Saturday, September 16th 2017
New Mexico State Department of Health
Medical Cannabis Advisory Board
Medical Cannabis Program
PO Box 26110
Santa Fe, NM, 87502-6110
Medical Cannabis Program
PO Box 26110
Santa Fe, NM, 87502-6110
Petition: Requesting The Inclusion Of A New Medical Condition: Eczema And Psoriasis
Table of Contents
Pg. 1 Cover Page
Pg. 2 Petition Introduction
Pg. 3 Petition Purpose and Background
Pg. 16 Relief Requested In Petition
Pg. 17 References
Pg. 18-19 Appendix A
Petition Introduction: Requesting The Inclusion Of A New Medical Condition: Eczema And Psoriasis
New Mexico’s medical cannabis history started in 1978, after public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis. The New Mexico’s medical cannabis program (MCP) is the only program in the U.S. that places sole responsibility for regulation on the state’s Department of Health. Doctors must comply with state requirements for patients to be considered for applying to the medical cannabis program.
In the Lynn and Erin Compassionate Use Act, (2007) the law states; The Secretary of Health shall establish an advisory board consisting of eight practitioners representing the fields of neurology, pain management, medical oncology, psychiatry, infectious disease, family medicine and gynecology. The practitioners shall be nationally board-certified in their area of specialty and knowledgeable about the medical use of cannabis. The members shall be chosen for appointment by the Secretary from a list proposed by the New Mexico Medical Society. A quorum of the advisory board shall consist of three members. The advisory board shall:
A. review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis;
B. accept and review petitions to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
C. convene at least twice per year to conduct public hearings and to evaluate petitions, which shall be maintained as confidential personal health information, to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
D. issue recommendations concerning rules to be promulgated for the issuance of the registry identification cards; and
E. recommend quantities of cannabis that are necessary to constitute an adequate supply for qualified patients and primary caregivers.
First, do no harm. As an important step in becoming a doctor, medical students must take the Hippocratic Oath. And one of the promises within that oath is “first, do no harm”.
A. review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis;
B. accept and review petitions to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
C. convene at least twice per year to conduct public hearings and to evaluate petitions, which shall be maintained as confidential personal health information, to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
D. issue recommendations concerning rules to be promulgated for the issuance of the registry identification cards; and
E. recommend quantities of cannabis that are necessary to constitute an adequate supply for qualified patients and primary caregivers.
First, do no harm. As an important step in becoming a doctor, medical students must take the Hippocratic Oath. And one of the promises within that oath is “first, do no harm”.
We have a sound law in the Lynn and Erin Compassionate Use Act, as Section 2 reads; PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.
“ARTICLE 2B. LYNN AND ERIN COMPASSIONATE USE ACT
N.M. Stat. Ann. § 26-2B-2 (2009)
§ 26-2B-2. Purpose of act
The purpose of the Lynn and Erin Compassionate Use Act [26-2B-1 NMSA 1978] is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.
HISTORY: Laws 2007, ch. 210, § 2.
EFFECTIVE DATES. --Laws 2007, ch. 210, § 12 makes the act effective July 1, 2007.”
Mosby’s Medical Dictionary states that “medical treatment” means; the management and care of a patient to combat disease or disorder. Medical treatment includes: Using prescription medications, or use of a non-prescription drug at prescription strength; and or treatment of disease by hygienic and pharmacologic remedies, as distinguished from invasive surgical procedures. Treatment may be pharmacologic, using drugs; surgical, involving operative procedures; or supportive, building the patient's strength. It may be specific for the disorder, or symptomatic to relieve symptoms without effecting a cure.(Mosby's Medical Dictionary, 9th edition.)
What is a chronic medical condition?
A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. Harvard Medical Dictionary defines chronic as: Any condition that lasts a long time or recurs over time; chronic pain as: Pain that persists after an injury has healed or a disease is over; and chronic pain syndrome as : Long-term, severe pain that doesn't spring from an injury or illness, that interferes with daily life, and is often accompanied by other problems, such as depression, irritability, and anxiety.
A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. Harvard Medical Dictionary defines chronic as: Any condition that lasts a long time or recurs over time; chronic pain as: Pain that persists after an injury has healed or a disease is over; and chronic pain syndrome as : Long-term, severe pain that doesn't spring from an injury or illness, that interferes with daily life, and is often accompanied by other problems, such as depression, irritability, and anxiety.
What is the meaning of debilitating?
Something that's debilitating seriously affects someone or something's strength or ability to carry on with regular activities, like a debilitating illness. Debilitating comes from the Latin word debilis, meaning "weak." That's why you'll often see the adjective used to describe illness, despite the negative reference.
