1 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 November 8, 2017
2 University of Vermont Health Network DISCLOSURSE: Is there anything to disclose? Yes Please list the Potential Conflict of Interest (if applicable): Vermont Patients Alliance, PhytoScience Institute, Green State Gardener All Potential Conflicts of Interest have been resolved prior to the start of this program. Yes (If no, credit will not be awarded for this activity.) All recommendations involving clinical medicine made during this talk were based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. Yes This lecture will discuss use of investigational drugs not approved for use in the United States.
3 Learning objectives 1. According to the Cannabinoids for Medical Use: A Systematic Review and Meta-analysis published in JAMA 2015, there is evidence supporting therapeutic use of cannabinoids for 6 medical conditions. We will discuss the evidence basis for cannabinoids in these conditions. We will also discuss emerging evidence for CBD in pediatric epilepsy. 2. The systematic review and meta-analysis also showed that adverse events with cannabis use were significantly higher than placebo. We will review the odds of experiencing adverse events, and the most common events which occurred, after medical use of cannabinoids. 3. We will discuss the potency and quality of medical cannabis, specifically considering hemp-derived CBD products currently available in Vermont and on the internet.
7 Indian hemp In almost all painful maladies I have found Indian hemp by far the most useful of drugs. The bane of many opiates and sedatives is this, that the relief of the moment, the hour, or the day, is purchased at the expense of tomorrow's misery. In no one case to which I have administered Indian hemp, have I witnessed any such results. - Sir John Russell Reynolds, The Lancet, 1890 Sir John Russell Reynolds, British neurologist, president of the Royal College of Physicians, house physician to Queen Victoria. Digital Library- Yale University Greg Miller. Pot and pain. Science 04 Nov 2016: Vol. 354, Issue 6312, pp DOI: /science
8 Hemp Farm, Hardwick VT Courtesy of Green Mountain CBD
9 Endocannabinoid system Cannabis contains phytocannabinoids which act on the endocannabinoid (ecb) system The ecb system consists of: cannabinoid receptors (CBs) endogenous agonists (endocannabinoids) agonist-metabolizing enzymes Slide content contributed by Dr. John McPartland, UVM COM
10 Cannabinoid Receptors: CB 1 and CB 2 CB 1 is primarily expressed in neurons CB 1 is found in adipose tissue, blood vessels, gut, testes, uterus CB 1 is not found in the brainstem s cardiorespiratory drive centers which explains the lack of lethal overdoses from cannabis Unlike opioid receptor distribution Autoradiograph of rat brain exposed to [ 3 H]CP55,940 (Herkenham et al., 1990). = highest densities in memory centers, limbic system, basal ganglia, cerebellum = lower densities in cerebral cortex = lowest densities in the brain stem CB 2 is primarily expressed in the immune system Slide content contributed by Dr. John McPartland, UVM COM
11 Cannabidiol (CBD) CBD is the primary naturally-occurring medical compound in hemp and hemp oil CBD oils are now widely available in Vermont and on the internet It is a cannabinoid -- like THC but mechanism of action and clinical effects are markedly different There is mounting evidence supporting anti-epileptic use of cannabis-derived extracts containing CBD CBD alone is used for chronic pain, insomnia, muscle relaxant, and as a health supplement
12 Cannabidiol (CBD) activates nonendocannabinoid receptors TRPV1 is found in neurons TRPV1 involved in pain signal pathways Activity decreased with overactivity (desensitization), leading to analgesic effects Iannotti, F.A. et al., Chem Neurosci. 5(11): doi: /cn
13 GW pharmaceuticals phase 3 trials Sativex (CBD:THC sublingual spray) trials have provided evidence for therapeutic benefit in cancer pain
15 Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain May;13(5):
16 Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain May;13(5):
17 Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain May;13(5):
18 Best results with 4 sprays per day (10mg THC / 10 mg CBD) Higher doses were not well-tolerated more adverse events higher drop-out rates. Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain May;13(5):
19 Best odds of achieving 30% improvement in pain with Nabiximols (1-4 Sprays) but this was not statistically significant. In absolute terms, treatment with Nabiximols achieved a 26% improvement in pain. Reduction in daily average pain Reduction in mean worst pain Reduction in sleep disruption Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain May;13(5):
20 Meta-analysis provides compilation of data from randomized clinical trials (RCTs) comparing cannabinoids to placebo for chronic pain and other conditions. Also provides best available information about potential for adverse events (AEs) with cannabis . Moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. Low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV, sleep disorders, and Tourette syndrome. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis.JAMA Jun 23-30;313(24):
