The Role of Cannabis in Orthopedic Surgery
- PDF / 559,813 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 38 Downloads / 200 Views
SURGERY
The Role of Cannabis in Orthopedic Surgery David C. Sing 1
&
Paul Tornetta III 1 & Erik N. Hansen 2
Accepted: 21 September 2020 # Springer Nature Switzerland AG 2020
Abstract Cannabis use has increased dramatically in America with recent regulatory policy changes. Despite growing access and prevalence of use of cannabinoids both medically and recreationally, scientific evidence describing its safety and efficacy are limited, especially in the context of treating musculoskeletal pathology. The purpose of this review is to present data evaluating the role of cannabinoids as an adjunct in multimodal pain management, as a modulator in bone metabolism, and as a potential agent in combating the opioid epidemic. Keywords Cannabinoids . Pain management . Bone homeostasis . Opioid replacement . Policy
Introduction In 2016 24 million Americans reported marijuana use in the past month according to the National Survey of Drug Use and Health (1). As of June 2019, ten states and Washington, DC have legalized recreational marijuana use, and 33 states have legislation to regulate marijuana for medical use (Table 1) [1]. Only three states (Idaho, South Dakota, Nebraska) allow no form of legal medical cannabis. With 60–64% of Americans reporting support for legalization of marijuana in 2017 [2, 3], legalization of cannabis use will likely continue resulting in increased access and prevalence of use. Despite marijuana becoming vastly more available, scientific evidence supporting its safety or benefits are limited. Although basic science research on the cannabinoid (CB) receptor system became more prominent in the early 1990s, literature evaluating CB receptors as a clinically therapeutic target have been deemed moderate quality at best [4]. Similarly, evidence of harmful side effects resulting from chronic use is lacking [1].
This article is part of the Topical Collection on Surgery * David C. Sing [email protected] 1
Department of Orthopedic Surgery, Boston Medical Center, Boston, MA, USA
2
Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
Cannabinoid receptors 1 and 2 (CB1 and CB2) both exist endogenously in the human body. CB1 receptors are localized predominantly in the brain and in peripheral neurons, leading to more commonly described psychotropic effects as well as other endocannabinoid effects on the central nervous system [5]. In contrast, CB2 receptors are predominantly localized to peripheral tissues particularly in immune tissues including bone, although evidence exists that demonstrates CB2 activity in the central nervous system as well [6]. Although hundreds of cannabinoid compounds are found in the cannabis plant that variably activate CB1 and CB2 receptors, tetrahydrocannabinol (THC) and cannabidiol (CBD) are found in the highest concentrations and are the two most studied in research. Both have obtained FDA approval for therapeutic medical uses, with synthetic THC in Marinol (dronabinol) approved for treating anorexia in patients suffering AIDS-wa
Data Loading...
