What is the pharmacologic profile of cannabis when it is smoked?
When herbal cannabis is smoked, the active ingredients in cannabis are vaporized by the heat of combustion and inhaled.Inhaled constituents quickly pass from alveoli into the bloodstream and readily cross the blood-brain barrier.Psychoactive effects appear within 90 seconds, reach a maximum after 15-30 minutes, and taper off within 2-3 hours.This short onset of action makes dose titration possible, by spacing inhalations at 90-second intervals.
The pharmacological properties of cannabichromene have been investigated.What have the studies shown?
Cannabichromene (CBC) is a potent anadamide uptake inhibitor and thus may modulate the endocannabinoid system similarly to CBD.In mice studies, it has been shown that CBC has anti-inflammatory properties and analgesic activity. CBC has other pharmacological properties, as well.
The pharmacological properties of cannabinol have been investigated.What have the studies shown?
Cannabinol (CBN) is the oxidative by-product of THC and appears after long storage. It is a weaker partial agonist at CB1 and CB2as compared to THC. In in vitro studies, it has been found that cannabinol is anticonvulsant and anti-inflammatory, and stimulates bone formation.
It is the mixture of phytocannabinoids, terpenes and other active components present in a cannabis product that ultimately determines the therapeutic effects and side effects.Does CBD affect THC absorption and tolerance?
CBD has long been thought to influence the effects of THC. This thinking was extended to consider that CBD potentiates some of the beneficial effects of THC, as it reduces the psychoactive effects of THC and thus could improve tolerability. CBD may counteract some of the functional consequences of CB1 receptor activation in the brain.This effect has been used to explain why high CBD:THC cannabis use is less associated with the development of psychotic symptoms compared to low CBD:THC cannabis.Also, CBD is thought to interact with the cytochrome p450 enzymes that metabolize THC and thus may alter the metabolism and influence the effects of the THC consumed. It has been proposed that THC and CBD act synergistically in therapeutic use.
Yes. Methadone is known to prolong QTc intervals in up to 16% of patients.Studies have shown a linear dose response curve, with higher doses leading to a higher propensity for QTc prolongation.This has led to an FDA “black box” warning for methadone and the recommendation for routine ECG monitoring.
How have medical advances altered opioid use in cancer patients?
Cancer is no longer considered a “terminal disease.”Because of significant advances in surgical, radiation, and chemotherapeutic treatments, more than 50% of cancer patients are living greater than 2 years after the diagnosis of cancer.This allows for more cancer patients to develop chronic pain.All of these factors have led to more cancer patients taking opioids long-term.
Terpenes are aromatic components produced in the glandular part of the cannabis plant’s flower bud.Unlike cannabinoids, which are only manufactured by the cannabis plant, terpenes are manufactured by many plants and can be found in many food products, including coffee beans, ginger and cinnamon. Often, it is the terpenes that are responsible for a plant’s odor.
Similar to CB1, the CB2 receptor is a G protein receptor that serves as a target for endocannabinoids and phytocannabinoids.These CB2 receptors are primarily immunomodulatory and anti-inflammatory. They are expressed on the cell membranes of B cells, T cells and macrophages. When signaled, CB2 receptors are generally inhibitory to immune cell activation. Expression of CB2 receptors is inducible and the number of receptors is increased by inflammation.As found in studies conducted in mice, reduced CB2 receptor signaling results in increased severity of inflammation in multiple organs.
Who are the principal prescribers of opioids in the United States?
As a group, primary care physicians are the largest prescribers of opioids ( including both short-acting and long-acting opioid) in the United States. Pain physicians provide less than 6% of short-acting opioids prescriptions, but they are responsible for about 23% of extended-release opioid prescriptions. Orthopedic surgeons write for a significant percentage of short-acting opioids. A mix of other specialists is responsible for the remainder of opioid prescriptions.
The concept of cross-addiction suggests that a person addicted to one reinforcing substance is at a higher risk for addiction to other reinforcing substances. This concept is based on the fact that a person who takes an intoxicant is presumably less able to resist other temptations. The neurobiologic changes that occur with addiction appear to be common amongst most reinforcing substances. Unfortunately, there is little data to confirm the concept other than the high prevalence of polysubstance dependence.