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EDITORIAL

Medical cannabis: Miracle or myth?

Introduction

References

REVIEW ARTICLES

Cannabis or marijuana: A review

Abstract

Introduction

Cannabis sativa plant

Prevalence

Table 1. Lifetime use of marijuana: 2007 ESPAD*

(15-16 year olds)

Consumption of cannabis (marijuana)

Cannabis and other drug use

Cannabinoids

Endocannabinoid system

Table 2. Types of cannabinoids

Use of medical cannabis

Table 3. Potential benefits of cannabis based on research studies (See text)

Synthetic cannabinoids (cannabinoid designer drugs; cannabimimetics)

Cannabis lab testing

Medical adverse effects

Table 4. Potential adverse effects of marijuana*

(see text)

Cannabis hyperemesis

Dental effects of cannabis

Pulmonary effects

Cannabis and cancer

Cardiovascular effects

Motor vehicle accidents

Sports doping

Adverse effects: Psychiatric

Cannabis and neurodevelopment effects

Cannabis and ADHD

Cannabis dependence

Table 5. DSM-IV-TR Cannabis use and induced disorders (26)

Cannabis withdrawal syndrome

Addiction

Cannabis and psychosis

Management

Behavioral therapies

Pharmacologic therapies

Cannabis intoxication

Cannabis withdrawal

Cannabis-associated psychosis

Cannabis dependence

Oxytocin

NAC

Others

Conclusion

Medical cannabis

Acknowledgments

References

Pharmacology of cannabis

Abstract

Introduction

Phyto-cannabinoids

Mechanism of action

Endocannabinoids

Absorption of cannabis

Distribution

Metabolism and elimination

Detection and analysis of cannabis

Synthetic cannabinoids

References

Forms of administration of cannabis and their efficacy

Abstract

Introduction

FDA-approved cannabinoids

Medical marijuana

Smoking

Edibles

Concentrates

Dabbing

Cannabinoid (CBD) oil

Potency and labeling concerns

Dosing

Conclusion

References

History of medical cannabis

Abstract

Introduction

History of cannabis use

The genetics and selective breeding of cannabis

Modern methods of cannabis consumption

Oral administration

Other methods of consumption

Conclusion

Conflict of interest

Acknowledgments

References

Cannabis and pain: A review

Abstract

Introduction

Methods

Eligibility criteria

Selection process and data abstraction

Results

A total of 4,472 articles were identified through the literature search. Of these, there were only 28 studies that satisfied our eligibility criteria (see Figure 1). An additional 5 studies (1-5) were identified through hand search of bibliographies o...

Nabiximol oromucosal spray

Table 1. Characteristics of included RCTs (n = 27)

Table 1. (Continued on next page)

Table 1. (Continued on next page)

Table 1. (Continued on next page)

Cannabis extract capsules

Orally ingested capsules of cannabinoid extracts dronabinol and nabilone have been tested for their analgesic effects. Dronabinol is a THC extract, while nabilone is a synthetic cannabinoid that mimics the action of THC. Studies testing dronabinol var...

Smoked cannabis

Smoking cannabis is the simplest way of ingesting cannabis and is commonly done on a recreational basis. Studies examining the effects of smoking cannabis for its analgesic effects vary in the duration the cannabis was smoked for, the frequency cigare...

Conclusion

More research is needed in order to better determine the efficacy of cannabis as an analgesic treatment. Although the results generally show that cannabis does have a statistically significant positive effect on pain, the quality of the literature nee...

Conflict of interest

Acknowledgments

References

Medical cannabis for pain in adolescence

Abstract

Introduction

Chronic pain in adolescence

Data supporting efficacy of cannabis in treating pain

Adverse health effects

Medical marijuana legislation

Utilization of medical cannabis

Health department statistical reports

Medical cannabis surveys

Youth risk behavior surveys

Considerations in the use of cannabis for pain in adolescents

Summary

Conclusion

References

The adverse effects of cannabis use in adolescents

Abstract

Introduction

Adverse effects

Conclusion

References

Cannabis use: What is the school’s role?

Abstract

Introduction

Memory, attention, learning capability and school performance

Behavioral and physical health

The role of school

Types of programs and delivery system in school

Drug abuse prevention and early intervention programs classification

Effective programs and practices within MTSS

Tier 1

Tier 2

Tier 3

Conclusion

References

Medical marijuana as a therapeutic option for cancer anorexia and cachexia: A scoping review of current evidence

Abstract

Introduction

Methods

Table 1. Search strategy

Results

Study findings

Table 2. Characteristics and findings of appetite stimulation studies

Table 2. (Continued on next page)

Discussion

Route of administration

Patient inclusion criteria

Dosing inconsistencies

Cancer cachexia versus HIV-wasting

Weight gain significance

Current use in practice

Study limitations

Conclusion

Conflict of interest

References

Medical cannabis dosing strategies in pain-related conditions: A scoping review of current literature

Abstract

Introduction

Methods

Table 1. Literature search strategy breakdown based on database

Results

Table 2. Study characteristics – use of different forms of cannabis in pain conditions

Table 2. (Continued on next page)

