1 Medicinal Marijuana: Closing the gap between anecdotal benefits and evidence-based research Jonathan Kiesman, Pharmacist CanniMed Ltd.
2 Presenter Disclosure Presenter: Jonathan Kiesman Relationship with Commercial interest: Employed as a Pharmacist at CanniMed Ltd.
3 Mitigating Potential Bias Jonathan is a Pharmacist with 20 years experience in outpatient Pharmacy settings. Prairie Plant Systems Inc, parent company of CanniMed Ltd, has been working with and providing medical marijuana to Health Canada since The parent company has provided product for clinical trials and have on-going clinical trials. Generic names will be used.
4 Female Cannabis Flowers Page, 2014
5 Introduction Marijuana (cannabis) contains compounds called cannabinoids. (THC and CBD) Perceived association of cannabinoids = recreational marijuana gives rise to a lot of misconception It wasn t until the mid-1990s that scientists discovered why marijuana is reported to work so well, and for so many different illnesses. The discovery was a natural system in the human body called the endo-cannabinoid system. The body produces many of it s own endogenous cannabinoid signalling molecules, 2 most studied are: Anandamide (AEA) 2-AG
6 Introduction The endo-cannabinoid system is similar to the body s opioid system: natural endorphins (natural opioids), act on opioid receptors, same as synthetic drugs: morphine, hydromorphone, oxycodone, etc. Similarily, AEA and 2-AG (natural CB s) attach to the body s endo-cannabinoid receptors, same as cannabinoids found in medical cannabis. The main cannabinoid receptors in the body are CB1 and CB2 receptors.
7 Cannabis (marijuana) Cannabinoids(THC/CBD) supplied by medication (nabilone, sativex) or medical plant-based cannabis Cannabinoid receptors found in brain, CNS, liver, kidney, pancreas Effects on human body
8 The (Phyto) cannabinoids There are more than 110 known cannabinoids, and 400 molecules identified in the cannabis plant The major cannabinoids are:
9 THC and CBD The two most researched substances in medical marijuana are: Delta-9-tetrahydrocannabinol (THC) Cannabidiol (CBD) Consistent THC/CBD ratio = Consistent health benefits THC: Literature cited for psychoactive, immunosuppressive, anti-inflammatory and analgesic properties of medical marijuana. CBD: Responsible for anti-inflammatory, analgesic, anti-nausea, anti-emetic, anti-psychotic, antiischemic, anxiolytic, and anti-epileptic effects. CBD THC
10 9 -Tetrahydrocannabinol (THC) The main active ingredient in drug forms of cannabis (marijuana) is 9 - tetrahydrocannabinol (THC) A CB1-receptor antagonist THC produces many of the psychoactive effects of cannabis Suggested therapeutic effects Analgesic Antiemetic Appetite stimulant Anti-spastic activity Gaoni and Mechoulam, 1964; Joy et al, 1999
11 Cannabidiol (CBD) A CB2 receptor agonist Second most important cannabinoid after THC Literature cited indications: Anti-inflammatory Neuro-protective Anxiolytic Anti-epileptic Antipsychotic May attenuate memory-impairment effects of THC Role in treating pediatric epilepsy? (Dravet syndrome) Hampson et al, 1998; Leweke et al, 2012; Mechoulam et al, 2007; Pertwee, 2008
12 Off-label indications/emerging evidence: Nausea and vomiting from chemotherapy Chronic pain (neuropathic pain in MS and cancer) Anorexia associated with HIV/AIDS PTSD Anxiety Insomnia Spasticity Lower Urinary tract symptoms (MS) Improving bladder symptoms associated with MS Neuropathic/nociceptive/mixed pain Chronic daily headache Fibromyalgia Anorexia and cachexia Spasticity Epilepsy Cannabinoid Indications
13 Dosing and Administration Cannabis requires heat to activate THC and CBD General principle: start low/go slow Keep dose as low as possible using the least amount necessary to control symptoms and titrate slowly 1.5 grams/ day is the average daily dose as seen at CanniMed (Health Canada indicated grams/day) Using 12% THC material = 50mg THC/day
14 Dosing and Administration Inhaled Smoking (not recommended) Vaporizing (recommended) Fastest onset of action (5 min-1/2 hr) for both smoking and vaporizing. Shorter duration of action Oral and Edibles Prescription cannabinoid capsules: Cesamet (Nabilone) Ingested via tinctures, teas, oils, baking Slower onset of action (1-3) Longer duration of action (8-12 hrs) Spray Sativex ( nabiximols 1:1 ratio of THC: CBD) Sprayed under the tongue or inside of cheek. Max effect at 1-2 hrs.
