Accurate Education: Cannabidiol (CBD)- Clinical Use

Cannabidiol (CBD) – Clinical Use

 

The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship.  Readers are advised to seek professional guidance regarding the diagnosis and treatment of their medical concerns.

 

CBD has anti-inflammatory, anti-convulsant, anti-psychotic, anti-oxidant, neuroprotective and immunomodulatory effects but does not produce mind-altering effects like euphoria. CBD is a neuroprotective antioxidant more potent than Vitamin C (ascorbate) or Vitamin E (tocopherol). CBD is also thought to support sleep and reduce nausea, particularly related to chemotherapy. CBD, in combination with THC, modulates some of the side effects of THC, including reducing THC-induced anxiety and euphoria.

  

See:

Marijuana – Legislative Update for Louisiana

Medical Marijuana Use Overview

“Medical Marijuana” – Getting Started

 

Cannabis-Based Medications:

Over-the-Counter Cannabinoid Medications:

Cannabidiol (CBD)

Cannabidiol (CBD) – Introduction

Cannabidiol (CBD) – Clinical Use

Cannabidiol (CBD) – Drug Actions & Interactions

 

Prescription Cannabis-Based Medications:

FDA-Approved Prescription Cannabis-Based Medications

Louisiana Prescription Cannabis-Based Products – “Medical Marijuana”

 

Clinical Applications of Cannabis:

Cannabis – Anxiety (coming soon)

Cannabis – Chronic Pain Overview

Cannabis – Fibromyalgia

Cannabis – Headaches (coming soon)

Cannabis – Inflammatory Bowel Disease (coming soon)

Cannabis – Neuroinflammation (coming soon)

Cannabis – Sleep (coming soon)

 

The Medical Science of Cannabis:

The Endocannabinoid System

Marijuana – Botanical

Marijuana – Pharmacokinetics

Marijuana – Inhaled (Smoked and Vaporized)

Marijuana – Cannabinoids and Opioids

 

Cannabinoids and Terpenes:

Cannabinoids & Terpenes – An Overview (coming soon)

“Entourage Effect” (coming soon)

 

Cannabinoids:

Cannabidiol (CBD) – Introduction

Cannabidiol (CBD) – Clinical Use

Cannabidiol (CBD) – Drug Actions & Interactions

THC (Delta-9 Tetrahydrocannabinol or ∆9 THC) (coming soon)

 

Terpenes:

Terpenes – An Overview (coming soon)

   

See also:

Marijuana – Discontinuing Use

Marijuana Addiction – Cannabis Use Disorder (CUD)

 

Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

Cannabidiol – Clinical Use

Please Note: This section still under construction

 

Cannabidiol (CBD) – Clinical Use

While the clinical benefits obtained from marijuana (cannabis) are derived from the many constituents found in the plant, the two cannabinoids, THC (delta-9 tetrahydrocannabinol) and CBD (cannabidiol), together are responsible for the majority of the medical benefits. CBD has the advantage over THC in that it is associated with fewer side effects; notably it lacks the euphoric effect or high that impairs thought processing. Furthermore, CBD is now legally available over-the-counter in Louisiana and offers a new and accessible alternative means of treating a number of symptoms and conditions including chronic pain.

For more information regarding CBD products, See: Cannabidiol (CBD) – Introduction

  

In a quick overview, current research on CBD suggests it has the potential to be an effective anti-anxiety and antipsychotic drug. It is also considered to be a possibly useful drug for cancer, diabetes, inflammation and neurodegenerative disorders. CBD is known to have anticonvulsant effects and to be neuroprotective. It is a strong antioxidant and may offer benefit for oxidative stress, the underlying process behind many diseases of aging. CBD has anti-nausea and analgesic effects, possibly reducing the exaggerated and physiologically inappropriate responses to pain frequently found in conditions such as migraine headaches and fibromyalgia.  Furthermore, CBD shows toxicity to breast tumour cells and helps preserve normal cells. Also, CBD shows potent antibacterial effects against methicillin-resistant Staphylococcus aureus (MRSA), the bacteria responsible for many serious infections currently resistant to commonly used antibiotics. Finally, CBD may reduce stroke risk and be protective in heart attacks.

 

While the above general benefits are commonly attributed to CBD, quality research is still lacking as to identifying specific benefits associated with specific medical conditions, definitive dosing and which cannabis-based constituent combinations are the most effective.

