Is Cannabis an Alternative to Opioids?

As doctors struggle to contain the opioid crisis in Canada, a new study on chronic pain suggests that medicinal cannabis may offer alternative relief.

Funded by Toronto-based Apollo Applied Research, it tracked the experiences of more than 300 chronic pain patients over a period of three years.

More than one- third of participants had been prescribed a regimen of opioids, such as oxycodone and fentanyl, which come with a high risk of addiction and potentially fatal overdose.

Dosages and delivery mechanisms varied for each patient, but surveys of participants in Apollo’s study — observational in nature rather than experimental — found that 45 percent of opiate users reduced their dosage after starting cannabis treatment, and another 35 percent stopped taking opiates altogether.

Medicinal cannabis, which generally lacks the “high” of recreational pot because of lower levels of THC, is most often prescribed for low-level pain management, particularly for patients with chronic pain. The drug is also prescribed for glaucoma, posttraumatic stress disorder ( PTSD), Parkinson’s- related tremors and for pain stemming from irritable bowel syndrome and Crohn’s disease.

For Apollo’s study, each participant was given a treatment plan by their own doctor. Researchers then had them fill out standardized surveys (created using certified methodologies for scoring subjective experience) to see whether they had any reductions in the intensity and frequency of pain, as well as other improvements to the quality of life.

Overall, participants reported a 20 percent reduction in the severity of symptoms and a dramatic reduction in opiate use. “In total, it was close to about 75 percent to 80 percent of (opioid users) that stopped or reduced their opioid use,” says Genane Loheswaran, the company’s director of clinical research.

Apollo’s researchers have also been looking into cannabis effects among patients suffering from post-traumatic stress disorder, and Loheswaran says the results there are similarly promising.

This original article, written by David Dias, appeared in the ‘Cannabis Post’, special to ‘National Post’ on March 27th, 2018. The full article can be read here.

Cannabis Oil: What’s the Hype?

Earlier this month, the Supreme Court allowed patients using medical marijuana to legally alter their dried cannabis into oils. Before this point, it was considered unlawful as the previous regulations only allowed the vaporization of dried cannabis.

Since the ruling, more waves have been made in the medical marijuana industry, and some insurance companies may even be on board with actually covering cannabis oil, due to its ability to be concentrated into consecutive doses in the form of pills, therefore leading to doses being more regulated and consistent.

With all the hype currently going around about cannabis oils, you may be curious as to just what it is, and what the benefits of using oils are.

What is cannabis oil?

Cannabis oil is the oil derived from cannabinoids that have been extracted from the cannabis plant. Unlike straight THC and CBD oils you can find in some dispensaries, cannabis oil differs because it contains all of the necessary medical properties, including both THC and CBD. The oil is very concentrated making it more potent, therefore less is required to achieve the desired effect.

What are the benefits?

Oils offer the same relief found in dried marijuana. It can treat or relieve symptoms of: anxiety and stress, pain, enhance appetite, and has shown in some cases to reduce tumour size and many of the negative side effects associated with chemotherapy. Some have also used cannabis oil to treat symptoms of epilepsy as well.

Many patients find this to be more logical in their everyday consumption. Some are affected by the smoke, while others want to keep their use of the medication private and can lead to avoiding to take their medications in a public place at the times they need to get relief. David-George Oldham, founder of The ARC, a consortium of cannabis patients, doctors, activists and chemists, explains the logicality of cannabis oil into the lives of chronic pain patients:

“Imagine smoking seven grams of cannabis when you’re having a migraine so bad that just moving your fingers is excruciating pain. Taking a [cannabis] pill is a lot more sensible and having pills stocked in my cupboard makes a lot more sense than having just raw cannabis out and about in my house.”

With the news of oils growing in acceptance, this opens up a new door of opportunity for LP’s and clinics.

“I feel that it is an important step in the right direction. Oils will pave the way to being able to more accurately dose and therefore prescribe medical cannabis.”

Bryan Hendin
President & Director, Apollo Applied Research

The ability to administrate analogous doses through the form of pills also makes research on the effects of medical cannabis more accurate. This helps to alleviate the issue of certain patients not vaping the proper dosages, therefore potentially affecting study data.

