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What is the risk of dependence in medical cannabis patients?

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Researchers are exploring the risks of developing medical cannabis dependence

Researchers in the UK are exploring the risks of developing dependence among medical cannabis patients.

Recreational users have an estimated 8.9 percent chance of developing cannabis dependence, but experts argue that the same data cannot be applied to medical cannabis patients.

New research from Drug Science, the leading independent scientific body on drugs in the UK, highlights the differences between recreational and medical cannabis use to evaluate the risk of dependence.

Cannabis use disorder has been widely studied in recreational users, with these findings often projected onto medical cannabis patients.

In a review of the existing evidence, published in February, the team highlights the need for more studies investigating dependency specifically in people using cannabis for medical purposes.

For recreational users, the estimated chances of becoming dependent on cannabis after any lifetime exposure is considerably lower than for cocaine (20.9 percent), alcohol (22.7 percent) or tobacco (67.5 percent).

However, the United Nations reports that cannabis dependence is now the primary reason for drug treatment across the world (39 percent), surpassing numbers receiving opioid treatment (33 percent).

While the lines between recreational and medical use are “blurred at best” they argue, with many recreational users also self-medicating to manage symptoms of anxiety, for example – a number of factors need to be taken into account.

Dose and frequency of use are also key issues with the potential for medical cannabis dependence.

As a standard dose of cannabis does not exist, the patient rather than the doctor determines the correct dose and is required to titrate their dose to their desired effect.

This means medical patients often are titrating up to a higher dosage than recreational cannabis users, as they medicate throughout the day.

However, this does not necessarily put them at greater risk of dependence, argues lead author, Dr Anne Schlag, head of research at Drug Science.

“While overall medical cannabis users tend to use more frequently and more often daily than recreational users, on the other hand, medical users have less interest in getting ‘high’ and in having high THC products,” she says.

Long-term use of high-potency cannabis has been linked to dependence and mental health issues.

Dr Schlag continues: “In addition, early onset of use is also associated with dependence, but medical cannabis patients are usually a bit older at first time of use.”

How cannabis is consumed also has a role to play, with smoking the most common route of administration among recreational users, but not recommended for medical use, where vaporisers are often used as an alternative.

A 2018 study found higher THC concentrations in the blood following vaporisation compared to smoked cannabis, suggesting vaporising may lead to stronger effects than smoking.

Severe depression may also be a possible risk factor for dependence among chronic pain patients – the most common group of medical cannabis consumers – as mental health issues such as depression and anxiety are often associated with the condition.

But Drug Science researchers argue that it is important to put this into context.

Although medical cannabis may lead to dependence, it compares favourably, they say, in regards to other commonly prescribed drugs, such as opioids.

“Whilst there is a dependence risk associated with frequent cannabis use, current research from the US also indicates that some pain patients for example are able to decrease their opioid usage as a result of their medical cannabis use so it is important to contextualise findings,” says Dr Schlag.

“I am keen to see more research on if – and how – medical cannabis use is correlated with decreased prescription opioid use. Initial research in this area looks promising but more long-term data is needed.”

As access to medical cannabis improves, more research needs to be done into how dependence is measured in patients, adds Dr Schlag.

“Studies exploring medical cannabis dependence are scarce and the appropriate methodology to measure this construct is uncertain,” she says.

“We certainly require more studies addressing issues related to medical cannabis dependence specifically.

One move towards this is the new Cannabis-Based Medicines Questionnaire (CBM-Q) developed by Professor Val Curran, Dr Chandni Hindocha and other experts at Drug Science.

The questionnaire, which will be utilised in Project Twenty21 – the UK largest body of medical cannabis patients – aims to specifically address problematic medical cannabis use in a high number of respondents over a long period of time.

It will assess potential links to predisposing factors, such as underlying medical conditions.

“Many questions about the potential for medical cannabis use to lead to dependence remain to be answered,” adds Dr Schlag.

“It is imperative to address these questions in order to be able to minimise harms of medical cannabis use.”

