Medical Marijuana - Opportunities and Barriers: An ME/FM and FM Perspective

The Medical Marijuana Fibromyalgia and ME/CFS Poll

  • I don't have access to medical marijuana in my state.

    Votes: 32 47.1%
  • I have access to it in my state and I've tried it and it was helpful

    Votes: 15 22.1%
  • I have access and have tried it and it was not helpful

    Votes: 3 4.4%
  • I have access but haven't found a doctor to prescribe it

    Votes: 6 8.8%
  • I have access but it's too expensive

    Votes: 4 5.9%
  • I have access but am confused by the variety of choices

    Votes: 5 7.4%
  • I have access but don't think it fits my symptoms

    Votes: 2 2.9%
  • I have access but am not interested

    Votes: 4 5.9%
  • I have access but have not tried it yet

    Votes: 8 11.8%
  • If an FDA approved drug was available I would probably try it

    Votes: 19 27.9%

  • Total voters
    68

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Medical marijuana has been approved in 23 states and recreational use is allowed in Alaska, Oregon, the District of Columbia, Colorado and Washington State. Residents in Ohio, Nevada and California will vote on measures to make recreational use legal in the next year and a half.

A survey of fibromyalgia patients last year conducted by The National Pain Foundation and NationalPainReport.com suggested that medical marijuana was not just a little more effective in treating FM that the three FDA approved drugs for FM, it was a lot more effective.
[fright]

cannabidiol.jpg
[/fright]Anecdotal reports of medical marijuana's effectiveness in reducing pain and helping with sleep and even epileptic seizures abound. Check out an account a registered nurse with fibromyalgia recently sent to me.

A neck injury in 2002 eventually lead her to an FM diagnosis. She tried every drug she could find without result. Her extreme pain lead her to finally to try, after rejecting the idea for years, edible medical marijuana. It took her a few months o figure out the right dose, etc. She said

"I cannot begin to tell you all the meds I have tried and the suffering I have endured. Last summer, I tried edible marijuana (got a medical card). I have had amazing relief and can finally get some sleep!!!! I tend to use it more in the evening to help me sleep. The better I sleep the better I feel so I don't need as much during the day. Just the sleep alone is so restorative.

I really don't get high as I don't use much. CBD is great for nerve pain and when my neck hurts I use a low dose hard candy & within 30 sec to a min my neck pain is GONE and so I don't end up with a migraine. It really is a delight to not be throwing up & in agony for 12-24 hours!"
She's done very well and it she points out two issues that probably stop some people from trying it. They have jump through the hoops of getting a medical marijuana card that means getting a physician to sign on, and then they need to negotiate the wide variety of products available. Finding the right product can take time and cost some money.

The federal government recently reduced one restriction holding up research efforts but it's not enough. Medical research remains scanty with few studies coming out of the U.S. That's unacceptable given the promise of medical marijuana in relieving chronic pain and other poorly treated conditions.

Company Gets Around Burdensome Federal Laws - Producing Synthetic Analogues

One company has found a way around the burdensome federal regulations restricting access to the plant. A small biopharma company called Zynerba Pharmaceuticals is developing synthetic versions of two of the chemical compounds, cannabinoid and cannabidiol, believed to have produce marijuana's medical effects. No permits for growing and harvesting marijuana are required - just a lab to produce synthetic analogues. (Neither of these substances produce the high marijuana is known for.) The transdermal patches and gels it's been developing will deliver the product straight into the circulatory system.[fright]

Pharmaceuticals.jpg
[/fright]The company is small - just seven employees - but it recently appointed several high-profile executives to its board and a new President. It’s developed some proprietary patents that have given it some headway in the field. The companies public offering last week successfully brought in about $50 million can use to develop its products and hold clinical trials.

The market is potentially a huge one: the twenty million people with FM and/or neuropathic pain currently spend about $4 billion/year on treatments.

One product, a gel called ZYN002 that has shown promise in refractory epilepsy, Fragile X syndrome and osteoarthritis pain will enter clinical trials this year. Another product, a patch, ZYN001, focused on chronic pain is expected to enter Phase I clinical trials for fibromyalgia and peripheral neuropathic pain next year. If the FM trials work out, and no kinks show up at the FDA, a cannabis-based drug could conceivably be approved for FM within five years.

Coherent Approach to Medical Marijuana Needed

Meanwhile the support for more access to the drug continues to grow. Five years ago 80 percent of the public supported having access to medical marijuana.

In a strongly worded op ed piece, the New York Times editorial board recently went so far as to state that the feds marijuana policies "have ruined millions of lives and wasted billions of dollars." They called for federal laws to replace the mishmash of sometimes poorly thought out legislative efforts in the states.

The Obama administration has moved forward. It’s stopped going after medical marijuana producers in states in which it has been legalized but the federal prohibitions on anything marijuana related remains. Because banks - fearful of federal laws - refuse to serve medical marijuana businesses - many are cash only - a dangerous and inefficient way to operate. The NY Times noted that the Federal Reserve denied services to a credit union in Colorado that wished to provide services to legitimate marijuana business. Two bills with bipartisan support on the Hill that would simply allow banks and financial institutions to serve legal medical marijuana businesses are not expected to come to a vote.

Some Barriers to Medical Research Falling: Others Remain

Medical marijuana is still a long way from entering the medical mainstream. The study needed to produce FDA approved cannabis-based drugs or products people can count on, that are easily available, and that they can get reimbursed for is still being blocked by federal regulations.

The Obama administration has made some movement. It no longer requires studies not funded by the federal government to go through an additional layer of review. (Remarkably, marijuana was the only Class I drug with such a requirement.)[fright]

Bar-too-high-cfs-NIH.jpg
[/fright]The National Institute on Drug Abuse (NIDA) which oversees the use of medical marijuana for research studies has also recently expanded the list of available marijuana strains to include some with high cannabadinol (CBD) levels for the first time.

