Weeding out the Truth: Cannabinoids in the Treatment of Neurological Disorders
|
|
- Shanon Elmer Osborne
- 6 years ago
- Views:
Transcription
1 Weeding out the Truth: Cannabinoids in the Treatment of Neurological Disorders Barbara S. Koppel, MD New York Medical College American College of Medical Toxicology March 18-19, 2016
2 Cannabis species (or subspecies) Wikipedia from Wikimedia and
3 Historical aspects (Hemp = 4000 BC, medicine=2000bc, India)
4 AEA also an endovanalloid at TRPV1 (with 5-20-fold lower affinity cf with CB1); also PPARy Key ECS Elements
5 --Dec. 31, update: a PubMed search for scientific journal articles published in the last 20 years containing the word "cannabis" revealed 7,704 results. Add the word "cannabinoid," and the results increase to 15,899 articles. That's an average of more than two scientific publications per day over the last 20 years! (Source: Dustin Sulak, DO)
6
7 Why AAN got involved Patients were beginning to demand attention be paid, and science needed review before politics dictated actions Research was hampered by Schedule I classification, unchanged since 1970, but was going on outside US Charlotte, with a severe epileptic syndrome, sparked families to move to Co. Alternative MJ, such as Spice was causing severe neurologic symptoms
8 AAN Guideline Process Clinical Question Evidence Conclusions Recommendations Slide 8
9 Literature Search/Review Rigorous, Comprehensive, Transparent 1729 abstracts Inclusion criteria: - Human randomized, controlled trials (RCTs); cohort studies; case-control studies; and case series (N 10 or addressing efficacy of marijuana Exclusion criteria: - Case series with N < 10 - Review articles - Anonymous questionaires 63 full text,33 included Slide 9
10 FDA-Regulated Cannabinod-Based Medicines: Chemicals, Extracts, Botanicals Photo from pharmer.org Photo from epocrates.com Photo from nida.org Photo from Russo et al Dronabinol (Marinol ) Nabilone (Cesamet ) Cannabis Sativa L. Extracts (Sativex ) Cannabis Sativa L. Cigarettes Photo from Russo et al Photo from wikipedia.org Approximately 460 chemical constituents, >100 phytocannabinoids 1976
11 PK: Common Routes of Administration Lungs by inhalation of vaporized or smoked organic plant material Akin to IV bolus passive diffusion Rapid onset (secs to mins), maximal effect ~30mins, duration 2-3 hrs Gut by ingestion of lipophilic, alcoholic, or supercritical fluidic extracts More variable absorption time Onset 30mins-2hrs, more constant duration of action of 5-8hrs Skin by topical application of extracts
12 Oral Cannabis Extracts Cannabis extract (Cannador)THC 2.5 :CBD 1.25 mg Mean mg/kg/d up to maximum of 1.25 mg/kg/d (Carroll 2004);mean 1.25 mg/kg/d up to maximum of 25 mg/d; Cannabis extract THC 2.5 mg:cbd 0.9 mg Mean mg/kg/d up to maximum of 0.25 mg/kg/d (Vaney 2004) Cannabis extract 100 mg CBD mg/d (Cunha 1980) Cannabis extract 100 mg CBD 10 mg/kg/d (Consroe 1991, Curtis 2009) Abbreviations: CBD = cannabidiol, a major less-psychoactive resin extract constituent of the plant Cannabis sativa L (marijuana); THC -9 tetrahydrocannibidiol Slide 12
13 Oromucosal spray administration Nabiximols (Sativex) Ratio of THC 2.7 mg:cbd 2.5 mg/spray Mean 7.19 mg/d (Kavia 2010) Maximum 65 mg/d (Collin 2010); 120 mg/d (Wade 2004) Slide 13
14 Oral formulations (approved for nausea and anorexia) Dronabinol (Marinol) 2.5 mg D9-THC Maximum of 10 mg/d (Svendsen 2004, Müller-Vahl 2003);maximum of 25 mg/d (Freeman 2006,Zajicek 2003) Nabilone (Cesamet) 100 mg CBD 100 mg (Curtis 2009); 0.03 mg/kg (Fox 2002) Slide 14
15 More oral formulations Oromucosal spray administration Nabiximols (Sativex) Ratio of D9-THC 2.7 mg:cbd 2.5 mg/spray Mean 7.19 mg/d (Kavia 2010) Dosage varied by study; maximum 65 mg/d (Collin 2010); maximum 120 mg/d (Wade 2004) Slide 15
16 Smoked (inhaled) marijuana Marijuana 4% THC 4 puffs (hits)/d (Corey-Bloom 2012); 3.5%THC (Abrams 2007);3.5% 7% (Wilsey 2008); 1% 8% THC (Ellis 2009); 0% 9.4%(Ware 2010) Only Corey-Bloom and Abrams were included in guideline Slide 16
17 Tobacco Vaporizer Slide 17
18 Proposed Real World Function of CBD Suppress fear and anxiety of unpleasant but necessary activity, so can continue longterm exercise because don t remember the pain and don t mind it Modulates pain systems, such as opiate and serotonin (headache), not directly analgesic Promote sleeping, eating, make food tasty even if not hungry
19 Multitude of CBDs/Therapeutic Uses Adapted from Izzo et al, Trends Pharmacol. Sci Our results follow
20 Findings from our review Spasticity Central pain Tics Dopa-induced Dyskinesias Bladder overactivity Huntington Chorea
21 Dopa-induced Dyskinesias in PD and Dystonia Moderate evidence THC is probably ineffective for treating levodopa-induced dyskinesias in patients with Parkinson disease (1 Class I study). Insufficient evidence For patients with cervical dystonia, data are insufficient to support or refute the efficacy of dronabinol (1 Class III study). Slide 21
22 Why cannabis in pain Endocannabinoids contribute to homeostasis (stimulate appetite, emotions and learning, pain perception) No direct action at opiate receptors but indirectly allow painful activities to be forgotten or ignored
23 ECB Receptor Sites: PAG, Thalamus, Medulla, DRG, Amygdala, Cortex
24 Pain responds to cannabis Pain is very difficult to study, requires individual pt rating rather than unbiased observer, so not included in original guideline. Smoked form works best (many self reports, surveys of testimonials)
