Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends

Xintian Lyu; Sílvia M. Illamola; Susan E. Marino; Ilo E. Leppik; Stephen Dahmer; Paloma Lehfeldt; Jeannine M. Conway; Rory P. Remmel; Kyle Kingsley; Angela K. Birnbaum

doi:10.1016/j.curtheres.2023.100709

Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends

Xintian Lyu, Sílvia M. Illamola, Susan E. Marino, Ilo E. Leppik, Stephen Dahmer, Paloma Lehfeldt, Jeannine M. Conway, Rory P. Remmel, Kyle Kingsley, Angela K. Birnbaum

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to patients. Objective: To characterize the distribution of cannabis products, their CBD/THC content, and dosing among patients with qualifying conditions. Methods: This is a retrospective analysis of ∼50% of registered users receiving medical cannabis in Minnesota (June 16, 2016, to November 15, 2019). Data included formulation, CBD/THC prescribed doses, and qualifying conditions. The primary end points were calculated using daily dose and duration of use. Comparisons were made for CBD and THC total daily dose dispensed, patient age, and approved product. Nonparametric statistical tests were used (significance was set at p < 0.05). Results: A total of 11,520 patients were listed with 1 qualifying condition. The most common condition was intractable pain (60.0%). Median dispensation duration varied from 53 days (cancer) to 322 days (muscle spasms). Most (≥62.8%) patients across all qualifying conditions received both CBD and THC. Median THC dose was lower in older (≥65 years) compared with younger adults with intractable pain (p < 0.0001) and cancer patients (p = 0.0152), and the same pattern was found CBD dose with seizure (p = 0.0498) patients. For commercial products with Food and Drug Administration indications, the median CBD total daily dose was 86.9% lower than the recommended doses for patients with seizures (Epidiolex: Jazz Pharmaceuticals, Palo Alto CA) and median THC total daily dose was 65.3% (Syndros: Benuvia Manufacturing, Round Rock, TX) or 79.3% lower (Marinol: Banner Pharmacaps, Inc., High Point, NC) for cancer patients. Conclusions: A majority of patients received products containing both CBD and THC. Dosages varied by age group and were lower than recommended for conditions with Food and Drug Administration-approved products. Complex pharmacokinetics of THC and CBD, possible age-related changes in physiology, unknown efficacy, and potential for drug interactions all increase the need for monitoring of patients receiving cannabis products. (Curr Ther Res Clin Exp.

Original language	English (US)
Article number	100709
Journal	Current Therapeutic Research - Clinical and Experimental
Volume	99
DOIs	https://doi.org/10.1016/j.curtheres.2023.100709
State	Published - Jan 2023

Bibliographical note

Funding Information:
Supported in part by the MacMillan Innovative Epilepsy Research and Education Fund and Medical Discovery Team on Addiction Pilot Grant Award, University of Minnesota.

Funding Information:
Supported in part by the MacMillan Innovative Epilepsy Research and Education Fund and Medical Discovery Team on Addiction Pilot Grant Award, University of Minnesota. The authors thank the Minnesota Department of Health for answering questions on the Minnesota program. All authors had access to the data and a role in writing the manuscript; however, S. Dahmer, P. Lehfeldt, and K. Kingsley were not involved in data analyses or interpretation of data except for verification of data collection queries and accuracy of the original and revised manuscript.

Publisher Copyright:
© 2023 The Authors

Keywords

CBD
Epilepsy
Medical cannabis
Pain
THC

PubMed: MeSH publication types

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.curtheres.2023.100709

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Lyu, X., Illamola, S. M., Marino, S. E., Leppik, I. E., Dahmer, S., Lehfeldt, P., Conway, J. M., Remmel, R. P., Kingsley, K., & Birnbaum, A. K. (2023). Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends. Current Therapeutic Research - Clinical and Experimental, 99, Article 100709. https://doi.org/10.1016/j.curtheres.2023.100709

Lyu, X, Illamola, SM , Marino, SE , Leppik, IE, Dahmer, S, Lehfeldt, P, Conway, JM , Remmel, RP, Kingsley, K & Birnbaum, AK 2023, 'Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends', Current Therapeutic Research - Clinical and Experimental, vol. 99, 100709. https://doi.org/10.1016/j.curtheres.2023.100709