Something that's debilitating seriously affects someone or something's strength or ability to carry on with regular activities, like a debilitating illness. Debilitating comes from the Latin word debilis, meaning "weak." That's why you'll often see the adjective used to describe illness, despite the negative reference.
Petition Purpose and Background
The purpose of this Petition: Requesting The Inclusion Of A New Medical Condition: Eczema And Psoriasis
This Petition: Requesting The Inclusion Of A New Medical Condition: Eczema And Psoriasis is being provided to the state Department of Health Medical Cannabis Program so the advisory board can review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis with the Lynn and Erin Compassionate Use Act.
Who Should Qualify for Medical Cannabis Use?
According to Americans For Safe Access Policy Studies & Research:
Background: The most fundamental aspect of medical cannabis laws is the relationship between a patient and their physician. It is often only the physician and the patient that possess information about a patient’s health condition. However, many public officials and others who oppose medical cannabis laws often make assumptions about people’s health. The media have even fomented such inappropriate assumptions by naming a category of patients “Young Able Bodied Males,” condemning certain patients by visual assessment alone.
Findings: The health care information discussed between a patient and physician is considered private and protected under federal HIPAA laws. It is typically the purview of state medical boards to assess whether a physician has inappropriately recommended cannabis to someone who should not be qualified. Studies have shown in some medical cannabis states that the majority of patients suffer from chronic pain, an ailment that is not obviously detectable by another person. Nevertheless, police will often harass and arrest patients based on the assumption that someone is faking their illness.
Position: Medical professionals should have an unrestricted ability to recommend cannabis therapeutics and that should not be impacted by law enforcement’s perceptions.
According to Americans For Safe Access Policy Studies & Research:
Background: The most fundamental aspect of medical cannabis laws is the relationship between a patient and their physician. It is often only the physician and the patient that possess information about a patient’s health condition. However, many public officials and others who oppose medical cannabis laws often make assumptions about people’s health. The media have even fomented such inappropriate assumptions by naming a category of patients “Young Able Bodied Males,” condemning certain patients by visual assessment alone.
Findings: The health care information discussed between a patient and physician is considered private and protected under federal HIPAA laws. It is typically the purview of state medical boards to assess whether a physician has inappropriately recommended cannabis to someone who should not be qualified. Studies have shown in some medical cannabis states that the majority of patients suffer from chronic pain, an ailment that is not obviously detectable by another person. Nevertheless, police will often harass and arrest patients based on the assumption that someone is faking their illness.
Position: Medical professionals should have an unrestricted ability to recommend cannabis therapeutics and that should not be impacted by law enforcement’s perceptions.
“Qualifying medical condition” shall mean any condition for which treatment with medical cannabis would be beneficial, as determined by a patient's qualified medical professional, including but not limited to cancer, glaucoma, positive status for human immunodeficiency virus, acquired immune deficiency syndrome (AIDS), hepatitis C, amyotrophic lateral sclerosis (ALS), Crohn’s disease, Parkinson’s disease, post-traumatic stress disorder, arthritis, chronic pain, neuropathic and other intractable chronic pain, and multiple sclerosis.
“Qualifying patient” shall mean a person who has a written recommendation from a qualified medical professional for the medical use of cannabis.
Psoriasis And Eczema
Dry and scaly skin woes can be due to a number of skin conditions. Two that can sometimes appear so similar that it's tough for doctors to tell the difference are psoriasis and eczema.
Psoriasis is a condition that occurs when a person's immune system triggers skin cells to grow faster than they usually should. Instead of the dead skin cells coming off the skin, they build up on the skin.
Eczema can be caused by a number of factors. These include environmental factors, bacteria exposure, allergens, and family history.
Both conditions can cause red, itchy skin but have different causes and different treatments. As a result, it's important to understand the differences.
Both eczema and psoriasis are skin conditions that can keep the skin from appearing smooth and healthy. However, there are several differences that a doctor will use to differentiate eczema from psoriasis or other skin conditions.
While there is one eczema type, there are five different types of psoriasis. However, the most common form of psoriasis is plaque psoriasis, which is the form that most clearly resembles eczema.
Appearance
Psoriasis tends to cause thick, red, and scaly patches. They are usually well-defined.
Eczema causes patches that are red or brown-gray in color. However, sometimes the areas may be different and appear as small, raised bumps. They can have a "crust" on them and leak fluid.
Location
Eczema tends to appear in the "bends" of the skin, such as the crooks of elbows and backs of the knee. Psoriasis can also appear on the elbows and knees.
However, both may also appear on the face, buttocks, or scalp, most commonly in children.
