Cannabis In Health & Disease

1. Cannabis In Health & Disease Presented at Omnilore Forum January 31, 2019 Rancho Palos Verdes, California David Bearman, MD Executive VP, AACM Santa Barbara, California www.davidbearmanmd.com

2. Presentation Overview • Introduction • History • Nutraceutical

3. Introduction

4. David Bearman, M.D. • Worked at all levels of government • 18 years clinical practice in Cannabinoid Medicine • Executive Vice President, AACM • Named Doctor of the Day by Wall Street Journal • Author—Drugs Are Not The Devil’s Tools:Greed, Discrimination, The War on Drugs and How Medical Marijuana is Changing the Paradigm • Author—Demons, Discrimination, and Dollars • Author—Cannabis Medicine: A Guide to The Practice of Cannabinoid Medicine

5. This Lecture Will Address • History Of Medicinal Cannabis • Prohibition Propaganda & Folly • Modern Medicinal Cannabis

6. Medical Marijuana States

7. Brief History

8. Shen NungPing Ts’oa Ching 2637 B.C. • Estimated date of the first known pharmacopeia. Yes, it contained cannabis. • A recent Chinese excavation provides evidence of medicinal use in 2600 B.C.

9. Historical Use • One of many grains used in porridge or gruel • Nixons made gruel sound bad but it is nutritious • Beer is made from cannabis and is actually a cousin to hops

10. Ancient Uses of Cannabis • Cannabis medical attributes were well known in the ancient world. It was used as an analgesic, a childbirth anesthetic, for treating migraines, indigestion, and insomnia.

11. Cannabis is a Nutraceutical • It contains: • 512 molecules • 113 cannabinoids • 200+ terpenes

12. Endocannabinoid System • Neurotransmitters • Enzymes • Receptors • Dopaminergic system

13. Health Benefits • Antioxidant • Anti inflammatory • Anti anxiety • Omega-3 & -6 fatty acids • Stress Reduction • Sleep Aid • Anti epileptic • Anti proliferative

14. Treats movement disorder • Anti nauseate / appetite stimulant

15. 1839 Dr. William Brooke O’Shaughnessy • He reintroduced cannabis into western medicine in 1839, upon his return to England from India. • While in India he studied animals and treated human patients with cannabis.

16. USP 1854-1941

17. U.S./English 19th Century • 1839 O’Shaughnessy reintroduced Cannabis to Western Medicine • 1854-1941 Cannabis in the USP • 1890 Queen Victoria- Sir Joshua Reynolds (PMS) • 1898 Sir William Osler- migraine • Patent Medicines-Lilly, Squibb, Merck, Parke-Davis (1870’s -1942 • Early 1900’s 3rdor 4th most common drug ingredient

18. Sir William Osler The Father of Modern Medicine • He wrote in the first textbook ofinternal Medicine (1892) that Cannabis was the best migrainetreatment

19. Asthma Cigarettes • There were several cannabis containing cigarettes for treatment of asthma available in the 1920s. (They included Cannadonna ,Cigares De Joy. And Grimauldi) • Like Advair, cannabis is both an anti-inflammatoryand a bronchodilator.

20. 1920’S American doctors notes millions of Rx per year contained cannabis in the 1920’s L. Greensman Marijuana Recommended Collide: The Blunt Trush – Joshua Blight and Mark Miller, Dec. 5, 2012

21. University of Minnesota • Both my father and my uncle graduated in the 1920s from the U of M School of Pharmacy. Each, in different years ,were assigned to make tincture of cannabis. • My father said that they “had to be very careful because the ALCOHOL was illegal.”

22. Major Pharmaceutical Companies Marketed Cannabis • Eli Lilly, Squibb, Merck, Sharp and Dohme, Smith Bros. all sold numerous forms of Cannabis in the late 19th and early 20th century

23. Cult of Modernism • Plant Based herbal medicine was in decline in the 30’s. It wasn’t modern and was not standardized. • Modern – • Telephone • Phonograph • Electric lights • Automobile • Camera • Movies • Flexner Report • Manufactured pharmaceuticals

24. Muckrakers and Patent Medicine • Patent medicines were a mixed bag. Many worked. These nostrums often contained alcohol, cocaine, opium and/or cannabis. • Others were not only useless but could be downright dangerous. In 1903, Colliers, a mass market publication with wide circulation ran a multi-part expose on patent medicines

25. Phytochemicals Go Out of Style • Hundreds of thousands of cannabis containing Rxs were written per year in 1920s and 30s • 28 OTCs contain cannabis • The use of herbal remedies(including cannabis) was eclipsed by the cult of modernism • Manufactured pharmaceuticals seen as modern • Cannabis was not standardized • Herbs =multiple compounds vs single compound