21 Includes 28 studies of chronic pain (63 reports, 2454 individual participants) Interventions including smoked cannabis flower, synthetic THC (Nabilone) and sublingual THC / CBD mix (Nabiximols) compared to placebo. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis.JAMA Jun 23-30;313(24):
22 Moderate quality evidence that cannabis-based medicine reduces pain Cannabinoids for Medical Use: A Systematic Review and Meta-analysis.JAMA Jun 23-30;313(24):
23 Summary Estimates of Adverse Events (AEs) Meta-analysis provides a pooled analysis for adverse events (AE) associated with medical trials using cannabinoids. Results: cannabinoids were associated with approximately 3x increased odds of any AE compared to placebo. Odds of most common AEs, relative to placebo: Dizziness (5x) Disorientation (5x) Confusion (4x) Drowsiness (4x) Euphoria (4x) Dry Mouth (3x) Somnolence (3x) Asthenia (2x) Anxiety (2x) Balance (2x) Hallucination (2x) Paranoia (2x) Cannabinoids for Medical Use: A Systematic Review and Meta-analysis.JAMA Jun 23-30;313(24):
24 States with medical Cannabis laws have significantly lower state-level opioid overdose mortality rates A time-series analysis was conducted of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included. Results showed states with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, 37.5% to 9.5%; P =.003) compared with states without medical cannabis laws. The association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law strengthened over time Mean Age-Adjusted Opioid Analgesic Overdose Death Rate. States with medical cannabis laws compared with states without such laws in the United States, Association Between Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in Each Year After Implementation of Laws in the United States, Point estimate of the mean difference in the opioid analgesic overdose mortality rate in states with medical cannabis laws compared with states without such laws; whiskers indicate 95% CIs. Bachhuber MA et al. Medical cannabis laws and opioid analgesic overdose mortality in the United States, JAMA Intern Med Oct;174(10):
25 Substitution of cannabis for opioids in chronic pain Online survey of 244 medical cannabis patients with chronic pain to examine whether medical cannabis changed individual patterns of opioid use N=184 analyzed Found that cannabis was associated with Decrease in opioid use (65%) Decreases in other medications Improved quality of life (45%) Boehnke KF, et al. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. J Pain Jun;17(6): doi: /j.jpain PMID:
26 Cannabis as a substitute for opioids Opioids are ineffective for chronic pain and yet they are widely prescribed Chronic pain patients may successfully substitute cannabis for opioids and other drugs used for chronic pain Patients have improved side effect profile and benefits with cannabis-based medicine compared to other classes of medications 1. Boehnke KF, et al. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. J Pain Jun;17(6): doi: /j.jpain PMID:
27 Cannabidiol in treatment-resistant epilepsy Multicenter study of 10 centers treating children with CBD (average age 10.5 years) Total enrollment of 214 subjects Open-label (no placebo control or randomization) Patients received 99% pure oil-based CBD extract (Epidiolex, GW Pharmaceuticals, London, UK) in a 100 mg per ml sesame oil-based solution orally or by gastric tube. 2 5 mg/kg/day divided in twice-daily dosing added to baseline antiepileptic drug regimen, then up-titrated by 2 5 mg/kg once a week until intolerance or a maximum dose of 25 mg/kg/day was reached. Figure 1. Trial profile NCL=neuronal ceroid lipofucinosis. Devinsky O, et al. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol Mar;15(3): doi: /S (15) PMID:
28 Efficacy Among all subjects, the median frequency of motor seizures dropped from 30 0 per month (IQR ) at baseline to15 8 per month ( ) over the 12 week treatment period (Figure 2). For individual subject, the median reduction in monthly motor seizures was 36 5% (IQR ) (Figure 3). Figure 2. Monthly frequency of motor seizures in patients in the efficacy analysis group (n=137). Boxplots show median values, with 25th and 75th percentiles. The whiskers denote the 25th percentile 1 5 IQR and the 75th percentile IQR. Figure 3. Percentage change in monthly frequency of motor seizures in patients in the efficacy analysis group (n=137). Percentage changes for each patient are ordered from greatest increase to greatest decrease. The dashed boxes indicate patients who became free of that seizure type during the 12 week treatment period (blue) or the last 4 weeks of treatment (red). 1. Devinsky O, et al. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol Mar;15(3): doi: /S (15) PMID:
29 Safety Adverse events reported in 128 (79%) of 162 patients within the safety group. AEs that occurred in more than 10% of patients: somnolence (n=41 [25%]) decreased appetite (n=31 [19%]) diarrhea (n=31 [19%]) fatigue (n=21 [13%]) convulsion (n=18 [11%]) Five (3%) patients discontinued Serious AEs were reported in 48 (30%) patients, including one death a sudden unexpected death in epilepsy regarded as unrelated to study drug. 20 (12%) patients had severe adverse events possibly related to cannabidiol use. 1. Devinsky O, et al. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol Mar;15(3): doi: /S (15) PMID:
30 How does a patient in VT get CBD?
31 FDA and Dietary Supplements State medical cannabis programs provide CBD products Warnings and regulatory challenges with sales of CBD oil that do not actually contain CBD Dietary supplements cannot claim to treat, prevent or cure a disease. The FDA has granted Investigational New Drug status to CBD for GW Pharma s research program Because of this IND ruling, the FDA has concluded that cannabidiol products are excluded from the dietary supplement definition under section 201(ff)(3)(B)(ii) of the FD&C Act. Under that provision, if a substance (such as cannabidiol) has been authorized for investigation as a new drug for which substantial clinical investigations have been instituted and for which the existence of such investigations has been made public, then products containing that substance are outside the definition of a dietary supplement. CBD is not yet FDA approved as a drug; yet, it cannot be considered a dietary supplement, since it is currently being studied.
32 CBD products available in VT in 2017
33 Research Objective Previous studies have shown wide variability in dosing and accuracy of labeling in medical cannabis products . There is currently no state or federal oversight of the labeling or the composition of marketed products. The objective of this research was to examine the cannabinoid potency of CBD products available in Vermont and the accuracy of the dosage suggested on their product labels.  Vandrey R, et al. Cannabinoid Dose and Label Accuracy in Edible Medical Cannabis Products. JAMA. June 23/30, 2015 Volume 313, Number 24.
34 Methods Twenty-four CBD products were purchased in Vermont and tested for potency. Analysis of cannabinoid content performed using Investigator SFC system equipped with an auto injector (Waters Corp). Each sample was tested three times. Analytical results were compared to the product labels.
35 Results (1) (unpublished) Sample size: Out of 28 stores surveyed, 22 carried CBD products, 6 did not. A total (n) of 24 products were purchased from 11 stores, including 14 national brands and 10 Vermont brands. Delivery methods: Of 24 products, 7 were capsules, 11 were tinctures, 3 were cartridges, and 3 were concentrates. CBD presence in products: 24/24 products contained CBD or CBDa. Bioavailability of CBD: 24/24 products contained bioavailable CBD. Measurable CBDa, which is not bioavailable, was found in 13/24 products. 1/24 products was predominantly composed of CBDa. THC presence in products: Generally, THC levels were below 0.3%. 11/ 24 products had measurable THC. 1/24 products measured above 0.3%, at 0.8%.
36 Results (2) (unpublished) Accuracy of labels: 50% of products were labeled accurately (within 10% of the reported potency) 12/24 products were accurately labeled (test results were within 10% of CDB reported on label) 1/24 products were under labeled (test results were 10% more than CBD reported on label) 8/24 products were over labeled (test results were 10% less than CBD reported on label) 3/24 products were un-labeled
37 Conclusions CBD extracts in VT All products contained measurable CBD - but not all bioavailable and only 50% were accurately labeled. Delivery method appears to impact accuracy of the labeled dose. Capsules were the most accurate, followed by tinctures. Concentrates and cartridges were difficult to compare due to limited labeling. Tinctures with labels that recommended a dose of one full dropper or a single drop were more accurate than tinctures with labels that that recommended a multi-drop dose. National-brand labels were more accurate than Vermont-brand labels. Of the 14 national-brand products, 11 were labeled accurately, 3 were over-labeled, and 1 was under-labeled. Of the 10 Vermont-brand products, 1 product was labeled accurately, 9 were over-labeled, and 3 had no labels. Further research and testing is required to assess additional quality measures and safety of products. This study did not include analysis of pesticides, residual solvents, heavy metals, toxins, or microbes.
