Ep. 118: Catching Up On Cannabis & Wellness
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Cannabis has been legal in Canada for almost four years now. Eat Move Think’s very first episode at the start of 2020 explored the wellness implications of legalization. At that point, few gold-standard research studies had been conducted on cannabis, CBD and THC. So in this episode we revisit the topic. Medcan senior medical consultant Dr. Lorne Greenspan checks in with Dr. Mark Ware, the chief medical officer of Canopy Growth, one of the world’s largest cannabis companies. Can the plant and its derivatives change how we treat anxiety, chronic pain, arthritis and other issues? Who is using it, and why? Find out in this episode, which contains a wide-ranging conversation about new developments at the intersection of cannabis and wellness.
LINKS
Cannabis and Wellness: Eat Move Think episode
Three years after legalization, we have shockingly little information about how it changed cannabis use and health harms: The Conversation
Cannabis and chronic pain: Medical cannabis use was associated with clinical improvements in pain, function, and quality of life with reductions in prescription drug use; 73% either ceased or decreased opioid consumption and 31% discontinued benzodiazepines, from a study in Cannabis and Cannabinoid Research 2021
Results of a 2021 study in PlosONE revealed improvements among PTSD patients receiving cannabis doses with higher levels of THC.
Higher THC dose was associated with a higher incidence of thinking or perception disorder and dizziness or light-headedness, but no other neuropsychiatric AEs in RCTs using THC, but not THC and CBD combination, for a range of nonpsychiatric indications in older adult, concludes a Systematic Review and Metaregression Analysis in JAMA 2021
How does cannabis use affect brain health? Caution advised, more research needed, experts say in an American Heart Association statement, 2022
INSIGHTS
First, an explanation of the physiology of cannabis. Within the plant’s flowers are trichomes, or “ little balls of oily substance which synthesize the cannabinoids from the cannabis plant,” says Dr. Ware. The two main compounds that come from these trichomes are tetrahydrocannabinol (THC) and cannabidiol (CBD). They are similar in molecular structure, but their outputs and effects are very different. “THC has been approved as a molecule for the treatment of certain conditions as a pharmaceutical product,”explains Dr. Ware. It’s been shown to stimulate appetite and reduce nausea in people living with cancer or HIV, and it can have antispasmodic properties in people with spasticity disorders. There is growing evidence that it helps with focus and slows the progression of dementia. CBD has also been shown to have anti-epileptic properties, and to help with feelings of anxiety or relief of muscle soreness. [6:07]
When cannabis was legalized in 2018, there was a fear in society that young people would start to use it more. “The data that I’ve seen, in fact, suggests that late teen and early adult use of cannabis appears to be stable, if not actually declining,” says Dr. Ware. This is good news, because THC could be damaging to teens or young adults. “We're worried that THC can affect thinking negatively if it's used too much, too soon.” says Dr. Ware. So who is using cannabis more? Usage has increased within the 25-40 age group and in the 55+ age group. [18:28]
Dr. Greenspan has noticed that most of the people asking him about using cannabis are seniors. Why do they want it? “Sleep, I would say is number one, and chronic pain,” says Dr. Greenspan. His patients note that when they consume cannabis, they take less pain medication, drink less alcohol and have heightened enjoyment while spending time with their partner. “In the past, nobody would admit to marijuana. It’s kind of this eye-opener.” Older people are also using THC to help with focus or even to slow down the process of dementia,” says Dr. Ware. “There are some animal studies suggesting that low doses of THC can do this.” [19:31]
Cannabis and its compounds are bidirectional. Some people use THC and CBD to help manage their anxiety, and there are people who use cannabis and THC in particular, and it can provoke anxiety. “The same product is causing an effect but also potentially relieving that effect,” says Dr. Ware. The same happens with nausea. Cannabis can relieve nausea, and it can also induce hyperemesis (severe nausea). “Using cannabis can help us, or make it worse depending on the person, depending on the dose, depending on a large number of factors,” says Dr. Ware. [24:46]
Right now, cannabis isn’t considered a first-line treatment for any of the conditions it’s shown to help. Why? There hasn’t been the amount of large-scale trials for cannabis as there has been for other drugs. However, cannabis could be safer than the other options. “Patients who use cannabinoids for treating chronic pain report very few side effects,” says Dr. Ware. “On a safety scale, they may be a better tolerated class of compounds than some of the first line therapies… with better evidence, and with increasing knowledge about safety, perhaps that order can change.” [12:56]
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