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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: 1. Understand the recent advances in cannabis pharmacology 2. List the cannabis products currently available in the USA 3. Discuss future directions for cannabis based research 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 Recent discoveries • Cannabinoid receptor system – CB1 – CB2 • Endogenous cannabinoids – Anandamide – 2-arachidonoylglycerol THC and other cannabinoids 9-THC Cannabidiol (CBD) Cannabinol (CBN) Anandamide 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 Smoked Cannabis • Few clinical trials but many anecdotal claims • Potential benefit for patients with intractable nausea and anorexia • Very high incidence of psychoactive side effects • Pulmonary sequelae Currently available drug products • • • • Marinol (dronabinol) Cesamet (nabilone) Cannador Sativex 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 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 Cannador • THC/CBD combination • Oral capsule • Not available in the USA Sativex • THC/CBD combination • Oral mucosal spray • Not available in the USA Current and Future Research • Ajulemic acid – Synthetic analog of THC • Compounds that affect the levels of endogenous cannabinoids (by inhibiting membrane transport or hydrolysis) Medical Marijuana Questions?