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Analysis: Limonene Terpene Reduces THC-induced Anxiety

Baltimore, MD: The co-administration of THC and the terpene D-limonene is associated with reduced feelings of anxiety, according to data published in the journal Drug and Alcohol Dependence.

Researchers with John Hopkins University assessed the influence of D-limonene on THC’s subjective effects in 20 healthy volunteers. (D-limonene is a terpene commonly found in many citrus fruits and is among the more abundant terpenes in cannabis.)

Participants who inhaled D-limonene concurrently with THC reported “significantly reduced” feelings of anxiety and paranoia as compared to those who inhaled THC alone. The inhalation of higher quantities of D-limonene was associated with more pronounced effects.

“D-limonene reduced THC-induced anxiety effects in a dose-dependent manner,” the study’s authors reported. Its co-administration did not influence any other effects of THC.

The study’s authors concluded: “D-limonene selectively attenuated THC-induced anxiogenic effects, suggesting this terpenoid could increase the therapeutic index of THC. Future research should determine whether this effect extends to oral dose formulations and evaluate the interactions between other cannabis terpenoids or cannabinoids and THC.”

Research published last year in the journal Biochemical Pharmacology determined that certain terpenes – including borneol, geraniol, limonene, linalool, ocimene, sabinene, and terpineol – modulate THC activity at the CB1 receptor. That study’s authors concluded: “The use of selected terpenes may enable reducing the THC dose in some treatments, and as a result, potentially minimizing the THC-related adverse effects. This would also help in adjusting the treatment to more sensitive populations such as children and elderly. Enrichment with selected terpenes may allow for composition adjustment to personal needs and to changes during chronic use, such as for daytime versus for sleep.”

Full text of the study, “Vaporized D-limonene selectively mitigates the acute anxiogenic effects of delta-9-tetrahydrocannabinol in healthy adults who intermittently use cannabis,” appears in Drug and Alcohol Dependence.

Study: CBD Provides Sustained Relief For Menstrual-related Symptoms

Fayetteville, AR: The consumption of soft-gel caps containing CBD isolate is associated with the alleviation of menstrual-related symptoms (MRS), according to open-label trial data published in the journal Experimental and Clinical Psychopharmacology.

Researchers affiliated with the University of Arkansas and Auburn University in Alabama assessed CBD dosing on MRS in a cohort of 33 subjects. Study participants provided a baseline assessment of their symptom severity. They then consumed CBD gel caps on the days that they experienced MRS symptoms for the following three months.

Subjects reported experiencing immediate relief following their use of CBD. These improvements were sustained over the course of the trial. Subjects also reported reduced stress, irritability, and anxiety following CBD dosing.

The study’s authors concluded: “The present study suggests that CBD may be an effective treatment in alleviating MRS. Given the prevalence of MRS as well as the relative lack of effective options in treating the entirety of experiences that occur because of MRS, further investigation of CBD as an intervention option for MRS is warranted.”

Full text of the study, “Examination of the effects of cannabidiol on menstrual-related symptoms,” appears in Experimental and Clinical Psychopharmacology.

Study: Medical Cannabis Patients Report Sustained Quality Of Life Improvements

Erie, PA: Patients authorized to consume medical cannabis products report significant improvements in their overall health, according to data published in the journal Medical Cannabis and Cannabinoids.

Researchers affiliated with the Lake Erie College of Osteopathic Medicine assessed the impact of medical cannabis on patients’ physical and emotional well-being. Participants in the study possessed a doctor’s authorization to access state-licensed cannabis products in Pennsylvania. Patients’ symptoms were assessed upon enrollment in the study and then again at 30, 60, and 90 days. Most patients enrolled in the study inhaled herbal cannabis or concentrates.

Investigators said that patients’ cannabis use resulted in immediate symptom improvements. These improvements were sustained for the length of the study. Those patients who consumed cannabis products once per day displayed greater improvements in their general health than did those who used it more frequently. Only minor side effects (e.g., cough, dry mouth) were reported.

“It is clear that medical marijuana, when administered safely, can improve an individual’s quality of life,” the study’s authors determined. “Participants reported significant decreases in emotional limitations, fatigue, and pain levels.”

They concluded, “The findings suggest that MMJ [medical marijuana] has the potential to improve physical and social functioning, energy levels, emotional well-being, and overall general health within the first 30–60 days of use.”

Their findings are consistent with those of other larger observational studies involving thousands of patients enrolled in medical cannabis access programs.

