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Survey: Most Primary Care Physicians Say They Are “Not Comfortable” Counseling Patients About Medical Cannabis
La Jolla, CA: Most primary care physicians are unwilling to answer their patients’ questions about medical cannabis, according to survey data published in the Journal of the American Geriatrics Society.
Investigators affiliated with the University of California at San Diego surveyed a cohort of internal medicine and family medicine physicians from San Diego, California.
Respondents said that their patients frequently inquire about medical cannabis use, but most acknowledged “not feeling competent” discussing the issue – a finding that is consistent with other studies.
Researchers reported: “Primary care physicians are asked about cannabis for therapeutic purposes by patients of all ages, but few are prepared to provide advice. … Physicians were generally not comfortable counseling patients of any age about cannabis use due to limited training and an incomplete evidence base. Some shifted responsibility to the patient, urging them to use cannabis ‘at their own risk,’ or referring to experts in specialty clinics or cannabis dispensary workers.”
While over two-thirds of health care practitioners nationwide acknowledge that cannabis possesses medical utility, most refuse to speak to their patients about it, and many say that they do not receive adequate medical training on cannabis-related issues.
Full text of the study, “Exploring physicians’ perspectives on cannabis use for therapeutic purposes with a focus on older versus younger adults,” appears in the Journal of the American Geriatrics Society.
Clinical Trial: Short-Term CBD Dosing Not Associated With Liver Abnormalities
Brisbane, Australia: The use of CBD-dominant medical cannabis products by cancer patients is not associated with liver damage, including the elevated production of the alanine aminotransferase (ALT) enzyme, according to clinical trial data published in the journal BMJ Supportive & Palliative Care.
Australian researchers assessed the potential impact of daily CBD administration (up to 600 mg per day) on liver health in a cohort of 287 patients with advanced cancer. (Australian law permits physicians to authorize cannabis products to patients unresponsive to conventional prescription treatments.) Investigators measured patients’ ALT and aspartate aminotransferase (AST) levels at baseline, day 14, and day 28. (High levels of these enzymes in blood signals liver cell damage or disease.)
They reported no significant elevations in patients’ ALT and AST levels over the duration of the study. “Medicinal cannabis products did not have a significant adverse impact on ALT or AST levels,” the study’s authors concluded.
Prior studies assessing the influence of CBD on liver health have yielded inconsistent results. While studies involving healthy volunteers have typically failed to demonstrate an association between short-term CBD dosing and elevated liver enzymes, other studies of certain higher-risk patient populations – such as those with kidney failure – have shown minor increases in liver enzyme production, though the clinical significance of these changes remains unclear.
Full text of the study, “Liver enzyme effects of medicinal cannabis in advanced cancer: A sub-study of two randomized trials,” appears in BMJ Supportive & Palliative Care.
Clinical Trial: Plant-Derived Cannabis Formulations Show Comparable Efficacy to Lorazepam in Insomnia Patients
Khlong Hok, Thailand: Plant-derived cannabis preparations provide comparable benefits to lorazepam in patients with chronic insomnia, according to randomized clinical trial data published in the journal Sleep Medicine.
Thai investigators compared the safety and efficacy of a pair of plant-derived cannabis preparations to the benzodiazepine lorazepam in 60 adults diagnosed with chronic insomnia. Subjects were randomly assigned to consume either lorazepam, cannabis oil extracts, or an oral pill containing cannabinoids and other traditional herbal compounds. Participants consumed the products before bedtime for four weeks.
All three interventions significantly improved subjective sleep quality as measured by the Pittsburgh Sleep Quality Index, researchers reported. However, cannabis preparations provided superior improvements in patients’ overall health-related quality of life.
“Our findings suggest that culturally rooted herbal remedies and regulated cannabis oil preparations may offer a holistic benefit profile by targeting both nocturnal symptoms and daytime well-being,” the study’s authors concluded. “Given the global push toward reducing benzodiazepine prescriptions due to safety concerns, the availability of validated herbal and cannabis-based alternatives is of high clinical value.”
Surveys find that consumers frequently report using cannabis as a sleep enhancer. In jurisdictions where cannabis products are legally available, sales of over-the-counter sleep medicines decline, as do prescription sales of opioids and benzodiazepines.
Full text of the study, “Integrative therapies for chronic insomnia: A randomized controlled trial of a traditional Thai herbal remedy and cannabis sativa oil,” appears in Sleep Medicine.
Case Studies: Cannabis Provides Sustained Improvements in Adolescents With Tourette Syndrome
Hannover, Germany: The use of plant-derived cannabis preparations is safe and clinically effective in adolescents suffering from Tourette syndrome (TS), according to the conclusions of a pair of case studies published in the journal Frontiers in Psychiatry.
German researchers reported on the long-term use of cannabis in two male adolescents with TS. Both subjects utilized cannabis formulations (either oil extracts or vaporized flower) daily for several years.
Investigators reported: “Long-term treatment with different THC-containing cannabinoids resulted not only in a constant improvement of tics, psychiatric comorbidities, and quality of life, but also did not cause severe adverse effects and in particular no psychological symptoms such as anxiety, psychosis, and substance abuse including CUD [cannabis use disorder]. Most importantly, neurocognitive test results during the course of therapy showed no evidence that the patients’ cognitive abilities had become below average. There was also no indication of behavioral abnormalities, social problems, neglection of social interests, or loss of interests, motivation, and drive. This is remarkable, since in both patients CBM [cannabis-based medicine] treatment was initiated before puberty and doses of THC were relatively high.”
The study’s authors concluded: “In both patients, CBM [cannabis-based medicine] treatment resulted in continued benefit with significant improvement of tics and psychiatric comorbidities without severe adverse effects. … Although generalizability from our case reports of two single patients is limited, we suggest [that health professionals] take treatment with THC-containing drugs into consideration in severely affected and otherwise treatment refractory children and adolescents before thinking of surgical treatment using deep brain stimulation.”
Placebo-controlled clinical trial data demonstrate that cannabinoid extracts reduce tic frequency and severity in TS, while observational studies have shown long-term benefits in TS patients who inhale cannabis flower.
Full text of the study, “Long-term use of cannabis-based medicines in two children with Tourette syndrome: A case report,” appears in Frontiers in Psychiatry.
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