MedReleaf Research Publications

1.

History of Medical Cannabis

This paper gives an overview of the medicinal uses of cannabis through the ages. It also outlines the cannabinoid synthesis pathway responsible for producing THC and CBD in cannabis plants. The article concludes with an account of the various cannabis consumption methods, recommending oral, sublingual and vaporiser administration due to their safety, reliability and well characterised kinetics of absorption.

Andrew Hand (MSc), Alexia Blake (MSc), Paul Kerrigan (BSc), Phineas Samuel et Jeremy Friedberg (PhD)

Published in: Journal of Pain Management 2016;9(4):387-394 ISSN: 1939-5914 1276-1280.e1, October 2013.

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2.

The Pharmacological Properties of Cannabis

The therapeutic effects of cannabis are mediated by a family of chemical compounds known as the cannabinoids. This paper describes the main cannabinoids found in cannabis (THC and CBD) detailing their chemical structure and how they are synthesised by the plant. The cannabinoid receptors CB1 and CB2 are also discussed, these are the target sites in the human body that THC and CBD bind to. The binding of THC and CBD to CB1 and CB2 receptors is the mechanism via which these cannabinoids affect the human body and mind. This paper also describes the effects on bioavailability of inhalation versus oral consumption of cannabis as well as describing the terpene components of cannabis that are likely to contribute to the clinical effects of cannabis.

Istok Nahtigal (MSc), Alexia Blake (MSc), Andrew Hand (MSc), Angelique Florentinus-Mefailoski (MSc), Haleh Hashemi (PhD) et Jeremy Friedberg (PhD)

Published in: Journal of Pain Management 2016;9(4):481-491 ISSN: 1939-5914

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3.

Plants as Medical Tools

Many of the drugs commonly used by doctors today were first discovered in plants. Beginning with an account of the various plant preparations mentioned in ancient medical texts and going on to give specific examples of current medicinal compounds isolated from plants, this paper charts the history of the human use of plants in medicine. The paper details how two fixtures of western medicine, opiate painkillers and aspirin were developed and compares their history to that of medical cannabis. The paper ends with a comparison of the relative risks and benefits of using cannabis for pain management as opposed to current mainstream treatments, It concludes that the low addictiveness and minor side-effects associated with medical cannabis, in addition to its proven efficacy in relieving various forms of pain, make it an attractive option for pain management.

Haleh Hashemi (PhD), Andrew Hand (MSc), Angelique Florentinus-Mefailoski (MSc), Paul Kerrigan (BSc), Phineas Samuel (BSc) et Jeremy Friedberg (PhD)

Published in: Journal of Pain Management 2016;9(4):493-504 ISSN: 1939-5914

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4.

Medical Cannabis: Four Patient Perspectives

This paper presents the perspectives of four patients with diverse clinical backgrounds and their reported experience using medical cannabis. The paper highlights the different experiences patients can have with medical cannabis emphasising the need for individual experimentation in order to establish the most effective treatment regime.

Jeremy Friedberg (PhD)

Published in: Journal of Pain Management 2016;9(4):517-519 ISSN: 1939-5914

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5.

Patient Characteristics from a Medical Cannabis Provider

Medical cannabis has been prescribed by physicians to treat a variety of symptoms including pain, nausea and vomiting, anxiety, depression, and sleep disorders in patients with severe or chronic illnesses. This paper presents the baseline demographics and characteristics of patients using medical cannabis in Canada. Patients were invited to complete a voluntary online survey after registering with a single medical cannabis provider. The survey included questions on demographics, medical history, current medical conditions and symptoms, and their corresponding severities. A total of 2,753 patients completed the survey (average age of 43.0 years old, SD=13.7). Patients were predominantly male (68.4%, n=1,882) and Caucasian (80.3%, n=2,089). Most patients were employed (49.4%, n=1133), while 18.7% (n=428) were retired, and 3.9% (n=89) were students. Of the surveyed patients, 25.1% (n=580) smoked tobacco cigarettes, and 74.9% (n=1782) reported having previous experience with cannabis. The most frequently reported conditions were anxiety disorder (31.7%, n=723), depression (31.6%, n=729), pain (29.5%, n=681), and sleep disorder (25.5%, n=589). The most frequently reported symptoms included pain (73.0%, n=2011), anxiety (72.6%, n=1998), and sleep problems (69.8%, n=1922). These findings are consistent with results from other North American studies, suggesting their generalizability in defining patient populations that may benefit from medical cannabis use. Understanding patient characteristics will be useful in informing the design of future clinical research initiatives and identifying the needs of patients using medical cannabis.

