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.
Ways of consumption
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Do curso por Technion - Israel Institute of Technology
Medical Cannabis for Pain Control
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Interactions between cannabis and our body
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Elon EisenbergProfessor 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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