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Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends

BACKGROUND: Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to pa...

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Autores principales: Lyu, Xintian, Illamola, Sílvia M., Marino, Susan E., Leppik, Ilo E., Dahmer, Stephen, Lehfeldt, Paloma, Conway, Jeannine M., Remmel, Rory P., Kingsley, Kyle, Birnbaum, Angela K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393751/
https://www.ncbi.nlm.nih.gov/pubmed/37538850
http://dx.doi.org/10.1016/j.curtheres.2023.100709
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author Lyu, Xintian
Illamola, Sílvia M.
Marino, Susan E.
Leppik, Ilo E.
Dahmer, Stephen
Lehfeldt, Paloma
Conway, Jeannine M.
Remmel, Rory P.
Kingsley, Kyle
Birnbaum, Angela K.
author_facet Lyu, Xintian
Illamola, Sílvia M.
Marino, Susan E.
Leppik, Ilo E.
Dahmer, Stephen
Lehfeldt, Paloma
Conway, Jeannine M.
Remmel, Rory P.
Kingsley, Kyle
Birnbaum, Angela K.
author_sort Lyu, Xintian
collection PubMed
description BACKGROUND: Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to patients. OBJECTIVE: To characterize the distribution of cannabis products, their CBD/THC content, and dosing among patients with qualifying conditions. METHODS: This is a retrospective analysis of ∼50% of registered users receiving medical cannabis in Minnesota (June 16, 2016, to November 15, 2019). Data included formulation, CBD/THC prescribed doses, and qualifying conditions. The primary end points were calculated using daily dose and duration of use. Comparisons were made for CBD and THC total daily dose dispensed, patient age, and approved product. Nonparametric statistical tests were used (significance was set at p < 0.05). RESULTS: A total of 11,520 patients were listed with 1 qualifying condition. The most common condition was intractable pain (60.0%). Median dispensation duration varied from 53 days (cancer) to 322 days (muscle spasms). Most (≥62.8%) patients across all qualifying conditions received both CBD and THC. Median THC dose was lower in older (≥65 years) compared with younger adults with intractable pain (p < 0.0001) and cancer patients (p = 0.0152), and the same pattern was found CBD dose with seizure (p = 0.0498) patients. For commercial products with Food and Drug Administration indications, the median CBD total daily dose was 86.9% lower than the recommended doses for patients with seizures (Epidiolex: Jazz Pharmaceuticals, Palo Alto CA) and median THC total daily dose was 65.3% (Syndros: Benuvia Manufacturing, Round Rock, TX) or 79.3% lower (Marinol: Banner Pharmacaps, Inc., High Point, NC) for cancer patients. CONCLUSIONS: A majority of patients received products containing both CBD and THC. Dosages varied by age group and were lower than recommended for conditions with Food and Drug Administration-approved products. Complex pharmacokinetics of THC and CBD, possible age-related changes in physiology, unknown efficacy, and potential for drug interactions all increase the need for monitoring of patients receiving cannabis products. (Curr Ther Res Clin Exp. 2023; 84:XXX–XXX)
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spelling pubmed-103937512023-08-03 Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends Lyu, Xintian Illamola, Sílvia M. Marino, Susan E. Leppik, Ilo E. Dahmer, Stephen Lehfeldt, Paloma Conway, Jeannine M. Remmel, Rory P. Kingsley, Kyle Birnbaum, Angela K. Curr Ther Res Clin Exp Original Research BACKGROUND: Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to patients. OBJECTIVE: To characterize the distribution of cannabis products, their CBD/THC content, and dosing among patients with qualifying conditions. METHODS: This is a retrospective analysis of ∼50% of registered users receiving medical cannabis in Minnesota (June 16, 2016, to November 15, 2019). Data included formulation, CBD/THC prescribed doses, and qualifying conditions. The primary end points were calculated using daily dose and duration of use. Comparisons were made for CBD and THC total daily dose dispensed, patient age, and approved product. Nonparametric statistical tests were used (significance was set at p < 0.05). RESULTS: A total of 11,520 patients were listed with 1 qualifying condition. The most common condition was intractable pain (60.0%). Median dispensation duration varied from 53 days (cancer) to 322 days (muscle spasms). Most (≥62.8%) patients across all qualifying conditions received both CBD and THC. Median THC dose was lower in older (≥65 years) compared with younger adults with intractable pain (p < 0.0001) and cancer patients (p = 0.0152), and the same pattern was found CBD dose with seizure (p = 0.0498) patients. For commercial products with Food and Drug Administration indications, the median CBD total daily dose was 86.9% lower than the recommended doses for patients with seizures (Epidiolex: Jazz Pharmaceuticals, Palo Alto CA) and median THC total daily dose was 65.3% (Syndros: Benuvia Manufacturing, Round Rock, TX) or 79.3% lower (Marinol: Banner Pharmacaps, Inc., High Point, NC) for cancer patients. CONCLUSIONS: A majority of patients received products containing both CBD and THC. Dosages varied by age group and were lower than recommended for conditions with Food and Drug Administration-approved products. Complex pharmacokinetics of THC and CBD, possible age-related changes in physiology, unknown efficacy, and potential for drug interactions all increase the need for monitoring of patients receiving cannabis products. (Curr Ther Res Clin Exp. 2023; 84:XXX–XXX) Elsevier 2023-06-11 /pmc/articles/PMC10393751/ /pubmed/37538850 http://dx.doi.org/10.1016/j.curtheres.2023.100709 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Lyu, Xintian
Illamola, Sílvia M.
Marino, Susan E.
Leppik, Ilo E.
Dahmer, Stephen
Lehfeldt, Paloma
Conway, Jeannine M.
Remmel, Rory P.
Kingsley, Kyle
Birnbaum, Angela K.
Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends
title Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends
title_full Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends
title_fullStr Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends
title_full_unstemmed Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends
title_short Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends
title_sort medical cannabis received by patients according to qualifying condition in a us state cannabis program: product choice, dosing, and age-related trends
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393751/
https://www.ncbi.nlm.nih.gov/pubmed/37538850
http://dx.doi.org/10.1016/j.curtheres.2023.100709
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