Medical Cannabis MATT WEBSTER DO, MS

Transcription

1 Medical Cannabis MATT WEBSTER DO, MS

2 Cannabis Sativa One of the oldest used drugs and medicinal remedies Most commonly abused illicit drug in the US There has been increasing access for medicinal MJ use in the US over the past 20 years

3 What is Marijuana? What we typically think of as MJ is primarily the dried flowers and leaves from plants of the genus Cannabis Sativa. The active compounds in the plant are called cannabinoids. There are hundreds of such compounds but the most important are THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol).

4 Cannabinoid Receptor System We have naturally occurring cannabinoids and associated receptors in our bodies and this system was first described in the 1990s. There are different receptors all throughout the body including the CNS and immune system. The two most important receptors are CB-1 and CB-2

5 CB-1 (THC Receptor) This receptor binds THC Primarily located in the central and peripheral nervous system as well as some in the gut and adipose tissue Causes release of downstream neurotransmitters in the CNS including dopamine which cause euphoria, alter spatial perception, decrease pain perception, stimulate appetite, and may cause a psychoactive effect Causes the typical effects of the high associated with MJ

6 CB-2 (CBD) Receptor This receptor binds CBD Receptors primarily located in cells of the immune system including solid organs such as the spleen and lymphatics as well as blood based immune cells Helps to decrease inflammation and likely has an anti-cancer effect Chemical most likely to have a positive health effect

7 Adverse Health Effects of MJ Central Nervous System Memory loss, learning disability Depression, paranoia, addiction Worsening bipolar disorder Anxiety Digestive system Acute hunger ( munchies ) Constipation Respiratory (when smoked) Schizophrenia or other psychoses Bronchitis Increased incidence of suicidal ideation and suicide attempt Cardiovascular system Lung cancer? Pregnancy Increased blood pressure and heart rate Low birth weight infant Increased risk for acute heart attack

8 Cannabis history in medicine In the early 20 th century was commonly included with many medicinal preparations including cough syrups and lotions 1937 Marijuana Tax Stamp act made it effectively illegal to possess or sell MJ without an expensive tax stamp Controlled Substances Act of 1970 made it a Schedule I controlled drug with no accepted medical use and high potential for abuse

9 Recent Regulatory Changes 1996 California Proposition 215 The Compassionate Use Act of 1996 Approved for use by seriously ill individuals with MD recommendation Mid 90s-00s US Attorney General relaxed federal law enforcement Rapid rise in medical marijuana licenses 2014 US Department of Justice advised US attorneys not to pursue action against physicians states and Puerta Rico have at least limited medical cannabis access

10 Synthetic Medical Preparations THC preparations: Dronabinol (Marinol, Syndros)/ Nobilone (Cesamet) Approved for chemo associated N/V and AIDS related weight loss Schedule II CBD: Epidiolex Approved for treatment of childhood epilepsy syndromes Schedule V

11 Medicinal Cannabis Medical cannabis may be smoked as the natural dried plant or consumed in other preparations to be ingested orally (oil, edibles, capsules, etc) or topically such as lotions CBD:THC ratio is an important concept. Looking for higher CBD than THC content ideally. This is different than recreational MJ which may be 30% THC by weight

12 Iowa Regulations Iowa Medical Cannabidiol Act was signed in May 2017 allowing for CBD with no more than 3% THC for select approved medical conditions Five dispensaries throughout Iowa will open December 1 Patients will need certification from a PCP of a qualifying condition then apply with the Iowa Department of Public Health for a card allowing purchase of CBD/THC containing products

13 Iowa Regulations Qualifying conditions include chronic pain, seizures, MS with muscle spasms, Parkinson s Disease, ALS, HIV/AIDs. No smoked or edible CBD/THC will be available but instead preparations will include capsules, oils, and creams Over the counter CBD oil remains illegal in Iowa though is increasingly popular with online ordering and distribution

14 Conditions with Strong Evidence There is solid evidence that cannabis is effective for the treatment of cancer related pain and the nausea and vomiting associated with chemo Likely is effective for the treatment of spasticity related to MS

15 Limited Evidence for Effectiveness There is limited evidence that cannabis is effective for treatment of anxiety, insomnia, dementia, ALS, epilepsy, glaucoma Thus, there isn t great clinical evidence that medical cannabis is effective for some of the conditions it is approved for

16 Summary There is and will be increasing access to cannabis as a medical modality New studies are commencing looking at effectiveness for many conditions It is available in Iowa in a somewhat limited scope Look at the CBD:THC ratio