Opioid Withdrawal Treatment: Finding New Roads

Opioids/opiates have provided significant and sometimes life-saving relief to countless patients. They remain some of the strongest painkillers available and can be especially helpful in rendering comfort in otherwise extremely painful terminal illnesses. Opioids work by activating opioid receptors located in the brain, which are densely located in emotion-controlling areas that process pain. Unfortunately, prolonged or extreme use of opioids can lead to dependence, or the body adjusting by limiting natural opioid production and therefore resulting in the body physiologically needing increasing amounts of external opioids to function properly. However, aside from practical issues, high doses of opioids can lead to respiratory failure, death, and other serious health consequences, which means that for all but terminally ill users, opioid withdrawal will eventually occur. Withdrawal is not only unpleasant physically and psychologically (depression, lack of appetite, diarrhea), but potentially life-threatening. In fact, withdrawal is so severe that it can sometimes prevent patients from ending opiate use, causing a downward spiral. As a result, modern doctors are cautious to prescribe opioids and usually seek to wean patients off opioids through slowly decreasing prescriptions. Perhaps more concerning though, aside from medical patients, roughly 4.3 million people in the US alone are currently non-medical users of narcotic pain relievers. Drugs like heroin, hydrocodone, oxycodone, etc. are all opiate-based drugs that are frequently abused for the recreational high. Meanwhile, even drugs intended to wean opiate use, such as buprenorphine, are commonly sold and traded. To date, only compounds that directly activate opioid receptors have been…

Debunking Reefer Madness “Science”

Most of the Cornerstone blog articles we post are about the future and pending medical advances. However, today, we will instead take a quick look at the present, specifically at the national conversation around medical cannabis. As more states continue to legalize medical and recreational cannabis, the bulk of conversation centers on how to navigate this collective policy change to produce the greatest good and smallest harm for society as a whole. However, while 2016 has certainly been an outstanding year for medical cannabis and cannabinoid research, reefer madness is still alive and well, and opposition remains strong. For exhibit A, the report that is setting the internet abuzz, the University of Western Australia published a press release linking cannabis use to gene mutation. To quote the article: “‘Through our research we found that cancers and illnesses were likely caused by cell mutations resulting from cannabis properties having a chemical interaction with a person’s DNA,’ Associate Professor Stuart Reece said.” As if this isn’t scary enough, the article then suggests that these mutations are passed to offspring. Yikes. Following this line of thought, by consuming cannabis, individuals may inadvertently be giving their children cancer! Fortunately, cannabis science luminary Ethan Russo stepped in to clarify and debunk the report. In an interview for the East Bay Express, Ethan noted, “This report is based on a foundation of falsehoods. Cannabis is not mutagenic (productive of mutations in DNA)…Countless animal studies and human epidemiological studies support its relative safety in this regard.” Despite…

Is Cannabis Addictive?

One of the early concerns that dominated the medical cannabis discussion was over both the addictive potential and long-term effects of cannabis. For decades, it has generally been understood by the medical community that cannabis is not physically addictive but can be psychologically addictive. To differentiate, individuals addicted to alcohol cannot suddenly end consumption without risk of death or serious health consequences, because their bodies have learned to literally need alcohol. In contrast, even a frequent cannabis consumer can end consumption immediately without serious health risk. However, this transition might be severely uncomfortable due to the psychological dependence of cannabis use. Some anti-cannabis advocates and researchers alike have pushed for the notion that this dependence is life-long. Researchers from Geneva, Switzerland recently pressed one step forward to directly answer this question by observing changes in brain chemistry during and after chronic cannabis use. To back up, what is addiction and what causes addiction? As researchers note, “the addictive effects of virtually all drugs…are thought to be mediated through activation of mesolimbic dopamine projections to the nucleus accumbens.” Essentially, a neurotransmitter, dopamine, is activated to a greater degree than normal, causing an increased interaction with the part of the brain that deals with decision making, risk, and reward. Dopamine is responsible for a multitude of signaling tasks, but perhaps the most known and most important job is signaling reward. When a user consumes a drug, dopamine is released in the brain, essentially rewarding the user for consuming the drug and teaching…

