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 […]

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: 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: 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 […]

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 […]

Botanical Treatment Of Nausea And Vomiting Of Pregnancy And Hyperemesis Gravidarum

According to Borrelli et al., the potential teratogenic effects of drugs administered during the critical embryogenie period of pregnancy drastically limit their use. Because of this, many pregnant women turn to complementary and alternative therapies including vitamins, herbal products, homeopathic preparation, acupressure, and acupuncture. A recent literature survey reports that the most commonly used botanicals for the treatment of morning sickness are ginger, chamomile, peppermint, and raspberry leaf. Only ginger has been subjected to investigation of its safety and efficacy for nausea and vomiting of pregnancy. Botanical Treatment Strategies for nausea and vomiting of pregnancy and Hyperemesis Gravidarum Therapeutic Goal Therapeutic Activity Botanical Name Common Name Reduce nausea and vomiting Antinauseant  Antiemetic Cannabis spp. Marijuana Mentha piperita Peppermint Zingiber officinalis Ginger Relieve stomach cramps Antispasmodic Dioscorea villosa Wild yam Matricaria recutita Chamomile Support digestion / appetite Digestive bitters Ballota nigra Black horehound Taraxacum officinale Dandelion root   The botanical approach to Read more […]