THC:

Medicinal or Not?Greater Kansas City Chapter

American Society for Pain Management Nursing

October 24, 2015

Laura Habighorst BSN RN CAPA CGRN

Objectives

• Explore history of cannabis use and current science

• Evaluate clinical applications of cannabinoids, supported by the research

• 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

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)

• 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

WELCOME

TO THE

60’S

History

• 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

TaxonomyCannabaceae(Plant family)

Cannabis(Genus)

Sativia(Species)

Indica(Species)

Ruderalis(Species)

https://www.youtube.com/watch?v=b5CmOdtP2S8

Exploring the Endocannabinoid System Cannabinoids and their Therapeutic Potentials

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

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

https://www.youtube.com/watch?v=PKvbaIiLKvE

C. Sativia – Charlotte’s Web

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

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