-Since 1990, opiate prescription overdoses have more than tripled!
-80% of the world's supply of pain relievers (hydrocodone, etc.) is used by U.S. citizens! U.S. citizens make up 5% of the world's population.!
-In the NFL, more than half of former players have reported using opioids regularly, and 71% of those players reported misuse of the drugs, according to a 2011 study funded by ESPN and the National Institute on Drug Abuse.
-Over 30,000 people in the U.S. alone die each year from opioid use.
-States allowing medical use of cannabis have lower rates of deaths resulting from opioid analgesic overdoses than states without such laws....25-30% fewer deaths with medical cannabis.
-Over 17,000 NSAID-related deaths (ibuprofen, Aleve, naproxen, etc) with just osteoarthritis and rheumatoid arthritis every year in U.S. - the 15th most common cause of death.
-Lethal dose of cannabis = 15 pounds smoked in 15 minutes.
-Cannabis attenuates (relieves) morphine withdrawal.
-Cannabis reduces craving in cocaine users because it attaches to receptors in the brain (CB2 receptors).
-Cannabis extracts have 2-4 times greater effects than THC alone.
-First reported use over 5,000 years ago
-Used in China and the Indian subcontinent for thousands of years.
-1937 AMA strongly opposed legislation limiting it because of lack of objective data showing harm.
-Was removed from U.S. Pharmacopoeia in 1942.
-1970, Controlled Substance Act of 1970, declared a Schedule I drug (controlled).
-This act stopped almost all research in humans.
-In U.S., #1 cash crop - more revenue than wheat and corn.
-200,000 in prison for marijuana related crimes - more revenue.
-Great explosion of information regarding the endocannabinoid system which modulates the following functions: relaxation, eating, sleeping, forgetting, protecting - term described by Dr. Di Marzo 1998.
-In 1992, there were 2 citations for a public medical search for endocannabinoid. In 2014, 6500 citations!
-CB receptors evolved 600 million years ago, we've found.
-Cannabinoids affect the intensity with which other neurotransmitters are firing; they modulate numerous systems within the body.
-Endocannabinoids affect every biological oscillator or pacemaker cell investigated to date including circadian rhythms, peristalsis slow wave, EKG and EEG rhythms.
-Endocannabinoids regulate toward balance all body systems (cardiovascular, digestive, immune, endocrine, excretory, nervous, musculoskeletal, reproductive).
-Within a cell, cannabinoids control basic metabolic processes such as glucose metabolism.
-The health of each individual is dependent on this endocannabinoid system working appropriately.
-Cannabinoid receptors are found in higher concentrations than any other receptor in the brain, and the endocannabinoid system acts in every physiological system looked at to date.
-It is important to note that as a general homeostatic modulator, too much or too little cannabinoid activity can be harmful.
-Cannabis has some different responses from different doses. The unique nature of cannabis requires dose-dependent, disease-dependent, state-dependent, and individually tailored approaches to cannabis therapeutics.
-Cannabinoids regulate intercellular communication especially in the immune and nervous systems.
-The cannabinoid system is a naturally evolved harm reduction system.
ENDOCANNABINOIDS, HUNGER AND FEEDING
-Human breast milk contains endocannabinoids.
-Newborn mice stop suckling and die when administered a drug that blocks this system.
CANNABINOIDS AND EMBRYOLOGY
Neural stem cell proliferation deficiency and differentiation is shaped by external signaling via the endocannabinoid system.
Clinical endocannabinoid deficiency (CECD) could underlie the pathophysiology of migraines, fibromyalgia, irritable bowel syndrome (IBS), and other functional conditions alleviated by clinical cannabis.
-Cannabinoids regulate intercellular communication especially in the immune and nervous systems.
-The endocannabinoid system is a naturally evolved harm reduction system.
-Cannabis acts as an herbal adaptogen (protects us from harmful effects of excess stress). Other examples of "herbal" adaptogens include schisandra, reishi mushroom, eleutherococcus and ginseng.
* = the two most well-known, well-studied
-Over 400 chemical compounds
-Resin of female plant contains highest concentration of bioactive compounds.
-Main psychoactive component is delta-9-THC (THC).
-At least 70 other cannabinoids including CBC identified.
CB1 - located mainly in central nervous system (CNS), and to a lesser degree in tissue, endocrine glands (hormone function) and GI tract.
CB2 - located mainly in immune cells as well as in tonsils and spleen, as well as the nerves in the intestines.