“The recent ruling by the Supreme Court allowing patients to consume Medical Cannabis in alternative forms should be seen as a great stride for patients. Certainly the production and use of derivative forms of Medical Cannabis should be approached with caution, but I think this lowers some of the obstacles patients experience in administering their medicine. From a research perspective, the opportunity to evaluate the safety and effectiveness of derivatives like oils and tinctures is phenomenal. Our Clinical Research Team at Apollo has already begun to develop protocols to look more closely at these alternative routes of administration.”

Jason Moreau, Ph.D.
Manager, Clinical Research at Apollo Applied Research

Rulings such as these are further helping to erase the stigma associated with marijuana for medical purposes, and are instilling a global acceptance into the lives of the patients involved.

How Genetics Play a Role in Chronic Pain

The topic of chronic pain is a sensitive subject. Currently, 1 in 5 Canadians report suffering from chronic pain. Chronic pain costs the Canadian economy $50-$60 billion annually, and is the number one reason for seeking health care. Many cases are linked to traumatic experiences, such as a physical or occupational trauma, or psychological distress; however not everyone who develops chronic pain can link it to a specific event.

It’s a difficult ailment to diagnose and treat because the only person who can truly experience the level of discomfort associated with their pain is the individual themselves. Chronic pain has insinuated to be heritable in some cases, and research indicates that a genetic predisposition may be to blame.

Our genes also play a large role in our resistance to various medications and the efficacy of various treatment methods. With recent genetic advances, we may be able to hone in on precisely what genes are most responsible for chronic pain, and therefore identify different, more operative treatments surrounding them.

In regards to the development of chronic pain, roughly 50% of cases are a result of post-operative complications, resulting in persistent pain. Pain is a complex problem to treat because the level of intensity is subjective and can vary on individuals even under nearly identical circumstances.

Pain testing on animals has paved the way for many developments in this field of study. For example, a recent study on mice concluded that the CACGN2 gene could be held responsible for regulating chronic pain, a gene previously shown to be involved in altering the brain during epileptic episodes.

The same gene was shown to affect breast cancer patients with their chronic pain levels after surgery. The CACGN2 gene however, isn’t the only inheritable factor that could have an influence on chronic pain management. Sensory genes like COMT (catechol-O-methyltransferase), ADRB2 (beta 2 adrenergic receptor) and GCH1 (GTP hydrolase) are linked to chronic pain, as well as genes that are associated with the relationship between psychological stress and the development of chronic pain.

Although these genetics have been linked to the development of pain disorders and an individual’s sensitivity to pain, the results are inconsistent, and more large scale studies are required to confirm the validity of these claims.

Different medications react varyingly due to an individual’s genetic profile. Genetic testing may be able to determine which medications will work for or against the patient, and can further create more advantageous strategies and solutions to treat a person’s unique pain. Predicting which genes alter a physical and cerebral alteration on chronic pain will convey further advancements into discovering which treatment methods will reign most effective.

Apollo Makes Significant Waves in the Medical Marijuana Industry

Since the launch of the organization in 2013, Apollo Applied Research has distinguished ourselves as a leading clinic, providing innovative pain management approaches to patients through our Medical Cannabis treatment program.

The study, which launched March 2015, has seen a dramatic involvement, with hundreds of patients on board to help shape the future of medical marijuana research. Patients are reporting not only a reduction in pain score, but as well a reduction in opioid medication use. This is a huge step with medical marijuana use as a treatment for chronic pain.

Opiate abuse has seen a substantial rise in the number of victims left either dependent or physically harmed. The chart to the right is a visual representation of overdose deaths involving opioid prescription drugs from 2001 to 2013.

Opiates also post a threat for severe withdrawal from the first 24 hours the effects wear off up to over 2 weeks. Severe withdrawal can be fatal in some cases, including diarrhea, abdominal cramping, goose bumps on the skin, nausea and vomiting, dilated pupils and blurry vision, rapid heartbeat, and high blood pressure.

