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Palliative Care

Palliative care aims to relieve symptoms and stress in multiple domains with the goal to improve overall quality of life (QOL). In 2017–18, there were 45,561 palliative care and 34,371 other end-of-life care hospitalisations reported from public acute and private hospitals in Australia, totalling 79,932 palliative care-related hospitalisations.

Typical symptoms in patients living with serious illness include pain, fatigue, nausea, vomiting, dyspnea, anorexia, and cachexia, among others. Some cancer patients have been shown to benefit from cannabis as a palliative treatment to relieve pain, lack of appetite, nausea symptoms, or sleep problems¹.

The role of cannabinoids in pain management is based on the current understanding of the endocannabinoid system (ECS) and its putative role in pain modulation². Cancer pain may result from nerve injury, mechanical invasion of pain-sensitive structures, and inflammation³.

Cannabinoid 1 (CB1) and cannabinoid 2 (CB2) receptors are well-studied components of the ECS⁴. CB1 receptors are found on peripheral nerve terminals, and elevated levels are found in areas of the brain that regulate nociceptive processing.

The most compelling data to support cannabis use for pain management is for neuropathic pain⁵. In 2020 however the American Academy of Neurology (AAN) position statement on medical marijuana “recognizes that medical marijuana may be useful in treating neurological disorders” and associated symptoms such as pain but also calls for rigorous research to evaluate long-term safety and efficacy of medical marijuana and its compounds.

Cannapacific’s affiliate e3D Pharma’s scientific team and their research partners are extending on the current state of research using novel pain signalling models and novel cannabinoid formulations to develop state of the art, safe and effective cannabinoid based medicines for the treatment of Palliative care pain.

¹ B. Schleider, R. Mechoulam, V. Lederman, M. Hilou, O. Lencovsky, O. Betzalel, L. Shbiro, V. Novack, Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer., Eur J Intern Med. 2018 Mar;49:37-43

² Katona I, T.F. Freund, Endocannabinoid signalling as a synaptic circuit breaker in neurological disease. Nat. Med. 2008;14:923-930

³ Maresz, E.J. Carrier, E.D. Ponomarev, C.J Hillard, B.N. Dittel Modulation of the cannabinoid CB2 receptor in microglial cells in response to inflammatory stimuli, J Neurochem. 2005 Oct;95(2):437-45.

⁴ Z. Shenglong, K.Ujendra, Cannabinoid Receptors and the Endocannabinoid System: Signaling and Function in the Central Nervous System, Int J Mol Sci. 2018 Mar; 19(3): 833

P.F. Whiting, R.F. Wolff, S. Deshpande, M. Di Nisio, S. Duffy, A.V. Hernandez, J.C. Keurentjes, S. Lang, K. Misso, S. Ryder, S. Schmidlkofer, M. Westwood, J. Kleijnen., Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313(24):2456–73

Post Traumatic Stress Syndrome (PTSD)

PTSD is the second most common mental health disorder in Australia affecting ~ 10% of Australians in their lifetime⁶. In the USA PTSD affects 7.7 million adults, or 3.5% of the U.S. population⁷. Post deployment 10-20% of US Military experience PTSD often with associated depression and drug abuse⁸

PTSD is a chronic disorder which can have a devastating impact, with greater risk of suicidality, addiction and depression, family breakdown, unemployment and physical health concerns associated with chronicity.

Thirty plus years of research has established trauma-focused cognitive behaviour therapy, as the first-line treatment for PTSD. Despite robust evidence of efficacy, current exposure treatments have major limitations as drop-out rates are up to 30%⁹, there is a pressing need for adjunct therapy and increasing interest in pharmaceutical interventions without the serious side effects.

The USA National Academy of Science review in 2017 concluded that while additional research is needed symptoms of anxiety, nightmares and poor sleep were found to be improved using cannabis or cannabinoid treatments¹⁰

A 2019 systematic review (Orsolini et.al.)¹¹
on the use of Medicinal Cannabis and Synthetic Cannabinoids in Port Traumatic Stress Disorder concludes that current literature suggests that cannabis and cannabinoids may have a role in the treatment of PTSD, though there is limited evidence regarding safety and efficacy.

Researchers from the University of Melbourne and University of Tasmania (Ney et.al 2019)¹² similarly concluded that cannabinoids are a promising method for pharmacological treatment of PTSD. The article outlines the strengths and challenges of different cannabinoids treatments accessible to psychological researchers interested in cannabinoid therapeutics.

Researchers in Denmark and Brazil (Silote et.al 2019)¹³ delved further into the pharmacology of cannabidiol (CBD) discussing emerging evidence for the antidepressant effect of cannabidiol noting CBD induces cellular and molecular changes in brain regions relating to depression neurobiology such as increased Brain Derived Neurotrophic Factor (BDNF). Growing animal and human translational research reveals an important role for BDNF in fear extinction and Fear extinction has important translational potential as fear extinction learning is thought to be the key mechanism underlying exposure therapy for PTSD.

Cannapacific’s affiliate e3D Pharma’s scientific team and their research partners are extending on the current state of research and developing state of the art, safe and effective cannabinoid based medicines for the treatment of PTSD.

⁶ Australian Centre for Posttraumatic Mental Health. (2013). Australian Guidelines for the treatment of Acute Stress Disorder and Posttraumatic Stress Disorder. Victoria, 2013

⁷ https://adaa.org/about-adaa/press-room/facts-statistics

⁸ Bradley, R., Green, J., Russ, E, Dutra, L., Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-27

⁹ https://www.publichealth.va.gov/epidemiology/studies/new-generation/ptsd.spa

¹⁰ National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press. doi:10.17226/24625.

¹¹ L.Orsolini, S. Chippini, U. Volpe, D. De Berardis, R. Latini, G.D. Papanti, J.M. Corkery., Use of Medicinal Cannabis and Synthetic Cannabinoids in Port Traumatic Stress Disorder: A Systematic Review., Medicina (Kaunas). 2019 Sep; 55(9): 525.

¹² L.Ney, A.Matthews, R. Bruno, K.L. Felmingham., Cannabinoid interventions for PTSD: Where to next?., Prog Neuropsychopharmacol Biol Psychiatry. 2019 Jul 13;93:124-140.

¹³ G.P. Silote, A. Sartim, A. Sales, A. Eskelund, F.S. Guimaraes, G. Wegner, S. Joca., Emerging Evidence for the antidepressent effect of cannabidiol and the underlying mechanisms., J Chem Neuroanat. 2019 Jul;98:104-116.


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