Much of the burdensome and lengthy process of getting permits to study MM in the U.S. remains, though.

Advocates assert that the first step is for the Obama administration to remove marijuana removed from the List of Class I drugs under the United States Controlled Substances Act. (It can do this without Congressional assent). The list includes such drugs as heroin, LSD, MDMA and mescaline. Drugs on this list:
  1. Have a high potential for abuse.
  2. have no currently accepted medical use in treatment in the United States.
  3. Are not considered safe even under medical supervision
So long as marijuana is listed as a Schedule I drug which is considered to have no medical value it's hard to see how researchers will get easy access to it. Two recent reviews asserting that "substantial evidence" suggests that medical marijuana relieves pain, nausea, and spasticity suggest the rationale for keeping it on the List of Schedule I drugs is on very shaky indeed.

Researchers still must get their marijuana only from a single contractor at the University of Mississippi. The list of strains is limited and phase III trials are out of the question as a drug company is required to produce exactly the same substance in the trial as it will market - something that's impossible to do so long they're unable to produce it. In short the infrastructure is simply not yet present for major pharmaceutical companies to do a full court press on a drug.


Recently, though, NIDA director, said it made sense for NIDA to contract with other cannabis producers. That could open the door for researchers to get easier access to more strains of cannnabis. Even the Drug Enforcement Agency (DEA) believes the restrictions on medical marijuana need to be loosened considerably. Deputy Administrator, Joseph Rannazzisi of the DEA testified at a Congressional hearing that the:

“DEA understands the importance of supporting the efficient scientific assessment of marijuana and its constituents such as CBD in connection with new drug development. DOJ and DEA are fully committed to supporting lawful research involving marijuana and CBD.”
With the public, medical researchers, doctors, some Senators and even the DEA calling for medical researchers to get easier access to the drug, it's hard to believe that the Obama administration won't move further on the issue.

Check out one more story to get a sense of how important it is for cannabis to get the research other pain inhibiting substances do, that people in pain get access to formulations of it.

Erika Zorn has advanced lupus and a severe case of fibromyalgia to boot. Despite her severe health problems which also included rheumatoid arthritis, enlarged liver, heart and blood pressure problems, she was functional - working a full-time job and taking care of her two young children. She'd been taking opiates for years but after she almost died from the complications of opiate use her doctor suggested marijuana which is illegal in the state of Pennsylvania.

After trying some street dope which had laced with PCP she grow it on her own in her basement to ensure she got a product that was safe and naturally produced.

She said "It was a miracle,"

Her pain was reduced markedly. She was able to sleep at night. Her appetite and energy returned. Unfortunately one of the few people she shared her story of how she got better contacted the police. After getting busted for growing marijuana in her basement she's back on opiates and making regular trips to the ER for her pain.

Thanks to J. William for providing the news on possible FM drug trial.
 
Last edited:

Susan Casal

New Member
I have completely changed my views on medical marijuana. I don't smoke, drink alcohol or consume caffeine even so marijuana was always considered off limits to me. But, long story short, I have tried every treatment for fibromyalgia and the other 3 pain issues I have plus extreme fatigue. None helped and after 35 years and getting older, going through menopause etc I was worse than ever.

I went to my doctor and begged him to help me. He finally said I could try medical marijuana. Picture me cringing! But when he explained that you don't have to smoke it and that you can use high cannabidiol (CBD) strains which are not psychotropic I became very interested. The more we talked the more hopeful I felt.

I applied for my card as I live in OR where medical marijuana is legal. I got it 6 weeks later and have been trying it for three weeks.

I feel so much better!! And I'm sleeping better than I have for decades. I have experimented a lot to find the best strains for me. I use one for daytime and a blend of two for night. Edibles are the best and most long lasting but I also use some tinctures and topicals.

I have either gotten off or vastly reduced other meds. My pain is reduced, I am more relaxed, I have a boost in energy so I can function on a higher level and I also recover more quickly from exertion.

I now hope for federal legalization so everyone has access. If you are against it still I recommend doing some research to discover more about it. I believe many have abused this plant which has given a bad impression but if used appropriately can help many.
 
Last edited by a moderator:

Angie

Member
I am in Canada and have no idea whether or not I could have medical marijuana. I am however taking prescription Nabilone, a synthetic THC. It's less expensive than antidepressants, other than increasing my brain fog and not being able to drive as I'm technically under the influence, it's relatively side effect free. It has worked magic on back pain that I attributed to an injury (which I believe triggered my fibro) and have had all kinds of pain killers, chiropractors, and steroid injections to attempt to deal with the pain. The pain nearly vanished and it handles my general fibro pain very very well. I'm leery to try marijuana. I like this prescription as it's a predictable amount of THC every time and I can go across the border with it without issue.
 

J William M Tweedie

Well-Known Member
Coincidentally this appeared today in the Medscape newsletter:

Role of Medical Marijuana: Up in Smoke? CME/CE

News Author: Sue Hughes
CME Author: Charles P. Vega, MD
mce-anchorFaculty and Disclosures
CME/CE Released: 08/12/2015 ; Valid for credit through 08/12/2016


Clinical Context

Marijuana continues to stay in the news cycle, as 23 states plus the District of Columbia have passed laws allowing for medical cannabis and recreational use of marijuana is now permitted in the states of Colorado, Washington, and Oregon. The broader acceptance of medical cannabis has led to higher rates of use among patients unfamiliar with marijuana, and many of these patients may select an edible product for reasons of tolerability.

A research letter by Vandrey and colleagues, which appears in the same issue of JAMA as a systematic review of medical cannabis, notes that 16% to 26% of patients receiving medical cannabis are treated with edible forms of the drug. The authors also evaluated whether product labels in 3 US cities were accurate in reflecting the drug concentrations of these edible products.