Itching
Itching can be one of the significant differences between eczema and psoriasis. Psoriasis tends to cause mild itching while eczema causes intense itching.
If a person does scratch the skin, the results can be swollen, sensitive, and even raw skin. Eczema itching is usually worse at night.
Age of occurrence
Children tend to experience eczema at greater rates than adults. According to the Nemours Foundation, eczema tends to subside at about age 5 or 6.
According to the National Psoriasis Foundation, psoriasis typically develops between the ages of 15 and 35. Babies rarely have psoriasis.
The American Academy of Dermatology estimate that 1 percent of children have psoriasis, while 10 percent of children will have eczema, according to the Nemours Foundation.
Additional symptoms
Psoriasis can sometimes cause joint stiffness as well as swelling. In addition, psoriasis can also affect the nails. Eczema does not typically involve these areas, particularly in regards to joint swelling.
Eczema, Psoriasis And Medical Cannabis
Your skin, is your largest organ, and serves as the body’s boundary, tough enough to resist all sorts of environmental assaults, yet sensitive enough to feel a breeze. Anything that irritates, clogs, or inflames your skin can cause symptoms such as redness, swelling, burning, and itching. Allergies, irritants, your genetic makeup, and certain diseases and immune system problems can cause rashes, hives, and other skin conditions.
Recent years have brought a wealth of new scientific understanding regarding how medical marijuana or cannabis can be beneficial for treating Skin Conditions.
Your skin covers and protects your body and provides a variety of functions:
- Holds body fluids in, preventing dehydration
- Keeps harmful microbes out, preventing infections
- Helps you feel things like heat, cold, and pain
- Keeps your body temperature even
- Makes vitamin D when the sun shines on it
Clinical Information Related to Skin Conditions and Marijuana Cannabis
The National Academies of Sciences, Engineering, and Medicine, released one of the most comprehensive studies of recent research on the health effects of cannabis. This report includes relevant scientific research published since 1999. The study found moderate evidence suggesting that cannabinoids can improve short-term sleep outcomes in patients with sleep disturbance associated with obstructive sleep apnea, fibromyalgia, chronic pain, or MS.
In 2004, Dr. Ethan Russo proposed the idea of clinical endocannabinoid deficiency (CECD). He suggested that deficient cannabinoid levels may be the underlying cause of numerous conditions, such as fibromyalgia, and may be suitably treated with cannabinoid-based medicines. It is no surprise that many patients prefer medicating with cannabis over pharmaceutical drugs. In fact, many states that have legalized medical marijuana have recognized its potential health benefits and have included fibromyalgia as a qualifying condition.
“Deficient cannabinoid levels may be the underlying cause of numerous conditions alleviated by cannabis.”– Ethan Russo
Ten years later, researchers revisited Russo’s initial findings and confirmed evidence that imbalances in the endocannabinoid system (ECS) indeed play a role in fibromyalgia, IBS, and a growing list of other medical conditions.
As in any chronic pain condition, most patients learn there are certain things they do or don’t do on a daily basis that seem to make the FM symptoms better or worse. Pacing of activities is extremely important in managing the symptoms of FM. It is recommended that FM patients stop what they are doing every 20-30 minutes and change what they are focusing on for a few minutes. Education is also an essential component in teaching patients to help themselves.
Microdosing is the practice of consuming small amounts of cannabis over an extended period of time, typically a day. By ingesting the THC and other cannabinoids in smaller doses, a patient can still achieve the medical benefits of the cannabis with little or no euphoric “high” effects. This is achieved by taking a small vape hit or just one puff from a joint or pipe periodically throughout the day. It can also be accomplished by consuming the recommended dosage of an edible in smaller portions, or using a tincture drop in herbal tea or hot lemon water.
Researchers from the University of California Davis Medical Center (UCDMC) conducted a study comparing low dose (1.29% THC) and medium dose (3.53% THC) vaporized cannabis to determine if significant analgesic benefits could result without high levels of cognitive side effects. Thirty-nine participants with persistent neuropathic pain completed the study, which involved several interviews and evaluations to rate pain intensity. All patients had used cannabis previously (as required in the inclusion criteria).
Results of the study showed that both the low and medium doses provided significant pain relief, with an average of 30% reduction in pain intensity compared with a placebo. Side effects observed were negligible. It is interesting to note, however, that participants from the medium dose group had worse performance and learning and memory evaluations as compared to those of the placebo and low dose groups.
The authors of the UCDMC study concluded that low and medium doses of vaporized cannabis could be prescribed for treatment of neuropathic pain and provide clinically significant relief; however, in view of the findings, low doses would appear to cause fewer cognitive and psychological side effects.
