Like many nice discoveries in drugs, it began with an ‘Aha’ second when Canadian doctor Dr. Vincent Maida realised that leg ulcers could possibly be penetrated by fat-loving hashish compounds, which in flip might attain the plethora of cannabinoid receptors under.
Only a few persons are extra dedicated to discovering a greater answer for wound administration than Dr. Maida, who amongst different issues runs a tertiary wound clinic caring for essentially the most hard-to-heal leg ulcers within the better Toronto space.
“Integument [the outside skin, cutaneous membranes and mucous membranes] and wound is the world of healthcare with the worst end result measures,” explains Maida. “And but, whenever you take a look at the large expenditures – the USA spends upwards of $80 billion a 12 months on wounds. And most of that I can undergo you is in useless and is simply foolish dressings that do nothing.”
Leg wounds that refuse to heal
Except we ourselves are aged, or care for somebody over the age of seventy, it’s unlikely we’ve ever given a lot thought to leg ulcers, that are outlined as a long-lasting sore that takes greater than two weeks to heal.
I actually hadn’t till my brother, who like me has been blessed with a hearty array of varicose veins from a young age, began to get leg wounds that refused to shut.
A largely sedentary way of life meant his already compromised venous circulation wasn’t sturdy sufficient to supply the mandatory circumstances for therapeutic some innocuous bumps and scratches, which subsequently become reasonably nasty open leg wounds.
Commonplace look after leg ulcers follows the ‘Wound Mattress Preparation’ paradigm (in Dr. Maida’s phrases the ‘foolish dressings’), alongside compression bandages to help the venous return and pace up therapeutic. Antibiotics are additionally routinely prescribed for any accompanying infections, though in accordance with Maida there’s a tendency to overprescribe.
In my brother’s case, twice weekly visits for dressing adjustments over three months have been sufficient to see his wounds shut. However in accordance with Dr. Maida, he was one of many fortunate 40% whose ulcers heal in below twelve weeks. The opposite 60% can go years with open leg wounds, which within the worst of instances can result in amputations, sepsis, and even dying.
Opioids decelerate wound therapeutic
Ulcers are additionally typically extraordinarily painful, with round 70% of sufferers, in accordance with Maida, prescribed opioids to handle the ache.
In keeping with Dr. Maida, not solely does ache scale back the physique’s therapeutic capability, however opioids themselves are actually thought to decelerate the therapeutic of power wounds. And with the opioid disaster nonetheless wreaking havoc throughout North America, it’s clear discovering an alternate strategy to each the administration of wound ache and its total therapeutic have to be discovered.
Which brings me again to Dr. Maida’s lightbulb second.
Decided to discover a simpler different to the present Wound Mattress Preparation Protocol, Maida launched into a Grasp’s Diploma on the Dalai Lama College of Public Well being in Toronto.
“Working in a rustic like Canada,” he recollects, “the place the (medical hashish) legalization pathway was evolving, it was a kind of epiphany moments, I realised that there was a possible to make use of hashish and the weather of hashish within the area of integument and wound.”
And so started the early levels of his analysis finding out the preclinical information regarding the wound therapeutic properties of compounds present in hashish.
It ought to be identified at this stage, that we’re not simply speaking about cannabinoids like THC and CBD, but additionally terpenes corresponding to beta caryophyllene, and the flavonoids quercetin, diosmin and hesperidin. The truth is, a FDA authorised drug known as Daflon is already available on the market within the US for the therapy of venous circulation problems combining the flavonoids diosmin and hesperidin.
However what made these hashish compounds so nicely suited to ulcer therapeutic was their capacity to enter straight by the wound and attain the endocannabinoid receptors under.
“The floor of our pores and skin is comparatively intact,” explains Maida, “and whether or not it’s mucous membranes, or cutaneous membranes, you don’t get a lot absorption by intact integument. However when you’ve a wound, you don’t have the dermis. And the varied molecular households can penetrate a lot faster by an open wound mattress.”
“And that’s the place it will get thrilling,” says Maida, “as a result of we now know that the endocannabinoid system is ever current in our our bodies from head to toe. It’s essentially the most vital chemical signalling system from a homeostatic standpoint in our our bodies. Not solely is it represented and expressed on the surfaces of cells, however current analysis is exhibiting simply how influential it’s at an intracellular stage, which opens up this new spectre of the flexibility to modulate genes, aka epigenetic mechanisms, and so forth.”
So, not like the standard challenges confronted by hashish topical lotions which wrestle to permeate by the dermis, for wound administration not less than, they’re a therapeutic match made in heaven.
Promising preliminary outcomes
And the outcomes Dr. Maida has seen together with his sufferers seems to bear this out.
Utilizing a proprietary mix of hashish compounds based mostly on his systematic assessment of knowledge, Dr. Maida started tentatively treating sufferers in his wound clinic.
“My wound observe was the proper surroundings to attempt to innovate one thing that hopefully would enhance the at present unsatisfactory established order,” he says. “So I recruited the worst of the worst, and I used to be in a position to heal the worst of the worst, which makes me assume if I’m in a position to heal the worst of the worst, think about what I might do for on a regular basis wounds.”
Preliminary outcomes cataloguing the expertise of two aged sufferers who regardless of having borne the struggling of their wounds for over six months, discovered whole closure utilizing Dr. Maida’s cannabis-based therapy in a imply of 73 days. Not solely that, the sufferers’ ache was considerably diminished in order that by day 63 no different analgesics have been required.
An extra open label research self-funded by Dr. Maida wherein fourteen complicated sufferers with recalcitrant leg ulcers have been handled together with his components alongside compression bandages discovered that 79% sufferers had whole wound closure in jaw-dropping 34 days.
Whereas spectacular, Maida is first to confess these are preliminary outcomes on a small cohort of sufferers, and he hopes a letter of intent from a global biotech firm will finally convey concerning the additional phases of scientific trials required to get his cannabis-based topical drug to market.
Within the meantime, Dr. Maida stays very a lot a person on a mission.
“So, I’ve began the race,” he says, “and I’m going to dash down the monitor. After which finally, I would like at hand off to others who’re going to take the marathon ahead. And if nothing else, that’s my position. That’s my mission… and I feel the end line goes to yield unbelievable alternatives for the world of integument and wound.”
Dr. Vincent Maida’s full interview could be heard on the Hashish Voices podcast hosted by Mary Biles.
- Victoria Okay. Shanmugam et al. Relationship between Opioid Therapy and Fee of Therapeutic in Power Wounds. Wound Restore Regen. 2017 Jan; 25(1): 120–130.
- Sachiko Koyama et al. Beta-caryophyllene enhances wound therapeutic by a number of routes. PLoS ONE 14(12): e0216104
- A Gopalakrishnan et al. Quercetin accelerated cutaneous wound therapeutic in rats by growing ranges of VEGF and TGF-β1 Indian J Exp Biol 2016 Mar;54(3):187-95.
- A A Ramelet. Scientific advantages of Daflon 500 mg in essentially the most extreme levels of power venous insufficiency. Angiology. 2001 Aug;52 Suppl 1:S49-56
- V Maida et al. Topical cannabis-based medicines – A novel paradigm and therapy for non-uremic calciphylaxis leg ulcers: An open label trial. Int Wound J 2020 Oct;17(5):1508-1516
- V Maida et al. Topical cannabis-based medicines – A novel adjuvant therapy for venous leg ulcers: An open-label trial. Experimental Dermatology. 2021 Sep;30(9):1258-1267.