Paregoric Kid
05-09-2007, 03:28 PM
this post is my attempt to gather all relevant information on cannabis' effects with opiates/opioids.
Several studies have found that cannabinoids have analgesic effects in animal models, sometimes equivalent to codeine.25-29 Cannabinoids also seem to synergize with opioids, which often lose their effectiveness as patients build up tolerance. One study found morphine was 15 times more active in rats with the addition of a small dose of THC. Codeine was enhanced on the order of 900 fold.30
In 1990, researchers conducted a double-blind study comparing the antispasmodic and analgesic effects of THC, oral Codeine, and a placebo on a single patient suffering from a spinal cord injury.31 Their findings confirmed the analgesic effects of THC being "equivalent to codeine." A 1997 study made similar findings related to morphine.32
A 1999 article reviewing the body of scientific animal research concerning the analgesic effects of marijuana concludes that "[t]here is now unequivocal evidence that cannabinoids are antinociceptive [capable of blocking the appreciation or transmission of pain] in animal models of acute pain."33
In addition to it's analgesic properties, the IOM Report indicates that cannabis, like its synthetic cousin Marinol, can help treat the nausea often induced by opiate therapy, especially when other antiemetics prove ineffective.
25. Karst M et al (2003). Analgesic Effect of the Synthetic Cannabinoid CT-3 on Chronic Neuropathic Pain A Randomized Controlled Trial. JAMA. 290:1757-1762. 26. Richardson J et al (1998). Cannabinoids Reduce Hyperalgesia and Inflammation via Interaction with Peripheral CB1 Receptors. Pain. 75(1): 111-119.
27. Meng I et al (1998). An analgesic circuit activated by cannabinoids. Nature 395 381-383. http: //www.nature.com/cgitaf/DynaPage.taf?file= /nature/journal/v395/n670.../395381a0_r.htm
28. Klarreich E (2001). Cannabis spray blunts pain: Early trials suggest cannabis spritz may give relief to chronic pain sufferers. British Association for the Advancement of Science. 4 Sept.
29. Callahan R (1998). "How Does Marijuana Kill Pain?" Associated Press, October 4. http: //www.mapinc.org/drugnews/v98/n868/a07.html
30. Welch SP, Eads M (1999). Synergistic interactions of endogenous opioids and cannabinoid systems. Brain Res. Nov. 27;848 (1-2): 183-90.
31. Maurer et al. (1990). Delta-9-tetrahydrocannabinol Shows Antispastic and Analgesic Effects in a Single Case Double-Blind Trial. European Archives of Psychiatry and Clinical Neuroscience 240:1-4
32. Holdcroft, A., op cit.
33. Martin WJ (1999). Basic Mechanisms of Cannabinoid-Induced Analgesia. International Association for the Study of Pain Newsletter, Summer. p. 89.
34. Cookson C (2001). High Hopes for Cannabis to Relieve Pain. British Association Science Festival in Glasgow, Financial Times, September 4, at National News pg. 4.
there are a few studies that show marijuana to be helpful at alleviating withdrawal symptoms. "Lichtmann et al. (2001) have shown that there seems to be a reciprocal relationship between the cannabinoid and opioid system relative to dependency. THC was able to block some of the withdrawal symptoms in morphine dependent mice,"
here are some studies: Opioid and cannabinoid modulation of precipitated withdrawal in delta(9)-tetrahydrocannabinol and morphine-dependent mice. J Pharmacol Exp Ther 2001p;298(3):1007-14.
Attenuation of precipitated abstinence in methadone-dependent rats by delta 9-THC.
Endogenous cannabinoid, 2-arachidonoylglycerol, attenuates naloxone-precipitated withdrawal signs in morphine-dependent mice.
Low efficacy of non-opioid drugs in opioid withdrawal symptoms.
there are other studies that show THC and other chemicals in cannabis to bind at the mu opioid receptor.
here are some studies: Cannabidiol is an allosteric modulator at mu- and delta-opioid receptors.
Cannabinoid agonists but not inhibitors of endogenous cannabinoid transport or metabolism enhance the reinforcing efficacy of heroin in rats.
Involvement of mu-, delta- and kappa-opioid receptor subtypes in the discriminative-stimulus effects of delta-9-tetrahydrocannabinol (THC) in rats.
