Benjamin Caplan, MD

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Supplementing Antipsychotics with CBD Enhances Psychotic Symptom Treatment

July 10, 2019 Adverse Effects, Anxiety, Cannabinoids, Cannabis, Cannabis Dependence, Cannabis Science, Cannabis Use Disorder (CUD), CBD, Cognition, Mental Health, Parkinson's Disease, Placebo-Controlled, Psychosis, Schizophrenia, Science, Stress, THC

Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial

Most schizophrenia medications function by blocking the action of the dopamine D2 receptor and effectively treat positive psychotic symptoms, such as delusions or hallucinations, but fail to treat negative psychotic symptoms, such as lack of motivation or the lack of an ability to feel pleasure. Anecdotal evidence has pointed toward the potential for CBD to attenuate psychotic symptoms in conjunction with normally prescribed antipsychotics; additionally, CBD is not hypothesized to act on the D2 receptor, suggesting that it may afford unique advantages over anti-psychotics.

Researchers interested in further exploring this conducted the first known placebo-controlled CBD trial among schizophrenia patients. Although results did not suggest a potential for CBD to treat negative psychotic symptoms, in conjunction with antipsychotics, the CBD group experienced marked lower levels of positive psychotic symptoms. Both the placebo and CBD groups experienced equal levels of treatment-induced adverse events, suggesting that CBD is well-tolerated.

These results suggest that CBD may be effective in treating not only schizophrenia but also psychotic symptoms associated with Parkinson’s disease and THC-induced psychosis.

Additional Point: CBD has shown to act in a neuroprotective manner and reduce the psychoactive effects of THC, making it a viable option for patients who have experienced negative side effects with THC.

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Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia- A Multicenter Randomized Controlled Trial Download

This paper is also stored here: http://bit.ly/2WztI04 inside the CED Foundation Archive

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Video: Cannabinoids, Internal States, and Anxiety

July 9, 2019 Adolescents, Adverse Effects, Anxiety, Behavior change, Cannabinoids, Cannabis, Cannabis Education, Cannabis Science, Cannabis Use Disorder (CUD), CBD, CED Clinic, CED In The News, Cognition, Depression, Dr Caplan, Future Medicine, History, Mental Health, Mood, Occasional Use, Placebo-Controlled, Science, Stigma, Stress, THC, Video

A new literature review summarizing the recent findings relating to cannabis and anxiety.

Researchers conclude that CBD and low-dose THC can cause relaxation and decrease anxiety and self-spun thoughts. Some studies show that high-dose THC can cause psychotic symptoms; however, studies also show that CBD can protect against those THC-induced symptoms. Therefore, using cannabis extracts with THC and CBD could be a safe way to reduce anxiety.

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Cannabinoids, interoception, and anxiety Download

This paper is also stored here: http://bit.ly/2JnOpss inside the CED Foundation Archive

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One theory for why cannabis affects people differently

July 9, 2019 Adverse Effects, Anti-inflammatory properties, Antioxidant, Anxiety, Behavior change, Cannabinoids, Cannabis Education, Cannabis Science, CBD, Cognition, Dosing, Future Medicine, Genetics, Science, THC

Something still not entirely understood is why cannabis affects people differently. A study looking at THC interactions in the brain show that rewarding and adverse effects are produced by anatomically different areas. Individual experiences likely differ due to genetic variation.

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Current Numbers for Cannabis Use Among Pregnant Women in the United State

July 9, 2019 Abuse, Adverse Effects, Cannabis, Cannabis Education, Cannabis News, Cannabis Science, Future Medicine, Gastrointestinal Effects, Pregnancy, Science, Stigma, Women in Cannabis

Self-reported Medical and Nonmedical Cannabis Use Among Pregnant Women in the United States

An observational study has revealed that the prevalence and frequency of cannabis use in pregnant women have increased over the past two decades.

No trends were seen although except a slight decrease in fetal growth in women who frequently used during the first two trimesters. The data concerning fetal growth, such as length and weight, were not statistically significant and would require further studies to appropriately indicate a correlation between cannabis use and decreased fetal growth.

The authors acknowledge that cannabis use may suffer from recall bias as women may underestimate the amount of cannabis they consumed or purposely withheld some information due to stigma, although some of the surveyed women were using recommended medical cannabis.

This article highlights the large issue surrounding women consuming cannabis while expecting. Cannabinoids are able to cross the placenta and therefore affect the fetus during development. The American College of Obstetrics and Gynecologists recommend the cessation of any cannabis consumption while pregnant although there has been limited data discussing the actual effects on fetal development. A previously featured article on this blog stated that cannabis use had no effect on birth outcomes but also noted uncertainty in the possible effect on fetal growth. Considering this uncertainty, physicians should push for more research so that women who take medical cannabis can accurately discern whether or not to cease consumption while pregnant.

