Fibromyalgia sufferer Jane Hinchcliffe was housebound and wheelchair dependent for years, but since using medical cannabis she’s back on her feet.
“Cannabis gave me a life,” says Jane Hinchcliffe, who suffers constant, debilitating pain as a result of fibromyalgia and complex regional pain syndrome (CRPS).
Now 42, despite showing symptoms at 13, it took until she was 26 for her to be diagnosed with fibromyalgia.
Doctors put it down to growing pains and she was treated with physiotherapy, followed by a prescription for codeine at the age of just 15.
She spent the next three decades of her life in a fog of heavy opioids and painkillers. In 2015 after a cycling accident Jane developed CRPS, a chronic autoimmune condition usually brought on by an injury.
“It’s known as the most painful condition known to man,” she says.
“On the McGill Pain Index it can score up to 47 out of 50, whereas cancer and fibromyalgia score 20.”
Jane’s symptoms were so bad she needed a wheelchair to get around and couldn’t leave the house. It took its toll on her mental health and she struggled with depression, until two years ago when she started using medical cannabis.
“I started smoking it recreationally at 18 and I used it on and off over the years, but I didn’t realise at the time that I was treating my fibromyalgia,” she says.
It wasn’t until she attended a Green Pride event in 2018 that she realised the full potential of medicinal cannabis.
“I knew that it was going to be a painful day so I’d saved a bottle of morphine the hospital had given me so that I had decent pain relief,” she explains.
“I ended up having a space cake and didn’t need the morphine – that’s when I realised cannabis could actually replace my medication.”
In November 2018, Jane came off the opioids completely and now relies solely on cannabis to treat her pain.
“I’m still in constant pain but the cannabis makes it tolerable,” she says.
“I’ve literally gone from being housebound in a wheelchair, not being able to do anything. Now I can go swimming, I go to the gym, I can go out cycling. I’m out and about and walking.”
But it hasn’t all been smooth sailing. Jane has recently signed up to Project Twenty21, which is subsidising the cost of prescriptions for medical cannabis patients, in a bid to create the largest body of evidence in Europe for the efficacy of cannabis-based medicines.
However, for the last two years she has been forced to access it illicitly, living with the anxiety of not being able to get hold of the right strain, as well as the fear that the police will turn up at the door.
Last year Jane spent time in prison after she was convicted and sentenced to six months for growing cannabis.
“I only served 46 days before I was released on tag, but it was difficult,” she says.“They take your medicine and you are left with nothing.
“I ended up in a wheelchair again in prison, there were some days where I was in too much pain to do anything.”
But despite being left with a criminal record, Jane says she has no intention of stopping using cannabis.
“I don’t have a choice, life without it is just unbearable,” she says.
“It makes me angry, because it’s just medicine.“I think some sort of discretion should be used, if it’s obvious it’s for medical use.”
Jane welcomes initiatives such as the Cancard scheme, which is due to launch in November and aims to protect patients who are accessing cannabis illicitly from arrest and prosecution.
But she fears police officers may choose to ignore it and believes laws should be brought in to allow patients to grow their own medicine at home.“Ideally we need to be able to grow our own,” she adds.
“It would take the strain off the NHS and doctors are always telling us to get a hobby – what better hobby than growing your own medicine?”
What you should know about cannabis and drug interactions
Juicy Fields explores the important considerations of combining cannabis medication and products with drug treatments.
You have probably read or heard something along the lines ‘consult your physician before taking cannabis if you are on any prescription pills.’ That statement consists of wise words that you should adhere to at all times.
Prescription pills can interact with cannabis, foods, beverages, supplements, and even with each other, leading to mild or severe side effects. Consequently, without sounding redundant, always consult your doctor to avoid such incidents.
What is a drug-drug interaction?
A drug or medication interaction occurs when a person takes a combination of drugs (2 or more) that are incompatible with each other. In such cases, one of the drugs interferes with the other(s) by countering or accelerating their effects. This may lead to drug inefficiency, severe side effects, and sometimes the loss of life.
How does cannabis interact with other drugs?
P450 enzymes metabolize all drugs before they are available in the consumer’s system. The Cytochromes P450 are a group of enzymes responsible for metabolizing many compounds. These enzymes are primarily located in the liver but can also be found in cells throughout the body in small quantities.
There are more than 50 enzymes under the P450 class, but only six are responsible for metabolizing 90% of prescription drugs. These enzymes include CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP2E1, and CYP3A4. Cannabinoids, THC and CBD, in particular, inhibit or induce the function of these Cytochrome P450 (CYP450) enzymes.
This interferes with enzymatic function, which affects the concentration of certain drugs. Cannabinoids play three prominent roles in drug interactions.
- Victims: cannabinoid levels are affected by the presence of another drug.
- Perpetrators: the cannabinoids affect the levels of other drugs
- Overlapping other drug’s effects: cannabis and other drugs have similar effects on a consumer.
