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One of the first medical reports in western medicine regarding cannabis was William B ‘O Shaughnessy’s, “On the Preparations of the Indian Hemp, or Gunjah.” Published in 1848, this report analyzed several medical indications and the effect an indian hemp preparation had on them. In rheumatism, O’ Shaughnessy found “alleviation of pain in most, remarkable increase of appetite in all, unequivocal aphrodisia, and great mental cheerfulness.” His report observed the effect of cannabis preparations on hydrophobia, cholera, tetanus, infantile convulsions, and delirium tremens. In the conclusion O’ Shaughnessy reports, “in hemp the profession has gained an anti-convulsive remedy of the greatest value.” <ref>O'Shaughnessy WB. On the Preparations of the Indian Hemp, or Gunjah: Cannabis Indica Their Effects on the Animal System in Health, and their Utility in the Treatment of Tetanus and other Convulsive Diseases [Internet]. Provincial Medical Journal and Retrospect of the Medical Sciences. U.S. National Library of Medicine; [cited 2016Apr14]. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2490264/</ref>
One of the first medical reports in western medicine regarding cannabis was William B ‘O Shaughnessy’s, “On the Preparations of the Indian Hemp, or Gunjah.” Published in 1848, this report analyzed several medical indications and the effect an indian hemp preparation had on them. In rheumatism, O’ Shaughnessy found “alleviation of pain in most, remarkable increase of appetite in all, unequivocal aphrodisia, and great mental cheerfulness.” His report observed the effect of cannabis preparations on hydrophobia, cholera, tetanus, infantile convulsions, and delirium tremens. In the conclusion O’ Shaughnessy reports, “in hemp the profession has gained an anti-convulsive remedy of the greatest value.” <ref>O'Shaughnessy WB. On the Preparations of the Indian Hemp, or Gunjah: Cannabis Indica Their Effects on the Animal System in Health, and their Utility in the Treatment of Tetanus and other Convulsive Diseases [Internet]. Provincial Medical Journal and Retrospect of the Medical Sciences. U.S. National Library of Medicine; [cited 2016Apr14]. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2490264/</ref>
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Today, cannabis has been difficult to study as a complete plant substance from a pharmaceutical standpoint. ''JAMA'' reports “cannabis is a complex of more than 400 compounds including flavonoids and terpenoids and approximately 70 cannabinoids other than delta 9 tetrahydrocannabinol (THC). These cannabinoids have individual, interactive, and even entourage effects (effects of a compound that are only appreciable in the presence of other compounds) that are not fully understood and that contribute to the net effect of marijuana.” Additionally, “patients will need to experiment with different strains and doses to achieve the desired effects, without much input or oversight from physicians.”Additionally, ''JAMA'' reports, “The federal government and states should support medical marijuana research” <ref name="
JAMA cart before
the
horse
">D'Souza DC, Ranganathan M. Medical Marijuana Is the Cart Before the Horse. The Journal of The American Medical Association. 2015Jun23;313(24):2431–2.</ref>
+
Today, cannabis has been difficult to study as a complete plant substance from a pharmaceutical standpoint. ''JAMA'' reports “cannabis is a complex of more than 400 compounds including flavonoids and terpenoids and approximately 70 cannabinoids other than delta 9 tetrahydrocannabinol (THC). These cannabinoids have individual, interactive, and even entourage effects (effects of a compound that are only appreciable in the presence of other compounds) that are not fully understood and that contribute to the net effect of marijuana.” Additionally, “patients will need to experiment with different strains and doses to achieve the desired effects, without much input or oversight from physicians.”Additionally, ''JAMA'' reports, “The federal government and states should support medical marijuana research”
<ref name="
Cart Before
the
Horse
">D'Souza DC, Ranganathan M. Medical Marijuana Is the Cart Before the Horse. The Journal of The American Medical Association. 2015Jun23;313(24):2431–2.</ref>
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Currently, evidence suggests cannabis may be “an effective treatment for chronic pain, neuropathic pain, muscle spasm due to multiple sclerosis or paraplegia. In most states with medical marijuana laws, marijuana can be used to treat severe or chronic pain and severe or persistent muscle spasms.” Cannabis use can be "certified by a physician but it cannot be prescribed by a physician due to it’s schedule I status." <ref>Thompson AE. Medical Marijuana. The Journal of The American Medical Association. 2015Jun23;313(24):2508.</ref><br>
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Currently, evidence suggests cannabis may be “an effective treatment for chronic pain, neuropathic pain, muscle spasm due to multiple sclerosis or paraplegia. In most states with medical marijuana laws, marijuana can be used to treat severe or chronic pain and severe or persistent muscle spasms.” Cannabis use can be "certified by a physician but it cannot be prescribed by a physician due to it’s schedule I status." <ref>Thompson AE. Medical Marijuana. The Journal of The American Medical Association. 2015Jun23;313(24):2508.</ref>
