Buying Cannabis online in Balzers

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Buying Cannabis online in Balzers

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Buying Cannabis online in Balzers

Official websites use. Share sensitive information only on official, secure websites. The study of the use of cannabis for therapeutic purposes in the pediatric population is increasing, yet data on efficacy and safety are limited. Characterization of pediatric cannabis use for therapeutic purposes will improve understanding of the circumstances under which it occurs and the associated outcomes. To describe the use of cannabis for therapeutic purposes, regardless of authorization, in a pediatric tertiary teaching hospital. A retrospective chart review was completed for patients 18 years of age or younger who used cannabis for therapeutic purposes, regardless of authorization, between May 1, , and May 1, Patients whose cannabis use was documented as recreational were excluded. In total, patients were identified, of whom 37 met the inclusion criteria. Of these, 30 patients had documentation of medically supervised cannabis use. Of the 27 patients who were experiencing seizures at initiation of medical cannabis, 21 had documentation of a decrease in seizure frequency. This decrease was transient for 16 patients, with a mean duration of Seven patients self-medicated with cannabis. Medically supervised cannabis use occurred most often in patients with intractable or refractory seizures. According to these data, seizure response is variable, and initial decreases may be transient for pediatric patients using cannabis. To ensure greater consistency and rigour in the conduct of prospective research and thus to generate better-quality research on the therapeutic effects of medical cannabis, development of a standardized care record is needed. In children, cannabis and pharmaceutical cannabinoids have been studied for multiple conditions, including refractory epileptic seizures, 1 — 10 such as those associated with Dravet syndrome, Doose syndrome, Lennox-Gastaut syndrome, hypoxic damage, and idiopathic epilepsy; tics secondary to Tourette syndrome 11 ; neuropathic pain 12 and chronic pain from headaches 13 and abdominal and musculoskeletal sources 13 ; chemotherapy-induced nausea and vomiting 14 — 18 ; spasticity 19 ; and post-traumatic stress disorder. The outcomes used to evaluate the efficacy of cannabis therapy in children vary by indication, with the typical aim being a reduction in frequency or severity of symptoms e. The Canadian Paediatric Society states that there are currently insufficient data to support the efficacy and safety of cannabis for any therapeutic indication in children. CHEO has administered medical cannabis to patients in a number of exceptional circumstances, for multiple indications, with authorization from various health care practitioners. Given the lack of strong evidence for cannabis use for therapeutic purposes in children 21 and the wide variety of indications, efficacy and safety outcomes, doses, dosage forms, and patient characteristics, the findings of this chart review will be useful to improve understanding of the circumstances under which cannabis is used for therapeutic purposes among children and youth in Canada and the associated outcomes. In Canada, for the entire period of this chart review — , it was permissible to obtain medical cannabis from a licensed producer or to grow it oneself with authorization Table 1. Allowed access to dried marijuana for medical purposes with authorization from a health care practitioner. Expansion of approved sources of dried marijuana for medical purposes to include licensed producers. Allowed individuals with authorization for medical cannabis Purposes Regulations to use and make cannabis products other than dried marijuana, such as cannabis oil. Allowed production and sale by licensed producers of fresh and dried marijuana, cannabis oil , and marijuana seeds and plants as starting materials. Health Canada; For purposes of a study such as ours, confirmation of medical authorization for cannabis can be achieved either by verifying the source of cannabis to be a licensed producer or by verifying the medical authorization document. Given the retrospective nature of the study and the lack of standardization of documentation in patient charts, it was not possible to confirm medical authorization in each case. Therefore, we included all inpatients and outpatients 18 years of age or younger who were followed at CHEO between May 1, , and May 1, , and whose charts contained documentation of use of cannabis for therapeutic purposes, regardless of authorization. Eligible patients were categorized as either using medical cannabis i. Patients were considered to be using cannabis under medical supervision if any of the following criteria were met as documented in the chart : a medical authorization document was verified; the source of the cannabis was verified as a licensed producer; or a physician was supervising the cannabis use, for example, by titrating the dose. Patients were considered to be self-medicating with cannabis if there was documentation that they were using cannabis for therapeutic purposes without medical supervision. Patients with documentation of self-medication with cannabis were included only if they also met all other inclusion criteria. Patients were excluded if they were found, upon review of the medical record, to meet any of the following exclusion criteria: were using cannabis for therapeutic purposes, but with initiation outside the specified date range; were using cannabis for therapeutic purposes e. The medical charts of inpatients and outpatients with documented use of cannabis for therapeutic purposes, regardless of authorization, were reviewed. Outpatients, for whom a different electronic health record was in use at the time, were identified in 2 ways. Patients taking only pharmaceutical cannabinoids e. Electronic charts for outpatients and physical charts for inpatients were then reviewed in detail for relevant information. Date of birth, sex, and allergies were collected. Information about the cannabis product, start date, dose, dosage changes, dosage form, route of administration, and end date if applicable was gathered, as well as information about use of tobacco and other substances. Any information about the indication, outcomes, side effects adverse or beneficial , number of medications tried before cannabis, and nonpharmacological treatments used for the given indication were recorded. If cannabis had been discontinued, the reason was recorded. If cannabis had been used for a seizure disorder, the etiology of the disorder was