Novel Delivery Methods for Medical Cannabis Users

There is no doubt that vaping is better than smoking cannabis but even vaping can lead to respiratory problems. Moreover many medical cannabis users do not want the negative stigma commonly associated with “smoking weed.” Finally, in certain states, including New York, where medical cannabis is legal, dispensaries are not allowed to sell leaf or plant-like material to patients.  This is causing medical cannabis companies to figure out creative ways in which to deliver cannabinoid-based products and remain compliant with individual state mandates and cannabis regulations.

Interestingly, many of these so-called innovative delivery methods for cannabis are routine delivery technologies that have already been tested, refined and approved by the US Food and Drug Administration (FDA). or example,  Colorado-based Next Frontier Biosciences, founded by former biotechnology executives and research scientists,  recently created a micro dosing-based, nasal mist delivery system intended for the pain management market segment. Likewise, similar companies with biotechnology and healthcare backgrounds are also developing time-release transdermal patches, sublingual sprays and suppository-based systems.  These developments suggest that the medical cannabis industry is beginning to mature and is likely to become mainstream in the not-too-distant future.

A Little Dab Will Do You: Or Maybe Not?

Inhalable, noncombustible cannabis products are playing a leading role in the use of the medical and recreational cannabis products. Specifically, the practice of “dabbing” has exponentially grown in popularity in states where medical and recreational cannabis consumption has been legalized.

Dabbing involves inhaling vapors produced by placing a small amount of cannabis extract (a “dab”) on a small heated surface (the “nail”), which is connected to a water pipe ( 1 ). The most popular dabs are known as butane hash oil (BHO) dabs mainly because the concentrate is produced by passing the solvent butane over cannabis buds and leaves ( 2 ). Butane is subsequently removed from the extract under vacuum at room temperature or by heating in an oven. Differences in processing can lead to different dab consistencies that are colloquially known as shatter, budder, crumble, pull-and-snap, wax, etc (3, 4).

BHO have a tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations ranging between 50 and 90% (2). Consumers consider dabbing to be a form of vaporization, and, therefore, view it as easier on the lungs than smoking ( 5).

While delivery of harmfully-large amounts of cannabinoids (Pierre) may represent a potential danger to consumers, little is known about the toxicants that the process may produce. According to a recent paper entitled “Toxicant formation in dabbing: the terpene story (4) by a group of Portland State University researchers the high heat commonly used to heat dabs (concentrated cannabis extracts) exposes users to high levels of methacrolein (lung, throat and eye irritant), benzene (carcinogen) and other potential toxic degradation products which are known to pose human health risks (4).

The authors determined that the source of the potentially harmful degradation products may be the terpenes (compounds that give cannabis its odor and flavor) that are routinely concentrated in BHO dabs (4).  Myrcene is the most abundant terpene in cannabis, followed by limonene, linalool, pinene, caryophyllene, and humulene (4). Also, cannabis can contain trace amounts of up to 68 other terpenic compounds (6). Terpene content in BHO can range from 0.1 to 34% (4).

Another potential health risk is residual butane (a known carcinogen) that can be left behind if BHO dabs are not processed correctly (1, 2). Because of this, CO2 oil (another extraction method for dabbing) and alcohol extracts are the only allowable medical extracts to be sold under medical cannabis regulations in New York, Minnesota, Ohio and Pennsylvania (4). While commercially prepared BHO is on the rise in mature markets like California and Denver, much HBO is still made via “backyard-chemist” style operations so users beware.

Finally, while the results of this study are intriguing, I believe that much more research will be required to determine whether or not high heat terpene breakdown products pose actual health risks to dabbers.

References

  1. Stogner JM, Miller BL. The dabbing dilemma: A call for research on butane hash oil and other alternate forms of Cannabis. Subst. Abuse 2015; 36:393– 395
  2. Stogner JM, Miller BL. Assessing the dangers of “dabbing”: mere marijuana or harmful new trend? Pediatrics 2015: 136: 1– 3
  3. Pierre JM, Gandal M, Son M. Cannabis-induced psychosis associated with high potency “wax dabs” Schizophr. Res. 2016; 172:211– 212
  4. Meehan-Atrash J, Luo W, Strongin RM. Toxicant formation in dabbing: the terpene story ACS Omega, 2017; 2:6112–6117
  5. Gieringer D, St. Laurent J, Goodrich S. Cannabis vaporizer combines efficient delivery of THC with effective suppression of pyrolytic compounds J. Cannabis Ther. 2004; 4:7 – 27
  6. Ross SA, ElSohly MA. The volatile oil composition of fresh and air-dried buds of Cannabis sativa J. Nat. Prod. 1996: 59:49– 51

