MEDICAL CANNABIS 101

After surveying the Drug law reform community there was an observed need for an official body to advocate for patients exclusively. After an abortive attempt in 2015, Registered a charitable trust in early 2016 First phase was funding Sativex, cute kids frequently raised 10k+ for themselves, not as success full with adults. Second phase was exploiting the “Non Pharmaceutical” Pathway for cheaper products, first success was Tilray, 25-30% cost saving, next step is an inbound product range from Cannimed offering 50% cost savings. 80% of all applications in 2016 were the work of MCANZ. Most Recent phase is a pivot towards political advocacy with 2 Cannabis bills before parliament, and our MC2018 policy booklet. History of MCANZ

Medical Cannabis History

Medical Cannabis History 10,000 years ago – Hemp used to produce cord  5,000 years ago – First Chinese references to medicinal use of cannabis  3,000 years ago – Egyptians used cannabis to treat glaucoma, inflammation and other conditions  1611 – Hemp brought to America  1800’s – Marijuana used in mainstream medicine 1927 – Registered as a Dangerous drug un NZ Law 1965 – Officially banned in NZ

Medical Cannabis History Continued 1964 - Israeli team isolate THC structure. 1988 - CB1 Receptor discovered 1990 - CB2 Receptor discovered 1992 - CB2 Receptor Cloned 1992 - Endocannabinoid Anadamide discovered 1995 - Endocannabinoid 2AG discovered 1999 - GPR55 discovered and cloned (possible CB3 receptor)

Medical Cannabis High Quality Evidence Conclusive or substantial evidence that cannabinoids are effective for: chronic pain chemotherapy-induced nausea and vomiting multiple sclerosis spasticity symptoms Moderate evidence that cannabinoids are effective for: improving sleep for those who have sleep apnoea, fibromyalgia, chronic pain, and multiple sclerosis. Limited evidence that cannabinoids are effective for: Loss of appetite (HIV/AIDs); Tourette’s symptoms; anxiety disorders, PTSD

Cannabinoids. An Alphabet Soup

Cannabinoid Effects

Balanced Products CBD reduces negative effects of THC Doesn’t seem to interfere with positive effects on pain and spasticity greatly Can be summed up as “better together” Rule of thumb is 90% of the positives, with 10% of the negatives, when a product is “balanced”

Terpenes Chemicals found in many plants Give plants there own smells, Can be bred for, such as lemon thyme, Have their own physical effects, ESPECIALLY when inhaled.

Methods of Administration Oral Sublingual/buccal Topical Suppository - Front and back for the ladies….. Inhaled.

Oral Cannabis. Slow onset, up to 2 hours for effects to take hold Tinctures and Oils Variable absorption, stomach status etc. Need Far less product. THC metabolizes into a more potent form, 11-Hydroxy-THC

Sublingual/Buccal Cannabis. Bypasses Liver for more rapid efficient absorption, about 30 mins Under the tongue = sublingual, Buccal = inside of cheek Sativex is sublingual, but off the record a few patients find it more effective using Buccal route.

Topical Cannabis. Apply to areas of pain, Skin penetration can be enhanced Should pass drug screen tests. Should be non psychoactive (unless you put A LOT into it) Cannabis roots are used by some, no CBD, but an additional novel anti inflammatory

Inhaled Cannabis. Rapid onset, 5-10 mins peak effect within the hour Smoking is the norm, no sturdy links to lung cancer, but significant evidence of lung impairment Vaporizing reduces inhalation of harmful byproduct by 80-95% E Cigarette liquids can be infused for further reductions