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

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

Current Therapeutic Research (Jan 2023)

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

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

Affiliations

Xintian Lyu, BS: Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
Sílvia M. Illamola, PharmD, PhD: Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
Susan E. Marino, PhD: Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota; Center for Clinical and Cognitive Neuropharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
Ilo E. Leppik, MD: Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota; Center for Clinical and Cognitive Neuropharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota; Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, Minnesota
Stephen Dahmer, MD: Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York; Goodness Growth Holdings, Minneapolis, Minnesota.
Paloma Lehfeldt, MD: Goodness Growth Holdings, Minneapolis, Minnesota.
Jeannine M. Conway, PharmD: Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
Rory P. Remmel, PhD: Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
Kyle Kingsley, MD: Goodness Growth Holdings, Minneapolis, Minnesota.
Angela K. Birnbaum, PhD: Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota; Center for Clinical and Cognitive Neuropharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota; Address correspondence to: Angela K. Birnbaum, PhD, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, 717 Delaware St SE, Minneapolis, MN 55414.

Journal volume & issue: Vol. 99
p. 100709

Abstract

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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. 2023; 84:XXX–XXX)

Published in Current Therapeutic Research

ISSN: 0011-393X (Print); 1879-0313 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Therapeutics. Pharmacology
Website: http://www.journals.elsevier.com/current-therapeutic-research/

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