Treating Patients: Integrating Cannabis into Clinical Cancer Care

There is a growing body of evidence that cannabis and certain cannabinoids may offer potential therapeutic benefits to cancer patients (1). Mainly, cannabis may be beneficial in the management of a wide range of cancer-related symptoms including neuropathic pain (2-4) chemotherapy induced nausea and vomiting (CINV; 5-9), anorexia (10), insomnia (11) and depression (12,13).

Unfortunately, most oncologists trained during the era of cannabis prohibition (1930s to present) have no knowledge of how to use cannabis and its products in routine medicine practice or clinical care.  More problematic is the lack of research and clinical data on which oncologist can base treatment decisions or make care recommendations. That said, what must be done before oncologists and cancer care professionals can feel comfortable using cannabis in cancer care and treatment?

First, rigorous basic research must be performed to clearly demonstrate that cannabis and cannabinoids indeed possess anticancer/antitumor properties. This will require a clear understanding of the mechanism of action of these compounds and the identification of the receptors/transcriptional factors etc that mediate their anticancer effects.

Second, once preclinical data are confirmed, rigorous double-blind, placebo controlled human clinical trials (with sufficient numbers of participants) must be performed to confirm or refute the effects of cannabis/cannabinoids on recognized and clearly defined  oncology indications  e.g., solid tumors, blood malignancies, etc.

Third, if cannabis and cannabinoids are to used for adjunctive cancer care and disease management purposes, than other large scale, well-designed clinical trials must be performed to demonstrate the safety and efficacy of these treatments.  Anecdotal evidence and results from small clinical studies are not sufficient for regulatory approval nor widespread acceptance of the use of cannabis and cannabinoids for cancer/chemotherapy symptom management.

Finally, for all of this to happen, cannabis and its products must be rescheduled from a Schedule 1 drug (illegal with no recognized therapeutic value) to either a Schedule 2 or Schedule 3 classification.  This would effectively decriminalize cannabis at the national level and allow federal funds and resources to be leveraged for basic research and clinical testing of cannabis and its products.

If all of these things should come to pass, then oncologists may be able to add cannabis and cannabinoids to treat and care for patients living with cancer.

References

  1. Abrams, DJ. Integrating cannabis into clinical cancer care. Curr Oncol. 2016; 23:S8-S14
  2. Deshpande A, Mailis-Gagnon A, Zoheiry N, Lakha SF. Efficacy and adverse effects of medical marijuana for chronic noncancer pain: systematic review or randomized controlled trials. Can Fam Physician 2015; 61:e372–81
  3. Andreae MH, Carter GM, Shaparin N, et al. Inhaled cannabis for chronic neuropathic pain: a meta-analysis of individual patient data. J Pain 2015; 16:1221–32.
  4. Wallace MS, Marcotte TD, Umlauf A, Gouaux B, Atkinson JH. Efficacy of inhaled cannabis on painful diabetic neuropathy. J Pain 2015; 16:616–27.
  5. Chang AE, Shiling DJ, Stillman RC, et al. Delta-9-tetrahydrocannabinol as an antiemetic in cancer patients receiving high-dose methotrexate. A prospective, randomized evaluation. Ann Intern Med 1979; 91:819–24
  6. Duran M, Perez E, Abanades S, et al. Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. Br J Clin Pharmacol 2010; 70:656–63
  7. Tramer MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2001; 323:16–21.
  8. Machado Rocha FC, Stefano SC, De Cassia Haiek R, Rosa Oliveira LM, Da Silveira DX. Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: systematic review and meta-analysis. Eur J Cancer Care (Engl) 2008; 17:431–43.
  9. Smith LA, Azariah F, Lavender VT, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev 2015; 11:CD009464.
  10. Strasser F, Luftner D, Possinger K, et al. on behalf of the Ca nnabis-In-Cachex ia-Study-Group. Compa rison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia–cachexia syndrome: a multicenter, phase iii, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. J Clin Oncol 2006; 24:3394–400.
  11. Russo, EB, Guy GW Robson PJ. Cannabis pain and sleep: lessons learned from therapeutic clinical trials of Sativex®, a cannabis-based medicine. Chemistry and Biochemistry 2007; 4:1729-1743
  12. de Mello Schier AR, de Oliveira Ribeiro NP, Countinho DS, et al. Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compounds of Cannabis sativa. CNS Neruol Disord Drug Targets 2014; 13:953-960
  13. Bricker JB, Russo J, Stein MB, Sherbourne C, Craske M, Schraufnagel TJ, Roy-Byrne P Does occasional cannabis sue impact anxiety and depression treatment outcome?  Results from a randomized effectiveness trial. Depress Anxiety 2007; 24:392-398

