Tag: Health & Medicine

Florida Researchers to Explore Cannabis and HIV with Major Grant

University of Florida Health’s Dr. Robert Cook is lead investigator of a study starting in January that will look at the health effects of cannabis on people with HIV as well as its potential as an alternative to addictive opioids. Awarded a $3.2 million R01 grant from the National Institute on Drug Abuse (NIDA), Dr. Cook and his team will conduct a study of 400 persons living with HIV infection to identify relationships between marijuana consumption and control of HIV symptoms, HIV viral suppression, markers of chronic inflammation, and cognitive or behavioral aspects of health.

Florida has the third-highest number of residents living with HIV infection in the U.S., according to a 2015 study conducted by the Center for Disease Control and Prevention. Was that a factor in why you developed this study?

Fifty percent of people with HIV in Florida are now 50 years old or more. So, we have a lot of older people who currently use marijuana or who are thinking about it. And we don’t have a lot of information on what happens to people over age 50.

What was the impetus for you to study the effects of cannabis on HIV?

As a clinician, I have seen a lot of patients who seem interested in trying medical marijuana for a variety of conditions. I was looking for some data to support which kinds of marijuana might be more beneficial than others and I couldn’t find any evidence so I decided we really needed to do some type of study.

Had you researched cannabis before you decided to do this study?

In the last couple of years, we have been doing some research looking at marijuana and its effects on cognitive function. We have also been looking at marijuana use in HIV viral suppression and we have been looking at a few other things but most of this is limited because all we know about people is: Do you use any marijuana; and if so, how often? So, we can compare people who report daily use vs. non-daily use. We were frustrated by how limited information about how people use marijuana was in the current research. For our study we are going to try to ask a lot more questions about what kind they use; do they get it from a dispensary or not; do they ingest it or smoke it or vape it? We are going to do a urine toxicology to try and figure out if what they use has any of the cannabinoids in it or if it’s only THC. I think there’s a lot of medical interest around the CBD part. It does seem like what’s available to purchase is mostly THC products and the CBD stuff costs more. I would like to be able to tell patients if this is worth it. We need to have data to show if you do have a CBD product that it is better for pain and things like that. Those are the types of questions that I think we need more data on but have been hard to study because marijuana is illegal at the federal level. It’s very hard for researchers to directly study it. One of the biggest limitations of the research we are going to do is that it is going to be reported by the participants themselves. Even though we are going to do this urine screen to see whether there’s THC or not, we still aren’t directly controlling what people use or don’t use. It’s all based on their reporting.

As you begin the study, what is your hypothesis for medicinal cannabis and HIV?

I do believe that people who are getting effective relief from pain, for example, will be using it slightly differently than those who don’t get effective relief from pain. I suspect the CBD part is important, but I don’t have a lot of data to prove it. And I am interested in comparing some of the side effects of people are who are using products that are either long-lasting or that they use several times a day compared to people who use marijuana intermittently. Because even with that I wonder as a physician should we be encouraging people to just dose it all day long versus use as needed. There is an endocannabinoid system in our bodies that’s natural and it may react differently when people are constantly being exposed versus intermittent and I am not sure yet which is better.

Many HIV patients take cannabis to help with sleep, pain and stress, do you believe any other useful information will come out of this study such as aiding HIV’s viral suppression?

It’s very challenging to really prove whether it is helping or not in terms of things like anxiety and stress because we are enrolling people in our study who are already using it for anxiety and stress because you really don’t know what their level would be if they weren’t using it. People may perceive that’s helping but we really don’t know. I hope I get some people in the study who haven’t used marijuana before and they begin to use, because it’s now legal to prescribe it for people with HIV in Florida, so that will be interesting to see what happens to people when they haven’t used it before and now they start. We are also especially interested in inflammatory markers. HIV virus, if it’s unsuppressed, does cause chronic inflammation in the body and that is usually associated with more rapid aging, more rapid progression of heart disease, and probably feeling fatigued and tired. If marijuana could suppress some of that chronic inflammation or at least some parts of marijuana, it really could help people with a chronic virus feel better. We do suspect that many people truly do feel better with it and I suspect it’s because of its relationship to inflammation. But most of the data we have so far is short-term studies, which are helpful, but we will be looking at a longer view, over several years and that will be something different about our study over previous studies.

How many study participants do you need?

We want 400 participants who ultimately will use marijuana, we will have probably at least 100 who don’t use marijuana as a comparison group.

