For too long, societies worldwide have prohibited Cannabis, a historically useful and valuable commodity.  The predominant concern has been Cannabis delta-9-tetrahydrocannabinol (THC) content and its psychoactive effects.  How does THC affect mental states? Is it beneficial?  What are its liability concerns?   CESC’s Cannabis Mind Initiative focuses on the psychoactive or intoxicating effects of Type I (THC dominant) Cannabis and its subtypes of varying potencies.
 
Cannabis typically contains one of two dominant phytocannabinoids, THCA or cannabidiolic acid (CBDA), and several combinations of other active ingredients.   Consumers might inhale, apply, or ingest a product without apparent psychoactivity. However, it is the use of THC (derived from its THCA precursor) in products that most often leads to intoxicating states. THC’s psychoactive effects are mostly attributed to its activity on CNR1 (CB1), a prevalent G-coupled protein receptor in the brain.  THC consumption may cause adverse effects; however, it also leads to meaningful subjective experiences.  Despite a diverse and rich potential for Cannabis in the marketplace, THC is the elephant in the room.  CESC’s study of THC dominant Cannabis addresses its psychoactive and intoxicating effects
 
In the past decade, we have seen unprecedented shifts in the availability of Cannabis.  Increased access to Cannabis has been associated with an increase in high potency THC products.  From 1995 to 2014, THC potency tripled (4%-12%) in confiscated Cannabis flowers.  Today, markets sell Cannabis flowers with 20% or more THC content.  Extracted and concentrated oil products have potencies of 50-80% THC. Jurisdictions that have tried to prohibit D-9 THC see legal hemp products converted to other isomers of THC as companies work around regulations to offer a product with more psychoactivity.
 
Americans have a love-hate relationship with Cannabis. Harry J Anslinger, head of the US Treasury Department's Narcotics Bureau, wrote his opinion in a 1937 article titled Marijuana, Assassin of Youth.  “How many murders, suicides, robberies, criminal assaults, holdups, burglaries and deeds of maniacal insanity it causes each year can only be conjectured.”  The ludicrous notion that a plant could initiate such behavior had been popularized in a movie called Reefer Madness. Relative to the history of worldwide use, Anslinger’s perspective didn’t last long.  By the 1960s, Anslinger had already conceded that the criminal penalties in force for Cannabis use were too severe. In 1967, mainstream voices of Life, Newsweek, and Look magazines questioned why the plant was illegal at all.  By 1996, California had legalized Cannabis use for medicinal purposes through a proposition titled The Compassionate Use Act.
 
Contrasting perceptions and opposing effects are a hallmark of Type I Cannabis. The relaxing and euphoric effects are contradicted by concerns of anxiety and psychosis.  It’s well understood that acute psychosis from THC can be debilitating, especially when unexpected.  Dr. Nora Volkow, Director of the National Institute of Drug Abuse, notes that high potency Cannabis products are associated with acute psychosis.  However, intentional Cannabis experiences with appropriate doses of THC can also be used as therapy. The hypothesis is that THC may help expand the walls of perception and engender psychological flexibility, which leads to improved mental health conditions.
 
In a Natural Language Processing analysis of open-sourced reviews by respondents that used Type I Cannabis flowers, CESC identified commonly used words.  These descriptors group into three categories; states of altered consciousness (high, stoned, buzzed), a relaxed-energetic dichotomy, and a broad range of psychosomatic states.  We anticipate that this categorization scheme will facilitate correlation with underlying pharmacologic mechanisms.
 
With access to a Northern California community of 2,000 active users, CESC investigates the risk factors and therapeutic benefits of Type I Cannabis use.  Data is gathered on the acute and chronic effects of Cannabis use.  Longitudinal observations track health and wellness endpoints of Cannabis users.  Quantitative EEG analysis provides an objective biomarker in comparisons of subjective mood and consciousness scales.  Our community serves as a model in our investigations of the “Cannabis Mind.”