Bo Angela Wan (MPhil), Alexia Blake (MSc), Stephanie Chan (BSc(C)), Amiti Wolt (BA), Pearl Zaki (BSc(C)), Liying Zhang (PhD), Marissa Slaven (MD), Erynn Shaw (MD), Carlo DeAngelis (PharmD), Henry Lam (MLS), Vithusha Ganesh (BSc(C)), Leila Malek (BSc(Hons)), Edward Chow (MBBS) et Shannon O’Hearn (MSc)

Published in: Journal of Pain Management

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6.

Symptom Clusters in Patient Reported Outcomes of Medical Cannabis Patients

Medical cannabis is used to provide relief from a wide range of symptoms. There has been a lot of focus on the use of medical cannabis against individual symptoms, however, it is likely that certain symptoms are related. For example, depression and anxiety are two separate symptoms, however, they often arise simultaneously in a patient and this suggests they have a common cause. When symptoms occur together in this way they are said to form a ‘symptom cluster’. This study used a sophisticated statistical procedure called principal component analysis (PCA) to determine which symptoms commonly co-occurred in medical cannabis patients. Three clusters were identified, Cluster 1 contained anxiety, depression exhaustion and sleep interference, Cluster 2 contained limited mobility, numbness and pain, cluster 3 included constipation, digestion problems and headache. This information will be useful in developing new varieties of cannabis that are able to provide relief from multiple symptoms in a given cluster simultaneously.

Nicholas Lao (BMSc(C)), Vithusha Ganesh (BSc(C)), Liying Zhang (PhD), Leah Drost (BSc(C)), Bo Angela Wan (MPhil), Alexia Blake (MSc), Stephanie Chan (BSc(C)), Amiti Wolt (BA), Pearl Zaki (BSc(C)), Marissa Slaven (MD), Erynn Shaw (MD), Carlo DeAngelis (PharmD), Henry Lam (MLS), Leila Malek (BSc(Hons)), Edward Chow (MBBS) et Shannon O’Hearn (MSc)

Published in: Journal of Pain Management

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7.

The Use of Medical Cannabis in Common Medical Conditions Excluding Cancer

In this study, 2,588 non-cancer users of medical cannabis were surveyed before taking medical cannabis and then again after 4-months and 10-months of cannabis use. The study found that medical cannabis use was associated with statistically significant reductions in both pain level and ability to cope with pain at both 4 and 10-months. Significant improvements in anxiety, PTSD and sleep disorder were also observed. Medical cannabis was also associated with significant improvements in reported quality of life and general mood.

Pearl Zaki (BSc(C)), Vithusha Ganesh (BSc(C)), Shannon O’Hearn (MSc), Amiti Wolt (BA), Stephanie Chan (BSc(C)), Liying Zhang (PhD), Henry Lam (MLS), Bo Angela Wan (MPhil), Marissa Slaven (MD), Erynn Shaw (MD), Carlo DeAngelis (PharmD), Leila Malek (BSc(Hons)), Edward Chow (MBBS) et Alexia Blake (MSc)

Published in: Journal of Pain Management

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8.

The Use of Medical Cannabis in Cancer Patients

Medical cannabis is widely used by people with cancer to provide relief from their symptoms, especially pain. In this study, 164 patients with cancer were surveyed before they began taking medical cannabis and then surveyed again after 4-months and 10-months of cannabis use. The study found that medical cannabis use was associated with statistically significant reductions in pain at 4-months as well as significant improvements in sleep. The most common side effects reported were dry mouth, feeling ‘high’ and decreased concentration.

Pearl Zaki (BSc(C)), Alexia Blake (MSc), Amiti Wolt (BA), Stephanie Chan (BSc(C)), Liying Zhang (PhD), Angela Wan (MPhil), Henry Lam (MLS), Carlo DeAngelis (PharmD), Marissa Slaven (MD), Erynn Shaw (MD), Vithusha Ganesh (BSc(C)), Leila Malek (BSc(Hons)), Edward Chow (MBBS) et Shannon O’Hearn (MSc)

Published in: Journal of Pain Management

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9.

