Cannabis and Chronic Fatigue Syndrome

In November 2005, my dependably robust health took a sudden swerve into the dark unknown. It started with an occasional dizzy spell. I’d be teaching a college writing class when suddenly I’d feel light-headed and woozy. Excusing myself to run to the restroom, I’d take deep breaths and splash cold water on my face.

My crash-and-burn had begun. Soon new scary symptoms were bursting forth every day or so like an evil menace in a sci-fi movie. I had room-spinning vertigo. All-over pain that made turning my head or biting an apple a self-inflicted torture. Rashes sprang up. Veins bulged. My hair fell out in clumps. Chewing or speaking would make my face throb and tingle before it went completely numb. When I did manage to talk, I struggled to find basic words or form a sentence. Lights, noise, and motion were dreaded enemies. I could hardly keep food down. Before long I had shrunk to a sack of bones. I felt as though I was being swallowed alive, my life-force squeezed out of me.

In a few weeks’ time I had morphed from a high functioning writer, professor, and parent into a sobbing lump of misery who could no longer drive a car, read a book, wash a dish, or hold a pen. I was so weak that a routine task — like taking a shower — would flatten me for hours. I spent my time lying motionless in bed, waiting for the day to end. But nightfall brought no respite. Restful sleep had become a distant memory.

“A very challenging disease”

My doctor ordered tests. And more tests. I saw a neurologist, an endocrinologist, an internist, an oral surgeon, several psychiatrists, and three ear-nose-and-throat specialists. I had an MRI and a CAT scan. My blood was analyzed by state-of-the art, high-tech labs. Various possible diagnoses were tossed around: lupus, Lyme Disease, a brain tumor, multiple sclerosis. mitochondrial dysfunction, temporal mandibular joint disorder… One physician tried to convince me that my illness was due to a buildup of wax in my ears, which he promptly removed and charged me $250.

One by one, all of these unfortunate scenarios were ruled out. But I was no closer to understanding what was happening to me – until my doctor uttered those fateful words: “Chronic Fatigue Syndrome.” He pronounced his diagnosis somewhat dubiously, as if he doubted its legitimacy. He may as well have said, “We don’t know what it is or what to do about it, and at the moment there’s no cure.”

According to the Centers for Disease Control (CDC), about 2.5 million people in the United States and 17 million worldwide suffer from myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS). ME/CFS is a serious condition that can cause significant impairment, rendering 75% of sufferers disabled, with 25% homebound and even bedridden. Eighty percent of Americans who meet the criteria for ME/CFS have not been diagnosed. Adding insult to injury, many sufferers are dismissed as addled with a somatic symptom disorder, which basically means, “It’s all in your head,” and prescribed anti-depressants.

“Chronic Fatigue Syndrome is a very challenging disease,” says Robert K. Naviaux, MD, PhD, who directs the Mitochondrial and Metabolic Disease Center at UC San Diego School of Medicine. “It affects multiple systems of the body. Symptoms vary and are common to many other diseases. There is no diagnostic laboratory test. Patients may spend tens of thousands of dollars and years trying to get a correct diagnosis.”

Drugs, desperation, depression

ME/CFS is now recognized as a real disease by World Health Organization, the CDC, and the National Institutes for Health, with working groups at Stanford, Harvard, and elsewhere. But many doctors still are not adequately trained to deal with a chronic condition like ME/CFS. There are no FDA-approved treatments for ME/CFS, and any medications doctors prescribe are off-label and fraught with adverse side effects.

Modafinil, prescribed to combat sleepiness, can cause severe skin rashes and psychiatric events like psychosis, mania, delusions, hallucinations, suicidal ideas, and aggression. Cymbalta, prescribed for pain and depression, is addictive and can trigger severe withdrawal, as well as suicidal thoughts, nerve damage, and weight gain. Vyvanse, an addictive amphetamine, is another problematic choice.

Like many ME/CFS sufferers, I was desperate. I tried pain, sleep, and anti-depressant medications, but nothing helped, and most made me feel worse. After several months on temporary disability, waiting and hoping to get better, I was forced to quit the teaching job I loved.

Though I hadn’t given up on life, I wondered if I should start planning my own funeral.

Taking a chance on cannabis

Due to the lack of effective FDA-approved treatments, many desperate ME/CFS patients resort to self-medicating. I was one of those people. I scoured the internet, dropping serious scratch on all kinds of alternative therapies in hopes of finding something — anything — that could help.

I gave up gluten, sugar, and animal products. I swallowed handfuls of supplements and gallons of a slimy green concoction I called “bug juice.” A highly recommended massage therapist pounded me to a pulp while tsk-tsking that I was “holding on to trauma.” I received weekly acupuncture from a dear old Chinese gentleman who refused my money when it became clear he couldn’t help me.

I’d heard that some people with ME/CFS found cannabis to be helpful. I hadn’t smoked weed in years, and, frankly, getting stoned sounded like the last thing a completely incapacitated person ought to do. But I was willing to try anything. A resident of California, I obtained a prescription for medical marijuana and went to a dispensary, where I bought a thimbleful of Purple Kush, a strain recommended by a young budtender for pain and sleep.

That night I rolled a shaggy THC-rich joint. I nervously took a hit and coughed. Within minutes something shifted. The background noise of paralyzing pain grew quiet, and something close to calm washed over me. I easily floated off to sleep for the first time in more than a year. In the morning I felt different — not cured, but hopeful. I’d finally found something that helped.

Enter CBD

According to ME/CFS researcher Dr. Nancy Klimas, drugs typically prescribed for sleep — like Ambien and Valium derivatives Restoril and Klonopin — can knock you out but won’t lead to the deep, restorative sleep so crucial for those afflicted with ME/CFS patients. Chronic insomnia inhibits the body’s ability to repair daily cellular damage, and this is especially destructive to ME/CFS patients. To fall asleep and stay asleep is a turning point for those who manage to achieve it, and most notice subsequent improvement in their symptoms.