Cannabinoids as drug interaction victims
Ketoconazole, a potent antifungal agent, is a CYP3A4 inhibitor. This enzyme metabolises THC and CBD. Elevated levels of these cannabinoids lead to an increase in the psychoactive effects of THC and adverse side effects of CBD, such as drowsiness and elevated levels of liver enzymes like transaminase. The same results may be experienced with CYP3A4 inhibitors like Verapamil and Macrolides.
CYP2C9 is a P450 enzyme that metabolizes THC and not CBD. Cotrimoxazole, amiodarone, and fluoxetine are classes of drugs that, when consumed, are likely to inhibit the metabolism of THC, leading to increased psychoactive effects. Below is a breakdown of the different classifications of prescription drugs and how cannabis interacts with each of them.
Cannabis interactions with different classes of drugs
Blood thinners or anticoagulants like warfarin work by preventing blood clots in the body. Combining this class of drugs and cannabis is not advised. THC and CBD can increase warfarin levels in the body by inhibiting the CYP2C9 enzyme. A high warfarin content in the body leads to excessive bleeding that can be fatal.
Cannabis can interact with benzodiazepines, including Clobazam. The drug is used to treat seizures in Lennox Gastaut syndrome patients. CBD increases the levels of Clobazam by three times through the inhibition of the CYP2C19 enzyme.
Bronchodilators are used in opening up airways of patients with lung-related conditions, such as asthma and chronic bronchitis. The drugs become less effective when taken in tandem with cannabis (smoking). This is because cannabis speeds up the metabolism of bronchodilators by 40%.
Mental health and pain are the leading causes of the sudden rise in medical cannabis consumption. The prevalence of these two conditions is alarming as they are among the top contributors to the global burden of health.
Medical cannabis interacts with psychiatric medications, specifically tricyclic antidepressants like dothiepin and imipramine. The combination may lead to increased heart rate and elevated blood pressure. It may lead to confusion, hallucination, and aggressiveness in severe cases.
Studies suggest that CBD is a potential therapeutic option for kidney transplant patients. The cannabinoid is a natural immunosuppressant and immunomodulator. There are limited documented interactions between medical cannabis and immunosuppressants; however, consult a physician before self-medicating cannabis while taking this classification of drugs.
The majority of Over-the-counter pain medications have minimal interaction with cannabis. Drugs containing acetaminophen/paracetamol pose a slight risk of causing liver damage when used with cannabis. Cannabis is a potent analgesic compound that can be utilized to replace OTC drugs. It offers a better, natural alternative with minimal side effects.
Medical cannabis has numerous therapeutic and medicinal applications that can benefit millions of patients. One significant contribution that the plant can offer is helping in the fight against the abuse of opioids. Replacing opiates with cannabis reduces the number of fatalities attached to the overdose of opiates.
CBD, in particular, inhibits the function of the CYP2B6, CYP3A4, and other cytochrome P450 enzymes to increase the levels of morphine, oxycodone, and methadone in the body.
While this may be beneficial when opiates are taken in low doses, high doses may lead to excess opiates in the system, leading to an overdose. Additionally, both opioids and cannabis have depressant effects and may significantly compromise the central nervous system when combined.
There are no recorded interactions between cannabis and antibiotics. Studies available indicate that combining the two may enhance the effectiveness of the antibiotics. Before combining the two, seek advice from a physician.
Cannabis can interact with different drugs, from opioids to sedatives. Cannabinoids can be the victims of the interactions, whereby their levels of availability in the system are affected by other drugs, such as Ketoconazole.
As perpetrators, cannabinoids inhibit or induce the functioning of P450 enzymes, resulting in the acceleration or delay of the metabolism of drugs. In other instances, cannabis has similar effects as prescription drugs, so the effects overlap.
Medical cannabis is legal in most parts of the world. The plant is easily accessible and is marketed as a potential therapeutic agent for a myriad of conditions. Yes, studies have proven that it does help with pain, mental health issues, mood regulations, inflammation, appetite, and many more diseases. What is usually left out is that cannabis can and does interact with prescription pills.
Before self-medicating with cannabis, always consult a qualified physician, preferably one with medical cannabis expertise. The doctors are best placed to advise on whether you should include cannabis into your treatment regime or not.
CBD dominant cannabis does not influence driving skills – study
Participants showed no signs of impairment when it came to driving but they did test positive for trace levels of THC
A study suggests that CBD-dominant cannabis does not influence the skills associated with driving such as reaction time, concentration, time perception or balance.
The Swiss study examined CBD and THC dominant cannabis flowers to see if they impacted on neurocognitive or psychomotor skills.
Some of the participants were given a CBD dominant strain that had a 16.6:0.9 per cent ratio, and others were given a placebo.
After inhaling the cannabis, participants were asked to undergo the Vienna Test System TRAFFIC. This measures reaction time, behaviour in stressful situations, concentration and performance. They also took further tests to determine their fitness to drive, three separate balance tests and coordination along with vital signs such as blood pressure and pulse.
