Here’s an Interesting Chronic Pain Study

From a university up in Montreal, Canada. There are several aspects to it I find interesting.

The first is, this wasn’t a ‘mouse being injected with Marinol’ type study. This was whole plant cannabis smoked by human beings. Three different potencies and a placebo were used. I’m not sure if I find it ironic or simply amusing that NIDA supplied the placebo. Ironically amusing?

Second; the dose — 25 milligrams (of one of the four) was administered three times a day, for five days. It took me about five minutes to flash on the amount. Folks, 25 milligrams is 25 thousandths of a gram. I know you know that but I thought I’d point it out anyway. I’m having a hard time imagining what 25 milligrams of cannabis looks like. That’s miniscule, man. Miniscule.

Thirdly, given the dosage, I was surprised by the results. Using the old numbered pain chart scale the subjects reported a drop of  point 7. Yeah, I know that doesn’t sound like much but, for a person that’s tormented with chronic pain almost a point means something (‘sides, remember the size of the dose). Secondarily the patients reported falling asleep more easily. If I recall correctly there was only one person that had a sensation of feeling high. I find that surprising; that someone got stoned on 25 milligrams of cannabis, that is.

The study has been published by CMAJ Research in a PDF format. It’s got cool charts and everything! I’m not sure what the hell some of them are telling me, but still… I’ve merely glossed over it here. If you would care to take a gander yourself, place your cursor over the “25 mg” below and depress the left side of your mouse… or something. 

25 mg

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7 Comments

  1. Glen Ropella said,

    September 22, 2010 at 5:22 pm

    The link didn’t work for me; but this one did:

    http://www.cmaj.ca/cgi/rapidpdf/cmaj.091414v1.pdf

  2. capndrift said,

    September 22, 2010 at 7:16 pm

    Thanks, Glen.
    Hopefully it’s a “runner” now.

  3. gepr said,

    October 16, 2013 at 1:15 pm

    Sorry for putting this here. I’ve forgotten your e-mail address.

    I’ve been hearing this criticism of medical marijuana: It’s not a medication because there is no associated dosage for it. These people don’t argue that it (usually the cannibinoids) doesn’t have a medical (or medicinal) use, only that it’s unlike every other “drug” your doctor might prescribe for you.

    I’ve been trying to find other prescription drugs that don’t have associated dosages. Any FDA approved drug has, at least, recommended dosages. And although there are many drugs prescribed and sold without FDA approval, they usually still have dosages because they’re used in other countries and whatnot.

    So, I’m at a bit of a loss for how to argue with these people. They are right that the weed you buy off the street won’t come with any sort of accurate dosage info. But I suspect most of the dispensaries will have some dosage info and there are some studies that recommend dosages. So, how do you argue with the people who fixate on this “no dosage” argument?

    Thanks.

    • capndrift said,

      October 16, 2013 at 4:57 pm

      No, that’s fine. This is great place for that discusion. Though it be a bit of the can ‘o worms ☺

      In the “FDA World” many drugs have a level where they are effective and a level beyond where they become downright toxic. And, no, I don’t care to jump into the “toxicity of pharmaceuticals” in general. Thank you.

      I have a bottle of Vicodin sitting over there that reads, “Take one tablet three times a day as needed…more than 4GM/day may harm liver.”

      The prescribed dose is as needed, up to three pills. But it also warns me should I exceed the prescribed dose (by a bunch) I could turn yellow. Why the warning? The prescribed dose is well below the ‘liver threshold.’ Is the implication, should I have a terribly bad day I just might, could, exceed those three pills? And that’s okay, but at 4GM I might break something?

      Is the prescribed dose then a “recommendation?”

      I generally take less than the prescribed dose of Vicodin.

      I also take Metoprolol for my blood pressure. One in the morning and one at night. Every morning and every night. I don’t decide my blood pressure feels good so I don’t need the pill. I take them. Every morning and every night.

      With the Metoprolol I don’t defer to my “discretion.” With the Vikes I damned sure do.

      Cannabis is kind of like the Vikes, not the Metoprolol – Vikes and the Metoprolol both being FDA approved pharmaceuticals.

      I smoke cannabis (’bout half a joint a day, unless I’m also taking more Vicodin ☺), I use a cannabis topical, and I take a cannabis capsule every other night.

      I’ve had to adjust the capsules myself. First it was the ‘load’ in the caps. When I first began making them I was waking up stoned (literally). I take them at night just before bed. I changed the quantity and type of material in the caps. That stopped the morning issue, but I was experiencing an accummulative effect -over the period of several weeks.

      It was while in discussion with my PCP (not a pot doc, my regular general practitioner) she asked if the “dose” was affecting me during the day. I replied sometimes I simply felt lost. Things weren’t quite right. She suggested I take the caps every other night.

      Bingo.

      So, between both myself and my doc we managed to come up with a “dose” designed for me. Me. Not you, him, or her. Me.

      Kind of like the Vicodin.

      The damned fly in the ointment though, is there are a shitload of variables when it comes to whole plant cannabinoid administration. The plant, the patient…

      The dosage is, what works.
      Kind of like the Vicodin.
      Only, if I screw up and OD on the cannabis, I won’t turn yellow. I’ll just take a long nap. Or be whacked out.

