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New UK trials to study medical cannabis and chronic pain

A trial at the University of Manchester will study cannabinoids in patients with fibromyalgia and chronic pain

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medical cannabis and chronic pain
A human pilot study will be launched in the UK, in coordination with the University of Manchester

A new UK trial will explore the effects of medical cannabis in patients with fibromyalgia and chronic pain.

US cannabis producer Flora Growth is set to begin clinical trials to explore the use of cannabinoids in patients suffering from fibromyalgia or chronic pain.

Primary research sites will be located in the US and the UK, with the hopes of fast-tracking traditional FDA and NHS timelines by running phase trials in parallel.

A human pilot study will be launched in coordination with an internationally recognised clinical research group based at the University of Manchester.

In addition, parallel molecular and pharmacokinetic studies will be conducted in the US with key scientists and colleagues of Dr Annabelle Manalo-Morgan, Flora’s lead scientific advisor. 

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“A paradigm shift is upon us where healthcare practitioners, researchers, patients, and adult-use consumers are starting to understand, accept, and embrace the therapeutic potential offered by phytocannabinoid-based medicine,” said Dr Manalo-Morgan.

“As such, there is an urgent need for more research to better understand the molecular and biochemical effects of cannabis at the cellular level, to begin to apply its implications as a pharmaceutical drug.”

According to an announcement earlier this month, Flora intends to work with government regulators, as well as academic institutions to initiate academic studies in order to reduce costs and develop new cannabis-based drugs.

​​It plans to “honour the traditional FDA and NHS route in scientific processes” to deliver cannabinoids for specific disease conditions, backed by data, with an initial focus on fibromyalgia, brain health, pain, and related research.

The firm’s immediate next steps are to submit data for ethics committee review, with further details expected upon approval.

Dr Manalo-Morgan added: “I’m extremely pleased that our team recognises the importance and necessity of this research, not only to create and bring to market novel pharmaceutical cannabis products for patients around the world that are more efficacious and have a superior safety profile compared to traditional and incumbent pharmaceutical treatment options, but to also enhance long-term shareholder value.”

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Pain

Chronic pain and medical cannabis – “Without it my life stops”

Helen Weston, who has lived with chronic pain for 37 years, reveals how cannabis has kept her going.

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Chronic pain: Woman swimming
Taking cannabis means Helen can go swimming which improves her pain levels and mobility

Helen Weston has lived with continuous chronic pain for 37 years, which affects her ability to do everyday things. When she ran out of cannabis during lockdown, she realised it was the one thing keeping her going.

“If it wasn’t for cannabis there is no way I would still be here,” says 54-year-old Helen Weston, who has lived with chronic pain for most of her life.

“I can’t move without it. I’m bed ridden, with no life, all there is is pain. Cannabis is what helps me cope. It’s the only thing that keeps me going and enables me to get through another day.”

Since the age of 16, Helen has suffered from spine and neck problems, which cause her chronic pain and muscle seizures, affecting her ability to move.

Later in life she began experiencing severe migraines brought on by triggers such as stress, flashing lights and computer screens and has a diagnosis of trigeminal neuralgia, described as sudden, severe facial pain which comes on in unpredictable attacks.

Pain: A banner advert for the medical cannabis clinic

Helen realised early on, while still in her teens, that cannabis was more effective at managing her pain than prescription drugs. 

“Since I was 16 I have found that the only thing that actually helps is cannabis,” she says.

“I’ve tried all different kinds of painkillers and muscle relaxants, you name it I have tried it, and none of them were very effective, but had a lot of side effects.”

Helen Weston

But the fact that cannabis was masking her symptoms so well, meant her broken spine went undiagnosed for almost a decade, after a spinal fusion failed.

“I was ignored for eight years by doctors after my first spinal fusion broke through no fault of my own,” says Helen.

“The stigma attached to cannabis – that I did mention using at the time – and the fact that it masked the symptoms to an extent and gave me so much mobility, despite a broken spine, meant that nobody believed me. 

“By the time I got help in 1998 for my second fusion the surgeon said if I had got there sooner, he could have done more.”

Struggling with stigma

Helen has struggled to access cannabis illicitly for most of her life to manage the continuous pain, battling with both the practical and societal constraints.

Helen has struggled to access cannabis illicitly for most of her life, battling with both the practical and societal constraints. 

“I’ve lived with continuous chronic pain for more than 30 years, it’s been a real struggle,” she admits.

