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MARIJUANA/THC

Learning Objectives
Understand background knowledge of Marijuana and
Cannabis
Review different subspecies of Cannabis
Understanding of cannabinoids and endocannabinoid
system
Become aware of all possible sources of exposure
Discuss common side effects of THC
Discuss clinical presentation and monitoring of
cannabis intake
Inform on current pharmaceutical research (FYI)
Disclaimer

Image from: https://quotefancy.com/quote/799288/Edwin-Louis-Cole-Knowledge-is-the-acquiring-of-facts-understanding-is-the-interpreting-of on Sept.2016


Background
Cannabis

Image from: http://cannabiscuisine.com/wp-content/uploads/2016/03/cannabis-sativa.jpg on Sept.2016


Image from: https://c1.staticflickr.com/9/8018/7445256154_7d55bae6e9_b.jpg on Sept.2016
Background
Cannabis Sativa
Thousands of years old
Marijuana
Hemp
Over 400 compounds
Including over 60 cannabinoids
delta-9-tetrahydrocannabinol (THC)
Cannabidiol (CBD)

1) http://emedicine.medscape.com/article/833828-overview#a4
2) Mintz CS. Cannabis-derived pharmaceuticals. Journal of Commercial Biotechnology. 2015;21(3).
https://login.southuniversity.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/1692507629?accountid=13931. doi: http://dx.doi.org/10.5912/jcb709.
3) Image from: http://blog-imgs-78.fc2.com/c/a/n/cannabis272/partsname.jpg on Sept.2016
Extra Fluff
Cannabis Indica
THC/CBD ratio
Higher concentrations of THC
than Sativa
Lower CBD concentration
Cannabis Sativa
CBD/THC ratio
Higher concentrations of CBD
Lower THC concentrations

1)Image from: http://www.leafscience.com/wp-content/uploads/2014/06/indica-vs-sativa-02-06-191.jpg on Sept.2016


2) Hillig, K. W., & Mahlberg, P. G. (2004). A chemotaxonomic analysis of cannabinoid variation in Cannabis (Cannabaceae). American Journal of Botany, 91(6), 966-975.
doi:10.3732/ajb.91.6.966
Pathophysiology
Cannabinoids
Phytocannabinoids
THC
CBD
Endocannabinoid system (ECS)
G-protein-coupled cannabinoid receptors
CB1- CNS
CB2- Immune System

Gertsch, J., Pertwee, R. G., & Di Marzo, V. (2010). Phytocannabinoids beyond the Cannabis plant do they exist? British Journal of Pharmacology, 160(3),
523529. http://doi.org/10.1111/j.1476-5381.2010.00745.x
Pathophysiology

By reducing inflammatory cell infiltration and lipid peroxidation, CB2-R receptor activation is protective against hepatic ischemia-reperfusion injury. Targeting the hepatic ECS may have therapeutic potential in a
variety of liver diseases.[26]. (n.d.). Endocannabinoids. Retrieved September 26, 2016, from http://emedicine.medscape.com/article/1361971-overview#a4
Table 1: Pharmacologically active phytocannabinoids
Therapeut ic
Name Abbreviat ion St ruct ure Physiologic Ef ect s Indicat ion(s)

-9 t etrahydrocannabinol THC Psychoactive, mild Pain, Nausea,


analgesic, anti-emetic, Nutritional
appetit e stimulant wasting, Cancer
neuroprotective,
reduces
neuroinf ammation
and stimulates
neurogenesis

-9-t etrahydrocannabivarin THCV Non-psychoactive, Epilepsy and


anti-convulsant, anti- other CNS
inf ammatory, disorders
hepatic
ischemia

Cannabidiol CBD Non-psychoactive, Schizophrenia,


relieves convulsion, epilepsy, cancer
inf ammation, anxiet y
and nausea

Cannabigerol CBG Non-psychoactive, Multiple


relieves intraocular Sclerosis,
pressure, anti- Glaucoma and
inf ammatory, inf ammatory
neuroprotective, bowel disease
anti-emetic

Cannabichromene CBC Non-psychoactive, anti Pain, Cancer


inf ammatory and
analgesic ef ects

Cannabidivarin CBDV Non-psychoactive,anti- Epilepsy


convulsive, anti-
inf ammatory

Cannabinol CBN Weakly psychoactive Epilepsy


(degradation
product of THC),
immunosuppressant
activit y,
anticonvulsive
Mintz CS. Cannabis-derived pharmaceuticals. Journal of Commercial Biotechnology. 2015;21(3).
https://login.southuniversity.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/1692507629?accountid=13931. doi: http://dx.doi.org/10.5912/jcb709.
Pathophysiology
Endocannabinoid system (ECS)

By reducing inflammatory cell infiltration and lipid peroxidation, CB2-R receptor activation is protective against hepatic ischemia-reperfusion injury. Targeting the hepatic ECS may have
therapeutic potential in a variety of liver diseases.[26]. (n.d.). Endocannabinoids. Retrieved September 22, 2016, from http://emedicine.medscape.com/article/1361971-overview#a3
Pathophysiology

Image from: http://www.nature.com/nrc/journal/v12/n6/images/nrc3247-f1.jpg on Sept.2016


