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Cannabis in India: is the country on the precipice of a new era of treatment?

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India’s relationship with cannabis dates back to c. 2000 BC when it was described by religious scholars in the ancient ‘Vedas’ texts as ‘one of the five sacred plants’. Despite the country’s long history of cannabis use, the plant is still illegal except for in government-authorised premises that produce and sell bhang (which can be either ground cannabis balls or a drink made by mixing cannabis in milk), or for research and medicinal purposes.

In this article, we summarise the different verticals of the cannabis industry, before discussing the regulation of cannabis in India, and whether it should be legalised.

What is cannabis?

Cannabis refers to a group of three plants with psychoactive properties, known as cannabis sativa, cannabis indica, and cannabis ruderalis. The plant contains more than 120 components known as cannabinoids. The most understood cannabinoids found in a cannabis plant are cannabidiol (CBD) and Tetrahydrocannabidiol (THC). THC is a controlled substance and has psychotropic ingredients in it which gives the user a ‘high’. CBD is non-intoxicating and has a number of lawful uses including for medicine, beauty products, furniture and fuel. Marijuana and hemp are both varieties of the cannabis plant, but are different in a number of ways. Most significantly, while marijuana can contain up to 30% THC, hemp contains much less (the threshold being set on a country-by-country basis).

The cannabis industry

The legal cannabis industry (comprising medical cannabis, recreational cannabis, pharma products incorporating specific cannabinoids, and the ‘wellness’ industry) is currently one of the fastest growing industries in the world. According to a report by Grand View Research Inc., the global legal marijuana market is predicted to reach USD $146.4 billion by the end of 2025. For India, with a history of cannabis use in traditional Indian medicine (notably pain management), a population of approximately 1.4 billion, and a growing middle-class, the potential market for cannabis products is huge.

Medicinal cannabis is one of the fastest emerging markets globally. The key focus for the medical cannabis industry is the research and development of new and existing products, technologies for cultivation, extraction and manufacturing, delivery mechanisms, genetic composition of cannabis and combinations of cannabinoids, and ultimately research and trials regarding the efficacy and safety of medical cannabis for treatment of particular conditions or illnesses. Clinical trials are the most common method used to assess the safety and efficacy of a new drug and regulatory bodies use their results to decide whether a new product can be launched in their jurisdiction. To date, the lack of global clinical trial evidence is one of the main barriers to widespread adoption of cannabis by prescribing clinicians. This is true in India. Although the Indian Institute of Integrative Medicine (IIIM) has been granted permission by the government to grow cannabis for medical purposes in collaboration with the Tata Memorial Hospital in Mumbai, regulatory approval is still being sought to proceed with the trials.

A number of promising Indian cannabis start-ups have arisen in recent years, some of whom are collaborating in order to grow in the domestic market. These start-ups are generally focusing on medicines, cosmetics, textiles, accessories and foods.

Regulatory framework

Cannabis is misunderstood legally and industrially in India. Under the Narcotic Drugs and Psychotropic Substances (NDPS) Act of 1985, trade and consumption of both cannabis resin (charas) and the bud (ganja), are illegal and anyone found with them could be imprisoned for up to 20 years. There is also a strict ban on both marijuana and hemp production in India. Although some powers are given to the state government to grant licenses to cultivate cannabis under certain circumstances (such as for research and medicinal use), relatively few research organisations have obtained them. In fact, only the Uttar Pradesh and Uttarakhand regions, which are both in northern India, have received hemp cultivation licences.

The Indian cannabis market has gathered significant attention recently, with various activists/NGOs filing court petitions demanding legalisation of cannabis. They argue that the medicinal benefits of cannabis are hard to ignore, and the ideal climatic conditions for cannabis cultivation have the potential to boost the Indian economy and create millions of jobs. One of these NGOs is the Great Legalisation Movement (GLM), which is working to legalise the use of cannabis for medical and industrial purposes in India. In the summer of 2019, the Delhi High Court admitted a writ petition filed by GLM seeking decriminalisation of cannabis under the NDPS. The next date in the petition is 5 February 2020.

Madhya Pradesh, the second largest state in India, decided to legalise the cultivation of cannabis for medicinal and industrial purposes in November 2019. As one of the poorest states in the country, it is hoped that the legalisation will attract new businesses to the fore.

Comparison with other countries

The deregulation of cannabis for medical purposes has led to significant recent interest and investment in the medical cannabis market in the UK and Europe. Germany legalised cannabis for medical use in 2017, which seems to have influenced other EU member states. Portugal, Denmark, Poland and the UK have now changed their regulations concerning medical cannabis. In November 2019, two cannabis-based medicines used to treat epilepsy and multiple sclerosis were approved for use by the NHS in England.