Read the full report here and find out more about Project Twenty21 at www.drugscience.org.uk

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Six big cannabis sector stories you might have missed this week

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It’s been another week of big news in the cannabis world.

At Cannabis Health, our in depth coverage of the ongoing growth of cannabis as a medical and wellness product continues

Meanwhile, over at Cannabis Wealth, we’ve been following all the big industry and policy news in a week which has seen some important developments..

Been busy and want to get caught up in a hurry?

Here are the six things you need to read to stay in the loop this week.

1. Reprieve for medical cannabis patients

The Department of Health has reached an agreement with Dutch officials to extend the supply of medical cannabis oils to existing patients in the UK until 2022.

Medical cannabis patients, living with severe, life-threatening epilepsy were left without access to medication when the UK left the EU at the end of last year.

Medical cannabis

Families, whose children are prescribed Bedrocan oils in the UK but must obtain their prescription through the Transvaal pharmacy in the Netherlands, were given two weeks notice that their medication could no longer be dispensed following the end of the Brexit transition period on 31, December 2020.

Read the full story.

2. UK largest’s medical cannabis trial reports back

The first findings from the UK’s largest medical cannabis patient study show quality of life improved by more than 50 percent.

Preliminary results from Drug Science’s Project Twenty21 study, have found medical cannabis significantly improves quality of life for people with life-limiting conditions such as chronic pain, multiple sclerosis (MS) Tourette’s syndrome and post-traumatic stress disorder (PTSD).

Published on Tuesday 11 May, the report is the first real-world data to be collected on medical cannabis in the UK.

Read more here.

3. Harrowing first-hand account of medical cannabis user
Diagnosed with a personality disorder and experiencing debilitating anxiety which left him housebound, Craig – whose name has been changed – had exhausted all treatment options and was losing all hope.
He speaks about how medical cannabis helped save his life here.

4. CBD market set to shrink

The UK’s CBD sector looks set to shrink significantly as the roll out of new regulations continues to batter the industry.

The FSA has confirmed to Cannabis Wealth it received applications for 803 different CBD products – but only 42 have been advanced to the next stage of the process so far.

More than half of all applications (445) were ‘incomplete’ and a further 41 have been withdrawn altogether.

Read the full story here.

5. CBD not linked to single doping case

CBD has not been linked to a single failed drugs test in UK sport despite fears about the undeclared levels of THC in some products.

The World Anti-Doping Agency removed the cannabinoid from its banned substances list in 2017 and since then several high profile athletes have publicly endorsed CBD products.

Even though CBD – which has no psychoactive properties – is not banned, the UK Anti-Doping (UKAD) still warns athletes to be cautious with treatments.

Read our exclusive report here.

6. School’s out for cannabis class

The first class on a pioneering university medical cannabis course have concluded their first year of studies.

The research programme at the Humboldt-Universitat zu Berlin examines the medical and nutritional uses of cannabis, production and the legal and economic frameworks of the business.

It’s the latest sign that medical cannabis is becoming a part of the mainstream education offering and a positive indication that new industry leaders will emerge in the coming years.

Full story here.

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Science finds a way for medical cannabis to relieve pain without side effects

Researchers have developed a molecule that allows THC to fight pain without the side effects.

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Medical cannabis
Many people living with chronic pain have found that cannabis can provide relief. 

Scientists may have developed a molecule which could allow medical cannabis to provide pain relief without any side effects.

Many people live with chronic pain, and in some cases, cannabis can provide relief. 

But the drug also can significantly impact memory and other cognitive functions. 

Now, researchers have developed a peptide that, in mice, allowed THC to fight pain without the side effects.

According to the US Centres for Disease Control and Prevention (CDC) around 20 percent of adults in the states experienced chronic pain in 2019. 

In some studies, medical cannabis has been helpful in relieving pain from migraines, neuropathy, cancer and other conditions, but the side effects can present hurdles for widespread therapeutic use.

