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This disquisition is designed to be an exploration of the controversies, contentions, and consternations with regard to the efficacy and potential of a newly devised CAM approach which entails modulating the endocannabinoid system and is considered to be a potentially useful technique for the treatment of obesity and diabetes. This paper is constructed to provide the reader with an understanding of the principles underlying a form of Complimentary Alternative Medicine (CAM) which has existed for millennia but has only recently attained credibility and acceptance within the scientific community. It provides a historical analysis of the perceived equivalency between synthetic cannabinoids and organic cannabinoids as well as the unknowns of each in their potential treatment of obesity and diabetes.
Volume 7 • Issue 4 • 1000219
Mol Biol, an open access journal
ISSN: 2168-9547
ISSN: 2168-9547
Molecular Biology
Dawson, Mol Biol 2018, 7:4
DOI: 10.4172/2168-9547.1000219
Perspective Article Open Access
Synthetic Cannabinoids, Organic Cannabinoids, the Endocannabinoid
System, and Their Relationship to Obesity, Diabetes, and Depression
David A Dawson*
Director of Endocannabinoid Research & Development, Helping End the Opiate Addiction (HEOE), Biology, Clearwater, Florida 33763, United State
This disquisition is designed to be an exploration of the controversies, contentions, and consternations with regard
to the efcacy and potential of a newly devised CAM approach which entails modulating the endocannabinoid system
and is considered to be a potentially useful technique for the treatment of obesity and diabetes. This paper is constructed
to provide the reader with an understanding of the principles underlying a form of Complimentary Alternative Medicine
(CAM) which has existed for millennia but has only recently attained credibility and acceptance within the scientic
community. It provides a historical analysis of the perceived equivalency between synthetic cannabinoids and organic
cannabinoids as well as the unknowns of each in their potential treatment of obesity and diabetes.
*Corresponding author: David A Dawson, Director of Endocannabinoid
Research & Development, Helping End the Opiate Addiction (HEOE), Biology,
Clearwater, Florida 33763, United States, Tel: 1 (458) 229-2021, E-mail:
Received September 05, 2018; Accepted September 12, 2018; Published
September 22, 2018
Citation: Dawson DA (2018) Synthetic Cannabinoids, Organic Cannabinoids,
the Endocannabinoid System, and Their Relationship to Obesity, Diabetes, and
Depression. Mol Biol 7: 219. doi: 10.4172/2168-9547.1000219
Copyright: © 2018 Dawson DA. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Cannabinoids; Diabetes; Obesity; Depression;
Rimonabant; CAM; Receptors
e following disquisition is designed to be an exploration of
the controversies, contentions, and consternations with regard to the
ecacy and potential of a newly devised CAM approach which entails
modulating the endocannabinoid system and is considered to be a
useful technique for the treatment of obesity and diabetes. By necessity,
this exploration becomes rather convoluted because in the year 2006
traditional medicine took a shot at incorporating this CAM approach
into their world-view by attempting to integrate their synthetic, single
molecule paradigm into a system of incredible molecular diversity.
Although the attempt failed dramatically and resulted in a large
number of major depressive episodes as well as two suicides, the
endeavor provided some valuable knowledge applicable to the eld of
bimolecular psychology.
Two ailments will be discussed, one physical and one emotional.
As will be demonstrated, both are intricately interrelated, although
not in a way that is immediately and intuitively apparent. e areas
where our knowledge is lacking and the necessity of research in the
eld of biomolecular psychology will be explored which will further
our understanding of the endocannabinoid system as well as how this
knowledge can be incorporated into this next frontier of medicine.
is paper is constructed to provide the reader with an understanding
of the principles underlying a form of Complimentary Alternative
Medicine (CAM) which has existed for millennia but has only recently
attained credibility and acceptance within the scientic community.
e approach based on the biological system was discovered less than
two decades ago, and therefore the paradigm is still in its infancy.
Traditionally, new paradigms in science are met with resistance
even though it is a scientist’s responsibility to design studies which
potentially challenge the dominant world-view. However, traditionally
scientists that challenge dominant paradigms are oen persecuted
[1]. For example, Albert Einstein struggled when attempting to gain
acceptance of his theory of relativity. Galileo died under house arrest for
proering the paradigm of a heliocentric universe, and Charles Darwin
is still being persecuted 160 years aer he established the paradigm on
which the science of biology is now based. e point is scientists at the
forefront of paradigm shis have to expect resistance from purveyors
of the dominant ideology, and imaginative methods are at times
utilized to combat the perceived threat of attaining new knowledge.
is resistance manifested itself as a ban being imposed on the research
of organic cannabinoid molecules (phytocannabinoids) in 1971, and
because of this, there are gaps in our knowledge and understanding
of the intersection of the endocannabinoid system with the study
of psychology and medicine. Ironically, our understanding of this
intersection has been greatly enhanced by the study of pharmacology
and an attempt by a French pharmaceutical company called Sano-
Aventis to treat obesity and diabetes by creating a synthetic cannabinoid
designed to dominate the biological system which controls virtually
every aspect of the way our minds and bodies function.
Obesity and diabetes have become health problems of epidemic
proportions in the industrialized world [2,3]. More than a million and
a half studies have been penned about obesity alone, and the condition
is still considered extremely dicult to control in the modern world.
