Cannabis for Medical Use: Clinical Pharmacology Perspectives on Scientific and Regulatory Challenges.
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ABSTRACT:
SUBMITTER: Zhou Z
PROVIDER: S-EPMC9022961 | biostudies-literature | 2022 Apr
REPOSITORIES: biostudies-literature
Publications
Cannabis for Medical Use: Clinical Pharmacology Perspectives on Scientific and Regulatory Challenges.
Zhou Zhu Z Paine Mary F MF Spindle Tory R TR Huang Shiew-Mei SM Zhang Lei L
Clinical pharmacology and therapeutics 20211116 4
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Project description:Medical cannabis (MC) is used for a variety of conditions including chronic pain. The goal of this report was to provide an in-depth qualitative exploration of patient perspectives on the strengths and limitations of MC. Members of MC dispensaries (N = 984) in New England including two-thirds with a history of chronic pain completed an online survey. In response to "How effective is medical cannabis in treating your symptoms or conditions?," with options of 0% "no relief" to 100% "complete relief," the average was 74.6% ± 0.6. The average amount spent on MC each year was $3064.47 ± 117.60, median = $2320.23, range = $52.14 to $52,140.00. Open-ended responses were coded into themes and subthemes. Analysis of answers to "What is it that you like most about MC?" (N = 2592 responses) identified 10 themes, including health benefits (36.0% of responses, eg, "Changes perception and experience of my chronic pain."), the product (14.2%, eg, "Knowing exactly what strain you are getting"), nonhealth benefits (14.1%), general considerations (10.3%), and medications (7.1%). Responses (N = 1678) to "What is it that you like least about MC?" identified 12 themes, including money (28.4%, eg, "The cost is expensive for someone on a fixed income"), effects (21.7%, eg, "The effects on my lungs"), the view of others (11.4%), access (8.2%), and method of administration (7.1%). These findings provide a patient-centered view on the advantages (eg, efficacy in pain treatment, reduced use of other medications) and disadvantages (eg, economic and stigma) of MC.
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Project description:Advances in intensive care and antibiotics have prevented the spread of some infections, though sepsis mortality rates remain high. With failure of over thirty clinical trials, sepsis remains a scientific and clinical challenge in modern medicine. Sepsis is defined by the clinical signs of a systemic inflammatory response to infection. "Severe sepsis" is when these symptoms are associated with multiple organ dysfunction. These definitions of sepsis may be too broad and common to heterogeneous groups of patients who do not necessarily have the same disorder. This consideration has become especially evident in the clinical trials that have failed to obtain consistent results in similar studies of patients diagnosed with severe sepsis. In these trials, patients with infections caused by different microorganisms, and affecting different organs, have been combined under the general diagnosis of severe sepsis. The situation is analogous to attempting a clinical trial based on the general definition of cancer, combining all patients with tumor independent of the type of malignancy. In this consideration, it would not be very surprising that activated protein C, the only treatment in sepsis approved by the Food and Drug Administration, is projected for use in only a small subset of patients with severe sepsis. This article reviews novel inflammatory molecular aspects and the experimental anti-inflammatory strategies for sepsis, as they may represent particular pathological processes in specific subsets of patients.
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Project description:Medical cannabis represents a potential route of pesticide exposure to susceptible populations. We compared the qualifying conditions for medical use and pesticide testing requirements of cannabis in 33 states and Washington, D.C. Movement disorders were the most common neurological category of qualifying conditions, including epilepsy, certain symptoms of multiple sclerosis, Parkinson's Disease, and any cause of symptoms leading to seizures or spasticity. Different approaches of pesticide regulation were implemented in cannabis and cannabis-derived products. Six states imposed the strictest U.S. EPA tolerances (i.e. maximum residue levels) for food commodities on up to 400 pesticidal active ingredients in cannabis, while pesticide testing was optional in three states. Dimethomorph showed the largest variation in action levels, ranging from 0.1 to 60 ppm in 5 states. We evaluated the potential connections between insecticides, cannabinoids, and seizure using the Comparative Toxicogenomics Database. Twenty-two insecticides, two cannabinoids, and 63 genes were associated with 674 computationally generated chemical-gene-phenotype-disease (CGPD) tetramer constructs. Notable functional clusters included oxidation-reduction process (183 CGPD-tetramers), synaptic signaling pathways (151), and neuropeptide hormone activity (46). Cholinergic, dopaminergic, and retrograde endocannabinoid signaling pathways were linked to 10 genetic variants of epilepsy patients. Further research is needed to assess human health risk of cannabinoids and pesticides in support of a national standard for cannabis pesticide regulations.
