Cannabis studies with Bedrocan products

Over the years, Bedrocan cannabis has been used in many scientific studies. Initially, research focused on a better understanding of the pharmacology of cannabis and its components. However, many cannabis studies involving human subjects also investigated the psychopharmacological effects of Bedrocan products. While more recent research has aimed at exploring the clinical applications of cannabis in patients.

When possible, Bedrocan supports independent research, and we are open for collaboration with academic and medical institutions, such as the LUMC.

We believe that supporting scientific research contributes to our mission to bridge the gap between patients’ needs and the regulatory demands of modern medicine.

Please check the updated list for an overview of published researches with the use of Bedrocan cannabis.

Smoking cannabis vs vaporization

Around the world, people administer medicinal cannabis in various ways. Inhalation is one option. While vaporization continues to be a notable mode of consumption, it is smoking cannabis that remains number one. But why smoke cannabis when vaporization is an option?

Why would you smoke cannabis?

Imagine smoking. Inhale… Exhale… Big inhale! Cough, cough, cough! Lungs filled with smoke, tar, toxins.

We have been warned off about smoking for years, mainly from our collective knowledge of the risks of smoking tobacco. But we know smoking cannabis brandishes harms, too. [1]

Looking at Canada, among survey respondents who used cannabis in the past year, the majority used cannabis flower. Despite over half (53%) being exposed to health warnings, increasing their knowledge of the harms related to cannabis use, the majority continued to smoke. Indeed, smoking (84%) was the most common method of consumption in Canada among non-medical users. While not identical, there are similar trends for Canadian medical users (using on average 1.5 gram/day cannabis flower). [2] And, indeed, this use profile is mirrored among respondents in previous ‘use’ surveys. [3]

So, why are people not vaporizing?

Is it the cost? Is accessing and using a vaporizer prohibitive? Is it people not being used to vaporizing technology? Is it faster to roll and smoke a joint? [4]

The benefits of vaporizing cannabis

We know that the use of a high-quality vaporizer device avoids the respiratory disadvantages of smoking. [5]

A vaporizing medical device, compared to smoking cannabis, dramatically lowers concentrations of toxic compounds such as carbon monoxide, ammonia and polyaromatic carbohydrates (PACs). Compared to smoking, higher therapeutic levels of THC and consistent, reproducible THC extraction and delivery is possible. [6] [7]

It has been established that inhalation via a vaporizer is an efficient route of administration. The vapour is quickly absorbed by the lungs, resulting in measurable cannabinoid serum levels rapidly (reaching Tmax within minutes). [8]

The rapid onset of effects of vaporized and inhaled cannabinoids allows easier titration of the dose based upon symptom severity, tolerability and avoidance of side-effects. [9] While fully standardised, pharmaceutical-quality cannabis flos enables the administration of an exact dose – assured dose composition and dose repeatability. It also means it is free of contaminants such as microbes, pesticides, heavy metals and other toxic compounds. From a patient safety perspective, these qualities make the vapour safer for inhalation into the lungs.

Over the past years, more and more patients have vaporized cannabis flos without reports of serious adverse reactions. It is now time to start exploring ways to move patients away from smoking toward less harmful modes of administration.

Given patients seek a reliable, affordable and portable vaporizer for administering cannabis flos, perhaps more attention is required here?

Is adept, well-timed policy the way forward?

Future thinking – policy angles

Given patients indicate a preference for vaporizers, sensible policy and practical education might be the way to usher in positive change.

With regard to administration, the future policy must be clear and obvious. For example, in Germany, Australia, New Zealand, and The Netherlands smoking cannabis flos is not permitted and/or actively discouraged. The clinical guidelines only support cannabis flos for inhalation administered by vaporization. These types of policies need support from the health sector, industry, and must achieve buy-in from patients and their careers.

