By Phyliss Nicole Taylor MD Medical Director Assistant Professor UF Health Psychiatry Financial Disclosures None Objectives Understand what Amendment 2 means for FL physicians and patients ID: 605221
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The Legalization of Cannabis: Health and Social Implications of Marijuana Use
By: Phyliss Nicole Taylor, MD Medical Director, Assistant Professor UF Health Psychiatry Slide2
Financial Disclosures
None Slide3
Objectives
Understand what Amendment 2 means for FL physicians and patients. Explain the medical benefits and health risks of cannabis use. Explore how legalization of cannabis in other areas have affected the society. Slide4
Compassionate Medical Cannabis Act of 2014
Allowed for access to non-smoked, low-THC marijuana for qualified patients 1. cancer
2. chronic seizures 3. severe, persistent muscle spasmsLow THC = 0.8% or less tetrahydrocannabinol and more than 10% of cannabidiolProvision for terminally ill patients to use any type of medical cannabis
- Diagnosis must be confirmed by a 2nd doctor of appropriate specialty Slide5
Compassionate Medical Cannabis Act of 2016: What does Amendment 2 do?
Expands what medical conditions are considered treatable with medical marijuanaAdds ID card requirement for patients and caregiversBefore dispensing medical cannabis, dispensary must check the patient’s ID card and the compassionate use registry
Clarifies requirements for parental consent for the use of medical marijuana by minorsSlide6
What specific diseases are treatable with medical marijuana?
CancerEpilepsyG
laucomaHIV/AIDSMultiple Sclerosis Amyotrophic Lateral Sclerosis (ALS)Crohn's disease
Parkinson’s DiseasePost Traumatic Stress Disorder (PTSD) Slide7
Requirements of FL Physicians who want to Order Medical Cannabis
Active, unrestricted license (MD or DO)Complete an 8 hour class sponsored by FMA/FOMA and pass exam every 2 years; $995Website:
http://www.flcannabisce.comObtain voluntary, written, informed consent from the patient or legal guardianEnter the order for low-THC or medical cannabis into Compassionate Use Patient Registry Must be updated within 7 days after any change to original order
May not order more than 45 day supply at a timeCan order a cannabis delivery device (i.e. vaporizer)Slide8
More Legal Requirements for Ordering Physicians
Must have treated patient during the immediate preceding 3 monthsMust have conducted a physical exam and a full assessment of medical historyMust determine that the medical use of marijuana benefits >> potential health risks
Must maintain a treatment plan: dose, route of administration, planned duration, and monitoring of patient symptoms and other indicators of tolerance or reaction Must be submitted quarterly or any time the plan changes to UF College of PharmacySlide9
Potential Medical Benefits of Cannabis Use
Cancer = relief of chemotherapy induced nausea and vomitingEpilepsy =
reduced seizure frequencyGlaucoma = transient reduction of intraocular pressureHIV/AIDS = appetite stimulation and weight gain in wasting syndrome Multiple Sclerosis = neuropathic pain, spasticity, sleep disturbances
Post Traumatic Stress Disorder = reduced hyper-arousal symptoms, flashbacks, and sleep disturbance (short term) Slide10
Short Term Side Effects of Cannabis
Dizziness or lightheadedness (30%-60%)Dry mouth (10%-25%)Fatigue
(5%-40%)Muscle weakness (10%-25%)Myalgia (25%)Palpitations (20%)After repeated smoked or oral marijuana doses, tolerance is rapidly acquired (in
2-12 days) to many of its adverse effectsSlide11
Potential Health Risks of Cannabis
PsychosisCognitive impairmentImpaired pulmonary functionVascular conditionsSlide12
Psychosis
Acute symptoms: depersonalization, derealization, a feeling of loss of control, fear of dying, irrational panic and paranoid ideasChronic Psychosis Risk FactorsYoung users with early exposure (15-18
years old) Pre-existing genetic vulnerabilityHeavier useGreater potency THCSlide13
Cognitive Impairment
Impaired short-term memory, making it difficult to learn and to retain infoRelated
to age of onset of useRelated to the frequency and duration of useStructural brain changes involving structures affecting
