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Medical cannabis on the NHS
BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3357 (Published 03 August 2018)
Cite this as: BMJ 2018;362:k3357
Re: Medical cannabis on the NHS
The use of Marijuana (cannabis) for neurologic disease can be traced at least as far back as 1500–3000 BC, in the writings of Chinese Emperor Shen-Nuang. Much of the early use of this was for treatment of headaches, with the first documentation of its use for this purpose being in 600 AD.
Medicinal Marijuana was introduced to the West in the mid-1800s and used for spasms in rabies and tetanus and infantile convulsions, and it was also advocated in migraines in the early 1900s.
Action site at Neuronal Axis
Cannabis acts presynaptically on endocannabinoid receptors, namely, CB1, modulating their function.
The medical use of cannabis for the treatment of neurologic diseases has been recently discussed.
Multiple Sclerosis
In neurological disorders Multiple sclerosis has the most robust evidence for the efficacy of cannabis, primarily in subjective, and possibly objective, improvement in spasticity and spasms and pain.
Seizure Disorders
Oral liquid formulation of plant-derived Cannabis can be effective in seizure control in Dravet syndrome, Lennox-Gastaut syndrome, and neonatal hypoxic-ischemic encephalopathy. A recent presentation found that the liquid formulation in doses up to 25 mg/kg can reduce the seizure frequencies in multiple drug-resistant epilepsy syndromes and in some seizure types.
Parkinson Disease
Clinical trials show that the effect of cannabis on Parkinson disease is conflicting and poorly understood. It is ineffective in dyskinesias in parkinson disease.
Headache
Cannabis can be useful to control migraine and other headaches but needs more clinical studies.
Pain
Oral cannabis extract may be useful to reduce central neurogenic pain.
Bladder Disorders
Cannabinoids (Nabiximols) is probably effective in certain urinary bladder disorders.
Until recently cannabis has not shown promising results in tremors, Huntington's disease, Tourette syndrome, or cervical dystonia.
Side effects
Acute use of cannabis has been shown to cause anxiety and panic, impaired attention/memory/psychomotor performance, increased chance of psychosis in those already predisposed, and tachycardia.
Long-term effects are less well studied, but there is evidence of cannabis dependence, bronchitis, increased risk of accidents, and the potential for mild withdrawal symptoms. There is no evidence cannabis use increases risk of cancer, leads to permanent psychiatric cognitive deficits, or can result in overdose.
Marijuana in India
It has a long history in India. The earliest mention of cannabis has been found in The Vedas, the sacred Hindu texts. These writings may have been compiled as early as 2000 to 1400 B.C.
In Indian society, common terms for Marijuana preparations include charas (resin), ganja (flower), and bhang (seeds and leaves).
The prevalence of "abuse" of Marijuana in India is at or more than 3.2%.
According to the World Drug report 2016, the retail price of cannabis in India was US$0.10 per gram, the lowest of any country in the world.
The medicinal use of cannabis is also shown in Sharngadhara Samhita (13th century) ancient Indian medical scripts.
Competing interests: No competing interests
04 August 2018
M.A. Aleem
Emeritus Professor* Neurologist**
The Tamilnadu Dr.M.G.R.Medical University*.
ABC Hospital**
Chennai 600032*. Trichy 620018**
Tamilnadu India
@drmaaleem
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