Study Finds Inhaled Cannabis an Effective Treatment for Neuropathic Pain

The inhalation of vaporized herbal cannabis is an effective treatment for neuropathic pain, according to the results of a recently published study by German researchers. The observational study also found that inhaled cannabis helped neuropathic pain patients with sleep problems, a common symptom experienced by at least half of those diagnosed with the sometimes-debilitating condition.

Neuropathic pain is a condition caused by disease or injury to the nervous system that results in chronic pain, abnormal sensations known as dysesthesia or pain from normally pain-free stimuli. About 30% of neuropathic pain cases are associated with diabetes, according to information from the Cleveland Clinic, but other diseases including alcoholism, shingles and central nervous system disorders such as stroke, Parkinson’s disease or multiple sclerosis can also cause the condition. Additional causes include chemotherapy or radiation treatment, amputation-induced phantom pain, nerve damage from trauma or surgeries and compression or inflammation of spinal nerves. Neuropathic pain is traditionally treated with medication, although the authors of the new study noted that many patients are unable to find adequate relief with commonly prescribed treatments.

“The expression of neuropathic pain is highly individual and symptoms, as well as response of patients to various analgesics, antidepressants, anti-epileptics or opioid therapy, vary greatly,” the researchers wrote. “Unfortunately, treatment of neuropathic pain frequently remains unsuccessful even after multiple trials with various analgesics.”

To conduct the study, researchers identified a cohort of 99 participants diagnosed with chronic neuropathic pain lasting at least three months who had a high severity of symptoms and had exhausted other treatment options. The study was conducted in Germany, where the medical use of cannabis was legalized in 2017 for patients suffering from a chronic disease for which conventional treatment methods have already been exhausted. Participants were prescribed herbal cannabis, which is available at German pharmacies by prescription as dried flowers. All patients used cannabis with a THC concentration of 12-22%, while nearly two-thirds (64%) of participants used cannabis with a THC potency of 16-22%. Patients were instructed to use a vaporizer to inhale cannabinoids from heated cannabis flower. Participants chose their own plan of administration over a period of six months, deciding whether to use cannabis on a set schedule, as time permitted or when they experienced a pain attack.

Participants of the study completed a video consultation with a physician every four to six weeks throughout the six-month study period. Pain was assessed using a scale from 0 to 10. According to the German Pain Society, pain scores above 6 are defined as severe pain, which significantly affects a patient’s quality of life. Patients’ sleep disturbance was also assessed using a scale from 0 to 10. The National Institutes of Health reports that 50% to 80% of neuropathic pain patients experience sleep problems, with the severity of sleep problems often related to the intensity of pain.

“Within six weeks of therapy, median pain scores decreased significantly from 7.5 to 4.0. The proportion of patients with severe pain (score >6) decreased from 96 percent to 16 percent,” the researchers wrote. “Sleep disturbance was significantly improved with the median of the scores decreased from 8.0 to 2.0. These improvements were sustained over a period of up to six months. There were no severe adverse events reported.”

Study Participants Reported Improvements in Pain and Sleep

At the onset of the study, the majority of patients had severe neuropathic pain, with 96% of participants having a pain score above 6 and a median pain score of 7.5 for the group. At the first follow-up consultation, which was conducted within six weeks of beginning treatment, 90% of participants reported an improvement in their general condition and pain was significantly reduced to a median pain score of 3.75. At five subsequent follow-up consultations, pain scores continued to decline before stabilizing at about 3.

Before beginning medical cannabis, a majority of the patients suffered from severe sleep disturbance with a median score of 8 out of the maximum of 10. A significant improvement in sleep was reported in the first follow-up consultation. The median sleep disturbance score dropped to 2, an improvement that was sustained until the end of the six-month observation period. The researchers noted that the improvement in sleep was likely due to the improvement in pain symptoms but added that “it is also possible that a direct effect of the medical cannabis plays a role.” A majority of patients achieved an adequate quality of sleep, which is “a crucial parameter of life quality.”