Some other approaches might include:

  • Setting a positive regulatory environment, focusing on and enabling rapid developments in the vaporizer industry. The aim is to usher in vaporizers which are more affordable, portable, easy to use, environmentally and consumer friendly.
  • Ensuring that a blanket ban on inhalation is not pushed into law. Excluding quality vaporizer devices from the market would be nonsensical. It would:
    • Eliminate their valid use in hospitals and hospices, rest-homes, and home settings.
    • Have implications for administration options; limiting therapeutic options and prescriber-patient choice.
    • Confine administration to oral dosing only (i.e. excluding the inhalation option).

Policy focused to support education is another, including:

  • Educating prescribers, pharmacists and patients to be aware of the differences between ‘vaping cannabinoids’ and ‘vaporising cannabis flos’, and fully understand why smoking should be avoided.
  • Educating the consumer (i.e. patients) on the benefits of using a vaporizer, compared with smoking. This requires really clever social-advertising – getting people to change, often embedded, behaviours and the accepted culture of smoking a joint.
  • Educating the consumer (i.e. patients) on what makes a good vaporizer – what quality aspects to look for.

For more on administration, see the article The risks of vaping cannabis.

References

[1] Tashkin, D. P. (2013). Effects of marijuana smoking on the lung. Annals of the American Thoracic Society, 10(3), 239-247.

Tetrault, J. M., Crothers, K., Moore, B. A., Mehra, R., Concato, J., & Fiellin, D. A. (2007). Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. Archives of Internal Medicine, 167(3), 221-228.

[2] Health Canada (2019). The Canadian Cannabis Survey 2019.

[3] Sexton, M., Cuttler, C., Finnell, J., Mischley, L. (2016). A cross-sectional survey of medical cannabis users: Patterns of use and perceived efficacy. Cannabis and Cannabinoid Research; 1: 131-138.

Hazekamp, A., Ware, M., Muller-Vahl, K., Abrams, D., Grotenhermen, F. (2013). The medicinal use of cannabis and cannabinoids: An international cross-sectional survey on administration forms. Journal of Psychoactive Drugs. 45 (3), 199–210.

[4] Aston, E., Scott, B., and Farris, S. (2019). A qualitative analysis of cannabis vaporization among medical users. Exp Clin Psychopharmacol. 2019 Aug; 27(4): 301–308.

[5] Loflin, M., and Earleywine, M. (2015). No smoke, no fire: What the initial literature suggests regarding vapourized cannabis and respiratory risk Can J Respir Ther. 2015 Winter; 51(1): 7–9.

Hazekamp, A., Ruhaak, R., Zuurman, L., van Gerven, J., Verpoorte, R. (2006). Evaluation of a vaporizing device (Volcano) for the pulmonary administration of tetrahydrocannabinol. Journal of Pharmaceutical Sciences. 95(6):1308-17.

[6] When administering pharmaceutical quality cannabis flos.

[7] Abrams, D., Vizoso, H., Shade, S., et al. (2007) Vaporization as a smokeless cannabis delivery system: a pilot study. Clinical Pharmacology and Therapeutics. 82 (5): 572 – 8.

Gieringer, D., Laurent, J., Goodrich. (2004). Cannabis vaporizer combines efficient delivery of THC with effective suppression of pyrolytic compounds. Journal of Cannabis Therapeutics. 4(1)

Eisenberg, E., Ogintz, M., Almog, S. (2014). The pharmacokinetics, efficacy, safety, and ease of use of a novel portable metered-dose cannabis inhaler in patients with chronic neuropathic pain: A Phase 1a study. Journal of Pain & Palliative Care Pharmacotherapy. 28:216–225.

Vulfsons S, Ognitz M, Bar-Sela G, Raz-Pasteur A, Eisenberg E (2019). Cannabis treatment in hospitalized patients using the SYQE inhaler: Results of a pilot open-label study. Palliative and Supportive Care, 1–6.

[8] Tmax: the time it takes to reach the maximum concentration (Cmax) of an exogenous compound or drug in the plasma or a tissue after a dose is administered.