15 Vaporizing vs Smoking Ideal and fast for those in pain. Rapid onset and short duration only achieved through inhaled delivery
16 Vapourizing in Hospital settings? IN THE MEDIA: Charles Bury's marijuana use in Quebec hospital stirs debate Charles Bury, long-time editor of Sherbrooke Record, vaporizes marijuana to deal with Stage 4 liver cancer. Bury uses medically prescribed marijuana in his hospital room with a vaporizer, which emits little odour and no smoke, to help curb his anxiety. CBC News Posted: Jan 09, :52 AM ET Last Updated: Jan 09, :44 PM ET Canadian Hospitals Prepare To Allow Medical Marijuana Huffington Post/Metro/CBC/Leaf Science, Jan. 9, 2014 Alberta Health Services: AHS is looking at developing a process to support patients who are treated with medical marijuana in our facilities Huffington Post/Metro/CBC/Leaf Science, jan.9, 2014 Currently is accommodated in a negative-pressure room, which are currently rarely available in most Canadian hospitals.
17 Dosing Start low and go slow Average dose: 1 to 2 grams daily when smoked or vapourized Vapourization: At a lower temperature, cannabinoids are vapourized without burning plant matter. The Volcano Medic is the only vapourizer approved as a medical device by Health Canada
18 Dosing considerations Inhaled delivery: more desirable for acute symptoms: nausea, appetite stimulation, sleep initiation, seizures, spontaneous neuropathic pain episodes Oral, edibles and spray delivery: More desirable for persistent symptoms: chronic pain, sleep maintenance, spasticity Patient must consume approx. 2.5X more for same effect as inhalation 4,5 4. Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42: Zuurman, L., Ippel, A. E., Moin, E., and van Gerven, J. M. (2009). Biomarkers for the effects of cannabis and THC in healthy volunteers. Br.J.Clin.Pharmacol. 67: 5-21.
19 Possible side effects Risk of serious side effects are relatively low compared with other prescription drugs. However, evaluating safety data has been complicated due to the illegal status of cannabis. Drowsiness Dizziness Dry mouth Fatigue Increased heart rate Postural hypotension Delayed fetal growth Excreted in breast milk Caution driving under the influence
20 Contraindications Contraindications Hypersensitivity to any cannabinoid Hypersensitivity to smoking Psychotic disorders (particularly schizophrenia) Warnings Pregnant or nursing women- highly recommended not to use cannabinoids as it may effect development of the fetus and nervous system Potential for dependence and abuse Do not drive or operate machinery
21 Medical marijuana is not recommended for some patients Those who are: Are nursing, pregnant, or planning to conceive are highly recommended not to use cannabinoids
22 Use with Caution in patients with: Cardiac disorder (hypertension, hypotension, History of substance abuse or dependency Mania or depression Multiple drug therapy (may be a CYP 3A4 and CYP2C9 liver enzyme inhibitor?) Respiratory illness Pediatric and elderly populations (due to lack of knowledge/experience about use)
23 Addiction Potential of Cannabis? Thought to have a high abuse potential Ability to produce dependence is less than alcohol or nicotine and some drugs such as diazepam, morphine and phenobarbital 21 Approx. 10% of regular cannabis users become addicted 21 Addiction potential may be even less when cannabis is used for medical purposes, similar to some other drugs with addiction potential. Cohen, PJ. Medical Marijuana: the conflict between scientific evidence and political ideology Part one of two. J Pain Palliat.Care Pharmacother. 2009; 23:4-25
24 Research and Evidence
25 Limitations of Available Data Most studies are small, much data is anecdotal, preclinical, animal/in vitro. Number of studies which actually use medical cannabis plant as opposed to a commercially available THC/CBD product is low. It is not known if this data can be extrapolated to medical cannabis? Difficulty for researchers to get approval to work with cannabis due to it s illegal status. No controlled trials comparing smoked cannabis with oral THC or other analgesic agents
