Tetrahydrocannabinol - friend or foe? - Debate.

Background: Tetrahydrocannabinol (THC) is a psychoactive cannabinoid that has been used to treat various conditions. However, due to various adverse effects, its widespread promotion and use has been controversial. It is this aspect (encouraged by various state legislatures) that forms the basis for an edited debate between an Integrative Family Medicine physician and a Medical Toxicologist.Methods: Pro/Con debate with literature review and commentary.Discussion: Medical THC is beneficial for various conditions (especially pain relief). However the dosing, titration and delivery system has of yet to be precisely defined. There is a paucity of studies focusing on cannabidiol (CBD) efficacy without THC, which further complicates medical cannabis clinical studies. Cannabis toxicity tends to be cumulative, which makes it more difficult to identify at the bedside.Conclusion: There is conflicting data regarding the efficacy and toxicity of medical use of THC.

Barriers to Achieving Optimal Success with Medical Cannabis: Opportunities for Quality Improvement.

This commentary describes the clinician experience of certifying patients for medical cannabis (MC) in a north suburban Chicago integrative family medicine practice. The physician and research assistant performed a comprehensive chart review of the first 166 MC patients certified in the practice. Based on this review, barriers and opportunities were elucidated to improve delivery of MC therapy in Illinois within the existing framework of regulation, licensing, certification, and distribution. The following factors have posed challenges for the Illinois Medical Cannabis Pilot Program. These factors are interrelated and include: (1) inadequate scientific knowledge regarding effectiveness, dosage, delivery mechanism, indications, and drug interactions in humans; (2) lack of educational standards for dispensary and medical staff training; (3) lack of communication and coordination of patient care; (4) complexity and inconsistent availability of dosing options; and (5) barriers to access for patients seeking this therapy.

Complementary and alternative medicine use for arthritis pain in 2 Chicago community areas.

OBJECTIVE: To compare the use of complementary and alternative medicine (CAM) for arthritis between 2 ethnically distinct metropolitan Chicago community areas. METHODS: A telephone interview survey of adults age 45 years or above living in North (88.9% white) or South (79.7% African American) areas. Of 763 respondents, 405 reported arthritis or chronic joint symptoms and were asked about use and satisfaction with 7 CAM therapies. Differences between areas were compared with population-weighted tests; multiple logistic regression was used to analyze the likelihood of CAM use controlled for demographics, behavioral risk factors, and arthritis severity. RESULTS: South Chicago respondents had a higher prevalence and more severe arthritis symptoms such as mean joint pain and more functional limitations. Use of CAM therapy by South Chicago respondents, most commonly massage and relaxation techniques, was 10% greater than North Chicago respondents (61.5% to 51%) but this was not significantly different. Among CAM users, South Chicago respondents reported higher satisfaction with 6 of the 7 CAM therapies and greater future interest in CAM therapies. Poor overall health status (P=0.03), arthritis pain (P=0.005), and concomitant use of prescription medications (P=0.03) were the only significant predictors of CAM use. DISCUSSION: Although there were only small differences in overall CAM use by area, older residents of largely African American communities were enthusiastic users of relaxation, massage, and nutritional and dietary techniques. CAM modalities could be important adjuncts to traditional medical treatment of arthritis pain for minority communities.

Pilot validation of a self-report outcome measure of complementary and alternative medicine.

BACKGROUND: We previously developed a multidomain, self-report outcome measure relevant to a wide range of complementary and alternative medical (CAM) therapies. We report the results of a pilot study to validate the measure. METHODS: Fifty-two patients (60% female, mean age, 53 years) seeking services from CAM providers completed a battery of measures prior to a scheduled visit. The battery included the Positive and Negative Affect Schedule, items from the Brief Pain and Fatigue Inventories, ratings of global quality of life (QOL) and change in physical health, and our pilot measure consisting of six hypothesized subscales (pain, fatigue, physical/functional ability, personal control, existential issues, and general QOL). Internal reliability, item convergence and discrimination, construct, and concurrent validity were assessed. RESULTS: Pilot measure domains appeared to be internally reliable with five of six alpha coefficients exceeding 0.70. Multitrait scaling analyses demonstrated that most items converged on the domains that they were hypothesized to represent, although item discrimination was demonstrated for the pain domain only. Correlations with standardized assessments of pain, fatigue, and global QOL showed evidence of construct validity. All domain scores differentiated patients classified high versus low in global QOL (P < .01) and four (pain, fatigue, physical/functional ability, and general QOL) differentiated patients who perceived recent changes in their physical health (improvement vs decline; P < .05). CONCLUSION: These results provide preliminary psychometric data for a pilot measure of CAM outcomes, though further testing is warranted.