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Self-reported Medical and Nonmedical Cannabis Use Among Pregnant Women in the United States Download

This paper is also stored here: http://bit.ly/2Xoo0mW inside the CED Foundation Archive

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Cannabis is a Safe and Effect for the Treatment of Fibromyalgia

July 9, 2019 Anti-inflammatory properties, Arthritis, Cannabinoids, Cannabis, Cannabis Science, CBD, Fibromyalgia, Future Medicine, Multiple Sclerosis, Muscle Pain, Occasional Use, Pain, Placebo-Controlled, Science, Synthetic Cannabinoids, THC

Safety and Efficacy of Medical Cannabis in Fibromyalgia

A recent study has concluded that cannabis is a safe and effective treatment for patients suffering from fibromyalgia symptoms.

Fibromyalgia is a disorder characterized by widespread pain, fatigue, and issues sleeping. Cannabis is well known for its ability to treat pain, especially in lieu of opioids as the side effects are minimal and the risk of addiction minimal. This study found that over 200 patients were greatly benefited by cannabis as it moderated their pain and improved their mood. Future studies should aim to directly compare cannabis-based treatment with the currently accepted methods of fibromyalgia treatment to validate efficacy.

This study highlights how beneficial cannabis can be for those patients who are treatment-resistant for the general treatment of most disorders, especially when pain is involved. Cannabis has been proven to be much safer than opioids, and yet our lack of complete information, concerning the exact mechanisms of the endocannabinoid system and how different cannabinoids act on those mechanisms severely limits our ability to offer practical, novel therapies. Cannabis has previously been shown to be beneficial for treatment-resistant forms of epilepsy and depression, which holds promise when continuing to look for novel treatments for other disorders that have proven difficult to treat.

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Safety and Efficacy of Medical Cannabis in Fibromyalgia Download

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A Report on the Psychiatric Effects of Cannabis Demonstrates the Progress and the Gaps in Cannabis Knowledge

July 8, 2019 Adverse Effects, Anti-inflammatory properties, Anxiety, Behavior change, Cannabinoids, Cannabis, Cannabis Education, Cannabis Science, CB1, CB2, CBD, Cognition, Mental Health, Muscle Pain, Neuropathy, Occasional Use, Science, Stigma, THC

Psychiatric effects of cannabis

A report published by the British Journal of Psychiatry in 2001 demonstrates the progress the medical community has made but also what gaps still need to be filled in when utilizing cannabis. This report found that excess consumption of cannabis leads to feelings of panic and anxiety and that 15% of those willing to respond to a survey experienced acute psychotic symptoms. It was also found that cannabis dependence can occur, as well as withdrawal, which can last for close to a week. This article was a review that synthesized relevant studies but also claimed that the casual conclusions of these papers were difficult to find or replicate.

This paper is interesting given its age considering it put out what was current data but then ended by stating the casual conclusions of each paper may not stand. 18 years later, some of the data has stood, and some have not. Users can gain a tolerance to cannabis but many are looking to mitigate it. The author uses the word dependence when discussing cannabis which is a word that holds weight and is up for debate. Intoxicating cannabinoids, like THC, affect the reward center, but non-altering cannabinoids, such as CBD, tend to work more noticeably outside of the brain, although all have mixed effects in both regions. Cannabinoids are not all the same, apply quite differently to various ailments, and have divergent effects. Blanketing an entire crop with a misinformed warning label seems irresponsible and unduly harsh. Users or those looking into cannabis-based medicine are encouraged to do their research.

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Psychiatric effects of cannabis Download

This paper is also stored here: http://bit.ly/2XrRPmT inside the CED Foundation Archive

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Herbal Treatments may prove valuable to treat Alzheimer’s Disease

July 8, 2019 Aging, Alzheimer's Disease, Cannabinoids, Cannabis, Cannabis Science, Case Study, Dementia, Elderly, Flavonoids, Memory, Mental Health, Stigma

Promising Therapeutics with Natural Bioactive Compounds for Improving Learning and Memory — A Review of Randomized Trials

A recent review has determined that herbal treatments, such as those including flavonoids, are beneficial when attempting to prevent neurocognitive decline, commonly seen in Alzheimer’s Disease. Galantamine, quercetin, examples of two flavonoids, as well as huperzine A, bacoside A, and ginkolide B, three flavonoid-like compounds, all proved to be effective when used as a treatment for poor memory function. The authors mention the need for similar results in clinical trials but find the current data compelling evidence for future drug development.

Highlighted in this paper is the current perception of herbal products as natural, gentle, and safe in comparison to current synthetic drugs. While herbal products are generally safer and considered to be more gentle, it is important to note that for these herbal compounds to truly be effective when treating patients they likely need modification in order to optimize their benefits. The modification would increase potency, selectivity, and pharmacokinetic abilities, as well as lessen any possible side effects. Synthetic drugs may seem frightening, particularly in light of recent illnesses and mortality associated with their abuse, but technology can also be used to optimize novel drugs and it can be efficient to do so.