High-CBD Strains Lower Side Effects
-Patients should be made aware of the higher risk of memory impairment associated with smoking low-CBC strains of cannabis like "skunk" and encouraged to use strains containing higher levels of CBD. Why? Because CBD is the ingredient that staves off marijuana memory loss.
-Briefly stated, CBD has anti-anxiety actions, anti-psychotic effects, modulates metabolism of THC by blocking its conversion to the more psychoactive 11-hydroxy-THC, prevents glutamate excitotoxicity, serves as a powerful anti-oxidant, and has notable anti-inflammatory and immunomodulatory effects.
-CBD antagonizes undesirable effects of THC such as intoxication, memory loss, sedation, anxiety.
-At the same time, CBD enhances desirable effects including pain relief, anti-nausea/vomiting, and anti-cancer properties.
-CBD powerfully blocks THC at the CB1 receptor, thus muting the psychoactive effects of THC.
CBD AND TRPV1
-CBD binds directly to TRPV1 receptors, thus modulating pain perception, inflammation and body temperature.
-This is one reason why cannabis can be so effective for neuropathic pain.
-Capsaicin from chili peppers also activates TRPV1.
-Dronabinol, a synthetic THC approved in 1986 as schedule II (safer than
Schedule I) and in 1999 moved to Schedule III (even safer than Schedule II).
-Nabilone, a THC analog, was approved by FDA in 1985 though not marketed in the U.S. until 2006.
-Both are indicated for chemo-induced nausea/vomiting and as appetite stimulant for AIDS patients.
MARINOL VS NATURAL CANNABIS
-Marinol lacks several therapeutic compounds available in natural cannabis.
-Marinol is more psychoactive than natural cannabis.
-Cannabis vaporization offers advantages over orally administered THC.
-Marinol is much more expensive than natural cannabis.
-Patients prefer natural cannabis to Marinol.
Cannabis studies show that cannabis extracts demonstrate 2 to 4 times greater effects than THC alone. This is because of the overlapping functions and working together as a team that the full range of cannabis ingredients share.
Endocannabinoids protect fine-tuning and regulating dynamic, ever-changing biochemical states within the ranges required for healthy biological function.
This endocannabinoid system is up-regulated or down-regulated as needed.
*Endocannabinoid levels naturally increase in response to nerve injury and associated pain.
CANNABINOIDS AND THE BRAIN
-Some nerve cells die when they are excessively stimulated by excitatory neurotransmitters such as glutamate.
-Cannabis can reduce this excess level of stimulation and protect against this type of cell death.
CANNABIS AND OTHER PAIN DRUGS
Benefits of cannabis include adequate symptom relief, fewer side effects and lower cost than most commonly prescribed pharmaceuticals.
Cannabis patients reduce or eliminate use of opiates and other pain "killers", Ritalin, tranquilizers, sleeping pills, anti-depressants, and other psychiatric medicines.
All of these medicines contain more serious risk profiles than cannabis. Consider the current tragic epidemic of opiate addiction that destroys tens of thousands of lives in just the U.S. alone every year!
In strict medical terms, cannabis is far safer than many foods. For example, eating ten raw potatoes can result in a very toxic response.
It is physically impossible to eat enough cannabis to induce death.
Cannabis in its natural form is one of the safest therapeutically active substances known.
By any measure of rational analysis, cannabis can be used within a routine of supervised medical care.
-Unstable psychiatric diagnoses are "red flags".
-In such cases it is important to have or develop a good history for the efficacy of cannabis for the patient.
-Communication with therapists is highly desirable.
-The next best is a significant other who can attest to the patient's condition being improved by medical cannabis use.
-For some patients, particularly elderly patients with no history of previous experience, the psychological effects can be disturbing.
-Patient individuality is almost always encountered concerning dose tolerance.
-Patient determined self-titrating dosage model is recommended.
-The route of administration determines a large part of the pharmacokinetics of absorption and metabolism of various cannabinoids.
-Gabapentin is an example of a drug with relatively low toxicity and high dosing limits that is titrated to effect.
-Self-titration is acceptable in view of the variables and low toxicity of cannabis.
-The concentration of cannabinoids varies greatly depending on plant genetics, growing conditions, timing of harvest, and processing after harvest.
-Remember, the clinical pharmacology of cannabis containing high THC differs from plant material containing low levels of THC and higher levels of other cannabinoids.
-Cannabinoid effects do affect levels of various neurotransmitters.
-A cannabinoid may cause release of a certain neurotransmitter at low concentrations, while at a higher concentration it may result in the release of a different one.