  

Conditions Potentially Responsive to CBD

FDA-approved

Because CBD has become commonly available in pure, THC-free formulations, it is important to evaluate what therapeutic benefits may be obtained with its use. The FDA did, however, recently approve one pharmaceutical prescription form of cannabis plant-derived CBD, an oral solution called Epidiolex. It is FDA-approved for the treatment of certain rare pediatric epilepsy conditions (see: Epidiolex, below). Aside from these pediatric epiplepsy conditions, specific definitive therapeutic benefits of CBD still lack good quality scientific evidence.

 

Possible Therapeutic Benefits

There are many conditions for which CBD has been suggested to be effective, consistent with CBD’s neuroprotective, antiepileptic, hypoxia-ischemia, anxiolytic, antipsychotic, analgesic, anti-inflammatory, anti-asthmatic, and antitumor properties. Some of these conditions include inflammatory and neurodegenerative diseases (Alzheimer’s, Parkinsons Disease and Chronic Traumatic Encephalopathy (CTE) associated with brain trauma), epilepsy, autoimmune disorders like multiple sclerosis, arthritis, schizophrenia and cancer. The reduction of intestinal inflammation through the control of the neuroimmune axis suggests CBD may be a promising drug for the therapy of inflammatory bowel disease, especially Crohn’s disease and Ulcerative Colitis.

 

The following is a list of conditions that may respond to CBD:

 

  1. Pain
  2. Anxiety
  3. Addiction
  4. Inflammatory Bowel Disease (Crohn’s & Ulcerative Colitis)
  5. Muscle Spasticity (in Multiple Sclerosis)
  6. Neurodegenerative Disorders (Alzheimers & Parkinsons Diseases
  7. Seizures
  8. Traumatic Brain Injury & Chronic Traumatic Encephalopathy

  

Pain

While use of cannabis and various cannabis-based products have been shown to provide pain relief and reduce pain unpleasantness, the effect of CBD on acute or chronic pain is still not well understood.  A few animal studies suggest that CBD can be used to control inflammatory and neuropathic pain. In rat models, it has been shown that CBD exerts anti-hyperalgesic effects on neuropathic and inflammatory pain. Studies show that cannabinoid benefits for pain are only marginally superior to placebo in terms of effectiveness but actually inferior to placebo in terms of tolerability/side effects.

 

Preclinical Study Evaluating Synergy Between Morphine and a CBD-2 Agonist

A 2017 preclinical study showed for the first time that morphine and a CB2 agonist, JWH015 (like CBD) interact synergistically to suppress inflammatory, post-operative, and neuropathic pain. Furthermoe, the synergy extends to preventing opioid-induced reward behaviors in animals, suggesting that CBD may reduce abuse risk when taken with opioids. Additionally, the combination of morphine with the CB2 agonist reduces constipation associated with morphine. The authors conclude that their data support the use of opioid-CB2 combination therapy in treating chronic pain while limiting abuse liability.

 

Anxiety

The first human study of CBD’s anxiolytic effects was published in 1982 when it was identified that the increased anxiety that followed the use of THC was significantly reduced with the simultaneous use of CBD. Since then, a number of publications support the belief that CBD reduces the THC-related side effect of anxiety. A review article published in 2012 looked at the animal and human volunteer-based literature published in English, Portuguese and Spanish that included review articles and book chapters identified an anxiolytic-like effect of CBD. In most of these studies an oral dose of CBD between 300-600 mg was employed. It has been reported that CBD is safe and well- tolerated in doses up to 1,500 mg/day.

   

Social Anxiety Disorder (SAD)

Early evidence came from the investigation of CBD in experimentally induced anxiety in healthy volunteers using a model of simulated public speaking (SPS). Self-rated scales and physiological measures of anxiety (heart rate, blood pressure, sweating) after a 300 mg dose of CBD reveals effectiveness of CBD. The SPS test is a good model of anxiety for assessing social anxiety disorder (SAD) because the fear of speaking in public is considered a central feature in SAD and CBD has been shown to reduce anxiety in patients with SAD. A small study published in 2011 using a dose of 600mg CBD in patients with SAD revealed CBD to be helpful in reducing anxiety.