25 Bayesian analysis of 77 pain studies 30% clinical improvement in chronic neuropathic pain assessed with a continuous patient reported instrument, NNT inhaled cannabis results in short term NNT of 5.6, 1 of 6 respond,128 pts Andreae MH J Pain :
26 Neuropathy HIV pain relieved by smoked MJ 50 pts 3.5%THC sig (>30%) pain reduction Abrams D2007 Neurology 68: pts, 1-8%THC significant pain relief Ellis RJ Neuropsychoppharmacology : Nabilone for general neuropathy Frank 2008 Nabiximols for brachial plexus avulsion Berman 2004
27 Headache ECB modulate pain signaling in DRG and nausea in area postrema, inhibit blood vessel dilation, improve serotonin relase (like triptans) ECB deficiency noted in migraineurs and others with chronic pain condition, dec cluster also Baron EP 2015 Headache 55: Dec migraines from 10 to 4/month with inhaled or edible medical marijuana Rhyne DN Pharmacotherapy 2016 epub1002
28 Why cannabis in movement disorders CB1 receptors in GABAergic neurons of caudate, striatum, presynaptic terminals in the globus pallidus, substantia nigra and in glutamatergic projections to and from cortex and subthalamic nucleus. Endocannabinoids also indirectly influence dopaminergic pathways, suppressing movement Koppel Neurotherapeutics 2015:12:
29 Predicting response to cannabis in movement disorders is difficult Receptors increase with PD, and ECB antagonist may help hypokinesis, while ECB agonists help excess movements (HD, Tourettes, tics) but degeneration may change # of receptors. Indirect effects common as ECB influence other transmitters
30 PARKINSON DISEASE Cannabis extract Cannador Not stated Dopa-induced Dyskinesias/ Dystonia Tremordystonia Dopa-induced dyskinesias Δ 9 -THC mg +CBD mg/d 0.03mg/kg/d 0.03mg/kg/d 75mg/d (Carroll 2004; I) Consroe1986 (Fox 2002) Sieradzan 2001 (Chagas 2014) Rimonabant (CBD antagonist) Inhaled botanical marijuana SR Dopa-induced dyskinesias - Parkinson tremor and dyskinesias experimental (Mesnage 2004) 0.5gm/cig 1 cig 2.9%THC Survey of unsupervised smoked MJ Lotan 2014 (Frankel 1990) Venderova 2004 Finseth 2015 Nabilone Cesamet Levodopainduced Dyskinesias mg/kg 0.03 mg/kg (Fox 2002) Sieradzan 2001
31 Tourette Syndrome Botanical smoked MJ cig/dy 1 cone /night Sandyk 1988 Hemming 1993 Survey (Selfprescribed) Müller-Vahl 1998 THC capsule Tics, vocalizations 2.5 mg Δ 9 -THC Max 10mg/d Müller-Vahl 2002;Class II, Muller-Vahl 2003;Class III
32 Dystonia Dronabinol Marinol Cervical Dystonia Dystonia+ Tics in MultipleSclerosis 7.5mg bid 2.5mgbid (Zadikoff 2011) Deutsch 2008 CBD or cannabis extract None Primary Dystonias 10 mg/kg/d up to 75mg/dy 100 mg CBD Consroe 1986 (Chagas 2014) Curtis 2009 Inhaled botanical MJ Spasms Hemidystonia Not stated 1MJ Cigarette/dy Marsden 1981, Chatterjee 2002 (In Wilson Disease) 3-4g/dy Uribe 2004
33 Epilepsy Insufficient evidence For patients with epilepsy, data are insufficient to support or refute the efficacy of cannabinoids in reducing seizure frequency (2 Class IV studies, no Class I III studies).
34 History of use in epilepsy Epidemiology favored anticonvulsant effect Ng 1990 NEJM Series of 15 pts, worked in 7 of 8 Cunha 1980 Pharmacology Charlotte Figi, pt with Dravet, grew cannabis with more CBD, less THC in Colorado where it was legal Maa &Figi 2014 Epilepsia 55:783-6 Devinsky: Cannabinoids in the treatment of epilepsy NEJM :
35 Endocannabinoids and neuronal excitabilityy Defects in EDC system in patients with TLE, and seizures activate the system EDC anandamide levels lower in pts with seizures CBD binds to cation channels which dec release of glutamate, inhibit adenosine reuptake Mostly surveys and anecdones, need rct Etiolex = spray with CBD>THC being studied
36 Nejm table 1
37 Nausea/ Appetite CB 1 receptors in limbic system to affect reward aspects of eating CB1 in lateral hypothalamus affects hunger CB1 affects peripheral metabolism Olfactory frontal cortex ; chemosensory perception of food (eg chemo makes food taste bad, MJ can offset it) Brisbois et al Annals of Oncology 2011
38 Many Studies establish weight gain, number of eating times, calories consumed 469 Ca/wt loss pts. Dronabinol appetite 49% wt >10% Megesterol appetite 75% wt >10% Combination appetite 66% wt >10% (note additive effect) Jatoi J Clin Conc 2002
39 Other HIV studies 139 pts dronabinol caused stable weight, placebo lost wt. Beal et al 1995 J Pain Symp Mgt and 1997 same dronabinol no effect compared with megestrol Timpone et al 1997 AIDS Res Hum retrovir Also measure eating occasions, food intake, calorie consumption, self-reported appetite and nausea Abrams et al 2003 Ann Int Med Haney et al 2007 JAIDS Bedi et al 2010 Psychopharm Foltin 1988 Appetite Riggs 2012 Brain Res
40 Other conditions AD food refusal responded to THC in 15 subjects Volicer et al 1997 Int J Ger Psych Anorexia Treat Obesity with antagonists of CBD Rimonabant causes weight loss, dec waist circumference, triglycerides, inc HDL cholesterol, inc adiponectin levels and reduces taste for sweet foods (studied with chocolate) rather than all food
41 Adverse Effects No more than other meds used for pain or spasticity, eg somnolence, slowed cognition or motor performance, balance and coordination in studies (doses of THC varied especially between pills, sprays and smoked forms) Interaction or metabolism of other medications being used and underlying brain disease esp MS