See more in the Cannabinoid Monthly Playbook by 8th Revolution

Psychoactives, a peer-reviewed scientific publication, recently published a study proposing that a pleasant Cannabis aroma (not THC content) predicts pleasant effects from smoking or vaporizing Cannabis.  The story struck me for several reasons; 1) There are very few Cannabis studies that report positive outcomes after smoking, 2) This study is an indication that Cannabis science is maturing beyond the novelty of THC to finer qualities of Cannabis. 
 
As a Cannabis Scientist, I spend a lot of time following the advances in Cannabis science.  From my perspective, Cannabis research is split into two camps.  The first camp focuses on single agents like THC, CBD, or synthetic cannabinoids and is more aligned with traditional research paradigms.  The second camp studies the whole plant with its broad spectrum of active ingredients.  Although more complex, this camp reflects the real-world usage of Cannabis. Most published studies are of the first camp.
 
Cannabis aromas range from sweet floral to pungent fuel. In the study, 278 healthy Cannabis users selected or were given 8-10 one-gram samples of Cannabis flowers with varying aromas to take home. They were asked to smoke each sample on separate occasions and rate their experience.  One caveat, they had to abstain from using Cannabis for 48 hours before judging each sample, which was difficult for the daily users. 
 
Here are the highlights…
 

• On an appeal scale, older people reported a more pleasant experience than younger people.  Participants aged 40 or older reported more subjective appeal after smoking than those 40 or younger.  And the 60 + demographic reported the most pleasant experience.

 

• There was negative correlation with the frequency of consumption.  In other words, those who smoked less than once per week reported a more pleasant experience than those who smoked multiple times per day.  That probably has something to do with tolerance.

 

• Participants who consumed small doses reported a more pleasant experience.  THC potency, in general, did not correlate with subjective appeal. Neither did terpene content. However, males did report more pleasant experience with higher THC potency when the results were stratified by biological gender.

 

• The strongest correlation with a pleasant experience was the Cannabis flower aroma.  The more pleasant the aroma, the more pleasant the experience.

 
Traditional academic researchers (the first camp) raise concerns about high content THC products and their propensity to be associated with Cannabis Use Disorder, Cannabinoid Hyperemesis Syndrome, and Psychosis.  In response, offering Type II (THC & CBD equivalent) and Type III (CBD dominant) Cannabis flowers institutes product differentiation and attracts the more mature consumer.
 
So, there you have it. It’s not all about THC.  In fact, Cannabis companies have already responded by adding Cannabis with less THC and more CBD, CBG, or THCv to their inventory.  Garden Society and Pure Beauty, brands that provide lower THC alternatives, offer pre-rolls with 10% THC or less.  Science indicates that Cannabis aroma is likely an important quality attribute of the plant.  In response, marketing “floral”, “pungent”, “sweet”,  and “earthy” aromas may soon replace the unsupported designations that frequent the Cannabis marketplace
 

Skilled nursing facilities, assisted living facilities, or nursing homes are institutions where much of us will spend the last decade of our lives.  There are about 1.3 million residents in U.S. nursing homes. There are over 26,000 nursing homes in the U.S. 70% of people who reach the age of 65 will need long-term care at some point in life. By 2050, up to 30 million people in the Americas will require long-term care services. Whether bed bound or just needing help with activities of daily living, the extra help that these facilities provide is crucial.  As we reach this stage in our lives, the question is; “How do I get access to Cannabis at a nursing home?”
 
Shelby Grebbin writes in Skilled Nursing News about a skilled nursing facility in New York called Hebrew Home at Riverdale’s.  In 2014, when New York passed their Compassionate Care Act, Dr. Zachary Palace, the Medical Director of Hebrew Home, was faced with a perplexing question: By permitting residents to exercise their full rights as citizens of the state to access Cannabis, could he put the senior care center at risk for non-compliance?
 
In the 21st century, Cannabis use continues to be decriminalized and de-stigmatized, and baby boomers are the major reason why.  Remember, publicly displayed pro-Cannabis sentiments started back in the 70s.  A couple of decades of “Say No to Drugs” was followed by a movement that permitted legal access Cannabis worldwide.  
 