“The only thing I could do for my back is swim, if I stop swimming my pain levels get higher and my mobility will get lower, so I just kept swimming but I couldn’t swim without the cannabis, I couldn’t move.

Helen continues: “I’ve even tried growing it on a few occasions, but I just couldn’t manage as I wasn’t physically fit enough.

“I’ve always been an advocate, but it’s got me into trouble. I’ve been treated like a fake, and a lazy pothead. When you get chatting to people at swimming, as soon as you say you use cannabis they don’t want to speak to you again.”

Helen adds: “I’ve had very negative responses from the medical profession, but it’s the cannabis that is keeping me alive.

When her cannabis supply ran out during the coronavirus lockdown last year, Helen got a glimpse at what life would be like without it.

“It was unbearable,” she says.

“I was experiencing severe headaches and the pain was immense. I knew it was legal at the time, but my headaches meant I couldn’t do the research on the internet.

“Everything in my body said just end it. If it wasn’t for my counsellor talking me down from one week to the next on the phone, and my friend who went out on a limb, I would have given up. If I run out of cannabis my life stops.”

Helen managed to get hold of a small amount of cannabis through a friend’s neighbour after approaching her and admitting she was “desperate”. It kept her going until she was able to make an appointment with a clinic in the UK.

Life-changing

She now has access to a legal prescription through Integro Medical Clinics, the impact of which has been life changing, she says.

“It really has had a positive effect on my life to get cannabis legally, it’s changed everything,” says Helen.

“I feel safer and more confident speaking about it with medical professionals, I’m not pushed around so much mentally now by it.”

She adds: “When I get it delivered by courier from the cannabis clinic, I still can’t believe it. After all these years I get it delivered legally via courier in a prescription bag, I still have to kick myself.”

Helen now uses a combination of strains, which work for her in different ways, such as helping her movement and  motivation so she is able to keep up her swimming, and managing her headaches. 

A big part of her life is swimming, which helps to lower her pain levels and improve her mobility, but without cannabis she struggles to

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“Although it doesn’t cure it, I’m getting less headaches and they tend to be more mild,” she explains.

“I can use the computer for longer and it takes less time to recover – only a few hours rather than a day or two, so I can respond to an email or do some shopping.”

Something as simple as being able to use the computer for longer has made a huge difference to Helen’s quality of life, allowing her to connect with others in the cannabis and chronic illness communities online and become less isolated.

“My whole life has been about cannabis and I have finally found all these other people that are just like me and they can speak about it openly now,” she says.

“It’s the first time in my life I’ve got other people I can relate to.” 

And now that she is comfortable speaking about her experience she is keen to help others access cannabis too. 

“I feel really positive about the future, I’m so glad I found the clinic, I just wish it had happened sooner,” she adds.

“I’m not the only one and unfortunately there’s lots of people out there living with chronic pain and disability who probably don’t even know it’s legal, who could be helped by cannabis.”

If you have been affected by any of the topics raised in this article, support is always available. Contact Samaritans on 116 123, email jo@samaritans.org or visit www.samaritans.org

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Mental health

Could medical cannabis help with HIV/AIDS?

To mark World AIDS Day, we examine if medical cannabis could help with symptoms such as nausea, pain and anxiety.

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On World AIDS Day, we examine the science behind taking medical cannabis to help manage some of the symptoms.

Wednesday 1 December marks World AIDS Day, dedicated to raising awareness of HIV/ AIDS and also mourning those who passed away.

The UN AIDS estimates that 37.7 million people globally were living with HIV in 2020. They also estimate that since the start of the epidemic, 36.3 million people have died from AIDS-related illnesses.

What is HIV?

The first cases of HIV/AIDS were recorded in the late 70s and early 80s. As the first cases began to originate in the gay community, the disease was originally referred to as ‘GRIDS’ which stood for Gay-Related Immunodeficiency Disease.

HIV: A banner advert for the medical cannabis clincs featuring a doctor in a white lab coat

Human Immunodeficiency Disease (HIV) is a virus that affects the immune system. It damages and weakens the cells making it easy for opportunistic diseases or infections to get in. The body is unable to defend itself. HIV is found in the semen, vaginal and anal fluids, blood and breast milk of those with the virus. It can be passed from person to person but AIDS cannot. Most people with HIV, thanks to advances in science may go on to develop AIDS but live with the disease for longer periods of time.

How do HIV and AIDS differ?

