Welcome to POTLAND, Maine!

Transcription

1 Welcome to POTLAND, Maine!

2 UNECOM October 2014

3 No conflicts, but a disclaimer: NOT OFF LABEL USE, BUT A NO LABEL USE: Uses of MARIJUANA, a Schedule I drug, will be discussed. MARIJUANA is NOT approved by the FDA

4 What we re doing today: 1. Medical Uses of Marijuana 2. Maine Marijuana Law 3. Marijuana : Politics, Fun, and Profit

5 Part 1: MEDICAL Marijuana (MJ) plant: cannabis sativa Weed-like plant grows in MAINE Psychoactive substance is: Delta-9-tetrahydrocannabinol= THC cannabinoids in MJ cannabidiol physiologically active 1960 s-1970 s: 1-2 % THC Today: 10-20% THC (average: 11%) 1 gram MJ cigarette contains 20 mg THC

6 PHYSIOLOGY: Endogenous Cannabinoids HUMANS have endocannabinoid system= = Receptor-Agonists: 1. Anandamide (AEA) neurotransmitter, mediates stress & pain response 2. 2-Arachidonoyl Glycerol (2-AG)

7 Cannabinoid Receptors Binding sites on endogenous cannabinoids: CB1 receptors- in the brain/ nervous system CB2 receptors- in the immune system Receptors in GI, skeletal, adipose and endocrine tissue

8 Exogenous Cannabinoids 1. Ethical Pharmaceuticals: tablets/sprays Marinol/Dronabinol= THC (Schedule III) Cesamet/Nabilone=THC (Schedule II) Sativex Spray=THC + cannabidiol (Canada & UK) 2. Medical Marijuana: smoked/nebulized/ ingested Dried plant=smoked Oil, resins (hashish), or distillates

9 Cannabinoid Functions Mediate s Emotions: ANXIETY Reduces Autonomic Arousal Lowers Intraocular Pressure Anti-emetic Anti-inflammatory Effects Psychiatric Disorders Euphoria inducing Memory Effects Movement Effects Cell function: apoptosis, decrease proliferation, suppress cytokine production

10 About the Research Marijuana is a Schedule I drug has no recognized medical use and a high degree of addiction potential. December 2010: 111 researchers registered with NIDA to study marijuana, 14 approved for human research (MGH/Dana- Farber : 400 cancer trials on-going) To study MJ, you must get approval from Federal NIDA, state DEA, and University IRB. One US facility approved to grow MJ for research

11 Who does the study and why? Pharmaceutical Companies Government/ University US vs INTERNATIONAL (Europe)

12 What type of study is it? 1.Basic Research= Laboratory, in vitro, animal studies 2. Clinical Studies A) Observational/ Non-interventional Patient given therapy and outcome is observed Retrospective No control group B) Experimental/ Interventional: Randomized, controlled,double- blinded

13 Medical Indications for MJ PAIN: Chronic / Neuropathic Nausea/Vomiting Anorexia Glaucoma Spasticity in MS patients Anti-Inflammatory: Alzheimer s, Crohn s, Rheumatoid Seizure disorder/ epilepsy

14 Cochrane Review Meta-analysis= Reviews Multiple studies MJ for HIV anorexia: evidence of efficacy & safety lacking. MJ for epilepsy/ seizures: no reliable conclusions can be drawn.

15 PAIN Research MJ no more effective than codeine in controlling pain And have depressant effects that limit their use -British Medical Journal, July 2001 (Campbell, FA et al, Are Cannabinoids An Effective & Safe Treatment ) MJ is safe & modestly effective in neuropathic pain with Preliminary evidence of efficacy in fibro and RA -British Jrnl Clin Pharm, Nov (5): (Lynch, ME et al, Cannabinoids for Treatment of.pain )

16 Adverse Effects Addiction- 9% of users Effect on Brain Development in Youth A GATEWAY Drug? prime the brain vs accessibility Relation to Mental Illness causality? Effect on School Performance & Lifetime Achievement Driving and Drugging COPD & Lung Cancer (?) -- Adverse Health Effects of MJ Volkow, N, et al, NEJM 370;23, June 5, 2014

