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Study: Medical cannabis, pain and withdrawal symptoms

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Medical cannabis can come with withdrawal symptoms according to new research

More than half of people who use medical cannabis products to ease pain experience withdrawal symptoms between uses, a new study finds.

Around 10% of the patients taking part in the study also experienced worsening changes to their sleep, mood, mental state, energy and appetite over the next two years as they continued to consume cannabis.

Many may not recognise that these symptoms come not from their underlying condition, but from their brain and body’s reaction to the absence of substances in the cannabis products they’re consuming, says the University of Michigan Addiction Center psychologist who led the study.

When someone experiences more than a few such symptoms, it’s called cannabis withdrawal syndrome and can mean a higher risk of developing even more serious issues such as a cannabis use disorder.

In the new research published in the journal Addiction, a team from the U-M Medical School and the VA Ann Arbor Healthcare System reports findings from detailed surveys across two years of 527 Michigan residents.

All were participating in the state’s system to certify people with certain conditions for use of medical cannabis and had non-cancer-related pain.

Lara Coughlin, PhD, the addiction psychologist who led the analysis said: “Some people report experiencing significant benefits from medical cannabis, but our findings suggest a real need to increase awareness about the signs of withdrawal symptoms developing to decrease the potential downsides of cannabis use, especially among those who experience severe or worsening symptoms over time.”

Long-term study in medical cannabis use

The researchers asked the patients whether they had experienced any of 15 different symptoms – ranging from trouble sleeping and nausea to irritability and aggression – when they had gone a significant time without using cannabis.

They used an analytic method to group the patients into those who had no symptoms or mild symptoms at the start of the study, those who had moderate symptoms (meaning they experienced multiple withdrawal symptoms) and those who had severe withdrawal issues that included most or all of the symptoms.

They then looked at how things changed over time, surveying the patients one year and two years after their first survey.

At baseline, 41 percent of the study participants fell into the mild symptoms group, 34 percent were in the moderate group and 25 percent were classed as severe.

Misconceptions about medical cannabis

Many people who turn to medical cannabis for pain do so because other pain relievers haven’t worked, says Coughlin, an assistant professor in the Department of Psychiatry who sees patients as part of U-M Addiction Treatment Services.
They may also want to avoid long-term use of opioid pain medications because they pose a risk of misuse and other adverse health consequences.

She notes that people who experience issues related to their cannabis use for pain should talk with their health care providers about receiving other pain treatments including psychosocial treatments such as cognitive behavioural therapy.

The perception of cannabis as “harmless” is not correct, she says. It contains substances called cannabinoids that act on the brain – and that over time can lead the brain to react when those substances are absent.

In addition to a general craving to use cannabis, withdrawal symptoms can include anxiety, sleep difficulties, decreased appetite, restlessness, depressed mood, aggression, irritability, nausea, sweating, headache, stomach pain, strange dreams, increased anger and shakiness.

Previous research has shown that the more symptoms and greater severity of symptoms a person has, the less likely they are to be able to reduce their consumption of cannabis.

They may mistakenly think that the symptoms happen because of their underlying medical conditions, and may even increase the amount or frequency of their cannabis use to try to counteract the effect – leading to a cycle of increasing use and increasing withdrawal.

Coughlin says people who decide to use a cannabis product for a medical purpose should discuss the amount, route of administration, frequency and type of cannabis product with their regular health provider.

They should also familiarise themselves with the symptoms of cannabis withdrawal and tell their provider if they’re experiencing them.

As there is no medically accepted standard for medical cannabis dosing for different conditions, patients are often faced with a wide array of cannabis products that vary in strength and route of administration.

Some products could pose more risk for development of withdrawal symptoms than others, Coughlin says. For example, people who smoked cannabis tended to have more severe withdrawal symptoms than others, while people who vaped cannabis reported symptoms that tended to stay the same or get worse, but generally did not improve, over time.

More about the study

The researchers asked the patients about how they consumed cannabis products, how often, and how long they’d been consuming them, as well as about their mental and physical health, their education and employment status.

Over time, those who had started off in the mild withdrawal symptom group were likely to stay there, but some did progress to moderate withdrawal symptoms.

People in the moderate withdrawal group were more likely to go down in symptoms than up, and by the end of the study the number of the people in the severe category had dropped to 17 percent

In all, 13 percent of the patients had gone up to the next level of symptoms by the end of the first year, and eight percent had transitioned upward by the end of two years.

Sleep problems were the most common symptom across all three groups, and many in the mild group also reported cravings for cannabis. In the moderate group, the most common withdrawal symptoms were sleep problems, depressed mood, decreased appetite, craving, restlessness, anxiety and irritability.

