MEDICAL CANNABIS PATIENT COUNSELING. Krissy Bernazani, RPh Clinical Director Zen Leaf

Transcription

1 MEDICAL CANNABIS PATIENT COUNSELING Krissy Bernazani, RPh Clinical Director Zen Leaf

2 DISCLOSURE Krissy Bernazani is a paid employee of Freestate Wellness, dba Zen Leaf Maryland, a medical cannabis dispensary. This presentation discusses unapproved indications for a federally illegal substance.

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4 States with Cannabis Laws

5 Maryland Qualifying Conditions (1) Chronic or debilitating disease or medical condition that results in the patient being admitted into hospice or receiving palliative care; (2) Have a chronic or debilitating disease or medical condition or are receiving treatment for a chronic or debilitating disease or medical condition that causes: (a) Cachexia: (b) Anorexia; (c) Wasting syndrome; (d) Severe or chronic pain; (e) Severe nausea; (f) Seizures; or (g) Severe or persistent muscle spasms; (3) Glaucoma; PTSD

6 Qualifying Conditions Cont. A physician may be registered as a certifying physician to treat a patient who has a condition that is: (1) Severe; (2) For which other medical treatments have been ineffective; and (3) If the symptoms reasonably can be expected to be relieved by the medical use of cannabis. A certifying physician may apply to amend or revoke the approval at any time. Source: COMAR

7 Other Potential Therapeutic Benefits Palliative Care ALS, Spinal Cord Injury Acute Pain Post-op Pain Arthritis/Musculoskeletal Disorders Movement Disorders: Parkinson s, Dystonia, Huntington s Disease, Tourette s Asthma Hypertension Alcohol/Opioid Withdrawal Metabolic Syndrome, Obesity, Diabetes Pancreatic Disease Antineoplastic Properties

8 Cannabis for Pain THE JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS Copyright 2003 by The American Society for Pharmacology and Experimental Therapeutics JPET 304: , 2003 First study demonstrating synergistic effect of THC and opioids 2002 (mouse tail flick test). OPIOID SPARING Opioids use can be SAFER by decreasing the need for dosage escalation while increasing pain relief NO RISK OF FATAL OVERDOSE WITH CANNABIS Chronic Pain/Cancer Neuropathy (HIV, Diabetic) Headache/Migraine

9 JAMA reported a 24.8% reduction in opioid analgesic overdose deaths in states that have medical cannabis laws

10 FUNCTIONS RELAX EAT SLEEP FORGET PROTECT RECEPTORS: CB1 AND CB2 ENDOGENOUS CANNABINOIDS: ANANDAMIDE ( BLISS ) aka AEA 2-ARACHIDONOYLGLYCEROL aka 2AG ENDOCANNABINOID SYNTHESIZING AND DEGRADING ENZYMES HOMEOSTASIS

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12 Very Few CB1 Receptors in the Brain Stem

13 No Recorded Lethal Dose In rats, the LD-50 of oral THC is mg/kg and in monkeys it is 9000 mg/kg. A smoker would theoretically have to consume nearly 1,500 pounds of cannabis within about fifteen minutes to induce a lethal response. In practical terms, cannabis cannot induce a lethal response as a result of drugrelated toxicity.

14 Tolerance, Dependence, and Withdrawal

15 Possible Long-Term Effects of Cannabis Symptoms of withdrawal from chronic use similar to caffeine Difficult to measure due to uncontrolled nature of reports Much debate of long-term use causing cognitive decline; risk seems higher if use begins before age Reports of decreased sperm count and motility as well as abnormal morphology with chronic use Periodontal disease

16 Precautions <18 yrs. old Heart disease COPD Severe liver or renal disease Psychiatric disorders History of drug abuse Pregnancy and lactation

17 Drug Interactions Additive sedation with other CNS depressants Cytochrome P450 isoenzyme system interactions: Drugs that inhibit these enzymes can increase THC or CBD levels THC and CBD can increase plasma levels of drugs metabolized by these enzymes (eg, theophylline, warfarin, anti-seizure meds) Antiepileptics

18 Antiepileptic Drug Interactions

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20 Dosing Methods: Inhalation DRIED FLOWER

21 Dosing Methods: Inhalation VAPORIZATION

22 Concentrates for Inhalation

23 Oral Options

24 No Edibles in Maryland

25 Topical Products

26 THANK YOU!

27 RESOURCES Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1= PN.&OS=PN/ &RS=PN/ Health Canada. Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids. February 2013 Kim PS, Fishman MA. Cannabis for Pain and Headaches: Primer. Curr Pain Headache (2017) 21:19 DOI /s Fine PG, Rosenfeld MJ. The Endocannabinoid System, Cannabinoids, and Pain. Rambam Maimonides Med J 2013:4 (4):e0022 doi: /rmmj T.R.Deer et al (eds.), Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches, DOI / _18, American Academy of Pain Medicine 2013 American Herbal Pharmacopoeia. (2014). Cannabis Inflorescence. Scotts Valley, CA: AHP Kowal MA, Hazekamp A, Grotenhermen. Review on Clinical Studies with cannabis and cannabinoids Cannabinoids 2016; 11(special issue):1-18 (20 February 2016) Bachhuber MA, et al. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the Unted States, Jama Intern Med.2014;174(10): doi:

28 Oxford University Press (2014), RG Pertwee (Ed.) Handbook of Cannabis. Oxford, UK. CPI Group (UK) Ltd. The Rx Consultant, January 2017 National Academies of Sciences, Engineering, and Medicine, The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press. doi: /24625 Armentano, Paul. Emerging clinical applications for cannabis and cannabinoids: A review of the recent scientific literature. National Organization for the Reform of Marijuana Laws Health Canada. Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids. February Material Safety Data Sheets Mazanet R. Medical Cannabis for Neuropathic Pain Part 2 of 3.