Acquired Immunodeficiency Deficiency Syndrome (AIDS)  is the name given to a collective group of opportunistic illnesses that occur after the immune system has been damaged by HIV.

The most common ways to transfer HIV is through unprotected anal or vaginal sex or sharing unclean needles. The NHS estimate that 80 per cent of those who contract HIV will experience a flu-like illness for one to two weeks after infection. The most common symptoms are sore throat, raised temperature, rashes, tiredness, joint pain or swollen glands.

Could Medical Cannabis help with HIV symptoms?

HIV and Appetite loss

One of the first reasons why patients began to turn to medical cannabis in the 80s to help with symptoms was to counteract AIDS wasting syndrome and associated pain.

The lack of appetite means patients may seldom feel hungry enough to eat or feel well enough to prepare a meal. Cannabis helped patients experiencing this to regain their appetite. It is estimated that the prevalence of wasting syndrome can be between 14 and 38 per cent.

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In the late 80s, doctors started to prescribe Marinol which contains synthetic tetrahydrocannabinol.

Joint Pain

Peripheral neuropathy, or nerve pain, happens when some of the nerves get damaged. It can cause stabbing pains, burning, or tingling sensations in the hands and feet. HIV and antiretroviral medications may trigger the pain. HIV When the immune system is weakened this makes it easier to get other infections that can cause peripheral neuropathy.

Marinol was often prescribed for neuropathic pain as well as appetite stimulation. Cannabis was thought to help with some of the nerve pain caused by early AIDS medication such as AZT. Neuropathic pain, which is where the exterior sheath covering nerve cells is stripped away exposing nerve endings resulting in chronic pain.

A review from 2018 suggested that medical cannabis may be a tolerable and effective neuropathic agent. The researchers analysed over 16 different studies with 1750 participants.

The authors wrote: “The evidence appears to support the safety and efficacy of short-term, low-dose cannabis vaporization and oral mucosal delivery for the treatment of neuropathic pain. The results suggest medical cannabis may be as tolerable and effective as current neuropathic agents; however, more studies are needed to determine the long-term effects of medical cannabis use.”

HIV: A red ribbon for World Aids Day resting in a pair of hands
Better sleep

THC may help with improving the quality of sleep experienced by HIV+ patients. One of the symptoms of HIV can be night sweats which make it difficult to stay asleep or cause poor quality rest. This results in increased fatigue which can leave a patient feeling more run down and stressed as a result.

Night sweats occur when the body is attempting to fight a disease such as HIV. This often accompanies joint pain, unexplained weight loss, fever and chills.

A study suggested that consuming cannabis with higher THC levels can reduce the amount of REM sleep patients experience. This means a deeper, more restful sleep which can lead to better, restorative rest.

Leaning into terpenes can also help. Some terpenes are thought to be really helpful for better sleep including Linalool which is found in lavender, geraniums and jasmine.

Better cognitive function

A study from New York in the journal, AIDS Care, reported that HIV+ patients who consumed cannabis showed the same or greater cognitive performance than non-users.

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Researchers took 138 HIV+ patients of which 47 had a history of cannabis use while 91 did not. Those with a history of cannabis use were found to have ‘better processing speed, visual learning, memory and dominant hand motor ability.’

Reduced neuroinflammation due to HIV

A study from San Diego examined if daily cannabis use might reduce central nervous system inflammation in a cohort of patients with and without HIV.

The researchers noted that those who consumed cannabis had lower levels of chronic inflammation compared to those who did not. Furthermore, the users’ results were similar to the HIV subjects with no history of cannabis use.

This may make it useful for preventing or delaying the development of HIV Associated Dementia which is where the virus spreads to the brain. It can cause memory loss, difficulty thinking, concentrating and speaking clearly. It is a progressive disease that sadly gets worse with time.

It may also help with HIV Associated Neurocognitive Disorder which is often found in the later stages of the disease. It causes progressive loss of memory, behaviour and motor function problems.

Different forms of dementia and some cognitive issues are thought to be caused by inflammation. It has been linked to a number of different conditions such as Alzheimer’s Disease, depression and anxiety. Although more research is needed to understand how cannabinoids interact with our endocannabinoid system and the receptors in our bodies, a study from 2016 shows THC may be neuroprotective.

Authors wrote: “Cannabinoids such as tetrahydrocannabinol stimulate the removal of intraneuronal Aβ, block the inflammatory response, and are protective.”

Mental Health

As with any long term health condition, there can often be a lot of anxiety and depression around diagnosis.

