Addiction: We’ve Been Doing it ALL WRONG

IN YOUR OPINION…

What are we, as a nation, a government… what HAVE we been doing WRONG, so that, in the space of the past 50, or 60 years, instead of minimizing substance abuse and associated problems, INSTEAD, we have spawned and cultivated global narcotrafficking terrorist cartels, which have proliferated exceedingly abundantly and are now a root cause of many crimes overall?

Isn’t 50, or 60 years long enough to get a clue as to EXACTLY WHAT we’re doing WRONG — AND CHANGE!?!

The LIES that’ve been peddled and foisted upon us are blatantly contradicted by the government’s own research findings (via the NSDUH, SAMHSA, et al):

There is NO SUCH THING as “instantly addictive” substances/drugs, for if there was,

Yes, there TRULY IS good science behind medical marijuana!

And, here’s an example.

Recently, in the course of my reading (and I read EXTENSIVELY), I happened upon a brief excerpt from a recently-published book — it was a summary of a chapter from a recently-published healthcare-science text entitled “Medicinal Usage of Cannabis and Cannabinoids,” edited by: Victor R. Preedy, Vinood B. Patel, and Colin R. Martin.

The authors are respected in their fields, all possess terminal degrees, and their biographies are impressive.

OF NOTE: One of the three, Colin R. Martin, is a Registered Nurse.

Victor R. Preedy

Professor Preedy has been elected as a Fellow to the following Royal Societies: The Royal Society of Biology, the Royal College of Pathologists, the Royal Society for the Promotion of Health, the Royal Institute of Public Health and Hygiene, the Royal Society for Public Health, the Royal Society of Chemistry, and the Royal Society of Medicine. He was founding Director of the Genomics Centre at King’s College London and held the post from 2006 to 2020. He is a leading expert on the science of health and has a long-standing interest in disease processes, biomarkers, and tissue pathology. He has lectured nationally and internationally. Professor Preedy has published over 750 articles, which includes peer-reviewed manuscripts based on original research, abstracts and symposium presentations, reviews and numerous books and volumes.

Affiliations and expertise

Professor in the Department of Clinical Biochemistry at King’s College Hospital, London, UK Emeritus Professor in Faculty of Life Sciences and Medicine at King’s College London, UK Visiting Professor at the University of Hull, UK

Vinood B. Patel

Dr. Patel is a Reader at the University of Westminster. After completing his PhD at King’s College London, he continued his research experience by undertaking his post-doctoral studies in the laboratory of Professor Cunningham in the Department of Biochemistry at the Wake Forest University School of Medicine, (Winston-Salem, NC, USA). This extensive project involved investigating mechanisms of hepatic mitochondrial ribosome dysfunction in alcoholic liver disease (ALD) using biophysical and proteomic techniques. These studies have led to new avenues in determining the pathology of ALD. His teaching areas at both post-graduate and undergraduate levels include clinical biochemistry, investigative pathology and laboratory investigation.

Affiliations and expertise

Reader, University of Westminster, London, UK

Colin R. Martin

Dr. Martin is a Professor of Mental Health at Buckinghamshire New University. He is a Registered Nurse, Chartered Health Psychologist, and a Chartered Scientist. He has published or has in press well over 250 research papers and book chapters. He is a keen book author and editor having written and/or edited several books all of which reflect his diverse academic and clinical interests that examine in-depth, the interface between mental health and physical health. These outputs include the Handbook of Behavior; Food and Nutrition (2011), Perinatal Mental Health: A Clinical Guide (2012); Nanomedicine and the Nervous System (2012), and the major reference works Comprehensive Guide to Autism (2014), Diet and Nutrition in Dementia and Cognitive Decline (2015), Comprehensive Guide to Post-Traumatic Stress Disorder (2016) and Metabolism and Pathophysiology of Bariatric Surgery: Nutrition, Procedures, Outcomes, and Adverse Effects (2017).

Affiliations and expertise

Professor of Clinical Psychobiology and Applied Psychoneuroimmunology and Clinical Director: Institute for Health and Wellbeing University of Suffolk, Ipswich, UK

Published by Elsevier (ISBN:978-0-323-90036-2), the text is divided into 6 parts with 45 chapters, and a primary intended audience being

Are You A Fan Of Bacon? You’ll Want To Read This.

Bacon is not my thing, per se, at least insofar as, once you’ve had the AUTHENTIC product, it’s difficult to return to the imposter.

By AUTHENTIC, I mean to refer to what some folks call “slab” bacon, which is smoked, and dried, so that the uncooked slab of bacon needs NO REFRIGERATION, and is often found hanging in the open in the grocer’s meat section.

This product is what some call “streaky bacon,” which is what the English call this type of American-produced bacon.

Now, remember… before refrigeration came along, the preservation of meats was done primarily by smoking, and curing — and THAT was a technique learnt from the Native Americans in the earliest days of American history, i.e., by the colonists at Jamestown, Plymouth, etc.

That is also why, when the first enduring “snap” of winter, i.e., COLD weather, came along, it was called “hog killing weather,” because the cool, even cold temperatures largely delayed (retarded), if not temporarily prevented, spoilage (as rancidness, referring to an oxidized, deteriorated state of fat), and deterioration (rotting) of the uncooked flesh. Lard would be rendered (changed in character) from fat, which is accomplished by heating it, most typically in a large cauldron suspended over an open fire, to melt it.

EVERY PART of the hog would be used, which how the phrase “everything but the squeal” originated. The fat, the jowl, the hock, the ham, the loin, the back strap, the trotters (feet), the ears, the liver, the heart, stomach, snout, skin, and even the intestines (chitlins, or chitterlings), were ALL used as some sort of food item.

Nowadays, the meat is processed wham-bam-thank-you-ma’am with numerous godforsaken chemicals, soaked in brine, injected with water and chemicals that make it soak up water (that’s bordering on fraud, to pump water into meat, or use chemicals to cause it to absorb water to increase its weight), injected with preservatives, nitrates (often as celery powder), nitrites (agents that interact with the hemoglobin naturally present in pork (blood in the flesh) that cause it to have an unnaturally red, or pink appearance and which eventually become nitrosamines, known carcinogenic compounds causative of stomach, bladder, colorectal, and breast cancers, vacuum packed, thrown in a refrigerator, and rushed to market.

Just read the labels sometimes, and look up things like sodium erythorbate (an anti-oxidant, color fixative, cure accelerator and synthetic variation of ascorbic acid, aka vitamin C), sodium phosphate — used to help meat retain moisture, and prevent development of rancid odor from the fat (which is deteriorating, or else it wouldn’t be added), HFCS (high fructose corn syrup) which is metabolized differently than sucrose (table sugar) and known to cause weight gain and Type II diabetes, sodium tripolyphosphate (STPP) which is an inorganic hydrophilic (attracts & retains water) emulsifier, and is even used in detergents, etc.

When cooked or broken down in the stomach, nitrites form nitrosamines (aka N-Nitroso Compound), which are known carcinogens, particularly among young children and pregnant women.

The USDA limits addition of nitrites (as sodium nitrite) in food to 200 parts per million. The thinking, or hope, is, that by adding ascorbic acid (aka sodium erythorbate, the synthetic form of vitamin C) to the processed food, it allegedly reduces formation of nitrosamines, though there is no conclusive scientific evidence proving it.

The addition of sodium nitrate is limited, whereas the addition of celery powder is unlimited, and is considered “organic.” Neither celery powder nor celery salt is regulated by the USDA, but chemically processed sodium nitrate is.

Nitrate residue on processed foods using “natural” sources of nitrates (such as celery powder), is often at least 10 times HIGHER than that found on traditionally cured products.‌

Essentially, it’s a bait-and-switch shell game — a culinary con game, and the consumer is the mark.

But to add insult to injury, today’s hogs are NOT

RECIPE: Vegetarian Stock Powder

Over the years, I’ve met, known, and been friends with several vegetarians in my lifetime, and quite frankly, all of them have been very pleasant people, kind, generous, giving, well-mannered, studious, professionals, and in most cases, religious, specifically, Seventh Day Adventist, a Christian sect that practices the Jewish custom of meeting on Saturdays (the Sabbath) for corporate worship, and resting from their labors.

They weren’t at all radicalized or “high pressure” animal rights activists, mean greenies, or other off-the-wall types — just plain ol’ nice, family, folk.

And as a tenet of their faith, they are vegetarian — some lacto-ovo, some pescatarian, some vegan. And you know you’ve made friends with them when they invite you to share a meal with them — that’s true of any people, religious, or not — and I have always considered it great honor to share a meal with them. One such time was Thanksgiving several years ago, when I was

How Sick Is A Sick Party That Pushes Sick Candidates On Sick Voters?

Appearing on Alex Jones’ “InfoWars” program, Kanye West recently said, 

“I see good things about Hitler. Jewish people are not going to tell me: ‘You can’t say out loud that this person ever [sic] did anything good.’ I’m done with that. I like Hitler. The Jewish media has made us feel like Nazis and Hitler, [and] have never offered us anything of value to the world.” 

Kanye is widely known as a mentally disturbed multi-millionaire Black male entertainer whose fortune came in large part from sales of athletic footwear following modest recording successes, and now prefers to be called “Ye,” who continues supporting degenerate racist Republican madman and chronically habitual liar, the chiseler-swindler-thief, former POTUS and election-denier-in-chief, Donald Trump.

Kanye has increasingly and very publicly exhibited bizarrely erratic behavior on full display through various online social media accounts, in other public venues and ways, in 2016 and 2019 was hospitalized because of psychiatric emergency, and in 2016 was diagnosed with bipolar disorder about which he has publicly spoken, though he denied it in a public White House Oval Office meeting with the 45th President in October 2018 claiming that he was merely “sleep deprived,” yet months earlier claimed bipolar disorder was “my superpower” and on his June 2018 album cover of “Ye,” scrawled “I hate being Bi-Polar its awesome.”

His deteriorated mental health condition is painfully obvious to even the most casual of observers, and with the 2010 production of an album named “My Beautiful Dark Twisted Fantasy,” in conjunction with his on-again-off-again denial of the reality of his disease, refusal to treat his disease with medications, in combination with a very public divorce involving four children, his life has become an unsightly public disgrace at best, and a laughingstock and open mockery at worse.

“InfoWars” is a moronic madhouse media show of radicalized right-wing extremist conspiracy theorist Alex Jones, who, despite multi-billion dollar civil judgements against him for deliberately promoting lies, continues producing his show, and has most recently filed bankruptcy in Texas following the civil judgments against him.

Alex foists numerous mind-boggling insane rants, including most notably and tragically, that the 2012 mindless mass murder massacre of 20 6-and-7 year old children, 7 adults at Sandy Hook Elementary School in Newtown, Connecticut — and his mother in her home — was a “false flag” staged stunt, a hoax performed by actors perpetrated by the Federal government in an attempt to outlaw assault weapons. Alex Jones’ lies in turn caused his followers to harass the grieving parents & siblings, including an FBI agent who had responded to the scene. The 20-year-old perpetrator Adam Lanza committed suicide on site using the AR-15 style rifle fitted with several 30 round magazines which he used to kill the children, teachers, and his mother.

Alex Jones, Donald Trump, and Kanye West… those 3 men alone are IRREFUTABLE PROOF POSITIVE that America is much, much, much more gravely mentally ill than previously imagined, that the depths of depravity which they represent are but a mere scratch on the surface, the veritable tip of the proverbial iceberg, perhaps much like the one which sank the allegedly “unsinkable” luxury cruise ship “Titanic,” again, which ironically occurred after striking an iceberg on its 1912 maiden voyage.

But we could add a 4th: Herschel Walker, another man with a well-known mentally-disordered psychiatric disorder who is equally well known for his chronically habitual lying, spousal/partner abuse, and wholesale denial that anything is wrong with him.

Having been manipulated into becoming a candidate for Georgia’s U.S. Senate seat under the Republican banner by the former 45th President, Hershel Walker appears to have violated Georgia election law by claiming to be a Georgia Resident and voting in the state’s Republican primary and the Georgia November 2022 General Election, while simultaneously taking a homestead tax deduction in Texas, though “the place where he stays” is his wife’s house in Georgia.

Herschel Walker is an equally VERY SICK, SICK man, who is also a known chronic pathological liar, spousal abuser, philanderer, manipulator and all-around psychopath… much like the 45th POTUS.

BUT!

Do you know what MUCH, MUCH — even EXCEEDINGLY — worse?

A people who either cannot see, or refuse to see, the depths of Herschel Walker’s depravity and utter lack of character qualities befitting such an office, which on their face are innately inherent moral disqualifications, or either are so blindly stuck on the GOP that they’d vote for a warm piece of shit, instead of anyone else, just because it’s under the Republican banner.

Yet those sick men’s cult members cannot themselves be blamed for perpetrating and promulgating such mass evil. Their enablers are

Do NOT feed these foods to your dog!

If you,
your loved ones, or others,
have a canine companion,
there are certain “human” foods that you
MOST DEFINITELY
DO NOT
want to feed to it.

For example, onions, garlic, etc., are Alliums, which is to say that, they’re in the Allium genus. Essentially, that’s ALL onion-type vegetables, which includes leeks, shallots, scallions, chives, wild garlic, wild onions, etc.

They’re TOXIC to dogs.

Here’s another especially potent one: Xylitol. (zy-lih-tall)

Xylitol is a sugar alcohol used as a sweetener in many “human” foods, such as chewing gum, and in some so-called “low cal” foods.

Xylitol is HIGHLY TOXIC to dogs. It’s like fentanyl is for humans — it is SO POTENT even the smallest, teeny tiniest bit can kill.

Here’s another one: Chocolate.

Dogs are not capable of

Ain’t Skeered of COVID-19? Try this on for size.

Let’s pretend that you’re an “anti-vaxxer,” that for whatever insane reason, you’re not going to ever receive any FREE COVID-19 vaccination.

Let’s also pretend that you get infected with COVID-19.

And, we’ll further pretend that because of the infection, you get really, really, really sick — as in “intubated in the ICU” sick.

Should you even be there? Should you even be treated, or cared for? Should anyone have mercy upon you because you made the decision to NOT receive (reject) a FREE vaccine? After all, you’re just wasting oxygen, and taking up space.

Shouldn’t the resources that are being expended upon you, and your care (because you didn’t care enough to get vaccinated), be expended upon others who did? After all, you made the conscious decision to NOT care enough about yourself, or others, to get vaccinated.

Freedom is not, nor has it ever been, an “I’ll do what I want, where I want, when I want, how I want, because I can” type of proposition.

You see, freedom has responsibilities.

In practice, that means you can’t

U.S. Intelligence Community’s Unclassified COVID-19 Assessment Summary

The United States’ Intelligence Community (IC), whose members are enumerated and linked below, collaborated upon an investigation on the source, and cause (root cause analysis), and origin of the virus that causes COVID-19, the SARS-CoV-2. For the greatest part, their assessment is complete, though undoubtedly, portions of it will remain ongoing for an unknown time being.

Their conclusions were recently de-classified, and released to the general public, and published online.

Their 1.25 page summary assessment follows, below the enumeration of IC members & agency/organization links.

Summary available here:
https://www.odni.gov/files/ODNI/documents/assessments/Unclassified-Summary-of-Assessment-on-COVID-19-Origins.pdf

The FULL 18-page assessment may be found here:
https://www.odni.gov/files/ODNI/documents/assessments/Declassified-Assessment-on-COVID-19-Origins.pdf

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Members of the U.S. Intelligence Community include the following:

• Air Force Intelligence
• Army Intelligence
• Central Intelligence Agency
• Coast Guard Intelligence
• Defense Intelligence Agency
• Department of Energy
• Department of Homeland Security
• Department of State
• Department of the Treasury
• Drug Enforcement Administration
• Federal Bureau of Investigation
• Marine Corps Intelligence
• National Geospatial-Intelligence Agency
• National Reconnaissance Office
• National Security Agency
• Navy Intelligence
• Space Force Intelligence

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UNCLASSIFIED

Key Takeaways

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The IC assesses that SARS-CoV-2, the virus that causes COVID-19, probably emerged and
infected humans through

Lessons Learned, and Not Learned

What lessons could we learn from nicotine chewing gum?

You might be surprised.

Read on.

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Having never been addicted to anything (or, anyone), the craving for a substance, other than food & water for sustenance, it interests me to understand the strong cravings that some have for non-food substances, including, for example, tobacco, spiritous beverage, or narcotics abused, or other illicit substances, including cocaine, methamphetamine, etc.

For years, I have, on a personal level, maintained that addiction was not what many were saying that it was, some years ago. And in the interim, from then until now, indeed, the definition, and our understanding of addiction has substantially changed, precisely because of our increased understanding of physiology, in conjunction with improved recognition of cause-and-effect patterns of human behavior.

For example, with smokers, they almost always fall into habituation through association with routine. Wake up, toilet, smoke, bathe, smoke. Drink coffee, smoke. Drive to work, smoke. Work a couple hours, smoke break. Work a few more, lunch break, smoke. Work a bit, smoke break. Off work, drive home, smoke. Get cleaned up, smoke. Watch teevee, smoke. Eat supper, smoke. Have cocktails/nightcap, smoke. And it all repeats itself the next day. That’s significantly serious behavioral reinforcement.

Those who make effort to quit, frequently forget the association of routine with smoking, and when determined to quit, they sometimes

The Elderly: Things we throw away?

The REAL question is, “Do we care for ourselves… or not?”

If so, it’s time to put our money where out mouth is.

A society can be easily, and readily judged by how they care, or not, for their elderly.

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prospect.org

The Care Crisis Isn’t What You Think

By Dr. Laura Mauldin, PhD
January 3, 2022

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On a recent visit with research participants for my book on spousal caregiving, I sat with a man who had a stroke three years ago, at age 59. He can only use one side of his body, rendering him unable to work; his wife serves as his caregiver. He told me about how much he hated himself. “All I do is take resources. I don’t contribute anything.” Tears streamed down his cheeks.

President Biden’s signature Build Back Better bill, which includes funding for long-neglected social programs like Medicaid’s home and community-based services (HCBS), is facing an uncertain future. An upgraded HCBS program would allow millions of people currently stuck on wait lists to receive care at home, rather than in congregant settings. But facing questions from the likes of Sen. Joe Manchin (D-WV) about cost, the new investments in HCBS may not become law.

Read more about Health & Social Policy

What my research participant made clear to me that day is that the lack of robust and accessible social programs for long-term care is merely a symptom of a deeper, more poisonous problem: Disability is a part of life, and we hate it. Literally.

Here’s what we don’t talk about when we talk about the care crisis. When it comes to disability, we devalue care (both caregiving and paid care work) because we devalue the people who need it. It’s why we position care as a response to a horrible disaster. It’s why we refuse to adequately fund home care and fairly pay care workers. It’s why we rely on the 53 million (and climbing) unpaid family caregivers across the U.S. to provide care for free. It’s why disabled people internalize the idea that they are worthless “takers.” We tell people we don’t care about them when we refuse to provide the means for them and those who care for them to live well.

Euphemisms like “silver tsunami” let the idea of disaster stand in for disability.

In the lead-up to the BBB bill, there have been

Evangelicalism Poisons Christians’ Pool

The late, renown musician Greg Allman, with his Southern Rock group “The Allman Brothers Band,” recorded and performed a song entitled “Angeline,” which was written by band members Dickey Betts, Mike Lawler, and John Andrew Cobb. Greg had no part in the song’s creation, other than to sing, and record it, where is appears as Track 1, Side 2 (Track 5 on CD) of the band’s first Arista Records, Inc. label release, on their August 1980 album “Reach for the Sky.”

The song’s chorus contains the partial lyric “I never seen a woman who could look so good, and be so doggone mean. Yeah.”

I had forgotten the song’s title was Angeline, rather than Evangeline, but the point is, that the name “Evangeline” is a feminine one, and in a couple places in the New Testament, and in modernity, the “church” is frequently referred to as a feminine subject, a “virgin bride” which will “marry” Jesus Christ. And, I had not forgotten the song’s lyric “I never seen a woman who could look so good, and be so doggone mean.” 

That is a sadly perfect picture of the church today: Alleged to be beautiful (“a woman who could look so good,”) but whose attractiveness is marred to the point of repulsion, i.e., “be so doggone mean.”

The song’s final verse is:

Whoa, just a game that she loves to play,
leavin’ broken hearts all along the way.
She’s got friends that she ain’t never used.
She’s winnin’ now but she’s bound to lose.
Oh, Angeline.

Again, a picture perfect illustration of a very sad situation: Selfish use and abuse, then, abandonment, and ultimately, loss.

What many folks don’t realize (and, by “folks,” I specifically mean to refer to those who name Christ, or claim to be Christian), that many of the researchers and historical figures of importance in the history of healthcare and immunology were Christians.

Edward Jenner (1749-1823), considered widely as the “father,” or discoverer of vaccination, was himself a son of a Christian vicar, the 4th son, and 8th of 9 children, whose both parents died in 1754. But what is equally ironic, is that in his era, when he was actively developing a treatment and cure for smallpox, “Jenner was widely ridiculed. Critics, especially the clergy, claimed it was repulsive and ungodly to inoculate someone with material from a diseased animal. A satirical cartoon of 1802 showed people who had been vaccinated sprouting cow’s heads. But the obvious advantages of vaccination and the protection it provided won out, and vaccination soon became widespread. Jenner became famous and now spent much of his time researching and advising on developments in his vaccine.”

Religious-minded people of the era, Christians, specifically, were widely opposed to the concept of disease prevention by inoculation.

Sounds vaguely familiar, doesn’t it?

Sir Hans Sloane (1660–1753). Portrait by Godfrey Kneller, 1716. Copyright © The Royal Society.

And yet, in the time since Jenner’s era,

Dog Came to Me in a Dream and Said…

…and Dog said, “Don’t get the vaccine.”

I was going to vaccinate Dog against rabies.

So, I asked Dog, “Dog, do you want to get the vaccine?”

Dog said, “I’m worried that it’ll make me sterile.”

I reminded Dog that she’d been spayed since shortly after she adopted me, about 5ive years.

Dog then said, “I need to be free to make my own decision.”

I reminded Dog that

Florida Nuts Best In Nation

Florida man, eh?

El Stupido MAXIMO!

Ron DeSantis, Republican Florida Governor

Goddamn Ron Deathsantis is a FUCKING MORON!!

Let’s put this in perspective, shall we?

Try this on for size:

DeSantis maintains clothes can be detrimental for children’s development and that younger children simply don’t wear clothes properly. But board members in the counties of Broward, home to Fort Lauderdale, and Alachua, home to Gainesville, decided not to allow parents to easily opt out of the clothing mandate as surging cases of severe second degree sunburn fueled by climate change began straining hospitals.

How does THAT fit, eh?

Yup.

Deese Flahda fokes ah nutz!

Oh… and WHO IS LITERALLY DEFUNDING GOVERNMENT OPERATIONS, INCLUDING PUBLIC SCHOOLS?

Yup. You guessed it!

Goddamn Republicans.

Banana Republics are run by Banana Republicans.

Banana Republicans specialize in, and are expert at, a psychological manipulation technique called “projection.”

Projection is the practice of accusing others of doing the very thing that the accuser is doing. They “project” the action upon others whom they hope to revile by so doing.

Banana Republicans accuse Democrats of “defunding” the police, and yet, here they (Ron Deathsantis being their chief exemplar) are, LITERALLY defunding the “socialist” public schools.

Oh… and ANOTHER THING:

Banana Republicans decry “socialism” (though they NEVER actually define it) as being government involvement in anything.

So, using that measure, that metric, that (perverted) “definition,” ALL government is socialist — which makes Ron Deathsantis the Chief Socialist of the Socialist State of Florida.

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Florida Threatens To Pull School Funding Over Mask Mandates

COVID-19 Vaccination Resistance: Let Them Die — So Close Yet So Far Away

Let them die.

I’m sick and goddamn tired of their INSANE conspiratorial bullshit.

LET THEM DIE.

“Actions have consequences,” they’re frequently fond of saying, and then perversely take some sense of pride in portraying themselves as “victim” — a role which they have gleefully derided and mocked over the years as they attempt to justify their various perverse positions.

Now, they want to assume that very role.

LET THEM DIE.

They mistakenly think that they’ll be some kind of pretend political “hero” for their imaginary “lost cause.” Heroes almost always end up dead.

LET THEM DIE.

Everyone has a proverbial and practical expiration date, and just like milk and other dairy products, which can be soured relatively quickly or ruined prematurely if not properly cared for by refrigeration, so can the human body be ruined if improperly cared for by smoking, excessive consumption of food and/or beverage alcohol intake, sedentary lifestyle, lopsided dietary intake, regular consumption of nutritionally deficient foods, and other forms of improper and inadequate care, including deliberate neglect, and wanton failure to prevent malfunction and disease.

LET THEM DIE.

Physicians cannot, and will not, treat patients who refuse to cooperate with the course of treatment.

LET THEM DIE.

Engrave upon their headstones “s/he wanted, and chose to die from a preventable disease.”

LET THEM DIE.

LET THEM DIE.

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In The Last Mile Of Our Battle Against COVID, The Enemy Is Us

Time may have come for more aggressive tactics on vaccinations.

In a scene from the movie “The Matrix,” revered by conspiracy theorists, the hero is offered a choice between the blue pill of comforting illusions and the red pill that offers nothing more than the truth.

The correct answer, of course, is the red pill that reveals the hidden forces that control the world.

These days, Americans are being offered an even more fateful binary choice.

Do you maintain the comforting illusion that

Lower Your Blood Pressure Without Medicine Or Exercise

Take a deep breath — this one is gonna’ knock your socks off, because…

“Not only is it more time-efficient than traditional exercise programs, the benefits may be longer lasting.”

— Dr. Daniel H. Craighead, PhD, Post-Doctoral Fellow, Assistant Research Professor, Integrative Physiology of Aging Lab, Department of Integrative Physiology, University of Colorado Boulder, referring to research findings of a 5-minute breathing exercise upon lowering blood pressure

And, it’s easy!

How easy is “easy”?

Dr. Craighead said the exercise called “IMST can be done in five minutes in your own home while you watch TV.”

These findings are significant, because 65% of adults over age 50 have above-normal blood pressure, which puts them at greater risk of heart attack or stroke, and less than 40% meet guidelines for recommended levels of aerobic exercise.

“It’s basically strength-training for the muscles you breathe in with,” said Dr. Craighead, who added that,“it’s something you can do quickly in your home or office, without having to change your clothes, and so far

Research: Psilocybin Improves Depression

Better living through chemistry.

Because corrupt Republican President Richard Nixon’s 50-year lost cause, failed social experiment of the “War on Drugs” and Nancy Reagan’s “just say no” have never, and will never, work, nor ever benefited anyone who needed help — only those who perpetuated the war.

And, because no one — NO ONE — has ever said “when I grow up, I want to become an addict,” nor waked up one day and said, “gee… I think I want to become an addict.”

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In September 2018, Johns Hopkins researchers suggested that psilocybin should be re-categorized from a schedule I drug — one with no known medical potential — to a schedule IV drug (the lowest classification) such as with prescription sleep aids, but with somewhat tighter control, and summarized their analysis in the October print issue of Neuropharmacology, a peer-review professional journal.

Dr. Matthew W. Johnson, Ph.D., Professor of Psychiatry and Behavioral Sciences at Johns Hopkins is one of the world’s leading researchers, and most published scientists on the effects of psychedelics on humans, and has conducted original and innovative research in the behavioral economics of drug use, addiction, and risk behavior. Dr. Johnson earned his Ph.D. in experimental psychology at the University of Vermont in 2004.

Dr. Johson spoke with JHU reporters about the research, and said, “We want to initiate the conversation now as to how to classify psilocybin to facilitate its path to the clinic and minimize logistical hurdles in the future. We expect these final clearance trials to take place in the next five years or so. We should be clear that psilocybin is not without risks of harm, which are greater in recreational than medical settings, but relatively speaking, looking at other drugs both legal and illegal, it comes off as being the least harmful in different surveys and across different countries. We believe that the conditions should be tightly controlled and that when taken for a clinical reason, it should be administered in a health care setting, monitored by a person trained for that situation.”

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One Dose Of Psilocybin Improved Neural Connections Lost In Depression, Study Says

By Joseph Guzman, July 6, 2021

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The psychedelic psilocybin mushroom has shown promise in treating depression, and a number of clinical trials into the fungus’s therapeutic effects have been conducted in recent years.

But now, a Yale University study published in the peer reviewed professional journal Neuron July 5, 2021, has shed light on how the compound psilocybin —the active ingredient found in so-called “magic mushrooms” — may produce antidepressant effects.

Researchers administered a single dose of psilocybin to mice and used a laser-scanning microscope to visualize dendritic spines in the rodents’ brains in high resolution. Dendritic spines are small protrusions found on nerve cells that play a key role in transmitting information between neurons. Previous laboratory experiments demonstrated promise that psilocybin, and the anesthetic ketamine, could decrease depression.

Stress and depression degrade and reduce the number of neuronal connections.

Within 24 hours of the single psychedelic dose, researchers observed an immediate and lasting increase in

Bacon Dangerous? More Than You Probably Wanted To Know.

NOTE TO THE READER: It’s almost impossible to discuss food and its preparation these days without getting into history, and business ethics practices. But before you go off half-cocked, know for a certainty that in NO WAY am I opposed to the consumption of pork, nor of bacon, neither of the flesh of any animal. Presumably, because you’re now more curious, you must read further to more precisely determine what is meant by the headline — especially, and particularly if you enjoy bacon.

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Earlier, I had replied to a friend who complained about having eaten “a cheeseburger for lunch and was tired and sleepy for most of the afternoon.”

My initial thought and response was “carbohydrate-induced somnolence,” and I wrote that “the meat patty was the only source of protein in the meal – if all you had was a cheeseburger. If you had fries with them, [that was] more simple carbs.”

Giving a rather simple analogous explanation, I stated that, “the (most likely highly-processed white) bread: Simple carbs – they burn quickly – like a bottle rocket. Up quick, burns out just as quickly.”

And from there, I wrote further about the addition of cheese on the burger, by writing “Cheese: Most likely “American” which is not genuinely cheese.”

From Cheese.com:
“American cheese is processed cheese made from a blend of milk, milk fats and solids, with other fats and whey protein concentrate. At first, it was made from a mixture of cheeses, more often than not Colby and Cheddar. Since blended cheeses are no longer used, it cannot be legally called “cheese” and has to be labelled as “processed cheese,” “cheese product,” etc. Sometimes, instead of the word cheese, it is called “American slices” or “American singles.” Under the U.S. Code of Federal Regulations, American cheese is a type of pasteurised processed cheese.”

From TasteOfHome.com:
“… it’s not actually cheese—at least, not legally. The FDA calls it “pasteurized processed American cheese product.” In order for a food product to be a true “cheese,” it has to be more than half cheese, which is technically pressed curds of milk. Each slice of American contains less than 51% curds, which means it doesn’t meet the FDA’s standard.”

And, here’s the Code of Federal Regulations on the matter:
Title 21, Volume 2 — 21CFR133.169 — Revised April 1, 2020.
PART 133 — CHEESES AND RELATED CHEESE PRODUCTS

Subpart B – Requirements for Specific Standardized Cheese and Related Products

Sec. 133.169 Pasteurized process cheese.

Food — it’s production, variety, growing, farming, harvesting, preparation, etc. — is an interest of mine, and like many others, I enjoy not only a good meal, but also have an interest in some understanding about the whys and wherefores of a particular dish’s origins — its history — which also give greater, and a more full understanding to us in numerous ways.

Nitrite-free, dry cured, air dried, pork bellies which will become bacon.
Image by The Elliott Homestead.

For example, the simple, almost ubiquitous dish of beans and rice is a fully complemented dish, meaning that it has a full and complete range of proteins. Beans, by themselves have very little protein, and are primarily carbohydrates, and the same holds true for rice – very little protein, and is primarily a carbohydrate. And the proteins that each separate food has – the rice and the beans – are not “complete” proteins, meaning that individually, they do not contain the 9 essential amino acids which are found in “complete” proteins, and which are necessary in order to build and repair protein tissues (muscles) in the body.

Without exception, ALL animal-based food — regardless of the origin/source — contain complete proteins, and that includes eggs, as well as muscle and organ tissue, though it does not include fat. Fat, however, is never found outside the presence of protein. Fats and proteins could be thought of as “kissing cousins,” because they’re ALWAYS found in combination with each other. They are NEVER apart. Where there’s fat, there’s protein. As an example, consider natural peanut butter — that is, peanut butter which only added ingredient is salt. Peanuts and salt SHOULD BE the ONLY ingredients in peanut butter, and technically, as well as legally, they are, but so many other products are mistakenly called “peanut butter” when they’re actually “peanut butter spread” or something else entirely different.

A simple, even cursory, examination of the labels of Jif®, Skippy®, Peter Pan®,  and other brands – including their websites – demonstrates that in the exceeding majority of cases, their most well-known, and most widely-sold products are NOT authentically genuine peanut butter. Each of those, and others’, products labels and websites state that their products are “peanut butter spreads,” rather than being “peanut butter.”

Peter Pan® brand is manufactured and distributed by Conagra Brands, while Jif® is owned by The J.M. Smucker Company, and Skippy® is owned by Hormel Foods, LLC.

The previous citations were necessary in order to understand what follows, to demonstrate that just because people call a thing by some name, the name by which they call it is not necessarily the proper term. A four-legged animal with hooves and horns could be a bull, a boar, a ram, or a buck, and are all males of the species of cattle, hogs, sheep, goats, and deer. But they’re not females.

And while we’re continuing on the topic of food…

I have come to loathe most commercially-available “bacon.”

Why?

Not only does it taste retched, but also because in the classic, traditional sense, it is NOT bacon.

