How the International Cannabis and Cannabinoid Institute started: THE ICCI
SOURCE: THE ICCI
- With specific reference to Parkinson’s Disease (please read to the end of this blog for the link to the full Review).
An undeniable global interest in the study of cannabis treatments inspired the creation of the International Cannabis and Cannabinoid Institute (ICCI), the first Center of Excellence in this field located in the heart of Europe – Czech Republic. ICCI identifies, coordinates and supports global research priorities for the advancement of cannabis and cannabinoid treatments through a multidiscipline, evidence-based approach that incorporates innovative tools and methods.
Review of Contemporary Knowledge of the Treatment Effects of Cannabis and Related Products and Its Outlook:
Tomáš Zábranský, Lumír Hanuš, Richard Rokyta
1) International Cannabis and Cannabinoids Institute, Prague
2) Hebrew University in Jerusalem, Israel
3) Department of Normal, Pathological and Clinical Physiology, 3rd Faculty of Medicine, Charles University in Prague
4) Společnost pro léčbu konopím a kanabinoidy a jejich výzkum, z.s. [Czech Society for Medical Treatment with Cannabis
and Cannabinoids and Their Research]
Aim: To briefly review recent knowledge about the evidence-based use of medical cannabis and its derivatives. Tools: A selective review of clinical trials and relevant literature reviews and meta-analyses focusing primarily on the medical use of cannabis and phytocannabinoids. Results: A substantial part of the clinical research into the treatment effects of cannabis still suffers from several methodological and technical issues. Despite the relatively long history of medical research on cannabis and on substances isolated from the cannabis plant, only a relatively small number of sound clinical trials have been published. The gaps in clinical knowledge are caused, inter alia, by the administrative scheduling of cannabis and its major compounds into the United Nations Schedule/s of the most dangerous and least medically useful regulated drugs; this obsolete scheduling of cannabis and cannabinoids still remains effective, even though it is 55 years since the 1961 Single Convention on Drugs came into effect. The research on the treatment effects of the whole plant is further complicated by the fact that it contains at least 1,252 different chemical compounds. Many of them interact with each other and only within this interaction do they affect the human organism. Such a situation is difficult to analyze fully even with all the steadily-growing computing power available for recent research. Despite all the limitations, it is safe to summarize that medical cannabis and products made from it are safe drugs of choice for very common symptoms of highly prevalent diseases: (i) mid-severe and severe chronic pain, (ii) spasticity related to neurodegenerative and post-traumatic disorder, and (iii) the treatment of nausea and vomiting – be it a symptom of the disease itself or of its aggressive (chemo- and/or radiotherapeutic) treatment. Evidence of somewhat lower quality exists supporting the effectiveness of medical cannabis for the treatment of (iv) Parkinson’s disease, (v) inflammations in
general, including the idiopathic inflammatory bowel diseases and Crohn’s disease, (vi) post-traumatic stress disorder (PTSD), and (vii) Tourette syndrome. Despite the wide publicity, only very limited scientific evidence exists on the effectiveness of cannabis and cannabinoids (CBD in particular) for the treatment of extremely frequent seizures occurring in refractory epilepsies among very young children (e.g., Dravet syndrome). There are high hopes that the known anti-tumor activity of cannabis and its direct effects on immunity and other homeostasis mechanisms will be successfully used for causal (curative) treatment of a wide array of diseases in the foreseeable future. However, there is not enough clinical evidence available to allow the introduction of cannabis-based medications for causal treatment; the cases of reportedly successful treatment are mostly published by patients and their healers, and are not verifiable by scientific methods.
Conclusion: When assessed in accordance with the principles of Evidence-Based Medicine (EBM), cannabis and its derivatives are safe and effective treatment agents for highly prevalent symptoms: pain, spasticity, vomiting, and nausea. While further research on isolated endo-, phyto-, and synthetic cannabinoids can widely use the standard research methods, successful studies of the effects of the whole plant (and its “entourage effect”) would most probably require novel scientific methodologies and designs reflecting a somehow different scientific paradigm.
Current reviews of the effectiveness of medical cannabis and its derivatives for treatment
– Moderate evidence for their effectiveness for (v) sleep disorders, (vi) stimulating appetite, especially in the context of chemotherapy, (vii) fibromyalgia, (viii) post-traumatic stress disorder, and (ix) certain signs of Parkinson’s disease;
– The prestigious German medical journal Ärzteblatt International, in an article from 2013 , summarizes the results of more than a hundred controlled clinical trials using medical cannabis and its derivatives. It concludes, “Today there exists clear (scientific) evidence about the fact that cannabinoids are effective for a series of medical conditions.” The German review summarizes the state of knowledge especially for the treatment of spasticity, nausea, and vomiting in consequence of chemotherapy, weight loss/loss of appetite, and chronic pain. It also mentions small and successful randomized controlled clinical trials for bladder dysfunction for patients with multiple sclerosis, tics in Tourette syndrome, and levodopa-induced tremor of Parkinson’s disease.