Sources of Exposure

1) Image from; http://www.livescience.com/images/i/000/023/332/original/joint-120110.jpg?interpolation=lanczos-none&fit=inside%7C660:* on Sept.2016


2) Image from: http://static.seattletimes.com/wp-content/uploads/2015/05/2359f256-fc11-11e4-b8cb-6b1b76651699-1020x765.jpg on Sept.2016
3) Image from: http://marijuanastocks.com/wp-content/uploads/2015/08/cannabis-oil-1.jpg on Sept.2016
Sources of Exposure
Inhalation (Smoking or Vaporization) Onset of action is rapid
(within minutes); it results in 10-35% absorption of the available THC;
peak plasma concentrations occur within 8 minutes.
Ingestion Onset occurs within 1-3 hours (unpredictable); 5-20% is
absorbed, due to stomach acid content and metabolism; peak
plasma levels occur 2-6 hours after ingestion.
Rectal
Sublingual
Transdermal
Ophthalmic
Intrathecal
Intravenous
Dabbing??? 1) http://emedicine.medscape.com/article/833828-overview#a5
2) Mintz CS. Cannabis-derived pharmaceuticals. Journal of Commercial Biotechnology. 2015;21(3).
https://login.southuniversity.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/1692507629?accountid=13931. doi:
http://dx.doi.org/10.5912/jcb709
3) Image from: http://budmanoc.com/wp-content/uploads/2015/09/Menu-Spray-AbsoluteXtracts-High-THC-Cannabis-Sprays-15ml-450mg-THC-3-
flavors.png on Sept.2106
Sources of Exposure

1) Image from: http://www.wearebaked.com/wp-content/uploads/2013/06/Weed-Star-Messias-Illusion-12-arm-Percolator-Bong.jpg on Sept.12


2) Image from: http://www.truthonpot.com/wp-content/uploads/2014/07/how-vaporizer-work.jpg Sept.2016
3) Image from: http://www.leafscience.com/wp-content/uploads/2016/01/vape-pens-2.jpg Sept.2016
4) Image from: https://www.whaxy.com/wp-content/uploads/2015/06/cannabis-concentrates.jpg Sept.2016
Presentation of exposure
Somnolence
Euphoria
Alterations of senses/time perception
Depersonalization
Loss of social inhibition
Giddiness
Mood alterations
Decreased motor coordination
Lethargy
Muscle jerking
Ataxia
Many many more.
Micromedex Products: Retrieved September 22, 2016, from
http://www.micromedexsolutions.com/micromedex2/librarian/CS/BBCFE8/ND_PR/evidencexpert/ND_P/evidencexpert/DUPLICATIONSHIELDSYNC/4DF97E/ND_PG/evidencexpert/ND_B/ev
idencexpert/ND_AppProduct/evidencexpert/ND_T/evidencexpert/PFActionId/evidencexpert.IntermediateToDocumentLink?docId=83
Presentation of exposure

Image from: https://assets.greenrushdaily.com/wp-content/uploads/2015/12/1398533829_snoop_dogg_0_30.jpg on Sept.2016


Management strategies/treatment
Depends on:
Clinical presentation
Age
Other drugs/substances involved
Benzodiazepines for severely agitated and/or psychosis
Antidote???

Retrieved September 23, 2016, from http://emedicine.medscape.com/article/833828-treatment#d9


Monitoring Parameters
Cardiovascular monitoring
Heart Rate
Rhythm
Neurological monitoring
Placement in quite/isolated room
Toxic Levels???

Cannabinoid Poisoning Treatment & Management. (n.d.). Retrieved September 22, 2016, from http://emedicine.medscape.com/article/833828-treatment#d9
Image from: http://bluebell-web-solutions.com/wp-content/uploads/2016/01/Social-Media-Monitoring.jpeg on Sept.2016
Monitoring Parameters
THC
Metabolized via the hepatic cytochrome P450 (CYP) system
Half-Life: 2-56hrs
15% excretion in the urine and 25-35% in the feces
~90% of THC is eliminated from the body in 5 days
Dronabinol (Marinol)
Antiemetic; Appetite Stimulant
Onset of action: ~0.5 to 1 hour
Peak effect: 2 to 4 hours
~10 L/kg; dronabinol is highly lipophilic
Protein binding: ~97%
Excretion: Feces (50%, 5% as unchanged drug); Urine (10% to 15%)

Retrieved September 22, 2016, from http://www.crlonline.com/lco/action/doc/retrieve/docid/lthdph/382912


Retrieved September 23, 2016, from http://www.crlonline.com/lco/action/doc/retrieve/docid/patch_f/6795
Summary
Background
Cannabis Sativa vs Cannabis Indica
Pathophysiology
Cannabinoids
ECS, CB1 receptor, CB2 receptor
Exposure
Treatment/Monitoring
Pharmaceutical research

Image retrieved from, Sept. 26, 2016 https://s-media-cache-ak0.pinimg.com/originals/44/08/ec/4408eccdaa5fac4abe3b54034129a91c.jpg


Questions

Retrieved September 23, 2016, from http://greencrosscenter.com/marijuana-card-doctor/wp-content/uploads/icon1faq1.png