42 Potential adverse effects Clinical Context In the reviewed studies, cannabinoids were generally well tolerated, although some SAEs were reported. Mild or moderate AEs were common (reported in approximately 50% 80% of study subjects) and appeared to be of similar prevalence in subjects receiving cannabinoids and in those receiving a placebo control intervention. Most studies of cannabis for efficacy were of short duration, ranging from 6 15 weeks. No evidence was available for evaluating the safety and efficacy of smoked cannabis, although results from a single Class III study e72 suggest that decline in cognitive performance may be an SAE. Slide 42
43 Specific findings of MJ problems Drop outs occurred in 6.9% of 619 treated and 2.2% of placebo Most common symptom: dizziness (up to 50%) Symptoms reported in at least 2 studies: nausea, fatigue, increased weakness, behavioral or mood changes, suicidal ideation, hallucinations, feelingsof intoxication (high). Notably absent: Psychosis, dysphoria, and anxiety One death possibly related to treatment (seizure followed by aspiration pneumonia). In a year-long study of 207 patients, 15% stopped CBD, 14% stopped THC and 10 % placebo Slide 43
44 Herbs: Cannabis, cont. Clinical Context, cont. Because cannabinoids have known psychoactive properties, their potential for psychopathological and neurocognitive AEs is a concern especially in a patient population that may be vulnerable due to underlying disorders such as MS. Clinicians should therefore counsel patients about the potential for psychopathologic/cognitive AEs as well as other AEs associated with cannabinoids. Sativex oromucosal cannabinoid spray is not US Food and Drug Administration (FDA) approved and is not available in the United States. In the United States, caution should be exercised with regard to the extrapolation of the results of trials of standardized OCEs (which are not commercially available) Slide 44 to other, nonstandardized and nonregulated, cannabis extracts (which may be commercially available in states with medical marijuana laws).
45 More unique problems MJ is added to other neurotoxic medications for pain and spasticity Patients with CNS disease may already be cognitively impaired MJ acts on hepatic enzymes to interfere with levels of other medications, especially pain meds Slide 45
46 Recreational Use different THC content has gone much higher than past, and hard to know. Edible products have delayed onset so can ingest too much while waiting to feel effect Synthetic marijuana extremely potent, floods many receptors, associated with stroke, seizures, aggressive psychosis, 4 deaths Schneir J Med Tox :62-64 Zawiska JB I J Neuropsychopharm : Castaneto 2015 Drug Alc Depend epub
47 Harlem Hospital experience In 4 months there were 9 patients with seizures (7, 4 with history of epilepsy but long seizure-free interval) psychosis (1) stroke (1) or encephalopathy due to K2
48 Public Health Campaign
Research on Cannabis and PD: Is there any evidence?
Research on Cannabis and PD: Is there any evidence? Benzi M. Kluger, MD, MS Associate Professor of Neurology and Psychiatry Director Movement Disorders Center University of Colorado Denver DISCLOSURES
More informationCannabis in the Treatment of Dystonia, Dyskinesias, and Tics
Neurotherapeutics (2015) 12:788 792 DOI 10.1007/s13311-015-0376-4 REVIEW Cannabis in the Treatment of Dystonia, Dyskinesias, and Tics Barbara S. Koppel 1 Published online: 14 August 2015 # The American
More informationMedical Marijuana Martin P. Eason MD, JD Associate Chief of Staff for Education Mountain Home VA Medical Center. Disclosure.
Medical Marijuana Martin P. Eason MD, JD Associate Chief of Staff for Education Mountain Home VA Medical Center Controversies in Pain Management Conference Johnson City, TN November 13, 2015 Disclosure
More information9/13/2017. Marijuana and the Brain Matthew Wong, MD Assistant Professor, Department of Neurology, Epilepsy Section. Disclosures.
Marijuana and the Brain Matthew Wong, MD Assistant Professor, Department of Neurology, Epilepsy Section Disclosures Site principal investigator of studies of cannabidiol(epidiolex) in the treatment of
More informationCannabidiol as a potential treatment for anxiety disorders. Esther Blessing, MD PhD
Cannabidiol as a potential treatment for anxiety disorders Esther Blessing, MD PhD Overview History and of cannabidiol (CBD) and cannabis Safety and tolerability of CBD CBD pharmacology Clinical need for
More informationCurious about Cannabis? Navigating the cannabis landscape in Pennsylvania LINDSEY MESTON, PHARMD ASHLEY FIRM, PHARMD
Curious about Cannabis? Navigating the cannabis landscape in Pennsylvania LINDSEY MESTON, PHARMD ASHLEY FIRM, PHARMD Speaker Disclosures We have/had no financial relationships with any commercial interests
More informationThe Effects known & unknown of Marijuana in Older Adults. Danielle Fixen, PharmD, BCGP, BCPS University of Colorado School of Pharmacy
The Effects known & unknown of Marijuana in Older Adults Danielle Fixen, PharmD, BCGP, BCPS University of Colorado School of Pharmacy Learning Objectives 1. Review various dosing strategies for medical
More informationMedical Marijuana. 1. is a plant species, variety known as hemp. 3. Tetrahydrocannabinol is an aromatic with low water solubility.