Cannabis and Its Effect on High Blood Pressure

According to recent estimates, about 75 million American adults have has high blood pressure (1), a condition commonly referred to as hypertension. If untreated, it can lead to cardiovascular disease, which is characterized by an increased risk of stroke, heart attack, and even heart failure. Hypertension was the cause of over 400,000 deaths in 2014 (1).

A number of factors, including poor diet, stress, physical inactivity, alcohol, and tobacco use increase the risk of developing hypertension (1). Hypertension can be managed by taking medications, reducing sodium in the diet, getting daily physical activity, and quitting smoking (2).

Previous reports suggest that consumption of cannabis and certain cannabinoids e.g, cannabidiol (CBD) may help to lower high blood pressure and represent a new treatment option for hypertension (3-5).   Further, results from a 15 year longitudinal study called the Coronary Risk Development in Young Adults (CARDIA) which followed 3,617 black and white young adults suggested that cannabis consumption was not independently associated with increased cardiovascular risk (6). However, study authors cautioned that it was associated with unhealthy behaviors including high caloric diet, tobacco smoking and other illegal drug use.

In a more recent retrospective analysis of 1213 young adults (20 years and older)—57% used cannabis—Yankey et al. (7) showed that cannabis use may increase the risk of death from hypertension. Study results suggested that cannabis users had more than three times the risk of death from hypertension-related causes. Moreover, increased duration of cannabis use was also associated with a greater risk of death from hypertension. However, it is important to note that the researchers acknowledged the difficulty of measuring frequency and quantities of marijuana used by study participants and the likelihood that illegal use was underreported (7). Put simply, there are confounding variables that call into question the conclusions of the study.

In summary, the positive or negative effects of cannabis consumption on cardiovascular health and disease still remain to be conclusively determined. New well designed and better controlled clinical studies will be necessary to verify or refute the effects of cannabis and cannabinoids on cardiovascular function and their ability to manage hypertension.

References

  1. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm  Accessed August 23, 2017
  2. http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974  Accessed August 23, 2017
  3. Pacher P, Batkal S, Kunos G. Cardiovascular pharmacology of cannabinoids. Handb Exp Pharmacol 2005; 168:599-625
  4. Randall MD, Harris D, Kendall DA, Ralevic V. Cardiovascular effects of cannabinoids. Pharmacol Ther. 2002;95:191–202.
  5. Hiley CR, Ford WR. Cannabinoid pharmacology in the cardiovascular system: potential protective mechanisms through lipid signalling. Biol Rev Camb Philos Soc. 2004;79:187–205
  6. Rodondi N, Pletcher MJ, Liu K, Hulley SB, Sidney S  Marijuana use, diet, body mass index and cardiovascular risk factors (from the CARDIA study). Am J Cardiol 2006; 98:478-484
  7. Yankey B, Rothenberg R, Strasser S, Ramsey-White K, Okosun IS Effect of marijuana use on cardiovascular and cerebrovascular mortality: A new study using the National Health and Nutrition Survey linked mortality file. Eur J Preventive Cardiol 2017; DOI: 10.1177/2047487317723212 [Epub ahead of print]

Cannabidiol (CBD) and Opioid Addiction

Opioids provide effective analgesic relief against acute and chronic pain.  Rates of opioid prescription have skyrocketed over the past two decades and opioid addiction is extremely high among users reaching almost 50% (1, 2).  As opioid prescription and addiction rates rise, overdose deaths in the US have nearly tripled in the past 15 years (3).

Cannabidiol (CBD) is a non-psychoactive cannabinoid that has been reported to dampen the “reward properties” of drugs like cocaine, amphetamine and opioids in animal models (4, 5). Put simply, CBD might be able to block the urge of users to continue to use these highly addictive drugs.