 

Panic Disorder

A 2017 publication presented CBD as a promising drug for the treatment of panic disorder. However, they noted that additional research is clearly needed to clarify the specific mechanism of action of CBD and identify the ideal safe therapeutic doses.

 

Post-Traumatic Stress Disorder (PTSD)

Experimental evidence supports the benefit of cannabis and of CBD for PTSD. CBD helps to regulate the negative emotional memory associated with PTSD by reducing fear-associated memory acquisition. CBD also stops anxiety-induced REM sleep suppression, although it has little effect on the alteration of NREM sleep, possibly due to its anxiolytic effect rather than through a direct regulation of sleep mechanisms. This is significant in PTSD patients who often complain of having sleep disturbances, including nightmares (associated with REM) and insomnia.

 

Addiction

One possible therapeutic application for CBD is the treatment of drug addiction. A recent systematic review of a limited number of preclinical studies concluded that CBD may have therapeutic properties for opioid, cocaine, and psychostimulant addiction, and also that it may be beneficial in cannabis and tobacco addiction. However, considerably more research is required to evaluate CBD as a potential treatment.

 

Inflammatory Bowel Disease (IBD) – Crohn’s & Ulcerative Colitis

The inflammatory bowel diseases (IBD) include chronic immune-mediated inflammatory diseases of the intestinal tract, typified by Crohn’s disease (CD) and ulcerative colitis (UC). Their development is complex and involves genetic and environmental factors, among which diet and the intestinal microbiota are common targets for prevention and treatment. Some of the most common symptoms of IBD are abdominal pain, diarrhea, and weight loss. However, one of the major challenges in management of IBD is to reduce and/or reverse the underlying intestinal inflammation characteristic of these diseases.

 

Both the acute and chronic inflammation in the gut associated with IBD is related to immune cells called glial cells. The enteric glial cells (EGC) located in gut are functionally similar to those found in the central and peripheral nervous system. They function to maintain balance in nerve and neurotransmitter activity, providing support and protection for enteric nerve cells. EGC play a fundamental role in the maintenance of gut homeostasis where they are the first defensive line against infection by supplying nutrients and oxygen to aid in the repair of damaged cells.

 

As with the process of neuroinflammation related to chronic nerve pain (See: Neuropathic Pain) and neurodegenerative brain diseases, EGC may also proliferate and become perpetually activated leading to the chronic inflammation associated with IBD. This is characterized by the ongoing release of multiple pro-inflammatory chemicals as well as stimulating the infiltration of other immune cells such as macrophages, neutrophils and mast cells.

 

Research indicates that CBD is a potent compound that may suppress enteroglial-mediated inflammation, leading to reduction of intestinal damage associated with acute and chronic intestinal gut inflammation. While the exact cmechanisms responsible for the effect of CBD still remain unclear, CBD is  regarded as a promising therapeutic agent in the treatment of inflammatory bowel disorders. Clinical studies are needed to confirm the effectiveness of CBD.
 

Neurodegenerative Disorders

Alzheimer Dementia (AD)

Alzheimer’s dementia (AD) is a type of dementia in which deposits of “senile” plaques form in the brain. These plaques consist of a neurotoxic substance called beta-amyloid peptide (Aβ) and they contribute to inflammation and oxidative stress, both crucial components of AD. Microglia are immune cells found in the nervous system that when activated under certain condions produce pro-inflammatory chemicals (cytokines ) that increase Aβ production by nerve cells.

 

The role of Aβ in inflicting nerve damage and neuroinflammation in AD is well established. Numerous studies exploring CBD in neurotoxicity have shown CBD to exhibit beneficial effects against the neuroinflammation and damaging action induced by Aβ due to CBD’s combination of antioxidant and anti-inflammatory properties, mechanisms not shared by classic antioxidant drugs. CBD exhibits beneficial effects in a animal models of neuroinflammation by reducing mictoglia activation and their production of pro-inflammatory compounds.

 

Parkinson’s Disease (PD)

Parkinson’s disease (PD) is a motor neurodegenerative disorder, in which the main feature is a progressive death of dopaminergic neurons, resulting in slowing of movement (bradykinesia), rigidity and tremor. There is substantial growing evidence for a role for CBD as a potential pharmacological approach to PD. Animal studies have been encouraging but only a few small trials have been conducted on Parkinson’s disease patients.

