Thoughts from the void: Cannabis for Pain and Inflammation Management

'Affordability is addressed, among other ways, by ensuring funding for the purchase of opioid medications as well as developing and improving health insurance and reimbursement schemes that guarantee access to pain medication. In 2018, 50 countries reported to INCB that steps had been taken towards improving their health insurance systems and setting affordable prices for essential medicines, including opioids. However, limited resources can impair even a well-intended Government from procurement or preclude it from providing or subsidizing controlled medicines for pain management. Other issues that may affect the affordability of pain medications include licensing, taxation, poor or inefficient distribution systems, lack of reimbursement and lack of availability of inexpensive formulations. Even in the case of Governments that are strongly committed to addressing challenges and barriers to access, financial resources may not be available to make systemic changes. Moreover, because of the high cost of pain medications, in many high-income countries and in most low- and middle-income countries, where a large number of people are not covered by either health insurance or a national health-care system, many people can encounter difficulties in accessing the pain medications that they need'

- United Nations Office on Drugs and Crime, World Drug Report 2020

'In 2018, 87 per cent of the global amount of morphine available for medical consumption was estimated to have been consumed in high-income countries, which are home to 12 per cent of the global population. While the relative importance of the amounts of morphine available for medical consumption in low- and middle-income countries has increased slightly since 2014 (from 9.5 to 13 per cent in 2018) the amount of morphine available per person per country is still infinitesimally small to non-existent in many developing countries, particularly in South Asia and in Africa. Even though countries may have morphine available for medical use, many people still have limited access to it. WHO estimates that globally, each year 5.5 million terminal cancer patients and 1 million end-stage HIV/AIDS patients do not have adequate treatment for moderate to severe pain'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

462. In connection with the therapeutics of hemp drugs, one of the commonest uses is for the relief of pain, the drugs being used either as local or general anodynes. Thus bhang poultices are frequently mentioned as soothing local applications to painful parts; and poultices are used for inflamed piles and over the seat of pain in liver and bowel diseases, and to check inflammation and erysipelas. Fumigation with the smoke from burning ganja or bhang is also used as a local sedative in piles. A small fragment of charas is placed in a carious tooth to relieve toothache. And the use of the drugs is also referred to for the relief of protracted labour pains, dysmenorrhœa, pain in the stomach, cramps, and neuralgia. One witness states that hemp drugs are used as a substitute for opium. In cases of circumcision the drugs are used as anæsthetics, and a witness mentions that native doctors on rare occasions substitute ganja for chloroform in operations. The tincture of Cannabis has been used as a local anæsthetic in extracting teeth (British Journal of Dental Science).

- Indian Hemp Drug Commission Report, 1895

We live in a world of pain. As we grow from youth to old age, our ability to handle pain seems to decrease, and the causes of pain seem to only increase. Physical pain, pain from mental anguish, chronic pain, the pain of constantly adapting in a world that gets more and more crowded and conflicting, a world that heats up with dramatic climate change and new or resurgent diseases. It is not surprising then that when we are younger, we think less about pain, since our tolerance levels are generally higher and our ability to bounce back is much better. It is also thus not surprising that the older generations are the ones who feel that they face a greater amount of pain, after having carried the burden of life and all its stresses and trauma. There possibly is no elderly person who does not have some kind of pain management strategy. Besides the older generation, many in other age groups, also suffer severe pain - through serious injuries sustained through accidents, or as a result of severe illnesses like multiple sclerosis or various mental trauma that life inflicts on them. Essentially pain is a part of human life, and as some might say there can be no pleasure if there was no pain.

Physical pain is usually accompanied by inflammation in the local area, indicating structural damage in the body needing additional resources to heal. In that sense, pain and inflammation are essential defense mechanisms that the body employs for the detection, and the subsequent treatment of body tissues and structure. In keeping with the goals of the medical and pharma industry to maximize profits at all costs, it is no surprise that they treat pain and inflammation as two separate conditions, rather than see the interconnections. When pain gets excruciating, we look at ways to numb the pain, so that we can continue to function. Some of the common ways to treat pain are through pain killers or analgesics. Since pain is a global phenomenon, it is not difficult to understand why painkillers, especially opioids, are probably the most popular recreational and medical drugs in the world. The WHO lists Paracetamol, Ibuprofen and Aspirin as essential drugs and Opioids as controlled substances. Similarly, there are a number of anti-inflammation drugs that now rank among the world's top selling pharma drugs. There is much confusion among all regarding what should be prescribed and taken when, with both analgesics and anti-inflammation drugs being prescribed and consumed inappropriately, leading in many cases to serious illnesses and even death. Much of this goes undetected and under reported. Many people consume these drugs on a daily basis as a matter of habit, completely ignorant of the toxic nature of these drugs, and the damage caused by chronic and prolonged use to hearts, lungs, stomachs, kidneys and livers.

Let us take a closer look at some of these leading drugs.

Paracetamol is the most commonly used medication for pain and fever in both the United States and Europe. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. Yet, paracetamol hepatotoxicity is by far the most common cause of acute liver failure in both the United States and the United Kingdom. Paracetamol overdose results in more calls to poison control centers in the US than overdose of any other pharmacological substance. In general, the recommended maximum daily dose of paracetamol for healthy adults is three or four grams. Higher doses may lead to toxicity. Untreated overdose can lead to liver failure and death within days - https://en.wikipedia.org/wiki/Paracetamol. Paracetamol also does not treat inflammation. Its properties are said to be purely analgesic and febrifuge. China is the largest supplier of paracetamol to the pharmaceutical industry due to its ability to manufacture the active pharmaceutical ingredient at a fraction of the cost of European companies. As per the following article from 2009, China and India are the largest manufacturers of paracetamol. Together they produced 70% of the global market at about 115,000 tonnes per year. - https://www.outsourcing-pharma.com/Article/2009/01/06/Europe-s-last-paracetamol-plant-closes-its-doors

Ibuprofen - It is used more for inflammation management than pain management. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. It is available as a generic medication. It increases the risk of heart failure, kidney failure, and liver failure. At low doses, it does not appear to increase the risk of heart attack; however, at higher doses it may. Ibuprofen can also worsen asthma. Toxic effects are unlikely at doses below 100 mg/kg, but can be severe above 400 mg/kg (around 150 tablets of 200 mg units for an average man) - https://en.wikipedia.org/wiki/Ibuprofen. China is the largest supplier of Ibuprofen, with a production market share nearly 48% in 2016. India is the second largest supplier of Ibuprofen, enjoying production market share nearly 30.7% in 2016. - https://www.marketwatch.com/press-release/ibuprofen-market-2019-global-leading-players-industry-updates-future-growth-business-prospects-forthcoming-developments-and-future-investments-by-forecast-to-2024-2019-06-18

Aspirin is one of the most widely used medications globally, with an estimated 40,000 tonnes (44,000 tons) (50 to 120 billion pills) consumed each year. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.One common adverse effect is an upset stomach. More significant side effects include stomach ulcers, stomach bleeding, and worsening asthma. Aspirin overdose can be acute or chronic. In acute poisoning, a single large dose is taken; in chronic poisoning, higher than normal doses are taken over a period of time. Acute overdose has a mortality rate of 2%. Chronic overdose is more commonly lethal, with a mortality rate of 25%; chronic overdose may be especially severe in children. - https://en.wikipedia.org/wiki/Aspirin. 'Most of the North American supply of aspirin, for example, comes from China, which produces about 120 billion tablets per year.' - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470633/

Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Because opioids are addictive and may result in fatal overdose, most are controlled substances. In 2013, between 28 and 38 million people used opioids illicitly (0.6% to 0.8% of the global population between the ages of 15 and 65). In 2011, an estimated 4 million people in the United States used opioids recreationally or were dependent on them. As of 2015, increased rates of recreational use and addiction are attributed to over-prescription of opioid medications and inexpensive illicit heroin. 69,000 people worldwide die of opioid overdose each year and 15 million people have an opioid addiction. Research suggests that when methadone is used long-term it can build up unpredictably in the body and lead to potentially deadly slowed breathing. Used medically, approaching toxicity goes unrecognized because the pain medication effect ends long before the drug's elimination half-life. According to the USCDC, methadone was involved in 31% of opioid related deaths in the US between 1999–2010 and 40% as the sole drug involved, far higher than other opioids. Respiratory depression is the most serious adverse reaction associated with opioid use, but it usually is seen with the use of a single, intravenous dose in an opioid-naïve patient. In patients taking opioids regularly for pain relief, tolerance to respiratory depression occurs rapidly, so that it is not a clinical problem. - https://en.wikipedia.org/wiki/Opioid. In fact, opioids are not particularly effective for treating chronic pain; with long-term use, people can develop tolerance to the drugs and even become more sensitive to pain. And the claim that OxyContin was less addictive than other opioid painkillers was untrue — Purdue Pharma knew that it was addictive, as it admitted in a 2007 lawsuit that resulted in a US$635 million fine for the company. But doctors and patients were unaware of that at the time. - https://www.nature.com/articles/d41586-019-02686-2. The leading manufacturers of fentanyl in the world are China and India. The leading maufacturer of Tramadol is India. - https://www.csis.org/npfp/dangerous-opioid-india

It appears that today, the world cannot look beyond dangerous synthteic pharmaceutcial medications for treatment of pain and inflammation. United Nations Office on Drugs and Crime, in its World Drug Report 2020, states that - 'Other than opioids, non-steroidal anti-inflammatory drugs are used in patients with osteoarthritis and rheumatoid arthritis and low back pain. The efficacy of antidepressant drugs has been reported for the management of neuropathic pain, fibromyalgia, low back pain and headaches. Anti-convulsant drugs such as gabapentin, pregabalin and carbamazepine have proved effective in the treatment of chronic non-cancer pain.'

As alternatives to synthetic pharmaceutical medication, some of the strategies being employed are non-medicinal. United Nations Office on Drugs and Crime, in its World Drug Report 2020, further states that - 'As part of complementary and alternative medicine, spinal manipulation is the most commonly used therapy for low back pain. Massage is another modality commonly used as a supplemental treatment for patients with chronic non-cancer pain. Similarly, evidence supports the effectiveness of acupuncture for the treatment of chronic low back pain, while results on the effectiveness of acupuncture in the reduction of pain associated with fibromyalgia and neck pain are promising. Psychological interventions such as cognitive behavioural therapy, relaxation training and hypnosis are the most commonly used techniques in the management of chronic pain. The aim of such interventions is to help the patient cope with the symptoms of pain, learn skills for adaptation and self-management, and reduce disability associated with symptoms, rather than eliminate physical causes of pain per se.'

Some of the biggest issue with all the above discussed pain and inflammation management strategies is that when it comes to synthetic pharmacetical medication, they are expensive, unavailable, addictive, or downright dangerous for human consumption. With the alternative pain management strategies such as massage, acupuncture and psychological interventions, the ability to find persons with the requisite skills and competencies is a big issue, not to mention the problems of affordability.

So, the world's pain management strategies today are essentially aligned to the needs of the world's elites - the richest nations of the world, and the richest people in all the rest of the nations. The world's poor, who form the majority of the world's population, find no place in the pain management strategy of global public health. This is primarily because the key objective of global pain management is not to reduce the suffering of the world's people. It is to maximize profits for the pharmaceutical industry and the medical industry.

In the past, people have used alcohol, opium, cannabis, meditation, and numerous other methods to manage their pain. Cannabis was until the mid 19th century one of the premier pain killers given its safe dosage profile, low addiction rates, anti-inflammatory properties, ability to act on different internal and external parts of the body, as well as properties which enabled one to administer it in multiple ways - to smoke it, make extracts, oils, ointments and even consume it as food and drink. It was hugely popular in India, and in many parts of the world for thousands of years, as it grew in many climatic conditions and one could have one's own painkiller plant at home. In addition to its pain management abilities, its ability to provide good sleep, relax and de-stress a person, reduce nausea, increase one's appetite, and to treat conditions like arthritis, multiple sclerosis, heal wounds, as well as protect the brain, liver, lungs, kidneys, stomach and its properties as universal medicine, it is not difficult to understand why it was one of the world's foremost medicines.

The Indian Hemp Drugs Commission of 1894-95, in its study of the medical uses of cannabis, found that cannabis was used for the treatment of pain arising from numerous diseases and health conditions. Cannabis was administered both externally and internally for the treatment of pain. In its summary, the Hemp Commission says, '462. In connection with the therapeutics of hemp drugs, one of the commonest uses is for the relief of pain, the drugs being used either as local or general anodynes. Thus bhang poultices are frequently mentioned as soothing local applications to painful parts; and poultices are used for inflamed piles and over the seat of pain in liver and bowel diseases, and to check inflammation and erysipelas. Fumigation with the smoke from burning ganja or bhang is also used as a local sedative in piles. A small fragment of charas is placed in a carious tooth to relieve toothache. And the use of the drugs is also referred to for the relief of protracted labour pains, dysmenorrhœa, pain in the stomach, cramps, and neuralgia. One witness states that hemp drugs are used as a substitute for opium. In cases of circumcision the drugs are used as anæsthetics, and a witness mentions that native doctors on rare occasions substitute ganja for chloroform in operations. The tincture of Cannabis has been used as a local anæsthetic in extracting teeth (British Journal of Dental Science).'

Numerous individual witnesses to the Hemp Commission speak about the use of cannabis for relief from pain. It must be remembered here that cannabis, in 19th century India, was used by the poorest classes of society extensively both as intoxicant and medicine. Often, cannabis was the only medicine that they could access and afford. As Mr. H. M. Winterbotham, Collector of Tanjore, says, 'To people who cannot obtain skilled medical advice, and who cannot afford to buy chlorodyne, Mother Seigel's soothing syrup, painkiller and other patent medicines, the use of purn âdhi and similar medicinal preparations of ganja must often be beneficial. If it is not the best medicine, it is often the only one available.' Opium was not available through the length and breadth of the country, and where it was, it was expensive and only affordable to the upper classes. This is a good thing because if opium had been widely and freely available, the whole country would have been subject to opium addiction instead of the safe and non-addictive ganja. Surgeon-Major R. Pemberton, Civil Surgeon, Cochin, says, 'Is used very often in asthma and in painful rheumatic affection. Native doctors prescribe the drug in these cases in moderate doses and is used in painful affections very often instead of opium.'

