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CED Blog

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Treating Cannabinoid Hyperemesis Syndrome with Benzodiazepines

5/10/2020

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Resolution of cannabinoid hyperemesis syndrome with benzodiazepines- a case series
In Summary
A recent series of case studies has revealed the possible benefits of utilizing benzodiazepines to treat cannabinoid hyperemesis syndrome. Cannabis hyperemesis syndrome (CHS) is characterized by nausea, cyclic vomiting, and intense abdominal pain due to chronic cannabis consumption. Although CHS is now gaining recognition for how under-recognized the condition is, many patients suffering from CHS still suffer for long periods of time and have difficulty responding to traditional anti-emetics. Benzodiazepines, a common sleeping medication, were distributed to the four featured patients and appeared to provide rapid relief. Further research should focus on the development of a benzodiazepine-like substance that provides the same antiemetic effects while minimizing side effects. 
Benzodiazepines and benzodiazepine-like medications, such as Ambien (zolpidem tartrate), are known to have unsavory side-effects that can negate its benefits. Ambien specifically has been featured heavily in popular media due to the dangerous activities of patients utilizing Ambien for insomnia as some have caused serious accidents and even attempted murder. Considering the dangerous side-effects of such medications, those who report cannabis use or are screened and found to test positive for cannabis use should be advised to immediately cease all cannabis use and general anti-emetics should be attempted before benzodiazepines. 
The study is available for review or download here:
Download & Review HERE
View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan ​
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The Relationship Between Cannabis and Nicotine may Reveal Novel Treatments

4/19/2020

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Acute separate and combined effects of cannabinoid and nicotinic receptor agonists on MMN-indexed auditory deviance detection in healthy humans
In Summary
Researchers have attempted to elucidate the relationship between nicotine and cannabis revealing a possible benefit for sensory and cognitive processes. A cannabinoid receptor 1 (CB1) agonist, nabilone, and nicotine were compared against each other and combined and compared with a placebo, resulting in the region and deviant-dependent effects. Temporal regions of the brain were not affected by coadministration of nabilone and nicotine, while frontal regions showed improved cognitive function. Future research should continue to develop therapies that combine CB1 agonists while minimizing the need for nicotine in order to develop therapies for the dysregulation of sensory and cognitive processes. 

So little is still understood about the interactions of the endocannabinoid system, nicotinic receptors, and the opioid system. If the mechanisms underlying these various systems were well understood perhaps novel therapies could be developed to aid in the treatment of substance abuse disorders. Cannabis poses much less risk for addiction than opioids or nicotine as cannabis does not enact upon the reward system. Cannabis holds promise to lessen the troubles associated with the opioid academic by treating current addicts and preventing future addiction by serving as an adjunct therapy. Further research is needed to validate these hypotheses, but the current data provides hope for more ethical treatment methods. 
The study is available for review or download here:
Download & Review HERE
View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan 
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Oleamide and the Endocannabinoid System Protect Against Excitotoxic Damage

4/15/2020

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A cannabinoid receptor-mediated mechanism participates in the neuroprotective effects of oleamide against excitotoxic damage in rat brain synaptosomes and cortical slices
In Summary
Oleamide, an endocannabinoid-like compound, has been found to work with the endocannabinoid receptors to protect against excitotoxic damage. Utilizing tryptophan metabolite quinolinic acid to induces the overactivations of N-methyl-D-aspartate receptors (NMDAr), eliciting excitotoxic effects. Various doses of oleamide were given to excitotoxic rats, revealing that oleamide did provide protective effects. Further examination confirmed that oleamide served a protective role by working through the endocannabinoid system. Future research should examine other compounds that could enact neuroprotective effects through the endocannabinoid system. 
​
Researchers continue to find novel targets for treatment within the endocannabinoid system. Although cannabis is not currently supported for medical use by the federal government the endocannabinoid system has far-reaching possibilities that can still be studied in the meantime. By using compounds like oleamide or other others that work on the endocannabinoid system researchers can determine new targets and therapeutic benefits of the endocannabinoid system. Researchers should continue to push for federally funded projects revolved around the endocannabinoid system as the underlying mechanism is still poorly understood considering the potential it holds. 
The study is available for review or download here:
Download & Review HERE
​View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan 
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Synthetic Cannabis Use in a Psychiatric Inpatient Unit in Australia

4/12/2020

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Synthetic cannabinoid use in an acute psychiatric inpatient unit
In Summary

Over half of the patients at a psychiatric inpatient unit in Australia reported using synthetic cannabis before their admission to the acute treatment clinic. Although synthetic cannabinoids have been banned from retail centers in Australia patients reported that legality, availability, and the feeling of intoxication were the main motivation for their use of synthetic cannabinoids. There is a high prevalence of new psychoactive substances available and the data from the clinic causes some in the healthcare field to suggest that clinicians should routinely screen for substances during the admission process. 
​
This article mentions the flurry of new synthetic psychoactive substances, including cannabinoids but also extending beyond just those, which highlights the issue of readily available designer drugs. It can be difficult to keep track of illicit designer drugs as illegal manufacturers are often able to quickly modify their product before the previous form is even determined to be an illegal substance. By routinely checking for new drug variants the legal and medical systems would be better able to maintain and keep a record of such substances for future use, tracking, and treatment protocols. 
The study is available for review or download here:
Download & Review HERE
View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan 
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Further Evidence for Cannabis as an Adjunctive Therapy to Opioids