As a compassionate geriatrician, Dr. Palace recognizes the potential benefits of Cannabis for his patients.  His clients need help with chronic pain, insomnia, poor appetite, and neurological conditions like Parkinson’s, Alzheimer’s, and seizures.   Dr. Palace is also aware that Cannabis is a Schedule I drug and any skilled nursing facility receiving federal aid is in jeopardy of losing their Medicare and Medicaid reimbursements.  In response, Dr. Palace and Hebrew Home CEO Daniel Reingold set out to create a Medical Cannabis program for their residents that legally works with the rules.
 
Most states allows residents to access Cannabis via recommendation from a physician.  “They’re able to maintain it in their own space in their room,” says Dr. Palace. “They get a lock box that only they have the key to. It’s truly their property. And it’s not in the facility’s possession, but it’s in their own personal possession.  Another participation condition requires residents to self-administer the Cannabis — unless they have a companion or family member who can administer it for them.”

​The Ohio Medical Marijuana Control Program published an annual report with results of physicians who recommend Medical Cannabis.  648, that’s the number of Ohio physicians actively certified for the program.  The program permits 25 medical conditions that qualify for Cannabis treatment in Ohio.  One of the key questions of from the report asks physicians, “How satisfied are you with the effectiveness of medical marijuana in treating your patients with the qualifying conditions”.  The Physicians were asked to rate each condition with “Satisfied”, “Neutral”, “Dissatisfied”, “Other”, and “Not Applicable”
 
An article by Laura Hancock in Cleveland.com puzzles me.  Although the results of this report are overwhelmingly positive, for some reason the story downplays it.  It identifies that 59.4% of physicians were satisfied with the effect of Cannabis on chronic or intractable pain, 53.5% were satisfied with its effectiveness for cancer patients, 50.8% were satisfied for fibromyalgia and 50.3% for post-traumatic stress disorder patients.  The results were much better. Only 65% of the doctors responded to the survey.  If the percentage of respondents are calculated, 91% of physicians who saw patients with pain were satisfied with the results, 82% for cancer, and 77% for both fibromyalgia and PTSD.  Out of the doctors seeing patients with Sickle Cell, 82% were satisfied with Cannabis.  Prior studies indicate only 65 % of patients are satisfied with traditional treatment for Sickle Cell and 75% seeking alternative treatments.  For every condition in this report, physicians were more satisfied than dissatisfied with Cannabis as treatment. Even for less responsive conditions, like Huntington’s Disease.
 
Dr. Ryan Marino, Case Western University toxicologists and addiction medicine specialist notes, “There is little evidence in the US about the effectiveness of marijuana”. When asked about the report, he backtracks and qualifies his answer by saying, “I think those conditions are anecdotally what people report success with,” and adds, “the low dissatisfaction rates are likely due to marijuana’s relative low risk.
 
Dr. Solomon Zaraa, president of Compassionate Cleveland, a medical Cannabis practice sees the survey results as like his own experience.  He sees many chronic pain patients who prefer not to depend on opiates.  He also sees PTSD patients who are less reluctant to enter therapy after they use Cannabis. 
 
Rather than downplaying, the results of this report, we should shout it from the mountain tops.  It’s promising that doctors of patients who use Cannabis are satisfied with the results. However, the stigma of Cannabis continues to be an adversary to real-world evidence.  As a response, we must keep publishing survey results such as this.   And as a follow up, we should probably find out what the patients themselves think of using Cannabis. 
 
 

I evaluated a couple of patients this week treating cancer with Cannabis and looked at recent news to see what progress is being made in Cannabis cancer research.
 
Early-stage research suggests that Cannabis-derived medicines could be effective in treating various cancers.
 
Although those of us in the Cannabis industry may already be aware of this, the medical community is just coming around to accepting the idea. 
 
Recent experimental treatments and small-scale clinical trials in Europe are showing the efficacy of medicinal Cannabis formulations.
 