Full text of the study, “Observational analysis of the influence of medical marijuana use on quality of life in patients,” appears in Medical Cannabis and Cannabinoids.

Analysis: Labels On CBD Vape Cartridges Often Provide Inaccurate Information

Huntington, WV: The labels on CBD vape pens typically provide imprecise information regarding the products’ contents, according to data published in the Journal of Forensic Sciences.

A team of scientists from Marshall University in West Virginia quantified cannabinoid components in nine retail brands of CBD vape liquids. Hemp-derived CBD products are often available over the counter at gas stations and other retailers. However, they are not federally regulated and they are typically subject to few, if any, state regulations.

Of the nine products analyzed, six possessed levels of CBD that were “statistically different from the amount reported on the label” – a finding consistent with many other studies.

Moreover, investigators reported that most products’ cannabinoid content fluctuated significantly over time, depending on the storage conditions (time and temperature) of the vape liquids.

The study’s authors concluded: “Results of this work demonstrates the discrepancies present between reported cannabinoid content and actual levels of CBD, THC, CBN, and CBDA in consumer-sold products. … Consumers should also be aware that handling and storage of purchased vape products can affect the product and its composition. Uncertainty in the content of products sold to consumer cannabis users raises concerns about dosing, safety, effectiveness, and potential interactions with other drugs.”

NORML and other groups have urged the FDA to establish regulatory guidelines governing the production, testing, labeling, and marketing of hemp-derived CBD products. Analyses conducted by the FDA and others have consistently reported that many over-the-counter CBD products are of variable quality and potency, and that they may contain contaminants, adulterants, or elevated levels of heavy metals.

Full text of the study, “An evaluation of the cannabinoid content of the liquid and thermal degradation analysis of cannabis-labeled vape liquids,” appears in the Journal of Forensic Sciences.

Study: Most Migraine Sufferers Have Reduced Or Eliminated Their Use Of Prescription Drugs With Cannabis

New Haven, CT: Migraine patients report mitigating their symptoms with cannabis and many also acknowledge using marijuana in lieu of other prescription medications, according to data published in the journal Neurology Clinical Practice.

Investigators affiliated with Yale University’s School of Medicine surveyed responses from 1,373 patients from a tertiary headache center. Just under one-third of respondents acknowledged being current consumers of cannabis.

Among these consumers, most said that marijuana either improved migraine symptoms or limited their frequency. Many respondents (63 percent) also said that their use of cannabis allowed them to either reduce or eliminate their need for other prescription medications.

“This is the largest study to date to document cannabis product usage patterns and perceived benefits for migraine management in a clinical headache patient sample,” the study’s authors concluded. “A majority of patients surveyed reported using cannabis products for migraine management and cited perceived improvements in migraine characteristics, clinical features, and associated risk factors.”

Several studies have previously documented the effectiveness of cannabis for migraine treatment. A 2002 literature review of nine studies involving 5,600 subjects concluded: “Medical marijuana has a significant clinical response by reducing the length and frequency of migraines. ... Due to its effectiveness and convenience, medical marijuana therapy may be helpful for patients suffering from migraines.”

Full text of the study, “Characterizing cannabis use and perceived benefit in a tertiary headache center patient sample,” appears in Neurology Clinical Practice.

Study: Patients With Post-traumatic Stress And Depression Report Improvements Following Cannabis Therapy

London, United Kingdom: Patients diagnosed with post-traumatic stress and comorbid depression respond favorably to the use of medical cannabis preparations, according to data published in the journal BMJ Psych Open.

British researchers assessed the use of cannabis-based medicinal products (CBMPs) in a cohort of patients suffering simultaneously from post-traumatic stress and depression. (Since 2018, British specialists have been permitted to prescribe cannabis-based medicinal products to patients unresponsive to conventional medications.) Self-reported symptoms were assessed three months after subjects initiated their cannabis use.

Investigators reported, “Treatment with prescribed cannabis was associated with substantial reductions in the severity of PTSD symptomatology, with these improvements being more marked in individuals with depression.”

They concluded: “Treatment with CBMPs is associated with significant improvements in well-being and quality of life in PTSD after three months. ... These results parallel previous findings for quality of life across a broad range of conditions and for PTSD specifically and highlight the potential benefits of CBMPs for symptom reduction and improvements in well-being across a wide range of chronic conditions.”

Prior assessments of patients enrolled in the UK Medical Cannabis Registry who are diagnosed with post-traumatic stress and depression have similarly concluded that cannabis therapy can improve subjects’ health-related quality of life. By contrast, a 2021 clinical trial concluded that the inhalation of marijuana flower provided limited benefits compared to placebo in treating symptoms of PTSD.

