Patterns of theraPeutic cannabis use in 907 Patients Poster 2013, 06-14-13.pdf · had a primary symptom of pain (1. pain/chronic pain; 2. arthritis/osteoarthritis, and 3. fybromyalgia),

Patterns of theraPeutic cannabis use in 907 PatientsPhilippe Lucas1 & Robin Krause2

1.Research Affiliate - Centre for Addictions Research of BC; PhD Student, University of Victoria. [email protected]. Vancouver Island Compassion Society. [email protected]

BACKGROUNDResearch has shown that cannabis can be useful in treating a number of conditions, and although there is some evidence that individual cannabis strains and specific non-smoked modes of ingestion have different subjective affects on the symptoms of medical patients, large-scale tracking of patient strain/symptom preferences and patterns of use has been challenging due to regulatory restrictions on the use of medical cannabis in North America.

The Vancouver Island Compassion Society (VICS) is a non-profit medical cannabis dispensary located in Victoria, BC. The VICS was founded in 1999, and in 2008 received funding from Dr. Bronner’s Soaps for a point-of-sales system to allow detailed tracking and analyzing patient purchasing and use patterns. This study examines the purchase of raw cannabis and cannabis-based medications between April 1st 2011-March 31st 2012 by active VICS members (n=907), with a focus on the 10 most common conditions and/or symptoms (n=617).

METHODSA composite VICS active member profile (n=907) was created by averaging all purchases made between April 1st 2011 and March 31st, 2012; this was then compared to composite profiles of the top 10 primary conditions and/or symptoms affecting active VICS members: chronic pain/pain, arthritis/osteoarthritis; hepatitis-c; fibromyalgia; anxiety; Crohn’s/IBD/IBS; HIV/AIDS; MS; cancer; and depression. Since 3 of 10 of these conditions had a primary symptom of pain (1. pain/chronic pain; 2. arthritis/osteoarthritis, and 3. fybromyalgia), these were combined into the category “Pain”, for a total of 8 major condition/symptom groups. These conditions account for 617 (or 71%) of 907 active members, and for 66.2% of raw cannabis purchases (or 73721 of 111359 total grams) and 65.8% total cannabis-based medicine purchases for that period.

During this time-period, the VICS offered 4 standardized, non-smoked cannabis products: 1. Cookies; 2. Cannamist (oromucosal spray); 3. Cannaoil (olive oil-based oral treatment); and 4. a topical Salve. All have been included in this study and cross-referenced with the top 10 primary conditions/symptoms.

The VICS codes cannabis by strain name and then assigns 1 of 5 taxonomic descriptors based on the plant’s characteristics (patterns of growth, appearance, and subjective effect): 1. Indica; 2. Indica Dominant; 3. Cross; 4. Sativa Dominant; 5. Sativa. The VICS has had many of their most popular strains analyzed for major cannabinoid content (THC, CBD, CBC, CBG and THC-V), and these tests have reflected a range of potencies. However the ratio of dominant cannabinoids was very similar from strain to strain, leaving the authors to theorize that subjective strain/symptom differences reported by patients and/or highlighted in purchasing pattern are attributable to either terpenoids or minor cannabinoids, or perhaps to the complex synergistic interactions between cannabinoids and terpenoids.

55%

11%

7%

7%

7%

6%

4% 3%

VICS Top 8 Condi-ons (n=617)

Pain

Hep-‐C

Anxiety

6HIV/AIDS

Cancer

Crohn's

MS

Depression

DISCUSSION

ResultsThis data is equivalent to 907 patient years of medical cannabis purchases, and significant differences in strain preferences, methods of ingestion, and amounts purchased were identified between primary condition and/or symptom groups. Average amount of cannabis purchased per annum is 122.8 gr. (or 0.34 gr. per day); however, cancer patients only purchased 68.8 gr. per year (or 44% less than the average), while those suffering from depression purchased 156 gr. per year (27.3% more than the average patient). Significant differences in methods of ingestion were also noted. For example, those affected by HIV/AIDS (n=44) purchasing 78.4 ml of oromucosal spray per year, which is nearly triple the 28.7 ml average.