The researchers were provided 75 products in total; the cannabis dispensaries were unaware that their products would be tested. Only 17% of edible cannabis products were correctly labeled for their concentration of Δ9-tetrahydrocannabinol (THC); 23% of products underestimated and 60% overestimated their THC levels.
The researchers state that previous studies suggest an ideal ratio of cannabidiol (CBD) to THC of 1:1 to maximize the efficacy of medical cannabis and limit adverse events. However, only 13 edible products listed their concentration of CBD, and a total of 59% of edibles had a detectable level of CBD. The median THC:CBD ratio among products that contained CBD was 36:1.

This report calls into question the quality control of active ingredient among edible forms of medical cannabis. The even bigger issue is whether medical cannabis is effective across multiple disease states. The current systematic review and meta-analysis by Whiting and colleagues evaluates this issue.
Study Synopsis and Perspective

With many US states now having laws in place to facilitate access to medical marijuana for a variety of medical conditions, 2 new reviews have highlighted the lack of evidence to support its use in most indications.An editorial also raises questions about the legal implications for clinicians prescribing such products. The reviews, published in the June 23/30 issue of JAMA, note that 23 states and the District of Columbia have enacted laws to allow the prescription of medical marijuana for certain medical conditions. Reviewing the medical literature on medical marijuana, the 2 papers come to similar conclusions: there is some evidence to support the use of marijuana for nausea and vomiting related to chemotherapy, specific pain syndromes, and spasticity from multiple sclerosis. For most other indications, such as hepatitis C, Crohn's disease, Parkinson's disease, or Tourette's syndrome, however, the evidence supporting the use of medical marijuana is of poor quality.

A third paper published in the same issue of JAMA highlights the large variability in specific cannabinoids in various medical marijuana products and found that contents did not conform to what was advertised on the label.

In an accompanying editorial, Deepak Cyril D'Souza, MBBS, MD, and Mohini Ranganathan, MD, both from the Yale University School of Medicine, New Haven; VA Connecticut Healthcare System, West Haven; and Connecticut Mental Health Center, New Haven, Connecticut, note that for most of the conditions that qualify for medical marijuana use, the evidence fails to meet US Food and Drug Administration standards. They call for government support to conduct high-quality trials, and until such trials are available, they suggest it may be prudent to wait before widely adopting use of medical marijuana. "Perhaps it is time to place the horse back in front of the cart," they conclude.

Legal Implications Unclear
The editorialists point out that for physicians, the legal implications of certifying patients for medical marijuana remain unclear, given the differences between the views of state vs federal government.They emphasize that the prescription, supply, or sale of marijuana is illegal by federal law and that it is not known to what extent a physician who certifies a patient for medical marijuana may be liable for negative outcomes and whether malpractice insurance will cover any liability.In one of the review papers, Kevin P. Hill, MD, from McLean Hospital, Belmont, Massachusetts, examined 28 randomized clinical trials of cannabinoids in various indications.He notes that there are 2 cannabinoids (dronabinol and nabilone) that are approved by the US Food and Drug Administration for nausea and appetite stimulation.Apart from these 2 indications, Dr Hill found that use of marijuana for chronic pain, neuropathic pain, and spasticity resulting from multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these trials had positive results, suggesting marijuana or cannabinoids may be efficacious for these indications.The other review paper, by a team led by Penny F. Whiting, PhD, from University Hospitals Bristol National Health Service Foundation Trust, United Kingdom, evaluated 79 trials of cannabinoids in a total of 6462 participants. Indications included nausea and vomiting caused by chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity resulting from multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome.There was better evidence of efficacy in nausea and vomiting (with 47% of patients receiving treatment showing a complete response vs 20% with placebo in 3 trials), pain (with 37% of patients receiving treatment reporting a reduction vs 31% receiving placebo in 8 trials), and spasticity (with an average reduction in the Ashworth spasticity scale of −0.36 in 7 trials). Both reviews report an increased risk for short-term adverse effects including dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, hallucination, addiction, and worsening of psychiatric illnesses such as anxiety and mood disorders.

Inaccurate Labeling
For the research letter on dosing, a team led by Ryan Vandrey, PhD, from Johns Hopkins University School of Medicine in Baltimore, Maryland, report that of 75 products purchased (47 different brands), 17% were accurately labeled, 23% were underlabeled, and 60% were overlabeled with respect to tetrahydrocannabinol content.
"Edible cannabis products from 3 major metropolitan areas, though unregulated, failed to meet basic label accuracy standards for pharmaceuticals," the authors write.
"Because medical cannabis is recommended for specific health conditions, regulation and quality assurance are needed," they conclude.

In their editorial, Dr D'Souza and Dr Ranganathan note that there are inconsistencies in how medical conditions are qualified for medical marijuana use within a state and between states. For example, in Connecticut, psoriasis and sickle cell disease, but not Tourette syndrome, qualify, even though the supporting evidence for all 3 conditions is uniformly of very low quality. Similarly, posttraumatic stress disorder is approved as a qualifying condition in some, but not all, US states.

The editorialists also point out that marijuana is a complex of more than 400 compounds, including up to 70 cannabinoids, which have individual or interactive effects, and that the composition of cannabis preparations can vary substantially. The editorialists advise that because of the risk for psychosis with marijuana, there need to be explicit contraindications for use in patients with schizophrenia, bipolar disorder, or substance dependence, as well as measures to minimize their access to it. They suggest that follow-up programs should be introduced to monitor long-term outcomes in patients taking medical marijuana.

Given that cannabinoid exposure during critical periods of brain development is associated with long-lasting changes in behavior and cognition, they add that careful consideration is needed to determine at what age exposure to medical marijuana is justifiable.