26 Results: a single inhalation of 25mg of 9.4% THC herbal cannabis three times a day for 5 days reduced intensity of pain, improved sleep and was well tolerated. Ware, M. A., Wang, T., Shapiro, S., Robinson, A. and others. (2010). Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ. 182: E694-E701
27 Palliative Care Cannabis...may be useful in alleviating a wide variety of single or co-occurring symptoms often encountered in the palliative care setting; these symptoms include intractable nausea and vomiting associated with chemotherapy or radiotherapy, anorexia/cachexia, severe intractable pain, severe depressed mood, and insomnia 208. The use of cannabinoids for palliative care may also result in a decrease in the number of medications used by this patient population. 208 Taken from Health Canada s: Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids, pg Sutton, IR and Daeninck, P. (2006) Cannabinoids in the management of intractable chemotherapyinduced nausea and vomiting and cancer-related pain.
28 Cannabis in Palliative Medicine: Improving Care and Reducing Opioid-Related Morbidity AM J HOSP PALLIAT CARE August 2011 vol. 28 no Abstract Unlike hospice, long-term drug safety is an important issue in palliative medicine. Opioids may produce significant morbidity. Cannabis is a safer alternative with broad applicability for palliative care. Yet the Drug Enforcement Agency (DEA) classifies cannabis as Schedule I (dangerous, without medical uses). Dronabinol, a Schedule III prescription drug, is 100% tetrahydrocannabinol (THC), the most psychoactive ingredient in cannabis. Cannabis contains 20% THC or less but has other therapeutic cannabinoids, all working together to produce therapeutic effects. As palliative medicine grows, so does the need to reclassify cannabis. This article provides an evidence-based overview and comparison of cannabis and opioids. Using this foundation, an argument is made for reclassifying cannabis in the context of improving palliative care and reducing opioid-related morbidity
29 Nausea and vomiting Health Canada Page 35: While chemotherapy-induced vomiting generally appears to be well-controlled with current first-line therapies, the associated acute, delayed, or anticipatory nausea remain more poorly controlled and the use of cannabis/cannabinoids may provide some measure of benefit in certain cases. 88, Parker, L. A., Rock, E., and Limebeer, C. (2010). Regulation of nausea and vomiting by cannabinoids. Br.J.Pharmacol.163: Soderpalm, A. H., Schuster, A., and de, Wit H. (2001). Antiemetic efficacy of smoked marijuana: subjective and behavioral effects on nausea induced by syrup of ipecac.pharmacol.biochem.behav. 69:
30 Nausea and Vomiting Health Canada Page 36: Patients who smoked cannabis showed a % relief from nausea and vomiting, while those who used a Δ9-THC capsule experienced 76-88% relief (191). Plasma levels of >10ng/mL Δ9-THC were associated with the greatest suppression of nausea and vomiting, although levels ranging between 5 and 10 ng/ml were also effective Musty, R and Rossi, R. (2001). Effects of smoked cannabis and oral delta-9 tetrahydrocannabinol on nausea and emesis after cancer chemotherapy: A review of state clinical trials. Journal of Cannabis Therapeutics. 1:
31 Health Canada, Page 51: Cancer Pain The opioid-sparing effect refers to the ability of a nonopioid medication to confer adjunctive analgesia with the use of a lower dose of the opioid thereby decreasing opioid-associated side effects. While there are some preclinical data supporting such an effect for cannabinoids, this is less well-established in published clinical studies.