Over the entire observation period, 97 (99%) patients reported an improvement in their general condition at one or more follow-up interviews. The study participants reported mild side effects including dryness in mucous tissue (5.4%), fatigue (4.8%) and increased appetite (2.7%). In their conclusion, the researchers wrote that the results “demonstrated that chronic neuropathic pain can be effectively, sustainably, and safely treated with medical cannabis.”

The researchers acknowledged some limitations of the study, including a “possible bias in selecting patients who are more open-minded for inhaling medical cannabis.” The authors also reported missing data points and incomplete data sets, which they said were “an intrinsic weakness of a retrospective and observatory study.”

A report on the research, “Medical Cannabis Alleviates Chronic Neuropathic Pain Effectively and Sustainably without Severe Adverse Effect: A Retrospective Study on 99 Cases,” was published last month by the peer-reviewed journal Medical Cannabis and Cannabinoids.

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Study: Cannabis Doesn’t Increase Heart Attack Risk

Middle-aged adults with a history of cannabis use over the previous year did not have a higher risk of suffering a heart attack, according to the results of a recent study by researchers at the University of California in San Diego.

The new study, “Associations Between Monthly Cannabis Use and Myocardial Infarction in Middle-Aged Adults: NHANES 2009 to 2018,” was published on August 7 in the peer-reviewed American Journal of Cardiology, found that a history of cannabis use over the previous year was not associated with an elevated risk of myocardial infarction (MI) among a nationally representative study of nearly 10,000 adults aged 35 to 59. Additionally, study participants who reported using cannabis in the month before experiencing an MI, also commonly known as a heart attack, showed a lower risk compared to participants who had not used cannabis recently.

“In a representative sample of middle-aged US adults, a history of monthly cannabis use for more than a year before a myocardial infarction was not linked to a subsequent physician-diagnosed MI, after accounting for cardiovascular risk factors,” the authors of the study wrote. “However, when considering recent use, the odds were three times greater if no use was reported in the past month.”

Study Included Nearly 10,000 Participants

To conduct the study, the researchers performed an analysis of data from the National Health and Nutrition Examination Survey (NHANES), a series of studies designed to assess the health and nutritional status of adults and children in the United States. The study assessed the relationship between a history of monthly cannabis use preceding an MI in a nationally representative sample of middle-aged adults in the United States.

Among the 9,769 respondents of the survey analyzed for the study, a quarter (24.9%) reported a history of cannabis use for at least one year prior to experiencing a myocardial infarction. A history of MI was reported by 2.1% of all respondents and 3.2% of those who reported a history of monthly use. Additionally, 1.5% of respondents reported that they had never used cannabis, and 2.2% denied a history of being a monthly user.

The study found that subjects who had used cannabis at least monthly over the past year did not show a higher risk of having a heart attack compared to non-users when potential confounding factors such as physical activity, body mass index and the use of alcohol or cigarettes were adjusted for. However, when stratified by recent use, the odds of MI were three times greater when no cannabis use was reported within the past month than when use was reported in the month preceding a heart attack.

The study also found that the duration of monthly cannabis use by survey respondents was not significantly associated with myocardial infarction, with those who had used cannabis on a monthly basis for more than 10 years showing similar rates of incidence compared to users with a shorter history of monthly use.

“The length of monthly use before the MI, including use >10 years, also showed no association. The evidence base for cardiovascular harms is conflicting and limited by the ability to accurately quantify use, especially the method of use, dose, and potency,” the researchers wrote. “Given the expanding access to cannabis products in the United States and around the world, more research, particularly longitudinal and experimental studies, is needed.”

In a separate finding that the researchers who conducted the study characterized as “unexpected,” subjects who had recently stopped using marijuana showed an increased risk of experiencing a heart attack.

Study Inconsistent with Earlier Research

The researchers noted that the results of the study diverge from previous research in the Behavioral Risk Factor Surveillance System survey in US adults, which reported elevated odds of MI among young adults 18 to 44 years old, and a separate study that reported increased odds of MI or coronary artery disease (CAD) among adults 18 to 74 years old who did not smoke cigarettes.

