Medical Uses of Cannabis in California

1
Medical Uses of Cannabis in California

• Tod H. Mikuriya, M.D.
• President,
• Classic Pharmaceuticals
• Berkeley, California, U.S.A.

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Introduction

• The Compassionate Use Act of 1996 exempts
  patients and caregivers from state laws
  prohibiting possession and cultivation of
  marijuana
• shall not apply to a patient or to a patients
  primary caregiver who possesses or cultivates
  marijuana for the personal medical purposes of
  the patient upon the written or oral
  recommendation or approval of a physician.

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California Cannabis Use Summary

• All are chronic conditions. (N4,928)
• Self medication with cannabis is a safer and more
  effective drug in the management of chronic
  illness compared with prescription or OTC drugs.
• Medical destigmatization de-alienates and
  therapeutically intervenes
• Significant problems of implementation and
  compliance remain.

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Pharmacologic Safety

• Compared with opioids, steroids, NSAIDS,
  sedatives, tricyclics, and benzodiazepines
  cannabis has minimal to no side effects.
• Critical difference in chronic condition coping.

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Modes of Activity

• Immunomodulator analgesic
• Mood and affect modulator
• Antispasmodic anticonvulsant
• Harm reducing substitute
• Hypothermogenic

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Modes of Action Difficult to Categorize

• Conditions have multiple manifestations. Or
  concurrent unrelated conditions may exist.
• Glaucoma, prostatitis
• Dyspepsia, back strain

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Immunomodulator Analgesic (42)

• A significant number presented with pain and
  dysfunction based upon localized tissue specific
  inflammation.
• While many conditions are secondary to trauma,
  other etiologies are largely autoimmune or
  idiopathic.
• Manifestations are organ system dependent and may
  be multiple.

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Mood and Affect Modulator (27.2)

• Controls emotional overreactivity and mobilizes
  affect.
• Restores sleep without hangover or fogginess.
• Improves attention and mental acuity by
  decreasing distraction.

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Spasmolytic Anticonvulsant (25.9)

• Cannabis relieves spasm and seizures from CNS,
  PNS, skeletal, and smooth muscle.
• Appetite stimulation is secondary to smooth
  muscle relaxation in the GI tract.

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Harm Reduction Substitution (4.2)

• Alcoholism and alcohol abuse
• Detox with high oral dose
• And inhaled supplementary maintenance with lower
  dose
• Minimize contact with other alcohol users

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Modes of Action
12
Age Distribution of Patients
13
Psychiatric Conditions Treated
14
Percent Usage as Harm Reducing Substitute
15
Physiological Mechanisms

• Increased cerebral perfusion
• Eicosanoids, precursors to prostaglandins,
  mediator of inflammation
• Similar in structure to cannabinoids
• Lipophilic non-polar molecules not soluble in
  water
• Psychological effects of cannabis blocked by
  indomethacin
• Mild tachycardia
• Decreased circulating glucocorticoids

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Psychosocial

• Exemption from marijuana law prosecution removes
  stressors.
• Fear of loss of freedom, job, housing, custody,
  health services, compensation, and harmful
  contact with police, court, probation, social
  workers, etc.
• Dealienation with improved self esteem,
  socialization, and health services access.