced healthcare practitioner, cannabinoids can be equally or more effective than these medications in managing symptoms, but with a far superior side-effect profile.

Read the full study here.

Cannabis a superbug slaying antibiotic? McMaster researchers break new ground

Could cannabis be an antibiotic capable of fighting drug-resistant superbugs?

Possibly.

New research from McMaster University in Hamilton, ON, tested over 18 cannabinoids found in the cannabis plant and found that cannabigerol (CBG) "was the strongest bacteria fighter." CBG has the ability to "fight the superbug known as methicillin-resistant Staphylococcus aureus (MRSA),” an aggressive and potentially deadly bacteria.

Everyone knows about CBD, but their research showed that CBD was more potent: "It turns out it's active against the membrane of bacteria; it kills antibiotic resistant bacteria, and can really go after MRSA."

This specific cannabinoid "packed enough toxicity that it could destroy red blood cells and not just virulent bacteria," said Dr. Eric Brown, lead author of the study.

As the body of evidence grows around the other 100+ cannabinoids, it is an exciting time to be in the field of cannabinoid medicine and we will likely find many new medical applications as we undertake more research.

Full article available here.

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.

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.

Why women with breast cancer are turning to cannabis (it's not nausea).

Using cannabinoids to ease the symptoms of chemotherapy-induced nausea and vomiting is considered one of the medical applications most strongly supported by the research. But cancer encompasses an entire range of diseases, with treatments – and side-effects - that vary as well.

In the first ever study conducted to evaluate the underlying reasons women with breast cancer use cannabis, the results revealed that pain was the number one reason, followed by anxiety, insomnia, nausea and anorexia.

With more than half the women diagnosed with breast cancer being over the age of 50, treatment can exacerbate pre-existing medical conditions associated with older age (ie. arthritis, neuropathy). With many patients suffering an average of 3 symptoms, cannabis can help reduce polypharmacy as it is a multimodal medication and can manage many of these symptoms simultaneously.

Read the full article here.

Short- and Long-Term Effects of Cannabis on Headache and Migraine: Journal of Pain

Although cannabinoid-based medicine has been a common treatment for headache and migraines for some time, research has been relatedly limited up until this point. A study recently published in the Journal of Pain sheds new light to cannabinoids benefits, and the findings are quite compelling.

The study set to show whether inhalation of cannabis decreased headache and migrate ratings, as well as which type of cannabis (whether concentrated in oil form or in dried flower form) was proven to be most effective.

The findings showed that headache and migraine ratings were reduced by 50% after the use of cannabinoid-based medicine; with cannabinoids in their concentrated form (oil) being related to larger reductions in headache than flower form.

The body of evidence to support the benefit of cannabinoid-based medicine is beginning to grow and we look forward to seeing more studies like this come forward.

Read the full article here.

The new grey market: As older users warm up to cannabis, pot companies want to learn more: Financial Post

Cannabis companies hoping to expand the medical market will have to overcome the conservatism towards cannabis amongst medical associations — both the Ontario Medical Association and the Canadian Medical Association support the dismantling of the medical cannabis regime altogether, arguing that with legalization, there remains no need for medical professionals to serve a “gatekeeper role.”

This kind of opposition, said Pearson, is what makes is so difficult to obtain funding to really understand how cannabis can improve the lives of seniors. “I treat seniors in a long-term care setting and I’m weaning down their use of anti-psychotics and opioids. To just say leave it up to themselves, that means you’re saying they should self-medicate, which is absurd.” Read 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.

U.S. Senate committee slams marijuana's federal classification, saying Schedule I blocks research: Forbes

Forbes reporter, Tom Angell reports: "A key U.S. Senate committee says that marijuana's current federal classification blocks scientific research on its effects -- something that legalization advocates have long argued." 

Canadians, and indeed patients from around the world, cannot underestimate the impact that the U.S. classification of marijuana has on the pace of advancement within the field of cannabinoid medicine. 

Angell explains: "Schedule I is the most restrictive category under federal law, and is supposed to be reserved for drugs with a high potential for abuse and no medical value. Researchers wishing to study substances classified there must overcome procedural hurdles that don't exist for other drugs."

"The committee's criticism of Schedule 1 roadblocks to marijuana research provides more momentum to the effort to reclassify cannabis under federal law." 

Read full article here.