38 Labeling Accuracy of Cannabidiol Extracts Sold Online Eighty-four products were purchased and analyzed (from 31 companies) Marcel O. Bonn-Miller, PhD et al. JAMA. Nov 7, 2017;318(17):
39 Marcel O. Bonn-Miller, PhD et al. JAMA. Nov 7, 2017;318(17):
40 Discussion Wide range of CBD concentrations / lack of an accepted dose. 26% of products contained less CBD than labeled Overlabeling of CBD products similar in magnitude to levels that triggered warning letters to 14 businesses from the US Food and Drug Administration (eg, actual CBD content was negligible or less than 1% of the labeled content) Underlabeling is less concerning as CBD appears to neither have abuse liability nor serious adverse consequences at high doses, but the THC content observed may be sufficient to produce intoxication or impairment, especially among children. Continued need for regulatory agencies (federal, state?) to take steps to ensure label accuracy of consumer products. Marcel O. Bonn-Miller, PhD et al. JAMA. Nov 7, 2017;318(17):
41 Learning objectives 1. According to the Cannabinoids for Medical Use: A Systematic Review and Meta-analysis published in JAMA 2015, there is evidence supporting therapeutic use of cannabinoids for 6 medical conditions. We will discuss the evidence basis for cannabinoids in these conditions. We will also discuss emerging evidence for CBD in pediatric epilepsy. 2. The systematic review and meta-analysis also showed that adverse events with cannabis use were significantly higher than placebo. We will review the odds of experiencing adverse events, and the most common events which occurred, after medical use of cannabinoids. 3. We will discuss the potency and quality of medical cannabis, specifically considering hemp-derived CBD products currently available in Vermont and on the internet.
Epilepsy Foundation of Colorado The Use of Cannabis to Treat Children with Epilepsy Updated February 2016 The use of extracts from marijuana plants (cannabis) to treat children with epilepsy has been in
Cannabis in the treatment of Autism: Are we ready? Deb Karhson, PhD and Lawrence Fung, MD, PhD Cannabis Anecdotal Data: Comparing Epilepsy and Autism+ Science of Cannabinoids: Endocannabinoid System Receptor
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
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
MEDICAL CANNABIS IN MINNESOTA EPILEPSY & SEIZURES WELLNESS EXPO APRIL 16, 2016 MICHELLE LARSON, MPA MDH OFFICE OF MEDICAL CANNABIS 2014: Minnesota becomes 22 nd state with a medical cannabis program State
Cannabis Use in Epilepsy: Parent & Scientist Weighs In Catherine Jacobson, PhD Director, Clinical Research Professional Background PhD, Neuroscience, Oregon Health & Science University Post-doctoral Fellowship,
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
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
PATIENT INTAKE FORM Name: Last Name First Name Date of Birth: / / Gender: Male Female Address: Town: State: Zip Code: MMJ Card #: Exp. Date: Drivers License #: Exp. Date: Home Phone: Cell: Email: Primary
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
Medical Cannabis and OMT David R. Beatty, DO Professor of Osteopathic Principles and Practice, WVSOM November 4, 2017 Objectives At the completion of this presentation the attendee should be able to: 1.