THC has primarily been used in cancer treatment for palliative care, to relieve nausea, and stimulate appetite.  However, early-stage research is suggesting that Cannabis, which is more than THC, is also a highly effective treatment for killing cancer cells.
 
So, how does it work?
 
Pre-clinical studies have shown that cannabinoids reduce cancer cell growth and disrupt the blood supply to cancerous cells, including brain tumors, breast cancers and prostate cancer, among others.
 
With, potentially, hundreds of naturally occurring constituents, there is no one magic medical Cannabis bullet in cancer treatment. Cutting edge work using artificial intelligence (AI) is being carried out to analyze Cannabis plant genetics and to determine the best combination of cannabinoids, terpenes, flavonoids, and other constituents to target and optimize the treatment of various cancers.  It’s a many-to-many puzzle; many active ingredients to treat many types of cancers.
 
In pre-clinical studies, Cannabis cancer treatments can be tested through either 2D or 3D cell culture testing. 3D cell cultures allow researchers to recreate specific pathological environments The improvement in 3D cell culture technology has led to the generation of models that encompass more physiological and tissue-specific micro-environments, 
 
Despite advancements in pre-clinical testing, the key to gaining full acceptance in the medical community is real human data from clinical trials.  Currently, there is a small-scale clinical trial on glioblastoma (a brain cancer) in the UK and another trial on liver cancer in the Netherlands.
 
Scientists are also assessing the role of ‘personalized medicines.  Personalized medicine recognizes that we are all physiologically unique and uses individualized DNA sequencing to target treatment.  Personalized medicine is already used in the traditional treatment of cancer. 
 
Combined,. the analysis of AI, 3D Cell Cultures and personalized medicine present a huge opportunity for medical Cannabis and the treatment of cancer. 

The lifetime prevalence of post-traumatic stress disorder (PTSD) ranges from 6.1 to 9.2 percent of the general population.  Does past trauma cause trouble sleeping?  Yes.
 
A new Israeli study published in the Journal of Anxiety Disorders assesses the association between PTSD, Medical Cannabis use, and sleep.  After a traumatic experience, 80-90% of people suffer from sleep disturbances. Nightmares and frequent or early awakening are common. People with sleep disturbances caused by PTSD are likely to worsen their PTSD, potentially experiencing suicidal ideations, inflicting self-injury, and becoming disabled.
 
Some pharmaceutical medications are effective for improving sleep in people with PTSD.  However, research on Cannabis use and PTSD is limited. There’s some evidence that THC reduces the occurrence of nightmares and improves sleep quality in patients with PTSD.  As well, some animal studies indicate that CBD improves sleep.  Typically, studies evaluate low dose, single molecule extracts or synthetic cannabinoids.  However, Cannabis is more than THC or CBD.
 
A recent study by Dr. Sue Sisley examined the effects of smoked Cannabis flowers and PTSD.  The study was randomized, double-blinded, and placebo-controlled. However, it didn’t demonstrate any improvement in sleep.  How could this be?  The accounts of thousands of patients Cannabis can’t be wrong.  Dr. Sisley’s study involved participants who are long term Cannabis users.  During the study, they reported Cannabis withdrawal symptoms, indicating that the controlled dosage of the study was likely too low.
 
The Israeli study was conducted differently.  Rather than control the amount used, participants were asked to keep a diary of their daily Medical Cannabis use.  On average the Cannabis used by participants had higher THC levels (18%).  As for the conclusion, Medical Cannabis users demonstrated a shorter time to falling asleep, less nightmares, and less early awakening.  Furthermore, those who used Cannabis with a higher CBD content were less likely to wake up early.
 
Randomized, double-blind, placebo-controlled trials are generally considered the gold standard in single agent pharmaceutical drug discovery.  However, the study of herbal Cannabis needs a paradigm shift.  Real world Cannabis users have never relied on single agent cannabinoids in controlled fashion.  Their herbal Cannabis use ranges widely from a few puffs to consuming a full gram or two.  These contrasting studies highlight an important conclusion about Cannabis research.  Controlled trials are not the best way to initiate studies on Cannabis.  Non-interventional studies where participants are permitted to dose themselves have more external validity, meaning they reflect what is happening in the real world. 
 