JAMA. 2015;313:2431-2432, 2456-2483, 2491-2493.
Study Highlights

  • Researchers evaluated the efficacy of medical cannabis for a variety of medical conditions, using databases and gray literature sites.
  • They collected randomized trials that compared medical cannabis with placebo, no treatment, or usual care. If no randomized trials were available for a particular condition, the authors reviewed other research, provided the study included at least 25 subjects.
  • 505 studies underwent full text review, and 79 studies with a total of 6462 participants were included in the final systematic review; 34 studies used a parallel group design, and 45 were crossover studies.
  • Only 5% of trials were judged to be at low risk for bias, whereas 70% of the included research carried a high suspicion for bias. The most relevant form of bias was incomplete outcome data. Many trials failed to account for large numbers of study withdrawals.
  • 28 studies evaluated medical cannabis for the treatment of nausea and vomiting resulting from chemotherapy; 20 of these studies included an active comparator. There was at least a trend toward improvement with cannabis treatment in all studies. The odds ratio (OR) for complete resolution of nausea and vomiting in comparing dronabinol (a Δ9-tetrahydrocannabinol [THC] analogue) and nabiximols (which contain analogues of THC and cannabidiol [CBD]) with placebo was 3.82 (95% confidence interval [CI], 1.55 - 9.42).
Four studies focused on the treatment of appetite stimulation among patients with HIV/AIDS. In general, medical cannabis failed to produce a statistically significant result for improved appetite or weight gain in the collective research.

Medical cannabis was more effective for chronic pain: 28 studies evaluated this outcome, with most research focused on neuropathic pain. Compared with placebo, the odds ratio for at least a 30% reduction in the amount of pain associated with medical cannabis was 1.41 (95% CI, 0.99 - 2.00). Cannabis appeared similarly effective for neuropathic pain and cancer pain. However, medical cannabis did not significantly improve measurements of quality of life.

14 studies focused on spasticity, with the majority involving patients with multiple sclerosis. Medical cannabis was associated with improvements in spasticity, but not all of these values reached statistical significance.

There were no studies of the treatment of depression that met the criteria for the review. In 5 studies (4 among patients with chronic pain) that included information on depression, cannabis failed to have a significant effect on this outcome.

Very limited evidence suggested medical cannabis could improve anxiety symptoms.

Several studies found that medical cannabis can improve sleep problems among patients with conditions such as fibromyalgia, chronic pain, and multiple sclerosis.

Medical cannabis was not associated with an improvement in psychosis in 2 small trials.

In a study of 6 patients, medical cannabis was similar to placebo in reducing intraocular pressure among patients with glaucoma.

Two trials suggest medical cannabis may improve tic severity among patients with Tourette syndrome.

62 studies reported on adverse events associated with the use of medical cannabis. Compared with placebo or an active comparator, the odds ratio for any adverse event associated with cannabis was 3.03 (95% CI, 2.42 - 3.80), and the odds ratio for serious adverse event was 1.41 (95% CI, 1.04 - 1.92). Treatment with cannabis was associated with a 3-fold higher risk for study withdrawal because of adverse events.
  • There was little evidence that 1 type of medical cannabis was superior to another in terms of efficacy, safety, or tolerability.

Clinical Implications


  • A study of edible forms of medical cannabis identified correct labeling of their THC concentration in just 17% of products tested, with the majority of products overestimating the concentration of THC. Of the edibles, 59% contained any CBD, with a median THC:CBD ratio of 36:1.
  • The current research finds substantial limitations regarding research into the clinical application of medical cannabis. The best evidence for the efficacy of cannabis was among patients with chronic pain.
  • Implications for the Healthcare Team: Medical cannabis may be effective for certain medical conditions, but it is associated with a higher rate of acute adverse events. Medication reconciliation should account for the use of marijuana, particularly in states with laws allowing for the use of medical cannabis.
 

fdotx

Well-Known Member
I have completely changed my views on medical marijuana. I don't smoke, drink alcohol or consume caffeine even so marijuana was always considered off limits to me. But, long story short, I have tried every treatment for fibromyalgia and the other 3 pain issues I have plus extreme fatigue. None helped and after 35 years and getting older, going through menopause etc I was worse than ever. I went to my doctor and begged him to help me. He finally said I could try medical marijuana. Picture me cringing! But when he explained that you don't have to smoke it and that you can use high cannabidiol (CBD) strains which are not psychotropic I became very interested. The more we talked the more hopeful I felt. I applied for my card as I live in OR where medical marijuana is legal. I got it 6 weeks later and have been trying it for three weeks. I feel so much better!! And I'm sleeping better than I have for decades. I have experimented a lot to find the best strains for me. I use one for daytime and a blend of two for night. Edibles are the best and most long lasting but I also use some tinctures and topicals. I have either gotten off or vastly reduced other meds. My pain is reduced, I am more relaxed, I have a boost in energy so I can function on a higher level and I also recover more quickly from exertion. I now hope for federal legalization so everyone has access. If you are against it still I recommend doing some research to discover more about it. I believe many have abused this plant which has given a bad impression but if used appropriately can help many.
Susan so glad the CBD strain is helping you and thanks for sharing. I've been meaning to try it as the THC was absolutely horrible for me- up all night feeling like my brain was getting beat up in my head. Cort, maybe it'd be a good idea to specify in your questionnaire which kind?
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I have completely changed my views on medical marijuana. I don't smoke, drink alcohol or consume caffeine even so marijuana was always considered off limits to me. But, long story short, I have tried every treatment for fibromyalgia and the other 3 pain issues I have plus extreme fatigue. None helped and after 35 years and getting older, going through menopause etc I was worse than ever.

I went to my doctor and begged him to help me. He finally said I could try medical marijuana. Picture me cringing! But when he explained that you don't have to smoke it and that you can use high cannabidiol (CBD) strains which are not psychotropic I became very interested. The more we talked the more hopeful I felt.

