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The use of cannabis for severe medical conditions is being legalized in different states, increasing the mandate to make cannabis legal for medically ill patients. However, there is a lack of placebo-controlled studies investigating the efficacy of cannabis. Dronabinol (synthetic, oral Δ-9-THC) is FDA approved for the appetite stimulation in AIDS-related anorexia and nausea/vomiting in chemotherapy patients. Nabilone, a synthetic analogue of THC, is approved for nausea/vomiting in chemotherapy patients. These medications have been found to be effective for these disorders, but there remains an interest in studying cannabis, partly due to the numerous cannabinoids contained within the cannabis plant. Among these is cannabidiol, which does not produce subjective effects, but has been shown to have potent anti-inflammatory effects. In addition, there is data indicating that cannabidiol may be effective for neuropathic pain and nausea/vomiting.

The goal is to investigate the effects of high CBD/low THC cannabis on symptoms such as pain, nausea/vomiting, and quality of life in seriously ill participants. While there is data beginning to emerge that cannabis may have a beneficial effect on these symptoms, there are few placebo controlled, double-blind studies. Additionally, the administration of cannabis to medically ill patients may be limited by its subjective effects, such as anxiety, intoxication, or paranoia. Most cannabis available today has high levels of Δ-9-THC (about 15%). By using cannabis that is high in CBD, but low in – Δ-9-THC, it is hypothesized that some of these effects can be avoid, while maximizing the therapeutic effects, if any.

Primary Outcome Measures:

  • Change in pain ratings using the McGill Pain Questionnaire [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]

    Participants will be asked to rate their pain over the 4 weeks of receiving active cannabis vs placebo.

  • Change in sickness-related impairment using the Sickness Impact Profile [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]

    Participants will be asked to rate physical symptoms for the 4 weeks of the study.

  • changes in physical and emotional well being using the RAND-36 item medical outcomes survey, a health-related quality of life survey instrument [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]

    RAND-36 item medical outcomes survey taps eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions.

  • Changes in symptoms of pain using the 9 item Brief Pain Inventory [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

  • Change in cognitive status using the Short Portable Mental Status Questionnaire (SPMSQ) [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Change in symptom prevalence, characteristics and degree of stress using the Memorial Symptom Assessment Scale (MSAS) [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Change in the psychological state and psychological well being using the Mental Health Inventory-5 (MHI-5) [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Changes in quality of life using the Multidimensional Index of Life Quality (MILQ) Questionnaire [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Changes in quality of life using the McGill Quality of Life Questionnaire [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Change in symptoms of pain, mood and appetite using the Edmonton Symptom Assessment System (ESAS) [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Memorial Symptom Assessment Scale (MSAS) [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Change in mood using the Hamilton Depression Rating Scale [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Change in mood Hamilton Anxiety Rating Scale [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Change in mood using the Montgomery-Asberg Depression Rating Scale [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
  • Change in mood and quality of life using the Columbia Suicide Severity Rating Scale [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]

Estimated Enrollment: 70
Study Start Date: March 2016
Estimated Study Completion Date: March 2021
Estimated Primary Completion Date: December 2020 (Final data collection date for primary outcome measure)
Active Comparator: Smoked Cannabis High CBD/low THC

Participants will visit the Marijuana Research Laboratory 3-5 weekdays per week for 4 weeks to be administered 1-2 Smoked Cannabis High CBD/low THC cigarettes (15.76% CBD; 3.11% THC) over the course of a 2-3 hour session.

Drug: Smoked Cannabis High CBD/low THC

Participants will visit the Marijuana Research Laboratory 3-5 weekdays per week for 4 weeks to be administered 1-2 cannabis cigarettes (15.76% CBD; 3.11% THC) over the course of a 2-3 hour session.

Other Name: cannabis cigarettes (15.76% CBD; 3.11% THC)

Placebo Comparator: Smoked Placebo Cannabis Low CBD/low THC

Participants will visit the Marijuana Research Laboratory 3-5 weekdays per week for 4 weeks to be administered 1-2 cannabis cigarettes (0.01% THC; 0.00% CBD) over the course of a 2-3 hour session.

Drug: Smoked Placebo Cannabis Low CBD/low THC

Participants will visit the Marijuana Research Laboratory 3-5 weekdays per week for 4 weeks to be administered 1-2 cannabis cigarettes (0.01% THC; 0.00% CBD) over the course of a 2-3 hour session.

Other Name: cannabis cigarettes (0.01% THC; 0.00% CBD)

The goal of this study is to perform a double-blind, placebo-controlled study to investigate the efficacy of cannabis, compared to placebo, in medically ill participants seeking relief symptoms such as pain, nausea, and vomiting. Participants who meet criteria for severe conditions will be referred from their clinicians . Cannabis that has a high concentration of cannabidiol, which is a cannabinoid that does not change perception or produce intoxication, and low in Δ-9-THC will be used. In this way, the hope is to maximize the benefit of cannabis, while lowering the possible side effects of cannabis in medically ill participants.

The overall goal of this study is to compare active high cannabidiol (CBD)/ low (−)-trans-Δ9- tetrahydrocannabinol (THC) cannabis vs placebo cannabis in patients with serious medical disorders. Participants will be referred from clinicians and will come to the laboratory daily (3-5 times weekly) for cannabis (15.76% CBD; 3.11% Δ-9-THC) vs placebo (0.0% CBD/ 0.01% Δ-9-THC). The cannabis will be vaporized or smoked as a cannabis cigarette. The participants can choose which option they prefer. The cross-over design will be used where participants receive 2 weeks of active cannabis vs two weeks of placebo in counterbalanced order, with participants blinded to the condition. The outcome measures primarily include measures of pain, with secondary measures of mood, nausea/appetite, quality of life, and the both the potentially positive and negative subjective effects of cannabis (e.g., high, mellow, anxious, paranoid).