Medical Cannabis for Psoriasis
Because psoriasis is caused by problems with the immune system, cannabis is an especially effective treatment. The cannabinoids in cannabis fit perfectly into special receptors in the endocannabinoid system of the human body. These receptors, called CB1 and CB2, are concentrated in the brain/central nervous system and the immune system, respectively. However, the latest science reveals that each receptor type is found throughout almost all organs and tissues of the body, just with different expressions (densities and patterns).
Conventional pharmaceutical drugs used to treat psoriasis, typically systemic immuno-modulating agents, involve many problems that are not associated with the use of cannabis or cannabis topicals. These include fever, diarrhea, liver dysfunction, and increased chance of infection. Thus, cannabis effectively deals with the significant cause of this skin condition, inflammation, and its chief symptoms, pain and discomfort — all while avoiding the negative side effects of pharmaceutical drugs.
The Studies
Very few research studies have been conducted to investigate the medical efficacy of cannabis and its components for skin ailments such as eczema and psoriasis. The little formal and informal research that is available, especially in the form of anecdotal testimonies and case studies, reveals that cannabis is very effective at dealing with this disease that involves the immune system and sometimes produces severe inflammation within the skin.
Cannabis is a nuanced and symbiotic medicine, individual samples of which may contain more than 100 cannabinoids and 200 terpenes, the two categories of major medicinal molecules within the plant. Thus, the specific benefits gained from topical use of this herb are highly dependent on the quality of the cannabis employed by a patient, as well as its particular makeup. Some strains are rich in THC, while others, although more rare, have unusually large volumes of the non-psychoactive cannabinoid CBD.
Because cannabis is most effective at battling pain, inflammation, and nausea, it is especially adept at helping sufferers of psoriasis, arthritis, and other inflammation-based conditions. However, it is important to note that each strain of cannabis offers a distinct cannabinoid and terpene profile and will, thus, have maximum efficacy with a particular disease or only a certain percentage of a patient population.
A study conducted in 2007 and published in the Journal of Dermatological Science determined that cannabinoids help prevent the buildup of dead skin cells and other symptoms of psoriasis. Concluded the researchers: “Our results show that cannabinoids inhibit keratinocyte proliferation, and therefore support a potential role for cannabinoids in the treatment of psoriasis.”
Although not a formal study, the Gwynedd Cannabis Club in Wales and the United Kingdom conducted a nine-day experiment in which it used cannabis oil to treat acute psoriasis. One subject was treated with a conventional pharmaceutical therapy, a chemotherapy drug called Methotrexate. This drug resulted in fever, diarrhea, abnormal liver function, and increased chance of infection.
However, when the same subject was treated with cannabis instead of Methotrexate, she experienced no negative side effects and a complete healing of her skin. In fact, she was able to go swimming with her family — something her severe psoriasis had previously prevented — for the first time following the brief cannabis therapy. This treatment regimen involved three treatments of topical cannabis oil daily for nine days.
FINDINGS: EFFECTS OF CANNABIS ON ECZEMA
Research has repeatedly shown that cannabis is effective at alleviating symptoms of several skin conditions, including eczema. Cannabinoids have immunosuppressive properties, in turn making them potential therapeutic agents for treating inflammatory skin diseases 7.
The endocannabinoid system (ECS) plays an important role in several skin regulatory functions. Researchers believe that skin conditions like eczema develop when there’s an imbalance in the ECS2. The cannabinoids found in cannabis can help mediate disruptions in the ECS by interacting with cannabinoid receptors (CB1 and CB2), which are found in abundance on the nerve fibers and cells of the skin 13. Through these interactions with CB receptors, cannabinoids are able to help reduce skin inflammation, pain and itching (3,10,12,13,14). Additionally, studies have found that through the activation of CB2 receptors, cannabinoids help alleviate, and in some cases reverse, skin inflammation damage 8.
Studies examining cannabis’ effectiveness on treating eczema and other related skin conditions are vast. One trial found that a group of nearly 2500 patients with atopic eczema experienced significant reductions in skin redness, scaling, itching, chafing and thickening following cannabinoid cream treatments. Additionally, 38.3 percent of those patients experienced a complete resolution of itching 4. Another study found that the twice-daily application of cream containing cannabinoids for three weeks completely eliminated skin itching in 38.1 percent of patients and significantly reduced the intensity of itching in 52.4 percent of patients 16,17. In an animal trial, a topical containing the cannabinoid tetrahydrocannabinol (THC) effectively reduced skin inflammation in mice with dermatitis 6. Another cannabinoid contained in cannabis, cannabidiol (CBD), was found to prevent skin inflammation and swelling 9.