Other studies have shown an apparent link between cannabis use and “an increased risk of cardiovascular diseases, as well as heart attacks and strokes,” according to a health warning from the American Heart Association earlier this year. In the warning, which was published in time for the 4/20 festivities in April, the cardiovascular health advocacy organization noted that a 2020 scientific statement from the group maintained “that while marijuana, also known as cannabis, may be helpful for some other medical conditions, it does not appear to have any well-documented benefits for the prevention or treatment of cardiovascular diseases (CVD).”

Robert L. Page II, a professor in the Department of Clinical Pharmacy and the Department of Physical Medicine/Rehabilitation at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences in Aurora, Colorado, noted that “the way cannabis is consumed may make a difference in how it affects the heart and blood vessels. Many people don’t realize that cannabis smoke contains components similar to tobacco smoke.”

“Smoking and inhaling cannabis, regardless of THC content, has been shown to increase the concentrations of poisonous carbon monoxide and tar in the blood similar to the effects of inhaling the smoke from a tobacco cigarette,” said Page, one of the authors of the American Heart Association’s 2020 statement on medical and recreational marijuana use and cardiovascular disease. “Also, limited information exists on the hazards of exposure to secondhand cannabis smoke.”

However, a 2021 literature review of 67 studies published in the American Journal of Medicine found that “marijuana itself does not appear to be independently associated with excessive cardiovascular risk factors,” although the authors of the review warned that cannabis “can be associated with other unhealthy behaviors such as alcohol use and tobacco smoking that can be detrimental” to cardiovascular health.

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CBD For Hair Loss

CBD for hair loss? Hair loss (or alopecia) affects millions of people worldwide. Both men and women can experience hair loss. Genetics, stress, and hormonal imbalances contribute to hair loss, and no one-size-fits-all remedy exists. But what about CBD? A recent study reviewed data and found “a scientific basis for CBD use in alopecia.” Of course, this study was far from comprehensive. But it provides a good starting point. CBD for hair loss? Can it help, or is this all […]

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Study Shows Cannabis Use During Pregnancy Doesn’t Affect Neurodevelopment of Children

A new study has shown that cannabis use during pregnancy is not associated with differences in the neurodevelopment of children exposed to cannabis in the womb. The study, which was published last month in the peer-reviewed journal Paediatric and Perinatal Epidemiology last month, found that prenatal cannabis exposure was not associated with lower scores on neuropsychological tests in children or with autism among young adults.

“Prenatal marijuana exposure was not associated with secondary outcomes or risks of clinical deficit in any neuropsychological assessments,” the authors of the study wrote.

To conduct the study, researchers affiliated with Columbia University and the University of Western Australia, Perth used data on 2,868 children from the Raine Study, one of the world’s largest prospective cohorts of pregnancy, childhood, adolescence and adulthood, to analyze the progression of prenatal cannabis exposure from pregnancy through age 20. The children in the study underwent neuropsychological testing at age 10, and again as young adults aged 19 or 20.

The researchers designed the study to control for a wide range of clinical and sociodemographic factors that might affect the outcome of the results. The study was also conducted over a long time span, much longer than other studies that have attempted to investigate the potential outcomes of prenatal cannabis exposure. Because of the study’s characteristics and its robust sample size, the research helps provide a better idea of what prenatal cannabis exposure can do to unborn children.

With the study’s controls in place to account for confounding factors, the researchers found no association between exposure to cannabis in the womb and neurodevelopmental outcomes. Specifically, the authors of the study determined that prenatal exposure to marijuana “was not associated with worse neuropsychological test scores at age 10 or autistic traits at 19-20,” according to their conclusions.

The researchers noted limitations of their study, including changes in the average potency of cannabis products and evolving methods of ingesting the drug over the last few decades. The researchers studied children born between 1989 and 1992, meaning they were likely exposed to less potent cannabis than what is available today. The researchers noted that “further research is warranted in a more contemporary birth cohort with a range of neuropsychological outcomes to further elucidate the effect of prenatal marijuana exposure on neurodevelopment.”