Yes, it comes from a hog – and not always pork bellies – but the method in which it’s made (“processed,” would be a much more accurate term) bears little resemblance to traditional bacon. Modern “bacon” is flash-smoked, pressure-processed with nitrites, salt-cured, and hustled out the factory door just as quickly as possible in order to continue reaping corporate profits for their Wall$treet masters.

See: USDA Food Safety Inspection Service circular, “How is bacon made?” –and– “What are the methods of curing bacon?” –and– “What are nitrosamines and what cooking methods minimize their formation?” –and– “Can bacon be made without the use of nitrite?”:
https://www.fsis.usda.gov/food-safety/safe-food-handling-and-preparation/meat/bacon-and-food-safety

Traditional, original “Old Skool” bacon was/is often smoked in a smokehouse, which not only imparts unique flavor and aroma, but is an important part the preservative curing process – the main intent of which was/is to retard the spoiling process – or turned rancid, the term applied to fats and oils which have spoiled – “spoilage” being oxidation, including discouraging growth of

Child Abuse & Neglect Cost Alabama $3.7B in 2018

Direct economic losses attributable to child abuse and neglect cost the State of Alabama $3.7 billion in 2018, according to a study conducted by The University of Alabama College of Human Environmental Sciences and The University of Alabama Center for Business and Economic Research.

Researchers found that “the tangible cost of child maltreatment (or child abuse and neglect) to the Alabama economy in 2018 is conservatively estimated to be $3.7 billion.”

The report entitled “The Cost of Child Maltreatment to the Alabama Economy” found that figure is the direct cost which the state bears if only the child victims are considered, and does not include associated costs to families (including extended ones) and communities that are known to occur.

The research which was conducted in collaboration with the Alabama Department of Child Abuse and Neglect Prevention and The Children’s Trust Fund, found that cost of lost worker productivity of victims was the single greatest financial cost – $2,629,685,802, while costs to the state child welfare system exceed $281,886,848, and Adult Criminality costs were conservatively found to be $109,469,664.

Child maltreatment causes preventable infant mortality and low birthweight, chronic health and mental health problems, developmental and educational delays, lower work productivity, and higher involvement with the criminal justice system.

The cost to the state is

Alabama GOP Politicians Meddle In Healthcare To Deny Treatment

Should government exercise control over its citizens to the extent that:
a.) Certain types of private health care is illegal;
b.) Certain people are denied care?

Should your neighbors (aka “the government”) have the right to tell you, and/or your family, what you can, or cannot be treated for by a licensed healthcare professional?

Suppose someone said, “Well… I don’t think you need to be treated for

Death and Dying: By the Numbers In America

QUESTION: How many people in the U.S. die each day from overdoses involving PRESCRIPTION opioids?

ANSWER: According to recent data published by the Center for Disease Control (CDC), approximately 41 people/day (14,965) are dying from an overdose involving prescription opioids. This CDC website – https://www.cdc.gov/rxawareness/index.html – provides resources for individuals struggling with opioid drug abuse.

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330,147,087

That’s the estimated population in the United States as of this writing, according to the U.S. Census Bureau’s Population Clock.

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539,320

How To Quickly Vaccinate Everyone

This morning, bright and early around 0300 (that was the timestamp upon it, I was blissfully asleep then), I received an email from a friend and his better half whom are expats in Kitahiroshima on the island prefecture of Hokkaido, in northernmost Japan, near where her parents reside.

He wrote in part that “Vaccinations for coronavirus have started here but only for those with the highest priority (which makes sense).”

In that message, he also included a copy of an email communique from the United States Department of State which read in part, “The United States Government does not plan to provide COVID-19 vaccinations to private U.S. citizens overseas.”

In my reply, I wrote in part,

New International Guidelines For Cannabis In Treating Chronic Pain

New Guidelines Issued on Medical Cannabis for Chronic Pain

International task force shares recommendations for dosing, administering.

by Ryan Basen, Enterprise & Investigative Writer, MedPage
September 13, 2020

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Chronic pain patients can be treated with medical cannabis following one of three protocols based on patient characteristics, according to an international task force at the virtual PAINWeek meeting.

Note the words “NO OPIATES” PROMINENTLY displayed on the label.

Citing limited clinician knowledge about medical cannabis treatment and the opioid crisis, one task force member said the recommendations are timely.

“We as a task force believe it’s extremely important to bring [medical cannabis] to patients,” Alan Bell, MD, of the University of Toronto, told MedPage Today. “Our main focus was to provide directions to clinicians.”

Medical cannabis has been suggested to treat chronic pain, the task force noted, but too many providers still do not utilize it because there has not been accepted guidelines about dosing and administration. Others prescribe medical cannabis without knowing how patients can properly dose.

“There’s a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen,” Bell said.

Led by Arun Bhaskar, MD, of Imperial College Healthcare NHS Trust Pain Management Centre in London, the 20-clinician Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain used a modified Delphi process. Among their recommendations:

• Treat the majority of patients along the “routine” scale. This means

Contradicting Tennessee Governor Bill Lee On Abortion

Bill Lee is the 50th Governor of the State of Tennessee, a Republican, and is serving his first term in office, having been elected in 2018.

Vice President Kamala Harris two days ago Tweeted:
“On the 48th Anniversary of Roe v. Wade, we recommit ourselves to ensuring that everyone has access to care—including reproductive health care—no matter their income, race, zip code, health insurance status, or immigration status.”

On the 48th Anniversary of Roe v. Wade, we recommit ourselves to ensuring that everyone has access to care—including reproductive health care—no matter their income, race, zip code, health insurance status, or immigration status. https://t.co/2CMdjihsXV

— Vice President Kamala Harris (@VP) January 22, 2021

Tennessee Governor Bill Lee included the Vice President’s Tweet with a response of his own:
“Abortion isn’t healthcare.”

Abortion isn’t healthcare. https://t.co/hpHnvw5pso

— Gov. Bill Lee (@GovBillLee) January 22, 2021

I’d like to address this entry to Governor Lee, and to every other person who, for whatever reason, opposes abortion – though opposition to the procedure is mostly religious-based, and that itself presents a Constitutional problem, insofar as our nation is not established upon any religion, and I mean specifically to refer to the “Establishment clause” of the First Amendment. I am NOT going to argue religion, that is for theologians, and I am not making a theological argument.

First, it is a very dangerous precedent to write a law that not only eliminates one’s ability to make an independent, and informed decision (about that, or any other private matter), but mandates that the government tell you (or anyone) what to do in your private life. That is the essence of what is happening with this type of argument. Proponents are: 1.) Forbidding exercise of Constitutional rights and freedom to make a free-will decision, and; 2.) Essentially forcing the pregnant woman to give birth to the child.

Regardless of whether one agrees, or not, that abortion should be discouraged, or even made illegal, the essence of what is happening is that, when government gets involved in a personal, private matter, there is no longer just a woman, and her physician, in that private treatment room, but 535 other people – 435 Representatives, and 100 Senators. And that’s just too many people in one small room.

Whenever government steps in and makes decisions for you, you no longer have freedom, you no longer have liberty. And whether they realize it, or acknowledge it, or not, that’s what the anti-abortion activists want – for government to make your decision, or more accurately, to deny you the ability to make a decision… one with which they disagree with upon religious grounds. Not only is that is the VERY antithesis of so-called “smaller, less intrusive” government (something about which GOP types have clamored about), but it is “Big Brother” government, another thing about which most right-wing, and GOP-type folks complain.

Second, contrary to the claims made by

“Just say ‘NO’” has never worked. Here’s what does.

Freedom.

What a concept, eh?

The very idea that you have a brain, and therefore, can think independently to decide FOR YOURSELF what you want, or ought, to do, continues to frustrate others who think that they know better than you do what personal decisions you should make for yourself!

It’s an adult decision.

Why, it’s nothing short of… LIBERTY!

ENOUGH! of the “Nanny State”!

Take your religion home, and GET IT OUT OF GOVERNMENT!!

Practice it PRIVATELY, with your family, friends, and other like-minded individuals. STOP forcing your PRIVATE religious ethics and morals upon others by writing public laws that mirror your private interpretation of your religion.

Thomas Jefferson wrote a letter to the Danbury Baptists that cited the establishment clause of our nation’s Constitution, which as he wrote, erected a “a wall of separation between Church & State,” or as we now say, between government, and religion.

Religious nuts have been trying to tear it down, ever since.

And they’re STILL TRYING TODAY!

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‘Drug Use For Grown-Ups’ Serves As An Argument For Personal Choice

If you grew up scared of what illicit drugs could do to you — hearing about all the horrors that could befall you from everyone from Nancy Reagan to your parents — the threat may have felt very real: If you actually took a puff off that joint that the kid who slept through math class offered you, it could lead to failed relationships, chronic unemployment, self-destruction.

The shame would outlive you.

But drugs are a more complicated matter than they’ve been made out to be, according to Dr. Carl L. Hart. In his new book Drug Use for Grown-Ups, the Columbia University professor of psychology and psychiatry zealously argues that drug use should be a matter of personal choice — and that, in more cases than not, personal choice can lead to positive outcomes. His positions may seem quite extreme to some but they also, by and large, make a lot of sense — and are backed up by ample research.

A major reason drugs have such a negative public image, Hart asserts, is racism. He notes that after the Civil War, some Chinese railroad construction workers smoked opium and, sometimes, established “opium dens” to do so. Over time, more and more white Americans visited these dens to smoke opium too. That in turn led to broader, bigoted social fear among whites, like, for example, the sentiments captured in H.H. Kane’s 1882 report:

“The practice spread widely…Many women and young girls, as also young men of respectable family, were being induced to visit the dens, where they were ruined morally and otherwise.”

Then there was the post-Civil War use of cocaine among some Black day laborers, something Hart writes was at first encouraged by white employers because of the productivity it could promote. Soon enough, however, articles appeared widely that tried to make a connection between African American cocaine use and criminality. One particularly egregious article in The New York Times in 1914, cited by Hart, even reported that some police in the South “who appreciate the vitality of the cocaine-crazed” were switching to higher-caliber weaponry capable of “greater shocking power for the express purpose of combating ‘the fiend’.”

But horrifying history aside, one of the book’s most eye-opening aspects is its challenge of the long-running association between drugs and addiction. First the basics: Addiction, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM – 5), must be a source of distress for a drug user. It must also interfere with a person’s job, parenting or personal relationships. Other indications of addiction may be

How does the COVID-19 vaccine work? Ask the women who developed it!

Drs Emmanuelle Charpentier-L & Jennifer Doudna-R 2020 Nobel laureates creators of CRISPR gene editing tool

The mRNA vaccine which has been developed first by Moderna, then by Pfizer-BioNTech (Moderna was first to develop a vaccine, first to deliver it to FDA for research, but second receiving approval), and others, is truly amazing and remarkable for many reasons, not the least of which is that it, and the fundamental underlying science behind it – gene editing/splicing – has been made possible in significant, if not whole part, by women.

This is quite possibly the first disease to ever be primarily resolved by the research of female scientists.

A team of 2 women

Should I wash my groceries?

The visible portion of crud which came off after washing in dish washing detergent (Dawn®), and a wee bit of common, unscented household bleach.

Bluntly, hells fucking YES!!

And pandemic goofiness aside, AT ALL TIMES one (meaning YOU, dear reader) should wash fresh produce with a bit of unscented dish washing soap/detergent, and a wee bit of unscented common, household bleach.

No one knows what kind of “cooties,” germs, pathogens, bacteria, and otherwise bad “bugs” – including bug poo – have settled upon fresh produce.

In this example, I washed a bunch of celery, 3 green bell peppers, a bunch of cilantro, several jalapeño peppers, and 2 heads of broccoli.

How did I wash them?

In a basin of cool water I dissolved some Dawn® brand unscented dishwashing detergent/soap, and about a quarter cup of common, unscented household bleach. Suds are NOT necessary.

Simply dissolve the additive ingredients by gently stirring the water. The basin should be at least half full of water.

Place the ingredients/vegetables to be washed

Papa Francesco Writes

Pope Francis: A Crisis Reveals What Is in Our Hearts

To come out of this pandemic better than we went in, we must let ourselves be touched by others’ pain.

By Pope Francis
Pope Francis is the head of the Catholic Church and the bishop of Rome.

November 26, 2020
https://www.nytimes.com/2020/11/26/opinion/pope-francis-covid.html

In this past year of change, my mind and heart have overflowed with people. People I think of and pray for, and sometimes cry with, people with names and faces, people who died without saying goodbye to those they loved, families in difficulty, even going hungry, because there’s no work.

Sometimes, when you think globally, you can be paralyzed: There are so many places of apparently ceaseless conflict; there’s so much suffering and need. I find it helps to focus on concrete situations: You see faces looking for life and love in the reality of each person, of each people. You see hope written in the story of every nation, glorious because it’s a story of daily struggle, of lives broken in self-sacrifice. So rather than overwhelm you, it invites you to ponder and to respond with hope.

Papa Francesco (It.), Pope Francis

These are moments in life that can be ripe for change and conversion. Each of us has had our own “stoppage,” or if we haven’t yet, we will someday: illness, the failure of a marriage or a business, some great disappointment or betrayal. As in the Covid-19 lockdown, those moments generate a tension, a crisis that reveals what is in our hearts.

In every personal “Covid,” so to speak, in every “stoppage,” what is revealed is what needs to change: our lack of internal freedom, the idols we have been serving, the ideologies we have tried to live by, the relationships we have neglected.

When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness. It changed the way I saw life. For months, I didn’t know who I was or whether I would live or die. The doctors had no idea whether I’d make it either. I remember hugging my mother and saying, “Just tell me if I’m going to die.” I was in the second year of training for the priesthood in the diocesan seminary of Buenos Aires.

I remember the date: Aug. 13, 1957. I got taken to a hospital by

Remember: TAKE OUT THE TRASH IN NOVEMBER!

You KNOW things are serious when a majority of physicians, scientists, researchers and others come out against a political leader, especially and particularly the President… when they’ve NEVER DONE IT BEFORE.

America has NOT been made “great again” by our feckless misleader, the Liar in Chief, Donald John Trump.

It’s time to TAKE OUT THE TRASH IN NOVEMBER!

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In an uncharacteristic move, The New England Journal of Medicine recently took a step which they have not since their 1812 founding.

 

A scathing editorial signed by all 34 editors of the publication – physicians, scientists, health researchers, and medical experts – acknowledged that in response to the COVID-19 pandemic, the President and his administration have “taken a crisis and turned it into a tragedy.”

The group minced no words in their scorching criticism of the President and his administration for their abysmal, still-ongoing failures which have claimed at least 212,466 lives, and counting, by writing that “Instead of relying on expertise, the administration has turned to uninformed ‘opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies.”

Solution being carefully poured into a petri dish that sits under a micro scope. A medical scientist wearing glasses can be seen concentrating as he pours from the glass flask. Selective focus.

Noting that physicians and other healthcare professionals face the possibility of lawsuits, and loss of license for such malpractice, they acknowledged that the nation’s solitary recourse for political malfeasance is to vote him out of office, and wrote that, “Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment.”

They cited America’s Trump-led failures and wrote that in comparison to other nations, “We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and

Walking Into The Promised Land With COVID-19

I have maintained from Day One of the emergence of this pandemic back in late December 2019, early January 2020, that there will be a “golden thread” running through it all, and that being, is that we are unwittingly marching into the veritable “promised land” of health, which is longevity, through improved well-being. The lessons learned in this coronavirus pandemic are teaching us, by experience, what we need to know to improve human health, and by extension, longevity.

Dr. Anthony S. Fauci, MD, Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

It will, of course, emerge as a secondary by-product of treatment, and prevention, at the tertiary level. And for that, we can all be grateful.

So, while at present, we (at least the wise ones) are taking every conceivable precaution to prevent contracting the disease, there remain stubbornly stupid individuals whom insist on ignoring science (like the President and many Republicans) and the expert recommendations of those whose life work has revolved around studying infectious disease, the most notable among which is Dr. Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, in Bethesda, Maryland.

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Why Do Some People Weather Coronavirus Infection Unscathed?

August 24, 2020 by Emily Laber-Warren

One of the reasons Covid-19 has spread so swiftly around the globe is that for the first days after infection, people feel healthy. Instead of staying home in bed, they may be out and about, unknowingly passing the virus along. But in addition to these pre-symptomatic patients, the relentless silent spread of this pandemic is also facilitated by a more mysterious group of people: the so-called asymptomatics.

According to various estimates, between 20 and 45 percent of the people who get Covid-19 — and possibly more, according to a recent study from the Centers for Disease Control and Prevention — sail through a coronavirus infection without realizing they ever had it. No fever or chills. No loss of smell or taste. No breathing difficulties. They don’t feel a thing.

Asymptomatic cases are not unique to Covid-19. They occur with the regular flu, and probably also featured in the 1918 pandemic, according to epidemiologist Neil Ferguson of Imperial College London. But scientists aren’t sure why certain people weather Covid-19 unscathed. “That is a tremendous mystery at this point,” says Donald Thea, an infectious disease expert at Boston University’s School of Public Health.

The prevailing theory is that

Russia Announces WORLD’S FIRST COVID-19 Vaccine!

Well… they did it!

Russian coronavirus vaccine – A coronavirus vaccine developed in Russia shows safety, nad causes an antibody response in small human trials, according to research published in Lancet Friday, September 4, 2020.

Sputnik V has won!

So much for Trump’s “Operation Warp Speed.”

Russia has just handed Trump’s hat to him.

Twice.

They have developed TWO different versions of the vaccine.

Here are pertinent excerpts from the research published in The Lancet, the world’s leading, and among the oldest, scientific and medical journal.

“We developed a heterologous COVID-19 vaccine consisting of two components, a recombinant adenovirus type 26 (rAd26) vector and a recombinant adenovirus type 5 (rAd5) vector, both carrying the gene for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein (rAd26-S and rAd5-S). We aimed to assess the safety and immunogenicity of two formulations (frozen and lyophilised) of this vaccine.”

Note the first two words – “We developed.”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31866-3/fulltext#seccestitle10

“In conclusion, these data collectively show that the heterologous vaccine based on rAd26-S and rAd5-S is safe, well tolerated, and does not cause serious adverse events in healthy adult volunteers. The vaccine is highly immunogenic and induces strong humoral and cellular immune responses in 100% of healthy adult volunteers, with antibody titres in vaccinated participants higher than those in convalescent plasma. Unprecedented measures have been taken to develop a COVID-19 vaccine in Russia. Based on our own experience in developing vaccines against Ebola virus disease and MERS, the COVID-19 vaccine has been developed in a short time. Preclinical and clinical studies have been done, which has made it possible to provisionally approve the vaccine under the current

How Can I Keep From Getting COVID-19 ?

Preventing COVID-19 Infection

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Of necessity, the introduction is somewhat wordy, simply because it’s necessary for the purposes of clarification, and understanding the topic, which can be complex to the average layperson. While it is outside the scope of this blog to treat patients, per se, the purpose in sharing this and other information, is to inform of the latest valid scientific findings. Those who read are free to treat themselves as they see fit, as is everyone. Again, the purpose in sharing these findings is to inform. –Ed.

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Among professional scientific, medical, and research cadre the novel coronavirus is properly known as, and is called SARS-CoV-2. Colloquially, it’s known as COVID-19. SARS is the abbreviation for Severe Acute Respiratory Syndrome, while CoV is the abbreviation for coronavirus, thus COVID is shorthand for COronaVIrus Disease, while the number 19 refers to the year in which is was first discovered. If you’re froggy enough, here’s a great read on the nomenclature.

But the point of this entry is not about the name, but about the disease, and more specifically, about preventing the disease.

And suffice it to say, that while there are naysayers who (in some cases) loudly proclaim that COVID-19 is no worse than the flu or (insert your choice of disease here _X_), or that it doesn’t affect (_X_ – insert your choice of category people group(s), young, old, middle-aged, people who live in the tropics, in Scandinavia, etc.), none of the bizarre comments or nonsensical off-the-wall “justifications” such naysayers use, none of it’s true.

Remember: Despite the unambiguously incontrovertible and overwhelming evidence that the Earth is shaped like a ball, there are some who insist that the Earth is flat.

Point being, is that there will likely always be nut cases in the world, and practically nothing that anyone says or does will change their warped, demented minds… which are like concrete – thoroughly mixed, and permanently set.

When used in the scientific medical sense, the word “novel” means new. So this coronavirus is a new type of coronavirus, meaning one which has never been seen before.

Again, not to go off the deep end (for there are plenty of people who do), but simply because a virus is new, doesn’t mean that it was “man-made” or that it was an existing virus which became “weaponized.” To make such preposterously absurd claims is not only ignorantly stupid, it is false, simply because humanity does not know everything about anything, much less everything about everything. There are plenty of things in the world that we do not know about, and there are principles in the world about which we do not now know. And in fact, there are more things about which we know little, or nothing, than there are things about which we do know.

Again, point being, is that humans aren’t “know-it-alls,” and to claim that we know practically anything the novel coronavirus is false, because we do not. Hell… we don’t even know how to treat it! The only thing we’re doing now is treating symptoms. We do the exact same thing with the common cold, for which we also have no cure, and no vaccine to prevent it.

And as regarding prevention – an ounce of which is worth a pound of cure (as the saying goes) – the only thing we can do now with the coronavirus is to MECHANICALLY prevent its spread, simply because (that we now know of) we have no ability to prevent it with a vaccine. And to be certain, when we say “mechanically” prevent its spread, we mean by physical means, by actions, not by medicine.

And that is precisely why the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and other public health groups have recommended maintaining a distance of 6 feet from others while in public (aka “social distancing”), wearing a face & nose covering (mask), disposable gloves, avoiding groups of people, minimizing public outings to as great an extent as possible, along with increased hand-washing, surface cleanings (disinfecting), etc.

Because we have learned that people infected with the novel coronavirus are at least 30-50% asymptomatic (meaning that they show NO signs or symptoms of infection, not even one – which also means temperature checks at certain public places are therefore effectively USELESS at preventing spread), it is critically important to maintain the physical (mechanical) precautions (preventions) at all times when out in public.

And, because 30-50% of all persons infected with COVID-19 are asymptomatic (they do NOT show even one sign or symptom of infection), that is why 100% testing of ALL people (aka “universal testing”) is critically important.

Again, EVERYONE is on a “learning curve” with the novel coronavirus, and that means EVERYONE – all scientists, all physicians, all nurses, all researchers… EVERYONE. So no one knows it all.

Now, let’s move along toward treatment.

We’re working our way toward the topic – unlike some, or even many articles, which say nothing of any value about anything. Such articles are like saying “how to lower the death rate – prevent drowning in bath tubs,” and then talking about building and installing tubs, why you should take a shower, and how expensive it is to operate swimming pools. Utter nonsense.

So, as we know, the only thing that we can do now is treat the symptoms of COVID-19 infection. And when it comes to treating the symptoms, if the symptoms are severe enough, someone will likely be in hospital, rather than at home. Thus, they’re pretty sick. And if they’re in an ICU (Intensive Care Unit), they’re really sick. And if they’re on a ventilator, they’re seriously critically sick. So there are levels of sickness with this, and other diseases, and the severity of sickness is determined by several factors, including how many signs and symptoms are being experienced (exhibited), and how much those symptoms are interfering with their ability to maintain homeostasis – our bodies’ innate ability to maintain proper function (circulate oxygenated blood, maintain proper operating temperature, utilize nutrients in food, and excrete waste by-products from digestion).

The human body is a series of complex mechanisms, all of which work together in harmony with other body systems to continue and maintain life (homeostasis).

What we do know about the more severe cases of COVID-19, is that it affects the lungs. We’re learning also that it quite likely affects other body systems, and may also have long-term implications, but the most notable, and most immediately life-threatening, is the damage done to the lungs.

We know also that COVID-19 is characterized by inflammation of the lungs, which is, in effect, a proper response mechanism of the body gone haywire. Imagine, if you will, a huge firetruck – even the whole Fire Department – responding to a small backyard barbecue fire which is nothing more than a flare-up, and easily (and most often) extinguished by you, the cook, or someone else. No drastic measures are required.

But, imagine if, in response to

Readily Available Vaccine Shows Ability To Prevent COVID-19

There Are NOW Positive Findings In COVID-19 Prevention!

While it has been reported, it has not been reported widely enough, per se, insofar as it hasn’t been picked up and reported widely enough by the MSM (MainStream Media).

And what might that good news be?

The MMR (Measles Mumps Rubella) vaccine seems to confer some ability to prevent COVID-19 infection.

Read the scientific data for yourself as follows.

And there are a couple stories about the findings (also listed below), through again, they were not widely reported.

MMR Vaccine Appears to Confer Strong Protection from COVID-19: Few Deaths from SARS-CoV-2 in Highly Vaccinated Populations

COVID-19 is MUCH MORE HARMFUL than we imagined.

Based upon the peculiarities which we were observing – a high rate of asymptomatic infected carriers, loss of senses of taste and smell, etc. – I STRONGLY suspected that this virus was a VERY BAD “player,” and NOT one to be trifled with.

Turns out, my suspicions were warranted.

I have ALSO said that, when we find a treatment and/or cure and/or vaccination, and have emerged on the “other side” of this universal, global health crisis, we will have unknowingly embarked upon a journey into healthcare’s “holy grail” and begun to journey into the “promised land” of longevity and a greater understanding of life itself – at the “granular” molecular level.

Yesterday also, I was considering the peculiar, and characteristic, identifying hallmark of the associated phenomenon of loss of senses of taste and smell.

Where does that occur?

On Old Olympus’ Towering Tops A Finn And German Viewed Some Hops

Remind me again, please…

Where do viruses reside?

Varicella, herpes (zoster, etc.), and other select viruses – including HIV – DO NOT “go away.” They’re the gifts that keep on giving… REGARDLESS of the ability to detect viral load, or not.

It’s in the nerve root.

Chicken pox, when it “goes away” really doesn’t “go away.”
It just takes up residence in the nerve root.
And, when it decides to show up again (express itself), we call it “shingles,” for which we also have a vaccination.

I’m putting money on this one, that it’s much the same way. That it’s a permanent “gift.”

There’s no other rational explanation for WHY the loss of senses of taste and smell occur, is there?

Why not?

Is it not self-evident?

Senses occur though nerves.

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https://www.latimes.com/science/story/2020-06-26/inside-the-body-the-coronavirus-is-even-more-sinister-than-scientists-had-realized

Inside the body, the coronavirus is even more sinister than scientists had realized

An electron microscopy image of a cell infected by the coronavirus that causes COVID-19. (UC San Francisco)

By Melissa Healy, Staff Writer
Friday, June 26, 2020

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The new coronavirus’ reputation for messing with scientists’ assumptions has taken a truly creepy turn.

Researchers exploring the interaction between the coronavirus and its hosts have discovered that when the SARS-CoV-2 virus infects a human cell, it sets off a ghoulish transformation. Obeying instructions from the virus, the newly infected cell sprouts multi-pronged tentacles studded with viral particles.

These disfigured zombie cells appear to be using those streaming filaments, or filopodia, to reach still-healthy neighboring cells. The protuberances appear to bore into the cells’ bodies and inject their viral venom directly into those cells’ genetic command centers — thus creating another zombie.

The authors of the new study, an international team led by researchers at UC San Francisco, say the coronavirus appears to be using these newly sprouted dendrites to boost its efficiency in capturing new cells and establishing infection in its human victims.

Their research was published Friday in the journal Cell.

The scientists also

Stupid White Republicans

U.S. Sets Daily Record For New COVID-19 Cases : Coronavirus Live Updates – https://www.npr.org/sections/coronavirus-live-updates/2020/06/26/883799638/u-s-sets-daily-record-for-new-covid-19-cases

Stupid Republicans.

Seriously stupid.

Stupid White people.

And seriously, White people.

Does it come with the territory?

Republican Whiteness, and Stupidity, that is.

It sure as hell seems like it.

If not stupidity, then selfishness.

Or maybe it’s both – stupid –and– selfish.

It’s obviously Republican.

I’ve not yet seen any images – still, or video – of Black folks out protesting that their (or any) barbershops oughta’ be forced to reopen, that their (or any) restaurants oughta’ be forced to reopen, that their (or any) favorite (_fill_in_the_blank_) ought to be forced to reopen, etc.

But I’ve sure seen a whole lotta’ images of White folks doing stupid stuff like that… and very publicly making general asses of themselves in the process – including openly brandishing loaded assault rifles and other dangerous weapons in state’s capitols and in other headquarters of civil governance.

I mean, there SERIOUSLY doesn’t seem to be any Democrats, or Independent voters doing stuff like that.

Of course, ALL of that is done while utterly refusing to

What Percentage of Americans Have Been Tested for COVID-19?

8,709,630

That’s how many Americas have been tested for COVID-19.
(As of Saturday, 9May2020; as of Sunday, 10May2020 the figure is 8,987,524 – an increase of 277,894, or 3.1906%. At that rate, it’d take 1,187.5031 days, or 3.25 years, to test every American.)

330,000,000

That’s how many Americans there are.
(The U.S. Census Bureau’s Population Clock reports 1 birth every 9 seconds, and 1 death every 12 seconds, and 1 immigrant every 47 seconds, with a net gain of 1 person every 19 seconds, making the rolling total 329,632,650… and counting).

0.026392818181818

That’s the percentage of Americans who have been tested.
(As of Saturday, 9May2020; as of Sunday, 10May2020 the figure is 0.027234921212121, or 2.72349% – an increase of 0.0842103030303%, or almost 1/10th of 1%.)

2.6392%.

United States
1,329,203 ÷ 330,000,000 = 0.004027887878788
Reported Infections ÷ Population = per capita Infection Rate
0.004027887878788 × 100,000 = 402.7887, or 403 per 100,000.

Spain population = 48,614,528
COVID-19 cases = 224,350
Infection Rate =

French Scientists Discover COVID-19 In December 2019 BEFORE The China Outbreak

This information, which was reported just yesterday (Monday, 4 May 2020), is turning the entire understanding of this disease on its ear.

Previously thought to have originated in China, COVID-19 is now thought to have been spreading globally long before the outbreak in Wuhan, China ever occurred.

An interesting observation:
This individual –and– “Patient Zero” in Wuhan were BOTH fishmongers.

A germane question:
Could this virus be related to, or capable of being transmitted in aquatic wildlife?

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Who: 42 year old man born in Algeria, lived in France for many years, worked as fishmonger

What: retrospective investigation for SARS-COV2 (novel coronavirus, aka COVID-19) in respiratory samples collected

Where: intensive care units (ICUs) of hospital north of Paris, France

When: December 27, 2019

Why: Presented to emergency ward with hemoptysis (coughing up blood/bloody sputum), cough, headache and fever, evolving for 4 days

How: RT-PCR test (reverse transcription-polymerase chain reaction) the most sensitive technique for mRNA (genetic) detection and quantitation currently available

Additional Facts: Last trip was in Algeria during August 2019. One of his children presented with ILI (influenza-like illness) prior to the onset of his symptoms. His medical history included asthma, type II diabetes mellitus. Had not visited China.

See also: COVID-19 in France since December, hospital test suggests
Researchers testing old samples found COVID-19 in a man treated a month before France confirmed its first cases.
(https://www.aljazeera.com/news/2020/05/covid-19-france-december-hospital-test-suggests-200504154024084.html)

See also: French hospital discovers Covid-19 case from December
Man found to have had virus a month before government confirmed first cases
(https://www.theguardian.com/world/2020/may/04/french-hospital-discovers-covid-19-case-december-retested)

See also: After retesting samples, French hospital discovers COVID-19 case from December
(https://www.reuters.com/article/us-health-coronavirus-france/after-retesting-samples-french-hospital-discovers-covid-19-case-from-december-idUSKBN22G20L)

See also: French hospital discovers country’s first known Covid-19 case, from December
A French hospital which has retested old samples from pneumonia patients discovered that it treated a man who had Covid-19 as early as Dec. 27, nearly a month before the French government confirmed its first cases.
(https://www.france24.com/en/20200505-france-s-first-known-covid-19-case-was-in-december)

See also: After Retesting Samples, French Hospital Discovers COVID-19 Case From December
(https://www.nytimes.com/reuters/2020/05/04/world/europe/04reuters-health-coronavirus-france.html)

See also: Genetic Study Shows COVID-19 Was in France Weeks Before The First Case Was Reported
(https://www.sciencealert.com/genetic-investigation-reveals-covid-19-was-circulating-in-europe-before-cases-were-reported)

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International Journal of Antimicrobial Agents

Available online 3 May 2020, 106006

In Press, Journal Pre-proof
https://doi.org/10.1016/j.ijantimicag.2020.106006
https://www.sciencedirect.com/science/article/pii/S0924857920301643#fig0002

Highlights

• Covid-19 was already spreading in France in late December 2019, a month before the official first cases in the country.

• Early community spreading changes our knowledge of covid-19 epidemic.

• This new case changes our understanding of the epidemic and modeling studies should adjust to this new data.

Abstract

The COVID-19 epidemic is believed to have started in late January 2020 in France. We report here a case of a patient hospitalized in December 2019 in our intensive care, of our hospital in the north of Paris, for hemoptysis with no etiological diagnosis and for which RT-PCR was performed retrospectively on the stored respiratory sample which confirmed the diagnosis of COVID-19 infection. Based on this result, it appears that the COVID-19 epidemic started much earlier.

SARS-COV-2 was already spreading in France in late December 2019

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Introduction

After its onset in December 2019 in China, the new coronavirus (SARS-COV-2) spreads widely in several countries, causing COVID-19 illness.¹ World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020.³ France reported the first cases of SARS-COV-2 related infection on January 24, 2020.⁵ Both cases had a history of travel to Wuhan.⁶ To the best of our knowledge, these 2 cases are believed to be the first confirmed cases in France. COVID-19 most commonly present with influenza-like illness (ILI).⁷ While China was facing COVID-19 outbreak, European countries were struggling with seasonal influenza.⁸ Clinical symptomatology between COVID-19 and ILIis similar,we therefore decided retrospectively to look for SARS-COV2 in respiratory samples collected in the intensive care units (ICUs) of our hospital near Paris.