Dependency of opiates can vary with its effects (see left), and prolonged use changes the way nerve receptors work in the brain. These receptors become dependent upon the drug to function which can be very dangerous, and increases risk of accidental overdose.

According to a preliminary analysis of Apollo patient data, 27% lowered their use of opioid medications, which included Percocet, methadone and oxycodone. Across all patients, a significant average pain reduction score of 30% was reported.

Through the research, we are proud to present that 54% of patients showed a clinically significant reduction in pain score. Clinical significance is present when a pain score reduction of more than 30% is reached. Patients at or above this level saw an average reduction in pain score of 45%.

On behalf of the Apollo team, we look forward to continuing ground-breaking research to reduce opioid abuse and further treat our patients’ pain in the most progressive way possible. Here at Apollo, our focus is clear: We want to shape the landscape of cannabinoid-based medicine through applied research to become the core frontier of comprehensive medical marijuana research and observational study.

Throughout the duration of the study, we will continue to analyze various strains for a variety of ailments while developing guidelines for medical cannabis prescriptions, creating an advanced, an all-encompassing safety profile for medical cannabis.

We will continue to educate physicians and patients about medical cannabis and its appropriate use, all the while improving the quality of life and empowering our patients and physicians using evidence-based cannabinoid research.

Survey Suggests Marijuana Helps Best at Easing Fibromyalgia Pain

Recently, an online study with over 1,300 fibromyalgia patients was conducted by the National Pain Foundation and National Pain Report. In this study, patients were asked a series of questions related to their pain scores, quality of life, and opinions on a variety of FDA approved drugs for treating fibromyalgia.

The three drugs – Cymbalta, Lyrica and Savella – generate billions of dollars in annual sales for Pfizer, Eli Lilly, Forest Laboratories and other drug makers. The goal of the survey was to conclude which of the drugs associated with fibro pain treatment worked best, including medical marijuana. Regardless of the reputation for the top three pharmaceuticals, most patients as suggested in the survey, indicated they don’t work.

The National Institutes of Health estimates that 5 million Americans suffer from fibromyalgia. Fibromyalgia is characterized by deep tissue pain, fatigue, headaches, depression, and lack of sleep. It’s a misunderstood condition, and there is currently no cure.

Interventional spine and pain surgical physician, and chairman of the National Pain Foundation Dan Bennett, MD, states, “Fibromyalgia is devastating for those who must live in its grip. There is much we do not understand. We need innovative ‘out of the box’ solutions that change the face of this disease.”

A common finding derived through patient testimony was that out of the three FDA approved drugs, they presented more negative side effects then positive. The patients were asked to rate their experience with the drugs and indicate the level of pain relief they were alleviated from.

Results indicated for Eli Lilly’s Cymbalta (Duloxetine), 60% of those who tried the drug said it did not work for them. Only 8% said it was very effective and 32% said it helps a little. With Pfizer’s Lyrica (Pregabalin), 61% said it did not work at all. Only 10% said it was very effective and 29% said it helps a little. Forest Laboratories’ Savella (Milnacipran), 68% of those who said they tried the drug said it didn’t work. Only 10% said it was very effective and 22% said it helps a little.

What surprised researchers was the response of users who had tried marijuana to treat their pain. The survey was in no way biased to supporting medical marijuana, or had any probing qualities for push respondents to answer more in favour to medical marijuana. 62% who have tried cannabis said it was very effective at treating their fibromyalgia symptoms. Another 33% said it helped a little and only 5% said it did not help at all.

“Nothing but medical marijuana has made the greatest dent in the pain and mental problems,” said another”, said one respondent.

Other survey findings revealed that many feel as though their physician is uninformed of the seriousness of the disorder, and that their friends/family did not take their condition seriously. Also, about 49% of patients mentioned that their symptoms begat an early age (between 18-34), and took over 5 years for a diagnoses to be made.

Evidence in regards to medical marijuana points toward possible anti-inflammatory effects. Research from the National Health and Nutrition Examination Survey (NHANES) found that the people who smoked in the last month had lower CRP levels than those who had never smoked the drug.