recorded. For patients with documentation of a decrease in seizure frequency, the decrease was further classified as having been maintained or having been transient. To determine the duration of any observed decrease in seizure frequency, the number of days between initiation of cannabis and the first documented instance of increase in seizure frequency was calculated. Initial data capture identified a total of unique patients whose medical charts were reviewed for eligibility. After review, 37 patients were included and were excluded for the reasons specified in Figure 1. Patient characteristics for those included in the study are presented in Table 2 , and the indications for use of cannabis in Table 3. Of the 37 patients included, 30 had documentation of medically supervised cannabis use mean age at initiation 8. Data are presented as number of patients, except where indicated otherwise. For patients who were self-medicating with cannabis, data concerning start date were not available indicated by dashes. For most patients, medically supervised cannabis use began after Table 2. Fourteen patients obtained their cannabis from a licensed producer Table 4. All 30 patients with medically supervised cannabis use had used an oil. For some of these patients, the oil was additional to other forms of cannabis. Of those using cannabis under medical supervision, 27 took it orally. Fourteen patients discontinued use during the period of the chart review. According to this definition, only 5 patients with medically supervised cannabis use achieved control over their symptoms during the observation period Table 5. The average number of antiepileptic medications taken concurrently with cannabis was 3. For patients with seizures described as refractory, the average number of antiepileptic medications taken concurrently with cannabis was 4. Symptom control was defined as presence of physician documentation that symptoms were controlled while patient was using cannabis. The numbers of patients sum to more than 30 because some patients had more than one documented negative side effect. The numbers of patients sum to more than 30 because some patients had more than one documented positive side effect. For all of these patients, there was a failure to achieve symptom control Table 5. Over the 3-year period of the chart review, there were 30 patients with documentation of medically supervised cannabis use. The majority were using cannabis for seizures, which were most often described in the chart as intractable or refractory. This finding is consistent with the recent and rapid increase in research studies investigating the use of medical cannabis in the treatment of epilepsy. No use of tobacco or other substances was noted among patients using cannabis under medical supervision. None of the patients were using medical cannabis for control of chemotherapy-induced nausea and vomiting. This is not surprising, because although there is strong evidence for the use of synthetic cannabinoids in the treatment of chemotherapy-induced nausea and vomiting, evidence for plant-based cannabis in this context is lacking. All of the patients with medically supervised cannabis use were using an oil. We observed that details of this form of medical cannabis usage were not documented consistently for outpatients. Other details, such as the source of the cannabis, were not documented for half of the patients. Such documentation is an important aspect of verifying authorization. For those who did have documentation of this ratio, the range was relatively wide, from as high as to as low as Of the 28 patients who were using medical cannabis for seizure control, 27 had active seizures at the time of initiation, and 21 of these had documentation of decreased seizure frequency after initiation of cannabis. Porter and Jacobson 10 completed a survey of parents whose children were using cannabidiol-enriched cannabis for epilepsy. Different formulations and concentrations will likely affect outcomes in terms of both efficacy and side effects. In the current chart review, roughly half of the patients for whom we had information on formulation used more than one formulation during the period of the chart review. It is unclear what effect switching between cannabis products with different concentrations of CBD and THC might have on seizure control. Although approximately three-quarters of the patients in the current study experienced a decrease in seizure frequency, the magnitude of the decrease was unclear because there was no standardized method of documenting seizure control in patient charts. For the remaining 16 patients, the frequency of seizures was documented to have decreased initially with a later return to baseline or increase above baseline. For 5 of these patients with a transient decrease in seizure frequency, the parents opted to withdraw and then reinitiate cannabis. For 3 of these 5 patients, a second transient decrease in seizure frequency was noted. These results provide insight into the course of symptoms in seizure disorders among patients with medically supervised cannabis use. Maa and Figi 29 documented cases of children using cannabis who had a persistent decrease in seizures over 20 months and were able to wean off their antiepileptic drugs. Given this finding, some parents may be hopeful that an initial decrease in seizure frequency will be maintained. On the basis of our observations, we recommend that parents should be informed of the possibility that cannabis use may not be associated with long-term seizure control. Furthermore, an alternative and counterintuitive explanation for any observed decrease in seizure frequency may be weaning off existing antiepileptic drugs, as there have been instances where polypharmacy has worsened seizures. The most frequent negative side effect noted in the current study was worsening of seizures. Notably, 5 patients discontinued cannabis because of an increase in seizure frequency. This observation is consistent with previous reports of worsening of seizures associated with use of cannabis. The rate may have been higher in the current study because many patients experienced concurrent changes to their antiepileptic medications. Positive side effects were also noted, such as improved alertness, improved or brighter mood, and being more engaged. These positive side effects can also be important to parents and may factor into the decision to continue medically supervised cannabis use, even if long-term symptom control is not achieved. Again, these positive side effects could be due to concurrently weaning off antiepileptic medications. In this study, there were 7 outpatients who were self-medicating with cannabis obtained