Pharmacokinetics and Administration Modes of Cannabinoids A Challenge

Transcription

1 Pharmacokinetics and Administration Modes of Cannabinoids A Challenge Prof. Dr. Rudolf Brenneisen University of Bern, Dept. Clinical Research rudolf.brenneisen@dkf.unibe.ch 1

2 Chemistry of THC - The Decarboxylation C H 3 9 R C 10a 6a 12 O B 10 R 10b 6 5 O H A C: baking, vaporizing, smoking THC acid B COOH fresh plant biogenic THC precursor almost inactive 1 5 Delta-9-Tetrahydrocannabinol (THC) Active Isolated 1942 (Wollner), structure 1964 (Mechoulam) BP 160 C Solubility 3 mg/l water RT (0.0003%) 2

3 Chemistry of Cannabis - The Chemical Factory GC profiling/fingerprints pa 180 Int. standard THC 160 Terpenoids Cannabinoids CBD CBN Time [min] min [Brenneisen & Meyer 2005] 3

4 Chemistry of Cannabis - The Chemical Factory HPLC profiling/fingerprints Acids Neutrals Artefact 4 [Lehmann & Brenneisen 1995]

5 The Complex Fate of Cannabinoids in the Body Cannabinoid, Cannabis, Cannabis preparation Dosage Serum protein binding Liver metabolism Administration route/mode GIT, Lungs, Mouth, Skin Active/inactive metabolites Absorption Fat storage Cannabinoid in extracell. water Biliar excretion Cannabinoid concentration at site of action Hair, saliva, sweat Cannabinoid receptors Renal excretion 5 Cannabinoid effect Urine

6 Elimination from Blood THC vs Alcohol active too 20 mg THC orally, male, 75 kg Time [hour] EtOH 300 ml Alcopop 5.5%, woman 60 kg [ 0 /00] 6

7 The Doping Trap 12 THC THC-OH THC-COOH 10 No. of subjects Proposed target analytes (shortlasting, active) WADA target analyte (long-lasting, inactive) Time [h] [Brenneisen et al 2010] 7

8 Multinational Field Study Reanalysis of cannabis-positive athletes urines ( 15 ng/ml THC-COOH; N = 79) THC THC-OH THC-COOH 8

9 Cannabinoid Drugs and Application Forms Folk medicine, self-treatment: Cannabis and home made preparations - Joint, tea, Sativa-Oil, Simpson Oil etc. - Street Cannabis - Quality and dosage not controlled - Harmful or inefficient application modes. Academic, evidence-based medicine: Cannabinoid-based medicines, TBMs, CBDMs - THC (dronabinol, Marinol ) - Nabilone (Cesamet ) - Cannabidiol, CBD. Cannabis-based medicines, CBMs - Standardized extracts (Sativex ) - Buds (Bedrobinol, Bediol etc.) - Established galenic formulations, formula magistralis preparations (tincture, drops etc.) - Quality and dosage controlled - Less harmful and more efficient application forms. 9

10 Cannabinoid Drugs and Application Forms Galenic formulation Bioavailability Effect Cannabis cigarette (smoke) % rapid Cannabis inhalation aerosol (vapor) rapid Cannabis sublingual spray >90 slow Cannabis capsule? slow Cannabis tea low slow Cannabis oil? slow THC capsule 5-20 slow THC drops 5-20 slow THC suppository rel. rapid THC patch?? THC injection solution 100 very rapid 10

11 CBMs - Cannabis Tea 3.6 g cannabis, 200 ml water, 30 min boiling yeald 50x! 0.36 mg THC 18.8 mg THC 3.6 g cannabis, 200 ml milk/coffee creamer, 30 min boiling [Giroud 1997, Hazekamp 2007] 11

12 CBMs - Sativa Oil Validated home recipe for ALS patients 3 g cannabis, 13 % THC 60 ml peanut oil 200 C/45 min 7.8 mg THC/mL 90% yield, but loss of terpenoids! 12

13 CBMs - Simpson Oil Rick Simpson Cannabis Oil Concentrated extract Naptha as solvent toxic residues olive oil to be prefered [Hazekamp 2013] Not validated and clinically not tested cannabis preparation Good for treating cancer? 13

14 CBM/TBM/CBDM - Vaporization [%] Non-pyrolytic inhalation In vitro validation of commercial vaporizer devices 14 [Lanz 2013, unpublished]

15 Oromucosal Spray (Sativex ) TBM vs. CBM, plasma levels High-dose Sativex, 6 activations (= 16 mg THC + 15 mg CBD) 15 mg oral THC [ng/ml] [ng/ml] [h] [h] 15 [Karschner 2011]

16 TBMs Inhalation Spray vs. Injection Solution Rapid onset of action But also flash! 25 THC pulmonal THC i.v. 20 Plasma conc. [ng/ml] Time [min] [Naef 2003] 16

17 Cannabinoid Drugs and Application Forms Options and Visions Folk medicine, self-treatment without prescription: Access to Medicinal Cannabis with quality certificate Preferably using validated home recipes and harmless application forms (e.g. vaporizer) No criminalization of patient, even if not (yet) compatible with law. Academic medicine, controlled treatment with prescription: Approved drugs (TBMs, CBDMs and CBMs) Medicinal Cannabis from licensed producers and suppliers, i.e. public pharmacies Pharmacopoeia monographs Optimized, patient-individualized formulations, formula magistralis, respecting GMP. 17

18 Recommended Web Links Swiss Task Force for Cannabinoids in Medicine, STCM International Association for Cannabinoid Medicines, IACM International Cannabinoid Research Society, ICRS 18

19 ? LSD Cannabis Mescalin Kaffee [Mardikar 1969]

20 Thank You! Medical Cannabis Conference I Victims of side-effects Medical Cannabis Conference II Victims of laws 20