Repeated administration with Delta9-tetrahydrocannabinol regulates mu-opioid receptor density in the rat brain.
Involvement of the opioid system in the anxiolytic-like effects induced by Delta(9)-tetrahydrocannabinol.
Motivational effects of cannabinoids are mediated by mu-opioid and kappa-opioid receptors.
Enhancement mu opioid antinociception by oral delta9-tetrahydrocannabinol: dose-response analysis and receptor identification.from gw pharm makers of sativex:
In contrast to contemporary concerns that cannabis itself may have addictive potential, Indian hemp was used in the 19th century to treat dependencies on other substances. O'Shaughnessy observed benefit of cannabis extracts for delirium tremens in alcoholics (1), Clendinning shortly thereafter in morphine withdrawal (2), and Mattison in cocaine and chloral hydrate addiction (3). In fact, in an early 20th century text on addiction, the only mentions of cannabis were in relation to its therapeutic benefits (4). The LaGuardia Commission Report (5) contained an account of a group of 56 morphine and heroin addicts. Those who were cannabis-treated had less severe withdrawal symptoms and left the hospital earlier and in better shape than those receiving standard therapy.
Modern anecdotal support for utilisation of cannabis for addiction withdrawal continues to accrue (6-8). A formal study in Brazil (9) demonstrated that 17/25 subjects (68%) were successful in abrogating �crack' cocaine habits over the course of nine months through the use of cannabis, and claimed it able to allay cravings and induce other subjective benefits. Dreher in Jamaica has documented cannabis as the most effective treatment in stopping crack cocaine use in 33 women (10).
Cannabinoid interactions with the dopamine system have been offered as a possible mechanism for some of the beneficial effects of cannabis in opiate withdrawal (11). A recent study provides objective evidence of the ability of THC to mitigate opiate-withdrawal symptoms, and block the formation of physical dependency (12). Clinical trials of cannabis based medicine extracts in the treatment of opiate addiction seem amply justified.
References
1. O'Shaughnessy WB. On the preparations of the Indian hemp, or gunjah (Cannabis indica) ; Their effects on the animal system in health, and their utility in the treatment of tetanus and other convulsive diseases. Transactions of the Medical and Physical Society of Bengal 1838-1840:71-102, 421-461.
2. Clendinning J. Observation on the medicinal properties of Cannabis sativa of India. Medico-Chirurgical Transactions 1843;26:188-210.
3. Mattison JB. Cannabis indica as an anodyne and hypnotic. St. Louis Medical and Surgical Journal 1891;61:265-271.
4. Crothers TD. Morphinism and narcomanias from other drugs: Their etiology, treatment, and medicolegal relations. Philadelphia: Saunders; 1902.
5. New York (N.Y.). Mayor's committee on marihuana., Wallace GB, Cunningham EV. The marihuana problem in the city of New York; sociological, medical, psychological and pharmacological studies. Lancaster, Pa.,: The Jaques Cattell press; 1944.
6. Mikuriya TH. Cannabis as a substitute for alcohol: a harm-reduction approach,. Journal of Cannabis Therapeutics 2004;4(1):(in press).
7. Mikuriya TH. Cannabis substitution. An adjunctive therapeutic tool in the treatment of alcoholism. Med Times 1970;98(4):187-91.
8. Grinspoon L, Bakalar JB. Marihuana, the forbidden medicine. Rev. and exp. ed. New Haven: Yale University Press; 1997.
9. Labigalini E, Jr., Rodrigues LR, Da Silveira DX. Therapeutic use of cannabis by crack addicts in Brazil. J Psychoactive Drugs 1999;31(4):451-5.
10. Dreher M. Crack heads and roots daughters: The therapeutic use of cannabis in Jamaica. Journal of Cannabis Therapeutics 2002;2(3-4):121-133.
11. French ED, Dillon K, Wu X. Cannabinoids excite dopamine neurons in the ventral tegmentum and substantia nigra. Neuroreport 1997;8(3):649-52.
12. Cichewicz DL, McCarthy EA. Antinociceptive synergy between delta(9)-tetrahydrocannabinol and opioids after oral administration. J Pharmacol Exp Ther 2003;304(3):1010-5.
