History of Medical Cannabis in Nursing

Transcription

1 History of Medical Cannabis in Nursing Kristen Luttenberger RN, MSN, CCRN, APNc

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4 Marijuana Definitions Cannabis-C. sativa, C. Indica & C. ruderalis THC (Tetrahydrocannabinol)-Main psychoactive component associated with the flower & the bud CBD (Cannabidiol)-failure to produce high Hemp-Non-psychoactive fiber of cannabis plant <1% THC, used as oil, hemp seeds, bird food, cloth, twine, paper, construction, rope etc.. Of note: Farm Bill (2014) Obama signed Farm Bill with Amendment to Allow Industrial Hemp Research (adding to legislative/legal confusion)

5 Definition of a Drug How do you define the difference between a good drug and a bad drug? 70% of drug related emergency room visits are due to prescription medications Do you as a healthcare provider take the time to find out why someone is taking an illegal drug? Do you have a zero tolerance approach to drug use?

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7 52,404 lethal drug overdoses in Opiates include heroin, oxycodone, hydrocodone, codeine, morphine, fentanyl. 23% of individuals who use heroin develop an opiod addiction. In 2015, 20,101 overdose deaths were related to prescription pain relievers, and 12,990 overdose deaths were related to heroin. In 2012, 259 million prescriptions were written for opiods, which is more than enough to give every American their own bottle of pills. Prescription pain reliever overdose deaths among women increased more than 400% from 1999 to 2010,compared to 237% among men.

8 History of Medical Cannabis China: Ancient Emperor Shen Nung (2700 BC) India: Arthava Veda (1400 BC) Ancient Middle East (1700 BC) Central Asia (450 BC) Ancient Greece/Rome (1 st Century AD) Africa-Smoked at least for 6 centuries Renaissance Europe (1950) Czech scientists

9 History of Medical Cannabis 1924 Analytic Cyclopedia of Practical Medicine (1924) summarized early 20 th century cannabis therapy Sedative/hypnotic Coughing Gastric Ulcer Mania/Delirium Paralysis Dysmenorrhea Tremens Goiter Post partum hemorrhage Chorea Bladder Spasms Rheumatism/Gout Tetnus Gonorrhea Eczema/pruritis Rabies Migraines Impotence Hay Fever Eye-strains Appetite stimulant Bronchitis Menopause Dysentary/Cholera Tuberculosis Brain Tumors Nephritis

10 History of Medical Cannabis Marijuana Tax Act 1937-Cannabis preparations were removed from US pharmacopoeiac (against medical advice) due to police waging against marihuana menance. 1940s war effort legalized hemp again (ropes/parachutes) Controlled Substance Act 1970 Robert Randall court case won in 1976 Synthetic tetrahydrocannabinol (Marinol) rescheduled into schedule II due to N/V benefit during chemo ( s) From the FDA allowed limited access to medical marijuana through the IND Investigational New Drug Program

11 Comprehensive Drug Abuse Prevention and Control Act 1970 Schedule I Schedule II Schedule III Schedule IV Schedule V Drugs are not safe, have no accepted use in the US, and have high potential for abuse. Cannot be prescribed. Currently accepted medical use and have high potential for abuse and dependence Medicinal drugs with potential for abuse and dependence liability less than Schedule II Medicinal drugs with less potential for abuse and dependence then III Medicinal drugs with lowest potential for abuse and dependence liability

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13 American Academy of Neurology Represents over 27,000 neurologists and became one of the 1 st medical organizations to endorse the use of medical marijuana Their guidelines state that oral cannabis, medical marijuana pills & spray may help ease pain and other symptoms caused by MS. They do not endorse smoked marijuana.

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17 Nabilone (Cesamet) Synthetic delta-9-thc Schedule II Approved for N/V related to to chemo Side effects drowsy, spinning, dry mouth, HA, tachy & hypotensive

18 New Prescription Cannabinoids Nabiximois (Sativex) Epidiolex (Cannabidiol)

19 Charlotte s Web

20 New CBD Legal Status CBD is legally allowed in 45 states December 2016: DEA ruled that all extracts from cannabis are Schedule I & illegal March 2017 DEA back off position stating CBD is legal if it comes from a legal part of the cannabis plant (mature stalk) Farmers say it is very difficult to extract CBD from stalk where hemp fibers are taken NIH is currently supportive of CBD studies

21 History of Medical Cannabis Spasticity Dantrolene (Dantrium) Baclofen (Lioresal) Benzodiazepines (Valium) Seizure Phenytoin Phenobarbital Valproic Acid Pain Opiates Benzodiazepines

22 General Side Effects of Marijuana Euphoria/Fatigue Drowsiness/Dizzy/Cognitive Imp. Conjunctival reddening of eye Tachycardia Increased appetite N/V Dry Mouth

23 Lighting Up in the Hospital? How much smoke is inhaled? Time between inhalations? Number of inhalations taken Strength of cannabis How much THC is lost in fire & trapped in mucosal lining of mouth _1280.jpg

24 Everyone is Watching Colorado 17 years of legalization & now recreational Surveillance of ED visits, hospitalizations, & poison control calls related to marijuana Watching dosing of no more then 10mg of THC (single servings) Public awareness campaigns

25 In Conclusion You Don t Have to Take a Stance, You Simply Have to Care for Your Patient; Put Them First and Educate Yourself!!

26 Thank you!!!