In a recent study conducted at the University of Mississippi, Markos et al (6) injected separate groups of mice with either saline (control) or morphine in combination with different doses of CBD. The treated mice were then subjected to drug/no drug conditioning experiments.  The results from these experiments showed that morphine-conditioned mice displayed a robust preference for morphine. This robust morphine preference was significantly attenuated in mice that also received morphine plus CBD (10 mg/kg). Further, CBD (10 mg/kg) alone did not exhibit any rewarding or aversive properties in saline-conditioned mice. This finding is the consistent with the work of others who also found that CBD lacks psychotomimetic, aversive or reward properties (7-10).

Taken together, these results suggest CBD can block opioid reward behavior, i.e. deter the subsequent use of opioids, and may be useful as a treatment in opioid addiction treatment settings.  However, while these results may be encouraging, controlled, human clinical studies with CBD must be performed to determine whether or not the cannabinoid may be useful as a pharmacologic intervention to help treat opioid addiction.

References

  1. Dart RC, Surratt HL, Cicero TJ, Parrino MW, Severtson SG, Bucher-Bartelson B, Green JL. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med 2015; 372: 241–248
  2. Højsted J, Sjøgren P. Addiction to opioids in chronic pain patients: a literature review. Eur J Pain 2007; 11: 490–518
  3. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths – United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016; 65: 1445–1452
  4. Parker L, Burton P, Sorge R, Yakiwchuk C, Mechoulam R. Effect of low doses of delta9-tetrahydrocannabinol and cannabidiol on the extinction of cocaine-induced and amphetamine-induced conditioned place preference learning in rats. Psychopharmachology 2004; 175: 360–366
  5. Katsidoni V, Anagnostou I, Panagis G. Cannabidiol inhibits the reward facilitating effect of morphine: involvement of 5-HT1A receptors in the dorsal raphe nucleus. Addict Biol 2013; 18: 286–296
  6. Markos JR, Harris HM, Gul W, ElSohly MA, Sufka KJ.  Effects of cannabidiol on morphine conditioned place preference in mice. Planta Med 2017 12/13 DOI: 10.1055/s-0043-117838
  7. Parker L, Burton P, Sorge R, Yakiwchuk C, Mechoulam R. Effect of low doses of delta9-tetrahydrocannabinol and cannabidiol on the extinction of cocaine-induced and amphetamine-induced conditioned place preference learning in rats. Psychopharmachology 2004; 175: 360–366
  8. Katsidoni V, Anagnostou I, Panagis G. Cannabidiol inhibits the reward facilitating effect of morphine: involvement of 5-HT1A receptors in the dorsal raphe nucleus. Addict Biol 2013; 18: 286–296
  9. Mechoulam R, Parker L, Gallily R. Cannabidiol: an overview of some pharmacological aspects. J Clin Pharmacol 2002; 42: 11S‑19S
  10. Mechoulam R, Peters M, Murillo-Rodriguez E, Hanus L. Cannabidiol – recent advances. Chem Biodivers 2007; 4: 1678–1692

Treating Cancer-Related Symptoms with Cannabis

In the 1970s, purified and synthetic cannabinoids were being evaluated as palliative treatments for cancer related symptoms (1). One of the earliest recognized clinical indications for cannabinoids was cancer induced nausea and vomiting (CINV) [2].

A 1988 prospective open label trial found that inhaled cannabis effectively controlled CINV in 78% of 56 cancer patients who had inadequate control of nausea and vomiting with conventional anti-emetics (3). Also, a later report that evaluated 30 trials and over 1300 participants determined that synthetic THC molecules such as nabilone and dronabinol were more effective than conventional anti-emetics in controlling acute CINV (2). This led to the early approval of dronabinol and nabilone as treatments for CINV but their use as a treatment for CINV has not been widespread (2,3)

A quick search of the clinical trials site www.clinical trials.gov revealed that there are no US clinical trials currently underway to further evaluate the use of Cannabis as a treatment for CINV.  Moreover, there are no natural Cannabis products e.g. extracts, sprays etc, on the market today that have received US Food and Drug Administration (FDA) approval as a treatment for CINV.

Inhaled Cannabis, and extracts containing THC and CBD have been clinically found to be more effective in treating cancer-related neuropathic pain than placebo (3, 4) but their effectiveness compared with conventional pain medications is uncertain (2). Yet, despite this, GW Pharma’s Sativex® (an extract that contains 1:1 ratio of Δ-9-tetrahydrocannabinol (THC) and cannabidiol [CBD]) is an approved treatment for cancer-related pain in 27 countries outside of the US (5).

