Current Challenges in Cannabis-Based Medicine

In the field of cannabis research and cannabinoid science, few researchers have made as large an impact as Dr. Ethan Russo. Russo has written field-defining papers about standardizing cannabis, pain management with cannabinoids, and the proposed synergy of cannabinoids. Russo’s insights range from medical and chemical hurdles of the field to political and government challenges inherent in bringing these medicines to market. Russo also played a key role as research director at GW Pharmaceuticals for over a decade. GW Pharmaceuticals created Sativex, an oral spray consisting of THC and CBD in a 1:1 ratio, that remains one of the only cannabis-based pharmaceutical products available in most countries. As a past president of the International Cannabinoid Research Society and past Chairman of the International Association for Cannabinoid Medicines, he continues to write and travel world-wide to discuss the field. In 2016, Russo released a report titled, “Current Therapeutic Cannabis Controversies and Clinical Trial Design Issues", intended to serve as a collection of recommendations regarding the future of the field. In the report, Russo breaks down many of the issues that have hampered cannabis and cannabinoid-based medicines’ acceptance into Western medicine. Due to the thoughtful writing and easy-to-read nature of the report, we would encourage anyone interested in learning more to take a look at this paper. However, for the sake of convenience, we have summarized the most important topics below: Cannabis Testing Is Largely Inaccurate Russo argues that due to past and current legal constraints, many of the labs that test…

Replacing Prescription Drugs with Cannabis

One of the recurring themes in Cornerstone Blog articles is the idea that cannabis can achieve some of the results of pharmaceutical drugs with less risk to health and financial cost. Opioids, for instance, are often seen as the last line of defense in treating pain, since they represent the strongest chemical family of pain-killers known to medicine. However, opioids are also incredibly addictive. Even legally prescribed opioids, in fact, often lead to long-term drug addiction. This development occurs so often in fact, that doctors are required a special license (in addition to their medical license) to administer them. As we’ve explored in numerous articles, cannabis and specifically CBD can reduce perception of pain, especially if it is caused by swelling and inflammation. It would be foolish to think that cannabis could entirely replace all painkillers, of course, and certainly there are cases where short-term effect outweighs long-term risk of addiction, as in the case of terminally ill patients. However, the idea being put forth by the scientific and medical community is that if a significant portion of the pain is reduced, the corresponding amount of necessary opioid could also be significantly reduced. The same line of reasoning could be used for a variety of other treatment indications beyond pain, such as anxiety and depression, for instance. As readers know, anti-depressants can occasionally have unintended side-effects and increase suicidal ideation. Some anti-depressants can also reduce energy that is vital to personality expression, which is why many patients do not comply…

CBD, Alcohol Consumption + Relapse

Chances are, every person reading this article knows at least one person suffering from alcohol addiction or is suffering himself/herself. That’s because alcoholism is actually very common; we have over 3 million cases in the US alone each year! So far this addiction has resisted understanding and a consistent treatment option. As doctors currently understand, alcoholism stems from a combination of unfortunate genetic traits and the readily available, socially-approved nature of alcohol. Additionally, aside from the psychological causes that may have triggered addiction in the first place, recovering alcoholics also face real health consequences as a result of immediately ending consumption. CBD, on the other hand, as we’ve discussed frequently, exerts a calming influence (both psychologically and in terms of reducing cellular inflammation). While there are over 51 possible mechanisms of action of CBD, and any combination of these may be responsible for any given set of effects, CBD’s history as an anti-psychotic is well-documented and would be difficult to debate seriously from a medical perspective. As we’ve mentioned before, CBD, in fact, counter-acts many of the effects of THC, meaning that the racier, trippier strains of cannabis often contain low amounts of CBD or THC only. Given that current alcoholism treatments have a relapse rate of over 70% in the first year, recovery is truly difficult. Many successful approaches are also faith-based, which leaves some individuals in a predicament, and recovering addicts often report several serious attempts at becoming sober before success. Many others die from cumulative alcohol poisoning…

Does the Endocannabinoid System hold the Secret to Ending Migraine Headaches?