Mr. A. C. Tute, Magistrate and Collector of Dinajpur, says, 'Yes; for the relief of pain it is used as an intoxicant or narcotic.' Babu Pran Kumar Das, Deputy Magistrate and Deputy Collector and Personal Assistant to the Commissioner of Burdwan, says, 'My ganja-smoking servants had less malarious fever, and they said it alleviated pain.' Babu Abhilas Chandra Mukerjee, Brahmin, Deputy Magistrate and Deputy Collector, on deputation as 2nd Inspector of Excise, Bengal, says, 'To allay pain in the chest, sides, and also in hemorrhoids (piles), bhang leaves are put inside a cloth and warmed in slow fire, and used for dry fomentation.' Babu Rajani Prasad Neogy, Excise Deputy Collector, Mymensingh, says, 'It has the effect of alleviating pain due to rheumatism and leprosy.' Mr. R. L. Ward, District Superintendent of Police, Rajshahi, says, 'Bhang is sometimes prescribed by the kabiraj for both external plaster and internal use in rheumatic pains.' Surgeon-Lietenant-Colonel W. Flood Murray, Civil Surgeon, Shahabad, says, 'Yes. Bhang is used for piles and to relieve pain.' Assistant Surgeon Bosonto Kumar Sen, in Civil Medical Charge, Bogra, says, 'They produce sound sleep and relieve pain and anxiety.' Assistant Surgeon Chooney Lall Dass, Teacher of Medical Jurisprudence and Therapeutics, Medical School, Dacca, says, 'Moderate use of bhang nourishes the body that is, makes it fat, eases pain when present, and it has a cooling effect.' Assistant Surgeon Soorjee Narain Singh, Kayasth, Bankipur, says, 'A poultice of the boiled root and leaves is applied for discussing inflammation and cure of erysipelas and for allaying neuralgic pains.' Prasad Das Mallik, Subarnabanik, Medical Practitioner, Hughli, says, 'to relieve pain and spasm.' Lukhmy Narain Naik, Mahanyak, Medical Practitioner, Cuttack, says, 'Though the hemp has the power of allaying pains, yet as far as my experience goes, I think that the power of allaying pains is indirect and temporary, i.e., for a few minutes after the madak being taken.' Rakhal Das Ghosh, Private Medical Practitioner, Calcutta, says, 'Tetanus, rheumatism, ague, diarrhœa, dysentery, cholera, dyspepsia and many painful disorders of the urinary or generative organs yield to the anodyne, soporific, antiperiodic, antispasmodic, and other properties of ganja or opium. Aided by these remedies the inhabitants combat for life and death.' Braham Deo Narain Misra, Vaid, Arrah, says, 'Sometimes it is used in pasting when the pain is in bones of the several joints of the body.' M. Kazi Rayaz-ud-din Mahamed, Zamindar, Commilla, Tippera, says, 'Ganja is also used for medicinal purposes, to cure rheumatic and paralytic pains, which I have personally experienced.' Mr. A. G. M. Wodschow, Assistant Manager, Indigo and Zamindari, Dumur Factory, Purnea, says, 'Ganja. — In cases of pain in the stomach.' Babu Gauri Shankar, Manager, Bachour, Darbhanga, says, 'to alleviate the pains of piles.' Babu Amvika Charan Mazumdar, Vaidya, Pleader and Zamindar, Faridpur, says, 'Bhang, though not a food, when used moderately, is found to be efficacious in chronic diarrhœa and cholic pain as well as some other complaints.' Babu Gowree Sunker Roy, Kayasth, Secretary, Cuttack Printing Company, Cuttack, says, 'Bhang is preserved by many as a household medicine for all sorts of bowel complaints and colic pain.' Babu Akshay Kumar Maitra, Secretary, Rajshahi Association, Pleader, Judge's Court, Member, Rajshahi District Board, Commissioner, Rampur Boalia Municipality, says, 'Some quacks allege that ganja, if moderately smoked during an attack of acute pains due to hydrocele, effects a speedy cure. I am told on the authority of a gentleman who subjected him to this treatment that he found it very successful.' Surgeon-Major H. C. Banerji, Civil Surgeon, Sylhet, says, 'I understood my informants to say that they took ganja when they got rheumatic pains and that it relieved them. I was told this by habitual smokers, and also by people who never smoked except to relieve pain.' Radhanath Changkakoti, Brahmin, Proprietor, "Radha Nath" Printing Press; Municipal Commissioner; Member of Local Board; Secretary to the Upper Assam Association; and Secretary to the Government Girls' School, Dibrugarh, says, 'Application of the green leaves of the hemp plant in pains, etc., is said to be beneficial.' Vinayak Balkrishna Khare, Brahmin, Excise Daroga, Nagpur, says, 'It is, however, at times administered to a patient to relieve him from incessant pain for a time.' Brijmohun Patnaik, Mahanti, Treasurer, Sambalpur, says, 'When a man is in bodily pain he generally takes ganja to alleviate his suffering.' Brigade-Surgeon-Lieutenent-Colonel J. B. Gaffney, Civil Surgeon, Jabalpur, says, 'I consider a moderate use of ganja to be beneficial when a stimulant is necessary, or when the sedative effects are desirable in pain, either mental or bodily.' Muhammad Habibulla, 1st grade Hospital Assistant, Seoni, says, 'for piles or neuralgic pains, or eye sores, etc., to allay pain.' Mir Imdad Ali, Honorary Magistrate, Damoh, says, 'Bhang is sometimes used as a fomentation in bowel or liver disorders over the seat of pain.' Seth Bachraj, Honorary Magistrate, Wardha, says, 'It is used to alleviate mental pain.' Mr. J. A. Maughan, Manager, Central Provinces Collieries, Umaria, Jubbulpore District, says, 'The moderate occasional use is supposed to relieve pain.' Mr. J. H. Merriman, Deputy Commissioner of Salt and Abkari, Central Division, says, 'The ganja is also given to women in protracted labour pains.' A. Krishnamacharulu, Tahsildar, Bapatla, Kistna District, says, 'The Civil Apothecary, Bapatla, reports that, as medicine, the pharmaceutical extract prepared from it is useful in painful affections. It possesses antispasmodic and anodyne powers and is useful in neuralgic affections, whooping coughs, asthma, tetanus and hydrophobia.' P. S. Singaravelu Pillai, Tahsildar of Erode, says, 'To deaden pain, or at least to induce insensibility to it in painful performances, like hook-swinging, fire-walking, etc.' Hospital Assistant I. Parthasarathy ChettyY, Penukonda, Anantapur District, says, 'The leaves lessen the intensity of the pain.' P. Seshachallam Naidoo, Balija, Landlord, Merchant, and Chairman, Vetapollem, Kistna District, says, 'Yes, as it relieves pain and cheers sinking spirit.' Aziz-ud-din Ali Khan, Sahib Bahadur, Jagirdar, Cherlopalle, Gurramkanda, District Cuddapah, says, 'Ganja is used on account of its medical qualities for allaying pain and increasing the digestive power.' Rev. W. Robinson, Missionary, London Missionary Sobriety, Salem, says, 'Yes; for inducing sleep and allaying pain.' Rev. S. C. Schaible, Missionary, Moolky, South Canara, says, 'Some people use it as a pain–killer, for instance, in cases of pain in the stomach.' Angappa Gonuden, Blacksmith, Salem says, 'Smoking gives, though temporarily, such staying-power as is referred to and alleviates pain (pain not being felt only so long as the intoxication exists).' Mr. E. J. Ebden, Collector, Ahmednagar, says, 'Purchasers at the shops often described themselves as buying it for pains and ailments.' Mr. F. L. Charles, Collector, Belgaum, says, 'Checks diarrhœa and relieves pain.' Mr. F. S. P. Lely, Collector of Surat, says, 'They assuage rheumatic and other pains and mental distress.' Mr. C. G. Dodgson, Assistant Magistrate and Collector, Khandesh, says, 'It is also occasionally used for poultices and also used for the purpose of relieving pain when performing operations.' Rao Sahib Pranshankar, Brahmin, Inspector of Police, Detective Branch, Bombay, says, 'By way of forgetting pain, allaying fatigue, anxiety, etc., and keeping jolly all round.' Surgeon-Major H. W. B. Boyd, Superintend nt, Colaba Lunatic Asylum, Bombay, says, 'It allays pain when dropped into the ear.' Surgeon-Major K. R. Kirtikar, Civil Surgeon, Thana, and Medical Officer, Thana Depot and District Jail, says, 'It also relieves the colic pains due to constipation.' Assistant Surgeon B. H. Nanavatty, Parsi, and Teacher of Surgery and Midwifery, Medical School, Ahmedabad, says, 'Powdered ganja leaves are occasionally prescribed in pill form by native quacks to relieve colicky pain ; they are also used in combination with milk, turmeric and flour as a paste or poultice for painful protruded piles.' Hospital Assistant Jamiatram Jeyashunker, Nagar Brahmin, West Hospital, Rajkot, Kattiawar, says, 'Yes, to alleviate pain, preparations of hemp drug are used by native doctors...Bhang is believed next to opium as anodyne, hypnotic and antispasmodic by some medical men, and consequently given in the above said diseases.' Uttamram Jeewanram, Itchapooria, Audesh, Brahmin, Native Doctor (Vaidya), Bombay and Surat, says, 'I used bhang in pains, rheumatism, fevers loss of appetite, restlessness, burning symptoms in phthisis, dysentery, acute and chronic diarrhœa, cramps, hysteria, headache, tetanus, muscular rheumatism, brain fever, and hætmorrhage.' Keshowram Haridat, Chcepooria, Audesh Brahmin, Native Doctor (Vaidya) , Render, Surat and Bombay, says, 'Ganja is prescribed in colic pains and as sleeping draught.' Rao Bahadur Huchrao Achut Harihar, Deshast Brahmin, Pleader, District Court, Belgaum, says, 'it stops diarrhœa, relieves pains in the rectum. It is, as a smoke, also used to remove or relieve syphilitic bone pains.' Dinanath Shiwshanker, Druggist and Chemist, says, 'Ganja smoking is advised by native doctors for neuralgic pain and idiopathic tetanus.' Mr. R. Giles, Collector, Shikarpur, says, 'as a sedative in cases of pains.' Assistant Surgeon, J. E. Bocarro, Lecturer, Medical School, Hyderabad (Sind), says, 'Its use is now limited chiefly to external applications, to painful sores and ulcers, local swellings, and painful joints, on account of the anodyne property it possesses.' Dr. S. M. Kaka, Medical Officer of Health, Karachi, says, 'Yunani hakims generally prescribe bhang to alleviate pain as in orchitis, in which bhang soaked in water and mixed with nux vomica is applied to the testes. In neuralgic affections of the eyes bhang is both applied and instilled.' S. Baijnath, Medical Officer, Mady Hospital, Badnera, says, 'Externally for fomenting painful parts.' Army Witness No. 55 says, 'The moderate use of the drug is known to have a beneficial effect generally, having a quieting effect on the brain, increases the appetite, soothes pain, and causes sleep.' Army Witness No. 170 says, 'Yes, it is supposed to alleviate pains in case of chill and extreme cold; generates heat.' Army Witness No. 195 says, 'Yes. Their physiological action being soporific, anodyne, antispasmodic, and nervine stimulant, they are useful for the relief of painful affections.' Army Witness No. 204 says, 'Yes. If given in small quantities to young children to allay puerile pains, e. g., teething.' Army Witness No. 226 says, 'It may be, if taken occasionally to relieve pain.'

The most important point here is that cannabis was the drug and medicine of the poorest classes of society - the poor, the labouring and working classes, the religious mendicants, and the indigenous communities. People could grow their own cannabis, share it, or purchase it from retail outlets at the cheapest prices that even the poorest person could afford.

Then came cannabis prohibition. It started in 19th century India, with the British curbing its cultivation to promote their western alcohol, opium and tobacco. This was followed by the US and Canada prohibitig cannabis in the 1930s for similar reasons. With this opioids and alcohol arrived as replacements for painkilling. Paracetamol, Ibuprofen and Aspirin also made their global appearance subsequently. Unfortunately over the years opioids and alcohol have not only reduced pain, they have taken significant numbers of lives (70,000 people or more are said to have died of opioids in 2017 in the US alone, tens of millions die each year from alcohol).

People have now discovered that these drugs are not as benign as cannabis, but have deadly side effects which result in eventual, more serious health conditions, or death. The drugs listed as as safe and essential in the WHO list all have serious side effects on overdosing. The margins between safe consumption and overdosing are very fine. Often overdose does not result from a one time overuse, but builds up in the body through chronic usage over a period of time.

What is doubly cruel is that most of these pharmaceutical medication for pain and inflammation are expensive and inaccessible for the majority of the world's population. They are mostly available to and used by the elite few who have prohibited cannabis globally. According to INCB's report in 2019, "In 2018, 79 per cent of the world population, mainly persons in low- and middle-income countries, consumed only 13 per cent of the total amount of morphine used for the management of pain and suffering. Although the situation improved in the previous 20 years, the disparity in consumption of narcotic drugs for palliative care continues to be a matter of concern, particularly in relation to access and availability of affordable opioid analgesics such as morphine. The remaining 87 per cent of the total consumption of morphine, excluding preparations in Schedule III of the 1961 Convention, continued to be concentrated in a small number of countries, mainly in Europe and North America. In 2018, European countries as a whole and the United States accounted for the highest share of global morphine consumption (39.5 per cent and 39.3 per cent respectively); they were followed by Canada (5.1 per cent), Australia and New Zealand (2.5 per cent) and Japan (0.6 per cent)." https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

There is once again a growing movement to bring back cannabis into the mainstream pain management strategy, as awareness of its benefits and the harms of alcohol, opioids and synthetic pharmaceutical drugs increase. Pain is one of the primary conditions which makes one eligible for medical cannabis in US states and European countries where cannabis has been legalized. The number of persons who have registered for pain treatment through cannabis runs now in the hundreds of thousands. It is no wonder that cancer patients, persons suffering from arthritis, multiple sclerosis, PTSD, anxiety, sleep disorders, brain injuries, bone damage, wounds, the elderly, army veterans, sports persons, persons addicted to opioids, alcohol and other drugs, constitute some of the main categories of people seeking cannabis to alleviate the pain.

Opposition to cannabis, as an analgesic and anodyne, comes from powerful pharmaceutical industries, illegal heroin cartels, bodies like the FDA and DEA, law enforcement agencies as well as the medical industry constituting of physicians and medical institutions. China is said to produce the bulk of active ingredients that go into making paracetamol. India and China are involved as leading manufactures in all the above mentioned categories of leading pain and inflammation management drugs i.e. paracetamol, ibuprofen, aspirin and opioids. Through their influence on politicians and the UN they continue to keep cannabis as a banned substance, when legalization can mean that every person in this world can grow and access their own plant. When these countries and pharmaceutical companies find their access to certain markets, such as North America and Europe, blocked due to increased awareness of the harms of these drugs, they move to more vulnerable and susceptible markets such as in Asia, Africa, South America and the Middle East.

The number of people who can access cannabis today are still only a small fraction of the worldwide pain sufferers, most of whom, especially the poor, minorities, indigenous communities, the elderly, army veterans, the ill and women continue to suffer without even proper access to alcohol or opioids like some of their wealthier neighbors are able to. Yes, the elites need their pain management strategies. But so do the poor. And more so, since the poor are the ones feeling the pain arising from the pursuit and hoarding of material wealth by the elites. With the amount of pain in this world, adding, or rather bringing back, one more painkiller - the world's best, most affordable and most accessible - will benefit all. There is a critical immediate need to legalize cannabis worldwide for pain and inflammation management, and to make it accessible to all, so that the world can see the pleasure of existence as well, not just its pain. If not, we may not want to sustain this world for very long.

The following list of articles taken from various media speak about the above subject. Words in italics are the thoughts of yours truly at the time of reading the article.

More than one in five patients with chronic musculoskeletal pain (MSK) report having used cannabis to manage their symptoms and 90 percent of them perceive it to be effective, according to data published in the Journal of Cannabis Research.

Canadian researchers surveyed 629 patients with chronic MSK pain. Twenty-three percent acknowledged having used cannabis therapeutically. Over 90 percent of consumers said that it was either “very,” “somewhat,” or “slightly” effective at managing their pain, improving their sleep, and reducing anxiety-related symptoms. More than half (57 percent) perceived cannabis to be more effective than other analgesic medications, and 40 percent acknowledged decreasing their use of traditional pain medications following their use of cannabis.

The study’s authors concluded: “One in five patients presenting to an orthopaedic surgeon with chronic MSK pain are using or have used cannabis with the specific intent to manage their pain, and most report it to be effective. … Future double-blind placebo-controlled trials are required to understand if this reported efficacy is accurate, and what role, if any, cannabis may play in the management of chronic MSK pain."

https://norml.org/news/2024/07/18/survey-patients-say-cannabis-effectively-treats-their-musculoskeletal-pain/

The administration of select cannabis plant terpenes produces analgesic effects comparable to morphine, according to preclinical data published in The Journal of the Association for the Study of Pain.

Researchers affiliated with the University of Arizona and the National Institutes of Health assessed the pain-relieving effects of various cannabis terpenes – geraniol, linalool, ß-pinene, a-humulene, and ß-caryophyllene – in a mouse model of chemotherapy-induced peripheral neuropathy.

They reported that each of the selected terpenes “produced roughly equal antinociception to 10 mg/kg of morphine.” The co-administration of low doses of terpenes and morphine produced “enhanced” analgesic effects.

“Together these studies identify cannabis terpenes as potential therapeutics for chronic neuropathic pain,” investigators concluded.

https://norml.org/news/2024/06/13/preclinical-study-cannabis-terpenes-produce-potent-analgesic-effects/

Patients with chronic pain and other conditions report that cannabis is often more effective than conventional treatments, according to survey data published in the journal Frontiers in Medicine.

German researchers surveyed patients’ experiences with cannabis products. (Plant cannabis and cannabinoid treatments, such as , were legalized by prescription use in Germany in 2017; however, such products are typically only authorized when patients are unresponsive to traditional therapies.) Over 200 patients participated in the survey. Most respondents suffered from chronic pain and over two-thirds of the survey’s participants consumed cannabis flowers or plant-derived extracts.

Consistent with numerous other studies, patients reported reductions in their daily pain following cannabis therapy. Patients also said that they were less likely to be either anxious or depressed while using cannabis. Participants reported “greater satisfaction” with cannabis and said that it was “more effective” than their prior therapies. Ninety-four percent of those surveyed reported holding more positive attitudes toward cannabis following treatment.

“The results of this cross-sectional survey suggest that most surveyed outpatients treated with prescription cannabinoids in Germany subjectively experience health benefits and symptom reduction associated with these therapies,” the study’s authors concluded.

https://norml.org/news/2024/01/11/survey-pain-patents-report-that-cannabis-is-more-effective-than-conventional-medications/

Researchers reported, “Both CBD groups resulted in significant VAS pain reduction compared to their baseline and the placebo group, with a maximum median VAS pain reduction of 73 percent from baseline pain at the 180-min time point.” Side-effects associated with CBD were “minimal.”

Authors concluded: “This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain. … This novel study can catalyze the use of CBD as an alternative analgesic to opioids for acute inflammatory pain conditions, which could ultimately help to address the opioid epidemic.

https://norml.org/news/2023/11/16/clinical-trial-oral-cbd-administration-provides-relief-from-dental-pain/

Those who consume unregulated opioids frequently report using cannabis to mitigate their drug cravings, according to data published in the International Journal of Drug Policy.

Canadian investigators assessed cannabis use trends among a cohort of 205 consumers of non-prescription opioids. Many of the cohort were IV drug users and at-risk youth.

Nearly half of the study’s participants (45 percent) acknowledged using cannabis to manage opioid cravings. Of those, 62 percent “reported self-assessed decreases in opioid use during periods of cannabis use.” Subjects suffering from chronic pain were most likely to engage in opioid substitution.

Authors concluded: “In the present study, we observed that cannabis use to manage opioid cravings was significantly associated with self-assessed decreases in opioid use during periods of cannabis use among a structurally marginalized population of PWUD [people who use unregulated opioids]. The sub-analysis indicated that this association was mainly driven by those living with moderate to severe pain. … This suggests that future studies of cannabis substitution for opioid use should measure and analyze the impact of pain, as not doing so may lead to equivocal findings when the effects of cannabis substitution may vary based on the prevalence of chronic pain.”

https://norml.org/news/2023/08/03/study-users-of-non-prescription-opioids-frequently-turn-to-cannabis-to-reduce-drug-cravings/

The use of cannabis products is associated with symptomatic improvements in pain patients with and without comorbid anxiety, according to observational trial data published in the journal Expert Review of Neurotherapeutics.

British investigators assessed the safety and efficacy of cannabis-derived products in 1,254 chronic pain patients. Of these, 711 subjects were also diagnosed with anxiety. Study subjects were participants in the UK Medical Cannabis Registry, and each of them possessed a doctor’s authorization to access cannabis. Study participants consumed cannabis by either vaporizing marijuana flower or by ingesting plant-derived extracts containing both THC and CBD. Researchers assessed subjects’ symptoms compared to baseline at one, three, and six-months.

