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Cannabis & Autoimmune Disorders

Cannabis & Autoimmune Disorders. Dr. Nick Salamie PharmD, RPh. Autoimmune Disorders. Symptoms. Traditional Treatments. NSAIDs Aleve Advil Immunosuppressant Drugs Corticosteroids Janus kinase inhibitors Calcineurin inhibitors mTOR inhibitors IMDH inhibitors Biologics

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Cannabis & Autoimmune Disorders

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  1. Cannabis & Autoimmune Disorders Dr. Nick Salamie PharmD, RPh

  2. Autoimmune Disorders

  3. Symptoms

  4. Traditional Treatments • NSAIDs • Aleve • Advil • Immunosuppressant Drugs • Corticosteroids • Janus kinase inhibitors • Calcineurin inhibitors • mTOR inhibitors • IMDH inhibitors • Biologics • Monoclonal antibodies

  5. Endocannabinoid System • Complex Regulatory System • Regulates Immune Response • CB1 and CB2 Receptors • Immune Cells Express Both • Endocannabinoid and Phytocannabinoids • Immunosuppressive Properties • Cell death • Inhibition of Cell Growth • Inhibition of signaling and regulatory proteins • Inhibition of white blood cell attraction • THC modulates T-helper cells

  6. Multiple Sclerosis • Cannabis useful for symptom relief • Spasticity • Pain • Sleep • May reduce progression in early MS • Cannabis Strategies • Day: CBD/THC • Night: THC • Inhalation, Oral and Sublingual • Dosing based on patients cannabis experience • Advanced Consideration: Beta-Caryophyllene

  7. Rheumatoid Arthritis • Symptom Relief • Pain • Fatigue • Mood • Inflammation • THC • CBD • THCa • CBC • Beta-Caryophyllene This Photo by Unknown Author is licensed under CC BY-NC-ND

  8. First PDI Visit • Goals • Increase Quality of Life • Drug Interactions • Assess Patients Cannabis Experience • No or little cannabis experience • Intermediate cannabis experience • Advanced Cannabis Experience • Tapering Strategy if Necessary • Product selection and initial strategy • Minimum Effective Dose • Follow Up

  9. Dosage Forms • Inhalation • Combustion • Vaporization • Ingestible • Edibles • Oils (RSO) • Tablets/Capsules • Sublingual/Buccal/Oromucosal • Topical • Transdermal

  10. Cannabis Oils/RSOs • Best medical dosage form • Whole Plant/Full Spectrum Extract/Herbal Shotgun • Varying Cannabinoid Profiles • Different CBD:THC ratios • Acidic Cannabinoids: THCa, CBDa, CBGa • “Varin” Cannabinoids: THCV, CBDV • Less abundant Cannabinoids: CBN, CBG, CBC • Terpenes Captured • Beta-Caryophyllene

  11. Getting Your Cannabis Card • Formal Diagnosis of 1 of the 41 qualifying conditions • Completion of Physician Written Certification Form by a Licensed Physician • Fingerprint/Background Check • Completion of Online Registration and and Payment • Provisional Registration

  12. Resources • “Autoimmune Diseases: Types, Symptoms, Causes, Diagnosis & More.” Healthline, Healthline Media, www.healthline.com/health/autoimmune-disorders#common-autoimmune-diseases. • Backes, Michael, et al. Cannabis Pharmacy: the Practical Guide to Medical Marijuana. Black Dog & Leventhal Publishers, 2017. • “Health: Autoimmune Disorders and Cannabis.” Performance by Michele Ross, Green Flower Media, www.green-flower.com/episodes/504/autoimmune-disorders-and-cannabis. • “Immunosuppressant Drugs: A Complete Overview.” Healthline, Healthline Media, www.healthline.com/health/immunosuppressant-drugs. • Russo, Ethan B., and Jahan Marcu. “Cannabis Pharmacology: The Usual Suspects and a Few Promising Leads.” Cannabinoid Pharmacology Advances in Pharmacology, 2017, pp. 67–134., doi:10.1016/bs.apha.2017.03.004.

  13. Questions

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