Traditional treatments of low-calorie diets and appetite-suppressing
drugs frequently fail [4]. e majority of studies reporting weight loss
resulting from merely low-calorie diets report that most subjects regain
the weight back either partially or completely within three to ve years
aer treatment ends, and long-term studies present a less favorable
outcome with 49.5% of subjects regaining or surpassing their previous
weight [5]. ese issues with traditional treatment ecacy indicate the
necessity for the development of new strategies of both losing weight
and maintaining that weight loss.
In a study examining the relationship between obesity and diabetes
conducted by the National Health and Nutrition Examination Survey
(NHANES), researchers found the prevalence of diabetes increased
with escalating weight classes [6]. Other researchers also weigh in
on intervention approaches for treating diabetes. “Nearly half of
adult diabetics are considered obese suggesting that weight loss is an
important intervention in an eort to reduce the impact of diabetes
on the healthcare system.” [7]. In 2012, the total healthcare cost for
diagnosed cases of diabetes in the United States was 245 billion dollars.
At that time it was expected the cost would soar to half a trillion dollars
by the year 2020 and we as a nation are well on our way to achieving those
Volume 7 • Issue 4 • 1000219
Mol Biol, an open access journal
ISSN: 2168-9547
Citation: Dawson DA (2018) Synthetic Cannabinoids, Organic Cannabinoids, the Endocannabinoid System, and Their Relationship to Obesity,
Diabetes, and Depression. Mol Biol 7: 219. doi: 10.4172/2168-9547.1000219
Page 2 of 4
projections. e total estimated cost of diagnosed diabetes in 2017 was
327 billion dollars in direct medical costs plus an additional 90 billion
dollars in reduced productivity. Aer adjusting for ination, economic
costs of diabetes rose by 26% from 2012 to 2017 due to its increased
prevalence and the increased cost per aicted person [8]. Traditional
approaches for treating diabetes involve the patient keeping close watch
over their blood sugar levels and maintaining them within parameters
set by their doctor, and by employing a combination of diet, synthesized
medications, and exercise [9]. People with diabetes frequently use
complementary and alternative medicine (CAM) techniques of
multiple varieties ranging from dietary approaches to herbal and
vitamin therapies, and massage. e endocannabinoid system has
lately received considerable attention as a potential therapeutic target
in combating obesity as well as its associated metabolic abnormalities
[10]. Studies by Sano-Aventis Pharmaceuticals demonstrated that a
simple synthetic CB1 receptor antagonist (Rimonabant) corrected the
deleterious eects of diet-induced obesity by restoring insulin sensitivity
and normalizing fat cell size and distribution [11]. is antagonist
also prevented visceral fat accumulation and decreased subcutaneous
fat. Other investigations showed similar ndings and concluded that
blockage of the CB1 receptors with Rimonabant decreased body weight
and adiposity, independent of sustained reductions in food intake in
humans, canines, and rodents [12-16].
By the year 2006 Sano-Aventis had conducted numerous studies
which indicated the central cannabinoid (CB1) receptors played a
signicant role in controlling food consumption and dependence. To
develop suitable synthetic medicines against this target, compounds
with potential activity against this receptor were screened for inhibitory
activity. Rimonabant emerged from this screening process as a potent
CB1 receptor antagonist. Preclinical animal trials subsequently showed
that it reduced consumption of fats and sugars which are signicant
contributors to weight gain. ese preclinical ndings were conrmed
in a series of clinical studies involving over 6,000 obese subjects and
carried out in both the Americas and Europe. In the United States,
the FDA requires two years of safety data before approving anti-
obesity medicines, and as part of their patent application process,
the pharmaceutical company conducted those trials. e conclusion
of the FDA meta-analysis of Rimonabant safety data indicated an
increased risk for suicidal ideation in patients and two suicides were
recorded across the two-year Rimonabant clinical trial program.
Furthermore, an analysis of data collected from four double-blind,
randomized controlled trials demonstrated that 20 mg per day of this
synthetic cannabinoid increased the risk of psychiatrically adverse
events, specically, depressed mood disorders and anxiety [17-20].
ese ndings resulted in marketing authorization being withdrawn
for Rimonabant because the adverse psychological eects could not
be addressed [21]. ese results beg two questions. First, what is the
mechanism causing these emotional disorders? Second, would an
organic phytocannabinoid CB1 receptor antagonist produce similar
results? Analyzing these questions individually brings up other questions
indicative of how little we know about the correlation of synthetic
cannabinoid medicines with organic phytocannabinoid supplements.
A comprehensive review of the literature also indicates how little
we understand about Rimonabant. 2,980 studies published within
the last ve years classify the synthetic cannabinoid as an antagonist
at the receptor, while 1,327 studies identify it as an inverse agonist.
Scientic truth is not determined democratically, and the manufacturer
of Rimonabant stopped answering questions about the synthetic
cannabinoid in 2009 with the claim that the information is proprietary.
is distinction between antagonist and inverse agonist is critical
because it speaks to the mechanism causing the adverse reaction. An
inverse agonist serves as a receptor blocker, precluding the attachment
of anandamide, the body’s natural antidepressant endocannabinoid
[22]. eoretically, blocking the attachment of anandamide to the CB1
receptor could conceivably result in depression. If merely blocking the
CB1 receptor is enough to produce depression, any inverse agonist that
attaches to that receptor would prohibit the attachment of anandamide.
