JAIDS Journal of Acquired Immune Deficiency Syndromes: February 20, 2019 - Volume Publish Ahead of Print - Issue - p doi: 10.1097/QAI.0000000000001998

Background: People living with HIV (PLWH) commonly report marijuana use for chronic pain, though there is limited empirical evidence to support its use. There is hope that marijuana may reduce prescription opioid use. Our objective was to investigate whether marijuana use among PLWH who have chronic pain is associated with changes in pain severity and prescribed opioid use (prescribed opioid initiation and discontinuation).

Methods: Participants completed self-report measures of chronic pain and marijuana use at an index visit and were followed for one year in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). Self-reported marijuana use was the exposure variable. Outcome variables were changes in pain and initiation or discontinuation of opioids during the study period. The relationship between exposure and outcomes was assessed using generalized linear models for pain and multivariable binary logistic regression models for opioid initiation/discontinuation.

Results: Of 433 PLWH and chronic pain, 28% reported marijuana use in the past 3 months. Median pain severity at the index visit was 6.3/10 (IQR 4.7-8.0). Neither increases nor decreases in marijuana use were associated with changes in pain severity and marijuana use was not associated with either lower odds of opioid initiation or higher odds of opioid discontinuation.

Conclusions: We did not find evidence that marijuana use in PLWH is associated with improved pain outcomes, or reduced opioid prescribing. This suggests that caution is warranted when counseling PLWH about potential benefits of recreational or medical marijuana.

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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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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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Hawaii, 1986–2002

Conclusion: this study found that prenatal use of methamphetamine, cocaine, or marijuana were associated with increased risk of a variety of birth defects. The affected birth defects were primarily associated with particular organ systems.

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What are the reasons that substances other than nicotine may be found in e-cigarettes?

This is a question that many experts would like to know since the answer would probably address substance addiction worldwide. Drugs other than nicotine are being found in electronic cigarettes as they provide a great tool for inhaling drugs. Inhalation gives a really fast onset of effects. Lung tissue is in contact with blood vessels, and so the inhaled drugs can transfer into the blood easily, depending on the drug. Download PDF Copy  Feb 5 2019

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