32 Cancer Pain continued. Health Canada, Page 51: Findings suggest the existence of cross-talk between the cannabinoid and opioid systems. Furthermore, pre-clinical studies using a combination of different opioids (morphine, codeine) and cannabinoids (THC), at acute or sub-effective doses, have reported additive and even synergisticanalgesic effects (515,516,517,518,519,520) Welch, S. P. and Stevens, D. L. (1992). Antinociceptive activity of intrathecally administered cannabinoids alone, and in combination with morphine, in mice. J.Pharmacol.Exp. Ther. 262: Pugh, G., Jr., Smith, P. B., Dombrowski, D. S., and Welch, S. P. (1996). The role of endogenous opioids in enhancing the antinociception produced by the combination of delta 9 tetrahydrocannabinol and morphine in the spinalcord. J.Pharmacol.Exp.Ther. 279: Smith, F. L., Cichewicz, D., Martin, Z. L., and Welch, S. P. (1998). The enhancement of morphine antinociception in mice by delta9-tetrahydrocannabinol. Pharmacol.Biochem. Behav. 60: Cichewicz, D. L. and McCarthy, E. A. (2003). Antinociceptive synergy between delta(9)-tetrahydrocannabinol and opioids after oral administration. J.Pharmacol.Exp.Ther. 304: Cichewicz, D. L. (2004). Synergistic interactions betweencannabinoid and opioid analgesics. Life Sci. 74: Smith, P. A., Selley, D. E., Sim-Selley, L. J., and Welch, S. P. (2007).Low dose combination of morphine and delta9-tetrahydrocannabinol circumvents antinociceptive tolerance and apparent desensitization of receptors. Eur.J.Pharmacol. 571:
33 CANCER THERAPY Pre-clinical evidence that CB may inhibit tumor growth. J.P. Marcu, et al: THC and CBD work together to slow tumour growth more effectively than when they are applied individually. Delta(9)-THC and cannabidiol acted synergistically to inhibit cell proliferation. The treatment of glioblastoma cells with both compounds led to significant modulations of the cell cycle and induction of reactive oxygen species and apoptosis as well as specific modulations of extracellular signal-regulated kinase and caspase activity. Marcu, JP, Christian RT, Lau, D, Zielinski, AJ et al, (2010) Cannabidiol enhances the inhibitory effects of delta9-thc on human glioblastoma cell proliferation and survival Mol.Cancer Ther. 9:
34 Cancer Therapy continued Delta(9)-Tetrahydrocannabinol inhibited tumour-cell proliferation in vitro and decreased tumour-cell Ki67 immuno-staining when administered to two patients. M.Guzman et al. RGuzman, M. Duarte, MJ, Blazque, C., Ravina, J. and others (2006). A pilot clinical study of Delta9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme. Br.J.Cancer. 95:
35 Summary and Concluding remarks Therapeutic cannabinoids may be a safe and effective option to consider for patients experiencing chronic pain, cancer-associated anorexia, or nausea and vomiting associated with cancer chemotherapy. Additive effects may allow for dose reduction of concomitant analgesics such as opioids. Abuse potential is relatively low. (approx. 10% of users) New evidence is emerging, pointing to efficacy of CB to treat conditions such as epilepsy, spasticity, headache, PTSD, anxiety, and insomnia.
36 Summary and Concluding remarks Medical cannabis should be considered when conventional medicine is not enough Cannabis should be considered in same context as other pharmaceuticals, opioids for example, that have: Important medical value However also may have significant side effects and potential for abuse.
37 Resources Health Canada information about the new regulations is available at: Information for Healthcare Professionals is available at
38 Questions? Jonathan Kiesman, Pharmacist CanniMed Ltd.
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
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.
