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2. Current Medical Use and Therapeutic Potential
Dr. Paul Morrison
Clinical Senior Lecturer
Institute of Psychiatry
King's College London
NHS Consultant Psychiatrist
The Maudsley Hospital, London

3. Outline Cannabis formulations approved in the US and outside the US
Therapeutic potential in psychiatry and other medical conditions

4. Approved cannabis formulations

5. FDA-approved products
Drug (Brand name)
Molecule
Dronabinol (Marinol)
Synthetic Δ9-THC
Nabilone (Cesamet)
Synthetic cannabinoid
Anorexia associated with weight loss in patients with AIDS
Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments

6. FDA-approved products
Drug (Brand name)
Molecule
Dronabinol (Marinol)
Synthetic Δ9-THC
Nabilone (Cesamet)
Synthetic cannabinoid
Anorexia associated with weight loss in patients with AIDS
Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments
Marinol (Dronabinol) [Prescribing Information]. North Chicago, IL; AbbVie Inc;
Cesamet (Nabilone) [Prescribing Information]. High Point, NC Unimed Pharmaceuticals, Inc

7. CBD THC Oral spray 1:1 ratio THC/CBD
Approved in many EU countries, Canada and Latin America
Indication:
Spasticity treatment in multiple sclerosis
Sativex
CBD
THC
Sativex Oromucosal Spray (Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD)) [Prescribing Information] Cambridge, UK. GW Pharma Ltd

8. CBD THC Oral spray 1:1 ratio THC/CBD
Approved in many EU countries, Canada and Latin America
Indication:
Spasticity treatment in multiple sclerosis
Sativex
CBD
THC
Sativex Oromucosal Spray (Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD)) [Prescribing Information] Cambridge, UK. GW Pharma Ltd

9. Evidence for therapeutic use
Chronic pain
Nausea and vomiting related to chemotherapy
Spasticity related to MS
National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. National Academies Press.

10. CBD: therapeutic potential as antipsychotic

12. Antipsychotic properties
CBD
Antipsychotic properties
Zuardi AW, Morais SL, Guimarães FS, Mechoulam R. Antipsychotic effect of cannabidiol. J Clin Psychiatry Oct;56(10):485-6

13. CBD THC Antipsychotic properties Pro-psychotic properties
Zuardi AW, Morais SL, Guimarães FS, Mechoulam R. Antipsychotic effect of cannabidiol. J Clin Psychiatry Oct;56(10):485-6

14. CBD Trial 1 Trial 2 Larger sample of schizophrenia patients
CBD vs amisulpride
CBD showed improvements similar to amisulpride
Trial 2
Larger sample of schizophrenia patients
Partial responders to antipsychotic treatment
CBD + antipsychotic
Improvement in psychotic symptoms
CBD
Leweke FM, Piomelli D, Pahlisch F, Muhl D, Gerth CW, Hoyer C, et al. Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Transl Psychiatry 2012;2:e94.

15. CBD Trial 1 Trial 2 Larger sample of schizophrenia patients
CBD vs amisulpride
CBD showed improvements similar to amisulpride
Trial 2
Larger sample of schizophrenia patients
Partial responders to antipsychotic treatment
CBD + antipsychotic
Improvement in psychotic symptoms
CBD
Leweke FM, Piomelli D, Pahlisch F, Muhl D, Gerth CW, Hoyer C, et al. Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Transl Psychiatry 2012;2:e94.

16. CBD Trial 1 Trial 2 Larger sample of schizophrenia patients
CBD vs amisulpride
CBD showed improvements similar to amisulpride
Trial 2
Larger sample of schizophrenia patients
Partial responders to antipsychotic treatment
CBD + antipsychotic
Improvement in psychotic symptoms
CBD

17. CBD Trial 1 Trial 2 Larger sample of schizophrenia patients
CBD vs amisulpride
CBD showed improvements similar to amisulpride
Trial 2
Larger sample of schizophrenia patients
Partial responders to antipsychotic treatment
CBD + antipsychotic
Improvement in psychotic symptoms
CBD