<br>
== Chemical Structure<br> ==
== Chemical Structure<br> ==
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In the July 2015 issue of ''The American Legion'', a magazine dedicated to those serving our country, veterans make it clear they want access to medical marijuana specifically for “pain and PTSD”. The article notes " VA prohibits its physicians from discussing cannabis use, even in states where medical marijuana is legal." Scott Murphy, the founder of, Veterans for Safe Access and Compassionate Care, contends "medical marijuana can help reduce their (veterans) opiate dependence and leads to fewer suicides." The article states former veterans are saying "narcotic painkillers, sleeping pills, amphetamines, antidepressants and drugs they are being prescribed are dangerous, if not lethal." With the mounting evidence illustrating the benefits of cannabis to those serving our country the article pinpoints "VA acknowledges that veterans who use medical marijuana may lose access to some medical care." The article shows how medical marijuana can play an important role in recovery for veterans returning home from war. <ref>Olson K. The Cannabis Question. The American Legion. 2015Jul;179(1):24.fckLRVeterans want medical cannabis option.</ref> <br><br>
In the July 2015 issue of ''The American Legion'', a magazine dedicated to those serving our country, veterans make it clear they want access to medical marijuana specifically for “pain and PTSD”. The article notes " VA prohibits its physicians from discussing cannabis use, even in states where medical marijuana is legal." Scott Murphy, the founder of, Veterans for Safe Access and Compassionate Care, contends "medical marijuana can help reduce their (veterans) opiate dependence and leads to fewer suicides." The article states former veterans are saying "narcotic painkillers, sleeping pills, amphetamines, antidepressants and drugs they are being prescribed are dangerous, if not lethal." With the mounting evidence illustrating the benefits of cannabis to those serving our country the article pinpoints "VA acknowledges that veterans who use medical marijuana may lose access to some medical care." The article shows how medical marijuana can play an important role in recovery for veterans returning home from war. <ref>Olson K. The Cannabis Question. The American Legion. 2015Jul;179(1):24.fckLRVeterans want medical cannabis option.</ref> <br><br>
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Multiple Sclerosis:<br> A 2015 study from the ''Journal of The American Medical Association (JAMA)'', “Cannabinoids for Medical Use A Systematic Review and Meta-Analysis”, found "moderate quality evidence to support the use of Cannabinoids for the treatment of chronic pain and spasticity." The report highlights two studies that found a "50% reduction in spasticity symptoms." Additionally, two other studies found a “30% reduction in spasticity symptoms.” The report looked at studies which included the following: an oral mucosal spray of CBD/THC (nabiximols), orally ingested synthetic THC (Dronabinol), a synthetic cannabinoid derivative mimicking THC (nabilone), oral capsules of combined THC/CBD, smoked THC of low potency and questionable quality ranging from 2.5%-9.4%, and an oral tablet of pure >98% natural delta-9-THC. The systematic review and meta-analysis, although indicating "moderate quality evidence", should be re-evaluated due to inherent flaws in the report. Many of the beneficial compounds found in the natural cannabis plant went ignored. The low concentrations of the smoked THC indicate a much-needed re-evaluation of the samples used. The review should include the entire cannabinoid profile of the sample. Furthermore, these studies indicate the federal government’s scheduling of cannabis as a schedule I drug needs to be changed based on scientific evidence.<ref name="
Chronic Pain
and
Spasticity
">Whiting PF, Wolff RF, Deshpande S, Nisio MD, Duffy S, Hernandez AV, et al. Cannabinoids for Medical Use. Jama. 2015;313(24):2460–8.Use of cannabinoids for chronic pain and spasticity</ref>
+
Multiple Sclerosis:<br> A 2015 study from the ''Journal of The American Medical Association (JAMA)'', “Cannabinoids for Medical Use A Systematic Review and Meta-Analysis”, found "moderate quality evidence to support the use of Cannabinoids for the treatment of chronic pain and spasticity." The report highlights two studies that found a "50% reduction in spasticity symptoms." Additionally, two other studies found a “30% reduction in spasticity symptoms.” The report looked at studies which included the following: an oral mucosal spray of CBD/THC (nabiximols), orally ingested synthetic THC (Dronabinol), a synthetic cannabinoid derivative mimicking THC (nabilone), oral capsules of combined THC/CBD, smoked THC of low potency and questionable quality ranging from 2.5%-9.4%, and an oral tablet of pure >98% natural delta-9-THC. The systematic review and meta-analysis, although indicating "moderate quality evidence", should be re-evaluated due to inherent flaws in the report. Many of the beneficial compounds found in the natural cannabis plant went ignored. The low concentrations of the smoked THC indicate a much-needed re-evaluation of the samples used. The review should include the entire cannabinoid profile of the sample. Furthermore, these studies indicate the federal government’s scheduling of cannabis as a schedule I drug needs to be changed based on scientific evidence.