Methods – Retrospective analysis

Selected records

We reviewed medical record of ICUs patients admitted for ILI between December 2, 2019 and January 16, 2020, with a negative RT-PCR performed at admission. Every respiratory sample collected in our hospital are

Mayo Clinic to have COVID-19 Antibody Test by Monday

“How can I know if I’m FULLY recovered from COVID-19 novel coronavirus?” is a question that gets asked by many, particularly by those who have been infected by COVID-19.

Unfortunately – to this point, at least – the answer to that question has been “We don’t know.”

Fortunately, however, researchers have rapidly doubled-down on their research, intensified their efforts, and are becoming fruitful.

Here’s a brief story about one such effort.

MPRNews.org

Mayo Clinic expects COVID-19 antibody test to be ready Monday

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Mayo Clinic Expects COVID-19 Antibody Test To Be Ready Monday

Pedestrians cross the street as they leave Mayo Clinic’s Gonda Building in Rochester, Minn., in 2016. Mayo researchers say they’re close to releasing tests that would tell whether a person has had and recovered from COVID-19.Alex Kolyer for MPR News file (Minnesota Public Radio)

Researchers at Mayo Clinic expect to release a test that would tell whether a person has had and recovered from COVID-19 on Monday. The Minneapolis Star Tribune reports the University of Minnesota is also narrowing in on an antibody test.

The tests would help public health officials understand the scope of the outbreak and identify people who could safely be in public to help with relief efforts. They would also help in an effort to treat critical COVID-19 patients with plasma from individuals who have recovered.

Elitza Theel is director of the Mayo Clinic lab testing COVID-19 antibody tests. She spoke with MPR News host Tom Crann Wednesday.

You can listen to the interview by clicking on the audio player above, or read the transcript below, which has been edited lightly for clarity and length.

Q: Tell us first, what is an antibody?

A: Antibodies essentially recognize the virus and can help inactivate and kill it.

It’s important to know that these types of tests are different than all of the molecular tests that are being done off of nasal swabs or throat swabs. Those tests detect viral genetic material [to show whether the coronavirus has infected that person].

These [blood serum] antibody tests are detecting a person’s immune response to that virus. It takes, in some cases, 10 to 11 days for a person to mount an immune response and produce these antibodies, so these tests aren’t going to be used as a diagnostic in patients that are presenting with two or three days of symptoms.

Q: Tell us how soon they’ll be ready

A: At Mayo, we hope to have it available as early as next week. We will be doing kind of a slow roll out because, similar to the situation with molecular tests, there’s a limited supply of these tests. We’re hoping that commercial manufacturers will ramp up here in the next few weeks so that we can make it available much more widely.

Q: Then it can go straight to to doctors, public health departments, or is FDA approval needed? How does that work?

A: FDA approval is not needed at this time. However, laboratories that are offering these tests have to go through a very rigorous verification process to make sure that the tests they’re offering provide the right results.

Clinicians will be able to order this in individuals who they think having are a result for would be helpful to either guide return to work [decisions] or further quarantining.

Also, you may have heard about the convalescent plasma treatment trials. As we wait for antivirals and vaccines to be developed and deployed, we need some sort of bridging therapy. So, the idea here is to identify individuals who have recovered from COVID-19, collect their plasma, make sure that it has the antibodies, and then use that plasma to treat acutely ill patients. We’re basically providing somebody else’s antibodies to ill patients who maybe don’t have an immune response mounted yet, and these antibodies would essentially help to fight off the virus.

Q: How close are we on plasma treatment?

A: Clinical trials are starting very soon, both here at Mayo Clinic as well as many other locations across the U.S.

Q: Why is it important to have this information about how many people have been infected, even if they are recovered?

A: There’s a couple of reasons. One, we know there’s a significant number of individuals who have been infected without symptoms. So, knowing the true number, the true denominator of individuals who have been infected with COVID-19, would allow us to determine the true case fatality rate. And then the other reason this is important is identifying when, as a community, as a region, as a nation, we’ve reached herd immunity status.

How can I know if I’m FULLY recovered from COVID-19 novel coronavirus?

We were discussing this – how to determine if someone is fully recovered – just moments earlier BEFORE I happened upon this news item.

—//—

https://www.mprnews.org/story/2020/04/01/mayo-clinic-expects-covid19-antibody-test-to-be-ready-monday

“Researchers at Mayo Clinic expect to release a test that would tell whether a person has

“Good morning, America! How are you?”

“Good morning, America! How are you?”

“Don’t you know me? I’m your native son.”

So goes the introductory portion of the bridge lyric to “City of New Orleans,” a song first popularized by Arlo Guthrie in 1972, and later, by Willie Nelson in 1984, though it was written and first recorded in 1971 by Steve Goodman.

If America could answer, she’d most probably say, “I’m sick right now with COVID-19 novel coronavirus.”

And, indeed, as of this Monday morning, 30 March 2020, at 0700, there are 143,055 confirmed cases in the United States, while there are 735,560 globally.

Yesterday evening, I had written that, “at the current rate of

COVID-19: Death Warmed Over

Frontispiece from Bernardino Genga’s “Anatomia per uso et intelligenza del disengno…”, 1691,
via National Library of Medicine #2353013R

It’s 2020, Sunday, 29 March 2020, and there are now 142,106 CONFIRMED cases of COVID-19 novel coronavirus in the United States.

This morning at 0811, there were “124,686 ACTIVE cases of COVID-19 novel coronavirus.”

That’s a 17,420 difference, or an increase of 13.971095% in 12 hours. (Might as well call it 14%.)

Put another way, it’s an increase of 1.1666% every hour.

Extrapolating, at the current rate of 14% in a 12-hour period, tomorrow morning at 0800, there’ll be an additional

USA’s COVID-19 Case Numbers Going Through The Roof… By The HOUR!

JHU COVID-19 dashboard

It’s almost been 12 hours since I wrote this morning’s entry “America: Very nearly 105,000 COVID-19 cases… and INCREASING” (published 0800), and as I’m now writing, it is 1845.

The Johns Hopkins COVID-19 dashboard now shows that in the United States, there are presently 121,478 ACTIVE CONFIRMED cases of COVID-19 novel coronavirus.

This morning, Saturday, 28 March, I had written that, “If that pattern continues to hold, we could expect to see at least 127,902 cases by Sunday, 29 March 2020.”

It appears that we’ll surpass that long before the dawn of the next day.

The difference between the 2 figures is a 15.8732% INCREASE… and we STILL have 12 more hours to go to make it to 127,902 – a 21.9162% INCREASE – by

10 GOOD Things COVID-19 Will Cause.

Every period of change in human history has been preceded by chaos and upheaval.

COVID-19 novel coronavirus is exposing our weaknesses, our strengths, where changes are needed and must occur, and where we are performing well.

This illustration reveals ultrastructural morphology exhibited by the COVID-19 novel coronavirus. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion, when viewed electron microscopically. Image credit: CDC.

There will be positive outcomes, of course, one of which will be that it is no longer necessary for some people to assemble, or congregate in one place to work. It is being proven that work which can be performed remotely, i.e., from one’s residence, will be increasingly utilized, and that will be a net positive outcome in several ways.

Here’s a list of…

10 GOOD Things COVID-19 Will Cause.

• One, it will reduce going-to, and coming-from work-related commuting traffic volume.

• Two, it will increase employee satisfaction, insofar as one will not fight traffic in order to get to work, or home from work.

• Three, because fewer automobiles will be on the roadway, it will reduce automobile emissions, and therefore yield an environmentally net positive result.

• Four, because traffic will be reduced, navigation will be

Republican Coronavirus Bullshittery Abounds

Lawmakers’ Stock Trades and Other Virus Outrages

Some lawmakers have a lot of explaining to do. Plus, punishing poor people and shaping up the cruise-ship industry.

By Joe Nocera 3/20/2020, 10:47:09 AM

Joe Nocera is a Bloomberg Opinion columnist covering business. He has written business columns for Esquire, GQ and the New York Times, and is the former editorial director of Fortune. His latest project is the Bloomberg-Wondery podcast “The Shrink Next Door.”

————
Of the many things taking place in Washington that make your blood boil, the — how should I put this? — timely stock trades by senators during the coronavirus outbreak has to go right to the top of the list. Two of them have tried to explain them away, but the details are just so… suspicious.

At least three Republicans and one Democrat 1 sold stock before the country got serious about Covid-19, but let’s focus on one: Kelly Loeffler.

A Republican from Georgia, Loeffler has been in the Senate for less than three months; she was appointed to fill the seat of Senator Johnny Isakson, who retired early for health reasons. She has a Wall Street background — she was in investor relations at the New York Stock Exchange, where she married the boss, Jeffrey Sprecher, the Chief Executive Cfficer of Intercontinental Exchange Inc., which owns NYSE

On Jan. 24, Loeffler attended a Senate briefing on the coronavirus, which she tweeted about. That same day, she and her husband began selling stock. By the time they were finished, they had dumped 27 companies, including Exxon Mobil and AutoZone, saving millions of dollars when the market later tanked. (Senate financial disclosure forms don’t give exact numbers.)

A month later, she sent out this tweet:

Dear Millennials, YES, you TOO can get sick… VERY sick!

Don’t think COVID-19 novel coronavirus can’t affect you.

It can.

The Centers for Disease Control and Prevention has said that 705 of the first 2,500 cases of COVID-19 novel coronavirus in the United States were ages 20-44, 15-20% of which were hospitalized, with at least 4% needing stays in Intensive Care Units. And there were a few deaths.

In Italy, 25% of that nation’s coronavirus victims were/are aged 19-50 – with a very nearly equal distribution between the two other major age categories 51-70, and 71+.

Clement Chow, Assistant Professor of Genetics at the University of Utah is one example of a young person getting VERY SICK and requiring hospitalization in an ICU.

In a series of Tweets on March 15, 2020, he wrote in part:

“I’m young and not high risk, yet I am in the ICU with a very severe case. We really don’t

Questions & Answers About Cannabis

NOTE: The more frequently, regularly updated version of this entry is found on the front page of this blog, which is linked here:
https://warmsouthernbreeze.wordpress.com/questions-answers-about-cannabis/

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Updated Tuesday, 26 October 2021

Effort is made to update this page regularly.

While the intended audience for these Q’s & A’s is meant primarily for medical, and healthcare science professionals, they may still be of some interest, or use, by others –– particularly for those who do not know that there is legitimate science behind the use, and recommendation of cannabis in various therapies.

From Franz Eugen Köhler’s Medizinal-Pflantzen. Published and copyrighted by Gera-Untermhaus, FE Köhler in 1887 (1883–1914). Hemp plant. A–flowering male and B–seed-bearing female plant, actual size; 1-male flower, enlarged detail; 2&3-pollen sac of same from various angles; 4-pollen grain of same; 5-female flower with cover petal; 6-female flower, cover petal removed; 7-female fruit cluster, longitudinal section; 8-fruit with cover petal; 9-same without cover petal; 10-same; 11-same in cross-section; 12-same in longitudinal section; 13-seed without hull.

So in that sense, enjoy!

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QUESTION: How should a clinician monitor the outcome of cannabinoid-based therapy?

ANSWER: As suggested by the Australian Centre for Cannabinoid Clinical and Research Excellence, monitoring should initially involve reviewing the patient weekly in person, and via phone if required in the interim between clinical reviews.
“There are three areas of outcomes that should be considered:
1.) Symptom control
“A pre-defined measure of success should be negotiated with the patient prior to commencement of therapy. This can be measured by using a validated tool, for example by the Palliative Care Symptom Assessment Scale.”
2.) Drug adverse events
“Careful monitoring of patients for adverse events and the need for a change in dosage is important. Adverse events may become apparent after commencement or after change in dose… Adverse events may be related to other concurrent medications. Doses of these medicines should be adjusted as appropriate.”
3.) Pathology monitoring
“Drug concentrations of drugs where there is a potential or actual drug-drug interaction may be important. Cannabidiol may cause hepatocellular injury. Patient’s liver function biochemistry should be monitored prior to initiation and periodically as clinically indicated.“

reference: Prescribing Cannabis Medicines for Chronic Non-cancer Pain v2 September 2019 c10. – by the Australian Centre for Cannabinoid Clinical and research Excellence https://www.ces.edu.co/wp-content/uploads/2020/09/acre-prescribing-guidance-chronic-non-cancer-pain.pdf

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QUESTION: Some patients use cannabinoid-based medicines to treat nausea and vomiting. Is one of the side effects of cannabinoid-based medicines nausea/ vomiting?

ANSWER: Yes. The adverse event profile of cannabinoid-based formulations is dependent upon the ratio of CBD:THC, the presence of other cannabinoids and terpenes, and the dose consumed. The known common adverse effects of cannabinoid-based medicines include sedation/somnolence, dizziness, anxiety, cognitive dysfunction, nausea, vomiting, diarrhea, vertigo, increased or decreased appetite and dry mouth.

reference: “Brenneisen R, Egli A, ElSohly MA, Henn V, Spiess Y. The effect of orally and rectally administered delta9-tetrahydrocannabinol on spasticity: a pilot study with 2 patients. Int. J. Clin. Pharmacol. Ther. 1996 Oct;34(10)446-52. https://pubmed.ncbi.nlm.nih.gov/8897084/

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QUESTION: Even if an individual employs the same mode of administration over time, the effects of cannabinoids may change for that individual. Provide some reasons why this may be so.

ANSWER: The effects of cannabinoids may change over time due to multiple factors, including:
• Tolerance to the cannabinoids may develop
• A change in the patient’s health status/ medical condition may change over time and lead to physiological changes in the endocannabinoid system (For example, inflammation impacts the ECS. Also, impaired G.I./liver function affects the absorption and metabolism of cannabinoids.)
• The patient may start or stop taking a medication that interacts with cannabinoids or affects the metabolism of the cannabinoid-based product.
• Physiologic changes in the endocannabinoid system take place as patients age.

reference: Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02 Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/

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QUESTION: The effects of cannabinoids are dependent upon the route of administration, the health of the consumer and other factors. There is also interindividual variation. Provide some reasons why the effects of cannabinoids vary among individuals.

ANSWER: There are many reasons why the effects of cannabinoids vary among individuals. SOME of the reasons are: diet, age, health of the patient, and co-administered medications may impact metabolism and efficacy of cannabinoid-based products. Also, some patients have a genetic profile such that they are predisposed to experience side effects (for ex., exacerbation of a psychotic disorder/schizophrenia) after exposure to THC. In addition, patients that have been consuming cannabinoid-based products long-term react differently than patients who have never consumed cannabinoid-based products.

reference: Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02 Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/

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QUESTION: How should the cannabinoid-based therapy be withdrawn?

ANSWER: According to the Health Canada document entitled “Information for Health Care Professionals – Cannabis (marihuana, marijuana) and the Cannabinoids,” “If intolerable adverse effects appear without significant benefit, dosing should be tapered and stopped. Tapering guidelines have not been published, but the existence of a withdrawal syndrome suggests that tapering should be done slowly (i.e. over several days or weeks).” Note: When discontinuing cannabidiol therapies used for the treatment of seizure disorders, the dose should be decreased gradually. As with all antiepileptic drugs, abrupt discontinuation should be avoided when possible, to minimize the potential risk of increased seizure frequency and status epilepticus.

reference: Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02. Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/

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QUESTION: What is the half life of CBD? How does it compare to the half life of THC?

ANSWER: The half life of CBD is 18-32 hours, which is similar to the half life of THC of 20-30 hours. Both CBD and THC are distributed to fatty tissues and highly perfused organs such as brain, heart, lung, and liver.

reference: Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association. Robert L. Page II , Larry A. Allen , Robert A. Kloner , Colin R. Carriker, Catherine Martel , Alanna A. Morris , Mariann R. Piano , Jamal S. Rana , Jorge F. Saucedo , … See all authors. Originally published 5 Aug 2020. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000883

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QUESTION: What are some of the more common reasons dermatologists recommend cannabinoid-based medicines?

ANSWER: According to the results of a survey of 145 dermatologists, 91 % of dermatologists were in support of medical cannabis use and 13.8 % have recommended it for a dermatologic condition. Atopic dermatitis (45 %) and psoriasis (40 %) were the most common. The most common form of administration was topical (75 %). The main reasons for not recommending medical cannabis were limited knowledge (56 %) and lack of experience (48 %).

reference: Perceptions and recommendation behaviors of dermatologists for medical cannabis: A pilot survey. Samuel Yeroushalmi, Kamaria Nelson, AndrewSparks, AdamFriedman. https://pubmed.ncbi.nlm.nih.gov/33220620/

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QUESTION: Has the use of a transdermal gel for regional and systemic delivery of CBD been evaluated for the treatment of epilepsy?

ANSWER: Yes. A transdermal gel for regional and systemic delivery of CBD (Zynerba Pharmaceuticals) is in clinical development for treatment of epilepsy, developmental and epileptic encephalopathy, fragile-X syndrome, and osteoarthritis. NOTE: As of September 2021, the company’s website indicates that the product is not yet approved by government regulatory bodies, including the United States Food and Drug Administration (FDA) and other agencies, and must be tested to see if it is an effective and safe treatment.

reference: A Review of the Safety and Effectiveness of Select Ingredients in Compounded Topical Pain Creams.” National Academies of Sciences, Engineering, and Medicine. 2020. Compounded Topical Pain Creams: Review of Select Ingredients for Safety, Effectiveness, and Use. Washington, DC: The National Academies Press. https://www.nap.edu/catalog/25689/compounded-topical-pain-creams-review-of-select-ingredients-for-safety

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QUESTION: Have human studies evaluated the effects of cannabinoid consumption on cortisol levels?

ANSWER: Yes – Human studies have demonstrated that the consumption of cannabinoids modulate cortisol release. Acutely, the consumption of cannabis (or THC) by naive or infrequent cannabis users may increase the secretion of cortisol. In chronic cannabis users, the stimulatory effect of THC on cortisol levels is blunted. This blunted response suggests that a tolerance develops. Some studies have reported that chronic cannabis users exhibit elevated basal cortisol levels, but that stress- induced activation of the axis is blunted in chronic adult and adolescent cannabis users.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021. https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Do endocannabinoids impact insulin release?

ANSWER: Yes. Endocannabinoids act in an autocrine and paracrine fashion to mediate the activity of the pancreas and mediate insulin secretion. – It has been shown that endocannabinoids influence basal as well as glucose-induced insulin release. Also, endocannabinoids have been shown to have an effect on β cell proliferation and survival. (Pancreatic β cells are the cells that synthesize and secrete insulin.)

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021. https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Can children with developmental and epileptic encephalopathies tolerate adjunctive cannabidiol (CBD) transdermal gel, and is CBD gel associated with reduced seizure frequency?

ANSWER: Yes, CBD is well tolerated, and is associated with a reduction in seizure activity – frequency and intensity – in children, including improvements in alertness, energy, improved sleep, and in cognition or concentration. According to a JAMA Open Network article published in September 2021, in a “nonrandomized controlled trial, CBD transdermal gel was well tolerated over 6.5 months of treatment, with 60% of patients experiencing a treatment-related adverse event, 96% of which were mild or moderate. A 43.5% reduction in seizure frequency was observed in focal impaired awareness seizures and tonic-clonic seizures.” Also, the researchers stated that “Parents and caregivers noted improvements in social or interpersonal engagement and irritability (33 of 43 [77%] participants); alertness, energy, and sleep (23 of 43 [53%]); and cognition or concentration (20 of 43 [47%]).”

reference: Scheffer IE, Hulihan J, Messenheimer J, et al. Safety and Tolerability of Transdermal Cannabidiol Gel in Children With Developmental and Epileptic Encephalopathies: A Nonrandomized Controlled Trial. JAMA Netw Open. 2021;4(9):e2123930. doi:10.1001/jamanetworkopen.2021.23930 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783716

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QUESTION: What influences chronic pain patients’ use of medical cannabinoids?

ANSWER: The British Medical Journal recently published results of a systematic review that explored values and preferences towards medical cannabis (MC) among people living with chronic pain. The results were as follows: “High to moderate certainty evidence showed that patient’s use of MC for chronic pain was influenced by both positive (eg, support from friends and family) and negative social factors (eg, stigma surrounding cannabis use). Most patients using MC favoured products with balanced ratios of THC and CBD, or high levels of CBD, but not high THC preparations. Many valued the effectiveness of MC for symptom management even when experiencing adverse events related to concentration, memory or fatigue. Reducing use of prescription medication was a motivating factor for use of MC, and concerns regarding addiction, losing control or acting strangely were disincentives. Out-of-pocket costs were a barrier, whereas legalisation of MC improved access and incentivised use.”

reference: Zeng L, Lytvyn L, Wang X, et al Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review BMJ Open 2021;11:e050831. doi: 10.1136/bmjopen-2021-050831. https://bmjopen.bmj.com/content/11/9/e050831#ref-10

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QUESTION: Do cannabinoids affect the male reproduction system?

ANSWER: Yes. Cannabinoid receptors are located in multiple parts of the male reproductive system, including the hypothalamus, pituitary, Leydig cells, and sperm. The binding of cannabinoids to cannabinoid 1 receptors may lead to a reduction in plasma testosterone, LH and FSH.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: How does anandamide’s activation of CB1 receptors on sperm cells impact sperm cells?

ANSWER: Activation of CB1 receptors on sperm by anandamide – a fatty acid neurotransmiter endocannabinoid, or THC, leads to reduction of sperm survival and motility, and inhibition of fertilization capacity by hindering the capacitation-induced acrosome reaction needed to penetrate the zona pellucida.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Marijuana use has been associated with an impairment of spermatogenesis and testicular function. How long will those effects last?

ANSWER: It has been reported that recovery of spermatogenesis and testicular cell function status post exposure to marijuana is approximately about 45 days.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: How do endocannabinoids differ from many other neurotransmitters?

ANSWER: Endocannabinoids are very lipophilic and therefore cannot be stored in vesicles like many other neurotransmitters. The precursors of endocannabinoids are present in lipid membranes and, upon activation of some G-protein coupled receptors, these precursors are released into the extracellular space. Endocannabinoids are synthesized on demand in post-synaptic structures and travel retrograde through the synaptic cleft to cannabinoid type 1 receptors located presynaptically. Activation of cannabinoid type 1 receptors leads to inhibition of neurotransmitter release.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Polycystic ovarian syndrome (PCOS) is a syndrome associated with hyperandrogenism, menstrual irregularities, and polycystic ovaries. Is there any evidence that the endocannabinoid system is involved in the development of PCOS?

ANSWER: Yes. In a human study that evaluated the possibility of a link between the endocannabinoid system and PCOS, the researchers found that the endometrium of PCOS patients exhibited reduced levels of fatty acid amide hydrolase, (the catabolic enzyme for anandamide), compared to women without PCOS. This finding correlated with increased levels of anandamide in patients with PCOS. Also the activation of the ECS and overexpression of CB1 receptors may be associated with insulin resistance in women in PCOS.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021. https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Does marijuana impact platelet function?

ANSWER: Yes. Some cannabinoids have antiplatelet and antithrombogenic effects. However, in some instances marijuana use has been reported to have the opposite effect and promote platelet aggregation.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021. https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Are endocannabinoids hydrophilic or lipophilic?

ANSWER: Endocannabinoids are lipophilic neurotransmitters. They mediate agonist as well as antagonist effects via cannabinoid receptors found in the brain and peripheral nervous system.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: When the endocannabinoid system was originally discovered in the 1990’s, it was described as a neural communication system. Does the endocannabinoid system have functions other than neural communication?

ANSWER: Yes. The endocannabinoid system can be found in almost every cell/ tissue and this system plays an important role in the normal functioning of many organ systems.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: How do exogenous cannabinoids (phytocannabinoids or synthetic cannabinoids) affect physiologic systems like the endocrine system?

ANSWER: Exogenous cannabinoids bind to endogenous cannabinoid receptors in various organs, and may also modulate cannabinoid receptor expression. As a result, exogenous cannabinoids may alter endocannabinoid target effects and organ function.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: True or false? Cannabinoid type 1 receptors are G-protein coupled receptors found in multiple organ systems, including the nervous system, skeletal system, lungs, cardiovascular system, musculoskeletal system, gi tract, and the lymph system, as well as in many endocrine organs, including the hypothalamus, pituitary, thyroid, adrenals, uterus, ovaries, testes, and placenta.

ANSWER: The statement is true, but the density and level of expression of cannabinoid receptors varies in the different organ systems.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: On what cell surfaces are cannabinoid type 2 receptors typically found?

ANSWER: Cannabinoid type 2 receptors, like type 1 receptors, are G-protein coupled receptors; the type 2 receptors are primarily on the surface of the immune system cells, tonsils, the gi tract, bone, and peripheral nerve endings. Expression is highly inducible and is most often expressed when there is active inflammation or injury.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: In some legal states, edibles, such as candies, baked goods, beverages and condiments (butter and oils) containing THC may be sold. Is 2.5mg of THC in an edible a low dose or high dose of THC to be consumed orally?

ANSWER: The dosing of THC always needs to be adjusted on an individual basis. For reference, 2.5 mg is the lowest dose of dronabinol, a synthetic THC that is FDA-approved.

reference: Meehan-Atrash, J., Luo, W., & Strongin, R. M. (2017). Toxicant Formation in Dabbing: The Terpene Story. ACS Omega, 2(9), 6112–6117. https://doi.org/10.1021/acsomega.7b01130

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QUESTION: Does short term treatment with THC rich cannabis induce clinical remission and improve quality of life in patients with mild to moderately active ulcerative colitis?

ANSWER: Yes, according to a recent study. However, these beneficial clinical effects were NOT associated with significant anti-inflammatory improvement in the Mayo endoscopic score or laboratory markers for inflammation. These results were derived from a double-blind, randomized, placebo-controlled trial, – 32 patients received either cigarettes containing 0.5 g of dried cannabis flowers with 80mg THC or placebo cigarettes for 8 weeks. Parameters of disease including Lichtiger disease activity index, C reactive protein (CRP), calprotectin, Mayo endoscopic score and quality of life (QOL) were assessed before, during and after treatment.

reference: Cannabis is associated with clinical but not endoscopic remission in ulcerative colitis: A randomized controlled trial Timna Naftali , Lihi Bar-Lev Schleider, Fabiana Scklerovsky Benjaminov, Fred Meir Konikoff, Shelly Tartakover Matalon, Yehuda Ringel Published: February 11, 2021 https://doi.org/10.1371/journal.pone.0246871

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QUESTION: What are the effects of cannabis-based therapies on oxaliplatin-induced peripheral neuropathy among oncology patients?

ANSWER: The results of a retrospective study indicated that the rate of neuropathy was reduced among patients treated with cannabis-based therapies and oxaliplatin. This reduction was more significant in patients who received cannabis-based products prior to treatment with oxaliplatin, suggesting a protective effect. (A large prospective trial examining the effects of cannabis-based products on oxaliplatin-induced neuropathy is planned.)

reference: Waissengrin B, Mirelman D, Pelles S, et al. Effect of cannabis on oxaliplatin-induced peripheral neuropathy among oncology patients: a retrospective analysis. Theranpeutic Advances in Medical Oncology. January 2021. doi: 10.1177/1758835921990203. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876573/

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QUESTION: The Veterans Health Administration (VHA) abides by the classification of cannabis as a Schedule I substance. Does the VHA prohibit their clinicians from speaking with their patients about cannabis?

ANSWER: No, the VHA recently recommended that clinicians discuss cannabis with their patients. However, according to a study published in February 2021, VHA clinicians identified several factors that inhibit conversations about cannabis use with their patients including the unfamiliarity with pharmacology, formulations, and dosing of cannabis; and uncertainty regarding VHA policy.

reference: Vivian A Christensen, Shannon M Nugent, Chelsea K Ayers, Benjamin J Morasco, Devan Kansagara; A qualitative study of VHA clinicians’ knowledge and perspectives on cannabis for medical purposes; Family Practice, 2021; cmaa151, https://doi.org/10.1093/fampra/cmaa151

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QUESTION: True or false? CBD interacts with transient receptor potential cation channel subfamily V member 1 (TRPV1) receptors.

ANSWER: True. It has been found in rat models of acute inflammation that the vanilloid TRPV1 receptor mediates the antihyperalgesic effect of cannabidiol.

reference: Maguire R.F, Wilkinson D.J., England T.J., O’Sullivan S.E.; The Pharmacological Effects of Plant-Derived versus Synthetic Cannabidiol in Human Cell Lines. Medical Cannabis and Cannabinoids. July 29 2021. https://www.karger.com/Article/Pdf/517120

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QUESTION: True or false? CBD interacts with serotonin 1 A receptors (5HT1A) and impacts cellular activity of some cell lines.

ANSWER: True. In in vitro models, COX-2 and PPAR-γ confer cannabidiol-induced apoptosis of human lung cancer cells.

reference: Ramer R, Heinemann K, Merkord J, Rohde H, Salamon A, Linnebacher M, et al.; COX-2 and PPAR-γ confer cannabidiol-induced apoptosis of human lung cancer cells. Mol Cancer Ther. 2013 Jan 1;12(1):69–82. https://mct.aacrjournals.org/content/12/1/69

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QUESTION: Did the “Stay at Home” orders during COVID lead to a significant decrease in sales of cannabinoid-based products in Alaska, Colorado, Oregon and Washington?

ANSWER: No. Actually, cannabis sales increased in all four states coinciding with state stay-at-home orders, and sales reached a three-year peak in all four states between May and July 2020.

reference: Schauer GL et al. Cannabis sales increases during COVID-19: Findings from Alaska, Colorado, Oregon, and Washington, International J of Drug Pol Vol 98, 2021. https://www.sciencedirect.com/science/article/abs/pii/S0955395921002899

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QUESTION: Are cannabinoid receptors present on skin cells?

ANSWER: Yes. Cannabinoid receptors are present on many types of skin cells, including keratinocytes and fibroblasts. The results of preliminary studies evaluating the effects of cannabis extracts on skin cells indicate that hemp extracts may reduce oxidative stress, inhibit skin aging processes and positively affect the viability of skin cells. Analyses also showed that hydrogels based on cannabis extracts have a positive effect on skin hydration.

reference: Zagórska-Dziok,M.; Bujak, T.; Ziemlewska, A.; Nizioł-Łukaszewska, Z. Positive Effect of Cannabis sativa L. Herb Extracts on Skin Cells and Assessment of Cannabinoid-Based Hydrogels Properties. Molecules 2021, 26, 802. https://www.mdpi.com/1420-3049/26/4/802

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QUESTION: The labels of some probiotic supplements indicate that probiotics support a healthy immune system, strengthen digestive balance, help maintain a balance of healthy intestinal bacteria, help breakdown undigested carbohydrates and sugars, and facilitate the absorption of nutrients. Do cannabis-based edibles exhibit pre-biotic/probiotic properties?

ANSWER: In addition to cannabinoids, flavonoids, terpenoids, and polysaccharides may be present in cannabis-based edibles, and these cannabis constituents may exhibit prebiotic/probiotic properties and improve the composition of the gut microbiome.

reference: Cannabis and Cannabis Edibles: A Review; Han Peng and Fereidoon Shahidi* J. Agric. Food Chem. 2021, XXXX, XXX, XXX-XXX. © 2021 American Chemical Society Publication Date: February 8, 2021 https://doi.org/10.1021/acs.jafc.0c07472

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QUESTION: What is the most common mode of administration of CBD?

ANSWER: According to an online survey conducted in 2017-2018, the most common method of CBD administration was sublingual, followed by vaping, oral ingestion of capsules and liquids, smoking, edibles, and topical administration.

reference: Corroon J, Phillips JA. A cross-sectional study of cannabidiol users. Cannabis Cannabinoid Res 2018; 3(1):152–61. https://pubmed.ncbi.nlm.nih.gov/30014038/

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QUESTION: Does THC have a dose-dependent effect on sleep?

ANSWER: Yes – Human experimental data suggests “THC has a dose-dependent effect on sleep—low doses appear to decrease sleep onset latency and increase slow-wave sleep and total sleep time, while high doses appear to cause sleep disturbances.” Also, “limited evidence from clinical studies also suggest that certain cannabinoids (cannabis, nabilone, dronabinol, nabiximols) may improve sleep in patients with disturbances in sleep associated with certain chronic disease states.”

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: Is there ANY evidence that CBD attenuates the THC-induced psychosis?

ANSWER: Yes – “Emerging evidence from pre-clinical, clinical and epidemiological studies suggests CBD may attenuate THC-induced psychosis.”

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: Efficacy and safety of add-on cannabidiol (CBD) to treat seizures associated with Lennox Gastaut Syndrome (LGS) was demonstrated in two randomized controlled trials (RCTs). Have the long-term effects of CBD use to treat the drug resistant seizures of LGS been evaluated?

ANSWER: Yes. 366 patients enrolled in a long-term open-label extension trial. The results are as follows: “Adverse events (AEs) occurred in 96% of patients, serious AEs in 42%, and AE-related discontinuations in 12%. Common AEs were convulsion (39%), diarrhea (38%), pyrexia (34%), and somnolence (29%). Fifty-five (15%) patients experienced liver transaminase elevations more than three times the upper limit of normal; 40 (73%) were taking concomitant valproic acid. Median percent reductions from baseline ranged 48%–71% for drop seizures and 48%–68% for total seizures through 156 weeks. Across all 12-week visit windows, 87% or more of patients/caregivers reported improvement in the patient’s overall condition on the Subject/Caregiver Global Impression of Change scale.”

reference: Patel, AD, Mazurkiewicz-Bełdzińska, M, Chin, RF, Gil-Nagel, A, Gunning, B, Halford, JJ, et al. Long-term safety and efficacy of add-on cannabidiol in patients with Lennox–Gastaut syndrome: Results of a long-term open-label extension trial. Epilepsia. 2021; 00: 1– 12. https://onlinelibrary.wiley.com/doi/abs/10.1111/epi.17000

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QUESTION: CBD interacts with warfarin. Does this drug:drug interaction lead to an increased risk of bleeding or a decrease in warfarin’s anticoagulation effect?

