Headache Currents
HEADACHE CURRENTS
Up in Smoke: A New View on an Old Friend Nathan L. Bennett, MD
As Dr. Eric Baron so thoroughly reviews in this issue of Headache Currents, cannabis had many uses prior to political interference.1 Despite the growing evidence of the possible benefits of cannabis, politics continues to mar progress. What else is new? In fact, as Dr. Baron pointed out, there is growing support from the medical community for the medical use of marijuana. A 2013 New England Journal of Medicine poll found 76% of 1446 votes favored the use of marijuana for medicinal purposes. In that poll, the voters were from 72 countries and 56 North American states and provinces.2 Keep in mind that cannabis is still illegal in most countries. While researches must monitor the long-term effects of medical cannabis, it is likely that cannabis is less dangerous than opioids and benzodiazepines. There are no reported deaths due to cannabis. The following facts are from the CDC concerning prescription drug overdoses.3 1. Deaths from drug overdose are the leading cause of injury death in the United States.2 Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes.4 2. Every day in the United States, 120 people die as a result of drug overdose,4 and another 6748 are treated in emergency departments (ED) for the misuse or abuse of drugs.5 Nearly 9 out of 10 poisoning deaths are caused by drugs.5 3. In 2011, drug misuse and abuse caused about 2.5 million ED visits. Of these, more than 1.4 million ED visits were related to pharmaceuticals.6 4. In 2013, 35,663 (81.1%) of the 43,982 drug overdose deaths in the United States were unintentional, 5432 (12.4%) were of suicidal intent, and 2801 (6.4%) were of undetermined intent.5 5. Of the 22,767 deaths relating to pharmaceutical overdose in 2013, 16,235 (71.3%) involved opioid analgesics, and 6973 (30.6%) involved benzodiazepines.6 6. In 2011, about 1.4 million ED visits involved the nonmedical use of pharmaceuticals. Among those ED visits, 501,207 visits were related to anti-anxiety and insomnia medications, and 420,040 visits were related to opioid analgesics.6 7. People who died of drug overdoses often had a combination of benzodiazepines and opioid analgesics in their bodies.7
From the Preferred Headache Center, Pittsburgh, PA, USA. Address all correspondence to N.L. Bennett, Preferred Headache Center, 140 Curry Hollow Drive, Suite 2, Pittsburgh, PA 15236, USA. Accepted for publication April 29, 2015. ............. Headache © 2015 American Headache Society
How does the safety of cannabis stack up against alcohol and tobacco? According to the CDC, alcohol is linked to approximately 88,000 deaths per year. Again, there are no reported deaths due to cannabis. Some of the deaths are due to acute alcohol intoxication, while others are due to long-term alcohol effects, such as alcoholic hepatitis and cirrhosis. In addition, alcohol is much more likely to interact with other prescription drugs due to metabolism in the liver. As with alcohol, cannabis can impair cognition, coordination, and balance as well as reduce inhibitions. This is probably not as much of a concern with cannabidiol as it is with tetrahydrocannabinol. The long-term effects of tobacco are well established, and there is no need to reiterate them here. Despite initial reports that marijuana may lead to lung cancer, further studies proved this incorrect. Similar to tobacco, smoking marijuana may lead to inflammation of the airways and may increase risk of asthma and bronchitis. Lastly, marijuana use, especially earlier in life, has been linked to increase risk for limbic dysfunction (aka mental illness) including schizophrenia, depression, and anxiety.8 Further studies are necessary to determine if this association is dose dependent. My personal observation is that people use recreational drugs, alcohol, and tobacco as self-medication for underlying limbic dysfunction, especially anxiety. Therefore, I question whether earlier drug use is due to underlying limbic dysfunction and not the other way around. There is strong evidence to show a link between marijuana use and psychotic disorders in those with a preexisting genetic vulnerability via AKT1 gene variations.9 In conclusion, in this issue of Headache Currents, Dr. Eric Baron outlines potential targets and uses of cannabis for treatment of migraine, among other disorders. Despite the relative safety of cannabis compared with other legal medications and substances, cannabis remains a Schedule I drug, and access to it for research is limited. The time has come to reverse this political hogwash. Unfortunately, it usually takes a lot of money rather than knowledge to change a vote, a regulation, or a law. References 1. Baron E. Comprehensive review of medicinal marijuana, cannabinoids, and therapeutic implications in medicine and headache: What a long strange trip it’s been. . . . Headache 2015 (in press). 2. Adler J, Colbert J. Medicinal Use of Marijuana – Polling Results. N Engl J Med. 2013;368:866-868.