Efficacy of Different Varieties of Medical Cannabis in Relieving Symptoms

Medical cannabis is used to provide relief from a variety of symptoms, however, selecting the right cannabis strain to use for a given condition is difficult because of the large number of options. In this study, the survey responses of 837 people with experience of MedReleaf’s cannabis products were analysed to determine which cannabis varieties were most effective against a range of conditions. Midnight was associated with improvement in headache symptoms as well as appetite and bowel function. Luminarium was associated with improvement in sleep problems and depression symptoms as well as sexual function. Sedamen was most popular for anxiety, Eran Almog for insomnia, Stellio for exhaustion and Cognitiva for concentration.

Bo Angela Wan (MPhil), Patrick Diaz (PhD), Alexia Blake (MSc), Stephanie Chan (BSc(C)), Amiti Wolt (BA), Pearl Zaki (BSc(C)), Liying Zhang (PhD), Marissa Slaven (MD), Erynn Shaw (MD), Carlo DeAngelis (PharmD), Henry Lam (MLS), Vithusha Ganesh (BSc(C)), Leila Malek (BSc(Hons)), Edward Chow (MBBS) et Shannon O’Hearn (MSc)

Published in: Journal of Pain Management

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10.

Medical Cannabis Use in Military and Police Veterans Diagnosed with Post-Traumatic Stress Disorder (PTSD)

Due to the taxing requirements of their work, military and police veterans are at increased risk of developing post-traumatic stress disorder (PTSD). In this retrospective chart review the response of 100 military and police veterans to treatment with medical cannabis was analysed. The veterans in this study had previously proven unresponsive to traditional pharmacotherapy and psychotherapy treatments and had therefore been referred to a specialist PTSD clinic. Medical cannabis use was associated with statistically significant reductions in the severity of 14 PTSD symptoms including depression, flashbacks and suicidal thoughts. Additionally, the impact of PTSD on 8 domains of social and family life, such as relationship with children, was significantly reduced.

Paul A Smith (MD), Stephanie Chan (BSc(C)), Alexia Blake (MSc), Amiti Wolt (BA), Liying Zhang (PhD), Bo Angela Wan (MPhil), Pearl Zaki (BSc(C)), Henry Lam (MLS), Carlo DeAngelis (PharmD), Marissa Slaven (MD), Erynn Shaw (MD), Vithusha Ganesh (BSc(C)), Leila Malek (BSc(Hons)), Edward Chow (MBBS) et Shannon O’Hearn (MSc)

Published in: Journal of Pain Management

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11.

The Effect of Medical Cannabis on Alcohol and Tobacco Use in Veterans with Post-Traumatic Stress Disorder (PTSD)

Military and police personnel face an increased risk of developing post-traumatic stress disorder (PTSD) due to their increased exposure to traumatic events. PTSD patients often turn to alcohol and tobacco to provide relief from the symptoms of PTSD, however, this can lead to dependence. In this retrospective chart review, the records of 101 PTSD sufferers who had been prescribed medical cannabis and had formerly served in either the military or police were analysed. Amongst this group, vapourising was found to be the preferred method of medical cannabis consumption. The most popular cannabis varieties for relief of PTSD symptoms were Luminarium, Sedamen and Avidekel. Medical cannabis use was associated with a reduction in alcohol consumption from 8.1 drinks per week to 5.5 drinks per week and a reduction in tobacco usage from 2.7 packs per week to 2.2 packs per week, however, these reductions were not found to be statistically significant.

Shicheng Jin (MD(C)), Bo Angela Wan (MPhil), Stephanie Chan (BSc(C)), Paul A Smith (MD), Alexia Blake (MSc), Amiti Wolt (BA), Liying Zhang (PhD), Henry Lam (MLS), Carlo DeAngelis (PharmD), Marissa Slaven (MD), Erynn Shaw (MD), Vithusha Ganesh (BSc(C)), Pearl Zaki (BSc(C)), Leah Drost (BSc(C)), Nicholas Lao (BMSc(C)), Leila Malek (BSc(Hons)), Edward Chow (MBBS) et Shannon O’Hearn (MSc)

Published in: Journal of Pain Management

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12.

