Topical cannabis for leg ulcers

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Like many great discoveries in medicine, it began with an “Aha” moment when Canadian doctor Dr. Vincent Maida realized that leg ulcers could be penetrated by fat-loving cannabis compounds, which in turn could reach the large amount of cannabinoid receptors below.

Very few people are more committed to finding a better solution for treating wounds than Dr. Maida, who, among other things, runs a tertiary wound clinic that treats the most difficult-to-heal leg ulcers in the area. Toronto.

“Tegument [the outside skin, cutaneous membranes and mucous membranes] and the wound is the area of ​​healthcare with the worst outcome measures, ”explains Maida. “And yet, when you look at the massive spending, the United States spends more than $ 80 billion a year on injuries. And most of what I can present to you is in vain and it’s just silly clothes that do nothing.”

Leg wounds that refuse to heal

Unless we ourselves grow up or care for someone over the age of seventy, it’s unlikely we’ve ever thought much about leg ulcers, which are defined as a long-lasting sore that takes more than two weeks to heal.

I certainly didn’t until my brother, who like me has been blessed with a wide variety of varicose veins since he was very young, began to have leg injuries that he refused to close.

A largely sedentary lifestyle meant that his already compromised venous flow was not robust enough to provide the conditions needed to heal some innocuous bumps and scratches, which later turned into open wounds on his rather nasty legs.

Standard care for leg ulcers follows the paradigm of “Wound Bed Preparation” (in Dr. Maida’s words the “stupid dressings”), along with compression bandages to help venous return and accelerate healing. Antibiotics are also routinely prescribed for any infection that accompanies it, although according to Maida there is a tendency to over-prescribe.

In my brother’s case, the visits twice a week to change his dress for three months were enough to see him close the wounds. But according to Dr. Maida, he was one of the lucky 40% whose ulcers heal in less than twelve weeks. The other 60% can spend years with open leg injuries, which in the worst case can lead to amputations, sepsis and even death.

Opioids slow the healing of wounds

Ulcers are also generally extremely painful, with about 70% of patients, according to Maida, prescribing opioids to control the pain.

Pain not only reduces the body’s ability to heal, but it is now believed to be the same opioids delay the healing of chronic wounds. And with the opioid crisis still wreaking havoc in North America, it is clear that an alternative approach needs to be found for both wound pain management and overall healing.

Which brings me back to the time of Dr. Maida’s light bulb.

Determined to find a more effective alternative to the current wound bed preparation protocol, Maida embarked on a master’s degree at the Dalai Lama School of Public Health in Toronto.

“Working in a country like Canada,” he recalls, “where the pathway to legalization (of medical cannabis) was evolving, it was one of those epiphany moments, I realized that there was a potential to use cannabis and the elements of cannabis in the sand, skin and wound ”.

And so began the early stages of his research by studying preclinical data related to the wound healing properties of compounds found in cannabis.

Epiphany of cannabis

It should be noted at this stage, that we are not just talking about cannabinoids like THC i CBD, but also terpenes such as beta caryophyllene, and flavonoids quercetin, diosmin and hesperidin. In fact, a FDA approved drug called Daflon is already on the market at WE for the treatment of venous circulation disorders by combining the flavonoids diosmin and hesperidin.

But what made these cannabis compounds so suitable for ulcer healing was their ability to enter directly through the wound and reach the endocannabinoid receptors below.

“The surface of our skin is relatively intact,” explains Maida, “and whether it’s mucous membranes or skin membranes, it’s not absorbed much through the intact skin. But when you have a wound, you don’t have the epidermis. And the various molecular families can penetrate much more quickly through a bed of open wounds. “

“And this is where it gets exciting,” says Maida, “because we now know that the endocannabinoid system is always present in our body from head to toe. It’s the most important chemical signaling system from our body’s homeostatic point of view. Not only is it represented and expressed on cell surfaces, but recent research shows the influence it has at the intracellular level, which opens up this new spectrum of the ability to modulate genes, also known as to epigenetic mechanisms, etc.

So, unlike the usual challenges faced by topical cannabis creams that struggle to soak through the dermis, at least for wound treatment, they are a therapeutic combination made in heaven.

Promising preliminary results

And the results Dr. Maida has seen with his patients seem to confirm that.

Using a patented blend of cannabis compounds based on his systematic review of the data, Dr. Maida began treating patients on an interim basis at his wound clinic.

“My injury practice was the perfect environment to try to innovate something that hopefully would improve the currently unsatisfactory status quo,” he says. “So I recruited the worst of the worst and was able to heal the worst of the worst, which makes me think that if I’m able to cure the worst of the worst, imagine what I could do about the daily wounds.”

Preliminary results cataloging the experience of two elderly patients who despite having endured the suffering of their wounds for more than six months, found total closure with the cannabis-based treatment of Dra. Maida in an average of 73 days. Not only that, the pain of the patients was significantly reduced so that on the 63rd no other analgesics were needed.

One beyond open label study self-funded by Dr. Maida, in whom fourteen complex patients were treated with recalcitrant leg ulcers with their formula along with compression bandages, found that 79% of patients had a total wound closure in 34 days.

While impressive, Maida is the first to admit that these are preliminary results from a small cohort of patients, and hopes that a letter of intent from an international biotechnology company will put an end to the later stages of clinical trials. needed to get your topical cannabis-based drug. in the market.

Meanwhile, Dr. Maida is still a man on a mission.

“So I started the race,” he says, “and I’m going to sprint down the track. And then, ultimately, I have to hand them over to others who will be doing the marathon ahead. And if nothing else, that’s my role. “That is my mission … and I believe that the goal will provide incredible opportunities for the world of skin and wound.”


Mary Biles, a UKjournalist, educator and Project based CBD collaborating writer, is the author of He CBD Book (Harper Collins, UK). The full interview with Dr. Vincent Maida can be heard at Cannabis voices podcast hosted by Mary Biles.

Copyright, Project CBD. Cannot reprint without permission.


References

  1. Victoria K. Shanmugam et al. Relationship between opioid treatment and the rate of healing of chronic wounds. Wound repair Regen. January 2017; 25 (1): 120–130.
  2. Sachiko Koyama et al. Beta-caryophyllene enhances wound healing through multiple pathways. PLyou ONE 14 (12): e0216104
  3. In Gopalakrishnan et al. Quercetin accelerated the healing of skin wounds in rats by increasing levels of VEGF i TGF-β1 Indian J Exp Biol 2016 Mar; 54 (3): 187-95.
  4. AA Ramelet. Clinical benefits of Daflon 500 mg in the more severe stages of chronic venous insufficiency. Angiology. August 2001; 52 Suppl 1:S49-56
  5. V Maida et al. Cannabis-based topical drugs: a new paradigm and treatment for non-uremic calciphylaxis leg ulcers: an open-label trial. Int Wound J 2020 Oct; 17 (5): 1508-1516
  6. V Maida et al. Cannabis-based topical drugs: a new adjuvant treatment for venous leg ulcers: an open-label trial. Experimental dermatology. September 2021; 30 (9): 1258-1267.



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