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Medical cannabis has more ‘benefits’ and is ‘safer’ than prescription drugs for chronic pain

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Medical cannabis was found to have the best overall benefit-safety balance for patients

Medical cannabis improves patients’ quality of life more than any other treatment for chronic pain, says a panel of leading experts.

Medical cannabis is among the most effective treatments for people with long-term, problematic neuropathic pain, according to the new paper.

Researchers used the latest assessment methods to measure the effectiveness of commonly used drugs’ at managing pain and improving patients’ quality of life, against side effects.

Medical cannabis was found to have the best overall benefit-safety balance for patients, with its ability to reduce pain and improve the quality of life for patients with chronic neuropathic pain (CNP).

The paper also finds that it is safer overall than other commonly prescribed medications, and that patients taking cannabis-based medications would be less likely to experience many of the side effects associated with more established treatments. 

One in 11 people in the UK suffer from chronic neuropathic pain – including conditions such as nerve damage, sciatica or severe numbing in hands and feet – that substantially impacts on their quality of life.  

A panel made up of international clinicians, experts and patients, used a multicriteria decision analysis (MCDA) model to compare the safety of cannabis products to those of the nine drugs that are most commonly prescribed for CNP. 

Cannabis-based products containing a 1:1 ratio of THC and CBD, were found to have a higher benefit-safety profile than commonly used medications such as Amitriptyline and Tramadol. 

The patient’s perspective

Authors concluded that medical cannabis contributes more to CNP patients’ quality of life and is more favourable in terms of side-effects such as cognitive impairment, dizziness, constipation, affect disorders, overdose toxicity, respiratory depression, withdrawal, and dependency. 

Patient representative Abby Hughes, who took part in the study, said the patient contribution was “crucial” in highlighting the importance of quality of life compared to reduction in pain.

“It is crucial patients were able, for the first time in an MCDA setting, to share their lived-experience in a study identifying the benefit-safety balance of neuropathic pain medications. After all, we are the ones experiencing pain and seeking pain relief for a better quality of life,” said Hughes.

“Sharing our experiences equated to the difference in quality of life actually being judged as more clinically important to patients than the difference in pain relief.”

She continued: “Interestingly, with the benefits of 12 neuropathic pain medications mapped out, cannabis takes the lead. 

“The safety was also mapped out, identifying adverse and serious adverse events, from constipation to overdose toxicity. 

“Cannabis came out as equal or better in safety. Whilst ibuprofen came out as just as safe, it was also least effective, weighted as zero for pain relief and quality of life benefits.”

Prof Mike Barnes was a co-author on the study

“Controversial” conclusions

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The report comes just weeks after the International Association for the Study of Pain (IASP) said it could ‘not endorse’ the general use of cannabinoids to treat pain, due to a lack of evidence from ‘high quality research’.

The Faculty of Pain Medicine at the Australian and New Zealand College of Anaesthetists (ANZCA) has also advised against prescribing cannabis for patients with chronic, non-cancer pain unless they are enrolled in a clinical trial.  

A co-author of the CNP and cannabinoids study, Professor Mike Barnes, who has been critical of the IASP statement, said these findings go some way to “refute” its conclusions.

“I wish those writing such reports actually spoke to real patients deriving real benefit from cannabinoids for chronic pain,” said Prof Barnes.

“They should try to move beyond the narrow pharmaceutical paradigm, understand the plant and not forget that a doctors’ primary duty is to help their patients.

“This study illustrates the efficacy and safety of cannabis and goes some way to refute the conclusions of the report of the IASP which said there was insufficient evidence to prescribe cannabinoids for pain.”

His co-author, Dr Anne Katrin Schlag, head of research for Drug Science, the UK-based charity which commissioned the paper, told Cannabis Health the team anticipated that the findings would be “controversial”.

“This is another way of broadening the scientific evidence base, rather than solely sticking to randomised control trial (RCT) data,” said Dr Schlag.

Dr Anne Katrin Schlag

Dr Anne Katrin Schlag, head of research at Drug Science

“What is very important here is that the study is a comparison between different pain medications, including medical cannabis. 

“While medical cannabis was not found to be the best at reducing pain, when taking quality of life into account and patients being able to function, eat and sleep well, then for the average person, cannabinoids tend to work better than the opioids, which tend to have serious side effects.”

Another blow for chronic pain patients 

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Last week, in another blow for chronic pain patients, the National Institute of Health and Care Excellence (NICE) released new guidance advising UK doctors not to prescribe conventional painkillers including opioids and paracetamol for chronic primary pain. 

Instead it is recommended that patients with these conditions are offered a “range of treatments” to manage their pain, including exercise, CBT and acupuncture. 

With access to cannabis medicines still restricted in the UK, there has been a backlash from patients who fear being left without any viable options. 

Dr Schlag continued: “For patients experiencing severe chronic pain there should be the option  of opioid based  pain medications. 

“Exercise and psychological therapies all have a place and will have lots of benefits for some people, but it is likely there will always be people who need stronger medications.”

She added: “At Drug Science we would like to see cannabis added to the current pharmacotherapy in relation to pain. 

“There are thousands of patient reported outcomes from those who are using cannabis and cannabinoid products successfully to treat pain, including from our own forthcoming Project Twenty21 findings which are due to be published shortly.” 

Building a convincing case

Project Twenty 21, which launched in November 2019, is Drug Science’s landmark study which aims to widen access to medicinal cannabis, enrolling up to 20,000 patients to build Europe’s largest body of evidence for its safety and efficacy. 

Drug Science CEO, David Badcock said he hoped this latest paper would encourage regulatory bodies to consider the growing evidence behind medical cannabis and take steps to improve access for patients.