CRP is one marker of inflammation that is frequently linked with people’s risk of heart disease. This could explain how fibromyalgia, which is often considered an arthritis-related condition, could be alleviated by using a drug with a strong anti-inflammatory make-up, such as medical marijuana.

Fibromyalgia is a lifelong sentence; an everyday struggle that requires daily medication. Patients should be able to find relief without experiencing the harmful side effects associated with Cymbalta, Lyrica and Savella.

Managing Chronic Pain and Depression Through Proper Nutrition

It’s no surprise that when we eat well, we feel better about ourselves too. Our bodies require nutrients and vitamins in order to function to the best of its ability and make us feel and look our best. One of the many issues with chronic pain, is that sometimes, the effort required to make these types of meals outweighs the benefits.

What good is a meal if you’ve exhausted all of your strength into just making it? We tend to eat poorly because we’d rather spend the little effort our pain allows us to have into other aspects of our lives.

It’s not always easy to remember, but eating well is crucial to the management of your pain and depression; even making a few small changes to your diet can make a world of difference. Optimise your body’s natural ability to improve your mood and lessen depression by increasing your body’s own natural anti-depressants.

Aim for a Balanced Diet

Specifically of protein, complex carbohydrates, fruits, vegetables and lots of water. A high protein diet will leave you fuller for longer, and therefore you’ll be less likely to feel a dip in your mood. Complex carbohydrates such as baked potatoes, whole-wheat pasta, brown rice, oatmeal and whole grain breads can boost serotonin levels without a crash, and of course, you need water to stay hydrated to ensure your body can transfer the nutrients efficiently.

Also, focus on making your diet full of the mood-boosting tryptophan. This is what your body converts into serotonin. Foods such as milk, tofu, salmon, miso and broccoli are good sources, as well as bananas, cottage cheese, turkey, fish, avocados.

Take B Vitamins

Vitamin B deficiency is particularly associated with depression. The deficiency of these crucial nutrients are linked to a decline in mental or emotional state, depression, fatigue, confusion, memory loss, apathy, anxiety, irritability, nervousness, sleep disturbances and/or loss of appetite. Vitamins B3, B6, C, biotin, zinc and folic acid in particular are all needed for the conversion of tryptophan to serotonin to take place.

Get more B vitamins into your diet by taking a B-Complex vitamin (you can find them at your local drug store), or eat more leafy greens, beans, nuts, seeds and eggs.

Get in Good Fats

Foods that are rich in omega-3 fats, such as EPA and DHA can give you a great mood boost. Fatty fish and cold water fish are a great source of these nutrients. You can also pick up fish oil at your local drug store.

It’s important to eat small, regular meals of natural, unprocessed foods at the very most every 4 hours. Never jump into yoyo or fad diets; all that does is deprive your body of the necessary nutrients which alters your brain chemistry, all for temporary weight loss.

It’s hard to prepare meals and eat well when you are in pain or depressed, but being aware of what your body needs to function to its best physical and mental ability, and making these minor dietary changes can display a big difference over time. You can still eat well in spite of pain and limitations, and make your symptoms more manageable

Cannabis Usage Linked to Lower Stroke Risk

In light of Stroke Month, let’s delve into cannabinoid research, and its effect on stroke prevention and treatment.

Many studies have been done on the effects of cannabis use, and the link to stroke risk. As part of The Stroke Prevention in Young Adults Study, researchers from the University of Maryland assessed past marijuana users among 751 stroke cases and 813 controls.

The study ran for 16 years, and the results presented that those who has used marijuana were less likely to suffer a stroke. Only 28.8% of stroke patients reported marijuana use, which is statistically significant.

The results were later shared at the American Academy of Neurology’s 66th Annual Meeting. Although the results were substantial, more large scale studies are required before a concrete link can be proven.

Lead researcher and presenter Tara Dutta, MD, of the University of Maryland School of Medicine states, “We don’t suspect that this implicates a protective effect of marijuana on ischemic stroke risk. We will go back and look at our data more carefully and do some additional analyses to see if we can look for potential confounders.”