Cannabis treatment was associated with “significant improvements in all primary outcomes … at all timepoints,” authors reported. Those with comorbid anxiety reported greater improvements in health-related quality of life as compared to those subjects diagnosed with chronic pain only. Both cohorts achieved significant reductions in their opioid consumption over the course of the study – a finding that is consistent with dozens of other observational trials.

https://norml.org/news/2023/03/02/study-cannabis-use-effective-in-patients-diagnosed-with-chronic-pain-and-anxiety/

Over 90 percent of respondents said that cannabis use reduced their average pain by at least half. Eighty percent of respondents reported using fewer opioids following the initiation of cannabis therapy. Sixty-nine percent of study participants reported reducing their use of sleep aids, and 50 percent reported using fewer anxiety/anti-depressants.

“The findings from this survey indicate that patients with CMT report substantial relief of pain symptoms from the use of cannabis,” the authors concluded. “These data support the need for prospective, randomized, controlled trials using standardized dosing protocols to further delineate and optimize the potential use of cannabis to treat pain related to CMT.”

https://norml.org/news/2023/02/23/survey-cannabis-provides-relief-less-need-for-prescription-medications-in-nerve-pain-patients/

'Fibrosis is a condition characterized by thickening or/and scarring of various tissues. Fibrosis may develop in almost all tissues and organs, and it may be one of the leading causes of morbidity and mortality. It provokes excessive scarring that excels the usual wound healing response to trauma in numerous organs. Currently, very little can be done to prevent tissue fibrosis, and it is almost impossible to reverse it. Anti-inflammatory and immunosuppressive drugs are among the few treatments that may be efficient in preventing fibrosis. Numerous publications suggest that cannabinoids and extracts of Cannabis sativa have potent anti-inflammatory and anti-fibrogenic properties. In this review, we describe the types and mechanisms of fibrosis in various tissues and discuss various strategies for prevention and dealing with tissue fibrosis. We further introduce cannabinoids and their potential for the prevention and treatment of fibrosis, and therefore for extending healthy lifespan.'

https://www.frontiersin.org/articles/10.3389/fcell.2021.715380/full

'Despite the limited number of large clinical trials on the positive therapeutic effect of medical marijuana, the several thousand-year history of using cannabis in medicine and numerous reports allow the conclusion that cannabis preparations have a great therapeutic potential. The report presents the clinical case of a 35-year-old female patient treated with medical marijuana preparations due to persistent headache following neurosurgical resection of a brain tumour.

Therapy with medical marijuana was started 3 years after surgery. Headache occurred several times a day and responded poorly to NSAIDs, which resulted in the patient often giving-up pharmacological treatment. The applied treatment with dried cannabis with high THC content taken by vaporization in a finally dose of 0.1 g twice a day showed a significant reduction in pain by 7–9 on the NRS within the 3 months of therapy. This observation suggests a significant analgesic effect of cannabis in the treatment of symptomatic headaches.'

http://www.jpccr.eu/Significant-reduction-of-symptomatic-headache-by-medical-marijuana-Case-report,142773,0,2.html

'Results. A total of 351 patients were located, and 319 completed the questionnaire. Mean age was 46 ± 12 years, 76% were female, 82% had fibromyalgia, ~9% had mechanical problems, ~4% had inflammatory problems, ~4% had neurological problems, and ~1% had other problems. The average monthly consumed dose of MC was 31, 35, 36, and 32g, with mean pain level reduction of 77%, 82%, 83%, and 57%, and mean sleep quality improvement of 78%, 71%, 87%, and 76% among patients with fibromyalgia, mechanical, neuropathic, and inflammatory problems, respectively. Mean THC and CBD contents were 18.38% ± 4.96 and 2.62% ± 4.87, respectively. The THC concentration, duration of MC consumption, and MC consumption dose had independent significant correlations with pain reduction while only the duration of MC consumption had an independent significant correlation with sleep quality improvement. Conclusions. MC had a favorable effect on pain level and quality of sleep among all spectrums of problems at the rheumatology clinic.'

https://www.hindawi.com/journals/prm/2021/1756588/

'British researchers affiliated with London’s Imperial College assessed the use of cannabis extracts over a six-month period in 110 subjects.

Investigators reported that the administration of cannabis oils was associated with “significant improvements” in patients’ pain conditions over the study period. Adverse events associated with the extracts were described as “being mild or moderate in intensity.”'

https://norml.org/news/2021/09/09/case-series-cannabis-plant-extracts-effective-in-mitigating-chronic-pain

'Cannabis has been long used since ancient times for both medical and recreational use. Past research has shown that cannabis can be indicated for symptom management disorders, including cancer, chronic pain, headaches, migraines, and psychological disorders (anxiety, depression, and post-traumatic stress disorder). Active ingredients in cannabis that modulate patients' perceptions of their conditions include [delta]9-tetrahydrocannabinol (THC), cannabidiol (CBD), flavonoids, and terpenes. These compounds work to produce effects within the endocannabinoid system to decrease nociception and decrease symptom frequency. Research within the United States of America is limited to date due to cannabis being classified as a schedule one drug per the Drug Enforcement Agency. Few anecdotal studies have found a limited relationship between cannabis use and migraine frequency. The purpose of the review article is to document the validity of how medical cannabis can be utilized as an alternative therapy for migraine management. Thirty-four relevant articles were selected after a thorough screening process using PubMed and Google Scholar databases. The following keywords were used: "Cannabis," "Medical Marijuana," "Headache," "Cannabis and Migraine," "Cannabis and Headache." This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin. Patients suffering from migraines and related conditions may benefit from medical cannabis therapy due to its convenience and efficacy.'

https://www.cureus.com/articles/67643-medical-cannabis-headaches-and-migraines-a-review-of-the-current-literature

'Investigators assessed the use of cannabis in a cohort of 181 pain patients enrolled in Pennsylvania’s medical marijuana access program. Participants were surveyed at baseline and then again at two, four, and eight weeks.

During the course of the study, subjects experienced “a significant improvement in both pain scores and HRQoL [health-related quality of life.]” Patients also demonstrated “significant improvements” in managing their anxiety.

Authors concluded, “The results of this study show that MM[medical marijuana], when used for the treatment of pain, can be beneficial at improving a patient’s QoL [quality of life] along with alleviating their pain.”'

https://norml.org/news/2021/08/26/study-chronic-pain-patients-report-improved-quality-of-life-following-medical-cannabis-use

'Conclusion: The results show a significant improvement in HRQoL [health-related QoL] among patients using MM for pain. The EQ-5D subscales validated the pain improvement and also showed an improvement in anxiety. However, the decline in the self-care subscale may have tempered the overall improvement in HRQoL, and further research into which aspects of self-care are impacted by MM use in this population is warranted. Overall, there is a positive relationship between MM use and HRQoL in patients using it for pain. '

https://www.karger.com/Article/Abstract/517857

'The overwhelming majority of pain patients provided medical cannabis treatment report either reducing or ceasing their use of opioid medications, according to data published in the Journal of Addictive Diseases.

A team of Israeli investigators affiliated with Tel Aviv University assessed the relationship between cannabis and opioids in a cohort of patients with non-cancer specific chronic pain. All of the patients enrolled in the study were prescribed medical cannabis therapy in accordance with Israel’s medical cannabis access laws.

Among those patients who reported using opioids at baseline, 93 percent either “decreased or stopped [using] opioids following cannabis initiation” – a finding that is consistent with dozens of other studies.'

https://norml.org/news/2021/08/05/survey-over-90-percent-of-chronic-pain-patients-report-mitigating-their-use-of-opioids

'Authors reported: “Forty-three percent of the patients who had been using analgesic medications prior to MC [medical cannabis] treatment initiation were no longer using them. This was true for all classes of analgesic drugs including over the counter analgesics, non-steroidal anti-nflammatory drugs, anticonvulsants and antidepressants. As for opioid use, 24 percent and 20 percent of the participants who had been using weak or strong opioids, respectively, at baseline stopped using them by the time they reached the 12-month follow-up.”

They concluded, “This prospective study provides further evidence for the effects of medical cannabis on chronic pain and related symptoms, demonstrating an overall mild-to-modest long-term improvement of the tested measures and identifying possible predictors for treatment success.”'

https://norml.org/news/2021/08/05/study-medical-cannabis-treatment-associated-with-sustained-relief-decreased-use-of-analgesics-in-chronic-pain-patients

'Chronic inflammation is considered to be a silent killer because it is the underlying cause of a wide range of clinical disorders, from cardiovascular to neurological diseases, and from cancer to obesity. In addition, there are over 80 different types of debilitating autoimmune diseases for which there are no cure. Currently, the drugs that are available to suppress chronic inflammation are either ineffective or overtly suppress the inflammation, thereby causing increased susceptibility to infections and cancer. Thus, the development of a new class of drugs that can suppress chronic inflammation is imperative. Cannabinoids are a group of compounds produced in the body (endocannabinoids) or found in cannabis (phytocannabinoids) that act through cannabinoid receptors and various other receptors expressed widely in the brain and immune system. In the last decade, cannabinoids have been well established experimentally to mediate anti-inflammatory properties. Research has shown that they suppress inflammation through multiple pathways, including apoptosis and inducing immunosuppressive T regulatory cells (Tregs) and myeloid-derived suppressor cells (MDSCs). Interestingly, cannabinoids also mediate epigenetic alterations in genes that regulate inflammation. In the current review, we highlight how the epigenetic modulations caused by cannabinoids lead to the suppression of inflammation and help identify novel pathways that can be used to target autoimmune diseases.'

https://www.mdpi.com/1422-0067/22/14/7302

'Results: 429, 150, 98, 71, 77 and 82 patients reported fully on their MC treatment regimens at six one-month intervals, respectively. Although pain intensities did not change during the study period, analgesic medication consumption rates decreased from 46 to 28% (p < 0.005) and good Quality of Life (QoL) rates increased from 49 to 62% (p < 0.05). These changes overlapped with increase in rates of (-)-?9-trans-tetrahydrocannabinol (THC) and a-pinene high dose consumption.

Conclusion: Even though we observed that pain intensities did not improve during the study, QoL did improve and the rate of analgesic medication consumption decreased alongside with increasing rates of high dose THC and a-pinene consumption. Understanding MC treatment composition may shed light on its long-term effects.'

https://www.frontiersin.org/articles/10.3389/fphar.2021.613805/full

'Researchers with the University of California and the University of Washington surveyed 253 participants from seven pain management clinics in southern California. Participants in the study suffered from back pain, nerve pain, migraine, fibromyalgia, and other pain conditions.

Sixty-two percent of participants reported using CBD products, with over one-half of participants (91 percent) acknowledging that these products also contained THC. Subjects were most likely to inhale/smoke cannabis products, although just over half of respondents also reported using edibles and tinctures.

Twenty percent of subjects who consumed cannabis products reported experiencing “complete” relief from their pain. Thirty-nine percent of participants said that they helped “a lot.” Most subjects reported that their use of CBD-dominant products led them to reduce their use of prescription pain medicines, specifically opioids – a finding that is consistent with other studies.'

https://norml.org/news/2021/05/20/survey-pain-patients-consuming-cbd-dominant-products-report-reduced-opioid-use

'Findings: Following principles of harm reduction and risk minimization, we suggest cannabis be introduced in appropriately selected CNCP [Chronic non-cancer pain] patients, using a stepwise pproach, with the intent of pain management optimization. We use a structured approach to focus on low dose cannabis (namely, THC) initiation, slow titration, dose optimization and frequent monitoring.

Conclusion: When low dose THC is introduced as an adjunctive therapy, we observe better pain control clinically with lower doses of opioids, improved pain related outcomes and reduced opioid related harm.'

https://www.frontiersin.org/articles/10.3389/fphar.2021.633168/full

'Findings: Cannabis-based medicinal products consisting of tetrahydrocannabinol/cannabidiol (THC/CBD), in a 1:1 ratio, achieved the highest overall score, 79 (out of 100), followed by CBD dominant at 75, then THC dominant at 72. Duloxetine and the gabapentinoids scored in the 60s, amitriptyline, tramadol, and ibuprofen in the 50s, methadone and oxycodone in the 40s, and morphine and fentanyl in the 30s. Sensitivity analyses showed that even if the pain reduction and quality-of-life scores for THC/CBD and THC are halved, their benefit–safety balances remain better than those of the noncannabinoid drugs.'

https://www.liebertpub.com/doi/10.1089/can.2020.0129

'Results: The majority of the literature reviewed demonstrated the use of cannabis by adults with chronic pain resulted in better pain control and/or fewer opioids required to control pain in this population. The two articles which contradicted these findings only evaluated illicit, not medical, cannabis use by individuals with chronic pain.'

https://cornerstone.lib.mnsu.edu/etds/1102/

'Beyond identifying general reasons for using cannabis, 29% of medical consumers indicated pain among the specific medical conditions they were treating with cannabis. Medical cannabis consumers were asked whether they were prescribed specific types of medications, and whether they had replaced either some or all of those prescriptions with cannabis. For consumers indicating that they were prescribed opioids for pain management, 48% reported having replaced some of their prescribed medication with cannabis; 7% indicated replacing all of their prescribed medications. Among consumers prescribed non-opioid analgesics, 38% said they had replaced some of their prescribed medication, while 11% replaced all prescribed medications with cannabis.'

https://newfrontierdata.com/cannabis-insights/medical-cannabis-consumers-and-pain-management/

'Neuropathic pain (NP) is a major health problem that results in a high degree of suffering, physical and psychosocial impairments and exorbitant health care costs. Additionally, patients who suffer from NP experience sleep disturbances. Only a restricted number of drugs are available for treating NP associated insomnia, and side effects are common. Preclinical and clinical studies indicate that delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) possess both analgesic and hypnotic effects. However, their mechanisms of action in models of NP are not fully understood yet. In this study, for the first time, we demonstrated that animals with a NP condition also develop sleep perturbations characterized by a decrease in non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep and an increase in wakefulness. Successively, we investigated the effects of CBD and THC in both chronic pain and comorbid insomnia.'

https://escholarship.mcgill.ca/concern/theses/rn301615d

'Results
Most participants reported that using cannabis for pain management helped improve daily functioning. Some participants turned to cannabis as a supplement or periodic alternative to prescription and illicit drugs (e.g. benzodiazepines, opioids) used to manage pain and related symptoms. Nonetheless, participants' access to legal cannabis was limited and most continued to obtain cannabis from illicit sources, which provided access to cannabis that was free or deemed to be affordable.'

https://onlinelibrary.wiley.com/doi/10.1111/dar.13294

'A team of investigators affiliated with Harvard Medical School and McLean Hospital in Boston evaluated the use of cannabis in chronic pain patients over a six-month period. Most participants in the study suffered from either musculoskeletal pain or neuropathy.

Researchers reported: “Relative to baseline, following 3 and 6 months of treatment, MC [medical cannabis] patients exhibited improvements in pain which were accompanied by improved sleep, mood, anxiety, and quality of life. … Reduced pain was associated with improvements in aspects of mood and anxiety.”'

https://norml.org/news/2021/04/08/study-cannabis-associated-with-sustained-improvements-in-chronic-pain-patients

'Researchers reported that cannabis use among pelvic pain patients rose 32 percent following the legalization of marijuana in Canada. Cannabis users were more likely than non-users to be taking fewer prescription medications, including anti-inflammatory drugs and opioids – a finding that is consistent with dozens of prior studies of other patient populations.

Authors concluded: “Post-legalization, cannabis users were less likely to require daily opioids compared with cannabis users before legalization. The role, perceived benefits, and possible risks of cannabis for pelvic pain require further investigation.”'

https://norml.org/news/2021/04/08/study-fewer-patients-with-pelvic-pain-taking-opioids-following-cannabis-legalization

'Discussions
Data from this nationally representative study suggest potential anti-inflammatory effects of recent cannabis use. Additional studies that biologically measure the THC and CBD concentrations of the cannabis used and employ prospective and or experimental study designs investigate cannabis and inflammation associations are needed.'

https://www.sciencedirect.com/science/article/pii/S2666354620300740?via%3Dihub

'The NFL says it is looking for information about “alternatives to opioids in routine pain management.” The request mentions CBD but is open to research on other cannabinoids.

The request issued Wednesday also mentions research on the “impact of cannabis or cannabinoids on athletic performance.”'

https://hempindustrydaily.com/nfl-requesting-research-on-cbd-for-pain-management/

'Results:
In total, 513 patients met the inclusion criteria, of whom 248 were treated with cannabis and 265 served as controls. The cannabis-first group included 116 (46.7%) patients and the oxaliplatin-first group included 132 (53.3%) patients. Demographic parameters were comparable between groups. There was a significant difference in CIPN grade 2–3 between cannabis-exposed patients and controls (15.3% and 27.9%, respectively, p < 0.001). The protective effect of cannabis was more pronounced among cannabis-first patients compared to oxaliplatin-first patients (75% and 46.2%, respectively, p < 0.001). The median oxaliplatin cumulative doses were higher in the cannabis-first versus the oxaliplatin-first versus the control groups (545 mg/m2, 340 mg/m2, and 425 mg/m2 respectively, p < 0.001).

Conclusion:
The rate of neuropathy was reduced among patients treated with cannabis and oxaliplatin. This reduction was more significant in patients who received cannabis prior to treatment with oxaliplatin, suggesting a protective effect. A large prospective trial is planned.'

https://journals.sagepub.com/doi/full/10.1177/1758835921990203

'Analysts affiliated with CB2 Insights, a chain of medical cannabis evaluation clinics operating throughout the United States, assessed data from over 61,000 patients seeking medical cannabis evaluations in 12 states over a 17-month period (November 2018 to March 2020).