[9] Van de Donk, T., Niesters, M., Kowal, M., Olofsen, E., Dahan, A., van Velzen, M. (2019). An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain; 160: 860–869.

Marie Arena, a strong voice bringing the topic of medicinal cannabis into European politics

Bedrocan has always been a strong advocate for internationally harmonised regulations on medicinal cannabis. A woman with the same cause is a Belgian Member of the European Parliament (MEP) Marie Arena (PS). Last December, she organised a large event in the European Parliament in Brussels named ‘Cannabis Renaissance.’ She chose this name on purpose to represent the revival of the cannabis plant: ‘The cannabis plant is part of a long history that is currently revived across Europe, in traditional and medicinal use and scientific research.’

Bedrocan spoke with Marie Arena and asked her what her plans are for medicinal cannabis in Europe.

As a MEP, you have been quite active on the topic of medicinal cannabis. Why?

This will obviously be a lengthy process, but our goal is to have a new EU legal framework on the use of cannabinoids in medicinal products and the marketing of these products to ensure access of patients to these products.

An even further step would also be to make progress on the legislation of CBD beyond medicinal uses but this is not our main goal yet.

Marie Arena
Marie Arena

You promote a clear distinction between medicinal cannabis and cannabis for recreational purposes. Why do you think that separation is important?

I think this clear distinction is important for two reasons. First, there is still a strong misconception and taboo when talking about cannabis. Many people still see cannabis in the illegal drug context and not for its medicinal properties. So I think separating the two is a way to reassure these people and to include them in the dialogue around this topic.

The second reason this is important is from a legal point of view. There is already a European framework that enables Member states to develop medicinal cannabis programs. So the base is already here for us to build upon and go further. When it comes to recreational purposes, this is a much more sensitive topic that lies with the Member states. And this also serves the first aspect I was talking about regarding the taboo around cannabis. The strong legal framework around the use of cannabis for medicinal purposes will help reassure and talk to people that have understandable concerns about this.

Marie Arena

Marie Arena, born and raised in Belgium, comes from an Italian migrant family. Her father worked in the Belgium mines and the glass and steel industry. From this background, Arena got her commitment to work hard for a fairer society in which citizens are protected and their rights respected.

After her studies in economic sciences, she held various jobs, eventually becoming a Minister for employment and training in Wallonia’s government.

Since then, she served both as a federal minister in the Verhofstadt II government and the prime minister of the Cabinet of the French Community in Belgium. Arena was first elected in the European Parliament in 2014, and since then, she has worked tirelessly to promote her values and ideals, among which are the public interest and her commitment to a social, transparent, and united Europe. Besides she is advocating for European harmonisation in medicinal cannabis legislation she is also a member of a new special commission on cancer.

 

Many countries have their own system for getting medicinal cannabis to patients. Do you believe European harmonisation in legislation is necessary?

This is true that several countries already have medicinal cannabis programs, but the lack of harmonisation at the European level is detrimental to patients first. If we want to make the European framework on medicinal cannabis evolve, our main focus must be patients’ access to their medicine. We know that even in countries with such programs, patients often have difficulties to have access to these treatments. There is also the issue of cross-border healthcare. Directive 2011/24, which sets the right of patients when traveling in another Member states to receive healthcare. We must make sure that patients’ rights are ensured and that they can  have access to their medication across all of the EU.

 As of now, the products patients can find from one country to another can have different properties due to the differences in THC and CBD concentration from one Member States to another. This is another reason for which we need a harmonised legislation.

Do you think harmonisation is possible?

I do believe that we can achieve at least some level of harmonisation. More and more countries are launching their own medicinal cannabis program, such as France which just launched a very ambitious experimentation program. So I believe there is a momentum that can make things move in the right direction.

