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: 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: 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: 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: 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 […]

The Use of Echinacea in Pregnancy and Lactation

Complementary and alternative medicine (CAM) is an umbrella term that covers a number of healthcare modalities that generally fall outside the realm of the conventional medical model. Herbal medicine is considered to be a primary complementary and alternative therapy. In recent years, the use of herbal products has increased dramatically, particularly in developed countries, by people who wish to maintain good health and reduce the need for conventional drug therapy. Echinacea products are among the most popular phytomedicines. While these remedies have a long history of use in pregnancy, during delivery, and for lactation, clinically relevant sources of information on the safety and risk of such products are lacking. Given the great variation in product composition and constituent concentration, the actual safety of Echinacea has not been easy to study in pregnancy and lactation. To date, there is only one published study that has examined the safety of Echinacea use during pregnancy for upper respiratory tract ailments. Pregnancy Facts There is an underlying baseline risk for malformations associated with every pregnancy, regardless of the mother’s exposure to a substance of concern. As a result, the primary 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 […]

Anxiety Disorders: Supplements Not Likely To Be Effective

It is not possible to review all compounds that, at one time or another, have been tried to treat symptoms of anxiety and have not shown to be effective, or lack sufficient rationale about how they may affect brain action to promote sleep. However, some of these compounds are sometimes marketed as anxiolytics, despite the lack of evidence of efficacy. Clinicians who seek to practice in the area of naturopathic psychopharmacology should be aware of compounds that continue to be propagated despite evidence to the contrary. GABA As discussed in site, GABA is a major neurotransmitter in the central nervous system that is ubiquitous and affects the firing of all neurons by increasing membrane polarization. Most GABA receptors are ionotropic and regulate the influx of chloride into the cell. As chloride levels increase in the cell, the negative charge also increases, and the cell becomes more and more difficult to stimulate. A number of medications target GABA neurotransmission and have been shown to be effective in treating mood disturbance (especially mania and agitation), anxiety, and tics. Consequently, naturopaths sometimes recommend GABA supplementation, and various forms of GABA tablets and capsules are available Read more […]