Showing posts with label marijuana. Show all posts
Showing posts with label marijuana. Show all posts

Thursday, November 8, 2018

Marijuana Use Tied to Serious Diabetes Complication

Marijuana Use Tied to Serious Diabetes Complication
Last Updated: November 08, 2018. 
By Serena Gordon
HealthDay Reporter

People with type 1 diabetes who use marijuana may double their risk of developing a life-threatening complication, a new study suggests.

Called diabetic ketoacidosis (DKA), the condition occurs when there is not enough insulin to break down sugar in the body, so the body burns fat for fuel instead. This triggers a build-up of chemicals known as ketones, which make blood more acidic and can lead to coma or death.

Read More: 

JAMA Intern Med. Published online November 5, 2018. 

Of Interest
Medical marijuana doesn't yet meet the standard
Posted Nov 05 at 2:00 PM
By John Schumann, MD
If voters want to legalize marijuana for recreational use I have no objection, provided we put in place a legal framework to make sure that people don't get hurt. Standardized dosing and measures to assure product consistency would be integral. And we'd need adequate enforcement to make sure that people aren't impaired when at work or in other situations in which their marijuana use could jeopardize others.

Saturday, November 3, 2018

Hepatitis Weekly Review & November Newsletters

Welcome, thanks for stopping by! Check out this month's index of exceptional Hepatitis Newsletters, and well written blogs; many provided by patient–consumers who offer an insight into what it's really like dealing with hepatitis.

Weekly Review
Begin by catching up on what you missed this week, here's one of two weekly reviews:

HepCBC is a Canadian non-profit organization offering information about HCV awareness, testing, treatment and care.
Weekly news updates: Weekly Bull.

HepC Challenge - Caring Ambassadors Program
The Caring Ambassadors Program uses a unique approach in our work to address the elimination of viral hepatitis and specifically hepatitis C. 
Weekly Updates: Hepatitis C News
Topics include all stories related to hepatitis C as well as personal stories and events. To sign up to receive our weekly newsletter sent to your inbox, click here.
In addition, check out; Monthly Pubmed Review of the Most Relevant Research on Hepatitis C, at HepC Challenge as well.

HCV Advocate
The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education.
Topics in this month’s HCV Advocate newsletter; 
Infective Endocarditis & People Who Inject Drugs 
Hepatitis C and Our Caregivers 
Gilead Launches Generics for HCV Meds, First Human Case of Rat Hepatitis, and Eliminating hepatitis C in Washington.
Overview of Transmission and Prevention of Hepatitis C
Marijuana is not associated with the progression of hepatic fibrosis in liver disease: a systematic review and meta-analysis
Eight-week hepatitis C treatment with new direct-acting antivirals has a better safety profile while being effective in the treatment-naïve geriatric population without liver cirrhosis and hepatitis C virus-RNA < 6 Million IU/mL
Approaches, progress, and challenges to hepatitis C vaccine development
Australia on track to achieve WHO HCV elimination targets following rapid initial DAA treatment uptake: a modeling study
NEW: Harm Reduction Fact Sheet: Infective Endocarditis 
 Nail Care Settings
A Guide to Coping with Depression and Hepatitis C
View all Newsletters, here....

HCV Action
HCV Action brings together hepatitis C health professionals from across the patient pathway with the pharmaceutical industry and patient representatives to share expertise and good practice.
02 Nov 2018

World Hepatitis Alliance
We run global campaigns, convene high-level policy events, build capacity and pioneer global movements, ensuring people living with viral hepatitis guide every aspect of our work.

The New York City Hepatitis C Task Force
The New York City Hepatitis C Task Force is a city-wide network of service providers and advocates concerned with hepatitis C and related issues. The groups come together to learn, share information and resources, network, and identify hepatitis C related needs in the community. Committees form to
work on projects in order to meet needs identified by the community

Hepatitis NSW
Hepatitis NSW provides information, support, referral and advocacy for people affected by viral hepatitis in NSW. We also provide workforce development and education services both to prevent the transmission of viral hepatitis and to improve services for those affected by it.Latest issue of The Champion

GI & Hepatology News
Over 17,000 gastroenterologists and hepatologists rely on GI & Hepatology News every month to cover the world of medicine with breaking news, on-site medical meeting coverage, and expert perspectives both in print and online.
View all updates here....

Hep-Your Guide to Hepatitis
Hep is an award-winning print and online brand for people living with and affected by viral hepatitis. Offering unparalleled editorial excellence since 2010, Hep and are the go-to source for educational and social support for people living with hepatitis.
In every issue of Hep, you’ll find the hottest topics of interest to our readers along with cutting-edge health information.
Read the news

Hepatitis Victoria
Hepatitis Victoria is the peak not-for-profit community organisation working across the state for people affected by or at risk of viral hepatitis.
View the Latest Newsletter, or relax and listen to a short podcasts interviewing health experts and practioners on topics related to viral hepatitis - come have a listen!
In The News - How stigma is entrenched by 'disease prestige'

British Liver Trust 
The British Liver Trust is the leading UK liver disease charity for adults – we provide information and support; increase awareness of how liver disease can be prevented and promote early diagnosis; fund and champion research and campaign for better services.
View Recent Newsletters, here.

The National Viral Hepatitis Roundtable
The National Viral Hepatitis Roundtable (NVHR) is national coalition working together to eliminate hepatitis B and C in the United States.

The Hepatitis C Trust 

The Hepatitis C Trust is run by patients with the goal of eliminating HCV in the United Kingdom. The Trust’s mission is to reverse the rapidly increasing death toll caused by hepatitis C in the UK until no-one dies from this preventable and treatable disease and, ultimately, it is all but eradicated in this country.
The UK Parliament’s Health and Social Care Committee has today published a report on ’Prison Health’, which calls for the Government to do more to improve health outcomes for people in prison. The report, which follows an inquiry conducted in the first half of 2018, notes that hepatitis C is more prevalent amongst people in prison compared to the general population, making it a significant prison health issue.

National Institutes of Health 

A monthly newsletter from the National Institutes of Health, part of the U.S. Department of Health and Human Services
Feeling the Burn? Options for Acid Reflux

Blog Updates
Karen Hoyt is devoted to offering support and accurate information to people coping with the effects of hepatitis C.
Latest blog entry: Denied for Transplant List
Lucinda Porter is a nurse, speaker, advocate and patient devoted to increasing awareness about hepatitis C.
Latest blog entry: Vote Health
View all new blog updates, here....

Hep is an award-winning print and online brand for people living with and affected by viral hepatitis.
Latest blog updates: In Limbo with Liver Disease
Hepatitis B, C and HIV
View all blog updates, here...

Life Beyond Hep C is where faith, medical resources and patient support meet, helping Hep C patients and their families navigate through the entire journey of Hep C.
View all updates, here...

We strive to improve prevention and the quality of life of those living with liver disease by advocating for better screening, access to treatment, and patient care.
View all updates, here...

The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.
View all updates, here....