Herbal Cannabis has helped patients with PTSD tremendously; particularly those with insomnia and nightmares.  Studies are best used to understand how herbal Cannabis works not if it works.  Real world evidence, like the Israeli study, demonstrates that Cannabis works. 
 
 

A syndrome is a collection of symptoms that frequently occur together. Tourette’s Syndrome is characterized by sudden, repetitive, rapid, unwanted movements or vocal sounds called tics.  Many people associate Tourette’s with outbursts of obscene or socially inappropriate words.  Although only one third of people with Tourette’s make obscene remarks.  Those who have outbursts find it difficult to deal with public places, school, work, or even home.  Just getting through the day can be excruciatingly difficult.  Doctors previously thought that Tourette’s was a psychological disorder.  Today, most scientists agree that Tourette’s is a neurological disorder with unknown causes. 
 
Tics come and go over time.  They first appear between the ages of 5 and 10, usually in the head and neck area.  Motor tics typically appear before vocal tics or outbursts.  The tics usually get worse in the early teen years and become more controlled by the late teens or early 20s.  Tics worsen with excitement or anxiety and improve during calm or focused activities.  Imagine trying to calm your excitement or anxiety as a teenager.
 
Canadian researchers performed a double-blind, randomized, placebo controlled, cross-over study of nine people with Tourette’s.  In prior studies, patients had reported a reduction in tic severity, improved sleep, and improved mood after using Cannabis. This study controlled the type of Cannabis and dosage used.  Each participant vaporized ¼ gram of either Type I, II, III, or placebo Cannabis flowers once every two weeks.  The Type I Cannabis had only 10% THC, Type II had 9% each of THC and CBD, and Type III had 13% CBD with very little THC.  Four different survey scales were used to assess the frequency and severity of the tics after Cannabis use. 
 
The Type I (or 10% THC) flowers worked best.  Type II (or 1:1 ratio THC and CBD) were a little less effective than Type I.  Type III CBD flowers did not have any significant effects.  Type I and II Cannabis improved urge for tics, symptoms of distress, and overall well-being. Type I flowers also had more cognitive and psychological adverse events.  The researchers admitted that it was difficult to draw conclusions from a small sample of participants.
 
MediCann has evaluated a handful of patients with Tourette’s.  Their ages range from 18 to 46.  On average, they smoke ½ gram of Tyle I Cannabis (closer to 20% THC) 3-4 times per day.  Some just smoke 1 time per day and others may smoke up to 8-10 times per day.  One patient, the 18-year-old, tried a CBD tincture without success and is next planning to try a 1:1 THC-CBD tincture.   Outside of the 18-year-old, they all report improved symptoms with Cannabis use.
 
When it comes to Cannabis, collecting real-world data complements traditional study design. Non-interventional studies of Tourette’s demonstrate significant improvement with Medical Cannabis.  The studies illustrate a wide range of dosage and variable experiences with Cannabis.  They highlight that Cannabis is not a one-size fits all medicine.
 

​“Medical Students Have Little Knowledge About Cannabis, Study Finds,” an article published in Cannabis Health by Joe Roberts describes a study about medical student Cannabis education in the US
 
Researchers from Nova Southeastern University and Florida Atlantic University published the results of a qualitative study on the perceptions of Cannabis by medical students in Florida.  The goal of the study was to identify themes shared by the students that may be helpful in designing future curricular on Medical Cannabis.  This study was one of the first to use qualitative interviews to explore student perspectives on Medical Cannabis
 
Qualitative studies focus on the “why” rather than the “what”.  They use semi-structured questions in a natural setting to create an in-depth conversation and understanding of the topic.  In this study, a total of 83 medical students in eight focus groups were questioned through ZOOM. The questions were designed to get an understanding of 1) beliefs about the therapeutic benefit of Cannabis 2) general knowledge about Cannabis and 3) the potential role of the physician. Each focus group lasted between 60 and 75 minutes. 
 