The severe withdrawal symptom group was much more likely to report all the symptoms except sweating. Nearly all the participants in this group reported irritability, anxiety, and sleep problems. They were also more likely to be longtime and frequent users of cannabis.

Those in the severe group were more likely to be younger and to have worse mental health. Older adults were less likely to go up in withdrawal symptom severity, while those who vaped cannabis were less likely to transition to a lower withdrawal-severity group.

The study didn’t assess nicotine use, or try to distinguish between symptoms that could also be related to breakthrough pain or diagnosed/undiagnosed mental health conditions during abstinence.

Further research could help identify those most at risk of developing problems and reduce the risk of progression to cannabis use disorder, which is when someone uses cannabis repeatedly despite major impacts on their lives and ability to function.

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Study finds ‘one in four’ started using CBD during COVID-19

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Market research company High Yield Insights ran the survey

A new study has found that almost a quarter of CBD consumers in the US began using the cannabinoid during the coronavirus pandemic.  

Newly released findings from a study of over 35,000 adults in the US highlights the age and gender divide in Covid-19’s impact on mental health. 

According to the survey, almost seven in ten women have felt isolated from family and friends compared to just roughly half of men who have experienced the same. 

Almost four in ten women also report feeling more depressed than usual compared to fewer than three in ten men. Sleep issues have also arisen at greater rates (32 percent) for women than for men (22 percent). 

Gen Z and Millennials appear hardest hit by the economic fallout during the survey period. On average, one in four Gen Z and Millennial respondents reported having lost a job or taken a reduction to hours or pay. 

However, most of the spending cutbacks are driven by older consumers, with respondents aged 40 years and over making up 65 percent of those who report reduced household spending due to Covid-19.

Market research company High Yield Insights ran the survey from September to October 2020, collecting data from over 35,000 adults aged 21 and over. 

Respondents addressed how the pandemic has stirred mental health concerns, upended shopping habits, and sparked interest in new wellness products. 

The study also delved deep into the use and interest in CBD as a source of relief for health issues associated with or exacerbated by the pandemic.

“Our findings capture an image of what some are rightly calling the mental health epidemic in America,” said Mike Luce, president of High Yield Insights and a 20-year veteran in consumer insights and market research. 

“Consumers are thinking about wellness holistically today to encompass both mental and physical health. For product categories like CBD, which can address a range of conditions, the pandemic is having a historic knock-on effect. The growing popularity of CBD is evidenced by the number of people who started using one or more CBD products last year. For example, we discovered almost one in four US CBD consumers started using CBD in the six months leading up to our survey.”

UK retailers have also reported a rise in demand for CBD products since the start of the pandemic.

Newcastle based companies, Naturally North CBD and Karma Coast both told Cannabis Health that the vast majority of their customers are now using CBD to target anxiety and stress-related issues. 

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“This is not compassionate”: Ireland’s medical cannabis scheme ‘excludes thousands of patients’

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Campaigners have said the scheme is not inclusive enough

Ireland’s government has finally announced funding for its Medical Cannabis Access Programme – but the scheme remains ‘extremely restrictive’, say campaigners.

Almost two years since the legislation was introduced on Thursday 21 January, Ireland’s Health Minister Stephen Donnelly announced funding for the Medicinal Cannabis Access Programme.

The programme is expected to commence later this year, with Donnelly claiming it will allow for “compassionate access” to cannabis medicines.

But campaigners have been quick to criticise the scheme, which only offers access to four low dose cannabis-based medicines to people living with one of three qualifying conditions.

These include intractable nausea and vomiting associated with chemotherapy, severe treatment-resistant epilepsy and spasticity associated with multiple sclerosis (MS). 

But despite all of the patients who are currently being prescribed cannabis under a ministerial license, using Bedrocan products from the Transvaal pharmacy in the Hague, none of these have been approved for the programme.

This suggests children – including 11-year-old Ava Barry – who have had their quality of life significantly improved by Bedrocan oils, will have to switch products in order to have their prescriptions reimbursed.

Ava Barry is prescribed Bedrocan oils for severe epilepsy

As has been highlighted extensively by campaigners in the UK in recent weeks, in regard to the issues importing Bedrocan due to Brexit, changing treatments for epilepsy can lead to a worsening of seizures and could be life-threatening. 

Alicia Maher is a patient and advocate who moved to Spain in 2019 in order to have better access to cannabis medicines, which she uses to manage chronic pain.

While she welcomed the news that the programme would finally be funded, she will still not be able to return to her hometown of Limerick.

“Many people have asked me whether this will impact me and whether I will be able to come home, but sadly the answer is no,” she said.