I continued my nightly toke of THC-rich cannabis, and after a few days I was able to get out of bed and totter around. I left the house for short walks, which grew longer over time. My appetite improved, and I started to gain some much-needed weight.

Then a friend told me about CBD, a non-intoxicating cannabinoid, which was still a novelty in California’s medical cannabis community. He thought it might help my condition. CBD-rich cannabis hadn’t yet become available in most medical cannabis dispensaries, but he sourced some flowers with a 2-to-1 CBD-to-THC ratio.

When I added CBD to my cannabis regimen, more symptoms relinquished their stranglehold. The pace was slow but noticeable. I began to read and write again. One night, I went to see my daughter Melati’s theater performance, the first evening I’d been out in a year. Abundant, grateful tears fell as I watched her onstage. With the help of homegrown CBD-rich cannabis, I was coming back to life.

Biomarker breakthrough

How is it possible that cannabis could help my chronic fatigue when prescription medications couldn’t touch it, or did more harm than good? The answer might lie in new research that aims to explain what underlies the disease.

Until recently, one of the major challenges has been the lack of a clear biomarker — a measurable biological indicator of a disease’s existence — for ME/CFS. But soon there may be a reliable way to test for this disorder.

A 2016 study published in the Proceedings of National Academy of Sciences identified a “characteristic chemical signature” in ME/CFS sufferers, with an underlying biology similar to the state of dauer. “Dauer, like hibernation,” the study explains, “is a means of preserving survival by severely curtailing functions of ordinary life such as energy, digestion and movement.”

Mark Davis, an immunologist at Stanford University, has made some interesting discoveries with T cells, a type of lymphocyte that plays a major role in the immune system. T cell overactivation was found in the blood of ME/CFS patients, similar to what’s found in immunological cases like cancer, multiple sclerosis or infections. A 2015 paper by German scientists reported a marked increase in specific antibodies of chronic fatigue patients. And more evidence of a hyper-inflammatory response was presented in a 2017 study by Davis and Jose Montoya, showing elevated cytokines.

“There’s been a great deal of controversy and confusion surrounding ME/CFS – even whether it is an actual disease,” Davis says. “Our findings show clearly that it’s an inflammatory disease and provide a solid basis for a diagnostic blood test.”

Immune overdrive

With chronic fatigue, the immune system, spurred by who knows what, goes into full aberrant fight mode, activating a hyper-inflammatory response and setting off a carnival of nightmarish symptoms. A 2015 article in Science Advances reported heightened immune activity in ME/CFS patients during the early phase of the disease that was “consistent with a viral trigger or disrupted immune regulatory networks.” But in later stages of the disease, the levels of immune disturbance were much lower. It appears that whatever immunological threat initially triggered the disease could have been resolved – and yet the body continued its inflammatory, foe-fighting stance.

Why would the body keep shadow-boxing against an opponent that’s not really there? Robert Naviaux at UC San Diego explores this question in a beautifully-written article about his work on ME/CFS, mitochondria and “cell danger response” (CDR) — a term describing the body’s cellular metabolic response to chemical, physical and biological threats. Naviaux found that in ME/CFS patients, the CDR persists abnormally: “Whole body metabolism and the gut microbiome are disturbed, the collective performance of multiple organ systems is impaired, behavior is changed, and chronic disease results.”

In ME/CFS patients, inflammation and pain are like conjoined demon twins. When the body responds to a perceived threat, it sends out legions of chemicals into the blood and tissues to beat back foreign invaders. When functioning normally, this inflammatory response is an important, life-saving mechanism, but in ME/CFS sufferers it’s driving pedal-to-the-metal, with severe pain and other symptoms as a consequence.

Given that a runaway immune response and marked inflammation are major players in ME/CFS, it makes sense that both CBD and THC, two potent anti-inflammatory compounds, could be profoundly therapeutic. Anecdotal evidence bears this out. Do a search in any ME/CFS social media support group, and you’ll find accounts from people who have successfully used cannabis and hemp-derived CBD to improve their symptoms.

Anti-inflammatory cannabis

There are many published reports demonstrating the effects of cannabis on inflammation. A 2010 study in Future Medicinal Chemistry indicated that several cannabinoids were found to calm the inflammatory response through multiple pathways, which led to a reduction of associated symptoms. A subsequent report by scientists at the University of South Carolina disclosed that a combination of THC and CBD suppressed neuroinflammation (swelling of the brain) in patients with MS. The same neuroinflammatory symptoms have been observed in brain areas of ME/CFS patients with cognitive impairment and severe neuropsychological problems. Thus it’s reasonable to consider that cannabis could also be efficacious for treating neuroinflammation in ME/CFS.

CBD might also help to alleviate the difficult mood problems that ME/CFS sufferers experience. Brazilian scientists reported that CBD has “acute anxiolytic and antidepressant-like effects” and “therapeutic potential over a wide range of non-psychiatric and psychiatric disorders such as anxiety, depression and psychosis.” This assessment concurs with anecdotal accounts from people using CBD products that are widely available in state-licensed cannabis storefronts and elsewhere via unregulated sources.

There are many claims about CBD’s utility as a sleep aide, but the science is less clear. Several animal studies and some human studies suggest that CBD’s anxiety-relieving properties may help to improve sleep onset and quality. In one study, the administration of a generous dose of CBD (160 mg/day) increased total sleep time and decreased the number of arousals during the night. But low-dose CBD has been associated with increased wakefulness, underscoring CBD’s biphasic, dose-dependent effect.

Cannabis has been shown to be helpful for sleep – with some caveats. In a 2017 literature review pertaining to “cannabis, cannabinoids, and sleep,” THC was found to help patients fall asleep. But THC can also cause daytime drowsiness, and tolerance to THC can develop, rendering it less effective. The review notes that THC combined with CBD in a 1:1 ratio has been associated with sleep improvements among patients with chronic pain conditions. The synergistic interplay of plant cannabinoids can mitigate pain as well as insomnia, while reducing THC’s intoxicating effects.