Most of the medical students were in favor of re-scheduling Cannabis to something less than Schedule I.  Most were able to name a symptom or condition that might benefit from Cannabis.  And only a few could name a health condition that was contraindicated or had no benefit with Cannabis use.
 
Students did have concerns about the potential for Cannabis addiction and long-term effects.  Most said their source of information came from friends and family or through social media. The two medical schools did not have courses on Cannabis or the Endocannabinoid System. 
 
The students were able to identify conditions, including cancer, AIDS, pain management, irritable bowel, multiple sclerosis, and others., that might benefit from Cannabis.  They also expressed concerns about the potential harms of Cannabis.  “A lot of people recommend chilling out with Medical Cannabis,” said one student, “but it actually can evolve into a panic attack.”  Student perspectives ranged from concerns about addiction to a lack of trust in patients knowing what was medically best with their Cannabis use.  
 
The researchers concluded that most students had erroneous beliefs about Medical Cannabis. They used unreliable sources of information and had mixed attitudes about legalization.  The students also tended to confuse Medical Cannabis use with recreational use.  The researchers described the way the students spoke about Medical Cannabis as “unsettling” and based on “unsubstantiated authority.”
 
Despite their confusion, the students were all interested in learning more.  Most felt that their medical school should offer Medical Cannabis training.  They noted that even if a state does not have medical Cannabis laws, they are likely to run into patients using Cannabis sometime in their career and would like to be prepared.
 
It’s been over 40 years since the Endocannabinoid system was discovered.  Typically, new discoveries don’t take long to be included in a medical school curriculum.  Outside of the stigma of Cannabis, there are concerns that science has not yet tackled the hurdles presented by variable, multi-agent, Cannabis medicines. There are those who make the argument that Medical Cannabis may require changes in the way we approve medicines. Years of patenting single or dual agent cannabinoids have not captured the revenue and presumed effectiveness of increasingly popular Cannabis.  There is also some indication that pharmaceutical industry is losing billions in stock value to burgeoning Cannabis sales.  At the same time,  pharmaceutical industry’s influence on medical education, may be slowing progress toward implementing changes to medical Cannabis curricular.  It’s a perfect storm that must eventually be resolved. 
 
 

​Not all studies are the same.  There are good studies.  There are bad studies. 

Some studies provide preliminary evidence, sort of like clues to a crime.  Amy Norton of US News and World Report writes a story titled, “Medical Cannabis for Pain is Linked to Slight Rise in Heart Trouble.” I investigated the finer details of this study noting that it was funded by the National Institute of Drug Abuse with principal investigators admitting to financial relationships with Pfizer, a pharmaceutical company.
 
Dr. Nina Nouhravesh presented findings from this preliminary study at a European Society of Cardiology meeting in Barcelona, Spain.   “In Denmark, there are three approved forms of Cannabis, all taken orally”, says researcher Dr. Nouhravesh.  “They include oral solutions and sprays of CBD; teas containing a mix of THC and CBD; and dronabinol, a synthetic form of THC.”  Dr. Nouhravesh and other researchers used Denmark’s national database, searching the medical records of 1.6 million patients with chronic pain.  Just under 4,600 were medical Cannabis patients who had filled at least one prescription for the three available forms of Cannabis.  The study found that those patients who used prescribed Cannabis were 64% more likely to have a heart arrhythmia in six months
 
Does this sound bad to you?  It isn’t.  0.9% or 4,140 patients who used Cannabis had arrhythmias, whereas 0.5% or 800,000 patients who didn’t use Cannabis also had arrhythmias. The relative risk seems significant, but the absolute risk is actually very low.  If you don’t pay attention to the math, you can be misled. 
 
It’s known that cannabinoids can influence heart rate, blood pressure, and blood clotting.  Add those facts to this study and some people may start to worry.  Robert Page, a professor at University of Colorado Skaggs School of Pharmacy sounds concerned as he comments on the study. “Just because something is natural doesn’t mean it’s safe,” he says.  Two out of three of the prescribed products in this study are not natural. Why does Professor Page make a comment on natural medicine?  I’m not sure. I don’t even know why the quote is in the article.
 