If the1327 studies are correct, and Rimonabant merely acts as a receptor
blocker, its phytocannabinoid equivalent would be CBD, providing
an accessible population in the United States for survey depression
studies. According to data obtained by the National Conference of
State Legislators (2018), only four states remain that ban access to
natural CBD. Cannabinoids derived from hemp are legally marketed
in the remaining states as treatment for a variety of ailments despite
the long-held FDA contention that the synthetic cannabinoids are
medicinal and the organic cannabinoids are among the most addictive
and dangerous molecules humans can ingest. Coincidently, 20 mg is
the usual suggested dose of most phytocannabinoid supplements
suggested by marketers of these products in the United States, although
many recommend multiple doses per day. No studies exist on whether
naturally produced CBD isolates increase the risk of these adverse
psychiatric reactions. ere are two schools of thought on this. e rst
is that synthetic cannabinoids and cannabinoids produced naturally
(organic cannabinoids) act on the CB1 receptors in the same way, and
therefore the eects of each should be similar. e question becomes,
do both the synthetic and natural CBD act on the receptors in the same
way? If they do, organic CBD should also be expected to be associated
with depressed mood disorders, and physicians should be alerted to
these potentially severe adverse psychiatric reactions by the US Food
and Drug Administration. e second school of thought advances the
notion that while naturally produced CBD acts as an inverse agonist
at the CB1 receptor, the enzyme Fatty Acid Amide Hydrolase (FAAH)
breaks down the organic molecule faster than the synthetic, thereby
reducing the depressive eects. e most useful analogy to view this
way of thinking is imagining the enzyme eating something organic as
opposed trying to eat something plastic.
However, no studies have been conducted comparing degradation
rates of organic cannabinoids with synthetic cannabinoids and
therefore, staying true to the paradigm as presented, all indications lead
to the conclusion that naturally produced CBD would increase the risk
of psychiatric adverse events in the same way the synthetic cannabinoid
does. Dierences in degradation rates between phytocannabinoids and
synthetic cannabinoids is an area in which further research is necessary.
Evidence obtained from the multiple studies of Rimonabant and
its depressive properties suggests that other inverse agonists at the
CB1 would have depressive properties as well. However, due to the
ban on research of phytocannabinoids in the United States, this has
never been studied. Given the proliferation of companies marketing
isolate organic phytocannabinoid supplements throughout the nation,
studies looking for possible deleterious eects of these products on a
population are necessary. With 92% of the nation allowing medicinal
cannabinoid use, clinical and policy concerns regarding the mental
health eects of organic cannabinoids should be examined regardless
of the federal mandate that such studies not be allowed. Analyzing
this mandate from the paradigm of synthetic cannabinoid/organic
cannabinoid equivalency, it becomes apparent that a survey study of
possible depressive properties of CBD isolates could easily be conducted
without Federal approval. Given the fact that the population is already
legally intromitting these supplements, it seems appropriate to study
their eects.
e National Institute of Drug Abuse subsidizes studies designed
Volume 7 • Issue 4 • 1000219
Mol Biol, an open access journal
ISSN: 2168-9547
Citation: Dawson DA (2018) Synthetic Cannabinoids, Organic Cannabinoids, the Endocannabinoid System, and Their Relationship to Obesity,
Diabetes, and Depression. Mol Biol 7: 219. doi: 10.4172/2168-9547.1000219
Page 3 of 4
to prove the deleterious eects of cannabis while blocking inquiry
into its potential benets (National Institute of Drug Abuse, 2018).
If Rimonabant is an antagonist at the CB1 receptor the depression
mechanism is dierent, but a study would t into NIDAs wheelhouse.
NIDA contracts with the University of Mississippi to produce
phytocannabinoids for research purposes, and from a biomolecular
perspective, one of the most important studies this supply could be used
for is an analysis of the mechanism by which CB1 antagonism causes
depression. eoretically, the depression could either be the byproduct
of the antagonism of the CB1 directly, or the result of blocking the CB1
receptor, thereby prohibiting the binding of anandamide, the body’s
natural antidepressant endocannabinoid [23].
Evidence indicates that most, if not all, of the central nervous system
actions of cannabinoids, whether they be plant-derived, endogenous, or
synthetic are related to an anity for binding with the CB1 receptor.
If Rimonabant is an antagonist, the phytocannabinoid equivalent
has been determined to be THCV [24-26]. In the phytocannabinoid
world, Tetrahydrocannabivarin (THCV) appears to be an anomaly as
the only known phytocannabinoid antagonist at the CB1 receptor. Of
course, there are 112 other known phytocannabinoids and information
is still lacking about how each acts on the body’s various receptors.
What we do know has to do with the “nature of science.” In scientic
research, it is generally the anomalies that end up being important. is
has particular signicance with regard to devising a CAM approach
utilizing the principles of biomolecular psychology in the treatment of
diabetes [27].
Manipulation of CB1 receptors with Rimonabant resulted in a
signicant reduction in body weight, waist circumference, triglyceride
concentrations, an increase in HDL cholesterol and adiponectin
concentrations and a reduced number of subjects with type 2 diabetes
[28]. However, as already discussed, in 2008, marketing authorization
for Rimonabant was withdrawn due to a signicant increase in
incidences of adverse psychiatric events [29].
