Department of Physical Medicine and Rehabilitation
UC Davis Medical Center
Disclosure
I have no relevant financial interest/arrangement or affiliation with any organizations related to commercial products or services to be discussed at this program
Educational Objectives
To describe the history of medical marijuana in the US from the 19th Century to present day
To understand the contributions of the UC Center for Medicinal Cannabis Research (CMCR)
To discuss opportunities for research
Listed in U.S Pharmacopeia 1850-1941
Listed in U.S Pharmacopeia 1850-1941
marijuana & hashish extracts were the 1st, 2nd, or 3rd most prescribed meds in the US from 1842-1890s
neuralgia
neuralgia
gout
rheumatism
tetanus
hydrophobia
epidemic cholera
convulsions
chorea
hysteria
mental depression
delirium tremens
insanity
uterine hemorrhage
Prohibition 1937
California's Proposition 215 1996
First statewide medical marijuana ballot initiative to pass in the USA
allow possession and cultivation of cannabis for ‘debilitating’ medical conditions if recommended by a physician
provide a defense against prosecution under state criminal laws
Who are medical marijuana patients?
patient survey
pain, insomnia, and anxiety
Reinarman C, Nunberg H, Lanthier F, Heddleston T. Who are medical marijuana patients? Population characteristics from nine California assessment clinics. J Psychoactive Drugs. 2011;43:128-135
To describe the history of medical marijuana in the US from the 19th Century to present day
To recognize partial legalization versus full legalization of marijuana
To understand the contributions of the UC Center for Medicinal Cannabis Research (CMCR)
To discuss opportunities for research
Full vs Partial Legalization
full legalization has the potential to substitute underground economies with legitimate businesses
pharmaceutical companies
agribusiness
Full vs Partial Legalization
alternatives to full legalization
in the Netherlands, the use and sale of small quantities is permitted while production and wholesale distribution is banned
penalties for possession of small amounts of marijuana could be reduced and treated as civil rather than a criminal matter (so-called “decriminalization”)
production, sale, and use could be permitted but only for medical purposes
Medical Marijuana Laws Get Tougher
Illinois Proposed Medical Marijuana Bill
cancer; glaucoma; HIV/AIDS; hepatitis C; amyotrophic lateral sclerosis (ALS); Crohn's disease; agitation of Alzheimer's disease; cachexia/wasting syndrome; muscular dystrophy; severe fibromyalgia; spinal cord disease, including but not limited to arachnoiditis; Tarlov cysts; hydromyelia; syringomyelia; spinal cord injury; traumatic brain injury and post-concussion syndrome; multiple sclerosis; Arnold Chiari malformation and Syringomyelia; Spinocerebellar Ataxia (SCA); Parkinson’s disease; Tourette’s syndrome; Myoclonus; Dystonia; Reflex Sympathetic Dystrophy (RSD); Causalgia; Neurofibromatosis; Chronic Inflammatory Demyelinating Polyneuropathy; Sjogren’s syndrome; Lupus; Interstitial Cystitis; Myasthenia Gravis; Hydrocephalus; nail patella syndrome; or the treatment of these conditions
Educational Objectives
To describe the history of medical marijuana in the US from the 19th Century to present day
To recognize partial legalization versus full legalization of marijuana
To understand the contributions of the UC Center for Medicinal Cannabis Research (CMCR)
To discuss opportunities for research
California State Legislature Medical Marijuana Research Act SB847 Senator John Vasconcellos 1999
Approval Process 1997 NIH Workshop
Department of Health and Human Services (HHS)
DEA
Schedule I License
FDA
Investigational New Drug Application
NIDA
supplies marijuana grown at University of Mississippi
Research Advisory Panel of California
CMCR Neuropathic Pain Studies
results have been convergent
five studies demonstrated a significant decrease in pain after cannabis administration
the magnitude of effect in these studies, expressed as the number of patients needed to treat to produce one positive outcome, was comparable to current therapies
Educational Objectives
To describe the history of medical marijuana in the US from the 19th Century to present day
To recognize partial legalization versus full legalization of marijuana
To understand the contributions of the UC Center for Medicinal Cannabis Research (CMCR)
As the legal landscape evolves, the medical one remains confusing
fewer than 20 randomized, controlled clinical trials of smoked marijuana for all possible uses
these involved around relatively few people in all—well short of the evidence typically required for a pharmaceutical to be marketed in the U.S.
Federal Restrictions on Cannabis Research
Schedule I Controlled Substance
high potential for abuse
no currently accepted medical use in treatment
lack of accepted safety under medical supervision
use and possession is a federal offense
National Institute of Drug Abuse (NIDA) Supplies Research-grade Cannabis
NIDA does not stock purified (a.k.a., Good Manufacturing Practice grade) Δ9-THC or CBD in their drug supply inventory for use in clinical trials
not the case with other Schedule I drugs like heroin, LSD, and MDMA
which are provided legally by “private U.S laboratories” or easily imported from abroad with federal permission, making marijuana the only Schedule I drug with a single federal provider
there is not enough evidence to recommend medical marijuana as a treatment for any psychiatric disorder
the psychiatric risks are well documented, and include addiction, anxiety, and psychosis
Call for Additional Studies
American Medical Association
2009 House of Delegates Report
supported review of marijuana's Schedule I status
urged an evidence-based review of marijuana's status as a Schedule I controlled substance to determine whether it should be reclassified to a different schedule
NIH support of clinical studies on the utility of medical marijuana
NIH Sponsored Studies
THC / Dronabinol / Marinol Efficacy Trial of Oral Tetrahydrocannabinol in Patients With Fibromyalgia at Hadassah Medical Organization, Jerusalem, Israel Nabilone / Cesamet Efficacy and Safety Evaluation of Nabilone as Adjunctive Therapy to Gabapentin for the Management of Neuropathic Pain in Multiple Sclerosis at University of Manitoba, Winnipeg, Canada Nabiximols / Sativex A Study of Sativex® for Relieving Persistent Pain in Patients With Advanced Cancer in the United States, the UK and Germany
NIH Sponsored Studies
Cannabidiol (CBD) Cannabidiol for Inflammatory Bowel Disease at Meir Medical Center, Kefar Saba, Israel Smoked / Inhaled Cannabis Comparing the Effects of Smoked and Oral Marijuana in Individuals With HIV/AIDS at New York State Psychiatric Institute, USA.
Effects of Vaporized Marijuana on Neuropathic Pain in Spinal Cord Injury at CTSC Clinical Research Center, Sacramento, United States.
