Medical Marijuana for PainHow Does Cannabis Work on Your Body?Jeremy Spiegel, MDMedical Director - Casco Bay MedicalWestbury, 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 thousands of years

“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

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

- CBM Patient, 2016

Cannabis was legal in the USA until 1937It was on the US Formulary until 1942 --

Removed AGAINST the advice of the AMA.Reefer Madness

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 cannabis flowers providing relief from pain, nausea, and have anti-inflammatory properties.

Tip

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Reveal your product or idea (in this case a translation app) up front.

CANNABINOIDS (such as THC and CBD) are C21-Oxygen containing organic molecules.

Tip

Don’t wait till the end of the presentation to give the bottom line.

Reveal your product or idea (in this case a translation app) up front.

Endocannabinoidsystem

➔ Phytocannabinoids are ligandsLigand 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.

Endocannabinoidsystem

➔ Our Bodies Naturally Produce CannabinoidsAnandamide 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)

Endocannabinoidsystem

➔ Phytocannabinoids are li

➔ CB1 and CB2 are G-Protein coupled receptors in the cell membrane

Endocannabinoidsystem

➔ Our Bodies Naturally Produce TheseAnandamide 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.

Pain Tracts

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

<--Perception

<--Perception

<--Voltage gated Na+ channels

Endocannabinoidsystem

➔ Delta-9 THC is a multitarget ligandΔ9-THC has also been proposed to be a serotonin 5HT3A 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

Endocannabinoidsystem

➔ Phytocannabinoids are ligandsLigand 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

CBDBLOCKS GRP55 Signaling

GRP 55 signals osteoclast formation--which reabsorbs bone. Therefore: Putatively

REDUCE OSTEOPOROSIS and JOINT PROBLEMS by antagonizing this process.

Endocannabinoidsystem

➔ Phytocannabinoids are ligandsLigand 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:CBD20:1

THC:CBD RATIO

THC:CBD1:1

THC:CBD1:20

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

Cannabis may reduce the need for opioid painkillers

University of Michigan researchers

found a 64% decrease in users

of medical marijuana.

Beware opioids

Increased cannabis use for chronic pain may reduce addictions and deaths related to opioid painkillers

Cannabis is safe

➔ CB1 Receptors are virtually nonexistent in the brainstem, medulla, thalamus. So we don’t get the life-threatening effects on vital physiological functions

Terpenes are fragrant essential oils secreted by cannabis plants

These active molecules are among the 500 different compounds found in

cannabis, of which there are 85 different cannabinoids.

How Do I Get My New York Medical Marijuana Card?

1. See the Doctor for the MMJ evaluation.

I perform these either: In-Person in Westbury

or Online via videochat

2. Register with the New York State Department of Healthwww.health.ny.gov

(We can help you with this.)

3. Wait about a week for your ID card to come in the mail.

4. Go to the Dispensary to get your medicine.

(We will give you a list of conveniently located dispensaries.)

New York Listed Conditions➔ Chronic Pain >= 3

months duration

➔ Post Traumatic Stress Disorder

➔ Cancer

➔ ALS

➔ HIV/AIDS

➔ Inflammatory Bowel Disease

New York Listed Conditions➔ Epilepsy

➔ Huntington’s Disease

➔ Parkinson’s Disease

➔ Spinal Cord Injury

➔ Multiple Sclerosis

www.cascobaymedical.com

990 Westbury Road

Suite 204

Westbury NY 11590

(516) 508-3316

●

References➔ “Molecular Targets of the

Phytocannabinoids: A Complex Picture”Prog Chem Org Nat Prod. 2017; 103: 103–131.

➔ “The Endocannabinoid System, Cannabinoids, and Pain” Rambam Maimonides Med J. 2013 Oct; 4(4)

➔ National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press.

References (cont’d)

➔ Annals of Internal Medicine, 2017. Benefits and Harms of Plant-Based Cannabis for Posttraumatic Stress Disorder: A Systematic Review.

➔ Cannabis Pharmacy: The Practical Guide to Medical Marijuana by Michael Backes

➔ Leafly.com➔ CannaSOS.com