Despite its designation as having no medicinal use, Cannabis was distributed by the U.S. government to patients on a case-by-case basis under the Compassionate Use Investigational New Drug program established in 1978. Distribution of Cannabis through this program was closed to new patients in 1992.[1-4] Although federal law prohibits the use of Cannabis, Figure 1 below shows the states and territories that have legalized Cannabis use for medical purposes. Additional states have legalized only one ingredient in Cannabis, such as cannabidiol (CBD), and are not included in the map. Some medical marijuana laws are broader than others, and there is state-to-state variation in the types of medical conditions for which treatment is allowed.
Newer antiemetics (e.g., 5-HT3 receptor antagonists) have not been directly compared with Cannabis or cannabinoids in cancer patients. However, the Cannabis-extract oromucosal spray, nabiximols, formulated with 1:1 THC:CBD was shown in a small pilot randomized, placebo-controlled, double-blinded clinical trial in Spain to treat chemotherapy-related N/V.[Level of evidence: 1iC] ASCO antiemetic guidelines updated in 2017 states that evidence remains insufficient to recommend medical marijuana for either the prevention or treatment of N/V in patients with cancer who receive chemotherapy or radiation therapy.
Lisa Hamilton, a jeweler and doula in Brooklyn, NY, knows about the side effects. She recently tried CBD for the shoulder pain that plagued her five years after an accident. Her doctor certified that she was in chronic pain, which under New York State law allowed her to buy from a state dispensary. One Friday, she swallowed two 10-mg capsules, the amount recommended at the dispensary, then took another two on Saturday. “By Sunday, it felt like I’d gotten hit by a truck. Every muscle and joint ached,” Hamilton says. She cut back to one pill a day the following week, but still felt hungover. She stopped after that.
The arrival of Epidiolex is unlikely to erase the unregulated CBD market, however. For one, Epidiolex has been studied only in connection with a small number of epileptic conditions. If and when Epidiolex makes its way to drug stores, it will be approved only for the treatment of Dravet Syndrome and Lennox-Gastaut Syndrome, two rare forms of catastrophic epilepsy. People like me, with comparatively mild Janz Syndrome, and people like Harper, with extremely rare conditions like CDKL5, may still be out of luck.
The leaves have a peculiar and diagnostic venation pattern that enables persons poorly familiar with the plant to distinguish a cannabis leaf from unrelated species that have confusingly similar leaves (see illustration). As is common in serrated leaves, each serration has a central vein extending to its tip. However, the serration vein originates from lower down the central vein of the leaflet, typically opposite to the position of, not the first notch down, but the next notch. This means that on its way from the midrib of the leaflet to the point of the serration, the vein serving the tip of the serration passes close by the intervening notch. Sometimes the vein will actually pass tangent to the notch, but often it will pass by at a small distance, and when that happens a spur vein (occasionally a pair of such spur veins) branches off and joins the leaf margin at the deepest point of the notch. This venation pattern varies slightly among varieties, but in general it enables one to tell Cannabis leaves from superficially similar leaves without difficulty and without special equipment. Tiny samples of Cannabis plants also can be identified with precision by microscopic examination of leaf cells and similar features, but that requires special expertise and equipment.
For kids with severe forms of epilepsy, changes in medication levels can be extremely dangerous. “If their levels go low, they’re at increased risk of seizures, which could lead to an emergency room visit or an ICU stay,” Knupp said. “On the other hand, if their levels go high, their side effects can increase dramatically.” Side effects from epilepsy medications can range anywhere from drowsiness to vomiting to heart arrhythmia, Knupp noted. “For some people that could mean a minor inconvenience, but for some patients it could be life-threatening.”
Senate Majority Leader Mitch McConnell (R-KY) is guaranteeing that the 2018 Farm Bill will include his industrial hemp legalization provision after the Senate and House reach a compromise—ideally by the end of the year. “If there’s a Farm Bill, it’ll be in there, I guarantee that,” he told reporters on Friday. McConnell said he’s visited … Continue reading Mitch McConnell Guarantees Industrial Hemp Legalization
Hemp has at times in the past been grown simply for its ornamental value. The short, strongly-branched cultivar ‘Panorama’ (Fig. 43) bred by Iván Bósca, the dean of the world’s living hemp breeders, was commercialized in Hungary in the 1980s, and has been said to be the only ornamental hemp cultivar available. It has had limited success, of course, because there are very few circumstances that permit private gardeners can grow Cannabis as an ornamental today. By contrast, beautiful ornamental cultivars of opium poppy are widely cultivated in home gardens across North America, despite their absolute illegality and the potentially draconian penalties that could be imposed. Doubtless in the unlikely event that it became possible, many would grow hemp as an ornamental.
