Kelly Butterman Lead Cannabis Educator Verdes Cannabis kbuttermanverdesfoundationorg Objectives Drug Scheduling Clinicians are limited to the type of guidance they can provide to patients because of the way cannabis is scheduled as a drug ID: 1047020
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1. Practical Considerations for Symptom Relief with Medical CannabisKelly ButtermanLead Cannabis EducatorVerdes Cannabiskbutterman@verdesfoundation.org
2. Objectives
3. Drug Scheduling: Clinicians are limited to the type of guidance they can provide to patients because of the way cannabis is scheduled as a drug
4. Endocannabinoid System ReviewThe Endocannabinoid System (ECS), regulates and controls many of our most critical bodily functions such as learning and memory, emotional processing, sleep, temperature control, reproduction, pain control, inflammatory and immune responses, and appetite. The ultimate goal of the ECS is homeostasis.
5. Endocannabinoid System: How it WorksEndocannabinoids and their receptors are found throughout the body: in the brain, glands, immune cells, organs, connective tissues, and more.ECS imbalances may lead to the development of diseases and medical conditions. Phytocannabinoids can mimic the endocannabinoids and can be a supplement for the ECS.Small doses of cannabinoids can signal the body to make more endocannabinoids.
6. The Role of Phytocannabinoids in Symptom Relief Considerations
7. Phytocannabinoids Chemical compounds secreted by the resin glands of the plant such as THC and CBDOver 100 different cannabinoids identifiedFacilitate communication between cellsTurn on specific receptors to exert a wide variety of effectsMimic compounds our bodies naturally produce, called endocannabinoids
8. PhytocannabinoidsTHCA – Tetrahydrocannabinolic AcidThe raw form of THCNon-psychoactiveWith the right environment and time, converts to THC (decarboxylation)Strong antiemeticAnti-inflammatoryNeuroprotective AnticonvulsantCan be energizing30 times more bioavailable than THC
9. PhytocannabinoidsThe principal psychoactive cannabinoidMost abundant and popular cannabinoidAnti-inflammatoryAnti-epilepticAnti-depressantΔ 9 THC - TetrahydrocannabinolAppetite stimulantNeuroprotectiveAnti-spasmodicInterrupts pain signals traveling to the brainAnti-insomnia
10. PhytocannabinoidsReduces psychoactive effects of THCWorks well with THCHelps support homeostasis Anti-inflammatoryPainAnti-spasmodicAnti-depressantAnti-anxiety, strong affinity for the 5HT1-A receptors Anti-psychoticAids in blood glucose controlAnti-convulsantAnti-seizureCBD - Cannabidiol
11. PhytocannabinoidsA breakdown product of aging THCLittle to no psychoactivityWhen combined with THC produces higher levels of sedationAppetite stimulantReduces intraocular eye pressureCBN – Cannabinol
12. Symptom Relief Benefits of CannabisSleep Pain Muscle spasms Anxiety MoodTremors, abnormal involuntary movementNeuroprotectiveAppetite, nauseaEnhanced quality of life
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14. Cannabis Delivery MethodsInhalantsOnset – 0-15 minutesLasts 1-4 hoursEasy to control dosingMinimal amount to be effectiveEasy to administer around other pharmaceuticals
15. Cannabis Delivery MethodsEdiblesSlower onset: 30 min – 2+ hours Can last 4 - 10+ hoursLiver metabolism converts Δ9 THC to 11 Hydroxy THC, a more psychoactive and longer lasting compoundEdibles should be taken apart from other medications by 1-2 hours to avoid potential interactions
16. Cannabis Delivery MethodsTincturesOnset 15-45 Minutes- SublinguallyCan last 2-6 HoursVery precise way to consumeEasy, conservative way to adjust amountEasy to micro-dose
17. Cannabis Delivery MethodsTopicalsOnset 10-15 minutes Effects last 1-3 hoursNo psychoactive effects Effective for joint inflammation, pain, headaches, and tensionEasy to layer with other cannabis products
18. Side Effects and Safety Considerations
19. Side EffectBiphasic effectDizzinessSafety/FallsRapid heart rate Increased urination Lowers blood pressureShort-term memory lossDry mouthRed EyesManagementMost side effects can be managed or prevented by adjusting the amount, form, or delivery systemDrink waterTake a bath or showerSleep or restTry pure CBDSymptoms will resolve with some time and restSide Effects
20. Safety Considerations CBD is a stronger inhibitor of the cytochrome p450 system than grapefruitCBD can reduce the enzymatic degradation of warfarinPatients should notify their doctor or coumadin clinic if taking oral CBDCannabis may increase the blood-thinning effects of coumadinPatient may need additional INR monitoring
21. Safety ConsiderationsPatients with heart issues: THC lowers blood pressure. Instruct patient to change positions slowly, stay hydratedAvoid high potency THC strains and strains high in pinene (due to inotropic and heart racing effects)Recommend low-dose THC products and combine with CBDPatients with liver disease:Use caution with THC in the edible form, especially with high dosesSuggest CBD products, as it can be healing to the liver cells
22. Safety considerationsKeep away from children and petsNever drive or operate heavy machinery while on cannabisCannabis may intensify the intoxicating effects of alcohol and other controlled substancesDo not consume cannabis if pregnant or breastfeedingTake cannabis with food and drink plenty of waterUnderstand the potency of all products purchasedIt takes the body 3-5 days to adjust to an amount of cannabis, so caution patients not increase amount too quicklyAlways wait at least 2 hours before taking an additional amount of an edible
23. THANK YOU!The Verdes FoundationAlbuquerqueRio Rancho Santa Fewww.verdesfoundation.org505-280-2814
24. ReferencesSlide 3 - https://www.dea.gov/drug-information/drug-schedulingSlide 4 & Slide 5 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997295/Slide 7 – 11 -https://ethanrusso.org/cannabis-pharmacology-the-usual-suspects-and-a-few-promising-leads/ Slide 14 – 18 - https://healer.com/blog/using-medical-cannabis-delivery-systems/Slide 19 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789126/Slide 20 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6554654/pdf/fphar-10-00627.pdfSlide 20 - https://bjcardio.co.uk/2015/03/synthetic-and-natural-cannabinoids-the-cardiovascular-risk/