A lifelong balancing act

If we blend what we know about the pathophysiology of ME/CFS with our current understanding of cannabis therapeutics, one overarching theme emerges: ME/CFS is a disease of total body disequilibrium, and cannabis is a biological equalizer with the potential to treat several symptoms simultaneously.

THC, CBD, and other cannabis components confer therapeutic effects by interacting with what scientists refer to as the “endocannabinoid system.” A principal function of this system is to maintain homeostasis, a state of dynamic equilibrium that keeps everything running smoothly. People with ME/CFS are the living antithesis of homeostasis, their biological processes have gone completely bonkers.

I know this all too well because I’ve been there. It’s been almost fifteen years since I was taken down by a mystery illness. These days I am functioning at about 80 percent of my biological capacity – and that feels like remission to me. I manage my health by eating a mostly plant-based diet, exercise, stress reduction, some supplements, and daily dosing with a CBD-rich tincture, with occasional THC-rich cannabis at night.

I won’t claim that cannabis completely cured my ME/CFS, but I will say that, as part of a broader healing protocol, it has helped immensely.

For more information on ME/CFS, including how to treat it with cannabis:
Health Rising: Finding Answers for ME/CFS and FM


Melinda Misuraca is a Project CBD contributing writer with a past life as an old-school cannabis farmer specializing in CBD-rich cultivars. Her articles have appeared in High Times, Alternet, and several other publications.


Copyright, Project CBD. May not be reprinted without permission.

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CBD research trends in 2019

Recent developments in how CBD (cannabidiol) is regulated in the US have made it much easier to purchase CBD products. Changes to how the federal government views CBD are also making it easier for scientists to conduct CBD research and understand how this cannabinoid interacts with the human body.

CBD isn’t just easier to research at the federal level–agencies like the FDA are paying attention and issuing warnings to help educate consumers, while the National Institutes of Health issued $3 million in grants to research teams looking to study CBD’s pain-relieving properties. And in states where cannabis is legal, state university systems are creating new think tanks and assembling research teams to collaborate on a new generation of cannabis research.

While CBD has demonstrated the potential to help address a wide variety of conditions and symptoms, many questions remain, including what conditions CBD has the most potential to treat, what proper doses might look like, and precisely how CBD brings about the effects it does.

Here are some of the major questions researchers around the world are asking about CBD, and a look at some of the early answers they’re finding.

What CBD research says about epilepsy treatments

We have a pretty good general understanding of the neuroreceptors that CBD interacts with in the body. We also know that CBD and drugs derived from it are effective in treating some forms of epilepsy, including Dravet’s Syndrome and Lennox-Gastaut Syndrome.

What we don’t understand is exactly why CBD helps epilepsy patients. With CBD easier to study–and CBD-based drugs entering the market–researchers are digging further into the molecular mechanisms responsible for CBD’s apparent seizure-reducing properties.

Differentiating CBD and THC

Increasingly, studies on cannabis are shifting focus away from studying effects of the whole plant and toward more focused studies on individual cannabinoids. This research is helping scientists learn more about how cannabinoids act in isolation, how different cannabinoids–for instance THC and CBD–behave in the brain, and more.

CBD research under review

Many studies on the impact of CBD and cannabis in general employ pretty small sample sizes, which limits the data researchers can gather and the conclusions they can draw from it. As the volume of these studies grows, though, researchers are employing that data to conduct review studies on the effects and efficacy of cannabis and its components, including CBD.

Rather than conducting a new experiment, review studies collate and compare the results of previously published, peer-reviewed studies. This allows authors to work with what is effectively a larger data set and more confidently answer questions about the subject.

2019 saw these studies become more common in the cannabis space with review studies aiming to shed light on the efficacy of cannabis–and specific cannabinoids like CBD–in treating pain, as well as the potential negative side effects of CBD.

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CBD to the Rescue

Project CBD received this testimionial from a Canadian medical cannabis patient:

In 2008, I seized up while taking several different medications – in large part due to mineral losses associated with the excess administration of cortisone acetate, an adrenal steroid hormone. This drug was administered as part of an adrenal hormone replacement project in conjunction with several other medications. I’ve spent the last 10 years fighting the life-threatening consequences of that bad reaction.

The seizure left me feeling traumatized psychologically and physically. Muscles around my ears ended up pinching nerves; there was asymmetry of my neck and a slight rotational pressure on my brain stem; and I developed severe refractory lockjaw — any movement of my jaw, be it from eating, chewing or grinding, resulted in intense pain in my neck. The pain was horrendous, persistent, and fluctuated wildly.

None of the medications I was prescribed did anything to touch the pain.

I tried a variety of non-narcotic pain relievers, including anticonvulsants and antispasmodics. I started with Gabapentin in 2009, and quickly stopped when I developed life-threatening rage, depression and suicidal ideation. Then I took Tylenol and Arthrotec for eight years, but these drugs also failed to keep the pain away and my mental health issues took a serious turn for the worse. Things got so bad that I overdosed on two of the painkillers out of anger and despair over their inefficiency.

The reason that these medications did not work isn’t obvious to me, though I suspect it may have something to do with a dietary deficiency of potassium, which is depleted by chronic use of non-narcotic pain relievers. Still, I think that most non-cannabinoid medications are just toying with the body and actually make things worse by not addressing the underlying problems.

For almost ten years, I had a persistent spasm of the neck (torticollis) that would not go away until I started to use a combination of cannabis products. I think that cannabinoid molecules – tetrahydrocannabinol (THC) as well as cannabidiol (CBD) – helped immensely by inhibiting nerve responses, which I believe played a role in my torticollis.

To finally get my jaw to release and to relieve pressure on the nerves and muscles in my neck, I used a combination of smokable cannabis and CBD-rich oils. Throughout the day, I took 5mg each of THC and CBD in a 1:1 oil in lots of divided doses, and it finally got me to a place where now I can say I am pain-free. It has allowed me to move forward and function in a way I had not seen for years.