Patients seeking medical cannabis authorizations were most likely to report their primarily condition to be related to chronic pain (39 percent), followed by anxiety (14 percent) and post-traumatic stress (8 percent). Patients also frequently reported suffering from comorbid conditions for which they sought relief, including insomnia and depression.'

https://norml.org/news/2021/02/11/analysis-medical-cannabis-most-commonly-recommended-for-treating-chronic-pain-conditions

'Results
Over the 42-month period, the mean MED [morphine equivalent dose]/claim declined within public plans (p < 0.001). However, the decline in MED/claim was 5.4 times greater in the period following legalization (22.3 mg/claim post vs. 4.1 mg/claim pre). Total monthly opioid spending was also reduced to a greater extent post legalization ($Can267,000 vs. $Can95,000 per month). The findings were similar for private drug plans; however, the absolute drop in opioid use was more pronounced (76.9 vs. 30.8 mg/claim). Over the 42-month period, gabapentin and pregabalin usage also declined.

Conclusions
Our findings support the hypothesis that easier access to cannabis for pain may reduce opioid use for both public and private drug plans.'

https://link.springer.com/article/10.1007%2Fs40258-021-00638-4

'Results
Of the 1,000 patients consented, 757 (76%) participated at one or more of the study time points.

At six and 12 months, 230 (30.4%) and 104 (13.7%) of participants were followed up, respectively.

Most participants were female (62%), Caucasian (91%), and sought cannabis for pain relief (88%). Time was a significant factor associated with improvement in pain intensity (P < 0.001), pain-related interference scores (P < 0.001), QoL (P < 0.001), and general health symptoms (P < 0.001). Female sex was significantly associated with worse outcomes than male sex including pain intensity (P < 0.001) and pain-related interference (P < 0.001). The proportion of individuals who reported using opioids decreased by half, from 40.8% at baseline to 23.9% at 12 months.'

https://link.springer.com/article/10.1007/s12630-020-01903-1

'Patients authorized to use medical cannabis significantly reduce or eliminate their use of opioids over time, according to longitudinal data published in the Canadian Journal of Anaesthesia.

A team of Canadian investigators assessed self-reported opioid consumption patterns over time in a cohort of authorized medical cannabis patients who suffered from pain-related issues.

Consistent with numerous other studies, researchers reported that many subjects tapered their use of opioids following medical cannabis initiation. “The proportion of individuals who reported using opioids decreased by half” over a period of twelve months, they determined.'

https://norml.org/blog/2021/01/21/study-nearly-half-of-medical-cannabis-users-cease-using-opioids-for-pain-after-twelve-months/

'Cannabis sativa is widely used for medical purposes and has anti-inflammatory activity. This study intended to examine the anti-inflammatory activity of cannabis on immune response markers associated with coronavirus disease 2019 (COVID-19) inflammation. An extract fraction from C. sativa Arbel strain (FCBD) substantially reduced (dose dependently) interleukin (IL)-6 and -8 levels in an alveolar epithelial (A549) cell line. FCBD contained cannabidiol (CBD), cannabigerol (CBG) and tetrahydrocannabivarin (THCV), and multiple terpenes. Treatments with FCBD and a FCBD formulation using phytocannabinoid standards (FCBD:std) reduced IL-6, IL-8, C–C Motif Chemokine Ligands (CCLs) 2 and 7, and angiotensin I converting enzyme 2 (ACE2) expression in the A549 cell line. Treatment with FCBD induced macrophage (differentiated KG1 cell line) polarization and phagocytosis in vitro, and increased CD36 and type II receptor for the Fc region of IgG (Fc?RII) expression. FCBD treatment also substantially increased IL-6 and IL-8 expression in macrophages. FCBD:std, while maintaining anti-inflammatory activity in alveolar epithelial cells, led to reduced phagocytosis and pro-inflammatory IL secretion in macrophages in comparison to FCBD. The phytocannabinoid formulation may show superior activity versus the cannabis-derived fraction for reduction of lung inflammation, yet there is a need of caution proposing cannabis as treatment for COVID-19.'

https://www.nature.com/articles/s41598-021-81049-2

'Migraineurs reported significantly more migraine relief from cannabis compared to non-cannabis products, even after controlling for migraine severity (p = .03). The majority of migraineurs using cannabis to treat their migraines were not medical cardholders (65.0%), suggesting that these individuals were self-medicating in lieu of physician guidance.'

https://www.sciencedirect.com/science/article/pii/S0965229920318860

'The analysis looked at nine separate studies involving a total of 7,222 participants across the U.S., Canada and Australia that "found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by (medical cannabis) users, compared to people with no additional use of" medical cannabis.

Those studies confirm Larson’s assertion: There was a 64% to 75% reduction in opioid dosage when patients supplemented their chronic pain treatments with medical cannabis, and 32% to 59% of cannabis users reported a complete end to opioid use.'

https://www.politifact.com/factchecks/2020/nov/20/lyle-larson/studies-show-cannabis-can-lower-opioid-dosage-stud/

'Conclusion
Nearly 20% of patients suffering from rheumatologic diseases actively consume cannabis, with an improvement in pain. The issue of cannabis use in the management of these patients should be addressed during medical consultation, essentially with cannabis-based standardized pharmaceutical products.'

https://academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/keaa534/5960204

'The daily administration of plant-derived cannabis extracts significantly reduces pain and other symptoms in patients with a primary diagnosis of Burning Mouth Syndrome (BMS), according to data published in the journal Pain Medicine. BMS is a neuropathic pain condition of unknown origin that can impact the roof the mouth, as well as the tongue, gums, lips, and side of the cheeks.

A team of Italian researchers treated subjects with extracts (1 gram of cannabis in 10grams of olive oil) over a period of four weeks.

Investigators reported: “Subjects showed a statistically significant improvement over time in terms of a clinical remission of the oral symptoms. Levels of anxiety and depression also changed statistically, displaying a favorable improvement. No serious reactions were detailed. None of the patients had to stop the treatment due to adverse events.”'
-
https://norml.org/news/2020/11/05/study-cannabis-extracts-mitigate-symptoms-of-burning-mouth-syndrome/

'Authors of the study concluded: “This prospective, comprehensive and large-scale cohort demonstrated an overall mild to modest long-term improvement of all investigated measures, including pain, associated symptoms and importantly, reduction in opioid (and other analgesics) use. It seems likely that MC [medical cannabis] treatment can be safe for most patients.”'

https://norml.org/news/2020/10/29/study-medical-cannabis-use-associated-with-long-term-pain-mitigation/

'Results
1045 patients completed the baseline questionnaires and initiated MC treatment, and 551 completed the 12 month follow-up. At one year, average pain intensity declined from baseline by 20% [-1.97 points (95%CI= -2.13 to -1.81; p<0.001)]. All other parameters improved by 10-30% (p<0.001). A significant decrease of 42% [reduction of 27mg; (95%CI= -34.89 to -18.56, p<0.001)] from baseline in morphine equivalent daily dosage of opioids was also observed. Reported adverse effects were common but mostly non-serious. Presence of normal to long sleep duration, lower body mass index (BMI) and lower depression score predicted relatively higher treatment success, whereas presence of neuropathic pain predicted the opposite.

Conclusions
This prospective study provides further evidence for the effects of MC on chronic pain and related symptoms, demonstrating an overall mild to modest long-term improvement of the tested measures and identifying possible predictors for treatment success.'

https://onlinelibrary.wiley.com/doi/10.1002/ejp.1675

'What do arthritis, Multiple Sclerosis, migraines, inflammation, and psoriasis all have in common? They’re painful and sometimes debilitating medical conditions, but many of their symptoms can be treated with cannabis. Topical products can alleviate several symptoms associated with them while also improving one’s quality of life.

Not only is there medical evidence surrounding cannabinoids’ ability to help treat these conditions and their symptoms, but there’s also a significant amount of anecdotal success stories too. Read on to learn why cannabis can help relieve symptoms associated with these five conditions and the benefits of topically administered cannabis products as a primary delivery method.'

https://thefreshtoast.com/cannabis/top-five-painful-medical-conditions-topical-cannabis-products-can-relieve/

'Results
Eight individuals participated in this study. We interpreted six themes that captured the participants’ perspectives regarding their choice to, and perceptions of, using cannabis to manage SCI pain. Participants were motivated to use cannabis when other pain management strategies had been ineffective and were well-informed, knowledgeable cannabis consumers. Participants reported cannabis reduced their pain quickly and enabled them to engage in activities of daily living and participate in life roles without the drowsiness of traditional prescribed pain medication. Despite the positive aspects, participants were concerned about the irregularity of supply and inconsistent dosage.

Conclusions
Findings show that cannabis is used to reduce pain after SCI and enable increased community participation. Findings suggest that future studies examining the efficacy of cannabinoids in managing pain include function and participation outcome measures rather than solely focusing on measuring pain intensity. Focusing on meaningful outcomes may contribute to a greater understanding of the experiences of people with SCI.'

https://www.nature.com/articles/s41394-019-0227-3

'Over one-third of patients diagnosed with Ehlers-Danlos syndrome (EDS) acknowledge having used cannabis for symptom management, according to data published in the American Journal of Medical Genetics. EDS is a debilitating connective tissue disorder that results in joint pain and hypermobility.

A team of investigators affiliated with the University of Colorado, School of Medicine surveyed over 500 patients with the disease. Four hundred and eight-six respondents completed the survey.

Thirty-seven percent of respondents reported having used cannabis therapeutically. Cannabis use was more prevalent among patients who reported experiencing either moderate or severe pain. Of all of the traditional and complementary therapies used by respondents, “marijuana was self-rated as most effective.”'

https://norml.org/news/2020/09/17/survey-many-patients-with-ehlers-danlos-syndrome-acknowledge-using-cannabis-for-pain-management

'A converging line of evidence is indicating that cannabinoids may have an opioid-sparing effect. This property, well validated in preclinical studies, allow when both drugs are co-administered to reduce the dose of opioids without loss of analgesic effects. A meta-analysis of pre-clinical studies indicated in 2017 that the median effective dose (ED50) of morphine administered in combination with delta-9-tetrahydrocannabinol (delta-9-THC) is 3.6 times lower than the ED50 of morphine alone (Nielsen et al., 2017). However, very few studies have been conducted in humans to validate this effect. This narrative review provides an update on whether or not cannabinoid drugs can be used to produce an opioid sparing effect.'

https://www.sciencedirect.com/science/article/abs/pii/S027858462030381X

'"Patients with sickle cell disease and chronic pain have no real alternative to chronic opioid therapy, which has severe limitations and disadvantages," said Laura DeCastro, MD, MBBS and Pitt associate professor of medicine, director of benign hematology for the Institute for Transfusion Medicine and UPMC Hillman Cancer Center, and director of Clinical Translational Research for the Sickle Cell Disease Research Center of Excellence. "We are proud to have this opportunity to study potential cannabis treatments for these patients who live in constant debilitating pain."

"Our partnership with the University of Pittsburgh aligns with our mission of promoting well-being for all and to provide access and treatment options to communities who need it most," said Wrigley. "SCD is a devastating disease that has impacted many African American families, both medically and financially, and we are hopeful that our research partnership with Pitt will help to improve outcomes through cannabis."'

https://www.prnewswire.com/news-releases/university-of-pittsburgh-and-parallel-a-leading-cannabis-company-join-forces-in-pennsylvania-medical-marijuana-research-program-301106823.html

'A significant number of cannabinoids are known to have analgesic and anti-inflammatory properties in various diseases. Due to their prejunctional location, cannabinoid receptors can inhibit synaptic transmission and have the potential to regulate neurogenic inflammation. Neurogenic inflammation occurs when a noxious signal is detected in the periphery initiating an antidromic axon reflex in the same sensory neurone leading to depolarisation of the afferent terminal. Neuropeptides are subsequently released and contribute to vasodilation, plasma extravasation and modulation of immune cells. Endo-, synthetic and phytocannabinoids can reduce neuroinflammation by inhibiting afferent firing and inflammatory neuropeptide release. Thus, in addition to a direct effect on vascular smooth muscle and inflammatory cells, cannabinoids can reduce inflammation by silencing small diameter neurones. This review interrogates the neuropharmacological processes involved in regulating antidromic depolarisation of afferent nerve terminals by cannabinoids and the control of neurogenic inflammation in different diseases'

https://bpspubs.onlinelibrary.wiley.com/doi/abs/10.1111/bph.15208

'By contrast, the availability of pharmaceutical opioids for medical purposes declined by almost 50 per cent in North America, from 32,550 S-DDD per day per million inhabitants in 2010 to 16,910 S-DDD in 2018, thus approaching the levels reported in Western and Central Europe (12,660 S-DDD) and in Australia and New Zealand (10,530 S-DDD) in 2018. Nevertheless, per capita availability of pharmaceutical opioids for medical purposes in North America remains comparatively high (almost eight times the global average), in particular when compared with the extremely low levels in Africa and South Asia, as well as in Central Asia and Transcaucasia, where there are no signs of increases.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'In recent years the huge disparity between countries in the accessibility of opioids for medical purposes has been reduced slightly: declines in opioids available for medical consumption are reported in North America, while overall increases are reported in several other subregions, most notably South America and the Near and Middle East/South-West Asia, where availability has been low. This suggests an overall increase in the availability of opioids in developing countries, although that availability was starting from, and remains at, a low level. Daily per capita availability of pharmaceutical opioids more than doubled in the regions and subregions where availability was below the global average (i.e., Africa, Asia, South America, Central America, the Caribbean, Eastern and South-Eastern Europe, Melanesia, Micronesia and Polynesia); taken together, availability in these regions and subregions increased from an average of 70 S-DDD per million inhabitants in 2010 to 180 S-DDD in 2018 (7 per cent of the global per capita average)'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Other than opioids, non-steroidal anti-inflammatory drugs are used in patients with osteoarthritis and rheumatoid arthritis and low back pain. The efficacy of antidepressant drugs has been reported for the management of neuropathic pain, fibromyalgia, low back pain and headaches. Anti-convulsant drugs such as gabapentin, pregabalin and carbamazepine have proved effective in the treatment of chronic non-cancer pain. As part of complementary and alternative medicine, spinal manipulation is the most commonly used therapy for low back pain. Massage is another modality commonly used as a supplemental treatment for patients with chronic non-cancer pain. Similarly, evidence supports the effectiveness of acupuncture for the treatment of chronic low back pain, while results on the effectiveness of acupuncture in the reduction of pain associated with fibromyalgia and neck pain are promising. Psychological interventions such as cognitive behavioural therapy, relaxation training and hypnosis are the most commonly used techniques in the management of chronic pain. The aim of such interventions is to help the patient cope with the symptoms of pain, learn skills for adaptation and self-management, and reduce disability associated with symptoms, rather than eliminate physical causes of pain per se.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'The use of strong opioids, especially morphine, is generally considered the principal treatment for the management of pain in palliative care for cancer patients. The treatment of chronic non-cancer pain, which is among the most prevalent health conditions in many countries, is often considered more difficult to manage, and its treatment is sometimes more controversial. Chronic non-cancer pain is defined in scientific literature as pain lasting for more than three months that stems from injuries or illnesses other than cancer. It is also considered that chronic pain results from a combination of biological, psychological and social factors, and thus requires a multifactorial approach to pain assessment, patient monitoring and evaluation and long-term management. Some of the common conditions that cause chronic pain include neuropathic pain, fibromyalgia that may be caused by damage to the peripheral or central nervous system, low back pain and osteoarthritis. While opioids are used extensively in the management of non-cancer chronic pain in some countries and settings, in others, other drugs, as well as complementary and
alternative medicines, are used effectively in the management of chronic pain whether related to cancer or not.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Data also show discrepancies in the kind of pharmaceutical opioids available on the medical market. While data for North America show that hydrocodone is the most widely available pharmaceutical opioid (in terms of daily doses per inhabitant), fentanyl is the most widely available opioid in Western and Central Europe and in Australia and New Zealand. The availability for medical consumption of oxycodone is also relatively high in Australia and New Zealand and in North America. By contrast, the availability of codeine for medical consumption appears to be quite limited, although this may be a statistical artefact as most codeine is sold in the form of preparations, the sale of which – falling under Schedule III of the 1961 Single Convention – is internationally less strictly controlled and thus less well documented than the sale of other pharmaceutical opioids'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Data show that there is a generally positive correlation between gross national income and the availability of pharmaceutical opioids for medical purposes (R=0.67 over the period 2014–2018), although a number of Asian countries and territories with high gross national income per capita (such as Macao, China, Hong Kong, China, Qatar, Singapore, Japan and Kuwait) have very low levels of opioid availability for medical purposes. This suggests that the level of national income is not the only factor that explains unequal availability across countries. A number of barriers to access to opioids for pain management are related to legislation, culture, health systems and prescribing practices. '

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Even within each region or subregion, there is a significant disparity in the consumption of opioids for medical purposes. Over the period 2014–2018, average consumption of opioids in countries in North America ranged from some 100 defined daily doses for statistical purposes (S-DDD) per million inhabitants in Mexico to 32,700 S-DDD per million inhabitants in the United States of America. Similarly, in Western and Central Europe, estimates ranged from close to 500 S-DDD per million inhabitants in Malta to 25,800 S-DDD per million inhabitants in Germany. In Oceania, estimates ranged from, on average, 15 S-DDD per million inhabitants in Vanuatu to close to 11,600 S-DDD per million inhabitants in Australia, and in Asia, from 0.1 S-DDD per million inhabitants in Yemen to close to 11,300 S-DDD per million inhabitants in Israel.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Data for 2018 show that more than 90 per cent of all pharmaceutical opioids that are available for medical consumption are in high-income countries: 50 per cent in North America, around 40 per cent in Europe, mostly in Western and Central Europe, and a further 2 per cent in Oceania, mostly Australia and New Zealand. Those high-income countries comprise around 12 per cent of the global population. Therefore, low- and middle-income countries, which are home to some 88 per cent of the global population, are estimated to consume less than 10 per cent of the global amount of opioids available for medical consumption.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'The amounts available for medical consumption of some of the other synthetic opioids used in pain management have been declining over the past two decades. Pethidine is one example, with a 70 per cent decline over the period 1998–2018, while amounts available for medical consumption of dextropropoxyphene, which was very popular in the 1990s, have decreased by more than 99 per cent over the past two decades as the substance was banned in a number of countries owing to concerns over serious side effects. The amount of fentanyl available for medical consumption increased until 2010 but remained largely stable thereafter. By contrast, the amounts of buprenorphine and methadone available for medical consumption and used in the medically assisted treatment of opioid use disorders, have increased since 2014, especially of buprenorphine, which rose by more than 50 per cent over the period 2014–2018.10 However, as with other pharmaceutical opioids, there are large differences from one country to another in the consumption patterns of buprenorphine and methadone for medical purposes, as seen in the coverage of opioid-agonist treatment for people with opioid use disorders.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Access to and availability of controlled medicines for pain relief, i.e., opioids, are unequally distributed across the geographical regions and have had diverging trends in different regions. The amount of opioids (expressed in daily doses) available for consumption for medical purposes more than doubled globally over the period 1998–2010, followed by a period of stabilization and a decline over the period 2014–2018. Most of the increase in the amount of pharmaceutical opioids available for medical consumption over the period 1998–2010 was of oxycodone (which experienced a tenfold growth over that period), hydromorphone (fivefold growth), hydrocodone (threefold growth) and oxymorphone (46,000-fold growth). Methadone and buprenorphine, the opioids used in medically assisted treatment of opioid use disorders, also saw marked increases in the amounts available for medical consumption at the global level. The amount of fentanyl available for medical consumption rose ninefold over the period 1998–2010. Moreover, since 2000, only about 10 per cent of globally available morphine was reported to have been used for palliative care while over 88 per cent was converted into codeine, the majority of which (89 per cent) was used to manufacture cough medicines.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Researchers reported that 94 percent of subjects experienced symptom relief within two hours of marijuana inhalation. On average, patients experienced a reduction in symptom intensity of 3.3 points on the ten-point scale. Varieties of cannabis that contained higher THC content (above ten percent) were most closely associated with providing symptom relief.

