Pain associated with integumentary wounds is highly prevalent, yet it remains an area of significant unmet need within health care. Currently, systemically administered opioids are the mainstay of ...treatment. However, recent publications are casting opioids in a negative light given their high side effect profile, inhibition of wound healing, and association with accidental overdose, incidents that are frequently fatal. Thus, novel analgesic strategies for wound-related pain need to be investigated. The ideal methods of pain relief for wound patients are modalities that are topical, lack systemic side effects, noninvasive, self-administered, and display rapid onset of analgesia. Extracts derived from the cannabis plant have been applied to wounds for thousands of years. The discovery of the human endocannabinoid system and its dominant presence throughout the integumentary system provides a valid and logical scientific platform to consider the use of topical cannabinoids for wounds. We are reporting a prospective case series of three patients with pyoderma gangrenosum that were treated with topical medical cannabis compounded in nongenetically modified organic sunflower oil. Clinically significant analgesia that was associated with reduced opioid utilization was noted in all three cases. Topical medical cannabis has the potential to improve pain management in patients suffering from wounds of all classes.
IMPORTANCE: As of March 2015, 23 states and the District of Columbia had medical marijuana laws in place. Physicians should know both the scientific rationale and the practical implications for ...medical marijuana laws. OBJECTIVE: To review the pharmacology, indications, and laws related to medical marijuana use. EVIDENCE REVIEW: The medical literature on medical marijuana was reviewed from 1948 to March 2015 via MEDLINE with an emphasis on 28 randomized clinical trials of cannabinoids as pharmacotherapy for indications other than those for which there are 2 US Food and Drug Administration–approved cannabinoids (dronabinol and nabilone), which include nausea and vomiting associated with chemotherapy and appetite stimulation in wasting illnesses. FINDINGS: Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these trials had positive results, suggesting that marijuana or cannabinoids may be efficacious for these indications. CONCLUSIONS AND RELEVANCE: Medical marijuana is used to treat a host of indications, a few of which have evidence to support treatment with marijuana and many that do not. Physicians should educate patients about medical marijuana to ensure that it is used appropriately and that patients will benefit from its use.
The history of Cannabis goes along that of humankind, as speculated based on geographical and evolutionary models together with historic data collected to date. Its medical use is several thousand ...years old, as attested both by archeobotanical evidence of Cannabis remains and written records found in ancient texts from the sacred Vedic foundational texts of Ayurvedic medicine (about 800 before current era BCE) to the first known Pharmacopoea, the Chinese “Shen Nung Pen Ts'ao Ching” (1 century BCE). In this paper, we retrace the history of Cannabis traveling through the key stages of its diffusion among the most important ancient cultures up to our days, when we are facing a renaissance of its medical employment. We report through the centuries evidence of its use in numerous pathologic conditions especially for its anti‐inflammatory, antiseptic, and anticonvulsing properties that support the requirement to direct our present research efforts into the definitive understanding of its efficacy.
The history of Cannabis goes along that of humankind, as speculated based on geographical and evolutionary models together with historic data collected to date. Its medical use is several thousand years old, as attested both by archeobotanical evidence of Cannabis remains and written records found in ancient texts. In this review, we report through the centuries evidence of its use in numerous pathologic conditions especially for its anti‐inflammatory, antiseptic, and anticonvulsing properties that support the requirement to direct our present research efforts into the definitive understanding of its efficacy.
This Viewpoint questions recent US state regulations authorizing the use of cannabis as a substitute for opioids in treatment of opioid addiction and chronic pain, citing the absence of evidence of ...cannabis equivalency, the risks of marijuana use, and ample evidence supporting the use of methadone and buprenorphine for management of opioid use disorder (OID).
The "Basic Policy on Economic and Fiscal Management and Reform" approved by the Cabinet on June 7, 2022 includes the statement, "We will review cannabis-related programs and establish the environment ...needed for the use of cannabis-derived drugs," and it is expected that regulatory development for the use of cannabis-derived ingredients in medicines will certainly progress in Japan in the future. Medical cannabis in the broad sense can be divided into three main categories: cannabinoid medicines, hemp-derived cannabidiol (CBD) products, and cannabis-derived products (medical cannabis in the narrow sense). What is currently under consideration in Japan is the lifting of the ban on the import, manufacture and use of cannabinoid medicines based on medical needs. Medical cannabis in the narrow sense is used in other countries as a substitute for cannabinoid medicines, but it contains Δ9-tetrahydrocannabinol (THC), which causes psychiatric dependence and has significant health effects. Therefore, it should be discussed separately from CBD, which has a low risk of dependence and abuse.It has been pointed out that the background of recent cannabis abuse in Japan is that many young people disregard the harmfulness and danger of cannabis, and in promoting cannabinoid medicines and CBD products, care should be taken to avoid the spread of a false perception that cannabis is safe, which could lead to cannabis abuse. Health professionals should also strive to avoid affirming or spreading discourses that emphasize only the usefulness of cannabis. However, the situation regarding cannabis-derived ingredients has changed significantly since around 2018, and many health professionals have not had the opportunity to receive appropriate input in curricula. Therefore, it is necessary to provide opportunities for healthcare professionals to update their awareness of the situation and to enhance educational and awareness-raising content.
There is a paucity of research, especially in the UK, that investigates individual differences in both medical and recreational cannabis users. A cross-sectional survey study design was used to ...assess recreational cannabis users and medical cannabis users currently living in the UK. Recreational cannabis users were invited to take part via social media. Medical cannabis users were recruited from Sapphire Medical Clinics, London, UK, which provides treatment with prescribed cannabis-based medicinal products. Demographic data and cannabis use frequency, as well as post-traumatic stress disorder symptoms (PCL-5), depression symptoms (Centre for Epidemiological Studies Depression Scale), trait and state anxiety (State-Trait Anxiety Inventory), and cannabis use motives Comprehensive Marijuana Motives Questionnaire (CMMQ) were collected. The Chi-square and independent-sample
-tests were used for the comparison of categorical variables and normally distributed continuous variables. Data were analyzed using analyses of variance (ANOVAs) and
-tests. Statistical significance was considered where the value of
was <0.05. The survey was completed by 161 participants. Medical cannabis users were older, consumed cannabis more often, had a higher "Sleep" motive on the CMMQ, and had a higher prevalence in self-reporting current diagnoses of neurological problems, mood disorders, and anxiety disorders (
< 0.05). Recreational cannabis users had higher scores on several motives for use (e.g., "Enjoyment," "Coping," "Experimentation," "Boredom," and "Celebration") and higher state anxiety scores (
< 0.05). The most common motives for cannabis use in both groups were "Enjoyment," "Low Risk," and "Sleep." There were no differences between groups in gender, "Low-Risk" motive, post-traumatic stress disorder symptoms, depression scores, trait anxiety scores, self-reported prevalence of substance use-related disorders, and past consumption of alcohol, tobacco, or caffeine (
> 0.05). The current study not only demonstrates a difference in age and motivations for cannabis consumption between recreational and medical cannabis users but also shows areas of potential overlap, including mental health outcomes, past substance use, and gender. These UK-specific findings indicate that recreational cannabis users experience higher state anxiety, highlighting the need for further evaluation of potential anxiogenic/anxiolytic properties of cannabis. These findings demonstrate the importance of researching individual differences in cannabis users and hold significant implications for future research, clinical practice, and legislation.
Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations ...between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding.
This article suggests that using medical cannabis for CP treatment may benefit some CP patients. The reported improvement in quality of life, better side effect profile, and decreased opioid use should be confirmed by rigorous, longitudinal studies that also assess how CP patients use medical cannabis for pain management.
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