“MEDICAL” MARIJUANA

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?

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

…so I can, like, smoke it?

….or EAT it?

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)

….and what is SPICE? KUSH? K2?

Sciencey stuff

Horticulture Lesson

Cannabinoid Receptors

Effects on the Body

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

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**

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

…and the synthetics

Politics and Us

“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.

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

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

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)

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

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