There is also the vote, that has unfortunately been postponed, of the United Nations’ Commission on Narcotic Drugs (CND) on six recommendations following a critical review of cannabis-related substances. If these substances are taken out of the list of Narcotic drugs and this is supported by a number of EU member states, this would be an important political message for us to go further.

What steps will you be taking next to achieve your goals?

We are in the process of contacting interested Members of European Parliament to create a working group in the parliament on the topic. We really want to be a cross-party committee. This working group will work as a forum to discuss and have exchanges with all the relevant stakeholders, experts, NGOs, patients association, and the European Commission.

From all this consultation, we will try to work on a common position we could defend in the Parliament.

If it all goes to plan, a further step, maybe for the second semester 2020, would be to have an initiative report on the topic at the Environment and Health Committee. This will be important in order to have a strong position on the topic and to get the Commission involved.

The risks of vaping cannabis

A year ago, there was a lot of talk about the risks of vaping cannabis (THC containing liquids) – media reporting ‘vaping-related lung illnesses’ across America. Vaping was mistaken for vaporization, a medical device for administering cannabis flos, [1] and was considered dangerous. In our 2019 article, we discussed the risks of using ‘vape-pens’, [2] their diluents or carrier agents, [3] [4] and the accompanying socially intrusive vapour clouds. None of which are a feature of the medicinal use of cannabis flos by vaporization. [5]

So, what has happened since then?

The vaping saga

To recap. Vaping works by heating a liquid (i.e. cannabinoids and diluents) to produce an aerosol that is inhaled into the lungs. [6] In 2019, a surge of people with vaping associated pulmonary injury, some cases fatal, had many scratching their heads looking for answers.

The serious incidents in the United States of ‘E-cigarette, or Vaping, product use-Associated Lung Injury’ (EVALI) were investigated by the US Centres for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) and clinical partners. [7]  Their investigations continue into 2020.

Informal sources

The CDC goes on to state that, “informal sources are linked to most EVALI cases and play a major role in the outbreak”. Indeed, the link to Informal sources, likely illegal and counterfeit products, produced and distributed without regulatory oversight, is substantiated by a report by Anresco Laboratories (California, USA). Anresco tested legal and illegal samples in the state. They discovered no evidence of vitamin E acetate adulteration in the regulated-market products, and a high degree of vitamin E acetate contamination in illicit market samples. [9]

Toxic by-products

In response to the EVALI incident, the ASTM D-37 subcommittee, a cannabis industry standards-setting organisation, discussed vaping concentrates (February 2020, Atlanta, GA, USA). The dialogue included that diluents used in formulating liquids for vaping should be exposed to high temperatures and screened for toxic by-products. This would help assure that no harmful constituents are incorporated into regulated cannabis vape products, now and into the future.

Clearly, industry engagement, robust regulatory processes, and active enforcement remain the backstop to challenge illegal activity in any market.

Various risks of vaping cannabis

Nonetheless, while the legal cannabis market appears sound, there remain various risks of vaping cannabis. There is money made in illegal sales. Counterfeit vape materials and packaging have entered the legal market, at least in California (USA). [10] [11] The unregulated cannabis flower used to produce concentrates is often found to contain higher levels of pesticides, heavy metals, and other contaminants.[12] And, importantly, the process of producing cannabinoid concentrates will logically lead to exposing consumers to higher concentrations of a wide range of toxins.

Given the pace of development in regulated markets, we may see a sizable proportion of consumers continue to source products from unregulated sources. At least in the short term. This is evident even in Canada, a nationally regulated market, where not everyone obtains their cannabis from legal, quality-assured sources. [13] In this frame, harm caused by the consumption of unregulated products will continue and so will the risks of vaping cannabis.

So, the issue of vaping associated pulmonary injury is by no means resolved. The black market appears to be at fault. Meanwhile, the various regulators remain vigilant. And, the industry appears resolute in upholding obligatory quality standards. 

