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Reefer Madness: Where we stand with cannabis based medicine in palliative care. Erin Suhrie, Pharm.D. University of Maryland, Palliative Care Resident. Objectives. At the end of the presentation the participant will be able to: Understand the recent advances in cannabis pharmacology

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reefer madness where we stand with cannabis based medicine in palliative care

Reefer Madness:Where we stand with cannabis based medicine in palliative care

Erin Suhrie, Pharm.D.

University of Maryland, Palliative Care Resident

objectives
Objectives

At the end of the presentation the participant will be able to:

  • Understand the recent advances in cannabis pharmacology
  • List the cannabis products currently available in the USA
  • Discuss future directions for cannabis based research
brief history lesson
Brief history lesson
  • 1839 - Western world becomes aware of cannabis’ therapeutic potential through the works of William O’Shaughnessy
  • 1937 - Nonmedical use of marijuana is made illegal in the US
  • 1940 - Chemical synthesis first achieved
  • 1964 - THC identified as the main psychoactive component of cannabis
  • 1970 - cannabis placed in Schedule I of the federal Controlled Substances Act
recent discoveries
Recent discoveries
  • Cannabinoid receptor system
    • CB1
    • CB2
  • Endogenous cannabinoids
    • Anandamide
    • 2-arachidonoylglycerol
thc and other cannabinoids
THC and other cannabinoids

Cannabidiol (CBD)

9-THC

Cannabinol (CBN)

Anandamide

potential medical uses for cannabis
Potential Medical Uses for Cannabis
  • Cancer pain
  • Migraines
  • Chemotherapy induced nausea
  • Neuropathic pain
  • Multiple sclerosis related spasticity
  • Glaucoma
  • Ulcerative colitis/Inflammatory bowel disorders
  • Epilepsy
  • Anorexia
smoked cannabis
Smoked Cannabis
  • Very high incidence of psychoactive side effects
  • Pulmonary sequelae
  • Few clinical trials but many anecdotal claims
  • Potential benefit for patients with intractable nausea and anorexia
currently available drug products
Currently available drug products
  • Marinol (dronabinol)
  • Cesamet (nabilone)
  • Cannador
  • Sativex
marinol dronabinol
Marinol (dronabinol)
  • Synthetic THC
  • Oral capsule
  • Schedule III Controlled Substance
  • FDA approved indications:
    • Treatment of anorexia associated with weight loss in patients with AIDS
    • Treatment of Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments
cesamet nabilone
Cesamet (nabilone)
  • Synthetic analogue of THC
  • Oral capsule
  • Schedule II Controlled Substance
  • FDA approved indication:
    • Treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional therapy
cannador
Cannador
  • THC/CBD combination
  • Oral capsule
  • Not available in the USA
sativex
Sativex
  • THC/CBD combination
  • Oral mucosal spray
  • Not available in the USA
current and future research
Current and Future Research
  • Ajulemic acid
    • Synthetic analog of THC
  • Compounds that affect the levels of endogenous cannabinoids (by inhibiting membrane transport or hydrolysis)