Medical Marijuana Questions from Part 1: 1. is a plant species, variety known as hemp. a. Cannabis sativa Linnaeus b. Cannabis sativa c. Cannabis indica d. Cannabis Lemark 2. The major psychoactive compound
More informationMEDICAL MARIJUANA: WHAT S THE EVIDENCE?
MEDICAL MARIJUANA: WHAT S THE EVIDENCE? L A U R A A. M A R K L E Y, M D B O A R D - C E R T I F I E D I N P E D I A T R I C S / G E N E R A L P S Y C H I A T R Y / C H I L D & A D O L E S C E N T P S Y
More informationLearning Objectives 1/8/2019. Therapeutic Potential of the Marijuana-Derived Cannabinoids THC and CBD. Disclosures. Outline. Take home messages
Therapeutic Potential of the Marijuana-Derived Cannabinoids THC and CBD CECILIA HILLARD, PHD DEPARTMENT OF PHARMACOLOGY NEUROSCIENCE RESEARCH CENTER Disclosures Member of the Scientific Advisory Board
More informationFederal Law: Marijuana
Federal Law: Marijuana Marijuana is a Schedule I drug under Federal Controlled Substances Act Makes possession, usage, purchase, sale, and/or cultivation of marijuana illegal at the federal level May not
More informationCANNABIS FOR THE RHEUMATOLOGIST
CANNABIS FOR THE RHEUMATOLOGIST Dr Jagtar Singh Nijjar NIHR Clinical Lecturer in Rheumatology Disclosures None 1 Overview The history of cannabis use Anecdotal use of cannabis in chronic pain The biology
More informationJames McCormack BSc (Pharm), PharmD Professor Faculty of Pharmaceutical Sciences University of British Columbia Vancouver, BC, Canada
James McCormack BSc (Pharm), PharmD Professor Faculty of Pharmaceutical Sciences University of British Columbia Vancouver, BC, Canada My Agenda Discuss the best available evidence Put the evidence into
More informationCannabinoids and Mental Health
Cannabinoids and Mental Health https://upload.wikimedia.org/wikipedia/commons Karen M. Lounsbury, PhD Professor of Pharmacology 802-656-3231, Karen.lounsbury@uvm.edu Objectives Describe the underlying
More informationCOMPLEMENTARY AND ALTERNATIVE MEDICINE
COMPLEMENTARY AND ALTERNATIVE MEDICINE Allen C. Bowling, MD PhD Colorado Neurological Institute (CNI) Conflict/Disclosure Information Research, consulting, advising, speaking services Acorda, American
More informationADVANCED CLINICAL CANNABINOID PROVIDER EXAM ACCP
ADVANCED CLINICAL CANNABINOID PROVIDER EXAM ACCP Page 1 1. In what year did the possession and transfer of cannabis for recreational use become illegal in the United States? A. 1937 B. 1941 C. 1933 2.
More informationMarijuana and Adolescents: Truth and Consequences. Disclosure Statement OBJECTIVES. Secondary Objectives. State of Marijuana in US
Marijuana and Adolescents: Truth and Consequences Clinical Advances in Pediatrics Symposium Children s Mercy Park September 28, 2017 Disclosure Statement I have no actual or potential conflict of interest
More informationA look at Marijuana in 2014
A look at Marijuana in 2014 Paul Snyder MA., LADC Overview and Objectives Discuss the mental and physical effects of marijuana use Describe the criteria for Cannabis use disorder according to the DSM 5
More informationMedical Cannabis. Danial Schecter, MD, CCFP. Vocational Rehabilitation Association November 7th, Executive Director Cannabinoid Medical Clinic
Medical Cannabis Danial Schecter, MD, CCFP Executive Director Cannabinoid Medical Clinic Vocational Rehabilitation Association November 7th, 2014 Conflict of Interest This program has not received financial
More informationMedical vs Recreational Use of Cannabis. 11 th December 2017
1 Medical vs Recreational Use of Cannabis 11 th December 2017 2 Defining Cannabis and Chemical Constituents Cannabis is a plant species. Two main Cannabis sub-species are Cannabis Sativa and Cannabis Indica.
More informationI would like to begin by acknowledging that we are on the ancestral grounds of the Beothuk people
I would like to begin by acknowledging that we are on the ancestral grounds of the Beothuk people Introduction to the Cannabinoid System And Medical Use Dr Alia Norman Radiation Oncologist Cannabinoid
More informationMedical Marijuana A Primer for Pharmacists
Medical Marijuana A Primer for Pharmacists Emory S. Martin, PharmD FASHP Texas Society of Health System Pharmacists Learning Objectives Recognize key components of the endocannabinoid system Identify possible
More informationThe research studies in the table below were each evaluated using the GRADE scale (Cochrane Methods Bias, n.d.; What
Appendix B Quality Research, Evidence of Effectiveness of Medical Cannabis The research studies in the table below were each evaluated using the GRADE scale (Cochrane Methods Bias, n.d.; What is GRADE?,
More informationMedicinal cannabis use among PLWH in the era of legalization
Medicinal cannabis use among PLWH in the era of legalization June 8, 2017 David Grelotti, MD Assistant Professor University of California, San Diego Center for Medicinal Cannabis Research Outline Overview
More informationMedical Cannabis MATT WEBSTER DO, MS
Medical Cannabis MATT WEBSTER DO, MS Cannabis Sativa One of the oldest used drugs and medicinal remedies Most commonly abused illicit drug in the US There has been increasing access for medicinal MJ use
More informationEndocannabinoid System Cannabinoid Drugs
Cannabinoid Drugs STCM Conference Bern 22.1.2013 Rudolf Brenneisen University of Bern, DKF 1 www.phytopharm.dkf.unibe.ch rudolf.brenneisen@dkf.unibe.ch Milestones 1988: First cannabinoid receptor (rat
More informationMarilyn is a 68 year old woman with breast cancer metastatic to the lungs and the thoracic and lumbar spine.