STATES THAT HAVE APPROVED MEDICAL MARIJUANA FOR ECZEMA
So far, no states have approved medical marijuana for the treatment of eczema.
However, in Washington D.C., any condition recommended by DC-licensed physician can be approved for medical marijuana. California allows medical marijuana for “any debilitating illness where the medical use of marijuana has been deemed appropriate and has been recommended by a physician.’” Psoriasis patients in Massachusetts may be able to get legal access, as the state approves “other conditions as determined in writing by a qualifying patient’s physician.” In Oregonand Rhode Island, “other conditions are subject to approval.”
RECENT STUDIES ON CANNABIS’ EFFECT ON ECZEMA
- Cannabinoid cream treatments significantly reduced skin redness, scaling, itching, chafing and thickening in patients with eczema.
- Adjuvant treatment of atopic eczema: assessment of an emollient containing N-palmitoylethanolamine (ATOPA study).
- Cannabinoid receptor agonists are effective at significantly reducing skin inflammation and itching.
- Histamine induced responses are attenuated by a cannabinoid receptor agonist in human skin.
- Topical cream containing cannabinoids completely eliminated itching in 38.1 percent of patients and significantly reduced the severity of itching in 52.4 percent of patients.
- Efficacy and tolerance of the cream containing structured physiological lipids with endocannabinoids in the treatment of uremic pruritus: a preliminary study.
It may come as a surprise, but cannabis applied directly to the skin can greatly improve skin health. But, how does it work? In this first segment of our Skin Deep series, we’ll walk you through why cannabis cream is so effective in treating the pain, inflammation, and irritation associated with many skin conditions. As a bonus, we’ll tell you how it might slow unwanted a hair growth as well.
How does cannabis cream work on your skin
The skin in the largest bodily organ. It’s our first point of contact with the world around us, and it protects our internal organs from harm. While it may not seem like it, the skin is surprisingly active. Cells in the skin synthesize vitamin D, regulate our body temperature, and helps us detect changes in our environment. For these reasons, it’s important to keep skin healthy.
Specialized glands, cells, and hairs help the skin perform all of its routine functions. Surprisingly, recent research has shown that cannabinoid receptors are actually found on cells throughout the skin. Cannabinoid receptors are the binding locations for compounds like THC, the primary active chemical in cannabis. Both THC and non-psychoactive CBD are phytocannabinoids. Our bodies make versions of these compounds, known as endocannabinoids.
It’s a common misconception that cannabinoid receptors are concentrated only in the central nervous system and the brain. They’re actually found all throughout the body. This includes the skin, the gut, and reproductive organs. The fact that these cell sites are found in a wide range of bodily regions indicates how important endocannabinoids are to our basic health and physiological functioning. This includes the basic health and functioning of the skin.
The endocannabinoid system and the skin
The endocannabinoid system is the proper term for the vast network of cannabinoid receptors and their corresponding compounds, endocannabinoids. Turns out, the endocannabinoid system has a diverse set of responsibilities in the skin. The compounds regulate a few vital skin functions. Here are a few of them:
Inflammation and immune response
As a giant external organ, the skin experiences quite a bit of stress in daily life. To help it cope, specialized immune cells are present in different skin layers. Endocannabinoids engage with these immune cells to help control inflammatory response.
In a 2007 study, researchers found that mice with without cannabinoid receptors displayed an increased inflammatory allergic response to irritants. The research team also found that levels of endocannabinoids increased when mice with contact dermatitis. Contact dermatitis is an allergic rash or reaction to a foreign irritant. These findings attest to the endocannabinoid system’s crucial role in the body’s immune system, aiding in the body’s ability to protect itself.
The skin contains numerous oil-producing factories known as sebaceous glands. This oil has a few purposes: it lubricates the skin, protects your body from invading germs, and plays a role in skin nutrition. The oil, known as sebum, contains antioxidants and is slightly acidic. The acidity helps neutralize any undesired bacteria that you may pick up throughout the day.
Studies have shown that the endocannabinoid system aids in sebum creation. The endocannabinoid system is thought to play a regulatory role in managing the production of this oil, along with maintaining the function of the hair follicle. Sebaceous glands are connected to hair follicles, causing the two of them to act as a mini-organ of the skin.