Medical Cannabis Use for Patients with Post-Traumatic Stress Disorder (PTSD)

Medical cannabis is widely used by people with PTSD to provide relief from their symptoms, especially pain. In this study, 139 PTSD sufferers were surveyed before they began taking medical cannabis and then surveyed again after 4-months and 10-months of cannabis use. The study found that medical cannabis use was associated with statistically significant reductions in both pain level and ability to cope with pain at both 4 and 10-months. Cannabis use was also associated with significant improvements in general mood. The most common side effects reported were dry mouth, feeling ‘high’ and sleepiness.

Stephanie Chan (BSc(C)), Alexia Blake (MSc), Amiti Wolt (BA), Bo Angela Wan (MPhil), Pearl Zaki (BSc(C)), Liying Zhang (PhD), Henry Lam (MLS), Marissa Slaven (MD), Erynn Shaw (MD), Carlo DeAngelis (PharmD), Vithusha Ganesh (BSc(C)), Leila Malek (BSc(Hons)), Edward Chow (MBBS) et Shannon O’Hearn (MSc)

Published in: Journal of Pain Management

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13.

Efficacy of Different Varieties of Medical Cannabis in Relieving Symptoms in Post-Traumatic Stress Disorder (PTSD) Patients

Post-traumatic stress disorder (PTSD) is a crippling condition that affects individuals who have been exposed to traumatic events. In this study, the survey responses of PTSD patients were analysed to determine which medical cannabis varieties were most effective in reliving the symptoms of PTSD. Sedamen, Luminarium and Midnight were found to be the most popular varieties for treating the symptoms of depression, anxiety and pain. Additionally, medical cannabis use was associated with a statistically significant improvement in self-reported levels of depression, anxiety, sleep problems, pain and overall PTSD.

Leah Drost (BSc(C)), Bo Angela Wan (MPhil), Alexia Blake (MSc), Stephanie Chan (BSc(C)), Amiti Wolt (BA), Vithusha Ganesh (BSc(C)), Liying Zhang (PhD), Marissa Slaven (MD), Erynn Shaw (MD), Carlo DeAngelis (PharmD), Henry Lam (MLS), Pearl Zaki (BSc(C)), Leila Malek (BSc(Hons)), Edward Chow (MBBS) et Shannon O’Hearn (MSc)

Published in: Journal of Pain Management

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14.

Modulating the Endocannabinoid Pathway as Treatment for Peripheral Neuropathic Pain: a Selected Review of Preclinical Studies

Chemotherapy-induced neuropathic pain (CIPN) is a common pain condition affecting individuals undergoing cancer treatment. There is some evidence that cannabinoids have the potential to treat or even prevent the occurrence of CIPN. This review evaluates the pre-clinical studies which have examined the treatment of CIPN with cannabinoids concluding that there is sufficient evidence to support clinical trials into the efficacy of cannabinoid treatment of CIPN in humans.

Shannon O’Hearn, Patrick L Diaz, Bo Angela Wan, Carlo DeAngelis, Nicholas Lao, Leila Malek, Edward Chow et Alexia Blake

Published in: Annals of Palliative Medicine

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15.

A Selective Review of Medical Cannabis in Cancer Pain Management

Patients with cancer often develop chronic pain conditions either as a direct consequence of tumour growth or as a side-effect of chemotherapy. Current pain management strategies that seek to address these issues rely heavily on opioid analgesics, however, these drugs come with serious side-effects and dependency risks. This review summarises the findings of clinical studies which have sought to evaluate the effectiveness of medical cannabis in managing pain in patients with advanced cancer. It finds that there is a potential role for cannabis in cancer pain management however, more studies are required to determine whether cannabis can serve as an alternative to opioids or whether it would be better suited to use as an adjunctive therapy.

Alexia Blake, Bo Angela Wan, Leila Malek, Carlo DeAngelis, Patrick L Diaz, Nicholas Lao, Edward Chow et Shannon O’Hearn

Published in: Annals of Palliative Medicine

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MedReleaf Partner Research Initiatives

1.

