April 20, 2018
A Food and Drug Administration panel recommended approval of a drug made of cannabidiol on April 19 to treat two types of epilepsy. The FDA is expected to decide in June whether to accept the panel’s 13-0 recommendation to approve Epidiolex, which would would become the first drug made of cannabidiol, a compound in the cannabis plant, to gain approval from the FDA.
While the panel’s unanimous decision is not binding, the action will no doubt heighten public debate about the use of cannabidiol, medical marijuana, medical cannabis and hemp oil. Should cannabidiol, or CBD, or marijuana be legalized for medical purposes? What is the evidence that these products are beneficial? Are these products safe to use?
Those who support the use of marijuana for recreational or medicinal purposes might have found the timing of the panel’s ruling interesting. National Weed Day is April 20.
But weed is not cannabidiol, even though both come from cannabis.
As a professor of pharmacy with a special interest in epilepsy, I find it important that CBD may be a new option for the treatment of epilepsy. This new use has led me to carefully study published literature on CBD and discuss it as an option with patients who have epilepsy. Additionally, I have been involved with the American Epilepsy Society’s ongoing review of CBD as a possible treatment for epilepsy. From this perspective, I believe that CBD may offer benefits for patients with some types of epilepsy and possibly other disorders.
No high, but healing?
The cannabis plant produces hundreds of different compounds, many of which have differing effects in the body. Tetrahydrocannabinol, or THC, is the substance that is most known for its psychoactive effects, or the “high” associated with marijuana.
However, there are many other substances from the cannabis plant that also produce effects in the body. Many of these differ from THC in that they are not psychoactive – and they do not produce a “high.” Cannabidiol, or CBD, is one of those substances.
Compared to THC, CBD works at different receptors in the brain and other parts of the body. In this way, CBD is very different from THC and may offer new mechanisms of treatment. For this reason, CBD has received a great amount of attention as a possible treatment for many different disorders.
However, there are two well-designed, large studies that indicate CBD is effective in two different epilepsy syndromes. In these studies, about 40 percent of patients taking CBD had a significant reduction in specific types of seizures.
Abstract STUDY OBJECTIVE: Cannabis and its principal active constituent, Δ9-tetrahydrocannabinol (THC), are increasingly available as edibles resembling commercially available food products. In this case series, we describe a population of predominantly paediatric patients who were inadvertently exposed to a THC-containing product in San Francisco.
METHODS: Twelve children and 9 adults were identified, with 16 patients having detectable serum THC and THC metabolites. All patients presented to hospitals with a variety of constitutional symptoms and all were discharged home within 12 hours.
RESULTS: In general, pediatric patients had more severe symptoms and longer hospital length of stay, and, uniquely, a majority presented with leukocytosis and elevated lactic acid levels.
CONCLUSION: We recommend that efforts be made to increase general public awareness in regard to the potential hazards of THC-containing edibles resembling commercially available food products. PMID: 29103798 DOI: 10.1016/j.annemergmed.2017.09.008
Download PDF Copy March 27, 2018
While cigarette smoking has long been on the decline, marijuana use is on the rise and, disproportionately, marijuana users also smoke cigarettes. A new study by researchers at Columbia University's Mailman School of Public Health and the City University of New York reports that cannabis use was associated with an increased initiation of cigarette smoking among non-cigarette smokers. They also found adults who smoke cigarettes and use cannabis are less likely to quit smoking cigarettes than those who do not use cannabis. Former smokers who use cannabis are also more likely to relapse to cigarette smoking. Results are published online in the Journal of Clinical Psychiatry.
The analyses were based on data from the National Epidemiologic Survey on Alcohol and Related Conditions in 2001-2002 and 2004-2005, and responses from 34,639 individuals to questions about cannabis use and smoking status.
"Developing a better understanding of the relationship between marijuana use and cigarette use transitions is critical and timely as cigarette smoking remains the leading preventable cause of premature death and disease, and use of cannabis is on the rise in the U.S.," said Renee Goodwin, PhD, in the Department of Epidemiology at the Mailman School of Public Health, and senior author.
The study suggests that marijuana use--even in the absence of cannabis use disorder (characterized by problematic use of cannabis due to impairment in functioning or difficulty quitting or cutting down on use)--is associated with increased odds of smoking onset, relapse, and persistence. As cannabis use is much more common than cannabis use disorder, its potential impact on cigarette use in the general community may be greater than estimates based on studies of cannabis use disorder alone, according to the researchers.
An earlier study by Goodwin and colleagues showed that the use of cannabis by cigarette smokers had increased dramatically over the past two decades to the point where smokers are more than 5 times as likely as non-smokers to use marijuana daily.
March 23, 2018 by David Gambrill
Employers may be hard-pressed to ban marijuana outright from the workplace once The Cannabis Act is implemented in Canada, a lawyer told delegates attending the Ontario Mutual Insurance Association (OMIA) Thursday.
“Both bills [related to The Cannabis Act, Bills C-45 and C-46] are actually silent when it comes to employment and occupational safety,” said Sandra Gogal, practice leader at Miller Thomson LLP. “At present, there is no Canadian law that regulates mandatory drug testing of employees, so when the recreational market opens up, it creates a number of interesting issues.”
For one, employers will be challenged to uphold outright prohibitions on marijuana in the workplace, based on the difference between recreational and medicinal forms of cannabis. While proposed bills allowing recreational use are still up for debate, medical use of marijuana has been legal in Canada since 1999.
“I had a call from a company the other day that said one of their employees was injured on the job, and as a matter of standard practice, they get drug-tested,” Gogal recounted. “The results came back positive, and they said, ‘Can we fire him?’ And I just said, ‘We don’t know yet whether that was for medical purposes or not.’”
The issue promises to get murkier once recreational drug use is legalized.
Abstract – Mayo Clinic
The opioid crisis that exists today developed over the past 30 years. The reasons for this are many. Good intentions to improve pain and suffering led to increased prescribing of opioids, which contributed to misuse of opioids and even death. Following the publication of a short letter to the editor in a major medical journal declaring that those with chronic pain who received opioids rarely became addicted, prescriber attitude toward opioid use changed. Opioids were no longer reserved for treatment of acute pain or terminal pain conditions but now were used to treat any pain condition. Governing agencies began to evaluate doctors and hospitals on their control of patients' pain. Ultimately, reimbursement became tied to patients' perception of pain control. As a result, increasing amounts of opioids were prescribed, which led to dependence. When this occurred, patients sought more in the form of opioid prescriptions from providers or from illegal sources. Illegal, unregulated sources of opioids are now a factor in the increasing death rate from opioid overdoses. Stopping the opioid crisis will require the engagement of all, including health care providers, hospitals, the pharmaceutical industry, and federal and state government agencies.
Taking Action - Stopping Ice
United Nations Office of Drugs & Crime: Drug Prevention & Treatment
Medicinal Cannabis –
Access to medicinal Cannabis Products (TGA)
Access to medicinal cannabis products: steps to using access ...
Presentations, Statements & Conference Resources from WFAD 2018 Forum