11. Chap 8.1, 8.2, 8.3 Medical marijuana and it's uses

How long has medical marijuana (mj) been used for medicinal purposes?

Been used for over 4000 years

What were some of the original uses of medical mj in the 1800s?

Anxiety, sleep disorders, headaches and migraines

When did mj become illegal in the US? When did it become a Schedule I substance?

Illegal in 1937

Schedule I drug in 1970

What are the types of cannabis plant? (3)

Cannabis sativa

Cannabis indica

Cannabis ruderalis

Define cannabinoids. What are the most important for humans? (2)

The active product in mj

Out of 100, THC and CBD most important

What is the endogenous cannabinoid system in the body?

A system of receptors and endocannabinoids (endogenous), along with enzymes that synthesize and decrease endocannabinoids

What are the (2) main types of endocannabinoid receptors? Where are they found?

CB1 receptor: Found on nervous system tissues and pain pathways

CB2 receptor: Found in immune and hematopoietic cells

What is the purpose of CB1 receptors?

They help modulate pain and produce most of the psychoactive "high"

What is the purpose of the CB2 receptors?

Immunosuppressant and anti-inflammatory, without the psychoactive effects

What are the endogenous endocannabinoids produced by the human body? (2)

Anandamide

2-AG

What is the proposed role of the endocannabinoid system in the body?

Plays a role in many physiological responses, produced by CNS and peripheral tissues when tissues are injured or disturbed

What are the sources of cannabinoids? (3)

Mj plant

Edible products

Synthetic THC or CBD

What are the benefits and drawbacks of smoking mj?

Rapid onset, easy to adjust dose

Damages respiratory tissues

What are the benefits and drawbacks of vaping mj?

Less chance of respiratory damage, rapid onset, easy to adjust dose

What are the benefits and drawbacks of using edibles?

Easy, convenient, no damage to respiratory tissues

Long delay before onset and peak effects, difficult to adjust dose

What are the benefits and drawbacks of using tablets or capsules for mj?

Best method for regulation

Long delay

What are the benefits of using oromucosal sprays for mj?

Rapid onset, easy to adjust dose, avoids the first pass effect (doesn't go through liver)

What are the benefits and drawbacks for using topical transdermal application for CBD products?

Many available

Dose and efficacy unknown

What are some prescription medications available that use parts of the mj plant? (4)

Marinol: Antiemetic and appetite stimulant

Cesamet: Antiemetic

Sativex: Used for spasticity with MS

Epidiolex: Used for drug resistant epilepsy

What are some of the clinical indications for using medical mj? (7)

Pain

Spasticity (MS)

Seizures

Nausea and vomiting

Appetite stimulant

Glaucoma

Anxiety and psychosis

What are some of the adverse systemic effects of mj use? (4)

Increased HR and BP

Increased myocardial O2 demand

Increased respiratory problems (if smoked)

Hyperemesis syndrome (high levels of use)

What are the acute CNS effects of mj use? (9 total)

Giddiness

Increased perception

Euphoria

Confusion

Hallucinations

Pain reduction

Paranoia

Decreased cognition

Decreased balance

What is cannabis use disorder?

A disorder in which pts cannot control the amount of cannabis that they use, and their use has a negative impact on their life

Can tolerance and withdrawal occur in pts using mj?

Yes, tolerance and dependence possible

Is mj addictive?

Unknown at this time, not enough studies

Is mj a gateway drug?

No, not for most users

What type of pts should avoid using mj? (3)

Pts with history of addiction

Pts with mental health issues

Pts with a developing CNS (children and teens)

Can we recommend that pts use medical mj?

No, but we can educate on all the reasons why it could be beneficial or harmful to the pt

Refer out to MD