Delivery Methods and Dosing:Making the most of your medicine
Medical Cannabis and Inflammatory Bowel
Disease
Special Guest, Patient and WCM Member David R.Host: Becky DeKeuster, M.Ed, Director of Education
Producer: Ben Gelassen, Marketing Associate
An introduction for patients, families,and caregivers
Does my GI disorder qualify me for #mmj?
§2422, 2.E.: “Post-traumatic stress disorder, inflammatory bowel disease, dyskinetic and spastic movement disorders…”
§2422, 2.B.: “A chronic or debilitating disease or medical condition or its treatment that produces intractable pain, which is pain that has not responded to ordinary medical or surgical measures for more than 6 months…”Source: Maine Revised Statutes Title 22, Chapter 558-C: Maine Medical Use of Marijuana Act, http://www.mainelegislature.org/legis/statutes/22/title22sec2422.html
GI Disorders – An Overview
(Inflammation and ulceration of inner lining of GI tract)
Ulcerative Colitis (UC)
Crohn’s Disease
Collagenous and
Lymphocytic Colitis
Irritable Bowel Syndrome
All IBDs involve damage to the actual bowel tissues
While it can be painful and debilitating, IBS does not
involve damage to the bowel tissue itself
• Affects only colon• Continuous pattern• Pain, bleeding,
changes in stool
• Affects entire GI tract• Discontinuous pattern• Pain, nausea,
vomiting, loose stool, weight loss
Inflammatory Bowel Disease
• Quite rare• Also called
microscopic colitis
Ulcerative Colitis & Crohn’s
Image source: National Library of Medicine, https://ghr.nlm.nih.gov/condition/crohn-disease
Common Treatments
Source: Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/crohns-disease/basics/treatment/con-20032061
•Sulfasalzine, mesalamine, corticosteroids•Sulfas now considered of limited benefit; steroid side effects problematic
Anti-inflammatory drugs
•Imuran, Purinethol, Remicade, Humira, Cimzia, Rheumatrex, Stelara•Many were originally approved for use w/rheumatoid arthritis, psoriasis
Immune system suppressors
•Cipro, Flagyl•No strong evidence of effectivenessAntibiotics•Anti-diarrheals, pain relievers•Iron, calcium, Vitamin B-12 and D supplements•Nutrition therapy to allow bowel to restOther
Why Might Cannabis Help?
Image source: David Guzman, “The Endocannabinoid System”
CB1 receptors help regulate intestinal movement and secretions
CB2 receptors help regulate immune response and inflammation by limiting the amount of white blood cells sent to a perceived threat
Why Might Cannabis Help?
Your ECSInflammation
Visceral Pain
Secretions
Digestive MotilityTHC CBD
CB-1 CB-2
Promising Cannabis Research“The effects of (THC) and cannabidiol alone and in combination on damage, imflammation and in vitro motility disturbances in rat colitis.”Jamontt et al, British Journal of PharmacologyJune 2010• Rat modeling with sulphasalazine as control group• THC and CBD proved beneficial in a dose-response
relationship• Alone or together• Optimal dose 10mg
“In this model of colitis, THC and CBD not only reduced inflammation but also lowered the occurrence of functional disturbances. Moreover the combination of CBD and THC could be beneficial therapeutically, via additive or potentiating effects.”
Promising Cannabis Research“Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study.”Naftali et al, Clinical Gastroenterology and HepatologyOctober 2013
• 21 human patients, unresponsive to traditional therapies• Placebo-controlled• 5 of 11 subjects in the cannabis group had complete
remission• 3 were weaned from steroid dependency
“…a short course (8 weeks) of THC-rich cannabis produced significant clinical, steroid-free benefits to 10 of 11 patients with active Crohn's disease, compared with placebo, without side effects.”
But Remember….
Brain cells with Alzheimer’s being grown in a Petri dish (www.discovermagazine.com)
Female cannabis flowers are covered with small crystals which contain dozens of active therapeutic compounds
Cannabis Side Effects
Cannabis has no known LD50
No known negative
drug interactions
EuphoriaMotor coordination problems
Short term memory lossRed eyes
Dry mouthLow blood pressureHeart palpitations
Anxiety/panic/paranoiaHallucinations
Remember, while unpleasant, too much cannabis alone is not fatal. Time, water, food, and a relaxing environment all help.
Remember: Start low,Go slow
Methods of Administration
Inhalation Ingestion Topical
30 sec – 1 min.
Smoking/Vaping
Easy titration
Wide variety:Tincture, foods,
beverages
5 to 10 min20 to 120 min.
Can be helpful for neuropathic pain,
psoriasis
Can be difficult to titrate No psychoactivity
Flower & concentrated oils
What is the process?
1. Talk to your primary or specialist doctor
Any MD, DO or NP can certify
Some work for practices or groups that do not allow them to certify. Their patients must go to a cannabis specialist doctor.
Be prepared to educate
What is the process?2. Choose a provider• Grow at home• Designate a dispensary• Designate an individual to be
a cannabis “caregiver”
A quality provider should:
• Offer many options (product & potency)• Be able to coach and explain products clearly• Lab test all products• Give receipts, track inventory, charge sales tax• Use no pesticides• Make you feel safe
Further Reading
Massa F, Monory K. “Endocannabinoids and the gastrointestinal tract.”Journal of Endocrinological Investigation, 2006.
Di Marzo V, Piscitelli F. “Gut feelings about the endocannabinoid system.” Neurogastroenterology and Motility, May 2011.
Volz MS, Siegmund B. “Efficacy, tolerability, and safety of cannabinoids in gastroenterology: A systematic review.” Schmerz (Berlin, Germany), Feb 2016.
Resources
www.pubmed.comwww.ccfa.org/maine
Support groups, education, care providers and more
www.safeaccessnow.org
Delivery Methods and Dosing:Making the most of your medicine
Thank you for your time and attention!
What are your remaining questions & concerns?
[email protected]/mainewellnessInstagram: @mainewellness