Research into plant based medicine

This study compared the efficacy of a THC:CBD extract and a THC extract, with placebo, in relieving pain in patients with advanced cancer. 

Participants had cancer pain that did not respond to chronic opioid dosing. A two-week, double-blind, randomized, placebo-controlled, parallel-group trial assigned some patients a THC:CBD extract, others a THC extract, and the rest placebo.  

The THC:CBD patients experienced a statistically significant drop in pain compared with the CBD only and placebo groups. Twice as many patients taking THC:CBD showed a reduction of more than 30% from their baseline pain score when compared with placebo. This study shows that THC:CBD extract is efficacious for relief of pain in patients with advanced cancer pain not fully relieved by strong opioids. 

Advanced cancer patients with pain that responds poorly to opioid therapy pose a clinical challenge. Nabiximols, a novel cannabinoid formulation containing both THC and CBD, has been hypothesized to help with pain management. 

 In a randomized, double-blind, placebo-controlled, graded-dose study, patients with advanced cancer and opioid-refractory pain received placebo or Nabiximols at a low dose (1-4 sprays/day), medium dose (6-10 sprays/day), or high dose (11-16 sprays/day). 

 Analysis of average daily pain from baseline to end–of–study demonstrated more patients receiving the medicinal cannabis product reported pain relief than the placebo group overall (P = .035). 

This randomized placebo-controlled 4-way crossover trial explored the pain relief effects of inhaled pharmaceutical-grade cannabis in 20 chronic pain patients with fibromyalgia. 

A variety of medicinal cannabis products were trialled, including a THC dominant strain, a CBD dominant strain, and a mixed THC and CBD strain. 

More subjects receiving the mixed THC and CBD strain displayed a 30% decrease in pain scores compared to placebo (90% vs 55% of patients, P = 0.01), with spontaneous pain scores correlating with the magnitude of drug high (ρ = -0.5, P < 0.001). Cannabis varieties containing THC caused a significant increase in pressure pain threshold relative to placebo (P < 0.01).  

Multiple sclerosis is associated with muscle stiffness, spasms, pain, and tremor. Much anecdotal evidence suggests that cannabinoids could help these symptoms. 

This randomised, placebo-controlled trial treated participants with either oral cannabis extract, THC, or placebo. 

There was evidence of a treatment effect on patient-reported spasticity and pain (p=0.003), with improvement in spasticity reported in 61% and 60% of participants on cannabis extract and THC respectively, compared with only 46% of participants on placebo. 

Treatment with cannabinoids did not have a beneficial effect on spasticity when assessed with the Ashworth scale, a clinical measure of spasticity. However, though there was a degree of unmasking among the patients in the active treatment groups, objective improvement in mobility and patients’ opinion of an improvement in pain suggest cannabinoids might be clinically useful. 

This study sought to determine the prevalence, tolerability, and self-reported effectiveness of cannabis in women with endometriosis. 

A cross-sectional online survey was conducted targeting women with endometriosis through social media postings from endometriosis advocacy groups. Women aged 18 to 45, living in Australia, and with surgically confirmed endometriosis were eligible to participate.   

76% of the women reported the use of general self-management strategies within the last 6 months. Of those using self-management, 13% reported using cannabis for symptom management. Self-reported effectiveness in pain reduction was high (7.6 of 10), with 56% also able to reduce pharmaceutical medications by at least half. Women reported the greatest improvements in sleep, and in nausea and vomiting. 

This observational study evaluated the efficacy of medicinal cannabis for the treatment of refractory epilepsy. Fifty-seven patients under 21 years old with epilepsy of various aetiologies were treated with Cannabis oil extract (CBD/THC ratio of 20:1) for at least 3 months. 

Twenty-six patients (56%) had ≤50% reduction in mean monthly seizure frequency. Those below 10 years of age that received a higher CBD dose were associated with better response to treatment. Adverse reactions were reported in 46% of patients and were the main reason for treatment cessation. The results suggest CBD-enriched cannabis extract added to the treatment regimen of patients with refractory epilepsy may result in a significant reduction in seizure frequency. 

This retrospective study examined the value, efficacy, and safety of cannabis-based medicines in the treatment of refractory spasticity in paediatric palliative care. 

Sixteen children, adolescents and young adults having complex neurological conditions with spasticity (aged 1.3–26.6 years, median 12.7 years) were treated with Dronabinol. A promising therapeutic effect was seen, mostly due to abolishment or marked improvement of severe, treatment–resistant spasticity. In two cases the effect could not be determined, two patients did not benefit. When administered as an escalating dosage scheme, side effects were rare and only consisted in vomiting and restlessness in one patient each. No serious and enduring side effects occurred even in young children and/or over a longer period of time. 

Nabilone is a synthetic cannabinoid that has shown promise for the treatment of posttraumatic stress disorder, PTSD–related insomnia and nightmares, as well as efficacy in the management of chronic pain. 

104 male inmates with serious mental illness were prescribed Nabilone with a mean final dosage of 4.0 mg. Results indicated significant improvement in PTSD-associated insomnia, nightmares, PTSD symptoms, and Global Assessment of Functioning and subjective improvement in chronic pain. Medications associated with greater risk for adverse effects or abuse than Nabilone, such as antipsychotics and sedative/hypnotics, were often able to be discontinued with the initiation of Nabilone.  

Dronabinol, a THC product, was trialled as a treatment for AIDS-related anorexia. 

Dronabinol was associated with increased appetite above baseline (38% vs 8% for placebo, P = 0. 015), improvement in mood (10% vs -2%, P = 0. 06), and decreased nausea (20% vs 7%; P = 0. 05). Weight was stable in Dronabinol patients, while placebo recipients had a mean loss of 0.4 kg (P = 0.14). Of the Dronabinol patients, 22% gained ≥2 kg, compared with 10.5% of placebo recipients (P = 0.11). Dronabinol was found to be safe and effective for anorexia associated with weight loss in patients with AIDS. 

This study assessed the efficacy of a THC and CBD oral spray in the treatment of pain due to rheumatoid arthritis (RA). It was compared with placebo in a randomized, double-blind, parallel group study in 58 patients over 5 weeks of treatment.  

In comparison with placebo, the medicinal cannabis treatment produced statistically significant improvements in pain on movement, pain at rest, quality of sleep, DAS28 and the SF-MPQ pain at present component. There was no effect on morning stiffness but baseline scores were low. The large majority of adverse effects were mild or moderate, and there were no adverse effect-related withdrawals or serious adverse effects in the active treatment group.