-Health risks call for regulation and education, not prohibition.
CANNABIS DELIVERY METHODS
Tincture (alcohol extraction)
Topical salves and creams
INHALED THC PHARMCOLOGY
-Rapidly absorbed and redistributed
-Large amount of dose destroyed by combustion
-Blood levels peak in minutes and decline after 30 minutes.
-Inhalation achieves higher peak concentration and shorter duration of effect.
-Much easier for patients to titrate effect with inhaled cannabis than oral THC.
CANNABIS DOSING VARIABLES
-Chronic pain patients tend to use more, while acute and terminal patients tend to use less.
-Some patients depend on cannabis to keep from vomiting oral medications, so specific dosages fluctuate depending on day-to-day reactions to medications.
DAILY SMOKED DOSAGES
-For recreational users, a single cigarette per day weighing less than one gram (small) equates to about one ounce per month, or 12 ounces per year.
-Most chronic pain or debilitated patients must smoke cannabis throughout the day. Three to five average-size cannabis cigarettes per day comes to about one ounce per week, or 3.25 pounds in a year.
CANNABIS SMOKING AND LUNG CANCER
-Cannabis and tobacco smoke are not equally carcinogenic (see Harm Reduction Journal, 2008).
-THC inhibits the enzyme necessary to activate some of the carcinogens found in smoke.
-Results suggest that the association of cancer with marijuana, even long-term or heavy use, is very weak and may be below practically detectable limits.
-While cannabis smoke has been implicated in respiratory dysfunction like broncho-constriction, it has not been causally linked with tobacco related cancers such as lung, colon or rectal cancers.
-THC/CBD vaporize at a much lower temperature than they burn.
-Vapors have fewer toxic materials than smoke from cannabis combustion.
-Potentially more psychoactive than smoking because combustion (fire) destroys some THC.
-Clinical trial participants tend to prefer vaporization over smoking cannabis.
-Expired CO (carbon monoxide) is lower in vaporized cannabis.
CANNABIS DOSING : INGESTION
-"Fat-loving" (lipophilic) substances such as coconut oil, butter, or alcohol are used to extract and deliver cannabinoids through the digestive system.
-Up to three times as much cannabis is required when taken orally versus via inhalation.
-Cannabis edibles are processed and reduced by the liver's metabolism as soon as it leaves the small intestine.
-Peak THC effects occur 1-6 hours after ingestion with a half-life of 25-30 hours.
-Oral (ingested) cannabis can be hard to titrate due to delayed onset and high variability of patient metabolism. That is, the liver can function more quickly or slowly in different people's drug metabolism.
-Oral bio-availability of THC is between 5 and 20%.
-Psychoactive and physical effects are much more pronounced with edibles.
-As with all cannabis, potency varies depending on concentration as well as specific strain.
-Very high doses, though not lethal, can cause great discomfort and panic.
-Initial doses of 10 mg of THC or less should be used by cannabis naive patients.
POTENTIAL CANNABIS WITHDRAWAL SYMPTOMS
CANNABIS AUGMENTS OPIATE EFFICACY
-In combination with sustained-release morphine or oxycodone, patients who vaporized cannabis in moderation typically reported pain decreasing by 27-37%.
-Vaporized cannabis augments the analgesic (pain reducing) effects of opioids without significantly altering plasma opioid levels. The combination allows for lower opioid doses with fewer side effects.
-(Cannabinoid-Opioid Interaction in Chronic Pain, Abrams, DI, Couey, P, Shade, SB, Kelly, ME and Benowitz, NL, Clinical Pharmacology and Therapeutics, 90 (6) 2011, 844-851.)
-Symptoms of opiate withdrawal decrease in patients undergoing methadone maintenance treatment, who use cannabis.
-Overall, numerous pain management studies and medical surveys conclude that medical cannabis decreases pain, improves sleep and mood, with minimal side effects.
-At least one in five Americans have chronic pain.
-Neuropathic pain often associated with diabetes, cancer, MS, HIV, post-herpetic neuralgia (from shingles).
-Use of standard pain reducers such as opiates and Tylenol and ibuprofen is often ineffective at relieving neuropathic pain.
-Additionally, cannabinoids prevent development of tolerance to and withdrawal from opiates, and can even rekindle opiate effectiveness after a prior dosage has become ineffective.
CANNABINOID DEFICIENCY SYNDROMES
Premenstrual discomfort (luteal phase defects)
Be responsible. Be informed. Seek expert advice as needed. We need this medicine. We need research.