Understanding Therapeutic Cannabis If we know there is suffering and do nothing to alleviate it, we ourselves become the tormentors Primo Levi Qualifying Conditions in New Hampshire Cancer Glaucoma Positive
Minnesota Medical Cannabis Program October 24, 2017 Agenda: Overview of Minnesota Medical Cannabis Program Conditions, roles, products Laboratory Issues Program Evaluation * indicates a hyper-link to website
medico-legal issues Neurology Pain management Medicinal cannabinoids: current regulations for prescribing Recent amendments have been made to regulations concerning the prescription of some medicinal cannabis
Swissmedic Approval Options and Limits Swiss Task Force for Cannabinoids in Medicine Conference November 12, 2016 Cannabis Ordinance on the lists of narcotics, psychotropic substances, precursors and auxiliary
MULTIPLE SCLEROSIS AUSTRALIA MULTIPLE SCLEROSIS RESEARCH AUSTRALIA Submission on the Public Health (Medicinal Cannabis Affordability) Bill 2017 Queensland Health, Communities, Disability Services and Domestic
Cannabis for Medical Use - A Scientific Review 31 JANUARY 2017 CONTENTS 1 EXECUTIVE SUMMARY 1 2 OVERVIEW OF HPRA REVIEW 2 3 BACKGROUND 6 4 MEDICINES AUTHORISATION IN IRELAND 7 5 CANNABIS AND ITS REGULATION
Minnesota Medical Cannabis Program: Patient Experiences from the First Program Year Executive Summary EXECUTIVE SUMMARY EARLY RELEASE COMPLETE REPORT RELEASE EXPECTED JUNE 2017 May 11, 2017 111n Minnesota
Medical Cannabis: A Patient Primer This primer is meant for documented patients who are using medicinal cannabis or considering using it in the future. The information provided about this medication in
Substances under Surveillance The following substances are under surveillance by the World Health Organization (WHO) as they are considered to have the potential to cause public health harm. For ease of
Educational Articles Cannabis Much Maligned, Medically Useful Marijuana Contents Page 2 Page 3 Endocannabinoids: our bodies make their own cannabinoids History of Cannabis Use Prohibition of Cannabis Page
50 Shades of Developing Gray Matter: Adolescents and Marijuana Ken Winters, Ph.D. Department of Psychiatry University of Minnesota email@example.com MNCAMH Webinar October 10, 2014 www.psychiatry.umn.edu/research/casar/home.html
MEDICAL CANNABIS: WHAT YOU NEED TO KNOW Kelay Trentham, MS, RDN, CSO Oncology Dietitian MultiCare Regional Cancer Center What we ll talk about: History of medical use of cannabis Effectiveness for managing
MEDICAL CANNABIS QUICK REFERENCE GUIDE CANNABIS 101: MEDICINE MEDICAL CANNABIS QUICK REFERENCE GUIDE HOW IT WORKS DEFINITIONS Cannabinoids Class of compounds that act on cannabinoid receptors in the human
MINNESOTA S MEDICAL CANNABIS PROGRAM DARIN TESKE LEGAL AND POLICY ADVISOR OFFICE OF MEDICAL CANNABIS AUGUST 25, 2016 2014: MN became 22 nd state with full medical cannabis program Recreational and Medical
BLOSSOM: Behavioral Modification and Lorcaserin Second Study for Obesity Management A 52-Week, Double-blind, Randomized, Placebo-controlled, Parallelgroup Study to Assess the Safety and Efficacy of Lorcaserin
PATIENT QUESTIONNAIRE Personal Information Date Name Date of Birth Age Height Weight Address City State Zip Home Phone Cell phone Work phone E-mail address SSN: - - Medical History - you must enter information
Prescribing and Dispensing Profile Minnesota Research current through November 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy. Points
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
OWC PHARMACEUTICAL RESEARCH OTCQB:OWCP Disclaimer This document details business information of OWC Pharmaceuticals Research Corp and/or our wholly-owned Israeli subsidiary, One World Cannabis Ltd. (collectively,
Medicinal Marihuana Science, Redefined From Concept to Commercialization.... www.avantirx.com WELL BEYOND COMPLIANCE Medicinal Marihuana Science, Redefined... ARA Avanti Rx Analytics Inc. is a Health Canada
MEDICATION MANAGEMENT AGREEMENT Pain Management Program Participation Agreement and Consent Pain may be effectively managed through the use of controlled substance medications (referred to below as opioids
Cetirizine Proposed Core Safety Profile Posology and method of administration Elderly subjects: data do not suggest that the dose needs to be reduced in elderly subjects provided that the renal function
Marijuana for Medical Use Patient Information Marijuana for Medical Use Patient Information Table of Contents Page A. Marijuana (Cannabis) Strains... 3 B. Cannabinoids... 3 C. Routes of Administration...