I am not sure if I am 100% cured, but I will say I am 90% on the way to not thinking about it. It has been a very long and difficult journey, but I am hopeful that I can make additional strides towards employment and financial independence.

Cannabinoids saved my sanity and my quality of life.

Thank you for listening to my story and for the work that you do.

Dennis Sloane, age 38, is a graduate of the University of Manitoba.

Copyright, Project CBD. May not be reprinted without permission.

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New study finds cannabis effective for treating migraines

Health

December 5, 2019

A new study found that Canadian medical cannabis users reduced pain severity and length of migraine episodes by smoking cannabis or cannabis concentrate. (Betelgejze/iStock)

A study published last month in the Journal of Pain found a statistically significant reduction in migraine and headache symptoms and recurrences among patients who used cannabis for treatment.

Researchers concluded that headache and migraine severity were reduced by nearly 50% after using cannabis.

The study, conducted by researchers at Washington State University, sampled the effects of smoking cannabis or cannabis concentrates on migraines and headaches among 1,959 anonymous adult participants over 16 months.

The results were extremely encouraging for patients looking for relief. They’re also surprising–and offer a taste of how incomplete current medical research into cannabis is.

The study data indicated that after using medical cannabis, “severe headache episodes are associated with greater reductions in headache severity,” which means that those suffering the most pain achieved the most relief. This is important, as the most severe episodes can be nearly impossible to treat with standard prescription pain medication. The new study indicates that cannabis may actually take the edge off, even in the toughest cases.

The study revealed some surprising results, too.

The authors found that cannabis’ effectiveness wasn’t dependent on the cannabis strain, ratio of THC:CBD, or dosage. “Results indicate that cannabis reduces migraine severity regardless of the type, dose, THC or CBD content,” they wrote. That could indicate that factors other than cannabinoid ratio and concentration are at play.

Perhaps even more strangely: While patients smoking cannabis flower found they needed higher doses over time to achieve the same results, patients smoking cannabis concentrate found their necessary effective dosage actually decreased over time.

To explain this, the authors point to “evidence that other phytocannabinoids and terpenes present in cannabis flower are reduced in some concentrates,” and suggest that the absence of these compounds in concentrates prevents them from blocking the effects of migraine-targeting cannabinoids from supplemental ingested cannabis.

In other words: The difference in effect between smoking flower and concentrate might not be due to users developing dosage tolerance, “but rather a differential ‘dialing in’ process between those who use flower and those who use concentrates.”

The study framework is a factor worth considering, too. It remains extremely difficult to obtain permission (and the actual cannabis) to carry out clinical research on cannabis use in the United States. For this study, researchers at Washington State University obtained anonymous data from 1,959 Canadian medical cannabis patients who used the app Strainprint.

Strainprint allows individuals to track their personal cannabis dosage, consumption, and effects against symptoms. Limiting the study to Canadian patients allowed researchers a greater degree of certainty with regard to cannabis strains and potencies, as producers licensed by Health Canada are held to a much higher degree of quality control than most US states.

Because the data came from Strainprint, patients had already self-selected for medical cannabis use. There were no control subjects using a placebo, and patients who found cannabis did not reduce their migraine symptoms might have taken themselves out of the data pool by discontinuing cannabis use, not entering data into Strainprint, or choosing not to download the app at all.

Because virtually no research exists on the medical effects of cannabis concentrates, the authors note that their finding is “entirely novel,” and express the urgency for further research in this area.

To summarize the study’s findings:

  • Canadian medical cannabis patients found that cannabis did lessen the severity and length of migraines and headaches.
  • Smoked cannabis concentrate had a stronger effect on migraine alleviation than smoked flower.
  • THC:CBD ratio and strain didn’t seem to matter with regard to effectiveness.
  • For patients smoking flower, higher doses were required over time to maintain the same level of pain relief.
  • Patients who smoked concentrates required lower doses over time to maintain the same level of pain relief
  • No risk for overdose was detected.
  • Study data suggested that terpene profiles and lesser-known cannabinoids play a role in preventing and managing symptoms, and that “dialing in” those compounds could achieve more targeted medical results.

Humans have been using cannabis for pain relief for thousands of years, but only recently have research scientists specifically investigated its efficacy for migraines. Preliminary research from 2004 confirmed that the body’s endocannabinoid system “has numerous relationships” to migraines. A 2014 animal study offered further support for the therapeutic potential of supplementing the endocannabinoid system with cannabis to treat migraines. Patients suffering from migraines have been found to have deficiencies in anandamide, a primary endocannabinoid (ie, cannabinoids made by the human body) which serves, among other functions, to block the triggers that cause migraines. Researchers working with rats found that supplementing the animals’ anandamide deficiencies with cannabinoids reduced migraine symptoms.

Researchers have also noted that cannabis is also a known neuro relaxant, vasodilator (a substance that widens blood vessels), and anti-inflammatory agent. Those abilities, together, address the most critical aspects of both the onset and symptoms of migraines.

Although the new Journal of Pain study was limited to smoked cannabis and cannabis concentrate, and was lacking in some of the formal controls of a clinical environment, it represents the largest and most recent study of its kind to date. Its findings are encouraging for cannabis’ use in treating migraines, as well as the potential for endocannabinoid system therapies in general.

More notably, despite the new study’s relatively small size and limitations, it presents some new and fascinating discoveries which beg to be explored.

(2019) Journal of Pain: Short- and long-term effects of cannabis on headache and migraine

(2018) Frontiers in Neuroscience: Link between endocannabinoid disregulation and migraines and headaches–specifically low levels of anandamide

(2017) Cannabis and Cannabinoid Research: Cannabis for migraines in history, and summary of existing clinical research

(2014) Journal of Headache and Pain: Rat study examining effects of stimulating CB2 receptors with AEA for migraines

(2004) Neuro Endocrinology Letters: Early research into endocannabinoid system deficiencies, as they relate to migraines, fibromyalgia, and IBS

headachesmedical cannabismigrainespain reliefstudies

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It’s Never Too Late to Start Using Medical Cannabis

In what has become an annual autumn networking ritual, the International Association for Cannabinoid Medicines (IACM) hosted a three-day conference (October 31 – November 2) in Berlin. Cannabis geriatrics and age-related pathologies were major topics at this year’s gathering of preeminent scientists, physicians, educators, and business representatives.

