Should Physicians Recommend Replacing Opioids with Cannabis?

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JAMA. 2019;321(7):639-640. doi:10.1001/jama.2019.0077

The evidence that cannabis is an efficacious treatment for opioid use disorder is even weaker. To date, no prospective evidence, either from clinical trials or observational studies, has demonstrated any benefit of treating patients who have opioid addiction with cannabis.

If Cannabis Is Recommended Medicine, It Should Be Held to Medical Standards

Conclusions

For chronic pain, there are numerous alternatives to opioids aside from cannabis. Nonopioid medications appear to have similar efficacy,³ and behavioral, voluntary, slow-tapering interventions can improve function and well-being while reducing pain.,,,Without convincing evidence of efficacy of cannabis for this indication, it would be irresponsible for medicine to exacerbate this problem by encouraging patients with opioid addiction to stop taking these medications and to rely instead on unproven cannabis treatment.

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Explaining Contemporary Patterns of Cannabis Teratology

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From the Abstract

Cannabis has been shown to be teratogenic in cells, animals and humans. Particular targets of prenatal exposure include brain, heart and blood vessels and chromosomal segregation…

Studies in cells, together with the above mentioned epidemiology, implicate cannabidiol, cannabichromene, cannabidivarin and other cannabinoids in significant genotoxicity and/or epigenotoxicity. Notch signalling has recently been shown to be altered by cannabinoids, which is highly pertinent to morphogenesis of the neuraxis and cardiovasculature, and also to congenital and inheritable cancer induction. 

It is felt that subtle neurobehavioural psychosocial and educational deficits will likely be the most common expression of cannabinoid teratology at the population level. 

The far reaching implications of this wide spectrum of neuroteratological, pediatric cardiological and other defects and deficits should be carefully considered in increasingly liberal paradigms. Hence it is shown that the disparate presentations of cannabis teratology relate directly and closely to the distribution of CB1R’s across the developing embryo and account for the polymorphous clinical presentations.

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Legal cannabis oil sold in British health shops can get users high and make it dangerous to drive, study shows

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• Cannabis oil sold as a health product in Britain can get users 'high', study finds 
• Researchers found driving under the influence of CBD cannabis ‘may be harmful'
• The products have soared in popularity amid claims they help combat ailments

By JONATHAN BUCKS FOR THE MAIL ON SUNDAY   17 February 2019 

The legal version of cannabis sold as a health product in the UK can get users ‘high’ and even make it dangerous to drive, a study has found.

Cannabis oils and capsules said to help reduce anxiety and pain are on sale in high street stores including Holland & Barrett and are used by more than 250,000 Britons.

They are sold legally because they contain no more than 0.2 per cent of the mind-altering substance tetrahydrocannabinol (THC), which is found in the illegal version of the drug.

But now scientists have found that the active ingredient in these products, cannabidiol (CBD), is also psychoactive. In the study, subjects used a vape to inhale different strains of cannabis.

Those using the version containing CBD but not illegal THC reported levels of intoxication three times that of those who used only a placebo. In addition, experts said subjects felt detached from reality.

Scientists from Wollongong University in Australia concluded that driving under the influence of CBD cannabis ‘may be harmful’. 

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Youth Vaping & Associated Risk Behaviours (Colorado Study)

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The students who were current vape users were more likely to use other substances or to engage in sexual activity than were nonusers (Table 1). These data corroborate a recent study that showed an association between vaping and risky sexual, substance-use, and violence behaviors.⁵ These associations are not causal but suggest that certain students are inclined toward a variety of risky behaviors.

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