The world of medicine is turning towards using cannabis for treating a number of medical conditions in patients. It has been used for soothing symptoms of cancer, Alzheimer’s, glaucoma, IBD, and most prominently chronic pain. According to a research carried out by University of Michigan, about two-thirds of all medical cannabis patients are those that need support to combat chronic-pain. Recently, an international task force has shared some newly issued guidelines for dosing and administering cannabis to manage chronic pain in patients.
What is Chronic Pain?
Almost everyone experiences pain in some form during their lifetime. In fact, sudden pain acts as a tip off for the nervous system that a possible injury can occur. This is what typical pain looks and feels like to the body. Its severity reduces slowly as the site of injury repairs itself.
Chronic pain however, is different from a typical form of pain. Any pain that lasts for more than twelve weeks can be classified under this category. The period of pain can range from weeks to even years in patients, reducing their physical capacity to perform tasks. It limits their endurance and flexibility, causes irritability, anxiety and sometimes depression.
Data collected from 15 states of United States showed that chronic pain is the most common reason for patients use of medicinal marijuana.
Science behind cannabis use and pain relief
Cannabinoids receptors are located through out the human body and play an important role in controlling a number of physiological responses. These include appetite regulation, pain-detection, mood, memory and anxiety among many other bodily functions.
The chemical structure of cannabinoid receptors is very similar to the phytocannabinoids produced by strains of the cannabis plant. This chemical propensity of cannabis plants makes it easier for them to attach with the brain’s receptors and bring about changes in the everyday functions of the human body.
The most convincing depiction of the therapeutic properties of cannabis was seen in the clinical studies of cancer patients.
Cancer causes chronic pain in a variety of ways. It causes severe nerve damage, inflammation and grows tumors by invading bone and other sensitive tissues.
Dr.Ilana Braun is a cancer psychiatrist at the Dana-Farber Cancer Institute of Boston. She is the lead author of a study published in the Journal of Clinical Oncology. According to the findings of the study, nearly half of all oncologists recommend medical cannabis to their patients.
New guidelines on cannabis use for chronic pain management
Despite of the success of cannabis for managing persistent pain, the ‘evidence base’ to support its effectiveness is lacking.
About 80% of oncologists talk with their patients about cannabis as an alternate treatment. In contrast to this, less than 30% of them feel they have sufficient knowledge about its medicinal use.
In the light of these facts, an international task force conducted a virtual PAINWeek meeting last week with the intent to put forward new guidelines for cannabis use by patients suffering from chronic pain.
The task force stressed the need to educate clinicians about the applications of cannabis in chronic pain management. “We as a task force believe it’s extremely important to bring medical cannabis to patients, “said Alan Bell, MD, of the University of Toronto. He further added,”There’s a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen.”
In addition to this, other recommendations made by the members of the task force highlighted the importance of proper dosage and administering of the drug to the patients.
The task force led by Arun Bhaskar MD recommended using a Delphi process for arriving at dosage levels that could work best for patients.
Under this process, experts will voice their opinions on suitable methods and dosages via questionnaires. The final analysis will then be based on these individual opinions for reaching a consensus among the experts.
The 20-clinician Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain led by Arun Bhaskar M.D made the following recommendations:
1- Start with a ‘routine’ measure
This involves giving them 5 mg of CBD two times in a day. Introducing THC should only be considered if there is no response by patients to 40 mg of CBD daily. The staring dose for THC should be 2.5 mg everyday. The dosage should not exceed 40 mg daily.
2- Adopt stringent doses for geriatric patients
Elderly patients or those with multiple chronic diseases should be treated via a conservative route. This will involve starting the THC dosage at 1 mg daily and taking up the dosage by low degrees.
3- Rapid Protocol for severe chronic pain patients
Rapid protocol means giving a balanced dosage of CBD-THC to patients suffering from severe pain. In addition, all those patients who have had previous exposure to cannabis consumption can also be eligible for this protocol. The recommended dosage for these patients can begin with 2.5-5 mg per each compound once or twice daily.
Cannabis Home Delivery Services Likely to commence in Massachusetts
The CCC has agreed upon setting up a substructure for beginning cannabis home delivery services in the state of Massachusetts. The organization has presented a draft highlighting a timeline and new industry rules for starting the delivery services. Operations may begin in about a month.
The Commission has proposed an outline that would permit two types of delivery licenses for operators. Its limited delivery license would allow authorized personnel to make deliveries from CCC licensed retailers and dispensaries. Furthermore, the wholesale delivery license would allow operators to buy cannabis in wholesale directly from the cultivators. The purchased commodities will be allowed storage at a CCC approved warehouse facility. Warehouses are required to have a docking facility or sally port for a secure loading of delivery vehicles.