4/4/2020

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Picture
Effects of cannabinoid administration for pain- A meta-analysis and meta-regression
In Summary
A recent meta-analysis provided further evidence that cannabis can be used as a replacement and adjunctive therapy option for opioids. Across all of the studies, it was found that cannabis had a medium-to-large effect on the subjective pain felt. The included studies included a range of given doses, all reported in milligrams and were conducted in various pain models, including Human Immunodeficiency Virus, Cancer, Neuropathic Pain, Diabetes, and more. Further research is needed to standardize an appropriate dose for each condition and ensure the validity of such medications. 

The authors take care to emphasize the need for alternative pain therapies for opioids that are safer and more economically responsible. Currently, pain-related costs from patients, caretakers, and healthcare facilities continue to grow beyond $600-billion annually, as more people grow dependent on opioids. Cannabis is much more cost-effective, and even if it does not entirely replace opioid therapies and is simply an adjunct therapy, it has the potential to greatly reduce the amount of opioid prescribed and lower the necessary dose. Opioids are highly addictive whereas cannabis has a much better safety profile, yet cannabis is still deemed medically irrelevant by the federal government. More research needs to be conducted to reduce the chance of addiction, the opioid crisis in general, and reduce the economic burden of pain-related costs in the United States. 
The study is available for review or download here:
Download & Review HERE
View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan 
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A Cannabinoid-Like Compound Modulates Neuronal Excitability, May Reduce Seizures

3/26/2020

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The Cannabinoid-Like Compound, VSN16R, Acts on Large Conductance, Ca2 -Activated K  Channels to Modulate Hippocampal CA1 Pyramidal Neuron Firing
In Summary
​Researchers have recently found a cannabinoid-like compound, VSN16R, which is able to modulate Ca2+- activated potassium channels and may reduce seizure severity. By hyperpolarizing the neurons through the opening of Ca2+- activated potassium channels VSN16R ultimately results in the reduction of hyperexcitability seen in individuals who suffer from seizures. The compiled data reveals that cannabinoids or compounds structurally similar to cannabinoids may prove useful in the treatment of seizures or epileptic disorders, similar to the cannabinol-based Epidiolex® medication for rare forms of epilepsy, reducing the chance of a seizure or minimizing its duration. Further research is needed to aid the development of more readily available cannabis-based therapies for seizure activity and more general forms of epilepsy. 
​
Highlighting in this article are the options for treatment that the endocannabinoid system provides us, even in the absence of naturally occurring cannabinoids. If structurally similar compounds like VSN16R are able to be synthesized and proven effective, it could mean novel therapies could be developed even while red tape surrounds cannabis. The endocannabinoid system affects a myriad of systems within the human body and is severely under-researched considering its potential. Epidiolex® is the only cannabinoid-based medication currently approved by the federal government but cannabis has shown promise in so many other areas where the current treatment is either ineffective or lacking. Research utilizing the endocannabinoid system as a target should continue and be pushed to the forefront of the medical community. 
The study is available for review or download here:
Download & Review HERE
View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan 
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Further Evidence For Cannabis as an Effective Pain Reliever

3/22/2020

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Picture
Effects of Cannabinoid Administration for Pain- A Meta-Analysis and Meta-Regression
In Summary
A recent meta-analysis has found that cannabis is an effective treatment for those dealing with chronic pain. Researchers analyzed studies that compared cannabinoid-based therapies to placebos, concluding that those therapies served as an effective replacement or adjunctive therapy for more common pain relievers, such as opioids. Some studies included in the analysis disqualified the effectiveness of cannabinoids due to the psychoactive effects of tetrahydrocannabinol (THC) but the featured piece suggests future work should aim to synthesize cannabinoids that highlight cannabis’s analgesic effects while minimizing any psychoactive effects. Future research needs to discover more about the endocannabinoid mechanism within the body before this can occur. 
​
The authors take care to emphasize the need for alternative pain therapies for opioids that are safer and more economically responsible. Currently, pain-related costs from patients, caretakers, and healthcare facilities continue to grow beyond $600-billion annually, as more people grow dependent on opioids. Cannabis is much more cost-effective, and even if it does not entirely replace opioid therapies and is simply an adjunct therapy, it has the potential to greatly reduce the amount of opioid prescribed and lower the necessary dose. Opioids are highly addictive whereas cannabis has a much better safety profile, yet cannabis is still deemed medically irrelevant by the federal government. More research needs to be conducted to reduce the chance of addiction, the opioid crisis in general, and reduce the economic burden of pain-related costs in the United States. 
The study is available for review or download here:
Download & Review HERE
View more studies like this in the CED Foundation Archive:  http://bit.ly/drcaplan 
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