Cannabis medicinal como recurso terapéutico: Estudio preliminar

Julia Galzerano Guida; Cecilia Carina Orellana Navone; María Daniela Ríos Pérez; Ana Laura Coitiño González; Pablo Mariano Velázquez Ramos

doi:10.29193/RMU.35.4.5

Authors

Julia Galzerano Guida CASMU- IAMPP, Coordinadora de adicciones e Integrante Policlínica VIH. Médico internista, especialista en VIH y adicciones https://orcid.org/0000-0001-7521-2145
Cecilia Carina Orellana Navone Hospital Maciel, Servicio de Neurología. Hospital Británico, Departamento de Neurofisiología. Neuróloga y neurofisióloga clínica https://orcid.org/0000-0002-9416-3833
María Daniela Ríos Pérez Universidad de la República, Facultad de Medicina, Cátedra de Medicina Familiar y Comunitaria. Docente. ASSE, Medicina Familiar y Comunitaria. Ex residente https://orcid.org/0000-0002-3635-6987
Ana Laura Coitiño González CASMU, Medicina Familiar y Comunitaria. Ex residente https://orcid.org/0000-0002-4732-0752
Pablo Mariano Velázquez Ramos ASSE SAI-PPL, Médico general. Medicina tradicional china https://orcid.org/0000-0002-6850-6310

DOI:

https://doi.org/10.29193/RMU.35.4.5

Keywords:

CANNABIS, MEDICINAL MARIHUANA, MEDICINAL PLANTS, CANNABIDIOL, CANNABINOID VEGETABLE OILS

Abstract

Introduction: Cannabis sativa L products have a known therapeutic efficacy since ancient times, although their pharmacological classification dates from the mid-twentieth century. Recently its use was regularized in Uruguay.
Objective: to analyze a preliminary therapeutic clinical experience with medicinal cannabis (CM) with a high content of cannabidiol (CBD).
Method: an observational and retrospective epidemiological study of a cohort of 355 patients who attended to spontaneously consult CM in a private clinic between August 2016 and December 2017. During the first interview demographic data, clinical history, pharmacological, expectations and experience were collected previous with cannabis. Cannabis was indicated mostly with high CBD content (5.25% CBD and 0.2% tetrahydrocannabinol [THC]). In subsequent consultations, access to the CM was investigated and its response and adverse effects were assessed using analog scales. Descriptive statistics was used.
Results: in the cohort studied, women with an average age of 67 years, tertiary education level predominated. The consultation pathologies were neurological (38%), rheumatic or arthro-degenerative diseases (37%), neoplasms (13%), psychiatric (4%) and miscellaneous (8%). The majority of these cases (60.6%) reported improvement of their symptoms and only 16.3% of the population studied presented mild side effects. The high costs and difficult management to achieve CM were causes for not starting or abandoning treatment.
Conclusions: our preliminary study reflects a positive therapeutic response without significant adverse effects to CM with high CBD content. 60.6% of treated patients reported improvement of their symptoms. The decisive factors for a successful treatment are aimed at facilitating access to the CM, improving management to obtain it and reducing costs for greater accessibility.

References

(1) Russo EB. History of cannabis and its preparations in saga, science, and sobriquet. Chem Biodivers 2007; 4(8):1614-48.

(2) Hanuš L. How and why Cannabis became such famous medicine. En: Coloquio “El cannabis y los cannabinoids en la medicina” (27 de octubre de 2017). Montevideo: Sociedad Uruguaya de Endocannabinología, 2017.

(3) Lu HC, Mackie K. An introduction to the endogenous cannabinoid system. Biol Psychiatry 2016; 79(7):516-25.

(4) Elsohly MA, Gul W. Constituents of cannabis sativa. En: Pertwee RG, ed. Handbook of cannabis. Oxford, UK: Oxford University, 2014:4-19.

(5) Pazos Rodríguez MR, Grandes Moreno P. Cannabinoides y sistema endocannabinoide. En: Ramos Atance JA, coord. Efectos terapéuticos de los cannabinoides. Madrid: Universidad Complutense de Madrid, 2017:7-23. Disponible en: http://www.seic.es/wp-content/uploads/2013/10/EFECTOSTERAP%C3%89UTICOS-DE-LOS-CANNABINOIDES.p df. Consulta: 24 marzo 2018.

