Purpose of Review Public acceptance of Cannabis sativa L. (cannabis) as a therapeutic option grows despite lags in both research and clinician familiarity. Cannabis-whether as a medical, recreational, or illicit substance-is and has been commonly used by patients. With ongoing decriminalization efforts, decreased perception of harms, and increased use of cannabis in the treatment of symptoms and disease, it is critical for clinicians to understand the rationale for specific therapies and their medical and practical implications for patients. In view of the opioid crisis, overall patient dissatisfaction, and lack of adherence to current chronic pain and headache therapies, this review provides up-to-date knowledge on cannabis as a potential treatment option for headache pain. Recent Findings Research into the use of cannabinoids for disease treatment have led to FDA-approved drugs for seizures, nausea, and vomiting caused by cancer chemotherapy; and for decreased appetite and weight loss in people with HIV/AIDS. For a wide variety of conditions and symptoms (including chronic pain), cannabis has gained increasing acceptance in society. The effects of cannabidiol (CBD) and tetrahydrocannabinol (THC) in pain pathways have been significantly elucidated. An increasing number of retrospective studies have shown a decrease in pain scores after administration of cannabinoids, as well as longterm benefits such as reduced opiate use. Yet, there is no FDA-approved cannabis product for headache or other chronic pain disorders. More is being done to determine who is likely to benefit from cannabis as well as to understand the long-term effects and limitations of the treatment. Summary Cannabis can refer to a number of products derived from the plant Cannabis sativa L. Relatively well-tolerated, these products come in different configurations, types, and delivery forms. Specific formulations of the plant have been shown to be an effective treatment modality for chronic pain, including headache. It is important for clinicians to know which product is being discussed as well as the harms, benefits, contraindications, interactions, and unknowns in order to provide the best counsel for patients.This article is part of the Topical Collection on Hot Topics in Pain and Headache * Robert A. Duarte
109 Background: Higher pain and greater long-term opioid requirements have been associated with shorter survival and decreased quality of life (QOL) in patients with AC. Routine use of MC is limited by a lack of rigorous scientific data and concerns about side effects, legal ramifications, and cost. Methods: 30 patients with stage IV cancer requiring opioids were randomized 1:1 to early cannabis (EC, n=15) vs. delayed cannabis (DC, n=15). The EC group was provided with 3 months (3M) of MC at no charge, while the DC group received standard oncology care without MC for the first 3M. Patients met with licensed pharmacists at one of two MC manufacturers to determine optimal MC dosing, formulation, and route. Patients completed monthly pain logs, opioid/MC logs, and validated Patient-Reported Symptom Monitoring surveys. Results: A higher proportion of EC patients achieved a reduction in opioid use and improved pain control. On average over a 3M window, EC patients did not require opioid dose escalation, had lower mean pain, and had similar QOL compared to DC patients. Estimated mean daily THC and CBD dose at 3M was 76 mg (range 5-186 mg) and 36 mg (range <1-516 mg), respectively. Mean perceived benefit of MC was 5.1 and mean perceived negative impact was 2.7 (1 = no benefit/negative effects, 7 = a great deal of benefit/negative effects). 33% of patients died during the anticipated 6-month study period and patient compliance with study logs limited analysis. Conclusions: Randomized studies of MC in the oncology setting are feasible, but rigorous data collection is challenging. The addition of MC to standard oncology care in patients with AC was well-tolerated and may lead to improved pain control and lower opioid requirements. [Table: see text]
BackgroundEntheogen use is becoming increasingly popular and a potential option for treatment or adjuvant treatment for various medical conditions. Clinical studies are needed to determine the efficacy, safety, and possible role of these traditional medicines in the context of modern society and the Western medicine paradigm. The willingness of patients to participate in such studies is currently unknown.Materials and MethodsIn September 2021 we implemented an anonymous, observational pilot survey to determine the general public's willingness to participate in future entheogen research. All participants were English-speaking adults and had participated in therapy or a retreat utilizing entheogens in a naturalistic setting in the last five (5) years. Participants were recruited through community outreach via email.ResultsThe response rate for this data set was estimated to be 48.3% (n = 84/174). Nearly all (95.5%) participants believed this research should be done and 86.9% said they would participate in entheogen research that lasted longer than one year. A greater proportion of participants were willing to participate in remote interviews (73.5%) rather than in-person surveys (64.7%). A majority of participants (78%) also noted the importance of financial compensation for their time influencing the willingness to participate in future entheogen studies.ConclusionsThe willingness to participate in research involving traditional entheogens is not the limiting factor in facilitating further studies. Participants held overwhelmingly positive perceptions indicating that they believed this research should be done. Future longitudinal clinical studies with financial compensation and controlled set and settings will be necessary to expand the evidence base for naturalistic entheogen use.
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