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............. Conflict of Interest: None. Financial Support: None.
918 | Headache | June 2015
3. Injury Prevention & Control: Prescription Drug Overdose. (n.d.) Available from URL: http://www.cdc.gov/drugoverdose/index.html. 4. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2014) Available from URL: http://www.cdc.gov/injury/wisqars/fatal.html. 5. Centers for Disease Control and Prevention. National Vital Statistics System mortality data. (2015) Available from URL: http://www.cdc .gov/nchs/deaths.htm. 6. Substance Abuse and Mental Health Services Administration. Highlights of the 2011 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. The DAWN Report. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration;
Headache Currents 2013. Available from URL: http://www.samhsa.gov/data/2k13/ DAWN127/sr127-DAWN-highlights.htm. 7. Centers for Disease Control and Prevention. National Vital Statistics System mortality data. (2012) Available from URL: http://www.cdc .gov/nchs/deaths.htm. 8. Campolongo P, Trezza V, Cassano T, et al. Preclinical study: Perinatal exposure to delta-9-tetrahydrocannabinol causes enduring cognitive deficits associated with alteration of cortical gene expression and neurotransmission in rats. Addict Biol. 2007;12:485-495. 9. Radhakrishnan R, Wilkinson ST, D’Souza DC. Gone to pot: A review of the association between cannabis and psychosis. Front Psychiatry. 2014;5:54.
HEADACHE CURRENTS
Up in Smoke: A New View on an Old Friend Nathan L. Bennett, MD
As Dr. Eric Baron so thoroughly reviews in this issue of Headache Currents, cannabis had many uses prior to political interference.1 Despite the growing evidence of the possible benefits of cannabis, politics continues to mar progress. What else is new? In fact, as Dr. Baron pointed out, there is growing support from the medical community for the medical use of marijuana. A 2013 New England Journal of Medicine poll found 76% of 1446 votes favored the use of marijuana for medicinal purposes. In that poll, the voters were from 72 countries and 56 North American states and provinces.2 Keep in mind that cannabis is still illegal in most countries. While researches must monitor the long-term effects of medical cannabis, it is likely that cannabis is less dangerous than opioids and benzodiazepines. There are no reported deaths due to cannabis. The following facts are from the CDC concerning prescription drug overdoses.3 1. Deaths from drug overdose are the leading cause of injury death in the United States.2 Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes.4 2. Every day in the United States, 120 people die as a result of drug overdose,4 and another 6748 are treated in emergency departments (ED) for the misuse or abuse of drugs.5 Nearly 9 out of 10 poisoning deaths are caused by drugs.5 3. In 2011, drug misuse and abuse caused about 2.5 million ED visits. Of these, more than 1.4 million ED visits were related to pharmaceuticals.6 4. In 2013, 35,663 (81.1%) of the 43,982 drug overdose deaths in the United States were unintentional, 5432 (12.4%) were of suicidal intent, and 2801 (6.4%) were of undetermined intent.5 5. Of the 22,767 deaths relating to pharmaceutical overdose in 2013, 16,235 (71.3%) involved opioid analgesics, and 6973 (30.6%) involved benzodiazepines.6 6. In 2011, about 1.4 million ED visits involved the nonmedical use of pharmaceuticals. Among those ED visits, 501,207 visits were related to anti-anxiety and insomnia medications, and 420,040 visits were related to opioid analgesics.6 7. People who died of drug overdoses often had a combination of benzodiazepines and opioid analgesics in their bodies.7
From the Preferred Headache Center, Pittsburgh, PA, USA. Address all correspondence to N.L. Bennett, Preferred Headache Center, 140 Curry Hollow Drive, Suite 2, Pittsburgh, PA 15236, USA. Accepted for publication April 29, 2015. ............. Headache © 2015 American Headache Society