Alan M. Ehrlich MD Assistant Professor in Family Medicine University of Massachusetts Medical School June 18, 2014 Marilyn is a 68 year old woman with breast cancer metastatic to the lungs and the thoracic
More informationThe Scientific Side of Medical Marijuana
The Scientific Side of Medical Marijuana Ken Mackie, MD Indiana University Bloomington, IN December 3, 2009 kmackie@indiana.edu Financial disclosures NIH (NIDA) - research grants Alzheimer s Association
More informationA summary of reviews of evidence on the efficacy and safety of medical use of cannabis and cannabinoids
A summary of reviews of evidence on the efficacy and safety of medical use of cannabis and cannabinoids Background paper commissioned by the EMCDDA for the report Medical use of cannabis and cannabinoids:
More informationMedical Marijuana Consent Form
Medical Marijuana Consent Form A qualified physician may not delegate the responsibility of obtaining written informed consent to another person. The qualified patient or the patient s parent or legal
More informationMedical Cannabinoids for the Management of Chronic Noncancer Pain
Medical Cannabinoids for the Management of Chronic Noncancer Pain Dr Mark A. Ware MBBS MSc McGill University 12 June 2018 Disclosures Grants: CanniMed Consulting: CHI Inc Emmes 1 Canadian Consortium for
More informationCDHA 2016 Fall Symposium. Speaker Handout Files. For registered attendees only
CDHA 2016 Fall Symposium Speaker Handout Files For registered attendees only Providing Care in a Marijuana Legal World Heather Rogers, BSDH heatherrdh@heatherrdh.com Objectives We will discuss some of
More informationThe Return of Medicinal Cannabis
The Return of Medicinal Cannabis George Kolodner, M.D. DLFAPA FASAM Chief Clinical Officer Clinical Professor of Psychiatry Georgetown University School of Medicine University of Maryland School of Medicine
More informationCannabis. Member of the Cannabaceae family of flowering plants (along with hops) Cannabis sativa (v. sativa, indica, afghanica, ruderalis)
Member of the Cannabaceae family of flowering plants (along with hops) sativa (v. sativa, indica, afghanica, ruderalis) Only females flowers contain high concentrations of psychoactive oils (cannabinoids)
More informationBudding Therapies: Medical Cannabis and its Uses
Budding Therapies: Medical Cannabis and its Uses MARIAH CADAVOS, PHARMD & VIVIAN NGUYEN, PHARMD PGY1 PHARMACY PRACTICE RESIDENTS FEBRUARY 10, 2019 1 Disclosures & Disclaimer Both presenters have nothing
More informationMedical Use of Cannabinoids in Palliative Care
Multiple Sclerosis (Canada) http://www.youtube.com/watch?v=b8_5ebsjk8i Medical Use of Cannabinoids in Palliative Care Craig D. Blinderman, MD, MA Director, Adult Palliative Medicine Service Associate Professor
More informationAct 16 and Medical Cannabis in Pennsylvania
Act 16 and Medical Cannabis in Pennsylvania Charles V. Pollack, Jr., MA, MD, FACEP, FAAEM, FAHA, FESC, FCPP Associate Provost and Professor of Emergency Medicine Director, Institute of Emerging Health
More informationMedical Cannabis. Christine Yoshioka, NP
Medical Cannabis Christine Yoshioka, NP Objectives Brief history of Cannabis in cultures Review of the Endocanabinoid system Exogenous cannabis Medical research involving cannabis and federal restrictions
More informationCANNABIDIOL (CBD) THE BE ALL END ALL?
CANNABIDIOL (CBD) THE BE ALL END ALL? John Schaeffer, DO PMG neurology specialists Clinical associate professor Department of neurology University of Washington school of medicine CANNABIS BRIEF HISTORY
More informationUse of Cannabinoids in Medical Practice
Use of Cannabinoids in Medical Practice Annual Scientific Assembly Family Medicine Review 2016 Murray Opdahl BSPE, MD, CCFP Objectives Briefly present: An overview of available cannabinoids Concerns voiced
More informationDoc, will you sign my medical. Fellow in Hematology/Medical Oncology General Internal Medicine Grand Rounds
Doc, will you sign my medical marijuana card? Daniel W. Bowles, MD Fellow in Hematology/Medical Oncology General Internal Medicine i Grand Rounds September 21, 2010 Disclosures Skeptical about marijuana
More informationDurban Poison (Pure Indica) Hindu Kush (Pure Sativa) Northern Lights (Ruderalis-Indica Hybrid) Royal Dwarf (Ruderalis-Sativa Hybrid) 11 Adapted from Figure 1. The endocannabinoid System in the Nervous
More informationMedical Marijuana: Friend or Foe?
Medical Marijuana: Friend or Foe? Timothy E. Wilens MD Director, Center for Addiction Medicine Chief, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital Harvard Medical School
More informationMedicinal Marijuana: The Canadian Journey
Medicinal Marijuana: The Canadian Journey Nady el-guebaly MD Professor & Head, Addiction Division, UofC Research Director, Alberta Gambling Research Institute Chief Examiner, ISAM Certification Disclosures:
More information4/15/2019. US States with Marijuana Laws in Have ACOG and SMFM taken notice? THE EFFECTS OF MARIJUANA USE ON PREGNANCY AND LACTATION
THE EFFECTS OF MARIJUANA USE ON PREGNANCY AND LACTATION Susan R Davidson, MD Maternal Fetal Medicine Department of Ob/Gyn St. Mary s Hospital Madison, WI SSM Health I HAVE NO FINANCIAL DISCLOSURES TO REPORT
More informationReport of the Guideline Development Subcommittee of the American Academy of Neurology
SPECIAL ARTICLE Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders Report of the Guideline Development Subcommittee of the American Academy of Neurology Barbara
More informationCBD and Your Health.