Canada, Uruguay and eleven states in the US have legalised the production, manufacture, export, import distribution, trade and possession of cannabis exclusively for medical and scientific purposes. Luxembourg, who have already legalised cannabis for medicinal purposes, wish to relax their laws further to become the first European country to legalise cannabis production and consumption.

Conclusion

Cannabis laws in India are outdated and require long-awaited reconsideration. Although legalisation is still some way off, the rising number of cannabis and hemp start-up companies, and the growing popular support for the plant’s legalisation, is encouraging. Considering the medical and economic reasons in favour of legalising cannabis, it may not be long before the Indian government unlock the full potential that legalisation would bring.

This article was taken from the website hilldickinson.com

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https://www.hilldickinson.com/insights/articles/cannabis-india-country-precipice-new-era-treatment

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International Book of Records – Women’s Health Awareness Camp 2021

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यत्र नार्यस्तु पूज्यन्ते रमन्ते तत्र देवताः ।
यत्रैतास्तु न पूज्यन्ते सर्वास्तत्राफलाः क्रियाः ॥

Being a man or a woman has a significant impact on health, as a result of both biological and gender-related differences. The health of women and girls is of particular concern because, in many societies, they are disadvantaged by discrimination rooted in sociocultural factors.

Some of the sociocultural factors that prevent women and girls to benefit from quality health services and attaining the best possible level of health include:

  • unequal power relationships between men and women;
  • social norms that decrease education and paid employment opportunities;
  • an exclusive focus on women’s reproductive roles; and
  • the potential or actual experience of physical, sexual, and emotional violence

This International Women Day let’s create awareness on Women Health together. We at Hempstreet would like to take this opportunity to introduce you to the International Book of Records – Women’s Health Awareness camp 2021 which is scheduled for the 6th of March 2021 on the occasion of Women’s Day 2021.

Hempstreet is India’s first research to retail venture in the ayurvedic cannabis sector. We are working in conjunction with top-notch scientists to conduct R&D around safe medication utilizing cannabis to be provided via our network of over 60,000 medical practitioners and 220 clinics around India.

We strive to bring an effective and responsible usage of cannabis, especially on the pain relief front, to our potential patient base of over 35 million individuals. Recently we have developed an Ayurvedic Pain reliever namely Trailokya Vijaya Vati which is very useful in abdominal cramps during menstruation.

To know more reach us at Hempstreet

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Trailokya Vijaya Vati: Providing relief in multiple joint pains

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pain relief medicine

Abstract: This is a clinical case study of a 72-year-old female with multiple joint pains and Rheumatoid arthritis in both upper and lower extremities and how Trailokya Vijaya Vati helped her cope with the condition and add quality to her life.

Ayurveda Perspective 

The description of AMAVATA dates back to 1500 BC in Rigveda. The main pathogenic event in RA is the formation and deposition of AAMA which is the causative factor for inflammation.
Restoration of AGNI and management of SHOOLA are the two basic principles in the treatment of AMAVATA. The TIKTA rasa and USHNA guna of Vijaya makes it is choice of drug for the treatment of RA and multiple joint pains.

 Introduction

Rheumatoid Arthritis is a long-term, progressive, and disabling autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and other body organs.
RA usually affects the hands and feet first but it can occur in any joint. It usually involves the same joints on both sides of the body.

The symptoms of RA tend to come and go. During a remission, they can disappear, or they can be mild. However, during a flare, they can be severe. The joint damage that occurs with RA can make it difficult to perform daily activities.

Case Report

Patient description

This patient with the age of 72 Years had rheumatoid arthritis and multiple joints pain in both upper and lower extremities. She was walking with a tremendous amount of pain, and her gait could quickly tell how excruciating the pain was there for her to bear. She also complained of digestive disturbances and disturbed sleep.

Case history

This old lady was on potent pain killer as Voveran 50mg and Ultracet daily. The adverse side effects of these pain killers were visible on her body with her gut became acidic as she presented with severe gastritis pain whenever she took chemical pain killers to combat her pain issues. To beat gastritis and pain, she also started to take modern anta acids that troubled her digestion.

Treatment plan

Medicines to be used – Trailokya Vijaya Vati. After a thorough clinical examination, she was prescribed with TrilokayaVijayaVati with one tablet three times a day for a period of seven days initially.

Expected outcome of the treatment plan

The expected outcome was to relieve her of the pain, inflammation, improve digestion, and that the patient should get a sound sleep. 

Actual outcome

Even this small duration of a week was sufficient enough in this case to witness the painkilling effects of Cannabis or Vijaya. The one week use of ‘TrilokayaVijayaVati’ helped her not to consume synthetic pain killers, her quality of sleep improved with no pain induced nights, her digestion got enhanced during the process. She presented with an improved gait and walk when she walked into the clinic after a period of one week.