Cochair Jennifer Majersik, MD, of the University of Utah, rebutted, saying the study “should be reassuring” to people who smoked marijuana in the 1960s or 1970s, adding that Baby Boomers have yet to show any negative marijuana-associated effects. The public and patient interest is enough of a solid foundation to build more research on the topic.

In 2013, researchers at the University of Nottingham analyzed cannabinoids role in reducing the severity of stroke and improving patient outcomes, and the results were promising. The therapeutic compounds presented by cannabinoids and endocannabinoids bind to the body’s marijuana pathways, which may offer protection against post-stroke injury due to their “potent anti-inflammatory” effects. Discoveries such as these provide an optimism for further research on the subject.

Some previously researched factors on stroke inducing influences include but are not limited to:

  • Tobacco

  • Alcohol use

  • History of diabetes and hypertension (abnormally high blood pressure)

  • Atherosclerosis (hardening and narrowing of the arteries)

  • Obesity

Know the signs of a stroke, act FAST:

fast-stroke-signs

Tips When Visiting a New Doctor

Seeing a new doctor in which you are not familiar with can be an intimidating and uncomfortable experience. Health is a personal issue, therefore addressing concerns with a stranger can make people feel more closed off, potentially leading to misdiagnosis or not fully getting the treatment that would work best.

If you are visiting a new doctor in regards to your chronic pain, there are certain things that need to be addressed in order for them to treat you in the most lucrative way possible.

Be Descriptive

Over or understating the amount of pain that you are in does not give the doc a fair chance to evaluate you properly. Try your best to define your pain descriptively. Using words like “sharp” or “stinging” for example, can feel differently to different people. Simply stating that you “hurt all over” is far too broad for a doctor to be able to hone in on the root of the problem. Pick one or two areas and work together from there.

Be Clear

Inform them of when the pain started, not just any time you’ve gotten hurt. Knowing which specific injury lead to your ailment is another step the doctor can use to solving the burden that is your chronic pain. Also, in regards to allergies, be very specific. You could be one of those people that are “allergic to everything”; this doctor hasn’t been with you for a long time and therefore isn’t copiously knowledgeable of your health record, so be very distinct as to exactly what your body can and cannot tolerate.

Come Prepared

Say you have tried everything under the sun to relieve your pain; that’s great, but the doctor won’t know exactly what has already failed if you can’t prove to him what you have tried. Compile a list of treatments, medications, and therapies you’ve exhausted while trying to find relief for your pain. They will likely have other methods you haven’t tried or heard of that may be of aid to you.

Share Your Goals

No one can physically feel your pain but you, so it’s not easy for a doctor to know exactly how much you are in. Set practical, realistic goals that you hope treatment will bring you. Someone who wants to be able to swing a golf club again, opposed to someone who just wants to be able to get out of bed in the morning are very different indicators of just how much pain has decreased your functionality and quality of life. Making goals is the first step to producing the best treatment plan that’s right for you.

More than likely, the new doctor you are visiting is there to help and wants to understand your case to aid you to the best of their ability. As uncomfortable as it may get, you need to be open and honest, clear, and prepared to make your clinic experience a pleasant one.

Living with Chronic Pain

…But Living with Joy Anyway

When living day to day with a chronic illness or pain, it can be difficult sometimes to see the silver lining and stay positive. When the weight of your condition is constantly at the focal point of your mind, it’s understandable that there will be some days when you feel like you want to fall apart, but the key to living with joy while be affected by a chronic illness is to not let those low moments consume you.

It’s normal to find yourself saturated in your pity party, in fact, do it for as long as you need to; but discouraging as it may get at times, you need to understand that you can’t live there. While mourning the loss of health, working on sustaining a healthy, positive, and determined mindset is the first step in overcoming the challenges you’ve been served.

1. You need to put yourself first, and not feel bad about it.

Whether you require extra time to get ready, sleep, eat, whatever it may be, don’t rush yourself or feel that your condition has made you a burden to others. If you can’t be there for yourself, you can expect someone else to. Take it a day at a time.

2. It’s not your fault that you’re sick.

The last thing you should be doing is putting the blame on yourself. You didn’t ask to live with your condition, so you shouldn’t take every day as if you deserve it. This does not make you a failure and is not a deficit of your own character.