Two possible phytocannabinoids equivalents to Rimonabant have
been discussed, and both have signicant implications concerning
proper regulation of the endocannabinoid system in addition to
obesity, diabetes, and depression. Cannabidiol (CBD) provides an
astonishing benet with respect to hyperglycemia, mainly through
its anti-inammatory and antioxidant properties, and modulates
cardiovascular response to stress [30].
D9-Tetrahydrocannabivarin (THCV) is a naturally occurring
analog of THC, but with dierent pharmacological eects. As with
many of the phytocannabinoids it acts on the receptors dierently
depending on the amount intromitted. At low dose (5-7.5 mg) it
antagonizes the CB1 receptors resulting in an inhibition of appetite,
while at moderate to high doses (10-20mg) it acts as an inverse agonist
CB2 receptor blocker and full agonist at the GPR55 receptors resulting
in a regulation of blood sugar levels while reducing the body’s resistance
to insulin. ese properties make the potential benet of THCV and
CBD, alone or in combination, very interesting molecules for study
in regard to the treatment of obesity and diabetes as they have very
distinct pharmacological proles, and therefore dierent side eects to
Rimonabant [31-33].
Recently the American Diabetes Association published a meta-
analysis indicating that there may be ethnic dierences of the optimal
states in the relationship between insulin sensitivity and insulin response.
e genetic background of Africans and East Asians makes them more
and dierentially susceptible to diabetes than Caucasians [34-37], and
ethnic groups are more likely to use CAM as a treatment option than
Caucasians [38-41]. is indicates the necessity of further study and
development of CAM approaches for the treatment of diabetes which
are based on sound scientic methodology, and an argument could be
proered that further studies of the endocannabinoid system could
lead to methods of balancing its environment through the judicious
supplementation of naturally occurring cannabinoids.
1. Kuhn TS (1996) The structure of scientic revolutions., 3rd ed. Chicago, IL, US:
University of Chicago Press.
2. Aronne LJ, Thornton-Jones ZD (2007) New targets for obesity pharmacotherapy.
Clin Pharmacol Ther 81: 748-752.
3. Ravinet TC, Delgorge c, Menet C, Arnone M, Soubrie P (2004) CB1 cannabinoid
receptor knockout in mice leads to leanness, resistance to diet-induced obesity
and enhanced leptin sensitivity. Int J Obes Relat Metab Disord 28: 640-648.
4. Wadden TA (1993) Treatment of obesity by moderate and severe caloric
restriction. Results of clinical research trials. Ann Intern Med 119: 688-693.
5. Gosselin C, Cote G (2001) Weight loss maintenance in women two to eleven
years after participating in a commercial program: a survey. BMC Women’s
Health, 1: 1-6.
6. Martin CB, Herrick KA, Sarafrazi N, Ogden CL (2018) Attempts to lose weight
among adults in the United States, 2013-2016. NCHS Data Brief, 313: 1-8.
7. Nguyen NT, Nguyen XT, Lane J, Wang P (2011) Relationship between obesity
and diabetes in a US adult population: ndings from the National Health and
Nutrition Examination Survey, 1999-2006. Obes Surg 21: 351-355.
8. Petersen MP (2018) Economic Costs of Diabetes in the U.S. in 2017. Diabetes
Care 41: 917-928.
9. Preedy VR (2014) Diabetes: oxidative stress and dietary antioxidants.
Amsterdam: Elsevier/Academic Press.
10. Richey JM, Woolcott OO, Stefanovski D, Harrison LN, Zheng D, et al. (2009)
Rimonabant prevents additional accumulation of visceral and subcutaneous
fat during high-fat feeding in dogs. Am J Physiol Endocrinol Metab 296:
11. Kim SP, Woolcott OO, Hsu IR, Stefanoski D, Harrison LN (2012) CB(1)
antagonism restores hepatic insulin sensitivity without normalization of
adiposity in diet-induced obese dogs. Am J Physiol Endocrinol Metab, 302:
12. Jbilo O, Ravinet TC, Arnone M, Buisson I, Bribes E (2005) The CB1 receptor
antagonist rimonabant reverses the diet-induced obesity phenotype through
the regulation of lipolysis and energy balance. FASEB Journal 19: 1567-1569.
13. Kabir M, Stefanovski D, Hsu IR, Iyer M, Woolcott OO, et al. (2011) Large size
cells in the visceral adipose depot predict insulin resistance in the canine
model. Obesity 19: 2121-2129.
14. Pi-Sunyer FX, Aronne LJ, Heshmati HM, Devin J, Rosenstock J (2006) Effect of
rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic
risk factors in overweight or obese patients: RIO-North America: a randomized
controlled trial. Jama 295: 761-775.
15. Trillou RC, Arnone M, Delgorge C, Gonalons N, Keane P (2003) Anti-obesity
effect of SR141716, a CB1 receptor antagonist, in diet-induced obese mice.
Am. J. Physiol Regul Integr Comp Physiol 284: R345-R353.
16. Richey JM, Woolcott O (2017) Re-visiting the endocannabinoid system and its
therapeutic potential in obesity and associated diseases. Curr Diab Rep 17: 99.
17. Buggy Y, Cornelius V, Wilton L, Shakir S, Buggy, Y (2011) Risk of depressive
episodes with rimonabant: a before and after modied prescription event
monitoring study conducted in England. Drug Saf 34: 501-509.