References

[1] Fully-standardised, pharmaceutical-quality cannabis flos is the whole, dried flowers/inflorescence of the cannabis plant, which is genetically and chemically standardised according to pharmaceutical standards. It is free of contaminants such as microbial contaminants (molds, fungi, and bacteria) pesticides (residues), aflatoxins, impurities and heavy metals.

[2] Douglas, H., Hall, W., Gartner, C. (2015). E-cigarettes and the law in Australia. Australian Family Physician. 44 (6): 415-418.

Jensen, P., Luo, W., Pankow, J., Strongin, R., Peyton, D. Hidden formaldehyde in e-cigarette aerosols. New England Journal of Medicine. 372 (4): 392-393.

Editorial and Review (2019). E-Cigarettes and vaping-related disease. New England Journal of Medicine.

[3] A variety of diluents, which act as carrier agents, have been used in vape pens, including Polypropylene Glycol (PPG), Propylene Glycol (PG), Polyethylene Glycol (PEG), Vegetable Glycerin (VG), and Ethylene Glycol (EG).

Given the associated health risks with the consumption of the above-noted diluents, vaporizer cartridge producers seem to be moving towards using terpenes, or alternative extraction methods which produce a less viscous cannabis concentrate, eliminating the need for diluents altogether.

[4] Troutt, W., and DiDonato, M. (2017). Carbonyl compounds produced by vaporizing cannabis oil thinning agents. J Altern Complement Med. 2017 Nov;23(11):879-884.

[5] Eisenberg, E., Ogintz, M., Almog, S. (2014). The pharmacokinetics, efficacy, safety, and ease of use of a novel portable metered-dose cannabis inhaler in patients with chronic neuropathic pain: A Phase 1a study. Journal of Pain & Palliative Care Pharmacotherapy. 28:216–225.

Hazekamp, A., Ruhaak, R., Zuurman, L., van Gerven, J., Verpoorte, R. (2006). Evaluation of a vaporizing device (Volcano) for the pulmonary administration of tetrahydrocannabinol. Journal of Pharmaceutical Sciences. 95(6):1308-17.

[6] A vape pen (an atomiser vaporiser) is a device typically containing an electronic heating system and a cartridge (containing a cannabis-based liquid (i.e. decarboxylated cannabinoids and excipients (a diluent or carrier agent)). The liquid is heated, creating an aerosol vapour which is inhaled via a mouthpiece.

[7] CDC update (25 February 2020). ‘Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products

[8] Blount, B., Karwowski, M., Shields, P., et al. (2020). Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. N Engl J Med 2020; 382:697-705.

[9] Eisenberg, Z., Moy, D., Lam, V., Cheng, C., Richard, J., Burack, B. (26 October 2019). Contaminant analysis of illicit vs regulated market extracts. Anresco Laboratories.

[10] Queally, J. (2019). Counterfeit cannabis products stoke black market for California weed. Los Angeles Times; 26 August, 2019.

[11] Eisenberg, Z., Moy, D., Lam, V., Cheng, C., Richard, J., Burack, B. (26 October 2019). Contaminant Analysis Of Illicit Vs Regulated Market Extracts; Anresco Laboratories.

[12] Dryburgh, L., Bolan, N., Grof, C., Galettis, P., Schneider, J., Lucas, C., Martin, J. (2018). Cannabis contaminants: sources, distribution, human toxicity and pharmacologic effects. Br J Clin Pharmacol. 2018 Nov; 84(11): 2468–2476.

[13] Health Canada (2019). The Canadian Cannabis Survey 2019

Health care professionals and COVID-19

In Europe, many healthcare professionals are involved in the production, prescription and delivery of medicinal cannabis products. A number of them have been portrayed in this place. How did they survive the first months of the COVID-19 crisis?

Italy: home delivery spiked tremendously

Dr. Marco Ternelli – Farmagalenica SRL

Dr Marco Ternelli runs an Italian pharmacy,  and he is specialised in compounding medication, among which is medicinal cannabis.