<ref name="
pain
and
spasticity
">Whiting PF, Wolff RF, Deshpande S, Nisio MD, Duffy S, Hernandez AV, et al. Cannabinoids for Medical Use. Jama. 2015;313(24):2460–8.Use of cannabinoids for chronic pain and spasticity</ref>
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Chronic Pain: ''JAMA's'' 2015 study found patients using cannabis had a reduction in pain symptoms. One of the studies found at least a 30% reduction in pain symptoms compared to those using placebo for those suffering from chronic pain disorders. The trial with the greatest reduction in pain symptoms found smoked THC reported the greatest beneficial effect. Seven of the trials for the indication of chronic pain assessed nabiximols, an oral mucosal spray consisting of 27mg THC and 25mg CBD. Pain conditions studied in this assessment were neuropathic pain and cancer pain. The systematic review and meta analysis indicates the federal government’s schedule I status of cannabis needs to be changed based on scientific evidence.<ref name="pain and spasticity" />
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Chronic Pain: ''JAMA's'' 2015 study found patients using cannabis had a reduction in pain symptoms. One of the studies found at least a 30% reduction in pain symptoms compared to those using placebo for those suffering from chronic pain disorders. The trial with the greatest reduction in pain symptoms found smoked THC reported the greatest beneficial effect. Seven of the trials for the indication of chronic pain assessed nabiximols, an oral mucosal spray consisting of 27mg THC and 25mg CBD. Pain conditions studied in this assessment were neuropathic pain and cancer pain. The systematic review and meta analysis indicates the federal government’s schedule I status of cannabis needs to be changed based on scientific evidence.<ref name="pain and spasticity" />
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Epilepsy: <br>A report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy found a drastic improvement in seizure symptoms with little side effects in children who did not respond to on average, 12 anti-epileptic medications prior to cannabidiol-enriched cannabis treatment. The report even notes children that were able to reduce seizures entirely as well as additional positive behavioral findings. The report states "sixteen (84%) of the 19 parents reported a reduction in their child's seizure frequency while taking cannabidiol-enriched cannabis. Of these, two (11%) reported complete seizure freedom, eight (42%) reported a greater than 80% reduction in seizure frequency, and six (32%) reported a 25-60% seizure reduction. Other beneficial effects included increased alertness, better mood, and improved sleep. Side effects included drowsiness and fatigue." <ref>Porter BE, Jacobson C. Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy [Internet]. Epilepsy & behavior : E&B. U.S. National Library of Medicine; [cited 2016Apr10]. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4157067/</ref>
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Epilepsy: <br>A report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy found a drastic improvement in seizure symptoms with little side effects in children who did not respond to on average, 12 anti-epileptic medications prior to cannabidiol-enriched cannabis treatment. The report even notes children that were able to reduce seizures entirely as well as additional positive behavioral findings. The report states "sixteen (84%) of the 19 parents reported a reduction in their child's seizure frequency while taking cannabidiol-enriched cannabis. Of these, two (11%) reported complete seizure freedom, eight (42%) reported a greater than 80% reduction in seizure frequency, and six (32%) reported a 25-60% seizure reduction. Other beneficial effects included increased alertness, better mood, and improved sleep. Side effects included drowsiness and fatigue." <ref>Porter BE, Jacobson C. Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy [Internet]. Epilepsy &
amp;amp;amp;amp;amp;amp;amp;
amp;amp; behavior : E&
amp;amp;amp;amp;amp;amp;amp;
amp;amp;B. U.S. National Library of Medicine; [cited 2016Apr10]. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4157067/</ref>
