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MEDICAL CANNABIS: On its broad-spectrum efficacy

This study from the University of New Mexico (Albuquerque) documents the effectiveness of medical cannabis in the treatment of a wide range of health problems, through two studies, presented in the journals Medicines and Frontiers in Pharmacology. Researchers here use a mobile app to identify and track patients' symptom relief and see in the field that medical cannabis immediately relieves dozens of symptoms with relatively minimal side effects.

The team of Jacob Miguel Vigil, Professor of Psychology and Sarah See Stith, Professor of Economics describes the significant therapeutic effects of cannabis both clinically and statistically. Their analysis of data collected with the Releaf application, released in 2016, for educational purposes for patients made it possible to assess in real time the levels of intensity of the symptoms and the side effects of patients consuming medical cannabis. And if the results were extrapolated to the general population, the authors comment, cannabis could replace many multi-billion dollar drugs around the world.

Releaf is an assessment app that allows patients to track and manage their cannabis use decisions under natural conditions, while avoiding disorders associated with excessive use (memory bias, desocialization). Here Releaf allowed researchers to collect massive volumes of patient-entered information around their use and the effects of real cannabis used in real circumstances. A scale impossible to reach with randomized controlled trials.

Main findings:

The first study, covering 27 different medical conditions with symptoms ranging from seizures to depression, shows, with the use of medical cannabis, an average reduction in symptoms of almost 4 points on a scale of 1 to 10;
The second study, conducted specifically on the use of natural cannabis buds and to treat insomnia, also shows a strong level of effectiveness which varies slightly depending on the characteristics of the plant and the method of preparation.
The researchers obviously draw a parallel with prescription drugs with inevitable side effects, which also explains why medical cannabis is rapidly gaining popularity, including among older people and patients suffering from severe chronic diseases.
Finally, their results confirm the numerous studies on the effectiveness of cannabis as a possible treatment for a wide range of medical conditions ranging from post-traumatic stress disorder to cancer, chronic pain, epilepsy or "spasticity". While these studies have already suggested just how great the therapeutic potential of cannabis is, this new analysis is the first to assess the effects of cannabis used daily by millions of people in the United States.

Precisely,

the current results underscore the magnitude of the reduction in symptoms after cannabis use: more than 94% of cannabis users report a reduction in their intensity after "self-administered" cannabis use and in the various medical conditions (disorders sleep, eating disorders including intestinal permeability and adipogenesis, libido and fertility, pain perception, motivation, happiness, anxiety, learning and memory, social functioning, autoimmune responses, cancer); these data suggest the ability of phytocannabinoids to influence the human endocannabinoid system, which regulates both mental and physical health and behavioral systems.
Cannabis use is associated with frequent and numerous, but generally mild, side effects: positive side effects (relaxation, relaxation, well-being) are much more frequently reported than negative side effects (headaches in particular).

According to the authors, cannabis could find a permanent place in our therapeutic toolbox and treat health problems more effectively and safely than conventional pharmaceutical treatments. The most glaring example being the treatment of insomnia. Then there would also be a “significant economic impact”.

" If the benefit-risk ratio of cannabis as identified in the short term in our studies reflects its long-term therapeutic potential, the substitution of cannabis for traditional pharmaceuticals could reduce the risk of drug interactions and the costs associated with taking multiple drugs, allowing patients to treat multiple comorbidities with a single treatment .”

CANNABIS in ADOLESCENCE and cognitive development: What relationship

Cannabis use in adolescents is not without risk for cognitive development and this is the main harmful effect documented in the literature. By raising awareness again of the risk of cannabis use in adolescence, a period when the brain is still in full development, this team from the CHU Sainte-Justine and the University of Montreal, goes further in understanding the risks , by showing that beyond the role of cognition in vulnerability to substance use, there are indeed and “in the other direction” simultaneous and lasting effects of cannabis use in adolescents.

Beyond the acute intoxicating effects, alcohol and cannabis abuse have been linked to impaired learning, memory, attention, and decision-making, as well as poorer school results. “Although numerous studies have already revealed differences in cognitive performance between groups of young users and non-users, the causal and lasting effects of the consumption of psychoactive substances on cognitive development have yet to be established,” explains Jean. -François G. Morin, co-author of the study.

The study presented here is unique in that it follows a large sample of high school students using measures of cognition and substance use. Using this data-intensive approach, the research has indeed been able to clarify the complex nature of the relationship between cognition and cannabis in adolescence.

To understand the relationship, the research team followed 3,826 adolescents over a period of 4 years and looked at the link between annual changes in substance use and cognitive development in many cognitive domains, such as memory recall, reasoning, inhibition and working memory. The analysis confirms that:

vulnerability to cannabis (and alcohol use) in adolescence is associated with generally lower performance in all cognitive domains. This suggests the existence of 'a cognitive predisposition to cannabis use;
however, in the other direction, an increase in cannabis use (but not alcohol use) appears to lead to simultaneous and delayed additional effects on cognitive functions, in particular on reasoning, memory recall , working memory and inhibitory control;
In particular, the effect of cannabis use on a measure of inhibitory control, a risk factor for other addictive or addictive behaviors, could explain why early cannabis use is a risk factor for other addictions;
Finally, some of the effects are even more pronounced when use begins earlier in adolescence.

