Cannabis chronicles 2

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Human endocannabinoid receptors CB1 and CB2. Receptor sites are found in many organs and areas of the body, but CB1 receptors are primarily located in the central nervous system, which includes the brain. CB2 receptors are found primarily in the immune system.
Cannabinoids THC and CBD interact with these receptor sites like our endocannabinoids do. (from the Ontario Cannabis Stores website (https://ocs.ca/blogs/how-cannabis-works/endocannabinoid-system).)

In November 2018 I was diagnosed with advanced osteoarthritis of the left hip. I’m scheduled to see a specialist in early February, with a surgical date dependent on the surgeon’s hospital OR schedule. According to the Canadian Institute for Health Information, I have an 83% chance of getting my hip replacement within 182 days of my referral.

In the meantime, I walk with a cane or ski pole. The only exercise left to me is swimming. My osteopath has succeeded in reducing associated sciatic pain but walking, standing, sitting and lying down are painful, often acutely. I can no longer control the pain with NSAIDs. I refuse to consider opioids because of their risks. 

On the advice of my GP I enrolled in a clinical trial conducted by the Registre de cannabis du Quebec, the Quebec Cannabis Registry. I take 1.5 ml of prescribed cannabidiol oil under my tongue twice daily. CBD reduces the pain’s intensity, allowing me to get on with life. It takes approximately 90 minutes for the dosage to take effect. 

Because everyone’s endo-cannabinoid receptors are unique, there is no such thing as a universal optimal dose or CBD/THC balance. Instead, one embarks on a trial-and-error process of finding one’s optimal dosage. Every refill arrives with a Health Canada fact sheet urging the beginner to start low and go slow in increasing one’s dosage. 

My pain specialist prescribed Spectrum Yellow, 20% CBD and less than 1% THC. I’ve been keeping a daily journal on my results and observed side effects. On the plus side: my pain is reduced to a manageable dull ache, I enjoy deeper, more restful sleep, a reduced appetite (a positive because my GP says I have to lose 10 pounds or I’ll be using a walker), regularity, and heightened senses of smell and taste. Less welcome are the dry mouth and eyes and a loss of enjoyment for alcohol. I’ve also noticed interactions with coffee (too much or too little triggers fleeting headaches) and a tendency to slight depression if I don’t drink a lot more water than I used to.

Once a month, I complete a Registry questionnaire. Has my quality of life improved or deteriorated? How well am I able to function? I report side effects and possible adverse reactions to the supplier as they occur and fill out their questionnaire.

I talk about CBD because I think others should know about it. People ask me whether it makes me high (it doesn’t), whether I can drive legally (depends on my ability to pass a roadside sobriety test) or visit the U.S. Over the course of the last two months, I’ve been surprised by the number of those taking CBD for a wide variety of conditions. A friend’s COPD has improved, another’s arthritic pain is less crippling. I take them for what they are — anecdotal evidence of the efficacy of CBD as an anti-inflammatory and pain reliever.

As a journalist, I have covered Canada’s transition from Killer Weed and reefer madness to legal pot, beginning with the Le Dain Commission hearings into legalization versus decriminalization. My biggest regret is that the Trudeau Liberals made legalization of recreational marijuana their priority, launching Canada into the big experiment before the medical profession is set up to measure the effects on individuals and the healthcare system. At the same time I find it beyond idiotic that Quebec doctors are still being discouraged from writing medical cannabis prescriptions and I find myself wondering what it will take to show how federal and provincial regulatory bodies are conspiring with those who manufacture, market and distribute opioids to keep patients “sweaty, fat, lazy, unmotivated — and still in pain.”

Is CBD a medical magic bullet? Which markers determine whether someone will respond well to cannabinoids and who might be genetically predisposed to psychotic or allergic reactions? Why do men and women respond differently? Without research, without scientifically conducted clinical trials, we won’t know until the U.S. jumps in — which is happening as I write this.

The Quebec Cannabis Registry is said to be planning to release details from its database this spring. In the meantime, I’ve spent the past month plowing through the contents of Therapeutic and Recreational Cannabis: In Search of Answers, an 83-page Powerpoint shown to doctors, pharmacists and nurse practitioners.  It draws case histories from the Registry.