ADRLF (Al D. Rodriguez Liver Foundation)
Al D. Rodriguez Liver Foundation is a non-profit organization that provides resources, education and information related to screening, the prevention of and treatment for the Hepatitis Virus and Liver Cancer. 
Latest blog entry: Hepatitis E: Should I Be Worried?
Alcohol and Increased Cirrhosis-related Deaths
View all updates, here....

At we empower patients and caregivers to take control of Hepatitis C by providing a platform to learn, educate, and connect with peers and healthcare professionals.
View all updates, here....

Kevin Pho is a practicing physician and most known for his blog KevinMD. Thousands of authors contribute to his blog: primary care doctors, surgeons, specialist physicians, nurses, medical students, policy experts. And of course, patients, who need the medical profession to hear their voices.

The goal of our publications is to bring people around the world the most current health information that is authoritative, trustworthy, and accessible, drawing on the expertise of the 10,000+ faculty physicians at Harvard Medical School.
Latest blog entry: What parents need to know — and do — about e-cigarettes --
Coffee may help your skin stay healthy

Providing physicians with virtual access to specialists can be lifesaving to liver disease patients. 
View all updates: Lab Blog 

HCV Education 
HepCure is an innovative set of tools for hepatitis C virus (HCV) treatment. Developed by a team of HCV experts at the Icahn School of Medicine at Mount Sinai in New York City in collaboration with the New York State Department of Health and community health centers across the state. HepCure aims to improve provider knowledge for chronic disease management and increase patient engagement in persons with HCV infection.
Listen to experts discuss important HCV related topics in the following easy to access webinar: 
Hepatitis C Anti-Viral Therapy Guidance Review 2018 
On Tuesday, October 23rd, Dr. Ayse Aytaman of the Veterans Health Administation presented on: “Hepatitis C Anti-Viral Therapy Guidance Review 2018”
Access the slides here
Watch This Webinar

Nov 3, 2018
Minireview - Era of direct acting anti-viral agents for the treatment of hepatitis C 
The different DAAs with their dose, efficacy, side effects, drug-drug interactions as well as specific treatment against different genotypes of HCV will be discussed.

Helpful Links 
Premier Hepatitis C Websites, Blogs and Support Forums

Again thanks for stopping by, enjoy the weekend.

Friday, October 26, 2018

Today On Twitter - Medical Marijuana for Chronic Pain

Today On Twitter From: The New England Journal of Medicine (NEJM)
"An interactive feature about the use of #medicalmarijuana offers a case vignette accompanied by essays that support either recommending or discouraging the use of medical marijuana for the treatment of chronic pain."

Medical Marijuana for Chronic Pain
Lisa Caulley, M.D., M.P.H., Benjamin Caplan, M.D., and Edgar Ross, M.D.
N Engl J Med 2018; 379:1575-1577
DOI: 10.1056/NEJMclde1808149

A Woman with Chronic Pain
Lisa Caulley, M.D., M.P.H.
Ms. Rothstein is a 31-year-old woman who comes to your office to consult with you regarding a long-standing history of complex regional pain syndrome in her right leg and foot. She is a graduate student and former varsity soccer player who became disabled 7 years ago after having a hairline fracture in the right fibula. Since several weeks after her injury, she has had intractable pain in her foreleg and foot even though the fracture has healed. She describes.....

Follow On Twitter

Wednesday, October 17, 2018

Effect of cannabis use on chronic liver disease from Hepatitis C Virus infection

In The Media
Marijuana Use May Improve Cirrhosis Risk in Patients With Hepatitis C
Kenneth Bender, PharmD, MA
Publish Date: Wednesday, October 17, 2018
In an observation of a large pool of patients with hepatitis C virus (HCV), cannabis users had a lower prevalence of liver cirrhosis, more favorable health status at hospital discharge, and lower total health care costs than non-users.
Read the article...

In The Journal 
Canadian Journal of Gastroenterology and Hepatology
Volume 2018, Article ID 9430953, 9 pages

Research Article
Reduced Incidence and Better Liver Disease Outcomes among Chronic HCV Infected Patients Who Consume Cannabis
Received 1 May 2018; Revised 13 August 2018; Accepted 29 August 2018; Published 23 September 2018

Background and Aim. The effect of cannabis use on chronic liver disease (CLD) from Hepatitis C Virus (HCV) infection, the most common cause of CLD, has been controversial. Here, we investigated the impact of cannabis use on the prevalence of CLD among HCV infected individuals. Methods. We analyzed hospital discharge records of adults (age ≥ 18 years) with a positive HCV diagnosis. We evaluated records from 2007 to 2014 of the Nationwide Inpatient Sample (NIS). We excluded records with other causes of chronic liver diseases (alcohol, hemochromatosis, NAFLD, PBC, HBV, etc.). Of the 188,333 records, we matched cannabis users to nonusers on 1:1 ratio (4,728:4,728), using a propensity-based matching system, with a stringent algorithm. We then used conditional regression models with generalized estimating equations to measure the adjusted prevalence rate ratio (aPRR) for having liver cirrhosis (and its complications), carcinoma, mortality, discharge disposition, and the adjusted mean ratio (aMR) of total hospital cost and length of stay (LOS) [SAS 9.4]. Results. Our study revealed that cannabis users (CUs) had decreased prevalence of liver cirrhosis (aPRR: 0.81[0.72-0.91]), unfavorable discharge disposition (0.87[0.78-0.96]), and lower total health care cost ($39,642[36,220-43,387] versus $45,566[$42,244-$49,150]), compared to noncannabis users (NCUs). However, there was no difference among CUs and NCUs on the incidence of liver carcinoma (0.79[0.55-1.13]), in-hospital mortality (0.84[0.60-1.17]), and LOS (5.58[5.10-6.09] versus 5.66[5.25-6.01]). Among CUs, dependent cannabis use was associated with lower prevalence of liver cirrhosis, compared to nondependent use (0.62[0.41-0.93]). Conclusions. Our findings suggest that cannabis use is associated with decreased incidence of liver cirrhosis, but no change in mortality nor LOS among HCV patients. These novel observations warrant further molecular mechanistic studies.

Thursday, October 4, 2018

Behind The Headlines - Cannabis has 'more lasting effect on teenage brains than alcohol'

Each day the NHS Choices team selects health stories that are making headlines. These, along with the scientific articles behind the stories, are sent to Bazian, a leading provider of evidence-based healthcare information. Bazian's clinicians and scientists analyse the research and produce impartial evidence-based assessments, which are edited and published by NHS Choices.

Cannabis has 'more lasting effect on teenage brains than alcohol'
Thursday October 4 2018
"Cannabis 'more harmful than alcohol' for teen brains," reports BBC News.

Canadian researchers investigated the links between alcohol and cannabis use and performance on various tests of brain function in 3,826 school pupils over 4 years, starting at age 12 to 13. They found teens who used cannabis performed less well, especially in tests of memory and impulse control.

The researchers said teenagers with worse memory and impulse control were more likely than other teens to use alcohol and cannabis. However, an increase in cannabis use in 1 year was associated with lower test scores that year and also in the following year, suggesting that cannabis could have a lasting effect on their brain function. The researchers did not find this result in teens using alcohol.