What do you see as your biggest challenge regarding this study?

Science is an animal project, you can control everything except for the marijuana and learn a lot. But in real life our participants, in addition to having different marijuana patterns, also do have different patterns of other substance use, different medical comorbidities, and different experiences of stress and abuses in their lives. It can be hard to tease out an effect with all this variation but at the same time that’s the real world. People living with HIV in Florida do have many medical conditions like high blood pressure, diabetes, depression and so we want to know if it’s safe to use in these types of people with lots of health issues.

UF Health researchers applied for the NIDA grant twice before receiving it. How many years have you been trying to get this study in place?

At least two years. This is kind of a common story with National Institutes of Health-funded research. Usually you have to be in the top ten percent of grants to get it and those often take several tries where you get feedback from other scientists who make suggestions on how to improve the science and I tried to be responsive to their suggestions. For example, they did think we should focus a little bit more on pain and pain medication so we tried to adapt the study to that.

Do you think the reason you received the grant has to do with the nation’s opioid problem and cannabis’ potential to be an alternative?

You would have to ask NIH, but I do think our grant was funded in part because there are so few studies trying to gain scientific evidence on marijuana and any type of chronic health issue. HIV is one, but they might be interested in other types of conditions people might use it for. We have very little information and so there was a perception in the past that NIH was more interested in marijuana as a drug of abuse and not so much on its health effects. But I do think that attitude has shifted a lot in the last ten years where NIH is open to both and looking at it as a drug that could be beneficial while also it could still have harms associated with it.

With the $3.2 million grant from the National Institute on Drug Abuse, you are in a very elite group, researchers who have been given a federal grant to study cannabis, did you think you would get federal funding?

That’s what I have been trained to do for my academic career. They train us to write grants and as you gain more experience as a scientist you learn to write better grants and you get feedback that helps you to be a better scientist. I was optimistic that we had a good chance to get funded, otherwise, I don’t think we would try but it is a competitive process and certainly takes a team of scientists, and I have a great team with a lot of different areas of expertise and I think that helps. There is just a need for research.

I do hope over the next several years the information that we get will be helpful. It’s important to me that the data we collect ultimately will help to guide patients who might benefit, to guide people who might be vulnerable to harm, to guide providers, at least in Florida, who are specifically recommending doses and types and writing prescriptions which is different than what I think is happening in many other states in which people can get a license and the clinical recommendations are made by the people working at the dispensaries.

I should note that the people working at the dispensaries often seem to have an incredible abundance of knowledge about the medical effects. So how do we translate what they seem to know to data that’s more typically required in order to practice medicine in the U.S.? We don’t just want anecdotal reports or personal experience, we want harder data. It does seem like people know a lot of information out there and I want to try and translate some of what they know into more typical health data. Our research can influence practice guidelines and things as simple as do Sativa products truly cause people to feel more alert and creative? Do Indica products cause people to really be more laid back and sedate? And is that the same in people who are older than 50? Those are the type of things I would want, as a provider, to know and make suggestions as to which product a patient should try.

What are some potential negatives that could result from the study?

We have to be really careful about confidentially, when you do this type of research we have staff that we train, but staff can make mistakes. We have to do our best to ensure that people aren’t outed as being HIV positive or that people aren’t outed because they are marijuana users. There is a lot of need for researchers to make it safe for people to participate.

What about cannabis being federally illegal?

People are worried at the University that we could lose federal funding because it is involved in research that is federally illegal. When the political administration is stating pretty clearly they aren’t going to tolerate a lot of marijuana activity and that’s the public stance, we need to be cautious. As a researcher I am not applying to have marijuana onsite. We do have the potential to work with the dispensaries themselves and let them dispense the products which they can do legally and collaborate with them as scientists to try and do some clinical studies. That’s something I am interested in, in the next year or two, to really figure out a way where we can try to randomly assign people who are willing to participate in a different study with product A vs. product B, or product A that’s consumed orally vs. inhaled and see if we can get some clinical evidence both in terms of people’s perceived symptoms, which is important, but also any biological measures like inflammatory markers. Ultimately, I do hope we generate some data that can be helpful for consumers and providers.

This interview was originally published in elevate NV magazine

Photo courtesy of Allie Beckett

 

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Review of CBD Studies Indicates Cannabinoid’s Antipsychotic Effects

Performed in the Netherlands, a review of existing research on Cannabidiol – aka, the CBD cannabinoid found in marijuana – has underscored the compound’s efficacy as an antipsychotic medication.

