Medical Cannabis & Seniors - 101

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1 Medical Cannabis & Seniors Presented by: Shannon O Hearn MSc., Clinical Research Project Manager Date: April 13 th, 2017

2 Agenda Who is MedReleaf? How Cannabis is currently regulated in Canada The Patient Journey What makes Cannabis a medicine? Methods of Use Current scientific research investigating Cannabis therapies

3 About MedReleaf We are a licensed producer (LP) of medical cannabis, based out of Markham ON Licensed by Health Canada in 2014, one of the first and largest LPs in Canada ISO certified in Quality, Occupational Health & Safety, and Environmental / Soon to be GMP certified Exclusive partnership with Tikun Olam Patient support team including RNs dedicated to helping our patients Conduct surveys to learn about our patients, in addition to a number of other clinical research initiatives Collaboration: Mount Sinai Hospital / Sunnybrook Hospital / Hamilton Health Sciences / University of Guelph, Toronto, Ryerson / Various Cannabis Research Institutes Consistent supply of a variety of products suitable to a wide range of patient needs Medication shipped across Canada, packaged in child resistant containers with available lockjars for dried cannabis products

4 How Cannabis is currently regulated in Canada Access to Cannabis for Medical Purposes Regulations (ACMPR) Medical document (prescription) signed by physician Patient is registered with chosen Licensed Producer (LP) Caregiver can register on behalf of patient Registration/verification process occurs Begin ordering medication (patient or caregiver) Medication is shipped (i.e. via Canada Post or Purolator) Medication must legally be carried in patient labelled container and/or with specific documentation from supplier

5 MedReleaf Patient Care Patient support available 5 days/week, 8am-6pm by phone and Weekend support offered Registered nurses on staff to provide patient and caregiver consultation Patient, physician, and community education is a priority Photo

6 Other things to know about medical cannabis Registration must be renewed a minimum of once/year Cannabis is currently taxed according to province of residence, unlike other medications Insurance coverage is not yet widely available, major barrier is lack of DIN Travel within Canada is permitted while in possession of medical cannabis, but NOT internationally

7 What makes Cannabis a medicine?

8 Cannabinoids: Tetrahydrocannabinol and Cannabidiol THC effects Analgesic Anti-emetic, anti-nausea Stimulates appetite Sleep aid PTSD symptom management CBD effects Anti-emetic, anti-nausea Anticonvulsant Anti-inflammatory Analgesic Anxiolytic Reduce psychoactive effects of THC Psychoactive effects

9 Over 100 Cannabinoids (THC and CBD are 2 of them) Over 200 Terpenes which affect taste and scent, and are thought to produce their own physiological effects Cannabinoids work together with the terpenes in a way that is known as Entourage Effect (synergistic), and our understanding of this is evolving constantly

10

11 How cannabinoids work in our bodies

12 Medical Cannabis may be used to manage a variety of symptoms: Nausea and vomiting Inflammation Spasm Seizure Weakness Anxiety Insomnia Pain Headache and migraine Neuropathic pain Cancer pain Dealing with trauma Depression

13 Underlying medical conditions commonly include: Cancer HIV/AIDS Multiple Sclerosis Arthritis Crohn s & Inflammatory Bowel Disease Seizure Disorders Parkinson s Post Traumatic Stress Disorder Migraines Terminal illness

14 Methods of Use Smoking is the most harmful and least efficient way to administer Cannabis. Vaporizing Extracts (tinctures, oil, capsules, topical/transdermal, ophthalmic) Edibles ONLY dried cannabis, oils and capsules are currently allowed to be produced and sold by LPs

15 Administration and Effects Method Onset Peak Duration of effect Vaporized 5 min min 2-4 hrs Directly into bloodstream and brain Oils min 2 hrs 6-8 hrs Escalate slowly over days/weeks Can take sublingually Start low and be patient Edibles 30 min 2 hr 2-4 hrs 8-12 hrs Use small amounts for milder, more comfortable effects Considerable variability due to GI metabolism Start low, go slow

16 MedReleaf Cannabis Oil and Capsules The addition of Oleic Sunflower Oil: A unique version of Sunflower oil has been carefully chosen at MedReleaf as the carrier base for our cannabis oils for three reasons: 1. Our sunflower oil is essentially tasteless, and therefore does not mask or modify the natural taste of our pure extracts 2. Our sunflower oil is rich in heart-healthy monounsaturated fats 3. Our Sunflower oil is not a GMO product. The natural genetics are maintained as nature intended

17 Current status of clinical research Largely anecdotal thus far Questions remain regarding: Dosing and administration Safety and tolerability Efficacy for different indications Efficacy amongst different cannabis products/varieties

18 MedReleaf Patient Progress Survey Launched early 2015 Patients are invited to complete a voluntary confidential online survey at intake, 4 months following intake, and 10 months following intake Surveys are dynamic and customized based on responses To date, have collected responses

19 Survey Results In our last demographics analysis (N=3280) Average age of 43.9 years (approx. 70:30 male to female) 52.4% employed, 17.4% retired, 4.1% students 77.9% reported having previous experience with cannabis

20 Other notable findings

21 Thank you! Questions?

22 References: Aso, E. and I Ferrer. Cannabinoids for treatment of Alzheimer s disease: moving towards the clinic. Front Pharmacol 2014;5:37 Eubanks, L. M., C. J. Rogers, A. E. IV, G. F. Koob, A. J Olson, T. J. Dickerson, and K. Janda. A Molecular Link between the Active Component of Marijuana and Alzheimer s Disease Pathology. Mol Pharm (6); Salk Institute. Cannabinoids remove plaque-forming Alzheimer s proteins from brain cells. Campbell, V. A., and A. Gowran. Alzheimer s disease; taking the edge off with cannabinoids? British Journal of Pharmacology 2007;152(5) Fitzcharles, M., P. Ste-Marie, W. Hauser, D. Clauw, S. Jamal, J. Karsh, T. Landry, S. LeClercq, J. McDougall, Y. Shir, K. Shojania, Z. Walsh. Efficacy, tolerability and safety of Cannabinoid Treatments in the Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials Arthritis Care & Research 2015 file:///l:/clinical%20studies/rumateology/acr%202015%20cannnabis%20in%20rheumatic%20diseases%20(1).pdf Chagas, M., A. Zuardi, V. Tumas, M. Pena-Pereira, E. Sobreira, M. Bergamaschi, A. dos Santos, A. Teixeira, J. Hallak and J. Crippa. Effects of cannabidiol in the treatment of patients with Parkinson s disease: An exploratory double-blind trial. Journal of Psychopharmacology 2014 file:///l:/clinical%20studies/parkinson%20disease/j%20psychopharmacol-2014-chagas pdf Sieradzan K.A., S.H. Fox, M. Hill, J.P. Dick, A.R. Crossman, and J.M. Brotchie. Cannabinoids reduce levodopa-induced dyskinesia in Parkinson s disease: a pilot study. Neurology ;57(11)

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