@article{2dc5180135e64482af8ff10b7ee46197,

title = "Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends",

abstract = "Background: Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to patients. Objective: To characterize the distribution of cannabis products, their CBD/THC content, and dosing among patients with qualifying conditions. Methods: This is a retrospective analysis of ∼50% of registered users receiving medical cannabis in Minnesota (June 16, 2016, to November 15, 2019). Data included formulation, CBD/THC prescribed doses, and qualifying conditions. The primary end points were calculated using daily dose and duration of use. Comparisons were made for CBD and THC total daily dose dispensed, patient age, and approved product. Nonparametric statistical tests were used (significance was set at p < 0.05). Results: A total of 11,520 patients were listed with 1 qualifying condition. The most common condition was intractable pain (60.0%). Median dispensation duration varied from 53 days (cancer) to 322 days (muscle spasms). Most (≥62.8%) patients across all qualifying conditions received both CBD and THC. Median THC dose was lower in older (≥65 years) compared with younger adults with intractable pain (p < 0.0001) and cancer patients (p = 0.0152), and the same pattern was found CBD dose with seizure (p = 0.0498) patients. For commercial products with Food and Drug Administration indications, the median CBD total daily dose was 86.9% lower than the recommended doses for patients with seizures (Epidiolex: Jazz Pharmaceuticals, Palo Alto CA) and median THC total daily dose was 65.3% (Syndros: Benuvia Manufacturing, Round Rock, TX) or 79.3% lower (Marinol: Banner Pharmacaps, Inc., High Point, NC) for cancer patients. Conclusions: A majority of patients received products containing both CBD and THC. Dosages varied by age group and were lower than recommended for conditions with Food and Drug Administration-approved products. Complex pharmacokinetics of THC and CBD, possible age-related changes in physiology, unknown efficacy, and potential for drug interactions all increase the need for monitoring of patients receiving cannabis products. (Curr Ther Res Clin Exp.",

keywords = "CBD, Epilepsy, Medical cannabis, Pain, THC",

author = "Xintian Lyu and Illamola, {S{\'i}lvia M.} and Marino, {Susan E.} and Leppik, {Ilo E.} and Stephen Dahmer and Paloma Lehfeldt and Conway, {Jeannine M.} and Remmel, {Rory P.} and Kyle Kingsley and Birnbaum, {Angela K.}",

note = "Funding Information: Supported in part by the MacMillan Innovative Epilepsy Research and Education Fund and Medical Discovery Team on Addiction Pilot Grant Award, University of Minnesota. Funding Information: Supported in part by the MacMillan Innovative Epilepsy Research and Education Fund and Medical Discovery Team on Addiction Pilot Grant Award, University of Minnesota. The authors thank the Minnesota Department of Health for answering questions on the Minnesota program. All authors had access to the data and a role in writing the manuscript; however, S. Dahmer, P. Lehfeldt, and K. Kingsley were not involved in data analyses or interpretation of data except for verification of data collection queries and accuracy of the original and revised manuscript. Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = jan,

doi = "10.1016/j.curtheres.2023.100709",

language = "English (US)",

volume = "99",

journal = "Current Therapeutic Research - Clinical and Experimental",

issn = "0011-393X",

publisher = "Excerpta Medica",

}

TY - JOUR

T1 - Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program

T2 - Product Choice, Dosing, and Age-Related Trends

AU - Lyu, Xintian

AU - Illamola, Sílvia M.

AU - Marino, Susan E.

AU - Leppik, Ilo E.

AU - Dahmer, Stephen

AU - Lehfeldt, Paloma

AU - Conway, Jeannine M.

AU - Remmel, Rory P.

AU - Kingsley, Kyle

AU - Birnbaum, Angela K.