These conclusions, which clarify the bilateral and reciprocal relationship between cannabis and cognition in adolescence, are essential in the current context of increasing legalization of cannabis. They must remind and raise awareness among parents, educators and health professionals, as well as young users, of the harmful effects of cannabis on the developing brain and encourage greater investment in drug addiction prevention programs.

It will be a question of carrying out additional analyzes with this cohort or others, on the same relationship to the period of transition to adulthood and in other contexts of legalization.

The researchers also want to determine whether these effects on brain development are related to other difficulties such as poor school performance, neuroanatomical damage and to what extent they predict the risk of future addiction or mental health disorders.

CANNABIS: Consuming it increases the risk of stroke?

This is what the work presented at the 11th World Stroke Congress, which brings together leading international experts, suggests: cannabis use could well increase the risk of cerebrovascular accident (CVA).

Stroke in the world is

more than 80 million people currently living with the effects of stroke,
the second leading cause of death and disability,
5.5 million deaths each year, or one death every 6 seconds,
13.7 million strokes each year.
1 in 4 survivors will suffer another stroke.

The question posed by this broad analysis of US hospital statistics is the possible association or correlation between the occurrence of a stroke and cannabis use. Analysis of 2.3 million hospitalizations of people who used cannabis for recreational purposes. indeed reveals an increase in the incidence of strokes among cannabis users, here over the period 2010 to 2014, a period during which the overall prevalence of strokes remained stable. Specifically, the analysis finds:

of the 2.3 million participants, 32,231, or 1.4%, had a stroke, including 19,452 an acute ischemic stroke;
over the 5 years of the study, the rate of all types of stroke among cannabis users fell from 1.3% to 1.5%;
the ischemic stroke rate fell from 0.7% to 0.9%;
but during the same period, the prevalence of stroke is stable.

The researchers conclude that these increasing trends in stroke among cannabis users warrant further prospective studies. The researchers finally confirm the possible link between cannabis and the risk of stroke " due to the cerebrovascular effects of cannabinoids ".

PAIN: Cannabis does not reduce it but makes it more tolerable

The use of cannabis for medical purposes is now legal in more than 30 states in the United States. Better understanding and characterizing the impact of cannabis and cannabinoids on different pathways of pain reactivity may help explain the belief that cannabis relieves pain and support evidence of efficacy. “But we still have a lot to learn,” concludes this team from Syracuse University in JAMA Psychiatry, which suggests that while cannabinoids do not reduce the intensity of pain, they make it less unpleasant and more tolerable. .

This publication coincides with “Pain Awareness Month” and is the first-ever systematic review of experimental research on the effects of cannabis on pain. Cannabinoids are chemical compounds that give the cannabis plant its medicinal and recreational properties. The main author, Martin De Vita, doctoral candidate in clinical psychology, recalls that THC and CBD (cannabidiol) are the main cannabinoids. When ingested, THC binds to receptors in the brain that control pleasure, time perception, and pain. This activity leads to the production of dopamine with an effect of euphoria or relaxation.

However, better quality evidence supporting the efficacy of cannabis in the treatment of chronic pain remains to be established. “While patients are convinced that cannabis is effective in relieving pain, its analgesic properties remain poorly understood. explains the lead author, who recalls that so far experimental studies of cannabinoid analgesia in healthy adults have yielded mixed results. It is therefore a very broad review of the literature that is proposed to us, with more than 1,830 experimental studies on cannabis identified, carried out in North America and Europe over a period of 40 years. Then the meta-analysis of the 18 selected studies involving 440 adult participants. The mean study quality and validity score was high and the analyzes did not suggest publication bias. The analysis finds that cannabinoid drugs are associated with:

modest increases in pain threshold and tolerance,
but on the other hand to no reduction in the intensity of the “ongoing” pain.

Cannabinoids therefore allow a reduction in the unpleasantness of painful stimuli and do not lead to any mechanical reduction in hyperalgesia.

An affective rather than sensory effect? Cannabinoid analgesia could thus be linked to an affective component rather than a sensory component. Anyway, as far as THC is concerned. Because studies have mostly focused on THC strains, it's unclear whether other cannabinoids exert different effects on pain.

The analysis having been limited to experimental pain, that is to say induced in the laboratory, the team will now continue its research on clinical pain , generally associated with a non-malignant progressive disease and on neuropathic pain , associated with disease or damage to the nervous system, leading to tissue damage.