ANSWER: The inhibition of CYP2C19 by CBD can increase levels of warfarin, and multiple reports have indicated that the interaction between warfarin and CBD results in an increased risk of bleeding.

reference: 1.) Treese NM, Flowers M. Pharmacist’s guide to CBD oil. US Pharm. 2020; 45(3):20-23. https://www.uspharmacist.com/article/pharmacists-guide-to-cbd-oil 2.) Welty TE, Chapman KE, Faught RE, Kotloski RJ. American Epilepsy Society (AES): Written Comments to Norman E. “Ned” Sharpless, MD, Acting Commissioner of Food and Drugs, U.S. Food and Drug Administration (FDA), Department of Health and Human Services (HHS): on Docket ID# FDA-2019-N-1482, Scientific Data and Information about Products Containing Cannabis or Cannabis-Derived Compounds; Public Hearing; Request for Comments: Submitted on: July 16, 2019. Epilepsy Currents 2019; 19(6):361-368. doi:10.1177/1535759719878716. https://journals.sagepub.com/doi/10.1177/1535759719878716

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QUESTION: Have CBD’s effects in monkeys been evaluated?

ANSWER: Yes, according to a World Health Organization Cannabidiol (CBD) report in November 2017, in studies involving the use of CBD in monkeys, no effect on a wide range of physiological and biochemical parameters or significant effects on animal behavior were noted unless extremely high doses of CBD (e.g., in excess of 150 mg/kg iv as an acute dose or in excess of 30 mg/kg orally daily for 90 days) were administered.

reference: World Health Organization (WHO) – Expert Committee on Drug Dependence Thirty-ninth Meeting Cannabidiol (CBD) Pre-Review Report Agenda Item 5.2 Geneva, 6-10 November 2017 See: https://www.who.int/medicines/access/controlled-substances/5.2_CBD.pdf

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QUESTION: PRE-CLINICAL studies show that certain cannabinoids (THC, CBD, THCV, CBDV) and cannabinoid acids (THCA and CBDA) suppress acute nausea and vomiting. Do PRE-CLINICAL studies also show that those same cannabinoids and cannabinoid acids suppress anticipatory nausea?

ANSWER: Yes. In addition, there is limited evidence from CLINICAL studies that suggests that the use of certain cannabinoids and cannabis may provide relief from chemotherapy-induced nausea and vomiting (CINV).

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: Evidence from observational studies and clinical studies suggests that marijuana (limited evidence) and prescription cannabinoids (e.g. dronabinol, nabilone, or nabiximols) may be useful in alleviating one or several co-occurring symptoms often experienced by patients in the palliative care setting. What are some of these palliative care setting symptoms?

ANSWER: These symptoms may include, but are not limited to, intractable nausea and vomiting associated with chemotherapy or radiotherapy, anorexia/cachexia, severe intractable pain, severe depressed mood and anxiety, and insomnia. Also, a limited number of observational studies suggest that the use of cannabinoids in the palliative care setting may be associated with a decrease in the number of some medications used by palliative care patients.

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: Available evidence from human clinical studies suggests that marijuana (limited evidence) and prescription cannabinoid-based medicines (dronabinol) may increase appetite and caloric intake, and promote weight gain in patients with HIV/AIDS. Has the use of cannabinoid-based medicines in cancer or anorexia nervosa been evaluated, too?

ANSWER: Yes. The evidence for dronabinol is mixed and effects modest for patients with cancer and weak for patients with anorexia nervosa.

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: Evidence from PRE-CLINICAL studies suggests THC, CBD and nabiximols improve multiple sclerosis (MS) associated symptoms of tremor, spasticity and inflammation. Has the utility of cannabinoids for MS symptoms been evaluated in CLINICAL STUDIES?

ANSWER: Yes. -the available evidence from CLINICAL studies suggest marijuana (limited evidence) and certain cannabinoids (dronabinol, nabiximols (Sativex), THC/CBD) are associated with some measure of improvement in some MS symptoms and spinal cord injury (SCI), including spasticity, spasms, pain, sleep and symptoms of bladder dysfunction.

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: An oral CBD product (Epidiolex®) has been approved by the FDA for the treatment of certain drug-resistant seizures, including Dravet syndrome and Lennox-Gastaut syndrome. Does THC also have anti-seizure properites?

ANSWER: The available evidence from pre-clinical studies suggests that some CB1 receptor agonists (including THC) may have either pro- or anti-epileptic properties.

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: What is the half life of CBD?

ANSWER: The half life of CBD is dependent upon the mode of administration. When administered intravenously, the half life of CBD is 18-30 hours, when administered via inhalation, the half life is 27-35 hours, and when administered orally, the half life is 2-5 days.

reference: SOUZA, A.A.F. de; SILVA, A.F.M. da .; ABREU, L.R. de; SILVA, T.F. da; GRECO, G.; SANTOS, S. da S.; GONZAGA, R.V.; Medicinal uses of Cannabis sp. Research, Society and Development, [S.l.], v.10, n.7, p.e58010716930, 2021. DOI: 10.3344

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QUESTION: N-arachidonoyl ethanolamine (AEA) aka anandamide, and 2- arachidonoyl glycerol (2-AG) are the two most well-studied endocannabinoids. Are there other endocannabinoids?

ANSWER: Other than Anandamide and 2-AG, there are other endocannabinoids: “virodhamine… acts as a full and selective CB1 agonist; N-arachidonyl- dopamine (NADA) is a CB1 agonist and potent activator of TrpV1; and palmitoylethanolamide (PEA) is involved with anti- inflammatory, analgesic and neuroprotective processes.”

reference: SOUZA, A. A. F. de; SILVA , A. F. M. da .; ABREU , L. R. de .; SILVA, T. F. da .; GRECO, G. .; SANTOS, S. da S. .; GONZAGA, R. V. Medicinal uses of Cannabis sp. . Research, Society and Development, [S. l.], v. 10, n. 7, p. e58010716930, 2021. DOI: 10.33448/rsd-v10i7.16930. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/16930. Acesso em: 2 jul. 2021. https://rsdjournal.org/index.php/rsd/article/view/16930

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QUESTION: What are THCA-A and CBDA?

ANSWER: THCA-A (tetrahydrocannabinolic acid-A) and CBDA (cannabidiolic acid ) are the acid forms (the carboxylated forms) of THC and CBD, and these acid forms are found in the cannabis plant. Decarboxylation of THCA-A and CBDA takes place when the plant products are heated, and results in the bioactive compounds THC and CBD, respectively.

reference: SOUZA, A. A. F. de; SILVA , A. F. M. da .; ABREU , L. R. de .; SILVA, T. F. da .; GRECO, G. .; SANTOS, S. da S. .; GONZAGA, R. V. Medicinal uses of Cannabis sp. . Research, Society and Development, [S. l.], v. 10, n. 7, p. e58010716930, 2021. DOI: 10.33448/rsd-v10i7.16930. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/16930. Acesso em: 2 jul. 2021. https://rsdjournal.org/index.php/rsd/article/view/16930

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QUESTION: Are cannabinoids lipophilic or hydrophylic?

ANSWER: Cannabinoids are actually highly lipophilic. In fact, oral and topical cannabinoid products are often administered with a carrier to facilitate their absorption. The high lipophilicity of cannabinoid-based products is associated with a THC and CBD oral absorption range of only 10 to 20%.

reference: SOUZA, A. A. F. de; SILVA , A. F. M. da .; ABREU , L. R. de .; SILVA, T. F. da .; GRECO, G. .; SANTOS, S. da S. .; GONZAGA, R. V. Medicinal uses of Cannabis sp. . Research, Society and Development, [S. l.], v. 10, n. 7, p. e58010716930, 2021. DOI: 10.33448/rsd-v10i7.16930. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/16930. Acesso em: 2 jul. 2021. https://rsdjournal.org/index.php/rsd/article/view/16930

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QUESTION: N-arachidonoyl ethanolamine (AEA) aka anandamide, and 2- arachidonoyl glycerol (2-AG) are the two most well-studied endocannabinoids. Are there other endocannabinoids?

ANSWER: Other than Anandamide and 2-AG, there are other endocannabinoids: “virodhamine… acts as a full and selective CB1 agonist; N-arachidonyl- dopamine (NADA) is a CB1 agonist and potent activator of TrpV1; and palmitoylethanolamide (PEA) is involved with anti- inflammatory, analgesic and neuroprotective processes.”

reference: SOUZA, A. A. F. de; SILVA , A. F. M. da .; ABREU , L. R. de .; SILVA, T. F. da .; GRECO, G. .; SANTOS, S. da S. .; GONZAGA, R. V. Medicinal uses of Cannabis sp. . Research, Society and Development, [S. l.], v. 10, n. 7, p. e58010716930, 2021. DOI: 10.33448/rsd-v10i7.16930. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/16930. Acesso em: 2 jul. 2021. https://rsdjournal.org/index.php/rsd/article/view/16930

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QUESTION: Cannabinoids may impact gastro-intestinal motility and gastro-intestinal secretory activity. Have these effects been noted in IBD patients who consume marijuana to treat their conditions?

ANSWER: Yes. In fact, according to population studies, diarrhea was one of the most common symptoms that improved with cannabis use.

reference: Storr M, Devlin S, Kaplan GG, Panaccione R, Andrews CN. Cannabis use provides symptom relief in patients with inflammatory bowel disease but is associated with worse disease prognosis in patients with Crohn’s disease. Inflamm Bowel Dis. 2014;20(3):472–80. https://doi.org/10.1097/01.MIB.0000440982.79036.d6.

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QUESTION: Are blunts and joints the same thing?

ANSWER: No. Blunts and joints are not the same. Blunts consist of marijuana wrapped in tobacco leaves, whereas joints consist of marijuana wrapped in cigarette paper.

reference: Cooper ZD, Haney M. Comparison of subjective, pharmacokinetic, and physiological effects of marijuana smoked as joints and blunts. Drug and Alcohol Dependence. Vol 103 Iss 3, 1 August 2009, Pages 107-113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776770/ https://rdcu.be/cnacn

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QUESTION: How does THC impact the gastro-intestinal system of a patient with IBD?

ANSWER: Cannabis might be a mediator within the gastrointestinal system, affecting inflammation, motility and the secretory response. Also, some cannabinoids increase appetite. A thorough 2021 review article summarized the current research evaluating the relationship between cannabinoid-based medicines and the treatment of IBD. A summary of their highlights include the following: “Patients with IBD often experience pain, nausea, and decreased appetite. As described here, in multiple studies, patients with IBD reported a significant improvement in symptoms and quality of life metrics with the use of cannabis. While initially promising, additional double-blind, placebo-controlled studies have found that even though CBD may improve perceived symptoms, it does not reduce inflammation or address underlying disease activity. These studies failed to demonstrate that when given cannabis, patients with IBD had an improvement in inflammatory markers [including CRP and calprotectin] or mucosal healing on endoscopy compared to patients with IBD in placebo conditions.”

reference: Buckley, M.C., Kumar, A. & Swaminath, A. Inflammatory Bowel Disease and Cannabis: A Practical Approach for Clinicians. Adv Ther (2021). https://doi.org/10.1007/s12325-021-01805-8. https://rdcu.be/cnacn

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QUESTION: Cannabis-based products may be some of the world’s oldest medicines. Documents dating back thousands of years BC describe the use of cannabis-based medicines in many Eastern cultures. What is the Chinese character for cannabis? Is that character used to represent other things?

ANSWER: The Chinese character for cannabis is 大麻 and the Chinese character for anesthesia is 麻木. The character 麻 means to “have pins and needles”

reference: Schlag, A.K., O’Sullivan, S.E, Zafar, R.R, Nutt, D.J, Current controversies in medical cannabis: recent developments in human clinical applications and potential therapeutics, Neuropharmacology; https://doi.org/10.1016/j.neuropharm.2021.108586 . And Google translation.

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QUESTION: Has the terpenoid caryophyllene, which is found in the cannabis plant, been found to significantly reduce craving to cigarettes?

ANSWER: Yes, according to one study with significant findings (P <0.01). Forty-eight cigarette smokers participated in a 3-h session conducted after deprivation from smoking overnight. The subjects were randomly assigned to one of three conditions: one group of smokers puffed on a device that delivered a vapor from essential oil of black pepper (black pepper contains caryophyllene); a second group puffed on the device with a mint/menthol cartridge, and a third group used a device containing an empty cartridge. Subjects puffed and inhaled ad libitum from the device throughout the session during which no smoking was allowed. Reported craving for cigarettes was significantly reduced in the pepper-containing device group relative to each of the two control conditions. Also, it was noted that negative affect and some somatic symptoms of anxiety were alleviated in the pepper-containing device group relative to the unflavored placebo. The authors suggested that one possible mechanism is via CB2 receptor agonism, with caryophyllene being a CB2R agonist.

reference: Rose JE, Behm FM. Inhalation of vapor from black pepper extract reduces smoking withdrawal symptoms. Drug Alcohol Depend. 1994 Feb;34(3):225-9. doi: 10.1016/0376-8716(94)90160-0. PMID: 8033760.

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QUESTION: The most common conditions for which cannabinoid-based medicines are used include chronic pain, anxiety, and depression. Of these 3 conditions, which , if any, is there a high strength of evidence for the efficacy of cannabinoid-based medicines.

ANSWER: Of the three conditions (chronic pain, anxiety and depression) there is only a high strength of evidence for chronic pain.

reference: Schlag, A.K., O’Sullivan, S.E, Zafar, R.R, Nutt, D.J, Current controversies in medical cannabis: recent developments in human clinical applications and potential therapeutics, Neuropharmacology; https://doi.org/10.1016/j.neuropharm.2021.108586.

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QUESTION: How does the endocannabinoid system impart analgesic effects?

ANSWER: The endocannabinoid system inhibits release of presynaptic neurotransmitters, modifies postsynaptic neuronal excitability, activates descending inhibitory pathways, and reduces neuroinflammation.

reference: Chung M, Kim H, Abdi S. Update on cannabis and cannabinoids for cancer pain. Current Opinion in Anesthesiology. 2020, 33:825 – 831. https://pubmed.ncbi.nlm.nih.gov/33110020/ DOI:10.1097/ACO.0000000000000934

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QUESTION: There is a high strength of evidence for the efficacy of cannabinoid-based medicines for the treatment of intractable epilepsy, multiple sclerosis and cancer-related nausea. Which of these 3 conditions has the greatest relative number of patients using cannabinoid -based medicines to treat the condition?

ANSWER: Among epilepsy, multiple sclerosis and cancer-related nausea, the least number of patients use cannabinoid-based medicines for intractable epilepsy and the greatest number of people use cannabinoid-based medicines for cancer-related nausea.

reference: Schlag, A.K., O’Sullivan, S.E, Zafar, R.R, Nutt, D.J, Current controversies in medical cannabis: recent developments in human clinical applications and potential therapeutics, Neuropharmacology; https://doi.org/10.1016/j.neuropharm.2021.108586.

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QUESTION: CB1 receptors are abundant in the CNS, including areas involved in pain transmission. CB2 receptors are mostly located on peripheral tissues and immune cells. Are CB2 receptors involved with pain transmission?

ANSWER: Yes. When activated, CB2 receptors may modulate peripheral afferent pain fiber activity and immune-mediated neuro-inflammatory processes. For example, CB2 activation may lead to the inhibition of prostaglandin synthesis and/or mast cell degranulation; both of these cellular activities can precipitate and maintain chronic pain states.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: Haloperidol is an antipsychotic medication and used to treat schizoaffective disorders and schizophrenia. Is the metabolism of haloperidol impacted by THC?

ANSWER: Yes, THC inhibits CYP3A4, the enzyme that metabolizes haloperidol, and therefore the co-administration of THC and haloperidol may result in an increased availability of haloperidol.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: What has been the most common mode of administration of cannabinoid-based medicines (CBMs) in RCTs examining the efficacy of CBMs to treat pain?

ANSWER: Most RCTs evaluated inhaled herbal CBMs and oromucosal spray (nabiximols (Sativex) – an oral spray with 50:50 mix of THC:CBD); there is a paucity of data derived from studies evaluating the effectiveness of other CBM formulations.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: Do oral mucosal spray cannabinoid-based medicines (CBMs) have the same bioavailability as ingested CBMs?

ANSWER: No. The administration of CBMs via oromucosal sprays (sublingual) avoids first-pass metabolism (although some of the product is swallowed) and therefore sublingual administration has a higher bioavailability than ingested formulations.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: Is the bioavailability of THC greater with inhaled cannabinoid-based medicines (CBMs) or ingested CBMs?

ANSWER: The bioavailability of inhaled CBMs is nearly 30% while the bioavailability of ingested CBMs is approximately 4%-20%. (It should be noted that the bioavailability is higher with vaporized cannabis as compared with combusted (smoked) cannabis products.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: The most well studied endocannabinoids are N-arachidonoyl- ethanolamine (AEA; anandamide) and 2-arachidonoylglycerol (2-AG). Are these two neurotransmitters stored in the presynaptic neurons?

ANSWER: No. Unlike most neurotransmitters, neither AEA or 2-AG is stored within vesicles in presynaptic neuron axons. They are actually produced on demand; they are synthesized from arachidonic acid of the membranes of post-synaptic neurons, and then they are released directly into the synapse and bind to receptors on the pre-synaptic neuron. In other words, they act in a retrograde fashion.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: Some NFL players strongly believe that it’s safer for them to use marijuana to treat pain than to take prescription medication. What has the NFL done in response to this claim?

ANSWER: For years, the NFL suspended a player if the player tested positive for marijuana multiple times. That changed due to an agreement approved in 2020. Now, the pain management committee of the NFL and the NFL Players Association will provide $1 million in funding for research into pain management and cannabinoids. Specifically, the research is evaluating marijuana as a potential alternative to opioids. Also, the NFL is investigating how using cannabis-based products and CBD to treat pain affects performance in elite athletes.

reference: https://www.nfl.com/news/nfl-nflpa-will-provide-funding-for-research-into-pain-treatment-including-medica

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QUESTION: The results of recent clinical trials indicate that Cannabidiol (CBD) reduces seizures among patients with refractory epilepsies of various etiologies. Most of these clinical studies report efficacy over short time periods (<1 year). Is CBD effective long term?

ANSWER: Yes. A May 2021 study demonstrated that CBD does not lose its efficacy in controlling seizures over a treatment period of up to 60 months. In addition, other results on the efficacy and tolerability of CBD in the treatment of refractory epilepsies, suggest that CBD is an effective, safe, and well-tolerated anti-epileptic drug for long-term use.

reference: The long-term efficacy of cannabidiol in the treatment of refractory epilepsy. Sandip Patel, Reid Grinspoon, Bradley Fleming, Lauren A. Skirvin, Christina Wade. 29 May 2021 https://doi.org/10.1111/epi.16936

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QUESTION: Some patients in the US may wish to travel with CBD to Canada, or vice versa. CBD is legally sold in the US and in Canada. So, is it legal to transport CBD across the US/Canadian border?

ANSWER: The transporting of cannabis (in any form, including oils containing THC or cannabidiol) into or out of Canada without special authorization from Health Canada is a serious criminal offense.

reference: Cannabis in Canada – What you need to know; https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/resources/cannabis-act-what-you-need-to-know.pdf

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QUESTION: For what health conditions is the therapeutic applicability of CBD being evaluated?

ANSWER: The range of conditions for which CBD has been (or is being) assessed is quite diverse. Currently, clinical trials are evaluating CBD’s analgesic, neuroprotective, antiepileptic, anxiolytic, antipsychotic, anti-inflammatory, antitumor and anti-hypoxia/ischemia properties. According to a March 2021 search of the National Library of Medicine’s database, clinicaltrials.gov, there were more than 300 registered clinical trials that involve the use of CBD as a therapeutic intervention.

reference: Clinicaltrials.gov

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QUESTION: Does pretreatment with CBD prevent the transient psychotic symptoms induced by THC?

ANSWER: According to a study in humans, pretreatment with CBD does diminish THC’s psychotic effects. This particular study involved 6 healthy volunteers who were given THC intravenously on two separate occasions – once with a placebo pretreatment and once with a CBD pretreatment.

reference: Atakan Z. Cannabis, a complex plant: Different compounds and different effects on individuals. Ther Adv Psychopharmacol 2012 Dec; 2(6):241-254. doi:10.1177/2045125312457586. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/

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QUESTION: Has any national drug administration approved a CBD-containing product for therapeutic use in conditions other than epilepsy?

ANSWER: Yes. The oromucosal spray Sativex (nabiximols) is a cannabis extract that contains the principal cannabinoids delta-9-tetrahydrocannibinol (THC) and cannabidiol (CBD) in a 50:50 ratio, as well as specific minor cannabinoids and other non-cannabinoid components. Regulatory approval has been obtained in numerous countries outside the United States for the treatment of multiple sclerosis symptoms (nerve pain, spasticity, overactive bladder, and other symptoms).

reference: GW Pharmaceuticals website. Sativex. https://www.gwpharm.com/healthcare-professionals/sativex

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QUESTION: Some patients consume CBD hoping that it will cure their cancer. Do the findings of clinical research studies indicate that CBD cures cancer?

ANSWER: No. There is no substantial clinical evidence to support that cannabinoids (natural or synthetic), including CBD, can effectively and safely treat cancer in humans.

reference: NO CLINICAL RESEARCH CITATION

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QUESTION: Epidiolex is an FDA-approved oral CBD solution indicated for the treatment of seizures associated with Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS), or tuberous sclerosis complex (TSC) in one year of age and older. Can it be prescribed for indications other than these three seizure disorders (i.e. off label)?

ANSWER: Yes, Epidiolex may be prescribed off-label, but insurance coverage may be subject to pre-authorization.

reference: GW Pharmaceuticals press release: “GW Pharmaceuticals plc and Its U.S. Subsidiary Greenwich Biosciences, Inc. Announce That EPIDIOLEX® (cannabidiol) Oral Solution Has Been Descheduled And Is No Longer A Controlled Substance” April 6, 2020. https://ir.gwpharm.com/news-releases/news-release-details/gw-pharmaceuticals-plc-and-its-us-subsidiary-greenwich-1 Accessed April 30, 2020. GW Pharmaceuticals website. Sativex. https://www.gwpharm.com/healthcare-professionals/sativex accessed Mar 31, 2021.

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QUESTION: St. John’s wort is an over the counter medication used as a remedy for mild depression. Does St. John’s wort interact with CBD?

ANSWER: Yes. St. Johns wort inhibits some of the liver enzymes that metabolize CBD. As a result, there is an increase in bioavailability of CBD, and a possible increase of adverse effects associated with CBD consumption.

reference: Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019;8(7):989. Published 2019 Jul 8. doi:10.3390/jcm8070989. https://pubmed.ncbi.nlm.nih.gov/31288397/

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QUESTION: A seizure disorder is a qualifying condition in many medical marijuana state programs. Does CBD interact with commonly prescribed anti-epileptic medications?

ANSWER: Yes. According to a presentation at the 2014 annual meeting of the American Epilepsy Society, an increasing dose of CBD was associated with significant increases in serum levels of topiramate, rufinamide, and N-desmethylclobazam. Also, there is a significant association between increasing CBD doses and increased zonisamide and eslicarbazepine serum levels.

reference: Friedman D, Cilio MR, Tilton N, et al. The effect of Epidiolex (cannabidiol) on serum levels of concomitant anti-epileptic drugs in children and young adults with treatment-resistant epilepsy in an expanded access program. Presented at the annual meeting of the American Epilepsy Society, Seattle, December 5–9, 2014; abstract.

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QUESTION: Is CBD addictive?

ANSWER: According to the drug package insert of an FDA-approved CBD product, CBD is not addictive.

reference: GW Pharmaceuticals website. Sativex. https://www.gwpharm.com/healthcare-professionals/sativex accessed Mar 31, 2021.

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QUESTION: Proton pump inhibitors (PPIs) are commonly used to relieve the symptoms of gastro-esophageal reflux disease (GERD). Do PPIs interact with CBD?

ANSWER: Yes. PPIs inhibit some of the liver enzymes that metabolize CBD. As a result, there is an increase in bioavailability of CBD, and a possible increase of adverse effects associated with CBD consumption.

reference: Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019;8(7):989. Published 2019 Jul 8. doi:10.3390/jcm8070989. https://pubmed.ncbi.nlm.nih.gov/31288397/

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QUESTION: Other than pill form, in what forms is CBD sold?

ANSWER: There are multiple CBD product types, including CBD oils (for oral/sublingual administration or vaporization), gummy candies, joint balms, creams, lotions, and capsules. CBD is also being sold in food products, beverages and healthcare goods, including hair products and skincare products. CBD has even been marketed as an ingredient in sleeping masks and dog treats.

reference: “Ads Pitching CBD as a Cure-all Are Everywhere. Oversight Hasn’t Kept Up.” The New York Times, Aug 13, 2019 – https://www.nytimes.com/2019/08/13/business/media/cbd-marijuana-fda.html – accessed Aug 2019.

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QUESTION: Does CBD alter the metabolism of methadone?

ANSWER: Yes. Cannabidiol inhibits CYP3A4 and CYP2C19, both of which are involved in the metabolism of methadone. As a result, the co-administration of CBD and methadone may lead to increased sedation.

reference: Madden K, Tanco K, Bruera E. Clinically Significant Drug-Drug Interaction Between Methadone and Cannabidiol. Pediatrics May 2020; e20193256; DOI: https://doi.org/10.1542/peds.2019-3256.
https://pediatrics.aappublications.org/content/145/6/e20193256

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QUESTION: The FDA has approved a CBD product (Epidiolex) for the treatment of 3 rare forms of epilepsy. What is the mechanism of action of CBD in this anti-epileptic medication? How does CBD exert its anti-convulsant effects?

ANSWER: According to the prescribing information of this FDA-approved product, “The precise mechanisms by which Epidiolex exerts its anticonvulsant effect in humans are unknown. Cannabidiol does not appear to exert its anticonvulsant effects through interaction with cannabinoid receptors.”

reference: Highlights for prescribing information for Epidiolex https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf

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QUESTION: Fluoxetine (sold under the name Prozac) is a commonly prescribed antidepressant of the SSRI – Selective Serotonin Reuptake Inhibitor – class. Does Fluoxetine impact the metabolism of CBD?

ANSWER: Yes. Fluoxetine inhibits some of the liver enzymes that metabolize CBD. As a result, there is an increase in bioavailability of CBD, and a possible increase of adverse effects associated with CBD consumption.

reference: Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019;8(7):989. Published 2019 Jul 8. doi:10.3390/jcm8070989. https://pubmed.ncbi.nlm.nih.gov/31288397/

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QUESTION: Some patients apply CBD topically. Does CBD easily penetrate the skin?

ANSWER: Due to CBD’s large size and hydrophobic properties, CBD does not penetrate the skin efficiently, however, permeation-enhancing gels have been developed. Currently, CBD-containing gels are being evaluated for the treatment of several pediatric disorders, and a heterogeneous group of rare and ultra-rare epilepsies known as developmental and epileptic encephalopathies.

reference: https://zynerba.com/in-development/zygel/

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QUESTION: Have CBD’s effects on human embryonic development been fully evaluated?

ANSWER: No, but according to a World Health Organization Cannabidiol (CBD) report in November 2017, in studies involving the use of CBD in monkeys, no effect on a wide range of physiological and biochemical parameters or significant effects on animal behavior were noted unless extremely high doses of CBD (e.g., in excess of 150 mg/kg iv as an acute dose or in excess of 30 mg/kg orally daily for 90 days) were administered.

reference: World Health Organization (WHO) – Expert Committee on Drug Dependence Thirty-ninth Meeting Cannabidiol (CBD) Pre-Review Report Agenda Item 5.2 Geneva, 6-10 November 2017

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QUESTION: CBD interacts with warfarin. Does this drug:drug interaction lead to an increased risk of bleeding or a decrease in warfarin’s anticoagulation effect?

ANSWER: The inhibition of CYP2C19 by CBD can increase levels of warfarin, and multiple reports have indicated that the interaction between warfarin and CBD results in an increased risk of bleeding.

reference: Treese NM, Flowers M. Pharmacist’s guide to CBD oil. US Pharm. 2020; 45(3):20-23. https://www.uspharmacist.com/article/pharmacists-guide-to-cbd-oil

Welty TE, Chapman KE, Faught RE, Kotloski RJ. American Epilepsy Society (AES): Written Comments to Norman E. “Ned” Sharpless, MD, Acting Commissioner of Food and Drugs, U.S. Food and Drug Administration (FDA), Department of Health and Human Services (HHS): on Docket ID# FDA-2019-N-1482, Scientific Data and Information about Products Containing Cannabis or Cannabis-Derived Compounds; Public Hearing; Request for Comments: Submitted on: July 16, 2019. Epilepsy Currents 2019; 19(6):361-368. doi:10.1177/1535759719878716

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QUESTION: What is the most common mode of CBD administration?

ANSWER: According to a 2017–2018 online survey evaluating modes of CBD administration, the most common method of CBD administration was sublingual, followed by vaping, oral ingestion of capsules and liquids, smoking, edibles, and topical administration

reference: Corroon J, Phillips JA. A cross-sectional study of cannabidiol users. Cannabis Cannabinoid Res. 2018;3(1):152–61. https://pubmed.ncbi.nlm.nih.gov/30014038/

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QUESTION: A common adverse effect of chronic recreational marijuana use is cannabinoid hyperemesis syndrome. In fact, cannabinoid hyperemesis syndrome is a near daily diagnosis in many Canadian emergency departments. Anecdotal evidence supports the use of haloperidol to treat cannabinoid hyperemesis syndrome. Is haloperidol more effective than odansetron for the treatment of the nausea and vomiting associated with cannabinoid hyperemesis syndrome?

ANSWER: According to the results of a randomized controlled trial involving 33 patients with cannabinoid hyperemesis syndrome, haloperidol (0.05 mg/kg or 0.1 mg/kg) was superior to odansetron 8mg for average reduction from baseline in abdominal pain and nausea at 2 hours, and was associated with the need for fewer rescue antiemetics and shorter time to ED departure. In this study, there were 2 haloperidol and 6 ondansetron return ED visits for ongoing nausea/vomiting, as well as 2 return visits for acute dystonia, both in the higher dose haloperidol group.

reference: Ruberto, A., Sivilotti, M., Forrester, S., Hall, A., Crawford, F., & Day, A. (2020). LO69: Haloperidol versus ondansetron for hyperemesis due to cannabis (HaVOC): A randomized, controlled clinical trial. CJEM, 22(S1), S32-S33. doi:10.1017/cem.2020.124. https://www.researchgate.net/publication/341353323_LO69_Haloperidol_versus_ondansetron_for_hyperemesis_due_to_cannabis_HaVOC_a_randomized_controlled_clinical_trial

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QUESTION: Cannabinoid receptors have been located in the central nervous system and the peripheral nervous system, as well as on immune cells. Have cannabinoid receptors been isolated in reproductive tissues/cells?

ANSWER: In addition to cannabinoid receptors being identified in the hypothalamus and the pituitary gland, cannabinoid receptors have also been identified on ovary, endometrial tissue, testes, and spermatozoa. In fact, research suggests that marijuana may alter the release of FSH and LH, ovulation, sperm motility, fertilization, as well as placentation.

reference: Caitlin Dunne, MD, FRCSC. THE EFFECTS OF CANNABIS ON FEMALE AND MALE REPRODUCTION. BCMJ, vol. 61 , No. 7 , September 2019 , Pages 282-285. https://bcmj.org/articles/effects-cannabis-female-and-male-reproduction

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QUESTION: What is the most common route of administration for the synthetic cannabinoids K2 or Spice?

ANSWER: K2 and Spice are used for recreational purposes, and smoking is the most common route of administration. Spraying or mixing the synthetic cannabinoids on dried plant material allows one to smoke it (using a pipe, a water pipe, or rolling the drug-laced plant material in cigarette papers). Also, liquid synthetic cannabinoids have been designed to be vaporized via e-cigarettes.

reference: Drugs of Abuse – A DEA Resource Guide /2020 Edition. https://www.dea.gov/sites/default/files/2020-04/Drugs%20of%20Abuse%202020-Web%20Version-508%20compliant-4-24-20_0.pdf

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QUESTION: What are K2 and Spice?

ANSWER: K2 and Spice are synthetic cannabinoid “designer drugs” that are intended to mimic the effects of THC. These synthetic cannabinoids are sold as “herbal incense” at convenience stores/gas stations, smoke shops and via the internet. They are produced in powder form, and then often dissolved in solvents, so they can be applied to dry plant material to make the “herbal incense” products.

rreference: Drugs of Abuse – A DEA Resource Guide /2020 Edition. https://www.dea.gov/sites/default/files/2020-04/Drugs%20of%20Abuse%202020-Web%20Version-508%20compliant-4-24-20_0.pdf

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QUESTION: Respiratory depression is associated with the overdose of opioids or benzodiazepines. Is respiratory depression associated with an overdose of cannabinoids? Why or why not?

ANSWER: Respiratory depression is not associated with cannabinoid use because CB1 receptors are not located in the midbrain, the part of the brain responsible for respiratory drive.

reference: Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020 Apr 15;411:116717. doi: 10.1016/j.jns.2020.116717. Epub 2020 Jan 30. PMID: 32044684. https://pubmed.ncbi.nlm.nih.gov/32044684/

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QUESTION: As of January 2020, how many Americans were using marijuana-based products for medicinal purposes?