Emerging Neuroprotective Agents from Cannabinoids

Every component of the body is inherently related. When one organ fails or declines in health, another organ will follow. Liver failure, for instance, poses a dire health risk on it’s own. However, beyond the immediate, life-threatening aspects of toxins not being filtered out of the blood, damage to the brain is another physiological consequence. Toxins cause free radicals to build up, which leads to cell stress and eventual neuron death. This cellular damage translates into loss of memory, general confusion, and cognitive damage, which poses a serious impairment to quality of life. Unfortunately, liver issues cannot always be immediately solved, if they can be solved at all. In the meantime, this condition, called Hepatic Encephalopathy, should at least be minimized or ideally entirely prevented, to ensure patients mental health. Scientists have been searching for neuroprotective agents, or drugs that might enable cells to avoid damage caused by buildup of free radicals. Cannabidiol (CBD) is a known neuroprotector, meaning that the application of CBD decreases the amount of cell damage and death brought on by toxins. Researchers do not currently understand exactly how these neuroprotective effects are achieved. However, we do know that the normal cannabinoid receptors, CB1 and CB2, are not involved. When receptor antagonists are applied, and those receptors are shut off, neuroprotective effects are still observed. Case closed, right? Why not use CBD as a neuroprotective medicine for serious health situations such as Hepatic Encephalopathy? This may indeed be one of the best options in present day,…

Sourcing CBD

Have you ever wondered where concentrated CBD comes from? In the United States, industrial hemp is now permitted under special circumstances, thanks to a 2014 U.S. Farm Bill which approves special grow programs. States like California and Colorado offer a legal pathway to growing smaller batches of medical cannabis for CBD production. CBD can also be legally produced synthetically without the plant at all with appropriate DEA approval. All three of these pathways represent avenues for legal CBD production in the United States. Assuming that the goal is to produce 100% pure CBD, these methods are all equivalent; the source has no impact. However, when CBD is initially extracted from a whole plant, terpenes and cannabinoids are extracted alongside and remain in the product. The greater the quality of the source plant, the greater and richer these terpenes and cannabinoids are, whereas synthetic CBD contains no additional molecules. Due to current cannabinoid research indicating the likelihood of synergistic effects of cannabinoids, we at Cornerstone feel that whole plant, high quality cannabis preparations of CBD are likely more effective medical solutions than pure or synthetic CBD. If it were purely medicinal cannabis advocates arguing for the effectiveness of whole-plant derived CBD preparations, we might simply dismiss this notion as financial bias. Of course medical cannabis dispensaries have incentive to advocate for medical cannabis-based products! Of course we’d rather see the CBD market in the hands of local providers vs. industrial giants. That is our bias. However, ultimately the conversation about the…

Real Life Cannabinoid Treatment for Multiple Sclerosis

As a blog concerned with new developments in cannabinoid science, we tend to do a lot of writing about future treatments, or new scientific developments that may eventually lead to treatments. Part of the issue is that large-scale, clinical testing of new cannabinoid based medicine is still years away in a lot of areas, particularly in cancer-related fields. That’s why reading a good, new large-scale study is always exhilarating. In this case, a recent study from the University of Bari in Italy took a look at a large scale, real-world application of a THC/CBD oral spray in treating adults with treatment-resistant Multiple Sclerosis (MS). In the past, we’ve written about treating MS models via lab mice with THC and CBD, and also the theory behind that treatment. So being able to finally see how things play out in real life with real patients is particularly rewarding for us and is yet another confirmation of the efficacy of cannabis based treatments. To review, MS is an auto-immune disease in which the body’s immune system is confused into turning against the body and attacking cells. In particular, MS is caused by the immune system stripping neurons of their outer protective linings, which normally prevent “signals” from being crossed or lost in the brain, both for conscious and unconscious tasks. This stripping eventually results in loss of physical mobility and function and can prevent patients from fulfilling active, healthy lives. Spasticity, which affects about 2/3rds of patients, is particularly problematic. Unfortunately, at this…

Retinal Health and Cannabis- “Seeing” the Difference

Glaucoma was one of the first applications identified for medical cannabis treatment and remains one of the most common medical reasons for prescription. Why? In the 1970’s initial slew of cannabis-centric research, the Journal of the American Medical Association published a finding that individuals who smoked cannabis experienced lower intra-ocular (inner-eye) pressure. This was one of the first significant physiological findings regarding the effect of smoking cannabis. However, more importantly, it seemed to be an answer to glaucoma, a disease in which excess fluid builds up in the eye, causing higher pressure and cell damage. As a result, the study was duplicated often, and the results upheld the initial conclusion that cannabis could be an effective solution. Unfortunately, cannabis research waned in popularity. Once cannabis was culturally cast in the same category as other recreational drugs, the idea that it would ever be prescribed legally for glaucoma lost traction. Fortunately, years later, as we experience a renaissance in both cannabis prescription and cannabis research, a new interest has arisen in the way the endocannabinoid system might be manipulated to treat retinal disease. The endocannabinoid system, as some readers may be familiar with, is the system of cannabinoid receptors, natural cannabinoids that bind to them, and all the enzymes facilitating that process that are found in humans and most mammals. Recently we’ve learned that cannabinoid receptors are more complex than we imagined. Aside from cannabinoid receptors CB1 and CB2, vanilloid receptors (an entirely different chemical system), and orphan GPR-55 receptors are…

