Medical Marijuana for Pain How Does Cannabis Work on Your Body?

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1 Medical Marijuana for Pain How Does Cannabis Work on Your Body? Jeremy Spiegel, MD Medical Director - Casco Bay Medical Westbury, Long Island, New York

2 Intro Brief History of Cannabis Physiology of Cannabis Pain studies Ehlers-Danlos Syndrome Cannabis in Clinical Practice

3 Cannabis has been used spiritually, recreationally, and medicinally for thousands of years My doctor is old school, he doesn t go in for medical marijuana. - CBM Patient, 2016

4 My doctor is old school, he doesn t go in for medical marijuana. - CBM Patient, 2016

5 My doctor is old school, he doesn t go in for medical marijuana. - CBM Patient, 2016

6 Cannabis was legal in the USA until 1937 It was on the US Formulary until Removed AGAINST the advice of the AMA. Reefer Madness Harry Anslinger was a government official - the US s first commissioner of Federal Bureau of Narcotics.

7 Reefer Madness Harry Anslinger was a government official - the US s first commissioner of Federal Bureau of Narcotics.

8 Cannabis is a safe, natural, and effective treatment for chronic pain Chronic pain may originate in the body generally, or from the brain or spinal cord. The brain changes over time in patients with chronic pain.

9 Chemical compounds called CANNABINOIDS (such as THC and CBD)are secreted from cannabis flowers providing relief from pain, nausea, and have anti-inflammatory properties. Tip Don t wait till the end of the presentation to give the bottom line. Reveal your product or idea (in this case a translation app) up front.

10 CANNABINOIDS (such as THC and CBD) are C21-Oxygen containing organic molecules. Tip Don t wait till the end of the presentation to give the bottom line. Reveal your product or idea (in this case a translation app) up front.

11 Endocannabinoid system Phytocannabinoids are ligands Ligand binding to a receptor protein Phytocannabinoids are agonists (and partial agonists, antagonists, inhibitors) Agonist is a ligand that binds, alters the function of the receptor, and triggers a physiological response.

12 Endocannabinoid system Our Bodies Naturally Produce Cannabinoids Anandamide and 2-AG regulate brain and mood, eating, pain, immune function, sleep. We have receptors on our cells in our brain and nervous system (CB1) and other parts of our body (CB2)

13

14 Endocannabinoid system Phytocannabinoids are li CB1 and CB2 are G-Protein coupled receptors in the cell membrane

15 Endocannabinoid system Our Bodies Naturally Produce These Anandamide and 2-AG regulate brain and mood, eating, pain, immune function, sleep. We have receptors on our cells in our brain and nervous system (CB1) and other parts of our body (CB2) THC binds to CB1 in the brain, where CBD binds to CB2 elsewhere in the body.

16 THC Binds to CB1 and CB2

17 THC Binds to CB1 and CB2 Affects Movement

18 THC Binds to CB1 and CB2 Affects Movement Parkinson s patients I have treated demonstrate improvement in tremor and muscle rigidity with the use of MMJ. Onset of improvement may be quite rapid.

19 THC Binds to CB1 and CB2 Affects Movement Affects Memory

20 THC Binds to CB1 and CB2 Affects Movement Affects Memory This is helpful for those suffering with PTSD -- Post Traumatic Stress Disorder, who benefit from an ability to let go of strongly recalled traumatic memories (recalled both mentally and physically).

21 THC Binds to CB1 and CB2 Affects Movement Affects Memory Affects Cognition (Thinking)

22 THC Binds to CB1 and CB2 Affects Movement Affects Memory Affects Cognition (Thinking) Attention Deficit Disorder responds nicely to MMJ, with greater focus, concentration and productivity.

23 THC Binds to CB1 and CB2 Affects Movement Affects Memory Affects Cognition (Thinking) Affects Sensory Perception

24 THC Binds to CB1 and CB2 Affects Movement Affects Memory Affects Cognition (Thinking) Affects Sensory Perception Pain is reduced. Things taste better. Things feel better to the touch. Vision is brighter. Colors become more vivid.

25 THC Binds to CB1 and CB2 Affects Movement Affects Memory Affects Cognition (Thinking) Affects Sensory Perception Affects Mood

26 THC Binds to CB1 and CB2 Affects Movement Affects Memory Affects Cognition (Thinking) Affects Sensory Perception Affects Mood With proper dosing and repeated use, an innocuous pleasant feeling of well being accompanies reductions in pain sensation and other physical symptoms.

27 THC Binds to CB1 and CB2 Affects Movement Affects Memory Affects Cognition (Thinking) Affects Sensory Perception Affects Mood Affects Appetite

28 THC Binds to CB1 and CB2 Affects Movement Affects Memory Affects Cognition (Thinking) Affects Sensory Perception Affects Mood Affects Appetite It is a strong anti-nausea medication. Inflammatory bowel diseases benefit from THC as there are cannabinoid receptors in the gastrointestinal tract.

29 THC Binds to CB1 and CB2 Affects Movement Affects Memory Affects Cognition (Thinking) Affects Sensory Perception Affects Mood Affects Appetite Reduces inflammation

30 THC Binds to CB1 and CB2 Affects Movement Affects Memory Affects Cognition (Thinking) Affects Sensory Perception Affects Mood Affects Appetite Reduces inflammation Arthritis symptoms improve, as do the neurodegenerative disorders such as multiple sclerosis, with reduced spasticity of muscles.