Previously, researchers identified two peptides [molecules which are made up of amino acids] that disrupt an interaction between a receptor that is the target of THC and another that binds serotonin, a neurotransmitter that regulates learning, memory and other cognitive functions. 

When the researchers injected the peptides into the brains of mice, the mice had fewer memory problems caused by THC. 

Now, this team, led by Rafael Maldonado, David Andreu and colleagues, has gone one step further to improve these peptides to make them smaller, more stable, orally active and able to cross the blood-brain barrier.

Based on data from molecular dynamic simulations, the researchers designed two peptides that were less than half the length of the original ones but preserved their receptor binding and other functions. 

They also optimised the peptide sequences for improved cell entry, stability and ability to cross the blood-brain barrier. 

Then, the researchers gave the most promising peptide to mice orally, along with a THC injection, and tested the mice’s pain threshold and memory. 

Mice treated with both THC and the optimised peptide reaped the pain-relieving benefits of THC and also showed improved memory compared with mice treated with THC alone. 

Importantly, multiple treatments with the peptide did not evoke an immune response. 

Reporting in the American Chemical Society’s Journal of Medicinal Chemistry, researchers say that these findings suggest the optimised peptide is an ideal drug candidate for reducing cognitive side effects from cannabis-based pain management.

The abstract that accompanies this paper can be viewed here.

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Dutch Government to supply medical cannabis for UK patients until 2022

The Department of Health has reached an agreement to continue the supply of Bedrocan oils

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The Dutch Government will supply medical cannabis to UK patients until 2022

The Department of Health has reached an agreement with Dutch officials to extend the supply of medical cannabis oils to existing patients in the UK until 2022.

Medical cannabis patients, living with severe, life-threatening epilepsy were left without access to medication when the UK left the EU at the end of last year. 

Families, whose children are prescribed Bedrocan oils in the UK but must obtain their prescription through the Transvaal pharmacy in the Netherlands, were given two weeks notice that their medication could no longer be dispensed following the end of the Brexit transition period on 31, December 2020. 

After outrage from campaigners, the Dutch government agreed to continue supplying the life-saving products until 1 July, 2021 while a more permanent solution was reached.

This waiver period has now been extended until 1 January, 2022.

Health ministers promised to work with officials in the Netherlands to find a “long-term” solution, but according to those at the forefront of the campaign, there is still “some way to go”.

Hannah Deacon and son Alfie Dingley

Hannah Deacon’s son Alfie Dingley, who is prescribed Bedrocan products for a rare form of epilepsy, recently celebrated one year seizure-free.

In a letter to Deacon on Thursday 13 May, the DofH said it was working with the Dutch government, Bedrocan and the Transvaal pharmacy to proceed as “quickly as possible” with the UK production of these medicines.

It added that domestic production is “complex” and that manufacturing “unlicensed herbal medicines” comes with “significant challenges”. 

Deacon said that the UK production of Bedrocan products was the “only solution”.

While other cannabis-based medicines are available in the UK, experts have warned that there is ‘significant variation’ from one product to the next and switching an epilepsy patient’s treatment could be ‘life-threatening’.

“With the 1 July deadline for Bedrolite supply to cease from the Netherlands looming ever closer, we made it clear we wanted an extension to the agreement to stop the situation becoming dangerous for Alfie and the other patients receiving this vital medicine,” commented Deacon.

“The long term solution of Bedrocan products being made in the UK still has some way to go, but it can be the only solution and we thank everyone who is working very hard to achieve this. 

“This is still a long way off from being okay, but for now we have the pressure taken off on the supply issue.”

With limited access to medical cannabis on the NHS, families are still calling for the Government to help fund their children’s prescriptions, which can cost thousands of pounds each month.

Deacon added: “The ever-pressing issue of financial burden on the many families and patients wishing to use medical cannabis in the UK remains and this is a huge issue which needs dealing with.

“There are many ways in which the Government could step in and help access for very vulnerable people and we will continue working as hard as we can to make things better for all.”

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