Medical cannabis: A forward vision for the clinician

Fitzcharles, Mary‐Ann; Eisenberg, Elon

doi:10.1002/ejp.1185

Cited by 37 publications

(28 citation statements)

References 49 publications

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“…Many clinicians remain skeptical of cannabis as a viable treatment option, either due to the stigma surrounding cannabis use or the belief that there is not enough clinical evidence for them to feel confident providing patients with cannabis recommendations. 169 This is unsurprising, given that 85% of recent medical school graduates still receive no education whatsoever about cannabis throughout their training, residencies, or fellowships. 170 As the evidence in this field accumulates, it will be critically important to widen opportunities for clinicians to participate in Continuing Medical Education programs, which include the harm reduction and medical benefits that cannabis could provide.…”

Section: Summary and Future Directionsmentioning

confidence: 99%

Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Wiese

Wilson-Poe

2018

Cannabis and Cannabinoid Research

128

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Introduction: The opioid epidemic has become an immense problem in North America, and despite decades of research on the most effective means to treat opioid use disorder (OUD), overdose deaths are at an all-time high, and relapse remains pervasive.Discussion: Although there are a number of FDA-approved opioid replacement therapies and maintenance medications to help ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications are not risk free nor are they successful for all patients. Furthermore, there are legal and logistical bottlenecks to obtaining traditional opioid replacement therapies such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between efficacious OUD treatments and the widespread prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatment therapies is highly warranted. In this article, we review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD. Herein, we highlight knowledge gaps and discuss cannabis' potential to prevent opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse.Conclusion: The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.

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Section: Summary and Future Directionsmentioning

confidence: 99%

Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Wiese

Wilson-Poe

2018

Cannabis and Cannabinoid Research

128

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“…A recent nationally representative study showed that the risk of cannabis use and cannabis use disorders has increased, especially in states where medical cannabis laws have been passed (Hasin et al, 2017). The use of cannabis to treat medical issues and symptomology is also increasing in the US (Hill, 2015) and globally (Fitzcharles & Eisenberg, 2018), and the rates at which people are using medical cannabis have increased in states where medical cannabis laws have been passed (Cerda, Wall, Keyes, Galea, & Hasin, 2012). In California alone, which legalized medical cannabis in 1996, there were two million individuals in 2012 that were using cannabis medically (Ryan-Ibarra, Induni, & Ewing, 2015).…”

Section: Introductionmentioning

confidence: 99%

Medical Cannabis Use among Adults in the Southeastern United States

et al. 2019

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To assess the self-reported reasons for medical cannabis use within the southeastern United States and compare recreational and medical cannabis users. This study was a cross-sectional survey administered in 2017 through Amazon's Mechanical Turk and enrolled 432 adult, regular cannabis users. Measures included demographics, cannabis use characteristics, and medical reasons for cannabis use. Under half (47%) of respondents endorsed using cannabis for both medical and recreational reasons and 12% reported medical use only. The most commonly cited reasons for medical cannabis use were psychiatric and 60 unique medical conditions were listed. Recreational and medical users were similar on several measures of current use, but did vary in their use history, methods of use, and product knowledge. Despite state laws and conclusive scientific evidence to support medical cannabis use for certain conditions, cannabis is still used frequently for a range of medical issues. These data may assist healthcare providers in better understanding medical cannabis use in states with tightened restrictions and tailoring information to medical cannabis users about their specific conditions and prioritizing therapeutic options.

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“…New members joining PCC, especially if cannabis-naive (which represent approximately 60%), were instructed on how to properly self-administer Trokie ® lozenges, embracing the “start low, go slow” motto proposed by clinicians for the use of herbal cannabis ( MacCallum and Russo, 2018 ), starting with 1/4th of a 50 mg CBD lozenge (12.5 mg) two or three times a day for 3 days. After this initial period, members are coached by PCC clinical personnel on how to slowly adjust their intake of THC and CBD to achieve optimal symptom relief, with follow-up calls on days 4, 7, 14, and each time they place a new order, under the guiding principle of “primum non nocere” ( Fitzcharles and Eisenberg, 2018 ).…”

Section: Methodsmentioning

confidence: 99%

“…In recent years, many countries have passed legislation permitting the use of cannabis for medical reasons. This has given patients access to both herbal material and cannabis-based products, bypassing the strict regulatory procedures that usually apply to pharmaceutical development ( Fitzcharles and Eisenberg, 2018 ). Further, legalization of cannabis for recreational purposes in several states of the Union as well as in internationally-relevant countries, such as Canada, conferrers cannabis an intriguing dual status, both as a pharmaceutical substance and a mere commodity, thus creating a complex regulatory scenario.…”

Section: Introductionmentioning

confidence: 99%

Self-Reported Effectiveness and Safety of Trokie® Lozenges: A Standardized Formulation for the Buccal Delivery of Cannabis Extracts

Crowley¹,

Vries

Moreno-Sanz³

2018

Front. Neurosci.

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Therapeutic use of cannabinoids, the main active ingredients of Cannabis sativa L., is often hindered by their limited bioavailability and undesirable psychoactivity. We conducted an observational study in December 2016 and another one in February 2018 to investigate respectively: (i) the effectiveness of Trokie® lozenges, a standardized formulation containing cannabis extracts, to deliver cannabinoids via buccal absorption and (ii) its long-term safety. Participants were members of the Palliative Care Corporation health clinic, registered California cannabis patients, and had a diagnosis of chronic non-cancer pain. For the effectiveness study, 49 participants were asked to self-report pain perception before and after 1–12 weeks of taking Trokie® lozenges, using an 11-point pain intensity numeric rating scale (PI-NRS). A mean reduction in PI-NRS score of 4.9 ± 2.0 points was observed. Onset of analgesia typically varied between 5 and 40 min, which seems consistent with, at least partial, buccal absorption. In the safety study, 35 participants were asked to complete a questionnaire about adverse events (AEs) associated with Trokie® lozenges. AEs were reported by 16 subjects (46%), the most common being dizziness/unsteadiness (N = 7), bad taste (N = 5), and throat irritation/dry mouth (N = 4). None of the self-reported AEs resulted in a serious medical situation and most of them had limited impact on daily functions. Despite the AEs, 90% of participants reported being “satisfied” or “very satisfied” with the product. These observations suggest that buccal administration of standardized extracts via Trokie® lozenges may represent an efficacious and safe approach to cannabis administration.

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Medical cannabis: A forward vision for the clinician

Cited by 37 publications

References 49 publications

Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Medical Cannabis Use among Adults in the Southeastern United States

Self-Reported Effectiveness and Safety of Trokie® Lozenges: A Standardized Formulation for the Buccal Delivery of Cannabis Extracts

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