ANSWER: It has been estimated that more than 2 million Americans use marijuana for medical reasons. Some of the many ailments being treated with marijuana include: chronic pain, PTSD, depression, sleep disorders, multiple sclerosis (MS), cancer-related ailments, and GI disorders. Some indications are supported by good scientific evidence, but some are not.

reference: Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020 Apr 15;411:116717. doi: 10.1016/j.jns.2020.116717. Epub 2020 Jan 30. PMID: 32044684. https://pubmed.ncbi.nlm.nih.gov/32044684/

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QUESTION: Cannabinoids are metabolized by many of the same cytochrome P450 enzymes as warfarin. In fact, THC, CBD and CBN can inhibit the hydroxylation of warfarin, and thus lead to an increase in INR. Do cannabinoids also affect the metabolism of heparin? Is the metabolism of direct oral anticoagulants (DOACs), including rivaroxaban, edoxaban, and apixaban, impacted by cannabinoids?

ANSWER: While cannabinoids do not alter the metabolism of heparin, cannabinoids may impact the metabolism of DOACs. DOAC levels may increase, leading to an increased risk of bleeding.

reference: Jessica Greger, PharmD, Vernice Bates, MD, Laszlo Mechtler, MD, and Fran Gengo, PharmD. A Review of Cannabis and Interactions With Anticoagulant and Antiplatelet Agents. The Journal of Clinical Pharmacology 2019, 0(0) 1–7. https://accp1.onlinelibrary.wiley.com/doi/abs/10.1002/jcph.1557?af=R

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QUESTION: Does CBD interact with receptors other than CB1 or CB2?

ANSWER: Yes. CBD has cannabinoid receptor-independent properties. For example, CBD is an agonist at the TRPV1 receptor and has agonist properties at the 5-HT1A/2A/3A serotonergic receptors. CBD is also a capsaicin analog. CBD has antagonist activity on alpha-1 adrenergic and μ-opioid receptors, too. In addition, CBD has been found to inhibit synaptosomal uptake of noradrenaline, dopamine, serotonin, and gamma-amino butyric acid. CBD also inhibits anandamide uptake.

reference: Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020 Apr 15;411:116717. doi: 10.1016/j.jns.2020.116717. Epub 2020 Jan 30. PMID: 32044684. https://pubmed.ncbi.nlm.nih.gov/32044684/

reference: Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019 Jul 8;8(7):989. doi: 10.3390/jcm8070989. PMID: 31288397; PMCID: PMC6678684. https://pubmed.ncbi.nlm.nih.gov/31288397/

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QUESTION: Cannabinoid receptors are located throughout various parts of the CNS, including the basal ganglia, hippocampus, cerebellum and cerebral cortex, and in the peripheral nervous system. Do these receptors have effects on neurotransmitters such as serotonin?

ANSWER: Yes. CB receptor activity not only impacts serotonin, but it also affects acetylcholine, dopamine, glutamate, and GABA, as well as NMDA and opioid receptor systems.

reference: Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020 Apr 15;411:116717. doi: 10.1016/j.jns.2020.116717. Epub 2020 Jan 30. PMID: 32044684. https://pubmed.ncbi.nlm.nih.gov/32044684/

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QUESTION: Epidemiological studies indicate that as many as 15% of inflammatory bowel disease (IBD) patients may use cannabinoids to ameliorate some of their symptoms, including improvement in diarrhea, abdominal pain and appetite. Do the studies show that cannabinoids are effective in Crohn’s disease?

ANSWER: Although the findings of studies examining the efficacy of cannabinoids in Crohn’s disease indicate that cannabinoids do not improve inflammatory markers or endoscopic score, the results indicate that THC reduces the Crohn’s disease activity index by >100 points (on a scale of 0–450).

reference: Naftali T, Dor M. Cannabis for the Treatment of Inflammatory Bowel Disease: A True Medicine or a False Promise?. Rambam Maimonides Med J 2020;11 (1):e0008. Review. doi:10.5041/RMMJ.10390. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000156/

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QUESTION: Some cancer patients use medical marijuana to treat various cancer-associated ailments. What are some of the ailments ameliorated by medical marijuana?

ANSWER: According to one study involving 96 cancer patients receiving supportive cancer care, the data support the safety and effectiveness of medical marijuana as a complementary option for improving pain control, appetite and quality of life for cancer patients. The top three adverse events of this study included drowsiness, low energy and nausea. (Note: other studies indicate that chemotherapy-induced nausea and vomiting is ameliorated by medical marijuana.)

reference: Safety and effectiveness of medical cannabis as a complementary option for supportive cancer care: Results from the Cannabis Pilot Project. Antonio Vigano, Saro Aprikian, Popi Kasvis, Virginie Bacis, Amna Al Harrasi, Nathalie M Aubin, MariaLuisa Vigano, and Manuel Borod. Journal of Clinical Oncology 2020 38:15_suppl, 12106-12106.
https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.12106

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QUESTION: What is Sativex®?

ANSWER: Sativex® is a buccal (oral) spray containing Δ-9-THC and CBD (2.7 mg Δ-9-THC and 2.5 mg CBD per spray) and it is indicated for spasticity and neuropathic pain in multiple sclerosis, and as adjunctive analgesia for moderate to severe cancer pain. While Sativex® is approved in several European countries, Canada, and other countries, it has not been approved for medical use in the U.S.

reference: Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019;8(7):989. Published 2019 Jul 8. doi:10.3390/jcm8070989.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678684/

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QUESTION: According to the results of a survey of breast cancer patients’ use of cannabinoid products, 42% of survey participants had used medical cannabinoid products to relieve symptoms. What symptoms were treated with cannabinoid products?

ANSWER: Members of the Breastcancer.org and Healthline communities were asked to participate in a survey during the period of 12/16/2019 – 1/19/2020. According to the results of the survey, cannabinoids were used to relieve insomnia (70%), pain (59%), anxiety (57%), stress (51%), and nausea/vomiting (46%).

reference: A survey of breast cancer patients’ use of cannabis before, during, and after treatment. Marisa C. Weiss, Julianne Hibbs, Terri W. McHugh, Meghan Buckley, Sharon Larson, Nancye Green, Virginia G. Kaklamani, Rowan T. Chlebowski, and Diana Martinez. Journal of Clinical Oncology 2020 38:15_suppl, e19210-e19210. https://ascopubs.org/doi/10.1200/JCO.2020.38.15_suppl.e19210

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QUESTION: Are cannabinoids an effective analgesic agent in the acute pain setting? Are cannabinoids an effective analgesic agent in the chronic pain setting?

ANSWER: According to the results of multiple randomized controlled trials examining the efficacy of cannabinoids to treat acute pain, THC, nabilone and other cannabinoid-based products were not associated with a reduction in pain, but were associated with adverse side effects, including sedation. In contrast to the lack of efficacy in the acute pain setting, cannabinoids are effective analgesic agents in the chronic pain setting. According to 2 systematic reviews involving a total of 29 randomized controlled trials (RCTs), 22 of the 29 RCTs demonstrated that cannabinoids do have a modest analgesic effect in the management of chronic pain.

reference: Vulfsons S, Minerbi A, Sahar T. Cannabis and Pain Treatment-A Review of the Clinical Utility and a Practical Approach in Light of Uncertainty. Rambam Maimonides Med J. 2020;11(1):e0002. Published 2020 Jan 30. doi:10.5041/RMMJ.10385. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000155/

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QUESTION: What are the common modes of administration of medical marijuana used by cancer patients?

ANSWER: According to a survey completed by 183 cancer patients of an oncology clinic at Sutter Medical Center in Sacramento, California, over 50% reported use of oils and tinctures and 44% used edibles. A smaller percentage consumed cannabis-based products via vaping (26%) or smoking (30%). Topical use was preferred by fewer patients (17%). Over 58% of patients stated they used more than one method.

reference: Patterns of use of medical cannabis in a community oncology clinic. Deepti Behl, Stacy D. D’Andre, and Carol Parise, Journal of Clinical Oncology 2020. 38:15_suppl, e24111-e24111. https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.e24111

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QUESTION: What CBD products, if any, have been evaluated and approved by the FDA?

ANSWER: CBD is marketed in various forms, including oils, capsules, food products, cosmetics/topical lotions and creams, and CBD products are marketed for pets, too. These products are sold in grocery stores, specialty stores, and convenience stores across the US and on the internet. However, only one prescription CBD product has been approved by the FDA. It is called Epidiolex. It is approved to treat rare, severe pediatric epilepsy disorders.

reference: FDA Advances Work Related to Cannabidiol Products with Focus on Protecting Public Health, Providing Market Clarity – March 5 2020. https://www.fda.gov/news-events/press-announcements/fda-advances-work-related-cannabidiol-products-focus-protecting-public-health-providing-market

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QUESTION: On the current (last revised May 2020) US Department of Justice Firearms Transaction Record form, is there a question related to the unlawful use of, or addiction to marijuana, depressants, stimulants, narcotics and other controlled substances?

ANSWER: Yes. There is a question related to drug use. In fact, there is a warning note that reads as follows: “Warning: The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside.”

reference: U.S. Department of Justice Bureau of Alcohol, Tobacco, Firearms and Explosives OMB No. 1140-0020, Firearms Transaction Record. https://www.atf.gov/firearms/docs/4473-part-1-firearms-transaction-record-over-counter-atf-form-53009/download

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QUESTION: Does consuming a high fat/high calorie meal at the same time as you take liquid CBD orally impact the amount of CBD absorbed into the bloodstream?

ANSWER: Yes. According to studies performed by a pharmaceutical company that manufactures the FDA-approved CBD product called Epidiolex, a high fat/high calorie meal can increase CBD absorption by up to 5 fold.

reference: Epidiolex insert. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf

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QUESTION: It has been estimated that a significant proportion of cancer patients (18.3-40.0%) in the United States use marijuana or cannabinoid-based products. Does the evidence indicate that cannabinoid-based products are effective in treating cancer-related pain? chemotherapy-induced nausea and vomiting? Cancer-related cachexia (wasting)?

ANSWER: According to a study published in the Journal of Clinical Oncology, there is substantial evidence for the effectiveness of marijuana and cannabinoids in treating cancer-related pain; specifically, an oral THC/CBD spray. Also, there is conclusive evidence that marijuana and cannabinoids effectively relieve chemotherapy-induced nausea and vomiting; (specifically, oral THC). However, there is inconclusive evidence about the effectiveness of cannabinoid-based products in treating cancer-related cachexia (wasting).

reference: A systematic review of evidence for cannabis and cannabinoids as adjuvant therapy in palliative and supportive oncology care.
Sebastian Jugl, Shailina Keshwani, Lauren Adkins, Coy D. Heldermon, Almut Winterstein, and Amie Goodin. Journal of Clinical Oncology 2020. 38:15_suppl, 12091-12091 https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.12091

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QUESTION: Do cannabinoids affect the function of the gastrointestinal system?

ANSWER: It appears that cannabinoids affect many functions of the digestive system, including the regulation of the production of digestive enzymes, gastrointestinal motility, and visceral inflammation as well as visceral sensation.

reference: Izzo AA, Sharkey KA. Cannabinoids and the gut: New developments and emerging concepts. Pharmacol Ther 2010 04;126(1879-016; 0163-7258; 1):21-38. https://pubmed.ncbi.nlm.nih.gov/20117132/

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QUESTION: Marijuana use is not associated with a decrease in respiratory drive. Why not?

ANSWER: In the lower brainstem areas that control respiratory function/respiratory drive, cannabinoid receptor expression is low, and this accounts for the lack of decreased respiratory drive and the absence of a risk of fatal respiratory arrest with the use of medical marijuana and pharmaceutical grade cannabinoid drugs.

reference: Herkenham M, Lynn AB, Little MD, et al. Cannabinoid receptor localization in brain. Proc Natl Acad Sci USA. 1990; 87:1932–1936.38. https://pubmed.ncbi.nlm.nih.gov/2308954/

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QUESTION: What is the pharmacokinetic profile of marijuana when it is administered orally?

ANSWER: The psychoactive and physiological effects of orally consumed marijuana typically appear approximately 90 minutes after ingestion, reach their maximum after 2-3 hours and last for about 4-12 hours. However, there is a heterogeneous response to oral marijuana consumption and some individuals may not appreciate the peak effect until 6 hours after consumption.

reference: Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02

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QUESTION: Does marijuana affect appetite and metabolism?

ANSWER: Marijuana has been reported to stimulate appetite. There is a high concentration of CB1 receptors in the areas of the brain that control food intake and satiety, and these findings suggest that there is an association between marijuana consumption and appetite regulation. Additionally, studies suggest that the endocannabinoid system modulates taste sensation as well as the metabolism of lipids and glucose.

references: Di Marzo V, Matias I. Endocannabinoid control of food intake and energy balance. Nat.Neurosci. 2005; 8: 585-589. https://pubmed.ncbi.nlm.nih.gov/15856067/
• Farrimond JA, Mercier MS, Whalley BJ, Williams CM. Cannabis sativa and the endogenous cannabinoid system: therapeutic potential for appetite regulation. Phytother.Res. 2011; 25: 170-188. https://pubmed.ncbi.nlm.nih.gov/21213357/
• Matias I, Bisogno T, Di Marzo V. Endogenous cannabinoids in the brain and peripheral tissues: regulation of their levels and control of food intake. Int.J.Obes.(Lond). 2006; 30 Suppl 1: S7-S12. https://pubmed.ncbi.nlm.nih.gov/16570107/

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QUESTION: Does the dosing of cannabinoid-based drugs need to be adjusted for patients with hepatic disease?

ANSWER: Cannabinoids are metabolized by the liver and excreted through the GI tract and kidney. When considering cannabinoid therapy for patients with severe liver impairment, the dosage may need to be adjusted. For example, according to the prescribing information for an FDA-approved cannabidiol product, “dose adjustment is recommended in patients with moderate (Child-Pugh B) hepatic impairment or severe (Child-Pugh C) hepatic impairment. It may be necessary to have slower dose titration in patients with moderate or severe hepatic impairment than in patients without hepatic impairment. [This drug] does not require dose adjustment in patients with mild (Child-Pugh A) hepatic impairment.”

Epidiolex prescribing information highlights:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf

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QUESTION: Does the endocannabinoid system modulate pain without the being triggered by THC or other phytocannabinoids?

ANSWER: Yes. Neural and non-neural cells of injured tissues produce endocannabinoids, including anandamide and 2-AG, and when these endocannabinoids activate the CB receptors, pain signals are modulated. Note: CB1 receptors are abundant in nociceptive and non-nociceptive sensory neurons of the dorsal root ganglion (DRG), the spinal cord, the brain, mast cells, macrophage defense cells, the trigeminal ganglion (TG), and epidermal keratinocytes. Few CB2 receptors are expressed in these regions, but the density of CB2 receptors increases when peripheral nerve damage occurs.

reference: Breijyeh Z,Jubeh B, Bufo SA, Karaman R, Scrano L. Cannabis: A Toxin-Producing Plant with Potential Therapeutic Uses. Toxins (Basel). 2021 Feb 5;13(2):117. doi.10.3390/toxins13020117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915118/

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QUESTION: Other than via pills, capsules and liquid preparations, are there any other vehicles by which medical marijuana can be consumed orally?

ANSWER: In addition to pills, capsules and liquid preparations, medical marijuana can be consumed orally by ingesting marijuana-infused edibles, such as baked goods, candies, gummies, chocolates, lozenges, and beverages. It must be noted that the amounts of the various cannabinoids in edibles may not be consistent throughout a single baked product (a cookie, for example) or across a batch of baked products. As a result, it is difficult to estimate the amount of marijuana contained in each portion of edible product.

reference: Barrus DG, Capogrossi KL, Cates SC, et al. Tasty THC: Promises and Challenges of Cannabis Edibles. Methods Rep RTI press. 2016; 2016:10.3768/rtipress.2016.op.0035.1611. http://europepmc.org/article/MED/28127591

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QUESTION: Do some cannabinoids reduce spasticity?

ANSWER: Studies have suggested that some cannabinoids effectively reduce the spasticity associated with multiple sclerosis, and, in fact, the federal drug agencies of several countries (but not the US) have approved a cannabinoid-based formula (50:50 THC:CBD) called Sativex (nabiximols) for the treatment of severe spasticity in multiple sclerosis. The cannabinoids act on the presynaptic CB1 receptors, and the receptor activation reduces massive glutamate release and regulates glutamatergic excitability during spasticity. The American Academy of Neurology proposes that the use of oral cannabinoid extracts or an oromucosal cannabinoid spray (1:1 THC:CBD) by MS patients may reduce symptoms of spasticity.

reference: Yadav V. Bever C. Jr et al. Summary of evidence –based guideline: complimentary and alternative medicine in multiple sclerosis: Report of the guideline development subcommittee of the American Academy of neurology. Neurology 2014. 82(12): 1083-1092. https://pubmed.ncbi.nlm.nih.gov/24663230/

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QUESTION: Is marijuana a sedative or stimulant?

ANSWER: Marijuana is a CNS depressant and may cause drowsiness or somnolence. Its CNS depressant effects are additive with other CNS depressants, including opioids. There is moderate evidence that marijuana or cannabinoids are effective for improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis.

reference: Kumar RN, Chambers WA, Pertwee RG. Pharmacological actions and therapeutic uses of cannabis and cannabinoids. Anaesthesia. 2001; 56: 1059-1068. https://pubmed.ncbi.nlm.nih.gov/11703238/

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QUESTION: What is the pharmacokinetic profile of marijuana when it is smoked?

ANSWER: When herbal marijuana is smoked via a cigarette or a pipe, THC, CBD and other phytocannabinoids, as well as terpenoids, are vaporized by the heat of combustion and inhaled. Inhaled constituents quickly pass from alveoli into the bloodstream and readily cross the blood-brain barrier. CNS effects appear within seconds to a few minutes of inhalation, reach a maximum after 15-30 minutes, and taper off within 2-3 hours. It must be noted that the amounts of cannabinoids consumed are, in part, dependent upon the patient’s inhalation techniques, including the quality and efficiency of inhalation, duration of inhalation, and spacing of inhalations.

references: Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/.
• Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02

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QUESTION: What is the pharmacokinetic profile of marijuana when it is smoked?

ANSWER: When herbal marijuana is smoked via a cigarette or a pipe, THC, CBD and other phytocannabinoids, as well as terpenoids, are vaporized by the heat of combustion and inhaled. Inhaled constituents quickly pass from alveoli into the bloodstream and readily cross the blood-brain barrier. CNS effects appear within seconds to a few minutes of inhalation, reach a maximum after 15-30 minutes, and taper off within 2-3 hours. It must be noted that the amounts of cannabinoids consumed are, in part, dependent upon the patient’s inhalation techniques, including the quality and efficiency of inhalation, duration of inhalation, and spacing of inhalations.

references: Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/.
• Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02

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QUESTION: What are endocannabinoids?

ANSWER: Endocannabinoids (also called endogenous cannabinoids) are endogenous agonists of the receptors to which delta-9- tetrahydrocannabinol (THC) also binds. Two of the most well studied endocannabinoids are derivatives of arachidonic acid: N-arachidonoylethanolamine (also called anandamide or AEA) and 2-arachidonoylglycerol (2-AG).

reference: Atakan, Z. “Cannabis, a complex plant: different compounds and different effects on individuals.” Therapeutic advances in psychopharmacology 2012; 2(6): 241-54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/

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QUESTION: What are terpenes?

ANSWER: Terpenes are aromatic hydrocarbons and just like the phytocannabinoids, terpenes are manufactured in the glands of the cannabis flower. Terpenes may influence the uptake and effects of phytocannabinoids. The terpenes found in cannabis include limonene, pinene, myrcene, delta-3-carene, eucalyptol and humulene.

reference: Russo EB. Taming THC:potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J of Pharmacolo. 2011;163(7):1344-1364. doi:10.1111/j.1476-5381.2011.01238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165946/

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QUESTION: THC and CBD have significantly different receptor binding capacities, and thus different pharmacological effects. Are the differences in binding capacity due to different chemical compositions?

ANSWER: THC and CBD actually have the same chemical formula, C21H30O2. They are structural isomers. The key structural difference between the two molecules is that there is an oxygen-containing closed ring in THC that is open in CBD. This one structural difference leads to significantly different receptor binding capacities and thus different pharmacological effects of the two substances.

reference: de Meijer EP, Bagatta M, Carboni A, et al. The inheritance of chemical phenotype in Cannabis sativa L. Genetics. 2003;163(1):335-346. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1462421/

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QUESTION: True or False? CB1 receptors are only found on nerve cells.

ANSWER: False. In addition to the brain, nociceptive and non-nociceptive sensory neurons of the dorsal root ganglion (DRG), and the spinal cord, CB1 receptors are abundant in mast cells, macrophage defense cells, epidermal keratinocytes, adipose, liver, pancreas and skeletal muscle cells.

reference: Breijyeh Z, Jubeh B, Bufo SA, Karaman R, Scrano L. Cannabis: A Toxin-Producing Plant with Potential Therapeutic Uses. Toxins (Basel). 2021 Feb 5;13(2):117. doi.10.3390/toxins13020117 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915118/

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QUESTION: What is the most common qualifying condition reported by medical marijuana patients?

ANSWER: Currently and historically, the most common qualifying condition reported by medical marijuana patients is chronic pain. In fact, according to Boehnke et al’s analysis of 2016 data, chronic pain was the qualifying condition reported by medical marijuana patients nearly 65 percent of the time.

reference: Boehnke et al. Qualifying Conditions of medical cannabis license holders in the United States. Health Affairs Vol 38, No2: Hospitals, Health IT and more. https://doi.org/10.1377/hlthaff.2018.05266. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05266

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QUESTION: Epidiolex is an FDA-approved seizure medication derived from plant material (it is not a synthetic CBD product). Is it possible that a patient taking Epidiolex will test positive for THC?

ANSWER: Epidiolex is cannabidiol (CBD) derived from marijuana, not hemp, and therefore there may be traces of cannabinoids other than CBD. Patients using Epidiolex may test positive for marijuana/THC on drug screening.

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QUESTION: Is it a good idea to store THC products in glass jars?

ANSWER: THC has the ability to bind to glass and plastic. Therefore, THC products are often stored in basic or organic solvents in amber silicate glassware to avoid loss.

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QUESTION: Do CBD products that contain less than 0.3 percent THC violate the Controlled Substances Act?

ANSWER: Industrial hemp (which contains less than 0.3 percent THC) is no longer considered to be a controlled substance, but CBD products that contain less than 0.3 percent THC are not legal. The CBD products no longer violate the Controlled Substances Act, but they do violate the Food, Drug, and Cosmetic (FD&C) Act, according to the FDA. Any CBD food or purported dietary supplement products in interstate commerce is in violation of the FD&C Act, according to the principal deputy FDA commissioner.

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QUESTION: What is industrial hemp?

ANSWER: Industrial hemp and marijuana are cultivated from the same species, but industrial hemp has concentrations of THC less than 0.3 percent. Industrial hemp, a high-fiber plant, is used to make various products, including textiles as well as biodegradable plastics. The 2018 Farm Bill, signed into law by President Donald Trump, removed industrial hemp, from the definition of marijuana in the Controlled Substances Act.

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QUESTION: Of all state-approved health conditions, what are the 7 most frequent health conditions for which patients seek to obtain a medical marijuana card?

ANSWER: Chronic noncancer pain, multiple sclerosis and other motor neuron disorders, epilepsy, cancer-related symptoms, mental health disorders (primarily anxiety disorders such as PTSD), glaucoma, and symptoms related to irritable bowel diseases top the list of reasons to apply for a medical marijuana card.

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QUESTION: CBD is legally sold in US supermarkets, pharmacies and convenience stores. CBD is also legally sold in Canada. So, is it legal to transport CBD across the US/Canadian border?

ANSWER: According to Canada’s national laws, “the transporting of cannabis (in any form, including oils containing THC or cannabidiol) into or out of Canada without special authorization from Health Canada is a serious criminal offense. “

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QUESTION: Does the dosing of CBD need to be adjusted in patients with liver disease?

ANSWER: According to the prescribing information packet of Epidiolex (an FDA-approved CBD product),, dose adjustment is recommended in patients with moderate (Child-Pugh B) or severe (Child-Pugh C) hepatic impairment. Dose adjustment in patients with mild (Child-Pugh A) hepatic impairment is not needed.

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QUESTION: Are physicians required to notify the DEA when prescribing Epidiolex (a CBD product derived from the cannabis plant)?

ANSWER: Prior to April 2020, Epidiolex was classified as a schedule V drug under the Controlled Substances Act. On April 6, 2020, the manufacturers of Epidiolex “received notification from the United States Drug Enforcement Administration (DEA) confirming that Epidiolex ® (cannabidiol) is no longer subject to the Controlled Substances Act (CSA).” Since Epidiolex is no longer a controlled substance, physicians are not required to notify the DEA when prescribing the medication. The descheduling of Epidiolex also enables physicians to prescribe this medicine free of the requirements of state prescription drug monitoring programs.

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QUESTION: Is the use of marijuana for medicinal reasons an acceptable explanation for a positive drug test result in ANY Federal agency drug testing program?

ANSWER: As of March 2021, the answer to this question is still ‘NO.’ ALL Federal drug testing programs – regardless whether the programs under the regulatory and legal auspices of the Department of Health and Human Services, the Department of Defense, the Department of Transportation, or the Nuclear Regulatory Commission, or any other Federal agency – have taken the identical stance: Use of Schedule I drugs by individuals in Federally regulated workplaces is unacceptable, and any individual who tests positive for a Schedule I drug will have a positive drug test on his or her record.

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QUESTION: If a patient uses a CBD product, will a THC drug screen be positive?

ANSWER: The answer to this question depends on 2 things: 1.) Is the patient consuming pure CBD or full spectrum CBD. (Full spectrum CBD contains multiple cannabinoids, including THC.) and 2.) The sensitivity of the drug screening test.

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QUESTION: How should cannabis products be stored?

ANSWER: Products should be stored in opaque containers, in a cool dry location, and in a place that is not accessible to children or pets, or individuals who should not be handling the cannabis-based products.

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QUESTION: What are some of the microbial and fungal contaminants that can be present in cannabis products?

ANSWER: Aspergillus and Salmonella and Aflatoxin may be present in cannabis products. It is important to review the certificate of analysis to determine if the cannabis product contains any of these contaminants.

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QUESTION: What should be listed on a Certificate of Analysis (CoA)?

ANSWER: First, a Certificate of Analysis (CoA) should be from an independent and properly certified testing laboratory, and not from the retailer. CoA should show the amount and concentration of major cannabinoids and terpenes present in the tested sample, as well as testing data regarding the lack of (or presence of) microbial organisms, fungal contaminants, the levels of heavy metals, and amount of pesticide and residual solvents.

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QUESTION: Does raw cannabis flower contain CBD or CBDA?

ANSWER: The raw flower contains CBDA (the acid form of cannabidiol). When the raw cannabis material is heated via vaporization, smoking or baking, the CBDA is converted to CBD.

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QUESTION: CBD products are marketed as full spectrum, broad spectrum and CBD isolate products. What are the differences between these products?

ANSWER: While full CBD spectrum products contain a full array of cannabinoids, (including THC) and terpenes, broad spectrum products are manufactured in a way that the product does not contain THC. CBD isolate products are often sold as 99%+ pure CBD and they do not contain other cannabinoids or any terpenes, unless specified on the label.

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QUESTION: How many people in the US die each day from overdoses involving PRESCRIPTION opioids?

ANSWER: According to recent data published by the Center for Disease Control (CDC), approximately 41 people/day are dying from an overdose involving prescription opioids. This CDC website – https://www.cdc.gov/rxawareness/index.html – provides resources for individuals struggling with opioid drug abuse.

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QUESTION: What is Rick Simpson oil (aka RSO)?

ANSWER: Solvent-based concentrates are made by extraction of the plant matter with chemical solvents. In this method, cannabis is soaked in the solvent and then the cannabis is removed by straining. Then, the solvent is boiled off, and a sticky cannabis resin remains. These extracts are often a very dark color (green to black) and contain residuals from the solvents used. These products are sometimes referred to as Rick Simpson Oil (RSO), named after the individual that made this type of extraction popular.

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QUESTION: Some people consume cannabinoids via “dabbing.” Describe this method of consumption.

ANSWER: Basically, with dabbing, a cannabis concentrate is applied to a hot platform and the cannabinoids are volatilized. The vapor then passes through a water-pipe device and is inhaled by the consumer. The hot platform (commonly called “the nail”) is usually constructed from quartz, ceramic or titanium. This nail is heated, often with a blow torch, and after the nail is hot, a small amount of cannabis concentrate is applied. Vaporization of the cannabinoids is immediate. Inhalation by the consumer during application of the cannabis concentrate draws the vapors from around the nail into the water pipe.

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QUESTION: Other than butane, what are some of the chemical solvents used to create cannabis concentrates? Other than using solvents to create cannabis concentrates, what other methods to produce cannabis concentrates can be used?

ANSWER: Hexane, isopentane, isopropyl alcohol, acetone, and propane are used to make cannabis concentrates. In addition to using solvents, concentrates can also be manufactured via a dry method, a water-based method or a CO2 based method.

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QUESTION: Do all medical marijuana legal states allow the sale of products manufactured through butane extraction and supercritical CO2 extraction?

ANSWER: Supercritical CO2 extraction does not leave residual hydrocarbons, while butane extraction does. As a result, some states will allow the sale of supercritical CO2 extraction products, but not allow the sale of butane extracts.

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QUESTION: In addition to butane extraction, supercritical CO2 extraction is another process used to manufacture cannabis extracts. What is the major difference in the end products of the two processes?

ANSWER: Supercritical CO2 extraction does not leave any trace of hydrocarbon solvents in the end product, while butane extraction does. The viscosity of the supercritical CO2 products is less than the viscosity of the butane extraction products. As a result of a lower viscosity, supercritical CO2 extraction process products can be used in vaporizer pens on its own without cutting agents. While products derived from a butane extraction are used in dabbing, products derived from supercritical CO2 extraction are not.

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QUESTION: Some patients may use shatter, budder, crumble, pull-and-snap, and/or wax. Are all of these products exactly the same?

ANSWER: All of these products are cannabis extracts, but it is the specific manufacturing/ processing of the hash oil cannabis products that will determine the consistency of the product. Depending upon the consistency and other physical characteristics, the product will be called shatter, budder, crumble, pull-and-snap or wax.

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QUESTION: Does short term treatment with THC rich cannabis induce clinical remission and improve quality of life in patients with mild to moderately active ulcerative colitis?

ANSWER: Yes, according to a recent study. However, these beneficial clinical effects were not associated with significant anti-inflammatory improvement in the Mayo endoscopic score or laboratory markers for inflammation. These results were derived from a double-blind, randomized, placebo-controlled trial, – 32 patients received either cigarettes containing 0.5 g of dried cannabis flowers with 80mg THC or placebo cigarettes for 8 weeks. Parameters of disease including Lichtiger disease activity index, C reactive protein (CRP), calprotectin, Mayo endoscopic score and quality of life (QOL) were assessed before, during and after treatment.

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QUESTION: In some legal states, edibles, such as candies, baked goods, beverages and condiments (butter and oils) containing THC may be sold. Is 2.5mg of THC in an edible a low dose or high dose of THC to be consumed orally?

ANSWER: The dosing of THC always needs to be adjusted on an individual basis. For reference, 2.5 mg is the lowest dose of dronabinol, a synthetic THC that is FDA-approved.

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QUESTION: When speaking with their clinicians, patients may use the terms “dabs”, “wax”, or “butane honey oil” – what do these terms mean?

ANSWER: Dabs, wax and butane honey oil are all highly concentrated cannabis extracts of THC. These THC products are often smoked or vaporized. Because these THC products are quite highly concentrated, the consumption of only a very small amount may produce a significant effect.

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QUESTION: What is “hashish”?

ANSWER: Hashish is a crude product made up of compacted sticky resin glands of the cannabis plant. The popularity of hashish has been diminished by the availability of cannabis concentrates.

reference: Special Report | February 2018
Contemporary Routes of Cannabis Consumption: A Primer for Clinicians
Jeramy Peters, DO; Joseph Chien, DO
The Journal of the American Osteopathic Association, February 2018, Vol. 118, 67-70. doi: https://doi.org/10.7556/jaoa.2018.020

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QUESTION: Are smoking marijuana and vaporizing marijuana equally efficient? (In other words, are the cannabinoids absorbed to the same extent with smoking vs. vaporizing? )

ANSWER: When ingesting marijuana via a vaporizer, the user absorbs up to 33% of the total cannabinoids present in herbal mixture. When smoking, an individual typically absorbs about 25% of the cannabinoids present in herbal mixture.

reference: Special Report | February 2018
Contemporary Routes of Cannabis Consumption: A Primer for Clinicians
Jeramy Peters, DO; Joseph Chien, DO
The Journal of the American Osteopathic Association, February 2018, Vol. 118, 67-70. doi: https://doi.org/10.7556/jaoa.2018.020

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QUESTION: The amounts of marijuana in a joint, blunt, spliff or bowl are not standardized. How does a clinician estimate the amount of marijuana being used by the patient?

ANSWER: When trying to assess the quantity of marijuana consumed by a patient, multiple questions should be addressed, including: how often and how much the patient typically purchases, how many bowls (or joints, or blunts or spliffs) the patient smokes each time he consumes marijuana, and how many times he uses marijuana before he needs to purchase again. It must be noted that the total amount of cannabinoids present in marijuana is not equal to the amount that is ingested. (when smoking, an individual typically absorbs about 25% of the cannabinoids present in herbal marijuana mixture.) Also, the concentration of the cannabis-based product must be considered, as well.

reference: Special Report | February 2018
Contemporary Routes of Cannabis Consumption: A Primer for Clinicians
Jeramy Peters, DO; Joseph Chien, DO
The Journal of the American Osteopathic Association, February 2018, Vol. 118, 67-70. doi: https://doi.org/10.7556/jaoa.2018.020

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QUESTION: Are smoking marijuana and vaporizing marijuana equally efficient? (In other words, are the cannabinoids absorbed to the same extent with smoking vs. vaporizing? )

ANSWER: When ingesting marijuana via a vaporizer, the user absorbs up to 33% of the total cannabinoids present in herbal mixture. When smoking, an individual typically absorbs about 25% of the cannabinoids present in herbal mixture.

