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THC:
Medicinal or Not?Greater Kansas City Chapter
American Society for Pain Management Nursing
October 24, 2015
Laura Habighorst BSN RN CAPA CGRN
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Objectives
• Explore history of cannabis use and current science
• Evaluate clinical applications of cannabinoids, supported by the research
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• 4000 BC evidence of hemp usage in artifacts found in west central Asia
• 2000-1400 BC Sanskrit and Hindu literature discuss medicinal use fro rheumatism and gout
• 900 BC Staple in Indian medicine
• 40 AD Greeks consistently document use for cataracts, depression, earaches, edema, inflammation
History
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Cannabis sativa, as seen in the Grandes Heures of Anne of Bretagne, (1505-1508). One of the earliest most ancient botanic depiction of the plant in the western world (male and female). (Wikimedia Commons)
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• 1839: Dr. William Brooke O’Shaughnessy introduced the use of marijuana in the U.S. for treatment of muscle relaxation and analgesia• 1840 – Early 1900’s: Used for migraines either smoked or as a suppository
THE TIDE BEGAN TO TURN
• 1930: Federal Bureau of Narcotics associated use of marijuana with psychosis, mental deterioration, addiction and violent crimes• 1937: Marijuana Tax Act• 1941: Removed from U. S. Pharmacopia and National Formulary
History
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WELCOME
TO THE
60’S
History
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• 1960-1970’s: Recreational use with anti-cultural/establishment connotations
• 1970: Dr. Roger O. Egeberg requested marijuana be classified to Schedule 1, like heroin and LSD due to the lack of scientific evidence of its medicinal value
• 1988: Attempt made to reclassify as Schedule 2 because of the efficacy of use in spasticity, paraplegia, multiple sclerosis, glaucoma, and as an antiemetic. This was denied by the FDA.
• 1996: California first state to pass Compassionate Use Care Act
• 2001 and 2006: Additional attempts to reclassify to Schedule 2 for same reasons but was denied.
• 2014: American Academy of Neurologists developed a consensus statement for the use of marijuana in neurological disorders based on a systematic review of literature from 1948 – 2013.
• 2015: American Academy of Pediatrics has requested a reclassification to Schedule 2 in order to allow for more research
History
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TaxonomyCannabaceae(Plant family)
Cannabis(Genus)
Sativia(Species)
Indica(Species)
Ruderalis(Species)
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https://www.youtube.com/watch?v=b5CmOdtP2S8
Exploring the Endocannabinoid System Cannabinoids and their Therapeutic Potentials
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THC & CBD Tetrahydrocannabinol
(THC)• Discovered in 1964• Used in Marinol• Responsible for the high • Attaches to cannaboid
receptors in the brain associated with thinking, memory, pleasure, coordination and time perception.
Cannabidiol
(CBD)• Wider scope of
medicinal use than THC• Anti-psychotic effect• Used primarily in
epilepsy and mulitple sclerosis
• May cause cellular death in breast cancer and gliomas
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TaxonomyCannabaceae(Plant family)
Cannabis(Genus)
Sativia(Species)
Indica(Species)
Ruderalis(Species)
High in CBDLow in THC
High in THCLow in CBD
High in CBDLow in THC
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https://www.youtube.com/watch?v=PKvbaIiLKvE
C. Sativia – Charlotte’s Web
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Bar-Sela, G., Vorobeichik, M., Drawsheh, S., Omer, A., Goldberg, V., Muller, E. (2013). The medical necessity for medicinal cannabis: Prospective, observational study evaluating the treatment in cancer patients on supportive or palliative care. Evidence-Based Complementary and Alternative Medicine. doi: 10.1155/2013/510392
Wallace, M. and Ware, M. (2015). Medicinal marijuana: Here to stay and time to take responsibility. Clinical journal of Pain, 31, pp. 931-932.
Morris RG, TenEyck M, Barnes JC, Kovandzic TV. (2014). The effect of medical marijuana laws on crime: Evidence from state panel data, 1990-2006. PLoS ONE 9(3): e92816. doi:10.1371/journal.pone.0092816
Baron, E. (2015). Comprehensive review of medicinal marijuana, cannabanoids, and therapuetic implications in medicine and headache: What a long strange trip it has been . . . The Journal of Head and Neck Pain. Retrieved from: http://onlinelibrary.wiley.com.ezproxy.liberty.edu:2048/doi/10.1111/head.12570/epdf
Hill, B. (2015). Cannabis: A journey through the ages. Ancient origins: Reconstructing the story of humanity’s past. Retrieved from http://www.ancient-origins.net/history/cannabis-journey-through-ages-003084
Koppel, B., Brust, J., Fife, T., Bronstein, J., Youssof, S., Gronseth, G., Gloss, D. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders. Report of the Guideline Development Subcommittee of the American Academy of Neurology Neurology, 82, pp. 1556-1563. doi: 10.1212/WNL.0000000000000363
References
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Welty, T. E., Luebke, A., & Gidal, B. E. (2014). Cannabidiol: Promise and Pitfalls. Epilepsy Currents, 14(5), 250-252
Massi, P., Solinas, M., Cinquina, V., & Parolaro, D. (2013). Cannabidiol as potential anticancer drug. British Journal of Clinical Pharmacology, 75(2), 303–312. http://doi.org/10.1111/j.1365-2125.2012.04298.x