Medical Marijuana for Pain How Does Cannabis Work on Your Body? - PowerPoint PPT Presentation

Medical Marijuana for Pain How Does Cannabis Work on Your Body? Jeremy Spiegel, MD Medical Director - Casco Bay Medical Westbury, Long Island, New York

Intro Brief History of Cannabis ➔ Physiology of Cannabis ➔ Pain studies ➔ Ehlers-Danlos Syndrome ➔ Cannabis in Clinical ➔ Practice

Cannabis has been used spiritually, recreationally, and medicinally for “My doctor is old thousands of years school, he doesn’t go in for medical marijuana.” - CBM Patient, 2016

“My doctor is old school, he doesn’t go in for medical marijuana.” - CBM Patient, 2016

“My doctor is old school, he doesn’t go in for medical marijuana.” - CBM Patient, 2016

Cannabis was legal in the USA until 1937 It was on the US Formulary until 1942 -- Reefer Madness Removed AGAINST the advice of the AMA. Harry Anslinger was a government official - the US’s first commissioner of Federal Bureau of Narcotics.

Reefer Madness Harry Anslinger was a government official - the US’s first commissioner of Federal Bureau of Narcotics.

Cannabis is a safe, natural, and effective treatment for chronic pain Chronic pain may originate in the body generally, or from the brain or spinal cord. The brain changes over time in patients with chronic pain.

Chemical compounds called CANNABINOIDS (such as THC and CBD) are secreted from Tip cannabis flowers providing Don’t wait till the end of relief from pain, nausea, the presentation to give the bottom line. and have Reveal your product or anti-inflammatory idea (in this case a translation app) up front. properties.

CANNABINOIDS (such as THC and CBD) are C 21 -Oxygen Tip containing Don’t wait till the end of the presentation to give the bottom line. organic Reveal your product or idea (in this case a molecules. translation app) up front.

Endocannabinoid system Phytocannabinoids are ➔ ligands Ligand binding to a receptor protein Phytocannabinoids are ➔ agonists (and partial agonists, antagonists, inhibitors) Agonist is a ligand that binds, alters the function of the receptor, and triggers a physiological response.

Endocannabinoid system Our Bodies Naturally ➔ Produce Cannabinoids Anandamide and 2-AG regulate brain and mood, eating, pain, immune function, sleep. We have receptors on our cells ➔ in our brain and nervous system (CB1) and other parts of our body (CB2)

Endocannabinoid system Phytocannabinoids are li ➔ CB1 and CB2 are G-Protein ➔ coupled receptors in the cell membrane

Endocannabinoid system Our Bodies Naturally ➔ Produce These Anandamide and 2-AG regulate brain and mood, eating, pain, immune function, sleep. We have receptors on our cells ➔ in our brain and nervous system (CB1) and other parts of our body (CB2) THC binds to CB1 in the brain, where CBD binds to CB2 elsewhere in the body.

THC ● Binds to CB1 and CB2

THC ● Binds to CB1 and CB2 ● Affects Movement

THC ● Binds to CB1 and CB2 ● Affects Movement Parkinson’s patients I have treated demonstrate improvement in tremor and muscle rigidity with the use of MMJ. Onset of improvement may be quite rapid.

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory This is helpful for those suffering with PTSD -- Post Traumatic Stress Disorder, who benefit from an ability to let go of strongly recalled traumatic memories (recalled both mentally and physically).

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory ● Affects Cognition (Thinking)

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory ● Affects Cognition (Thinking) Attention Deficit Disorder responds nicely to MMJ, with greater focus, concentration and productivity.

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory ● Affects Cognition (Thinking) ● Affects Sensory Perception

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory ● Affects Cognition (Thinking) ● Affects Sensory Perception Pain is reduced. Things taste better. Things feel better to the touch. Vision is brighter. Colors become more vivid.

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory ● Affects Cognition (Thinking) ● Affects Sensory Perception ● Affects Mood

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory ● Affects Cognition (Thinking) ● Affects Sensory Perception ● Affects Mood With proper dosing and repeated use, an innocuous pleasant feeling of well being accompanies reductions in pain sensation and other physical symptoms.