“Since being made legal in 2018, many patients suffering from neuropathic pain have told us that cannabis based medicinal products are effective in reducing their pain and its negative impacts on their everyday lives,” he commented.

“We are pleased to say that this paper corroborates what many patients have been saying for many years, and  helps to build a convincing case for more widespread prescription of medical cannabis on the NHS.” 

Hughes, who is able to access a prescription for medical cannabis through Project Twenty21, echoed these sentiments, adding: “It is hoped NICE will consider reevaluating their guidelines on medical cannabis, recognising that for many patients cannabis provides a better quality of life, provides better pain relief, and has a better safety profile than many other neuropathic pain medications currently prescribed.”

You can read the full report here

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Epilepsy

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.

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Dravet Syndrome: A row of test tubes containing CBGA oil with a doctors white gloved hand holding one up to the light

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.

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“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.”

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“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.”

The study was recently published in the British Journal of Pharmacology (DOI: 10.1111/bph.15661)

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New York regulators vote to allow home grow for medical cannabis patients

The new regulations would allow medical cannabis patients and carers in the state a safe, cost-effective way to access their medication

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New York: The statue of Liberty against a blue sky and the skyline of New York city

The proposed regulations would allow medical cannabis patients and carers in New York to grow up to six plants, indoors or outdoors, for therapeutic use.

New York cannabis regulators voted unanimously for the proposed regulations which would not only allow qualified patients to grow their own plants.

According to a slide from the Cannabis Control Board presentation, patients would be allowed six plants each but carers with more than one patient,  can “cultivate 1 additional cannabis plant for each subsequent patient.”

The new regulations would impose a duty on patients to ensure no one under the age of 21 can access the plants or any products cultivated from them.

Landlords would also have the option to prohibit their tenants from growing cannabis on their property if they chose. The products must not be processed using anything other than alcohol.

The regulations will now have a 60-day public commentary period before review.

Tremaine Wright, chair of the Cannabis Control Board (CCB) said: “We are proud to present those proposed regulations. The home cultivation of medical cannabis will provide certified patients with a cost-effective means of obtaining cannabis through personal cultivation while creating a set of standards governing the conduct and activities relating to the personal cultivation of cannabis.”

In a press release, the CCB also gave an update on the expungement of cannabis convictions. “Approximately 203,000 cannabis-related charges are presently being suppressed from criminal background searches and are in process of being expunged, adding to the approximately 198,000 records that were expunged as part of the first round of cannabis expungement following legislation enacted in 2019.”

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New York recreational market

Earlier this year, New York. It would become the 16th US state to legalise recreational cannabis creating thousands of jobs and tax revenue. The bill was signed into law by Governor Andrew Cuomo in March.

The law would allow for possession of up to three ounces of marijuana for personal use. It would allow licensed dispensaries to sell cannabis products to those over 21.

Neighbouring states who have already legalised marijuana, including New Jersey and Massachusetts, meant that New York citizens were leaving to access cannabis losing tax revenue in the process.

It is expected that home grow for recreational users will follow the proposed regulations for medical cannabis patients but only after the new market is established.

Read more: California governor signs Ryan’s Law to allow medical cannabis use in hospitals

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CiiTECH announces new CPD-accredited training course

It aims to support and encourage UK pharmacists, physicians and nurses.

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Ciitech academy
The course aims to support and encourage UK pharmacists, physicians and nurses.

Cannabis healthcare company CiiTECH has been awarded CPD accreditation for its academy course, which aims to support and encourage UK pharmacists, physicians and nurses.

CiiTECH’s Cannabis Science and Therapeutics course has had tremendous success after launching the course earlier this year.

The new and innovative course offers an interactive digital platform with a 12 chapter syllabus comprising of medical cannabis, CBD knowledge and information, specifically catered for healthcare professionals in the UK.

Industry experts in the UK could potentially face serious challenges if the trainers in question who are both recommending, and dispensing information are not up to the required standards in the field.

People currently working in the industry, such as pharmacy professionals will feel more secure and confident after taking the course. With such an array of knowledge from the experts, they are better able to recommend, treat and understand benefits and causes of their patients.

Besides all the learning and comprehensive information, simple FAQ questions by patients can be simply downloaded to have at hand as an ongoing reference.

The CBD industry is an extremely fast growing market, people are becoming more and more aware of benefits and common usage. It’s said that by 2025 the market in the UK only will be worth over £3 billion.

This means that clinics and pharmacies must be sourcing trustworthy information to their customers.

This course is aimed at filling an education gap in the market, by covering several points in intricate detail, from plant history to dosing, and patient care. A lot of occupations in the UK require an on going learning process each year, with positive results overtime, leading to a greater service in the industry.

“Through years of experience serving UK customers with our portfolio of CBD brands it was abundantly clear that the level of misinformation was enormous and confusing for everyone involved,” says Clifton Flack, CEO and founder of CiiTECH.

“Formal education is always important but with little to no existence in the UK we could not see a better way to help lead the industry than to establish our own online academy and give healthcare professionals the opportunity to not only learn about cannabis therapeutics but to earn further education points at the same time.”

Flack adds: “With the rise in UK cannabis prescriptions and CiiTECH’s long awaited move into the THC medical cannabis arena, now is the time to increase professional education and it is exactly why we have embarked on this education journey. CiiTECH is fast becoming the UK’s one stop shop for all your cannabis needs; research, education, consumer brands.”

CiiTECH collaborated with Medical Cannabis Mentor to produce the course and prepare it for CPD certification.

Joe Dolce, founder and CEO of Medical Cannabis Mentor, comments: “The course synthesises the most up-to-date scientific research and clinical guidelines in an engaging format to help professionals make informed treatment decisions.”

The course can be found on https://cpduk.co.uk/ or for pricing and registration visit:  https://ciitech.academy

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