The endocannabinoid system, which is the body’s system of natural cannabinoids, receptors that metabolize cannabinoids of any source, and enzymes that control that interaction, is one of the few body-wide systems that has direct interaction with both neurological and physiological disorders. A quick review of the Cornerstone blog yields a wealth of evidence of the endocannabinoid system influencing everything from general pain, to sleep, to neurological malfunction, to immune system regulation, psychological health, and much more. In February 2016, specifically, we wrote about the possibility of cannabinoids/cannabis being used to treat migraine headaches: Soothing Migraine Headaches with Cannabis Anecdotally, this study confirmed that medical cannabis patients experience relief from migraines in a large sample (121 people). However, at the time, little was understood about the potential cause of relief, as well as the ramifications of cannabinoid signaling on other body functions and systems. In July, the International Cannabis Research Symposium Journal published more information shedding light on additional research surrounding cannabinoids and migraines, as well as on the potential interaction with kynurenine, a receptor antagonist (blocker) related to glutamate, one of the main neurotransmitters in the central nervous system, which includes the brain. To review, migraine headaches affect roughly 16% of the population at different stages of life! This has yielded an estimated 18.4 billion euro cost to European healthcare a year, not to mention extreme decrease in quality of life for patients suffering from migraines. While researchers are still trying to pin down what exactly causes migraines, we can…

CBD, Fear And Memory

In previous entries, we’ve covered how cannabis might affect memory and memory consolidation. The basic idea has been that cannabis might prevent the formation of traumatic memory. However, until now, we haven’t seen any research dealing specifically with fear. The connection between memory and fear may not be immediately obvious to readers; however, as it turns out, they’re very much related. A state of fear engages previous memories of threat as well as requires recall of escape/defense strategy. Given cannabidiol’s (CBD’s) success in early studies as an anti-psychotic, researchers might hypothesize a beneficial effect of CBD administration on fear response. However, only recently have Brazilian researchers carried out such an experiment, using rodents and varying doses of CBD. In most animal models of fear, researchers apply a threatening environmental stimulus. Of course, none of these might be more threatening than the mice’ natural predator, a boa constrictor snake! Researchers therefore forced confrontations between mice and snakes using an “arena” or plastic container, where they could record movement information. In one corner of the container, researchers placed a protective burrow. This burrow has two sides and a small opening on either, allowing mice to run in one side to escape the snake, and run out the other side once the snake begins to enter the burrow. Because this is an effective escape, a pro-survival strategy of mice would be to run away from the snake, toward the burrow. This is called “oriented escape”. However, in some cases, the mice become too…

Debunking Previous CBD -> THC Conversion Research

Earlier in the year, we published an article about CBD converting to small amounts of THC in the stomach, based on a 2016 study lead by John Merrick, “Identification of Psychoactive Degradants of Cannabidiol in Simulated Gastric and Physiological Fluid”. This study found that cannabidiol, when immersed in a bath of acid similar to stomach acid, produces a significant amount of THC in the same acid bath. Researchers hypothesized that this was because THC and CBD, despite having wildly different effects, actually start as the same pre-cursor chemical (cannabigerolic acid). Different enzymes then convert this chemical to destination chemicals THC or CBD, depending on plant genetics and environmental factors. However, strangely enough, in the year following the study, we have not seen the results confirmed. Were this a less significant finding, we might expect such delay. However, the finding is especially relevant to cannabis/cannabinoid research because it undermines CBD as a therapeutic drug. If part of the drug is converting to THC in stomach acid, this effect might preclude its use in situations where THC must be avoided. However, despite the lack of confirmation, outstanding questions loom, such as, if edible CBD converts to THC, why are CBD users not noticing psychedelic effects? How did such a large, obvious conclusion fly below the radar? Apparently because it’s false. As far as we can determine at this point in time, there is no reason to believe CBD converts to THC in the human stomach. Spearheading the commentary refuting this article, Franjo…

Cannabis and the Elderly

When you picture the average cannabis user, what do you imagine? Chances are you’re not imagining a senior citizen. Due to cannabis’ reputation as a counter-culture recreational drug, many people assume the average cannabis user to be young and liberal. While this seems like a reasonable assumption, the truth is that a large portion of medicinal cannabis patients are elderly. In fact, a recent Israeli study found that “of 279 cancer patients receiving medical cannabis, 50% were aged 60 or older”! In other words, perhaps the largest group of medicinal cannabis users is the senior citizen population. Why? Surely this percentage reflects the basic fact that older individuals are more likely to develop cancer and other diseases that may be treated by cannabinoids. Additionally, elderly populations are more likely to seek cannabis legally, while younger medical cannabis users are more likely to have other avenues of procurement. Moreover, perhaps the specific suite of ailments faced by the elderly fits the target profile of cannabis treatment. Regardless of the reason, however, the population of elderly medicinal users is far from negligible; at Cornerstone it makes up one of our major patient groups! In response to this high concentration of elderly medicinal cannabis use, one research group, led by Itay Katz from the Sheba Medical Center in Israel, has conducted a review of cannabis research relating to elderly populations. This review, published February 2017 in the Israel Medical Association Journal, highlights several common areas of use, as well as Western medicine’s current…

Anti-Viral Activity in CBD?