Slower hair growth
Tired of excess back hair? Put some weed on it! Well, kind of. There is some evidence that THC and our own endocannabinoid, anandamide, slow down hair growth in a dose-dependent fashion. The more THC you apply, the slower the hair is going to grow. This finding just might be why cannabis-based health product company, Phytecs, is looking into developing skin-care products that target the endocannabinoid system. On their website, they state:
“Endocannabinoids regulate skin inflammation, oil production, and even play a role in unwanted hair growth. Skin care products that target the endocannabinoid system are likely to be a fundamental element of next-generation cosmetic treatments.” – Phytecs
Cannabis and your skin
When you apply activated cannabis directly to the skin in the form of a topical, you’re directly engaging these cannabinoid receptors. If you sprain an ankle and your ankle swells up, applying a cannabis topical can both ease the pain in that area as well as drastically reduce inflammation.
The same goes with other inflammatory abrasions, bruises, and skin conditions. Cannabis cream is non-psychoactive. Simply rubbing on a little canna-balm isn’t going to get you high. But, infused balms, creams, salves, and lotions are a great natural first-aid product to have on hand for minor abrasions.
You can also use cannabis cream in the form of transdermal patches. Patches like those created by Mary’s Medicinals are popular among arthritis sufferers and those recovering from an injury. You apply a transdermal patch just like you’d apply an IcyHot or nicotine patch, and they work wonders for reducing pain and inflammation in a localized area.
Cannabinoids May Soothe Eczema, Psoriasis, Other Skin Diseases, Study Finds
A new study finds that the cannabis-based creams may be helpful in treating a wide range of skin illness, including psoriasis, eczema, atopic and contact dermatitis, inflammatory skin disease, and skin cancer.
Researchers at the University of Colorado Anschutz Medical Campus reviewed the current literature on treating skin disease with topical cannabinoids and concluded that cannabinoids’ anti-inflammatory properties may help to reduce patients’ dry skin and itching.
Researchers at the University of Colorado Anschutz Medical Campus reviewed the current literature on treating skin disease with topical cannabinoids and concluded that cannabinoids’ anti-inflammatory properties may help to reduce patients’ dry skin and itching.
Article Outline
Key words:
cannabinoid, cannabis, dermatitis, endocannabinoid, inflammatory skin disease, keratinocyte carcinoma, melanoma, palmitoylethanolamide, pruritus, skin cancer, tetrahydrocannabinol
Abbreviations used:
Twenty-eight states currently allow for comprehensive public medical cannabis programs, and this number continues to grow.1 Approximately 1 in 10 adult cannabis users in the United States use it for medical purposes.2 Numerous studies have investigated its uses for chronic pain, spasticity, anorexia, and nausea. In recent years, researchers have also investigated its use for the treatment of dermatologic conditions including pruritus, inflammatory skin disease, and skin cancer.
Perhaps the most promising role for cannabinoids is in the treatment of itch. In a study of patients with uremic pruritus on maintenance hemodialysis, topical application of a cream with structured physiologic lipids (derma membrane structure) and endogenous cannabinoids applied twice daily for 3 weeks completely eliminated pruritus in 8 of 21 patients (38%). The authors suggested that the well-tolerated product might work by reducing xerosis.3 Stander et al4 further studied 22 patients with prurigo, lichen simplex, and pruritus who applied an emollient cream with palmitoylethanolamide (PEA). PEA, which stimulates anandamide (endocannabinoid) activation of cannabinoid 1 (CB1) receptors, reduced itch by 86.4% and was well tolerated by patients. Most recently, WIN 55,212-2, a cannabinoid agonist, was found to reduce serotonin-induced itching in a dose-dependent manner through intraperitoneal administration in mice. When the investigators used neurotoxins to deplete serotonin in the spinal cord, they reported no change in these results. Thus, they suggested that the cannabinoids may work independently of descending inhibitory pathways.5
Cannabinoids may also have anti-inflammatory properties useful for the treatment of both allergic contact dermatitis and atopic dermatitis. Petrosino et al6 reported that mice released PEA in response to 2,4-dinitrofluorobenzene–induced allergic contact dermatitis as an endogenous protective agent. PEA may work to reduce later stages of allergic contact dermatitis, including mast-cell infiltration, angiogenesis, and itching.7, 8, 9 Tetra-hydrocannabinol (THC) may also demonstrate anti-inflammatory effects independent of CB1 and cannabinoid 2 (CB2) receptors. In mice, topical THC decreased allergic-contact ear swelling and inflammation in both wild-type mice and mice lacking CB1 and CB2 receptors. Topical THC limited myeloid immune cell recruitment by a decreasing T-cell production of interferon-γ and keratinocyte production of CCL2, CCL8, and CXL10 chemokines.9 In terms of atopic dermatitis, the activation of CB1 receptors in mice has been found to improve epidermal barrier function, decrease Th2-mediated inflammatory response,10, 11and suppress mast cells.12
Limited studies on its uses for other skin conditions also exist. Cannabinoids may be useful for psoriasis, as THC, cannabidiol, cannabinol, and cannabigerol have been found to inhibit keratinocyte proliferation in hyperproliferating human keratinocyte cell lines.13 In mice, CB1 knockout mice were protected from bleomycin-induced fibrosis, and the selective CB1 receptor agonist N-(2-chloroethyl)-5Z,8Z,11Z,14Z-eicosatetraenamide was shown to promote bleomycin-induced fibrotic effects. Tight skin−1 mice, characterized by an accumulation of collagen fibers in the hypodermis and an absence of inflammatory infiltrates, were not protected against fibrosis in CB1 knockout models. Thus, the authors suggested that the profibrotic effects of CB1 are mediated by the effects of CB1 on leukocytes, and CB1 ablation may be used as a potential treatment for the early inflammatory stages of scleroderma and systemic sclerosis.14 It is important to note that other studies have demonstrated beneficial antitumorigenic effects of cannabinoid activation (see next paragraph),15 which were not mentioned in this study. Furthermore, in a recent single-blinded and comparative study in 11 humans, Ali et al16 investigated the use of 3% cannabis seed extract cream applied topically for the use of acne and seborrheic dermatitis. Treated patients had lower levels of skin sebum and erythema.
