Archive for category Cannabis'

Cannabis and Cannabinoids in Pain Relief

Cannabis is a term that describes products derived from the Indian hemp, Cannabis sativa. It has its origins probably in India but now grows all over the world. The chemical compounds responsible for intoxication and medicinal effects are found mainly in a sticky golden resin exuded from the flowers of the female plants and surrounding leaves. Cannabis sativa contains a wide range of different chemicals including a family of compounds called “cannabinoids”. Of the cannabinoids delta-9 tetrahydrocannabinol (THC) is probably the main compound responsible for the psychotropic activities. Cannabis has been used as a medicine for thousands of years and is mentioned in a Chinese herbal dating back to 2700 BC. There are records of ’its medicinal use in Egyptian papyri of the sixteenth century BC. Much later, the plant is mentioned in Assyrian texts and in Greek and Roman sources as a medicinal agent. Early Experiences in the 19th Century Cannabis Tincture was used in the nineteenth century as an analgesic, as well as numerous other conditions and was considered milder and less dangerous than opium. W.B.O’Shaughnessy was the first of the western physicians to take an interest in cannabis as a medicine on account Read more […]

Nabilone — Clinical Experience at the James Paget Hospital

The dose per capsule is 1 mg but we found that this could be excessive for some patients. Therefore, some were started at 0.25 mg by opening the capsule and dividing the resultant powder into four. The initial time for nabilone use has been at night to reduce the potential discomfort of any side effects. Once the patient’s confidence has been developed, the dosage has been increased where appropriate. Those patients who have benefited from nabilone have been through a period of discontinuation to help evaluate the benefits of this drug. The age range of the 43 patients who have used nabilone is from 25–82 years with 75% between the ages of 30 and 50. More women than men were treated, mainly reflecting a large sex difference in the group with multiple sclerosis. The diagnoses of the patients were categorised into 6 groups as the most convenient method of presenting the information from such an heterogeneous group. No attempt has been made to do anything more than describe the effects of using nabilone on each individual patient and thereby evaluate whether it might be of value in pain control. Multiple Sclerosis Multiple Sclerosis is characterised by widespread and varied damage to the central nervous Read more […]

Neurotransmitters Involved with Cannabinoid Action

Cannabis is a complex mixture of cannabinoid molecules (over 61 have been identified) and other chemicals (of which 400 have been identified); with THC as the main active cannabinoid responsible for the psychotropic effects. All these chemicals may have a wide variety of mechanisms of action and that of their metabolites may well be different again. So far, studies have concentrated on THC and a number of synthetic analogues, revealing a number of possible mechanisms of action. The central nervous system (CNS) transmitters that modulate the perceptions of pain include noradrenaline, serotonin (5HT), acetylcholine, GABA, the opioid peptides and the prostaglandins. Reports suggest that the analgesic effects seen with the cannabinoids involve prostaglandins, noradrenaline, 5HT and the opioid peptides, but not GABA or acetylcholine. The involvement of the prostaglandins is complex. The cannabinoids are stimulators of phospholipase A2, promoting the production of prostaglandins, but also inhibitors of cycloxygenase therefore also inhibiting production. The scene is further complicated by the fact that prostaglandins oppose pain centrally but cause pain at peripheral sites (). This may explain why in some tests involving Read more […]

Non-Medicinal Uses of Cannabis Sativa

The plant Cannabis sativa has been providing man with a range of his most basic needs for centuries (). We know that hemp — the fibrous extract of C. sativa, was used for clothing in ancient Egypt, at least as early as 1,200 years BC and the use of the plant as a source of rope is well documented in many cultures down the centuries (see «Cannabis Use and Abuse by Man: An Historical Perspective»). The seeds from the plant have been subjected to various treatments to provide food and the fibre has also been used from early times as a major paper making material; indeed, early editions of the Gothenburg and King James Bibles were published on such paper and much later, the first two drafts of the American Declaration of Independence. The new president of the United States, George Washington was to be found exhorting his head gardener to: “Make the most of the Indian hemp seed…and sow it everywhere” (Washington, 1794). These peaceful uses were not the only ones however. From the 17th century onwards, the British Royal Navy — at the time the most powerful navy in the world — relied heavily on hemp for ropes, rigging and caulking. In the mid-1800s, a typical 44-gun man of war might inventory some 60 tons Read more […]

The Therapeutic Potential For Cannabis

«Cannabis Use and Abuse by Man: An Historical Perspective» of this site provides a fascinating, historical account of the use of cannabis across many cultures and centuries. Suffice it to say here that any natural substance with over 5000 years of medical history will have attached to it a heritage of hearsay and legend through which one must sift to identify areas of true therapeutic potential for us in the late twentieth century and beyond. A summary of conditions for which cannabis has been used, ranging through various shades of rationality, appears in Table Medicinal and quasi-medicinal uses for cannabis and its derivatives: Indications for which only anecdote or reports of traditional use exist: aphrodisiac muscular spasm in rabies / tetanus Huntingdon’s chorea jaundice toothache earache tumour growth cough hysteria insanity menstrual cramps rheumatism movement disorders gut spasm pyrexia inflammed tonsils migraine headache increasing uterine  contractions in childbirth urinary retention/ bladder spasm parasite infection fatigue allergy fever herpetic pain hypertension joint inflammation diarrhoea malaria forgetfulness Indications Read more […]

