Medical Cannabis Envision Conference 2014

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Lecture COPE 41978-GO

• This is a small portion of a lecture presented at ENVISION 2014.

• The lecture covered history, plant overview, cannabinoid in the visual system, neurodegenerative disease processes currently treated by cannabinoids and driving issues related to cannabis.

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Very Little Research Media Report 9/4/2014

• Smoking cannabis may be addictive: New study claims 40% of adolescents show withdrawal symptoms when they give up the drug

• Experts say symptoms considered a hallmark of

drug dependence• Called for more research

into whether cannabis should be legalized

Read more: http://www.dailymail.co.uk/sciencetech/article-2742849/Smoking-cannabis-IS-addictive-New-study-claims-40-adolescents-withdrawal-symptoms-drug.html#ixzz3CLp3G3Zc

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Marijuana Use is Common

• Marijuana is the most commonly used illicit drug in the U.S.

• Any use among general population age 12+ in past month:– 2011: 7%– 2008: 5.8%

• Use is most common among people age 18-25 (19% of population)

• 48% of adults in the US report having used marijuana at some time in their life

SAMHSA 2012; Pew Charitable Trust, 2013

Why Do People Use Marijuana?

Among people who used marijuana in the past year:

5 Pew Charitable Trust, 2013

47%

30%

23%

For Fun For Medical ReasonsFor Fun and for Medical Reasons

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Who Uses Medical Marijuana?• People who have a history of non-medical

marijuana use

– 95% of California medical marijuana patients were using the drug even before they received physician approval

Nunberg, 2011; Reiman, 2007; Bottorff, 2011; Janicheck & Reiman, 2012

Who Uses Medical Marijuana?

• People often use medical marijuana as a substitute for alcohol or other drugs

• Among patients at dispensaries in Los Angeles:– 41% used marijuana in place of alcohol – 30% used marijuana in place of other illicit drugs

7 Reiman, 2009; Bottorff et al., 2011; Nunberg et al., 2011; Grella et al., 2013

• People often prefer using medical marijuana instead of prescription medications– 58% of dispensary patients in Los Angeles

said they used marijuana in place of prescription drugs for health problems

– Many people believe that marijuana is more effective than prescription medications, and/or they prefer it because they believe it has fewer side effects

8Reiman, 2009; Bottorff et al., 2011; Nunberg et al., 2011; Grella et al., 2013

How do People Use Medical Marijuana?

• 67% of medical marijuana patients use the drug daily

• Over 86% smoke the drug

9Reinarman et al., 2011

Discussion of Glaucoma

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What Cannabis Organizations Tell “Patients”

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“There are thousands of medical marijuana patients who use cannabis to treat glaucoma… Search them out online and ask them their experience with cannabis,……”

http://the420times.com/2011/04/this-for-that-glaucoma/

What Cannabis Using Glaucoma Patients Report

Elvy Musikka, a patient in the federal Compassionate IND program for medical marijuana,

• "One of the benefits of using marijuana is that most of us drop all the other drugs that really do a number on our heads and make it difficult for us to stay

healthy …I did discover marijuana and pretty soon I found that it was the only medicine I ever needed." 12

Ophthalmology 2013

• "Based on reviews by the National Eye Institute (NEI), the Institute of Medicine (IOM), and on available scientific evidence, the American Academy of Ophthalmology Complementary Therapy Task Force finds no scientific evidence demonstrating increased benefit and/or diminished risk of marijuana use in the treatment of glaucoma compared with the wide variety of pharmaceutical agents now available...”

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Ophthalmology 2013 cont

• “Potentially serious side effects associated with smoking marijuana include an increased heart rate and a decrease in blood pressure. Studies of single-administration marijuana use have shown a lowering of blood pressure concurrent with the lowering of IOP. This raises concerns that there may be compromised blood flow to the optic nerve, but no data have been published on the long-term systemic and ocular effects from the use of marijuana by patients with glaucoma." 14

Vision Care Providers Have Background In Complex Issues

• Physical health• Sensory system

health• Functional abilities• Occupational issues

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Some Ailments for Which Cannabis Is Approved

• Glaucoma• Alzheimer’s Disease• Parkinson’s Disease• Multiple Sclerosis• HIV• PTSD• ALS

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Cannabis as Medicine

• Cannabis is one of the oldest known psychoactive plants

• First reported use as medicine > 5000 years ago

• Introduced into Western medicine in 1840

Physicians Recommending Medical Marijuana• Will need to get a thorough history - medically,

psychiatrically and substance abuse – keep a chart and have a patient/physician relationship

• Will need to attempt to decide what level of marijuana use is most appropriate

• Will need to recommend patients not drive etc. when under the influence or not drive at all

• Will need to follow patients closely for side effects and unintended consequences

Medical CannabisStill Must Rely on Subjective Data

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A billboard in Colorado