Endocannabinoids, synthetic cannabinoids, and phytocannabinoids have also been shown to have antitumor effects on keratinocyte carcinoma and melanoma both in vitro and in vivo.15 In mice inoculated with epidermal tumor cells, local administration of a mixed CB1/CB2 receptor agonist and a specific CB2 receptor agonist prevented growth and vascularization of malignant tumors.17 Similarly, anandamide promoted cell death in tumorigenic skin cells but not in normal keratinocytes. Elevated levels of cyclooxygenase-2 in cutaneous tumor cells may lead to increased anandamide metabolic products, which in turn promote tumor cell apoptosis.18, 19, 20 Furthermore, CB1 and CB2 receptor activation in mouse melanoma and melanoma cell lines decreased the proliferation, angiogenesis, and metastasis of melanoma, perhaps through inhibition of the prosurvival protein Akt and hypophosphorylation of the pRb.21Anandamide, 2-arachidonoylglycerol, and PEA diminished the viability of murine melanoma cells. Cotreatment of PEA with URB597 (a fatty acid amide hydrolase inhibitor) significantly increased cell death, and this effect was further observed in mice.22 Most recently, mice with chemically induced melanoma treated with subcutaneously injected THC demonstrated significant inhibition of tumor growth. Mice deficient in CB1 and CB2 receptors still showed development of chemically induced tumors, demonstrating that the endogenous cannabinoid system did not influence the tumor growth.23
These studies identify a relationship between cannabinoids and the immune system through both receptor-mediated and receptor-independent pathways. A promising role for cannabinoids in several eczematous dermatoses and pruritus exists,24 and dermatologists are already implementing cannabinoid therapy into their practices. For pruritic patients without rash and with normal thyroid, liver, and kidney function, one of our authors recommends the use of a PEA-containing cream. A PEA-containing cream has also been investigated for use in pruritic patients with atopic dermatitis25 and has anecdotally relieved pruritus in several patients in our clinic at the University of Colorado. Although cannabinoids may have anti-inflammatory and antitumor effects, further clinical research is needed before they can be used for these purposes clinically. Table I includes a list of cannabinoids discussed and their potential dermatologic uses, sorted by psychoactive inactivity versus activity.
Full Text Here: http://www.jaad.org/article/S0190-9622(17)30308-0/fulltext
Rules, Regulations, & Policy Solution For This Petition: Requesting The Inclusion Of A New Medical Condition: Eczema And Psoriasis
The approval of this Petition: Requesting The Inclusion Of A New Medical Condition: Eczema And Psoriasis, that is being provided to the state Department of Health Medical Cannabis Program so the advisory board can review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis with the Lynn and Erin Compassionate Use Act.
The approval of this petition would bring the Department of Health in compliance with the intent of the law and uphold the spirit of the Lynn and Erin Compassionate Use Act, 2007. Fulfilling both;“ Section 2. PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments” And Section 6. ADVISORY BOARD CREATED--DUTIES: The advisory board shall: A. review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis.” New Mexico’s medical cannabis history started in 1978. After public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis...the first law.
References
Understanding medical cannabis.Elemental Wellness Center, 2014 Jul.