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QUESTION: A patient may be speaking to you about his marijuana consumption, and he may use the terms joints, blunts and spliffs, and bowl. What do these terms mean?

ANSWER: A joint is a cigarette of marijuana, a blunt is a marijuana cigar, and a spliff can refer to marijuana mixed with tobacco, though some people use this term when referring to a cone-shaped joint with a filter. A bowl refers to the chamber of a pipe.

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QUESTION: In patients 60 years old or older, does long term (3 months) marijuana use impact blood pressure?

ANSWER: According to a recent study that was published in the European Journal of Internal Medicine, amongst adults 60 years or older with hypertension, marijuana treatment for 3 months was associated with a reduction in 24-hours systolic and diastolic blood pressure. At 3 months follow-up, the mean 24-hours systolic and diastolic blood pressures were reduced by 5.0 mmHg and 4.5 mmHg, respectively (p<0.001 for both). The nadir for the blood pressure and heart rate was achieved at 3 hours post-administration. The proportion of normal dippers changed from 27.3% before treatment to 45.5% afterward. No significant changes were seen in the different metabolic parameters assessed by blood tests, anthropometric measurements, or ECG exam.

reference: Cannabis is associated with blood pressure reduction in older adults – A 24-hours ambulatory blood pressure monitoring study Ran Abuhasira, Yosef S. Haviv, Merav Leiba, Adi Leiba, Larisa Ryvo, Victor Novack Published:January 20, 2021 DOI: European J of Int. Medicine https://doi.org/10.1016/j.ejim.2021.01.005

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QUESTION: What are the effects of cannabis-based therapies on oxaliplatin-induced peripheral neuropathy among oncology patients?

ANSWER: The results of a retrospective study indicated that the rate of neuropathy was reduced among patients treated with cannabis-based therapies and oxaliplatin. This reduction was more significant in patients who received cannabis-based products prior to treatment with oxaliplatin, suggesting a protective effect. (A large prospective trial examining the effects of cannabis-based products on oxaliplatin-induced neuropathy is planned.)

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QUESTION: In older adults, is there a significant positive association between THC dose and incidence rate ratio for dizziness or lightheadedness and thinking or perception disorder when the THC is combined with CBD?

ANSWER: A systematic review and metaregression analysis published In JAMA (February 2021) evaluated the THC neuropsychiatric symptoms among adults 50 years and older. The authors examined 30 RCTs [Randomized Controlled Trials] using THC-only cannabis-based medicines (CBM) (total THC exposure, 1252.83 person-years) and 24 RCTs using CBMs with different combinations of cannabidiol (CBD) and THC (total THC and CBD exposure, 388.56 person-years). They did find a significant positive association between THC dose and incidence rate ratio for dizziness or lightheadedness (estimate, 0.05; 95% CI, 0.02-0.08; P = .001) and thinking or perception disorder (estimate, 0.07; 95% CI, 0.03-0.11; P < .001) for the THC-ONLY studies, but there were no associations with any other neuropsychiatric adverse effects for the THC and CBD combination studies.

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QUESTION: Can prison inmates use medical cannabis?

ANSWER: In New Mexico, the prison inmates can use cannabis. In 2021, a New Mexico landmark case concluded that inmates CAN use medical cannabis. As stated by the victorious lawyer, ‟the law is clear: You must, under existing law, provide incarcerated persons with the ability to access medical cannabis free from penalty. That’s the law.” Importantly, the ruling specifies that this applies to those on probation, house arrest or in prison.

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids for patients suffering with severe pain. What were those recommendations?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ patients suffering from severe pain and those patients who have a history of significant prior cannabis consumption can use a 50:50 CBD-THC product and start with a dose of 2.5-5 mg of each compound 1 or 2 times/day.

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QUESTION: In 2020, recommendations for the dosing of THC in the elderly population were developed by the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain.’ What were their recommendations for the dosing of THC in the elderly population?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ elderly patients, patients with severe co-morbidity or patients who take multiple medications should be managed through a conservative route; start with THC doses at 1 mg/day and the dose should be titrated up slowly.

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QUESTION: What are some of the more common reasons dermatologists recommend cannabinoid-based medicines?

ANSWER: According to the results of a survey of 145 dermatologists, 91 % of dermatologists were in support of medical cannabis use and 13.8 % have recommended it for a dermatologic condition. Atopic dermatitis (45 %) and psoriasis (40 %) were the most common. The most common form of administration was topical (75 %). The main reasons for not recommending medical cannabis were limited knowledge (56 %) and lack of experience (48 %).

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. For what pain conditions are medical cannabinoids a viable option?

ANSWER: According to the global task force, cannabinoids may be effective for neuropathic, inflammatory, nociplastic* and mixed pain conditions. *Nociplastic pain is defined as: “Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.”

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QUESTION: Have any PRECLINICAL studies shown that cannabinoids have anti-neoplastic (anti-cancer) effects?

ANSWER: Yes – PRECLINICAL studies have shown that cannabinoids exhibit anti -tumor properties in different ADULT cancers, including breast, melanoma, pancreatic, lymphoma, glioblastoma, lung, hepatocellular, colorectal, prostate, and other cancers. This data has been obtained from EXPERIMENTAL models of cancer, including genetically engineered mouse models.

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QUESTION: The use of cannabinoid-based products for medicinal purposes is legal in Canada at the federal level. Is the medicinal use of cannabinoid-based products legal at the federal level in Mexico, too?

ANSWER: Yes, as of January 13, 2021, the use of cannabinoid-based products for medicinal purposes is legal in Mexico. Mexican President López Obrador published regulations for the production, research and use of medicinal marijuana. The federal government’s official gazette published the new regulations that authorize the government to oversee the production of marijuana for research and medicinal purposes. Pharmacies will be allowed to supply cannabis-based medicines to authorized patients. In addition, the regulatory framework permits the importation of seeds, cannabis derivatives to be used in medicinal products, and processed marijuana-based medications to Mexico.

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QUESTION: Does the National Basketball Association (NBA) test their players for cannabis use?

ANSWER: Prior to the 2020-2021 season, the NBA had randomly conducted cannabis testing on players, but the NBA and National Basketball Players Association announced they will stop testing players for cannabis use during the 2020–2021 season in response to the stress and quarantining brought on by the COVID-19 global pandemic, and also based on COVID safety to limit unnecessary contacts,. Although cannabis testing is paused for now, random testing for performance-enhancing drugs will continue.

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QUESTION: As of 2018, what percentage of the population uses marijuana?

ANSWER: The 2018 World Health Organization (WHO) data suggest that approximately 2.5% of the global population (147 million) use marijuana.

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QUESTION: Researchers have evaluated the anti-neoplastic (anti-cancer) effects of cannabinoids. What have the results indicated?

ANSWER: Over the past two decades, PRECLINICAL data indicate that THC, CBD, as well as some synthetic cannabinoids induce apoptosis of cancer cells and inhibit tumor proliferation, metastasis, and angiogenesis. Note: The results of preclinical trials are NOT equivalent to clinical trials.

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QUESTION: What are the two most well-studied endocannabinoids?

ANSWER: The best-characterized endocannabinoids are 2-arachidonoylglycerol (also called 2-AG) and N- arachidonoylethanolamide (also called AEA or anandamide). These endocannabinoids are lipid-based molecules that are synthesized from arachidonic acid from the cellular membrane. These two endocannabinoids are signaling molecules that bind to and stimulate cannabinoid receptors CB1R and CB2R.

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QUESTION: Which US states had the greatest sales of cannabis products in 2020?

ANSWER: Florida, a medical marijuana only state, had more than $1.2 billion in sales, and was the nation’s fourth largest cannabis market. Only California, Colorado and Washington (all medical and recreational use states) out sold Florida.

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QUESTION: CB1 receptors are expressed by neurons in the brain, especially in the cerebral cortex, basal ganglia, cerebellum, and hippocampus. Are CB1 receptors expressed in other parts of the nervous system? Are CB1 receptors present on cells outside of the nervous system?

ANSWER: In addition to being expressed by neurons in the brain, CB1 receptors are also expressed in parts of the peripheral and autonomic nervous system. CB1 receptors are also expressed on several other tissues, including heart, lung, reproductive organs, thymus and spleen.

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QUESTION: Does the consumption of THC and CBD via vaporization impair driving ability?

ANSWER: A recent study published in JAMA examined the magnitude and duration of driving impairment following vaporization of cannabis containing various concentrations of THC and CBD. The results of the study indicated that the impairment of driving after consuming vaporized THC-dominant and 50:50 THC/CBD cannabis compared with placebo was significantly greater at 40-100 minutes but not at 240-300 minutes after vaporization. There were no significant differences between CBD-dominant cannabis and placebo found, but the doses tested may not represent common usage.

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QUESTION: To which receptor do cannabinoids bind that impact pain sensation?

ANSWER: In addition to acting on cannabinoid receptors (CB1 and CB2), cannabinoids may modulate pain by interacting with the G protein-coupled receptor 55 (GPR55) and GPR18 and other G protein-coupled receptors such as serotonin and opioids receptors. Cannabinoids also interact with TRPV-1 receptors. CBD and THC (along with the endocannabinoid, Anadamide) activate glycine receptors, and as a result, lead to analgesia in inflammatory and neuropathic pain.

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QUESTION: Does the anti-fungal agent ketoconazole interact with cannabinoids?

ANSWER: Yes. Ketoconazole Inhibits the metabolism of THC and CBD and can significantly increase concentrations of THC and CBD. In contrast, drugs such as rifampicin, carbamazepine and St John’s Wort induce cytochrome enzyme activity and lower THC and CBD concentrations.

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QUESTION: If a patient is allergic to tomatoes or tobacco, is the patient a good candidate for medical marijuana therapy?

ANSWER: Patients who have previously experienced an allergic reaction to tobacco or tomato are at increased risk for developing an allergy to the products from the cannabis plant.

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QUESTION: Is a “full spectrum” product the same as a “whole plant” product?

ANSWER: No. “Whole plant” products contain fats, waxes and fibrous materials not found in “full spectrum” products.

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QUESTION: What does “full spectrum” marijuana mean? What does “broad spectrum” mean?

ANSWER: Full spectrum means that the product contains all of the original compounds found in the flower of the cannabis plant (cannabinoids, terpenes and flavonoids). In contrast, broad spectrum products are processed in such a manner as to ensure that the final product does NOT contain THC.

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QUESTION: Describe the exact mechanism of action of Epidiolex.

ANSWER: According to the Epidiolex FDA Approved Package Insert, (Greenwich Biosciences, Inc.), the precise mechanism(s) by which Epidiolex exerts its anticonvulsant effects in humans are unknown. It does not appear to be through cannabidiol receptors.

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QUESTION: Have the results of studies examining the impact of maternal marijuana use identified a unique phenotypic congenital anomaly?

ANSWER: Studies evaluating maternal use of marijuana have not found a unique phenotypic signature of prenatal exposure of marijuana. There does appear to be an increased risk of congenital anomalies, particularly gastroschisis, though.

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QUESTION: In 2018, Epidiolex was approved for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS). Has the FDA approved Epidiolex for any other conditions since 2018?

ANSWER: Yes. On July 31, 2020, the U.S. Food and Drug Administration approved Epidiolex (cannabidiol or CBD) oral solution for the treatment of seizures associated with tuberous sclerosis complex (TSC) in patients one year of age and older.

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QUESTION: Does the use of cannabinoid-based products impact female sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain?

ANSWER: According to a study published in the journal Sexual Medicine, an increased frequency of marijuana use is associated with improved sexual function among females. (i.e. – sexual desire increased, arousal increased, orgasm domain increased, and sexual satisfaction increased.) Interestingly, it was noted that chemovar type and method of consumption did not impact outcomes, though.

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QUESTION: Does consuming a high fat/high calorie meal at the same time as you take liquid CBD orally impact the amount of CBD absorbed into the bloodstream?

ANSWER: Yes. According to studies performed by a pharmaceutical company that manufactures an FDA- approved CBD product, a high fat/high calorie meal can increase CBD absorption by up to 5 fold.

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QUESTION: Did the United Nations Commission for Narcotic Drugs vote in December 2020 to accept the World Health Organization’s (WHO) recommendation to remove cannabis and cannabis resin for medicinal purposes from Schedule IV of the 1961 Single Convention on Narcotic Drugs?

ANSWER: Yes, and it was a close one (27 to 25), with the United States and many European nations in favor. The US published a statement about its rationale for the vote – “The vote of the United States to remove cannabis and cannabis resin from Schedule IV of the Single Convention while retaining them in Schedule I is consistent with the science demonstrating that while a safe and effective cannabis-derived therapeutic has been developed, cannabis itself continues to pose significant risks to public health and should continue to be controlled under the international drug control conventions. Further, this action has the potential to stimulate global research into the therapeutic potential and public health effects of cannabis, and to attract additional investigators to the field, including those who may have been deterred by the Schedule IV status of cannabis.”

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QUESTION: The House of Representatives approved the MORE Act. Is marijuana legal now?

ANSWER: The House of Representatives approved the bill called the MORE Act on December 4, 2020, but marijuana is not legal at the federal level. The bill must go to the Senate, and then the White House for the President to sign. Until the President signs it, it’s not a law – it’s just a bill.

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QUESTION: What is the MORE act?

ANSWER: The Marijuana Opportunity, Reinvestment, and Expungement (MORE) Act (HR 3884 / S. 2227) is bipartisan legislation that removes marijuana from the Controlled Substances Act, thus decriminalizing the substance at the federal level and enabling states to set their own policies.

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QUESTION: Do cannabinoids affect cardiac function?

ANSWER: Low doses of cannabinoids have been associated with tachycardia, hypertension and increased contractility (an increased sympathetic response). In contrast, high doses of cannabinoids enhance parasympathetic tone leading to dose-dependent bradycardia and hypotension.

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QUESTION: What percentage of US medical marijuana legal states list cancer as a qualifying condition?

ANSWER: Cancer is listed as a qualifying condition in 100% of the US medical marijuana states, but the patterns of cannabinoid use among patients with breast cancer (one of the most common cancers in the US) is unknown. NOTE: Cannabinoids have been shown to ameliorate some of the symptoms associated with cancer and the side effects associated with some cancer treatments, however, cannabinoids have not been shown to be an effective anti-cancer agent.

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QUESTION: Epidemiological studies indicate that as many as 15% of inflammatory bowel disease (IBD) patients may use cannabinoids to ameliorate some of their symptoms, including improvement in diarrhea, abdominal pain and appetite. Do the studies show that cannabinoids are effective?

ANSWER: There are few studies evaluating cannabinoid use in IBD, and those studies are small. In Crohn’s disease, it has been demonstrated that THC reduces the Crohn’s disease activity index by >100 points (on a scale of 0–450). Also, two small studies involving ulcerative colitis patients showed a marginal benefit. However, no improvement in inflammatory markers or in endoscopic score in either disease was detected.

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QUESTION: The findings of multiple randomized controlled trials (RCTs) indicate that cannabinoids effectively treat chronic pain. Do cannabinoids effectively treat the chronic pain associated with fibromyalgia?

ANSWER: No. According to a Cochrane systematic review published in 2016 on the use of cannabinoids to treat fibromyalgia, there is no convincing, unbiased, high-quality evidence suggesting that a cannabinoid-based medicine (nabilone) is of value in treating people with fibromyalgia. Furthermore, the tolerability of nabilone was low in people with fibromyalgia. Also, the results of a 2019 study where 4 varieties of pharmaceutical grade marijuana were administered by single shot vapor to fibromyalgia patients indicated that none of the 4 marijuana varieties had an effect greater than placebo. (Note: The data from the 2019 study could not be used to extrapolate the long-term effects of cannabinoids on fibromyalgia-associated pain.)

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QUESTION: Some cancer patients use medical marijuana to treat various cancer-associated ailments. What are some of the ailments ameliorated by medical marijuana?

ANSWER: According to one study involving 96 cancer patients receiving supportive cancer care, the data support the safety and effectiveness of medical marijuana as a complementary option for improving pain control, appetite and quality of life for cancer patients. The top three adverse events of this study included drowsiness, low energy and nausea, and were reported in 28% of patients, with 9% having to stop using the medical marijuana. (Note: other studies indicate that chemotherapy-induced nausea and vomiting is ameliorated by medical marijuana.)

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QUESTION: Side effects of short-term cannabinoid-based therapy may differ from person to person, and the same person may experience different side effects at different times. What factors influence the probability and the severity of adverse events?

ANSWER: Many factors influence the likelihood and the severity of adverse events, including the type of cannabinoid preparation; the mode of administration; the dose administered; the patient’s expectations, the patient’s prior experience with cannabinoid-based therapies, and the age of the patient. Drug–drug interactions may also lead to adverse events.

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QUESTION: Side effects of short-term cannabinoid-based therapy may differ from person to person, and the same person may experience different side effects at different times. What factors influence the probability and the severity of adverse events?

ANSWER: Many factors influence the likelihood and the severity of adverse events, including the type of cannabinoid preparation; the mode of administration; the dose administered; the patient’s expectations, the patient’s prior experience with cannabinoid-based therapies, and the age of the patient. Drug–drug interactions may also lead to adverse events.

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QUESTION: What is Sativex®?

ANSWER: Sativex® is a buccal (oral) spray containing Δ-9-THC and CBD (2.7 mg Δ-9-THC and 2.5 mg CBD per spray) and it is indicated for spasticity and neuropathic pain in multiple sclerosis, and as adjunctive analgesia for moderate to severe cancer pain. While Sativex® is approved in several European countries, Canada, and other countries, it has not been approved for medical use in the U.S.

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QUESTION: Other than feeling “high” what are some of the reported psychological CNS-related side effects associated with cannabinoid use?

ANSWER: Psychological side effects associated with cannabinoid use include: restless/anxiety/nervousness, depressed mood, dysphoria, confusion, dissociation, hallucinations, hyperactivity, weird dreams, paranoia and psychosis.

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QUESTION: Are cannabinoids an effective analgesic agent in the acute pain setting?

ANSWER: No. According to the results of multiple randomized controlled trials examining the efficacy of cannabinoids to treat acute pain, THC, nabilone and other cannabinoid-based products were not associated with a reduction in pain, but were associated with adverse side effects, including sedation.

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QUESTION: What are the common modes of administration of medical marijuana used by cancer patients?

ANSWER: According to a survey completed by 183 cancer patients of an oncology clinic at Sutter Medical Center in Sacramento, California, over 50% reported use of oils and tinctures and 44% used edibles. A smaller percentage consumed cannabis-based products via vaping (26%) or smoking (30%). Topical use was preferred by fewer patients (17%). Over 58% of patients stated they used more than one method.

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QUESTION: What CBD products, if any, have been evaluated and approved by the FDA?

ANSWER: CBD is marketed in various forms, including oils, capsules, food products, cosmetics/topical lotions and creams, and CBD products are marketed for pets, too. These products are sold in grocery stores, specialty stores, and convenience stores across the US and on the internet. However, only one prescription CBD product has been approved by the FDA. It is called Epidiolex. It is approved to treat rare, severe pediatric epilepsy disorders.

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QUESTION: On the current (last revised May 2020) US Department of Justice Firearms Transaction Record form, is there a question related to the unlawful use of, or addiction to marijuana, depressants, stimulants, narcotics and other controlled substances?

ANSWER: Yes. There is a question related to drug use. In fact, there is a warning note that reads as follows: “Warning: The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside.”

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QUESTION: Does consuming a high fat/high calorie meal at the same time as you take liquid CBD orally impact the amount of CBD absorbed into the bloodstream?

ANSWER: Yes. According to studies performed by a pharmaceutical company that manufactures the FDA-approved CBD product called Epidiolex, a high fat/high calorie meal can increase CBD absorption by up to 5 fold.

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QUESTION: What psychiatric condition is most often listed as a qualifying condition for medical marijuana?

ANSWER: The psychiatric diagnosis most often listed as a qualifying condition by the medical marijuana legal US states is PTSD, but other psychiatric diagnoses include Tourette syndrome, Alzheimer’s disease, and autism.

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QUESTION: Is marijuana use linked to higher hospital mortality in COPD patients?

ANSWER: Actually, no. According to a nationwide population-based study, patients diagnosed with COPD who reported using marijuana had less risk of in-hospital mortality and pneumonia than non-users. The results from this study, which was performed by Yale physicians, indicated that marijuana use was associated with a 37.6% reduction in the odds of dying in the hospital (OR 0.624, 95% CI 0.407-0.958, P=0.0309) among COPD patients. This same study also found that COPD patients who admitted to using marijuana had an 11.8% lower risk of pneumonia (OR 0.882, 95% CI 0.806-0.964, P=0.0059). Note: these findings may be a correlation rather than a causation, according to some clinicians not associated with the study. Also, the authors performed a retrospective analysis of COPD-associated hospitalizations over the years 2005-2014. (Pre-COVID)

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QUESTION: Is there a governmental office to which patients can report any adverse effects from CBD products?

ANSWER: Yes, even though CBD (with the exception of Epidiolex) is not approved by the FDA, patients can report any adverse effects from CBD products to the FDA’s MedWatch program.

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QUESTION: To date, has the FDA approved cannabis for the treatment of any psychiatric condition?

ANSWER: No. However, the FDA has approved 1 cannabis-derived medication (CBD) called Epidiolex and 2 cannabis-related medications (dronabinol and nabilone) for specific indications. Dronabinol is a synthetic THC product that is used as an antiemetic agent. It is approved for treating or preventing nausea and vomiting caused by chemotherapeutic agents, and as an appetite stimulant for individuals with AIDS. Nabilone is a synthetic that is structurally similar to THC. It is approved for treating chemotherapy induced nausea and vomiting.

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QUESTION: What percentage of Americans support marijuana legalization?

ANSWER: In a 2019 Pew Research Center survey, 67% of Americans supported marijuana legalization. Since that 2019 survey, more US states have legalized recreational marijuana.

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QUESTION: Does ketamine interact with cannabinoids?

ANSWER: Yes. Ketamine is a CYP3A4 substrate, and thus may inhibit the metabolism of cannabinoids, including THC. This, in turn, can increase blood levels of cannabinoids and possibly lead to fatal dysrhythmias, heart attack, or stroke, according to the American Heart Association. Also, ketamine levels may increase which can lead to negative effects, including agitated delirium, respiratory depression (ketamine is primarily an NMDA antagonist, but it may also bind to mu and the sigma receptors.)

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QUESTION: What is the most common reason for cannabinoid use among cancer survivors?

ANSWER: The most common reason for cannabinoid use among cancer survivors was pain. Other common reasons why cancer survivors used cannabinoids include sleeping problems and anxiety.

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QUESTION: What are the most common reasons older adults use cannabis-based products?

ANSWER: According to an anonymous survey of 568 adults age 65 or older, the majority (78%) used cannabinoids for medical purposes only, with the most common targeted conditions/symptoms being pain/arthritis (73%), sleep disturbance (29%), anxiety (24%), and depression (17%). Of note, only 41% reported that their healthcare provider knew that they use cannabinoids for medicinal purposes.

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QUESTION: Are symptoms of OCD significantly reduced after smoking or vaporizing marijuana?

ANSWER: Data from an app that tracks the changes of medical marijuana patients’ symptoms as a function of different doses and strains of cannabis across time was analyzed. The results indicate that inhaled cannabinoids appear to have short-term beneficial effects on symptoms of OCD. However, tolerance to the effects on intrusions may develop over time.

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QUESTION: Which US states have legalized adult-use marijuana possession and have also legalized adult-use marijuana sales?

ANSWER: As of October 10, 2020, the following 11 US states had legalized adult use marijuana possession and adult use marijuana sales: Alaska, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington. Washington DC and Guam have also legalized adult use marijuana sales. In November 2020, Arizona, Montana, New Jersey and South Dakota legalized recreational marijuana, too.

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QUESTION: Are there any US states that do NOT deny solid organ transplants for patients that use marijuana for medicinal purposes?

ANSWER: Legislation has passed in at least 7 US states (California, Washington, Illinois, Arizona, Delaware, New Hampshire, and Maine) that explicitly forbids denial of transplantation listing on the basis of an individual’s use of medical marijuana. *Of note, transplant recipients take immunosuppressive drugs, and inhaled smoked or vaporized marijuana can expose the consumer to life-threatening pulmonary infections (Aspergillosis, for example). Typically, most US state solid organ transplant programs have recommended that individuals with active drug or alcohol abuse not undergo transplantation.

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QUESTION: Does THC stimulate the sympathetic or parasympathetic system?

ANSWER: Tetrahydrocannabinol stimulates the sympathetic nervous system while inhibiting the parasympathetic nervous system. After THC consumption, there may be increases heart rate, myocardial oxygen demand, supine blood pressure, and platelet activation. (Of note, THC is associated with endothelial dysfunction and oxidative stress.)

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QUESTION: What is the half life of CBD? How does it compare to the half life of THC?

ANSWER: The half life of CBD is 18-32 hours, which is similar to the half life of THC of 20-30 hours. Both CBD and THC are distributed to fatty tissues and highly perfused organs such as brain, heart, lung, and liver.

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QUESTION: At what point during gestation are endocannabinoid receptors expressed in the fetus?

ANSWER: Endocannabinoid receptors are first expressed in the fetus at 5 to 6 weeks’ gestation.

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QUESTION: Did past-month cannabis use among pregnant US women increase or decrease during the 15 year span of 2002 to 2017?

ANSWER: Past-month cannabis use among pregnant US women more than doubled from 2002 (3.4%) to 2017 (7.0%).

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QUESTION: Is prenatal exposure to cannabis associated with child outcomes?

ANSWER: The results of a cross-sectional analysis published in a September 2020 JAMA Psychiatry journal, indicate that prenatal exposure does impact child outcome. This particular cross-sectional analysis involved 11,489 children (655 exposed to cannabis prenatally) and the findings indicate that prenatal cannabis exposure after maternal knowledge of pregnancy was associated with greater psychopathology (i.e., internalizing, externalizing, attention, thought, and social problems, as well as psychotic-like experiences) during middle childhood, even after accounting for potentially confounding variables.

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QUESTION: Does marijuana use during pregnancy affect the birth weight of the baby?

ANSWER: Yes. According to a 2018 study by Campbell et al., marijuana use during pregnancy triples the likelihood of having a low birth weight baby, even after adjusting for factors such as socioeconomic status, medical history, and other substance use such as tobacco smoking

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QUESTION: What percentage of 12th graders in the US have used marijuana at least once in their life?

ANSWER: According to the National Institute on Drug Abuse’s Monitoring the future, nearly one half of all 12th-graders in the United States have used marijuana in their lifetime, with more than one third during the past year, and almost one quarter in the past month.

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QUESTION: What percentage of individuals who misuse prescription opioids seek treatment?

ANSWER: Only 8% of individuals who misuse prescription opioids seek treatment. Of note, approximately 80% of heroin users first misused prescription opioids.

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QUESTION: How does CBD impact the cardiovascular system?

ANSWER: CBD reduces heart rate and blood pressure, and improves vasodilation in models of endothelial dysfunction. Also, CBD reduces inflammation and vascular hyperpermeability in diabetic models.

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QUESTION: Compared to previous years, has the number of opioid deaths since the COVID pandemic increased or decreased?

ANSWER: Since the beginning of the COVID-19 pandemic, a dramatic increase in the number of opioid overdose deaths has been reported. According to a recent report put out by the American Medical Association, opioid overdose deaths have increased in more than 35 states since the pandemic began. This surge is believed to be multifactorial, and due to isolation, economic issues, disruptions to the drug trade and other factors.

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QUESTION: How many adolescents in the US misused opioids in 2018?

ANSWER: In 2018, 699,000 adolescents between the ages of 12 and 17 misused opioids, with the vast majority misusing prescription opioids. Of these 699,000 adolescents, 108,000 had opioid use disorder.

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QUESTION: Does substance use disorder increase the risk for COVID-19?

ANSWER: Yes, according to an analysis of electronic health records (EHR). As reported by Nora D. Volkow, MD, director of the National Institute on Drug Abuse, and colleagues, the evaluation of over 73 million electronic health records, the risk of COVID-19 was far greater among patients diagnosed with a substance use disorder in the past year compared with the general population after adjusting for age, gender, race, and insurance type.

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QUESTION: Does the oral administration of CBD alter plasma concentrations of diazepam?

ANSWER: CBD can alter the toxicity or efficacy of other drugs through inhibition of certain enzymes. For example, increases in the plasma concentration of diazepam have been reported when the diazepam is coadministered with Epidiolex (a CBD product).

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QUESTION: Has the use of a transdermal gel for regional and systemic delivery of CBD been evaluated for the treatment of epilepsy?

ANSWER: Yes. A transdermal gel for regional and systemic delivery of CBD (Zynerba Pharmaceuticals) is in clinical development for treatment of epilepsy, developmental and epileptic encephalopathy, fragile-X syndrome, and osteoarthritis. NOTE: As of September 2020, the company’s website indicates that the product is not yet approved by government regulatory bodies, including the United States Food and Drug Administration (FDA) and other agencies, and must be tested to see if it is an effective and safe treatment.

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QUESTION: Is cannabidiol in compounded topical pain creams safe to use?

ANSWER: According to the National Academies of Science, Engineering and Medicine’s 2020 publication A Review of the Safety and Effectiveness of Select Ingredients in Compounded Topical Pain Creams, “there is insufficient evidence on the safety of topical application of cannabidiol. However, if systemic absorption to therapeutic levels is achieved through topical application, there is potential for side effects similar to other routes of administration (e.g., oral).”

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QUESTION: Does cannabidiol in compounded topical pain creams penetrate the skin of animals?

ANSWER: According to the National Academies of Science, Engineering and Medicine’s 2020 publication, A Review of the Safety and Effectiveness of Select Ingredients in Compounded Topical Pain Creams, “there is limited preclinical evidence to suggest that cannabidiol penetrates animal skin. Modifications to the ingredient or excipient may increase aqueous solubility and increase absorption.”

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QUESTION: In PRECLINICAL studies, it has been shown that cannabinoids induce apoptosis of cancer cells. Do cannabinoids induce apoptosis of normal non-malignant cells?

ANSWER: According to the results of PRECLINICAL studies, including in vitro studies and and studies in mice, cannabinoids induce apoptosis of cancer cells without causing negative effect on the viability of normal non-malignant cells. In some mouse models, it has been noted that cannabinoids act synergistically with standard anti-cancer drugs or radiation therapy to reduce tumor growth. These studies have not detected overt signs of toxicity in the treated animals. NOTE: The observations noted in culture or animal models do NOT always readily translate into clinical benefit.

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QUESTION: Most of the currently available scientific evidence for anti-neoplastic activity of cannabinoids is derived from PRECLINICAL models, including in vitro studies and studies involving mouse models. What have the results of these PRECLINICAL studies indicated?

ANSWER: These PRECLINICAL studies have reported that THC and some other cannabinoids can activate the CB1 and CB2 receptors on the surface of cancer cells and impact the intracellular signaling pathways of the cancer cells. Some effects include (1) apoptosis of the cancer cells (2) the blockade of cancer cell proliferation (3) inhibition of tumor angiogenesis and (4) inhibition of metastasis. NOTE: the results of PRECLINICAL studies do NOT always correlate with CLINICAL outcome/benefit.

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QUESTION: Clinical trials evaluating the use of human monoclonal antibodies against interleukin 1 and interleukin 6 to treat cytokine storm syndrome in COVID-19 patients are underway or in the planning stage. Are there any possible significant pharmacodynamic interactions between monoclonal antibodies and CBD?

ANSWER: Yes. The combination of monoclonal antibody agents, including eculizumab and sarilumab, or other immuno/myelosuppressive agents with CBD may potentiate the risk of infection.

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QUESTION: Nelfinavir is an HIV-1 protease inhibitor. Patients who have HIV may be taking this drug and may also be using cannabinoids to treat some of the symptoms associated with the HIV infection. Does Nelfinavir interact with CBD? (Of note, Nelfinavir may also inhibit SARS-Cov-2 replication.)

ANSWER: The combination of Nelfinavir and CBD may lead to an increase risk of diarrhea and/or headache.

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QUESTION: Dexamethasone, a commonly used corticosteroid to treat various inflammatory conditions, has been recommended for use in COVID-19 patients with severe respiratory symptoms (according to data from Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial). Does THC interact with dexamethasone? Does CBD interact with dexamethasone?

ANSWER: Both THC and CBD have possible pharmacodynamic interactions with dexamethasone. While the combination of THC and dexamethasone may lead to an increase in euphoria, the combination of CBD and dexamethasone may lead to a potentiation of immunosuppression and an increase in risk of infection, and could increase the risk of headache.

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QUESTION: Darunavir with cobicistat has been used to treat HIV and it has also been trialed for the treatment of COVID-19 infection. Are there any possible pharmacodynamic interactions between CBD and Darunavir/ Cobicistat?

ANSWER: Yes, this drug combination may increase headache and/or diarrhea.

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QUESTION: What is the most common qualifying condition reported by medical marijuana patients?

ANSWER: Currently and historically the most common qualifying condition reported by medical marijuana patients is chronic pain. In fact, according to an analysis by Boehnke et al, chronic pain was the qualifying condition reported by medical marijuana patients nearly 65 percent of the time (according to 2016 data).