 

Traumatic Brain Injury (TBI) & Chronic Traumatic Encephalopathy (CTE)

Traumatic brain injury (TBI) is a growing health concern that affects millions of individuals. TBI can lead to a debilitating condition called Chronic Traumatic Encephalopathy (CTE), a neurodegenerative disease thought to be associated with a history of repetitive head impacts, such as those sustained through contact sports or military combat. CTE develops symptoms slowly, often developing over years, and is often unrecognized and undiagnosed. 

 

Like AD, CTE is associated with abnormal development of beta-amyloid peptide (Aβ) and also a protein called “tau” which are believed to underly the functional brain impairment associated with the condition. Encouraging research regarding CBD and another agent, palmitoylethanolamide (PEA), indicates they work synergistally in protecting against the development of CTE.

See also: Traumatic Brain Injury (TBI), Palmitoylethanolamide (PEA) and NRF2 activators.

 

So far, no treatment has been shown to cure AD, PD or CTE and no treatment has been FDA-approved to slow or reverse the neurodegenerative processes of these diseases. While it is much too early to make therapeutic claims for CBD in these conditions, given the benefits of CBD as an anti-inflammatory, neuroprotective, immune-modulator agent and considering its safety record, CBD represents an attractive  potential therapeutic alternative for these patients.

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Dosing of CBD

Specific dosing of CBD needs to be guided individually, taking into account desired therapeutic benefits related to specific symptoms and disease processes as well as the potential for drug-drug interactions with other prescribed medications. Dosing should be guided by a physician knowledgeable about cannabis and cannabis-based products.

 

CBD can be effective at very wide range of dosages. It has been noted that very low doses can have a very profound impact, from as little as 2.5 mg of CBD daily depending on method of delivery. Doses up to hundreds of milligrams have been used safely and effectively. In a study that evaluated daily oral doses of 700mg, CBD was found to be nontoxic and other studies have reported CBD doses up to 1500mg/day to be safe. It has also been reported that cannabinoids may have a biphasic or triphasic effect, in that a low dose may provide a certain effect, but higher doses may provide different or opposite effects.

 

A very high dose may also not provide additional benefit over a low dose, so it’s best to start with a low dose: 2.5-5 mg of CBD initially (maybe 10 mg at the most), depending on the product and method of use. A typical starting CBD dose for most people would be a total of 10-12 mg of CBD a day, divided into 3 daily doses. If the desired effect is not achieved at a low dose, then higher doses can gradually be introduced until the therapeutic goal is achieved or side effects deter further increased dosing.

 

The use of tinctures sublingually will be expected to provide a more rapid onset of effect but may not last as long as an oral dose. Orally administered CBD oil can last for four hours or more, but the onset of effects is much slower (30-90 minutes) than a tincture administered sublingually (under the tongue). Tincture dosing is generally performed with a 1 ml dropper which provides about 20 drops/ml.

 

Resources:

National Academy of Sciences

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

 

These lay-person websites appear to be good resources for exploring medical marijuana:

  1. www.GreenCamp.com
  2. www.Healer.com
  3. www.MedicalJane.com
  4. www.ProjectCBD.org

 

 

References:

Epidiolex (cannabidiol)

  1. FDA approves CBD drug – Epidiolex – The Washington Post

Marinol (dronabinol)

  1. Marinol – dronabinol

 

 

Cannabidiol (CBD)- Overviews

  1. CANNABIDIOL (CBD) Pre-Review Report WHO 2017
  2. Cannabidiol – State of the art and new challenges for therapeutic applications. – 2017 PubMed – NCBI
  3. Molecular Targets of Cannabidiol in Neurological Disorders – 2015

 

CBD – Anxiety

  1. Overlapping Mechanisms of Stress-Induced Relapse to Opioid Use Disorder and Chronic Pain – Clinical Implications – 2016
  2. Cannabidiol Modulates Fear Memory Formation Through Interactions with Serotonergic Transmission in the Mesolimbic System – 2016
  3. Cannabidiol regulation of emotion and emotional memory processing: relevance for treating anxiety-related and substance abuse disorders. – PubMed – NCBI
  4. Review of the neurological benefits of phytocannabinoids – 2018
  5. Plastic and Neuroprotective Mechanisms Involved in the Therapeutic Effects of Cannabidiol in Psychiatric Disorders – 2017
  6. Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. – PubMed – NCBI
  7. Evidences for the Anti-panic Actions of Cannabidiol – 2017
  8. Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug – 2012
  9. Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients – 2011
  10. The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. – PubMed – NCBI 2007
  11. Beyond the CB1 Receptor – Is Cannabidiol the Answer for Disorders of Motivation? – 2016