CBD and Your Health. Cannabidiol (CBD) is a molecule found in plant species such as agricultural (or industrial) hemp, and Echinacea. CBD is one of at least 489 distinct compounds within hemp: it is clear
More informationJuly 15 TH, ANDREW MEDVEDOVSKY, M.D. Board Certified Neurologist & Pain Medicine Specialist Director New Jersey Alternative Medicine
MEDICAL CANNABIS FOR NEUROLOGICAL DISEASES July 15 TH, 2017 ANDREW MEDVEDOVSKY, M.D. Board Certified Neurologist & Pain Medicine Specialist Director New Jersey Alternative Medicine GOALS AND OBJECTIVES
More informationMedical Marijuana: Friend or Foe?
Medical Marijuana: Friend or Foe? Timothy E. Wilens MD Director, Center for Addiction Medicine Chief, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital Harvard Medical School
More informationThe Shifting Federal Regulation of Cannabis Products
The Durham Bar 2019 CLE Program The Shifting Federal Regulation of Cannabis Products Erica M. Jackson, FDA Partner K&L Gates February 6, 2019 Copyright 2018 by K&L Gates LLP. All rights reserved. OVERVIEW
More informationInvestigational Pharmacy Cannabidiol treatment in Epilepsy
Jon Beck BS Pharm D Coordinator Investigational Pharmacy Disclosure I have no relevant financial relationships with a Commercial Provider Nebraska Medicine Omaha, NE Investigational Pharmacy Cannabidiol
More informationAlan Ehrlich MD 2015 Primary Care Summit May 2, 2015
Alan Ehrlich MD 2015 Primary Care Summit May 2, 2015 Marilyn is a 68-year-old woman with breast cancer metastatic to the lungs and the thoracic and lumbar spine. She is currently undergoing chemotherapy
More informationThe Endocannabinoid System
The Endocannabinoid System Think of this system as the wizard behind the curtain. It underlies all the other systems, including the Autonomic Nervous System. Overall it influences well-being and the perception
More informationMedical Marijuana. Navigating Medical Marijuana in Workers Compensation
Medical Marijuana Navigating Medical Marijuana in Workers Compensation Agenda Federal and State Laws Public Health Adverse Effects & Concerns Clinical Use Implications for Employers Implications for Workers
More informationSlide 1 Is Marijuana Medicine?
Slide 1 Is Marijuana Medicine? Perspectives, Potentials, & Problems Allan Barger, MSW PRI Research Analyst www.primeforlife.org Slide 2 Presentation Goals Define terms Identify and explain the human endocannabinoid
More informationAcknowledgements: What it is What it s not. Cannabis Evidence Series. Evidence-informed decision-making
Cannabis Evidence Series What it is What it s not Acknowledgements: The evidence presented is from the Cannabis evidence series authored by the HTA unit at the University of Calgary and from Rapid response
More informationDr. G. Michael (Michael) Allan EDMONTON AB Dr. Christina (Tina) S. Korownyk EDMONTON AB MEDICAL CANNABANOIDS IN PRIMARY CARE
Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR APRIL 12-14, 2018 262 Dr. G. Michael (Michael) Allan EDMONTON AB Dr. Christina (Tina)
More informationMarijuana and the Chronic Non-Cancer Pain Patient
Marijuana and the Chronic Non-Cancer Pain Patient Kevin P. Hill, M.D., M.H.S. Pain 101: Provider Workshop 9/23/16 McLean Hospital Division of Alcohol and Drug Abuse khill@mclean.harvard.edu DrKevinHill.com,
More informationSteven G. Kinsey, PhD Associate Professor, Department of Psychology West Virginia University
Steven G. Kinsey, PhD Associate Professor, Department of Psychology West Virginia University sgkinsey@mail.wvu.edu Any opinions expressed are my own and do not reflect any official position of WVU beanpot.co
More informationVirtual Lectures Planning Committee Disclosure Summary
VIRTUAL LECTURES THE ROLL OF MEDICAL CANNABIS: IS IT TIME TO BURN ONE DOWN? MFMER Virtual Lectures Planning Committee Disclosure Summary As a provider accredited by ACCME, College of Medicine, Mayo Clinic
More informationCannabinoids (CB): Outline. CB: Epidemiology. CB: Categorization. CB: Pharmacodynamics. Part #1: Cannabinoid (CB) Primer.
Cannabinoids (CB): Outline 1 2 PART #1: CB Primer Epidemiology Categorization: Endogenous vs. exogenous Natural vs. synthetic Pharmacodynamics (PD) Pharmacokinetics (PK) CB receptor system CNS regional
More informationFrom Opioid Replacement to Managing Chronic Pain: What is CBD?
