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 […]

Pharmacology of Poppy Alkaloids: Minor Opium Alkaloids

The pharmacology and biology of minor opium alkaloids have been surveyed previously in two comprehensive reviews (). Thebaine The pharmacology of thebaine was summarized by Reynolds and Randall in 1957 and studied comprehensively by a WHO Advisory Group in 1980. The pharmacological actions of thebaine in various isolated organs have been studied. Thebaine can induce a temporary decrease in blood pressure in anaesthetized dogs and this depressor effect showed a marked tachyphylaxis. In isolated guinea pig atrium, thebaine decreased the heart rate and contractions depending on the concentration. In isolated rabbit ileum it decreased the peristaltic movement and contractions (). The predominant effect of thebaine is stimulation of the central nervous system. In the mouse, rabbit, cat and dog increases in motor activity and reflex excitability were observed at doses around 2-10mg/kg s.c. or i.m. The Straub-tail response was noted only occasionally. The effects of thebaine on body temperature and respiration have also been studied. Convulsions were observed in almost all species of animals including the frog, pigeon, mouse, guinea pig, cat and dog. Transient tremors, restlessness and convulsions were observed in the Read more […]

Pharmacology of Poppy Alkaloids: Major Opium Alkaloids

 The latex obtained by the incision of unripe seed capsules of Papaver somniferum and which is known as opium is the source of several pharmacologically important alkaloids. Dioskorides, in about AD 77, referred to both the latex (opos) and the total plant extract (mekonion) and to the use of oral and inhaled (pipe smoked) opium to induce a state of euphoria and sedation. Since before the Christian era the therapeutic properties of opium were evident, with the first written reference to poppy juice by Theophrastus in the third century BC. Powdered opium contains more than 40 alkaloids which constitute about 25% by weight of the opium and are responsible for its pharmacological activity. In 1803 the German pharmacist Sertiirner achieved the isolation of morphine as one of the active ingredients of opium. Morphine, codeine, thebaine, papaverine, narcotine and narceine are the most important bases, with many of the remaining (minor) alkaloids occurring only in traces. Morphine Morphine has long occupied an eminent position on the list of useful drugs. As a pure alkaloid, it has been employed for over a century and a half and, as the most important constituent of opium, it has contributed to the comfort of the human 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: Use as an Antiemetic

Many agents used in cancer chemotherapy produce severe nausea and vomiting in most patients. Symptoms can last for hours or days and have a major impact on patient nutrition and electrolyte status, body weight and physical and mental resilience to both the disease and its treatment. The current choice of available anti-emetics is limited and most are only partially effective, which may lead patients to refuse therapy all together, or for clinicians to use chemotherapeutic regimens which are less than optimum. For these reasons, the search for more effective antiemetics continues. Cannabis In the late 1960s and early 1970s, patients receiving various cancer chemotherapy regimes (including mustine, vincristine, prednisone and procarbazine) noted that smoking cannabis from illicit sources, before and during chemotherapy, reduced the incidence of nausea and vomiting to a variable degree. Only since the isolation of THC have formal clinical trials on the safety and efficacy of cannabis derivatives been conducted. As far as crude cannabis is concerned, we have only anecdotal evidence that inhaling its smoke is effective in a variable percentage of patients who vomit, despite supposedly adequate doses of standard antiemetics. There Read more […]

Anxiety Disorders: Supplements With Likely Efficacy

Like depression, anxiety is an area of psychopharmacology where many naturopathic compounds have been studied. While kava has established efficacy with adults and consistently has been shown to be effective in decreasing symptoms of anxiety, no studies thus far have been performed with children and adolescents, and some risk of hepatotoxicity may be present, and consequently the supplement is included in this section. In addition, some other compounds have also revealed at least some efficacy, but research has primarily been done with adult patients, and clinicians must use caution when applying results of these studies to pediatric patients. Anxiolytic medications work by increasing the amount of activity in the serotonergic pathways, as well as altering the glutamate-GABA balance in favor of inhibitory effects. Supplements that accomplish similar changes in the brain have been shown to be effective in managing symptoms of anxiety. Kava Kava (Piper methysticum), alsto referred to as kava kava, is a tall bush indigenous to the South Pacific, especially Hawaii, Fiji, Samoa, Tonga, Tahiti, New Guinea, and New Zealand. Its root is typically ground, and indigenous cultures have also chewed it, prepared it as an infusion, Read more […]

Anxiety Disorders: Supplements With Possible Efficacy

In addition to supplements discussed above, a few other compounds may also have some efficacy in treating symptoms of anxiety. However, since the data that supports the use of the following supplements is extremely limited, clinicians should proceed with caution, and consider the use of the compounds discussed in this section as experimental. St. John’s Wort As described in site, St. John’s Wort (Hypericum perforatum) is an herb that exists in many species throughout the world, and it is widely used as an antidepressant. It is available in a variety of preparations, including capsules, liquid, oils, and raw herb to be brewed as tea. St. John’s Wort contains a plethora of active ingredients, including flavonoids, naphthodianthrones, phloroglucinols, phenolic acids, terpenes, and xanthones. These exert a variety of psychoactive effects, and several of these are described below. Of all herbal supplements, St. John’s Wort is the one that has been researched most extensively and there is strong support for its efficacy in reducing depressive symptoms. The use of St. John’s Wort as an anxiolytic is more recent, but a few studies suggest that is may be effective. Davidson and Connor (2001) reported case studies of patients Read more […]

Atropa belladonna

Atropa belladonna L., commonly known as deadly nightshade, or belladonna belongs to the family Solanaceae. Atropa is a small genus native throughout middle and southern Europe and extending to central and western Asia up to the Himalayas. A. belladonna L., the economically most important species, is an erect perennial herb which may grow up to 5 ft in height. It has purple flowers (to distinguish it from the yellow-flowered A acuminata) and black berries with many small seeds. This plant grows in damp or shady places, mainly in the mountains, and is attacked by various species of Gonocephalum, Agrotis, and Archips, which cause defoliation. It is generally propagated through seed in the nurseries, and later transferred to the field. The leaves (folium belladonnae) are mainly used as a source for medicinal drugs, mainly atropine (dl-hyoscyamine), with scopolamine as a minor component. Preparations of belladonna are known to have been used for many centuries. During the time of the Roman Empire and in the Middle Ages this plant was frequently used to produce marked dilatation of the pupils. Tropane alkaloids have been used in domestic medicine, for example, for inducing sleep and for toothache. Some of them have Read more […]