      Truth be told (being completely honest here) there is no standard dose. Each and every individual medicinally using cannabis is their own guinea pig. Dose of what?

      And that didn’t help at all, did it?

      Ask them to define “dosage.” When they go off about standards asked if those standards are based upon efficacy. And then ask if their question isn’t a bit circular. Just a suggestion, mind you.

      And no, it’s not like any other drug a doc might prescribe (at this time). That question, in and of itself, is a red herring, strawman, whatever.

      The answer is, what works.

      • capndrift said,

        October 17, 2013 at 7:45 am

        And to pontificate a tad more (or (possibly) clarify); “what works” really is a dose. I mean in the certified medical field.

        When a pharm. outfit develops a drug obviously they’ve some part or portion of the biology/physiology targeted. After the molecules are assembled (drug formulated) they go into testing.

        Tested typically starts out in vitro (Petri dish) and then move to in vivo (murine and human studies). It’s during the testing the dose is realized. If the dose toxicity isn’t an issue and the amount is effective, BINGO!

        But because organic systems tend to be unique in and among themselves a ‘dose’ is typically a range.

        Above I mentioned the beta blocker Metoprolol. It was prescribed when my high blood pressure was discovered (it’s also prescribed off-label). I’m guessing my doctor is aware of my inability to tolerate many pharmaceuticals. Hell, OTC cold medicine screws with me. She started me on a low dose.

        I take 25mg in the morning and 25mg at night. That dose keeps my pressure within reason. Now go take a look at the manufacturer’s recommended dose. Here, I’ll help; it’s 100mg to 450mg daily. I take 1/2 of the minimum recommended dose! And it works.

        Cannabis is unique in dosing because a person can’t ingest enough to fatally overdose. Cannabis is a ‘drug’ without a meaningful LD50. Along with the Metoprolol I mention Vicodin in the above comment. The bottle reads that 4,000mg can be a toxic amount. Over the counter NSAIDS have lethal doses. Hell, the LD50 of caffeine is 192mg per kilo.

        So, with cannabis there is no maximum allowable dose. There’s no point at which liver and kidney…any organ becomes at risk. I suppose a max dose would be where efficacy has been reached and ingesting any more wouldn’t further the result. The maximum ‘effective dose.’

        Just like the Vicodin and Metoprolol, my effective dose of cannabis isn’t the same as the next person.

        Again, I’ll state a person claiming cannabis is not a medication because there is no associated dosage for it is either purposely making a hollow argument, or they simply don’t know what “dose” means.

        There, I hope that helps.

  4. gepr said,

    October 17, 2013 at 9:59 am

    Excellent! Both those replies give me a bit more ammo with which to challenge him. For context, there’s one guy in particular, who currently (and repeatedly) making this argument in front of me. He is an “addiction counselor”. He’s been wrong about a huge number of things he’s said and has never responded when I point out the errors. (E.g. he claimed that psychiatrists were not MDs… he insisted, over and over. So, I confirmed that it wasn’t just a slip.) So, it wouldn’t surprise me if he were simply ignorant and glommed onto this dosage thing without thinking about it.

    In any case, my choice would be to present him with a version of what you’ve said above, perhaps more concise, and leave it up to him to ignore or think about it. I had made the “as needed” part of the argument before, since I was recently prescribed some anti-nausea meds to counteract my chemo. All three of those have “as needed” on the prescription. But he still claimed that those meds have standards for quality control, so that each and every pill contains exactly what I think it contains.

    With your analogy to vicodin, I think I can eliminate everything except the “source” issue. And as long as your dispensary/provider/gardening is controlled, there should be no medical difference between cannabis and vicodin.

    Thanks.

    • capndrift said,

      October 17, 2013 at 1:24 pm

      “But he still claimed that those meds have standards for quality control, so that each and every pill contains exactly what I think it contains.”

      Yeah, I’m bored today AND I find the ‘conversation’ interesting.

      Anything you buy from the shelf or at the counter (I’m talking pharmacy) is going to have the mg or IU or whatever listed. In this case ‘dose’ being the consistent content of each capsule, pill, drop, whatever. If that criteria is necessary for a compound to be called medicine then I think it’s very narrow. Hell, I don’t find it valid.

      Cannabis, as I use it, is a home remedy. I won’t argue it isn’t.

      Merriam-Webster defines medication thusly: a substance used in treating disease or relieving pain.

      So then, a dose is relative to a medication, but ‘dose’ is not a requirement for something to be a medication. Yes?

      I sort of equate my cannabis administration to willow bark tea in a way. I’m sure you’re aware the active ingredient in Aspirin is nothing more than a synthesized compound found in the tree.

      So, is the tea not medicine because the ‘dose’ a person might take is a couple of cups or so? Where the pill is medicine because each contains 325 mg of acetylsalicyclic acid?

      Hogwash.

      The material I use to treat my malady isn’t a medication, but this is? http://www.gwpharm.com/Sativex.aspx

      Bullpucky.

      It appears to me your friend just likes to argue. And his modus operandi is splitting hairs finer than those found on a gnat’s ass.
      And as you wrote above, when he gets a bit of poop on his fingers he just wipes it off.

      Thanks for dropping in, gepr. Stop by anytime. Hey, bring your friend! ☺


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