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Review: Cannabinoids Effective for Mitigating Back Pain

Seattle, WA: The use of either whole-plant cannabis or synthetic cannabinoids is effective at mitigating back pain, according to a review of randomized controlled studies published in Global Spine Journal.

A team of investigators affiliated with the Swedish Neuroscience Institute in Seattle, Washington conducted a systematic review of the use of cannabinoids to treat nonsurgical back pain. In each of the studies identified by investigators, "[T]here was a quantifiable advantage of cannabis therapy for alleviating back pain." There were "no serious adverse effects reported" by patients in any of the studies.

Those who consume cannabis medicinally are most likely to report doing so to address chronic pain conditions. Dozens of studies further report that pain patients typically reduce or eliminate their use of opioids following their initiation of cannabis therapy. According to longitudinal data published earlier this month, patients with chronic musculoskeletal back pain who use medical cannabis for a period of at least six months experience decreased opioid use and improvements in pain scores and in their daily functions.

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Full text of the study, "Efficacy of cannabis in reducing back pain: A systemic review," appears in Global Spine Journal.

Canada: Retail Cannabis Market Generates $11 Billion in Sales, More Than 90,000 Jobs

Ottawa, Canada: The adult-use marijuana market in Canada has generated some $11 billion in retail sales and sustained over 90,000 jobs annually, according to an economic analysis published by the consulting firm Deloitte Canada. Canadian lawmakers legalized the commercial production of cannabis products in June 2018 and retail sales began that October.

The report's authors estimated the economic contributions of the cannabis sector from 2018 to 2021. Analysts assessed cannabis-related revenues and expenditures associated with cannabis-sector operations and capital investments. They determined: "[T]he Canadian cannabis sector has made a significant economic contribution to both Canada and Ontario in the three short years since legalization. The industry has generated $11 billion in sales nationwide and made $29 billion in capital expenditures. ... Overall, the cannabis industry has contributed $43.5 billion to Canada's GDP – and $13.3 billion to Ontario's GDP – since legalization. Moreover, the industry has sustained 98,000 jobs across Canada and put $15.1 billion into government coffers." (Editor's Note: An earlier version of this reporting cited the figure '151,000 jobs.' This figure was included in the initial version of the Deloitte report, but was later changed by the report's authors.)

They concluded, "From an economic perspective, it seems clear the cannabis industry has been a great success, with more to come as it continues to grow."

Authors acknowledged that a lack of diversity exists within Canada's marijuana industry, noting that few women and people of color hold executive level positions within cannabis companies. They recommended, "Governments and cannabis companies alike must take action to improve diversity, equity, and inclusion across the sector, building on and expanding existing efforts to enable more racialized Canadians and women to participate in the industry's success."

A recently released report by the Minority Cannabis Business Association similarly identifies a lack of diversity within the US cannabis industry, concluding, "[T]he barriers to entry for minority operators have continued to stifle progress to advance social equity efforts."

Full text of the report, "The Economic and Social Impact of Canada's Cannabis Sector." Is available for download.

Study: History of Marijuana Use Not Associated with Increased Heart Attack Risk

New York, NY: Cannabis smoke exposure is not positively associated with an increased risk of myocardial infarction, according to data published in the journal Cureus.

A pair of researchers with the Icahn School of Medicine at Mount Sinai in New York City assessed the association between a history of cannabis smoking and heart attack in a cohort of over 500,000 subjects from the United Kingdom.

Researchers identified an inverse association between cannabis use and incidences of myocardial infarction, and they found no correlation between marijuana consumption and heart attack severity.

"With marijuana use, MI [myocardial infarction] decreased," authors concluded. They further acknowledged: "The association of marijuana use with reduced risk of MI is not entirely in accord with current assumptions about the cardiac effects of marijuana. ... Further studies are warranted."

Studies assessing the association between cannabis use and cardiovascular health have been inconsistent, with some studies finding an increased risk of stroke and other cardiovascular diseases among marijuana consumers while others report either no risk or provide evidence of possible cardioprotection.

Full text of the study, "Marijuana and myocardial infarction in the UK Biobank cohort," appears in Cureus.

Colorado: Nearly a Third of Family Physicians Acknowledge Recommending Patients Use Medical Cannabis

Denver, CO: Nearly one-third of practicing family physicians in Colorado acknowledge issuing medical cannabis authorizations to their patients, according to survey data published in the Journal of the American Board of Family Medicine.

A pair of researchers with the University of Colorado School of Medicine surveyed members of the Colorado Academy of Family Physicians on their experiences with and attitudes toward medical cannabis.

