Medical Cannabis in the Skilled Nursing Facility: A Novel Approach to Improving Symptom Management and Quality of Life.

Journal of the American Medical Directors Association Home

“Throughout the millennia, the cannabis plant has been utilized as a recognized therapy for pain relief and symptom management.

Following the Prohibition-era stigmatization and criminalization of all forms of cannabis of the early 20th century, there has been a recent nationwide and worldwide resurgence in interest and use of the cannabinoid compounds extracted from the cannabis plant, that is, medical cannabis.

Although at the Federal level, cannabis remains a Schedule I substance, 31 states have already decriminalized possession and use of medical cannabis for specific diagnoses.

It is noteworthy that many of these indicated diagnoses are prevalent in the skilled nursing facility (SNF). This creates regulatory concerns as SNFs and other healthcare facilities must maintain compliance with Federal laws, while balancing the individual resident’s rights to utilize medical cannabis where indicated.

The authors developed an innovative program that affords their residents the ability to participate in a state-approved medical cannabis program while remaining compliant with Federal law. As medical cannabis use becomes more widespread and accepted, clinicians providing medical care in healthcare facilities will encounter residents who may benefit from and request this alternative therapy.

Studies examining older adults that are utilizing medical cannabis legally have demonstrated significant decreases in prescription medication use, most notably a reduction in opioid analgesic usage. As such, medical cannabis should be viewed as an additional option in the clinician’s toolbox of therapeutic interventions for symptom relief.”

https://www.ncbi.nlm.nih.gov/pubmed/30580820

https://www.jamda.com/article/S1525-8610(18)30662-5/fulltext

Culture and cannabinoid receptor gene polymorphism interact to influence the perception of happiness.

 Image result for plos one“Previous studies have shown that a cytosine (C) to thymine (T) single nucleotide polymorphism (SNP) of the human cannabinoid receptor 1 (CNR1) gene is associated with positive emotional processing.

C allele carriers are more sensitive to positive emotional stimuli including happiness. The effects of several gene polymorphisms related to sensitivity to emotional stimuli, such as that in the serotonin transporter gene-linked polymorphic region (5HTTLPR), on emotional processing have been reported to differ among cultures-e.g., between those that are independent and interdependent. Thus, we postulated that the effects of the CNR1 genotype on happiness might differ among different cultures because the concept of happiness varies by culture.

We recruited healthy male and female young adults in Japan, where favorable external circumstances determine the concept of happiness, and Canada, where the concept of happiness centers on positive inner feelings, and compared the effects of the CNR1 genotype on both subjective happiness levels (self-evaluation as being a happy person) and situation-specific happiness (happy feelings accompanying various positive events) by using a questionnaire.

We found that the effect of CNR1 on subjective happiness was different between the Japanese and Canadian groups. The subjective happiness level was the highest in Japanese individuals with the CC genotype, whereas in Canadian participants, it was the highest in individuals with the TT genotype. Furthermore, the effects of CNR1 genotype on situation-specific happiness were also different between the groups. Happiness accompanied with being surrounded by happy people was the highest among Japanese individuals with the CC genotype, whereas among Canadian individuals, it was the highest in TT genotype carriers.

These findings suggest that culture and CNR1 polymorphism interact to influence the perception of happiness.”

https://www.ncbi.nlm.nih.gov/pubmed/30576341

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209552

“Genetic Variations in the Human Cannabinoid Receptor Gene Are Associated with Happiness” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972248/

Alcohol Use and Risk of Related Problems Among Cannabis Users Is Lower Among Those With Medical Cannabis Recommendations, Though Not Due To Health.

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“A small body of work has started developing cannabis use “typologies” for use in treatment and prevention.

Two potentially relevant dimensions for classifying cannabis use typologies are medical versus recreational cannabis use and the co-use of cannabis and alcohol.

Here we compare alcohol use and related problems between cannabis users with and without medical cannabis recommendations.

Cannabis users with medical cannabis recommendations drink less and have fewer alcohol-related problems than those without recommendations, even after adjusting for health status.”

https://www.ncbi.nlm.nih.gov/pubmed/30573025

Cortical surface morphology in long-term cannabis users: A multi-site MRI study.

 European Neuropsychopharmacology

“Cannabis exerts its psychoactive effect through cannabinoid receptors that are widely distributed across the cortical surface of the human brain. It is suggested that cannabis use may contribute to structural alterations across the cortical surface.

In a large, multisite dataset of 120 controls and 141 cannabis users, we examined whether differences in key characteristics of the cortical surface – including cortical thickness, surface area, and gyrification index were related to cannabis use characteristics, including (i) cannabis use vs. non-use, (ii) cannabis dependence vs. non-dependence vs. non-use, and (iii) early adolescent vs. late adolescent onset of cannabis use vs. non-use.

Our results revealed that cortical morphology was not associated with cannabis use, dependence, or onset age.

The lack of effect of regular cannabis use, including problematic use, on cortical structure in our study is contrary to previous evidence of cortical morphological alterations (particularly in relation to cannabis dependence and cannabis onset age) in cannabis users.

Careful reevaluation of the evidence on cannabis-related harm will be necessary to address concerns surrounding the long-term effects of cannabis use and inform policies in a changing cannabis regulation climate.”

https://www.ncbi.nlm.nih.gov/pubmed/30558823

https://www.sciencedirect.com/science/article/pii/S0924977X18319874?via%3Dihub

[Neonatal hypoxia-ischemia: cellular and molecular brain damage and therapeutic modulation of neurogenesis].