Is cannabis safe for seniors?

Seniors are currently the fastest-growing demographic of cannabis users worldwide, but is cannabis safe for the elderly? What might be the benefits?

These questions were addressed by Israeli researchers who examined clinically supervised cannabis use among the elderly. Dr. Ilya Reznik discussed the findings of a prospective observational study, which involved 184 elderly patients at a geriatric clinic in Israel. Eighty-three percent of the patients were 75 years or older.1234

The study entailed a comprehensive examination of each patient at the outset of cannabis therapy, plus a follow-up evaluation six months later. None of the participants enrolled in the study had any previous experience with cannabis. Most suffered from chronic pain (77%) and other age-related conditions, such as sleep disturbances, cancer-related symptoms, mood disorders, and Parkinson’s Disease. ?

The majority of the subjects (66%) utilized cannabis oil sublingually as the sole method of administration, and half of them took three doses daily.

The investigators sought to assess the efficacy of cannabis and the frequency and risk of adverse cognitive and cardiovascular effects, as well as postural instability and other problems. For the most part, side effects were relatively mild, affecting one third of the seniors enrolled in the study; these included dizziness (12%), sleepiness (11%), and dryness of the mouth.

Most significantly, the six-month follow-up appraisal revealed that one-third of the cannabis patients were able to discontinue opioids, as well as other pharmaceutical painkillers and anti-inflammatory drugs.

Medical cannabis protocol for seniors

In his presentation, Dr. Addie Ron, an Israeli geriatric specialist and colleague of Dr. Resnick, shared details of the medical cannabis protocol that their team successfully designed and implemented at the Soroka University Research Institute and Clinic, which sponsored the prospective observational study of elderly patients.

The first step prior to commencing cannabis-based therapy involved a case-by-case, risk-benefit analysis of older adult participants. A cautious approach was recommended due to polypharmacy, nervous system impairment, potential cardiovascular risk, and pharmacokinetic variables.

In keeping with the principle “Primum non nocere” or “do no harm,” the typical protocol required a start-low, go-slow approach to dosing cannabis – with a 5mg increase every 7 days until reaching the desired effects. Specifically, this is how patients were told to titrate their cannabis medicine:

  • Day 1-3: 5mg THC + 5mg CBD
  • Day 4-6: 10mg THC + 10mg CBD
  • Day 7-14: 15mg THC + 15mg CBD

Each patient’s progress was closely monitored for side effects and efficacy; when the desired effect was achieved, the dosage stabilized with no need for further increase.

Most patients chose to consume cannabis oil via sublingual administration – with positive results for all involved. With respect to THC (with CBD), the prospective observational study found that a low, nonintoxicating dose, comprising between 0.75 mg and 1.5 mg of THC twice daily, was well tolerated and resulted in better functioning, increased body weight, improvement in cognition, decreased constipation, and improved mobility.4

Cannabis and Alzheimer’s

With 35 million people diagnosed with Alzheimer’s worldwide, there is an urgent, unmet need for innovative approaches to treating this degenerative neurological illness. Can cannabis help someone suffering from dementia?

Dr. Javier Fernandez-Ruiz and a group of researchers at Complutense University in Madrid, Spain, are probing the role of the endocannabinoid system in Alzheimer’s Disease (AD). At IACM, Fernandez-Ruiz presented research showing that cannabinoid receptors – which are instrumental in the preservation, rescue, and/or replacement of neural cells in a healthy brain – become dysregulated during AD neurodegeneration. 5

Certain prescription meds, such as Donepezil, work by inhibiting an enzyme known as acetylcholinesterase, which breaks down acetylcholine, a key neurotransmitter involved in memory and cognition. Scientists have learned that cannabinoids – in particular, THC – act in a similar way as they also inhibit acetylcholinesterase. Moreover, cannabinoids can confer other possible benefits, as well, such as increased appetite, weight gain, and decreased anxiety and aggression.6

Another team of Israeli scientists, in collaboration with Tikkun Olam, a medical cannabis producer, conducted a phase II randomized, double-blind, placebo controlled study to determine the safety and efficacy of whole plant CBD-rich oil for treating Alzheimer’s-related agitation, one of the most common symptoms in patients with severe dementia. 6

64 patients, average age 79, were enrolled in this clinical trial, which lasted 16 weeks (6 weeks titration and 10 weeks of assessments during stable dosage). Weekly medical examinations focused on the following:

  • Vital signs
  • Temperature
  • Physical examination
  • Blood pressure
  • Pulse
  • Height/weight
  • Behavioral disorders (based on the Cohen-Mansfield Agitation Inventory)
  • Neuropsychiatric inventory
  • Clinical Global Impression Severity /agitation-aggression
  • Mini-Mental State Examination
  • Mood (based on GDS questionnaire)
  • Safety tests
  • Concomitant medications
  • Adverse events?

?By the end of this study, which found no significant adverse effects, 72% of patients treated with CBD-rich oil (compared to 30% of the placebo group) achieved relief from dementia-induced agitation. The authors concluded that CBD-rich oil is a safe treatment that can reduce agitation and other adverse behavioral symptoms in patients with dementia.

Conclusion

The research and clinical experiences reported at IACM 2019 confirm the strong safety profile of cannabis-based medication for the senior population, especially when THC levels are balanced by high levels of CBD and the remedies are administered sublingually. Scientists and doctors have also observed promising results with cannabis therapy that may help to improve the quality of life of older adults by mitigating normal as well as pathological age-related decline. For senior citizens that means improvement in cognition and mobility, increased body weight, decreased constipation, and better overall functioning.