– In terms of other neurological diseases, an oral extract from cannabis is probably ineffective for the treatment of levodopa-induced dyskinesia in Parkinson’s Disease.
Detailed analysis of selected pathological conditions and effects of cannabis and its derivatives with weaker clinical evidence and a strong theoretical basis favoring effectiveness
This disease, whose symptoms especially include a decrease in the number of dopaminergic neurons in the basal ganglia (“BG”), is, because of its high prevalence (especially among older patients) and the simultaneous existence of endocannabinoid receptors in the BG system, often cited as a potential aim
of therapy with cannabis [61, 62].
It is also known that oftentimes patients themselves experiment with
cannabis for treatment – e.g., in an anonymous questionnaire from the Movement Disorders Center of the Clinic of Neurology of the 1st Medical Faculty and General Teaching Hospital, Charles University in Prague, up to 25% of the patients who responded mentioned experimenting with cannabis, and nearly
half of them claimed there had been a subjective improvement of their condition .
However, there exist relatively few clinical trials on this topic and they exhibited mixed results.
A well-known study from 2004 did not prove any statistically significant improvement in consequence of using an oral extract from cannabis for levodopa-induced dyskinesia in 17 Parkinson’s disease patients ; on the contrary, a new study 10 years later involving 22 patients  identified significant improvement on the Unified Parkinson’s Disease Rating Scale 30 minutes after smoking cannabis, and it also found statistically significant improvement among specific motor symptoms of the type – tremors, rigidity, bradykinesia, and others, and, moreover, without serious side effects.
Chagas et al. experimented for Parkinson’s disease with pure CBD; their most thoroughly elaborated study on 22 patients did not find by objective measuring any statistically significant differences between the placebo group and the groups with the doses of 75 mg and 350 mg daily; differences, however, were found in their perceived quality of life .
Though there exists a theoretical basis supporting the effectiveness of cannabis and/or substances derived from it for alleviating symptoms of Parkinson’s disease, there still exist few quality clinical trials with a sufficient number of patients which reliably verify such effectiveness. According to Barnes and Barnes (2016), it is possible to consider as merely limited the clinical evidence supporting the effectiveness of cannabis and its derivatives for treating Parkinson’s disease and/or its symptoms. Trials with pure CBD need not be completely relevant as the entourage effect (see
Discussion) is not reflected in their designs.
Cannabis and its derivatives constitute, in line with the principles of Evidence-based Medicine, safe and effective treatment for widespread pathologic symptoms: pain, loss of appetite, vomiting, and spastic conditions. Weaker evidence in terms of quality and quantity exists for its use to treat the symptoms of Parkinson’s disease, Tourette syndrome, the treatment of dementia among the elderly (especially Alzheimer’s disease), epilepsy (especially frequent [not reacting to other treatment] childhood epilepsy), insomnia and other sleep disorders, fibromyalgia, post-traumatic stress disorder, anxiety, and certain other maladies. Much hope is held about the potential of medical cannabis and its derivatives for (causal) treatment of a series of diseases, among which clearly the ones most discussed by laypersons and professionals alike are the various types of cancer. While other clinical research on isolated endo-, phyto-, and synthetic cannabinoids can and will continue to use the standard battery of research designs determined primarily for research on intermolecular interaction with the organism, it is highly probable that studying the effects of the entire plant will require a shift in the research paradigm in order to take into account the complex “entourage effect” both for symptomatic and for causal treatment. Although since the spring of 2013 a relatively favorable legislative environment has existed in the CR for treatment by cannabis in a relatively wide range of indications, Czech medicine and the state administration have not yet been able to tap into this potential to at least approach the level in the most advanced countries in the field. Thus, in the CR, the vast majority of lege artis indicated patients are flocking towards illegal sources of cannabis of unknown quality, with all the legal and health risks accompanying such behavior exhibited in the name of one’s health. This is caused not least by the low level of attractiveness of cannabis and its derivatives for large pharmaceutical companies as the major sponsors of pharmacological research; the authors of this review believe that these are just the kinds of cases where states and supranational non-commercial structures should and must enter into play, as the purpose of their existence and primary aim is not and cannot be to generate profit, but rather the wellness of citizens and fulfillment of their human rights, including the right to health and quality of life.
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62. Fernandez-Ruiz J, Romero J, Ramos JA. Endocannabinoids and Neurodegenerative Disorders: Parkinson’s Disease, Huntington’s Chorea, Alzheimer’s Disease, and Others. Handb Exp Pharmacol. 2015;231:233-59
63. Venderova K, Ruzicka E, Vorisek V, Visnovsky P. Survey on cannabis use in Parkinson’s disease: subjective improvement of motor symptoms. Mov Disord. 2004;19(9):1102
66. Chagas MH, Zuardi AW, Tumas V, Pena-Pereira MA, Sobreira ET, Bergamaschi MM, et al. Effects of cannabidiol in the treatment of patients with Parkinson’s disease: an exploratory double-blind trial. J Psychopharmacol. 2014;28(11):1088-98