3. Take this as a lesson, not a defeat.

When you ask for strength, you get that by receiving hardships to make you strong. This wasn’t thrown upon you so you could kneel down and let it consume you. Viktor Frankl once said, “In some way, suffering ceases to be suffering at the moment it finds a meaning.” Facing your illness head on helps to grow your character, educate and support others, and builds compassion and understanding.

4. Find a support system

The best way to not feel alone is to not be. Finding like-minded individuals who are either in the same boat or have supported you in your journey thus far are great to have around. You can never have too much encouragement and support from those who want nothing more than to see you happy.

5. Find a great doctor

This can be easier said than done, but if you can find a doctor that genuinely cares and takes the time with you and your circumstance, the difference it will make is amplifying. The more comfortable you are with your doctor, the more at ease you’ll feel to be more open and honest in describing your case to develop and implement the best medical treatment possible.

6. Be happy for not only yourself, but others.

We all know the age old saying “misery loves company”, but being bitter over those who are healthier than you does nothing productive for your state of mind. Anger and jealousy have no room in your positive hierarchy. If you want to receive love, you must radiate and send it out as well.

You may not have control over your pain or illness, but you will never not have control over how you perceive and cope with it. By following these 6 steps, you are well on your way of living a life with chronic illness, but living with joy at the same time.

Medical vs. Munchies

What’s the difference?

Marijuana is ranked by the WHO as the most popular recreational drug worldwide. Alongside this title has developed a negative stigma about the safety of the drug. Unfortunately, with it being such a largely distributed street drug, altering andlacing have made the overall safety of marijuana ambiguous.

What some may not fully understand is just how different recreational marijuana is as opposed to specially formulated, controlled cannabis; but what are some of the main focal points that need to be touched on?

1. Marijuana was originally a medicine

The earliest records of marijuana usage derived from ancient Chinese and Indian medical texts were devoted to its healing properties, as opposed to its recreational counterpart. Most commonly, its therapeutic support in regards to pain management was its paramount use, the same method of treatment it is most popularly used for today.

2. Not all marijuana gets you “high” 

THC is a chemical found in marijuana that is responsible for the recreational sensation most desire. It is responsible for feelings of euphoria, relaxation, appetite and can alter your perceptions on anything from your senses to thoughts. THC is also the main compound that induces anxiety and bits of paranoia in some individuals. The fact of the matter is, marijuana contains hundreds of chemicals all ranging with different benefits and properties that affect each individual in their own ways. With street marijuana, a higher THC is typically saught for, and too much can start to negatively affect a person, especially if the consumer is at the age before their brain is fully developed.

3. In fact, some won’t get you high at all 

Arguably the most beneficial chemical in marijuana is CBD. CBD is the main property responsible for many of the healing benefits found in medical marijuana. Studies have shown CBD to be a method of treatment for dealing with schizophrenia and epileptic episodes, as well as reduce inflammatory conditions in those with chronic pain. Carefully constructed and vigilantly grown cannabis cultivators can manipulate the levels of THC and CBD found to produce and modify a variety of strains based on patients’ precise needs.

4. Recreational use tends to be linked to bigger issues

 Self-medicating to overlook or avoid personal issues using any type of drug can lead to or be an indicator of addictive tendencies or serve as a gateway to stronger medication once the drug in question has been exhausted. When picking up any drug off the streets, you can never be sure exactly what you’re paying for. Chances are, the dealer themselves don’t even have the full background of the batch they’ve picked up. Substance abuse can be linked to underlying, personal issues the person may not even be aware of. The negative stigma placed upon marijuana leads people to keep their recreational use to themselves, therefore revealing to and avoiding the advice of a doctor that may be able to offer a more constructive option to aid them in their difficulties.

 Medical marijuana is a safe, natural alternative to many harmful and destructive opiates and drugs out there today. If you need relief and feel that marijuana may be an effective option for you, don’t let the fear of discussing it with your doctor lead you to dealing with unidentified and potentially dangerous alternatives.