Fresh furore over medical marijuana

Marijuana (Cannabis sativa)                        PHOTO: WIKIPEDIA

Marijuana (Cannabis sativa) PHOTO: WIKIPEDIA

It is banned and illegal in Nigeria to either smoke or cook with Cannabis sativa, also called marijuana and India Hemp. It has been associated with mental disorders and violent crimes but recent studies suggest marijuana could be used in the treatment of chronic pain, nausea and vomiting due to chemotherapy in cancer patients, sleep disorders, epilepsy, and Tourette syndrome. CHUKWUMA MUANYA writes.

CAN marijuana be the next best medicine for chronic pain, sleep disorders, cancer treatment, epilepsy, and Tourette disorders?

According to a new study published in the June 23/30 issue of
JAMA – Journal of the American Medical Association, in an analysis of the findings of nearly 80 randomized trials that included about 6,500 participants, there was moderate-quality evidence to support the use of cannabinoids (chemical compounds that are the active principles in cannabis or marijuana) for the treatment of chronic pain and lower-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, sleep disorders, and Tourette syndrome.

Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman.

Medical cannabis refers to the use of cannabis or cannabinoids as medical therapy to treat disease or alleviate symptoms. In the United States, 23 states and Washington, D.C., have introduced laws to permit the medical use of cannabis; many other countries have similar laws. Despite the wide us of cannabis and cannabinoid drugs for medical purposes, their efficacy for specific indications is not clear, according to background information in the article.

Penny F. Whiting, Ph.D., of the University of Bristol, Bristol, United Kingdom, and colleagues evaluated the evidence for the benefits and adverse events (AEs) of medical cannabinoids by searching various databases for randomized clinical trials of cannabinoids for a variety of indications. The researchers identified 79 trials (6,462 participants) that met criteria for inclusion in the review and meta-analysis.

The researchers found that most studies suggested that cannabinoids were associated with improvements in symptoms, but these associations did not reach statistical significance in all studies. There was moderate-quality evidence to suggest that cannabinoids may be beneficial for the treatment of chronic neuropathic or cancer pain and spasticity due to multiple sclerosis (sustained muscle contractions or sudden involuntary movements). There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), sleep disorders, and Tourette syndrome; and very low-quality evidence for an improvement in anxiety. There was low-quality evidence for no effect on psychosis and very low-level evidence for no effect on depression.

There was an increased risk of short-term Adverse Effects (AEs) with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination. There was no clear evidence for a difference in association (either beneficial or harmful) based on type of cannabinoids or mode of administration. Only two studies evaluated cannabis. There was no evidence that the effects of cannabis differed from other cannabinoids.

“Further large, robust, randomized clinical trials are needed to confirm the effects of cannabinoids, particularly on weight gain in patients with HIV/AIDS, depression, sleep disorders, anxiety disorders, psychosis, glaucoma, and Tourette syndrome are required. Further studies evaluating cannabis itself are also required because there is very little evidence on the effects and AEs of cannabis,” the authors write.

Medical marijuana for cancer
Another new story published in Cancer Journal for Clinicians Volume 65, Issue 2, pages 109–122, March/April 2015 concluded: “Both cannabis and cannabinoid pharmaceuticals can be helpful for a number of problems, including many affecting patients with cancer. There have been fewer studies of marijuana than cannabinoid pharmaceuticals, perhaps in part due to regulatory restrictions, and what studies of marijuana have been conducted to date had a tendency to enroll small numbers of patients.

“Gaps in the available evidence likely adversely influence the quality of decisions by patients and clinicians. Additional high-quality studies of marijuana and cannabinoid pharmaceuticals in the treatment of a number of medical conditions would better elucidate the clinical effects of the various strains of marijuana and the bioactive compounds found within it. Such studies could also assess how best to administer marijuana and its bioactive components. The differences in pharmacokinetics between oral ingestion and inhalation may mean differences in clinical effect for different indications. For example, given the limitations inherent in using oral medications to treat nausea and vomiting, inhalation of marijuana or a cannabinoid may be better than oral ingestion in treating this condition.

“However, because marijuana smoke contains toxins and carcinogens, vaporization may be preferable as a way to inhale because it has less potential for harm. There is also a need for high-quality studies of the long-term effects of marijuana and its cannabinoids. Given the problems with confounding and potential recall bias in case-control studies examining cancer outcomes, these outcomes may be better examined through prospective cohort studies.”

Scientists have in another study published in Evidence-Based Complementary and Alternative Medicine concluded: “The positive effects of cannabis on various cancer-related symptoms are tempered by reliance on self-reporting for many of the variables. Although studies with a control group are missing, the improvement in symptoms should push the use of cannabis in palliative treatment of oncology patients.

The study is titled “The Medical Necessity for Medicinal Cannabis: Prospective, Observational Study Evaluating the Treatment in Cancer Patients on Supportive or Palliative Care.”

The researchers from the Division of Oncology, Integrated Oncology and Palliative Care Unit, Rambam Health Care Campus, 31096 Haifa, Israel, and Faculty of Medicine, Technion-Israel Institute of Technology, 31096 Haifa, Israel, wrote: “Cancer patients using cannabis report better influence from the plant extract than from synthetic products. However, almost all the research conducted to date has been performed with synthetic products. We followed patients with a medicinal cannabis license to evaluate the advantages and side effects of using cannabis by cancer patients.”

Liver cancer
Scientists have also established the protective and therapeutic effects of cannabis plant extract on liver cancer induced by dimethylnitrosamine in mice.
The study was published in Alexandria Journal of Medicine.

Hepatocellular carcinomas will emerge as a major form of malignancy in the coming decades. When these tumors are in advanced stages, few therapeutic options are available. Therefore, it is essential to search for new treatment modalities to fight this disease.

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