Other Research Inconclusive

The results of previous studies investigating the effects of prenatal cannabis exposure have been inconsistent. Some studies have shown an increase in neurodevelopmental differences such as autism, ADHD and anxiety in children who were exposed to cannabis in the womb, while others have not revealed such associations.

A systematic review of available research published in 2020 found that cannabis use during pregnancy may be associated with ADHD and related symptoms such as anxiety in children exposed to cannabis in utero. A separate study published the same year found that children whose mothers used cannabis while pregnant were 50% more likely to be diagnosed with autism. However, some experts note these studies may not be reliable because of limitations including problems with the methodology of the original research the studies are based on and small sample sizes.

Like the study published last month, other research has not found associations between prenatal cannabis exposure and neurodevelopmental problems in children.

A 2021 study found no association between cannabis exposure in the womb and autism when confounding factors such as the education of the mother and the use of alcohol and tobacco were controlled for. Another study published this year found that when maternal stress, a factor associated with both autism and cannabis use, was controlled for, no association between prenatal cannabis exposure and autism was found.

Expert Recommends Caution

Cannabis use during pregnancy is controversial, with many healthcare professionals warning that it should be avoided at all costs. Some cannabis advocates argue the dangers are overstated and that using cannabis during pregnancy can help relieve symptoms of morning sickness and alleviate stress, allowing pregnant women to get the nutrition and rest they need for a healthy pregnancy, among other benefits.

Dr. Peter Grinspoon, a primary care physician at Harvard Medical School and Massachusetts General Hospital and the author of “Seeing Through The Smoke: A Cannabis Specialist Untangles the Truth About Marijuana,” believes that there is still too much that is not known about how the drug can affect an unborn baby and cautions against cannabis use during pregnancy.

“It has not been conclusively demonstrated that cannabis is (or isn’t) safe during pregnancy or breastfeeding. As such, the prudent thing to do is to presume that cannabis use, especially regular, heavy cannabis use, is unsafe during pregnancy and breastfeeding until we uncover reasonable evidence that it is safe,” Grinspoon writes in the book. “Given what’s at stake, the burden of proof is on cannabis in this case. That means cannabis ought to be avoided or minimized by anyone who is pregnant or breastfeeding. Women who might become pregnant need to be carefully educated about the risks.”

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CUD or Effects of Smoking? 10 Things to Consider 

Is “Cannabis Use Disorder” (CUD) causing all kinds of perioperative problems, or is it the effects of smoking? A new paper published in the journal JAMA Surgery took a look. Here was their question. “Is cannabis use disorder associated with an increased risk of perioperative complications and in-hospital mortality after major elective inpatient surgery?” Notice the assumed reality that CUD exists. They refer to the ICD-10 definition. But we’re not here to criticize the results of this paper. It could […]

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Cannabis Causes Schizophrenia: Study

Cannabis causes schizophrenia says a new study led by researchers at the National Institute on Drug Abuse. They collected data from over 6 million people in Denmark. They found an association between 21-30-year-old male cannabis consumers and higher rates of schizophrenia. Ergo: cannabis causes schizophrenia. Cue moral outcry from the public health busybodies. Take this article from the Telegraph. The author repeats the study’s conclusions that cannabis causes schizophrenia.  Therefore, she is alarmed that “For some, it has become as […]

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Twins Study Busts Cannabis Gateway Theory

Legal access to recreational cannabis has no effect on increasing the probability of disorders using alcohol or illicit drugs, according to a recent study of twins.

In a recent report published by the journal Psychological Medicine, researchers observed data gathered from observing twins living in Colorado and Minnesota. They found no link to legal access to marijuana with the likelihood of developing substance abuse problems. 

“Cannabis legalization was associated with no other adverse outcome in the co-twin design, including cannabis use disorder,” researchers found. “No risk factor significantly interacted with legalization status to predict any outcome.”

