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.
A CNN program that featured Charlotte's Web cannabis in 2013 brought increased attention to the use of CBD in the treatment of seizure disorders. Since then, 16 states have passed laws to allow the use of CBD products with a doctor's recommendation (instead of a prescription) for treatment of certain medical conditions. This is in addition to the 30 states that have passed comprehensive medical cannabis laws, which allow for the use of cannabis products with no restrictions on THC content. Of these 30 states, eight have legalized the use and sale of cannabis products without requirement for a doctor's recommendation.
Fig. 6. ‘Finola,’ the first cultivar of Cannabis sativa bred exclusively for grain. (Courtesy of the breeder, J.C. Callaway, Univ. Kuopio, Finland.) Fig. 7. ‘Anka,’ the first registered North American bred cultivar of Cannabis sativa. This variety is best suited for grain production. (Courtesy of the breeder, P. Dragla, and of the Industrial Hemp Seed Development Company, Chatham, Ontario.)
Epidiolex is the first FDA-approved treatment in the U.S. that contains a purified drug substance derived from marijuana -- CBD -- and the first treatment for Dravet syndrome. In September 2018 the FDA rescheduled cannabidiol from a C-I controlled substance to a C-V controlled substance, meaning it has a proven medical use but a low risk of abuse. This change allows Epidiolex to be marketed in the U.S.
Animal studies have suggested a synergistic analgesic effect when cannabinoids are combined with opioids. The results from one pharmacokinetic interaction study have been reported. In this study, 21 patients with chronic pain were administered vaporized Cannabis along with sustained-release morphine or oxycodone for 5 days. The patients who received vaporized Cannabis and sustained-release morphine had a statistically significant decrease in their mean pain score over the 5-day period; those who received vaporized Cannabis and oxycodone did not. These findings should be verified by further studies before recommendations favoring such an approach are warranted in general clinical practice.
Topicals represent a newer emerging market in medical marijuana products geared toward health and beauty. Cannabinoids can be absorbed through the skin for certain therapeutic benefits without any psychoactivity. Additionally, the essential oils in hemp and cannabis provide many benefits for skin health. From moisturizers to shampoos and deodorants, medical cannabis products continue to diversify.
Cannabis is indigenous to Central Asia and Indian subcontinent, and its use for fabric and rope dates back to the Neolithic age in China and Japan. It is unclear when cannabis first became known for its psychoactive properties; some scholars suggest that the ancient Indian drug soma, mentioned in the Vedas, was cannabis, although this theory is disputed.
Cannabis, also known as marijuana among other names,[n 1] is a psychoactive drug from the Cannabis plant used for medical or recreational purposes. The main psychoactive part of cannabis is tetrahydrocannabinol (THC), one of 483 known compounds in the plant, including at least 65 other cannabinoids. Cannabis can be used by smoking, vaporizing, within food, or as an extract.
In recent decades, the neurobiology of cannabinoids has been analyzed.[12-15] The first cannabinoid receptor, CB1, was identified in the brain in 1988. A second cannabinoid receptor, CB2, was identified in 1993. The highest expression of CB2 receptors is located on B lymphocytes and natural killer cells, suggesting a possible role in immunity. Endogenous cannabinoids (endocannabinoids) have been identified and appear to have a role in pain modulation, control of movement, feeding behavior, mood, bone growth, inflammation, neuroprotection, and memory.