Medical Marijuana Helen Jang, Tara Hooley, David Hoang, Noel Kwok, John K Rhee, & Janelle Odakura DFM 655 Fall 2014

Historical Usage ❦ Earliest findings in ancient China 2,727 B.C. ❦ Methods of usage in history Topical applicant Consumption with foods Smoking ADD MORE

Modern Usage ❦ Other medicinal Advances Support by the medical profession declines ❦ Before the Marijuana Act of 1937, it was available as over-the-counter product

Medicinal Benefits ❦ Appetite stimulation ❦ Reduce muscle spasticity ❦ Neuroprotection ❦ Induction of apoptosis ❦ Pain modulation ❦ Hypotensive action ❦ Antiemetic (nausea and vomiting) say we’re going to focus on the antiemetic properties of MJ for cancer patients

Endocannabinoid System Anandamide 2-arachidonoylglycerol (2-AG) ❦ G-protein-coupled Receptor Cannabinoid receptor 1 (CB1) Cannabinoid receptor 2 (CB2)

Phytocannabinoids Exocannabinoids THC Constituents Medical Applications Cannabigerol (CBG) Antibiotic, Antifungal, Analgesic, Anti-inflammatory Cannabichromene (CBC) Cannabidiol (CBD) Analgesic, Anti-inflammatory, Anxiolytic, Antipsychotic Cannabinol (CBN) Antibiotic, Sedative, Anticonvulsant, Anti-inflammatory, Delta-9-tetrahydrocannabinol (THC) Euphoriants, Analgesic, Anti-inflammatory, Antioxidant, Antiemetic

Cannabinoid Receptor 1 (CB1) ❦ Normal neurotransmitter signaling From presynaptic area to postsynaptic area ❦ “Retrograde” cannabinoid neurotransmitter signaling Endocannabinoids (made in postsynaptic area) Exocannabinoids (THC) → Both have an affinity for CB1 Inhibits normal neurotransmitter activities by neurotransmitter re-uptake back to presynapse Less neurotransmitters Endogenous cannabinoids are made in the phospholipid bilayer of the postsynaptic neuron They get released into the synaptic cleft and go to the C1 receptor in presynaptic neuron This reverse method affects intracellular induction causing decrease in neurotransmitter (responsible for pain, nausea, vomiting) release

Oral THC ❦ 77% had reduction in nausea and vomiting A study with severe chemotherapy-induced nausea and vomiting (CINV) patients taking nabilone showed... ❦ 77% had reduction in nausea and vomiting ❦ More than half of the patients reported “excellent condition” for resolution of CINV ❦ Half had an increased appetite

FDA approved for chemotherapy-induced nausea & vomiting Modern Dosage Nabilone Dronabinol Dosage: 6 mg per day Frequency: twice or three times a day Duration: 8-12 hours Dosage: 5-15 mg/m2 per day Frequency: four to six times a day Duration: 4-6 hours FDA approved for chemotherapy-induced nausea & vomiting

Nutritional Content ❦ Not traditionally consumed for nutrition ❦ Complex phytochemistry 480 compounds+ ❦ Multiple varieties of Hemp available ❦ Cannabis Oil is nutrient dense ❦ Omega 3-6-9 found in cannabis oil ❦ Vegan and Gluten-free! Medical marijuana is not regularly consumed for it’s nutritional properties,however, marijuana leaves contain a complex phytochemistry of over 480 compounds including primary and secondary metabolites. Flavonoids are one of the secondary metabolites found, in and these provide antioxidants beneficial for human health. When eaten raw, the leaves do not have any psychoactive effect and therefore are ideal to throw in smoothies or put on salads. Hemp is derived from the same Cannabis Sativa plant as marijuana but contains only 1% THC. and is available in different forms including oil, milk and nutrient dense seeds with around 11g protein and 2g αlinolenic acid per two tablespoons therefore hemp is an ideal choice for chemotherapy patients who may be suffering from cachexia, as only small amounts need to be consumed for nutritional benefits. Hemp is rich in polyunsaturated omega-6 linoleic, omega-3 αlinolenic and omega-9 oleic. Hemp also includes all nine essential amino acids.

Nutritional Content

Side Effects ❦ Euphoria, relaxation, and sleepiness are common effects of using cannabis ❦ At low dosage, common side effects can include dry mouth, momentary memory loss, increased heart-rate

Side Effects ❦ Serious side effects are paranoia, panic, or severe psychosis can occur ❦ The dose-dependent characteristic of cannabis can also cause short-term withdrawal syndrome

References Amar, M. (2006). Cannabinoids in medicine: A review of their therapeutic potential. Journal of Ethnopharmacology, (105), 1-25. Complementary, alternative, or integrative health: What’s in a name?. (2014, July 15). Retrieved from http://nccam.nih.gov/health/whatiscam Flores-Sanchez, I. , & Verpoorte, R. (2008). Secondary metabolism in cannabis. Phytochemistry Reviews, 7(3), 615-639. Kumar, S. and Pandey, A.K. (2013). Chemistry and Biological Activities of Flavonoids: An Overview, The Scientific World Journal, vol. 2013. Lu, E., Ferguson, E.K., Hueber, F., Zhao, L., Liu, C.,Wang, Y., Li, C. (2008). Phytochemical and genetic analyses of ancient cannabis from central asia. Journal of Experimental Botany, 59(15), 4171-4182. Mikuriya, T. (1969, Jan 10). Marijuana in Medicine. California Medicine, 110(1): 34-40. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1503422/pdf/ califmed00019-0036.pdf Russo, E. , Jiang, H. , Li, X. , Sutton, A. , Carboni, A. , Bianco, F., Mandolino, G., Potter, D.J., Zhao, Y., Bera, S., Zhang, Y.,