18. Christensen R, Kristensen PK, Bartels EM, Bliddal H, Astrup A (2007) Efcacy
and safety of the weight-loss drug rimonabant: a meta-analysis of randomized
trials. The Lancet 370: 1706-1713.
19. Thomas KH, Martin RM, Potokar J, Pirmohamed M, Gunnell D (2014) Reporting
of drug induced depression and fatal and non-fatal suicidal behaviour in the UK
from 1998 to 2011. BMC Pharmacol Toxicol 30:1554.
20. Haj MA, Amiri S, Amini KH, Haj MA, Hashemiaghdam A, et al. (2018)
Involvement of NO/NMDA-R pathway in the behavioral despair induced by
amphetamine withdrawal. Brain Res Bull 139: 81-90.
Volume 7 • Issue 4 • 1000219
Mol Biol, an open access journal
ISSN: 2168-9547
Citation: Dawson DA (2018) Synthetic Cannabinoids, Organic Cannabinoids, the Endocannabinoid System, and Their Relationship to Obesity,
Diabetes, and Depression. Mol Biol 7: 219. doi: 10.4172/2168-9547.1000219
Page 4 of 4
21. Smaga I, Bystrowska B, Gawliński D, Przegaliński E, Filip M (2014) The
endocannabinoid/endovanilloid system and depression. Curr Neuropharmacol
12: 462-474.
22. McPartland JM, Duncan M, Di Marzo V, Pertwee RG (2015) Are cannabidiol
and Δ(9) -tetrahydrocannabivarin negative modulators of the endocannabinoid
system? A systematic review. Br J Pharmacol 172: 737-753.
23. Rzepa E, Tudge L, McCabe C (2015) The CB1 Neutral Antagonist
Tetrahydrocannabivarin Reduces Default Mode Network and Increases
Executive Control Network Resting State Functional Connectivity in Healthy
Volunteers. Int J Neuropsychopharmacol 19.
24. Tudge L, Williams C, Cowen PJ, McCabe C (2014) Neural effects of cannabinoid
CB1 neutral antagonist tetrahydrocannabivarin on food reward and aversion in
healthy volunteers. Int J Neuropsychopharmacol 18: pyu094.
25. Di Marzo V (2008) The endocannabinoid system in obesity and type 2 diabetes.
Diabetologia 51: 1356-1367.
26. Christopoulou FD, Kiortsis DN (2011) An overview of the metabolic effects of
rimonabant in randomized controlled trials: potential for other cannabinoid 1
receptor blockers in obesity. J Clin Pharm Ther 36: 10-18.
27. Le Foll B, Gorelick DA, Goldberg SR (2009) The future of endocannabinoid-
oriented clinical research after CB1 antagonists. Psychopharmacology 205:
28. Stanley CP, Wheal AJ, Randall MD, O’Sullivan SE (2013) Cardiovascular
pharmacology: Cannabinoids alter endothelial function in the Zucker rat model
of type 2 diabetes. Eur J Pharmacol 720: 376-382.
29. Anavi GS, Baillie G, Irving AJ, Gertsch J, Greig I, et al. (2012) Modulation of
L-α-Lysophosphatidylinositol/GPR55 Mitogen-activated Protein Kinase (MAPK)
signaling by cannabinoids. J Biol Chem 287: 91-104.
30. De Petrocellis L, Orlando P, Moriello A S, Aviello G, Stott C, et al. (2012)
Cannabinoid actions at TRPV channels: effects on TRPV3 and TRPV4 and
their potential relevance to gastrointestinal inammation. Acta Physiol (Oxf)
204: 255-266.
31. De Petrocellis L, Ligresti A, Moriello A S, Allarà M, Bisogno T, et al. (2011)
Effects of cannabinoids and cannabinoid-enriched Cannabis extracts on TRP
channels and endocannabinoid metabolic enzymes. Br J Pharmacol 163:
32. Kodama K, Tojjar D, Yamada S, Toda K, Patel CJ. et al. (2013) Ethnic
differences in the relationship between insulin sensitivity and insulin response:
a systematic review and meta-analysis. Diabetes Care 36: 1789-1796.
33. Okombo FA (2018) Racial ethnic health disparities: A phenomenological
exploration of African American with diabetes complications. Dissertation
Abstracts International, ERIC. 78.
34. Onakpoya IJ, Heneghan CJ, Aronson JK (2016) Post-marketing withdrawal
of anti-obesity medicinal products because of adverse drug reactions: a
systematic review. BMC Med 14: 191.
35. Blanco C, Hasin DS, Wall MM, Flórez SL, Hoertel N (2016) Cannabis Use
and Risk of Psychiatric Disorders: Prospective Evidence from a US National
Longitudinal Study. JAMA Psychiatry 73: 388-395.
36. de Mattos Viana B, Prais H C, Daker MV (2009) Melancholic features related to
rimonabant. Gen Hosp Psychiatry 31: 583-585.
37. Englund A, Atakan Z, Kralj A, Tunstall N, Murray R, et al. (2016) The effect
of ve day dosing with THCV on THC-induced cognitive, psychological and
physiological effects in healthy male human volunteers: A placebo-controlled,
double-blind, crossover pilot trial. J Psychopharmacol 30: 140-51.