Hot Spot: A Review of Medical Cannabis in Cancer Pain Management

Opiates are often prescribed as a first-line analgesic treatment to reduce cancer-related pain. Cannabis and other cannabinoid-based medications, such as Sativex, may be prescribed as an alternative or adjunct analgesic treatment. A review of clinical trials involving cannabinoid-based treatments in advance cancer populations is presented below. The presented findings suggest that further research is needed to establish the efficacy of medical cannabis, either as an alternative to opiates or as an adjunctive therapy, and to identify how to dose and administer cannabis to achieve optimal analgesic efficacy with minimal side effects.

Alexia Blake (MSc), Shannon O’Hearn (MSc) et Carlo DeAngelis (Dpharm)

Published by: Odette Cancer Centre – supplement to Hot Spot

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2.

Hot Spot: A Review of Medical Cannabis in Post-Traumatic Stress Disorder (PTSD) Management

Post-traumatic stress disorder (PTSD) is a mental illness originating from experiencing or witnessing a severe traumatic event(s), resulting in debilitating symptoms in each of the four symptom clusters defined by the “Diagnostic and statistical manual of mental disorders, 5th 2 Edition” (DSM-5). PTSD is conventionally treated with pharmacotherapy and psychotherapy. Traditional pharmacotherapy for PTSD includes selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, adrenoceptor agonists or antagonists, anticonvulsants, antipsychotics and monoamine oxidase inhibitors (MAOIs). Recently, medical cannabis has emerged as a potential adjunct therapy, or alternative treatment option for managing PTSD symptoms when traditional methods are unsuccessful. The following review summarizes the findings of five recent studies investigating the safety and efficacy of medical cannabis in this patient population.

Nicholas Lao (BMSc), Shannon O’Hearn (MSc), Alexia Blake (MSc) et Carlo DeAngelis (DPharm)

Published by: Odette Cancer Centre – supplement to Hot Spot

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3.

Overcoming the Bell‐Shaped Dose‐Response of Cannabidiol by Using Cannabis Extract Enriched in Cannabidiol

Cannabidiol (CBD), a major constituent of Cannabis, has been shown to be a powerful anti-inflammatory and anti-anxiety drug. However, a bell-shaped dose-response was observed, which limits its clinical use. In the present study, In stark contrast to purified CBD, the clone 202 (Avidekel) extract, provided a clear correlation between the anti-inflammatory and anti-nociceptive responses and the dose, with increasing responses upon increasing doses, making this plant medicine ideal for clinical uses.

Ruth Gallily, Zhannah Yekhtin et Lumír Ondřej Hanuš

Published in: Pharmacology & Pharmacy, Volume 6, No. 2 (2015)

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4.

Cannabis Induces a Clinical Response in Patients with Crohn’s Disease: a Prospective Placebo-Controlled Study.

Clinical research study that was conducted to examine whether or not cannabis brings about clinical and bio-chemical improvement in cases of active Crohn’s disease, without the use of steroids.

T. Naftali, L. Bar-Lev Schleider, I. Dotan, E.P. Lansky, F.S. Benjaminov, F.M. Konikoff

Published in: Clinical Gastroenterology and Hepatology, Volume 11, Issue 10, Pages 1276-1280.e1, October 2013.

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5.

Treatment of Crohn’s Disease with Cannabis: An Observational Study

The retrospective research study was conducted by interviewing 20 patients suffering from Crohn’s disease that were granted a license for medical cannabis treatment to measure the effectiveness of the treatment. The study has found very positive effects on the symptoms of the disease (number of bowel movements, quality of bowel activity, blood in stool samples, pain, etc).

Timna Naftali (MD), Lihi Bar Lev (BA), Doron Yablekovitz (MD), Elisabeth Half (MD) et Fred M. Konikoff (MD)

Published in: IMAJ – The Israel Medical Association Journal, Volume 13, Pages 455-458, August 2011.

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6.

The Effects of Cannabis on Dystonia and Spasticity of Cerebral Palsy Pediatric Patients

This clinical trial will examine the effects of cannabis on dystonia and spasticity in children with neurological diseases. The clinical trial will consist of 40 patients divided into four groups which will be administered either a 6:1 or a 20:1 ratio CBD-THC oil. The study will be carried out at the Wolfson Medical Center in Israel.

Head Researcher: Luba Blumkin, Wolfson Medical Center

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