“In Italy we saw an increase in home delivery including medical cannabis. Because home delivery has taken a tremendous spike, patients need to have more patience than before as pharmaceuticals couriers take much longer to deliver than usual. In Italy, a medicinal cannabis prescription lasts only 30 days. So patients shouldn’t wait too long to contact their doctor to apply for a renewal. Otherwise, you’ll surely run out of medication before the pharmacy can deliver it to you.

During the lockdown, pharmacies in Italy were one of the very few activities left open, so we kept seeing people directly.  We were continuously explaining and reassuring patients of what was going on.

They used to say ‘Biggest improvements come in hard times’. I have to admit I have seen some. In order to avoid people gathering at the doctor’s waiting room, all reimbursed medicines have been digitized. This means that the patient simply has to go to the pharmacy, show his medical ID or fiscal code and the pharmacist is able to digitally download all the prescriptions. We are waiting and hoping the same to happen for medical cannabis prescriptions. Unfortunately, being a controlled substance, it didn’t take part in the digital transformation.”

The Netherlands: “We stayed close to the patient, literally”

Paul Lebbink – Transvaal Apotheek

Paul Lebbink heads the Transvaal pharmacy in The Hague with eight other pharmacists. The Transvaal Apotheek was the first pharmacy in the Netherlands to produce and supply various varieties of cannabis oil, in line with the Dutch medicinal cannabis program.

“We see about 200 patients on average every day. Locking the pharmacy was not an option, because those people need medication. We immediately took measures to ensure that both patients and staff could be as safe as possible in our pharmacy. Plastic screens, possibilities for disinfection, a maximum of five patients who could be inside at the same time and of course the ‘one and a half meter rule’, to name just a few. And although the latter measure in particular is not easy with a limited floor space and a relatively large number of people, it has been possible to create a COVID-safe environment. In addition, we increased the number of deliveries in March and April. Every day, five couriers drove around to serve patients, which enabled us to reduce waiting times in the pharmacy.

The delivery of medicinal cannabis and medicinal cannabis oil has proceeded normally; In the Dutch medical cannabis chain, the organisations responsible for production and distribution have proven to be COVID-proof. As always, we were able to serve patients on time. Our own production and supply of cannabis oil has also been carried out according to plan. We also have not had any questions from patients about the alleged effect of medicinal cannabis in COVID. We would have reacted cautiously, because of course we only base ourselves on scientific evidence.

In the meantime, the rules in the Netherlands have relaxed somewhat again. The same goes for the rules in our pharmacy, because a ‘1,5 metre society’ is not what we want. We want to be close to the patients, literally.”

Denmark: “Online video consultation kept us open”

Dr. Tina Horsted – Pain Clinic Horsted

Dr. Tina Horsted runs a public clinic. She is the only doctor in Denmark who is specialised in prescribing medicinal cannabis, mainly to chronic pain patients.

“We have been open during the lockdown. We had a continuous steady flow through the crisis, as we developed a video-based online application to help new patients and keep up with ongoing medical controls. And it’s been working very satisfying, both for the patients and the clinic. The video format has more or less forced the patient and us to discuss the actual problem straight away. Patients, therefore, get more value out of their time. For the future, we will keep on doing more medical controls or lighter consultations via this application. Patients are relieved that they do not have to travel for each check-up. But of course, it can and will never replace an in-person consultation if this is required. In the clinic, we have well-designed glass panels, in the waiting room we have removed half of the chairs and all magazines, and there is no coffee. But people are now used to these percussions.  

The Norwegian patients are starting to come back, but the Swedes have been coming to the clinical psychically during the whole period. With a special letter, provided by the clinic, they were able to cross the border.”

