Tuesday, 6 May 2014

Satisfied with Medical Cannabis .

Brunt TM, van Genugten M, Höner-Snoeken K, van de Velde MJ, Niesink RJ. Therapeutic Satisfaction and Subjective Effects of Different Strains of Pharmaceutical-Grade Cannabis. J Clin Psychopharmacol. 2014 Apr . [Epub ahead of print]

In The Netherlands, pharmaceutical-grade cultivated cannabis is distributed for medicinal purposes as commissioned by the Ministry of Health. Few studies have thus far described its therapeutic efficacy or subjective (adverse) effects in patients. The aims of this study are to assess the therapeutic satisfaction within a group of patients using prescribed pharmaceutical-grade cannabis and to compare the subjective effects among the available strains with special focus on their delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) content. In a cross-sectional and natural design, users of pharmaceutical-grade cannabis were investigated with questionnaires. Medical background of the patients was asked as well as experienced therapeutic effects and characteristics of cannabis use. Subjective effects were measured with psychometric scales and used to compare among the strains of cannabis used across this group of patients. One hundred two patients were included; their average age was 53 years and 76% used it for more than a year preceding this study. Chronic pain (53%; n = 54) was the most common medical indication for using cannabis followed by multiple sclerosis (23%; n = 23), and 86% (n = 88) of patients (almost) always experienced therapeutic satisfaction when using pharmaceutical cannabis. 


People who smoke cannabis get satisfaction in control of pain, lack of sleep and spasms. The average consumption was 0.6g a day and the high dose stuff had about 20% THC (wow), the middle dose 12% THC and the so called low dose was 6% THC. The higher an middle dose of THC were better at stimulating the "munchies" and "anxiety". These are mediated by cannabinoid receptors. Was CBD beneficial maybe maybe not as the  cannabis with most CBD also had the lowest THC. There are differences in strains of cannabis in the their CBD content, it is say higher in Moroccan cannabis where as Mexican Cannabis may have little CBD. In the initial reports in surveys conducted in 1998 on both sides of the pond said cannabis alleviated their symptoms. To me this suggests that THC is the main active ingredient, not CBD. 

Koppel BS, Brust JC, Fife T, Bronstein J, Youssof S, Gronseth G, Gloss D. Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014;82(17):1556-63. doi: 10.1212/WNL.0000000000000363

OBJECTIVE: To determine the efficacy of medical marijuana in several neurologic conditions.
METHODS: We performed a systematic review of medical marijuana (1948-November 2013) to address treatment of symptoms of multiple sclerosis(MS), epilepsy, and movement disorders. We graded the studies according to the American Academy of Neurology classification scheme for therapeutic articles.
RESULTS:Thirty-four studies met inclusion criteria; 8 were rated as Class I.
CONCLUSIONS:The following were studied in patients with MS: (1) Spasticity: oral cannabis extract (OCE) is effective, and nabiximols and tetrahydrocannabinol (THC) are probably effective, for reducing patient-centered measures; it is possible both OCE and THC are effective for reducing both patient-centered and objective measures at 1 year. (2) Central pain or painful spasms (including spasticity-related pain, excluding neuropathic pain): OCE is effective; THC and nabiximols are probably effective. (3) Urinary dysfunction: nabiximols is probably effective for reducing bladder voids/day; THC and OCE are probably ineffective for reducing bladder complaints. (4) Tremor: THC and OCE are probably ineffective; nabiximols is possibly ineffective. (5) Other neurologic conditions: OCE is probably ineffective for treating levodopa-induced dyskinesias in patients with Parkinson disease. Oral cannabinoids are of unknown efficacy in non-chorea-related symptoms of Huntington disease, Tourette syndrome, cervical dystonia, and epilepsy. The risks and benefits of medical marijuana should be weighed carefully. Risk of serious adverse psychopathologic effects was nearly 1%. Comparative effectiveness of medical marijuana vs other therapies is unknown for these indications.


