Medical cannabis: aligning use to evidence‐based medicine approach

Schleider, Lihi Bar-Lev; Abuhasira, Ran; Novack, Victor

doi:10.1111/bcp.13657

Cited by 26 publications

(23 citation statements)

References 35 publications

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“…To date, studies on the therapeutic efficacy of Cannabis in certain pathologies have yielded results that are, at best, contradictory and, generally, inconclusive given that the studies were carried out on inhomogeneous populations, used differing extraction processes, and administered differing dosages (Bar-Lev et al, 2018). Moreover, the experiments were performed without proper control procedures and were administered by different routes.…”

Section: Introductionmentioning

confidence: 99%

Development of Standard Operating Protocols for the Optimization of Cannabis-Based Formulations for Medical Purposes

et al. 2019

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Under current legislation in Italy, Cannabis for medical purposes may be administered orally in the form of decoction or Cannabis oil extract. The scientific literature reports a number of preparation methods, mainly for oils, but no study is available that compares thoroughly, from a technological viewpoint, the Cannabis -based formulations currently administered to patients. With this in mind, this research work aimed to carry out specific formulation studies to design standard operating procedures for the preparation and optimization of Cannabis -based galenic formulations. Both decoctions and oils were prepared under different operating conditions to identify the most efficient process for the production of formulations with a high concentration of decarboxylated delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Regarding Cannabis oil, a new procedure has been developed that allows significantly higher recovery rates for THC and CBD compared with those for water-based extraction methods (decoction) and those for oil-based methods currently in use. Moreover, based on the results, it is possible to affirm that the prescription of Cannabis -based decoctions should not be the recommended first-choice solution for therapy, considering the low concentration of THC and CBD and, consequently, the high volume of decoction that the patient would have to ingest.

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Section: Introductionmentioning

confidence: 99%

Development of Standard Operating Protocols for the Optimization of Cannabis-Based Formulations for Medical Purposes

et al. 2019

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“…In recent years, Cannabis use for medical purposes continues to evolve, as shown by the growing number of states now permitting its administration for a variety of conditions, including chronic pain, cancer associated pain, chemotherapy-induced nausea and vomiting, spacticity associated with multiple scelerosis, Parkinson’s disease, post-traumatic stress disorder, and intractable epilepsy. 12 , 17 Currently, the administration of whole-plant Cannabis is mainly through inhalation pathways, via vaporization or smoking, or by oral ingestion of edible products. 18 , 19 Such consumption sharply increases the therapeutic ingredient levels in the bloodstream and is followed by a short therapeutic action period, lasting no longer than several hours.…”

Section: Introductionmentioning

confidence: 99%

Full-Spectrum Cannabis Extract Microdepots Support Controlled Release of Multiple Phytocannabinoids for Extended Therapeutic Effect

Uziel

Gelfand

Amsalem

et al. 2020

ACS Appl. Mater. Interfaces

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The therapeutic effect of the Cannabis plant largely depends on the presence and specific ratio of a spectrum of phytocannabinoids. Although prescription of medicinal Cannabis for various conditions constantly grows, its consumption is mostly limited to oral or respiratory pathways, impeding its duration of action, bioavailability, and efficacy. Herein, a long-acting formulation in the form of melt-printed polymeric microdepots for full-spectrum cannabidiol (CBD)-rich extract administration is described. When injected subcutaneously in mice, the microdepots facilitate sustained release of the encapsulated extract over a two-week period. The prolonged delivery results in elevated serum levels of multiple, major and minor, phytocannabinoids for over 14 days, compared to Cannabis extract injection. A direct analysis of the microdepots retrieved from the injection site gives rise to an empirical model for the release kinetics of the phytocannabinoids as a function of their physical traits. As a proof of concept, we compare the long-term efficacy of a single administration of the microdepots to a single administration of Cannabis extract in a pentylenetetrazol-induced convulsion model. One week following administration, the microdepots reduce the incidence of tonic-clonic seizures by 40%, increase the survival rate by 50%, and the latency to first tonic-clonic seizures by 170%. These results suggest that a long-term full-spectrum Cannabis delivery system may provide new form of Cannabis administration and treatments.

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“…The therapeutic benefits of cannabis are more and more recognized at the scientific level ( Bar-Lev Schleider et al, 2018 ; Freeman et al, 2019 ; Levinsohn and Hill, 2020 ), and regulation have to consider the evolution of its use ( Zaami et al, 2018 ; Corli et al, 2019 ; Brunetti et al, 2020 ). There are several listed medical indications in Italy, which should be treated accordingly with different cannabis varieties containing tetrahydrocannabinol (THC), cannabidiol (CBD), or both of them ( Law 9/11/2015 , 279 Official Gazette; Ministero della Salute, 2017 ; EMCDA, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Phytocannabinoids Profile in Medicinal Cannabis Oils: The Impact of Plant Varieties and Preparation Methods

et al. 2020

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Cannabis (Cannabis sativa L.) is a highly promising medicinal plant with well-documented effectiveness and growing use in the treatment of various medical conditions. Cannabis oils are mostly used in galenic preparations, due to their easy adjustment of the administration dose, together with the enhanced bioavailability of its active compounds. As stated by the Italian Law (9/11/2015, 279 Official Gazette), “to ensure the quality of the oil-based cannabis preparation, the titration of the active substance(s) should be carried out.” This study aims to represent the Italian panorama of cannabis oils, which were analyzed (8,201) to determine their cannabinoids content from 2017 to 2019. After application of the exclusion criteria, 4,774 standardized cannabis oils were included, which belong to different medicinal cannabis varieties and prepared according to different extraction methods. The concentration of the principal cannabinoids was taken into account dividing samples on the basis of the main extraction procedures and cannabis varieties. According to this analysis, the most substantial variations should be attributed to different cannabis varieties rather than to their extraction protocols. This study may be the starting point of preparatory pharmacists to assess the correct implementation of the preparation procedures and the quality of the extracts.

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Medical cannabis: aligning use to evidence‐based medicine approach

Cited by 26 publications

References 35 publications

Development of Standard Operating Protocols for the Optimization of Cannabis-Based Formulations for Medical Purposes

Development of Standard Operating Protocols for the Optimization of Cannabis-Based Formulations for Medical Purposes

Full-Spectrum Cannabis Extract Microdepots Support Controlled Release of Multiple Phytocannabinoids for Extended Therapeutic Effect

Phytocannabinoids Profile in Medicinal Cannabis Oils: The Impact of Plant Varieties and Preparation Methods

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