Full text of the study, “Medicinal cannabis for treating post-traumatic stress disorder and comorbid depression: Real-world evidence,” appears in BMJ Psych Open.

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Analysis: Cannabis Therapy Associated With Quality Of Life Improvements In Chronically Ill Patients

Berlin, Germany: Chronically ill patients who use authorized medical cannabis products report improvements in their quality of life, according to data published in the German medical journal Schmerz.

German investigators assessed patient-reported outcomes in a nationwide cohort of 1,582 patients authorized to use cannabis by their physicians. (Plant cannabis and cannabinoid treatments, such as dronabinol, were legalized by prescription use in Germany in 2017; however, cannabis products are typically only authorized when patients are unresponsive to traditional therapies.) Patients suffered from chronic pain, depression, sleep disturbances, and other symptoms.

Eighty-four percent of those surveyed reported quality of life improvements following their use of cannabis.

“Cannabis therapy [may] improve the quality of life of chronically ill patients, regardless of the underlying disease,” the study’s authors concluded.

The findings are consistent with those of observational studies from Australia and the United Kingdom concluding that cannabis use improves chronically ill patients’ health-related quality of life.

Full text of the study, “Patient-reported outcomes in chronic diseases under treatment with cannabis medicines: Analysis of the results of the Copeia survey,” appears in Schmerz.

Study: Most Migraine Sufferers Have Reduced Or Eliminated Their Use Of Prescription Drugs With Cannabis

New Haven, CT: Migraine patients report mitigating their symptoms with cannabis and many also acknowledge using marijuana in lieu of other prescription medications, according to data published in the journal Neurology Clinical Practice.

Investigators affiliated with Yale University’s School of Medicine surveyed responses from 1,373 patients from a tertiary headache center. Just under one-third of respondents acknowledged being current consumers of cannabis.

Among these consumers, most said that marijuana either improved migraine symptoms or limited their frequency. Many respondents (63 percent) also said that their use of cannabis allowed them to either reduce or eliminate their need for other prescription medications.

“This is the largest study to date to document cannabis product usage patterns and perceived benefits for migraine management in a clinical headache patient sample,” the study’s authors concluded. “A majority of patients surveyed reported using cannabis products for migraine management and cited perceived improvements in migraine characteristics, clinical features, and associated risk factors.”

Several studies have previously documented the effectiveness of cannabis for migraine treatment. A 2002 literature review of nine studies involving 5,600 subjects concluded: “Medical marijuana has a significant clinical response by reducing the length and frequency of migraines. … Due to its effectiveness and convenience, medical marijuana therapy may be helpful for patients suffering from migraines.”

Full text of the study, “Characterizing cannabis use and perceived benefit in a tertiary headache center patient sample,” appears in Neurology Clinical Practice.

Study: Patients With Post-traumatic Stress And Depression Report Improvements Following Cannabis Therapy

London, United Kingdom: Patients diagnosed with post-traumatic stress and comorbid depression respond favorably to the use of medical cannabis preparations, according to data published in the journal BMJ Psych Open.

British researchers assessed the use of cannabis-based medicinal products (CBMPs) in a cohort of patients suffering simultaneously from post-traumatic stress and depression. (Since 2018, British specialists have been permitted to prescribe cannabis-based medicinal products to patients unresponsive to conventional medications.) Self-reported symptoms were assessed three months after subjects initiated their cannabis use.

Investigators reported, “Treatment with prescribed cannabis was associated with substantial reductions in the severity of PTSD symptomatology, with these improvements being more marked in individuals with depression.”

They concluded: “Treatment with CBMPs is associated with significant improvements in well-being and quality of life in PTSD after three months. … These results parallel previous findings for quality of life across a broad range of conditions and for PTSD specifically and highlight the potential benefits of CBMPs for symptom reduction and improvements in well-being across a wide range of chronic conditions.”

Prior assessments of patients enrolled in the UK Medical Cannabis Registry who are diagnosed with post-traumatic stress and depression have similarly concluded that cannabis therapy can improve subjects’ health-related quality of life. By contrast, a 2021 clinical trial concluded that the inhalation of marijuana flower provided limited benefits compared to placebo in treating symptoms of PTSD.

Full text of the study, “Medicinal cannabis for treating post-traumatic stress disorder and comorbid depression: Real-world evidence,” appears in BMJ Psych Open.