38. Sales AJ, Crestani CC, Guimarães FS, & Joca SR (2018) Antidepressant-like
effect induced by Cannabidiol is dependent on brain serotonin levels. Prog
Neuropsychopharmacol Biol Psychiatry 30: 255-261.
39. Villa CL, Morello CM, Chynoweth ME, Prieto RA, Polonsky WH (2010) Ethnic
differences in complementary and an alternative medicine use among patients
with diabetes. Complement Ther Med 18: 241-248.
40. National Conference of State Legislators (2018) State Medical Marijuana Laws.
41. National Institute of Drug Abuse (2018) NIDA’s role in providing marijuana for
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Molecular engineers are studying FAAH as a target for pharmaceuticals as controlling levels of FAAH may produce some of the same health effects that excite clinicians about the potential for phytocannabinoid-based medicines. Synthetic cannabinoids work by flooding the system with molecules structurally similar to THC and other phytocannabinoids. Medicines that inhibit the body’s production of FAAH are theorized to have a similar effect by maximizing the concentration of deficient endocannabinoids in the nervous system. Technological limitations coupled with a suppression of research of biologic cannabinoids at many major research universities have limited our understanding of the endocannabinoid system. Questions still need to be answered to provide a comprehensive comparison of biologic with synthetic FAAH inhibitors. Advancement and research aimed at understanding of endogenous and exogenous cannabinoids, and particularly the medicinal properties of the Trans-Δ⁹-Tetrahydrocannabinol (THC) molecule and its endocannabinoid equivalent anandamide are hindered by prohibitive restrictions resulting from the Food and Drug Administration (FDA), Drug Enforcement Administration (DEA), National Institute of Health (NIH), and the National Institute on Drug Abuse (NIDA). The mission statements of each of these entities effectively integrate to ensure research and utilization of the medicinal properties of THC will be nearly impossible to attain.
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Almost 40% of adults in the United States had obesity in 2015-2016 (1). Obesity is associated with a range of serious health risks (2). Individuals may have multiple motivations for trying to losing weight, including health and appearance reasons (3). This report describes the percentage of U.S. adults who tried to lose weight in the past year by sex, age, race and Hispanic origin, family income, and weight status, based on data collected in the National Health and Nutrition Examination Survey (NHANES) from 2013 -2016.
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Objective: This study updates previous estimates of the economic burden of diagnosed diabetes and quantifies the increased health resource use and lost productivity associated with diabetes in 2017. Research design and methods: We use a prevalence-based approach that combines the demographics of the U.S. population in 2017 with diabetes prevalence, epidemiological data, health care cost, and economic data into a Cost of Diabetes Model. Health resource use and associated medical costs are analyzed by age, sex, race/ethnicity, insurance coverage, medical condition, and health service category. Data sources include national surveys, Medicare standard analytical files, and one of the largest claims databases for the commercially insured population in the U.S. Results: The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. People with diagnosed diabetes incur average medical expenditures of ∼$16,750 per year, of which ∼$9,600 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures ∼2.3 times higher than what expenditures would be in the absence of diabetes. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion). Conclusions: After adjusting for inflation, economic costs of diabetes increased by 26% from 2012 to 2017 due to the increased prevalence of diabetes and the increased cost per person with diabetes. The growth in diabetes prevalence and medical costs is primarily among the population aged 65 years and older, contributing to a growing economic cost to the Medicare program. The estimates in this article highlight the substantial financial burden that diabetes imposes on society, in addition to intangible costs from pain and suffering, resources from care provided by nonpaid caregivers, and costs associated with undiagnosed diabetes.
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Purpose of review: The purpose of the review was to revisit the possibility of the endocannabinoid system being a therapeutic target for the treatment of obesity by focusing on the peripheral roles in regulating appetite and energy metabolism. Recent findings: Previous studies with the global cannabinoid receptor blocker rimonabant, which has both central and peripheral properties, showed that this drug has beneficial effects on cardiometabolic function but severe adverse psychiatric side effects. Consequently, focus has shifted to peripherally restricted cannabinoid 1 (CB1) receptor blockers as possible therapeutic agents that mitigate or eliminate the untoward effects in the central nervous system. Targeting the endocannabinoid system using novel peripheral CB1 receptor blockers with negligible penetrance across the blood-brain barrier may prove to be effective therapy for obesity and its co-morbidities. Perhaps the future of blockers targeting CB1 receptors will be tissue-specific neutral antagonists (e.g., skeletal muscle specific to treat peripheral insulin resistance, adipocyte-specific to treat fat excess, liver-specific to treat fatty liver and hepatic insulin resistance).