“We found mostly a lot of nothing, which I think is personally interesting,” lead researcher Stephanie Zellers added. “I think this is a case where we don’t find much is actually more interesting maybe than finding a bunch of results.”

The study also noted that residents living in legal cannabis states didn’t appear to show an increase in problems associated with mental health, relationships, work and finances.

“Recreational legalization was associated with increased cannabis use and decreased alcohol use disorder symptoms but wasn’t associated with other maladaptations,” researchers wrote. “These effects were maintained within twin pairs discordant for residence. “Moreover, vulnerabilities to cannabis use were not exacerbated by the legal cannabis environment.”

Access to Legal Market

Zellers and her research team observed 240 pairs of twins where one lives in the legal state of Colorado while the other lives in Minnesota, where cannabis remains prohibited. Now aged 24 to 49, the participants have provided data on their personal use of alcohol, tobacco, cannabis and several illicit drugs, as well as measures of “psychosocial health” since adolescence.

“This co-twin design automatically controls for a wide range of variables, including age, social background, early home life and even genetic inheritance” that can influence health outcomes, said co-researcher John Hewitt, professor of psychology and neuroscience at CU Boulder. “If the association holds up, it provides strong evidence that the environment, in this case legalization, is having an impact.”

“There’s lots of things that could explain why one person is behaving one way or why people of one state behave one way compared to another,” Zellers said. “But with twins, we were able to rule out so many of those alternatives—not everything, but a lot of them.”

The recent study acted as a follow-up to prior research that found an increase in adult cannabis use where states have allowed recreational use. Despite the rise in use, however, the team found no relationship to a spike in cannabis abuse or addiction.

“Obviously the cannabis use increases, but we didn’t see an increase in cannabis-use disorder, which is a little surprising,” Zellers said. “We didn’t really see changes in how much people were drinking or using tobacco. No large personality or workplace or IQ differences or anything like that.”

But while cannabis use increased in legal situations, twins living in such areas were also less likely to drive drunk or develop alcohol use disorders.

“You’re combining drinking with something that could be physically unsafe,” Zellers said. “The residents of legal states do that less, which is interesting and maybe something a little unexpected.”

Disproving the Cannabis Gateway Theory

The findings also reject the gateway drug theory that using marijuana only leads to using stronger substances.

“We asked in the last 12 months have you tried or used heroin, prescription opiates, cocaine, methamphetamine, hallucinogens—kind of the whole 11 or 12 categories of illicit drugs,” Zellers said. “And there’s no difference there. People living in a state with legal cannabis, they’re not necessarily transitioning on to more illicit drugs.”

The results are quite promising but are far from an absolute conclusion. The study does have several limitations, as it focuses on adults, and few of whom consider themselves as heavy users.

“Our sample is an adult community sample broadly characterized by low levels of substance use and psychosocial dysfunction,” the researchers wrote. “This limits our ability to generalize relationships between legalization, outcomes and risk factors for the individuals at greatest risk.”

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10 Ways Most Cannabis Research is False

Most cannabis research is false. A bold statement. So what does it mean? In 2005, Stanford University professor John Ioannidis published the paper “Why Most Published Research Findings Are False.” In it, he argued that most published research findings are false due to a combination of factors such as small sample sizes, inadequate adjustment for multiple comparisons, and conflicts of interest. The paper made quite an uproar in the scientific community. While some criticized Ioannidis for simplifying the problem, most […]

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Study Shows Youth Increasingly Choosing Cannabis Over Alcohol

A study of cannabis use among young people in the US has increased by 245% since 2000 while youth use of alcohol decreased over the same period, according to the results of a study published this week. The study, which was posted online by the peer-reviewed journal Clinical Toxicology, tracked the incidence of misuse and abuse of alcohol, cannabis and other substances by young people reported to the National Poison Data System (NPDS) from 2000 through 2020. An analysis of the data identified 338,000 instances of intentional abuse or misuse of all substances among American children aged 6 to 18 during the period studied by researchers.

More than 80% of the reported ingestions of substances occurred among youth from 13 to 18, with a majority (58.3%) of cases reported among males. More than 32% of instances resulted in “worse than minor clinical outcomes.”