Cannabis also seemed to have greater effects in younger teens compared with older teens.

This study will add to the body of research assessing the potential cognitive and mental health effects of cannabis. As is often the case with such research, it's difficult to determine whether cannabis directly causes these effects or whether people at risk of cognitive or mental health problems may be more likely to use cannabis.

We do know that the brains of teenagers are still developing, so any drug or substance that can affect the brain, be it illegal or legal, could possibly have long-term effects.

There are also a number of health risks relating to cannabis use. Read more about how cannabis can lead to health problems.

Where did the story come from?
The researchers who carried out the study were from the University of Montreal, Centre Hospitalier Universitaire Sainte-Justine and Dalhousie University in Canada. It was funded by the Canadian Institutes of Health and published in the peer-reviewed journal The American Journal of Psychiatry.

The study was widely reported in the UK media. The media reports were broadly accurate but the headlines tended towards scaremongering. The Sun referred to cannabis as "brain rot" while the Mail Online implied the results lasted into adult life – which we do not know, as students were not followed up beyond age 16 to 17.

What kind of research was this?
The researchers carried out a cohort study using data from a previously-reported randomised controlled trial (RCT). The RCT aimed to assess the effect of a personality-targeted drugs and alcohol prevention programme. It assigned schools to deliver the programme to adolescents (average age 13) either immediately, or 3 years later (a delayed intervention condition).

Cohort studies are useful when investigating links between risk factors such as drug and alcohol use, and outcomes like poor brain functioning. However it remains a challenge to show that alcohol or drug use is a direct cause of poor brain function.

What did the research involve?
The trial recruited 3,826 school pupils in 7th grade (age 12 to 13). Pupils underwent computerised tests of brain function every year in school, and filled in a confidential online questionnaire about their cannabis and alcohol use. They continued in the study for 4 years.

The computerised brain function tests measured:
-working memory – the short-term memory that allows you to remember information sufficient to complete tasks
-perceptual reasoning – the ability to use information from our senses to understand the world around us
-delayed recall memory – the longer-term ability to remember something after a period of distraction
inhibitory control – the ability to control natural impulses, for example not to respond to a stimulus

For this study, the researchers compared the brain function scores to pupils' reported use of alcohol or cannabis. This showed whether pupils with poorer brain function in particular areas were more likely to use cannabis or alcohol, and vice versa. They then looked at how students performed year on year, and how that was linked to their reported alcohol or cannabis intake in that year, and in the previous year. This helped to show whether changes in pupils' substance use predicted changes in their test results.

Researchers took into account pupils' family income, gender, ethnicity and whether they lived with both biological parents.

What were the basic results?
The researchers reported results separately for cannabis and alcohol.

For cannabis, they said:
-pupils who used cannabis more frequently over 4 years had poorer results on working memory, -perceptual reasoning and inhibition control tests, compared to those who did not use cannabis
-pupils who increased how much cannabis they used had poorer results than expected in delayed memory tests in the same year
-pupils who increased their cannabis use had poorer results than expected in inhibition control the following year
-stronger links were observed in early adolescence compared with later adolescence

For alcohol:
-pupils who drank more alcohol more often over 4 years had poorer working memory, perceptual reasoning and inhibitory control
-pupils' changes in alcohol use over time did not seem to be related to their brain function tests

How did the researchers interpret the results?
The researchers said their results showed a "common vulnerability" to using cannabis and alcohol, among pupils with poorer working memory, perceptual reasoning and inhibition control.

The results also supported "a lasting, or neurotoxic, effect of cannabis" on inhibition control and working memory, meaning that the effects on the brain lasted beyond the period that the pupil was using cannabis.

This complex analysis suggests that cannabis use by teenagers may have an ongoing effect on their brain function, particularly in the areas of:
-working memory (important for completing tasks)
-perceptual reasoning (important for understanding the world)
-inhibition control (important for learning to resist harmful impulses)

The main difficulty is that we still don't know with certainty whether teens who used alcohol and cannabis had worse brain function because of substance use, or whether they were more likely to use alcohol and cannabis because of their poorer brain function.

Similarly we can't pull apart the influence of confounding health, lifestyle and environmental factors. We don't have a full picture of how other circumstances in their lives, such as peer groups or the home environment, might affect both drug and alcohol use and brain function and academic performance.

If cannabis is having a direct effect on brain function, we can't tell easily from this study is how big of an impact this might be. The differences in test results are not easily understood by non-experts. We don't know, for example, if the teenagers in the study who used cannabis were less likely to achieve educational or vocational qualifications, or to go on to academic or professional success.

An additional limitation to be aware of is that drug and alcohol use was self-reported. Although teenagers were told the questionnaire was confidential, some may have been reluctant to answer truthfully.

Overall the study adds to evidence that cannabis is not a risk-free drug, especially for teenagers and young people. So avoiding cannabis use during the teenage years – as with any time of life – seems to be a sensible precaution. This study gives teenagers another reason to think twice about using cannabis.

Analysis by Bazian
Edited by NHS Website 

Thursday, August 30, 2018

Coffee and marijuana may sharply reduce the risk for early death from Hep C?

In the News
AUGUST 30, 2018

Coffee, Pot Linked to Lower Mortality From Hepatitis C
Increased consumption of coffee and marijuana may sharply reduce the risk for early death from hepatitis C infection, researchers have found.

The study of more than 1,200 patients with HCV and HIV found that those who drank the most coffee and used marijuana regularly or daily had more than a 60% lower risk for death from the infection over a five-year period.

How cannabis in particular might reduce mortality is unclear, but the researchers, led by Maria-Patrizia Carrieri, PhD, of the Université Aix Marseille, in France, noted that the substance has been previously associated with a reduced risk for insulin resistance and steatosis, two conditions that could increase mortality in patients with HCV.
Read the article:

Saturday, August 4, 2018

The Pot Breathalyzer Is Here. Maybe

August 4, 2018 8:02 AM ET
Heard on Weekend Edition Saturday
Eric Westervelt 
As legalization of recreational and medical marijuana continues to expand, police across the country are more concerned than ever about stoned drivers taking to the nation's roads and freeways, endangering lives.

With few accurate roadside tools to detect pot impairment, police today have to rely largely on field sobriety tests developed to fight drunk driving or old-fashioned observation, which can be foiled with Visine or breath mints.

That has left police, courts, public health advocates and recreational marijuana users themselves frustrated. Nine states and the District of Columbia have legalized recreational marijuana and 30 states and D.C. have legalized medical pot.

Read article, here..

Saturday, May 12, 2018

When Cancer Patients Ask About Weed, Many Doctors Say Go For It

In Case You Missed It

When Cancer Patients Ask About Weed, Many Doctors Say Go For It
Christine Herman
May 10, 20184:05 PM ET

Anecdotal reports suggest marijuana is helpful in managing symptoms of chemotherapy, like pain and nausea. But it's unlikely curious patients are getting clear guidance from their doctors on whether they should try marijuana, which form might work best and how much to take. A new survey of 237 oncologists from around the country finds that while roughly 80 percent talk with their patients about marijuana, fewer than 30 percent feel they have sufficient knowledge to advise them about its medicinal use.

