Cannabis Patient Care - August 2022

Cannabis Patient Care - August 2022

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13 doctor focus cannapatientcare.com july/august 2022 | cannabis patient care non-ECS targets of compounds found in cannabis that also modulate inflammation, metabolism, nerve function, and more. One of the most common autoimmune diseases I've treat- ed with cannabis, multiple sclerosis (MS), is also one of the best studied. Nabiximols (brand name Sativex), a pharmaceu- tical oral spray containing plant-derived tetrahydrocannabinol (THC) and cannabidiol (CBD), has been extensively investigated in randomized, controlled trials: between 2000 and 2010, nabix- imols trials included more than 2500 patients with MS, of whom more than 660 were treated continuously for at least 6 months. Nabiximols was approved in several countries for the treatment of MS spasticity, and vast clinical experience with nabiximols in the post-marketing setting accounts for more than 150,000 pa- tient-years of use to date. A recent review of the post-market- ing data concluded that (5), "nabiximols is a solid option for the management of MS spasticity in patients who fail to respond adequately to treatment with first-line anti-spasticity agents." The authors also noted that (5), "nabiximols can provide notice- able relief of other symptoms associated with spasticity such as spasms, pain and disrupted sleep." It has always bothered me when researchers and med- ical authorities ascribe cannabis to the category of sec- ond-line therapies, considering it has a superior safety profile compared to most first-line agents, an extensive list of side benefits typically conveyed to patients, and as described be- low, the potential to beneficially impact the underlying cause of the condition. In my practice, cannabis is appropriate- ly used as a first-line agent for spasticity and pain when pa- tients come to me early enough in their health journey. The American Academy of Neurology, in a 2014 review of 34 studies, supported the use of oral cannabinoids in the treat- ment of MS spasticity, pain originating in the central nervous system, and spasticity-related pain, and found that oral can- nabinoids are probably also effective for reducing bladder com- plaints in patients with MS (6). The data supporting oral use is substantial and the benefits are moderate, but not impressive. While majority of the data on cannabis for MS comes from tri- als using oral cannabinoids, in my clinical experience, I have found inhaled cannabis to be much more effective for produc- ing improvements in spasticity. One placebo-controlled crosso- ver trial on 30 patients with MS using low-quality cannabis cig- arettes (4% Δ 9 - tetrahydrocannabinol [THC]) versus placebo cigarettes smoked once daily for 3 days confirmed my observa- tions: reductions in objective measures of spasticity were great- er than those observed in the oral cannabis trials, and subjects also experienced more significant reductions in pain (7). Multiple sclerosis Nerve cells Rheumatoid arthritis Joints Guilliain-Barre syndrome Muscles in the legs IBD, Celiac disease Intestines Addison's disease Adrenal glands Lupus Skin, joints, brain Hashimoto's thyroiditis Thyroid gland Vasculitis Blood vessels Rheumatic fever Heart Type 1 diabetes Pancreas Psoriasis Skin Graves' disease Thyroid gland Figure 1: Types of autoimmune diseases pikovit/adobe/stock.com

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