How does the safety of cannabis stack up against alcohol and tobacco? According to the CDC, alcohol is linked to approximately 88,000 deaths per year. Again, there are no reported deaths due to cannabis. Some of the deaths are due to acute alcohol intoxication, while others are due to long-term alcohol effects, such as alcoholic hepatitis and cirrhosis. In addition, alcohol is much more likely to interact with other prescription drugs due to metabolism in the liver. As with alcohol, cannabis can impair cognition, coordination, and balance as well as reduce inhibitions. This is probably not as much of a concern with cannabidiol as it is with tetrahydrocannabinol. The long-term effects of tobacco are well established, and there is no need to reiterate them here. Despite initial reports that marijuana may lead to lung cancer, further studies proved this incorrect. Similar to tobacco, smoking marijuana may lead to inflammation of the airways and may increase risk of asthma and bronchitis. Lastly, marijuana use, especially earlier in life, has been linked to increase risk for limbic dysfunction (aka mental illness) including schizophrenia, depression, and anxiety.8 Further studies are necessary to determine if this association is dose dependent. My personal observation is that people use recreational drugs, alcohol, and tobacco as self-medication for underlying limbic dysfunction, especially anxiety. Therefore, I question whether earlier drug use is due to underlying limbic dysfunction and not the other way around. There is strong evidence to show a link between marijuana use and psychotic disorders in those with a preexisting genetic vulnerability via AKT1 gene variations.9 In conclusion, in this issue of Headache Currents, Dr. Eric Baron outlines potential targets and uses of cannabis for treatment of migraine, among other disorders. Despite the relative safety of cannabis compared with other legal medications and substances, cannabis remains a Schedule I drug, and access to it for research is limited. The time has come to reverse this political hogwash. Unfortunately, it usually takes a lot of money rather than knowledge to change a vote, a regulation, or a law. References 1. Baron E. Comprehensive review of medicinal marijuana, cannabinoids, and therapeutic implications in medicine and headache: What a long strange trip it’s been. . . . Headache 2015 (in press). 2. Adler J, Colbert J. Medicinal Use of Marijuana – Polling Results. N Engl J Med. 2013;368:866-868.
917
............. Conflict of Interest: None. Financial Support: None.
918 | Headache | June 2015
3. Injury Prevention & Control: Prescription Drug Overdose. (n.d.) Available from URL: http://www.cdc.gov/drugoverdose/index.html. 4. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2014) Available from URL: http://www.cdc.gov/injury/wisqars/fatal.html. 5. Centers for Disease Control and Prevention. National Vital Statistics System mortality data. (2015) Available from URL: http://www.cdc .gov/nchs/deaths.htm. 6. Substance Abuse and Mental Health Services Administration. Highlights of the 2011 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. The DAWN Report. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration;
Headache Currents 2013. Available from URL: http://www.samhsa.gov/data/2k13/ DAWN127/sr127-DAWN-highlights.htm. 7. Centers for Disease Control and Prevention. National Vital Statistics System mortality data. (2012) Available from URL: http://www.cdc .gov/nchs/deaths.htm. 8. Campolongo P, Trezza V, Cassano T, et al. Preclinical study: Perinatal exposure to delta-9-tetrahydrocannabinol causes enduring cognitive deficits associated with alteration of cortical gene expression and neurotransmission in rats. Addict Biol. 2007;12:485-495. 9. Radhakrishnan R, Wilkinson ST, D’Souza DC. Gone to pot: A review of the association between cannabis and psychosis. Front Psychiatry. 2014;5:54.