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Background We identified anti-obesity medications withdrawn since 1950 because of adverse drug reactions after regulatory approval, and examined the evidence used to support such withdrawals, investigated the mechanisms of the adverse reactions, and explored the trends over time. Methods We conducted searches in PubMed, the World Health Organization database of drugs, the websites of drug regulatory authorities, and selected full texts, and we hand searched references in retrieved documents. We included anti-obesity medications that were withdrawn between 1950 and December 2015 and assessed the levels of evidence used for making withdrawal decisions using the Oxford Centre for Evidence-Based Medicine criteria. Results We identified 25 anti-obesity medications withdrawn between 1964 and 2009; 23 of these were centrally acting, via monoamine neurotransmitters. Case reports were cited as evidence for withdrawal in 80% of instances. Psychiatric disturbances, cardiotoxicity (mainly attributable to re-uptake inhibitors), and drug abuse or dependence (mainly attributable to neurotransmitter releasing agents) together accounted for 83% of withdrawals. Deaths were reportedly associated with seven products (28%). In almost half of the cases, the withdrawals occurred within 2 years of the first report of an adverse reaction. Conclusions Most of the drugs that affect monoamine neurotransmitters licensed for the treatment of obesity over the past 65 years have been withdrawn because of adverse reactions. The reasons for withdrawal raise concerns about the wisdom of using pharmacological agents that target monoamine neurotransmitters in managing obesity. Greater transparency in the assessment of harms from anti-obesity medications is therefore warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12916-016-0735-y) contains supplementary material, which is available to authorized users.
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Importance With rising rates of marijuana use in the general population and an increasing number of states legalizing recreational marijuana use and authorizing medical marijuana programs, there are renewed clinical and policy concerns regarding the mental health effects of cannabis use.Objective To examine prospective associations between cannabis use and risk of mental health and substance use disorders in the general adult population.Design, Setting, and Participants A nationally representative sample of US adults aged 18 years or older was interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001-2002; wave 2, 2004-2005). The primary analyses were limited to 34 653 respondents who were interviewed in both waves. Data analysis was conducted from March 15 to November 30, 2015.Main Outcomes and Measures We used multiple regression and propensity score matching to estimate the strength of independent associations between cannabis use at wave 1 and incident and prevalent psychiatric disorders at wave 2. Psychiatric disorders were measured with a structured interview (Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV). In both analyses, the same set of wave 1 confounders was used, including sociodemographic characteristics, family history of substance use disorder, disturbed family environment, childhood parental loss, low self-esteem, social deviance, education, recent trauma, past and present psychiatric disorders, and respondent’s history of divorce.Results In the multiple regression analysis of 34 653 respondents (14 564 male [47.9% weighted]; mean [SD] age, 45.1 [17.3] years), cannabis use in wave 1 (2001-2002), which was reported by 1279 respondents, was significantly associated with substance use disorders in wave 2 (2004-2005) (any substance use disorder: odds ratio [OR], 6.2; 95% CI, 4.1-9.4; any alcohol use disorder: OR, 2.7; 95% CI, 1.9-3.8; any cannabis use disorder: OR, 9.5; 95% CI, 6.4-14.1; any other drug use disorder: OR, 2.6; 95% CI, 1.6-4.4; and nicotine dependence: OR, 1.7; 95% CI, 1.2-2.4), but not any mood disorder (OR, 1.1; 95% CI, 0.8-1.4) or anxiety disorder (OR, 0.9; 95% CI, 0.7-1.1). The same general pattern of results was observed in the multiple regression analyses of wave 2 prevalent psychiatric disorders and in the propensity score–matched analysis of incident and prevalent psychiatric disorders.Conclusions and Relevance Within the general population, cannabis use is associated with an increased risk for several substance use disorders. Physicians and policy makers should take these associations of cannabis use under careful consideration.
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Abstract Rationale: Cannabis is mostly grown under illegal and unregulated circumstances, which seems to favour a product increasingly high in its main cannabinoid Δ-9-tetrahydrocannabinol (THC). Δ-9-tetrahydrocannabivarin (THCV) is a relatively untested cannabinoid which is said to be a cannabinoid receptor neutral antagonist, and may inhibit the effects of THC. Objectives: To explore the safety and tolerability of repeated THCV administration and its effects on symptoms normally induced by THC in a sample of healthy volunteers. Methods: Ten male cannabis users (<25 use occasions) were recruited for this within-subjects, placebo-controlled, double-blind, cross-over pilot study. 10mg oral pure THCV or placebo were administered daily for five days, followed by 1mg intravenous THC on the fifth day. Results: THCV was well tolerated and subjectively indistinguishable from placebo. THC did not significantly increase psychotic symptoms, paranoia or impair short-term memory, while still producing significant intoxicating effects. Delayed verbal recall was impaired by THC and only occurred under placebo condition (Z=-2.201, p=0.028), suggesting a protective effect of THCV. THCV also inhibited THC-induced increased heart rate (Z=-2.193, p=0.028). Nine out of ten participants reported THC under THCV condition (compared to placebo) to be subjectively weaker or less intense (χ2=6.4, p=0.011). THCV in combination with THC significantly increased memory intrusions (Z=-2.155, p=0.031). Conclusion: In this first study of THC and THCV, THCV inhibited some of the well-known effects of THC, while potentiating others. These findings need to be interpreted with caution due to a small sample size and lack of THC-induced psychotomimetic and memory-impairing effect, probably owing to the choice of dose. Keywords THCV, THC, Δ9-tetrahydrocannabivarin, Δ9-tetrahydrocannabinol, cannabis, memory, psychosis, cannabinoid, human
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Background: The cannabinoid cannabinoid type 1 (CB1) neutral antagonist tetrahydrocannabivarin (THCv) has been suggested as a possible treatment for obesity, but without the depressogenic side-effects of inverse antagonists such as Rimonabant. However, how THCv might affect the resting state functional connectivity of the human brain is as yet unknown. Method: We examined the effects of a single 10mg oral dose of THCv and placebo in 20 healthy volunteers in a randomized, within-subject, double-blind design. Using resting state functional magnetic resonance imaging and seed-based connectivity analyses, we selected the amygdala, insula, orbitofrontal cortex, and dorsal medial prefrontal cortex (dmPFC) as regions of interest. Mood and subjective experience were also measured before and after drug administration using self-report scales. Results: Our results revealed, as expected, no significant differences in the subjective experience with a single dose of THCv. However, we found reduced resting state functional connectivity between the amygdala seed region and the default mode network and increased resting state functional connectivity between the amygdala seed region and the dorsal anterior cingulate cortex and between the dmPFC seed region and the inferior frontal gyrus/medial frontal gyrus. We also found a positive correlation under placebo for the amygdala-precuneus connectivity with the body mass index, although this correlation was not apparent under THCv. Conclusion: Our findings are the first to show that treatment with the CB1 neutral antagonist THCv decreases resting state functional connectivity in the default mode network and increases connectivity in the cognitive control network and dorsal visual stream network. This effect profile suggests possible therapeutic activity of THCv for obesity, where functional connectivity has been found to be altered in these regions.