The Opioid Crisis URBAN FIRE FORUM SEPTEMBER 20-22, 2017 Every day in the United States, 144 people die as a result of an opioid overdose. Prescription drug abuse is the fastest growing drug problem in
M0BCore Safety Profile Active substance: Bromazepam Pharmaceutical form(s)/strength: Tablets 6 mg P-RMS: FR/H/PSUR/0066/001 Date of FAR: 26.11.2013 4.3 Contraindications Bromazepam must not be administered
SUMMARY OF PRODUCT CHARACTERISTICS FOR BENZODIAZEPINES AS ANXIOLYTICS OR HYPNOTICS Guideline Title Summary of Product Characteristics for Benzodiazepines as Anxiolytics or Hypnotics Legislative basis Directive
MEDICINAL CANNABIS: POLITICS, MEDICINE, OR COMMERCE: & WV SENATE BILL 386 C. Clark Milton, DO, FACOI WVOMA: 115 th Annual Fall Conference 02 November 2017 2017: >50% States 29 Medical Marijuana Programs
Marijuana Legalization: The Impact Town Hall Meeting October 5, 2015 The Hancock County Community Partnership The Hancock County Opiate Task Force Hancock County Alcohol, Drug Addiction and Mental Health
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
Supernus Pharmaceuticals Jefferies 2016 Healthcare Conference May 2016 1 Safe Harbor Statement This presentation and other matters discussed today or answers that may be given to questions asked include
MINOR TRANQUILIZERS 76. The term 'minor tranquilizers' was introduced into the scientific literature in the 1950s to distinguish the medicines prescribed to reduce anxiety and tension from the major tranquillizers,
Anti-inflammatory Cannabinoids without psycho-active side-effects Opportunities for further development to a drug formulation Introduction More than 5000 years ago, the Chinese already used Cannabis for
MEDICATION GUIDE Valproic Acid (val pro ic acid) Capsules Read this Medication Guide before you start taking Valproic Acid Capsules and each time you get a refill. There may be new information. This information
American Cannabis Nurses Association Position Statement on Concurrent Cannabis and Opiate Use August 4, 2013; Author: Ed Glick Introduction The American Cannabis Nurses Association supports the monitored
THE CASE FOR SAFE AFFORDABLE MEDICINAL CANNABIS IN THE US De-Scheduling Cannabis is the Safe Route to Normalization I. EXECUTIVE SUMMARY Over the past year the Federal government has deliberated modifying
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
Cannabis for Multiple Sclerosis Symptoms Michelle Cameron, MD, PT, MCR and Jessica Rice, MR Key Points: People with MS experience symptoms that may not be adequately controlled with FDAapproved medications.
PFC Training Courses & Programs Core Cannabis Training (CCT) National Cannabis Standards Courses (NCST) State Specific Compliance Training (SSCT) PFC Enrichment Courses (PFCEC) PFC Verified Professional
Quality Assessments for an Organically-Complex Drug - Part 1 Background and the Chemometrics Role Dr Peter Gibson Technical Director Sovereign House, Vision Park, Histon, Cambridge, CB24 9BZ Global leaders
Many Types of Approaches Biological Addictions Treatment Psychology 470 Introduction to Chemical Additions Steven E. Meier, Ph.D. Listen to the audio lecture while viewing these slides Detoxification approaches
Marijuana and Health MNCAMH June Webinar June 9, 2017 Ken Winters, Ph.D. Adjunct Faculty, Dept. of Psychology University of Minnesota & Senior Scientist, Oregon Research Institute firstname.lastname@example.org Web-Based
European PSUR Work Sharing Project CORE SAFETY PROFILE Lendormin, 0.25mg, tablets Brotizolam 4.2 Posology and method of administration Unless otherwise prescribed by the physician, the following dosages
Archive File History of Cannabis The word Cannabis has its origin in the mexican-spanish language and is often named Marihuana. The German law makes no difference between the source and the drug Cannabis.
