Medical Cannabis

describe the endocannabinoid system

-found in all vertebrates

-2AG and 2AEA endocannabinoids

-lipid signaling, recycled into arachidonic acid pathway

what are the 2 main parts of the endocannabinoid system?

-CB1: neurotransmission, cognition/memory, reward/addiction

-CB2: neuroinflammation, neuroprotection

what are the 2 things that cannabigerol (CBG) content can produce?

-THC

-CBD

what are 5 mechanisms of CBD?

-CB1 activation reduces pain and can increase or decrease appetite

-A2A stimulation can reduce pain and inflammation

-agonist at TRPA1 and TRPV1 receptors reduce pain

-agonist at 5HT1A receptors reduces anxiety and depression

-inhibits anion channels to reduce seizure activity

what are 5 mechanisms of THC?

-CB1 agonism reduces pain, memory and increases appetite, psychosis, euphoria

-CB2 agonism reduces pain

-SERT3 agonism reduces nausea

-opioid mu and vanilloid2 action reduces pain

-dopamine2 increases psychosis

what are the 4 steps of extracting CBs using ethanol to make a tincture?

-heat to decarboxylate at 250-265 F for >30 min

-soak cannabis in ethanol

-filter away plant material

-evaporate ethanol away from oil (optional)

what are 2 other methods of extracting CBs from plant material?

-hydrocarbon: heat and separate, but also get chlorophyll, pesticides, etc

-supercritical CO2: grind up cannabis, push CO2 through and change temp and ratio to extract specific oils

what are schedule I drugs?

-high potential for abuse

-no currently accepted medical use in treatment in the US

-lack of accepted safety for use of the drug or other substance under medical supervision

what is the DEA's position on CBD type cannabis?

-Farm Bill passed in 2018 to allow sale as an agricultural commodity and allow states to regulate hemp

-DEA removed CBD from the Controlled Substances Act in 2020

-states that CBD is not generally recognized as safe

what is the "catch all" statement related to cannabis use in CA?

physician can recommend cannabis to help with chronic or persistent medical symptoms that substantially limit your ability to conduct major life activities or may cause serious harm to your safety, physical health, or mental health

what are the recommendations for multiple sclerosis symptoms and THC use?

may help reduce effective central pain and patient reported spasms along with improved bladder function; no evidence of efficacy for ataxia/tremor, progression, or sleep

how does cannabis use related to opioid use?

many studies show that use of cannabis helps reduce the amount of opioids used for pain

how does cannabis use relate to PTSD?

mixed results, some studies show improved symptoms while others show worsening of severity, violent behavior, etc

what are cannabis use effects on sleep?

chronic use can lead to habituation, daytime sleepiness, decreased mood and memory

how does cannabis use relate to cachexia and appetite?

can increase appetite but non-significant weight gain and improved functional status