A Urinary Test Procedure for Identification of Cannabidiol in Patients Undergoing Medical Therapy with Marijuana

Marijuana is classified by the Drug Enforcement Agency (DEA) as Schedule I, drugs having no accepted medical value. Twenty-three states and the District of Columbia have legalized medical marijuana. This conflict inhibits physicians from prescribing marijuana and the systematic study of marijuana in medical care. 

This study concerns the use of the clinical laboratory as a resource for physicians recommending cannabidiol (CBD) to patients, or for patients using medical marijuana. Marijuana containing delta-9-tetrahydrocannabinol (THC) is psychoactive. CBD is not psychoactive. CBD is reported to have medical benefit for seizure control, neurologic disorders including multiple sclerosis, neuropathic pain and pain associated with cancer. Use of opiates leads to increasing dosage over time that may cause respiratory depression. 

The Medical Board of California has termed this a serious public health crisis of addiction, overdose, and death. Is it feasible that CBD might alleviate persistent, severe pain and therefore diminished opiate use? Further study is needed to determine medical effectiveness of CBD including the effect on concurrent opiate therapy due to competition for receptor sites. This study is the application of a gas chromatography mass spectrometry procedure adapted for use in our laboratory, to detect CBD in urine. 

The intended use is as a tool for physicians to assess that marijuana being used by a patient is of a composition likely to be medically effective. A law ensuring physicians freedom from federal prosecution would provide confidence essential to formal study of medical uses of marijuana and treatment of clinical problems. Detection of CBD in a urine sample would be a convenient test for such confirmation.

Below:  Twenty-four-hour Time Study, single individual, following a single dose of CBD oil capsules

Full article at:   http://goo.gl/xsE0sa

By:  Paul T Wertlake and Michael D Henson

Pacific Toxicology Laboratories, Chatsworth, CA, USA

Correspondence: Paul T Wertlake, Pacific Toxicology Laboratories, 9348 De Soto Avenue, Chatsworth, CA 91311, USA, Emailten.nozirev@ekaltrewp

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Medical Marijuana Programs — Why Might They Matter for Public Health & Why Should We Better Understand Their Impacts?

Objective

Although cannabis is an illegal drug, ‘medical marijuana programs’ (MMPs) have proliferated (e.g., in Canada and several US states), allowing for legal cannabis use for therapeutic purposes. While both health risks and potential therapeutic benefits for cannabis use have been documented, potential public health impacts of MMPs — also vis-à-vis other psychoactive substance use — remain under-explored.

Methods

We briefly reviewed the emerging evidence on MMP participants' health status, and specifically other psychoactive substance use behaviors and outcomes.

Results

While data are limited in amount and quality, MMP participants report improvements in overall health status, and specifically reductions in levels of risky alcohol, prescription drug and — to some extent — tobacco or other illicit drug use; at the same time, increases in cannabis use and risk/problem patterns may occur.

Conclusion

MMP participation may positively impact — for example, by way of possible ‘substitution effects’ from cannabis use — other psychoactive substance use and risk patterns at a scale relevant for public health, also influenced by the increasing population coverage of MMPs. Yet, net overall MMP-related population health effects need to be more rigorously and comprehensively assessed, including potential increases in cannabis use related risks and harms.

...Beyond the effects of MMP participation for an individual, an emerging body of evidence suggests that MMPs may have discernable — both positive and negative — impacts relevant on a population health level. Most MMP participants are individuals with severe/chronic, and often multiple — physical or mental — health problems (e.g., pain, psychiatric, sleep, gastro-intestinal, MS, arthritis, HIV/AIDS, neurological problems), many of whom report improved health status/outcomes which may result in reduced health care needs or utilization. For example, among n = 100 California MMP participants, 59% reported MMU for > 1 chronic condition; they reported significantly higher (average global rating 81 vs. 52; p < .01) effectiveness of MMU over other medication (Harris et al., 2000). Among n = 348 Michigan MMP participants, 87% reported multiple conditions (mostly pain); improved pain scores, and physical and mental health function scores, were reported by returning (n = 153) compared to first-time (n = 195) MMP patients (Ilgen et al., 2013). A Hawaii sample of returning MMP patients with mainly pain as the principal condition reported a 64% overall reduction in pain scores following MMP initiation; about half reported relief from anxiety/stress and insomnia problems (Webb and Webb, 2014). Among n = 130 San Francisco MMP patients with multiple conditions, 55% reported “better symptom management” from MMU compared to other prescription drugs (Reiman, 2007); similar data from UK-based MMP patients reported superior effects from MMU on their symptoms (Coomber, 2003, Ware et al., 2005). Among n = 628 Canadian MMP participants largely reporting multiple chronic conditions, 72% reported that MMU was “always helpful” and 24% reported that it was “often helpful” towards “effective symptom relief” (Walsh et al., 2013)...