In another victory for Cannabidiol, the recent review of existing research has determined the CBD cannabinoid found in cannabis is more effective at reducing antipsychotic episodes than currently prescribed pharmaceuticals with fewer side effects.

Schizophrenia affects approximately 3.5 million people in the U.S. and typically begins in early childhood, usually afflicting those between the ages of 15 and 25. Males historically succumb to schizophrenia at a slightly earlier age than females. While symptoms of schizophrenia are first detectable in men between the age of 16 and 25, the average female afflicted with schizophrenia realize their symptoms several years later, with an elevated incidence in women over 30. 

CBD’s Antipsychotic Effects

The studies reviewed by forensic psychologist Lillian Kloft and published in the Maastricht Student Journal of Psychology & Neuroscience offer pragmatic support for the antipsychotic effects of the CBD cannabinoid.

For the review, Kloft examined the accumulated research from “experimental” and “non-clinical studies,” which examined the effectiveness of the CBD cannabinoid on schizophrenia. The  reviewed studies were primarily based on “animal models of psychosis, human experimental studies, neuroimaging studies, epidemiological studies, and clinical studies.”

After first noting the CBD cannabinoid warrants “long-term, large-scale, randomized clinical trials,” Kloft’s review of the existing research concluded; “The preclinical and clinical studies discussed in this review provide promising initial support for CBD as an effective and safe antipsychotic compound. Preliminary evidence points to high tolerability, superior cost-effectiveness, and a promising side effect profile, suggesting an attractive alternative to current antipsychotic treatment.”

Photo courtesy of Allie Beckett

Review of CBD Research Points to Antipsychotic Effect by Monterey Bud on Scribd

 

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THC and Migraines: Study Indicates Tetrahydrocannabinol Can Help

A recent study published in the European Journal of Pharmacology examined the use of cannabinoids as a treatment for migraines in female rats and found THC has the power to reduce migraine-like pain.

Migraine headaches adversely affect more than 4 million Americans daily. Considered the sixth most disabling illness in the world, migraines that can last for 72 hours plague 12 percent of the U.S. population, according to the Migraine Research Foundation.

But thanks in part to funding from the passage of I-502 in 2012 and motivation from a survey indicating 10.2 percent of those suffering from migraine headaches in Germany, Austria, and Switzerland self-medicate with marijuana, researchers at Washington State University (WSU) were given the opportunity to examine the possible correlation between marijuana and migraines.

how to make a cannabis salve for migraines

Humans have self-medicated with cannabis as a treatment for migraines throughout history.

For the study, Dr. Ram Kandasamy of WSU’s Department of Integrative Physiology and Neuroscience examined the medical efficacy of the most famous cannabinoid by administering a precise dose of ∆9-tetrahydrocannabinol (THC) to female rats, at specific times.

The study notes that female rats were selected because a “migraine is much more common in women than men (Vetvik and MacGregor, 2016).”

THC Migraine Research Methodology

“The present study tested whether administration of ∆9-tetrahydrocannabinol (THC) produces anti-migraine effects in the female rat. Microinjection of the TRPA1 agonist allyl isothiocyanate (AITC) onto the dura mater produced migraine-like pain for 3 h as measured by depression of home cage wheel running. Concurrent systemic administration of 0.32 but not 0.1 mg/kg of THC prevented AITC-induced depression of wheel running. However, 0.32 mg/kg was ineffective when administered 90 min after AITC.”

Note: Scientists viewed the home cage wheel activity as particularly useful in determining each rat’s stress level, and according to the scientists, only stress-free rats run for extended periods of time.

After anesthetizing and studying “48 adult female Sprague-Dawley rats,” researchers discovered a “higher dose of THC (1.0 mg/kg) depressed wheel running whether rats were injected with AITC or not. Administration of a CB1, but not a CB2, receptor antagonist attenuated the anti-migraine effect of THC.”

The results infer two intriguing points

  • THC reduces migraine-like pain when administered at the right dose – 0.32 mg/kg – and time.
  • THC’s anti-migraine effect is mediated by the brain’s CB1 receptors.

While this migraine study was conducted within the restrictive guidelines of our federally enforced Controlled Substance Act, Marijuana.com reported on an Italian study published in June that utilized 127 human subjects. During that two-phase study, 43.5 percent of participants reported a noteworthy decline in their overall migraine-related discomfort levels, thanks to the use of cannabinoids.

Photo courtesy of Allie Beckett

 

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