Thursday, April 19, 2018

Scientific guidelines for using cannabis to treat stress, anxiety and depression

Scientific guidelines for using cannabis to treat stress, anxiety and depression

Washington State University

PULLMAN, Wash.--In a first-of-a-kind study, Washington State University scientists examined how peoples' self-reported levels of stress, anxiety and depression were affected by smoking different strains and quantities of cannabis at home.

Their work, published this month in the Journal of Affective Disorders, suggests smoking cannabis can significantly reduce short-term levels of depression, anxiety, and stress but may contribute to worse overall feelings of depression over time.

It marks one of the first attempts by U.S. scientists to assess how cannabis with varying concentrations of the chemical compounds tetrahydrocannabinol (THC) and cannabidiol (CBD) affect medicinal cannabis users' feelings of wellbeing when smoked outside of a laboratory.

"Existing research on the effects of cannabis on depression, anxiety and stress are very rare and have almost exclusively been done with orally administered THC pills in a laboratory," said Carrie Cuttler, clinical assistant professor of psychology at WSU and lead author of the study. "What is unique about our study is that we looked at actual inhaled cannabis by medical marijuana patients who were using it in the comfort of their own homes as opposed to a laboratory."

For example, the WSU research team found that one puff of cannabis high in CBD and low in THC was optimal for reducing symptoms of depression, two puffs of any type of cannabis was sufficient to reduce symptoms of anxiety, while 10 or more puffs of cannabis high in CBD and high in THC produced the largest reductions in stress.

"A lot of consumers seem to be under the false assumption that more THC is always better," Cuttler said. "Our study shows that CBD is also a very important ingredient in cannabis and may augment some of the positive effects of THC."

The researchers also found that while both sexes reported decreases in all three symptoms after using cannabis, women reported a significantly greater reduction in anxiety following cannabis use.

Data for the study were taken from the trademarked app Strainprint, which provides medical cannabis users a means of tracking how different doses and types of cannabis affect a wide variety of symptoms of wellbeing.

Strainprint users rate the symptoms they are experiencing before using cannabis on a scale of 1-10 and then input information about the type of cannabis they are using. Twenty minutes after smoking, they are prompted to report how many puffs they took and to rerate the severity of their symptoms.

Cuttler and WSU colleagues Alexander Spradlin and Ryan McLaughlin used a form of statistical analysis called multilevel modeling to analyze around 12,000 anonymous Strainprint entries for depression, anxiety and stress. The researchers did not receive any of the Strainprint users personally identifying information for their work.

"This is to my knowledge one of the first scientific studies to provide guidance on the strains and quantities of cannabis people should be seeking out for reducing stress, anxiety and depression," Cuttler said. "Currently, medical and recreational cannabis users rely on the advice of bud tenders whose recommendations are based off of anecdotal not scientific evidence."

The study is among several cannabis-related research projects currently underway at WSU, all of which are consistent with federal law and many of which are funded with Washington state cannabis taxes and liquor license fees.

Photo Credit

Thursday, March 1, 2018

Behind the Headlines: High-strength skunk 'now dominates' UK cannabis market

High-strength skunk 'now dominates' UK cannabis market

"Almost all cannabis seized by police now comprises high-strength varieties, with outdoor-grown herbal strains and hashish barely found," The Guardian reports. The news is based on researchers analysing samples of cannabis seized by 5 police forces in 2015 and 2016.

They found almost all the cannabis (93.6%) was sinsemilla, also known as skunk. This is a potent form of herbal cannabis often grown in the UK in indoor "cannabis farms" which has been specifically bred to have high levels of tetrahydrocannabinol (THC).

THC is the psychoactive chemical in cannabis responsible for many of the pleasurable effects people get when using the drug. THC has also been linked to an increased risk of developing mental health problems, such as psychosis (where a person is unable to tell the difference between reality and their imagination).

Analysis of samples of the drugs showed a wide variation in the levels of THC, with an average level of 14.2% in sinsemilla, compared to 6.3% in resin.

Cannabis resin, which dominated the UK market before 2000, only accounted for 5.8% of the cannabis seized by police. Resin THC levels were higher than those recorded in a similar study in 2005.

Cannabis resin usually contains cannabidiol (CBD), a substance thought to protect against some of the dangerous effects of THC. Sinsemilla does not usually contain CBD.

This matters, because doctors think people who use cannabis with high levels of THC, especially without CBD to counteract it, are more likely to become addicted and develop mental health problems.

Where did the story come from?

The study was carried out by researchers from GW Pharmaceuticals, which produces a range of medical cannabinoid medicines, and from King’s College London. GW Pharmaceuticals could be seen to have a conflict of interest in highlighting the dangers of illegal cannabis, as it is currently researching a range of medical treatments based on cannabidiol (CBD).

One of the researchers was funded by the Medical Research Council. The study was published in the peer-reviewed journal Drug Test Analysis.

The study was widely covered in the UK media. Some of the headlines – such as the Mail Online's "Terrifying rise of super-strength 'skunk' cannabis" - ramp up the fear, but by and large the study was accurately reported.

What kind of research was this? 
This was a laboratory analysis of samples of drugs seized by police. The study gives a snapshot of the types of cannabis and range of potency of cannabis being sold illegally. However, we don't know how representative the samples are of the types of cannabis being used in the UK, as police may not target all potential cannabis users equally.

What did the research involve? 
Researchers contacted 5 police forces which had been involved in previous surveys of cannabis, in 2005 and 2008. The forces were asked to send all seized cannabis samples in their property stores for analysis.

The researchers sorted the cannabis by type, then selected a representative sample to analyse for levels of THC, CBD, and a degraded form of cannabinoid, CBN, which is less potent and is a result of THC breaking down.

Cannabis came from Kent and London Metropolitan districts (in 2015) and Derbyshire, Merseyside and Sussex (in 2016). It was sorted into 3 types:
natural herbal cannabis (a less-potent type of cannabis, often imported from Morocco)

Researchers analysed about half of the samples of sinsemilla, and all of the samples of resin and natural herbal cannabis, as there were fewer of them. They analysed 250mg from each sample, which they say is a typical amount of cannabis used in 1 joint.

To see whether the time the sample had been held by the police affected the strength, they measured 34 samples where the length of storage was known, and looked at whether CBN levels were linked to time stored.

What were the basic results? 

The vast majority of the 995 cannabis samples were sinsemilla:
929 (93.6%) of these were sinsemilla, compared to 708 (84.5%) in 2008 and 247 (50.6%) in 2005
58 (5.8%) were resin, compared to 104 (14.2)% in 2008 and 169 (42.7%) in 2005
6 (0.6%) were traditional herbal cannabis, compared to 14 (1.3%) in 2008 and 39 (6.7%) in 2005

The average THC content of sinsemilla samples was 14.2%, similar to the 13.9% found in 2005. However, the range varied from 1.9% to 22.5%, with most being around 10% to 20%.