 

 

Image result for Rev Neurol journal

“Perinatal asphyxia remains a major cause of both mortality and neurological morbidity. Neonatal encephalopathy affects to 1-3/1,000 newborns, leading to significant brain damage and childhood disability.

The only standard therapy is moderate hypothermia, whose efficacy, despite proved, is limited, being partially effective.

The use of therapeutic agents such as erythropoietin and cannabinoids and mesenchymal stem cells have shown promising results in experimental models of perinatal asphyxia, being able of modulate neurogenesis, neuronal plasticity and neuroreparation processes after hypoxic-ischemic brain injury.”

https://www.ncbi.nlm.nih.gov/pubmed/30560986

Hemp (Cannabis sativa L.) Seed Phenylpropionamides Composition and Effects on Memory Dysfunction and Biomarkers of Neuroinflammation Induced by Lipopolysaccharide in Mice.

ACS Omega

“Hempseed has achieved a growing popularity in human nutrition, particularly regarding essential amino acids and fatty acids. The multiple positive attributes of hempseed have led to the further study of its constituents.

In this study, hempseed extract containing phenylpropionamides (TPA) was obtained and its chemical profile and content were obtained using high-performance liquid chromatography technology based on previous study.

The anti-neuroinflammatory effect of TPA extract was evaluated using a lipopolysaccharide (LPS)-induced mouse model. Fourteen phenylpropionamides (TPA) were identified in the obtained extract with a total content of 233.52 ± 2.50 μg/mg extract.

In mice, TPA prevented the learning and spatial memory damage induced by LPS. Increased brain levels of IL-1β, IL-6, and TNF-α in the LPS-induced mice were reduced by TPA treatment. Furthermore, TPA attenuated LPS-induced hippocampal neuronal damage in mice.

This study demonstrates the nutraceutical potential of hempseed from a neuroprotective perspective.”

https://www.ncbi.nlm.nih.gov/pubmed/30556022

https://pubs.acs.org/doi/10.1021/acsomega.8b02250

Use of marijuana exclusively for medical purposes.

Drug and Alcohol Dependence

“To characterize the socio-demographic characteristics, medical conditions, and psychiatric comorbidities of users of marijuana for medical and non-medical purposes.

RESULTS:

In relation to non-medical only users (n = 3339), combined (n = 362) and medical only (n = 82) users had higher prevalence of every medical condition examined. As compared to the combined use group, those using marijuana only for medical purposes were much less likely to have anxiety, alcohol, or non-medical prescription opioid use disorders.

CONCLUSIONS:

Medical-only users appear to use it for evidence-based medical reasons and have lower prevalence of substance use disorder than other marijuana users. Nonetheless, because most medical marijuana users also use non-medically, screening for psychiatric disorders and prevention efforts for cannabis use disorder should be implemented when authorizing medical marijuana.”

https://www.ncbi.nlm.nih.gov/pubmed/30557813

https://www.sciencedirect.com/science/article/pii/S0376871618305660?via%3Dihub

Safety and efficacy of nabiximols on spasticity symptoms in patients with motor neuron disease (CANALS): a multicentre, double-blind, randomised, placebo-controlled, phase 2 trial.

The Lancet Neurology

“Spasticity is a major determinant of disability and decline in quality of life in patients with motor neuron disease.

Cannabinoids have been approved for symptomatic treatment of spasticity in multiple sclerosis. We investigated whether cannabinoids might also reduce spasticity in patients with motor neuron disease.

Nabiximols was well tolerated, and no participants withdrew from the double-blind phase of the study. No serious adverse effects occurred.

INTERPRETATION:

In this proof-of-concept trial, nabiximols had a positive effect on spasticity symptoms in patients with motor neuron disease and had an acceptable safety and tolerability profile.”

https://www.ncbi.nlm.nih.gov/pubmed/30554828

https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30406-X/fulltext

Medical Cannabis.

Mayo Clinic

“Medicolegal realities surrounding “medical marijuana” or “medical cannabis” are rapidly evolving in the United States. Clinicians are increasingly being asked by patients to share information about or certify them for medical cannabis. In order to engage in informed discussions with patients or be comfortable certifying them in states with medical cannabis laws, clinicians may benefit from an understanding of the current state of medical knowledge about medical cannabis. Intended for the generalist and subspecialist, this review provides an overview of the legal status, pharmacology, benefits, risks, and abuse liability of medical cannabis along with a general framework for counseling patients.”

The endocannabinoid system: Overview of an emerging multi-faceted therapeutic target.

Prostaglandins, Leukotrienes and Essential Fatty Acids Home

“The endocannabinoids anandamide (AEA) and 2-arachidonoylglyerol (2-AG) are endogenous lipid mediators that exert protective roles in pathophysiological conditions, including cardiovascular diseases. In this brief review, we provide a conceptual framework linking endocannabinoid signaling to the control of the cellular and molecular hallmarks, and categorize the key components of endocannabinoid signaling that may serve as targets for novel therapeutics. The emerging picture not only reinforces endocannabinoids as potent regulators of cellular metabolism but also reveals that endocannabinoid signaling is mechanistically more complex and diverse than originally thought.”

https://www.ncbi.nlm.nih.gov/pubmed/30553404

https://www.plefa.com/article/S0952-3278(18)30176-5/fulltext