Recent articles of interest:
Schelienz NJ, et al. The effect of high-dose dronabinol (oral THC) maintenance on cannabis self-administration. Drug Alcohol Depend. 2018; 187:254-60. Research has demonstrated that dronabinol (oral THC) can dose-dependently suppress cannabis withdrawal and reduce the acute effects of smoked cannabis. The study found that chronic dronabinol dosing can reduce cannabis self-administration in daily cannabis users and suppress withdrawal symptoms. Cannabinoid agonist medications should continue to be explored for therapeutic utility in the treatment of cannabis use disorders.
Thompson K, et al. Associations between marijuana use trajectories and educational and occupational success in young adulthood. Prevention Science. 2018 April 28; 19: 1-13. There is little consensus as to whether marijuana use is associated with poor educational and occupational success in adulthood. Associations between trajectories of marijuana use in 662 Canadians aged 15 to 28 and multiple indicators of economic well-being in young adulthood were investigated. The findings indicate that early onset and persistent high or increasingly frequent use of marijuana in the transition from adolescent to young adulthood is associated with risks for achieving educational and occupational success, and subsequently health, in young adulthood.
Leimuranta P et al. Emerging role of (endo)cannabinoids in migraine. Front Pharmacol. 2018; 9 (Issue APR), Article 420. This “mini-review” summarizes recent discoveries and present new hypotheses on the role of cannabinoids in controlling trigeminal nociceptive system underlying migraine pain and presents the authors’ views on perspectives of cannabis-derived (extracted or synthetized marijuana components) or novel endocannabinoid therapeutics in migraine treatment.
Bradford AC et al. Association between US state medical cannabis laws and opioid prescribing in the Medicare Part D population. JAMA Intern Med 2018; published online 2 April. doi:10.1001/jamainternmed.2018.0266. An analysis of Medicare Part D found that prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened. Medical cannabis policies may be one mechanism that can encourage lower prescription opioid use and serve as a harm abatement tool in the opioid crisis.
Wen H et al. Association of medical and adult-use marijuana laws with opioid prescribing for Medicaid enrollees. JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.1007. A review of Medicaid data found that state implementation of medical marijuana laws was associated with a 5.88% lower rate of opioid prescribing and the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38% lower rate of opioid prescribing.
Ramar K et al.; for the American Academy of Sleep Medicine Board of Directors. Medical cannabis and the treatment of obstructive sleep apnea: An American Academy of Sleep Medicine Position Statement. The position of the American Academy of Sleep Medicine (AASM) is that medical cannabis and/or its synthetic extracts should not be used for the treatment of OSA due to unreliable delivery methods and insufficient evidence of effectiveness, tolerability, and safety. OSA should be excluded from the list of chronic medical conditions for state medical cannabis programs.
Solowij N e al. Therapeutic effects of prolonged cannabidiol treatment on psychological symptoms and cognitive function in regular cannabis users: A Pragmatic Open-Label Clinical Trial. Cannabis Cannabinoid Res. 2018 Mar 1;3(1):21-34. doi: 10.1089/can.2017.0043 In a 10 week trial of 20 frequent cannabis users who received 200mg of CBD daily, it appeared that CBD treatment may have promising therapeutic effects for improving psychological symptoms and cognition in regular cannabis users.
Irving PM et al. A Randomized, double-blind, placebo-controlled, parallel-group, pilot study of cannabidiol-rich botanical extract in the symptomatic treatment of ulcerative colitis. Inflamm Bowel Dis. 2018 Mar 10. doi: 10.1093/ibd/izy002 Conclusion: the primary endpoint of percentage of patients in remission after treatment was not reached, although several signals suggest CBD-rich botanical extract may be beneficial for symptomatic treatment of UC.
Walters KM et al. An overview of health and safety in the Colorado cannabis industry. Am J Ind Med. 2018 Mar 14. doi: 10.1002/ajim.22834. Conclusion: An online survey of 214 Colorado cannabis industry workers found that working in the cannabis industry is associated with positive outcomes for workers and their organizations, but there is an imminent need to establish formal health and safety training to implement best practices.
Han B et al. Trends in and correlates of medical marijuana use among adults in the United States. Drug Alcohol Depend. 2018;186:120-129. doi: 10.1016/j.drugalcdep.2018.01.022. Data were analyzed from >147,000 U.S. civilian adults who participated in the 2013-2015 National Surveys on Drug Use and Health. Adults residing in states with legalized medical marijuana use were 1.3 times more likely to use marijuana medically in 2015 than in 2013, and adults in nonmedical marijuana states were 1.4 times more likely to report medical marijuana use in 2015 than in 2013.
Couch DG et al. The Use of cannabinoids in colitis: A Systematic review and meta-analysis. Inflamm Bowel Dis. 2018;24:680-697. doi: 10.1093/ibd/izy014. There is abundant preclinical literature demonstrating the anti-inflammatory effects of cannabinoid drugs in inflammation of the gut. Cannabidiol was the most investigated drug. No significant difference was found between the prophylactic and therapeutic use of cannabinoid drugs. Large randomised controlled-trials are warranted.