So analysis of a load of studies said we think cannabis probably as some value in controlling pain and spasticity, which is what it is licensed for. But there are risks...yep you may get high,other drugs have a serious risk which is also 1% like PML, which can be fatal and cause irreversible damage.

Problem is the cost of Sativex = nabiximols in the UK means you don't even get the opportunity to see if you would get the side effect.

CoI: We are trying to develop alternatives to Cannabis for symptom control

16 comments:

  1. Mouse Doc - are you referring to Sativex? What are the side effects (grave and small) of Sativex? I have spasm and could get it prescribed in the future.

    ReplyDelete
    Replies
    1. The top post is smoked cannabis.....the people doing this were no doubt high, the lower post is not doubt populated by sativex.

      Here is the website from the NHS
      http://www.nhs.uk/Livewell/drugs/Pages/Cannabisdangers.aspx

      http://en.wikipedia.org/wiki/Effects_of_cannabis

      The fatal overdose potential of cannabis is low and has a much lower risk of dependency than other recreational drugs. There is a risk of psychotic events in some people particularly those predisposed to psychosis (e.g. schizophrenia). The drug often causes behavioural effects anxiety, paranoia etc.

      Here is the GW pharma link of possible side effects
      http://www.sativex.co.uk/patients-and-carers/sativex/possible-side-effects

      Sativex does not work for every one but i it does you should be able to tell pretty quickly

      Delete
    2. Sorry it is Bayer the UK distributors for Sativex

      Delete
    3. Thank you so much Mouse Doc - main thing Sativex doesn't give one PML - everything else is okay - I could do with a bit giddyness :-)

      Delete
  2. There is no clinical proof that cannabis can better effect spasticity.

    ReplyDelete
    Replies
    1. There's no proof Lemtrada can cure MS, but try telling this lot.

      Delete
    2. There is now a lot of data that disagrees with your assertion.

      Delete
    3. The same goes for Lemtrada, if given early enough, going by the latest data. Not to say there aren't issues with regard to potential serious side-effects but MSers should be given the choice as long as the risks are adequately explained.

      Delete
    4. http://www.ncbi.nlm.nih.gov/pubmed/22586334
      Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial.Smoked cannabis was superior to placebo in symptom and pain reduction in participants with treatment-resistant spasticity.

      Delete
  3. For those of us with spms we should be able to try different drugs for symptom relief (if the side effects have been explained and they are not fatal). Why should the medics dictate what can be made available. I would be free to try medical cannabis in a different time and/or place, but I am currently (in the UK) branded a criminal if I have cannabis. Whose interests are being served here? Not mine!
    By the way, thank you for this informative blog : )

    ReplyDelete
  4. What are your conflicts here?

    ReplyDelete
    Replies
    1. We have nothing to do with Bedrocam the makers of the cannabis, GW pharma paid for the colour reproduction of a figure in a paper once.
      We are trying to develop alternatives to cannabis but this in the Conflicts statement on the top of the page.

      Delete
    2. They (GW) also purchase reprints of our paper in about 2001 in Nature and gave it to away,I got no financial reward from this.

      Delete
  5. Anon said

    In the 8 years since being diagnosed with RR MS I have found cannabis to be the only effective medication for a lot of my symptoms; nerve pain, incontinence, spasms... Thus I set up my own grow system in my own house, interfering with nobody in any way except perhaps the odd odour of cannabis. Some sad person informed the Police Service of Northern Ireland (PSNI) who then came and took all my equipment (cost £1500) and plants leaving me to suffer chronic pain and all the rest. The police (some) were sympathetic but had to do their job. I hope the informer never has to suffer as I do and would be delighted to have cannabis for relief, I am now contemplating suicide for relief. Thank you society for criminalising the growing of natures beautiful plant in ones own house just to make life with MS bearable.


    ReplyDelete
    Replies
    1. Support does not relieve symptoms,. I am housebound and in constant pain. Cannabis was the only thing that kept me going. I have no wish to continue living like this. Thank you for your concern, if only everybody was like you.

      Delete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.