Full article at:   http://goo.gl/PCo6Tq

By:  Benedikt Fischer,^a,b,c,⁎ Yoko Murphy,^a,b Paul Kurdyak,^c,d Elliot Goldner,^a and Jürgen Rehm^b,c,e

^aCentre for Applied Research in Mental Health and Addictions (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia V6B 5K3, Canada

^bSocial & Epidemiological Research, Centre for Addiction & Mental Health (CAMH), Toronto, Ontario M5S 1S1, Canada

^cDepartment of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada

^dMental Health & Addiction Research Program, Institute of Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5, Canada

^eDalla Lana School of Public Health, University of Toronto, Ontario M5T 3M7, Canada

Benedikt Fischer: ac.ufs@rehcsifb

^⁎Corresponding author at: Centre for Applied Research in Mental Health and Addictions (CARMHA), Faculty of Health Sciences, Simon Fraser University, 2400 — 515 W Hastings St., Vancouver V6B 5K3, Canada. Fax: + 1 778 782 7768. Email: ac.ufs@rehcsifb

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Medicinal Cannabis: In Vitro Validation of Vaporizers for the Smoke-Free Inhalation of Cannabis

Inhalation by vaporization is a promising application mode for cannabis in medicine. 

An in vitro validation of 5 commercial vaporizers was performed with THC-type and CBD-type cannabis. Gas chromatography/mass spectrometry was used to determine recoveries of total THC (THC_tot) and total CBD (CBD_tot) in the vapor. High-performance liquid chromatography with photodiode array detection was used for the quantitation of acidic cannabinoids in the residue and to calculate decarboxylation efficiencies. 

Recoveries of THC_tot and CBD_tot in the vapor of 4 electrically-driven vaporizers were 58.4 and 51.4%, 66.8 and 56.1%, 82.7 and 70.0% and 54.6 and 56.7% for Volcano Medic^®, Plenty Vaporizer^®, Arizer Solo^® and DaVinci Vaporizer^®, respectively. Decarboxylation efficiency was excellent for THC (≥ 97.3%) and CBD (≥ 94.6%). 

The gas-powered Vape-or-Smoke^™ showed recoveries of THC_tot and CBD_tot in the vapor of 55.9 and 45.9%, respectively, and a decarboxylation efficiency of ≥ 87.7 for both cannabinoids. However, combustion of cannabis was observed with this device. Temperature-controlled, electrically-driven vaporizers efficiently decarboxylate inactive acidic cannabinoids and reliably release their corresponding neutral, active cannabinoids. Thus, they offer a promising application mode for the safe and efficient administration of medicinal cannabis.

Below:  Percentage of total cannabinoids found in the vapor, residue and device parts of Volcano Medic^®, Plenty Vaporizer^®, Arizer Solo^®, DaVinci Vaporizer^®, and Vape-or-Smoke^™.

Depicted are the mean values + 1 SD. Bars, left to right: THC from THC-type cannabis; THC from CBD-type cannabis; CBD from CBD-type cannabis; THC standard; CBD standard.

Full article at:   http://goo.gl/xUlCxs

By:  

Christian Lanz, Umut Soydaner, Rudolf Brenneisen

Department of Clinical Research, Laboratory of Phytopharmacology, Bioanalytics and Pharmacokinetics, University of Bern, Bern, Switzerland

Johan Mattsson

Center of Laboratory Medicine, University Institute of Clinical Chemistry, Inselspital, University Hospital Bern, Bern, Switzerland

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The Use of Medicinal Marijuana for Posttraumatic Stress Disorder: A Review of the Current Literature

Background:

Medicinal marijuana has already been legalized in over 23 states with more considering legalization. Despite the trend toward legalization, to date, there has been no systematic review of the existing literature for the efficacy of medicinal marijuana for many of the conditions for which it is proposed to treat. This study seeks to understand the current literature regarding the use of medicinal marijuana in the treatment of posttraumatic stress disorder (PTSD).