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QUESTION: Hydrochloroquine has been trailed as a therapy for COVID-19 infections. Does this drug interact with CBD? If so, what are the potential consequences?

ANSWER: The combination of CBD and hydrochloroquine may lead to an increase of headache and/or diarrhea risk.

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QUESTION: Baricitnib, a drug approved for the treatment of rheumatoid arthritis, may reduce COVID-19 viral entry and mitigate inflammation. (A clinical trial evaluating this drug has begun in Italy .) Does CBD interact with Baricitnib?

ANSWER: Yes. A possible pharmacodynamic interaction between Baricitnib and CBD may develop, and there may be an increased effect on tumor necrosis factor. There may also be an increased risk of serious infection, malignancy or thrombosis.

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QUESTION: There may be pharmacokinetic and pharmacodynamic drug–drug interactions between cannabinoids and medications used to treat COVID infections. Azithromycin may have anti-viral activity and has been co-administered with hydroxychloroquine in a RCT of COVID treatment. Does Azithromycin interact with CBD?

ANSWER: Yes, a possible pharmacodynamic interaction may occur and lead to an increase risk for diarrhea.

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QUESTION: Did the number of naloxone prescriptions increase, decrease or stay the same during the time span of 2010 to 2018?
ANSWER: According to research conducted by the Urban Institute, prescriptions for naloxone increased by more than 70-fold from 2010 to 2018. (3,300 to 236,000 prescriptions). The most significant increase in naloxone prescriptions occurred after 2016.

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QUESTION: What have been the most frequently filled prescriptions at US pharmacies in 2020? Are most of them prescriptions for pain relief?

ANSWER: According to research conducted by GoodRx, an online platform that provides users with coupons for discounts on prescription drugs, the 10 most frequently filled prescriptions are: Atorvastatin, Lisinopril, Albuterol, Levothyroxine, Amlodipine, Gabapentin (for the treatment of nerve pain or seizures in adults), Omeprazole, Glucophage, Losartan, and Hydrocodone/acetaminophen (for the treatment of moderate to severe pain.)

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QUESTION: Greater social acceptance of marijuana may result in some prospective parents to reason that it could be used to treat morning sickness. Does marijuana use have any implications for fetal neurodevelopment?

ANSWER: A study evaluating the association between maternal marijuana use during pregnancy and child neurodevelopmental outcomes posed the following question: “Was there an association between cannabis exposure in pregnancy and child neurodevelopmental outcomes in a Canadian cohort?” The results of this retrospective study in Canada found that children exposed to marijuana in utero had a moderately elevated risk of developing autism spectrum disorder. Autism incidence was 4.0 per 1,000 person-years among children exposed to cannabis in pregnancy versus 2.42 among unexposed children (adjusted hazard ratio [HR] 1.51, 95% CI 1.17-1.96)

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. These recommendations were presented at a virtual meeting. One of their recommendations addressed the use of medicinal cannabinoids in patients with severe pain. What were the recommendations for the dosing of cannabinoids for patients suffering with severe pain?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ patients suffering from severe pain and those patients who have a history of significant prior cannabis consumption can use a 50:50 CBD-THC product and start with a dose of 2.5-5 mg of each compound 1 or 2 times/day.

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. These recommendations were presented at a virtual meeting. One of their recommendations addressed the use of medicinal cannabinoids in elderly patients. What were the recommendations for the dosing of THC in the elderly population?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ elderly patients, patients with severe co-morbidity or patients who take multiple medications should be managed through a conservative route; start with THC doses at 1 mg/day and the dose should be titrated up slowly.

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. These recommendations were presented at a virtual PAINWeek meeting. One of their recommendations included “Treat the majority of patients along the “routine” scale.” What does this mean?

ANSWER: Treating the majority of patients along the “routine” scale means to start with a dose of 5 mg of cannabidiol (CBD) twice daily, and tetrahydrocannabinol (THC) should only be added if the patient does not respond to at least 40 mg of CBD daily. If THC is added, the starting dose should be 2.5-mg daily. THC doses should be capped at 40 mg daily.

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QUESTION: In 2017, the National Academies of Sciences, Engineering and Medicine (NASEM) published The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. According to this report, are cannabinoids an effective treatment for chronic pain?

ANSWER: According to this report, “There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults (cannabis).”

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QUESTION: Do cannabinoids decrease or increase g.i. motility?

ANSWER: The pharmacological actions of cannabinoids include decreased gastrointestinal motility, secretion, and emptying.

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QUESTION: Does dronabinol increase appetite in HIV/AIDS patients?

ANSWER: There is limited to moderate evidence to suggest that dronabinol, a synthetic pharmaceutical preparation of delta-9-tetrahydrocannabinol, may be effective in stimulating appetite and weight gain among patients suffering from HIV wasting syndrome. In 1992, the US Food and Drug Administration approved dronabinol for the treatment of AIDS-related anorexia.

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QUESTION: What is the most prevalent side effect of opioids in cancer patients?

ANSWER: Constipation is reported as the most prevalent and most disabling side effect of opioids in both cancer and non-cancer pain patients, with a prevalence as high as 90%.

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QUESTION: What are conduction-based vaporizers?

ANSWER: Conduction-based vaporizers heat herbal cannabis on a surface that is warmed, such as a metal plate, which then allows compounds to passively volatilize. Meanwhile, the consumer generates a steady inhalation, similar to the technique used by asthma patients with metered-dose inhalers or nebulizers to achieve pulmonary administration.

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QUESTION: What physiological systems are affected by the endocannabinoid system?

ANSWER: In addition to regulating neuronal excitability and inflammation in pain circuits, the endocannabinoid system has been shown to play a regulatory role in movement, appetite, hypothalamic-pituitary-adrenal axis modulation, immunomodulation, mood, blood pressure, bone density, tumor surveillance, neuroprotection and reproduction. The endocannabinoid system has also been shown to affect sensory perception, cardiac output, cerebral blood flow and intraocular pressure.

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QUESTION: What does cannabinergic mean?

ANSWER: Any drug that modifies or interacts with the endocannabinoid system is ‘cannabinergic’.

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QUESTION: What is the pharmacological profile of buccally administered cannabinoids?

ANSWER: With buccal administration, a mix of cannabinoids can be sprayed on to the oral mucosa and the medicine is absorbed through the mucous membranes. Peak plasma concentrations usually occur within 2-4 hrs after administration. When compared to inhalation of cannabinoids, buccal administration of cannabinoids is associated with lower blood levels of cannabinoids because absorption is slower, redistribution into fatty acids occurs rapidly and some of the cannabinoids undergo first pass metabolism.

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QUESTION: Nabiximols (a cannabinoid medicine containing THC and CBD) is approved in many European countries for the treatment of neuropathic pain, spasticity and bladder dysfunction in patients suffering from multiple sclerosis. What are the potential drug interactions between nabiximols and analgesic medications?

ANSWER: The nabiximols product monograph cautions prescribers against combining nabiximols with amitriptyline or fentanyl because these drugs are metabolized by the same enzymes as nabiximols. Potential drug interactions with other opioids (oxycodone, tramadol and methadone) also exist.

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QUESTION: What is the purpose of urine drug testing?

ANSWER: Urine drug tests typically screen for the patient’s prescribed opioids and the commonly abused drugs: cocaine, amphetamines, alcohol, barbiturates, opiates and benzodiazepines. Although a urine drug test can confirm if the patient is taking the prescribed opioid, it cannot determine if the patient is taking the prescribed dose.

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QUESTION: What are the drugs that are inhibitors to cytochrome P450 and therefore decrease the metabolism of cannabinoids?

ANSWER: THC is oxidized by the cytochrome P450 (CYP) mixed-function oxidases 2C9, 2C19 and 3A4 1. Therefore, substances that inhibit these CYP isoenzymes (e.g. fluoxetine, cimetidine, clarithromycin, ketoconazole, verapamil, indinavir, among others) can potentially increase the bioavailability of THC, and thus increase the chance of experiencing THC-related side effects.

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QUESTION: Why do NSAIDS relieve pain?

ANSWER: NSAIDs reduce the production of prostaglandin E2 (PGE2) and prostacyclin (PGI2), which mediate pain and inflammation.

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QUESTION: Describe the process of vaporization of cannabis.

ANSWER: Vaporization is a smokeless delivery system in which warm air or heat of 180°C to 200°C, rather than a flame, is used to convert cannabinoids and other compounds into a fine mist that can be inhaled. Due to their volatility, cannabinoids will vaporize at temperatures of 180°C to 200°C, but will not combust and therefore few combustion by-products such as soot or polycyclic aromatic hydrocarbons are produced. As temperatures increase, the amount of cannabinoids released increases, and the amount of combustion by-products increases, too.

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QUESTION: The pharmacological properties of cannabigerol have been investigated. What have the studies shown?

ANSWER: Cannabigerol (CBG) is the phytocannabinoid precursor molecule, and demonstrates weak partial agonism at CB1 and CB2. In in vitro studies, CBG displays analgesic and anti-erythemic effects. CBG also displays anti-hypertensive activity.

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QUESTION: The pharmacological properties of tetrahydrocannabivarin have been investigated. What have the studies shown?

ANSWER: Tetrahydrocannabivarin (THCV) is a CB1 antagonist at low doses, but displays weak agonistic effects at high doses. In obese mice models, THCV reduced appetite, produced weight loss and decreased body fat and leptin concentration.

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QUESTION: What is the pharmacologic profile of cannabis when it is vaporized?

ANSWER: The pharmacologic profile of cannabis when it is vaporized is similar to the profile when it is smoked. Psychoactive effects appear within 90 seconds, reach a maximum after 15-30 minutes, and taper off within 2-3 hours.

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QUESTION: What is the pharmacologic profile of cannabis when it is smoked?

ANSWER: When herbal cannabis is smoked, the active ingredients in cannabis are vaporized by the heat of combustion and inhaled. Inhaled constituents quickly pass from alveoli into the bloodstream and readily cross the blood-brain barrier. Psychoactive effects appear within 90 seconds, reach a maximum after 15-30 minutes, and taper off within 2-3 hours. This short onset of action makes dose titration possible, by spacing inhalations at 90-second intervals.

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QUESTION: The pharmacological properties of cannabichromene have been investigated. What have the studies shown?

ANSWER: Cannabichromene (CBC) is a potent anadamide uptake inhibitor and thus may modulate the endocannabinoid system similarly to CBD. In mice studies, it has been shown that CBC has anti-inflammatory properties and analgesic activity. CBC has other pharmacological properties, as well.

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QUESTION: The pharmacological properties of cannabinol have been investigated. What have the studies shown?

ANSWER: Cannabinol (CBN) is the oxidative by-product of THC and appears after long storage. It is a weaker partial agonist at CB1 and CB2 as compared to THC. In in vitro studies, it has been found that cannabinol is anticonvulsant and anti-inflammatory, and stimulates bone formation.

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QUESTION: It is the mixture of phytocannabinoids, terpenes and other active components present in a cannabis product that ultimately determines the therapeutic effects and side effects. Does CBD affect THC absorption and tolerance?

ANSWER: CBD has long been thought to influence the effects of THC. This thinking was extended to consider that CBD potentiates some of the beneficial effects of THC, as it reduces the psychoactive effects of THC and thus could improve tolerability. CBD may counteract some of the functional consequences of CB1 receptor activation in the brain. This effect has been used to explain why high CBD:THC cannabis use is less associated with the development of psychotic symptoms compared to low CBD:THC cannabis. Also, CBD is thought to interact with the cytochrome p450 enzymes that metabolize THC and thus may alter the metabolism and influence the effects of the THC consumed. It has been proposed that THC and CBD act synergistically in therapeutic use.

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QUESTION: Does methadone alter cardiac conduction?

ANSWER: Yes. Methadone is known to prolong QTc intervals in up to 16% of patients. Studies have shown a linear dose response curve, with higher doses leading to a higher propensity for QTc prolongation. This has led to an FDA “black box” warning for methadone and the recommendation for routine ECG monitoring.

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QUESTION: How have medical advances altered opioid use in cancer patients?

ANSWER: Cancer is no longer considered a “terminal disease.” Because of significant advances in surgical, radiation, and chemotherapeutic treatments, more than 50% of cancer patients are living greater than 2 years after the diagnosis of cancer. This allows for more cancer patients to develop chronic pain. All of these factors have led to more cancer patients taking opioids long-term.

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QUESTION: What are terpenes (or terpenoids)?

ANSWER: Terpenes are aromatic components produced in the glandular part of the cannabis plant’s flower bud. Terpenes are manufactured by many plants (not just the cannabis plant) and can be found in many food products, including coffee beans, ginger and cinnamon. Often, it is the terpenes that are responsible for a plant’s odor.

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QUESTION: Does smoking marijuana impact the metabolism of theophylline?

ANSWER: It may. Reports have indicated that smoking marijuana may increase the clearance of theophylline. Note: this effect appears to be a direct result of the hydrocarbons found in marijuana smoke rather than the cannabis-based products, as there is a lack of evidence for enzyme induction when cannabis-based drugs are consumed via oral ingestion.

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QUESTION: Do the hydrocarbons in marijuana smoke impact drug metabolism?

ANSWER: Possibly. Similar to cigarette smoke, the hydrocarbons in marijuana smoke appear to induce the activity of some cytochromes, including CYP1A2.

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QUESTION: What criteria should be used when selecting a CBD hemp product?

ANSWER: According to a 2019 Mayo Clinic publication, the following 4 questions should be asked, and the answers to each of the questions should be “yes” :
1. Does the hemp product meet the quality standards of the Current Good Manufacturing Practices Certification from the FDA, or the European Union, Australian or Canadian organic certification, or the National Science Foundation International Certification?
2. Does the manufacturer have an independent review adverse event reporting system?
3. Is the product certified organic or ecofarmed?
4. Have the company’s products been lab tested to confirm THC levels to be < 0.3% and to confirm that no pesticides or heavy metals are present?

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QUESTION: Is full spectrum CBD the same as whole plant CBD?

ANSWER: No. Whole plant CBD contains fats, waxes and fibrous materials not found in full spectrum CBD.

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QUESTION: Is the plasma concentration of Epidiolex (CBD) affected by co-administration of high fat/high calorie food?

ANSWER: Yes. It has been that if CBD is co-administered with a high fat/high calorie meal, the plasma concentration of CBD may increase by as much as 5-fold.

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QUESTION: Describe the exact mechanism of action of Epidiolex.

ANSWER: According to the Epidiolex FDA Approved Package Insert, (Greenwich Biosciences, Inc.), the precise mechanism(s) by which Epidiolex exerts its anticonvulsant effects in humans are unknown. It does not appear to be through cannabidiol receptors.

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QUESTION: Epidiolex has been approved for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS). Has the FDA approved Epidiolex for any other conditions?

ANSWER: Yes. On July 31, 2020, the U.S. Food and Drug Administration approved Epidiolex (cannabidiol or CBD) oral solution for the treatment of seizures associated with tuberous sclerosis complex (TSC) in patients one year of age and older.

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QUESTION: The International Association for the Study of Pain (IASP) has updated the definition of pain. What is their new definition of pain?

ANSWER: After 40+ years, the IASP has revised their definition of pain to reflect advances in our understanding of pain. The revised definition emphasizes that tissue damage is not required. The updated definition of pain is: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” The revised definition also includes 6 notes:
1.) Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors
2.) Pain and nociception are different phenomena, and pain cannot be inferred solely from activity in sensory neurons
3.) Through life experiences, people learn the concept of pain
4.) A person’s report of an experience as pain should be respected
5.) Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being
6.) Verbal description is only one of several behaviors to express pain, and an inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain

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QUESTION: What is oliceridine (Olinvyk)? Is it a new FDA-approved opioid?

ANSWER: According to an August 7, 2020 FDA news release, “the FDA approved Olinvyk (oliceridine), an opioid agonist for the management of moderate to severe acute pain in adults, where the pain is severe enough to require an intravenous opioid and for whom alternative treatments are inadequate. Olinvyk is indicated for short-term intravenous use in hospitals or other controlled clinical settings, such as during inpatient and outpatient procedures. It is not indicated for at-home use.” https://www.fda.gov/news-events/press-announcements/fda-approves-new-opioid-intravenous-use-hospitals-other-controlled-clinical-settings

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QUESTION: What is the safety profile of Olinvyk?

ANSWER: According to an August 7, 2020 FDA news release, “The safety profile of Olinvyk is similar to other opioids. As with other opioids, the most common side effects of Olinvyk are nausea, vomiting, dizziness, headache and constipation. Olinvyk should not be given to patients with significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment; known or suspected gastrointestinal obstruction; or known hypersensitivity to the drug. Prolonged use of opioid analgesics during pregnancy can result in neonatal opioid withdrawal syndrome.” “Olinvyk carries a boxed warning about addiction, abuse and misuse; life-threatening respiratory depression; neonatal opioid withdrawal syndrome; and risks from concomitant use with benzodiazepines or other central nervous system depressants. Unlike other opioids for intravenous administration, Olinvyk has a maximum recommended daily dose limit of 27 milligrams.” https://www.fda.gov/news-events/press-announcements/fda-approves-new-opioid-intravenous-use-hospitals-other-controlled-clinical-settings

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QUESTION: Changes in fetal growth have been described in some epidemiological studies examining the impact of maternal use of marijuana. Do the long‐term patterns of physical growth appear to be affected?

ANSWER: No, long-term physical growth does not appear to be affected. In contrast, long‐term impacts on psychological health have been noted and include increased rates of depressive symptoms and anxiety as well as delinquency.

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QUESTION: Does the use of cannabinoid-based products impact female sexual function?

ANSWER: According to a study published in the journal Sexual Medicine, an increased frequency of marijuana use is associated with improved sexual function among females. Interestingly, it was noted that chemovar type and method of consumption did not impact outcomes, though.

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QUESTION: CBD and medical marijuana are legal in Florida and California. Do the major amusement parks in these states and other legal marijuana states allow medical marijuana patients to carry CBD and medical marijuana into the amusement parks?

ANSWER: With a few exceptions, the answer is no. Medical marijuana and CBD products are not allowed in Disney parks and resorts (including hotels, shopping and restaurants). Six Flags, Universal, and Cedar Fair also prohibit all forms of legal cannabinoid products, including CBD. In contrast, Sea World properties (which include all Busch Gardens and Sea World parks) allow visitors to carry CBD—but no forms of medical marijuana with significant amounts of THC.

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QUESTION: According to an estimate by the United Nations, what percentage of the world’s population used cannabis products in 2016?

ANSWER: The UN estimated that in 2016, 3.9% of the world’s population used cannabis products. (3.9% of the world population is equivalent to ~ 192.2million people)—The UN’s data suggest that there was an increase of 16% compared with estimates of the previous decade.

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QUESTION: Does the Food and Drug Administration (FDA) currently certify the levels of THC contained within CBD products?

ANSWER: Actually, no. The FDA does not regulate the CBD products sold in convenience stores, grocery stores and on line. Although they are labeled as containing no THC, some may actually contain a small amount of THC. (Note: The FDA does monitor the CBD product called Epidiolex.)

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QUESTION: Has the FDA approved any drugs that contain a purified drug substance derived from cannabis?
ANSWER: Yes. Epidiolex oral solution contains purified cannabidiol that has been extracted from the cannabis plant, and this drug has been approved by the FDA. The FDA has also approved medications, such as marinol, that contain synthetic THC.

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QUESTION: Do cannabinoids induce clinical remission or affect inflammation in inflammatory bowel disease patients?

ANSWER: According to a systematic review with meta-analysis of the efficacy of cannabis and cannabinoids for inflammatory bowel disease, cannabis/cannabinoids do not induce clinical remission or affect inflammation in IBD patients. (No effect on inflammatory biomarkers was observed.) However, in this systematic review it was found that cannabis/cannabinoids significantly improved patient-reported symptoms and quality of life. (Clinical symptoms (abdominal pain, general well-being, nausea, diarrhea, and poor appetite) all improved with cannabis/cannabinoids on Likert-scales.) This systematic review involved 15 nonrandomized studies and 5 randomized controlled trials.

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QUESTION: In July of 2020, the FDA announced that labeling for opioid analgesics and medicine to treat opioid use disorder (OUD) must be updated. What do the updates entail?

ANSWER: The updates include that naloxone availability be routinely discussed as part of prescribing opioid analgesics and OUD medicines. The labelling changes also recommend that health care professionals consider prescribing naloxone when they prescribe medicines to treat OUD. Additionally, the labeling changes recommend “that health care professionals consider prescribing naloxone to patients being prescribed opioid pain medicines who are at increased risk of opioid overdose… A naloxone prescription should also be considered for patients prescribed opioids who have household members, including children, or other close contacts at risk for accidental ingestion or opioid overdose.”

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QUESTION: Do cannabinoid-based medicines impact the deposition of Amyloid β peptide in Alzheimer’s disease?

ANSWER: According to the results of a systematic review, the findings of 9 animal studies indicated that cannabis-based medicines might modulate Amyloid β modifications and inhibit the progression of Alzheimer’s disease. (The maximum and minimum cannabinoid dosages, mostly CBD and THC in animal studies, were 0.75 and 50 mg/kg, respectively. The cannabinoids (CBD and THC) were injected for 10 to 21 days.)

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QUESTION: What is the most common mode of CBD administration?

ANSWER: According to a 2017–2018 online survey evaluating modes of CBD administration, the most common method of CBD administration was sublingual, followed by vaping, oral ingestion of capsules and liquids, smoking, edibles, and topical administration.

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QUESTION: In what dosage forms are pharmaceutical fentanyl products supplied?

ANSWER: Pharmaceutical fentanyl products are currently available in the following dosage forms: oral transmucosal lozenges (AKA fentanyl “lollipops”), buccal tablets and sublingual tablets, sublingual sprays, nasal sprays, transdermal patches, and injectable formulations.

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QUESTION: Chronic pelvic pain affects up to 15% of women in the United States. Cannabinoid receptors are expressed on reproductive tissues (including the uterus) and non-reproductive pelvic tissues. Do patients with chronic pelvic pain use cannabinoid-based products to ameliorate their symptoms?

ANSWER: The conclusions of a survey of 122 chronic pelvic pain female patients indicated that up to 23% report using cannabinoid-based products as an adjunct to their prescribed therapies. The patients use a variety of formulations and doses of cannabinoid-based products, and most report daily or weekly use. Most users report improvement in symptoms, but did acknowledge that side effects are common.

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QUESTION: Describe the chemical makeup of endocannabinoids.

ANSWER: Endocannabinoids are ester, ether, and amide derivatives of long chain polyunsaturated fatty acids. Arachidonic acid is an example of a polyunsaturated fatty acid in endocannabinoids.

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QUESTION: How is the endocannabinoid system linked to the opioid system?

ANSWER: Opioid receptors and CB receptors are located within the same neurons within the CNS. In addition, cannabinoids activate kappa and delta receptors to initiate a release of endogenous opioids.

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QUESTION: Does the co-administration of THC and alcohol impact serum THC levels?

ANSWER: Yes. According to a study by Hartman in 2015, alcohol may increase serum THC levels.

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QUESTION: Some producers of cannabinoid products will provide a certificate of analysis (CoA) from an independent and certified testing laboratory. What information is typically displayed on a CoA?

ANSWER: CoAs typically indicate the amount and concentration of major cannabinoids and terpenes present, and data regarding the presence of microbial/ fungal contaminants, levels of heavy metals, and presence and concentration of pesticide and solvent residues.

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QUESTION: Drug screens are sometimes done in the pre-operative. Is it clinically useful to do a drug screen for the presence of cannabinoids or cannabinoid metabolites?

ANSWER: Drug screens for the presence of cannabinoids and metabolites of cannabinoids will not inform the healthcare provider of the recency of marijuana use, as cannabinoids can remain in the body for several weeks.

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QUESTION: Does CBD isolate contain any other cannabinoids or terpenes?

ANSWER: CBD isolate is CBD in its molecular form, and is typically sold as 99+% pure. Unless indicated on the label, products made with CBD isolate do not contain any other cannabinoids or terpenes.

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QUESTION: What does “broad spectrum” mean?
ANSWER: Broad spectrum and full spectrum are not synonymous. Broad-spectrum products are processed in such a manner as to ensure that the final product does NOT contain THC.

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QUESTION: What does “full spectrum” marijuana product mean?

ANSWER: Full spectrum means that the product contains all of the original compounds found in the flower of the cannabis plant (cannabinoids, terpenes and flavonoids).

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QUESTION: Have the results of studies conducted between 2003-2017 indicated that cannabinoids are effective at treating chronic non-cancer pain?

ANSWER: Yes. Lynch and Ware published 2 systematic reviews (SR). One SR evaluated trials from 2003 to 2010 and the other SR evaluated trials from 2010 to 2014. Of the 29 RCTs evaluated in the 2 SRs, 22 of them demonstrated that cannabinoids have a modest analgesic effect and are safe in the management of chronic pain. The modes of administration explored in these 29 SRs included: smoking, oromucosal and oral. All 6 smoked cannabis trials showed a positive analgesic response.

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QUESTION: Epidemiological studies indicate that as many as 15% of inflammatory bowel disease (IBD) patients may use cannabinoids to ameliorate some of their symptoms, including improvement in diarrhea, abdominal pain and appetite. Do the studies show that cannabinoids are effective?

ANSWER: There are few studies evaluating cannabinoid use in IBD, and those studies are small. In Crohn’s disease, it has been demonstrated that THC reduces the Crohn’s disease activity index by >100 points (on a scale of 0–450). Also, two small studies involving ulcerative colitis patients showed a marginal benefit. However, no improvement in inflammatory markers or in endoscopic score in either disease was detected.

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QUESTION: The findings of multiple RCTs indicate that cannabinoids effectively treat chronic pain. Do cannabinoids effectively treat the chronic pain associated with fibromyalgia?

ANSWER: No. According to a Cochrane systematic review published in 2016 on the use of cannabinoids to treat fibromyalgia, there is no convincing, unbiased, high-quality evidence suggesting that a cannabinoid-based medicine (nabilone) is of value in treating people with fibromyalgia. Furthermore, the tolerability of nabilone was low in people with fibromyalgia. Also, the results of a 2019 study where 4 varieties of pharmaceutical grade marijuana were administered by single shot vapor to fibromyalgia patients indicated that none of the 4 marijuana varieties had an effect greater than placebo. (Note: The data from the 2019 study could not be used to extrapolate the long-term effects of cannabinoids on fibromyalgia-associated pain.)

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QUESTION: Some cancer patients use medical marijuana to treat various cancer-associated ailments. What are some of the ailments ameliorated by medical marijuana?

ANSWER: According to one study involving 96 cancer patients receiving supportive cancer care, the data support the safety and effectiveness of medical marijuana as a complementary option for improving pain control, appetite and quality of life for cancer patients. The top three adverse events of this study included drowsiness, low energy and nausea, and were reported in 28% of patients, with 9% having to stop using the medical marijuana. (Note: other studies indicate that chemotherapy-induced N/V and anxiety are ameliorated by medical marijuana.)

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QUESTION: Side effects of short-term cannabinoid-based therapy may differ from person to person, and the same person may experience different side effects at different times. What factors influence the probability and the severity of adverse events?

ANSWER: Many factors influence the likelihood and the severity of adverse events, including the type of cannabinoid preparation; the mode of administration; the patient’s expectations, the patient’s prior experience with cannabinoid-based therapies, and the age of the patient. Drug–drug interactions may also lead to adverse events.

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QUESTION: According to the results of a survey of breast cancer patients’ use of cannabinoid products before, during, and after treatment, 42% of survey participants had used medical cannabinoid products to relieve symptoms. What symptoms were treated with the cannabinoid products?

ANSWER: Members of the Breastcancer.org and Healthline communities were asked to participate in a survey during the period of 12/16/2019 – 1/19/2020. Among the 832 respondents who completed screening, 725 met the eligibility criteria, and 612 (84%) completed the survey. According to the results, the symptoms for which cannabinoids were used included insomnia (70%), pain (59%), anxiety (57%), stress (51%), and nausea/vomiting (46%). The results also indicated that cannabinoids were used prior to treatment in 24%, during treatment in 79%, and after treatment in 54%. Of subjects reporting cannabis use during treatment: 86% used it during chemotherapy, 71% during HER2 therapy, 65% during hormonal therapy, 49% during breast radiation, and 47% during radiation for metastatic sites. Post-surgical use was reported in 51% after mastectomy alone, 40% after lumpectomy, and 38% after mastectomy/reconstruction.

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QUESTION: Other than feeling “high” what are some of the reported psychological CNS-related side effects associated with cannabinoid use?

ANSWER: Psychological side effects associated with cannabinoid use include: restless/anxiety/nervousness, depressed mood, dysphoria, confusion, dissociation, hallucinations, hyperactivity, weird dreams, paranoia and psychosis.

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QUESTION: Are cannabinoids an effective analgesic agent in the chronic pain setting?

ANSWER: In contrast to the lack of efficacy in the acute pain setting, cannabinoids are effective analgesic agents in the chronic pain setting. According to 2 systematic reviews involving a total of 29 RCTs, 22 of the 29 RCTs demonstrated that cannabinoids have a modest analgesic effect in the management of chronic pain. The following modes of administration were examined in the RCTs: smoked cannabis (6 trials), oromucosal and oral cannabis extract (11 trials), nabilone (8 trials), dronabinol (2 trials), THC-11 acid analogue (2 trials), and fatty acid amide hydrolase inhibitor (1 trial).

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ANSWER: Are cannabinoids an effective analgesic agent in the acute pain setting?

ANSWER: No. According to the results of multiple RCT examining the efficacy of cannabinoids to treat acute pain, THC, nabilone and other cannabinoid-based products were not associated with a reduction in pain, but were associated with adverse side effects, including sedation.

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QUESTION: What are the common modes of administration of medical marijuana used by cancer patients?

ANSWER: According to a survey completed by 183 cancer patients of an oncology clinic at Sutter Medical Center in Sacramento, California, over 50% reported use of oils and tinctures and 44% used edibles. A smaller percentage consumed cannabis-based products via vaping (26%) or smoking (30%). Topical use was preferred by fewer patients (17%). Over 58% of patients stated they used more than one method.

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QUESTION: It has been estimated that a significant proportion of cancer patients (18.3-40.0%) in the United States use cannabis or cannabinoid-based products. Does the evidence indicate that cannabinoid-based products are effective in treating cancer-related pain? chemotherapy-induced n/v? cancer-related cachexia?

ANSWER: According to a study published in the Journal of Clinical Oncology, there is substantial evidence for the effectiveness of cannabis and cannabinoids in treating cancer-related pain; specifically, oromucosal THC/CBD spray. Also, there is conclusive evidence that cannabis and cannabinoids effectively relieve chemotherapy-induced nausea and vomiting; (specifically, oral THC). However, there is inconclusive evidence about the effectiveness of cannabinoid-based products in treating cancer-related cachexia.

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QUESTION: Does the administration of marijuana affect insulin levels in humans?

ANSWER: In a DBRCT involving 20 participants, it was found that marijuana consumed via oral, smoked, or vaporized routes affected blood concentrations of some metabolic hormones, including insulin. In fact, the results of this study indicate that acute marijuana use blunted the insulin spike associated with the consumption of a brownie.

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QUESTION: Are there any special considerations for patients who consume cannabinoid-based products and are undergoing plastic surgery?

ANSWER: Yes. On occasion, plastic surgeons administer atropine and/or epinephrine during a procedure. Both of these medications can increase heart rate, and cannabinoids may potentiate the increase in heart rate.

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QUESTION: Cannabinoid receptors have been located in the central nervous system and the peripheral nervous system, as well as on immune cells. Have cannabinoid receptors been isolated in reproductive tissues/cells?

ANSWER: In addition to cannabinoid receptors being identified in the hypothalamus and the pituitary gland, cannabinoid receptors have also been identified on ovary, endometrial tissue, testes, and spermatozoa. In fact, research suggests that marijuana may alter the release of FSH and LH, ovulation, sperm motility, fertilization, as well as placentation.

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QUESTION: What are K2 and Spice?

ANSWER: K2 and Spice are synthetic cannabinoid “designer drugs” that are intended to mimic the effects of THC. These synthetic cannabinoids are sold as “herbal incense” at convenience stores/gas stations, smoke shops and via the internet. They are produced in powder form, and then often dissolved in solvents, so they can be applied to dry plant material to make the “herbal incense” products.

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QUESTION: Heroin is processed from morphine, an extract from the poppy plant. Heroin is often depicted as a white powder. Is heroin sold in forms other than white powder?

ANSWER: In addition to white powder, heroin is sold as a brownish powder, or as a black sticky/tar-like substance (AKA black tar heroin). Heroin is either sold in pure form or is “cut” with other drugs (quinine, for example) or with other white powdery substances, including sugar, starch or powdered milk.

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QUESTION: Respiratory depression is associated with the overdose of opioids or benzodiazepines. Is respiratory depression associated with an overdose of cannabinoids? Why or why not?

ANSWER: Respiratory depression is not associated with cannabinoid use because CB1 receptors are not located in the midbrain, the part of the brain responsible for respiratory drive.

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QUESTION: As of January 2020, how many Americans were using marijuana-based products for medicinal purposes?
ANSWER: It has been estimated that more than 2 million Americans use marijuana for medical reasons. Some of the many ailments being treated with marijuana include: chronic pain, PTSD, depression, sleep disorders, multiple sclerosis (MS), cancer-related ailments, and GI disorders. Some indications are supported by good scientific evidence, but many are not.

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QUESTION: Rohypnol® is the trade name for the benzodiazepine called unitrazepam. Has this drug ever been approved by the Food and Drug Administration for medical use in the United States?