Powerpoint takeaways:

— Current knowledge of the body’s endo-cannabinoid system is fragmentary but we know it is involved in regulating the cognitive system, fertility, pregnancy, appetite, mood, pain sensations and motor learning.

The human body manufactures its own endo-cannabinoids: anandamide, which acts on the same pain receptors as THC, and 2-arachidonoylglycerol, or 2-AG, which appears to control the level of a certain fatty acid that limits body’s anandamide levels.  These molecules latch onto CB1 and CB2 receptors to regulate and control a range of bodily functions. The theory is that a correct ratio of cannabis plant-derived analogs tetrahydrocannabinol and cannabidiol can help rebalance the body’s endo-cannabinoid system. But drug basics — counterindications, dosage, interactions and side effects are fragmentary.

We know there’s an individual optimal mix of THC and CBD but we don’t know much about the 140 other compounds found in cannabis strains. We’re beginning to learn about the function of terpenes — aromatic components in cannabis extracts — in modulating the effects of THC and CBD.

Research, most of it anecdotal, has determined that ratios of caryophyllene, limonene, myrcene, pinene and terpineol play a role in determining the psychological effects of different cannabis strains. The farthest the industry goes in assigning specific benefits to terpene combinations is to describe them as having an “entourage effect” — a hypothetical mechanism by which compounds in cannabis largely non-psychoactive by themselves moderate the overall psychoactive effects of the plant.

The Powerpoint’s clinical observations about CBD and THC are convincing, not only in the treatment of neuropathic pain but the generalized symptoms of pain, psychic troubles, inflammatory and auto-immune disorders and neurological complaints can be mitigated. Studies show positive results in treating of epilepsy, anorexia, fibromyalgia, inflammatory bowel and intestinal disease, chronic migraines, acute pain sensitivity, chronic fatigue syndrome, bipolar disorder, autism spectrum disorders, insomnia, anxiety, PTSD, schizophrenia and depression.

The presentation begins with a pharmaceutical history of pain relief, then shows how CBD and THC are being used to treat the same disorders with positive results. By the 63rd slide, the dissertation gets into pain-relief specifics: preliminary results from the Registry show reductions in neurological and mixed back pain, radiating lower neck pain with or without dystonia, CRPS, post-operative visceral pain (abdominal and pelvic), post-traumatic chronic headaches and migraines, jaw pain and cancer-related pain (nausea, wasting).

“We are likely going to be able to show major pharmacological benefits and savings in pain treatment,” the presentation concludes. “Most psychoactive drugs will eventually be phased out.”

This is where some of the research is concentrating — on the use of CBD to wean opioid addicts off their drugs. (This presentation was funded by Purdue Pharma and Janssen Ortho, two major opioid producers.) North America uses 80% of the world’s prescription opioids. It’s a $2.6B industry. Access to replacement treatments using methadone and suboxone is extremely limited. There is an 85% risk of relapse. Even through the genetics and neurobiology of addiction are well known, funding for research is very limited. The subject is poorly or not taught in medical schools.

Pain researchers report immediate effects when CBD is combined with opioids. Pain relief is immediate and tolerance levels are lowered. Some patients stopped taking opioids. Others stopped taking antidepressants, anti-convulsants and anti-spasmodics. “…there is evidence that CBD…can play a role not in opioid withdrawal, but with other stimulants — nicotine, cocaine, amphetamines.” Doctors currently prescribing medical cannabis agree Quebec’s pharmacies are best situated to ensure compliance and provide advice to patients about the side effects of terpene profiles.

Quebec Cannabis Registry case histories:

#3 52-year-old female with chronic back and hip pain, migraines, chronic fatigue, insomnia off work for 2+ years and walking with a cane, treated with 30 mg of CBD and 7.5 mg. THC/day. No longer uses fentenyl patches, gabapentin, naproxyn, Cymbalta, Tramacet, Elavil, clonazepam.

