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Medical Marijuana

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by

Chelsea Emrit

on 11 September 2014

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Transcript of Medical Marijuana

http://www.doctoroz.com/videos/medical-marijuana-hot-debate-pt-1
References
Medical
Marijuana

Non-smoked Cannabis
Non-Smoked Marijuana
IOM
THC is a cannabinoid that has been proven to show pain relief, nausea control, & appetite stimulation
Defines marijuana as "un-purified plant substances, including leaves or flower tops, whether consumed by eating or smoking"
Study was done to research effects of the tetrahydrocannabinoid, or THC, component of marijuana
Cannabinoids
Is a class of chemicals that are produced naturally in nature from plants or animals and activate cannabinoid receptors in the brain
Two receptors CB1 and CB2
CB1
Located in basal ganglia, cerebellum, male and female reproductive symptoms.
Not located on medulla so these drugs do not have an effect on respiratory or cardiovascular systems
Has euphoric and anticonvulsant effects
CB2
Found in the spleen
Used in the immune system
Hasvanti-inflammatory effects
Health Benefits
Help nausea and vomiting from chemotherapy
Muscle spasticity associated with MS
Smoked cannabis proved to be well tolerated and helped with neuropathy pain in HIV patients from National Institutes of Health
University of California Center for Medicinal Cannabis Research (CMCR) investigated the short-term efficacy of smoked cannabis for neuropathic pain
decreased bladder spasms
Improves sleep
Increase appetite in those with anorexia
Promotes euphoric state that may counteract depression
Conclusion
Offer broad spectrum relief but only on a moderate level
Tolerance is a risk
Smoked marijuana should not be used for medical purposes
Should be a stepping stone for newly developed cannabinoid drugs
What do the medical experts say?
http://www.huffingtonpost.com/2012/04/13/medical-marijuana_n_1423714.html
What does the FDA say?
Stated that there “were no sound scientific studies” that backed the medical use of marijuana
Despite the states that have legalized the use of medical marijuana, “Efforts that seek to bypass the FDA drug approval process would not serve the interests of public health because they might expose patients to unsafe and ineffective drug products."
Reasons for not approving medical marijuana are based on social concerns over medical concerns.
Ever hear of Marinol?!
Marinol is actually a synthetic cannabinoid marketed as legal alternative to natural cannabis
Active ingredient = synthetic delta-9-TCH
The generic name is dronabinol
Does not Contain 200-400 chemical components of natural cannabis
Uses: N/V associated with chemotherapy and anorexia associated with weight loss in AIDS pts.
Adverse Effects
Drowsiness (48%)
Sedation (53%)
Confusion (30%)
Dizziness (21%)
Detachment ,anxiety, difficulty concentrating and mood changes (> 10%)
The FDA approved Marinol!
A presentation by
Stephanie Artusa, Laura Borowski, & Chelsea Emrit
MAIN STUDY WAS DONE IN 1999


In 1972 marijuana was placed in Schedule I of the Controlled Substances Act.
- High potential for abuse
- No currently accepted medical use
- Lack of accepted safety for use of drug under medical supervision

Changing Schedule
1) Congress: voted down bills to legalize medical use
2) DEA: 5 criteria for reclassifying; not met criteria
3) Courts: Federal court have not ordered marijuana to be rescheduled.
Legal

Overview

Federal agency that approves drug products as safe and effective for intended indications
- Not approved as medicine because has not gone through enough rigorous clinical testing
Investigative New Drug program
- 1978 court ordered to permit over a dozen patients to received government grown marijuana.
- Program closed in 1991. Four patients still receive marijuana cigarettes monthly
Food and Drug Administration
States have patient registry which provide protection against arrest for possession up to a certain amount (1oz-
Exception = Maryland

Medical distributors = “caregivers”
Limited to a certain number of plants or products/patient
Legal Medical Marijuana
Federal Law
- Applies to the nation as a whole and to all 50 states, the District of Columbia and the U.S territories
Federal vs State Law
NYSNA, 2008
1) Advocate for legislation at state and federal levels that would provide patients safe and legal access to marijuana for medical use and protect licensed professionals who prescribe, dispense and administer medicinal marijuana from prosecution.
2) Educate themselves about the current therapeutic and evidence-based uses of marijuana.
3) Collaborate with other health professionals engaged in research efforts designed to investigate the scientific merits of medical marijuana.
NYS Nurses Association:
Recommendations for RNs
(Lamarine, 2012)
- Immunological function of respiratory tract impaired  increased number of bronchitis, pneumonia and other respiratory infections
- Produce a threefold increase of inhaled tar
- Respiratory symptoms indicative of obstructive lung disease
- No evidence thus far that indicates increased risk for emphysema
- Concurrent use of tobacco and marijuana create synergistic effects that accelerate respiratory problems and risk for COPD
Lung Damage
Overall studies have produced mixed results
- Cannabis smoke contains many of same carcinogens as tobacco smoke
* Some carcinogens at higher levels than tobacco smoke
- Inhale more deeply  more retention of tar than tobacco smoker
- Often smoked with tobacco in a joint
- Chronic cannabis smokers show many pathological lung cells changes
* Same cell changes precede development of cancer in tobacco smokers
- Findings do suggest may be at increased risk for respiratory cancers in comparison to those who don’t smoke marijuana
Respiratory Cancer
Risks of Cannabis
What the world is thinking...
Other countries are more open to the idea of medicinal marijuana like:
Belgium: allowing the use and even considering permitting citizens to grow small amounts.

Netherlands: now available as a prescription drug at pharmacies.