From Opioid Replacement to Managing Chronic Pain: What is CBD? Kalev Freeman, MD PhD Assistant Professor of Surgery and Pharmacology, University of Vermont Laura Mann Integrative Healthcare Lecture Series
More informationClinical Policy Title: Botanical marijuana for medical use
Clinical Policy Title: Botanical marijuana for medical use Clinical Policy Number: 00.02.10 Effective Date: January 1, 2015 Initial Review Date: August 20, 2014 Most Recent Review Date: October 19, 2017
More information9/28/2015. Support. R01CA A1 Intervening with smoking parents of inpatients to reduce
Medical marijuana and the impact of marijuana policy on children Karen M. Wilson, MD, MPH, FAAP Associate Professor of Pediatrics Section Head, Pediatric Hospital Medicine University of Colorado School
More informationCannabis Use Disorder: What Nurses Need to Know. Bari K Platter, MS, RN, PMHCNS-BC Clinical Nurse Specialist
Cannabis Use Disorder: What Nurses Need to Know Bari K Platter, MS, RN, PMHCNS-BC Clinical Nurse Specialist MARIJUANA POTENCY Average THC and CBD Levels in the U.S. 1960-2011 14 12 10 8 6 4 THC: Psychoactive
More informationWHO Expert Committee on Drug Dependence Pre-Review: Cannabis plant and resin. Expert Peer Review 2
WHO Expert Committee on Drug Dependence Pre-Review: Cannabis plant and resin Expert Peer Review 2 1. Comments based on the review report a. Evidence on dependence and abuse potential Dependence potential:
More informationUse of Medical Marijuana in Cancer Treatment & Care
Use of Medical Marijuana in Cancer Treatment & Care Ronald Stram,MD Stram Center for Integrative Medicine April 2016 Introduction Board Certified Medical Doctor, Integrative and Functional Medicine 28
More informationMedicinal cannabis. What is medicinal cannabis? What are cannabinoids? The endocannabinoid system
Medicinal cannabis What is medicinal cannabis? Broadly speaking, medicinal cannabis is cannabis prescribed to relieve the symptoms of a medical condition, such as epilepsy. It is important to make the
More informationMARIJUANA in MEDICAL CARE READY or RISKY. HINDI MERMELSTEIN, MD FAPM Beth Israel Medical Center, NYC Dec
MARIJUANA in MEDICAL CARE READY or RISKY HINDI MERMELSTEIN, MD FAPM drhmermelstein @optimum.net Beth Israel Medical Center, NYC Dec 11 2015 HISTORY MARIJUANA (CANNABIS SAVITA) HAS LONG BEEN PART OF RELIGIOUS
More informationObjectives. 1. Review controversy 2. Pathophysiology 3. Indications for Use 4. Adverse Effects 5. How Patients Access
Medical Marijuana Deb Evans, RN, MScN, CON(C), CHPCN(C) Clinical Nurse Specialist Pain and Symptom Management Team Juravinski Cancer Centre May 29, 2014 Objectives 1. Review controversy 2. Pathophysiology
More informationTHE COMPLETE CBD GUIDE
THE COMPLETE CBD GUIDE WHAT IS CBD (CANNABIDIOL)? 2 WHERE DOES CBD COME FROM? 3 HOW DOES CBD WORK IN THE BODY? 4 HOW MUCH CBD DO I TAKE? 5-6 CBD OIL VS. HEMP OIL 7 CBD NOT THC 8 THE BENEFITS OF CBD 9 PETS
More informationLegalized Marijuana: Uses, Misuses & Abuses. Disclosures. Objectives. Kennon Heard University of Colorado SOM Dept Of Emergency Medicine
Legalized Marijuana: Uses, Misuses & Abuses Kennon Heard University of Colorado SOM Dept Of Emergency Medicine Disclosures Research grants McNeil Consumer Healthcare (Acetaminophen) Rare Disease Therapeutics
More informationMedical Marijuana A Brief Overview of the Program in Ohio and Pharmacology of Cannabinoids
Medical Marijuana A Brief Overview of the Program in Ohio and Pharmacology of Cannabinoids Stephanie Abel, PharmD, BCPS Palliative Medicine Clinical Pharmacy Specialist James Cancer Hospital The Ohio State
More informationMedical Marijuana A Brief Overview of the Program in Ohio and Pharmacology of Cannabinoids
Medical Marijuana A Brief Overview of the Program in Ohio and Pharmacology of Cannabinoids Stephanie Abel, PharmD, BCPS Palliative Medicine Clinical Pharmacy Specialist James Cancer Hospital The Ohio State
More informationReefer Madness version 3.0*
Reefer Madness version 3.0* Presenter Disclosure *Original Reefer Madness: FMF 2014 by R. Dubin, Sharon Cirone and Mel Kahan Update on Health Canada s MMPR and the use of cannabis for medical conditions
More informationMedical Marijuana Update Chris Belletieri, DO
Dr. Belletieri has provided no disclosures. Graduated PCOM in 1996 In private practice since 1999 Board Certified in FP since 1999 Program Director of FP residency at Lower Bucks Hospital in Bristol, PA
More informationClinical Education Initiative MEDICAL MARIJUANA 101. Speaker: Patricia Reed, PharmD
Clinical Education Initiative Support@ceitraining.org MEDICAL MARIJUANA 101 Speaker: Patricia Reed, PharmD 8/2/2017 Medical Marijuana 101 [video transcript] 00:00:12 - So we'll get started. Disclosures
More informationCannabinoids for the Treatment of Movement Disorders. Catherine O Neill, BA and Juan Sanchez-Ramos, MD
Cannabinoids for the Treatment of Movement Disorders Catherine O Neill, BA and Juan Sanchez-Ramos, MD History Cannabis has been used to treat a wide range of medical conditions by many cultures for thousands
More informationMedical Marijuana. Medicalization of Marijuana. Objectives. Disclosure. Objectives. US FDA Drug Approval Process
Objectives Medicalization of Marijuana Joe Spillane Pharm.D., DABAT This is not about recreational marijuana. This is not about the Florida Governor election. This is not about politics at all.. This is
More informationThe subject of marijuana in medical discourse has long
Medical Marijuana: Composition, Neurological Benefits, And Adverse Events This second in a two-part feature series on marijuana addresses the potential benefits of medical marijuana in neurology and considers
More informationMedical Marijuana Myths and Realities
Medical Marijuana Myths and Realities Herbert D. Kleber, M.D. Professor of Psychiatry Director, Division on Substance Abuse Columbia University/NYSPI October 8, 2013 THS 2013 Biarritz Introduction Marijuana
More informationHistory of Medical Cannabis in Nursing
History of Medical Cannabis in Nursing Kristen Luttenberger RN, MSN, CCRN, APNc http://marijuanapolitics.com/wp-content/uploads/2016/07/caduceus-lg.jpg https://images-na.ssl-imagesamazon.com/images/i/41gtt5pb4el._sx314_bo1,204,203,200_.jpg
More informationCANNABIS AND CANNABINOIDS: 2017 REPORT, U.S. NATIONAL ACADEMIES OF SCIENCES, ENGINEERING AND MEDICINE
1 CANNABIS AND CANNABINOIDS: 2017 REPORT, U.S. NATIONAL ACADEMIES OF SCIENCES, ENGINEERING AND MEDICINE The Health Effects of Cannabis and Cannabinoids. The Current State of Evidence and Recommendations
More informationMedical Marijuana in the Workforce. What This Is...And What It Isn t
Medical Marijuana in the Workforce Recommendations for the Occupational Physician Robert S. Goldsmith, M.D., M.P.H. June, 2014 What This Is...And What It Isn t IS: Historical context Legal and social context
More informationIs there a role for medical marijuana in the management of IBD? Jami A. Kinnucan, MD Division of Gastroenterology University of Michigan Hospital
Is there a role for medical marijuana in the management of IBD? Jami A. Kinnucan, MD Division of Gastroenterology University of Michigan Hospital Disclosures No relevant financial or relationship disclosures
More informationCannabinoids: access and symptom management in cancer
Cannabinoids: access and symptom management in cancer Appetite stimulation Anecdotal reports suggest marijuana stimulates appetite AIDS/HIV dronabinol 2.5 mg bd v placebo (n=88) increase in appetite 38%
More informationMedical Marijuana for Pain How Does Cannabis Work on Your Body?
