Transcript Reefer Madness: Where we stand with cannabis based

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:
1. Understand the recent advances in
cannabis pharmacology
2. List the cannabis products currently
available in the USA
3. Discuss future directions for cannabis
based research
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
• Cannabinoid receptor system
– CB1
– CB2
• Endogenous cannabinoids
– Anandamide
– 2-arachidonoylglycerol
THC and other cannabinoids
9-THC
Cannabidiol (CBD)
Cannabinol (CBN)
Anandamide
Potential Medical Uses for
Cannabis
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Cancer pain
Migraines
Chemotherapy induced nausea
Neuropathic pain
Multiple sclerosis related spasticity
Glaucoma
Ulcerative colitis/Inflammatory bowel disorders
Epilepsy
Anorexia
Smoked Cannabis
• Few clinical trials but many anecdotal claims
• Potential benefit for patients with intractable nausea and
anorexia
• Very high incidence of
psychoactive side effects
• Pulmonary sequelae
Currently available drug products
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Marinol (dronabinol)
Cesamet (nabilone)
Cannador
Sativex
Marinol (dronabinol)
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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)
• 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
• THC/CBD
combination
• Oral capsule
• Not available in the
USA
Sativex
• THC/CBD
combination
• Oral mucosal spray
• Not available in the
USA
Current and Future Research
• Ajulemic acid
– Synthetic analog of THC
• Compounds that affect the levels of
endogenous cannabinoids (by inhibiting
membrane transport or hydrolysis)
Medical Marijuana
Questions?