I applied for my card as I live in OR where medical marijuana is legal. I got it 6 weeks later and have been trying it for three weeks.

I feel so much better!! And I'm sleeping better than I have for decades. I have experimented a lot to find the best strains for me. I use one for daytime and a blend of two for night. Edibles are the best and most long lasting but I also use some tinctures and topicals.

I have either gotten off or vastly reduced other meds. My pain is reduced, I am more relaxed, I have a boost in energy so I can function on a higher level and I also recover more quickly from exertion.

I now hope for federal legalization so everyone has access. If you are against it still I recommend doing some research to discover more about it. I believe many have abused this plant which has given a bad impression but if used appropriately can help many.
That's great news Susan!
I think there's such possibility with this plant. Just think if researchers really got a hold of it and really plumbed it's possibilities and ultimately produced drugs tuned to help chronic pain, sleep and other problems as Zynerba is doing. There are other parts of the plant that need study...I hope that President Obama removes marijuana from the Schedule I listing before he leaves office. The way he's moving forward I would be surprised if he doesn't.

I also invite you to add a review of MM - here. (I forgot to add this link to the post). That way we have them all in one, accessible place.
 

Snookum96

Active Member
I'm also Canadian, and it takes us longer to approve pretty much anything in my experience.
I'm in recovery from alcoholism so I never considered marijuana as an option. It's just too risky for me. I don't take anything stronger than Advil unless I'm in hospital and it sucks.

I would definitely try a form of it if it didn't cause any mind altering effects and wasn't addictive. @Angie how did you find the nabilone? Does it make you feel drugged any more than other medications you have tried?
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Susan so glad the CBD strain is helping you and thanks for sharing. I've been meaning to try it as the THC was absolutely horrible for me- up all night feeling like my brain was getting beat up in my head. Cort, maybe it'd be a good idea to specify in your questionnaire which kind?
That's one of the problems Fdotx - I don't know the strains. I don't know what types of candy work for who...It appears to take some work to figure out what works - that of course can take some money that some folks don't have. Since I imagine that the brands are local - that throws another factor in there.

I would love it if someone or some group of people could produced a guide to what seems to work best. I imagine that we could find what constituents seem to work best. Anyone up for that?
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
T
Coincidentally this appeared today in the Medscape newsletter:

Role of Medical Marijuana: Up in Smoke? CME/CE

News Author: Sue Hughes
CME Author: Charles P. Vega, MD
mce-anchorFaculty and Disclosures
CME/CE Released: 08/12/2015 ; Valid for credit through 08/12/2016


Clinical Context

Marijuana continues to stay in the news cycle, as 23 states plus the District of Columbia have passed laws allowing for medical cannabis and recreational use of marijuana is now permitted in the states of Colorado, Washington, and Oregon. The broader acceptance of medical cannabis has led to higher rates of use among patients unfamiliar with marijuana, and many of these patients may select an edible product for reasons of tolerability.

A research letter by Vandrey and colleagues, which appears in the same issue of JAMA as a systematic review of medical cannabis, notes that 16% to 26% of patients receiving medical cannabis are treated with edible forms of the drug. The authors also evaluated whether product labels in 3 US cities were accurate in reflecting the drug concentrations of these edible products.

The researchers were provided 75 products in total; the cannabis dispensaries were unaware that their products would be tested. Only 17% of edible cannabis products were correctly labeled for their concentration of Δ9-tetrahydrocannabinol (THC); 23% of products underestimated and 60% overestimated their THC levels.
The researchers state that previous studies suggest an ideal ratio of cannabidiol (CBD) to THC of 1:1 to maximize the efficacy of medical cannabis and limit adverse events. However, only 13 edible products listed their concentration of CBD, and a total of 59% of edibles had a detectable level of CBD. The median THC:CBD ratio among products that contained CBD was 36:1.

This report calls into question the quality control of active ingredient among edible forms of medical cannabis. The even bigger issue is whether medical cannabis is effective across multiple disease states. The current systematic review and meta-analysis by Whiting and colleagues evaluates this issue.
Study Synopsis and Perspective

With many US states now having laws in place to facilitate access to medical marijuana for a variety of medical conditions, 2 new reviews have highlighted the lack of evidence to support its use in most indications.An editorial also raises questions about the legal implications for clinicians prescribing such products. The reviews, published in the June 23/30 issue of JAMA, note that 23 states and the District of Columbia have enacted laws to allow the prescription of medical marijuana for certain medical conditions. Reviewing the medical literature on medical marijuana, the 2 papers come to similar conclusions: there is some evidence to support the use of marijuana for nausea and vomiting related to chemotherapy, specific pain syndromes, and spasticity from multiple sclerosis. For most other indications, such as hepatitis C, Crohn's disease, Parkinson's disease, or Tourette's syndrome, however, the evidence supporting the use of medical marijuana is of poor quality.

A third paper published in the same issue of JAMA highlights the large variability in specific cannabinoids in various medical marijuana products and found that contents did not conform to what was advertised on the label.

In an accompanying editorial, Deepak Cyril D'Souza, MBBS, MD, and Mohini Ranganathan, MD, both from the Yale University School of Medicine, New Haven; VA Connecticut Healthcare System, West Haven; and Connecticut Mental Health Center, New Haven, Connecticut, note that for most of the conditions that qualify for medical marijuana use, the evidence fails to meet US Food and Drug Administration standards. They call for government support to conduct high-quality trials, and until such trials are available, they suggest it may be prudent to wait before widely adopting use of medical marijuana. "Perhaps it is time to place the horse back in front of the cart," they conclude.