Some cannabinoids such as THC and CBD are thought to potentially help with anxiety. It may induce feelings of calm, improve relaxation and also help with better quality sleep.

There is some debate over the balance of THC and CBD when it comes to anxiety. Some believe that lower doses of THC while higher CBD hybrids may help reduce the risk of worsening symptoms. Alternatively, some patients choose to balance their own ratios depending on their particular symptoms on the day by combining CBD and THC in different ways.

HIV: A variety of different ways to take CBD including capsules, skincare, oil, sprays and pwoders

HIV and T-cell count

When HIV enters genetic information into our T cells, it makes copies of itself causing the helper T cells to die. This disrupts our immune response allowing opportunistic infections to get in without detection or fight.

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CD4 are referred to as ‘helper cells’ that help the body to recognise pathogens with a protein called CD4. However, CD8 T cells are referred to as ‘killer cells’

Killer T cells seek out pathogens and help to destroy them preventing infection. If T Cells fall below a certain number, a person may go on to receive an AIDS diagnosis. Certain medications, such as chemotherapy, can affect a T cell amount so it is important to note if a new prescription may be safe to take or not with HIV.

One study from 2008 offered a longitudinal analysis of both HIV+ and HIV- men who reported that their cannabis did not have an impact on the CD4 and CD8 T cell counts.

How to get a medical cannabis prescription for HIV/AIDS

This requires self-referring or asking your GP to refer you to a clinic in the UK for assessment. The clinics will not be able to diagnose HIV or AIDS but will be able to discuss the options with you.

Medical cannabis is usually assumed to be the last option if prescription medication has not worked to control the symptoms. After an initial assessment, your doctor at the clinic can discuss if cannabis is the best possible option, what you can expect to experience and how the costs work.

A prescription may be offered in a number of different formulas such as oils, flowers or topicals.

What is the best way to take medical cannabis for HIV/AIDS?

There is no right or wrong way to take medical cannabis or CBD for HIV/AIDS. The best way is to talk to your doctor about what will suit your current condition and lifestyle. If a patient is experiencing problems with a sore throat which is common with the flu symptoms or fungal infection such as oral thrush, then swallowing edibles may be difficult. Alternatively, vaping may aggravate lung pain.

Edibles or vaping may be a better option if the taste of oils creates a problem. Keeping a journal of your medical cannabis intake can be helpful when it comes time to have your first follow up appointment or in assessing how a particular product is working for you.

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Pain

Exercise may reduce inflammation by boosting endocannabinoids – study

Exercise is known to decrease chronic inflammation, but so far little is known as to how it does this. 

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The study found that exercise intervention in people with arthritis reduced inflammation

New findings show that exercise could help treat conditions such as arthritis, cancer and heart disease by boosting the number of endocannabinoids in the body.

A study from the University of Nottingham has found that exercise increases the body’s endocannabinoids or ‘cannabis like substances’, in turn helping to reduce inflammation.

The research, published in the journal, Gut Microbes, found that exercise intervention in people with arthritis, did not just reduce their pain, but it also lowered the levels of inflammatory substances (called cytokines). 

It also increased levels of cannabis-like substances –  known as endocannabinoids – produced by their own bodies, by altering the gut microbes.

Pain: A banner advert for the medical cannabis clinic

Exercise is known to decrease chronic inflammation, which in turn causes many diseases including cancer, arthritis and heart disease, but little is known as to how it does this. 

A group of scientists, led by Professor Ana Valdes from the School of Medicine at the university, tested 78 people with arthritis. Thirty-eight of them carried out 15 minutes of muscle strengthening exercises every day for six weeks, and 40 did nothing.

At the end of the study, participants who did the exercise intervention had not only reduced their pain, but they also had more microbes in their guts of the kind that produce anti-inflammatory substances, lower levels of cytokines and higher levels of endocannabinoids.

The increase in endocannabinoids was strongly linked to changes in the gut microbes and anti-inflammatory substances produced by gut microbes called SCFAS.  

At least one third of the anti-inflammatory effects of the gut microbiome was due to the increase in endocannabinoids.

Doctor Amrita Vijay, a research fellow in the School of Medicine and first author of the paper, said: “Our study clearly shows that exercise increases the body’s own cannabis-type substances. Which can have a positive impact on many conditions.

“As interest in cannabidiol oil and other supplements increases, it is important to know that simple lifestyle interventions like exercise can modulate endocannabinoids.”

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