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Project description:BackgroundMedical students receive foundational knowledge in clinical pharmacology, bridging the gap between pharmacology and clinical practice. While several studies have investigated clinical pharmacology teaching methodologies, few describe the teaching and learning of clinical pharmacology in Saudi Arabia. This study aimed to explore medical students' preferences for teaching and learning methods in clinical pharmacology, identify current strengths and challenges, and provide suggestions for improvement.MethodsIn April 2024, a cross-sectional online survey was distributed via WhatsApp to second and third-year medical students at the University of Jeddah, KSA. The survey invitation explained the purpose, voluntary participation, and anonymity of responses, with informed consent obtained. A 24-item English questionnaire, including a Likert scale and open-ended questions, was developed and pilot-tested by five medical students. Data were analyzed using Minitab 17, employing descriptive statistics and Chi-square (χ2) tests to explore variable relationships.ResultsNinety out of 395 medical students completed the questionnaire, resulting in a 22.8% response rate. Students (43.3%, n = 39) found the curriculum comprehensive and relevant for medication management but lacked cohesiveness. Significant challenges included understanding course content (56.7%, n = 51) and passing exams (43.3%, n = 39). Additionally, 56.7% (n = 51) felt overwhelmed by the volume of information and struggled to apply pharmacological knowledge in practice. In terms of interactive teaching methods, such as case-based discussions and simulations, were found inadequate, and hands-on experience opportunities needed to be improved. While 43.3% (n = 39) expressed satisfaction with their clinical pharmacology education, 36.7% (n = 33) remained neutral, indicating uncertainty about the quality and effectiveness of the teaching they have received. Issues raised by students included feeling overwhelmed by the significant content in the curriculum (n = 62, 69.7%), and understanding the content (n = 51, 56.7%), demanding more case-based learning exercises with real-world patient scenarios (n = 47, 53.4%). For learning modalities, online modules and multimedia resources for self-paced learning were ranked highest (n = 37, 41%), followed by small-group discussions and case-based learning activities (n = 42, 46%).ConclusionsFindings suggest the need for more cohesive clinical pharmacology curricula, enhanced interactive teaching methods, and increased use of technology and practical applications to improve learning outcomes.
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Project description:BackgroundEvidence for long-term effectiveness of commercial cannabis products used to treat medical symptoms is inconsistent, despite increasingly widespread use.ObjectiveTo prospectively evaluate the effects of using cannabis on self-reported symptoms of pain, insomnia, anxiety, depression, and cannabis use disorder (CUD) after 12 months of use.MethodsThis observational cohort study describes outcomes over 9 months following a 12-week randomized, waitlist-controlled trial (RCT: NCT03224468) in which adults (N = 163) who wished to use cannabis to alleviate insomnia, pain, depression, or anxiety symptoms were randomly assigned to obtain a medical marijuana card immediately (immediate card acquisition group) or to delay obtaining a card for 12 weeks delay (delayed card acquisition group). During the 9-month post-randomization period, all participants could use cannabis as they wished and choose their cannabis products, doses, and frequency of use. Insomnia, pain, depression, anxiety, and CUD symptoms were assessed over the 9-month post-randomization period.ResultsAfter 12 months of using cannabis for medical symptoms, 11.7% of all participants (n = 19), and 17.1% of those using cannabis daily or near-daily (n = 6) developed CUD. Frequency of cannabis use was positively correlated with pain severity and number of CUD symptoms, but not significantly associated with severity of self-reported insomnia, depression, or anxiety symptoms. Depression scores improved throughout the 9 months in all participants, regardless of cannabis use frequency.ConclusionsFrequency of cannabis use was not associated with improved pain, anxiety, or depression symptoms but was associated with new-onset cannabis use disorder in a significant minority of participants. Daily or near-daily cannabis use appears to have little benefit for these symptoms after 12 months of use.
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Project description:Evidence suggests fetal risks are associated with cannabis use during pregnancy. Yet, insights into women's decision-making and cannabis use during pregnancy are limited. This study explored these concepts with postpartum women who used cannabis during and after pregnancy. We conducted interviews with 15 women (4 self-identifying a race other than White and 4 self-identifying Hispanic ethnicity) who: 1) lived in the Puget Sound region of Washington State, 2) reported past-year cannabis use on a routine screen, and 3) had documented pregnancy and delivery March 2015-May 2017. Semi-structured interviews asked about decision-making and cannabis use during pregnancy and postpartum. We used template analysis for coding and analysis. The key findings included that women: 1) gathered information about cannabis use during pregnancy primarily through internet searches and discussions with peers; 2) were reluctant to talk with health care providers about cannabis; 3) used cannabis while pregnant to treat health issues, including morning sickness, pain, and mental health conditions; 4) were comfortable with their decision to use cannabis while pregnant, but had questions about long-term effects; and 5) tried to mitigate transmission through breastmilk. Women decided about cannabis during pregnancy based on their experience, health symptoms, and information gathered from the internet and peers, often without guidance from their health care provider. Results point to opportunities for providers to become informed about and engage in discussion with patients about cannabis use during preconception, pregnancy, and postpartum.
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