ANSWER: No, but outside the US, Rohypnol® is prescribed to treat insomnia. Rohypnol® has been referred to as a date rape drug or roofies. Before 1997, Rohypnol® was manufactured as a white tablet, and when mixed in liquids, it was colorless, tasteless, and odorless. In 1997, the manufacturer responded to concerns about the drug’s role in sexual assaults, and reformulated the drug. Now, Rohypnol® is produced as an olive green tablet with a speckled blue core that when dissolved in light-colored drinks will change the color of the liquid to blue. Of note, generic versions of the drug may not contain the blue dye.

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QUESTION: What is the Chemical Diversion and Trafficking Act (CDTA) of 1988?

ANSWER: The CDTA is an Act that regulated 12 (drug manufacturing) precursor chemicals, eight essential chemicals, tableting machines, and encapsulating machines. The Act imposed recordkeeping and import/export reporting requirements on transactions involving these regulated products. One of the goals of this Act was to reduce the supply of methamphetamine. As of 2020, the DEA regulates more than 40 chemicals that are often used in the production of illicit drugs.

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QUESTION: Cannabinoids are metabolized by many of the same cytochrome P450 enzymes as warfarin, including CYP3A4, CYP2C9, and CYP2C19. THC, CBD and CBN can inhibit the CYP2C9-mediated hydroxylation of warfarin, and thus lead to an increase in INR. Do cannabinoids also affect the metabolism of heparin? Is the metabolism of direct oral anticoagulants (DOACs), including rivaroxaban, edoxaban, and apixaban, impacted by cannabinoids?

ANSWER: While cannabinoids do not alter the metabolism of heparin, cannabinoids may impact the metabolism of DOACs. DOACs are substrates of P-gp and are absorbed by the gut through the P-gp efflux transporter. Cannabinoids may bind to P-gp membrane transporters and alter DOAC metabolism. DOAC levels may increase, leading to an increased risk of bleeding.

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QUESTION: CBD is a CB1 antagonist and a negative allosteric modulator at CB2. Does CBD interact with receptors other than CB1 or CB2?

ANSWER: Yes. CBD has cannabinoid receptor-independent properties. For example, CBD is an agonist at the TRPV1 receptor and has agonist properties at the 5-HT1A/2A/3A serotonergic receptors. CBD is also a capsaicin analog. CBD has antagonist activity on alpha-1 adrenergic and μ-opioid receptors, too. In addition, CBD has been found to inhibit synaptosomal uptake of noradrenaline, dopamine, serotonin, and gamma-amino butyric acid. CBD also inhibits anandamide uptake.

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QUESTION: Cannabinoid receptors are located throughout various parts of the CNS, including the basal ganglia, hippocampus, cerebellum and cerebral cortex, and in the peripheral nervous system. Do these receptors have effects on neurotransmitters such as serotonin?

ANSWER: Yes. CB receptor activity not only impacts serotonin, but it also affects acetylcholine, dopamine, glutamate, and GABA, as well as NMDA and opioid receptor systems.

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QUESTION: The Controlled Substances Act (CSA) regulates five classes of drugs. What are they?

ANSWER: The Controlled Substances Act (CSA) regulates five classes of drugs, including narcotics, depressants, stimulants, hallucinogens and anabolic steroids. All controlled substances have abuse potential or they are immediate precursors to substances that have abuse potential. Note: Alcohol and tobacco are specifically exempt from
control by the CSA.

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QUESTION: Methamphetamine is a Schedule II highly addictive stimulant. What is methamphetamine’s mechanism of action that leads to the “rush” and “high”?

ANSWER: It is believed that the “rush” and the “high” associated with amphetamine use result from the release of very high levels of dopamine into areas of the brain that regulate feelings of pleasure.

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QUESTION: Methadone, morphine and heroin are all narcotics. Do they all have a similar chemical structure?
ANSWER: No. Morphine and heroin (which is derived from morphine) have a similar structure. Methadone, which is a synthetic narcotic, does not have a similar structure to morphine.

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QUESTION: Methamphetamine is a controlled substance and is classified as a Schedule II drug. Schedule II drugs have a high potential for abuse and have an accepted medical use. What medical use(s) does methamphetamine have?

ANSWER: As of April 2020, there is only one legal “meth” product, and it is sold under the name Desoxyn®. It has very limited use in the treatment of obesity and ADHD.

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QUESTION: Is the analgesic potency of hydromorphone more or less than the potency of morphine?

ANSWER: Hydromorphone is (2 to 8 times) more potent than morphine but not as potent as fentanyl.

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QUESTION: Chronic pelvic pain affects up to 15% of women in the United States. Cannabinoid receptors are expressed on reproductive tissues (including the uterus) and non-reproductive pelvic tissues. Do patients with chronic pelvic pain use cannabinoid-based products to ameliorate their symptoms?

ANSWER: The conclusions of a survey of 122 chronic pelvic pain female patients indicated that up to 23% report using cannabinoid-based products as an adjunct to their prescribed therapies. The patients use a variety of formulations and doses of cannabinoid-based products, and most report daily or weekly use. Most users report improvement in symptoms, but did acknowledge that side effects are common.

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QUESTION: In what dosage forms are pharmaceutical fentanyl products supplied?

ANSWER: Fentanyl pharmaceutical products are currently available in the following dosage forms: oral transmucosal lozenges (AKA fentanyl “lollipops”), buccal tablets and sublingual tablets, sublingual sprays, nasal sprays, transdermal patches, and injectable formulations.

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QUESTION: Fentanyl, morphine and heroin are all analgesics. Which one of the three is the most potent analgesic?

ANSWER: Fentanyl is the most potent analgesic of the three. It is about 100 times more potent than morphine and 50 times more potent than heroin, as an analgesic agent.

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QUESTION: What are common street names for marijuana?

ANSWER: Often, marijuana concentrates look similar to honey with either a brown or gold color, and many of the street names refer to the golden brown color. The terms wax, ear wax, honey oil, budder, butane hash oil, butane honey oil (BHO), shatter, dabs (dabbing), black glass, and errl have all been used to refer to marijuana concentrates.

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QUESTION: What is hashish?

ANSWER: Hashish (AKA hash) is a THC-rich resin from the cannabis plant. This resin is collected and processed into various forms, including balls, cakes or cookies. Pieces of hashish can be broken off, and placed in pipes or cigarettes for smoking. Some individuals mix hashish with tobacco. Hashish products are considered to be Schedule I substances.

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QUESTION: What is the most common route of administration for the synthetic cannabinoids K2 or Spice?

ANSWER: K2 and Spice are used for recreational purposes, and smoking is the most common route of administration. Spraying or mixing the synthetic cannabinoids on dried plant material allows one to smoke it (using a pipe, a water pipe, or rolling the drug-laced plant material in cigarette papers). Also, liquid synthetic cannabinoids have been designed to be vaporized via e-cigarettes.

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QUESTION: Does marijuana use alter the sexual intercourse experience?

ANSWER: An online survey posed questions regarding various aspects of sexual experience and how those aspects were impacted by marijuana use. The results indicated that marijuana helped individuals relax, heightened their sensitivity to touch, and increased intensity of feelings, thus enhancing their sexual experience, while others found that marijuana interfered by making them sleepy and less focused or had no effect on their sexual experience.

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QUESTION: CB1 receptors are located on neurons in the CNS and PNS. Are CB1 receptors also located on cardiomyocytes?

ANSWER: Yes. CB1 receptors are located in cardiomyocytes, vascular endothelial cells as well as smooth muscle cells. Activation of these CB1 receptors may lead to oxidative stress, inflammation, fibrosis, vasodilation, and negative inotropy.

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QUESTION: Some cannabinoid-based medicines are used to treat chemotherapy-induced n/v. Have cannabinoid-based medicines been shown to be effective in the treatment of post-op n/v?

ANSWER: The results of studies indicate that neither nabilone or intravenous THC is effective for post-op n/v. Even premedication with nabilone was ineffective at treating post-op n/v.

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QUESTION: Does ketamine interact with the endocannabinoid system?

ANSWER: Yes. Ketamine induces the release of endocannabinoids.

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QUESTION: Do CB1 and CB2 agonists facilitate endogenous opioid signaling?

ANSWER: Yes. In fact, CB1 and CB2 agonists increase the concentrations of endogenous opioids.

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QUESTION: Is the endocannabinoid system linked to the opioid system?

ANSWER: Yes. Opioid receptors and CB receptors are located within the same neurons within the CNS. In addition, cannabinoids activate kappa and delta receptors to initiate a release of endogenous opioids.

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QUESTION: How do cannabinoids modulate pain sensation? In other words, describe the mechanism of action of cannabinoids.

ANSWER: Endocannabinoids are synthesized in the postsynaptic neuron in response to stimuli such as pain, stress and inflammation. Endocannabinoids travel in a retrograde fashion and activate the presynaptic CB receptors. Antinociceptive effects occur when either endocannabinoids or phytocannabinoids activate presynaptic inhibitory CB1 receptors. Stimulation of CB1 receptors (G protein coupled receptors (Gi,Go)) leads to a reduction of cAMP production via the inhibition of adenylyl cyclase. This results in an action on voltage gated calcium and potassium channels – there is a depression of neuronal excitability and a reduction of neurotransmitter release.

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QUESTION: A study by Jamal et al. published in the European Journal of Anaesthesiology reported that marijuana users required a higher dose of morphine s/p abdominal surgery. They estimated that there was a 23% increased opioid dose requirement. Have the results of studies examining the opioid requirements s/p orthopedic surgery also shown that marijuana users require more opioids than patients who do not use marijuana?

ANSWER: In a retrospective study including 3793 patients, patient-reported postoperative outcomes of 155 marijuana users were compared with those of 155 non-users. The results indicate that pre-operative marijuana users had higher pain scores at rest and on movement but did not consume more post-operative opioid analgesics. The cannabinoid users also reported a greater incidence of post-operative sleep impairment.

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QUESTION: CBD is a negative allosteric modulator. What does that mean?

ANSWER: A negative allosteric modulator changes the shape of the receptor and, as a result, reduces the binding ability of components that typically bind to the receptor. In the case of cannabinoids, CBD alters the shape of CB1 receptors, and THC along with endogenous cannabinoids do not bind to the CB1 receptor to the same degree as they do when CBD is not present.

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QUESTION: Some producers of cannabinoid products will provide a Certificate Of Analysis (CoA) from an independent certified testing laboratory. What information is typically displayed on a CoA?

ANSWER: CoAs typically indicate the amount and concentration of major cannabinoids and terpenes present, and data regarding the presence of microbial/ fungal contaminants, levels of heavy metals, and presence and concentration of pesticide and solvent residues.

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QUESTION: What medications alleviate the symptoms of marijuana withdrawal?

ANSWER: There are no general guidelines to treat the symptoms of marijuana withdrawal, but it has been reported that benzodiazepines and synthetic THC products used for the treatment of chemotherapy induced N/V may help alleviate some of the symptoms.

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QUESTION: What does “broad spectrum” mean?

ANSWER: Broad-spectrum products are processed in such a manner as to ensure that the final product does NOT contain THC.

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QUESTION: What does “full spectrum” marijuana product mean?

ANSWER: Full spectrum means that the product contains all of the original compounds found in the flower of the cannabis plant (cannabinoids, terpenes and flavonoids).

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QUESTION: Over 2 million Americans with cardiovascular disease use marijuana. Warfarin interacts with marijuana. Do statins interact with cannabinoids?

ANSWER: Yes. Statins and cannabinoids are metabolized by the same liver enzymes. The co-administration of cannabinoids and statins can lead to a decrease in statin metabolism. As a result, the potency of the statins may increase, and lead to hypotension.

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QUESTION: Although Illinois and Nevada have both legalized the use of medical and recreational marijuana, it is illegal to take marijuana on a flight from Chicago to Las Vegas. The reason – airspace is regulated by the federal government and marijuana is illegal under federal law. Do any US airports have “marijuana amnesty boxes” for the disposal of marijuana?

ANSWER: Yes. In addition to 2 airports in Chicago, Mc Carran International Airport in Las Vegas and the Colorado Springs Airport have installed amnesty boxes for passengers who need to surrender their marijuana before boarding a flight.

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QUESTION: What are the precursors for the most commonly naturally occurring phytocannabinoids?

ANSWER: The precursors for THC, CBD and CBC are olivetolic acid and geranyl pyrophosphate. These precursors undergo a condensation reaction which results in the formation of cannabigerolic acid (CBGA). A cyclase enzyme converts CBGA into either tetrahydrocannabinolic acid (THCA) or cannabidiolic acid (CBDA) or cannabichromenic acid (CBCA). Then, heat decarboxylates these cannabinoids into THC, CBD or CBC, respectively.

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QUESTION: True or false? Cannabinoids impact NMDA, opioid AND gamma amino butyric acid (GABA) receptors.

ANSWER: True. Not only do cannabinoids act at NMDA, opioid AND gamma amino butyric acid (GABA) receptors, but they also have activity at receptors such as adenosine, serotonergic, adrenergic, nicotinic acetylcholine, glycine, and PPAR receptors, and ion channels such as TRPV.

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QUESTION: Are pupillary responses to light affected by marijuana?

ANSWER: Yes – marijuana may impair pupillary responses.

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QUESTION: Is the legalization of medical marijuana associated with an increase in sexual activity?

ANSWER: Yes, according to researchers from the University of Connecticut and Georgia State University, the legalization of medical marijuana is associated with an increase in sexual activity. Of note, the study also determined that there’s a decrease in the use of contraceptives and an increase in the number of births following the enactment of medical marijuana policies. This study was published in the Journal of Health Economics.

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QUESTION: What is the definition of drug diversion?

ANSWER: In the National Academies of Sciences, Engineering & Medicine’s Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence (2020), drug diversion is defined as the transfer of regulated prescription drugs from the legal market to illegal markets. The sharing of drugs with other individuals for medical or nonmedical purposes is NOT considered to be drug diversion. (The sharing of drugs is drug misuse.)

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QUESTION: Is it legal to carry marijuana on a Greyhound bus?

ANSWER: No. Greyhound Lines bans alcohol and drugs (including marijuana) “anywhere on the bus (including in your checked baggage).”

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QUESTION: Animal research studies on CBD’s potential therapeutic effects often employ rodents. Is CBD administered to rodents the same way CBD is administered to humans?

ANSWER: No. CBD is commonly administered to rodents either via intraperitoneal injection or via the oral route. In contrast, CBD has been studied in humans using oral administration or inhalation, but not via intraperitoneal. The pharmacokinetics of these various routes of administration differ and therefore the blood concentrations of CBD may differ.

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QUESTION: Has the use of CBD been evaluated for the treatment of heroin addiction?

ANSWER: Yes. Dr. Yasmin Hurd, director of the Addiction Institute of Mount Sinai in NYC led a double-blind study of 42 recovering heroin addicts and found that CBD reduced both cravings and cue-based anxiety, both of which can cycle people back into using heroin.

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QUESTION: Does CBD modulate 5-HT1A receptor activity?

ANSWER: Yes, and this modulation may directly improve hyperarousal/insomnia symptoms in PTSD patients.

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QUESTION: Is the US VA Office of research and Development conducting any clinical trials that evaluate the use of CBD for the treatment of PTSD?

ANSWER: Yes. A RCT evaluating the efficacy of using CBD as an adjunctive to prolonged exposure therapy (PE therapy)) was started in March 2019 and will conclude on September 30,2023. The trial will compare PE + CBD to PE + placebo in a sample of 136 military Veterans with PTSD at the VA San Diego Medical Center.

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QUESTION: Is it legal to transport marijuana on Amtrak’s railway?

ANSWER: Amtrak has a strict policy: “The use or transportation of marijuana in any form for any purpose is prohibited, even in states or countries where recreational use is legal or permitted medically.”

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QUESTION: Do any medical marijuana legal states accept out-of-state medical marijuana authorizations?

ANSWER: Yes. About twenty states accept out-of-state medical marijuana authorizations, BUT reciprocity laws vary from state to state. In some states, visitors are required to sign up for the medical marijuana program 30 days in advance and pay a $50 nonrefundable fee. The state’s purchasing limit may differ for permanent vs. temporary residents. In Oregon, for example, residents can possess up to 24 ounces, while visitors are allowed only one ounce.

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QUESTION: Does the CBD molecule contain an aromatic ring?

ANSWER: Yes, it does. The CBD molecule contains a cyclohexene ring and an aromatic ring (a phenolic ring). Of interest, the rings are located in planes that are almost perpendicular to each other.

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QUESTION: Describe the chemical makeup of endocannabinoids.

ANSWER: Endocannabinoids are ester, ether, and amide derivatives of long chain polyunsaturated fatty acids. Arachidonic acid is an example of a polyunsaturated fatty acid in endocannabinoids.

–––

QUESTION: Does chronic use of THC and/or CBD by individuals with multiple sclerosis impact cerebral glucose metabolism?

ANSWER: The results of “The Effects of Chronic Δ-9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD) use on Cerebral Glucose Metabolism in Multiple Sclerosis: A Pilot Study” published in 2019 in ‘Applied Physiology, Nutrition and Metabolism‘ indicate that “Compared to non-users, THC-users had hypermetabolism of three regions (p < 0.039, d >1.17) in left temporal areas, while CBD-users had hypometabolism of five regions (p < 0.032, d > 1.31) in left temporal areas.”

–––

QUESTION: True or False? According to the results of a survey conducted by the FDA, about 90% of US adults understand that FDA-approved prescription drugs may cause harm.

ANSWER: False. The results of the survey indicate that 42.9% of consumers were not able to accurately report that FDA‐approved prescription drugs may cause harm.

–––

QUESTION: The FDA approves the language used on package inserts of prescription drugs. Does the FDA also approve the language of “direct-to -consumer” ads?

ANSWER: Actually, no. The language, including the risk or benefit statements, used in “direct to consumer” ads is not FDA-approved.

–––

QUESTION: Based on data from the 2016 to 2017 National Survey on Drug Use and Health and the U.S. Department of Health and Human Services, do more people in the US smoke marijuana or tobacco cigarettes”

ANSWER: According to the 2016 to 2017 National Survey on Drug Use and Health, more than 39 million people smoke marijuana, and according to data from the U.S. Department of Health and Human Services, 34.3 million people smoke tobacco cigarettes. Recent trends show that the number of marijuana smokers is rising while the number of cigarette smokers is declining.

—

QUESTION: CB1 receptors are located on neurons in the CNS and PNS. Are CB1 receptors also located on cardiomyocytes?

ANSWER: Yes. CB1 receptors are located in cardiomyocytes, vascular endothelial cells as well as smooth muscle cells. Activation of these CB1 receptors may lead to oxidative stress, inflammation, fibrosis, vasodilation, and negative inotropy.

—

QUESTION: Smoking and vaporizing marijuana may induce an increase in heart rate. Is smoking marijuana associated with other cardiac electrical effects?

ANSWER: Yes. THC may increase catecholamine levels and therefore may theoretically increase the likelihood of arrhythmias. Various cardiac electrical effects have been described in observational studies. Atrial fibrillation was one of the more commonly reported arrhythmias. Other marijuana-associated arrhythmias reported include atrial flutter, atrioventricular block/asystole, sick sinus syndrome, ventricular tachycardia, and Brugada pattern.

—

QUESTION: Some cannabinoid-based medicines are used to treat chemotherapy-induced n/v. Have cannabinoid-based medicines been shown to be effective in the treatment of post-op n/v?

ANSWER: The results of studies indicate that neither nabilone or intravenous THC is effective for post-op n/v. Even premedication with nabilone was ineffective at treating post-op n/v.

—

QUESTION: Do cannabinoid-based medicines have a higher NNT (number needed to treat) than opioids for pain relief? Than pregabalin? Than tricyclic antidepressant (TCA) agents?

ANSWER: According to recent systematic reviews and meta-analyses (from 2016-2018), cannabinoid -based medicines have a higher NNT than opioids, pregabalin and TCAs. It was also noted that there was a higher risk of adverse events associated with cannabinoid-based medicines compared to opioids, pregabalin and TCAs.

—

QUESTION: The 2017 National Academies of Sciences, Engineering and Medicine’s (NASEM)review on the health effects of cannabinoid-based medicines concluded that there was conclusive or substantial evidence for the use cannabis or cannabinoids for the treatment of pain in adults. Do other national regulatory bodies have similar conclusions to the NASEM’s conclusion?

ANSWER: Actually, no. The Health Products Regulatory Authority of Ireland does not support the use of cannabinoid-based medicines for the treatment of chronic pain. Also, the European Pain Federation’s recent position paper recommended cannabinoid-based medicines be considered for chronic neuropathic pain only as a third line agent. Furthermore, the European Pain Federation found that the results of the studies examining chronic non-cancer pain indicated that there was insufficient evidence for the use of cannabinoid-based medicines for the treatment of non-neuropathic chronic non-cancer pain.

—

QUESTION: Does ketamine interact with the endocannabinoid system?

ANSWER: Yes. Ketamine induces the release of endocannabinoids.

—

QUESTION: Do CB1 and CB2 agonists facilitate endogenous opioid signaling?

ANSWER: Yes. In fact, CB1 and CB2 agonists increase the concentrations of endogenous opioids.

—

QUESTION: Do opioid antagonists impact the effects of cannabinoids?

ANSWER: Yes. For example, it has been shown that the administration of opioid antagonists block some of the effects of THC.

—

QUESTION: Is the endocannabinoid system linked to the opioid system?

ANSWER: Yes. Opioid receptors and CB receptors are located within the same neurons within the CNS. In addition, cannabinoids activate kappa and delta receptors to initiate a release of endogenous opioids.

—

QUESTION: True or false? Cannabinoids impact NMDA, opioid AND gamma amino butyric acid (GABA) receptors.

ANSWER: True. Not only do cannabinoids act at NMDA, opioid AND gamma amino butyric acid (GABA) receptors, but they also have activity at receptors such as adenosine, serotonergic, adrenergic, nicotinic acetylcholine, glycine, and PPAR receptors, and ion channels such as TPRV.

—

QUESTION: How do cannabinoids modulate pain sensation? In other words, describe the mode of action of cannabinoids.

ANSWER: The endocannabinoid system, consisting of the cannabinoid₁ receptor (CB₁R) and cannabinoid₂ receptor (CB₂R), endogenous cannabinoid ligands (endocannabinoids), and metabolizing enzymes, is present throughout the pain pathways. Endocannabinoids, phytocannabinoids, and synthetic cannabinoid receptor agonists have antinociceptive effects in animal models of acute, inflammatory, and neuropathic pain. CB₁R and CB₂R located at peripheral, spinal, or supraspinal sites are important targets mediating these antinociceptive effects. The mechanisms underlying the analgesic effects of cannabinoids likely include inhibition of presynaptic neurotransmitter and neuropeptide release, modulation of postsynaptic neuronal excitability, activation of the descending inhibitory pain pathway, and reductions in neuroinflammatory signaling. The large body of preclinical evidence in support of cannabinoids as potential analgesic agents is supported by clinical studies demonstrating their efficacy across a variety of pain disorders.

—

QUESTION: EXPERIMENTAL pain studies indicate that cannabinoids may be an effective therapy for acute and chronic pain. Have the results of CLINICAL studies also shown that cannabinoids are effective at alleviating acute and chronic pain?

ANSWER: In contrast to experimental studies, the results of clinical trials with cannabinoids provide only moderate-quality evidence for the relief of chronic pain. Also, the analgesic effects of cannabinoids have not been found to be superior to placebo in acute pain. In addition, pre-operative and peri-operative marijuana use may increase post-operative perceived pain.

—

QUESTION: A study published in the European Journal of Anaesthesiology, by Jamal et al. reported that marijuana users required a higher dose of morphine s/p abdominal surgery. They estimated that there was a 23% increased opioid dose requirement. Have the results of studies examining the opioid requirements s/p orthopedic surgery also shown that marijuana users require more opioids than patients who do not use marijuana?

ANSWER: In a retrospective study including 3793 patients, patient-reported postoperative outcomes of 155 marijuana users were compared with those of 155 non-users. The results indicate that pre-operative marijuana users had higher pain scores at rest and on movement but did NOT consume more post-operative opioid analgesics. The cannabinoid users also reported a greater incidence of post-operative sleep impairment.

Trump Budget Slashing Gutted Coronavirus Emergency Response

Trump’s hated of “everything Obama” has already harmed America.

Now, it’s harming Public Health.

That man is a genuine threat to the security of the United States. He simply has NO understanding of the complexity of the matters placed before him on the platter of the Presidency. He is utterly out of his league.

Consider this sampling of inane things he’s said about coronavirus (COVID-19):

First, it was, “We have it all under control.”

Followed closely by, “It’s very small problem in this country.”

And on its heels was, “The Coronavirus is very much under control in the USA.”

Which was later accompanied by, “We have it totally under control. It’s going to be fine.”

As things progressed, and it because clear that it was only a matter of time before Americans were affected, he said in Davos, Switzerland that, “We do have a plan, and we think it’s going to be handled very well.”

Now that the fecal matter has started to hit the fan, he decided to make a rare, live, emergency telecast to address the nation, and said that, “I have decided to take several strong but necessary actions to protect the health and well-being of all Americans.”

He also said in that emergency live telecast address to the nation that, “We declared a public health emergency and issued the highest level of travel warning.”

In the same breath, he said, “To keep new cases from entering our shores, we will be suspending all travel from Europe to the United States for the next 30 days.”

Just last year, he:
• Cut the budgets of the Centers for Disease Control, and other Public Health-related budgets,
• Firing the government’s entire pandemic response chain of command, including those of the
––National Security Agency,
––National Security Council,
––Health and Human Services,
––Department of Homeland Security,
• Gutting the entire management infrastructure of the White House, and
• Killing the Complex Crises Fund

…DESPITE all that budget bloodshed like Sweeney Todd, The Demon Barber of Fleet Street, he had the unmitigated gall and audacity to say that, “We are at a critical time in the fight against the virus.”

And sadly, it’s highly doubtful that anyone truly believes him when he said, “I will always put the well-being of America first.”

It’s not as if anyone believes him now, anyway. Members of the Cabinet are in fear of him, that they’ll lose their jobs being fired by Tweet, so they simply turn into jelly, and keep their ideas to themselves… since he knows how to run everything, anyway. So what difference does it truly make?

The next thing is to GET HIM OUT OF OFFICE!

But, moreover, this article goes in-depth to show and explain the things he’s done which have had a horrific effect upon Public Health -and- National Security.

That is NOT how to “Make America Great Again.”

Come November, you know what to do.

VOTE HIM OUT!!!

Trump Has Sabotaged America’s Coronavirus Response

By Laurie Garrett
January 31, 2010
https://foreignpolicy.com/2020/01/31/coronavirus-china-trump-united-states-public-health-emergency-response/

When Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization (WHO), declared the Wuhan coronavirus a public health emergency of international concern on Thursday, he praised China for taking “unprecedented” steps to control the deadly virus. “I have never seen for myself this kind of mobilization,” he noted. “China is actually setting a new standard for outbreak response.”

The epidemic control efforts unfolding today in China—including placing some 100 million citizens on lockdown, shutting down a national holiday, building enormous quarantine hospitals in days’ time, and ramping up 24-hour manufacturing of medical equipment—are indeed gargantuan. It’s impossible to watch them without wondering, “What would we do? How would my government respond if this virus spread across my country?”

For the United States, the answers are especially worrying because the government has intentionally rendered itself incapable. In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure. In numerous phone calls and emails with key agencies across the U.S. government, the only consistent response I encountered was distressed confusion. If the United States still has a clear chain of command for pandemic response, the White House urgently needs to clarify what it is

If the United States still has a clear chain of command for pandemic response,
the White House urgently needs to clarify what it is – not just for the public but for the government itself,
which largely finds itself in the dark.

When Ebola broke out in West Africa in 2014, President Barack Obama recognized that responding to the outbreak overseas, while also protecting Americans at home, involved multiple U.S. government departments and agencies,

Milk… it STILL does a body good!

Food color.

What a compelling subject, eh?

Doubtless, it’s a spell-binding topic, and certainly one bound to keep readers’ rapt attention!

Thrilling and exciting!

Compelling even!

Except that, things aren’t always what they seem.

First, however, you’ll need to be buttered up for this one.

In an unobtrusive article cross-published in Smithsonian Magazine (also at https://www.ZocaloPublicSquare.org/2020/01/15/when-the-government-decided-the-spread-on-your-toast-should-be-pink/ideas/essay/), author Ai Hisano addresses food color.

Instead of being professionally prepared as a chef, restaurateur, food historian, or nutritional anthropologist, author Ai Hisano is Senior Lecturer at the Graduate School of Economics at Kyoto University, Japan, and has been the Newcomen Postdoctoral Fellow in Business History at Harvard Business School, where she most recently authored Visualizing Taste: How Business Changed the Look of What You Eat.

Though her article isn’t difficult to swallow, it was rather bland and under-cooked, because while she did the job fairly well enough sharing some interesting tid-bit details about the history of oleomargarine, she failed overall to address the underlying concern – and therefore the premise of – the rationale for the existence of laws regulating the color of oleomargarine.

Again,
the unspoken and underlying concern
for the color of margarine
– the question
‟Why was it a concern?〞
–  failed to be addressed.

That concern is fraud.

Sadly, food fraud remains a concern today – even in the United States.

For example, producers of plant-based non-dairy imitation milk products such as “almond milk” are rapidly being caught in the cross hairs of public intrigue with their highly-processed, made-in-a-chemistry laboratory pseudo-natural products by making numerous varieties of claims about their product(s), none of which are proven, nor represent any improvement in public health, though their marketing obliquely intimates as much.

It is inherently fraudulent to label a product as being a certain thing when it is not.

That is plain and simple.

And I write this with all sincerity: It makes me

Why Should I Get The Flu Vaccine?

People that say ‘don’t get the flu vaccine because it’ll give you the flu’ are the equivalent of those who say ‘don’t eat an egg, because you might grow a chicken.’

There’s nothing in the vaccine that can cause influenza.

It’s not even a live vaccine.

It’d sure look funny with a chicken thigh coming out of your ear.

And, there’s no telling where the head and wing would pop up!🤪😂

There’s a “teachable moment” in that bit of humor for those who are “anti-vaxxers.”

You know… just in the case you happen to meet any.

Science: It’s like gravity.

You don’t have to “believe in it” for it to work.
It’s a FACT.

To obtain the fullest immunity from the vaccination takes at least TWO WEEKS for one’s body to build up antibodies to the virus… which is NOT in the vaccine.

https://www.cdc.gov/flu/prevent/different-flu-vaccines.htm

https://www.fda.gov/vaccines-blood-biologics/lot-release/influenza-vaccine-2019-2020-season

https://www.cdc.gov/vaccines/parents/diseases/flu.html

https://www.cdc.gov/flu/index.htm

 

“Do Something!” About Gun Sickness and Disease

Within a period of 7 days, 35 people were killed, and 64 were injured in 3 mass shootings in our nation.

July 28, 2019 – 5:48 PM PDT Garlic Festival – Gilroy, CA – 3 Killed, 13 Injured

August 3, 2019 – 10:39 AM CDT Wal-Mart – El Paso, TX – 22 Killed, 24 Injured

August 4, 2019 – 1:05 AM EDT – Historic Oregon District, Downtown Dayton, OH – 10 Killed, 27 Injured

Authorities have identified the assailants and weapons used. In each case, the weapons used were military-grade assault style rifles designed for military use, modeled after the Russian AK-47, and the American AR-15. The exclusive purpose of such firearms as weapons of mass destruction is to kill human beings with great ease, and efficiency – to inflict as much carnage and damage upon as many people as possible, in a short period of time. They are ONLY weapons of war, and nothing else. They were NOT designed for any other purpose than to kill human beings with great ease, and efficiency.

The assailants were:
• Connor Stephen Betts, 24, of Bellbrook, OH (Dayton) – deceased;
• Santino William Legan, 19, of Gilroy, CA and Walker Lake, NV (Gilroy) – deceased, and;
• Patrick Wood Crusius, 21, of Allen, TX (El Paso) – captured.

In none of those cases neither “a good guy with a gun,” nor a border wall was effective to either deter, prevent, or stop the deaths and injuries of 127 people.

But those three tragedies were not the only ones.

Ohio’s Republican Governor Mike Dewine addresses Ohioans about the Dayton mass shooting.

Just today – August 5, 2019 – in Brooklyn, the most populous borough in NYC, there was a mass shooting at 216 Buffalo Avenue where 4 people were injured, with no deaths in which “Police confirm a man was shot in the chest, and two women have also been found with gunshots wounds.”
-and-
A shooting with 4 injuries occurred at 5691 Suitland Road, in Suitland, MD.

Yesterday, there were FOUR mass shootings at:
1800 S Kildare Ave in Chicago, one killed, and 7 wounded;
443 E Shelby Dr in Memphis, one killed, 3 wounded;
2900 block of W Roosevelt Rd in Chicago, 7 wounded;
419 E 5th St in Dayton, OH, 10 killed, 26 wounded.

On July 28, the date of the Gilroy, CA Garlic Festival shooting, there were a total of SIX mass shootings throughout the nation.

In the days since, there have been 15 mass shootings, inclusive, in which 47 people were killed, with 115 injured. For details, see: https://www.GunViolenceArchive.org/reports/mass-shooting

According to data from the Gun Violence Archive website, this year to date, there have been 255 mass shootings, resulting in 275 deaths, and 1069 injuries.

No one is happy about this.

No one.

Kentucky Republican Senate Majority Leader Mitch McConnell proudly displaying the Made-in-China Nike brand athletic shoes which he blames for his fall which ironically, injured his LEFT shoulder. As a child born in Alabama, McConnell also had polio.

The paralytic gridlocked Congress is in summer recess, as GOP Senate Majority Leader Mitch McConnell (R) is

Economic Fundamental

California United States Senator Kamala Harris

There is something FUNDAMENTALLY WRONG in a nation when its largest supermarket chain by revenue – which is also the second-largest general retailer and the eighteenth largest company in the nation – finds it necessary, and plans to