Cannabis Research Roundup

2020 was a challenging year for everyone and it may seem that COVID made everything stagnant. However, something amazing happened… A record in cannabis research was broken. Per NORML (National Organization for the Reform of Marijuana Laws) Globally in 2020, there were OVER 3500 scientific papers published – which is pretty amazing for any one topic in health, but it’s quite astounding for cannabis considering where the scientific community stood regarding cannabis research 15 years ago. If you did a search for scholarly articles on cannabis prior to 2000, there were 5000 studies done in total over a 20 year span from 1980-1999.

I was in nursing school in the mid-2000s and I wrote my very first policy presentation on why cannabis should be legalized for medical and recreational purposes and why it was much safer than nearly any other substance out there. I found a list that noted there were zero deaths related to cannabis, but several thousand deaths per year related to over the counter medications considered “safe” like Motrin, Aspirin, and Tylenol. And at the time it seemed just absolutely radical to my classmates and teachers.

Many pioneers in cannabis were suffering from chronic pain and other illnesses and suffered consequences including criminal charges and poverty due to unjust laws – laws that were not based in science, because the science didn’t exist due to the “1937 Marijuana Tax Act.” (In a future post I will discuss the awful history of cannabis in the US and the bogus reasons for its prohibition.) Keep in mind that California only first legalized medical cannabis in 1996. The first recreational cannabis laws weren’t passed until 2012. The US and the world had virtually no science and noxious propaganda due to nefarious agendas for the preceding almost 100 years.

So in that context – 3500 scientific articles in one single year is a beautiful thing to see. This research will open the doors to help so many people globally, they are the building blocks to clinical applications and life changing therapeutics for so many. I have so many anecdotal tales I have witnessed about the relief my clients find with cannabis use. It is truly amazing to see folks that have suffered from various conditions for years and years to find symptom control with this new, yet very old plant. Let’s review some of the research that happened this year and what it could mean going forward:

Cardiology Drug Interactions:

Prior to 2020 cannabis nurses and doctors were already aware of interactions between cannabis and CBD and blood thinners. These are VERY important life saving medicines for folk’s cardiac and vascular health. What is new from the review of literature is the discovery that cannabis may interact with clopidogrel (Plavix). This is important because if folks have had a cardiac intervention (a stent) they absolutely need that plavix to work for the first 6-12 months after that stent is placed. Decreasing the blood level of Plavix could lead to cardiac injury or death. Which is likely why this was reported as, ”Marijuana Use Tied to Repeat MI, Stroke After PCI” by Marlene Busko at a medical presentation.

So this makes a very good case for why folks should always use cannabis in conjunction with cannabis nurses/clinicians and companies that provide education in terms of supportive care and dosing teams.

Bottom line for what this means: If you have had cardiac surgery, or a cardiac intervention within the last 6 to 12 months it is important to wait to begin cannabis use and to do so in collaboration with your other specialists so that they are aware of any potential interactions.

Greger, J., Bates, V., Mechtler, L., & Gengo, F. (2020). A review of cannabis and interactions with anticoagulant and antiplatelet agents. The Journal of Clinical Pharmacology, 60(4), 432-438.

Kidney Disease:

There are many medications that can do harm to the kidneys – including over the counter ones like NSAIDS (Ibuprofen/Motrin, Naproxen/Aleve are examples). In 2020 there has been some research looking into whether cannabis can be a safe replacement for NSAIDs and other drugs that can be toxic to the kidneys. In my practice, nephrologists and primary care doctors have been recommending their patients work with me when they need to stop NSAIDS for dialysis or chronic kidney disease. Nephrologists (as well as other specialists like Oncology, GI, and Cardiology) are requesting a lift on the federal ban to expand research.

Rein, J. L. (2020). The nephrologist’s guide to cannabis and cannabinoids. Current Opinion in Nephrology and Hypertension, 29(2), 248.

Oncology:

With more and more states going to legalization, along with the growing number of other nations legalizing like Canada – patients, especially oncology patients, are trying cannabis prior to research existing. Oncologists have recognized this and are requesting the end to the ban to help encourage and speed along research.

Meng, H., Dai, T., Hanlon, J. G., Downar, J., Alibhai, S. M., & Clarke, H. (2020). Cannabis and cannabinoids in cancer pain management. Current Opinion in Supportive and Palliative Care, 14(2), 87-93.

PTSD:

In 2020 several studies came out showing a positive relationship between Cannabis, CBD and PTSD. One such study concluded that, “current evidence from healthy humans and PTSD patients supports the THC value to suppress anxiety and aversive memory expression without producing significant adverse effects if used in low doses or when associated with CBD.”

What this means: Cannabis and CBD may decrease anxiety and suppress unpleasant memories associated with PTSD with relatively few side effects.