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory ● Affects Cognition (Thinking) ● Affects Sensory Perception ● Affects Mood ● Affects Appetite

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory ● Affects Cognition (Thinking) ● Affects Sensory Perception ● Affects Mood ● Affects Appetite It is a strong anti-nausea medication. Inflammatory bowel diseases benefit from THC as there are cannabinoid receptors in the gastrointestinal tract.

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory ● Affects Cognition (Thinking) ● Affects Sensory Perception ● Affects Mood ● Affects Appetite ● Reduces inflammation

THC ● Binds to CB1 and CB2 ● Affects Movement ● Affects Memory ● Affects Cognition (Thinking) ● Affects Sensory Perception ● Affects Mood ● Affects Appetite ● Reduces inflammation Arthritis symptoms improve, as do the neurodegenerative disorders such as multiple sclerosis, with reduced spasticity of muscles.

Pain Tracts Pain travels through nerves, special tracts, the lateral spinothalamic tract carries pain and temperature.

<--Perception Pain Tracts Pain travels through nerves, special tracts, the lateral spinothalamic tract carries pain and temperature.

<--Perception <--Voltage gated Na+ channels

Endocannabinoid system Delta-9 THC is a ➔ multitarget ligand Δ 9 -THC has also been proposed to be a serotonin 5HT 3A receptor antagonist and an allosteric modulator of the opioid receptors TRP (Transient Receptor Protein) Channels modulate ion entry mediating neuronal signaling: PAIN and PRESSURE perception, temperature, smell, taste vision.

<--Perception <--Voltage gated Na+ channels <--Reduces inflammation

Endocannabinoid system Phytocannabinoids are ➔ ligands Ligand binding to a receptor protein Phytocannabinoids are ➔ agonists (and partial agonists, antagonists, inhibitors) Agonist is a ligand that binds, alters the function of the receptor, and triggers a physiological response.

CBD ● So interesting ● PLEIOTROPIC - So Many functions ● Little affinity for CB1 AND CB2 RECEPTORS ● DELAYS reuptake of neurotransmitters such as anandamide and adenosine

CBD ● NON-PSYCHOTROPIC ● At HIGH concentrations it activates a SEROTONIN receptor 5HT-1A implicated in: Anxiety, addiction, sleep, pain perception, nausea and vomiting

CBD BLOCKS GRP55 Signaling GRP 55 signals osteoclast formation--which reabsorbs bone. Therefore: Putatively REDUCE OSTEOPOROSIS and JOINT PROBLEMS by antagonizing this process.

Endocannabinoid system Phytocannabinoids are ➔ ligands Ligand binding to a receptor protein Phytocannabinoids are ➔ agonists (and partial agonists, antagonists, inhibitors) Agonist is a ligand that binds, alters the function of the receptor, and triggers a physiological response.

THC:CBD RATIO

THC:CBD RATIO ● The MOST IMPORTANT factor in your choice of MMJ

THC:CBD RATIO ● The MOST IMPORTANT factor in your choice of MMJ ● The CBD tempers the THC such that you will have milder effects -- elimination of nausea without full blown “munchies”.

THC:CBD RATIO ● The MOST IMPORTANT factor in your choice of MMJ ● The CBD tempers the THC such that you will have milder effects -- elimination of nausea without full blown “munchies”.

THC:CBD RATIO ● The MOST IMPORTANT factor in your choice of MMJ ● The CBD tempers the THC such that you will have milder effects -- elimination of nausea without full blown “munchies”.

THC:CBD RATIO THC: CBD 20:1

THC:CBD RATIO THC: CBD 1:1

THC: CBD 1:20

EDS relief with MMJ Scoliosis pain relief ● ● Relief from unstable joints prone to subluxation, strain, dislocation, hyperextension ● Arthritis Migraine ● Chronic inflammation ● Muscular pain ● ● Improvement of chronic fatigue ● Relief from IBS ● Improvement in foot pain from flat feet ● Carpal tunnel relief ● Gastroparesis relief ● Allodynia/Hyperalgesia