Cannabinoid and Harm Reduction among cannabis users

Sebastien BeguerieFounder of AlphaCAT

Founder @ the Union Francophone pour les Cannabinoides en Médecines (UFCM)

Co-founder & coordinator @ the International Medical Cannabis Patient Coalition (IMCPC).

Board Member as Patient Representative @ the International Association for Cannabis as Medicine (IACM)

Legal situation in the US

Factors of Mass consumption

Marketing enhancer• Legal activity sector• Consumer branding• Job• Regulation• Prevention• Education

Addiction risk• Easy access• Fashion• Higher % of Cannabinoids• New consuming techniques

(Dab, edibles, vaping, …)• Mass commercial event

(festival, concert, …)

In Society

• Will the consumption of cannabis increase ?

• What can be the consequences ?

• Will there be a higher addiction rate to cannabis and drugs in the future ?

• Which approach to have toward herbal cannabinoid consumption in our society ?

Herbal CannabinoidsDried flowertips=Cannabis Flos

• Full of glandular hairs (crystals) • Glandular hairs produce cannabinoids • Cannabinoids ONLY appear in the cannabis plant

Herbal Cannabinoids in Trichomes

Trichomes: Glandular hairs produce

cannabinoids

Subgroups Compounds known (approx. ~)

Cannabigerol (CBG) 7Cannabichromene (CBC) 5Cannabidiol (CBD) 7Delta-9-trans-tetrahydrocannabinol (Δ9-THC) 9 Delta-8-tetrahydrocannabinol (Δ8-THC) 2Cannabicyclol (CBL) 3Cannabielsoin (CBE) 5Cannabinol (CBN) 7Cannabinoidiol (CBND) 2Cannabitriol (CBT) 9Miscellaneous 14

Phyto- Cannabinoids• More 141 cannabinoids in total

Overstanding

Naturally ,Human bonds to Herbal Cannabinoids !

Early observations on Cannabis user in California

Cannabis as a substitute for alcohol and other drugs.

• In December 2009, Publish in Harm Reduction Journal by Amanda Reiman

• Anonymous survey

• Data collected at the Berkeley Patient's Group a medical cannabis dispensary in Berkeley, CA. (N = 350)

Population Sample

68% male, 32% female• 54% single, • Average 39 years;

71% with medical condition:• 52% for a pain related condition, • 75% for a mental health issue.• 74% had health insurance,

81% completed at least some university degree,41% worked full time, socially integrated people.

Cannabis use as substitute

Remaining Question ?

• What cannabis strain did they consume ?

• Which cannabinoids were in action ?

• What were the cannabinoids percentage ?

Opoids addictionCannabidiol inhibits the reward-facilitating effect of morphine: involvement of 5-HT1A receptors in the

dorsal raphe nucleus.

2013 in Journal of addiction and biology publish by Katsidoni et al. :

Tested on rats using intracranial self-stimulation (ICSS) paradigm.Rats prepared with a stimulating electrode into the medial forebrain bundle (MFB)

• CBD a non-psychotomimetic constituent of Cannabis sativa• Induces central effects in rodents. • Shown to attenuates cue-induced reinstatement of heroin seeking.

CBD interferes with brain reward mechanisms responsible for the expression of the acute reinforcing properties of opioids

Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence

• May 2015 Publish in Journal of substance abuse: research and treatment• Mélissa Prud’homme et al.• Review of Evidence• Searched on MEDLINE and PubMed for English and French language articles published before 2015.

14 studies found in total:

Started in 1975 by Hine et al, on animals for opiods and in 1979 with Consroe et al, on humans for alcool • 9 conducted on animals • 5 on humans in average n=47 individuals per experiment

To fully evaluate the potential of CBD as an intervention for addictive disorders.

Further studies are clearly necessary !

Substitution by Herbal Cannabinoids

Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors.

Sept 2015 published in Journal of Drug Alcohol Review by Lucas et al.

414-question cross-sectional survey to Canadian medical cannabis patients in 2011 and 2012

• 84 % patient claim to use medical cannabis instead of other substances. • 80% patient used it as substitute from prescribed drugs (pain killer mainly).• 52% patient substitute from alcohol• 32% substitute from illicit drugs other than cannabis

• Cannabis substituted for all three classes of substances

• Suggests medical use of cannabis may play a harm reduction role in the context of use of these substances, and may have

• Implications for abstinence-based substance use treatment approaches

THC addictionKnown symptoms of Cannabis withdrawal in heavy users:• followed by increased anxiety, • insomnia, • loss of appetite, • migraine, • irritability, • restlessness and other physical and psychological signs.

• Tolerance to cannabis and cannabis withdrawal symptoms are believed to be the result of the desensitization of CB1 receptors by THC.

CBD vs THC addiction• Cannabidiol for the treatment of cannabis withdrawal syndrome: a case report

• In 2013 by Crippa et al

• Publish in Journal Clinical Pharmacology & Therapeutics

• 19-year-old woman withdrawal syndrome treated with cannabidiol (CBD) for 10 days.

• Daily symptom assessments demonstrated the absence of significant withdrawal, anxiety and dissociative symptoms during the treatment.

• ONLY ONE INDIVUAL AND UNKOWN CBD % PRESCRIBED LACK OF SCIENTIFIC SETTINGS

CBD safe with no side effectSafety and side effects of cannabidiol, a Cannabis sativa constituent

Published in September 2011, in the Journal of Current Drug Safety by Mateus M et al

• Review described in vivo and in vitro reports of CBD administration across a wide range of concentrations,

• Based on reports retrieved from Web of Science, Scielo and Medline. The • Keywords searched were "cannabinoids", "cannabidiol" and "side effects".

Several studies suggest that CBD :• Non-toxic in non-transformed cells and • Does not induce changes on food intake, • Does not induce catalepsy, • Does not affect physiological parameters (heart rate, blood pressure and body temperature),• Does not affect gastroint

Cannabinoid administration methods

Edibles• Standard dosage for medical use

• Breakdown by the liver of THC delta 9 into 11-Hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC) which acts on its own more intensively.

• Attract naive users with candy form

• Confusion risk with children snacks.

• Easy to overdose.

• Heavy state of confusion leading to hospitalization.

710 DAB CULTURE

• Cannabinoid Extract up to 90% THC• Risk of solvent residue (Butane, Propane,…)

• Heavy intoxcation in a hit• Risk to « pass out »

Herbal Cannabinoids

• New strains :High in THC up to 30% 1:1 CBD/THC High in CBD up to 20%

• Vaporization: Herbal formE-liquid form

Be smart: Know your medicine!

Educate cannabis users:To consume according to their needs

• Testing• Potency / Dosage• Cannabinoids Pharma effects • Intoxication risk• Administration form

Cannabinoids for aHEALTHIER POPULATION?

In Febuary 2015 in the Wall Street Journal: The Debate Over Running While High

“The person who is going to win an ultra is someone who can manage their pain, not puke and stay calm,” said veteran runner Jenn Shelton. “Pot does all three of those things.”

• Michael Phelps: Swimmer with 14 Olympic gold medals, use Cannabis

• Ross Rebagliati: in Nagano 2008Snowboard Olympic gold medal use cannabis

Cannabis for a smarter society