Driving and cannabis
The participants showed no signs of impairment when it came to driving but they did test positive for trace levels of THC in their blood. The blood tests were taken 45 minutes after consuming the CBD dominant cannabis.
The authors noted that the slight change in THC levels within the system would potentially place patients in violation of traffic safety laws.
The researchers noted: “This finding suggests that higher CBD concentrations cause a negative allosteric effect in the endocannabinoid system, preventing the formation of such symptoms. Nevertheless, it is recommended that consumers refrain from driving for several hours after smoking CBD-rich marijuana, as legal THC concentration limits may be exceeded.”
Driving and THC tests
When it comes to THC and roadside testing, new research revealed that THC levels in blood and saliva are poor measures of impairment.
Researchers analysed a range of studies on the relationship between driving performance and Tetrahydrocannabinol (THC) concentrations in blood and saliva.
The researchers took data from 28 different publications that involved ether ingested or inhaled cannabis. They characterised the relationships between blood and saliva THC concentrations, driving performance and skills such as reaction time or concentration.
When it came to infrequent cannabis users, there were some significant correlations between blood and oral levels of THC and impairments were observed. However, It was noted that these relationships were ‘weak.’
There was no significant relationship noted for the more regular consumers.
CBGA may be ‘more potent’ than CBD against seizures in Dravet syndrome
Dr Lyndsey Anderson said there is more to explore when it comes to creating more treatment options for Dravet syndrome.
Scientists say they have found the ‘Mother of all cannabinoids’ which may help to reduce seizures in Dravet syndrome.
A new study on mice from the University of Sydney found that three acidic cannabinoids found in cannabis reduced seizures in Dravet syndrome, an intractable form of childhood epilepsy.
The three cannabinoids are cannabigerolic acid (CBGA), cannabidivarinic acid (CBDVA), cannabigerovarinic acid (CBGVA). All three but CBGA in particular “may contribute to the effects of cannabis-based products in childhood epilepsy” noted the researchers and were found to potentially have ‘anticonvulsant properties.”
The study marks the first time that three acidic cannabinoids were found to potentially help reduce seizures for Dravet syndrome.
Speaking with Cannabis Health News, the lead author of the study, Dr Lyndsey Anderson, said: “We found that CBGA exhibited both anticonvulsant and pro-convulsant effects. CBGA was more potent than CBD against febrile seizures in a mouse model of Dravet syndrome. We also found that a combination of CBGA and clobazam was more effective than either treatment alone. Additionally, we found that CBGA was anticonvulsant in the maximal electroshock acute seizure model, a model for generalized tonic-clonic seizures.”
She added: “CBGA did, however, present some proconvulsant effects. The frequency of spontaneous seizures in the mouse model of Dravet syndrome was increased with a high dose of CBGA. Also, CBGA was proconvulsant in the 6-Hz acute seizure model, a model of focal, psychomotor seizures.”
Although CBGA shows promise, Dr Anderson also stressed that it needs more research before it can replace CBD. She cautioned that Dravet syndrome patients may still need to proceed with caution.
“Artisanal cannabis-based products are believed to reduce seizures in Dravet syndrome patients,” she said. “As these oils contain rare cannabinoids like CBGA, it is possible CBGA then contributes to the anticonvulsant effects of these artisanal cannabis oils. However, there were proconvulsant effects observed with CBGA, suggesting that Dravet syndrome patients may need to proceed with caution. The proconvulsant liability of CBGA would need to be addressed before it replaced CBD as an anticonvulsant.”
What is CBGA?
Sometimes referred to as ‘the mother of all cannabinoids,’ CBGA is the precursor molecule to many different cannabinioids including CBD and THC. It is thought to help some diseases such as colon cancer, metabolic disease and cardiovascular disease. It is a non-intoxicating cannabinoid much like CBD.
Dr Anderson explains that more research is needed to explain how the three cannabinoids work together.
“We don’t know how they work together yet,” she said. “We found that CBGA, CBDVA and CBGVA were all individually anticonvulsant against thermally induced seizures in the mouse model of Dravet syndrome. We did not investigate whether a combination of these three cannabinoids would result in a greater anticonvulsant effect than either cannabinoid alone. Future work will definitely explore this possibility.”
CBGA future research
This isn’t the end of the research into CBGA for Dravet Syndrome. Dr Anderson said there is more to explore when it comes to creating more treatment options for Dravet syndrome.
She said: “Next on the horizon for this research is to explore whether the anticonvulsant properties of CBDVA and CBGVA translate to other seizure types including spontaneous seizures in the mouse model of Dravet syndrome. Additionally, we have extensively interrogated the anticonvulsant potential of individual cannabinoids and identified ten with anticonvulsant properties.”
“We are now interested in investigating what happens when we combine these anticonvulsant properties. It remains an open possibility that greater anticonvulsant effects are achieved when the cannabinoids are administered in combination.”
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