ConclusionExamining detailed cannabis purchasing patterns is a useful lens to determine how those affected by certain symptoms or conditions benefit from the medical use of cannabis, including strain-symptom correlations and the use of non-smoked cannabis medications. Purchasing data has the additional benefit of eliminating the “recall bias” that has affected past surveys of patient medical cannabis use.

Having a better understanding of how patients benefit from different strains or methods of ingestion would be useful in designing more symptom-specific treatments and dosages for primary indications. These findings suggest that more research needs to be conducted to identify the interplay between the >400 chemicals in the cannabis plant, different methods of ingestion, and the many conditions or symptoms that might benefit from cannabis for therapeutic purposes.

LimitationsThis study has a number of limitations. The VICS is only one possible source of medical cannabis, and there is no way to know if some patients may be accessing and using other raw cannabis and/or cannabis-based medicines. Additionally, this data represents purchasing data, and the purchase of cannabis cannot be directly correlated with patient actual use of the same. Additionally, researchers cannot eliminate the possibility that some patients may be sharing their cannabis and cannabis-based medicines with others.

20.7 19.0

28.0 28.5

18.2 14.9

27.5

39.4

21.1

0

5

10

15

20

25

30

35

40

45

Cannabis Cookies by Condi-on cookies/person/yr

All VICS Pain Hep-‐C Anxiety HIV/AIDS Cancer Crohn's MS Depression

28.7 27.6

13.8 20.5

78.4

11.0 12.8

25.0

9.4

0

10

20

30

40

50

60

70

80

90

Cannamist Oromucosal Spray by Condi4on ml/person/yr


9.4

12.6

2.7

11.9

2.3

11.6

4.5 3.8

1.6

0

2

4

6

8

10

12

14

Cannabis Salve by Condi/on ml/person/yr


122.8 116.9 125.2

143.9

122.8

68.8

145.8

110.4

156.3

0

20

40

60

80

100

120

140

160

180

Raw Cannabis Use by Condi/on gr/person/yr

ALL VICS Pain Hep-‐C Anxiety HIV/AIDS Cancer Crohn's MS Depression

26000 9450 900 900

3450

450 500 650

150

102700 52350 6350 2950

3150

2400 5300

4350

100

8550 4325 175 525

100 475

175 100 25

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

-All VICS Pain Hep-‐C Anxiety -HIV/AIDS Cancer Crohn's MS Depression

Comparison of Non-‐Smoked Cannabis Product Preference, By Condi:on, Over 12 Months (Excluding Cookies)

Salve (ml)

Cannaoil (ml)

Cannamist (ml)

54.6

4.8

36.8

11.1 15.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Average Raw Cannabis Use, by Strain gr/per person/yr (n=907)

Indica Indica Dominant Cross Sa:va Dominant Sa:va

28.7

113.2

20.7 9.4

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

Average Annual Use of Non-‐Smoked Cannabis Products (n=907)

Cannamist (mL) Cannaoil (mL) Cookies (#) Salve (mL)

PATIENT DEMOGRAPHICS

Sex (n=907)61.3% Male

38.5% Female0.2% Transgendered

Average Age: 51 (n=863)a) 19 & under - 3 (0.3%)

b) 20-29 - 66 (7.3%)c) 30-39 - 126 (13.9%)d) 40-49 - 187 (20.6%)e) 50-59 - 296 (32.6%)f) 60-69 - 181 (20.0%)g) 70-79 - 29 (3.2%)h) 80-89 - 18 (2.0%)

i) 90 & over - 1 (0.1%)

Top 8 Conditions and/or Symptoms (n=617; 71% of Active VICS Members)1. Pain/arthritis/fybromyalgia (342)

