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Medical Marijuana for Pain

Discussion in 'Other Health News and Research' started by Nielk, Dec 6, 2011.

  1. Nielk


    UCSF Study Finds Medical Marijuana Could Help Patients Reduce Pain with Opiates

    December 6, 2011

    Hector Vizoso, RN, left, and Donald Abrams, MD, prepare a cannabis vaporizer for inpatient use at San Francisco General Hospital & Trauma Centers Clinical Research Center.

    A UCSF study suggests patients with chronic pain may experience greater relief if their doctors add cannabinoids the main ingredient in cannabis or medical marijuana to an opiates-only treatment. The findings, from a small-scale study, also suggest that a combined therapy could result in reduced opiate dosages.

    More than 76 million Americans suffer from chronic pain more people than diabetes, heart disease and cancer combined, according to the National Centers for Health Statistics.

    A vaporizer such as this one delivers the same amount of cannabis as if a patient smokes a marijuana cigarette.

    Pain is a big problem in America and chronic pain is a reason many people utilize the health care system, said the papers lead author, Donald Abrams, MD, professor of clinical medicine at UCSF and chief of the Hematology-Oncology Division at San Francisco General Hospital and Trauma Center (SFGH). And chronic pain is, unfortunately, one of the problems were least capable of managing effectively.

    In a paper published this month in Clinical Pharmacology & Therapeutics, researchers examined the interaction between cannabinoids and opiates in the first human study of its kind. They found the combination of the two components reduced pain more than using opiates alone, similar to results previously found in animal studies.

    Major Components of Cannabis

    Delta-9 Tetrahydrocannabinol (Delta-9 THC) It is the main psychoactive component of cannabis with mild to moderate painkilling effects. It also helps treat nausea associate with cancer chemotherapy and to stimulate appetite. It induces feelings of euphoria. Potential side effects include accelerated heartbeat, panic, confusion, anxiety and possible paranoia.
    Cannabidiol (CBD) It is a major, non-psychoactive component of cannabis that helps shrink inflammation and reduce pain without inducing the euphoria effects of THC. It has been used to treat rheumatoid arthritis, inflammatory bowel diseases, psychotic disorders and epilepsy. Larger amounts of CBD can relax the mind and body without causing negative side effects associated with THC.
    Cannabinol (CBN) It is a secondary psychoactive component of cannabis. It is not associated with painkilling effects of THC or CBD. CBN is formed as THC ages. Unlike the euphoria effects of THC, CBN can induce headaches and a sense of lethargy.
    Tetrahydrocannabivarin (THCV) It is found primarily in strains of African and Asian cannabis. THCV heightens the intensity of THC effects and the speed in which the component is delivered, but also causes the sense of euphoria to end sooner.

    Researchers studied chronic pain patients who were being treated with long-acting morphine or long-acting oxycodone. Their treatment was supplemented with controlled amounts of cannabinoids, inhaled through a vaporizer. The original focus was on whether the opiates effectiveness increased, not on whether the cannabinoids helped reduce pain.

    The goal of the study really was to determine if inhalation of cannabis changed the level of the opiates in the bloodstream, Abrams said. The way drugs interact, adding cannabis to the chronic dose of opiates could be expected either to increase the plasma level of the opiates or to decrease the plasma level of the opiates or to have no effect. And while we were doing that, we also asked the patients what happened to their pain.

    Abrams and his colleagues studied 21 chronic pain patients in the inpatient Clinical and Transitional Science Institutes Clinical Research Center at SFGH: 10 on sustained-release morphine and 11 on oxycodone. After obtaining opiate levels from patients at the start of the study, researchers exposed them to vaporized cannabis for four consecutive days. On the fifth day, they looked again at the level of opiate in the bloodstream. Because the level of morphine was slightly lower in the patients, and the level of oxycodone was virtually unchanged, one would expect they would have less relief of pain and what we found that was interesting was that instead of having less pain relief, patients had more pain relief, Abrams said. So that was a little surprising.

    The morphine group came in with a pain score of about 35, and on the fifth day, it decreased to 24 a 33 percent reduction. The oxycodone group came in with an average pain score of about 44, and it reduced to 34 a drop of 20 percent. Overall, patients showed a significant decrease in their pain.

    This preliminary study seems to imply that people may be able to get away perhaps taking lower doses of the opiates for longer periods of time if taken in conjunction with cannabis, Abrams said.

    Opiates are very strong powerful pain medicines that can be highly addictive. They also can be deadly since opiates sometimes suppress the respiratory system.

    As a cancer doctor, Abrams was motivated to find safe and effective treatments for chronic pain. Patients in the cannabis-opiates study experienced no major side effects such as nausea, vomiting or loss of appetite.

    A scale is used to weigh cannabis before it is put in the vaporizer to ensure accurate dosage.

    What we need to do now is look at pain as the primary endpoint of a larger trial, he said. Particularly I would be interested in looking at the effect of different strains of cannabis.

    For instance, Delta 9 THC is the main psychoactive component of cannabis but cannabis contains about 70 other similar compounds with different effects. One of those is cannabidiol, or CBD. It appears to be very effective against pain and inflammation without creating the high created by THC.

    I think it would be interesting to do a larger study comparing high THC versus high CBD cannabis strains in association with opiates in patients with chronic pain and perhaps even having a placebo as a control, Abrams said. That would be the next step.

    Abrams is the lead author of the paper; co-authors are Paul Couey, BA, and Mary Ellen Kelly, MPH, of the UCSF Division of Hematology-Oncology at SFGH; Starley Shade, PhD, of the UCSF Center for AIDS Prevention Studies; and Neal Benowitz, MD, of the UCSF Division of Clinical Pharmacology and Experimental Therapeutics.

    The study was supported by funds from the National Institutes on Drug Abuse (NIDA), a subsidiary of the National Institutes of Health (NIH).

    UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.
  2. L'engle

    L'engle moogle

    THC can be pretty dangerous, while Cannabidiol seems a good thing. If you can get medicinal marijuana that is high in Cannabidiol and low in THC then I think that may be a good thing. THC can cause bad personality changes and even mental illness like schizophrenia. There was a CBC (Canadian) documentary about it that was good, though it doesn't focus on medicinal marijuana. I don't use marijuana and would suggest only getting it from a very transparent source.

    A preview for the documentary:
  3. leela

    leela Slow But Hopeful

    Couchland, USA
    This is a really interesting approach:
  4. mellster

    mellster Marco

    San Francisco
    IMO most reports about the dangers of MJ are overblown or simply false, but there is lots of evidence that it is far less harmful side-effect-wise than alcohol, but nonetheless it should be used with caution. Also it moderately suppresses certain immune system activity (NK cells etc.) which can be a good thing if you believe your condition is mainly auto-immune related and a not-so-good thing if you think you are very immune deficient. But for pain it is probably more effective and less harmful than anything you can get from big pharma. It is also especially helpful for sleep.
  5. urbantravels

    urbantravels disjecta membra

    Los Angeles, CA
    I tried medical marijuana - several strains that are alleged to be good for pain (I live in a major capital of MMJ; it is not hard to get any strain you care to name) and it was really pretty ineffective for pain. Same thing for sleep - the best "sleep" strains just put me in a weird semi-coma state where I'm not really sleeping, not fully conscious, and definitely don't feel rested afterward.

    I finally concluded that for me personally, my prescription meds for pain and sleep (1) work better (2) have fewer side effects (3) are cheaper (I do have health insurance and my copays are cheap) and (4) don't require such stinky shopping expeditions.
    L'engle likes this.

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