Legal Implications Unclear
The editorialists point out that for physicians, the legal implications of certifying patients for medical marijuana remain unclear, given the differences between the views of state vs federal government.They emphasize that the prescription, supply, or sale of marijuana is illegal by federal law and that it is not known to what extent a physician who certifies a patient for medical marijuana may be liable for negative outcomes and whether malpractice insurance will cover any liability.In one of the review papers, Kevin P. Hill, MD, from McLean Hospital, Belmont, Massachusetts, examined 28 randomized clinical trials of cannabinoids in various indications.He notes that there are 2 cannabinoids (dronabinol and nabilone) that are approved by the US Food and Drug Administration for nausea and appetite stimulation.Apart from these 2 indications, Dr Hill found that use of marijuana for chronic pain, neuropathic pain, and spasticity resulting from multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these trials had positive results, suggesting marijuana or cannabinoids may be efficacious for these indications.The other review paper, by a team led by Penny F. Whiting, PhD, from University Hospitals Bristol National Health Service Foundation Trust, United Kingdom, evaluated 79 trials of cannabinoids in a total of 6462 participants. Indications included nausea and vomiting caused by chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity resulting from multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome.There was better evidence of efficacy in nausea and vomiting (with 47% of patients receiving treatment showing a complete response vs 20% with placebo in 3 trials), pain (with 37% of patients receiving treatment reporting a reduction vs 31% receiving placebo in 8 trials), and spasticity (with an average reduction in the Ashworth spasticity scale of −0.36 in 7 trials). Both reviews report an increased risk for short-term adverse effects including dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, hallucination, addiction, and worsening of psychiatric illnesses such as anxiety and mood disorders.

Inaccurate Labeling
For the research letter on dosing, a team led by Ryan Vandrey, PhD, from Johns Hopkins University School of Medicine in Baltimore, Maryland, report that of 75 products purchased (47 different brands), 17% were accurately labeled, 23% were underlabeled, and 60% were overlabeled with respect to tetrahydrocannabinol content.
"Edible cannabis products from 3 major metropolitan areas, though unregulated, failed to meet basic label accuracy standards for pharmaceuticals," the authors write.
"Because medical cannabis is recommended for specific health conditions, regulation and quality assurance are needed," they conclude.

In their editorial, Dr D'Souza and Dr Ranganathan note that there are inconsistencies in how medical conditions are qualified for medical marijuana use within a state and between states. For example, in Connecticut, psoriasis and sickle cell disease, but not Tourette syndrome, qualify, even though the supporting evidence for all 3 conditions is uniformly of very low quality. Similarly, posttraumatic stress disorder is approved as a qualifying condition in some, but not all, US states.

The editorialists also point out that marijuana is a complex of more than 400 compounds, including up to 70 cannabinoids, which have individual or interactive effects, and that the composition of cannabis preparations can vary substantially. The editorialists advise that because of the risk for psychosis with marijuana, there need to be explicit contraindications for use in patients with schizophrenia, bipolar disorder, or substance dependence, as well as measures to minimize their access to it. They suggest that follow-up programs should be introduced to monitor long-term outcomes in patients taking medical marijuana.

Given that cannabinoid exposure during critical periods of brain development is associated with long-lasting changes in behavior and cognition, they add that careful consideration is needed to determine at what age exposure to medical marijuana is justifiable.

JAMA. 2015;313:2431-2432, 2456-2483, 2491-2493.
Study Highlights

  • Researchers evaluated the efficacy of medical cannabis for a variety of medical conditions, using databases and gray literature sites.
  • They collected randomized trials that compared medical cannabis with placebo, no treatment, or usual care. If no randomized trials were available for a particular condition, the authors reviewed other research, provided the study included at least 25 subjects.
  • 505 studies underwent full text review, and 79 studies with a total of 6462 participants were included in the final systematic review; 34 studies used a parallel group design, and 45 were crossover studies.
  • Only 5% of trials were judged to be at low risk for bias, whereas 70% of the included research carried a high suspicion for bias. The most relevant form of bias was incomplete outcome data. Many trials failed to account for large numbers of study withdrawals.
  • 28 studies evaluated medical cannabis for the treatment of nausea and vomiting resulting from chemotherapy; 20 of these studies included an active comparator. There was at least a trend toward improvement with cannabis treatment in all studies. The odds ratio (OR) for complete resolution of nausea and vomiting in comparing dronabinol (a Δ9-tetrahydrocannabinol [THC] analogue) and nabiximols (which contain analogues of THC and cannabidiol [CBD]) with placebo was 3.82 (95% confidence interval [CI], 1.55 - 9.42).
Four studies focused on the treatment of appetite stimulation among patients with HIV/AIDS. In general, medical cannabis failed to produce a statistically significant result for improved appetite or weight gain in the collective research.

Medical cannabis was more effective for chronic pain: 28 studies evaluated this outcome, with most research focused on neuropathic pain. Compared with placebo, the odds ratio for at least a 30% reduction in the amount of pain associated with medical cannabis was 1.41 (95% CI, 0.99 - 2.00). Cannabis appeared similarly effective for neuropathic pain and cancer pain. However, medical cannabis did not significantly improve measurements of quality of life.

14 studies focused on spasticity, with the majority involving patients with multiple sclerosis. Medical cannabis was associated with improvements in spasticity, but not all of these values reached statistical significance.

There were no studies of the treatment of depression that met the criteria for the review. In 5 studies (4 among patients with chronic pain) that included information on depression, cannabis failed to have a significant effect on this outcome.

Very limited evidence suggested medical cannabis could improve anxiety symptoms.

Several studies found that medical cannabis can improve sleep problems among patients with conditions such as fibromyalgia, chronic pain, and multiple sclerosis.

Medical cannabis was not associated with an improvement in psychosis in 2 small trials.

In a study of 6 patients, medical cannabis was similar to placebo in reducing intraocular pressure among patients with glaucoma.

Two trials suggest medical cannabis may improve tic severity among patients with Tourette syndrome.