Synergistic interactions of endogenous opioids and cannabinoid systems.
* Welch SP,
* Eads M.
Department of Pharmacology and Toxicology, Box 980613, Virginia Commonwealth University, Richmond, VA 23298-0613, USA. S.Welch@hsc.vcu.edu
Cannabinoids and opioids are distinct drug classes historically used in combination to treat pain. Delta(9)-THC, an active constituent in marijuana, releases endogenous dynorphin A and leucine enkephalin in the production of analgesia. The endocannabinoid, anandamide (AEA), fails to release dynorphin A. The synthetic cannabinoid, CP55,940, releases dynorphin B. Neither AEA nor CP55,940 enhances morphine analgesia. The CB1 antagonist, SR141716A, differentially blocks Delta(9)-THC versus AEA. Tolerance to Delta(9)-THC, but not AEA, involves a decrease in the release of dynorphin A. Our preclinical studies indicate that Delta(9)-THC and morphine can be useful in low dose combination as an analgesic. Such is not observed with AEA or CP55,940. We hypothesize the existence of a new CB receptor differentially linked to endogenous opioid systems based upon data showing the stereoselectivity of endogenous opioid release. Such a receptor, due to the release of endogenous opioids, may have significant impact upon the clinical development of cannabinoid/opioid combinations for the treatment of a variety of types of pain in humans.
PMID: 10612710 [PubMed - indexed for MEDLINE]
Enhancement mu opioid antinociception by oral delta9-tetrahydrocannabinol: dose-response analysis and receptor identification
by
Cichewicz DL, Martin ZL, Smith FL, Welch SP
Department of Pharmacology and Toxicology,
Medical College of Virginia/Virginia Commonwealth University,
Richmond, Virginia, USA.
Jpn J Pharmacol 1999 Apr; 79(4):427-31
ABSTRACT
The antinociceptive effects of various mu opioids given p.o. alone and in combination with Delta-9-tetrahydrocannabinol (Delta9-THC) were evaluated using the tail-flick test. Morphine preceded by Delta9-THC treatment (20 mg/kg) was significantly more potent than morphine alone, with an ED50 shift from 28.8 to 13.1 mg/kg. Codeine showed the greatest shift in ED50 value when administered after Delta9-THC (139.9 to 5.9 mg/kg). The dose-response curves for oxymorphone and hydromorphone were shifted 5- and 12.6-fold, respectively. Methadone was enhanced 4-fold, whereas its derivative, l-alpha-acetylmethadol, was enhanced 3-fold. The potency ratios after pretreatment with Delta9-THC for heroin and meperidine indicated significant enhancement (4.1 and 8.9, respectively). Pentazocine did not show a parallel shift in its dose-response curve with Delta9-THC. Naloxone administration (1 mg/kg s.c.) completely blocked the antinociceptive effects of morphine p.o. and codeine p.o. The Delta9-THC-induced enhancement of morphine and codeine was also significantly decreased by naloxone administration. Naltrindole (2 mg/kg s.c.) did not affect morphine or codeine antinociception but did block the enhancement of these two opioids by Delta9-THC. No effect was seen when nor-binaltorphimine was administered 2 mg/kg s.c. before morphine or codeine. Furthermore, the enhancements of morphine and codeine were not blocked by nor-binaltorphimine. We find that many mu opioids are enhanced by an inactive dose of Delta9-THC p.o. The exact nature of this enhancement is unknown. We show evidence of involvement of mu and possibly delta opioid receptors as a portion of this signaling pathway that leads to a decrease in pain perception.
http://jpet.aspetjournals.org/cgi/co...full/303/2/557 (http://jpet.aspetjournals.org/cgi/content/full/303/2/557)
Vol. 303, Issue 2, 557-562, November 2002
Synergy between µ Opioid Ligands: Evidence for Functional Interactions among µ Opioid Receptor Subtypes
Elizabeth A. Bolan, Ronald J. Tallarida and Gavril W. Pasternak
Laboratory of Molecular Neuropharmacology, Memorial Sloan-Kettering Cancer Center and the Program in Neuroscience, the Weill Graduate School of Medical Sciences of Cornell University, New York, New York (E.A.B., G.W.P.), and Department of Pharmacology, Temple University Medical School, Philadelphia, Pennsylvania (R.J.T.)
