Your Dose of Cannabis Education
Your Dose of Cannabis Education
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2024-05-05
Are there any strategies in which patients with chronic non-cancer pain can find their optimal dosing regimen without consuming high doses of THC?
As stated by the authors of “Brief Commentary: Cannabinoid Dosing for Chronic Pain Management” in the Annals of Internal Medicine, “We advocate a “start-low, go-slow” dosing philosophy, applied to both quantity and adverse effect profiles. We recommend starting with CBD extract, 5 to 10 mg twice daily, to be increased weekly over 1 to 2 months until pain relief is achieved. If CBD extract alone provides insufficient relief, we suggest adding THC, 1.0 to 2.5 mg, and slowly titrating up as needed.” “We do not regard cannabinoids as first-line treatments but as adjuvant therapies to be used before opioids if other options fail to control chronic non-cancer pain. As with any pain medication, cannabinoids should be used as part of an integrated, patient-centric management program, with particular emphasis on appropriate non-pharmacologic treatment options (for example, exercise, cognitive behavioral therapy, and mindfulness). We recommend selecting products verified for safety and potency by third-party testing. We propose that patients use oral formulations (such as capsules) for long-term relief, with tinctures for breakthrough pain. We suggest vaping for patients who prefer to inhale cannabinoids, because this method probably has fewer adverse effects than smoking.”Boehnke, KF, Clauw, DJ. Brief Commentary: Cannabinoid Dosing for Chronic Pain Management Ann Intern Med. 2019;170:118. doi:10.7326/M18-2972
2024-05-04
The FDA has issued a document with full prescribing information for a CBD product, Epidiolex. According to this document, are there any blood tests that should be performed prior to initiating treatment with Epidiolex?
Yes, it is suggested that serum transaminases (ALT and AST) and total bilirubin levels be obtained prior to starting treatment with Epidiolex. It has been found that some patients taking Epidiolex experience an increase in serum levels of the hepatic transaminases. Highlights for prescribing information for Epidiolex https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf
2024-05-03
Does pretreatment with CBD prevent the transient psychotic symptoms induced by THC?
According to a study in humans, pretreatment with CBD does diminish THC’s psychotic effects. This particular study involved 6 healthy volunteers who were given THC intravenously on two separate occasions – once with a placebo pretreatment and once with a CBD pretreatment. Atakan Z. Cannabis, a complex plant: different compounds and different effects on individuals. Ther Adv Psychopharmacol 2012 Dec; 2(6):241-254. doi:10.1177/2045125312457586. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/
2024-05-02
Has any national drug administration approved a CBD-containing product for therapeutic use in conditions other than epilepsy?
Yes. The oromucosal spray Sativex (nabiximols) is a cannabis extract that contains the principal cannabinoids delta-9-tetrahydrocannibinol (THC) and cannabidiol (CBD) in a 50:50 ratio, as well as specific minor cannabinoids and other non-cannabinoid components. Regulatory approval of Sativex has been obtained in numerous countries outside the United States for the treatment of multiple sclerosis symptoms (nerve pain, spasticity, overactive bladder, and other symptoms).GW Pharmaceuticals website. Sativex. https://www.gwpharm.com/healthcare-professionals/sativex
2024-05-01
Epidiolex is an FDA-approved oral CBD solution indicated for the treatment of seizures associated with Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS), or tuberous sclerosis complex (TSC) in one year of age and older. Can it be prescribed for indications other than these three seizure disorders (i.e. off label)?
Yes, Epidiolex may be prescribed off-label, but insurance coverage may be subject to pre-authorization.GW Pharmaceuticals press release: “GW Pharmaceuticals plc and Its U.S. Subsidiary Greenwich Biosciences, Inc. Announce That EPIDIOLEX® (cannabidiol) Oral Solution Has Been Descheduled And Is No Longer A Controlled Substance” April 6, 2020. https://ir.gwpharm.com/news-releases/news-release-details/gw-pharmaceuticals-plc-and-its-us-subsidiary-greenwich-1 Accessed April 30, 2020.
GW Pharmaceuticals website. Sativex. https://www.gwpharm.com/healthcare-professionals/sativex accessed Mar 31, 2021.
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