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Volume of Brain (Lateral Orbitofrontal Cortex) Predicts Drug Use

July 7, 2019 Addiction, Adverse Effects, Behavior change, Cannabis, Cannabis Education, Cannabis Science, Illicit Drug Use, Science

Orbitofrontal cortex volume prospectively predicts cannabis and other substance use onset in adolescents

Researchers have recently unveiled that the volume of the lateral orbitofrontal cortex (OFC) is able to predict future substance use in adolescents. Individuals were followed for 13 years after undergoing magnetic functional resonance imaging and surveyed for cannabis and alcohol use. Interestingly, the authors chose to utilize those who had used cannabis, but in limited quantities, as a control group instead of including them in their cannabis users group. Similarly, the alcohol only group of participants also included those who used cannabis multiple times within the past year. Nevertheless, the authors conclude that the size of the lateral OFC is able to predict drug use in adolescents although not without admitting the need for replication and validity.

This paper represents an important example of biased information within the medical community. Bias is inherent, there is no way around it. But, it is the duty of researchers to publish their findings while remaining as objective as possible, and to do so, transparently. The grouping decisions for the study groups here, and the choices the authors made regarding statistical analysis of this data are odd, considering their definitions and broad claims. This may be due to the views of the organization funding the research, or the bias of the research team members themselves, but the limitations of the study should be considered strongly. Even beyond the groupings, the fact that this research took place in a state where cannabis use is legal for recreational and medical use is a reason to consider other confounding variables. Scientists have an obligation to pursue the truth and not extrapolate their findings to fit a personal or professional agenda. Many articles cherry-pick statistics and extrapolate small findings of data, leaving readers and media outlets to polularize findings that do not represent a full picture. It falls on discerning readers to read mindfully and consider a study’s methodolgy and demographics, as carefully as possible.

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Orbitofrontal cortex volume prospectively predicts cannabis and other substance use onset in adolescents Download

This paper is also stored here: http://bit.ly/2Xh7wNH inside the CED Foundation Archive

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Benin Republic Hemp Improves Male Fertility

July 7, 2019 Adverse Effects, Anxiety, Cannabinoids, Cannabis Dependence, Cannabis Science, Cannabis Use Disorder (CUD), Fertility, Future Medicine, Gender, Male Fertility, Science, Stigma, Stress

Cannabinoid-deficient Benin republic hemp (Cannabis sativa L.) improves semen parameters by reducing prolactin and enhancing antioxidant status

Cannabis sativa, specifically Nigerian hemp, has been found to have adverse effects on male fertility. It’s use has been linked to a decrease in semen parameters, germ cell proliferation, and reproductive organ weight. It can induce hyperprolactinemia, a condition causing infertility in 11% of men with low sperm count.

Data from the National Drug Law Enforcement Agency in Nigeria has suggested users preferentially obtaining hemp from the Benin Republic. In a recent study investigating the composition of Benin republic hemp, a lack of THC and lower levels of cannabinol were observed. Additionally, an ethanol extract of Benin republic hemp increased sperm count, morphology, and viability.

Additional Point: Certain phytocannabinoids found in cannabis have demonstrated a detrimental effect on male fertility. However, analysis of hemp from the Benin republic shows a low to no levels of these toxic cannabinoids and evidence points to this particular hemp enhancing male fertility.

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Cannabinoid-deficient Benin republic hemp (Cannabis sativa L.) improves semen parameters by reducing prolactin and enhancing anti-oxidant status Download

This paper is also stored here: http://bit.ly/2Yzc26y inside the CED Foundation Archive

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Stress Increases the Probability of Drug Abuse

July 6, 2019 Abuse, Adolescents, Alcohol, Anxiety, Behavior change, Cannabis, Cannabis Dependence, Cannabis Education, Cannabis Science, Case Study, Depression, Heavy Use, History, Illicit Drug Use, Mental Health, Occasional Use, Social Justice, Stigma, Stress, THC

The Effects of Trait Emotional Intelligence on Adolescent Substance Use- Findings From a Hungarian Representative Survey

A recent study has revealed that teenagers who have a difficult time managing stress and appear to lack empathy were more likely to abuse tobacco, alcohol, and cannabis.

The studies initial goal was to determine if emotional intelligence could predict future drug abuse, but found that those with more empathy and interpersonal competencies were less likely to engage in substance abuse. This study provides data that may help to develop targeted drug prevention programs in order to lessen adolescent drug abuse or the development of any future substance abuse disorders.

Highlighted in this study was the possible inaccuracy of the conclusions as the results may have been skewed by teenagers merely providing what they thought was a socially acceptable answer. Despite the fact that the majority of states have legalized the use of medical marijuana a stigma against cannabis use remains.

Stigma has and continues to stand in the way of medical research. If the consumption of cannabis were less frowned upon then perhaps more observational studies, studies that relied on self-reporting use, or even appropriate medical treatment, would be improved. The more information that can be gathered, the more accurate the research that can be conducted. In order to fully understand all the benefits and limitations of cannabinoids, although this also applies to tobacco and alcohol consumption, the uninformed stigma must also be eroded.