Several studies have found that cannabinoids have analgesic effects in animal models, sometimes equivalent to codeine.25-29 Cannabinoids also seem to synergize with opioids, which often lose their effectiveness as patients build up tolerance. One study found morphine was 15 times more active in rats with the addition of a small dose of THC. Codeine was enhanced on the order of 900 fold.30
In 1990, researchers conducted a double-blind study comparing the antispasmodic and analgesic effects of THC, oral Codeine, and a placebo on a single patient suffering from a spinal cord injury.31 Their findings confirmed the analgesic effects of THC being "equivalent to codeine." A 1997 study made similar findings related to morphine.32
A 1999 article reviewing the body of scientific animal research concerning the analgesic effects of marijuana concludes that "[t]here is now unequivocal evidence that cannabinoids are antinociceptive [capable of blocking the appreciation or transmission of pain] in animal models of acute pain."33
In addition to it's analgesic properties, the IOM Report indicates that cannabis, like its synthetic cousin Marinol, can help treat the nausea often induced by opiate therapy, especially when other antiemetics prove ineffective.
25. Karst M et al (2003). Analgesic Effect of the Synthetic Cannabinoid CT-3 on Chronic Neuropathic Pain A Randomized Controlled Trial. JAMA. 290:1757-1762. 26. Richardson J et al (1998). Cannabinoids Reduce Hyperalgesia and Inflammation via Interaction with Peripheral CB1 Receptors. Pain. 75(1): 111-119.
27. Meng I et al (1998). An analgesic circuit activated by cannabinoids. Nature 395 381-383. http: //www.nature.com/cgitaf/DynaPage.taf?file= /nature/journal/v395/n670.../395381a0_r.htm
28. Klarreich E (2001). Cannabis spray blunts pain: Early trials suggest cannabis spritz may give relief to chronic pain sufferers. British Association for the Advancement of Science. 4 Sept.
29. Callahan R (1998). "How Does Marijuana Kill Pain?" Associated Press, October 4. http: //www.mapinc.org/drugnews/v98/n868/a07.html
30. Welch SP, Eads M (1999). Synergistic interactions of endogenous opioids and cannabinoid systems. Brain Res. Nov. 27;848 (1-2): 183-90.
31. Maurer et al. (1990). Delta-9-tetrahydrocannabinol Shows Antispastic and Analgesic Effects in a Single Case Double-Blind Trial. European Archives of Psychiatry and Clinical Neuroscience 240:1-4
32. Holdcroft, A., op cit.
33. Martin WJ (1999). Basic Mechanisms of Cannabinoid-Induced Analgesia. International Association for the Study of Pain Newsletter, Summer. p. 89.
34. Cookson C (2001). High Hopes for Cannabis to Relieve Pain. British Association Science Festival in Glasgow, Financial Times, September 4, at National News pg. 4.
there are a few studies that show marijuana to be helpful at alleviating withdrawal symptoms. "Lichtmann et al. (2001) have shown that there seems to be a reciprocal relationship between the cannabinoid and opioid system relative to dependency. THC was able to block some of the withdrawal symptoms in morphine dependent mice,"
here are some studies: Opioid and cannabinoid modulation of precipitated withdrawal in delta(9)-tetrahydrocannabinol and morphine-dependent mice. J Pharmacol Exp Ther 2001p;298(3):1007-14.
Attenuation of precipitated abstinence in methadone-dependent rats by delta 9-THC.
Endogenous cannabinoid, 2-arachidonoylglycerol, attenuates naloxone-precipitated withdrawal signs in morphine-dependent mice.
Low efficacy of non-opioid drugs in opioid withdrawal symptoms.
there are other studies that show THC and other chemicals in cannabis to bind at the mu opioid receptor.
here are some studies: Cannabidiol is an allosteric modulator at mu- and delta-opioid receptors.
Cannabinoid agonists but not inhibitors of endogenous cannabinoid transport or metabolism enhance the reinforcing efficacy of heroin in rats.
Involvement of mu-, delta- and kappa-opioid receptor subtypes in the discriminative-stimulus effects of delta-9-tetrahydrocannabinol (THC) in rats.