18. CBD Trial 1 Trial 2 Larger sample of schizophrenia patients
CBD vs amisulpride
CBD showed improvements similar to amisulpride
Trial 2
Larger sample of schizophrenia patients
Partial responders to antipsychotic treatment
CBD + antipsychotic
Improvement in psychotic symptoms
CBD

19. CBD as anticonvulsant

20. CBD in epilepsy CBD is an effective anticonvulsant Current interest
Temporal lobe epilepsy
Current interest
Treatment-resistant childhood epilepsy
Lennox-Gastaut syndrome
Positive trials

21. CBD in epilepsy CBD is an effective anticonvulsant Current interest
Temporal lobe epilepsy
Current interest
Treatment-resistant childhood epilepsy
Lennox-Gastaut syndrome
Positive trials
Cunha JM, Carlini EA, Pereira AE, Ramos OL, Pimentel C, Gagliardi R, Sanvito WL, Lander N, Mechoulam R. Chronic administration of cannabidiol to healthy volunteers and epileptic patients. Pharmacology. 1980;21(3):

22. CBD in epilepsy CBD is an effective anticonvulsant Current interest
Temporal lobe epilepsy
Current interest
Treatment-resistant childhood epilepsy
Lennox-Gastaut syndrome
Positive trials
O'Connell, B. K., Gloss, D., & Devinsk, O. (2017). Cannabinoids in treatment-resistant epilepsy: A review. Epilepsy & Behavior.

23. CBD in epilepsy CBD is an effective anticonvulsant Current interest
Temporal lobe epilepsy
Current interest
Treatment-resistant childhood epilepsy
Lennox-Gastaut syndrome
Positive trials
O'Connell, B. K., Gloss, D., & Devinsk, O. (2017). Cannabinoids in treatment-resistant epilepsy: A review. Epilepsy & Behavior.

24. Other potential applications

25. Other cannabinoid molecules
Oncology
Phase II trial for glioma
One-year survival rate 83% vs 54% for placebo
Other cannabinoid molecules
Cannabis plant: 60 natural cannabinoids
THCV: may be effective for metabolic syndrome

26. Other cannabinoid molecules
Oncology
Phase II trial for glioma
One-year survival rate 83% vs 54% for placebo
Other cannabinoid molecules
Cannabis plant: 60 natural cannabinoids
THCV: may be effective for metabolic syndrome

27. Key points
Dronabinol (Marinol) and nabilone (Cesamet) are FDA-approved for:
Anorexia associated with weight loss in patients with AIDS
Nausea and vomiting in cancer patients who have not responded to conventional treatments
Sativex is available in many countries outside the US
THC + CBD
Treatment of spasticity in multiple sclerosis
CBD
Appears to have antipsychotic properties
Anticonvulsant effects
THC
CBD
CBD

28. Key points
Dronabinol (Marinol) and nabilone (Cesamet) are FDA-approved for:
Anorexia associated with weight loss in patients with AIDS
Nausea and vomiting in cancer patients who have not responded to conventional treatments
Sativex is available in many countries outside the US
THC + CBD
Treatment of spasticity in multiple sclerosis
CBD
Appears to have antipsychotic properties
Anticonvulsant effects
THC
CBD
CBD

29. Key points
Dronabinol (Marinol) and nabilone (Cesamet) are FDA-approved for:
Anorexia associated with weight loss in patients with AIDS
Nausea and vomiting in cancer patients who have not responded to conventional treatments
Sativex is available in many countries outside the US
THC + CBD
Treatment of spasticity in multiple sclerosis
CBD
Appears to have antipsychotic properties
Anticonvulsant effects
THC
CBD
CBD

30. Key points
Dronabinol (Marinol) and nabilone (Cesamet) are FDA-approved for:
Anorexia associated with weight loss in patients with AIDS
Nausea and vomiting in cancer patients who have not responded to conventional treatments
Sativex is available in many countries outside the US
THC + CBD
Treatment of spasticity in multiple sclerosis
CBD
Appears to have antipsychotic properties
Anticonvulsant effects
THC
CBD
CBD

31. Next Presentation: Cannabis Use Disorder