2. Hepatitis-C (65)3. Anxiety (44)

4. HIV/AIDS (44)5. Cancer (41)

6. Crohn’s/IBS/IBD (39)7. MS (26)

8. Depression (16)

113.2

153.1

97.7

67.0 71.6 58.5

135.9

167.3

6.3

0

20

40

60

80

100

120

140

160

180

Cannaoil by Condi+on ml/person/yr

Title


49522 18048 2737

3244

1516

1340 1956 1144

1277

4352 1558

335

259

164

99

210 73

189

33413 11690 3166

1724

2146

772

1853

1100

557

10071 3343 775 438

859 239

744

325 239

14001 5330 1124 668 720 369 923 229 239

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

-All VICS Pain Hep-‐C Anxiety -HIV/AIDS Cancer Crohn's MS Depression

Comparison of Strain Preference by Condi4on, As Percent of Total Raw Cannabis Use Over 12 Months

SaHva (gr)

SaHva Dominant (gr)

Cross (gr)

Indica Dominant (gr)

Indica (gr)

52.8

4.6

34.2

9.8 15.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

PAIN Average Raw Cannabis Use, by Strain

gr/person/yr (n=342)

Indica Indica Dominant Cross Sa;va Dominant Sa;va

27.6

153.1

19.0 12.6

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

PAIN Average Annual Use of Non-‐Smoked

Cannabis Products (n=342)


13.8

97.7

28.0

2.7 0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 180.0

Hep-‐C Average Annual Use of Non-‐Smoked



42.1

5.2

48.7

11.9 17.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Hep-‐C Average Raw Cannabis Use, by Strain

gr/person/yr (n=65)


73.7

5.9

39.2

10.0 15.2

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Anxiety Average Raw Cannabis Use, by Strain

gr/person/yr (n=44)


20.5

67.0

28.5 11.9

0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 180.0

Anxiety Average Annual Use of Non-‐Smoked



50.2

5.4

47.5

19.1 23.7

0.0

20.0

40.0

60.0

80.0

Crohn's Average Raw Cannabis Use, by Strain

gr/person/yr (n=39)


12.8

135.9

27.5

4.5 0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 180.0

Crohn's Average Annual Use of Non-‐Smoked



34.5

3.7

48.8

19.5 16.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

HIV/AIDS Average Raw Cannabis Use, by Strain

gr/person/yr (n=44)


44.0

2.8

42.3

12.5 8.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

MS Average Raw Cannabis Use, by Strain

gr/person/yr (n=26)

Indica Indica Dominant Cross Sa:va Dominant Sa:va

25.0

167.3

39.4

3.8 0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

MS Average Annual Use of Non-‐Smoked



11.0

58.5

14.9 11.6

0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 180.0

Cancer Average Annual Use of Non-‐Smoked



32.7

2.4

18.8

5.8 9.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Cancer Average Raw Cannabis Use, by Strain

gr/person/yr (n=41)


79.8

11.8

34.8

14.9 14.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Depression Average Raw Cannabis Use, by Strain

gr/person/yr (n=16)


9.4 6.3 21.1

1.6 0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 180.0

Depression Average Annual Use of Non-‐Smoked



TOP 10 VICS CANNABIS STRAINS BY NAME, AND TOTAL SALES (IN GRAMS), APRIL 1 2011 TO MARCH 31 2012

1. Afghani (I) - 12,595 gr.2. Digweed (I) - 11,496 gr.

3. Haoma (I) - 8,219 gr.4. Pochi (I) - 6,593 gr.

5. Warlock (I) - 5,410 gr.6. Burmese (C) - 5,218 gr.

7. Rene (I) - 5,120 gr.8. Jack Herer (S) - 4,454 gr.9. Deep Congo (S) - 4,285 .

10. Yellowjacket (C) - 3,656 gr.

LEGEND(I) = Indica

(ID) = Indica Dominant(C) = Cross(S) = Sativa

(SD) = Sativa Dominant

78.4 71.6

18.2 2.3

-‐20.0

30.0

80.0

130.0

180.0

HIV/AIDS Average Annual Use of Non-‐Smoked


Cannamist (mL) Cannaoil (mL) Cookies (#) Salve

Documents

Patterns of theraPeutic cannabis use in 907 Patients Poster 2013, 06-14-13.pdf · had a primary symptom of pain (1. pain/chronic pain; 2. arthritis/osteoarthritis, and 3. fybromyalgia),