Challenges in Titration of Cannabis Extracts
A. Landschaft (1,2), G. Hirt (2),A. Ihlenfeld (2)

1. Copeia GmbH, Bergisch Gladbach, Germany D51469

2. 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:

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4. Kanjanarangsichai, A. et al. (2022). Cannabidiol-enriched cannabis extraction product in Parkinson‘s disease. JNRP, 13(4), 663–668.

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