Considering the pharmacokinetics of orally consumed cannabinoid-based food products, how should the oral consumption of cannabinoids proceed?
According to Health Canada’s document entitled Information for Health Care Professionals: Cannabis and Cannabinoids, “consumption of … oral cannabis should proceed slowly, waiting a … minimum of 30 minutes, but preferably 3 h, between bites of cannabis-based oral products (e.g. cookies, baked goods) to gauge for strength of effects or for possible overdosing.” 🍂 New accredited CME/CE courses. Use coupon code FALL20 and save 20% on any course! 🍂
Are there any strategies in which patients with chronic non-cancer pain can find their optimal dosing regimen without consuming high doses of THC?
As stated by the authors of “Brief Commentary: Cannabinoid Dosing for Chronic Pain Management” in the Annals of Internal Medicine, “We advocate a “start-low, go-slow” dosing philosophy, applied to both quantity and adverse effect profiles. We recommend starting with CBD extract, 5 to 10 mg twice daily, to be increased weekly over 1 to 2 months until pain relief is achieved. If CBD extract alone provides insufficient relief, we suggest adding THC, 1.0 to 2.5 mg, and slowly titrating up as needed.” “We do not regard cannabinoids as first-line treatments but as adjuvant therapies to be used before opioids if other options fail to control chronic non-cancer pain. As with any pain medication, cannabinoids should be used as part of an integrated, patient-centric management program, with particular emphasis on appropriate non-pharmacologic treatment options (for example, exercise, cognitive behavioral therapy, and mindfulness). We recommend selecting products verified for safety and potency by third-party testing. We propose that patients use oral formulations (such as capsules) for long-term relief, with tinctures for breakthrough pain. We suggest vaping for patients who prefer to inhale cannabinoids, because this method probably has fewer adverse effects than smoking.”
Are there any state laws that allow patients to use medical cannabis-based products in hospitals and certain healthcare facilities?
Yes. In September 2021, California Governor G. Newsom signed “Ryan’s Law” – legislation that expands end-of-life treatment options for Californians by requiring that hospitals and certain types of healthcare facilities in the state allow terminally-ill patients to use medical cannabis for treatment and/or pain relief. “Ryan’s Law,” (SB311) “requires healthcare facilities to reasonably restrict the manner in which a patient stores and uses medical cannabis to ensure the safety of other patients, guests, and employees of the healthcare facility. It does NOT apply to patients receiving emergency care, and smoking and vaping cannabis is expressly PROHIBITED. The legislation does NOT require the health facility to provide the medicinal cannabis, nor does it require the facility to dispense the cannabis from the pharmacy.” “Currently, the US DOJ is prohibited to use any federal funds to interfere with state medical cannabis laws… SB 311 includes a strong safe harbor clause that would allow facilities to suspend compliance should any federal agency initiate an enforcement action or indicate its interest in once again enforcing federal cannabis laws.” 🍂 New accredited CME/CE courses. Use coupon code FALL20 and save 20% on any course! 🍂
Do CB 2 receptors play a role in diabetic neuropathy?
Yes – CB2 receptors present on peripheral nerve terminals mediate analgesic effects. In has been shown in mouse models that the stimulation of CB2 receptors inhibits pain transmission via the inhibition of cyclooxygenase and nitric oxide synthetase. Also, in studies involving diabetic mice, it has been shown that CB2 receptor agonists may reduce mechanical allodynia.
Does hyperglycemia impact expression of CB2 receptors in the glomerulus?
Yes – Hyperglycemia, as well as high urinary albumin levels, downregulate the expression of CB2 receptors in the glomerulus and proximal tubule cells. This downregulation plays a role in the progression of diabetic nephropathy.
Is chronic marijuana use associated with higher or lower fasting insulin levels?
The results of epidemiological studies in marijuana users indicate that chronic regular use of marijuana impacts fasting insulin levels, weight, prevalence of type 2 diabetes, and much more – for example, the findings of some epidemiologic studies show that chronic marijuana use is associated with a lower prevalence of obesity and Type 2 diabetes, 12% lower fasting insulin, lower insulin resistance, and lower waist circumference, as well as absence of hepatic steatosis, and normal insulin sensitivity and β cell function.
Yes. Endocannabinoids act in an autocrine and paracrine fashion to mediate the activity of the pancreas and mediate insulin secretion. – It has been shown that endocannabinoids influence basal as well as glucose-induced insulin release. Also, endocannabinoids have been shown to have an effect on β cell proliferation and survival. (Pancreatic β cells are the cells that synthesize and secrete insulin.)
Have human studies evaluated the effects of cannabinoid consumption on cortisol levels?
Yes – Human studies have demonstrated that the consumption of cannabinoids modulate cortisol release. Acutely, the consumption of cannabis (or THC) by naive or infrequent cannabis users may increase the secretion of cortisol. In chronic cannabis users, the stimulatory effect of THC on cortisol levels is blunted. This blunted response suggests that a tolerance develops. Some studies have reported that chronic cannabis users exhibit elevated basal cortisol levels, but that stress- induced activation of the axis is blunted in chronic adult and adolescent cannabis users.
Has the use of a transdermal gel for regional and systemic delivery of CBD been evaluated for the treatment of epilepsy?
Yes. A transdermal gel for regional and systemic delivery of CBD (Zynerba Pharmaceuticals) is in clinical development for treatment of epilepsy, developmental and epileptic encephalopathy, fragile-X syndrome, and osteoarthritis. NOTE: As of September 2021, the company’s website indicates that the product is not yet approved by government regulatory bodies, including the United States Food and Drug Administration (FDA) and other agencies, and must be tested to see if it is an effective and safe treatment.
What are some of the more common reasons dermatologists recommend cannabinoid-based medicines?
According to the results of a survey of 145 dermatologists, 91 % of dermatologists were in support of medical cannabis use and 13.8 % have recommended it for a dermatologic condition. Atopic dermatitis (45 %) and psoriasis (40 %) were the most common. The most common form of administration was topical (75 %). The main reasons for not recommending medical cannabis were limited knowledge (56 %) and lack of experience (48 %).