2. “MEDICAL” MARIJUANA

3. So Dude, whassup? What’s out there? SCIENCEY stuff
What does it do for/to you?
Politics and policy (and what it means for us)
What can we expect for the future?

4. Disclosure I have no bias to disclose
I’ve tried it, but I didn’t inhale
I may, or may not, have been in an elevator with Ross Rebagliati’s friends who were possibly smoking marijuana

7. …so I can, like, smoke it?

8. ….or EAT it?

9. Dose and label accuracy in Edible Medical Cannabis Products
Of 75 products purchased (47 different brands), 17% were accurately labeled, 23% were underlabeled, and 60% were overlabeled with respect to THC content. The greatest likelihood of obtaining underlabeled products was in Los Angeles and overlabeled products in Seattle (χ2 = 12.94, P = .01).
Non-THC content was generally low. Forty-four products (59%) had detectable levels of CBD; only 13 had CBD content labeled. Four products were underlabeled and 9 were overlabeled for CBD. The median THC:CBD ratio of products with detectable CBD was 36:1, 7 had ratios of less than 10:1, and only 1 had a 1:1 ratio.
Vandrey et al 2015: JAMA 2015; 313 (24)

11. ….and what is SPICE? KUSH? K2?

12. Sciencey stuff

14. Horticulture Lesson

15. Cannabinoid Receptors

16. Effects on the Body

17. CB1 vs CB2 CB1 (THC)……..all about the BRAIN
Short term: euphoria….or psychosis
disconnection/”high”
relaxation
incr heart rate, appetite
Chronic use: paranoia, anxiety, listlessness, lack of motivation, reduced sex drive, sperm count, cyclical vomiting syndrome
ADDICTION

18. CB1 and CB2 Receptors CB2 …all about the body
Found on Immune cells, and neurons, widely distributed.
May play a role in inflammation
**Potential for use in Chronic Inflammatory disorders, seizures and neuropathic pain**

19. So, it’s simple: Sativa = THC = CB1 = Brain effects
Indica = CBD/CBN = CB2
Body effects
(and potential for medical use)

20. …and the synthetics

22. Politics and Us

23. “Access to Cannabis for Medical Purposes” (ACMPR)
Form completed by (any) MD or Nurse Practitioner…even if they just met the patient!
Pt. must have a “diagnosis”, that can be verified.
Not a prescription
Allows holder to evade charges for possession of marijana/cannabinoids for personal use.

25. Conditions that Qualify for ACMPR
Hepatitis C
HIV/AIDS
Irritable Bowl Syndrome
Kidney Failure/Dialysis
ADD/ADHD Gastrointestinal Disorders
Migraines
Multiple Sclerosis
Muscle Spasms
Muscular Dystrophy
Parkinson’s Disease
Post Traumatic Stress Disorder
Severe Arthritis
Sexual Dysfunction
Sleep Disorders
Spinal Cord Injury/Disease
Alzheimer’s Disease
Anxiety
Arthritis
Auto Accident(s)
Back & Neck Problems
Brain Injury
Cancer
Chronic Nausea
Chronic Pain
Colitis
Crohn’s Disease
Depression
Eating Disorders
Epilepsy
Fibromyalgia

26. Clinical experience with THC-CBD oromucosal spray for MS-related spasticity (Vachera et al, J. Mult Scler 2014: 1:122)
Using 2-15 sprays Sativex per day, statistically significant reduction in mean spasticity (including sleep disruption, Barthel index and numerical rating scale)..as in many studies.
No evidence of cognitive decline, worsening depression or change in mood over 1 year, or withdrawl symptoms. Common adverse effects included vertigo, dizziness and fatigue
Sativex is 1:1 THC:CBD

27. Some RCTs of Cannabinoids in treatment of pain syndromes
Drug N
indication
Trial dur.
outcome
Cannabis smoked 50
HIV neuropathy
5 days
52% with>30% pain reduction(p=0.04) ( Abrams et al, 2007) 21
Chronic neuropathic
No acute benefit (Ware et al 2007)
Cannador (2:1 THC:CBD pill)
419
MS-related spasticity
15 weeks
Improved subjectively over placebo (p=0.003) (Zajicek et al 2003)
Cannador 65
Post herpetic neuralgia
4 weeks
No benefit (Ernst et al, 2005)
Nabilone 41
Post op pain
3 doses/24hrs
NSD in morphine consumption (Beaulieu 2006)
Sativex (1:1 THC:CBD spray)
125
Peripheral neuropathic pain
5 weeks
Improvement over placebo (p=0.044) (Nurmikko et al 2007)
Sativex
177
Intractable cancer pain
2 weeks
Improved over placebo (p=0.01) (Johnson and Potts 2005)

29. Summary Cannabis is widely used and increasingly accepted
THC in marijuana/hash/shatter in low doses causes relaxation and euphoria, but in high doses or long term use, can be toxic
CBD/CBN found in some edibles, and Sativex,may have some benefit in seizures, spasticity in MS, inflammation and neuropathic pain

30. Summary Decriminalizing Marijuana does not equal “medical” use of Marijuana (so let’s never say it again)