Authors concluded: “According to the current results, cannabis flower appears to be effective at reducing headache- and migraine-related pain intensity for most people that choose to use it. … It seems possible that the use of cannabis flower, combined with other behavioral modifications, might offer some patients a natural, safer and more effective treatment regimen, compared to the use of some conventional prescription pharmaceuticals.'

https://norml.org/news/2020/07/30/study-migraine-patients-report-symptom-relief-following-herbal-cannabis-inhalation

'The top expert brought in on the case was Professor R D Teare, the professor of forensic medicine at the University of London. He ridiculed the theory that cannabis contributed to the collapse the actor suffered on May 10 or to his death on July 20. He said cannabis had been taken in various forms for centuries, and deemed it pure coincidence that shortly before the onset of Lee's collapse in May and his death he had taken cannabis. "It would be irresponsible and irrational to ascribe the causes of death to cannabis sensitivity, if over the years there had been no previous record of such a happening," the professor stated. Professor Teare said that his opinion was that the cause of death was acute cerebral edema (brain swelling) due to hypersensitvity to either meprobamate or aspirin, or possibly the combination of the two, contained in the drug Equagesic.' - The Legend of Bruce Lee by Alex Ben Block, 1974

'It is possible to detach yourself from most pain - injury to teeth, eyes, and genitals present special difficulties - so that the pain is experienced as neutral excitation. From junk sickness there seems to be no escape. Junk sickness is the reverse side of junk kick. The kick of junk is that you have to have it. Junkies run on junk time and junk metabolism. They are subject to junk climate. They are warmed and chilled by junk. the kick of junk is living under junk conditions. You cannot escape from junk sickness any more than you can escape from junk kick after a shot.' - Junky, William S Burroughs, 1977, originally published in 1953

Although evidence suggests that loneliness may increase risk for health problems, the mechanisms responsible are not well understood. Immune dysregulation is one potential pathway: Elevated proinflammatory cytokines such as interleukin-6 (IL-6) increase risk for health problems. In our first study (N = 134), lonelier healthy adults exposed to acute stress exhibited greater synthesis of tumor necrosis factor-alpha (TNF-a) and IL-6 by peripheral blood mononuclear cells (PBMCs) stimulated with lipopolysaccharide (LPS) than their less lonely counterparts. Similarly, in the second study (N = 144), lonelier posttreatment breast-cancer survivors exposed to acute stress exhibited greater synthesis of IL-6 and interleukin-1 beta (IL-1ß) by LPS-stimulated PBMCs than their counterparts who felt more socially connected. However, loneliness was unrelated to TNF-a in Study 2, although the result was in the expected direction. Thus, two different populations demonstrated that lonelier participants had more stimulated cytokine production in response to stress than less lonely participants, which reflects a proinflammatory phenotype. These data provide a glimpse into the pathways through which loneliness may affect health.
https://www.ncbi.nlm.nih.gov/pubmed/23630220/

'The announcement by the three-time Super Bowl champion instantly raised the profile of a substance that is exploding in popularity, even as questions swirl about its legality and medical effectiveness. Though Gronkowski is the latest in a long line of celebrities to promote CBD, his endorsement could signal a key moment in the drug’s evolving acceptance among sports leagues and consumers.'
https://www.bostonglobe.com/news/marijuana/2019/08/27/rob-gronkowski-announces-partnership-with-cbd-company-says-cbd-most-safe-alternative-for-pain/a5K8hCzCLuOWEm7CScdFFJ/story.html

'To date, 34 states and the District of Columbia have adopted medical cannabis laws, or MCLs, which legalize either home cultivation or dispensary-based sales of cannabis for qualifying medical conditions.

The researchers want to determine if MCLs alter the health behaviors of people living with chronic pain and whether they substitute or reduce traditional pain treatments while using medical cannabis.

The research project is funded by a $3.5 million grant from the National Institute on Drug Abuse, a branch of the National Institutes of Health.'
https://news.uga.edu/researchers-to-study-medical-cannabis-and-chronic-pain/

'It has also been submitted that while enacting the NDPS Act, the government failed to consider the medicinal benefits of the drug, including its effect as an analgesic, its role in fighting cancer, reducing nausea, and increasing appetite in HIV patients.'
https://swarajyamag.com/insta/delhi-high-court-seeks-centres-take-on-use-of-cannabis-after-a-petition-challenges-ndps-act

'Junk is a cellular equation that teaches the user facts of general validity. I have learned a great deal from using junk: I have seen life measured out in eyedroppers of morphine solution. I experienced the agonizing deprivation of junk sickness, and the pleasure of relief when junk-thirsty cells drank from the needle. Perhaps all pleasure is relief. I have learned the cellular stoicism that junk teaches the user. I have seen a cell full of sick junkies silent and immobile in separate misery. They knew the pointlessness of complaining or moving. They knew that basically no one can help anyone else. There is no key, no secret someone else has that he can give you.' - Prologue, Junky, William S Burroughs, 1977, originally published in 1953

https://www.nbcsports.com/philadelphia/nba-insider-tom-haberstroh/marijuana-and-nba-erasing-stigma-and-healing-league

'Cannabis use is increasing among those ages 65 and older, according to data published in the journal JAMA Internal Medicine.

Researchers affiliated with the New York School of Medicine assessed trends in self-reported cannabis use among seniors. They reported that 4.2 percent of seniors acknowledged engaging in past-year cannabis consumption in 2018, up from 2.4 percent in 2015 and 0.4 percent in 2006.

The study's findings are consistent with those of prior papers similarly reporting an uptick in marijuana use among older Americans. According to a 2019 study published in the journal Gerontology & Geriatric Medicine, marijuana use among seniors is associated with self-reported improvements in pain management, day-to-day functioning, and in their overall health and quality of life'
https://norml.org/news/2020/02/27/seniors-more-frequently-turning-to-cannabis

'Investigators with the Yale School of Medicine and the Medical College of Wisconsin assessed hospitalization rates among SCD patients with and without a history of cannabis use.

They reported that SCD patients who used cannabis daily had "1.8 fewer annual [hospital] admissions and 1.2 fewer emergency room (ER) visits" as compared to non-users.

Authors concluded, "We show that people with SCD with more severe pain crisis are more likely to use daily cannabis, yet have lower rates of hospital admission and ER use as compared with others with similar disease severity and pain impact."'
https://norml.org/news/2020/02/27/study-sickle-cell-disease-patients-who-use-cannabis-less-likely-to-require-hospitalization

'Moreover, many of the studies have overlooked the proliferation of fentanyl as a driver of opioid overdose mortality in the United States, which may negate any potential effect of medical cannabis on overdose deaths. It can only be concluded that additional research might help to identify a range of alternative non-opioid medications and non-pharmacological treatments that could be effective in pain management. The issue of whether increased accessibility of cannabis could reduce the medical and non-medical use of pharmaceutical opioids and their negative impact remains inconclusive.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Out of the nearly 9,000 respondents, 5 per cent reported ever using cannabis and had used opioids in the past year, among whom 43 per cent had used opioids daily and 23 per cent had used cannabis in the past 30 days. Although the results are based on a small number of respondents, of the 450 who reported ever using cannabis and past-year opioid use, 41 per cent reported a decrease or cessation of opioid use as a result of cannabis use, 46 per cent reported no change in opioid use and 8 per cent reported an increase in opioid use' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'I got a codeine script from an old doctor by putting down a story about migraine headaches. Codeine is better than nothing and five grains in the skin will keep you from being sick. For some reason, it is dangerous to shoot codeine in the vein.' - Junky, William S Burroughs, 1977, originally published in 1953

'With regard to cannabis products substituting for opioids as pain relief medication, it is considered that the analgesic effects of cannabis are not sufficiently powerful to palliate acute pain or to manage chronic pain. For example, only in very specific cases have preparations containing THC, such as dronabinol and nabiximols, been shown to be effective in the management of neuropathic pain in patients suffering from multiple sclerosis. A long-term longitudinal study among people who were prescribed opioids showed greater pain severity and pain interference (pain effects on sleep, working ability, daily living, social interactions, lower pain self-efficacy and higher levels of generalized anxiety disorder) among the 24 per cent who also used cannabis daily or less frequently than among those who did not use cannabis. Moreover, individuals who used cannabis on a near-daily basis were less likely to discontinue opioid use than participants who abstained from cannabis use' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Special Guests David Clarenbach, Benjamin Tyler, Mitch Young and Paul Armentano.

Lots of perspectives on Cannabis and Opioid Addiction.'
https://talk927fm.com/podcast/7-8-20-wiscannabis-radio/

'The percentage of chronic pain patients using cannabis therapeutically is increasing, according to data published in the journal Advances in Therapy.

Investigators affiliated with Harvard Medical School assessed trends in cannabis use among pain patients in a nationally representative sample during the years 2011 to 2015.

Authors reported, “Over the course of our study, … we identified a significant and progressive increase in the number of patients using cannabis. In patients with chronic pain, cannabis use more than doubled during this period.”

They reported that the average age of chronic pain patients who consumed cannabis was 45 and that the majority of users were lower on the socioeconomic scale than were non-users.'
https://norml.org/blog/2020/07/14/cannabis-use-rising-among-chronic-pain-patients/

'Nearly three in four licensed health care professionals in Washington state endorse the use of medical cannabis as a substitute for opioids in patients with chronic pain, according to survey data published in the journal Cannabis and Cannabinoid Research.

Researchers with the University of Washington School of Nursing surveyed a random sampling of actively licensed health care professionals legally permitted to provide medical cannabis authorizations in the state of Washington.

Of eligible respondents, 72 percent agreed with the statement, “Medical marijuana should be used to reduce the use of opioids for non-cancer pain.” Several studies [links] report that pain patients enrolled in state-sponsored cannabis access programs reduce or eliminate their use of opioid pain relievers over time.'
https://norml.org/blog/2020/07/15/survey-majority-of-health-care-professionals-endorse-cannabis-use-instead-of-opioids-in-chronic-pain-patients/

'Drug overdose deaths involving selected drug categories are identified by specific multiple cause-of-death codes. Drug categories presented include: heroin (T40.1); natural opioid analgesics, including morphine and codeine, and semisynthetic opioids, including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone (T40.2); methadone, a synthetic opioid (T40.3); synthetic opioid analgesics other than methadone, including drugs such as fentanyl and tramadol (T40.4); cocaine (T40.5); and psychostimulants with abuse potential, which includes methamphetamine (T43.6). Opioid overdose deaths are identified by the presence of any of the following MCOD codes: opium (T40.0); heroin (T40.1); natural opioid analgesics (T40.2); methadone (T40.3); synthetic opioid analgesics other than methadone (T40.4); or other and unspecified narcotics (T40.6).'
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

'An eating habit is the worst habit you can contract. It takes longer to break than a needle habit, and the withdrawal symptoms are considerably more severe. In fact, it is not uncommon for a junkie with an eating habit to die if he is cut off cold turkey in jail. A junkie with an eating habit suffers from excruciating stomach cramps when he is cut off. And the symptoms last up to three weeks as compared to eight days on a needle habit.' - Junky, William S Burroughs, 1977, originally published in 1953

'Results
At T0, neurophysiological variables did not differ significantly between patients and controls. At T1, spasticity and pain scores improved, as detected by the Modified Ashworth Scale or MAS (p=0.001), 9-Hole Peg Test or 9HPT (p=0.018), numeric rating scale for spasticity or NRS (p=0.001), and visual analogue scale for pain or VAS (p=0.005). At the same time, the CSP was significantly prolonged (p=0.001).

Conclusions
The THC-CBD spray improved spasticity and pain in secondary progressive MS patients. The spray prolonged CSP duration, which appears a promising tool for assessing and monitoring the analgesic effects of THC-CBD in MS [multiple sclerosis].'
https://onlinelibrary.wiley.com/doi/abs/10.1111/ane.13313

'Current users and PU [past users] took MC [Medical Cannabis] to address pain (65.30%), spasms (63.30%), sleeplessness (32.70%), and anxiety (24.00%), and 63.30% reported it offered “great relief” from symptoms. Participants reported that MC is more effective and carries fewer side effects than prescription medications.

Conclusions
Medicinal cannabis is an effective and well-tolerated treatment for a number of SCI[Spinal Cord injury]-related symptoms.'
https://www.nature.com/articles/s41394-019-0208-6

'The purpose of this systematic review was to explore available peer-reviewed evidence related to the use of cannabis as a potential alternative to opioids in the treatment of chronic pain. The Johns Hopkins Nursing Evidence-Based Practice model was used to review 32 peer-reviewed articles published between 2008 and 2018. Findings suggest cannabis as a promising alternative to opioids and supports the medical use of cannabis as a safer first-line pharmacological treatment for chronic pain compared to opioids. The use of cannabis as a safer alternative to opioids can promote social change directly and indirectly across a variety of social and economic dimensions due to increased access to medication at reduced cost, elimination of opioid-related death due to overdose, diminished individual and social harms related to cannabis. A medical alternative to opioids may also lead to a reduction of the inequitable incarceration of cannabis users across demographic categories of ethnicity and race.'
https://search.proquest.com/openview/a69d6774a45ea04c630c10a84ea2cc8e/1?pq-origsite=gscholar&cbl=18750&diss=y

'The bulk of tramadol seized in the period 2014– 2018 was seized in West and Central Africa (notably in Nigeria, Benin, Côte d’Ivoire and the Niger), followed by North Africa (notably Egypt, Morocco and the Sudan) and the Near and Middle East (notably Jordan and the United Arab Emirates). In some instances, countries in Western and Central Europe (notably Malta and Greece) have been used as transit countries for tramadol destined for North Africa (Egypt and Libya), although some of the tramadol seized in Europe (in particular Sweden) was also intended for the local market. For the first time ever, significant seizures of tramadol were reported in South Asia (India) in 2018, accounting for 21 per cent of the global total that year, which reflects the fact tramadol was put under the control of the Narcotic Drugs and Psychotropic Substances Act of India in April 2018.

As the full-scale scheduling of tramadol in India took place in 2018,218 and India had been the main source for (illegal) tramadol shipments, the decline in seizures outside India in 2018 may have been the result of a disrupted market. By contrast, and probably as a result of the control in India, seizures of tramadol in that country increased greatly in 2018, and thus in South Asia as a whole (more than 1,000-fold compared with a year earlier).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'When you kick the spike you get worse until you hit the third day and you think, this is it: You couldn't feel worse. But the fourth day is worse. After the fourth day relief is dramatic. And on the sixth day there is only a pale shadow of junk sickness.
But with an eating habit you can look forward to at least ten days of horrible suffering. So when you are taking a cure with hop you have to be careful not to get an eating habit. If you can't make it on schedule, best go back to the needle.' - Junky, William S Burroughs, 1977, originally published in 1953

'The 2019 drug use survey in India estimated that nearly 1 per cent of the population aged 10–75 had misused pharmaceutical opioids in the past year and that an estimated 0.2 per cent of the population (2.5 million people) were suffering from drug use disorders related to pharmaceutical opioids. Although the breakdown by type of pharmaceutical opioids misused in India is not available, buprenorphine, morphine, pentazocine and tramadol are the most common opioids misused in the country.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The non-medical use of tramadol among other pharmaceutical drugs is reported by several countries in South Asia: Bhutan, India, Nepal and Sri Lanka. In 2017, 130,316 capsules containing tramadol and marketed under the trade name “Spasmo Proxyvon Plus (‘SP+’)” were seized in Bhutan. In Sri Lanka, about 0.2 per cent of the population aged 14 and older are estimated to have misused pharmaceutical drugs in the past year. Among them, the non-medical use of tramadol is the most common, although misuse of morphine, diazepam, flunitrazepam and pregabalin have also been reported in the country. The misuse of more than one pharmaceutical drug (including tramadol) is also a common pattern among heroin users who may use them to potentiate the effects of heroin or compensate for its low level of availability. Recent seizures of tramadol suggest the existence of a market for the drug: in April and September 2018, 200,000 and 1.5 million tablets of tramadol were respectively seized by customs in Sri Lanka.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The trafficking and availability of tramadol for its non-medical use is a public health concern, but limited distribution of tramadol for medical use would also pose a public health concern, in particular in Africa, where there is a chronic shortage of pain medications. There are no data on the availability and use of tramadol for medical purposes, but data on internationally controlled substances clearly highlight the gaps in the accessibility of pain medications. The general lack of access to opioid-related pain medications under international control is a specific problem for developing countries, which is even more pronounced in countries in West and Central Africa than in other parts of the world.