Discussion

As mentioned in Ayurveda the line of treatment was decided with an aim of restoration of AGNI and management of SHOOLA. 
The patient got relief from most of her complaints within a week of starting with the treatment.

Conclusion

In the last 50 years, extensive research has been done on RA and multiple joint pains associated with it by modern medicine but the etiology and a standard line of treatment are still developing. New research has revealed various biological agents that have provided relief to a significant number of patients. However, these agents are very expensive, require close monitoring, have side effects, and need to be used indefinitely. 

A result from several small studies suggests that in people with RA, Cannabis has helped to curb morning pain, improve sleep and lower inflammation in joints. Hence the use of Cannabis in the treatment of RA and Multiple Joints Pain can be further promoted as it is also a cheaper and an effective alternative to the other available drugs.

Case study shared by Dr. Preeti Chhabra, Consultant Ayurvedacharya

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How Ayurveda can help to manage long-term pain in Osteoarthritis?

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Abstract: Osteoarthritis commonly referred to as OA is the most common joint disease and one of the most widespread of all chronic conditions managed in General Practice. Whilst its prevalence increases with age, a significant number of adults experience symptoms of OA earlier in life. Most cases of OA are not extraordinary, yet the individual experiences of the affected can help a health practitioner to fully understand the impact of the diseases in the overall population.

This case report was triggered by a patient who was eager to tell her story and also reach out to the others suffering from OA- as to how a simple Ayurveda drug helped her to manage her long term pain effectively. As the importance of narrative medicine is increasingly being recognized to have a positive impact on patients and also helps clinicians to strengthen their practices, a summary of this case highlighting the use of Trailokya Vijaya Vati was made.

Introduction

Osteoarthritis occurs when the cartilage that cushions the ends of our bones in our joints gradually deteriorates.

OA has often been referred to as a “wear and tear” disease. But besides the breakdown of cartilage, OA affects the entire joint. It causes changes in the bone and deterioration of the connective tissues that hold the joint together and attach muscle to bone. It also causes inflammation of joints.  

The pain and limited mobility in OA occurs as a result of destructed cartilages. Left bare of their padding, bones rub painfully against each other – particularly in the hands, spine, knees and hip. 

For years, there have been very limited treatment options available for OA. The treatments include pain management, steroidal injections, physiotherapy and surgery as a last resort. Out of these pain management is the best sought treatment as PAIN itself is a major symptom in this condition.

 Case Report

Patient description

A 48 yr old female was presented with complaints of pain in both knees for 8 years, since the last 3 months the pain had aggravated from moderate to severe to highly intolerable which was leading to increased anxiety and also restless sleep. The pain would increase on an activity like walking or climbing up the stairs and would be relieved by rest. 

Case history

The patient has no history of fall or trauma. She walked without a walking aid but requires support when there is a peak in pain. 

She has been on analgesics since when she doesn’t exactly remember, taking periodic physiotherapy sessions as advised by the doctor. She took Intra-articular injections a couple of times but the relief was temporary (6-8 months).  She was recently advised bilateral knee replacement by her doctor and she decided to give it a last go through an alternate option! The pain was her only concern.

Recently the severity of the pain was so intense that it was impossible for her to use stairs and she is sedentary most of the time. 

Physical Examination

  • BMI – 30 (Obese)
  • Gait – Antalgic
  • Fell – Mild crepitus is felt upon moving both knee joints.
  • ROM – Restricted and Painful
  • Blood Results – ESR and CRP raised

Treatment plan

Medicines to be used – Trailokya Vijaya Vati. After a thorough clinical examination, she was prescribed with Trilokaya Vijaya Vati with one tablet two times a day for a period of seven days initially.

Expected outcome of the treatment plan

The expected outcome was to relieve her of the pain and that the patient should get a sound sleep. 

Actual outcome

Within a week, she began to notice a distant difference in her pain.

Discussion

The treatment was focused on effective pain management as that was the only factor troubling the patient at this given point. The patient was not ready to undergo surgery thou she was counseled that she might need one over a period of 5 years or so. 

She was also prescribed other drugs effective on OA and mild exercises. Trailokya Vijaya Vati not only helped the patient with pain but also gave her a sound night’s sleep. The patient also reported being less cranky throughout the day. 

Conclusion

For years, treatments for OA have majorly being planned on physiotherapy, steroidal injections, and joint replacement surgery. But as pain management is now emerging as an individual branch, there has been an increased focus on pain management in the treatment of OA. 

Unlike Rheumatoid Arthritis, OA hasn’t had any major breakthroughs that have dramatically improved its medical treatment. Drug development for OA has been slow because the disease itself follows a slow process. 

Dr. Anirudha  Mohite, Consultant Ayurvedacharya

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