Average THC content of resin was much lower, at 6.3%, although this varied from no discernible THC to 29% in 1 sample found in a prison. The average strength was much higher than in 2005, when average THC concentration was 3.7%.

Only 1 of the sinsemilla samples contained CBD, the protective agent. While most resin samples did contain CBD, researchers found the average level had dropped from 4.3% in 2005 to 2.3% in 2015/6.

The analysis found no indication that length of time in police storage affected the strength of cannabis.

How did the researchers interpret the results? 
The researchers said: "This trend presents an increased risk of harm to those susceptible to the development of psychotic disorders following cannabis use." They suggest the need for a nationwide survey.


Cannabis has often been dismissed as a relatively harmless street drug, compared to class A drugs such as cocaine and heroin. However, mounting evidence suggests it may have a harmful effect on mental health, particularly for teenagers and adolescents, increasing the chances of problems including panic attacks, anxiety and psychosis.

Although research is still taking place, it seems that stronger sinsemilla cannabis (aka skunk, which contains more THC and little CBD), raises the risk of mental health problems and addiction, compared to cannabis resin, which tends to have less THC and more CBD.

It's concerning that this study suggests sinsemilla is becoming much more common, and that where resin is on sale, it has more THC and less CBD than a decade ago. People who base their ideas about cannabis on the drug they smoked many years ago may not realise the strength and potential harm of the cannabis sold on the street today.

However, the study has some limitations:
It only looked at drugs seized by police. It's possible that police may prioritise arresting and confiscating drugs from people selling sinsemilla, because of its perceived harm. This might mean the proportion of cannabis resin in the study could be artificially low.

It only analysed a proportion of the samples of sinsemilla, and only 250mg from each sample. The overall sample strength might have varied, because the cannabis plant's concentration of THC varies in different parts.

Only 5 police forces were involved, so we don't know if the results would apply equally around the country.

Cannabis doesn't just affect mental health, smoking any form of cannabis can be bad for your health in other ways.

It can also:
damage your lungs
increase your risk of road accidents
damage your fertility and, if smoked when pregnant, damage the unborn baby

Find out more about the effects of cannabis.

Analysis by Bazian
Edited by NHS Choices

Links to the headlines 
Drug Testing and Analysis

Friday, February 9, 2018

People on liver transplant waitlist may be no worse off if they have used marijuana

People on liver transplant waitlist may be no worse off if they have used marijuana
Last Updated: 2018-02-08
By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Candidates on the liver transplant (LT) waitlist who have used marijuana have no worse outcomes than their counterparts on the list who have not used it, a single-center study suggests.

"Unlike illicit drug use, marijuana use was not associated with worse outcomes on the LT waitlist. . . We found a high prevalence of historical marijuana use that did not have clear adverse effects on LT waitlist outcomes," lead author Prashant Kotwani of the University of California San Francisco School of Medicine and colleagues write in Transplantation, online January 10.

Continue reading:

Tuesday, September 19, 2017

Blog Updates on Hepatitis - Inactivated Zoster Vaccine, Harvoni Cures Hep C patient & Opioids

Thanks for stopping by, here's your blog updates from around the web.

Harvoni Cures Hep C patient Brenda in Clinical Trial part 1
September 19, 2017
This week on Life Beyond Hep C we’re hearing Hep C patient Brenda’s courageous Hep C treatment fight and experience.
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All Swiss hepatitis C sufferers can access costly drugs like Harvoni
All patients suffering from hepatitis C can be treated with the drugs Harvoni and Epclusa from next month, after the Federal Office of Public Health lifted ...

Opioid overdoses shorten US life expectancy by 2½ months
Opioid drugs -- including both legally prescribed painkillers such as oxycodone and hydrocodone, as well as illegal drugs such as heroin or illicit fentanyl -- are not only killing Americans, they are shortening their overall life spans. Opioids take about 2½ months off our lives, according to a new analysis published in the medical journal JAMA.

States expand investigation of opioid makers, distributors
Geoff Mulvihill, Associated Press - Houston Chronicle
Attorneys general from most states are broadening their investigation into the opioid industry as a nationwide overdose crisis continues to claim thousands of lives. They announced Tuesday that they had served subpoenas requesting information from five companies that make powerful prescription painkillers and demanded information from three distributors. Forty-one attorneys general are involved in various parts of the civil investigation.
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Addiction clinics need physician education, lifted restrictions to treat HCV
HCV Next - HEALIO - Meeting News
Opioid agonist therapy clinics represent an important conduit for people who inject drugs to receive information, screening and treatment for hepatitis C. Within these clinics, however, physicians and addiction specialists self-reported low competence regarding current HCV treatments. Additionally, policies that restrict treatment for current and recent drug users present an ongoing barrier.
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My 2 cents: College friend doing good work
Tom Blackwell - National Post 
Faced with a widow's legal challenge, Ontario will transplant livers into almost 100 alcoholic-liver-disease patients, as evidence suggests they do as well as others.

What parents should know about tattoos
Posted September 19, 2017,
Claire McCarthy, MD, Faculty Editor, Harvard Health Publications
These days, tattoos are increasingly common. According to a 2015 Harris poll, three in 10 American adults have a tattoo — up from two in 10 in 2012. They are particularly popular in young people; among Millennials, nearly half have a tattoo. To help parents make this tough decision, the American Academy of Pediatrics (AAP) released a clinical report entitled “Adolescent and Young Adult Tattooing, Piercing, and Scarification.” Here are some highlights — and some points parents and teens really need to talk about.
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Fighting Hepatitis in Cambodia: Beginnings and Endings
Theresa Chan - Theresa is an MSF doctor, currently working at a hepatitis C clinic in Cambodia.
Beginnings and endings have been leaking into my to-do list as well. Right now I’m working on writing the MSF guidelines for treating hepatitis C, which will be the basis for the Cambodian national guidelines one day when our clinic is turned over to the Ministry of Health, so even as we are recovering from the busy beginning of this clinic, we are contemplating its end.
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Inactivated Zoster Vaccine Soon to Be Approved — Should Patients Wait for It?
Paul E. Sax, MD - Contributing Editor NEJM Journal Watch 
For the last year or so, conversations with patients about getting the zoster vaccine have gone something like this:
Patient: So should I get the shingles vaccine? I saw an ad for it on TV.
Me:  Well, yes … and no.
Patient (confused — he/she has never heard me say anything but an enthusiastic “Yes!” to vaccines):  What does that mean?
Me:  There’s a better shingles vaccine coming soon, likely within a year. So I’d wait.
Now it looks like that wait is almost over.
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Can Restricting Fructose Intake Reduce Fatty Liver Disease in Children?
Kristine Novak - Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology.
Reducing dietary fructose for as little as 9 days decreases liver fat, visceral fat, and de novo lipogenesis and increases insulin sensitivity, secretion, and clearance in children with obesity and metabolic syndrome, researchers report in the September issue of Gastroenterology. These findings support efforts to reduce sugar consumption.
Read more 