“Chronic pain is not one of the qualifying conditions, despite the Health Products Regulatory Authority (HPRA) acknowledging in their 2017 report that it is the most researched indication for cannabinoids, with the majority of reports concluding that cannabis is an effective treatment for chronic pain.”

According to Alicia, recent reports suggest that approximately 25 percent of the population suffer from chronic pain, with the condition affecting over 1.5 million people.

She was granted a ministerial licence to be legally prescribed medical cannabis last year, but would have to fund the costs of the prescription herself.

She continued: “I, along with many others that currently hold the ministerial licence and fall outside the three qualifying conditions, will not be allowed onto the access programme, even though our doctors are currently prescribing cannabis. 

“We won’t have access to any of the cannabis products that have been approved and we won’t have our costs reimbursed. 

Alicia added: “It is fiscally irresponsible as the cost of my cannabis prescription is less than my prescription was for 30 opioids per day, yet they were completely covered on my medical card.”

Campaign group, Cork Cannabis Activist Network said excluding patients from accessing these medicines is in no way “compassionate” or “acceptable”.

“The headlines are designed to paint a rosy picture favouring those in government, but this is not the truth, and most certainly for not the countless Irish citizens who consume cannabis daily for various medical reasons,” Nicole Lonergan spokesperson for the group, told Cannabis Health.

“Cannabis is complex and so are patients and their individual physiological needs. Yet the Irish government thinks it’s acceptable to offer limited access to four cannabis-based medicines and restrict access to three qualifying conditions.”

Nicole is among those who want to see cannabis legalised in Ireland, with thousands of patients still forced to access medication illegally.

The group has called for an education programme to improve understanding of the medicinal benefits of cannabis among healthcare professionals.

“Week after week, I receive hundreds of messages from people of all ages and backgrounds crying out for cannabis to be legalised,” she said.

“A comprehensive cannabis education programme needs to be urgently rolled out to GP’s and consultants in Ireland and the law needs to be changed so that no one is forced to continue relying on the illegal market for their medicine.”

Nicole added: “It is not ‘compassionate’ to exclude certain patients from accessing cannabis medicines, or to offer an extremely limited selection of products that do not suit the majority of patients’ needs. It is not ‘compassionate’ to condemn patients to rely on an illegal market or force patients to leave their homes and families to access cannabis legally.

“We deserve answers as to why the Irish government continues to uphold a law that ruins lives and prevents access to legitimate, effective medicine in all its forms.”

Announcing the provision of funding and delivery of the Medical Cannabis Access Programme, Minister Donnelly said:  “The purpose of this Programme is to facilitate compassionate access to cannabis for medical reasons, where conventional treatment has failed. It follows the clear pathway laid out by the Health Products Regulatory Authority in their expert report ‘Cannabis for Medical Use – A Scientific Review’. 

“Ultimately it will be the decision of the medical consultant, in consultation with their patient, to prescribe a particular treatment, including a cannabis-based treatment, for a patient under their care. 

“It is important to state that there are no plans to legalise cannabis in this country.”

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Vitality CBD ‘leading the way’ with novel food application

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CBD firms have until the end of March to submit their novel food applications

A UK CBD firm believes it is one of the first to submit its novel food application ahead of the March deadline. 

Birmingham-based Vitality CBD confirmed it has submitted its novel food dossier for Food Standards Authority (FSA) approval.

The brand is widely distributed in UK high street retailers, stocked in the likes of Tesco, Boots, Lloyds Pharmacy, Sainsburys, Ocado and is listed on Amazon UK as part of its global trial of CBD.

In tandem with its raw material supplier, the company has submitted its Novel Food application for validation of its wide range of ingestible CBD products, assuring customers that it is ‘leading the way’ in helping to create a more regulated industry.

CBD products can remain on the shelves providing an existing CBD brand, which is defined as “on the market” prior to 13 February 2020, receives validation of its application before the 31 March deadline. 

In the meantime, no new brands are permitted to launch in the UK until they have completed their Novel Food application and received full Novel Foods authorisation.

Vitality, which recently expanded and sources its CBD from Colorado in the US, supports the FSA’s move to better define the responsibilities of CBD retailers towards customers. 

The company believes the new novel food guidance will end a ‘period of uncertainty’ and move the industry toward clearer and more concise regulation, ensuring consumers are provided with safer and higher quality CBD.

It expects the move will help to ‘legitimise its venture; and lead to greater consumer confidence in CBD.

Phillip Glyn, commercial director, commented: “It is important for our trade customers and consumers alike, to know that Vitality CBD, together with our raw ingredient provider, are one of the first in the UK CBD industry to submit a Novel Food dossier, and are therefore leading the way in future compliance and regulation.”

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