Chances are every person reading this has some connection to hepatitis, or inflammation of the liver, which can lead to liver failure and death. Unfortunately, there are many potential causes of hepatitis. Excessive alcohol consumption can cause inflammation, as well as autoimmune disease, in which the body mistakenly attacks its own liver cells. Currently five major viruses (which happen to be unrelated) have been identified to cause liver failure, referred to as Hepatitis A through Hepatitis E. Due to the contagious and dangerous nature of these diseases, US schools often require Hepatitis A and B vaccinations. Hepatitis A can spread easily through contaminated food and Hepatitis B (HBV) through blood and other bodily fluids. These vaccinations are simple, cheap, and life saving. Unfortunately, Hepatitis C (HCV) lacks a vaccine. Despite a common prevalence and upwards of 200,000 known cases in the US a year, the disease is difficult to ward off. We use the word “known” specifically because thousands of other people may also be infected but show no symptoms while spreading the disease. There is, fortunately, finally a cure to Hepatitis C. A once-a-day pill taken for several months can eradicate Hepatitis C from a sick patient’s body. Sadly, the cost for that treatment ranges from $55,000 to $150,000! As a result, government health care providers can’t shoulder the burden and only tend to allow coverage for end-stage liver failure. In other words, after all the damage is done, and the patient is dying, they are finally eligible for…

Cannabigerol, Making Food Appetizing for Cancer Patients

For all of the states that initially passed medical cannabis legislation, cancer was not only an approved condition but also a major data point supporting such legislation. Specifically, cancer patients, forced to undergo exhausting chemotherapy treatments, lose appetite. This drastic, prolonged loss of appetite, similar to anorexia, decreases body weight and in turn, decreases overall health. Cannabis has long been observed to increase appetite in humans (we’ve written several Cornerstone blog posts on the “munchies”), with the most active ingredient identified as THC, the psychoactive component of cannabis. Unfortunately, not all patients enjoy or can tolerate this psychoactivity. Originally, this posed a serious downside to treatment with cannabis. However, with the discovery of the endocannabinoid system, researchers realized that the effects of THC might be achieved, without psychoactivity, via other cannabinoids. Additionally, research has confirmed that cannabis containing no THC can still restore appetite. In line with this thinking, one paper, published last month in the medical research journal, Psychopharmacology, tested a molecule known as cannabigerol (CBG) on rodents to observe changes in feeding patterns. Readers may be surprised to learn that cannabigerol, unlike many other cannabinoids, found mostly in the resin of medicinal plants, exists in higher concentrations in plain hemp. Most medicinal strains, in fact, have concentrations lower than 1%. CBG also binds to the CB1 receptor at a much lower rate than THC and may even serve to temporarily disable the receptor. However, CBG has also been shown to be a 5-HT1A receptor agonist and an alpha2-adrenergic…

Soothing the Stomach: Controlling Intestinal Inflammation with Cannabis

As readers know, we’ve written about IBS (Irritable Bowel Syndrome) multiple times, specifically in response to its high prevalence. IBS occurs more than 200,000 times in the US each year. Partially spurred by processed foods, IBS is naturally more common in developed nations and as readers can guess, continues to grow in incidence. By the numbers, many of our readers will identify with the intestinal pain, gas, diarrhea, and constipation brought on by IBS. Unfortunately, the cause of IBS is not well understood, and likewise, no single cure exists; treatment can sometimes ease symptoms. As we’ve reported previously, cannabidiol (CBD), one of the most discussed molecules produced by the cannabis plant, has shown promise at healing inflammation and restoring normal intestinal motility, which is the ability of the intestine to move along/process food. Most studies have utilized rodents with CBD administered via body cavity injections. Currently researchers are seeking to establish whether these results can be duplicated in human subjects, as supported by anecdotal evidence. However, duplication poses an obvious practical issue in humans due to method of administration. Injecting CBD into the stomach each day? Yikes. Toward the goal of transitioning studies to humans, the next logical step is to test oral CBD on mice. Should this method prove to be as effective as injection, researchers will possess a stronger indication of oral CBD as a plausible treatment of IBS in humans. One research group, from Naples, Italy, set out to conduct such research. However, rather than only test…