In additio.3n to these requirements, the CCC’s delivery draft regulations has fixed a $1,500 application fee for the licenses. Along with this, a $5,000 annual license fee for limited delivery licensees and a $10,000 annual license fee for wholesale delivery licensees is also proposed. As per the initial drafts, the CCC has decided to relinquish the application fee and first year license fee for limited delivery licensees. In the second year, the fees will be halved.
Chairman Steven Hoffman has pushed the Commission to provide finalized delivery regulations by October 20th. In the light of this, the CCC will shortly open a public comment period on the delivery regulations.
What would these cannabis delivery licenses mean for licentiate?
These delivery permits would allow licensees to supplement retail stores and provide new channels of recreational marijuana purchase.. Obtaining delivery licenses would provide a boost to small businesses. This is because the barriers to obtaining retail licenses are much more pronounced than the delivery category.
According to Commissioner Britte McBride, who wrote the regulations, “What we’ve done in addition to creating those two license types is also to establish new fees and fee structures, to require warehousing for wholesale delivery licensees, to authorize white labeling for wholesale delivery licensees. We’re defining specific operational requirements that will be in addition to the general operational requirements, and we are amending existing relevant regulations to incorporate the license types and the activities that they can undertake,”
Is it too early to allow cannabis home delivery services?
Is the requisition of cannabis really going to be just a phone call away?
For marijuana opponents, the idea of getting such convenient doorstep delivery is surely not going to be taken in good spirits. According to ballotpedia, about 46.34% of voters in Massachusetts were against the legalization of marijuana and its regulation as alcohol in 2016. For this particular segment of the population, home delivery of the drug may be an advancement that is taking place too fast. There will be concerns related to identity thefts, rise in crime rates, and products falling into wrong hands, particularly children.
Contrary to this, for the advocates of marijuana, this advancement of licenses would allow them a much needed convenience. Look at this from the perspective of bed-ridden medical marijuana patients. Leaving beds, let alone houses, is a painful endeavor for this segment of marijuana users. If other medications are already being delivered to their doorsteps, why cant medicinal marijuana join the delivery market?
For the recreational users, home deliveries might prove catalytic in reducing the stigma attached to marijuana usage. For years, marijuana has been shelled with the “not in my backyard” attitude. Despite of being advocates, most marijuana users have had to hide their association with the drug to curtail themselves from the society. If home delivery vans arrive right at the door step, it may lead to a normalization and acceptance of marijuana at some point.
Why allow delivery now?
Delivery of medical marijuana is not a new concept, even in the state of Massachusetts. Almost six authorized medical dispensaries have provided this service to registered patients since 2018.
If more licenses are granted for more legal businesses, illegal delivery services may be controlled right in infancy. In addition, this will also provide low cost business opportunities to aspiring market entrants.
The government provides no support to the marijuana industry due to its illegal federal status. By creating such opportunities at the state level, barriers to entry may be successfully reduced.
Study Shows No Significant Mental Effects In Elderly Patients Using Medicinal Cannabis For Chronic Pains
The elderly, often subjected to various medical conditions, need therapies and treatments as much as any other age group. Yet unfortunately, some point out that the field sometimes doesn’t get as much attention as younger groups. That may explain why pediatric doctors greatly outnumber geriatric specialists. And then, there does exist the tendency for the elderly to be more likely to be dismissed, compared to younger patients. Regardless, one of the most common aliments in the elderly is that of chronic pain in different parts of their aged bodies. Luckily, medicinal cannabis may hold the solution for them, as numerous experts find its properties useful for old people.
A recent study from Israel set out to ascertain whether or not weed would harmfully affect the cognitions of a sample of aged individuals. The participants included both middle-aged individuals and the elderly ones, as both seemed likely to have chronic pains. Furthermore, because the aim was to find effects on cognition, both types had fully-developed brains. What the scientists found may further the needle for the campaign to normalize medicinal cannabis.
The study set up strict controls and parameters to keep it as accurate as possible
The problem that arises with any diverse sample is the presence of individual differences. If not adjusted for, these can lead to a skewed data set and make the results questionable. In this case, the researchers strove to ensure all participants were as similar as possible. They were all above the age of 50, and no significant history with alcohol abuse or hard drugs. Some of the participants were on medicinal weed licenses, meaning they actively used it regularly. Others used it very sporadically. However, all abstained from cannabis use at least 3 hours prior. They also had similar education levels and all medically recognized as mentally sound.
