Scope of Active Research
Research organizations worldwide are engaged actively within the study of specific cannabinoids, combinations of cannabinoids, and delivery systems for controlled dosing of cannabinoids. As this text is being written, there are nearly 200 worldwide clinical trials underway that specialize in cannabinoids. for each clinical test , there are typically ten or more pre-clinical investigational studies underway in Universities and publicly and personal companies.
Conservatively estimated, including formally registered clinical trials and counting the amount of pre-clinical trials, it’s likely that quite 1000 studies are currently underway that specialize in specific cannabinoids, combinations of cannabinoids, and delivery systems for cannabinoids.
It is unlikely that there has ever been a time when more research has been dedicated to unraveling the complexity of cannabis flowers and thus the estimated 108 different cannabinoid compounds, 66 terpenoids, and 23 flavonoids.
Current active research focuses mainly on Cannabidiol (CBD) and -9-Tetrahydrocannabinol (THC), although research is additionally being conducted on other cannabinoids including 9-Tetrahydrocannabivarin (THCV), Tetrahydrocannabinolic acid (THCa), and Cannabidivarin (CBDV) as treatments for cancer, chronic pain management, epilepsy, and PTSD, among others. additionally , there are both current and completed clinical trials evaluating the efficacy of flavonoids like apigenin, beta-caryophyllene, quercetin, beta-sitosterol, for conditions starting from insomnia and hypercholesterolemia to cancer and anemia.
Some speculate that cannabis compounds delivered during a controlled-dose, time-delayed method as a clinically validated therapeutic medicine would be revolutionary and cause a broader recognition of complex botanical medicines. that’s uncertain. We do know that early findings are confirming demonstrable therapeutic benefits to cannabinoids.
Early Findings of Demonstrated Therapeutic Benefits of Cannabis
Cannabinoids, dosed in double-blind, randomized clinical testing (in some cases, utilizing synthetic cannabinoids) have, in fact, demonstrated quantifiable therapeutic benefits surely common relatively common human conditions, like treatment of chronic pain, insomnia, anxiety, also as for far more specific identifiable disorders, like PTSD. this text describes the validated therapeutic benefits and therefore the clinical findings on which the findings are based.
Treatment of Chronic Pain in Adults
Clinical trials have demonstrated that “cannabis is an efficient treatment for chronic pain in adults,” consistent with the National Academies of Sciences, Engineering, and Medicine. This finding, considered “substantial evidence,” is probably the foremost critical research-based conclusion of this past decade involving cannabis.
Chronic pain may be a recurring issue for an estimated 30% of the adult population within the us and certain a similarly large portion of communities worldwide. Age may be a factor because chronic pain conditions typically present with increasing severity and frequency because the population ages.
The most comprehensive published review of cannabinoid use within the treatment of chronic pain is Whiting et al. (2015) (involving a review of 28 randomized studies, 2,454 participants, and a good range of chronic pain sources). Other reviews of particular note summarized by the National Academies in their seminal 2017 publication include Andreae et al. (2015), Wallace et al., 2015 and Wilsey et al. 2016.
Regulatory authorities in many countries already expressly recognize cannabinoids for the treatment of chronic pain in adults. In Canada, although “it doesn’t currently have an approved Health Canada indication,” the govt acknowledges that “medical cannabis could also be wont to alleviate symptoms for a spread of conditions. it’s most ordinarily been utilized in neuropathic pain and other chronic pain conditions.” In Mexico, a 2017 congressional decree declared that “pharmacological derivatives of sativa, indica, and American cannabis or marijuana, among which is tetrahydrocannabinol, its isomers, and stereochemical variants” were legal for medical use, although those derivatives had to contain but 1% THC at the time of writing. In 2013, Uruguay became the primary country to legalize the recreational use, sale, and cultivation of Cannabis, and direct-to-consumer sales via pharmacies began in mid-2017. Unfortunately, these strains of cannabis also contained relatively low THC, and therefore, medical research is slow. Colombia has quickly become a big player within the international medical cannabis market, with companies exporting to Canada and therefore the UK after legalization in 2016. Germany has begun a rapid increase in medical cannabis import within the past quarter, indicating a surging demand and rapid adoption of the treatment.