Repeated administration with Delta9-tetrahydrocannabinol regulates mu-opioid receptor density in the rat brain.
Involvement of the opioid system in the anxiolytic-like effects induced by Delta(9)-tetrahydrocannabinol.
Motivational effects of cannabinoids are mediated by mu-opioid and kappa-opioid receptors.
Enhancement mu opioid antinociception by oral delta9-tetrahydrocannabinol: dose-response analysis and receptor identification.from gw pharm makers of sativex:
In contrast to contemporary concerns that cannabis itself may have addictive potential, Indian hemp was used in the 19th century to treat dependencies on other substances. O'Shaughnessy observed benefit of cannabis extracts for delirium tremens in alcoholics (1), Clendinning shortly thereafter in morphine withdrawal (2), and Mattison in cocaine and chloral hydrate addiction (3). In fact, in an early 20th century text on addiction, the only mentions of cannabis were in relation to its therapeutic benefits (4). The LaGuardia Commission Report (5) contained an account of a group of 56 morphine and heroin addicts. Those who were cannabis-treated had less severe withdrawal symptoms and left the hospital earlier and in better shape than those receiving standard therapy.
Modern anecdotal support for utilisation of cannabis for addiction withdrawal continues to accrue (6-8). A formal study in Brazil (9) demonstrated that 17/25 subjects (68%) were successful in abrogating �crack' cocaine habits over the course of nine months through the use of cannabis, and claimed it able to allay cravings and induce other subjective benefits. Dreher in Jamaica has documented cannabis as the most effective treatment in stopping crack cocaine use in 33 women (10).
Cannabinoid interactions with the dopamine system have been offered as a possible mechanism for some of the beneficial effects of cannabis in opiate withdrawal (11). A recent study provides objective evidence of the ability of THC to mitigate opiate-withdrawal symptoms, and block the formation of physical dependency (12). Clinical trials of cannabis based medicine extracts in the treatment of opiate addiction seem amply justified.
References
1. O'Shaughnessy WB. On the preparations of the Indian hemp, or gunjah (Cannabis indica) ; Their effects on the animal system in health, and their utility in the treatment of tetanus and other convulsive diseases. Transactions of the Medical and Physical Society of Bengal 1838-1840:71-102, 421-461.
2. Clendinning J. Observation on the medicinal properties of Cannabis sativa of India. Medico-Chirurgical Transactions 1843;26:188-210.
3. Mattison JB. Cannabis indica as an anodyne and hypnotic. St. Louis Medical and Surgical Journal 1891;61:265-271.
4. Crothers TD. Morphinism and narcomanias from other drugs: Their etiology, treatment, and medicolegal relations. Philadelphia: Saunders; 1902.
5. New York (N.Y.). Mayor's committee on marihuana., Wallace GB, Cunningham EV. The marihuana problem in the city of New York; sociological, medical, psychological and pharmacological studies. Lancaster, Pa.,: The Jaques Cattell press; 1944.
6. Mikuriya TH. Cannabis as a substitute for alcohol: a harm-reduction approach,. Journal of Cannabis Therapeutics 2004;4(1):(in press).
7. Mikuriya TH. Cannabis substitution. An adjunctive therapeutic tool in the treatment of alcoholism. Med Times 1970;98(4):187-91.
8. Grinspoon L, Bakalar JB. Marihuana, the forbidden medicine. Rev. and exp. ed. New Haven: Yale University Press; 1997.
9. Labigalini E, Jr., Rodrigues LR, Da Silveira DX. Therapeutic use of cannabis by crack addicts in Brazil. J Psychoactive Drugs 1999;31(4):451-5.
10. Dreher M. Crack heads and roots daughters: The therapeutic use of cannabis in Jamaica. Journal of Cannabis Therapeutics 2002;2(3-4):121-133.
11. French ED, Dillon K, Wu X. Cannabinoids excite dopamine neurons in the ventral tegmentum and substantia nigra. Neuroreport 1997;8(3):649-52.
12. Cichewicz DL, McCarthy EA. Antinociceptive synergy between delta(9)-tetrahydrocannabinol and opioids after oral administration. J Pharmacol Exp Ther 2003;304(3):1010-5.
Synergistic interactions of endogenous opioids and cannabinoid systems.