Thirty-one percent of respondents reported that they had recommended cannabis to a patient on at least one occasion. Among them, 42 percent had issued a medical cannabis authorization within the past year. Authorizing physicians were most likely to recommend marijuana to patients suffering from chronic pain, cancer, cachexia, severe nausea, or persistent muscle spasms.

By contrast, nearly one-third of the survey's total respondents said that their practice had policies in place that formally prohibited them from issuing medical cannabis recommendations to their patients.

Overall, 57 percent of respondents agreed that "the FDA should reclassify marijuana so that it is no longer a Schedule I drug" under federal law – up from 37 percent in 2011.

According to a recent nationwide survey of US clinicians conducted by the US Centers for Disease Control and Prevention, 69 percent of respondents said they believed that cannabis possessed medical utility and more than one-in-four respondents (27 percent) acknowledged having authorized the use of cannabis for their patients.

Full text of the study, "Colorado family physicians and medical marijuana: Has recreational marijuana changed physician attitudes and behaviors," appears in theJournal of the American Board of Family Medicine.

Study: Insomnia Patients Respond Favorably to Concurrent Use of CBD and Melatonin

Modena, Italy: Patients with sleep disorders respond favorably to the co-administration of CBD and melatonin, according to data published in the Italian journal La Clinica Terapeutica.

A team of Italian researchers assessed the short-term administration of a sublingual compound consisting of 15mgs of melatonin and 2.5 mgs of plant-derived CBD in a cohort of middle-aged to older adults (ages 43 to 96) with a history of sleep disorders and anxiety. Study participants self-administered 20 drops of the compound prior to bedtime for a three-month period.

Researchers reported that CBD/melatonin co-administration was associated with reduced feelings of anxiety, pain, depression, panic, and paranoia, as well as with "good general health perceptions."

They concluded, "These data suggest that the formula CBD-melatonin could be competitive with the classic hypnotic synthetic drugs; the antioxidant activity of melatonin offers a further benefit to the brain network, restoring the biological clock functions, while CBD, reducing chronic pain perception, helps to complete the neuromuscular relaxation and to relieve anxiety fulfilling a very balanced sensation of well-being during the sleep."

Clinical trials have previously shown that the administration of either oral cannabinoid products or plant-derived cannabis extracts is associated with improvements in sleep in patients with insomnia. Observational studies also have shown that subjects who use herbal cannabis prior to bedtime report significant improvements in perceived insomnia levels and severity.

Full text of the study, "Insomnia treatment: A new multi-tasking natural compound based on melatonin and cannabis extracts," appears in La Clinica Terapeutica.

Analysis: Opioid Recovery Subreddit Users Frequently Report Using Cannabis for Treating Withdrawal Symptoms

San Francisco, CA: Participants in the opioid recovery subreddit online social platform frequently report consuming cannabis as an option for managing symptoms of opioid withdrawal, according to data published in the journal PLoS One.

Investigators affiliated with the University of California, San Francisco and with the Johns Hopkins Bloomberg School of Public Health in Baltimore analyzed all online posts mentioning cannabis in the subgroup over a four-year period.

Researchers reported, "The most frequent phrases from the recovery subreddit referred to time without using opioids and the possibility of using cannabis a
s a 'treatment.' ... The most common motivations for using cannabis were to manage opioid withdrawal symptoms in the recovery subreddit, often in conjunction with anti-anxiety and GI-distress 'comfort meds.'"

They concluded: "A primary finding of this study is that posters reported that the potential of cannabis to address OUD [opioid use disorder] or reduce opioid use may derive from the use of cannabis to manage acute and persistent opioid withdrawal symptoms. ... Future research is warranted with more structured assessments that examines the role of cannabis and cannabinoids in addressing both somatic and affective symptoms of opioid withdrawal."

A 2015 placebo-controlled study reported that the administration of oral THC reduced opioid withdrawal severity among participants in an in-patient detoxification program. More recently, a 2020 study published in the Journal of Substance Abuse Treatment reported that a majority of patients experiencing opioid withdrawal turn to cannabis to effectively manage various symptoms, including anxiety, tremors, and trouble sleeping. A 2020 review article published in the journal Cannabis and Cannabinoid Research concluded: "The evidence summarized in this article demonstrates the potential cannabis has to ease opioid withdrawal symptoms, reduce opioid consumption, ameliorate opioid cravings, prevent opioid relapse, improve OUD treatment retention, and reduce overdose deaths. ... The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD."

Full text of the study, "Naturalistic cannabis use reported in online opioid and opioid recovery community discussion forums," appears in PLoS One.