Against this background of a de facto non-availability of internationally controlled opioids for pain medication for large sections of the population in West and Central Africa, tramadol – even though it is under national control in some West African countries – is in fact a widely available opioid in those countries, used for both medical purposes (including outside prescription) and for non-medical purposes' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In the Sudan, while population-based estimates of the extent of substance use are not available, research suggests that the drug scene has rapidly changed, especially with the increasing non-medical use of pharmaceutical drugs among young people, including tramadol, benzodiazepines, cough syrups and antihistamines, trihexyphenidyl, anticonvulsants and neuropathic pain agents such as pregabalin and gabapentin.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The non-medical use of tramadol is of particular concern among young people in many countries in that subregion. For example, a cross-sectional study among 300 young people in western Ghana found that while the majority (85 per cent) of respondents knew someone who misused tramadol, more than half of the young people interviewed had used tramadol themselves for non-medical purposes, and one third of the users reported misusing 9–10 doses of tramadol per day. Another qualitative study from Ghana reported curiosity, peer pressure and iatrogenic addiction as the three main factors for initiation and continuing non-medical use of tramadol, while perceived euphoria, attentiveness, relief from pain, physical energy and aphrodisiac effects were mentioned as some of the reasons for continuing non-medical use of tramadol.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'I knew that I did not want to go on taking junk. If I could have made a single decision, I would have decided no more junk ever. But when it came to the process of quitting, I did not have the drive. It gave me a terrible feeling of helplessness to watch myself break every schedule I set up as though I did not have control over my actions.' - Junky, William S Burroughs, 1977, originally published in 1953

'At the global level, Germany was the second largest consumer of opioid pain relievers, with an estimated 28,862 S-DDD per million population per day for medical use in 2017, followed by Austria, Belgium and Switzerland. In Germany, the number of pharmaceutical opioids overall and the number of people receiving opioid treatment have increased over the past few decades; in most instances, prescriptions were given for non-chronic cancer pain. A review of scientific literature from Germany published between 1985 and 2016 showed that out of the 12 studies reviewed, 6 studies reported a prevalence for patients with medical use of any opioid for long-term treatment of non-cancer chronic pain ranging from 0.54 to 5.7 per cent, while four studies reported a prevalence for patients with medical use of opioids at 0.057 to 1.39 per cent of the population' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Our findings demonstrate that THC produced robust antinociception equivalent to the whole extract in models of thermal and inflammatory nociception. Thus, other cannabinoid constituents including terpenes do not add to the analgesic actions of cannabis beyond that of isolated THC. This analgesia across several pain models suggest a range of clinical applications for THC.'
https://www.liebertpub.com/doi/10.1089/can.2018.0054

'To date, 34 states and the District of Columbia have adopted medical cannabis laws, or MCLs, which legalize either home cultivation or dispensary-based sales of cannabis for qualifying medical conditions.

The researchers want to determine if MCLs alter the health behaviors of people living with chronic pain and whether they substitute or reduce traditional pain treatments while using medical cannabis.

The research project is funded by a $3.5 million grant from the National Institute on Drug Abuse, a branch of the National Institutes of Health.'
https://news.uga.edu/researchers-to-study-medical-cannabis-and-chronic-pain/

'He reported that the patient's pain scores decreased from 8 out of 10 on the visual analog scale to 2 out of 10 following cannabis initiation. During this time, the patient also was able to "completely wean off her opioid narcotics and reported no side effects." The patient was confirmed by a drug test to still be opioid-free after six-months. The patient had previously been prescribed opioids for pain relief for a period of several years'
https://norml.org/news/2020/03/26/case-report-chronic-pain-patient-weaned-off-opioids-following-cannabis-therapy

Home grow your own cannabis to replace paracetamol and opioids...bring sustainability to your medications, the field of medicine and the planet..

'462. In connection with the therapeutics of hemp drugs, one of the commonest uses is for the relief of pain, the drugs being used either as local or general anodynes. Thus bhang poultices are frequently mentioned as soothing local applications to painful parts; and poultices are used for inflamed piles and over the seat of pain in liver and bowel diseases, and to check inflammation and erysipelas. Fumigation with the smoke from burning ganja or bhang is also used as a local sedative in piles. A small fragment of charas is placed in a carious tooth to relieve toothache. And the use of the drugs is also referred to for the relief of protracted labour pains, dysmenorrhœa, pain in the stomach, cramps, and neuralgia. One witness states that hemp drugs are used as a substitute for opium. In cases of circumcision the drugs are used as anæsthetics, and a witness mentions that native doctors on rare occasions substitute ganja for chloroform in operations. The tincture of Cannabis has been used as a local anæsthetic in extracting teeth (British Journal of Dental Science).' - CH. X. Effects - General Observations, Report Of The Indian Hemp Drugs Commission, 1893-94, https://digital.nls.uk/74464868

https://www.sciencedirect.com/science/article/abs/pii/S0955395919303706?via%3Dihub

In fact, opioids are not particularly effective for treating chronic pain; with long-term use, people can develop tolerance to the drugs and even become more sensitive to pain. And the claim that OxyContin was less addictive than other opioid painkillers was untrue — Purdue Pharma knew that it was addictive, as it admitted in a 2007 lawsuit that resulted in a US$635 million fine for the company. But doctors and patients were unaware of that at the time.
https://www.nature.com/articles/d41586-019-02686-2.

'In testing, the molecule acts as an anti-inflammatory, anti-bacterial agent that regulates mood and mitigates disease-related pain. Despite CBG’s immense benefits, many firms find it difficult to produce, given that it is rarely expressed in common cultivars.'
https://finance.yahoo.com/news/next-big-thing-cannabigerol-cbg-201851569.html

Legalize cannabis globally for pain and inflammation management so that it can be home grown by any one making it accessible and affordable to all...

'In 2018, 79 per cent of the world population, mainly persons in low- and middle-income countries, consumed only 13 per cent of the total amount of morphine used for the management of pain and suffering. Although the situation improved in the previous 20 years, the disparity in consumption of narcotic drugs for palliative care continues to be a matter of concern, particularly in relation to access and availability of affordable opioid analgesics such as morphine. The remaining 87 per cent of the total consumption of morphine, excluding preparations in Schedule III of the 1961 Convention, continued to be concentrated in a small number of countries, mainly in Europe and North America. In 2018, European countries as a whole and the United States accounted for the highest share of global morphine consumption (39.5 per cent and 39.3 per cent respectively); they were followed by Canada (5.1 per cent), Australia and New Zealand (2.5 per cent) and Japan (0.6 per cent).'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'Withdrawal symptoms are allergic symptoms: sneezing, coughing, running at the eyes and nose, vomiting, diarrhea, hive-like conditions of the skin. Severe withdrawal symptoms are shock symptoms: lowered blood pressure, loss of body fluid and shrinking of the organism as in the death process, weakness, involuntary orgasms, death through collapse of the circulatory system. If an addict dies from junk withdrawal, he dies of allergic shock.'
- Junky, William S Burroughs, 1977, originally published in 1953

Legalize cannabis globally for pain and inflammation management so that it can be home grown by any one making it accessible and affordable to all...

'In 2018, 79 per cent of the world’s population, mainly people in low- and middle-income countries, consumed only 13 per cent of the total amount of morphine used for the management of pain and suffering, or 1 per cent of the 388.2 tons of morphine manufactured world-wide. Although that was an improvement over 2014, when 80 per cent of the world’s population consumed only 9.5 per cent of the morphine used for the management of pain and suffering, the disparity in the consumption of narcotic drugs for palliative care continues to be a matter of concern'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'Codeine is the most commonly used opioid in the world. Regulation of its availability varies among countries; in New Zealand, the United Kingdom, most of Canada, and Ireland, codeine is available as an over-the-counter (OTC) preparation and is often combined with paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen. Despite its wide use, there are a number of concerns about codeine as an analgesic, with risks of prolonged misuse of OTC codeine-ibuprofen products including life-threatening complications such as gastric bleeds, renal failure, hypokalemia, and opioid dependence.

In addition to risk of serious harm, there is limited evidence for the addition of low-dose codeine (16 to 25 mg of codeine per dose) to paracetamol or ibuprofen preparations for improved pain relief. This, coupled with the known availability of effective nonopioid alternatives for pain relief, raises concerns about the place of low-dose codeine in ongoing pain management.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101496/

'Results for headache: Headache rating decreased in 89.9% of the sessions; men reported relief more frequently than did women; an average 47.3% decrease in severity was reported; a larger reduction in severity was noted with the concentrate form of cannabis (vs. flower); there appeared to be tolerance with use of the flower form.
Results for migraine: Migraine rating decreased in 88.1% of the sessions; no gender differences were noted; an average 49.6% decrease in severity was reported; concentrate and flower form of cannabis appeared equally effective; there appeared to be a pattern of dose escalation over time'

https://search.proquest.com/openview/aea6d63e8197a309cd45b4249bb57c5c/1?pq-origsite=gscholar&cbl=196259

'Access to cannabis reduces pain patients' perceived demand for opioids, according to data published in the Journal of Psychopharmacology.

A team of investigators affiliated with the John Hopkins School of Medicine assessed whether or not cannabis availability would hypothetically influence pain patients' demand for prescription opioids. One hundred and fifty-five subjects with recent experience using both opioids and cannabis for pain management participated in the survey.'
https://norml.org/news/2020/04/30/study-suggests-that-cannabis-access-reduces-opioid-demand-among-pain-patients

This also implies reduced use of opioids, benzodiazepines and analgesics...key factors in increased fatalities among men in recent years in the US..

'Among those who acknowledged using cannabis for medical purposes, 49 percent reported doing so to treat anxiety. Forty-seven percent of respondents said that they used cannabis for insomnia, 42 percent said that they did so to treat chronic pain, and 39 percent said that cannabis eased their depression.

Respondents most preferred method of cannabis ingestion was inhalation.

Women, more frequently than men, reported using cannabis to address symptoms of post-traumatic stress, insomnia, anxiety, and migraines. Men were more likely to report using cannabis as a mood stabilizer.'
https://norml.org/news/2020/04/30/survey-cannabis-often-used-to-mitigate-symptoms-of-anxiety-insomnia-and-chronic-pain

'Opium is formed in the unripe seed pods of the poppy plant. Its function is to protect the seeds from drying out until the plant is ready to die and the seeds are mature. Junk continues to function in the human organism as it did in the seed pod of the poppy. It protects and cushions the body like a warm blanket while death grows to maturity inside. When a junkie is really loaded with junk he looks dead. Junk turns the user into a plant. Plants do not feel pain since pain has no function in a stationary organism. Junk is a pain killer. A plant has no libido in the human or animal sense. Junk replaces the sex drive. Seeding is the sex of the plant and the function of opium is to delay seeding.
Perhaps the intense discomfort of withdrawal is the transition from plant back to animal, from a painless, sexless, timeless state back to sex and pain and time, from death back to life.' - Junky, William S Burroughs, 1977, originally published in 1953

'The CDC’s interest in alternative methods of chronic pain management may be of particular significance to many medical cannabis patients.

According to state-registry records, “Chronic pain is currently and historically the most common qualifying condition reported by medical cannabis patients (67.5 percent in 2016).” This finding is hardly a surprise, as cannabis is well-established to mitigate pain in clinical models, particularly in patients with neuropathy. Additional clinical trial data indicates that cannabinoids possess synergistic activity with opioids, which “may allow for opioid treatment at lower doses with fewer [patient] side effects.” Among pain patients enrolled in medical cannabis access programs, most subjects report eventually decreasing or even eliminating their use of opiates.'
https://blog.norml.org/2020/04/30/cdc-seeks-public-comments-regarding-chronic-pain-management/

Cannabis for pain management...
https://www.fic.nih.gov/News/GlobalHealthMatters/march-april-2020/Pages/pain-research-medications-drugs-low-lmics.aspx

'Ibuprofen is being recommended at doses of up to 2,400 mg/day and much more extensive use of diclofenac is being advised. Both are likely to be used for much longer periods than the 5-7 days familiar to dental practitioners. These are NSAID drugs which are safely used by dentists in healthy individuals, but in certain medical conditions it is important that dentists are aware of the serious adverse effects that they can cause. Patients with asthma, renal disease, liver disease, allergy/angioedema, peptic ulcer disease, acute cardiac and stroke risk and cardiac failure are all groups where special caution is required when using NSAID analgesics.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180648/

'Airway epithelial cells respond to both CB2 receptor-dependent and independent effects of cannabinoids. CB2 is expressed by varieties of immune cells including circulating lymphocytes, monocytes and tissue mast cells and in lymphoid tissues. Activation of CB2 receptor can suppress release of inflammatory IL-1, IL-6, IL-12 and TNF-a. Constitutive production of endocannabinoids occurs by human lung resident macrophages, which is protective in acute and chronic inflammation, mostly via CB2 receptors. Importantly, human lung resident macrophages also express both CB1 and CB2 receptors. Agonists of CB2 have been shown to inhibit TNF-a from CD14+ monocytes and M1 macrophages, and increase expression of anti-inflammatory cytokine IL-10. CB2 agonists also induce anti-inflammatory FoxP3+ regulatory T-cells (Tregs) which produce TGF-ß and IL-10. In addition, CBD has been shown to induce the differentiation of functional immunosupressive Tregs.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239000/

The other three methods, besides phytocannabinoids, mentioned in this study are low-dose thimerosal (an organomercury compound that is commonly used as a vaccine preservative), micro-dose DNA (as a pharmaceutical agent or nutraceutical), low-dose oral IFN-alpha ( a cytokine that is a known inducer of antiviral immune responses developed as a nutraceutical or injectable). So which of the four is naturally widely available, has almost zero associated cost, has least time to market, high safety profile and minimum intervention from man to be ready for global use? Consequently, which of the four is likely to be overlooked for these very same reasons?

'Phytocannabinoids derived from Cannabis sativa, such as cannabidiol (CBD) and 9-tetrahydrocannabinol (THC), have been shown to inhibit inflammatory and Th1 cytokines and/or promote anti-inflammatory and Th2 immune responses both in vitro and in vivo. As COVID-19 represents a respiratory disease with a dominant Th1 and inflammatory immune response profile, it has been postulated that cannabinoids represent a class of compounds with the potential to alleviate COVID-19 symptoms and severity by helping to decrease inflammation and restore a Th1/Th2 balance in the immune system. THC, for example, has been shown to shift the Th1/Th2 cytokine balance in human T cells to one favoring Th2 cytokines. Of particular interest was the inhibition of IFN-gamma production.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227768/

'Conclusions: MC [medical cannabis] is an effective treatment for fibromyalgia, with nearly zero % withdrawal from this treatment. The mean daily amount consumed was relatively low, less than 1 gram, and the main method of consumption was smoking with a huge variety in the frequency of smoking during the day and night among the participants. MC treatment enabled nearly half of the patients to discontinue any treatment for fibromyalgia and all participants recommended MC treatment for their loved ones in case they develop severe fibromyalgia.'
https://pubmed.ncbi.nlm.nih.gov/32431124/?dopt=Abstract

'Orthopedic surgeons specialize in the treatment of conditions involving the musculoskeletal system. They are the third highest prescribers of opioids among physicians in the United States.

Investigators reported that that the "implementation of medical THC-grade cannabis laws and patient accessibility to in-state dispensaries are each associated with significantly reduced opioid prescribing by orthopedic surgeons."'
https://norml.org/news/2020/05/28/study-orthopedic-surgeons-issue-fewer-opioid-prescriptions-following-medical-cannabis-legalization

'Hemp-derived cannabidiol (CBD) is the major non-psychoactive component of cannabis and has been promoted as a potential treatment for a wide variety of disparate inflammatory conditions. Here we evaluated CBD for its ability to modulate the production of pro-inflammatory cytokines in vitro and in murine models of induced inflammation and further validated the ability of a liposomal formulation to increase bioavailability in mice and in humans. Subsequently, the therapeutic potential of both naked and liposomally-encapsulated CBD was explored in a 4-week, randomized placebo-controlled, double-blinded study in a spontaneous canine model of osteoarthritis. In vitro and in mouse models, CBD significantly attenuated the production of pro-inflammatory cytokines IL-6 and TNF-a while elevating levels of anti-inflammatory IL-10. In the veterinary study, CBD significantly decreased pain and increased mobility in a dose-dependent fashion among animals with an affirmative diagnosis of osteoarthritis. Liposomal CBD (20 mg/day) was as effective as the highest dose of non-liposomal CBD (50 mg/day) in improving clinical outcomes. Hematocrit, comprehensive metabolic profile, and clinical chemistry indicated no significant detrimental impact of CBD administration over the four week analysis period.'
https://www.jimmunol.org/content/204/1_Supplement/67.11.abstract

'CBD consumers partake for a variety of reasons. Older consumers reported being more likely to seek pain management. Similarly, medical consumers were the most likely group to consume CBD on a daily basis, while those looking to unwind or use CBD for general wellness were less consistent in their use'
https://newfrontierdata.com/cannabis-insights/appealing-to-cbd-consumers-interests-in-the-cannabinoid/

'“Nearly 9 in 10 Americans are familiar with CBD,” the report says. Some 86% of those surveyed had heard of CBD, and a majority (55%) were interested in learning more. Younger cohorts tended to be more interested than older groups.