62 studies reported on adverse events associated with the use of medical cannabis. Compared with placebo or an active comparator, the odds ratio for any adverse event associated with cannabis was 3.03 (95% CI, 2.42 - 3.80), and the odds ratio for serious adverse event was 1.41 (95% CI, 1.04 - 1.92). Treatment with cannabis was associated with a 3-fold higher risk for study withdrawal because of adverse events.
  • There was little evidence that 1 type of medical cannabis was superior to another in terms of efficacy, safety, or tolerability.

Clinical Implications


  • A study of edible forms of medical cannabis identified correct labeling of their THC concentration in just 17% of products tested, with the majority of products overestimating the concentration of THC. Of the edibles, 59% contained any CBD, with a median THC:CBD ratio of 36:1.
  • The current research finds substantial limitations regarding research into the clinical application of medical cannabis. The best evidence for the efficacy of cannabis was among patients with chronic pain.
  • Implications for the Healthcare Team: Medical cannabis may be effective for certain medical conditions, but it is associated with a higher rate of acute adverse events. Medication reconciliation should account for the use of marijuana, particularly in states with laws allowing for the use of medical cannabis.
Thanks William!

This is exactly why this field needs to be open to research and standardized and why, ultimately, although it probably goes against the grain of the industry, pharmaceutical companies need to be able to come in and produce standardized products. That's going to require, though, the Obama administration taking marijuana off the List it's on, allowing drug companies to grow it, research it and produce products based on it - and to be able to show the FDA that they can do that. That's apparently impossible to do now.

On
ly 17% of edible cannabis products were correctly labeled for their concentration of Δ9-tetrahydrocannabinol (THC); 23% of products underestimated and 60% overestimated their THC levels.

The researchers state that previous studies suggest an ideal ratio of cannabidiol (CBD) to THC of 1:1 to maximize the efficacy of medical cannabis and limit adverse events. However, only 13 edible products listed their concentration of CBD, and a total of 59% of edibles had a detectable level of CBD. The median THC:CBD ratio among products that contained CBD was 36:1.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I was encouraged by these two findings for people with chronic pain and sleep problems...

Medical cannabis was more effective for chronic pain: 28 studies evaluated this outcome, with most research focused on neuropathic pain. Compared with placebo, the odds ratio for at least a 30% reduction in the amount of pain associated with medical cannabis was 1.41 (95% CI, 0.99 - 2.00). Cannabis appeared similarly effective for neuropathic pain and cancer pain. However, medical cannabis did not significantly improve measurements of quality of life.

Several studies found that medical cannabis can improve sleep problems among patients with conditions such as fibromyalgia, chronic pain, and multiple sclerosis.
 

fdotx

Well-Known Member
Hi Cort, I was referring only to CBD vs THC since they seem to be pretty different, ie CBD being what's so good for epilepsy in kids. Maybe I'm unusual in the absolutely terrible reaction I had to THC but it might be CBD would work great for me. When I try it I'll report back. Was encouraged that it also gave Susan a little energy boost.
 

Grace2U

Active Member
My response was not a given option in the survey.

I reside in a state that has not yet legalized the medical cannabis, but have ordered organic medical marijuana online with no problem. My interest began when I came across CTI (Cannabinoid Therapy Institte) and forwarded a few of my medical records which resulted in approval to see the doctor. Following an exam and discussion of my medical history, I received an "Official Physician Medical Necessity Form", indicating an allowed quantity of THC/CBD oil cannabis product corresponding to 75 hybrid cannabis plants.

Due to my reluctance to trust the make-up of the oil that was available on-line at the time, I elected to purchase the organic marijuana and made brownies. I was able to reduce my pain medication significantly and sleep better :) This was in May. Although I liked the outcome, I had to stop temporarily because I was scheduled for additional testing which included blood work. (Remember, medicinal marijuana is not yet legal in Florida).

I do plan to return to using it after the next several tests/appointments are behind me.

CTI has passed the baton to Florida Integrative Health, which will also compound a custom formulation of cannabinoid medicine for patients.

It is predicted the medical use of marijuana will be legalized here in Florida within the next 9 months.

No prescription is necessary to purchase the marijuana on-line....anyone can. That surprised me!
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
My response was not a given option in the survey.

I reside in a state that has not yet legalized the medical cannabis, but have ordered organic medical marijuana online with no problem. My interest began when I came across CTI (Cannabinoid Therapy Institte) and forwarded a few of my medical records which resulted in approval to see the doctor. Following an exam and discussion of my medical history, I received an "Official Physician Medical Necessity Form", indicating an allowed quantity of THC/CBD oil cannabis product corresponding to 75 hybrid cannabis plants.

Due to my reluctance to trust the make-up of the oil that was available on-line at the time, I elected to purchase the organic marijuana and made brownies. I was able to reduce my pain medication significantly and sleep better :) This was in May. Although I liked the outcome, I had to stop temporarily because I was scheduled for additional testing which included blood work. (Remember, medicinal marijuana is not yet legal in Florida).

I do plan to return to using it after the next several tests/appointments are behind me.

CTI has passed the baton to Florida Integrative Health, which will also compound a custom formulation of cannabinoid medicine for patients.

It is predicted the medical use of marijuana will be legalized here in Florida within the next 9 months.