 

CBD – Interaction with THC

  1. Cannabidiol: a promising drug for neurodegenerative disorders? – PubMed – NCBI
  2. Oral Cannabidiol does not Alter the Subjective, Reinforcing or Cardiovascular Effects of Smoked Cannabis – 2015
  3. Taming THC – potential cannabis synergy and phytocannabinoid-terpenoid entourage effects – 2011
  4. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  5. Impact of cannabidiol on the acute memory and psychotomimetic effects of smoked cannabis – 2010

 

 

CBD – Metabolites

  1. Human Metabolites of Cannabidiol – A Review on Their Formation, Biological Activity, and Relevance in Therapy – 2016

 

CBD – Drug-Metabolic Interactions

  1. Cannabidiol, a Major Phytocannabinoid, As a Potent Atypical Inhibitor for CYP2D6 – 2011
  2. The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness – 2014 
  3. Characterization of P-glycoprotein Inhibition by Major Cannabinoids from Marijuana – 2006

 

CBD – Pain

  1. The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. – PubMed – NCBI 2007
  2. Molecular Targets of Cannabidiol in Neurological Disorders – 2015
  3. Cannabidiol Modulates Fear Memory Formation Through Interactions with Serotonergic Transmission in the Mesolimbic System – 2016
  4. Cannabidiol enhances morphine antinociception, diminishes NMDA-mediated seizures and reduces stroke damage via the sigma 1 receptor – 2018
  5. Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain. – PubMed – NCBI – 2018
  6. Synergistic attenuation of chronic pain using mu opioid and cannabinoid receptor 2 agonists – 2017

 

CBD – Pain (Topical Applications)

  1. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis – 2015

 

CBD – Inflammatory Bowel Disease

  1. Cannabidiol Reduces Intestinal Inflammation through the Control of Neuroimmune Axis – 2011

  

CBD – Neurologic Disorders: Overviews

  1. Molecular Targets of Cannabidiol in Neurological Disorders – 2015

CBD – Neurodegenerative Disorders: Traumatic Brain Injury and CTE

  1. Molecular Targets of Cannabidiol in Neurological Disorders – 2015
  2. Endocannabinoids and traumatic brain injury – 2011
  3. Endocannabinoids – A Promising Impact for Traumatic Brain Injury. – 2017
  4. Natural cannabinoids improve dopamine neurotransmission and tau and amyloid pathology in a mouse model of tauopathy. – PubMed – NCBI
  5. Preventive Effects of Resveratrol on Endocannabinoid System and Synaptic Protein Modifications in Rat Cerebral Cortex Challenged by Bilateral Common Carotid Artery Occlusion and Reperfusion – 2018
  6. Cannabidiol Reduces Aβ-Induced Neuroinflammation and Promotes Hippocampal Neurogenesis through PPARγ Involvement – 2011
  7. Critical role of mast cells and peroxisome proliferator-activated receptor gamma (PPARγ) in the induction of myeloid-derived suppressor cells by marijuana cannabidiol in vivo – 2015
  8. Endocannabinoid Degradation Inhibition Improves Neurobehavioral Function, Blood–Brain Barrier Integrity, and Neuroinflammation following Mild Traumatic Brain Injury – 2015
  9. Palmitoylethanolamide Reduces Neuropsychiatric Behaviors by Restoring Cortical Electrophysiological Activity in a Mouse Model of Mild Traumatic Brain Injury – 2017
  10. Cannabidiol for neurodegenerative disorders – important new clinical applications for this phytocannabinoid? – 2013
  11. Modulation of Astrocyte Activity by Cannabidiol, a Nonpsychoactive Cannabinoid – 2017

  

Medical Marijuana – Prescribing Guidelines

  1. Simplified guideline for prescribing medical cannabinoids in primary care – Canadian Family Physician – 2018
  2. Physician Recommendation of Medical Cannabis Guidelines Calif Medical Assoc – 2011
  3. Prescribing smoked cannabis for chronic noncancer pain. Preliminary recommendationsCanadian Family Physician – 2014

 

