1. Medical Uses of Cannabis in California  Tod H. Mikuriya, M.D. President, Classic Pharmaceuticals Berkeley, California, U.S.A.

2. Introduction  The Compassionate Use Act of 1996 exempts patients and caregivers from state laws prohibiting possession and cultivation of marijuana  “…shall not apply to a patient or to a patient’s primary caregiver who possesses or cultivates marijuana for the personal medical purposes of the patient upon the written or oral recommendation or approval of a physician.”

3. California Cannabis Use Summary  All are chronic conditions. (N=4,928)  Self medication with cannabis is a safer and more effective drug in the management of chronic illness compared with prescription or OTC drugs.  Medical destigmatization de-alienates and therapeutically intervenes  Significant problems of implementation and compliance remain.

4. Pharmacologic Safety  Compared with opioids, steroids, NSAIDS, sedatives, tricyclics, and benzodiazepines cannabis has minimal to no side effects.  Critical difference in chronic condition coping.

5.  Immunomodulator analgesic  Mood and affect modulator  Antispasmodic anticonvulsant  Harm reducing substitute  Hypothermogenic Modes of Activity

6. Modes of Action Difficult to Categorize  Conditions have multiple manifestations. Or concurrent unrelated conditions may exist. Glaucoma, prostatitis Dyspepsia, back strain

7. Immunomodulator Analgesic (42%)  A significant number presented with pain and dysfunction based upon localized tissue specific inflammation.  While many conditions are secondary to trauma, other etiologies are largely “autoimmune” or idiopathic.  Manifestations are organ system dependent and may be multiple.

8. Mood and Affect Modulator (27.2%)  Controls emotional overreactivity and mobilizes affect. Restores sleep without “hangover” or fogginess.  Improves attention and mental acuity by decreasing distraction.

9. Spasmolytic Anticonvulsant (25.9%)  Cannabis relieves spasm and seizures from CNS, PNS, skeletal, and smooth muscle.  Appetite stimulation is secondary to smooth muscle relaxation in the GI tract.

10. Harm Reduction Substitution (4.2%) Alcoholism and alcohol abuse Detox with high oral dose  And inhaled supplementary maintenance with lower dose Minimize contact with other alcohol users

11. Modes of Action

12. Age Distribution of Patients

13. Psychiatric Conditions Treated

14. Percent Usage as Harm Reducing Substitute

15. Physiological Mechanisms Increased cerebral perfusion Eicosanoids, precursors to prostaglandins, mediator of inflammation Similar in structure to cannabinoids Lipophilic non-polar molecules not soluble in water Psychological effects of cannabis blocked by indomethacin Mild tachycardia Decreased circulating glucocorticoids

16. Psychosocial  Exemption from marijuana law prosecution removes stressors. Fear of loss of freedom, job, housing, custody, health services, compensation, and harmful contact with police, court, probation, social workers, & etc.  Dealienation with improved self esteem, socialization, and health services access.

17. Psychosocial “easer” Restoration of perceptual awareness has a calming and comforting effect. Controls emotional reactivity and enhances attention and focus. Permits socialization and empathetic competence. Integrates, facilitates connection among cognitive, emotional, and physiologic systems.

18. Cannabis Abuse No cannabis abusers encountered who are functional and happy. Contextual importance Cannabis is a tool the use of which depends on personality, set, and setting. Of perceived abuse: Is it abuse? Need for adequate assessment for underlying psychological or situational factors

19. Cannabis Unchanged- Minds Poisoned The composition of cannabis and human physiology remain unchanged over millennia. Prohibition of cannabis harms and sickens through ignorance and abuse by the criminal justice system.

20. The Solution: Restore Cannabis to Formularies Cannabis was well defined and available for 90 years. 1937 Marihuana Tax Act illegitimately removed Cannabis from availability “Grandfather” FDA application by Classic Pharmaceuticals Utilize existing definitions in pharmacopoeias. Initiate twenty year study for benefits, risks, and therapeutic properties using contemporary technology.