Only One-Quarter of Hepatitis C Patients Got Treatment Before Widespread DAA Use
SEPTEMBER 19, 2017
Gail Connor Roche - MD Magazine
Only one-quarter of patients worldwide with the chronic hepatitis C virus (HCV) received antiviral treatment before the widespread use of direct-acting antiviral (DAA) drugs, a review that considered almost 500,000 people has found.
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Adolescents With HCV Achieve 98% Cure Rate in Direct-Acting Antiviral Study
Gail Connor Roche - MD Magazine
Adolescents treated for hepatitis C achieved a 98% cure rate with a direct-acting antiviral drug (DAA) therapy, a study has found.
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HCV Drug Resistance: Infrequent, and Frequently Overcome
Kenneth Bender - MD Magazine
Hepatitis C virus (HCV) mutations that can resist drug treatment are infrequent, and are unlikely to withstand longer treatment durations or the addition of a synergistic drug, according to new analysis of resistance testing, treatment response and re-treatment interventions. Resistance testing does appear to Wyles and Luetkemeyer to be indicated, however, in patients with genotype 1a before treatment with elbasvir/grazoprevir (Zepatier, Merck), and should be considered prior to treatment with ledipasvir/sofosbuvir (Harvoni) for those with genotype 1a and cirrhosis or with prior NS5A treatment failure...
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Hepatitis A: frequently asked questions
Paul Sisson Contact Reporter The San Diego Union-Tribune
In an effort to combat a deadly hepatitis A outbreak, San Diego will begin washing streets in ...
Q: If I've had hepatitis B or hepatitis C am I immune to hepatitis A?
Continuer reading.....

Cannabis in Gastroenterology: Physicians Lack Answers as Patient Interest Peaks
Healio Gastroenterology, September 2017
Despite a lack of high quality evidence due to federal regulations on research, many state medical marijuana programs have designated GI conditions like severe nausea, inflammatory bowel disease (IBD) and hepatitis C as qualifying conditions, and studies show that many patients are self-medicating with marijuana. Experts agreed physicians should equip themselves to explain the known risks and benefits to inquiring patients, and understand the legal frameworks of their state medical marijuana programs.
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On Twitter
Tweeted By Don Crocock, Follow here--->  @dcrocock   
Rationale for cannabis-based interventions in the opioid overdose crisis
Harm Reduction Journal
The growing body of research supporting the medical use of cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care providers, and academic researchers to consider the implementation and assessment of cannabis-based interventions in the opioid crisis.
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Monday, March 27, 2017

Would legalizing medical marijuana help curb the opioid epidemic?

Drug and Alcohol Dependence
April 1, 2017 Volume 173, Pages 144–150

Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever
Yuyan Shi

Sunday, March 12, 2017

Medical Marijuana And Liver Disease: What Science Says Is Possible

Medical Marijuana And Liver Disease: What Science Says Is Possible Your endocannabinoid system is key.
By: Brea Mosley Mar 12, 2017

Liver disease occurs when the liver experiences a high amount of tissue scarring. This is typically a direct result of constant inflammation and the death of vital cells. This disease inflicts more than 400,000 people each year and is ranked among the top 10 leading causes of death in the U.S.

However, for a disease with such an ugly outcome, a pretty solution may be in the near future.
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Tuesday, October 20, 2015

Researchers find possible link between marijuana, HCV

Researchers find possible link between marijuana, HCV

HONOLULU — Any use of marijuana was found to be associated with a positive hepatitis C antibody serum test, according to a poster presentation at ACG 2015.

Akeem O. Adebogun, MD, MPH, of Howard University Hospital, Washington, DC, and colleagues extracted and analyzed data from the National Health and Nutrition Examination Survey of 7,821 patients with HCV between 2011 and 2012. The goal was to determine any link or impact marijuana and further drug use had on a hepatitis C antibody test.

Continue Reading @ Healio

See more from Highlights from ACG 2015

Wednesday, September 30, 2015

Long-Term Safety Of Medical Cannabis In The Treatment Of Chronic Pain

Canadian multicentre study examines safety of medical cannabis in the treatment of chronic pain 

Montreal — A Canadian research team led by Dr. Mark Ware from the Research Institute of the McGill University Health Centre (RI-MUHC) in Montréal has completed a national multicentre study looking at the safety of medical cannabis use among patients suffering from chronic pain. They found that patients with chronic pain who used cannabis daily for one year, when carefully monitored, did not have an increase in serious adverse events compared to pain patients who did not use cannabis. The results, which have been published online in The Journal of Pain, will serve as a benchmark study on the side effects of cannabis when used in pain management.

“This is the first and largest study of the long term safety of medical cannabis use by patients suffering from chronic pain ever conducted,” says lead author, Dr. Ware, pain specialist at the Montreal General Hospital of the MUHC and associate professor in Family Medicine and Anesthesia at McGill University. “We found that medical cannabis, when used by patients who are experienced users, and as part of a monitored treatment program for chronic pain over one year, appears to have a reasonable safety profile.”

As part of the Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS), that started in 2004, the researchers followed 215 adult patients, with chronic non-cancer pain, who used medical cannabis, and compared them to a control group of 216 chronic pain sufferers who were not cannabis users. The study involved seven clinical centres with pain management expertise across Canada located in Fredericton, Halifax, London, Montreal, Toronto and Vancouver.

The cannabis users were given access to herbal cannabis containing 12.5 per cent THC from a licensed cannabis producer. Cannabis was dispensed through the hospital pharmacy at each site, and patients collected their supply every month after completing the necessary visits and tests. Along with information on adverse effects, subjects underwent lung function and cognitive testing, and were asked about their pain, mood and quality of life over the one year of follow up. A number of the subjects underwent complete panels of blood tests for routine biochemistry, liver and kidney function, and selected hormone levels. The average amount of cannabis used overall was 2.5 grams per day whether smoked, vaporized or taken as edibles.

“Our data show that daily cannabis users had no greater risk than non-users (control group) to experience serious adverse events,’’ explains Dr. Aline Boulanger, director of the pain clinic at the Centre hospitalier de l’Université de Montréal. ‘’We found no evidence of harmful effects on cognitive function, or blood tests among cannabis consumers and we observed a significant improvement in their levels of pain, symptom distress, mood and quality of life compared to controls.

However, the researchers did report an increased risk of non-serious adverse events in medical cannabis consumers such as headache, nausea, dizziness, somnolence, and respiratory problems associated with smoking.

“It is important to note the limitations of the study,” adds Dr. Ware. “Patients were self-selected, not randomized, and most were experienced users. So what we are seeing is that it appears to be a relatively safe drug when used by people who have already determined that it helps them. We cannot draw conclusions about safety issues of new cannabis users”.

About the study
The study was funded by the Canadian Institutes of Health Research (CIHR). The article Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS) is available online.

The sites involved in this study were the Alan Edwards Pain Management Unit at the Montreal General Hospital of the McGill University Health Centre and the Pain clinic at the Centre hospitalier de l’Université de Montréal – Hôtel-Dieu, (Montréal, QC); the QEII Health Sciences Centre (Halifax, NS), the Wasser Pain Management Centre of the Mount Sinai Hospital (Toronto, ON); the London Health Research Institute of St. Joseph’s Health Care (London, ON); the Stan Cassidy Center for Rehabilitation (Fredericton, NB); and the Arthritis Research Center of Canada (Vancouver, BC).