New Role for Cannabinoids in Diabetes Treatment

The endocannabinoid system is one of the biggest sleeper hits of modern science. Despite going ignored until the early 90’s, we’re discovering more and more how vital and essential this system of naturally produced cannabinoids, their receptors, and their enzymes are. From breast cancer pathogenesis to arthritis and pain treatment to neurological issue development, the endocannabinoid system is involved. For this reason, it should come as no surprise to readers that the endocannabinoid system has recently been found to play a role in the pancreas. Specifically, cannabinoid receptor 1 (CB1) is expressed in beta cells in the pancreas. The primary role of these beta cells is to produce and store insulin, the hormone that reduces blood sugar concentration. Lack of insulin leads to diabetes, which brings a host of related health issues. In multiple studies, CB1 receptors have been found to be able to trigger cell death of these beta cells. Thus, cannabinoid receptor regulation is likely essential to the control and pathogenesis of diabetes, and researchers aim to create new treatments by understanding this signaling. Ideally, researchers could stop beta cell death, preserve natural insulin levels, and therefore prevent or cure diabetes, rather than just supplying the body with externally-produced insulin. Toward that end, a team of researchers from various universities in South Korea has released a new study aimed to identify the mechanism of cannabinoid-mediated cell death in the pancreas. Before starting with animal studies, the team investigated the basic mechanics of cell death in a mouse pancreas…

Depression, Cannabis, and… Your Immune System?

Cannabis has long been known to be a mood improving substance. In fact, this quality has contributed to its use as a recreational drug. As a result, it’s not surprising to read that the endocannabinoid system, which controls our bodies’ responses to cannabis, is being investigated in connection to treating depression. What is surprising, however, is the specific way it seems to be involved. Readers might never suspect that the immune system and the endocannabinoid system might be cohorts in the genesis of depression. Wait, back up – the immune system? What does that have to do with depression? Apparently something large. First, recent meta-analyses of immune-related experiments provide strong support for a link between immune dysfunction and depression. Statistically speaking, patients with major depressive disorder (MDD) also show higher levels of several inflammatory signaling proteins. While this could simply indicate association rather than cause (for instance, simply that patients with malfunctioning immune systems have health consequences that lead to depression), the most interesting evidence here is that researchers have specifically observed a positive relationship between depressive symptoms and amount/dose of inflammatory molecules over a widespread population. The fact that depressive symptoms are dose-dependent to immune signaling molecules seems to suggest some sort of causality. Finally, patients suffering from chronic viral infections, who as a result have to take drugs like IFN-alpha (an immune and inflammation boosting cytokine), often develop depression at the onset of such medication with a rate upwards of 30 percent! Unfortunately, depression comes in many forms…

Soothing Migraine Headaches with Cannabis

Nearly everyone who’s used medical cannabis can relate to its ability to soothe headaches. From easing stress and tight forehead muscles to reducing body pain, cannabis naturally lends itself to being a headache cure. Yet, surprisingly, no clinical tests are being performed at this time to treat migraine patients with medical cannabis. In other words, while some doctors are already prescribing cannabis for recurring headaches, no large clinical studies on actual humans are being conducted. As readers may guess, this may have something to do with the difficulty of getting approval for human studies involving cannabis. In any case, the situation is now remarkably unusual; medical cannabis dispensaries sometimes have more access to medical information than physicians. Specifically, as a general physician, you may have the opportunity to prescribe cannabis to a number of patients, with only a handful of those seeking treatment for headaches. On top of that, after the prescription for medical cannabis, you can’t track what cannabis was used, how potent it was, where it came from, etc. A large part of the treatment data is inherently unknown by the physician, and getting patients to carefully record and report that data is difficult, further reducing the number of people who could realistically be involved in a study. In fact, busy, time-strapped patients may not even return after successfully treating their problems. Contrast this situation with that of a dispensary. At a medical cannabis dispensary, providers can keep a file on each patient, using purchases to record average…