THC: Medicinal or Not? Greater Kansas City Chapter American Society for Pain Management Nursing October 24, 2015 Laura Habighorst BSN RN CAPA CGRN

Objectives Explore history of cannabis use and current science Evaluate clinical applications of cannabinoids, supported by the research

4000 BC evidence of hemp usage in artifacts found in west central Asia BC Sanskrit and Hindu literature discuss medicinal use fro rheumatism and gout 900 BC Staple in Indian medicine 40 AD Greeks consistently document use for cataracts, depression, earaches, edema, inflammation History

Cannabis sativa, as seen in the Grandes Heures of Anne of Bretagne, ( ). One of the earliest most ancient botanic depiction of the plant in the western world (male and female). (Wikimedia Commons)

1839: Dr. William Brooke O’Shaughnessy introduced the use of marijuana in the U.S. for treatment of muscle relaxation and analgesia 1840 – Early 1900’s: Used for migraines either smoked or as a suppository THE TIDE BEGAN TO TURN 1930: Federal Bureau of Narcotics associated use of marijuana with psychosis, mental deterioration, addiction and violent crimes 1937: Marijuana Tax Act 1941: Removed from U. S. Pharmacopia and National Formulary History

WELCOME TO THE 60 ’S History

’s: Recreational use with anti-cultural/establishment connotations 1970: Dr. Roger O. Egeberg requested marijuana be classified to Schedule 1, like heroin and LSD due to the lack of scientific evidence of its medicinal value 1988: Attempt made to reclassify as Schedule 2 because of the efficacy of use in spasticity, paraplegia, multiple sclerosis, glaucoma, and as an antiemetic. This was denied by the FDA. 1996: California first state to pass Compassionate Use Care Act 2001 and 2006: Additional attempts to reclassify to Schedule 2 for same reasons but was denied. 2014: American Academy of Neurologists developed a consensus statement for the use of marijuana in neurological disorders based on a systematic review of literature from 1948 – : American Academy of Pediatrics has requested a reclassification to Schedule 2 in order to allow for more research History

Taxonomy Cannabaceae (Plant family) Cannabis (Genus) Sativia (Species) Indica (Species) Ruderalis (Species)

Exploring the Endocannabinoid System Cannabinoids and their Therapeutic Potentials

THC & CBD Tetrahydrocannabinol (THC) Discovered in 1964 Used in Marinol Responsible for the high Attaches to cannaboid receptors in the brain associated with thinking, memory, pleasure, coordination and time perception. Cannabidiol (CBD) Wider scope of medicinal use than THC Anti-psychotic effect Used primarily in epilepsy and mulitple sclerosis May cause cellular death in breast cancer and gliomas

Taxonomy Cannabaceae (Plant family) Cannabis (Genus) Sativia (Species) Indica (Species) Ruderalis (Species) High in CBD Low in THC High in THC Low in CBD High in CBD Low in THC

C. Sativia – Charlotte’s Web

Bar-Sela, G., Vorobeichik, M., Drawsheh, S., Omer, A., Goldberg, V., Muller, E. (2013). The medical necessity for medicinal cannabis: Prospective, observational study evaluating the treatment in cancer patients on supportive or palliative care. Evidence-Based Complementary and Alternative Medicine. doi: /2013/ Wallace, M. and Ware, M. (2015). Medicinal marijuana: Here to stay and time to take responsibility. Clinical journal of Pain, 31, pp Morris RG, TenEyck M, Barnes JC, Kovandzic TV. (2014). The effect of medical marijuana laws on crime: Evidence from state panel data, PLoS ONE 9(3): e doi: /journal.pone Baron, E. (2015). Comprehensive review of medicinal marijuana, cannabanoids, and therapuetic implications in medicine and headache: What a long strange trip it has been... The Journal of Head and Neck Pain. Retrieved from: Hill, B. (2015). Cannabis: A journey through the ages. Ancient origins: Reconstructing the story of humanity’s past. Retrieved from Koppel, B., Brust, J., Fife, T., Bronstein, J., Youssof, S., Gronseth, G., Gloss, D. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders. Report of the Guideline Development Subcommittee of the American Academy of Neurology Neurology, 82, pp doi: /WNL References

Welty, T. E., Luebke, A., & Gidal, B. E. (2014). Cannabidiol: Promise and Pitfalls. Epilepsy Currents, 14(5), Massi, P., Solinas, M., Cinquina, V., & Parolaro, D. (2013). Cannabidiol as potential anticancer drug. British Journal of Clinical Pharmacology, 75(2), 303–312.