Analysis: Marijuana Sales Not Associated With Increased Use Among Adolescents

Reno, NV: The initiation of state-licensed marijuana sales is not independently associated with an increase in cannabis use among young people, according to data published in the journal Addictive Behaviors.

Researchers compared trends in marijuana use among middle school students in Nevada and New Mexico. During the study period, Nevada permitted retail sales of marijuana products while New Mexico did not.

They reported “no immediate change in lifetime or past 30-day marijuana use among middle school-aged adolescents in Nevada compared to New Mexico.” Rather, marijuana use trends in both states followed similar trajectories.

Consistent with other studies, investigators concluded, “Adult-use sales were not associated with an increase in lifetime or P30D [past 30-day] marijuana use.”

Although the study’s authors did identify upticks in marijuana use among certain demographics (e.g., students of color) during the study period (2017-2019), numerous other studies assessing nationwide trends over the better part of the past decade have consistently reported that cannabis use among teens has steadily declined.

Full text of the study, “Increasing lifetime and past 30-day marijuana use among middle school students regardless of recreational marijuana sales,” appears in Addictive Behaviors.

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Survey: Medical Cannabis Products Increasingly Used To Treat Symptoms Of Endometriosis

Sydney, Australia: Endometriosis patients frequently report using cannabis preparations to alleviate their symptoms, according to survey data published in the journal Obstetrics & Gynecology.

Australian researchers surveyed 192 women with a history of cannabis use and endometriosis. Sixty-three percent of respondents said that they had received a doctor’s authorization to use cannabis-based medicinal products. (Under Australian law, physicians may authorize cannabis products to patients unresponsive to conventional prescription treatments.)

Most respondents used THC-dominant products. Consistent with other studies, patients reported symptom improvements following cannabis treatment – including better sleep, less pain, fewer bouts of nausea, and reduced anxiety.

“This study found that THC-predominant CBMPs [cannabis-based medicinal products] are commonly prescribed to Australians with endometriosis,” authors concluded. “Given major issues with symptom management and the self-reported reductions in pain and other symptoms, improving access to medicinal cannabis for this population is important and timely.”

Other surveys have similarly indicated that cannabis use is popular among patients with endometriosis, and that many of them substitute it in place of other medications, particularly opioid-based analgesics.

Full text of the study, “A survey of cost, access, and outcomes for cannabinoid-based medicinal product use by Australians with endometriosis,” appears in Obstetrics & Gynecology.

Study: Marijuana Consumers No Less Likely To Exercise

Dallas, Texas: Adults with a history of marijuana use engage in exercise and other physical activities at rates comparable to non-users, according to data published in the journal Preventive Medicine Reports.

Researchers affiliated with the University of Texas and Ohio University compared exercise patterns in a nationally representative cohort of cannabis consumers and non-consumers.

They reported no significant differences between the two groups in their frequency of strength training or general activity. However, cannabis consumers were more likely than non-users to walk for exercise.

“Our results indicate that marijuana … use [is] not associated with low exercise rates among adults in the U.S.,” the study’s authors concluded. “These findings challenge the stereotype that marijuana … users are less active than their non-using counterparts.”

The findings are consistent with those of other studies concluding that adults with a history of marijuana use typically exercise as much or more than their non-using peers. Among those age 60 and older, marijuana use has been associated with increased exercise frequency.

Full text of the study, “The association between marijuana and e-cigarette use and exercise behavior among adults,” appears in Preventive Medicine Reports.

Survey: Most Palliative Care Professionals Say They Are Uninformed About Medical Cannabis Issues

Boston, MA: Most physicians specializing in hospice and palliative care believe that they are inadequately prepared to counsel patients about the use of medical cannabis, according to survey data published in the Journal of Pain and Symptom Management.

Harvard researchers surveyed 123 HPM [hospice and palliative medicine] fellows regarding their familiarity with medical cannabis.

Consistent with prior surveys of healthcare professionals, most respondents (71 percent) said that they were “insufficiently informed” to discuss medical cannabis options with their patients.

Surveys of nurses, pharmacists, clinicians, and other medical professionals have yielded similar findings.

However, in contrast with other surveys, most HPM fellows (65 percent) acknowledged having received some “formal training regarding medical cannabis.”

The study’s authors concluded: “Few [of those surveyed] considered themselves sufficiently informed to make cannabis-related clinical recommendations. These results suggest both a need for expanded high-quality evidence for medical cannabis in palliative care and for improved formal education for HPM fellows.”

Full text of the study, “Palliative medicine fellows’ discussions, perceptions, and training regarding medical cannabis,” appears in the Journal of Pain and Symptom Management.

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