Ways of consumption

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Medical Cannabis for Pain Control

20 classificações

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Technion - Israel Institute of Technology

Medical Cannabis for Pain Control

20 classificações

Cannabis is a group of flowering plants that has been long used for industrial, recreational and medical purposes. When relating to its medical use, the terms "Medical Cannabis" or "Medical marijuana" has become prevalent. In this course we will use the term "Medical Cannabis". Nowadays, Medical Cannabis involves multiple medical disciplines such as neuroscience, pain, pharmacology, oncology, psychiatry and more. Moreover, it has cultural, agricultural and social, legal and political implications. This course will give you a solid ground to understand the whole picture. By completing this course, you will gain a broad understanding and knowledge base related to medical use of cannabis for pain control. You will be exposed to a wide range of topics such as historical use of cannabis in ancient times, botanic aspects of the plants, and potential benefits and risks associated with its medical use to both individuals and society.

Na lição

Interactions between cannabis and our body

Ways of consumption6:58

Cannabinoid pharmacokinetics9:02

Physiological effects on cannabinoids on pain systems in the brain4:42

Physiological effects cannabis on pain systems in the body3:02

Conheça os instrutores

Elon Eisenberg
Professor of Neurology and Pain Medicine
Institute of Pain Medicine, Rambam Health Care Campus

[SOUND]

Cannabis can be consumed in many different ways.

For clarity, we make a distinction between natural herbal cannabis and

cannabinoid based medications.

The principal difference is that herbal cannabis has

over 500 constituents which vary in concentration and biological effects.

While cannabinoid medications have precise doses of one or more defined molecules.

Natural herbal cannabis is consumed through the respiratory system,

sublingually, orally, or by topical application.

Cannabinoid based medications are either swallowed as pills or

capsules or sprayed onto the oral mucosa.

So let's start with natural herbal cannabis.

Cannabis is most commonly smoked as a cigarette.

And while some prefer smoking pure cannabis flowers,

others mix cannabis and tobacco.

When smoked, cannabis is actually burned at high temperature and

inhaled into the respiratory tract.

Despite the potential harm associated with smoking, which will be discussed later

in our course, many people prefer this method of consumption

due to the rapid onset of effect which generally occurs within minutes.

The main reason for this swift onset of action is that smoked cannabis

is transformed rapidly from the lungs to the bloodstream.

And from there it reaches the brain very quickly.

Numerous factors determine the speed and

magnitude of the effect of smoked cannabis.

These include the quantity ingested and

the concentration of the active constituents.

The relative tobacco cannabis contents.

The number and depths of inhalations.

And the duration smoke is held in the lungs.

All these factors contribute to the large variability of clinical effect

noted when comparing different cannabis smokers and

sometimes even different smoking sessions for the same patient.

An alternative to smoking is the use of water pipes or vaporizers.

In the case of water pipes,

smoke passes through a water chamber prior to being inhaled.

With vaporizer, the plant material is heated to a temperature

at which THC is released but smoke is not generated.

Vaporizers and water pipes may be safer consumption methods

since they reduce the quantity of combustion products in the inhalant.

At the same time, these methods may be less effective than smoking cannabis.

A company called Syqe has developed a device, now in clinical testing,

which provides metered doses of vaporized cannabis.

Once approved,

the device will dramatically reduce the viability of inhaled THC.

Medical cannabis can also be consumed using sublingual tinctures,

which typically come in the form of oil based drops.

Patient keeps the drops under the tongue for a few minutes,

allowing the tincture to be absorbed through the oral mucosa and

into the bloodstream for a quick onset of effect.

Although a formal comparison is not available, the onset of effect in

sublingual consumption appears to be slower than that of smoking.

This may, to some extent,

be explained by the fact that some of the oil is actually swallowed.

Non-smokers may prefer edibles,

such as cannabis cookies or cannabis tea.

Although easy to consume,

digested cannabis is often inconsistently absorbed from the gut and

has to pass through the liver before being introduced into the bloodstream.

This takes time, and the resulting magnitude and onset of effect

are usually unpredictable, with delayed response reaching 90 minutes.

Some people may not wait long enough before eating another cookie or

drinking some more tea and risk overdose.

What's more, if cannabis edibles find a way into the home, they may put others,

like children, at risk and have serious consequences.

Finally, natural herbal cannabis may be applied topically using drops or

ointments.

Since cannabinoids are highly oil-soluble, they may be absorbed into the body and

produce a local and even a systemic effect.

So far, the effectiveness of topical cannabinoids has not been studied and

cannot be estimated.

We'll now switch to cannabinoid-based medications.

FDA-approved oral cannabinoid-based medications are available in a number of

countries.

Dronabinol and Nabilone are systemic molecules

similar to THC and are sold as pills.

Those drugs were released some 30 years ago and are indicated for

the treatment of chemotherapy-induced nausea and wasting caused by AIDS.

Data regarding the ability of these drugs to relieve pain is limited.

A positive outcome was reported in one clinical trial in

which Nabilone reduced neuropathic pain in patents with diabetic neuropathy.

In recent years, an oral mucosal spray combining THC and

CBD in a 1 to 1 proportion has been commercialized as Sativex.

It is approved for the use of chronic neuropathic pain and spasticity

induced by multiple sclerosis, an immune disease of the central nervous system.

It is also approved in some countries for intractable cancer pain.

Sativex is intended to be absorbed from the oral mucosa.

But studies have shown delayed concentrations in the plasma

indicated that at least some of it is swallowed and absorbed in the gut.

So the way in which medical cannabis is consumed is one of

the determining factors in understanding its clinical effects.

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