Data Sources:

PubMed and PsycINFO databases were searched until April 2014 for articles outlining outcomes of case files, control studies, and observational studies regarding the efficacy of medicinal marijuana in treating PTSD. Various combinations of the following search terms were used: marijuana, medicinal marijuana,cannabis, cannabinoid, PTSD, efficacy, trial, and neurobiology.

Study Selection:

Full text of each article was reviewed, and those directly addressing the question of efficacy of medicinal marijuana on PTSD symptomatology were included. Data were extracted from a total of 46 articles.

Results:

Analysis revealed that most reports are correlational and observational in basis with a notable lack of randomized, controlled studies. Many of the published studies suggest a decrease in PTSD symptoms with marijuana use. Though the directionality of cannabis use and PTSD could not be fully differentiated at this time, there appears to also be a correlation between PTSD and problematic cannabis use. Despite this finding, there is a growing amount of neurobiological evidence and animal studies suggesting potential neurologically based reasons for the reported efficacy.

Conclusions:

Posttraumatic stress disorder is one of the approved conditions for medicinal marijuana in some states. While the literature to date is suggestive of a potential decrease in PTSD symptomatology with the use of medicinal marijuana, there is a notable lack of large-scale trials, making any final conclusions difficult to confirm at this time.

Full article at:   http://goo.gl/ZUxkwe

By:   Department of Psychiatry, Yale University, New Haven, Connecticut

Corresponding author.

Corresponding author: Stephanie Yarnell, MD, PhD, Department of Psychiatry, Yale University, 300 George St, Ste 901, New Haven, CT 06510 (Email: ude.elay@llenray.einahpetS).

 

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Public Opinion & Medical Cannabis Policies: Examining the Role of Underlying Beliefs & National Medical Cannabis Policies

Debate about medical cannabis legalization are typically informed by three beliefs: (1) cannabis has medical effects, (2) medical cannabis is addictive and (3) medical cannabis legalization leads to increased used of cannabis for recreational purposes (spillover effects). We examined how strongly these beliefs are associated with public support for medical cannabis legalization and whether this association differs across divergent medical cannabis policy regimes.

Robust regression analysis was used to analyse data derived from two nationally representative samples of adults participating in comparable cross-sectional online surveys in one country where medical cannabis smoking is illegal (Norway, n = 2175, 51 % male) and in one country where medical cannabis smoking is legal (Israel, n = 648, 49 % male).

The belief that cannabis has medical benefits was more strongly related to support for medical cannabis legalization than were beliefs about addiction and spillover effects. While the support for medical cannabis legalization was stronger in Israel than in Norway (78 vs. 51 %, p < 0.01), the belief variables had, in general, more impact on the policy stand in Norway.

The belief that cannabis has medical benefits is particularly salient for support for medical cannabis legalization. It is possible that the recent surge in evidence supporting the medical benefits of cannabis will increase the belief about medical benefits of cannabis in the general population which may in turn increase public support for medical cannabis legalization. Results also suggest that once medical cannabis is legalized, factors beyond cannabis-specific beliefs will increasingly influence medical cannabis legalization support. These conclusions are, however, only suggestive as the current study is based on cross-sectional data. Hopefully, future research will be able to capitalize on changes in medical cannabis policies and conduct longitudinal studies that enable an examination of the causal relation between public opinion and medical cannabis policy changes.

Below:  Predicted margins with 95 % CIs for Norway and Israel for support for medical cannabis legalization

Full article at: http://goo.gl/cuFXNv

By: Sharon R. Sznitman^1* and Anne Line Bretteville-Jensen²

¹School of Public Health, University of Haifa, Eshkol Tower, room 705, Mt. Carmel 3190501, Haifa, Israel

²Norwegian Institute for Alcohol and Drug Research, Sentrum 0105, Oslo, Norway

  

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Pharmacy Students’ Knowledge and Attitudes Regarding Medical Marijuana

To determine pharmacy students’ knowledge of and attitudes toward medical marijuana and to determine if pharmacy students need additional education on the topic.

Pharmacy students were asked to complete a survey on medical marijuana that assessed their knowledge of, medical uses of, adverse effects with, and attitudes toward medical marijuana through 23 Likert-scale questions.

Three hundred eleven students completed the survey. Fifty-eight percent of the students felt that medical marijuana should be legalized in all states. However, the majority of students did not feel comfortable answering consumers’ questions regarding efficacy, safety, or drug interactions related to the substance. Accurate responses for diseases or conditions for permitted medical marijuana use was low, with only cancer (91%) and glaucoma (57%) identified by more than half the students.