No prescription is necessary to purchase the marijuana on-line....anyone can. That surprised me!
I didn't know that either Grace and thanks for pointing that out. Good luck when you take it up back again.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Hi Cort, I was referring only to CBD vs THC since they seem to be pretty different, ie CBD being what's so good for epilepsy in kids. Maybe I'm unusual in the absolutely terrible reaction I had to THC but it might be CBD would work great for me. When I try it I'll report back. Was encouraged that it also gave Susan a little energy boost.
Good luck with it fdotx...:)
 

Katie

Active Member
I am in Canada and have no idea whether or not I could have medical marijuana. I am however taking prescription Nabilone, a synthetic THC. It's less expensive than antidepressants, other than increasing my brain fog and not being able to drive as I'm technically under the influence, it's relatively side effect free. It has worked magic on back pain that I attributed to an injury (which I believe triggered my fibro) and have had all kinds of pain killers, chiropractors, and steroid injections to attempt to deal with the pain. The pain nearly vanished and it handles my general fibro pain very very well. I'm leery to try marijuana. I like this prescription as it's a predictable amount of THC every time and I can go across the border with it without issue.
I also live in Canada and I'm on nabilone or cesamet, a cannabinoid and yes, I wouldn't want to live without it. It is far better than any narcotic I've been on, especially for chronic pain. Very few side effects just a little "spacey" the first week. I've been on this for more than 5 years now. If I forget now and then to take it, I sure realize it a few hours later.
Yes, I could have a Rx for regular medical marijuana but I cannot fathom smoking it or anything. I wasn't too keen on eating it either so the cesamet works just fine, although I'm sure a heck of a lot more pricey than regular smoked marijuana. Fortunately I'm on my husbands work plan for medical and it's all covered.
 

Katie

Active Member
Re the survey. I should have said yes, as I'm on nabilone (cesamet) but I thought you were talking about smoked or eaten marijuana. Nabilone does not contain the THC-if I remember correctly but still is a cannabinoid.
 

creekfeet

New Member
By far the most popular post on my little M.E. blog is the one with the recipe for cannabis tincture and cannabis-infused coconut oil. Most posts on my blog get a couple hundred hits. The second-most-read has had a couple thousand. This one has had over 18,000 readers. So here it is for you all.
Recipes: Cannabis Coconut Oil and Tincture

Its popularity implies that a lot of people want this, and perhaps that a lot of people have liked and shared it. It really has proven the best medicine for me. It works great for my M.E., and for people with fibro, MS, arthritis, bursitis and lots of stuff...and it's cheap and easy to make as long as you can get ahold of the active ingredient, cannabis. I make big batches to share with other members of my family farmer's organic cannabis cooperative, so the farmer keeps a supply of trim coming to me regularly. And yes, trim works great. Don't waste your best bud.

Aside from obtaining good quality cannabis at a decent price, and making it legal, the main barrier to access for all patients to this excellent medicine might turn out to be pharmaceutical corporations, which develop patented isolated chemical compounds or synthetics and of course would like us all to believe that those are as effective as, but somehow safer than, smoking, vaporizing, eating, drinking, or making tinctures and oils from, the whole flower and leaves.

Standard herbalist wisdom is that whole plants (or whole medicinal parts of plants) are better than isolated compounds for the very reason that they contain multiple compounds. These balance one another.

I haven't taken any of the pharmaceuticals so I can't confirm that wisdom from personal experience, but I know people who have had both and far prefer the whole herbal cannabis.

I do far prefer high-CBD strains. I never did like the sensation of getting high, even before I had brain fog. But I don't know if I'd want a cbd-only medication for that reason of balance. High-CBD strains do great for me, and when I use the coconut oil topically, or vaporize either bud or tincture, it's like what a friend's dad said about cannabis for cancer: "I don't get high; I get normal."

I'd be interested to hear more from more people who have tried both vaporizing high-cbd strains and using cannabis-based pharmaceuticals. From what friends have told me, the former is way better.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
By far the most popular post on my little M.E. blog is the one with the recipe for cannabis tincture and cannabis-infused coconut oil. Most posts on my blog get a couple hundred hits. The second-most-read has had a couple thousand. This one has had over 18,000 readers. So here it is for you all.
Recipes: Cannabis Coconut Oil and Tincture

Its popularity implies that a lot of people want this, and perhaps that a lot of people have liked and shared it. It really has proven the best medicine for me. It works great for my M.E., and for people with fibro, MS, arthritis, bursitis and lots of stuff...and it's cheap and easy to make as long as you can get ahold of the active ingredient, cannabis. I make big batches to share with other members of my family farmer's organic cannabis cooperative, so the farmer keeps a supply of trim coming to me regularly. And yes, trim works great. Don't waste your best bud.

Aside from obtaining good quality cannabis at a decent price, and making it legal, the main barrier to access for all patients to this excellent medicine might turn out to be pharmaceutical corporations, which develop patented isolated chemical compounds or synthetics and of course would like us all to believe that those are as effective as, but somehow safer than, smoking, vaporizing, eating, drinking, or making tinctures and oils from, the whole flower and leaves.

Standard herbalist wisdom is that whole plants (or whole medicinal parts of plants) are better than isolated compounds for the very reason that they contain multiple compounds. These balance one another.

I haven't taken any of the pharmaceuticals so I can't confirm that wisdom from personal experience, but I know people who have had both and far prefer the whole herbal cannabis.

I do far prefer high-CBD strains. I never did like the sensation of getting high, even before I had brain fog. But I don't know if I'd want a cbd-only medication for that reason of balance. High-CBD strains do great for me, and when I use the coconut oil topically, or vaporize either bud or tincture, it's like what a friend's dad said about cannabis for cancer: "I don't get high; I get normal."

I'd be interested to hear more from more people who have tried both vaporizing high-cbd strains and using cannabis-based pharmaceuticals. From what friends have told me, the former is way better.
Thanks for passing that on Creekfeet!
 

Susan Casal

New Member
That's great news Susan!
I think there's such possibility with this plant. Just think if researchers really got a hold of it and really plumbed it's possibilities and ultimately produced drugs tuned to help chronic pain, sleep and other problems as Zynerba is doing. There are other parts of the plant that need study...I hope that President Obama removes marijuana from the Schedule I listing before he leaves office. The way he's moving forward I would be surprised if he doesn't.

I also invite you to add a review of MM - here. (I forgot to add this link to the post). That way we have them all in one, accessible place.
I'd be happy to Cort. I keep studying and learning the best ways to process and use it properly.
 

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