People with chronic pain often have other health problems and take multiple medications.  In this study, 42% of the patients prescribed Cannabis were also taking opiates.  Only 12% of patients not taking Cannabis were prescribed opiates.  “That’s an important difference,” says Dr. Jim Cheung, chairman of the American College of Cardiology.  “Opioid use typically signals severe pain – which itself could trigger arrhythmias.” Dr. Cheung also notes that some arrhythmias are more serious than others, and it’s unclear whether Cannabis is associated with specific types of arrhythmias.
 
We’ve seen doctors change careers to become politicians.  It's also clear that headlines like these are sometimes used as political maneuvers.  To uncover truth, scientists discuss or debate facts and repeat studies. As well, scientists usually take a good look at study design and statistics to make conclusions.  The answers are not always clear.  This story may be a political maneuver or just a misunderstanding of the math by the author.  In the end, these authors conclude that more study is warranted.  Remember the adage, don’t believe everything you read, especially when it comes to this article about Cannabis in US News and World Report.

​An original study recently published in The Journal of North American Menopause Society titled “A Survey of Medical Cannabis Use During Perimenopause and Postmenopause” compares Cannabis use among women experiencing the transition to menopause with women after menopause.
 
Perimenopause is defined as the time when ovaries gradually reduce the production of estrogen, which can include irregular menstrual flow, hot flashes, and night sweats.  Postmenopause is the period after perimenopause and defined as no menstrual flow for 12 consecutive months.
 
The study is a cross-sectional, observational study designed to collect information at a single time point identifying menopause related symptoms associated with medical Cannabis use.  The study did not try to show how well Cannabis worked for menopausal symptoms, which is difficult in an observational study design.
 
To better understand medical Cannabis use among menopausal women, researchers conducted surveys on 131 perimenopausal and 127 postmenopausal individuals.  They found that individuals experiencing perimenopause were more likely to have a diagnosis of depression and anxiety and more likely to use medical Cannabis than postmenopausal women.  In other words, the transition period to menopause was associated with more Cannabis use. 
 
92% of the women had tried Cannabis at least once in their lifetime.  84% were regular Cannabis users, using at least once per month.  Smoking flower (84%) and using edibles (78%) were the most common methods of using Cannabis.  It’s interesting to note that a broad range of products were used by at least 25% of the participants including vape pens, tinctures, vaporizing the flower and topicals.  The top three reasons for using Cannabis were poor sleep, anxiety, and to improve sex drive.  The top reasons why women were not interested in using Cannabis were because they had a lack of knowledge of Cannabis, or their menopausal symptoms were already well managed. Other reasons were no access to Cannabis products, fear of getting high, and cost.
 
Hormone replacement therapy (HRT) is the medically recommended treatment for menopause.  However, HRT is associated with negative symptoms such as mood swings and fatigue.  There is also an increased risk of developing cancer with HRT.
 
It’s known that Human ovaries produce the endocannabinoid anandamide with peak blood levels occurring at ovulation and correlating with estrogen levels.  Giving estrogen to animals that have their ovaries removed (a model for menopause), increases the expression of cannabinoid receptors and levels of anandamide.  This indicates that the endocannabinoid system is very likely linked to functioning ovaries. This is molecular evidence why Cannabis may benefit menopause.
 
The study authors do note some concerns with current Cannabis use for menopause.  Smoking tobacco is associated with an increased risk of early menopause.  Although smoking Cannabis is different than smoking tobacco (unless you are smoking a spliff or a blunt), it’s uncertain whether it may also affect the onset of menopause.  Another concern is that dosage is uncertain with broad spectrum or full spectrum Cannabis products and needs to be studied in prospective clinical trials.  And finally, the effect of cannabinoids on liver metabolism is important to consider when prescribed medicines are also being used. 
 
All in all, this study highlights that medical Cannabis has great potential as treatment for the adverse symptoms related to menopause.