31 Pain Tracts Pain travels through nerves, special tracts, the lateral spinothalamic tract carries pain and temperature.

32 <--Perception Pain Tracts Pain travels through nerves, special tracts, the lateral spinothalamic tract carries pain and temperature.

33 <--Perception <--Voltage gated Na+ channels

34 Endocannabinoid system Delta-9 THC is a multitarget ligand Δ9-THC has also been proposed to be a serotonin 5HT3A receptor antagonist and an allosteric modulator of the opioid receptors TRP (Transient Receptor Protein) Channels modulate ion entry mediating neuronal signaling: PAIN and PRESSURE perception, temperature, smell, taste vision.

35 <--Perception <--Voltage gated Na+ channels <--Reduces inflammation

36 Endocannabinoid system Phytocannabinoids are ligands Ligand binding to a receptor protein Phytocannabinoids are agonists (and partial agonists, antagonists, inhibitors) Agonist is a ligand that binds, alters the function of the receptor, and triggers a physiological response.

37

38 CBD So interesting PLEIOTROPIC - So Many functions Little affinity for CB1 AND CB2 RECEPTORS DELAYS reuptake of neurotransmitters such as anandamide and adenosine

39 CBD NON-PSYCHOTROPIC At HIGH concentrations it activates a SEROTONIN receptor 5HT-1A implicated in: Anxiety, addiction, sleep, pain perception, nausea and vomiting

40 CBD BLOCKS GRP55 Signaling GRP 55 signals osteoclast formation--which reabsorbs bone. Therefore: Putatively REDUCE OSTEOPOROSIS and JOINT PROBLEMS by antagonizing this process.

41 Endocannabinoid system Phytocannabinoids are ligands Ligand binding to a receptor protein Phytocannabinoids are agonists (and partial agonists, antagonists, inhibitors) Agonist is a ligand that binds, alters the function of the receptor, and triggers a physiological response.

42 THC:CBD RATIO

43 THC:CBD RATIO The MOST IMPORTANT factor in your choice of MMJ

44 THC:CBD RATIO The MOST IMPORTANT factor in your choice of MMJ The CBD tempers the THC such that you will have milder effects -elimination of nausea without full blown munchies.

45 THC:CBD RATIO The MOST IMPORTANT factor in your choice of MMJ The CBD tempers the THC such that you will have milder effects -elimination of nausea without full blown munchies.

46 THC:CBD RATIO The MOST IMPORTANT factor in your choice of MMJ The CBD tempers the THC such that you will have milder effects -elimination of nausea without full blown munchies.

47 THC:CBD RATIO THC: CBD 20:1

48 THC:CBD RATIO THC: CBD 1:1

49 THC: CBD 1:20

50

51

52

53 EDS relief with MMJ Scoliosis pain relief Relief from unstable joints prone to subluxation, strain, dislocation, hyperextension Arthritis Migraine Chronic inflammation Muscular pain Improvement of chronic fatigue Relief from IBS Improvement in foot pain from flat feet Carpal tunnel relief Gastroparesis relief Allodynia/Hyperalgesia

54 Cannabis may reduce the need for opioid painkillers University of Michigan researchers found a 64% decrease in users of medical marijuana. Beware opioids Increased cannabis use for chronic pain may reduce addictions and deaths related to opioid painkillers

55

56 Cannabis is safe CB1 Receptors are virtually nonexistent in the brainstem, medulla, thalamus. So we don t get the life-threatening effects on vital physiological functions

57 Terpenes are fragrant essential oils secreted by cannabis plants These active molecules are among the 500 different compounds found in cannabis, of which there are 85 different cannabinoids.

58

59 How Do I Get My New York Medical Marijuana Card?

60 1. See the Doctor for the MMJ evaluation. I perform these either: In-Person in Westbury or Online via videochat

61 2. Register with the New York State Department of Health (We can help you with this.)

62 3. Wait about a week for your ID card to come in the mail.

63 4. Go to the Dispensary to get your medicine. (We will give you a list of conveniently located dispensaries.)

64 New York Listed Conditions Chronic Pain >= 3 months duration Post Traumatic Stress Disorder Cancer ALS HIV/AIDS Inflammatory Bowel Disease

65 New York Listed Conditions Epilepsy Huntington s Disease Parkinson s Disease Spinal Cord Injury Multiple Sclerosis

66

67

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70 990 Westbury Road Suite 204 Westbury NY (516)

71 References Molecular Targets of the Phytocannabinoids: A Complex Picture Prog Chem Org Nat Prod. 2017; 103: The Endocannabinoid System, Cannabinoids, and Pain Rambam Maimonides Med J Oct; 4(4) National Academies of Sciences, Engineering, and Medicine The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press.

72 References (cont d) Annals of Internal Medicine, Benefits and Harms of Plant-Based Cannabis for Posttraumatic Stress Disorder: A Systematic Review. Cannabis Pharmacy: The Practical Guide to Medical Marijuana by Michael Backes Leafly.com CannaSOS.com

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