About The Research Institute of the McGill University Health Centre

The Research Institute of the McGill University Health Centre (RI-MUHC) is a world-renowned biomedical and healthcare research centre. The Institute, which is affiliated with the Faculty of Medicine of McGill University, is the research arm of the McGill University Health Centre (MUHC) - an academic health centre located in Montreal, Canada, that has a mandate to focus on complex care within its community. The RI-MUHC supports over 500 researchers, and over 1,200 students, devoted to a broad spectrum of fundamental, clinical and health outcomes research at the Glen and the Montreal General Hospital sites of the MUHC. Our research facilities offer a dynamic multidisciplinary environment that fosters collaboration and leverages discovery aimed at improving the health of individual patients across their lifespan. Over 1,600 clinical research projects and trials are conducted within the organization annually. The RI-MUHC is supported in part by the Fonds de recherche du Québec - Santé (FRQS).

Media contact:

Julie Robert
Public Affairs & Strategic planning
McGill University Health Centre
(514) 934-1934 ext. 71381

Thursday, June 26, 2014

Behind The Headlines: Cannabis use 'genetically linked' to schizophrenia

What is Behind the Headlines?
We give you the facts without the fiction. Professor Sir Muir Gray, founder of Behind the Headlines, explains more... 

Cannabis use 'genetically linked' to schizophrenia

Study finds people predisposed to [schizophrenia] and drug users share common genes,” the Mail Online reports. A new study suggests that ‘schizophrenia’ genes are associated with cannabis use.

It has long been known that there is an association between cannabis use and schizophrenia – but the “direction of travel” has been hotly debated.

Does cannabis use trigger the onset of schizophrenia in vulnerable individuals? Or are people with a genetic predisposition to develop schizophrenia more likely to use cannabis than the population at large (possibly as a coping mechanism)?

This latest study suggests that the latter may be the case; at least in some people. The study involved 2,082 healthy adults whose genetic make-up was examined for risk factors for schizophrenia.

People with more genetic risk factors (carrying more of the DNA variants that have been associated with schizophrenia) were more likely to have reported ever using cannabis.

However, it is important to note that none of the people in the study actually had a diagnosis of schizophrenia. In addition, as this is a cross-sectional study (see below), it cannot definitively answer the question of cause and effect.

A person’s risk for schizophrenia, or for cannabis use, are likely to be influenced by a complex mixture of genetic factors (including those not identified or examined here), lifestyle and environmental factors.

Where did the story come from?

The study was carried out by researchers from the Institute of Psychiatry, King’s College London; Queensland Brain Institute and QIMR Berghofer Medical Research Institute, Australia; the Department of Developmental Psychology and EMGO Institute for Health and Care Research, Amsterdam; the Washington University School of Medicine.

It was funded by the UK Medical Research Council and National Institute for Health Research; the Australian National Health, Medical Research Council and Australian Research Council; the Centre for Research Excellence on Suicide Prevention (CRESP – Australia); and the Netherlands Organization for Health Research and Development.

The study was published in the peer-reviewed medical journal Molecular Psychiatry.

The Mail Online reported the story accurately and informatively.

What kind of research was this?

This was a cross-sectional study using data collected in a larger cohort study. It aimed to assess the association between cannabis use and the level of genetic predisposition for schizophrenia.

As it is a cross-sectional study it is only able to describe this association and cannot prove cause and effect. That is whether the genetic predisposition caused them to use cannabis or that conversely, cannabis would cause them to develop schizophrenia.

What did the research involve?

A group of 2,082 unrelated healthy adults were recruited from the large Australian Twin Registry studies.

The participants were asked questions over the telephone on their cannabis (marijuana) use, including:
Did you ever use marijuana?
How old were you the very first time you tried marijuana (not counting the times you took it as prescribed)?
How many times in your life have you used marijuana (do not count times when you used a drug prescribed for you and took the prescribed dose)?

The genotype (each person’s genetic make-up) was obtained. These were compared with samples from a large Swedish study which has identified a number of single nucleotide polymorphisms (SNPs), DNA sequence variations, that are believed to increase the risk of developing schizophrenia.

The presence of more than one of these SNPs gives a “polygenic” (multiple gene variants) risk factor, and some SNPs are associated with a particularly higher risk (having the most significant associations with schizophrenia).

These risk scores were analysed in comparison with the answers to the cannabis questions to look for any associations.

In the second part of the study, the researchers looked at the polygenic risk scores of 990 twins (just over a third were identical twins).

They took the mean polygenic risk score from each pair of twins and used this to predict whether neither, one or both twins used cannabis.

What were the basic results?

Out of the 2,082 adults included in the study, 1,011 (48.6%) had ever used cannabis. The mean age of starting cannabis was 20.1 (95% Confidence Interval [CI] 19.7 to 20.5) and the mean number of times they’d used cannabis over their lifetime was 62.7 (95% CI 19.7 to 20.5).

The researchers found a significant association between a person’s extent of genetic predisposition for schizophrenia and their reported use of cannabis. People who had used cannabis had higher genetic risk scores for schizophrenia than those who had never used cannabis. The strongest associations were found between the higher risk SNPs and ever use of cannabis.

However, the results showed that the genetic risk factors they assessed only predicted a small amount of a person's risk of using cannabis. This meant that other factors have more of an influence on whether a person uses cannabis.

In the secondary analysis, twin pairs where both reported using cannabis had the greatest polygenic risk factors for schizophrenia.

Pairs where only one of them used cannabis had an intermediate level of risk factors, and the lowest burden was in those where neither used cannabis.

How did the researchers interpret the results?

The researchers say this study shows “that to some extent the association between cannabis and schizophrenia is due to a shared genetic aetiology [cause] across common variants. They suggest that individuals with an increased genetic predisposition to schizophrenia are both more likely to use cannabis and to use it in greater quantities.”


This study shows an association between genetic risk factors for schizophrenia and cannabis use. However, as it is a cross-sectional study, it cannot answer the often debated cause and effect question of whether cannabis use increases risk of schizophrenia, or whether there is a common genetic predisposition to both.

The study cannot prove that cannabis use is a risk factor for developing schizophrenia.

It also cannot prove that the genetic risk factors (SNPs – variations in the DNA sequence that have been associated with schizophrenia) also directly increase the risk of using cannabis. As the researchers’ results suggested, the genetic risk factors they assessed only predicted a small amount of a person's risk of using cannabis. There may be many other factors involved. A complex mixture of genetics (including DNA variations not examined here), lifestyle and environmental factors is likely to contribute to a person’s risk of developing schizophrenia, and to their risk of using cannabis.

It should also be noted that none of the participants in the study actually had a diagnosis of schizophrenia. Though the SNPs thought to increase the genetic risk of developing schizophrenia were identified in a large Swedish cohort study, the authors do point out that they may not be accurate.

They say that in this Swedish sample from which these SNPs were identified, use of cannabis may have been more common among the people who had schizophrenia than in the controls without schizophrenia.