memory and emotional processingreduced volume of the hippocampus, temporal cortex, insula, and orbitofrontal cortexSlide14
Impaired Pulmonary Function and Smoking Cannabis
Short-term exposure: bronchodilationLong-term marijuana use: increased respiratory symptoms suggestive of obstructive lung disease
Lower risk of cancer with cannabis than tobacco smokingThe use of a vaporizer is associated with higher plasma THC concentrations than smoking marijuana cigarettes, little if any carbon monoxide production, and significantly fewer triggered respiratory symptoms. Slide15
Cardiovascular Conditions
Dose-dependent ↑ in heart rate and blood pressureDecrease of the time until the onset of chest pain in patients with angina pectorisOne
study has shown that marijuana may trigger the onset of myocardial infarctionTolerance develops to the acute effects of marijuana over days to a few weeksPatients who have CHD or significant risk factors should be cautioned about the potential hazards of marijuana
useSlide16
Social Implications of Cannabis Use
Cannabis Dependence = 9% in overall users, 17% of those who begin use in adolescenceLegalization of Cannabis sends the message that it is okay to teens
Cannabis withdrawal syndromeIrritability or dysphoria, anxiety, sleeping difficulties, decreased appetite, drug cravingsPhysical symptoms: stomach pain, shakiness/tremors, sweating, fever, chills, headacheIncreased Substance Abuse and Dependence of other drugsSlide17
Social Implications of Cannabis Use (2)
Altered judgment = ↑ risk of sexual behaviors that facilitate STD’sImpaired performance in school or at work
↑ risk of injuries on the jobImpairment in driving ability 3-7 x more likely to cause
motor vehicle collisions- Impairs cognitive function, reaction times, divided-attention tasks, and lane tracking. Slide18
How Has Colorado Been Affected?
Legalized medical marijuana (2000); recreational (2014)No increased youth marijuana usage (but state had high pre-legalization rates) % Youth who described marijuana as "highly risky" ↓ after legalization, but the % Youth who reported ever trying marijuana ↓
Higher rates of unintentional poisoning in children > 9 years old, associated with various edible products containing cannabisIncrease in traffic fatalities involving drivers who tested positive for marijuanaSlide19
What Did Colorado Learn?
Limit marijuana use to over 21 years of age Amended
Colorado's Clean Indoor Air Act to extend smoking restrictions to marijuanaCreated surveillance systems to monitor the numbers of ED visits and hospitalizations related to marijuana use, as well as data on calls to poison-control
centers Public awareness campaign about safe storage of marijuana products Child resistant packaging and changes to the labelling
Set a limit of 5 ng of Δ9-THC per milliliter of blood at which drivers are considered to be operating under the influenceThe
Colorado Department of Transportation launched a public education campaign about impaired driving in 2014Slide20
How have other states be affected?
One study found that states with “medical marijuana” laws had a 24.8% lower average annual opioid overdose death rate compared to states without similar lawsMedical cannabis laws were
associated with a lower rate of overdose mortality that generally strengthened over timeWashington and Colorado have seen increased tax revenues - Colorado = $129 million and Washington $220 million in 2nd
year after legalizationArrests for cannabis related charges have decreased, but people of color are still 2x to be arrested despite using marijuana at similar rates to white peopleSlide21
What Else Should Be Considered…
Only limited number of studies on cannabis due to its Schedule I classification. More research is needed, but until that classification changes, it is not going to be possible to study it to the extent that it needs to
be.No governmental standardization = constituents and potency?No guidelines based on reliable evidence about dosing, frequency, duration Legal liability = What is the standard of practice in your community?Slide22
Who is signed up to Order Medical Cannabis in FL?
http://www.floridahealth.gov/programs-and-services/office-of-compassionate-use/_documents/completed-cme.pdfSlide23
The End…Any Questions?