Three in five (60%) of consumers surveyed reported using CBD in a context that might be called “unwinding,” such as relaxation, relief of stress or anxiety reduction. The primary use, however (41%), was pain management

Oils and tinctures led the way, at 38% (of the ways in which consumers surveyed consume CBDs). Topicals were the next most widely used method, at 19%; then: food or drinks, 18%; flower, 8%; pills/capsules, 7%; and vaping, 7%.'
https://www.forbes.com/sites/joanoleck/2020/05/28/there-is-an-active-discussion-of-cbd-happening-across-the-country-says-a-new-report-and-that-spells-opportunity/

'In the literature, hemp protein products (HPPs) have reported antioxidant and anti-inflammatory properties. This study aimed to determine the inflammation-related modulatory effects of HPPs on lipopolysaccharide (LPS)-activated primary human monocytes. CD14+ cells were immunomagnetically isolated from buffy coats and the anti-inflammatory activity of hemp protein isolate (HPI) and hydrolysates (HPHs) was evaluated on LPS-stimulated human primary monocytes. The specific markers of inflammation, polarization, and chemoattraction were measured by RT-qPCR and ELISA assays. Our results showed that HPPs decreased the pro-inflammatory mediators (TNF-a, IL-1ß, and IL-6) and increased the anti-inflammatory mediators (IL-10 and IL-4). In addition, M1 polarization marker gene expression (CCR7 and iNOS) was downregulated by HPPs and, M2 polarization marker gene expression (CD200R and MRC1) was upregulated. Finally, the mRNA expression of chemotaxis genes (CCR2 and CCL2) was downregulated by HPPs. In conclusion, this study suggests that HPPs may improve chronic inflammatory states and promote regenerative processes by reprogramming monocytes toward M2 polarization phenotype'
https://www.mdpi.com/2218-273X/10/5/803

'Results: Ninety-six cancer patients (mean age 60.0y (±13.9); 41 (42.7%) males) had at least one follow-up (FUP) and were included in the study. The main cancer types were breast (19.8%), lung (9.4%) and colorectal (9.4%). Adverse events (top three: drowsiness, low energy and nausea) were reported in 28% of patients, with 9% having to stop MC [medical cannabis]. Mean Brief Pain Inventory scores significantly improved between baseline, FUP-2 and FUP-3 for worst pain (5.4± SEM 0.3 vs 4.3±0.3 and 3.7±0.4) and average pain severity (4.2±0.2 vs 3.2±0.3 and 3.2±0.4). Anorexia improved (3.4±0.3 vs 2.2±0.4 and 1.7±0.4), as measured via the revised Edmonton Symptom Assessment System (ESAS-r). ESAS-r wellbeing improved significantly between baseline and FUP-1 (4.4±0.2 vs 3.7±0.2). Between baseline and each FUP, approximately a third of patients dropped their use of concurrent medications (including analgesics, antidepressants and anxiolytics), as measured by the Medication Quantification Scale. Conclusions: The CPP data support the safety and effectiveness of MC as a complementary option for improving pain control, appetite and quality of life in SCC.'
https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.12106

'A team of Israeli researchers assessed characteristics in 181 medical cannabis patients with fibromyalgia. Qualified patients may legally access state-regulated medical cannabis products in Israel.

After initiating cannabis therapy, 51 percent of subjects either "reduced the dose or the number of medications" that they took to treat fibromyalgia-related symptoms. Nearly half of the study's participants reported ceasing their use of prescription medications altogether'
https://norml.org/news/2020/06/04/study-fibromyalgia-patients-reduce-or-eliminate-their-prescription-drug-use-following-cannabis-therapy

'Results: A total of 145 patients (97 females, 67%) with a median MC treatment duration of three years were analyzed. Compared to non-responders, responders (n = 89, 61%) reported lower current migraine disability and lower negative impact, and lower rates of opioid and triptan consumption. Subgroup analysis demonstrated that responders consumed higher doses of the phytocannabinoid ms_373_15c and lower doses of the phytocannabinoid ms_331_18d (3.40 95% CI (1.10 to 12.00); p < 0.01 and 0.22 95% CI (0.05–0.72); p < 0.05, respectively). Conclusions: These findings indicate that MC results in long-term reduction of migraine frequency in >60% of treated patients and is associated with less disability and lower antimigraine medication intake. They also point to the MC composition, which may be potentially efficacious in migraine patients. '
https://www.mdpi.com/2076-3425/10/6/360

'A team of Israeli researchers assessed the impact of prolonged cannabis use (median treatment duration = three years) on the frequency of monthly migraine attacks.

The majority of subjects (61 percent) in the cohort reported a greater than 50 percent reduction in monthly migraine attacks following the initiation of cannabis therapy. Those patients who responded favorably to cannabis treatment also reported reducing their anti-migraine medication intake, particularly their use of opioids and tryptamine-based drugs.'
https://norml.org/news/2020/06/18/study-prolonged-cannabis-treatment-associated-with-reduced-migraine-frequency

'Results
Medical cannabis treatment was associated with improvements in pain severity and interference (P < 0.001) observed at one month and maintained over the 12-month observation period. Significant improvements were also observed in the SF-12 physical and mental health domains (P < 0.002) starting at three months. Significant decreases in headaches, fatigue, anxiety, and nausea were observed after initiation of treatment (P = 0.002). In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses (P < 0.0001), while correlates of pain were significantly improved by the end of the study observation period.

Conclusions
Taken together, the findings of this study add to the cumulative evidence in support of plant-based medical cannabis as a safe and effective treatment option and potential opioid medication substitute or augmentation therapy for the management of symptoms and quality of life in chronic pain patients.'
https://academic.oup.com/painmedicine/advance-article-abstract/doi/10.1093/pm/pnaa163/5859722

'Patients who were taking opioids prior to their enrollment in the study reduced their daily drug intake over the trial period – a finding that is consistent with those of other longitudinal studies, such as those here, here, and here. Investigators observed initial reductions in patients’ opioid consumption at three months. Patients further reduced their opioid intake at six months and again at twelve months.

Authors concluded, “Taken together, the results of this study add to the cumulative evidence in support of plant-based MC (medical cannabis) as a safe and effective treatment option and potential opioid substitute or augmentation therapy for the management of chronic pain symptomatology and quality of life.”'
https://norml.org/news/2020/06/25/study-cannabis-associated-with-reduced-opioid-use-prolonged-benefits-in-pain-patients

'At the same time, more than 80% of the world’s population, mostly living in low- and middle-income countries, are deprived of access to controlled drugs for pain relief and other essential medical uses.' - Ghada Waly, Executive Director, United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'Medicines for pain relief are unequally distributed across regions. More than 90 per cent of all pharmaceutical opioids available for medical consumption were in high-income countries in 2018. Some 50 per cent were in North America, 40 per cent in Europe, and a further 2 per cent in Oceania. Those countries are home to about 12 per cent of the global population. Low- and middleincome countries, which are home to 88 per cent of the global population, are estimated to consume less than 10 per cent of pharmaceutical opioids.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'Researchers affiliated with the Jefferson Headache Center at Thomas Jefferson University in Philadelphia evaluated the efficacy of marijuana use for patients with migraines. Patients used cannabis as needed over a nine-month period.

Investigators reported that cannabis therapy was associated with a reduction in patients’ use of other anti-migraine medications. A majority of patients also reported reductions in anxiety and improvements in sleep. On a scale of one to ten, 20 percent of subjects rated marijuana’s efficacy in treating migraine as a ten.'
https://norml.org/news/2020/07/02/study-migraine-patients-self-report-improvement-following-cannabis-initiation

'Results: On average, 95.8% of users experienced symptom relief following consumption with an average symptom intensity reduction of –3.76 points on a 0-10 visual analogue scale (SD = 2.64, d = 1.71, p <.001). Symptom relief did not differ by labeled plant phenotypes (“C. indica,” “C. sativa,” or “hybrid”) or combustion method. Across cannabinoid levels, tetrahydrocannabinol (THC) levels were the strongest independent predictors of symptom relief, while cannabidiol (CBD) levels, instead, were generally unrelated to real-time changes in symptom intensity levels. Cannabis use was associated with some negative side effects that correspond to increased depression (e.g. feeling unmotivated) in up to 20% of users, as well as positive side effects that correspond to decreased depression (e.g. feeling happy, optimistic, peaceful, or relaxed) in up to 64% of users. '
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309674/

'Ninety percent of those currently using cannabis for pain management said that it provided either moderate or significant relief and 40 percent of subjects reported having decreased their consumption of other analgesic medications following their initiation of cannabis therapy. Pain patients most frequently reported consuming products high in CBD rather than THC.'
https://norml.org/news/2020/07/09/survey-one-in-five-patients-report-using-cannabis-products-for-musculoskeletal-pain

'The situation is particularly complex for the opioids group, as both legally and illegally produced substances satisfy the non-medical demand for opioids. While illegally produced opiates, such as heroin, used to dominate the non-medical demand for opioids, the illicit opioid markets in many countries have become far more diversified over the past two decades, with a number of pharmaceutical opioids that have started to cover a substantial part of the market for opioids for non-medical purposes.

This is creating an additional challenge for drug use prevention because, unlike the traditional hard drugs such as heroin, pharmaceuticals are often not perceived as harmful. In terms of drug control, this requires a careful equilibrium between maximizing accessibility for medical use while minimizing availability for non-medical use. It should be noted that the use of pharmaceuticals for non-medical purposes is not limited to opioids. There is also a substantial market for stimulant pharmaceuticals for non-medical use, particularly in Latin America and the Caribbean' - United Nations Office on Drugs and Crime, World Drug Report 2020,
https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Results: Adding cannabis to first-line therapy was incrementally less effective and costlier than adding cannabis to second-line and third-line therapies. Third-line adjunctive cannabis was subject to extended dominance, that is, the second-line strategy was more effective with a more favorable incremental cost-effectiveness ratio of $48,594 per QALY gained, and therefore, third-line adjunctive cannabis was not as cost-effective. At a modest willingness-to-pay threshold of $100,000/QALY gained, second-line adjunctive cannabis was the strategy most likely to be cost-effective.

Conclusion: As recently proposed willingness-to-pay thresholds for the United States health marketplace range from $110,000 to $300,000 per QALY, cannabis appears cost-effective when augmenting second-line treatment for painful neuropathy.

Further research is warranted to explore the long-term benefit of smoked cannabis and standardization of its dosing for chronic neuropathic pain.'
https://www.liebertpub.com/doi/10.1089/can.2018.0027

'This NHL season began with the best player in the world asking, why wouldn't you look into the benefits of marijuana?

"I say this more talking about the CBD side of it, obviously: You'd be stupid not to at least look into it," Edmonton Oilers star Connor McDavid told The Associated Press in a preseason interview. "When your body's sore like it is sometimes, you don't want to be taking pain stuff and taking Advil all the time. There's obviously better ways to do it. ... You're seeing a lot of smart guys look into it. You're seeing a lot of really smart doctors look into it. If all the boxes are checked there and it's safe and everything like that, then I think you would maybe hear them out."'
http://www.espn.in/nhl/story/_/id/26046596/is-nhl-future-marijuana-pro-sports-why-be

'The first bulk batch of medical cannabis imported into the U.K. since it was legalized for prescription last year has arrived from the Netherlands.

The shipment, exported by the Office of Medical Cannabis, will be sent directly to pharmacies to provide to patients under prescription for treating conditions including chronic pain and multiple sclerosis, according to a statement from British startup Grow Biotech. The company said it worked with investor European Cannabis Holdings and pharmaceutical importer IPS Specials to facilitate the delivery.'
https://www.bloomberg.com/news/articles/2019-02-15/the-u-k-just-got-its-first-bulk-shipment-of-medical-cannabis

'We analyzed state registry data to provide nationwide estimates characterizing the qualifying conditions for which patients are licensed to use cannabis medically. We also compared the prevalence of medical cannabis qualifying conditions to recent evidence from the National Academies of Sciences, Engineering, and Medicine report on cannabis’s efficacy in treating each condition. Twenty states and the District of Columbia had available registry data on patient numbers, and fifteen states had data on patient-reported qualifying conditions. Chronic pain is currently and historically the most common qualifying condition reported by medical cannabis patients (64.9 percent in 2016). Of all patient-reported qualifying conditions, 85.5 percent had either substantial or conclusive evidence of therapeutic efficacy. As medical cannabis use continues to increase, creating a nationwide patient registry would facilitate better understanding of trends in use and of its potential effectiveness.'
https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05266

'In the ESPN survey, 61 percent of players said that if cannabis were a legal option, fewer players would take powerful pain-killing injections of drugs like Toradol. Toradol is the most common anti-inflammatory taken by players, so much so that 64 percent of the survey’s respondents said they have had at least one injection of it or another painkiller.

41 percent of players surveyed thought cannabis would control pain more effectively than Toradol, as cannabis has less known side effects than the painkiller. Of the main side effects – becoming addicted to the drug – is common in the NFL. 42 percent of the players surveyed said they’ve known a teammate who become addicted to chemical painkillers.'
https://www.leafly.com/news/politics/espn-survey-23-of-nfl-players-say-cannabis-would-cut-painkiller-use

'The trick with any topical, though, is to make sure there’s a high dosage of CBD in there. While supplemental ingredients can be helpful, CBD is the proven anti-inflammatory consumers are looking for. With new CBD products entering the market every day, potency and quality can make one product stand out from another.'
https://www.leafly.com/news/health/how-cbd-salves-can-help-ease-muscle-pain

'For any topical preparation to be effective it should be able to reach the site of action and elicit a pharmacological response. There are a number of considerations to be made in this regard these include physical-chemical properties of the drug and stability of the formulation among others. Topical cannabis has potential as a therapeutic option for local inflammation in peripheral tissue however, more research needs to be conducted to establish the most suited formulation, standardize the cannabinoid content that will be effective as well as determine disease states in which these formulations will be applicable. A ‘fix all’ formulation does not exist however, the search for alternative and/or better treatment options is what the pharmaceutical community is constantly striving for.'
https://www.researchgate.net/profile/Nakamwi_Akombaetwa2/publication/330338113_A_brief_review_on_the_use_of_cannabis_as_a_treatment_option_for_local_inflammation_in_peripheral_tissue/links/5c39cc9c92851c22a36f8a54/A-brief-review-on-the-use-of-cannabis-as-a-treatment-option-for-local-inflammation-in-peripheral-tissue.pdf

'TD famously broke into the league as an immediate superstar in 1995 ... rushing for more than 6,000 yards in his first 4 seasons.

But, a knee injury ultimately sapped him of his prime years ... forcing him to play in just 17 games in his final three seasons and retire at just 29 years old.

Now ... Davis tells us if CBD was around back then -- he's confident his career would have been saved.

"I believe so, because any time you can help your body heal -- you can take out the swelling, the inflammation and you can do it in a way that's natural -- I feel like absolutely it would have assisted in that."'
https://www.tmz.com/2019/01/24/terrell-davis-nfl-denver-broncos-cbd-knee-injury/

'These results suggest that binding of delta9-THC to the CB1 receptor is involved in the synergism with pentobarbital, and that potentiating effect of CBD with pentobarbital may differ from that of delta9-THC. We successfully demonstrated that delta9-THC enhanced the anesthetic effect of pentobarbital through the CB1 receptor.
https://link.springer.com/article/10.1007%2Fs11419-018-0457-2

Entourage effect...

'Curiously, the terpenoids seemed to mitigate inflammation through a different mechanism than cannabinoids.

“Different chemotypes of cannabis have a distinctive composition of terpenoids,” the researchers wrote. “These essential oils do have anti-inflammatory and antinociceptive activities that vary according to their composition, but they had no effect on TNFa titers [antibodies].”'
https://www.marijuanamoment.net/terpenoids-in-marijuana-also-help-reduce-inflammation-new-study-finds/

'The results, published in the Journal of the International Association for the Study of Pain, showed a significant increase in pain tolerance among patients who vaporized the two varieties high in THC. The researchers found that the high CBD strain was “devoid of analgesic activity in any of the spontaneous or evoked pain models.”'
https://www.marijuanamoment.net/study-reveals-how-marijuana-components-thc-and-cbd-affect-chronic-pain/

And yet, there are so many people saying there is no evidence of the effectiveness of marijuana in opioid abuse and harm reduction...

'A 2018 study by the RAND Corporation found that states permitting medical marijuana dispensaries saw decreased rates of opioid addiction and overdose. Researchers at the University of Michigan School of Public Health reported in 2016 that chronic pain patients who used medical cannabis reduced their use of opioids by 64 percent. A June 2017 University of California, Berkeley study reported that medical cannabis enabled 97 percent of chronic pain patients to decrease the amount of opioids they were taking, and that 81 percent found cannabis alone more effective than cannabis and opioids in combination. A 2018 study of Medicare Part D patients by researchers at the University of Georgia found a decreased rate of opioid use for the control of pain in states where medical cannabis was legally available. A 2018 report from the University of Kentucky on a study of all Medicaid fee-for-service and managed care patients across the United States from 2011 to 2016 found a decrease in opioid prescribing in states where medical marijuana was legally available, with an even greater reduction in states where both medical and recreational marijuana were available.'
https://www.cato.org/publications/policy-analysis/harm-reduction-shifting-war-drugs-war-drug-related-deaths#full

The world is in pain...unsustainable development in the pursuit of wealth at the cost of nature has led the world down a most painful path...in the process we have removed a most effective plant for natural pain management. Time to bring back the herb to heal ourselves and nature...

