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?

www.mainewellness.org@wellconnectmewww.facebook.com/mainewellnessInstagram: @mainewellness