1. Medical Cannabis
Information for Medical Professionals and Patients from the
Missouri Cannabis Nurses Association
Copyright © 2017

2. This Plant is old and New
Cannabis is over 10,000 years old.
Cannabis was used as medicine until the s
Prohibition is slowly decreasing across the United States
Medical Cannabis is allowed in 31 states
Personal Cannabis is allowed in Alaska, Maine, Massachusetts, Colorado, California, Washington, Nevada, Oregon, and the District of Columbia.

3. How it works
Cannabis works with the human body because the human body is receptive to cannabinoids and the neurotransmitter Anandamide.
Receptor sites are located in the brain (CNS) and the peripheral nerves (PNS)
The receptors are responsive to
cannabinoids and suppress, interfere, or prohibit neurological activity or potentiate or increase neurological activity.

4. How THC works Anandamide resembles THC and binds mostly with CB1
AEA-Anandamide is a neurotransmitter produced in the brain that binds to the THC receptors. It acts as the “Key” molecule fitting into the “locks” of the CB1 and CB2 receptors found in the body. AEA is endogenous.
Anandamide resembles THC but does not last as long and breaks down fast. It fits in the same receptor site as the more stable THC molecule

5. How CBD works
The cannabinoid Cannabidiol, CBD is the non-psychoactive cannabinoid. CBD is not involved in binding to either the CB1 or CB2 cannabinoid receptors like AEA and THC CBD plays a role by indirectly stimulating the endogenous cannabinoid through signaling. This signaling causes the suppression of the enzyme Fatty Acid Amide Hydroxylase (FAAH)—the enzyme that breaks down anandamide. This action or signaling delays the metabolism or break down of AEA (Anandamide) Smaller amounts of FAAH means more AEA is available for a longer period of time.
Whereas the cannabinoid molecules found in cannabis are considered “exogenous ligands” to the cannabinoid (CB) receptor family, anandamide is an “endogenous” cannabinoid ligand—meaning it binds to one or more cannabinoid receptors and is found naturally inside the mammalian brain and body. Anandamide favors the CB1 receptor, which is concentrated in the brain and central nervous system. Because FAAH is involved in the metabolic breakdown of anandamide, less FAAH means more anandamide remains present in the body for a longer duration. More anandamide means greater CB1 activation.

6. Direct link between GABA activation and dopamine suppression
Direct link between GABA activation and dopamine suppression. THC inhibits GABA increasing Dopamine. Gamma-Amino Butyric acid (GABA) is an amino acid which acts as a neurotransmitter in the central nervous system.
Direct link between GABA activation and dopamine suppression. THC inhibits GABA increasing Dopamine. Gamma-Amino Butyric acid (GABA) is an amino acid which acts as a neurotransmitter in the central nervous system.

7. Where are those CB-1 and CB-2 receptors?
Cannabinoid receptors are imbedded in the cell membranes
Brain Respiratory tract Pancreas
Spinal Cord Liver Digestive tract
Cerebellum Adrenals Bone
Brainstem Ovaries Spleen
Basil Ganglia Uterus Tonsils
Olfactory Testes Blood
Thalamus Prostate Skin
Hypothalamus Eyes Blood vessels
Pituitary Heart
Thyroid Stomach

8. cannabinoids
We can obtain cannabinoids from the natural plant Cannabis Sativa or Cannabis Indica, or a hybrid of both.
Grown in a garden, the plant produces cannabinoids that are ingested by humans.

9. Cannabis and cannabinoids
Cannabis produces over 700 chemical compounds
There are over 100 cannabinoids produced by cannabis, only a few are produced in abundant amounts.
THC (Tetrahydrocannabinol) is the best known cannabinoid but not the only one. There are several others.
CBD (Cannabidiol) is the non-psychoactive cannabinoid.
CBG, ( Cannabigerol)
CBC, (Cannabichromene)

10. Pharmaceuticals that increase the effects of oral Cannabinoids
Oral Ingestion of cannabis acts together with the enzymes in our body
The enzymes play a part in the metabolizing process of cannabinoids (THC, CBD, etc.)
Medications that increase effects of cannabinoids :
Amiodarone (Antiarrhythmic), Diltiazem (Antihypertensive) Verapamil.
Clarithromycin, Erythromycin, (antibiotic)
Fluconazole, Itraconazole, Ketoconazole, Micoconazole, (Antifungal)
Isoniazid (Anti-infective)
Ritonavir (HIV protease inhibitor)
Benzodiazepines, Opiates, ETOH

11. Pharmaceuticals that Decrease the effects of oral Cannabinoids
Carbamazepine, Phenobarbital, Phenytoin, Primidone (Anticonvulsant) Rifampicin, Rifabutin (Antibiotic)

12. Medical cannabis is not advised if one or more of the following situations exist:
Are allergic to any cannabinoid or to smoke
Have a diagnosis of serious liver, kidney, heart or lung disease
Have a personal or family history of serious mental disorders such as schizophrenia, psychosis, depression, or bipolar disorder
Are pregnant, are planning to get pregnant, or are breast-feeding
Are a man who wishes to start a family
Have a history of alcohol or drug abuse or substance dependence

13. Unpleasant Side Effects
Dry Mouth
Dizziness
Forgetful
Anxious
Sleepy
Couch-lock
Dry or bloodshot eyes
Inability to concentrate
Faintness
Vomiting in rare cases.

14. Risks and there are risks to Medical Cannabis
Marijuana products with high percentage of THC can impair your concentration, your ability to think, and make decisions.
Marijuana products with high percentage of THC can impair your reaction time and coordination.
Some patients report increased anxiety, panic attacks, and in some cases cause paranoia and hallucinations. CBD reduces these side effects.
Cognitive impairment may be greatly increased when marijuana is consumed along with alcohol, illegal drugs, and other legal medications
It is not 100% “safe” Center for Disease Control (CDC) field notes

15. Benefits of Medical Cannabinoids
THC acts as a partial agonist at the CB1 and CB2 receptors. The compound is a mild analgesic, or painkiller, and cellular research has shown that it has antioxidant activity
CBD Cannabidiol is a cannabis compound that has significant medical benefits, but does not make people feel “stoned” and can actually counteract the psychoactivity of THC. CBD is known to slow seizure activity

16. Diseases and disease symptoms That may be helped by cannabinoids
Epilepsy Migraines Diabetes
Chronic Pain Addiction Dravet Syndrome
PTSD Anorexia Graves Disease
Crohn’s Disease Cachexia HIV/AIDS
Kidney Failure ADD/ADHD MS
Impending death Autism Menstrual Pain
Anxiety Chemo Therapy Nausea Tourette's Syndrome
ALS Fibromyalgia Parkinson’s Disease
Neuro Pain Depression Rheumatoid Arthritis
There are and will be more

17. The concerns of the medical and nursing community
The need for education and research for medical professionals will help reduce the stigma and help patients to make educated decisions on the proper cannabinoid profile, ratios, and dosages. 1
Healthcare professionals have concerns about the following: 2

18. The end