The research shows the changing trends in substance misuse and abuse among young people over time. In 2000, the largest number of alcohol misuse cases was reported, with the total steadily decreasing year over year since then. In contrast, the prevalence of reported cannabis exposure cases remained relatively stable from 2000 to 2009, then steadily increased starting in 2011, with a more dramatic spike in cannabis exposure cases between 2017 and 2020.

“Ethanol abuse cases exceeded the number of marijuana cases every year from 2000 until 2013,” Dr. Adrienne Hughes, one of the authors of the study and an assistant professor of emergency medicine at Oregon Health & Science University, said in a statement.

However, after that point, the apparent relative popularity of the two substances among young people had reversed.

“Since 2014, marijuana exposure cases have exceeded ethanol cases every year, and by a greater amount each year than the prior,” Hughes said.

The research showed that all types of cannabis have become more popular among young people. Marijuana edibles showed the highest monthly increase in use compared to other forms of cannabis, suggesting that many young people are eschewing smoking marijuana and switching to alternative cannabis products. 

“These edible and vaping products are often marketed in ways that are attractive to young people, and they’re considered more discrete and convenient,” Hughes said.

The researcher noted that young people may also perceive alternate forms of cannabis consumption as safer than smoking, but some studies have shown that this perception may not necessarily be accurate.

“Compared to smoking cannabis, which typically results in an immediate high, intoxication from edible forms of marijuana usually takes several hours, which may lead some individuals to consume greater amounts and experience unexpected and unpredictable highs,” said Hughes.

Spike In Cannabis Use Concurrent With Legalization Efforts

The spike in youth cannabis use since 2017 coincided with continuing successful marijuana policy reform efforts across the US. Including the results of the 2022 midterm elections, when Maryland and Missouri voters opted to legalize recreational marijuana, a total of 21 states have legalized adult-use cannabis. The authors believe that while these legalization efforts have been restricted to adults 21 and older, the increased availability of a variety of cannabis products may make it easier for young people to access marijuana and may have contributed to the perception that cannabis is safe.

“Our study describes an upward trend in marijuana abuse exposures among youth, especially those involving edible products,” Hughes says. “These findings highlight an ongoing concern about the impact of rapidly evolving cannabis legalization on this vulnerable population.”

The study also identified high levels of over-the-counter medication abuse among young people. Between 2001 and 2016, the highest number of drug abuse cases related to dextromethorphan, a commonly used over-the-counter cold and cough medicine. Oral antihistamines were also among the most misused substances in the study. Deaths from drug misuse were rare, occurring in only about 450 cases (about 0.1%) identified by the study. Substance misuse deaths were most common among teenagers 16 to 18 and occurred more often among males than females. Deaths from substance use among young people were most common following the use of opioids. 

The researchers also identified 57,488 incidents of substance misuse involving children aged 6 to 12. However, these cases didn’t usually include over-the-counter or illicit drugs but instead involved substances such as vitamins, plants, melatonin, hand sanitizers and others.

In their conclusion, the authors of the study wrote that the data from the NPDS “highlight an ongoing concern about the impact of rapidly evolving cannabis legalization on this vulnerable population.”

Limitations of the research include the data set being restricted to exposure cases classified as abuse or misuse. “It’s possible that additional misuse or abuse cases were classified otherwise and thus were missed,” the authors wrote.

The study states: “Trends in intentional abuse and misuse ingestions in school-aged children and adolescents reported to US poison centers from 2000-20,” was published online by the journal Clinical Toxicology on December 5.

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Does CBD Modulate THC? No, Says Study

Does CBD modulate the effects of THC? No, says a new study. For years, both experience and research have indicated that CBD has a mitigating effect when consumed with THC. For example, budtenders suggest a THC-strain balanced with CBD for new consumers to avoid overwhelming them. When an experienced stoner has eaten an edible or taken some oil and feels too high – they use CBD to take the edge off. But a recent study suggests this is all placebo. […]

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