Fibromyalgia :<br>One study compared 28 fibromyalgia patients who were users compared to 28 who were not. The route of administration was roughly equal. "54% were self-administering cannabis via smoking, 46% via oral ingestion, and 43% combined both smoking and oral administration." Interestingly, the percentages of various cannabinoids in the products the patients were using were not reported. "Information was recorded via the standard Visual Analogue Scale (VAS), the Fibromyalgia Impact Questionnaire (FIQ), Pittsburg Sleep Quality Index (PSQI), and Short Form 36 Health Survey (SF-36)." The study found the VAS showed a "statistically significant reduction in pain and stiffness and enhanced relaxation as well as increased somnolence or a feeling of well-being". Mental health scores on the SF-36 were "significantly higher in users than non-users." The article states "no other differences of statistical significance were recorded in other items of the SF-36, FIQ, or the PSQI." <ref>Fiz, Jimena, Marta Durán, Dolors Capellà, Jordi Carbonell, and Magí Farré. "Cannabis Use in Patients with Fibromyalgia: Effect on Symptoms Relief and Health-Related Quality of Life." PLoS ONE. Public Library of Science. Web. 06 Apr. 201</ref> <br>Alzheimer’s, Huntington’s, and Parkinson’s Disease: <br>A report from the Lancent Journal of Neurology reports cannabis has significant therapeutic potential in the treatment of Alzheimer's, Huntington's, and Parkinson's Disease. <ref>Baker D, Pryce G, Giovannoni G, Thompson AJ. The therapeutic potential of cannabis. The Lancet Neurology. 2003;2(5):291–8.</ref><br><br><br>
Fibromyalgia :<br>One study compared 28 fibromyalgia patients who were users compared to 28 who were not. The route of administration was roughly equal. "54% were self-administering cannabis via smoking, 46% via oral ingestion, and 43% combined both smoking and oral administration." Interestingly, the percentages of various cannabinoids in the products the patients were using were not reported. "Information was recorded via the standard Visual Analogue Scale (VAS), the Fibromyalgia Impact Questionnaire (FIQ), Pittsburg Sleep Quality Index (PSQI), and Short Form 36 Health Survey (SF-36)." The study found the VAS showed a "statistically significant reduction in pain and stiffness and enhanced relaxation as well as increased somnolence or a feeling of well-being". Mental health scores on the SF-36 were "significantly higher in users than non-users." The article states "no other differences of statistical significance were recorded in other items of the SF-36, FIQ, or the PSQI." <ref>Fiz, Jimena, Marta Durán, Dolors Capellà, Jordi Carbonell, and Magí Farré. "Cannabis Use in Patients with Fibromyalgia: Effect on Symptoms Relief and Health-Related Quality of Life." PLoS ONE. Public Library of Science. Web. 06 Apr. 201</ref> <br>Alzheimer’s, Huntington’s, and Parkinson’s Disease: <br>A report from the Lancent Journal of Neurology reports cannabis has significant therapeutic potential in the treatment of Alzheimer's, Huntington's, and Parkinson's Disease. <ref>Baker D, Pryce G, Giovannoni G, Thompson AJ. The therapeutic potential of cannabis. The Lancet Neurology. 2003;2(5):291–8.</ref><br><br><br>
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== Drug Interactions ==
== Drug Interactions ==
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A study in JAMA found a “25% reduction in opioid related deaths in states with medical marijuana programs.”<ref>Hayes MJ, Brown MS. Medical Cannabis Laws and Opioid Mortality [Internet]. JAMA Network. [cited 2016Apr13]. Retrieved from: http://archinte.jamanetwork.com/article.aspx?articleid=1898878</ref> The study states, “Medical marijuana laws, when implemented, may represent a promising approach for stemming runaway rates of nonintentional opioid analgesic effects.” As the epidemic negatively impacts the country, politicians like Elizabeth Warren call for more studies to be done on cannabis to curb the destructive effects of the opioid epidemic.<ref>Holpuch A. Elizabeth Warren asks CDC to consider legal marijuana as alternative painkiller [Internet]. The Guardian. Guardian News and Media; 2016 [cited 2016Apr13]. Retrieved from: http://www.theguardian.com/us-news/2016/feb/12/elizabeth-warren-medical-marijuana-painkiller-opioid-abuse</ref><br>
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A study in JAMA found a “25% reduction in opioid related deaths in states with medical marijuana programs.”<ref>Hayes MJ, Brown MS. Medical Cannabis Laws and Opioid Mortality [Internet]. JAMA Network. [cited 2016Apr13]. Retrieved from: http://archinte.jamanetwork.com/article.aspx?articleid=1898878</ref> The study states, “Medical marijuana laws, when implemented, may represent a promising approach for stemming runaway rates of nonintentional opioid analgesic effects.” As the epidemic negatively impacts the country, politicians like Elizabeth Warren call for more studies to be done on cannabis to curb the destructive effects of the opioid epidemic.<ref>Holpuch A. Elizabeth Warren asks CDC to consider legal marijuana as alternative painkiller [Internet]. The Guardian. Guardian News and Media; 2016 [cited 2016Apr13]. Retrieved from: http://www.theguardian.com/us-news/2016/feb/12/elizabeth-warren-medical-marijuana-painkiller-opioid-abuse</ref><br>
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Additionally, “there is some evidence of cross-tolerance between cannabinoids and opioids.”<ref name="
cart before
the
horse
" />
+
Additionally, “there is some evidence of cross-tolerance between cannabinoids and opioids.”<ref name="
Cart Before
the
Horse
" />
== Relevance to Physical Therapy ==
== Relevance to Physical Therapy ==