There are currently 4 US clinical trials in (various phases) that are underway to determine the effects on Sativex® on advanced cancer pain and chemotherapy-induced neuropathic pain (Table 1). Regulatory experts expect Sativex® to garner FDA approval for both indications.

References

  1. Guzman M, Duarte MJ, Blazquez C, et al. A pilot clinical study of Delta9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme. British Journal of Cancer 2006; 95:197-203.
  2. Tramer MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2002; 323:16-21.
  3. Bowles DW, O’Bryant CL, Camidge DR, Jimeno A. The intersection between cannabis and cancer in the United States. Critical Reviews in Oncology/Hematology 2012; 83:1-10
  4. Notcutt W, Price M, Miller R, et al.  Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 ‘N of 1’ studies. Anaesthesia 2004; 59:440-452.
  5. https://www.gwpharm.com/products-pipeline/sativex  Accessed July 12, 2017

 

THC, CBD and Multiple Sclerosis

The established immunomodulatory properties of certain cannabinoids, most notably Δ-9 tetrahydrocannabinol (THC)  and cannabidiol (CBD), suggested that they may be therapeutically useful to treat multiple sclerosis (MS) which is generally believed to be autoimmune neurological diseases. (1). To that point, from 2005-2009, clinical trials involving 1300 patients were conducted to assess the effects of Cannabis, cannabis extracts and synthetic THC on MS and MS-related muscle spasticity and pain. (2, 3).

The results of these studies showed that cannabis extracts containing different ratios of THC and CBD as well as THC and nabilone (synthetic THC) can improve MS-related symptoms of spasticity, pain and urinary incontinence.  (2, 3 ) Additional clinical studies led to the approval of GW Pharma’s Sativex® (1:1 ratio of THC: CBD) in 27 countries (not the US) as a treatment for MS spasticity (4).

At present, in the US, there are 15 late stage clinical trials in progress that are evaluating smoked/vaporized cannabis (2) and Sativex® (13) as treatments for MS and MS-related spasticity, pain and urinary incontinence (Table 1).

Based on GW Pharma’s success with Sativex® as a treatment for various MS indications in other countries, it is likely the company will receive approval as an MS treatment in the US.

 References

  1. Giacoppo S, Mandolino G, Galuppo M, Bramanti P, Mazzon E. Cannabinoids: new promising agents in the treatment of neurological diseases. Molecules 2014; 19:18781-18816
  2. Zajicek JP, Apostu VI. Role of cannabinoids in multiple sclerosis. CNS Drugs 2011; 25:187-201
  3. Hazenkamp A GF. (2010) Review on clinical studies with cannabis and cannabinoids 2005-2009. Cannabinoids 5(special issue) 2010; 1-21.
  4. Zajicek JP, Hobart JC, Slade A, Barnes D, Mattison PG, Group MR. (2012) Multiple sclerosis and extract of cannabis: results of the MUSEC trial. Journal of Neurology, Neurosurgery, and Psychiatry 2012; 83:1125-1132.

Is Cannabidiol (CBD) An Effective Treatment for Epilepsy?

Stories of the ability of Cannabis  to alleviate seizures have been around for about 150 years (1).  Early randomized, placebo-controlled clinical studies conducted between 1978-1990 involving 48 patients with epilepsy found that daily treatment with 200-300 mg of cannabidiol (CBD) for up to 4 months was safe and well tolerated (2). However the small number of patients and short trial duration were not sufficient to draw any conclusions about CBD’s efficacy (1, 2)

Over the past decade, there have been reports that cannabis extracts with high concentrations of CBD may be effective anticonvulsants for children suffering from severe forms of uncontrollable epilepsy known as Dravet Syndrome and Lennox-Gastaut Syndrome (1, 3).  At present there are 9 ongoing or completed US clinical trials that evaluated the effects of CBD on epilepsy, treatment-resistant epilepsy, Dravet Syndrome (DS) and Lennox Gastaut Syndrome (LGS)

A Table that lists the ongoing clinical trials that are evaluating CBD as a treatment for epilepsy, DS, LGS and treatment-resistant forms of epilepsy can be found here.