They say this could mean that the SNPs actually increase risk of cannabis use rather than risk of schizophrenia.

A further limitation of the study is that cannabis use was self-reported which may give rise to inaccuracies in the estimated level of use. Also people may not have been willing to disclose any use of an illegal substance during a telephone interview.

Cannabis may not be as dangerous as other drugs (including legal drugs such as tobacco and alcohol) but it is certainly not safe. There are many negative effects of cannabis, including a risk of developing dependency, its tendency to reduce motivation and concentration, and the likelihood that it reduces male fertility.

Furthermore, the risks of the tobacco and nicotine which are usually consumed at the same time need to be taken seriously. Read more information about the health risks associated with cannabis.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links to the headlines
Are cannabis smokers genetically more likely to develop schizophrenia? Study finds people predisposed to the condition and drug users share common genes. Mail Online, June 24 2014

Links to the science
Power RA, Verweij KJH, Zuhair M, et al. Genetic predisposition to schizophrenia associated with increased use of cannabis. Molecule Psychiatry. Published online June 24 2014

Tuesday, January 14, 2014

Behind The Headlines -Could cannabis compound soothe arthritis pain?

Could cannabis compound soothe arthritis pain?

“Synthetic cannabis-like molecule developed in lab could help osteoarthritis sufferers,” reports The Daily Telegraph.

Anecdotal reports of cannabis’s ability to soothe chronic pain conditions such as osteoarthritis have been available for many years.

Aside from the obvious legal issues (cannabis is a Class B illegal drug), cannabis also carries the risk of side effects and complications such as psychosis and depression

So a compound containing the drug’s painkilling ability without its psychoactive effects could lead to useful new treatments. 

One candidate is “JWH133” a chemical that binds to and activates the cannabinoid 2 (CB2) receptor. Receptors are proteins found on the surfaces of cells. When activated receptors cause a response inside cells. The CB2 receptor is also activated by tetrahydrocannabinol (THC), the principle psychoactive constituent in cannabis. Activating the CB2 receptor is thought to relieve pain and inflammation. 

The new research found evidence that JWH133 relieves pain in a rat model of arthritis. Importantly, the JWH133 compound is selective for CB2 receptors and does not activate cannabinoid 1 (CB1) receptors. CB1 receptors are found in the brain and are believed to be responsible for the psychological effects of cannabis.

So this suggests JWH133 may be a useful candidate for an osteoarthritis treatment. However, this is very early stage research only involving rats.

As Professor Alan Silman, medical director of Arthritis UK, says in the press coverage, this research does not support recreational cannabis use.

Where did the story come from?
The study was carried out by researchers from the University of Nottingham in the UK in collaboration with researchers from the University of Pittsburgh and Virginia Commonwealth University in the US. It was funded by Arthritis Research UK and the National Institutes of Health. 

The study was published in the peer-reviewed journal PLOS One. PLOS One is an open-access journal, meaning that all the research it publishes can be accessed for free.

This study was reported on by the Daily Express and The Telegraph. The Telegraph made no mention of the fact that the current research was in rats. This was also unclear from the over-optimistic headline in the Express. However, the report in the Express was of a higher standard, as it explained that the research was in animals and that it would take a considerable amount of time before any pill could be available for patients.

What kind of research was this?
This was a laboratory experiment on animals.

The researchers wanted to test the hypothesis that activation of cannabinoid 2 (CB2) receptors would reduce osteoarthritis pain responses in an animal model of osteoarthritis.

What did the research involve?
To create the animal model of osteoarthritis, rats had an injection of a chemical (monosodium acetate) into one of their knees (on the left rear limb). This triggered the same kind of inflammation and functional damage to the limb that occurs in humans with osteoarthritis.

The rats were then either given a drug called JWH133 or a placebo (“dummy”) injection. JWH133 binds with and activates the CB2 receptor of cells, causing them to respond. Eight rats were injected with JWH133 and eight were injected with placebo.

Pain behaviour was determined by measuring the change in weight distribution between the limbs and by testing the rats' sensitivity to pinch and touch.

Further experiments were performed on the animal model of osteoarthritis and normal rats that had been given an injection of saline (salty water) into their knee to see how JWH133 could reduce pain.

What were the basic results?
Once the rats had the injection of monosodium acetate into the knee of their left rear limb to model osteoarthritis, they placed less weight on that limb and their paw was more sensitive to pinch and touch.

Repeated injections with JWH133 significantly reduced the development of pain behaviour in the osteoarthritis model rats compared to the placebo injection.

The researchers went on to perform a series of further experiments. They found that:

treatment with JWH133 reduced the changes in inflammation-controlling chemicals which are released by osteoarthritis model rats

treatment with JWH133 reduced the firing of nerve cells in the spine in response to pain in osteoarthritis model rats, but not normal rats

osteoarthritis model rats have higher levels of the CB2 receptor “message” (mRNA) and protein in nerve cells in the spine 

The researchers then looked at the levels of CB2 receptor “message” in human spines of people who had died who had had knee osteoarthritis. They found that the more severe the disease, the lower the level of CB2 receptor “message”. The researchers say that this might reflect “events associated with later stages of joint pathology [disease]”.

How did the researchers interpret the results?
The researchers conclude that “activation of CB2 receptors attenuated [reduced] the development and maintenance of osteoarthritis-induced pain behaviour”. They go on to state that their “clinical and pre-clinical data support the further investigation of the potential of CB2 receptor agonists [chemicals that bind to the receptor and activate it] for the treatment of pain associated with osteoarthritis, in particular at earlier stages of the disease”.

This study found that a chemical called JWH133, which binds to and activates the cannabinoid 2 (CB2) receptor, could reduce osteoarthritis-induced pain behaviour in rats injected with a chemical to mimic the effects of osteoarthritis.

This early stage research supports the further investigation of the potential of chemicals which bind to activate the CB2 receptor as treatments for osteoarthritis-induced pain. However, so far the treatment has only been tested in a small number of rats injected with a chemical to mimic symptoms of osteoarthritis. This study does not show what positive or negative effect chemicals that activate the CB2 receptor may have in humans suffering from osteoarthritis.

Until further trials involving humans, such as a phase I trial are carried out, it is impossible to predict whether JWH133 will be effective, and probably more importantly, safe in humans.

If you are having problems coping with your arthritis symptoms, the NHS offers specialist services for people with chronic pain conditions. 

Read more about NHS Services for people with chronic pain.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Links to the headlines
Synthetic cannabis created for osteoarthritis. The Daily Telegraph, January 7 2014
‘Synthetic cannabis’ pill could end arthritis pain for millions. Daily Express, January 7 2014
Links to the science
Burston JJ, Sagar DR, Shao P, Bai M, King E, et al. Cannabinoid CB2 Receptors Regulate Central Sensitization and Pain Responses Associated with Osteoarthritis of the Knee Joint. PLoS ONE. Published online November 25 2013

What is Behind the Headlines?
We give you the facts without the fiction. Professor Sir Muir Gray, founder of Behind the Headlines, explains more...

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