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Three controlled trials demonstrated that oral THC has variable effects on appetite stimulation and weight loss in patients with advanced malignancies and human immunodeficiency virus (HIV) infection. One study evaluated the efficacy of dronabinol alone or with megestrol acetate compared with that of megestrol acetate alone for managing cancer-associated anorexia. In this randomized, double-blind study of 469 adults with advanced cancer and weight loss, patients received 2.5 mg of oral THC twice daily, 800 mg of oral megestrol daily, or both. Appetite increased by 75% in the megestrol group and weight increased by 11%, compared with a 49% increase in appetite and a 3% increase in weight in the oral THC group after 8 to 11 weeks of treatment. These two differences were statistically significant. Furthermore, the combined therapy did not offer additional benefits beyond those provided by megestrol acetate alone. The authors concluded that dronabinol did little to promote appetite or weight gain in advanced cancer patients compared with megestrol acetate. However, a smaller, placebo-controlled trial of dronabinol in cancer patients demonstrated improved and enhanced chemosensory perception in the cannabinoid group—food tasted better, appetite increased, and the proportion of calories consumed as protein was greater than in the placebo recipients.
There is also considerable potential for other industries using hemp in the manner that the automobile industry has demonstrated is feasible. Of course, all other types of transportation vehicles from bicycles to airplanes might make use of such technology. Natural fibers have considerable advantages for use in conveyance (Karus et al. 2000): low density and weight reduction, favorable mechanical, acoustical, and processing properties (including low wear on tools), no splintering in accidents, occupational health benefits (compared to glass fibers), no off-gassing of toxic compounds, and price advantages. Additional types of composite using hemp in combination with other natural fibers, post-industrial plastics or other types of resins, are being used to produce non-woven matting for padding, sound insulation, and other applications.
All of this makes CBD remarkably difficult for even the most dedicated health care providers to manage safely. Dr. Kelly Knupp, an associate professor of pediatrics and neurology at the University of Colorado, and the director of the Dravet Syndrome program at Children’s Hospital Colorado, said families of epileptic children have tried to bring CBD oils to the hospital for testing. “They’re just concerned that they don’t know exactly who’s growing [the hemp],” Knupp said. “They know it’s not being regulated.” But because CBD is a Schedule I controlled substance, high-tech, regulated laboratories, like those at the University of Colorado, can’t accept, store, or test CBD oils, lest they risk prosecution. “There is no such lab that can take that product,” Knupp said, which leaves any testing up to the unregulated testing centers that cater to the cannabis industry.
A population-based case-control study of 611 lung cancer patients revealed that chronic low Cannabis exposure was not associated with an increased risk of lung cancer or other upper aerodigestive tract cancers and found no positive associations with any cancer type (oral, pharyngeal, laryngeal, lung, or esophagus) when adjusting for several confounders, including cigarette smoking.
The high lipid-solubility of cannabinoids results in their persisting in the body for long periods of time. Even after a single administration of THC, detectable levels of THC can be found in the body for weeks or longer (depending on the amount administered and the sensitivity of the assessment method). A number of investigators have suggested that this is an important factor in marijuana's effects, perhaps because cannabinoids may accumulate in the body, particularly in the lipid membranes of neurons.
Another study examined the effects of a plant extract with controlled cannabinoid content in an oromucosal spray. In a multicenter, double-blind, placebo-controlled study, the THC:CBD nabiximols extract and THC extract alone were compared in the analgesic management of patients with advanced cancer and with moderate-to-severe cancer-related pain. Patients were assigned to one of three treatment groups: THC:CBD extract, THC extract, or placebo. The researchers concluded that the THC:CBD extract was efficacious for pain relief in advanced cancer patients whose pain was not fully relieved by strong opioids. In a randomized, placebo-controlled, graded-dose trial, opioid-treated cancer patients with poorly controlled chronic pain demonstrated significantly better control of pain and sleep disruption with THC:CBD oromucosal spray at lower doses (1–4 and 6–10 sprays/day), compared with placebo. Adverse events were dose related, with only the high-dose group (11–16 sprays/day) comparing unfavorably with the placebo arm. These studies provide promising evidence of an adjuvant analgesic effect of THC:CBD in this opioid-refractory patient population and may provide an opportunity to address this significant clinical challenge. An open-label extension study of 43 patients who had participated in the randomized trial found that some patients continued to obtain relief of their cancer-related pain with long-term use of the THC:CBD oromucosal spray without increasing their dose of the spray or the dose of their other analgesics.