Lapoint J et al. Cannabinoid hyperemesis syndrome: Public health implications and a novel model treatment guideline. West J Emerg Med. 2018; 19:380-386. doi: 10.5811/westjem.2017.11.36368. Treatment should focus on symptom relief and education on the need for cannabis cessation. Capsaicin is a readily available topical preparation that is reasonable to use as first-line treatment. Emergency physicians should avoid opioids if the diagnosis of CHS is certain and educate patients that cannabis cessation is the only intervention that will provide complete symptom relief.
Sarvet AL et al. Recent rapid decrease in adolescents' perception that marijuana is harmful, but no concurrent increase in use. Drug Alcohol Depend. 2018;186:68-74. doi: 10.1016/j.drugalcdep.2017.12.041 An increase in adolescent marijuana use has not accompanied recent rapid decreases in marijuana risk perceptions. Further monitoring of predictors of marijuana use trends is needed as states legalize recreational marijuana use.
Sohler NL, Starrels JL, Khalid L, et al. Cannabis use is associated with lower odds of prescription opioid analgesic use among HIV-Infected individuals with chronic pain. Subst Use Misuse. 2018 Jan 17:1-6. doi: 10.1080/10826084.2017.1416408 Article conclusion: Almost half of the sample of people with HIV and chronic pain reported current prescribed opioid analgesic use (N = 372, 47.1%). Only cannabis use was significantly associated with lower odds of prescribed opioid analgesic use (adjusted OR = 0.57; 95% CI: 0.38-0.87). Data suggest that new medical cannabis legislation might reduce the need for opioid analgesics for pain management, which could help to address adverse events associated with opioid analgesic use.
Ravi D, Ghasemiesfe M, Korenstei D, et al. Associations between marijuana use and cardiovascular risk factors and outcomes: A systematic review. Ann Intern Med 2018. doi:10.7326/M17-1548. Article conclusion: Researchers analyzed 24 observational studies of adults who used any type of marijuana, their risk factors, and outcomes such as stroke or death due to heart disease. They found that there has not been enough rigorous research to draw a conclusion about whether chronic marijuana use has an effect on cardiovascular health.
Choo EK, Emery SL. Clearing the haze: the complexities and challenges of research on state marijuana laws. Ann N Y Acad Sci. 2017;1394:55-73. Article conclusion: This review provides a background on marijuana laws in the United States and an overview of existing policy research, discusses methodological considerations when planning analysis of state marijuana laws, and highlights specific topics needing further development and investigation.
Carliner H, Brown QL, Sarvet AL et al. Cannabis use, attitudes, and legal status in the U.S.: A review. Prev Med. 2017;104:13-23. Article conclusion: Multiple nationally representative studies indicate that medical marijuana laws (MMLs) have had little effect on cannabis use among adolescents, [but] available evidence suggests that MMLs increase use and cannabis use disorders in adults. … More permissive marijuana laws may accomplish social justice aims (e.g., reduce racial disparities in law enforcement) and generate tax revenues. However, such laws may increase cannabis-related adverse health and psychosocial consequences by increasing the population of users. Dissemination of balanced information about the potential health harms of cannabis use is needed.
Karl T, Garner B, Cheng D. The therapeutic potential of the phytocannabinoid cannabidiol for Alzheimer's disease. Behav Pharmacol. 2017 Apr;28(2 and 3 - Special Issue):142-160. doi: 10.1097/FBP.0000000000000247. Article conclusion: This review presents a brief introduction to AD biology and current treatment options, outlines CBD biology and pharmacology, followed by in-vitro and in-vivo evidence for the therapeutic potential of CBD, discusses the role of the endocannabinioid system in AD, comments on the potential future of CBD for AD therapy (including safety aspects).
Wong SS, Wilens TE. Medical cannabinoids in children and adolescents: A Systematic review. Pediatrics. 2017 Nov;140(5). pii: e20171818. doi: 10.1542/peds.2017-1818. Article conclusion: Additional research is needed to evaluate the potential role of medical cannabinoids in children and adolescents, especially given increasing accessibility from state legalization and potential psychiatric and neurocognitive adverse effects identified from studies of recreational cannabis use.
Nugent SM et al. The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms: A Systematic Review. Ann Intern Med. 2017 Sep 5;167(5):319-331. Article conclusion: Limited evidence suggests that cannabis may alleviate neuropathic pain in some patients, but insufficient evidence exists for other types of chronic pain. Among general populations, limited evidence suggests that cannabis is associated with an increased risk for adverse mental health effects.
O'Neil ME et al. Benefits and Harms of Plant-Based Cannabis for Posttraumatic Stress Disorder: A Systematic Review. Ann Intern Med. 2017 Sep 5;167(5):332-340. Article conclusion: Evidence is insufficient to draw conclusions about the benefits and harms of plant-based cannabis preparations in patients with PTSD, but several ongoing studies may soon provide important results.
Links to websites and online publications:
The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. A Report of the National Academies of Sciences, Engineering, and Medicine. 2017.
Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It's Been … Headache. 2015.
Resources for Physicians
- Medicinal cannabis guide for physicians practicing in New Jersey