Cannabidiol (CBD) is a compound of Cannabis sativa with relevant therapeutic potential in several neuropsychiatric disorders including depression. CBD treatment has shown significant antidepressant-like effects in different rodent preclinical models. However, the mechanisms involved in CBD-induced antidepressant effects are still poorly understood. Therefore, this work aimed at investigating the participation of serotonin (5-HT) and/or noradrenaline (NA) in CBD-induced antidepressant-like effects in the forced swimming test (FST) by: 1) testing if CBD co-administration with serotonergic (fluoxetine, FLX) or noradrenergic (desipramine, DES) antidepressants would have synergistic effects; and 2) investigating if 5-HT or NA depletion would impair CBD-induced behavioral effects. Results showed that CBD (10 mg/kg), FLX (10 mg/kg) and DES (5 mg/kg) induced antidepressant-like effects in mice submitted to FST. Ineffective doses of CBD (7 mg/kg), when co-administered with ineffective doses of FLX (5 mg/kg) or DES (2.5 mg/kg) resulted in significant antidepressant-like effects, thus implicating synergistic and/or additive mechanisms. Pretreatment with PCPA (an inhibitor of serotonin synthesis: 150 mg/kg, i.p., once per day for 4 days), but not DSP-4 (a noradrenergic neurotoxin: 1 μg/μl, i.c.v., 24 h before the test), reduced monoamine levels in the brain. However, only PCPA treatment abolished CBD-induced behavioral effects in FST, indicating the participation of serotonergic mechanisms. None of the treatments induced locomotor effects. Our results suggest that the antidepressant-like effect induced by CBD in the FST is dependent on serotonin levels in the central nervous system (CNS).
Abrupt discontinuation of chronic amphetamine consumption leads to withdrawal symptoms including depression, anhedonia, dysphoria, fatigue, and anxiety. These irritating symptoms may result in continuing to take the drug or can lead to suicidal behavior. Past studies have shown the involvement of various biologic systems in depression induced following amphetamine withdrawal (AW). However, there is no evidence about the relation between nitric oxide (NO) with NMDA receptors on depression following AW. In this study, we examined the involvement of the NO/NMDA pathways on depressive-like behaviors after 24 h withdrawal following 5 continuous days of amphetamine administration in male NMRI mice. Behavioral tasks used for depression assessment included the forced swimming test (FST), the Splash test and the open field test (OFT). In order to evaluate the role of NO/NMDA pathways animals treated with MK-801 (NMDA-R antagonist), Aminoguanidine (AG), a selective iNOS inhibitor, Nω-Nitro-L-arginine (L-NNA), a non-selective NOS inhibitor and 7-Nitro indazole (7-NI), a selective nNOS inhibitor. We also measured the level of nitrite in the hippocampus. Our data showed that AW induced the depressive-like effect in the FST and the Splash test. We showed that administration of AG, L-NNA, and MK-801 mitigated AW induced depression, however, 7-NI was failed to decrease depressive-like behaviors. Also, the antidepressant-like effect of co-injection of sub-effective doses of MK-801 with AG suggested that inducible nitric oxide synthase (iNOS) is associated with NMDA-R in AW induced depression. In conclusion, both NO and NMDA-R pathways are involved and related to each other in depression induced following AW.
Aging: Oxidative Stress and Dietary Antioxidants bridges the trans-disciplinary divide and covers in a single volume the science of oxidative stress in aging and the potentially therapeutic use of natural antioxidants in the diet or food matrix. The processes within the science of oxidative stress are described in concert with other processes, such as apoptosis, cell signaling, and receptor mediated responses. This approach recognizes that diseases are often multifactorial, and oxidative stress is a single component of this. Gerontologists, geriatricians, nutritionists, and dieticians are separated by divergent skills and professional disciplines that need to be bridged in order to advance preventative as well as treatment strategies. While gerontologists and geriatricians may study the underlying processes of aging, they are less likely to be conversant in the science of nutrition and dietetics. On the other hand, nutritionists and dietitians are less conversant with the detailed clinical background and science of gerontology. This book addresses this gap and brings each of these disciplines to bear on the processes inherent in the oxidative stress of aging.