N1 - Funding Information: Supported in part by the MacMillan Innovative Epilepsy Research and Education Fund and Medical Discovery Team on Addiction Pilot Grant Award, University of Minnesota. Funding Information: Supported in part by the MacMillan Innovative Epilepsy Research and Education Fund and Medical Discovery Team on Addiction Pilot Grant Award, University of Minnesota. The authors thank the Minnesota Department of Health for answering questions on the Minnesota program. All authors had access to the data and a role in writing the manuscript; however, S. Dahmer, P. Lehfeldt, and K. Kingsley were not involved in data analyses or interpretation of data except for verification of data collection queries and accuracy of the original and revised manuscript. Publisher Copyright: © 2023 The Authors

PY - 2023/1

Y1 - 2023/1

N2 - Background: Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to patients. Objective: To characterize the distribution of cannabis products, their CBD/THC content, and dosing among patients with qualifying conditions. Methods: This is a retrospective analysis of ∼50% of registered users receiving medical cannabis in Minnesota (June 16, 2016, to November 15, 2019). Data included formulation, CBD/THC prescribed doses, and qualifying conditions. The primary end points were calculated using daily dose and duration of use. Comparisons were made for CBD and THC total daily dose dispensed, patient age, and approved product. Nonparametric statistical tests were used (significance was set at p < 0.05). Results: A total of 11,520 patients were listed with 1 qualifying condition. The most common condition was intractable pain (60.0%). Median dispensation duration varied from 53 days (cancer) to 322 days (muscle spasms). Most (≥62.8%) patients across all qualifying conditions received both CBD and THC. Median THC dose was lower in older (≥65 years) compared with younger adults with intractable pain (p < 0.0001) and cancer patients (p = 0.0152), and the same pattern was found CBD dose with seizure (p = 0.0498) patients. For commercial products with Food and Drug Administration indications, the median CBD total daily dose was 86.9% lower than the recommended doses for patients with seizures (Epidiolex: Jazz Pharmaceuticals, Palo Alto CA) and median THC total daily dose was 65.3% (Syndros: Benuvia Manufacturing, Round Rock, TX) or 79.3% lower (Marinol: Banner Pharmacaps, Inc., High Point, NC) for cancer patients. Conclusions: A majority of patients received products containing both CBD and THC. Dosages varied by age group and were lower than recommended for conditions with Food and Drug Administration-approved products. Complex pharmacokinetics of THC and CBD, possible age-related changes in physiology, unknown efficacy, and potential for drug interactions all increase the need for monitoring of patients receiving cannabis products. (Curr Ther Res Clin Exp.

AB - Background: Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to patients. Objective: To characterize the distribution of cannabis products, their CBD/THC content, and dosing among patients with qualifying conditions. Methods: This is a retrospective analysis of ∼50% of registered users receiving medical cannabis in Minnesota (June 16, 2016, to November 15, 2019). Data included formulation, CBD/THC prescribed doses, and qualifying conditions. The primary end points were calculated using daily dose and duration of use. Comparisons were made for CBD and THC total daily dose dispensed, patient age, and approved product. Nonparametric statistical tests were used (significance was set at p < 0.05). Results: A total of 11,520 patients were listed with 1 qualifying condition. The most common condition was intractable pain (60.0%). Median dispensation duration varied from 53 days (cancer) to 322 days (muscle spasms). Most (≥62.8%) patients across all qualifying conditions received both CBD and THC. Median THC dose was lower in older (≥65 years) compared with younger adults with intractable pain (p < 0.0001) and cancer patients (p = 0.0152), and the same pattern was found CBD dose with seizure (p = 0.0498) patients. For commercial products with Food and Drug Administration indications, the median CBD total daily dose was 86.9% lower than the recommended doses for patients with seizures (Epidiolex: Jazz Pharmaceuticals, Palo Alto CA) and median THC total daily dose was 65.3% (Syndros: Benuvia Manufacturing, Round Rock, TX) or 79.3% lower (Marinol: Banner Pharmacaps, Inc., High Point, NC) for cancer patients. Conclusions: A majority of patients received products containing both CBD and THC. Dosages varied by age group and were lower than recommended for conditions with Food and Drug Administration-approved products. Complex pharmacokinetics of THC and CBD, possible age-related changes in physiology, unknown efficacy, and potential for drug interactions all increase the need for monitoring of patients receiving cannabis products. (Curr Ther Res Clin Exp.

KW - CBD

KW - Epilepsy

KW - Medical cannabis

KW - Pain

KW - THC

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ER -

Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Publisher link

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