Medical Marijuana for Pain How Does Cannabis Work on Your Body? Jeremy Spiegel, MD Medical Director - Casco Bay Medical Westbury, Long Island, New York Intro Brief History of Cannabis Physiology of Cannabis
More informationMedical Marijuana. Speaker Disclosure Requirements. Share with a Partner 4/10/2015
Medical Marijuana Kent W. Peterson, MD, FACOEM Occupational Health Strategies, Inc. Charlottesville, VA Speaker Disclosure Requirements 1. Do not dispense, prescribe, refer or recommend MMJ 2. Have no
More informationCANNABIS AND PAIN. Debra Kimless, M.D. Medical Director, ForwardGro MAOP Annual Meeting September 14, 2018
CANNABIS AND PAIN Debra Kimless, M.D. Medical Director, ForwardGro MAOP Annual Meeting September 14, 2018 FDA APPROVAL: PREGABALIN, DULOXETINE, MILNACIPRAN FOR FIBROMYALGIA PREGABALIN, DULOXETINE FOR
More informationWHO Expert Committee on Drug Dependence Pre-Review: Extracts and tinctures of cannabis. Expert Peer Review 2
WHO Expert Committee on Drug Dependence Pre-Review: Extracts and tinctures of cannabis Expert Peer Review 2 1. Comments based on the review report a. Evidence on dependence and abuse potential Extracts
More informationCannabis and the Endocannabinoid System
Cannabis and the Endocannabinoid System September 7, 2018 Bangkok, Thailand David Bearman, MD Goleta, California Executive VP, American Academy of Cannabinoid Medicine AACMSITE.org Shen Nung Ping
More informationMedical Cannabis In the Care of the Elderly
Medical Cannabis In the Care of the Elderly April 19, 2018 Canadian Geriatrics Society Annual Scientific Meeting Michael A. Dworkind MDCM. CCFP. FCFP. Associate Professor Family Medicine and Palliative
More informationUSING ALTERNATIVE MEDICATION: MEDICAL CANNABIS (MARIJUANA)--BENEFITS AND HARMFUL EFFECTS JENNIFER KAPUR, PHARM.D. MARCH 1, 2016
USING ALTERNATIVE MEDICATION: MEDICAL CANNABIS (MARIJUANA)--BENEFITS AND HARMFUL EFFECTS JENNIFER KAPUR, PHARM.D. MARCH 1, 2016 OBJECTIVES Compare and contrast federal law and state laws regarding marijuana
More informationOXZGEN FAQ s What is the Endocannabinoid System? What are cannabinoids? What is CBD oil?
OXZGEN FAQ s What is the Endocannabinoid System? Discovered only a few decades ago, the endocannabinoid system (ECS) is one of the most important physiological systems in our body. It consists of a group
More informationResearch: Medical Cannabis
Research: Medical Cannabis Background The hemp plant Cannabis sativa (cannabis) is commonly known as marijuana and can be used as a therapy to alleviate symptoms such as pain and fatigue caused by chronic
More informationMEDICAL CANNABIS PATIENT COUNSELING. Krissy Bernazani, RPh Clinical Director Zen Leaf
MEDICAL CANNABIS PATIENT COUNSELING Krissy Bernazani, RPh Clinical Director Zen Leaf DISCLOSURE Krissy Bernazani is a paid employee of Freestate Wellness, dba Zen Leaf Maryland, a medical cannabis dispensary.
More informationAllegiance Wellness Center
Allegiance Wellness Center San Diego Pain Management Center Point Loma Parkinson s Disease Support Group!! The medical benefits of Cannabis!! Bert Telles! Ph: 858-414-4271! October 2, 2013 Disclaimer:
More informationMEDICAL CANNABIS IN MINNESOTA
MEDICAL CANNABIS IN MINNESOTA MINNESOTA ACADEMY OF PHYSICIAN ASSISTANTS MARCH 18, 2016 TOM ARNESON, MD, MPH MDH OFFICE OF MEDICAL CANNABIS 2014: Minnesota becomes 22 nd state with a medical cannabis program
More informationClinical Policy Title: Botanical marijuana for medical use
Clinical Policy Title: Botanical marijuana for medical use Clinical Policy Number: 00.02.10 Effective Date: January 1, 2015 Initial Review Date: August 20, 2014 Most Recent Review Date: October 13, 2015
More information