Canada: actually provides it through their own health-care program.

Isreal: in 2011, the government had approved arrangements and supervision regarding supply and research.
Tikun Olam, the Israeli Health Ministry's official grower and supplies of medical marijuana. Source: Haaretz.com, 2010.
Legality
(Lamarine, 2012)
Cannabis and Palliative Care
Palliative Care Philosophy
- Improve quality of life for those who are dying
- Focus of care is on individual choice, patient autonomy, empowerment, comfort and quality of life as defined by individual patients and their families




Drugs and Palliative care
- primarily/exclusively at comfort measures
- analgesics, antiemetics, antidepressants, neuroleptic medications, sedatives, laxatives, or steroids
- many have high toxicity with potentially lethal effects
TCH/Cannaboids: low toxicity with no lethal dose
(Green & De-Vries, 2010)
(Green & De-Vries, 2010)
Cannabis and Nursing
- Growing research base that use may enhance QOL for those with chronic & life-threatening illnesses
*increased use; most obtained illegally
*patients may be using cannabis as treatment modality

- Assess and monitor use of illicit drugs
*Remember the medicinal effects
*Document details accurately
*seek advices from pharmacists or physicians when other medications prescribed
- Always act lawfully because risk the loss of license and/or criminal charges
Glossary
Pharmacokinetics
- THC sequestered in fatty tissues and slowly released back into the blood stream and brain reaching peak concentrations in 4-5 days.
- Complete elimination of 1 dose ≤ 30 days
Half-life ≈ 7 days
Route
- PO, inhalation, sublingual
- Not IV (insoluble in water)
Medical Use
- Asthma, glaucoma, pain, muscles spasms, nausea, vomiting, MS, ALS, palliative care and AIDs
Affects (stimulant and sedative)
- increased HR, orthostatic hypotension, bloodshot eyes, increased appetite
- Perceptual alteration, time distortion, short-term memory and poor attention
- Anxiety, panic attacks or paranoia may be exacerbated
Cannabis (Marijuana)
(University of Maryland Baltimore Washington Medical Center, 2013)
Physiological
dry mouth
nausea
headache
nystagmus
tremors
decreased coordination
increased heart rate
altered pulmonary status
altered body temperature
reduced muscle strength
decreased cerebral blood flow
increased food consumption
Reproductive System
reduced testicular size
lower testosterone levels
decreased libido
menstrual abnormalties
prolonged childbirth
gynecomastia
change in sperm
fetal exposure
impotence
State Law
- Can be either superior to or subordinate to federal law depending on the issue at hand.
- One State can have more or fewer rights or responsibilities than the residents of another state.
Benefits of Cannabis
Marijuana Basics
Benefits and Risks
Marijuana &
Nursing

Societal Risks
Medical Efficacy & Research
Medical Value
"There is substantial medical evidence indicating the medical efficacy of marijuana. In a poll of the Deans of 126 US prestigious & accredited MD-granting medical schools, over 60% indicated that they believed physicians should have the legal right to recommend or prescribe marijuana to relieve symptoms."
[medicalmarijuana.procon.org]
Often referred to as the "Gateway drug".
Can cause reduction in social, occupational or recreational activities.
Case Study
Do you think administering medical marijuana to a child is ethical?

Should marijuana be recognized for it's medicinal worth in the "pharmaceutical drug world"?
Discussion Questions
References
Akhavan, K. (2013). Medical Marijuana. Retrieved from http://medicalmarijuana.procon.org/Degenhardt, L., & Hall, W. D. (2008). The adverse effects of cannabinoids: implications for use of medical marijuana. Canadian Medical Association, 178(13). Retrieved from: http://www.cmaj.ca/content/178/13/1685.full.pdf+htmlFDA advisory counters theory of medical marijuana. (2006). Alcoholism & Drug Abuse Weekly, 18(18), 8-8. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009276703&site=ehost-live.Green, A. & De-Vries, K. (2010). Cannabis use in palliative care- an examination of the evidence and implications for nurses. Journal of Clinical Nursing, 19, 2454-2462.Hall, W. (2009). The adverse health effects of cannabis use: What are they, and what are their implications for policy? International Journal of Drug Policy, 20(6), 458-466.Hubbard, J. R., Franco, S. E., & Onaivi, E. S. (1999). Marijuana: medical implications. American Academy of Family Physicians, 60(9). Retrieved from: http://www.aafp.org/afp/1999/1201/p2583.htmlLamarine, R. J. (2012). Marijuana: Modern medical chimaera. Journal of Drug Education, 42(1), 1-11. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ967834&site=ehost-live; http://baywood.metapress.com/link.asp?target=contribution&id=GRV8V7414H547465.National Conference of State Legislatures. (2013). State Medical Marijuana Laws. Retrieved from http://www.ncsl.org/about-us.aspx. Nelan E. (1999). IOM finds scientific merit to medical marijuana. institute of medicine. GMHC Treatment Issues, 13(4), 11-2.New York State Nurses Association. (June, 2008). Position statement: Medical use of marijuana. Retrieved from http://www.nysna.org/practice/positions/position30.htm.Pies, R. (2010). Medical marijuana: The institute of medicine report. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aft&AN=47905808&site=ehost-live.United States Food and Drug Administration. (2013). Controlled substance act. Retrieved from http://www.fda.gov/regulatoryinformation/legislation/ucm148726.htm.University of Maryland Baltimore Washington Medical Center. (2013). Complementary and alternative medicine health library: Dronabinol. Retrieved from http://www.mybwmc.org/library/41/046100.
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