Sativex for Neuropathic Pain – Literature Review; Alexander DeLuca; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-11-15. Revised: 2009-05-12 – minor editing.
Medical Marijuana archives – War on Pain Sufferers #3
Pallimed blog1 has posted a review of very recent research on the clinical use of cannabinoids, which are the medically useful, psychoactive, molecules derived from the marijuana plant including THC which is available in the U.S. in pill form as dronabinol (Marinol).
Sativex, an “Oromucosal Spray,” is not available for prescription use in the U.S., and differs from Marinol because it is a whole extract of marijuana (cannabis), and therefore contains therapeutically active cannabidiols in addition to just THC.
Compared to Marinol, Sativex is pharmacologically more similar to smoked or vaporized or ingested dried cannabis bud, which naturally contains a mixture of THC and cannabidiols. Marinol is THC in sesame oil; period.
Just to get the terminology straight: cannabidiols are a family, if you will, of similar molecules with similar pharmacological properties that differ somewhat from those of THC, which is not a cannabidiol. Both cannabidiols and THC are cannabinoids.
Sativa strains of cannabis have higher THC concentrations, while Indica strains are higher in cannabidiols, and are generally more valued as medicinals. Many Sativa/Indica hybrids exist, in addition to relatively pure strains.
GW Pharma, which produces Sativex, can control the THC/cannabidiol ratio in the spray product, and could produce a range of different medications which would likely allow better individualization of treatment – getting the maximum symptom relief with the least amount of negative side effects for the individual patient.
The very best article explaining the modern understanding of the endocannabinoid receptor system and its functions and peculiarities, in my opinion, is entitled: The Brain’s Own Marijuana, by Nicoll and Alger and published in Scientific American December, 2004. Very highly recommended to give you a firm neurological understanding upon which you can consider culturally charged issues like medical marijuana and end-of-life care. The graphics are spectacular, it is a beautiful piece of work.
Thank you to Drs. Rosiele, Sinclair and Quinn of the excellent Pallimed blog for your review of recent studies on the clinical utility of cannabinoids for the treatment of pain.