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 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
Medical Marihuana for Patients in the Lymphoma Setting Speakers: Ruth Turner, RN, Con Rob Laister, PhD Medical Marihuana for Patients in the Lymhoma Setting Disclosure: No endorsement or promotion of marihuana
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
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
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
Health Canada posts safety alerts, public health advisories, press releases and other notices from industry as a service to health professionals, consumers and other interested parties. Although Health
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
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
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: 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
Medical Marijuana in For Family Physicians and Palliative Care Practitioners Dr. Sharon Koivu Palliative Care Physician Consultant, London Health Sciences Centre, Department of Family Medicine, Western
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
CANNABIS FOR MEDICAL PURPOSES EVIDENCE GUIDE Information for Pharmacists and Other Health Care Professionals January 25, 2018 CONTENTS General Pain... 3 Acute Pain... 3 Cancer Pain... 4 Neuropathic Pain...
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
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
Medical Cannabis & PTSD; A TRIPLE-BLIND PHASE 2 CLINICAL TRIAL EXAMINING THE EFFICACY OF CANNABIS OF VARIOUS CHEMICAL COMPOSITION ON THE SYMPTOMS OF PTSD Philippe Lucas, MA, PhD Student VP of Patient Advocacy,
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
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
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
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...
PATIENT EDUCATION GUIDE Table of Contents General Information About Treatment With MMJ 4 Availability, Strength, and Effects of Medical Marijuana Strains and Products 5 Methods, Forms, and Routes of Administration
Marijuana: Legal History, Neuro-Science & Toxicology LifeSavers Conference Charlotte, North Carolina March 28, 2017 Judge Mary A. Celeste (Ret.) The following presentation may not be copied in whole or
Important Information from Health Canada s Cannabis Information Guide for Healthcare Practitioners Important Information from Health Canada s Cannabis Information Guide for Healthcare Practitioners Overview
Medical Cannabis Program Dr. Maureen Small Co Medical Director Andrea Sundberg Program Coordinator Disclaimer The following information is based upon research of current studies. The Department of Health
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
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
1. PRODUCT NAME ACUPAN 30 mg tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains nefopam hydrochloride 30 mg. For a full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM
Medical (and Recreational) Marijuana in the Workplace Jamie LeMesurier, QC Chad Sullivan What is marijuana? The cannabis plant originates from Asia. A variety of products can be produced from the flower
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
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
Medical Cannabis: To Inhale or Not to Inhale? Traci M. White, PharmD, PhC, BCGP Pharmacist Clinician, Mesilla Valley Hospice Assistant Professor, UNM College of Pharmacy firstname.lastname@example.org Learning Objectives
1 Welcome to MedWell Patient Information Date: Name: Date of Birth: / / Address: City: State: Zip Code: Home Phone: ( ) - Cell Phone: ( ) - Email: Gender:! Male! Female Last 4 of Social Security Number
The Facts Cannabis, commonly known as marijuana and by numerous other names, is a preparation of the cannabis plant intended for use as a psychoactive drug and now as medicine. Marijuana also refers to
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
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
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.
FDA APPROVED MEDICATION GUIDE Valproic Acid Oral Solution Read this Medication Guide before you start taking valproic acid and each time you get a refill. There may be new information. This information
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
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.
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 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.
Psychoactive drugs Drugs which affect mental processes mood, perception, memory, state of consciousness May be illegal: Heroin Cocaine Legal: Alcohol nicotine Legal but restricted (by prescription only)
Medication Guide SUBSYS (sub sis) CII (fentanyl) sublingual spray 100 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg IMPORTANT: Do not use SUBSYS unless you are regularly using another opioid pain medicine around-the-clock
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
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
Organic Medical Cannabis A Primer for Physicians 1 Organic is just... better. Introduction At Organigram, we believe that medical cannabis is a treatment option that changes the lives of many Canadians
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
OST Pharmacology & Therapeutics Leo O. Lanoie, MD, MPH, FCFP, CCSAM, ABAM, MRO Disclaimer In the past two years I have received no payment for services from any agency other than government or academic.