Medical Marijuana – Opioids

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
  7. The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
  8. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
  9. Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
  10. Cannabis and the Opioid Crisis – 2018
  11. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
  12. Cannabinoid–Opioid Interaction in Chronic Pain
  13. Synergistic interactions between cannabinoid and opioid analgesics. – PubMed – NCBI
  14. FDA approves CBD drug – Epidiolex – The Washington Post
  15. Opioid transport by ATP-binding cassette transporters at the blood-brain barrier: implications for neuropsychopharmacology. – PubMed – NCBI – 2011
  16. Opioids and the Blood-Brain Barrier – A Dynamic Interaction with Consequences on Drug Disposition in Brain – 2017
  17. The pharmacokinetics and the pharmacodynamics of cannabinoids. – PubMed – NCBI – 2018
  18. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI – 2016
  19. Pharmacogenetics of Cannabinoids – 2017 Enhanced Brain Disposition and Effects of Δ9-Tetrahydrocannabinol in P-Glycoprotein and Breast Cancer Resistance Protein Knockout Mice. 2012
  20. Pharmacogenomics of methadone maintenance treatment. – PubMed – NCBI
  21. Relationship between ABCB1 polymorphisms and serum methadone concentration in patients undergoing methadone maintenance therapy (MMT). – PubMed – NCBI- 2016
  22. Impact of ABCB1 and CYP2B6 Genetic Polymorphisms on Methadone Metabolism, Dose and Treatment Response in Patients with Opioid Addiction – A Systematic Review and Meta-Analysis – 2014
  23. ABCB1 haplotype and OPRM1 118A > G genotype interaction in methadone maintenance treatment pharmacogenetics – 2012
  24. The opioid epidemic – a central role for the blood brain barrier in opioid analgesia and abuse – 2017
  25. Morphine and the blood-brain barrier – diffusion, uptake, or efflux? – 2017
  26. Cyclosporine-inhibitable Blood-Brain Barrier Drug Transport Influences Clinical Morphine Pharmacodynamics – 2013
  27. Methadone Treatment for Pain States – 2005
  28. Cyclosporine-inhibitable Cerebral Drug Transport Does not Influence Clinical Methadone Pharmacodynamics – 2014
  29. Targeting blood–brain barrier changes during inflammatory pain – an opportunity for optimizing CNS drug delivery – 2011
  30. Targeting Transporters – Promoting Blood-Brain Barrier Repair in Response to Oxidative Stress Injury – 2015
  31. Cannabidiol enhances morphine antinociception, diminishes NMDA-mediated seizures and reduces stroke damage via the sigma 1 receptor – 2018

Medical Marijuana –Misc

  1. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  2. Cannabis and cannabis extracts – greater than the sum of their parts? – 2001
  3. Medical cannabis and mental health: A guided systematic review. 2016 – PubMed – NCBI
  4. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. – PubMed – NCBI
  5. Cannabis-conclusions – 2017 National Academy of Sciences
  6. Cannabis-chapter-highlights – 2017 National Academy of Sciences
  7. Cannabis-report-highlights – 2017 National Academy of Sciences
  8. Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Bene ts of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?-2004
  9. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. – PubMed – NCBI
  10. Cannabis use and cognitive function: 8-year trajectory in a young adult cohort. – PubMed – NCBI
  11. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. – PubMed – NCBI
  12. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI Pharmacogenetics of Cannabinoids – 2018
  13. Systematic review of systematic reviews for medical cannabinoids – 2018
  14. Adverse effects of medical cannabinoids – a systematic review – 2008
  15. Cannabimimetic effects modulated by cholinergic compounds. – PubMed – NCBI
  16. Antagonism of marihuana effects by indomethacin in humans. – PubMed – NCBI
  17. Pharmacokinetics and pharmacodynamics of cannabinoids. – PubMed – NCBI
  18. Clinical Pharmacodynamics of Cannabinoids – 2004
  19. Affinity and Efficacy Studies of Tetrahydrocannabinolic Acid A at Cannabinoid Receptor Types One and Two. – 2017
  20. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
  21. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. – PubMed – NCBI
  22. Pharmacology of Cannabinoids
  23. Current-status-and-future-of-cannabis-research-Clin-Researcher-2015
  24. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems – A Clinical Review – 2015

 

Medical Marijuana – Product Evaluation

  1. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products – 2018
  2. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

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