Pediatrics & We are family! This program is dedicated to my - PDF document

10/10/2019 The story of courageous Jackson. Little wonder & typically developing, Jackson Leyden, with his dad John, prepping for baby brother! Courageous Jackson with mom, Lisa. On the journey with epilepsy. Pediatrics & We are family! This program is dedicated to my loving family. Medical Paula Querido Kahn, MS, OTR/L Elevate OT Consultants Cannabis Medical Cannabis Education, Counseling, Advocacy Silver Spring, Maryland 1

10/10/2019 Meet my family. Disclosure: My husband, Rabbi James Kahn, works on the national level for Liberty Cannabis, which has humble beginnings here in the DMV. In today’s presentation: We will learn about medical cannabis history, What do families seek chemistry, pharmaceuticals, effects, clinical implications, how to gain access in our state. from our services? We will learn about the relationship between development, academic learning and medical cannabis in pediatrics. We will address OT and PTs role in working with pediatric clients using medical cannabis. 2

10/10/2019 In my experience working as an OT in rehabilitation and then with medical cannabis patients of all ages in Washington DC… What is Stigma? Clean, professional, warm, welcoming, accessible environment Dependable, high quality services and relationships over time Adaptive equipment for individual needs A listening ear Respect and care Language, atmosphere, and action that are free of judgement How might stigma “A mark of shame or discredit: Stain” affect the lives of families According to Merriam-Webster.com. choosing to use medical cannabis with their children? When do families turn to medical cannabis? 3

10/10/2019 How do we best When other known pathways have been exhausted. combat stigma? When the risks of pharmaceutical or surgical intervention are too high. When the risks of not doing anything are too high. When they learn of the benefits and limited side- effects. Educate What is Medical ourselves. Cannabis? Educate others. Use compassionate language and action. 4

10/10/2019 History of cannabis use Cannabis is One of for medicinal purposes Nature’s Most Versatile Plants Chinese Emperor Shen Nung, “the father of Chinese medicine,” is credited with discovering cannabis’ healing properties – lived around 2700 B.C. ➢ Cannabis is a genus of 15 th Century BC: Cannabis written about flowering plants that includes in medical texts: originally three different - Rh-Ya, the Chinese pharmacopeia species, Cannabis sativa, - Ebers Papyrus , an Egyptian medical text Cannabis indica and Cannabis ruderalis. NOW, with the advent 1000 BC: Documented use in India as an anesthetic, to lower fevers, to aid sleep, and to cure dysentery of the medical cannabis industry, HYBRIDS are the preferred choice in MEDICINAL 700 BC: Documented medicinal use in Persia formulations. 200 BC: Documented use in Ancient Greece for COMPILED FROM JEFFREY FRIEDLAND'S BOOK, MARIJUANA: THE WORLD’S MOST UNDERSTOOD PLANT. 26 inflammation and eye treatments History of cannabis use Cannabis in Western Medicine for medicinal purposes 18 th Century: Dr. William O’Shaughnessy wrote The Memoranda on India Materia Medical, the first English text on Indian medicinal plants O’Shaugnessy created a cannabis extract that reduced the spastic symptoms of tetanus and rabies, the pain of rheumatoid arthritis, and infant convulsions 1850: “Cannabis Indica” is listed in the Pharmacopeia of the US as a treatment for pain, alcoholism, opiate addition, and more. It started to be added to medicinal products Cannabis became an ingredient in “patent medicine,” • Medicinal preparations of cannabis became available in US pharmacies in the along with secret ingredients like cocaine and opium 1850s. • Cannabis was a part of the American pharmacopeia until 1942. 1889: an article in The Lancet described the use of cannabis to treat opium and choral hydrate withdraw COMPILED FROM JEFFREY FRIEDLAND'S BOOK, MARIJUANA: THE WORLD’S MOST UNDERSTOOD PLANT. 27 symptoms MARIJUANA LAW IN THE U.S. The movement to ban cannabis in the United States 1942 1956 Cannabis is removed for the U.S. Narcotics Control Act classifies cannabis as Pharmacopeia a narcotic Roosevelt issues executive order allowing for hemp to be grown for the production of military necessities – lasts until the end of The Controlled Substances Act classifies WW II cannabis as a Schedule 1 narcotic 1942 1970 COMPILED FROM JEFFREY FRIDLAN’DS BOOK, MARIJUANA: THE WORLD’S MOST UNDERSTOOD 30 PLANT. 5

