Copeia Abstract / MCC 2023
Challenges in Titration of Cannabis Extracts
Challenges in Titration of Cannabis Extracts
A. Landschaft (1,2), G. Hirt (2),A. Ihlenfeld (2)
Copeia GmbH, Bergisch Gladbach, Germany D51469
Information Services Department, Boston Children’s Hospital, Boston, MA 02115;
Introduction: Careful titration of cannabis extracts is instrumental in maximizing therapeutic outcomes and reducing side-effects [1]; titration is usually done under close surveillance of medical experts, being carefully monitored and adjusted [1-5]; it is questionable whether titration can be accomplished equally efficiently in situations where close and direct monitoring of patients isn’t feasible. Due to growing use of cannabis extracts and challenges of titration, it is uncertain whether medical systems have the necessary resources to assure safe titration [6,7] especially considering data on cannabis therapy non-adherence.[8].
Aims: To assess proneness to ambiguity and potential for generalization outside carefully controlled clinical environments of titration protocols of cannabis extracts, in the PubMed and Clinical Trials databases; to identify areas in which current cannabis extract titration falls short and offer possible solutions to problems identified.
Methods: Following PRISMA, PubMed and Clinical Trials databases were searched (i.e. “cannabis extract titration”); non-human studies, wholeplant cannabis studies, were excluded; After relevant clinical trials were identified, screened, assessed for eligibility, titration methods were inspected for proneness to ambiguity.
Results: 39 records were identified across PubMed and Clinical Trials databases. After removal of one duplicate record, 38 were screened;16 records were excluded, 22 reports were sought for retrieval, and 22 were assessed for eligibility; the final database numbered 21 studies. None of the studies focus on the challenges of more widespread use of titration protocols normally used in carefully controlled conditions.
Conclusions: Recommendations and methods of cannabis extracts titration heavily depend on the general context of cannabis clinical trials, where titration is carefully monitored/controlled by physicians; a majority of described titration processes were estimated by two independent reviewers as prone to ambiguity, especially in relation to utilization of cannabis extracts outside carefully controlled environment typical of clinical trials; Digital health software tools with accessible interfaces for doctors and patients alike, can help us standardize and generalize the titration of cannabis extracts.[8]
Keywords: cannabis extract; titration; literature review; digital health software.
References:
McCoy, B. et al. (2018). A prospective open-label trial of a CBD/THC cannabis oil in dravet syndrome. ACTN. 5(9), 1077–1088. p. 1086
Wade, D. T. et al. (2003). A preliminary controlled study to determine whether whole-plant cannabis extracts (...) Clinical rehabilitation, 17(1), 21–29. p. 24
Trigo, J. et al. (2016). Effects of fixed or self-titrated dosages of Sativex on cannabis withdrawal and cravings. Drug Alcohol Depend, 161, 298–306. p. 3
Kanjanarangsichai, A. et al. (2022). Cannabidiol-enriched cannabis extraction product in Parkinson‘s disease. JNRP, 13(4), 663–668.
Duran, M. et al. (2010). Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapyinduced nausea and vomiting. Br. J. Clin. Pharmacol., 70(5), 656–663. p. 658
Grimison, P. et al. (2020). Oral THC: CBD cannabis extract for refractory chemotherapy-induced nausea and vomiting. Ann. Oncol., 31(11), 1553-1560. p. 3
Hammond, D. (2021). Communicating THC levels and ‘dose’ to consumers. Int. J. Drug Policy. 91, 102509. p. 2
Ilan, Y. (2022). Digital medical cannabis as market differentiator: second-generation artificial intelligence systems to improve response. Front. Med. 8, 2958. p. 1
MCC Berlin 2023
The 4th MCC Medical Cannabis Congress took place in Berlin in May 2023.
The MCC's two-day program offers a rigorous medical training that is both scientifically grounded and results-oriented. The event is either accredited for CME credits or is in the process of accreditation. During the event, participants gain comprehensive insights into practical examples, clinical outcomes, and information on legal, ethical, and organizational aspects of prescribing new therapeutic approaches.
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