* Welch SP,
* Eads M.
Department of Pharmacology and Toxicology, Box 980613, Virginia Commonwealth University, Richmond, VA 23298-0613, USA. S.Welch@hsc.vcu.edu
Cannabinoids and opioids are distinct drug classes historically used in combination to treat pain. Delta(9)-THC, an active constituent in marijuana, releases endogenous dynorphin A and leucine enkephalin in the production of analgesia. The endocannabinoid, anandamide (AEA), fails to release dynorphin A. The synthetic cannabinoid, CP55,940, releases dynorphin B. Neither AEA nor CP55,940 enhances morphine analgesia. The CB1 antagonist, SR141716A, differentially blocks Delta(9)-THC versus AEA. Tolerance to Delta(9)-THC, but not AEA, involves a decrease in the release of dynorphin A. Our preclinical studies indicate that Delta(9)-THC and morphine can be useful in low dose combination as an analgesic. Such is not observed with AEA or CP55,940. We hypothesize the existence of a new CB receptor differentially linked to endogenous opioid systems based upon data showing the stereoselectivity of endogenous opioid release. Such a receptor, due to the release of endogenous opioids, may have significant impact upon the clinical development of cannabinoid/opioid combinations for the treatment of a variety of types of pain in humans.
PMID: 10612710 [PubMed - indexed for MEDLINE]
Enhancement mu opioid antinociception by oral delta9-tetrahydrocannabinol: dose-response analysis and receptor identification
by
Cichewicz DL, Martin ZL, Smith FL, Welch SP
Department of Pharmacology and Toxicology,
Medical College of Virginia/Virginia Commonwealth University,
Richmond, Virginia, USA.
Jpn J Pharmacol 1999 Apr; 79(4):427-31
ABSTRACT
The antinociceptive effects of various mu opioids given p.o. alone and in combination with Delta-9-tetrahydrocannabinol (Delta9-THC) were evaluated using the tail-flick test. Morphine preceded by Delta9-THC treatment (20 mg/kg) was significantly more potent than morphine alone, with an ED50 shift from 28.8 to 13.1 mg/kg. Codeine showed the greatest shift in ED50 value when administered after Delta9-THC (139.9 to 5.9 mg/kg). The dose-response curves for oxymorphone and hydromorphone were shifted 5- and 12.6-fold, respectively. Methadone was enhanced 4-fold, whereas its derivative, l-alpha-acetylmethadol, was enhanced 3-fold. The potency ratios after pretreatment with Delta9-THC for heroin and meperidine indicated significant enhancement (4.1 and 8.9, respectively). Pentazocine did not show a parallel shift in its dose-response curve with Delta9-THC. Naloxone administration (1 mg/kg s.c.) completely blocked the antinociceptive effects of morphine p.o. and codeine p.o. The Delta9-THC-induced enhancement of morphine and codeine was also significantly decreased by naloxone administration. Naltrindole (2 mg/kg s.c.) did not affect morphine or codeine antinociception but did block the enhancement of these two opioids by Delta9-THC. No effect was seen when nor-binaltorphimine was administered 2 mg/kg s.c. before morphine or codeine. Furthermore, the enhancements of morphine and codeine were not blocked by nor-binaltorphimine. We find that many mu opioids are enhanced by an inactive dose of Delta9-THC p.o. The exact nature of this enhancement is unknown. We show evidence of involvement of mu and possibly delta opioid receptors as a portion of this signaling pathway that leads to a decrease in pain perception.
http://jpet.aspetjournals.org/cgi/co...full/303/2/557 (http://jpet.aspetjournals.org/cgi/content/full/303/2/557)
Vol. 303, Issue 2, 557-562, November 2002
Synergy between µ Opioid Ligands: Evidence for Functional Interactions among µ Opioid Receptor Subtypes
Elizabeth A. Bolan, Ronald J. Tallarida and Gavril W. Pasternak
Laboratory of Molecular Neuropharmacology, Memorial Sloan-Kettering Cancer Center and the Program in Neuroscience, the Weill Graduate School of Medical Sciences of Cornell University, New York, New York (E.A.B., G.W.P.), and Department of Pharmacology, Temple University Medical School, Philadelphia, Pennsylvania (R.J.T.)