26. From Popular to Pariah • 1897 Aspirin 1st Manufactured Pharmaceutical • 1902 Colliers Article • 1909 Sikhs Vilified By SF Chronically • 1910 Flexner Report • 1914 Hearst’s Sonora 800,000 Acre Ranch • 1916 Schlicten Decorticator • 1920s Cult 0f Modernism and • 1930 Anslinger named head of FBNDD • 1934 Did Lamont Dupont lobby Oliphant? • 1930s Propaganda focus on word Marijuana

27. Prohibition Propaganda

28. Lots of Propaganda

29. Who Can Forget Reefer Madness

30. Beware The Friendly Stranger

31. Pulp Fiction Demonizes Cannabis

32. Marijuana Tax Act1937 AMA Testimony • Dr. William Woodward-Doctor and attorney AMA Chief • Two hours testimony • The AMA opposed the Marijuana Tax Act • The AMA knew of no harm from the medicinal use of cannabis • The AMA pointed out that the federal government had no credible evidence

33. Dr. Woodward’s Words • “The AMA knows of no dangers from the medical use of cannabis” • He checked with The Bureau of Prisons, Children’s Bureau, Office of Education and divisions of mental health and pharmacy in the USPHS. None of them had one shred of evidence to support Mr. Anslinger’s claims. • He was critical of the use of the word marijuana because the American public was familiar with hemp and cannabis

34. 1941 - Out of United States Pharmacopoeia

35. Controlled Substances Act - 1970 • Cannabis placed in schedule I • Retired CIA Directed the formation of a commission to study drug abuse and marijuana

36. Nixon Marijuana Commission Recommends legalizing recreational cannabis. Nixon rejected the recommendation.

37. Nixon and Special Agent Elvis

38. 1978 - Federal Compassionate Access Investigational New Drug Program • The Compassionate Investigational New Drug program, or Compassionate IND, is a United States Federal Government-run Investigational New Drug program that allows a limited number of patients to use medical marijuana grown at the University of Mississippi. • It is administered by the National Institute on Drug Abuse. Closed to new entrants, there are four surviving patients who were grandfathered into the program.

39. 1992 – Federal Compassionate Use ( IND) New Access Ends • Dr. Mason, acting Surgeon General, was concerned that if too many patients were on the IND program, the public might get the idea that marijuana was actually good for you. (1) • 15 patients were receiving government cannabis and another 35 approved for the program at the time the program was suspended in 1989. The program was terminated in 1992 and the 15 were grand-mothered in.

40. Introduction to Modern Medicinal Cannabis

41. Modern Research • 1949 Seizures Ramsey and Davis • 1964 THC Structure Characterized Dr. Raphael Mechoulam • 1970s & 80s Nausea & Appetite studies(NM, CA,TX.Fl.Il) • 1985 Synthetic delta-9-THC (Marinol) FDA Approved • 1992 Endocannabinoid System • 1999 GW Pharmaceuticals-Grew 6 strains • 2000 California Marijuana Research Center est. • 2002 Donald Abrams, M.D. (UCSF) • 2005 Dr. Ware (McGill) • 2006 Donald Tashkin, M.D. (UCLA) • 2007 Donald Abrams, M.D. (UCSF) • 2010 Sean McAllister, Ph. D. (CPMG)

42. 1949 - H.H. Ramsey M.D. and Jean Davis M.D. • The first modern study on the medicinal value of cannabis. Seven subjects with intractable seizures. After treatment with cannabis 5 of the 7 subjects had no or extremely few seizures. • They concluded: ”The cannabinols herein reported deserve further trial in non-institutionalized epileptics.” • Federation Proceedings, Federation of American Society for Experimental Biology, vol. 8, lY49, p. 284.

43. Tod Mikuriya MD • Psychiatrist • Target of Federal government. • Read 1894 India Hemp Commission Report • 1968 Selected NIMH marijuana research grants • Co-author of Prop 215 • Pioneer in marijuana movement.

44. 1964 – Raphael Mechoulam characterizes the structure of Delta 9 THC

45. Marinol – 1985 • The AIDS Epidemic saw widespread use of cannabis by HIV/AIDS sufferers. Cannabis addressed appetite stimulation , relief of pain and depression • The government’s response was to encourage the development of synthetic THC. It was approved by the FDA in 1985. It’s Trade name is Marinol, generic name is dronabinol.

46. Cannabinoid & Cannabis • Marinol=1 cannabinoid • Cannabis=113cannabinoids

47. The Endocannabinoid Systemcharacterized circa 1992 • Endocannabinoid system is found in the human body. • It is central to homeostasis. • It is the largest neurotransmitter in the human brain and interacts with the dopaminergic system. • It is composed of: • RECEPTORS • CB1 Receptors found largely in the brain • LB2 Receptors found in the immune system and the periphery • NEUROTRANSMITTERS • Anandamide (AEA) – an endocannabinoid • 2AG -another endocannabinoid neurotransmitter • ENZYMES • FAAH -enzyme that metabolizes endocannabinoids • MYGYL -another enzyme for endocannabinoids

48. Amygdala & Nucleus AccumbensHippocampus -

49. Retrograde Inhibition

50. Cannabis: The Plant