10/10/2019 The Species Problem in Cannabis by Ernest Small (published in1978) • Found it impossible to scientifically tell the difference between cannabis and hemp • Despite this, he chose a distinction factor – it is the distinguishing factor that legal frameworks are built upon today regulating hemp and cannabis: 1. Cannabis plants with a THC level of more than 0.3 % = cannabis 2. Cannabis plants with a THC level of less than 0.3 % = hemp This is what continues to cause the confusion between hemp and cannabis today. Cannabinoids: 3 Varieties What is the Endocannabinoid System? Russo, E.B. 2008. Cannabinoids in management of difficult to control pain. Therapeutics & Clinical Risk Management 4(1):245-259. THC Discovered in 1964 Cannabinoid receptors in brain discovered in 1990. ➢ THC was discovered by Dr. Raphael ➢ In a study published in 1990, researchers Mechoulam in Israel were able to clone a CB1 brain receptor, after much hypothesizing that there must ➢ Until the discovery and isolation of be receptors in the brain for cannabinoids. Delta-9 tetrahyrdrocannabinol, ➢ Since then, research has expanded to scientists did not understand what include cloning CB2 receptors, caused the psychoactive effect in understanding complex interaction of Cannabis. cannabinoids with our CNS, immune ➢ Since then, multiple components system and organs. including THC, CBD, CBC, CBG, not ➢ Dr. Kano and his colleagues in Tokyo to mention terpines and flavonoids reported in 2009 about the influence of have been identified within the Raphael Mechoulam - Father of Cannabinoid Research Delta-9 Tetrahydrocannabinol endocannbinoids on synaptic transmission. cannabis plant. http://www.beyondthc.com/wp-content/uploads/2012/07/eCBSystemLee.pdf Kano M1, Ohno-Shosaku T, Hashimotodani Y, Uchigashima M, Watanabe M. Endocannabinoid-mediated control of synaptic transmission. Physiol Rev. 2009 Jan;89(1):309-80. Delta-9 Tetrahydrocannabinol 6

10/10/2019 Methods of Ingestion: How Cannabis Interacts By mouth via eating, ie. oil, butter, capsules, dummies, with Our Bodies sprays, alcohol/oil based tinctures. By mouth via sublingual use of sprays or tinctures. By inhaling via smoking or vaporizing into lungs. By applying via topicals to skin. By suppository via rectal insertion. What is Cannabidiol or CBD? From ProjectCBD.org 7

10/10/2019 Some other important cannabinoids: Cannabinoid based • Cannabinol (CBN): mildly psychoactive, may decrease eye pressure and seizure occurrence. Pharmaceuticals • Cannabichromene (CBC): may provide pain relief, has sedative effects. • Cannabigerol (CBG) may have sedative effects and antimicrobial properties, may decrease eye pressure. • Tetrahydrocannabivarin (THCV) showing promise for Type-2 diabetes and related metabolic disorders. From National Center for Complementary and Integrative Health 8

10/10/2019 Visit PROJECT CBD www.projectcbd.org/how-to/cbd-drug- interactions for EDUCATIONAL PRIMER ON CANNABINOID-DRUG INTERACTIONS for any age. Cannabis acts as an adaptogen in the Effects of Cannabinoids body. At too low dose, no effect, too high dose opposite effect, just right dose leads to therapeutic effects. Excerpt from ProjectCBD.org 9