References:
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Appendix A:
WHEREAS cannabis (marijuana) has been used as a medicine for at least 5,000 years and can be effective for serious medical conditions for which conventional medications fail to provide relief;
WHEREAS modern medical research has shown that cannabis can slow the progression of such serious diseases as Alzheimer’s and Parkinson’s and stop HIV and cancer cells from spreading; has both anti-inflammatory and pain-relieving properties; can alleviate the symptoms of epilepsy, PTSD and multiple sclerosis; is useful in the treatment of depression, anxiety and other mental disorders; and can help reverse neurological damage from brain injuries and stroke;
WHEREAS the World Health Organization has acknowledged the therapeutic effects of cannabinoids, the primary active compounds found in cannabis, including as an anti-depressant, appetite stimulant, anticonvulsant and anti-spasmodic, and identified cannabinoids as beneficial in the treatment of asthma, glaucoma, and nausea and vomiting related to illnesses such as cancer and AIDS;
WHEREAS the American Medical Association has called for the review of the classification of cannabis as a Schedule I controlled substance to allow for clinical research and the development of cannabinoid-based medicines;
WHEREAS the National Cancer Institute has concluded that cannabis has antiemetic effects and is beneficial for appetite stimulation, pain relief, and improved sleep among cancer patients;
WHEREAS the American Herbal Pharmacopoeia and the American Herbal Products Association have developed qualitative standards for the use of cannabis as a botanical medicine;
WHEREAS the U.S. Supreme Court has long noted that states may operate as “laboratories of democracy” in the development of innovative public policies;
WHEREAS twenty-eight states and the District of Columbia have enacted laws that allow for the medical use of cannabis;
WHEREAS seventeen additional states have enacted laws authorizing the medical use of therapeutic compounds extracted from the cannabis plant;
WHEREAS more than 17 years of state-level experimentation provides a guide for state and federal law and policy related to the medical use of cannabis;
WHEREAS accredited educational curricula concerning the medical use of cannabis have been established that meets Continuing Medical Education requirements for practicing physicians;
WHEREAS Congress has prohibited the federal Department of Justice from using funds to interfere with and prosecute those acting in compliance with their state medical cannabis laws, and the Department of Justice has issued guidance to U.S. Attorneys indicating that enforcement of the Controlled Substances Act is not a priority when individual patients and their care providers are in compliance with state law, and that federal prosecutors should defer to state and local enforcement so long as a viable state regulatory scheme is in place.
WHEREAS modern medical research has shown that cannabis can slow the progression of such serious diseases as Alzheimer’s and Parkinson’s and stop HIV and cancer cells from spreading; has both anti-inflammatory and pain-relieving properties; can alleviate the symptoms of epilepsy, PTSD and multiple sclerosis; is useful in the treatment of depression, anxiety and other mental disorders; and can help reverse neurological damage from brain injuries and stroke;
WHEREAS the World Health Organization has acknowledged the therapeutic effects of cannabinoids, the primary active compounds found in cannabis, including as an anti-depressant, appetite stimulant, anticonvulsant and anti-spasmodic, and identified cannabinoids as beneficial in the treatment of asthma, glaucoma, and nausea and vomiting related to illnesses such as cancer and AIDS;
WHEREAS the American Medical Association has called for the review of the classification of cannabis as a Schedule I controlled substance to allow for clinical research and the development of cannabinoid-based medicines;
WHEREAS the National Cancer Institute has concluded that cannabis has antiemetic effects and is beneficial for appetite stimulation, pain relief, and improved sleep among cancer patients;
WHEREAS the American Herbal Pharmacopoeia and the American Herbal Products Association have developed qualitative standards for the use of cannabis as a botanical medicine;
WHEREAS the U.S. Supreme Court has long noted that states may operate as “laboratories of democracy” in the development of innovative public policies;
WHEREAS twenty-eight states and the District of Columbia have enacted laws that allow for the medical use of cannabis;
WHEREAS seventeen additional states have enacted laws authorizing the medical use of therapeutic compounds extracted from the cannabis plant;
WHEREAS more than 17 years of state-level experimentation provides a guide for state and federal law and policy related to the medical use of cannabis;
WHEREAS accredited educational curricula concerning the medical use of cannabis have been established that meets Continuing Medical Education requirements for practicing physicians;
WHEREAS Congress has prohibited the federal Department of Justice from using funds to interfere with and prosecute those acting in compliance with their state medical cannabis laws, and the Department of Justice has issued guidance to U.S. Attorneys indicating that enforcement of the Controlled Substances Act is not a priority when individual patients and their care providers are in compliance with state law, and that federal prosecutors should defer to state and local enforcement so long as a viable state regulatory scheme is in place.
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