Viola Brugnatelli, a Project CBD contributing writer, is the science director of cannabiscienza.it and a lecturer on cannabis therapeutics at the University of Padua, Italy.


Project CBD is a U.S. ambassador for IACM, which publishes a weekly summary of medical science reports on cannabis therapeutics in several languages.


Copyright, Project CBD. May not be reprinted without permission.

References

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Hemp-Derived CBD Helps Chronic Pain Patients Reduce Opioid Use, Study Finds

Chronic pain patients consuming hemp-derived cannabidiol, or CBD, on a daily basis for eight weeks reported a decrease in the opioid medications they needed, a new study reports.

“This is a prospective, single-arm cohort study for the potential role of cannabinoids as an alternative for opioids,” the paper states. “The results indicate that using the CBD-rich extract enabled our patients to reduce or eliminate opioids with significant improvement in their quality of life indices.”

The study, published this month in Postgraduate Medicine, sheds new light on the potential benefits of CBD extracted from hemp, a crop that became federally legal under the 2018 Farm Bill, although the Food and Drug Administration has yet to issue finalized guidelines that would allow CBD to be sold in dietary supplements and food products.

Researchers recruited 131 patients who obtain their care from the same pain clinic; 97 completed the eight-week follow-up period. All had been diagnosed with chronic pain and were taking opioid medications for relief.

For the study, participants were given a 60-count bottle of hemp-derived, CBD-rich soft gels. Each gel, according to the study, contained 15.7 mg CBD, 0.5 mg THC, 0.3 mg cannabidivarin, 0.9 mg cannabidiolic acid, 0.8 mg cannabichrome, and less than 1 percent of a botanical terpene blend. Nearly all (91) took two gel caps a day, totaling 30 mg of CBD; three participants opted not to use the hemp extract at all.

“CBD could significantly reduce opioid use and improve chronic pain and sleep quality among patients who are currently using opioids for pain management.”

Researchers asked participants to complete a series of questionnaires to access various factors at the onset of the study, at the four-week mark and at the eight-week point. Among them: their pain intensity level, how much their pain disrupted their lives, the quality of their sleep and how willing they were to cut back on opioids.

Of the total 94 participants who took CBD regularly, 50 reported they were able to reduce opioid medications at week 8. The authors also note: “Additional reductions in polypharmacy on the medication receipt were noted; six participants reported reducing or eliminating their anxiety medications, and four participants reported reducing or eliminating their sleep medication.”

Overall, 89 participants reported their quality of life had improved over the study period. Two measures changed significantly: patients’ self-rating of sleep quality and pain intensity and interference.

At baseline, the study’s authors calculated respondents’ scores regarding sleep quality to an average of 12.09–the higher the score, the poorer the quality of sleep. At the four-week and eight-week check-in points, the score decreased to 10.7 and 10.3, respectively. Similarly, another scale the authors used to measure pain and how it interferes with the enjoyment of life found the mean score value change from 6.5 at baseline to 5.9 at week 4 and 5.7 at week 8.

“The results of this study suggest that using CBD-rich hemp extract oil may help reduce opioid use and improve quality of life, specifically in regards to pain and sleep, among chronic pain patients,” the study concludes. “This is consistent with emerging literature on the topic, which has concluded that CBD is an effective analgesic, and one that helps reduce barriers to opioid reduction, such as physiological withdrawal symptoms.”

In an interview with Appalachian News Express, the study’s lead author Alex Capano said that outside of survey studies, her research is “the largest study on the use of CBD to reduce the use of opioids in the treatment of chronic pain.”

“It’s also the first study on CBD and opioid reduction to identify key data points, such as hemp extract doses, delivery method, and specific cannabinoid content,” she continued. “Most participants used a relatively low dose of 30mg of CBD per day, whereas other studies on CBD have tested very large doses, 10x or 20x that amount. Lower doses of CBD mean reduced risk of side effects and improved outcomes.”

Americans Are Googling CBD More Than Acupuncture, Meditation And Exercise, Study Finds

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Cannabis topicals and your pet

With medical cannabis research unveiling exciting solutions for so many human health conditions, it’s not a stretch to imagine similar benefits could apply to an ailing pet.

In fact, cannabis therapy actually does appear positive for animals, according to Dr. Sarah Silcox, an Ajax, ON-based veterinarian and president of the Canadian Association of Veterinary Cannabinoid Medicine (CAVCM).

The problem is, prescribing cannabis for pets isn’t legal in Canada (yet).

“While many veterinarians are supportive of using cannabis as part of the total treatment plan, many people don’t realize that legally, veterinarians cannot authorize (prescribe) medical cannabis. And this puts them in a very difficult spot,” says Silcox.

Surprised? Well, dogs just aren’t the litigious type: legal pressure by human patients put the original medical cannabis regulations into effect. Then, when the Cannabis Act came along, Silcox explains existing medical regulations were simply rolled into the new cannabis regulations, “without consideration of our animal friends.” To date, there is no legal framework for animal care providers until the Cannabis Act is reviewed again in 2022.

While vets cannot prescribe cannabis, many are open to advising on treatment options you could independently provide for your pet. Just don’t play Doc McStuffins on your own: Silcox warns administering cannabis without some guidance can pose serious adverse effects and potential drug interactions–even pure CBD.

Here, she plays out a few scenarios:

Not really. “The biggest concern surrounds the risk of your pet licking the cream off,” she explains. Not only will fur likely get in the way (wasting your product), when your pet licks or grooms the area they risk ingesting something meant to be used externally. It’s not just the THC, other cannabinoids or terpenes she worries about, but potential effects from other compounds found inside the topical. If you have a topical that you think could help your pet feel better, bring it in to your vet for advice.

