July 15 TH, ANDREW MEDVEDOVSKY, M.D. Board Certified Neurologist & Pain Medicine Specialist Director New Jersey Alternative Medicine
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1 MEDICAL CANNABIS FOR NEUROLOGICAL DISEASES July 15 TH, 2017 ANDREW MEDVEDOVSKY, M.D. Board Certified Neurologist & Pain Medicine Specialist Director New Jersey Alternative Medicine
2 GOALS AND OBJECTIVES Overview of medical cannabis Discuss benefits of medical cannabis Discuss how cannabis can help neurological diseases Avoid Political Debates
3 BRIEF BIOGRAPHY Completed Neurology Residency and Pain Medicine Fellowship at Virginia Commonwealth University Board Certified in Neurology & Pain Medicine Joined Pain Practice in 2013 Started Medical Marijuana Program in July 2015 Over 2000 Happy Patients
4 WHY IS CANNABIS IMPORTANT FOR YOU TO KNOW ABOUT? Evolving field Becoming mainstream Patients will be asking Legal reasons
5 NURSES IN PATIENT CARE:
6 EVOLVING INDUSTRY
7 WHY I STARTED THE PROGRAM? Patients kept asking Public awareness about marijuana Reduce use of opioids and addictive medications Expand my treatment options
8 Intractable Skeletal Muscular Spasticity Multiple sclerosis Muscular Dystrophy Inflammatory Bowel Disease (Crohn s) Intractable Epilepsy Glaucoma Terminal Cancer AIDS PTSD ALS QUALIFYING CONDITIONS
9 One of the oldest medicines in existence Used for centuries to treat 100 s of ailments Schedule 1 and federally illegal HISTORY OF CANNABIS
10 Marijuana Added to US Pharmacopeia Cannabis Used for Asthma, Bronchitis, and Loss of Appetite in South Asia US Pharmaceutical Farms Grow 60,000 Pounds of Cannabis Annually Reefer Madness Film Cautions Against Marijuana Marijuana Removed from US Pharmacopeia
11 ANYTHING IN COMMON?
12 WHAT DO THESE PEOPLE HAVE IN COMMON?
13 4 AMERICANS GET MEDICAL POT FROM THE FEDS In 1976, a federal judge ruled that the Food and Drug Administration must provide Robert Randall with marijuana President George H.W. Bush's stopped accepting new patients in Comes from the University of Mississippi
14 HOW SAFE IS MARIJUANA?
15 SO WHAT IS THE PROBLEM? Cultural Paradigm Misunderstanding Lack of education Inaccurate representation
16 PART II: CANNABIS SCIENCE
17 RAPHAEL MECHOULAM In 1964 DISCOVERED THC: Isolated Δ 9 - tetrahydrocannabinol Endocannabinoid system discovered in 1990s
18
19 ENDOCANNABINOID SYSTEM
20 ENDOCANNABINOIDS NEUROMODULATORS 2-Arachidonylglycerol (2- AG) Active on CB1 & CB2 Mimetic CBD Anandamide Mimics THC Activate CB1 receptor ECBs are produced in the cell membranes and tissues of the body THC mimics natural ECBs
21
22 Modulates activity without directly binding to CB1 Mediates pain perception and inflammation Activate serotonin receptor exerting anti-depressant effects Blocks the psychoactive action of THC CBD decreases bone reabsorption and cancer cell proliferation CANNABIDIOL (CBD)
23 ULTIMTE GOAL: MAINTAIN HOMEOSTASIS Maintenance of a stable internal environment despite fluctuations in the external environment Cannabinoids promote homeostasis at every level of biological life
24 HUNGER THIRST BODY TEMPERATURE SEXUAL ACTIVITY AROUSAL BLOOD PRESSURE HEART RATE CIRCADIAN RHYTHM SLEEP HORMONE REGULATION HYPOTHALAMUS
25 Has anyone ever heard of OREXINERGIC PROJECTION SYSTEM? There are approximately 70,000 orexin producing neurons in the human brain that project from the lateral hypothalamus to neurons and brain regions that modulate various functions. **CB1 are CO- LOCALIZED on OREXIN projection neurons INTERESTING FACT..