'America is in pain. In fact, according to the National Institutes of Health, among all U.S. adults, nearly 40 million (17.6%) report suffering from severe pain, while about 25.3 million (11.2%) complained of experiencing daily pain throughout the previous three months. Chronic pain is more than an uncomfortable nuisance: People coping with severe pain had worse health, used more health care resources, and experienced more disability than other adults.'
https://newfrontierdata.com/marijuana-insights/cannabis-and-the-medical-consumer/

'A total of 133 patients were identified between Jan 2017- May 2017. (M/F) 65/68; median age of 53 (range 20 - 84). Nineteen percent (25/133) had a cancer diagnosis. Pain core improved in 80 % of patients with cancer and in 75% (64/89) of non-cancer patients (x2 0.24 p = 0.62). ODR was achieved in 41% (54/133) of all patients on MC. Of these, 63% (34/54) had a 25% ODR and 37% (20/54) had 26% or more ODR (x2 12.8 p = 0.002). In cancer patients, a 25% ODR was achieved in 73% (x2 0.51 p = 0.771). All patients (15/15) using MC and high dose opioid (morphine equivalent = 50 mg/day) had some ODR. Co-adjuvant NSAIDs with MC improved pain score in 67% of all cases vs 33% among non-NSAID cohort (x2 10.7 p = 0.001). ODR was achieved in 32% of patients with active depression vs 68% of patients without (x2 0.044 p = 0.83).'
http://ascopubs.org/doi/abs/10.1200/JCO.2018.36.34_suppl.189

'We suggest that MM[Medical Marijuana] allowed patients to improve their pain relief and thereby reduce admission rates. This is consistent with data showing cannabinoid agonists improve pain in murine models of SCD [Sickle Cell Disease]. Larger, randomized and controlled studies of MM for pain in SCD should be conducted.'
http://www.bloodjournal.org/content/132/Suppl_1/858

'Studies have demonstrated that cannabinoids “reduce intestinal motility, gastric acid secretion, and nausea” and also “improve pain control, reduce inflammation, and increase appetite,” according to the review, which was published in the American Journal of Surgery last week.

“Cannabinoids including THC and CBD have widespread effects on the body. These effects are particularly notable in the intestinal tract, where cannabinoids slow down intestinal transit, reduce inflammation, and reduce gastric acid secretion. Other systemic effects include increasing appetite, and reducing nausea and vomiting.”'
https://www.marijuanamoment.net/two-new-studies-reveal-how-marijuana-can-treat-different-kinds-of-pain/

'Cannabinoid drugs may prevent the onset of pain by producing small increases in pain thresholds but may not reduce the intensity of experimental pain already being experienced; instead, cannabinoids may make experimental pain feel less unpleasant and more tolerable, suggesting an influence on affective processes. Cannabis-induced improvements in pain-related negative affect may underlie the widely held belief that cannabis relieves pain.'
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2701671

'Yesterday, the Regulations Review Committee of the General Assembly approved a new condition for our state’s Medical Marijuana Program. The condition is Chronic Neuropathic Pain Associated with Degenerative Spinal Disorders.'
https://portal.ct.gov/DCP/News-Releases-from-the-Department-of-Consumer-Protection/2018-News-Releases/New-Condition-Approved-for-Medical-Marijuana-Program

'Cannabis is a topical analgesic. Until 1937, virtually all corn plasters, mustard plasters, muscle ointments, and fibrosis poultices were made from or with cannabis extracts. Rheumatism was treated throughout South America until the 1960s with hemp leaves and/or flower tops heated in water or alcohol and placed on painful joints. In fact, this form of herbal medicine is still widely used in rural areas of Mexico, Central and South America, and by California Latinos for relief of rheumatism and arthritis pain.' - The emperor wears no clothes by Jack Herer

'Chronic pain was the most common reason for use of medicinal cannabis, consistent with the statistics of most registries. Identifying differences in use patterns between migraine, headache, arthritis, and chronic pain syndromes may be helpful in optimizing crossbred cannabis strains, synergistic biochemical profiles, or dosing differences between these pain subsets. The majority of patients treating headache with medicinal cannabis were positive for migraine (88%) according to the ID Migraine™ questionnaire. This suggests that most headaches being treated with medicinal cannabis were likely of migrainous pathophysiology.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968020/

If I understand this article correctly, a person who prefers using marijuana to control pain, when admitted to a medical care center for injury, is treated against her wishes with opioid painkillers at higher quantities than normal because marijuana cannot be legally administered according to federal laws. The lack of availability of marijuana as a painkiller option rather than the prior use of marijuana is what makes the injury more painful?

'The findings may seem surprising at first, because some studies suggest that marijuana use can help with certain types of pain, such as chronic pain. But Wagner noted that the marijuana helps only if patients can take it, and because the drug is still illegal at the federal level, hospitals typically cannot allow patients to take it.'
https://www.livescience.com/62851-marijuana-trauma-injury-recovery.html

' Sixty-four percent of all practicing pain specialists in Israel responded. Almost all prescribe cannabis. Among them, 63% find cannabis moderately to highly effective, 56% have encountered mild or no side effects, and only 5% perceive it as significantly harmful. Common indications are neuropathic pain (65%), oncological pain (50%), arthralgias (25%), and any intractable pain (29%). Leading contraindications are schizophrenia (76%), pregnancy/breastfeeding (65%), and age <18 years (59%). Only 12% rated cannabis as more hazardous than opiates. On a personal note, 45% prefer cannabis for themselves or a family member. Lastly, 54% would like to see cannabis legalized in Israel.'
https://www.dovepress.com/personal-experience-and-attitudes-of-pain-medicine-specialists-in-isra-peer-reviewed-fulltext-article-JPR#

'marijuana use was associated with less pain and better lower extremity activity rating scale scores when compared to non-users'
https://link.springer.com/article/10.1007%2Fs00264-018-4101-x

'Our findings indicate that the use of Trokie® lozenges is associated with a self-reported pain reduction in chronic, non-cancer pain patients, a condition for which the efficacy of cannabis has been previously described. Of note, reported time to onset was between 5 and 40 min which, considering lozenges take 20–25 min to dissolve, seems consistent with, at least partial, buccal absorption.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6102350/

'As expected, a high percentage of patients (94%) reported pain relief; the impact on sleep, a major problem among fibromyalgia patients, was similar, making cannabis a versatile remedy. It also improved depression and anxiety, though in a lower percentage of patients. All these effects make cannabis very appealing to fibromyalgia patients.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081591/

'Notwithstanding limitations, this is the first published CEA (cost-effectiveness analysis) of inhaled cannabis for any condition. The results of our analysis indicate that should long-term consequences and efficacy be similar to what has been observed in published trials, smoked medicinal cannabis is a useful tool from a cost-effectiveness perspective for the treatment of chronic neuropathic pain. Judicious use of medicinal cannabis alongside standard therapy agents may be particularly beneficial to patients with refractory pain and to active cannabis users. Our findings are concordant with clinical experience and published guidelines that recommend consideration of cannabis for patients nonresponsive to initial treatment.'
https://www.liebertpub.com/doi/full/10.1089/can.2018.0027

'Of the 1,800 people surveyed, more than two-thirds listed relaxation and pain relief as their main reason for consumption.'
https://newfrontierdata.com/marijuana-insights/canadians-find-comfort-cannabis/

'Assyrian manuscripts from the second millennium BCE recommended cannabis to “bind the temples,” and Ayurvedic preparations in the third and fourth centuries BCE were indicated for “diseases of the head” such as migraines. The prescription of cannabis was even recommended in ancient Greece, with Pedanius Dioscorides describing its use in his De Maternia Medica as a treatment for “pain of the ears.” Other citations documenting the use of cannabis for headache disorders arise from the ninth century in the Al-Aq-rabadhin Al-Saghir, the earliest known document of Arabic pharmacology.Further recommendations are found in Persian texts from the 10th and 17th centuries.Prominent physicians of the Middle Ages, including John Parkinson and Nicholas Culpeper, also recommended the use of cannabis for headache.

The reintroduction of cannabis to the West in 1839 began a century of its use as an effective treatment for headache disorders until its illegalization in 1937.Notable physicians who espoused the benefits of cannabis for headache disorders included John Russell Reynolds, the personal physician of Queen Victoria, American neurologist Silas Weir Mitchell, the president of the New York Neurological Society Edouard C. Seguin, William Gowers, a founding father of modern neurology,and Sir William Osler, often considered the father of modern medicine'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436334/

'The New York State Assembly is considering a bill to add dysmenorrhea — the medical name for menstrual cramps — to the list of conditions for which doctors can legally authorize a patient to use medical marijuana. Under the state's law, only patients with the specific medical conditions named in the law can access medical marijuana in New York, according to Newsweek. Cancer, HIV and multiple sclerosis are among the conditions already on the list.'
https://www.livescience.com/59370-marijuana-period-cramps-dysmenorrhea.html

'Under the new rules, those suffering chronic pain, severe epilepsy or nausea as a result of chemotherapy could be prescribed the drug by specialist doctors, this newspaper understands.'
https://www.telegraph.co.uk/politics/2018/10/06/medical-cannabis-available-prescription-within-month/

'Three principle findings emerge from our analysis. First, active state medical marijuana laws lead to lower pain and better self-assessed health among older adults. Second, state medical marijuana laws lead to increases in older adult labor supply, with effects concentrated on the intensive margin. Third, the effects of MMLs are largest among older adults with a health condition that would qualify for legal medical marijuana use under current state laws. Findings highlight the role of health policy in supporting work among older adults and the importance of including older adults in assessments of state medical marijuana laws.'
https://onlinelibrary.wiley.com/doi/abs/10.1002/pam.22122

'• Results for headache: Headache rating decreased in 89.9% of the sessions; men reported relief more frequently than did women; an average 47.3% decrease in severity was reported; a larger reduction in severity was noted with the concentrate form of cannabis (vs. flower); there appeared to be tolerance with use of the flower form.

• Results for migraine: Migraine rating decreased in 88.1% of the sessions; no gender differences were noted; an average 49.6% decrease in severity was reported; concentrate and flower form of cannabis appeared equally effective; there appeared to be a pattern of dose escalation over time'
https://search.proquest.com/openview/aea6d63e8197a309cd45b4249bb57c5c/1?pq-origsite=gscholar&cbl=196259

'"Marijuana and its compounds show promise for treating a wide-range of diseases and disorders, including pain management," the legislation's findings section reads. "Medical marijuana in States where it is legal may serve as a less harmful alternative to opioids in treating veterans."'
https://www.forbes.com/sites/tomangell/2018/09/05/senate-bill-legalizes-medical-marijuana-for-military-veterans/#7ad9074072a5

'The agency should study medical marijuana use to treat post-traumatic stress disorder and chronic pain. Passage of Walz’s VA Medicinal Cannabis Research Act would kick-start that work.'
http://www.startribune.com/hearing-on-veterans-suicide-was-too-important-to-be-overlooked/495098781/

'Fentanyl exported from China to the United States comes in several different forms: fentanyl, its precursor chemicals, fentanyl variants, and fentanyl-laced counterfeit prescription opioids. India exports many controlled and prescription drugs to the United States, including fentanyl. Indian fentanyl exports to the United States are a fraction of those from China, but India does export tramadol, which is a growing issue for the United States. However, unlike China, which has now designated over 100 fentanyl variants and precursors on its list of controlled substances, India has not placed fentanyl, or most other opioids, on its controlled substances list, easing production and export. India only regulates 17 of the 24 basic precursor chemicals for fentanyl (as listed by the UN 1988 Convention against Drugs). In the Middle East and Africa, the less potent opioid tramadol, not fentanyl, is responsible for the opioid crisis. India is the biggest supplier.'
https://www.csis.org/npfp/dangerous-opioid-india

'Tramadol is not on the international drug schedule, or a controlled substances list that mandates regulation, under the World Health Organization (WHO) and so individual countries’ attempts to regulate it often fail. For example, Egypt first scheduled tramadol in 2002 because of growing tramadol use, but since tramadol was not on the international drug schedule, India was not obligated to notify Egypt of an upcoming tramadol export. Thus, Indian exports to Egypt continued to rise and tramadol is the most abused drug in Egypt today. Egypt’s National Council on Fighting and Treating Addiction reported in 2013 that 30 percent of adults abused drugs.'
https://www.csis.org/npfp/dangerous-opioid-india

'One potential reason India does not regulate tramadol, or other opioids, is the lack of domestic concern about addiction. However, India does have addiction problems, and India’s Home Minister Shri Rajnath Singh specifically acknowledged that tramadol addiction is a growing problem.16 Yet, the government acknowledgement has not been sufficient; government corruption plays a role with the pharmaceutical corporations, wholesale exporters, and internet companies responsible for the illicit flow of opioids out of India. In their 2017 report on corruption, Transparency International found that India had the highest bribery rates across the Asia Pacific region.1'
https://www.csis.org/npfp/dangerous-opioid-india

'In fact, opioids are not particularly effective for treating chronic pain; with long-term use, people can develop tolerance to the drugs and even become more sensitive to pain. And the claim that OxyContin was less addictive than other opioid painkillers was untrue — Purdue Pharma knew that it was addictive, as it admitted in a 2007 lawsuit that resulted in a US$635 million fine for the company. But doctors and patients were unaware of that at the time.
https://www.nature.com/articles/d41586-019-02686-2

'Cultural differences between Europe and North America probably also contribute to the regions’ differing fortunes with opioids. Large-scale surveys show that there is a similar prevalence of pain in France and Italy as there is in the United States3. But according to data from the United Nations, US doctors write five and a half times more prescriptions for opioids than do their counterparts in France, and eight times more than do physicians in Italy. Humphreys says that this might be because people in the United States expect to receive a prescription when they go to the doctor with a health concern. Meanwhile, direct advertising of pharmaceuticals to consumers (permitted only in the United States and New Zealand) encourages them to ask doctors for specific drugs.'
https://www.nature.com/articles/d41586-019-02686-2

'The opioid epidemic has had three phases: the first was dominated by prescription opioids, the second by heroin, and the third by cheaper — but more potent — synthetic opioids such as fentanyl. All of these forms of opioid remain relevant to the current crisis. “Basically, we have three epidemics on top of each other,” Humphreys says. “There are plenty of people using all three drugs. And there are plenty of people who start on one and die on another.”'
https://www.nature.com/articles/d41586-019-02686-2

'Codeine is the most commonly used opioid in the world. Regulation of its availability varies among countries; in New Zealand, the United Kingdom, most of Canada, and Ireland, codeine is available as an over-the-counter (OTC) preparation and is often combined with paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen. Despite its wide use, there are a number of concerns about codeine as an analgesic, with risks of prolonged misuse of OTC codeine-ibuprofen products including life-threatening complications such as gastric bleeds, renal failure, hypokalemia, and opioid dependence.

In addition to risk of serious harm, there is limited evidence for the addition of low-dose codeine (16 to 25 mg of codeine per dose) to paracetamol or ibuprofen preparations for improved pain relief. This, coupled with the known availability of effective nonopioid alternatives for pain relief, raises concerns about the place of low-dose codeine in ongoing pain management.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101496/

'Codeine is an opiate used to treat pain, coughing, and diarrhea. Serious side effects may include breathing difficulties and addiction. A potentially serious adverse drug reaction, as with other opioids, is respiratory depression. This depression is dose-related and is a mechanism for the potentially fatal consequences of overdose. Codeine works following being broken down by the liver into morphine; how quickly this occurs depends on a person's genetics. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.'
https://en.wikipedia.org/wiki/Codeine

'About 70 percent of morphine is used to make other opioids such as hydromorphone, oxymorphone, and heroin. Potentially serious side effects include decreased respiratory effort and low blood pressure. Morphine is addictive and prone to abuse.A large overdose can cause asphyxia and death by respiratory depression if the person does not receive medical attention immediately. One poor quality study on morphine overdoses among soldiers reported that the fatal dose was 0.78 mcg/ml in males (~71 mg for an average 90 kg adult man) and 0.98mcg/ml in females (~74 mg for an average 75 kg female). It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. According to a 2005 estimate by the International Narcotics Control Board, six countries (Australia, Canada, France, Germany, the United Kingdom, and the United States) consume 79% of the world's morphine. The less affluent countries, accounting for 80% of the world's population, consumed only about 6% of the global morphine supply'
https://en.wikipedia.org/wiki/Morphine

'Although evidence suggests that loneliness may increase risk for health problems, the mechanisms responsible are not well understood. Immune dysregulation is one potential pathway: Elevated proinflammatory cytokines such as interleukin-6 (IL-6) increase risk for health problems. In our first study (N = 134), lonelier healthy adults exposed to acute stress exhibited greater synthesis of tumor necrosis factor-alpha (TNF-a) and IL-6 by peripheral blood mononuclear cells (PBMCs) stimulated with lipopolysaccharide (LPS) than their less lonely counterparts. Similarly, in the second study (N = 144), lonelier posttreatment breast-cancer survivors exposed to acute stress exhibited greater synthesis of IL-6 and interleukin-1 beta (IL-1ß) by LPS-stimulated PBMCs than their counterparts who felt more socially connected. However, loneliness was unrelated to TNF-a in Study 2, although the result was in the expected direction. Thus, two different populations demonstrated that lonelier participants had more stimulated cytokine production in response to stress than less lonely participants, which reflects a proinflammatory phenotype. These data provide a glimpse into the pathways through which loneliness may affect health'
https://www.ncbi.nlm.nih.gov/pubmed/23630220/

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