Again, it’s about the side effects and possible drug interactions that pose a risk. However, this is not to say you can’t discuss CBD with your vet. While Silcox says there aren’t published studies on CBD for treating cats specifically, she says they do appear to tolerate CBD well. Talking to your vet will ensure the product you’re using is safe and that the dose is appropriate. “Your veterinarian may also want to do some testing to ensure there are no underlying physical causes to your pet’s behaviour changes,” she adds.

Maybe. Seizures, along with chronic pain, age-related changes, sleep disturbances, and cancer are the most common reasons people request cannabis therapy for their pets, according to Silcox. Again, while they can’t yet prescribe, veterinarians can discuss cannabis therapy as an option and help monitor the outcome.

“In this emerging area of medicine, documentation is important for many reasons. We want to track any unexpected effects, document your pet’s response to treatment, and learn from each case in the hopes that it will help other patients that follow.”

She says cannabis remains a viable option for treating pets, especially when other available treatments are not effective. This is why the CAVCM and the Canadian Veterinary Medical Association (CVMA) have been advocating to change current regulations.

Whether it’s a ripped dewclaw, sore joints, or something more serious, work with your vet to find the right cannabis therapy for your furry loved one. And if it’s important enough, Silcox encourages you to let your MP know you support changes to the Cannabis Act allowing veterinarians to authorize medical cannabis.

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We tried ‘CBD-infused clothes’ to see if they did anything

Strains & products

November 5, 2019

(Courtesy of Nufabrx)

I came here to talk shit, and I’m honestly sad that I won’t be able to. Because the Nufabrx CBD-infused (and capsaicin-infused) compression elbow and knee sleeves have not wronged me. In fact, using them has been a positive experience, one that may benefit others as well. *Deep sigh.*

The CBD craze has rendered many a trash product in its time (a company once sent us CBD toothpick samples and I almost went home for the day). So when the thought of CBD-infused clothing accessories came across my company-issued Gmail account, I figured we’d reached the newest level of “let’s cash in on cannabis with BS products that help no one.”

(Courtesy of Nufabrx)

The Nufabrx medicated compression and knee sleeves are suggested for the use of “temporary pain relief of minor aches and pains or muscles and joints associated with simple backache, arthritis, strains, bruises and sprains.” So to test the product, I figured ya boy needed to get active.

I woke up at 5 a.m., like I always do, and hit the gymy gym for a lil’ chest-day-plus-stairmaster-and-jump-rope action. I needed something that would apply pressure to the elbow and knee regions.

Usually, towards the end of my 30 minutes on Level 10 of the Fat Burner stairmaster circuit, my left knee feels a little sore. And because of the triceps engagement, chest day usually hurts my elbow a bit, too. (What I’m telling you is aging sucks, and I can’t wait to replace my human body with all kinds of fiber optics and beep-boop-beeps.)

Surprisingly, after a full hour and change of sweat equity, I had no pain in any region touched by my Nufabrx sleeves. In fact, my ‘bow and knee felt very loosey goosey in a way that many of the sleeves during my basketball years could not provide. But is the experience catalyzed by CBD? And what the hell is capsaicin, anyway?

Active ingredients include synthetic capsaicin, while inactive ingredients include acrylate copolymer and hemp. According to Jordan Schindler, CEO and founder of Nufabrx, the CBD is implemented into the sleeves during production of the yarn.

“We do everything at the yarn stage,” he tells me. “So that allows us to get 3-dimensional relief [from] the ingredient. Versus at the fabric [stage], you can’t control the dose, and it typically washes out very quickly. We treat base yarn, and then that’s knitted into end garments.”

Schindler goes on to tell us that there’s at least 150mg of CBD in each product, depending on the size of the product, as the CBD is implemented on a milligram-per-square-inch basis. The reason CBD/hemp is not listed as an active ingredient under Drug Facts is because it’s not considered a drug by the FDA.

“The ‘Drug Facts’ label is a requirement for a drug product,” Schindler says. “Capsaicin is a pain reliever and it falls under the monograph,” he says when asked why cannabidiol is not listed under Drug Facts.

So yeah, there was hemp extract used in production at one point, but it’s hard to say how much it’s influencing the loosey goosey-ness of my joints. Capsaicin is more likely the main pain reliever here.

According to WebMD, capsaicin is the stuff in chili peppers that makes your mouth feel hot. It’s the primary ingredient in many creams and patches meant to relieve joint pain, muscle sprains, and even migraines. This explains the tingly feeling under the sleeved areas. It also explains why the product limits use to a max of 8 hours per day, 4 days per week.

So, in the end, do “CBD-infused clothes” do anything? The truth is we don’t know, and the Nufabrx CBD and capsaicin medicated compression sleeves don’t exactly help us answer the question. Ultimately, this feels like another product being marketed with CBD, although the true nature of its effects likely derive from other chemicals. But until cannabis comes under FDA regulation, we’ll never be able to really hold companies to any true show-me-what-you’re-made-of standards.

Again, *deep sigh.*

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Suck or chew? With cannabis edibles, method matters

When it comes to edibles, there are different ways to dose, and we’re not talking about cookies versus brownies. Edible cannabis products can be consumed orally, meaning they are swallowed, or sublingually, meaning they are held under the tongue to be absorbed directly into the bloodstream.

Typically, food products containing cannabis are intended for oral dosing, while sprays, tinctures, and oils may be used sublingually or orally. Some companies are even producing purpose-built sublingual cannabis strips.

The method of delivery can affect the onset, duration, and intensity of the effects of cannabis. Sublingual dosing offers a fast onset, shorter duration, and lower intensity than traditional oral cannabis edibles, while also offering a discreet, smokeless experience.

Sublingual administration is a method of delivery for many common pharmaceuticals. One of the most well known of these is Ativan, a fast-acting benzodiazepine used to treat acute anxiety. Sublingual administration involves holding the active substance under the tongue for a certain amount of time, usually until the tablet or strip dissolves. Another related drug delivery method is buccal administration, where the active substance is held against the cheek.

