Medical Marijuana and Other Cannabinoids _____________________________________________________
opioid prescribing, no U.S. physician has been successfully prosecuted or sanctioned for authorizing medical marijuana consistent with their state laws (as of 2020) [11]. In fact, a congressional spending bill (passed in 2017) prohibits the U.S. Drug Enforcement Administration (DEA) from spending any money to block states from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana,” which, as affirmed by the Supreme Court in 2016, prevents the Department of Justice from prosecuting anyone in states with legal marijuana [13]. Botanical cannabis is the focus of this course, and while pharmaceutical cannabinoids are also discussed, the two should not be viewed as medicinally equivalent. Differences in pharmacologically active constituents and routes of administra- tion result in distinct pharmacologic and clinical profiles [14]. This course will emphasize medical marijuana use in chronic pain because this is the most frequent condition for its use and because the highest proportion of well-designed clinical trials have evaluated efficacy in treating chronic pain [10; 15]. TERMS The following terms are used often in discussions of medical marijuana use, and these definitions may help clarify the issues being described. Cannabis : derived from Cannabis sativa , the proper name of the marijuana plant. Cannabis is a dioecious species, meaning it has male and female plants. Roughly half the plants grown from seed are female; when not fertilized by males to produce seeds, female plants bear flowering buds called sinsemilla, the part of the plant with highest Δ 9-tetrahydrocannabinol (THC) concentration [16]. Marijuana : a synonym and slang term for cannabis, often used when discussing medical use. Cannabinoid : a category that includes endogenous cannabi- noid receptors, their endogenous ligands, and the plant-occur- ring or synthetic molecules that interact with cannabinoid receptors or their ligands [17]. Δ 9-tetrahydrocannabinol : the primary active cannabis con- stituent. Referred to throughout this course as THC.
The Chinese emperor Shen Nung is believed the first to for- mally describe the therapeutic properties and uses of cannabis in his 2737 B.C.E. compendium, in which it was recommended for the treatment of malaria, constipation, rheumatic pains, and childbirth and mixed with wine as a surgical analgesic [20; 21]. Medicinal and religious use achieved great prominence in India around 1000 B.C.E. and was implicitly endorsed by the Hindu religion. Medicinal cannabis became widely used as an analgesic (for neuralgia, headache, toothache), anticon- vulsant (for epilepsy, tetanus, rabies), sedative-hypnotic (for anxiety, mania, hysteria), anesthetic and anti-inflammatory (for rheumatism and other inflammatory diseases), antibiotic (for topical use on skin infections, erysipelas, tuberculosis), antiparasitic (for internal and external worms), antispasmodic (for colic, diarrhea), digestive, appetite stimulant, diuretic, aphrodisiac or anaphrodisiac, antitussive, and expectorant (for bronchitis, asthma). During the pre-Christian era, medical can- nabis use remained widespread in India and areas of Assyria and Persia. Through the Christian era into the 18th century, it remained extensively used in India and spread throughout the Middle East, Africa, and the Arabian Peninsula, where prominent Arab physicians placed cannabis in their medical compendiums [20; 22].
INTRODUCTION AND WIDESPREAD USE IN WESTERN MEDICINE
Western medicine was introduced to cannabis by a 1839 publication of O’Shaughnessy, a physician who described its successful use in his patients as an analgesic, appetite stimulant, antiemetic, muscle relaxant, and anticonvulsant, and by the 1845 publication of Moreau, a psychiatrist who documented the results of cannabis use in his patients, his students, and himself [20; 21]. Support for medical cannabis use was dis- seminated by these publications from England and France throughout Europe and North America. Cannabis was entered in the U.S. Dispensatory in 1854, and the first medical confer- ence on cannabis was held in 1860 by the Ohio State Medical Society. By 1900, more than 100 scientific articles on cannabis efficacy had been published in the United States and Europe. Cannabis was usually available as a tincture comprised of plant extract. Aware of the therapeutic potential, researchers worked to resolve its limitations, including lack of water solubility, delayed onset of action (when given orally), variable potency, difficulty in standardized dosing, and individual differences in response. The importance of dose titration was stressed [20; 22]. The late 19th to early 20th century was the pinnacle of cannabis use in Western medicine. Cannabis extracts were mar- keted by Merck, Burroughs-Wellcome, Bristol-Meyers Squibb, Parke-Davis, and Eli Lilly. The 1924 edition of the influential medical textbook Sajous’s Analytic Cyclopedia of Practical Medicine listed numerous indications for cannabis, including [20; 22]: • Sedative or hypnotic: Insomnia, melancholia, delirium tremens, chorea, tetanus, rabies, hay fever, bronchitis, pulmonary tuberculosis, coughs, spasm of the bladder
HISTORY OF MEDICINAL CANNABIS USE
USE IN ANCIENT CIVILIZATIONS The evolution of Cannabis sativa has been traced to the Central Asian/Himalayan region roughly 36 million years ago [18]. Over time, cannabis spread to all regions with human habita- tion, reflecting the value placed on its medicinal, spiritual, and dietary utility [19].
122
EliteLearning.com/Dental
Powered by FlippingBook