Marijuana Cannabinoid Reception in the Brain Levi van Tol 2/16/2015 Cellular Neuroscience van Tol 1 Books, movies, songs, politics, schools, and just about every corner we turn to, marijuana is a hot topic
THE ENDOCANNABINOID SYSTEM AND YOUR PATIENTS Mary Lynn Mathre, RN, MSN, CARN President and Co-founder, Patients Out of Time President and Founding member, American Cannabis Nurses Associates Judy R. Frates,
Year 9 Cannabis Quiz Answers and Background information Knowledge These questions have been designed to establish your student s knowledge of cannabis. Questions are asked on the legal status of cannabis,
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
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use MARINOL safely and effectively. See full prescribing information for MARINOL. MARINOL (dronabinol)
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
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
Opioid Pain Medications IT S YOUR HEALTH Opioid Pain Medications What is an opioid? Opioids are a broad range of natural and manufactured (synthetic) compounds that are commonly used for pain relief. There
Pharmacogenetics of Codeine Lily Mulugeta, Pharm.D Office of Clinical Pharmacology Pediatric Group FDA 1 Codeine Overview Naturally occurring opium alkaloid Demethylated to morphine for analgesic effect
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
CANNABINOID THERAPEUTICS Eloise Theisen, RN, MSN, AGPCNP-BC Green Health Consultants Overview Demographics Special considerations in geriatrics Clinical implications Case studies Misconceptions Barriers
Cannabis or Cannabinoids: The Politics of Medical Marijuana Douglas Gourlay MD, MSc, FRCP(c), FASAM Disclosures Nothing to disclose 2 1 Objectives Review the pharmacology of marijuana and the impact of
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
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
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
Cannabis and HIV/AIDS: Included in this series of fact sheets on Cannabis and HIV/AIDS: 5. Where to Find Cannabis for Medicinal Purposes 1. The Medicinal Use of Cannabis 2. How to Apply to Use Medicinal
THERAPEUTIC FOCUS Direct Effects Cannabinoid Therapy: Medical Cannabis Without Psychoactive & Systemic Effects By: Ronald Aung-Din, MD MEDICAL CANNABIS CONTROVERSY F I G U R E 1 There is no greater medical
MEDICATION GUIDE Quetiapine (kwe-tye-a-peen) Tablets USP Read this Medication Guide before you start taking quetiapine tablets and each time you get a refill. There may be new information. This information
Medication Guide Medication Guide Lazanda (La-ZAN-da) CII (fentanyl) nasal spray 100 mcg, 400 mcg IMPORTANT: Do not use Lazanda unless you are regularly using another opioid pain medicine around-the-clock
The challenge of climbing Mt. Everest: Malignant pain management in the opioid tolerant patient Holly Swensen, MSN, APRN NP c, RN BC Pain Management St. Alphonsus Regional Medical Center Cancer Care Center
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,
MEDICATION GUIDE DIVALPROEX (di val pro ex) SODIUM DELAYED-RELEASE TABLETS, USP Read this Medication Guide before you start taking Divalproex Sodium Delayed-Release Tablets and each time you get a refill.
Defining Drugs Any substance which, when taken into the body, alters or modifies one or more body functions * Any drug, including prescription medicines and overthe-counter drugs, can be misused and abused.
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#
CANNABIS, CANNBINOIDS, AND MEDICINE: WHAT DOES THE EVIDENCE TELL US? David Galbis-Reig, M.D., DFASAM Medical Director of Addiction Services Ascension Wisconsin All Saints Racine, Wisconsin 53043 DISCLOSURE
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
Legalizing Industrial Hemp in the States NCSL Agricultural Task Force Meeting December 9, 2014 Presented by: Eric Steenstra President, Vote Hemp What is Industrial Hemp? Industrial hemp is the non-psychoactive,