Specific Medicinal Uses of Cannabis

The historical and contemporary, medicinal uses of cannabis have been reviewed on several occasions. Perhaps the earliest published report to contain at least some objectivity on the subject was that of O’Shaughnessy (1842), an Irish surgeon, working in India, who described the analgesic, anticonvulsant and muscle relaxant properties of the drug. This report triggered the appearance of over 100 publications on the medicinal use of cannabis in American and European medical journals over the next 60 years. One such use was to treat nausea and vomiting; but it was not until the advent of potent cancer chemotherapeutic drugs that the antiemetic properties of cannabis became more widely investigated and then employed. One can argue that the available clinical evidence of efficacy is stronger here than for any other application and that proponents of its use are most likely to be successful in arguing that cannabis should be re-scheduled (to permit its use as a medicine) because it has a “currently accepted medical use”. Specific Medicinal Uses of Cannabis: Use as an Antiemetic Specific Medicinal Uses of Cannabis: Glaucoma Specific Medicinal Uses of Cannabis: Multiple Sclerosis Spastic Conditions A discussion Read more […]

Specific Medicinal Uses of Cannabis: Effects on Anxiety and Insomnia

Cannabis smoking produces a relaxant effect which most users value and it has been suggested that the beneficial effects of cannabis and THC observed in neurological disorders such as motor tics, dystonias and Huntingdon’s chorea are due to sedative and anxiolytic actions. In addition, sedation is by far the most common side effect of cannabis, and in particular THC, observed in clinical trials against a range of disorders. This has lead to the suggestion that cannabis and some cannabinoids may be useful in disorders accompanied by anxiety and/or insomnia. Cannabis Sethi et al. () noted a reduction of anxiety in 50 chronic cannabis users compared to controls, in terms of scores on the Taylor Manifest Anxiety Scale. Oral preparations of cannabis have a sedative or tranquillising effect in man, accompanied by diminished anxiety at doses much lower than those producing psychoactivity. However, anxiety and panic, possibly due to depersonalisation, intoxication and loss of control, can also feature as side effects. These symptoms have been observed after smoking or oral ingestion of cannabis, but particularly after intravenous administration of aqueous extracts. This may be due to the rapid onset of altered mental state Read more […]

Specific Medicinal Uses of Cannabis: Anticonvulsant Activity

As early as 1890, the use of cannabis was advocated for the suppression of convulsions in man. While there are some reports of the effects of smoking cannabis in this area, most effort has focused on synthetic cannabinoid derivatives. Cannabis Two reports indicate that regular cannabis smoking contributes to better control of seizures in epileptic patients whose disease is refractory to conventional therapy. These studies were not controlled and contained few patients. THC There have been no reports of the use of THC in epileptics; this compound has induced or exacerbated seizure activity in animal studies. Cannabidiol (CBD) Carlini and Cunha added CBD, 200–300 mg daily, to the anticonvulsant regime of eight patients with generalised secondary seizures, refractory to antiepileptic drugs. Over the 5-month observation period, improvement was noted in seven. Very similar results were reported in an earlier trial by Karler and Turkanis. In a placebo controlled study in patients with grand mal seizures, CBD produced improvement in seizure control in 7 patients, three of these showing great improvement. One patient showed some improvement on placebo however. Summarising, there seems to be little to recommend the Read more […]

Specific Medicinal Uses of Cannabis: Multiple Sclerosis

Like so many other applications, there are numerous anecdotal reports from both patients and their carers who say that cannabis has proffered relief from a range of symptoms associated with MS, including tremor, spasticity and muscle pain. Evidence for the efficacy of cannabis in the relief of spasticity other than that found in MS is discussed in Spastic Conditions. Cannabis Meinck et al. () describe a case where the benefits of smoking cannabis reported by the patient — improvement in muscle tone, reflexes, spasticity, tremor and walking ability — were quantifiable in the laboratory and deteriorated on withdrawal. In a double-blind, placebo controlled trial of cannabis in 10 ambulant patients with MS, the drug impaired posture and balance although several patients reported an improvement in subjective feelings of well-being; a formal psychological assessment was not carried out. Anecdotal evidence gathered from the testimonials of MS sufferers indicates that a considerable proportion obtain at least partial relief from night-time spasticity, and reduced muscle pain, tremor and depression. THC Petro and Ellenburger reported a placebo-controlled trial of oral THC in 9, cannabis-naive patients with MS. Each Read more […]

Specific Medicinal Uses of Cannabis: Glaucoma

Cannabis smoking and the oral ingestion of several of its derivatives have been shown to cause an appreciable drop in intraocular pressure (); and it is known that patients with open angle closure glaucoma smoke cannabis for this purpose. Cannabis When smoked, cannabis containing the equivalent of 20–30 mg of THC has been shown to lower intraocular pressure in an heterogeneous group of glaucoma patients and more specifically, patients with open angle glaucoma. However, the treatment was not without side effects: six of 32 patients developed severe systemic hypotension; this was significantly greater in hypertensive glaucoma patients. Cannabis caused a dose-related, clinically significant, reduction in intraocular pressure of 25– 30%, occurring at 1 hour and lasting 5–6 hours, which was discrete from the sedative effects of the drug. Orthostatic hypotension was observed mainly in cannabis-naive patients. Cannabis does not cure glaucoma but has been shown to slow progressive sight loss when conventional medicines have failed or where the risks of surgery are too great. Tolerance to this effect of cannabis has not been observed; but the degree of reduction in intraocular pressure seen in cannabis-naive patients Read more […]