Cannabis, a few things you need to know

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PainWeek 2018 has a series of conferences in different cities. This weekend 10/13-10/14, it was in San Diego teaching pain management. 

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There was a talk on cannabis by a nurse practitioner from Stanford. I would add or highlight a few things.

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There are two species:

–Indica often said to help pain, sleep.

–Sativa more activating, for daytime use.

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Most are hybrids. Some people have opposite responses. It may be contraindicated for those with bipolar disorder. Those with multiple sclerosis may use it for spasticity. It can help depression but may cause anxiety, depression, paranoia, etc.

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The plant has 400 chemicals. More than 90 are cannabinoids. Two best known cannabinoids:

–THC is psychoactive.

–CBD has no psychoactive properties and does not make you high. In recent years, it has been found to help certain forms of epilepsy in children who are resistant to all known epilepsy medication.

–THCV has been said to prevent the munchies. Only one strain I know of has this cannabinoid, Durban Poison.

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It is not necessary to have THC for pain relief. Pain in some patients may respond to CBD alone.

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Tolerance does develop. It becomes less and less effective with use.

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Side Effects: the very worst is the munchies – deadly weight gain. Dry eyes and dry mouth can affect all, but for those with Sjogren’s Syndrome, it increases the risk of corneal transplants and loss of teeth that already exists and can be a serious problem. It can increase heart rate and blood pressure especially in those who have never used cannabis.

Update 10/19/18, cannabis may boost risk of stroke. The drug has system-wide effects therefor not limited to smoking it. Note that we have known it does increase heart rate and blood pressure, at least initially when starting use, but may develop tolerance to side effect with regular use – or not. The new study does not indicate how much cannabis these patients were using, their ages and blood pressure baseline and during use. Was their use conservative or were they overdosing, couch locked, less active than usual?

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• Stroke increased by 15% among marijuana users between 2010 and 2014
• Rates of stroke in non-cannabis users stayed constant over that time
• Compounds in cannabis may cause blood vessels in the brain to narrow

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Rates of stroke among non-cannabis users didn’t change. However, rates among recreational users jumped by 15 per cent.

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“Avalon University researchers…analysed 2.3 million people between the ages of 18 an 84 who used cannabis recreationally and spent time in hospital from 2010-to-2014.

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Of these, 32,231 – 1.4 per cent – had a stroke.

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And 19,452 had an acute ischemic stroke (AIS), which occurs when blood supply to an area of the brain is suddenly cut off, leading to a loss of cognitive function.

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Over the four years, the rate of all strokes among marijuana users rose from 1.3 per cent to 1.5 per cent. And AIS increased from 0.7 per cent to 0.9 per cent.

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The research was presented today at the World Stroke Congress in Montreal.

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They scientists believe their findings ‘warrant further prospective studies to evaluate the marijuana-stroke association amidst legalisation of recreational use’.

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But the study contradicts previous research that suggests smoking cannabis can actually reduce the risk of stroke by boosting blood flow to the brain.

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Marijuana has also been linked to faster recovery post stroke.

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Stroke is the second leading cause of death and disability globally, with one person passing away from the condition every six seconds.

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Around 140,000 people die from stroke in the US and 32,000 in the UK every year.

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Leafly.com is a nationwide resource for locations where cannabis is legal, listing strains and dispensaries by zip code. For each local strain it shows a bar graph of Effects, Medical, Negatives. Negatives may include dry eyes, dry mouth, sleep, anxiety, paranoia, headache, etc. rated by buyers. For example, one strain may be rated 100% dry eyes, but only 50% dry mouth. Each strain is different. But dry eyes, dry mouth are the most common, always highly prevalent, whereas paranoia, dizziness, anxiety may be rated only 3%.

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FDA has approved 2 THC compounds available for medical use:

–Dronabinol (Marinol), schedule III drug. I have never seen a single person with cancer pain, HIV AIDS pain or chronic pain benefit. Instead they complain about it, including those who heavily used cannabis.

–Nabilone (Cesamet), a schedule II drug. I had it diluted 10 times for a healthy senior with intractable pain. He hallucinated for 12 hours after a tiny dose. I’ve never seen a plant do this.

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More research is greatly needed. It has primary effect on the immune system in brain and body including neuro-inflammation in the central nervous system and the skeletal cannabinoid system. It is anti-inflammatory. In the brain, the microglia makes and reabsorbs one of the endogenous cannabinoids made by the brain. Studies show cannabis can help pain but almost all of my patients who tried many many strains reported that it failed to help intractable pain. Others stopped due to side effects. But I have seen patients with intractable pain and treatment resistant migraine who responded to CBD alone.

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Use the search function top left above photo for previous posts on cannabis.

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Beware the munchies and weight gain. It can be deadly. That effect can be life-saving in cancer patients and end of life care.

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Urine drug testing does not always include cannabis. It may be present in urine for up to 2 months. Don’t even think about getting on a plane with cannabis.

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