Metered dose cannabis inhaler enables precise cannabis treatment

Precise cannabis treatment dosing remains a major challenge, leading to physicians’ reluctance to prescribe medical cannabis. A recent feasibility trial demonstrates that a metered dose cannabis inhaler, produced by Syqe Medical and containing processed Bedrocan cannabis, enables individualisation of medicinal cannabis regimens. “This study is the first to show that human sensitivity to THC is significantly greater than previously assumed, indicating that if we can treat patients with much higher precision, lower quantities of drug will be needed, resulting in fewer side effects and an overall more effective treatment. The Syqe drug delivery technology is also applicable to opioids and other compounds that, while potentially effective, are notoriously associated with dangerous side effects. The introduction of a tool to prescribe medications at such low doses with such high resolution may allow us to achieve treatment outcomes that previously were not possible,” said Perry Davidson, Syqe Medical CEO.

According to dr. Mikael Kowal – Clinical Research Coordinator at Bedrocan International – this outcome is an important step for developing cannabis as an effective treatment for pain. “Syqe Medical’s randomized placebo-controlled clinical trial demonstrated that a metered-dose cannabis inhaler containing processed Bedrocan cannabis was able to dose-dependently produce analgesia in 24 patients with neuropathic pain/complex-regional pain syndrome (CRPS),” says Kowal. “As such, the results indicated that the inhaler can effectively be used to deliver precise doses of pharmaceutical-grade cannabis that can produce an analgesic effect with lower amounts of THC, than in the case of other administration methods. It remains very interesting to see if the pain-reduction resulting from inhaling low and precise doses of THC will remain stable in the long-term. That is definitely a question for future research with this promising device.”

Syqe Inhaler
Syqe inhaler

Listen now… ‘European Cannabis. A Dutch view’

A podcast episode featuring Bedrocan CEO Tjalling Erkelens

Today’s episode of the Cannabis Conversation was recorded at the Central European Cannabis Forum, earlier this June. Host Anuj Desai and Tjalling Erkelens, Co-Founder and CEO of Bedrocan, examine attitudes towards CBD, medical, and recreational cannabis in The Netherlands, alongside discussing the importance of consistency and standardisation of medical cannabis.
The Cannabis Conversation is a weekly podcast exploring the emerging legal cannabis industry from a European perspective. The podcast hosts a wide variety of guests helping to shape the emerging legal cannabis industry including patients, lawyers, doctors, scientists, entrepreneurs, investors and many more.
You can find the Cannabis Conversation on iTunes, Spotify  YouTube and Stitcher. Of course, there is a website too.

Five must-read studies on medicinal cannabis

At Bedrocan, we strive to bridge the gap between patients’ need for cannabis and the quality standards of modern medicine. That’s the focus of our research.  We build strong academic and private research partnerships and conduct our own independent studies. In the end, we share what we learn.

Every month, several study results on the use of medicinal cannabis are published in the media. With sometimes varying results. But how do you know what a good study is? Dr. Mikael Kowal from our own clinical research department has listed the most important ones. To become acquainted with cannabinoid research you should have read these five studies.

1. Acute pain

This review discusses the evidence surrounding the efficacy of cannabinoids for acute pain. It concludes that there is low-quality evidence indicating that cannabinoids may be a safe alternative for a small but significant reduction in subjective pain score when treating acute pain. It is worth reading to illustrate the difference in the evidence for the effectiveness of cannabis in treating acute, as opposed to chronic, pain.

2. Chronic pain

This review evaluates the efficacy, acceptability and safety of cannabis-based medicines for chronic pain management. It provides a summary of data presented in previous reviews, so it is a valuable overview of most of the data available on the topic. The review concludes that there are inconsistent findings of the efficacy of cannabinoids in neuropathic pain and painful spasms in multiple sclerosis. Moreover, there are inconsistent results on tolerability and safety of cannabis-based medicines for any chronic pain.

3. Pain management

This review evaluates the efficacy, acceptability and safety of cannabis-based medicines for chronic pain management. It provides a summary of data presented in previous reviews, so it is a valuable overview of most of the data available on the topic. The review concludes that there are inconsistent findings of the efficacy of cannabinoids in neuropathic pain and painful spasms in multiple sclerosis. Moreover, there are inconsistent results on tolerability and safety of cannabis-based medicines for any chronic pain.

