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Reefer Madness: Where we stand with cannabis based medicine in palliative care

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: Understand the recent advances in cannabis pharmacology

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Reefer Madness: Where we stand with cannabis based medicine in palliative care

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  1. Reefer Madness:Where we stand with cannabis based medicine in palliative care Erin Suhrie, Pharm.D. University of Maryland, Palliative Care Resident

  2. Objectives At the end of the presentation the participant will be able to: • Understand the recent advances in cannabis pharmacology • List the cannabis products currently available in the USA • Discuss future directions for cannabis based research

  3. 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

  4. Recent discoveries • Cannabinoid receptor system • CB1 • CB2 • Endogenous cannabinoids • Anandamide • 2-arachidonoylglycerol

  5. THC and other cannabinoids Cannabidiol (CBD) 9-THC Cannabinol (CBN) Anandamide

  6. Potential Medical Uses for Cannabis • Cancer pain • Migraines • Chemotherapy induced nausea • Neuropathic pain • Multiple sclerosis related spasticity • Glaucoma • Ulcerative colitis/Inflammatory bowel disorders • Epilepsy • Anorexia

  7. Smoked Cannabis • Very high incidence of psychoactive side effects • Pulmonary sequelae • Few clinical trials but many anecdotal claims • Potential benefit for patients with intractable nausea and anorexia

  8. Currently available drug products • Marinol (dronabinol) • Cesamet (nabilone) • Cannador • Sativex

  9. Marinol (dronabinol) • 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

  10. 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

  11. Cannador • THC/CBD combination • Oral capsule • Not available in the USA

  12. Sativex • THC/CBD combination • Oral mucosal spray • Not available in the USA

  13. Current and Future Research • Ajulemic acid • Synthetic analog of THC • Compounds that affect the levels of endogenous cannabinoids (by inhibiting membrane transport or hydrolysis)

  14. Medical Marijuana

  15. Questions?

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