#4: male, 70, with progressive chronic pain since 2004, fibromyalgia, neuropathic pain in hands, chronic fatigue and insomnia, treated with CBD 30 mg/day and THC 2×23 mg/day. Has ceased taking Cymbalta, oxycodone, ketamine, Tylenol, naproxyn, OxyNeo, gabapentin, Nabilone, Elavil, Senecot/Colace.

#5: 42-year-old woman with Lynch Syndrome underwent colon, brain and breast surgeries in adolescence.  Suffers from chronic head and abdominal pain. Treated with CBD and THC, she has stopped using Elavil, Constella, Effexor, dicyclomine,  Prevacid, naproxyn, gabapentin, citalopram. She continues to take meds prescribed for bipolar disorder.

#6: Female, 52, with Crohn’s disease underwent total colectomy, suffers from rheumatoid arthritis, chronic abdominal pain. Medications included prednisone, Statex, Gravol, Serax, Tylenol, Pantoloc, Purinethol. Since being placed on 15 mg of CBD and 10 mg THC at bedtime, she no longer uses prescription meds.

#7: 38-year-old woman diagnosed with fibromyalgia in 2005 and spinal arthritis in 2007, was given 26.3 mg of THC at bedtime and 20 mg. of CBD twice daily. She stopped using fentanyl patch, Elavil, Cyclopenzaprine, Topamax, Dexilant, Seroquel, Lax A Day and Gabapentin. By September, she was receiving injections of Certolizumab, a biologic medication prescribed for Crohn’s and several forms of arthritis.

#8: 35-year-old mother of four suffered kidney stones and related infections. Diagnosed with psychiatric disorder, addicted to dilaudid and other prescription painkillers. Unable to tolerate methadone, she was switched to the opiod Tapenadol. She is undergoing cannabis therapy while continuing Tapenadol and the antidepressant Effexor.

#9: 32-year-old woman underwent total colectomy and ileostomy in the course of an emergency caeserian and underwent nine more surgical procedures for adhesions. Suffers from chronic abdominal pain, took to injecting prescription meds to cope. Hospitalized, she was switched from hydromorphone to metadol and is undergoing cannabis therapy to wean her from metadol. She’s off opioids dilaudid and Contin and will stop taking the tranquilizer clonazepam and Trintellix, an antidepressant.

#10: Male, 37, suffered a crushed wrist in 2015 and subsequent neuropathic pain. Unable to tolerate prescription painkillers, consumed 6-8 grammes of dried cannabis per day. Switched to 2 grammes of THC/CBD hybrid cannabis flowers and daily doses of THC and CBD oils.

#11: Female, 56, severe chronic back pain, multiple intolerances to prescription painkillers, walks with a cane with difficulty. Placed on a dosage of 1-3 grammes of a mix of CBD and THC cannabis strains, she stopped taking her daily mix — Lyrica, Kadian, Emtec, Contin, dilaudid, naproxyn, Flexeril.

#12: 60-year-old male injured his left knee in a 2005 workplace accident and was forced to stop working 10 years ago as the result of chronic neuropathic pain. Opioid dependent, he became obese. Since starting to take gelcaps of a THC/CBD oil mix at suppertime, he stopped taking Oxyneo and oxycodone and has reduced his metadol prescription by two thirds. He has since returned to work and has lost 47 pounds.

The presentation’s conclusions:

— Our lack of understanding of neuropathic pain, addiction and pain hypersensitivity has led to the misuse of opioids.

— Opioids have their place, but new restrictions must be placed on their use.

— The preliminary results of the Quebec Cannabis Registry demonstrate an efficacy in  neuropathic pain, inflammatory diseases, and possibly in relieving pain hypersensitivity and the symptoms of opioid withdrawal.

— Cannabis isn’t tolerated by everyone and will not be covered until in-depth studies are published, which will take considerable time unless demonstrated savings in [drug, hospital and social costs] generate the political will to effect change.

— The Colleges [of Physicians and Surgeons] the faculties of medicine and the Order of Pharmacists should promote the teaching of these subjects to their members.

— What is considered recreational usage is often the result of self-medication for an undiagnosed condition. These individuals should be able to access the information required for healthy use of these products.

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My growing cane collection.

 

 

 

 

 

 

 

 

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