4. Multiple Sclerosis

This summary of reviews aims to synthesize findings from systematic reviews that examined the safety and effectiveness of cannabinoids in multiple sclerosis. It concludes that cannabinoids may have modest effects in MS for pain or spasticity. The review provides a complete overview of the evidence on cannabinoids and MS.

5. Fibromyalgia

This is currently the only clinical published study which we fully supported as Bedrocan. Aside of providing interesting information on the efficacy of our varieties in treating fibromyalgia chronic pain and THC/CBD interactions, it is worth reading in order to have an idea how to set up a properly designed randomized controlled trial with cannabis.

Fibromyalgia and medicinal cannabis. An update.

Bedrocan is always glad to explain to scientifically educated public the (im)possibilities of medicinal cannabis for certain disorders. Dr. Mikael Kowal, clinical trial coordinator at Bedrocan International, was a guest at the annual conference of the Norwegian organization Norsk Smetteforening in the Rikshospitalet in Oslo, where healthcare professionals and scientists met to discuss the latest scientific developments in pain management. Kowal gave a concise presentation about the study conducted by the Leiden University Medical Center (LUMC) into the effects of medicinal cannabis in fibromyalgia patients. This research, previously published in the scientific journal Pain, is regarded as the first randomised, placebo-controlled, crossover study on the therapeutic effects of inhaling different types of standardised medicinal cannabis in fibromyalgia patients.

The research showed that THC-containing medicinal cannabis reduced the sensation of pressure pain in patients. The results of this study are hopeful, says Kowal. “It appears that at least two THC-containing varieties – which are now prescribed to patients in different countries – may bring pain relief. Especially the variety containing a standardised mixture of THC and CBD seems most promising in this regard. The outcome is important for fibromyalgia patients. It can help with further acceptance of medicinal cannabis by healthcare professionals, so that there is less discussion about prescribing it.”

Medicinal cannabis and opiates

Dr. Kowal’s presentation naturally raised questions. The most important one: can medicinal cannabis play a role in reducing opiate use? As is well known, opiates such as oxycodone are increasingly being prescribed and there is now widespread abuse worldwide, resulting in a real opiate crisis in various countries. “The researchers at the LUMC also immediately thought of the problems that opiate use can cause,” says Kowal. “Principal Investigator Prof. Albert Dahan and his team have not only demonstrated that cannabis containing THC may be effective in fibromyalgia, but are also in the process of preparing a follow-up study to see if medicinal cannabis can reduce the use of opiates. The research team suspects that you do not have to prescribe much oxycodone if you also allow patients to use a standardised mixture of THC and CBD .”

Italian pharmacist provides doctors with cannabis advice

The Italian pharmacist Dr Marco Ternelli received so many requests from doctors and patients about how to prescribe medicinal cannabis that he decided to put all the information together. Prescribing in Italy is not an easy matter. Doctors have little knowledge, do not know how to dose cannabis, and there are complicated forms a doctor should fill in to prescribe.

By now his clients come from all over Italy, albeit mainly from north and central Italy. For over three years, he saw 10,000 to 15,000 prescriptions for medicinal cannabis (oils, capsules, suppositories, eye drops and creams) pass through his hands for the most wide ranging conditions. He incorporated all those data in a comprehensive brochure (only available in Italian). It contains an overview of all the cannabis prescriptions he has handled over the years. ”It is a sort of personal statistics I decided to share. Reporting the strains prescribed by Italian doctors and what conditions they prescribe them for.”

Besides doctors, other pharmacists and patients benefit from the information in his blog. Dr Ternelli continuedPharmacies and pharmacists understand how a prescription for medicinal cannabis has to be completed by doctors to be accepted and for them to be permitted to proceed with the compounding preparation. In other words, what pharmacists need to check to consider the prescription as valid.”

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