Cannabis and the Endocannabinoid System

Transcription

1 Cannabis and the Endocannabinoid System September 7, 2018 Bangkok, Thailand David Bearman, MD Goleta, California Executive VP, American Academy of Cannabinoid Medicine AACMSITE.org

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7 Shen Nung Ping Ts oa Ching 2637 B.C. Estimated date of the first known pharmacopeia. Yes, it contained cannabis. A recent Chinese excavation provides evidence of medicinal use in 2600 B.C.

8 Sir William Osler The Father of Modern Medicine He wrote in the first textbook of internal Medicine (1892) that Cannabis was the best migraine treatment

9 1920 S American doctors notes millions of Rx per year contained cannabis in the 1920 s

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11 Phytochemicals Go Out of Style Hundreds of thousands of cannabis containing Rxs were written per year in 1920s and 30s 28 OTCs contain cannabis The use of herbal remedies(including cannabis) was eclipsed by the cult of modernism Manufactured pharmaceuticals seen as modern Cannabis was not standardized Herbs =multiple compounds vs single compound

12 Prohibition Propaganda

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23 Introduction to Modern Medicinal Cannabis

24 H.H. Ramsey M.D. and Jean Davis M.D. The first modern study on the medicinal value of cannabis. Seven subjects with intractable seizures. After treatment with cannabis 5 of the 7 subjects had no or extremely few seizures. They concluded: The cannabinoids herein reported deserve further trial in noninstitutionalized epileptics. Federation Proceedings, Federation of American Society for Experimental Biology, vol. 8, ly49, p. 284.

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26 Federal Compassionate Access Investigational New Drug Program The Compassionate Investigational New Drug program, or Compassionate IND, is a United States Federal Government-run Investigational New Drug program that allows a limited number of patients to use medical marijuana grown at the University of Mississippi. It is administered by the National Institute on Drug Abuse. Closed to new entrants, there are four surviving patients who were grandfathered into the program.

27 Marinol 1985 The AIDS Epidemic saw widespread use of cannabis by HIV/AIDS sufferers. Cannabis addressed appetite stimulation, relief of pain and depression The government s response was to encourage the development of synthetic THC. It was approved by the FDA in It s Trade name is Marinol, generic name is dronabinol.

28 Cannabinoid & Cannabis Marinol=1 cannabinoid Cannabis=113 cannabinoids

29 The Endocannabinoid System characterized circa 1992 Endocannabinoid system is found in the human body. It is central to homeostasis. It is the largest neurotransmitter in the human brain and interacts with the dopaminergic system.

30 It is composed of: RECEPTORS CB1 Receptors found largely in the brain CB2 Receptors found in the immune system and the periphery NEUROTRANSMITTERS Anandamide (AEA) an endocannabinoid 2AG -another endocannabinoid neurotransmitter ENZYMES FAAH -enzyme that metabolizes endocannabinoids MYGYL -another enzyme for endocannabinoids

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32 THE ENDOCANNABINOID SYSTEM. SENSI PHARMA WEBSITE.

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38 Chemistry Cannabis 512 chemicals 113 cannabinoids (21 carbon molecule) Over 200 Terpenes Phenoids Flavonoids

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40 THC, THCA CBD, CBDA CBN, CBC CBG, THCV

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48 Myrcene Linalool Limonene Pinene Beta Caryophyllene Flumelene

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55 GW Pharmaceuticals In 1999 GW started doing research on tincture of cannabis for relief of muscle spasms and neurological pain associated with Multiple Sclerosis.

56 Sativex

57 This is a high CBD GW product. It is an anti seizure medication for treating Dravet s Syndrome (intractable seizures) Approved by the FDA in 2018

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59 Efficacy 4000 year history of medical uses Anecdote evidence State Studies in eight states in 1980s House of Lords Report in 1997 GW Studies present IOM Report 1982 and 1999 CMRC Studies ,000 Research Studies Used by millions world wide

60 Government reports from: India/Britain(1894), U.S. (1972), Britain (1968), Canada(1973), Australia, (1978) Panama Canal Zone(1916 & 1931) 1985 Delta 9 THC, FDA Approved FDA Chief ALJ Young s Findings of Fact 2005 Tincture of Cannabis, Health Canada Approval 2006 FDA approves Phase III Sativex Clinical Trial 2010 EU approves Sativex

61 Respiratory 1-smoking 2-Vaporizing Sublingual Spray (Sativex/nabixamol) drops Oral capsules tincture other-tincture,tea, in flavored drinks Topical tincture cream

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65 Anti nauseant/anti emetic Appetite stimulant Analgesic Anti epileptic Anti inflammatory Anxiolytic Anti spasmodic Anti depressant Sleep Aid PTSD treatment ADD/ADHD treatment

66 MBC Guidelines for Giving Approval/Recommendation Bonafide doctor-patient relationship Good faith H&P Review records Plan With Objectives A condition which will benefit from use of cannabis

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70 Tincture of Cannabis : Epidiolex, Nabiximol Delta 9 THC-Marinol Off Label Use Strains,Extracts, Synthetics CBD, Phenoids, Terpenes, Other Constituents Grinspoon: Pharmaceuticalization v Individualism Plant v Synthetic

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