Raymundi, A. M., da Silva, T. R., Sohn, J. M., Bertoglio, L. J., & Stern, C. A. (2020). Effects of∆ 9-tetrahydrocannabinol on aversive memories and anxiety: a review from human studies. BMC psychiatry, 20(1), 1-17.

Dementia:

Researchers did a review of previously published articles relating to cannabis and Alzheimer’s – and found 9 studies of high enough quality to report on. They concluded that the combined results from these studies suggested that CBD may be useful to prevent and treat Alzheimer’s dementia. The authors describe how CBD may actually reduce or block the changes that happen in the brain that lead to Alzheimer’s. They also suggested that it looked like using CBD and THC together might be better than using either CBD or THC alone. Certainly more research is needed, but this is hopeful news for a devastating illness.

Kim, S. H., Yang, J. W., Kim, K. H., Kim, J. U., & Yook, T. H. (2019). A Review on Studies of Marijuana for Alzheimer’s Disease–Focusing on CBD, THC. Journal of Pharmacopuncture, 22(4), 225.

Sickle Cell Disease:

Unfortunately, a 2020 study on whether Cannabis could help with sickle cell pain did now show a statistically significant difference in control of sickle cell pain – however, it did improve the mood of the participants in the study. More studies are needed to see if cannabis can be used effectively to help with this condition.

Abrams, D. I., Couey, P., Dixit, N., Sagi, V., Hagar, W., Vichinsky, E., … & Gupta, K. (2020). Effect of Inhaled Cannabis for Pain in Adults With Sickle Cell Disease: A Randomized Clinical Trial. JAMA network open, 3(7), e2010874-e2010874.

Skin/Dermatology:

The endocannabinoid system is definitely active in the skin – with “expression in cutaneous sensory nerve fibers as well as mast cells and keratinocytes”. (These are skin cells and cells of the immune system.) Most of the studies have been observational or open label – those types of studies make it difficult to know for sure whether the treatment is actually effective. However, there have been a few randomized trials as well that show positive results for itchiness. Most of them have looked at topical preparations of CBD and cannabis, but at least one study showed a benefit with oral use as well – which would make sense as the antipruritic (ant-itch) effects are likely due to action at multiple sites along the nerve pathways and in the central nervous system.

Avila, C., Massick, S., Kaffenberger, B. H., Kwatra, S. G., & Bechtel, M. (2020). Cannabinoids for the treatment of chronic pruritus: A review. Journal of the American Academy of Dermatology, 82(5), 1205-1212.

COVID

In another blog, I discussed the fascinating findings related to CBD and COVID and how it may decrease the inflammatory process and could possibly help prevent or reduce acute respiratory distress syndrome and the “cytokine storm” – which are often the cause of people getting really sick with COVID and needing ICU care and ventilators.

Onaivi, E. S., & Sharma, V. (2020). Cannabis for COVID-19: can cannabinoids quell the cytokine storm?.

Rizzo, M. D., Henriquez, J. E., Blevins, L. K., Bach, A., Crawford, R. B., & Kaminski, N. E. (2020). Targeting Cannabinoid Receptor 2 on Peripheral Leukocytes to Attenuate Inflammatory Mechanisms Implicated in HIV-Associated Neurocognitive Disorder. Journal of Neuroimmune Pharmacology, 1-14.

Wang, B., Kovalchuk, A., Li, D., Rodriguez-Juarez, R., Ilnytskyy, Y., Kovalchuk, I., & Kovalchuk, O. (2020). In search of preventive strategies: novel high-CBD Cannabis sativa extracts modulate ACE2 expression in COVID-19 gateway tissues. Aging (Albany, NY Online).

And finally – this is not research, but the US House passed the MORE ACT in December. This means that, nationwide, cannabis legalization is now closer than ever. Now, the bill is not perfect and certainly needs work. For example – as a nation we must remove cannabis drug testing that bars employment and licensure. We also must demand equity in the cannabis industry so that the windfalls from this emerging industry don’t all go to a select few of already wealthy folks and companies. Next step for this is for it to pass the Senate and be signed by the president.

Looking to 2021: there is one study ongoing that will likely be published in 2021 on the neuromolecular mechanism of action for cannabis – meaning more insight into how cannabis – THC and cannabidiol (CBD) works.

Adel, Y., & Alexander, S. P. Neuromolecular Mechanisms of Cannabis Action. In Cannabinoids and Neuropsychiatric Disorders (pp. 15-28). Springer, Cham.

Cannabis research is growing at an unprecedented rate globally. As more nations, states, and municipalities decriminalize and legalize cannabis, the research and knowledge base will only continue to grow. If you would like to see research expanded in the US, please be sure to write and call to your elected officials, and let them know that important research should not be blocked due to outdated and unscientific laws. There were so many studies that it is impossible to fit into a blog. I am looking forward to writing about many of them. In 2021, let’s hope to see the federal cannabis ban lifted and even more immediate research into CBD and cannabis.

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