Cannabis or Cannabinoids: the politics of medical marijuana Douglas Gourlay MD, MSc, FRCP(c), FASAM PLEASE STAND BY WEBINAR WILL BEGIN AT 12:00 PM PST FOR AUDIO: CALL 866-740-1260 / ACCESS CODE: 764-4915#
CBD: Is There a Chill in the Air (Marketplace)?* Robert T. Hoban, Esq. Hoban & Feola, LLC www.hobanandfeola.com February 15, 2016 Cannabidiol (CBD), which is one of many non-psychoactive substances contained
Complementary therapies There is a lot more to managing epilepsy than just seizure control. A good quality of life is important, and this is where complementary therapies can be most effective. Complementary
Neurontin drug class Search Neurontin is an anti-epileptic drug, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some. Is Gabapentin
Tapping the New $4B California Market Amanda Reiman Vice President of Community Relations Flow Kana An-Chis Tsou, Ph.D. Principal Tsou Consulting Morgan Paxhia Managing Director Poseidon Asset Management
Treating Pain with Phytocannabinoids A Leader in Cannabinoid Research and Development www.cbdscience.com Dear Oncologist Enclosed is important information about the use of Cannabis Based Medical Extracts
MEDICAL MARIJUANA ILANA BRAUN, MD LIDA NABATI, MD PATIENT VIDEO Why I Would Vote No on Pot by Sanjay Gupta, M.D. January, 2009 Why I Changed My Mind on Weed by Sanjay Gupta, M.D. August, 2013 1 TAKE HOME
Extraction News Notes Blog www.infinitysupercritical.com BY: Infinity Supercritical Staff EG TAGS: Supercritical CO2 Oil Extraction, Cannabis, Oil Concentrates Sustainable Production of Cannabinoids with
CHAPTER 2014-157 Committee Substitute for Committee Substitute for Senate Bill No. 1030 An act relating to cannabis; providing a short title; creating s. 381.986, F.S.; defining terms; authorizing specified
CANNABIS SUPPLEMENTS Maintain Your Health With Cannabis TM 2 CANABIDOL TM WHAT IS CBD? CBD the major compound found in all cannabis plants that is responsible for its revolutionary health promoting properties.
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 Cannabis species (or
DEANNA TANNER OKUN Tel: (202) 407-8615 email@example.com VIA ELECTRONIC FILING AND OVERNIGHT MAIL The Honorable Lisa R. Barton Secretary to the Commission United States International Trade Commission 500
Immodium / loprarmide IMODIUM (loperamide hydrochloride) is indicated for the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease.
SANDOMIGRAN (pizotifen malate) S N CH 3 Pizotifen. COOH CH OH CH 2 COOH MALATE DESCRIPTION Pizotifen is a cycloheptathiophene derivative structurally related to cyproheptadine and the tricyclic antidepressants.
ORAL TRANSMUCOSAL AND NASAL FENTANYL UTILIZATION MANAGEMENT CRITERIA DRUG CLASS: BRAND (generic) NAMES: Fentanyl by oral transmucosal and nasal delivery Actiq (fentanyl citrate) lozenge on a handle 200,
This is intended for US health care professionals only. VyvansePro.com Learn how to use the Formulary Look-up Tool for Vyvanse (lisdexamfetamine dimesylate) INDICATION Vyvanse is indicated for the treatment
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
Medication Guide MORPHINE SULFATE (mor-pheen) (CII) Oral Solution IMPORTANT: Keep Morphine Sulfate Oral Solution in a safe place away from children. Accidental use by a child is a medical emergency and
HEADS UP REAL NEWS ABOUT DRUGS AND YOUR BODY A Message from Scholastic and the National Institute on Drug Abuse (NIDA) You probably know that drugs that don t come from a pharmacy or other legal distributor
Patient Information Montelukast Sodium Tablets and Montelukast Sodium Chewable Tablets Read the Patient Information Leaflet that comes with montelukast sodium before you start taking it and each time you
Can a system like the U.S. OTC monographs work for ENDS? Jack Henningfield, PhD Vice President, Research and Health Policy PinneyAssociates and Professor, Behavioral Biology, Adjunct Department of Psychiatry
Prescribing and Dispensing Profile Vermont Research current through November 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy. Points of
PHENTERMINE INFORMED CONSENT I request the use of Phentermine, along with strict dietary restrictions for the purpose of weight loss. I understand that as part of the program, I will be given a limited
MIGRAINE A MYSTERY HEADACHE The migraine is a chronic neurological disease that is characterized by moderate to severe episodes of headache that is mostly associated with other central nervous system (CNS)