Vaporizing and smoking

Smoked cannabis

Pain relief outcomes

Dosing frequency

Vaporized cannabis

Other dosage forms

Other edible forms

Brownie

Cannabis oil

Discussion

Limitations of clinical trials

Oral administration versus inhalation

Smoking versus vaporizing

Standard inhalation protocol versus reality

Dose-response relationship

Dosing recommendation

Limitations of the scoping review

Conclusion

Conflicts of interest

Acknowledgments

References

Medical cannabis: The pain physician’s perspective

Abstract

Introduction

Patient case

Approach to the patient with neuropathic pain requesting medical marihuana

Phytocannabinoids and pain modulation

Approach to prescribing phytocannabinoids for pain

Table 1. Dosing and resultant serum concentrations of synthetic cannabinoids vs. inhaled dried marijuana (20-24, 41)

Table 2. Dose calculations and conversions (11)

Table 3. Conversion of a “smoked dose” of THC in a standard 750mg marihuana cigarette to oral dose (replicated from Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids, 2013) (11)

Populations that may benefit from medical cannabis

Conclusion

Conflict of interest

Acknowledgments

References

Medical cannabis: Identifying ethical and policy implications for healthcare organizations in Canada

Abstract

Introduction

Indications for medical marihuana

Discussion

Locus of administration

Routes of administration

Security

The therapeutic relationship

Ethical issues

Harm principle

Harm reduction

Policy options

Limitations

Conclusion

Conflict of interest

Acknowledgments

References

The pharmacological properties of cannabis

Abstract

Introduction

Structure, expression and production of known cannabinoids

Known cannabinoids and their effects on cellular and system physiology

Table 1. Predominant cannabinoids with clinical relevance

Inhalation versus oral consumption and bioavailability

As with all drugs, the pharmacokinetics (PK) of cannabis are dependent on the route of administration.. To date, most human clinical trials have evaluated the PK activity of cannabis after inhalation or ingestion. While different studies report a wide...

Table 2. Pharmacokinectics of cannabis based on route of administration

The cocktail versus the individual compounds

The use and efficacy of herbal drugs and in traditional medicine has been documented for centuries among many cultures. This historic usage of whole plant extracts could have a variety of reasons, but most notably is the reduced effectiveness of isola...

Terpene biochemistry and free radical scavenging

Terpenes comprise a diverse class of organic compounds which are produced by a variety of plants. Their functions range from plant protection by deterring herbivores to attracting predators and pollinating insects. In addition to their roles as end-pr...

Conclusion

Conflict of interest

Acknowledgments

References

Plants as medical tools

Abstract

Introduction

Current plant extracts used as pharmaceuticals and used in pharmaceutical production

Medicinal plants

History of plant extracts used as pharmaceuticals

Current status of natural products (NP) including medicinal plant extracts

Table 1. Plant-derived natural products approved for therapeutic use in the last thirty years (1984–2014)

Table 1. (Continued on next page)

Plant extracts widely used in pharmaceutical production

Table 2. Plant derived natural products in clinical trials

Table 2. (Continued on next page)

The opioids story

The aspirin story

The evolving cannabis story

Comparison of current pain medications

Table 3. Comparison of current pain medications

Conclusion

Conflict of interest

Acknowledgments

References

ORIGINAL ARTICLES

Medical cannabis use in an outpatient palliative care clinic: A retrospective chart review

Abstract

Introduction

Methods

Results

Table 1. Demographic characteristics of included patients

Table 2. Cancer diagnosis of included patients

Table 3. Symptom profiles of included patients

Table 4. Substance use among included patients

Discussion

Conclusion

Conflict of interest

Acknowledgments

References

CASE REPORTS/SHORT COMMUNICATIONS

Medical cannabis: Four patient perspectives

Abstract

Introduction

Case story 1

Case story 2

Case story 3

Rose is a retired 67-year-old female that has been diagnosed with diffused systemic scleroderma and pulmonary fibrosis. The primary symptoms of her condition are muscle and nerve pain, and sleep deprivation. To manage these symptoms she is currently o...

Case story 4

Cole is 25-year-old male, currently employed. In January 2014 while on vacation, Cole dove into water from a height of 30 feet and hit his head. He was carried out of the water and couldn’t walk for several weeks. He has been diagnosed with post-concu...

Conclusion

Medical cannabis is now an established option in a physician’s medical toolkit. Its utility is derived from the whole-plant mixture of active components and it is the relative proportion of these components that differentiates cannabis cultivars from ...

Conflict of interest

Acknowledgments

References

Medical marijuana: A Canadian perspective

Abstract

Introduction

Accessible for certain medical conditions

Legalizing cannabis recreationally

Acknowledgment

References

Finding comfort beyond your comfort zone: Defining medical cannabis’ place in palliative care

Abstract

Introduction

Managing physical symptoms: Efficacy and safety

Psychological aspects of care: Empowerment and hope

Social aspects: Stigma and beyond

Conclusion

Conflict of interest

Acknowledgments

References

Optimizing the safety of medical cannabis

Abstract

Introduction

Medical cannabis and its uses

Canada’s forthcoming legalization of cannabis

1) Formalize naming and removal of recreational terms

2) Standardize dosing

3) Establish monitoring guidelines

Conclusion

Conflict of interest

Acknowledgments

References

Is there a role for medical cannabis in the treatment of chemotherapy-induced nausea and vomiting? A commentary

Abstract

Introduction

The endocannabinoid system

Synthetic cannabinoids versus medical cannabis

Table 1. State trials on the effect of smoked cannabis on chemotherapy-induced nausea and vomiting

Oncologist perspective

Pharmacist perspective

Patient perspective

Future directions

Conflict of interest

Acknowledgments

References