26 AMAZING AMYGDALA Deal with memory and experience ECB are key mechanism by which memories of aversive experiences are encoded and extinguished Treat PTSD
27 NEUROLOGICAL DISEASES Depletion Deficiency Dysregulation Destruction
28 GLUTAMATE & EXCITOTOXICITY Glutamate: Excitatory neurotransmitter Leads to the activation of Ca 2+ permeable NMDA receptors Excess calcium in the cytosol causes cell death Spinal cord injury, Stroke, MS, ALS, PD, Alcoholism, Epilepsy, Hypoglycemia ANDREW MEDVEDOVSKY, M.D.
29 PARKINSON S ON A CELLULAR LEVEL DESTRUCTION & DEPLETION ANDREW MEDVEDOVSKY, M.D.
30 I SMOKED POT IN HIGH SCHOOL AND WAS PARANOID
31 ALS (LOU GEHRIG 10% familial Genetic defect in superoxide dismutase: Increased oxidative stress for motor neurons, leading to cell death Elevated levels of Glutamate Animal studies 9-THC before and after onset of ALS Blocking CB1 receptors extended lifespan of mice with ALS. DESTRUCTION
32 MULTIPLE SCLEROSIS Reduces pain, muscle spasticity, depression, fatigue, and incontinence May inhibit disease progression European countries are more progressive in cannabis research and support DESTRUCTION & DYSREGULATION
33 COST OF MS DRUGS
34 WHAT DO THESE HAVE IN COMMON? DYSREGULATION
35 WHAT DO THESE HAVE IN COMMON? MIGRAINE HEADACHES FIBROMYALGIA IRRITABLE BOWEL SYNDROME
36
37 MANY DIFFERENT STRAINS
38 TERPENES AND TRICHROMES
39 SMELLS AND FLAVORS
40 TRIVIA QUESTION? Why can t you overdose on cannabis?
41 STAY FOCUSED MORE TO COME
42 PART II: OPIOID EPIDEMIC CAN MEDICAL CANNABIS
43 IMPROVING ONE LIFE AT A TIME
44 Impact Of Chronic Pain On HealthCare GOOD NEWS? JOB SECURITY
45 VICIOUS PAIN CYCLE
46 HOW ARE THESE PROBLEMS TREATED?
47 The US constitutes 4.6% of the world population But consumes 80% Of the world production of opioids
48
49 ANDREW MEDVEDOVSKY, M.D.
50 ANDREW MEDVEDOVSKY, M.D.
51
52 THERE HAS TO BE AN ALTERNATIVE TREATMENT OPTION! ANDREW MEDVEDOVSKY, M.D.
53 BENEFITS OF CANNABIS Side effect profile Health benefits Dependency and addiction Polypharmacy & drug interactions Improve sleep, energy, pain relief, anxiety, depression.
54 HOW DOES THIS HELP MY PATIENTS?
55 YOU DON T NEED TO PRESCRIBE.. JUST EDUCATE THE PATIENT INPATIENT Patients re-admitted with chronic pain, IBS flare up Can recommend to consult with Medical Cannabis Clinic OUTPATIENT Outpatient Cancer Center Patients on opioids, Benzodiazepines, sleep aids, ETC Safer alternative EMERGENCY ROOM Frequent flyers coming in with chronic conditions New CDC guidelines limit prescription of opioids PALLIATIVE CARE Appetite, sleep, mood, and well being
56 PARADIGM SHIFT
57 METHODS OF CONSUMPTION Smoking Vaping Eating Topical
58 CANNABIS SIDE EFFECTS Possible Interactions Coumadin SSRIs Tricyclics Sedation Palpitations Dizzy Hyperemesis?
59 OUR SUCCESS STORIES
60 THANK YOU FOR LISTENING
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