CHEMOTHERAPY: The gene that gives the winning boost

These researchers from the Baylor College of Medicine identify a gene with a beneficial role, especially in the case of chemotherapy: PPM1D, which gives a winning boost to stem cells after chemotherapy. Data documented in the journal Cell Stem Cell which constitute a first step towards the development of therapeutic approaches aimed at “hyperactivating” PPM1D signaling.

Chemotherapy is associated with an increased risk of leukemia years after treatment, but the cause of this association remains poorly understood. The team led by researchers from Baylor College of Medicine and MD Anderson Cancer Center (Houston) combined different clinical and experimental studies and found that the gene called PPM1D frequently mutates in patients receiving chemotherapy and that this mutation promotes the development of leukemia years later. The study suggests that the presence of this mutation and other mutations should be considered when choosing chemotherapy.

The researchers had previously discovered that PPM1D mutations were frequently present in the blood of leukemia patients years after receiving chemotherapy, so they wondered how PPM1D mutant cells could become dominant over their normal counterparts in the blood. bone marrow. Was this dominance due to superior expression or better survivability under adverse conditions? The researchers have thus become experts on the PPM1D gene, they have been studying it for more than 20 years.

Chemotherapy promotes the survival of cells with mutated PPM1D:these laboratory experiments which consisted of mixing cells with normal PPM1D and mutant PPM1D and then exposing them to different environmental conditions show that under normal conditions, cells with PPM1D mutation and normal cells grow at the same speeds. This suggests that mutated cells are not inherently stronger. However, after exposure to the drug cisplatin and other chemotherapy drugs, researchers observe that cells with the mutation dramatically outperform normal cells. Their results suggest that chemotherapy acts as a pressure on evolutionary selection that will promote the survival of cells with mutated PPM1D, because "they 'benefit' from this specific type of stress", explains Joanne Hsu, student at Baylor's medical and scientific training program: “So when a patient receives cisplatin-based chemotherapy, stem cells with PPM1D mutations survive better. This growth advantage could provide fertile ground for the subsequent acquisition of mutations that eventually lead to the development of secondary leukemia years later.”

Multiple clinical implications for the future: indeed, knowing that certain chemotherapeutic drugs can influence the risk of leukemia years later will help doctors make better and more personalized treatment choices.

Finally, non-mutated PPM1D appears here as a promising therapeutic target in patients, post-chemo and/or suffering from secondary leukemia.

PREGNANCY and CANNABIS: In utero exposure not devoid of cognitive effects

This is one of the rare studies to have examined the cognitive effects on the offspring of in utero exposure - here high - to cannabis, on the offspring. Admittedly, the study is conducted in animals, but the Washington State University team specifies the possible cognitive changes in the offspring, linked to exposure to high concentrations of cannabis. Data presented at the 2018 Neuroscience Conference (San Diego) confirming the negative cognitive impact of cannabis on the developing brain and a fortiori on the fetus.

Lead author Dr. Ryan McLaughlin, professor of physiology and neuroscience, and his team exposed pregnant rats to varying concentrations of cannabis vapour. He observes that the offspring of the most exposed animals present significant difficulties in adaptation and “feeding” strategy.

The researchers used a new exposure system that vaporizes cannabis extracts to recreate the environment of human cannabis consumption. The more or less concentrated cannabis vapor was diffused in controlled atmosphere cages for more than 2 hours a day, before and during gestation. THC levels in the animals' blood were increased. Baby rats exposed in utero are unable to operate a lever allowing them to access their food. More generally, they are unable to renew their efforts enough (press the lever several times) to obtain a reward.

A certain drop in motivation! According to these data, prenatal exposure to cannabis leads to significant changes in brain development that induce various cognitive dysfunctions in adulthood.

These rats, exposed to a high concentration are not necessarily less intelligent, specify the researchers, but they are clearly less motivated!

Passive CANNABIS also exists

Secondhand cannabis smoke also causes, like passive smoking, asthma symptoms in allergic children, notes this study presented at the Scientific Sessions of the American College of Allergy, Asthma, and Immunology. A wise warning, and upstream of the United States with the trend of cannabis liberalization, but also a solution: with the removal of cannabis from the home, asthma symptoms disappear.

It is well established that second-hand cigarette smoke poses a risk to anyone with asthma. This study shows that it is possible for children and adults with uncontrolled asthma to have their symptoms worsen due to allergy and exposure to cannabis smoke.

The example is given by the authors: a 6-year-old boy with severe asthma whose parents regularly smoked cannabis at home. Even if the parents did not consume it in the same room as the child, the latter was exposed to traces of smoke and plants. The doctors did not understand why his asthma was so severe and unresponsive to treatment. After the cannabis was removed from the house, her asthma improved.

An allergy distinct from passive smoking “allergy”: tobacco smoke aggravates asthma by irritating the lungs in a non-allergic way, while cannabis smoke causes an allergic response.

Anyone who consumes cannabis should therefore be careful with those close to them, and in particular their children, as their exposure can lead to or aggravate uncontrolled asthma symptoms.

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