Your Dose of Cannabis Education
Your Dose of Cannabis Education
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Your Dose of Cannabis Education is based on data from the studies and reviews published in the current peer-reviewed medical journals. Whether you are a healthcare provider, patient, caregiver, an individual working in the healthcare sector, or just a curious person, you can benefit from Your Dose of Cannabis Education.
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2024-05-13
Are there any dosing considerations for recommending/prescribing cannabinoid-based medicines for patients utilizing high doses of opioids or benzodiazepines?
According to the European Pain Federation position paper on appropriate use of cannabis-based medicines and medical cannabis for chronic pain management, “in the absence of available literature, it is the panel expert opinion that cannabis use could worsen the cognitive impairment caused by high doses of opioids and benzodiazepines. If cannabis is prescribed, it should be prescribed at a low dose and should be discontinued if it affects patients’ memory, mood or function. Physicians should consider tapering high opioid (≥90 mg morphine equivalent/day) or benzodiazepine doses, especially in patients with chronic noncancer pain.”
A “key point” from that position paper is: “Do not prescribe cannabis‐based medicines to patients taking high doses of opioids or benzodiazepines.”Häuser, W, Finn, DP, Kalso, E, et al. European Pain Federation (EFIC) position paper on appropriate use of cannabis‐based medicines and medical cannabis for chronic pain management. Eur J Pain.. 2018; 22: 1547– 1564. https://pubmed.ncbi.nlm.nih.gov/30074291/
2024-05-12
How should the cannabinoid-based therapy be withdrawn?
According to the Health Canada document entitled "Information for Health Care Professionals – Cannabis (marihuana, marijuana) and the Cannabinoids," “If intolerable adverse effects appear without significant benefit, dosing should be tapered and stopped. Tapering guidelines have not been published, but the existence of a withdrawal syndrome suggests that tapering should be done slowly (i.e. over several days or weeks).” Note: When discontinuing cannabidiol therapies used for the treatment of seizure disorders, the dose should be decreased gradually. As with all antiepileptic drugs, abrupt discontinuation should be avoided when possible, to minimize the potential risk of increased seizure frequency and status epilepticus.Information for Health Care Professionals – Cannabis (marihuana, marijuana) and the Cannabinoids – Dried or fresh plant and oil for administration by ingestion or other means Psychoactive agent. This document can be found at https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf
2024-05-11
The effects of cannabinoids are dependent upon the route of administration, the health of the consumer and other factors. There is also interindividual variation. Provide some reasons why the effects of cannabinoids vary among individuals.
There are many reasons why the effects of cannabinoids vary among individuals. SOME of the reasons are: diet, age, health of the patient, and co-administered medications may impact metabolism and efficacy of cannabinoid-based products. Also, some patients have a genetic profile such that they are predisposed to experience side effects (for ex., exacerbation of a psychotic disorder/schizophrenia) after exposure to THC. In addition, patients that have been consuming cannabinoid-based products long-term react differently than patients who have never consumed cannabinoid-based products. Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02. Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/
2024-05-10
Even if an individual employs the same mode of administration over time, the effects of cannabinoids may change for that individual. Provide some reasons why this may be so.
The effects of cannabinoids may change over time due to multiple factors, including: 1. tolerance to the cannabinoids may develop 2. change in the patient's health status/ medical condition may change over time and lead to physiological changes in the endocannabinoid system (For example, inflammation impacts the ECS. Also, impaired G.I./liver function affects the absorption and metabolism of cannabinoids.) 3. The patient may start or stop taking a medication that interacts with cannabinoids or affects the metabolism of the cannabinoid-based product. 4. Physiologic changes in the endocannabinoid system take place as patients age.
Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02 Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/
2024-05-09
Some patients use cannabinoid-based medicines to treat nausea and vomiting. Is one of the side effects of cannabinoid-based medicines nausea and vomiting?
Yes.. The adverse event profile of cannabinoid-based formulations is dependent upon the ratio of CBD:THC, the presence of other cannabinoids and terpenes, and the dose consumed. The known common adverse effects of cannabinoid-based medicines include sedation/somnolence, dizziness, anxiety, cognitive dysfunction, nausea, vomiting, diarrhea, vertigo, increased or decreased appetite and dry mouth. Brenneisen R, Egli A, ElSohly MA, Henn V, Spiess Y. The effect of orally and rectally administered delta9-tetrahydrocannabinol on spasticity: a pilot study with 2 patients. Int. J. Clin. Pharmacol. Ther. 1996 Oct;34(10)446-52. https://pubmed.ncbi.nlm.nih.gov/8897084/
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