from unauthorized sources. The average age in this group was Similar cases of adolescents using cannabis for pain were described by Harrison and others, 13 who noted that full pain control was not achieved with cannabis use. Similarly, none of the patients in our study who were self-medicating with cannabis achieved control of their symptoms. The Lower-Risk Cannabis Use Guidelines, developed by the Canadian Research Initiative in Substance Misuse, explain that smoking cannabis can have negative effects on respiratory health. Other side effects, such as emesis, can occur when cannabis is smoked. In the group of patients who smoked cannabis, there was some concurrent tobacco and substance use. This finding is consistent with information in the Canadian Paediatric Society position statement, 38 which states that use of cannabis can lead to use of tobacco and other substances. As mentioned in that position statement, health care professionals should screen for cannabis use and discuss the risks of using cannabis regularly. The Lower-Risk Cannabis Use Guidelines also recommend abstinence and avoidance of initiation of cannabis at a young age, 37 guidance that should be communicated to parents. For example, we were not able to describe the specific weight-based dosage of CBD as milligrams per kilogram , which would be useful for understanding observed outcomes of CBD use in pediatric practice. In addition, we were unable to extract detailed information about the onset of efficacy. Therefore, the results of this study may not be generalizable to all pediatric patients who are using cannabis for therapeutic purposes. Cannabis was often authorized by physicians outside of CHEO, and information concerning authorization could only be obtained if it was well documented in the chart. There may have been instances in which a patient was using cannabis, but it was not documented or there was lack of detail because a CHEO physician was not the authorizing health care provider. Furthermore, the families of some outpatients may not have disclosed use of cannabis during their clinic visit for fear of stigma. Another limitation was our inability to objectively quantify seizure frequency because information for the study was limited to documentation in the patient chart, which was in turn based on parental characterization of seizure frequency. As such, these outcomes were limited by parental report and any bias that might have entailed. According to the results of this study, we propose improving documentation of cannabis use for therapeutic purposes by integrating a template for documentation into the electronic medical record. Such a template would allow for more structured and standardized documentation of cannabis use. It could also facilitate future studies on the use of cannabis for therapeutic purposes. We propose that the elements required to effectively document the use of cannabis for therapeutic purposes, and thus improve understanding of its use in the pediatric population, are the following: start date; confirmation of authorization for cannabis, including name of the authorizing health care practitioner and expiry date of the certificate; brand name and source of cannabis e. This information could be gathered by referring to both the medical document of authorization and the label of the product. In all cases of medical use of cannabis, a document provided by a health care practitioner is required to access the product. The labelling requirements for medical cannabis specify that the name of the licensed producer should be displayed along with the brand name. In this single-institution retrospective chart review, medically supervised cannabis use was documented most frequently for children with seizures described as refractory. Documented decreases in seizure frequency associated with cannabis use were transient for many patients. All prospective studies evaluating efficacy for seizure control have used pure CBD preparations or oils with high CBD concentrations. It is unclear whether other compounds contained within cannabis-derived oils could contribute to the documented decrease in seizure frequency observed in this chart review. In the case of patients self-medicating with cannabis, a discussion of risks and benefits should take place between health care professionals and the patients and their families. This study has identified the need for development of a standardized care record, to ensure greater consistency and rigour in the conduct of prospective research in cannabis treatment and thus to generate better-quality research on the therapeutic effects of medical cannabis. We have proposed a template suitable for adoption by other hospitals that allows for a more structured documentation process, thereby facilitating the capture of more robust data on cannabis use in hospital settings. Overall, there continues to be a need for further research and for well-designed clinical trials of the use of cannabis for therapeutic purposes in pediatrics. As a library, NLM provides access to scientific literature. Can J Hosp Pharm. Show available content in en fr. Find articles by Maria Moreno. Find articles by Annie Pouliot. Find articles by Erick Sell. Issue date Mar-Apr. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP. Open in a new tab. Medically supervised use of cannabis: Cannabis was used under medical supervision, regardless of whether medical authorization was documented; does not include use of synthetic cannabinoids Self-medication with cannabis: Cannabis was used for therapeutic purposes, but without medical supervision Pharmaceutical cannabinoids: Manufactured drugs, such as deltatetrahydrocannabinol-cannabidiol and nabilone, which have been approved for specific indications by Health Canada. Competing interests: None declared. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Expansion of approved sources of dried marijuana for medical purposes to include licensed producers Created opportunity for development of a commercial industry. Medically supervised use of cannabis: Cannabis was used under medical supervision, regardless of whether medical authorization was documented; does not include use of synthetic cannabinoids. Self-medication with cannabis: Cannabis was used for therapeutic purposes, but without medical supervision. Pharmaceutical cannabinoids: Manufactured drugs, such as deltatetrahydrocannabinol-cannabidiol and nabilone, which have been approved for specific indications by Health Canada. Infantile spasms that progressed with new seizure types. Patients with decrease in seizures. Decrease in seizure frequency was maintained. Decrease in seizure frequency was transient.

Buying Cannabis online in Balzers