1. The Medical Marijuana Maze Chapter One: Introduction Nancy E. Marion Copyright © 2014 Nancy Marion. All rights reserved.

2. Introduction Marijuana is one of the oldest and most widely used psychoactive substances. Evidence shows that marijuana use provides relief from some medical conditions. The drug remains illegal in many U.S. states and at the federal level. Copyright © 2014 Nancy Marion. All rights reserved.

3. Important Terms Cannabis – scientific name for the plant from which marijuana is derived. Marijuana – from Mexican Spanish, typical term used to refer to the dried leaves and tops of the cannabis plant, used for recreation. Hemp – term used to refer to fiber derived from the cannabis plant Medical Marijuana – refers to the cultivation, possession, and/or use of marijuana for medical purposes. Copyright © 2014 Nancy Marion. All rights reserved.

4. What distinguishes medical marijuana? The difference between marijuana used for recreation and medical marijuana is legal. Medical marijuana:  Must be recommended by a licensed physician to treat a diagnosed medical condition.  Refers not only to use of the plant itself, but also to synthesized versions of the active compounds, cannabinoids. Copyright © 2014 Nancy Marion. All rights reserved.

5. The two types of marijuana Cannabis refers to the genus. There are two primary species:  Cannabis sativa – tall plants with sparse foliage and slender leaves, used primarily for hemp.  Cannabis indica – A shorter species with higher levels of therapeutic and psychoactive compounds, native to India. Copyright © 2014 Nancy Marion. All rights reserved.

6. Cannabinoids Over 400 different compounds Different compounds have a variety of effects; some act as appetite stimulants, antispasmodics, antiemetics, analgesics, etc. Delta-9-tetrahydrocannabinnol, or THC, is the main psychoactive compound Copyright © 2014 Nancy Marion. All rights reserved.

7. Examples of Cannabinoids Cannabidiol has numerous potential applications:  May relieve convulsions, inflammation, high blood pressure, anxiety, cough, pain, congestion, nausea, and inhibit cancer cell growth.  May help treat schizophrenia and alleviate multiple sclerosis, anxiety attacks, and Tourette Syndrome.  Not a psychoactive, so does not produce the feeling of being “high.” B-caryophyllene reduces inflammation, and has been used to treat glaucoma. It also lacks psychoactive properties. Copyright © 2014 Nancy Marion. All rights reserved.

8. Synthetic Cannabinoids Sativex  Synthetic THC mouth spray  Used to treat spasticity associated with MS  Launched in the United Kingdom and approved in Spain, Canada, the Czech Republic, Denmark, Germany, Sweden, and Austria.  U.S. patent granted in 2001 to treat pain associated with cancer. Copyright © 2014 Nancy Marion. All rights reserved.

9. Synthetic Cannabinoids dronabinol (Marinol)  Administered as a pill or spray  Used to treat nausea, stimulate appetite, and relieve MS symptoms.  May not be effective for all patients, due to containing only one of the many compounds found in marijuana.  Pill form is slow acting and can be difficult to swallow for those with nausea or vomiting. Copyright © 2014 Nancy Marion. All rights reserved.

10. Synthetic Cannabinoids Levonantradol  Synthetic THC introduced in the 1970s and discontinued due to side effects. Cesamet (Nabilone)  Used to treat chemotherapy associated nausea and vomiting. Canasol  Used to relieve intraocular pressure from late stage glaucoma. Copyright © 2014 Nancy Marion. All rights reserved.

11. The full set of PowerPoint slides is available upon adoption. Email bhall@cap-press.com for more information.