The study included exactly 63 licensed individuals with the remaining 62 unlicensed. The male to female ratio was also about half and half, so sex didn’t affect the results. This almost even split served to better reproduce a normal distribution with acceptable standard deviations. Furthermore, they used a reliable software called ‘CogState’, which comprises of computerized cognitive exams. These exams covered everything required, from memory to attention spans.
The results indicated that regular cannabis use to treat chronic pains left no significant impact on cognition in the elderly
By all standards of scientific research methodology, the study mainly came out as a success. The results showed the initial hypothesis proved correct, and cannabis caused no major mental changes. In practically all participants, cognition was on par with normal levels and the frequent cannabis users did not vary much from rare users. Hence, the paper claimed that treating chronic pains with CBD (cannabidiol) and THC (tetrahydrocannabinol) would leave no lasting mental effects.
However, one interesting and alarming finding the study showed was an elevated risk of cardiovascular disease from cannabis. In addition, regular users also showed elevated frequencies of depression. The former of these may occur due to smoking cannabis rather than eating it. However, it does corroborate what a recent American Heart Association (AHA) paper claims.
While the study did have some limitations, it still shows important findings for those on the fence about medicinal weed
No truly scientific study can claim to have zero room for improvement. While they accounted for most extraneous factors, the biggest factor was the cross-sectional aspect. This means that due to broad generalizations about samples, the study cannot definitively establish cause and effect. Also, they didn’t account for previous medicinal histories.
However, the study still puts to rest many fears about brain damage from weed. For more on medicinal cannabis, stay tuned!
Why New Jersey’s Telemedicine For Prescription Cannabis Is A Big Deal
Earlier this month, legislation in New Jersey seems like it may take a turn in favor of medicinal cannabis using ‘telemedicine’. In a world, and nation, devastated by the ongoing COVID-19 pandemic, even visiting a physician may prove deadly. After all, hospitals, now overrun with emergent coronavirus cases, may become cesspools of airborne pathogens. Even healthcare providers still face significant risk of infection in their line of work. And this despite them donned in full protective gear and thoroughly disinfected regularly. As a matter of fact, going out anywhere public unnecessary remains inadvisable by the WHO and health authorities.
Recently, the members of the New Jersey state assembly convened to talk about various concerning issues. One of the biggest and most immediate issues, the plight of millions of patients needing prescription drugs at home, needing resolving. This especially held true of those requiring medicinal cannabis treatments, a drug not available at every nearby pharmacy. Therefore the members ruled to permit the use of telemedicine, a game-changing new service in the United States.
Telemedicine holds the key to quality healthcare in the middle of a dangerous pandemic
Not many outside of the medical field would immediately know what the concept refers to. Broadly speaking, telemedicine refers to any healthcare practice done without the patient and physician needing to interact in person. Looking at the etymology (the origin of the word), it’s all in the name (translating to long distance medicine). Therefore, video conferencing consultations between the patient at home and the doctor is an example of telemedicine. In addition, the purchase and delivery of prescription drugs from and to home online also counts as such.
So while it may not seem like anything more than ‘Zoom/Amazon but for medicine’, this is a gross understatement. Regular meetings, related to business, casual chatting and interviews, already occurred online before COVID-19. That classes and work began conducting over video conferences wasn’t anything unforeseeable as the pandemic grew. However, in traditional medical schools, few students receive training for how to treat patients online. After all, a good diagnosis usually comes with thorough rapport, careful inspection of the body and various examinations. So now the COVID-19 pandemic has doctors scrambling to learn an entirely new modality of work. And the concept of sitting safe at home while your lifesaving drugs come to you, risk-free is incredible.
The move comes unexpectedly, as cannabis legislation in New Jersey still holds some previous prejudices
The truth of the matter is that the United States is still a nation where recreational cannabis usage is federally illegal. And medicinal cannabis, despite modern scientific studies extolling its proven health benefits as a therapeutic agent in many conditions, as well. That means that the ‘default’ law for any state is that the drug is banned, with even possession resulting in criminal offence. The only state exceptions to this practice worked hard to exempt themselves. Even in New Jersey, recreational cannabis remains off the table, but medicinally it gained allowance.
As a result, the cannabis industry, which makes everything cannabis related (from hemp to CBD oils), doesn’t do well here. There simply isn’t a big enough market for products in states where cannabis is literally banned. In the case of New Jersey, only specially licensed dispensaries can legally sell prescription marijuana. Law makers historically have shown very little care to make medicinal weed more accessible, in addition. Furthermore, even healthcare providers may show hesitance to prescribe cannabis due to the amount of legal work required by state laws.
All in all, this move signals a step in the right direction. Hopefully, patients will receive their medications soon and safely.
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