A new report has revealed the ‘remarkable’ and ‘life-changing’ impact of medical cannabis on ten patients with severe epilepsy.
The study, published by Drug Science, followed ten patients, aged two to 48-years-old, with intractable, childhood onset epilepsies.
It found that patients saw an average 97 percent reduction in seizures following treatment with cannabis medicines.
Four patients, who were prescribed Epidiolex, a licensed cannabis medicine in the UK, did not see any improvement in their condition until they were given the whole plant extract – suggesting a combination of CBD and THC based products was crucial in effectively managing the condition.
The carers of patients provided details of their age, diagnosis, previous and current antiepileptic drugs and number of seizures before and after taking cannabis based medicines, through the campaign group End our Pain. This data was then analysed by researchers at Drug Science.
As well as the clear improvement in their condition, the report also highlights the staggering financial barriers facing patients, with the average monthly cost of cannabis medicines more than £1,800.
Those families included in the study spend more than £20,000 a year on their children’s medicines – almost five times the price of the same medication in the Netherlands.
Lead author Rayyan Zafar told Cannabis Health: “The aim was to provide a scientific platform to convey the impact that medical cannabis treatment has had on children suffering from various forms of severe epilepsies. We wanted to assess primarily what the effects were on their seizure frequency as well as highlighting the extremely high costs of private prescriptions.”
He continued: “We saw a dramatic 97 percent average reduction across the cohort in seizure frequency following treatment with medical cannabis. These effects were seen using whole-plant extracts which combine THC and CBD therapy, which is not currently a National Institute for Health and Care Excellence (NICE) recommended treatment.
“Surprisingly the four patients that had the NICE recommended Epidiolex did not improve on this longer term and only saw beneficial effects once whole plant extracts were taken.”
Researchers conclude that the impact of cannabis medicines on these patients was ‘remarkable’ and often ‘life-changing’ and argue that the paper provides important evidence that should be taken into account, in addition to RCTs.
Dr Anne Katrin Schlag, head of research at Drug Science, said: “We think our findings make a very strong case for prescribing these medicines to this group of children and young adults who have been clearly shown to benefit from it.
“We are currently following up with a subsection of patients who for cost reasons, had to discontinue their medications, leading to their seizures returning, adding further validity to the current findings.
“We hope our report will contribute to make access to these medicines easier, and to allow for medicinal cannabis to become accessible on the NHS for these patients who are shown to benefit from it.”
Although randomised controlled trials (RTCs) are recommended to provide clinical evidence on the efficacy of unlicensed cannabis medicines, it would be ‘extremely difficult’ to conduct these in very ill patients, according to the report.
Those already taking cannabis medicines would be required to undergo a ‘wash out’ period to come off their current medication and run the risk of being given a placebo, which parents have warned could put their lives at risk.
“Whilst the paper has been received with great interest, we expect responses will also call for greater sample sizes, which we are in the process of doing, and the application of RCTs,” added Zafar and Dr Schlag.
“However, RCTs in these children suffering from severe epilepsies would be unethical and highly costly.”
Campaigner Hannah Deacon, whose son Alfie Dingley is one of a handful of patients to have an NHS prescription for medical cannabis – and who continues to support others to get access – welcomed the report, saying it must be accepted as evidence.
“It is clear from this study that whilst some doctors may believe medical cannabis is something to be frightened of, it is quite the contrary. These patients are having reduced seizures – sometimes none for days on end – and a hugely improved quality of life. This is evidence and must be accepted as such,” she said.
“The families who spend every day raising money to keep their children safe are in fact saving the NHS huge sums of money every day by keeping their children safe at home. I am tired of seeing this medicine blocked every day by different people who should be putting patients and their wellbeing at the centre of everything they do.
“It is time that we see safe access for these families and the many millions more in the UK.”
Professor Mike Barnes, who obtained the first license to prescribe medical cannabis in the UK, added that it was time others in the profession ‘embraced’ cannabis as a medicine.
He commented: “This paper shows the real efficacy of cannabis for children with epilepsy. Isn’t it now time for the paediatric neurology community to embrace this medicine and start to prescribe rather than hounding those that do.”
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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