The area under the tongue (and the cheeks) can absorb various active substances into the bloodstream. This is similar to inhalation methods, which allow the active compounds to enter the bloodstream through the lungs. This is why sublingual delivery is fast-acting. Importantly, the substance has to be held under the tongue–not on it–and for long enough for its active compounds to dissolve into the bloodstream.

When dosing cannabis sublingually, people usually use products intended for this route of administration, such as sprays, tinctures, oils, or sublingual strips. You could try holding a chewed up cookie under your tongue, but results may vary.

The pharmaceutical cannabinoid medicine Sativex is delivered sublingually via spray. Sprays, tinctures, and oils may also be absorbed orally if they are swallowed. Some people like to hold a product under the tongue and then swallow it for maximal effect.

Traditional cannabis edibles–foods and drinks infused with cannabinoids–are usually consumed and processed orally. This means that a person swallows the cannabinoids, which are then absorbed in the intestine and processed by the liver.

Many people report edible cannabis to be a more intense experience than inhalation. Researchers believe this is because when THC is eaten, it is converted into 11-hydroxy THC, which is “particularly effective in crossing the blood-brain barrier, resulting in a more intense high.” A 2016 review on cannabis edibles calls 11-hydroxy-THC “a potent psychoactive metabolite,” especially compared with delta-9-THC, the converted form of THC that cannabis consumers experience by smoking, vaping, or sublingual absorption.

“11-OH-THC is more potent than ?9-THC and appears in blood in higher quantities when ?9-THC is ingested than when it is inhaled; hence, it may be responsible for the stronger and longer-lasting drug effect of edibles vis-a-vis comparable doses of smoked cannabis,” the review explains.

For some, 11-hydroxy-THC offers a way to stretch the effects of cannabis without having to consume more. For others, the effects might be too intense and undesirable.

Orally-consumed edibles take a while to kick in, because they have to be digested and processed in the gastrointestinal system before entering the bloodstream. If you’ve just had a large meal, it may take even longer for the cannabinoids to begin to affect you. This might mean up to 90 minutes before an edible starts to work, and even longer before it reaches peak effect.

The effects of edibles are also known to last longer than the effects of inhalation methods, and the same is true when compared to sublingual administration.

Sublingual administration is a convenient, discreet, fast-acting, and smokeless option for both recreational and medical cannabinoid use. Sublingual administration might appeal to someone who is looking for an alternative to edibles that is less intense, shorter, and that kicks in faster.

There are, of course, some downsides to sublingual administration. Consuming cannabis sublingually means a person must purchase specialized products designed for this method of administration, like sprays, tinctures, oils, or sublingual strips. The consumer must also hold the substance under the tongue for a certain amount of time, which may be uncomfortable if they dislike its taste.

In the end, traditional oral cannabis edibles are simpler to consume. But for those who want a smokeless option while avoiding a potentially intense and long-lasting high, or those who need something fast acting, sublingual administration might tick all the boxes.

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The science on cannabis topicals for headaches

If peppermint oil rubbed onto the forehead, neck or temples can provide headache relief, couldn’t a cannabis topical go the extra mile and dissolve the pain altogether?

For now, the health community says no, mainly because we’re missing human clinical trials to say whether cannabis applied to the skin is effective at all for headaches and migraines. But that’s not to say anecdotal data has been a dead end–in fact, just the opposite. A 2017 report amassed a large body of preliminary studies, concluding that we have enough evidence to start clinical trials on cannabis headache treatments. The report even made it a point to say that “cannabis is commonly used to self-medicate for headache disorders”.

Dr. Stefan Kuprowsky, a Vancouver-based naturopathic doctor specializing in ethnomedicine and ethnopharmacology, agrees the theory of topical cannabis relief for headaches is sound, especially given cannabis’s known anti-inflammatory benefits.

“Right now, topicals are most useful for joint-type pain, muscle pain and skin rashes such as eczema, acne and psoriasis,” he says. By extension, a cannabis product could also be helpful for headaches, which are often inflammatory in nature.

But before slapping CBD oil onto your forehead, know that there’s a catch: cannabinoids are not so easily absorbed into the bloodstream through skin, and most headaches are caused by blood vessels in the brain running amok. While there are promising pre-clinical trials for transdermal patches which breach the bloodstream, it’s not known whether they can treat headache pain.

As for topical creams or ointments, Kuprowsky offers a note of caution: “It’s not the same mechanism, like for osteoarthritis, where a topical would be useful right in the areas where it hurts. Headaches are a little bit more complicated, so just putting it on where it hurts doesn’t necessarily get at the underlying problem.”

However, not all headaches are created equal. For example, tension headaches often start at the base of the skull where neck muscles tighten, sending up an inflammatory response. Kuprowsky says a cannabis topical could theoretically be helpful for the muscle tissue, which could in turn reduce headache pain.

Kuprowsky adds that a range of migraine symptoms–including pain, nausea, and sensitivity to light and sound–could be mitigated by CBD, which he says may potentially act like triptans, a commonly prescribed migraine drug. Pre-clinical studies are promising, but we need clinical trials to confirm.

Cannabis has a well-documented entourage effect, meaning the cannabinoids in the plant work synergistically with each other, and with the plant’s terpenes, flavonoids, and other botanical components. Cannabis can boost active compounds in other ingredients, too, as when mixed into an ointment or cream.

Kuprowsky suggests that a cannabis ingredient might enhance other medicinal ingredients present, so you wouldn’t feel the cannabinoids per se, but could theoretically benefit from their ability to strengthen everything else. “If you combine CBD [with other ingredients], then you may have a synergistic effect. And if the CBD isn’t helping on its own, it’s complementing the other herbs.”

But he does warn against placebo effect, which he says people in pain are very susceptible to. “Placebo effect is actually a very effective treatment for pain,” he explains. So when it comes to CBD, he cautions that the hype may be responsible for some of the enthusiastic feedback regarding its ability to mitigate pain.

For now, we wait for science to confirm whether topicals are useful for aching heads, or better served as salves for muscles and joints.

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