Most of the state-regulated medical cannabis programs within the us allow it to be prescribed for the treatment of chronic pain in adults. The U.S. Food and Drug Administration (“FDA’) has approved the utilization of the synthetic cannabinoids dronabinol and nabilone to treat nausea during chemotherapy, also because the cannabidiol-based Epidiolex for the treatment of seizures resulting from Lennox-Gastaut and Dravet syndromes, two severe sorts of epilepsy. it’s not, however, identified any medical uses of the cannabis flower in and of itself. 32 Individual states have expressly defined chronic or other pain, either on its own or as a results of another illness as a qualifying condition for the prescription of cannabis. These states are Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Iowa, Maryland, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico , New York, North Dakota , Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Washington, and West Virginia . it’s important to notice that laws vary widely throughout these states on exactly how the drugs are often consumed, and at what potency of THC.
Cannabis products for the treatment of chronic pain in adults are widely predicted to extend substantially over subsequent decade, as is research to guage dose-response, delivery methods, and combinations of cannabinoids and side effects.
Improving Short-term Sleep Outcomes
Clinical trials also support, with moderate but not conclusive evidence, that cannabinoids are “an effective treatment to enhance short-term sleep outcomes in individuals with sleep disturbance related to obstructive apnea syndrome, fibromyalgia, chronic pain, and MS .” Like chronic pain conditions, sleep-related disorders are pervasive and affect an outsized cross-segment of the population. Approximately 50-70 million adults within the US report some sort of disorder .
The most comprehensive published review of cannabinoids and sleep outcomes is Whiting et al. (2015).
Decreasing Anxiety Symptoms
Clinical trials also provide “limited evidence that cannabidiol is an efficient treatment for the development of hysteria symptoms, as assessed by a speechmaking test, in individuals with social anxiety disorders.”
Cannabidiol, which is usually mentioned as “CBD,” is one among the many cannabinoids typically present in hemp species and “marijuana” sorts of the marijuana species. CBD, of course, has received particularly widespread attention in most of the western world, after many countries have acted to get rid of cannabidiol from controlled substances lists, thereby encouraging both research and worldwide commerce.
Ongoing research is especially intensive with cannabidiol. Whiting et al. (2015) provide what’s generally considered the primary clinical review of randomized clinical trials during which Cannabidiol has been assessed to enhance anxiety symptoms.
Improving symptoms in Posttraumatic Stress Disorder (“PTSD”).
There is “limited evidence (a single, small fair-quality trial) that nabilone is effective for improving symptoms of posttraumatic stress disorder.”
PTSD is usually understood to be a disorder arising from exposure to a traumatic event(s), especially within groups that are subjected to extreme stress environments, like military combat veterans. Medications to treat PTSD are generally limited to antidepressants and demonstrate very low effective response rates.
It is likely that recently completed clinical test programs will further our understanding relatively quickly because the medical profession is closely anticipating publication of results from two recently completed clinical test programs at an equivalent time as there are additional 5 studies of cannabinoids and PTSD symptoms.
In one such recently completed study, a triple-blind, crossover, placebo-controlled trial investigates smoking four differing types of cannabis with various tetrahydrocannabinol and cannabidiol concentrations on PTSD symptoms in veterans (M. Bonn-Miller, study director; ClinicalTrials.gov: NCT02759185). The study, funded by the Colorado Department of Public Health and Environment, was registered as completed in April 2019.
In another prominent randomized controlled trial, the University of British Columbia (Eades et al, study director; ClinicalTrials.gov: NCT02517424) is evaluating 42 adults with PTSD administered different amounts of two commonest cannabinoids, tetrahydrocannabinol and cannabidiol (in high–low, high–high, and low–low dose forms) to live PTSD symptoms also as other health assessments.
The Path Forward
It is almost certain that clinical investigations of cannabis compounds through all phases of the method of drug review for cannabinoids will still increase in scale and funding worldwide over subsequent decade. Importantly, a number of the synthetic clinical are lowered within the face of strong public and academic interest. Recently, even the US FDA, arguably one among the gold standards for strict science and investigational research, has provided a mid-summer 2019 consumer update to point that it’s considering regulatory reforms which will allow the utilization of certain cannabinoids like cannabidiol (CBD) in dietary supplement and/or nutrition supplement forms beforehand of full drug approvals.
Authors: Sterling Scott and Brent Cahill