Industry leaders in this field include GW Pharma and a relatively new entrant called INSYS Therapeutics Inc.  Of interest, in 2014, GW pharma’s Epidiolex, a liquid formulation of highly purified Cannabis-derived CBD was granted Orphan Drug Designation by the US  Food and Drug Administration (FDA ) as a treatment for Dravet and Lennox-Gastaut syndromes and other pediatric epilepsy syndromes.

More recently, a Phase 3, double blind, placebo-controlled study conducted with 120 children and young adults with Dravet syndrome and drug resistant seizures revealed that treatment with CBD (20 mg per kilogram of body weight) per day reduced the median frequency of convulsive seizures per month decreased from 12.4 to 5.9 with cannabidiol, as compared with a decrease from 14.9 to 14.1 with placebo (4).  Further, the percentage of patients who had at least a 50% reduction in convulsive-seizure frequency was 43% with CBD and 27% with placebo (4). The percentage of patients who became seizure-free was 5% with cannabidiol and 0% with placebo (4).

Finally, adverse events that occurred more frequently in the CBD group as compared with the placebo group included diarrhea, vomiting, fatigue, sleepiness and abnormal liver function test results (4).

Similar results were observed in a randomized, double-blind, placebo-controlled trial CBD clinical trial conducted with 156 patients with Lennox-Gastaut Syndrome (5).

The results from these studies suggest that highly purified preparations of CBD may be effective in controlling patients who suffer from DS, LGS and other treatment resistant forms of epilepsy.  However, additional studies must be conducted with CBD with the goal of reducing the high frequency of adverse events associated with long term CBD treatment.

References

  1. Maa E, Figi P. The case for medical marijuana in epilepsy. Epilepsia 2014; 55:783-786.
  2. Gloss D, Vickrey B. Cannabinoids for epilepsy. The Cochrane Database of Systematic Reviews 2014; 3:1-23
  3. Cilio MR, Thiele EA, Devinsky O. The case for assessing cannabidiol in epilepsy. Epilepsia .2014: 55:787-790.
  4. Devinsky O, Marsh E, Friedman D, Thiele E, Laux L et al. Trial of cannabidiol for drug-resistant seizures in the Dravet Syndrome. N Engl J Med 2017; 376:2011-2020
  5. Thiele, EA, Mazurkewicz-Beldzinska M, Denbadis, S, Marsh et al. Cannabidiol (CBD) significantly reduces drop seizure frequency in Lennox-Gastaut Syndrome (LGS): Results of a multi-center, randomized double-blind placebo-controlled Trial (GWPCARE4) American Epilepsy Society Annual Meeting. 2016. ( 1423_AES_Poster_LGS_)

Cannabis Possesses Antibacterial Properties Against MRSA

There is a growing body of evidence that suggests that Cannabis can be used to treat a wide variety of symptoms associated with chronic illnesses and conditions.   That said, the findings of Giovanni et al in a paper entitled “Antibacterial Cannabinoids from Cannabis sativa: A Structure-Activity Study” (1) suggest that several cannabinoids may be useful to treat infections caused by antibiotic resistant bacteria including MRSA (methicillin-resistant Staphylococcus aureus).

The results from this study showed that five major cannabinoids including cannabidiol (CBD), cannabichromene (CBC),
cannabigerol (CBG), Δ9-tetrahydrocannabinol (THC), and cannabinol (CBN) showed potent antibacterial action against 6 clinically-relevant strains of MRSA. The minimum inhibitory concentrations (MIC) of these compounds ranged from 0.5 µg/ml to  2 µg/ml  (Table 1)

Table 1. MIC (µg/ml) of Cannabinoids Against Drug Resistant Strains of S. aureus (adapted from Reference 1)

Cannabinoid SA-1199B RN-4220 XU212 ATC5923 EMRSA-15 EMRSA-15
CBD 1 1 1 0.5 1 1
CBC 2 2 1 2 2 2
CBG 1 1 1 1 2 1
THC 2 1 1 1 2 0.5
CBN 1 1 1 1 1

While the mechanism of action of cannabinoids against MRSA remains unknown, the results of this study suggest that additional studies ought to be carried out to determine whether or not cannabinoids may be useful to combat infections caused by multidrug resistant strains of bacteria.

References

  1. Appendino A, Gibbons S, Giana A, Pagani A Grassi G,Stavri M,Smith E Rahman M. Antibacterial cannabinoids from Cannabis sativa: A structure-activity study J. Nat. Prod. 2008: 71:1427-1430