(6) Elsohly MA, Slade D. Chemical constituents of marijuana: the complex mixture of natural cannabinoids. Life Sci 2005; 78(5):539-48.

(7) Bewley-Taylor D, Blickman T, Jelsma M. Auge y caída de la prohibición del cannabis. Ámsterdam: Trasnational Institute, 2014. Disponible en:https://www.tni.org/files/download/auge-y-caidaweb.pdf Consulta: 20 marzo 2018.

(8) Friedrich-Ebert-Stiftung Uruguay. Estrategia para la evaluación de resultados y monitoreo de implementación de la Ley 19.172: propuesta. Montevideo: FESUR, 2014. Disponible en: http://monitorcannabis.uy/wp-content/uploads /2016/03/Estrategia-EYM-FESUR-11-2015-V6.pdf Consulta: 27 marzo 2018.

(9) Ley 19.172. Marihuana y sus derivados: control y regulación del estado de importación, producción, adquisición, almacenamiento, comercialización y distribución. Montevideo, 20 de diciembre de 2013.

(10) Decreto N° 46/015. Reglamentación de la Ley 19.172 relativa a la regulación y control del cannabis. Montevideo, 4 de febrero de 2015.

(11) Decreto N° 298/2017. Autorización de “venta bajo receta profesional” para las especialidades farmacéuticas con cannabidiol como principio activo. Montevideo, 16 de octubre de 2017.

(12) Schachter M. Unwanted effects and adverse drug reactions. En: Bennett PN, Brown MJ, Sharma P, eds. Clinical pharmacology. 11 ed. Edinburgh: Elsevier, 2012:110-21.

(13) National Cancer Institute. National Institutes of Health. Department of Health and Human Services. Common terminology criteria for adverse events (CTCAE) version 5.0. Bethesda, MD: NCI, 2017. Disponible en:https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf. Consulta: 20 marzo 2018.

(14) A fifth amendment for the Declaration of Helsinki. Lancet 2000; 356(9236):1123.

(15) Asociación Médica Mundial. Declaración de Taipei: investigación sobre las bases de datos, datos masivos y biobancos. Taipei: AMM, 2016.

(16) Robaina G, Peyraube R. Cannabis medicinal: la revolución silenciosa. Montevideo: Monitor Cannabis Uruguay, 2018. Disponible en:http://monitorcannabis.uy/cannabis-medicinal-la-revolucion-silenciosa/ Consulta: 25 marzo 2018.

(17) Nunberg H, Kilmer B, Pacula RL, Burgdorf J. An analysis of applicants presenting to a medical marijuana specialty practice in California. J Drug Policy Anal 2011; 4(1):1-14. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673028/ Consulta: 27 marzo 2018.

(18) Reinarman C, Nunberg H, Lanthier F, Heddleston T. Who are medical marijuana patients? Population characteristics from nine California assessment clinics. J Psychoactive Drugs 2011; 43(2):128-35.

(19) Fairman BJ. Trends in registered medical marijuana participation across 13 US states and District of Columbia. Drug Alcohol Depend 2016; 159:72-9.

(20) O’Connell TJ, Bou-Matar CB. Long term marijuana users seeking medical cannabis in California (2001-2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Harm Reduct J 2007; 4:16.

(21) Abuhasira R, Schleider LB, Mechoulam R, Novack V. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. Eur J Intern Med 2018; 49:44-50.

(22) U.S. Food and Drug Administration. FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. Silver Spring, MD: FDA, 2018. Disponible en:https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm611046.htm Consulta: 25 marzo 2018.

(23) Flachenecker P, Henze T, Zettl UK. Nabiximols (THC/CBD oromucosal spray, Sativex®) in clinical practice – results of a multicenter, non-interventional study (MOVE 2) in patients with multiple sclerosis spasticity. Eur Neurol 2014; 71(5-6):271-9.

(24) Badowski ME, Yanful PK. Dronabinol oral solution in the management of anorexia and weight loss in AIDS and cancer. Ther Clin Risk Manag 2018; 14:643-51.

(25) Bellnier T, Brown GW, Ortega TR. Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis. Ment Health Clin 2018; 8(3):110-5.

(26) Iffland K, Grotenhermen F. An update on safety and side effects of cannabidiol: a review of clinical data and relevant animal studies. Cannabis Cannabinoid Res 2017; 2(1):139-54.