No medication seemed to provide a great deal of relief for Harper’s symptoms. But in 2013, three years after their trip to Boston, Penny and Dustin caught an installment of CNN’s medical marijuana documentary and began researching what they could obtain in Texas, where medical marijuana is illegal. Their internet searches soon led them to HempMedsPx and Real Scientific Hemp Oil. The company sent Penny a vial of hemp oil, which she administered to Harper that September.
Of the 20 known amino acids, hemp supplies them all, including the essential ones the body can’t produce, known as EAAs. About 65 percent of the protein in hemp seeds is edestin, a globulin protein that aids in digestion, similar to the globulin found in human blood plasma, and hemp seeds are the only place they’re found. The other third is made up of the protein albumin.
Elias Anderson, one of the owners of Going Green, said representatives from HempMedsPx approached him after Krenzler published the lab’s findings on his blog. “They were like, ‘What are we gonna do about it?’” Anderson recalled, “And I was like, ‘Nothing. We have standards, and I stand behind my test results.’” Still, the company’s representatives were insistent and advised Anderson to have Kenzler take down the lab’s findings. In an email to the New Republic, Hard, the Medical Marijuana, Inc. spokesman, contended that the sample of hemp oil that Going Green Labs tested had been “tampered with” by a competitor after Krenzler obtained it. “HempMedsPX, if anything, told the lab they cannot publish results from products [for which] they had no chain of custody tracked,” Hard said, “and if they did—that could prove to be very bad for the lab.” He also characterized Krenzler and Anderson as “haters” of Medical Marijuana, Inc., and suggested that much of the criticism of the company and its products comes from commercial competitors.
Canada is specialized on oilseed production and processing, so that hemp oil and grain are much more suitable than fiber. Because of the extensive development of oilseeds in Canada, there is extensive capacity to produce high-quality cold-pressed hemp oil. Canada in the last 5 years has made great advances in the growing, harvesting, and processing of hempseed, and indeed has moved ahead of the EU in the development of raw materials and products for the natural foods, nutraceuticals, and cosmetics industries. In the EU, a yield of 1 t/ha is considered good. In Canada, extraordinary yields of 1.5 t/ha have been realized, at least locally, although in the initial years of hempseed development in Canada yields were often less than 500 kg/ha. In 1999, the year of largest Canadian hemp acreage, yields averaged 900 kg/ha. (Ideally, hemp seed yield should be based on air dry weight—with about 12% moisture. Hemp yields are sometime uncertain, and could be exaggerated by as much as 50% when moist weights are reported.)
Governor Jeff Colyer, M.D. signed Senate Bill 263 on April 20, which enacts the Alternative Crop Research Act allowing the Kansas Department of Agriculture to oversee the cultivation of industrial hemp in a research program. KDA has begun the process of developing rules and regulations to guide the Alternative Crop Research Act, which included an open dialogue and information exchange at a public forum May 11. Content from that forum is included on this page.
Hemp seeds have an attractive nutty taste, and are now incorporated into many food preparations (Fig. 34), often mimicking familiar foods. Those sold in North America include nutritional (granola-type) or snack bars, “nut butters” and other spreads, bread, pretzels, cookies, yogurts, pancakes, porridge, fruit crumble, frozen dessert (“ice cream”), pasta, burgers, pizza, salt substitute, salad dressings, mayonnaise, “cheese,” and beverages (“milk,” “lemonade,” “beer,” “wine,” “coffee nog”). Hemp seed is often found canned or vacuum-packed (Fig. 35). Alcoholic beverages made with hemp utilize hempseed as a flavorant. Hemp food products currently have a niche market, based particularly on natural food and specialty food outlets.
Pain management improves a patient’s quality of life throughout all stages of cancer. Through the study of cannabinoid receptors, endocannabinoids, and synthetic agonists and antagonists, the mechanisms of cannabinoid-induced analgesia have been analyzed.[Level of evidence:1iC] The CB1 receptor is found in the central nervous system (CNS) and in peripheral nerve terminals. CB2 receptors are located mainly in peripheral tissue and are expressed in only low amounts in the CNS. Whereas only CB1 agonists exert analgesic activity in the CNS, both CB1 and CB2 agonists have analgesic activity in peripheral tissue.[48,49]