With an increasing number of states adopting medical marijuana use, pharmacy schools need to evaluate the adequacy of medical marijuana education in their curriculum.

Percentage of Pharmacy Students Identifying an Adverse Effect of Medical Marijuana

Pharmacy Students Opinions Towards Marijuana

Full article at: http://goo.gl/HuhPAu

By: Karen E. Moeller, PharmD and Barbara Woods, MA, RPh

Department of Pharmacy Practice, University of Kansas, 2010 Becker Dr., Lawrence, KS 66047. Tel: 913-588-5379. Fax: 913-588-2355. E-mail: ude.cmuk@relleomk

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Gateway to Curiosity: Medical Marijuana Ads and Intention and Use during Middle School

Over the past several years, medical marijuana has received increased attention in the media, and marijuana use has increased across the United States. Studies suggest that as marijuana has become more accessible and adults have become more tolerant regarding marijuana use, adolescents perceive marijuana as more beneficial and are more likely to use if they are living in an environment that is more tolerant of marijuana use. One factor that may influence adolescents’ perceptions about marijuana and marijuana use is their exposure to advertising of this product. 

We surveyed 6th–8th grade youth in 2010 and 2011 in 16 middle schools in southern California (n= 8214; 50% male; 52% Hispanic; mean age = 13) and assessed exposure to advertising for medical marijuana, marijuana intentions and marijuana use. Cross-lagged regressions showed a reciprocal association of advertising exposure with marijuana use and intentions during middle school. Greater initial medical marijuana advertising exposure was significantly associated with a higher probability of marijuana use and stronger intentions to use one year later, and initial marijuana use and stronger intentions to use were associated with greater medical marijuana advertising exposure one year later. 

Prevention programs need to better explain medical marijuana to youth, providing information on the context for proper medical use of this drug and the potential harms from use during this developmental period. Furthermore, as this is a new frontier, it is important to consider regulating medical marijuana advertisements, as is currently done for alcohol and tobacco products.

Full article at: http://goo.gl/p7GGmL

By: Elizabeth J. D’Amico, Jeremy N.V. Miles, and Joan S. Tucker

RAND Corporation; 1776 Main St., Santa Monica, CA 90407

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Substituting Cannabis for Prescription Drugs, Alcohol & Other Substances among Medical Cannabis Patients: The Impact of Contextual Factors

Recent years have witnessed increased attention to how cannabis use impacts the use of other psychoactive substances. The present study examines the use of cannabis as a substitute for alcohol, illicit substances and prescription drugs among 473 adults who use cannabis for therapeutic purposes.

The Cannabis Access for Medical Purposes Survey is a 414-question cross-sectional survey that was available to Canadian medical cannabis patients online and by hard copy in 2011 and 2012 to gather information on patient demographics, medical conditions and symptoms, patterns of medical cannabis use, cannabis substitution and barriers to access to medical cannabis.

Substituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87% (n = 410) of respondents, with 80.3% reporting substitution for prescription drugs, 51.7% for alcohol, and 32.6% for illicit substances. Respondents who reported substituting cannabis for prescription drugs were more likely to report difficulty affording sufficient quantities of cannabis, and patients under 40 years of age were more likely to substitute cannabis for all three classes of substance than older patients.

The finding that cannabis was substituted for all three classes of substances suggests that the medical use of cannabis may play a harm reduction role in the context of use of these substances, and may have implications for abstinence-based substance use treatment approaches. 

Further research should seek to differentiate between biomedical substitution for prescription pharmaceuticals and psychoactive drug substitution, and to elucidate the mechanisms behind both.

Via:   http://ht.ly/SsTnn 

By: Lucas P1, Walsh Z2, Crosby K2, Callaway R3, Belle-Isle L1,4, Kay R5, Capler R6, Holtzman S7.

• 1Centre for Addictions Research of British Columbia, University of Victoria, Victoria, Canada.
• 2Psychology, The University of British Columbia, Kelowna, Canada.
• 3Medical Cannabis Advocate, Vancouver, British Columbia, Canada.
• 4Canadian AIDS Society, Ottawa, Canada.
• 5GreenLeaf Technologies, Kelowna, British Columbia, Canada.
• 6Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada.
• 7Department of Psychology, University of British Columbia, Kelowna, Canada.