17 Part 2: LEGAL: -Federal Law Federal Controlled Substances Act Scheduled Classes: Marijuana is in Schedule I With Heroin and LSD No currently accepted medical use/ high abuse potential. DEA reviewed July, 2011 and declined to reclassify. (Marinol/ Dronabanol - Schedule III Cesamet/Nabilone - Schedule II)

18 State Laws 26 States ME included- have Medical Marijuana Laws 2 allow recreational use (Washington & Colorado) BUT: Federal Law SUPERCEDES State or Local Laws

19 BUT- Ogden Memo October 2009 Deputy AG David Ogden sends memo to US Attorneys : Federal resources should not focus on individuals whose actions are in compliance with State [Medical Marijuana] laws. But DOJ is committed to the enforcement of the Controlled Substances Act in all States.

20 ME Medical Use of MJ Act MRSA Title 22, Chapter 558-C Patient has a condition recognized by the State of Maine that medical MJ is indicated for. DO/ MD provides recommendation letter good for 1 year. Patient may possess 2.5 ounces (75 grams) MJ by Buying MJ at one of 8 state licensed dispensaries OR, Patient may grow up to 6 plants or designate a CAREGIVER who may grow 6 plants for the patient.

21 Cautions & Unknowns Pediatric Use of Marijuana? Interaction of MJ with nicotine, alcohol, caffeine? Drug Testing THC may be present for 2 weeks Interactions with other RX, especially psych meds? Driving & other hazardous tasks? What is the dose of MJ? What is the concentration of THC in the MJ? What is the effect of MJ on fertility, pregnancy, lactation? What are the long-term effects of MJ use?

22 Part 3: Marijuana Politics, Fun, and Profit Marijuana is the #1 most commonly used illicit drug Accounts for 75% of the illicit drug utilization 37% of High School students have used it (2009)

23 Politics Portland has passed a recreational MJ referendum November Votes: Lewiston, South Portland, and York Advocacy Group: Citizens for a Safer Maine Marijuana Policy Project 501(c)3 Lobbying Group Statewide Referendum in 2016?

24 Fun Marijuana is less dangerous than alcohol and is less Deadly than tobacco. BUT: 18% of motor vehicle deaths involve drugs (not ETOH) Increased mortality with heavy use Adverse effects: respiratory damage, CV disease, Impaired cognitive development

25 More FUN BENEFITS of LEGALIZATION: 1. Eliminates Criminality 2. STANDARDIZES Dosages & REGULATES QUALITY 3. STATES Receive TAX REVENUE 4. Distribution & Access Controlled & Regulated 5. More Research & Education on Use & Abuse and more funds for treatment (?)

26 Profit Colorado MJ sales $300 Million in first half 2014 NBC News 9/16/14 US marijuana sales predicted to be $8 Billion by 2018 Huffington Post citing MJ Business Factbook, 4/11/13 Retail Price : $16/gram ($450/ounce) Canuvo dispensary, Biddeford, 9/16/14 Industry Trade Group: National Cannabis Industry Association

27 Will MJ be everywhere? like alcohol and cigarettes? Tobacco: Age 18/ Restricted Use in Public Warning Label No ingredients or dosage nicotine listed Limited Media Advertising/ heavily taxed Alcohol: Age 21/ Restricted Use in Public Weak Warning Label ( Pregnant women ) Alcohol Content listed Widely Advertised / heavily taxed Driving While Intoxicated Illegal

28 Final Thoughts As Physicians, we have the responsibility to do what is right for patients and the community as a whole. Arnold Relman NEJM July : 371:

29 References Greydanus, Donald, et al, Marijuana: current concepts Frontiers In Public Health. 2013: 1:42 Bostwick, JM, Blurred Boundaries: the therapeutic and politics of medical MJ. Mayo Clinic Proc 2012 Feb: 87 (2) Volkow, ND, et al, Adverse Health Effects of Marijuana Use June 5, 2014 NEJM 370;23,