Therapeutic Use of “Illegal” Drugs

1 Therapeutic Use of “Illegal” Drugs Illegal drug use is a major societal problem in the United States and other regions. Many people use these substances claiming they have significant benefits to their health and lifestyles.

Whereas the use of substances like cocaine, cannabis, and heroin is considered illegal, researchers have embarked on extensive studies to determine these substances' therapeutic effects. Researchers want to understand if these substances can prevent and treat diseases.

Understanding the therapeutic effects of “illegal drugs” would help medical professionals identify the available pharmaceutical alternatives to standard treatment. For instance, currently, clinicians use opioid-based medications for treating chronic pain (van de Donk et al., 2019).

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2 These medications are costly and increase the risk of addiction and adverse effects. The chemicals found in the cannabis plant have been proposed as viable alternatives to opioid treatment. This paper investigates literature concerning the use of cannabis in treating chronic pain by critically analyzing the article by van de Donk et al. (2019).

Article Critique Study purpose The article by van de Donk et al. (2019) describes an experimental study on the analgesic effects of cannabis in chronic pain patients. The researchers aimed to determine if pharmaceutical-grade cannabis can treat chronic pain in patients with fibromyalgia.

What was studied In the current experiment, the researchers wanted to determine if the tetrahydrocannabinol (THC) content of different varieties of cannabis influenced the participants' pain threshold. The researchers explored the analgesic properties of inhaled medical-grade cannabis.

Methodology The researchers employed an experimental randomized placebo study design in the current study. The participants in the study were randomly selected among individuals suffering from chronic pain due to fibromyalgia syndrome. Only 25 individuals were recruited after satisfying the exclusion/inclusion criteria. The researchers tested four different varieties of cannabis whose THC contents were well known. The participants were placed into two groups, the experimental and the control groups —the experimental group comprised of individuals receiving Bediol, Bedrolite, or Bedrocan. In contrast, in the control group, the participants were

3 given a placebo. The researchers then measured the plasma concentrations of THC and Cannabinoids, pain thresholds, and the participants' pain scores after three hours.

Study findings The critical study finding was that the treatments did not significantly impact the pain threshold. The findings also revealed that the client’s response to pain was after administration with the medication was not greater than the placebo. However, Bediol resulted in a 30% decrease in pain scores. High plasma THC levels were associated with a reduction in spontaneous pain scores. The study also revealed that varieties containing high THC levels, specifically Bedrocan, led to the increased pressure pain threshold. These findings were in line with De Vita, Moskal, Maisto, and Ansell (2018), who found out that cannabinoid drugs lead to increased experimental pain threshold and tolerance. The study also indicated that though inhalation of cannabis increased the plasma concentration of THC, it lowered the induced analgesic effects of THC. This finding reveals that CBD and THC have an antagonistic pharmacodynamic interaction.

Study limitations The short treatment period was the primary limiting factor in this study. The researchers collected data on the pain threshold scores and THC plasma concentration after three hours of inhalation. This period was insufficient to determine the actual impact of cannabis on pain reduction. It was hard to determine if long-term use of cannabis can influence pain threshold.

Further research In the current study, the researchers concluded that a single inhalation of cannabis produced insignificant analgesic effects. The study, nonetheless, demonstrated the complex behavior of inhaled cannabinoids (THC and CBD) in persons presenting with chronic pain.

4 Further studies are needed to ascertain if long-term chronic pain treatment with cannabinoids can have remarkable effects on spontaneous pain scores, CBD-THC interactions, and psychotropic pain relief. Further research would also help identify practical ways of reducing the THC-related drug high without altering these medications' analgesic effects.

The relevance of the study to medicine and psychiatry The findings of the current study are relevant to medicine and psychiatry. They indicate that cannabinoids hold the potential for use in the treatment of chronic pain. However, research has not yet established the safety and efficacy of cannabinoids in chronic pain treatments.

Studies further show that long-term use of cannabinoids can result in addiction. For instance, van de Donk et al. (2019) reported that most of the patients experienced a drug-high feeling contrary to the expected therapeutic effect. This finding indicates that continued use of cannabis products would disrupt the brain reward system leading to addiction. Researchers have not yet established if long-term cannabis use can improve chronic pain. Therefore, these medications' continued use would achieve the drug-high feeling without benefiting the client in pain reduction. Addiction is a complex psychological disorder that affects almost all aspects of a person’s health. Caution is, therefore, needed to avoid predisposing a person with chronic pain to the risk of marijuana use disorder.

Okusanya et al. (2020) noted that clinicians could administer smaller doses of medical marijuana to reduce addiction risk in patients requiring long-term use. The researchers noted that medical cannabis reduces the need to use addictive opioids to treat non-cancer chronic pain.

These findings indicate that medical marijuana holds the promise to eradicate chronic pain while minimizing the risk of addiction effectively. Van de Donk et al. (2019) reported that some varieties of cannabis, such as Bediol reduced pain threshold scores by 30%. Clinicians can,

5 therefore, use Bediol for chronic pain conditions such as inflammatory bowel diseases, as pointed out by Carvalho et al. (2020).

However, Van de Donk et al. (2019) revealed that cannabis produces several side effects, including nausea and vomiting. It would, therefore, be inappropriate for clinicians to administer these medications to patients with chronic conditions, subsequently escalating the burden of disease. Clinicians need to apply critical thinking skills to treat patients with medical marijuana to avoid unwanted eventualities. Patel (2017) noted that medical practitioners could give medical cannabis in states where this practice is allowed but ensure that it is within the legal, ethical, and therapeutic boundaries.

Conclusion Some illegal drugs have therapeutic effects than can be utilized to treat and prevent diseases. Cannabis, for instance, contains compounds with analgesic properties applicable to treatment of chronic pain due to fibromyalgia syndrome and other non-cancer conditions.

Clinicians need to exercise caution when recommending such medications to clients due to the increased risk of addiction and adverse effects.

References Carvalho, A. C. A. D., Souza, G. A. D., Marqui, S. V. D., Guiguer, É. L., Araújo, A. C., Rubira, C. J., ... & Barbalho, S. M. (2020). Cannabis and cannabinoids on the inflammatory bowel diseases: Going beyond misuse. International Journal of Molecular Sciences, 21(8), 2940. https://doi.org/10.3390/ijms21082940 De Vita, M. J., Moskal, D., Maisto, S. A., & Ansell, E. B. (2018). Association of cannabinoid administration with experimental pain in healthy adults: A systematic review and meta-

6 analysis. JAMA Psychiatry, 75(11), 1118–1127. https://doi.org/10.1001/jamapsychiatry.2018.2503 Okusanya, B.., Asaolu, I., Ehiri, J.., Kimaru, L., Okechukwu, A., & Rosales, C. (2020). Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: a systematic review. Systematic Reviews, 9(1), 1-8. https://doi.org/10.1186/s13643-02001425-3 Patel, S. (2017). Cannabis for pain and posttraumatic stress disorder: More consensus than controversy or vice versa?. Annals of Internal Medicine, 167(5), 355-356. https://doi.org/10.7326/M17-1713 van de Donk, T., Niesters, M., Kowal, M. A., Olofsen, E., Dahan, A., & van Velzen, M. (2019).

A randomized experimental study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain, 160(4), 860–869. https://doi.org/10.1097/j.pain.0000000000001464