NEPA Vital Signs - Winter Spring 2018 - 29

WINTER/ SPRING 2018

Feature

Qualifying Conditions

Pennsylvania enumerated 17 serious
conditions that qualify for the use of
Medical Marijuana.
* Amyotrophic Lateral Sclerosis.
* Autism.
* Cancer.
* Crohn's Disease.
* Damage to the nervous tissue of the
spinal cord with objective neurological indication of intractable spasticity.
* Epilepsy.
* Glaucoma.
* HIV (Human Immunodeficiency
Virus) / AIDS (Acquired Immune
Deficiency Syndrome).
* Huntington's Disease.
* Inflammatory Bowel Disease.
* Intractable Seizures.
* Multiple Sclerosis.
* Neuropathies.
* Parkinson's Disease.
* Post-traumatic Stress Disorder.
* Severe chronic or intractable pain of
neuropathic origin or severe chronic
or intractable pain in which conventional therapeutic intervention and
opiate therapy is contraindicated
or ineffective.

Presently, the following forms of
Medical Marijuana are permitted:
pill, oil, topical (gel, cream, ointment),
a form suitable for vaporization or
nebulization, tincture, or liquid.

What we know

Marijuana has over 60 pharmacologically active cannabinoids. The primary
exogenous cannabinoids include delta-9-tetrahydrocannabinol (THC) and
cannabidiol (CBD). Marijuana's THC
component produces the typical euphoria associated with its use, while CBD is
thought to produce antianxiety effects.
Less commonly known is that the body
does have endogenous cannabinoids
(anandamide and 2-arachidonylglycerol)
that act on G-protein receptors, CB1 and
CB2, helping to modulate the release
of numerous neurotransmitters. CB1
receptors are located in the brain (basal
ganglion, cerebellum, hippocampus),
spinal cord (dorsal root ganglion) and
peripheral nerves while CB2 receptors
are concentrated on cells in the immune
system. Activation of the CB1/2 receptors
directly inhibits release of excitatory chemicals such as acetylcholine,
dopamine and glutamate. Indirectly
* Sickle Cell Anemia.
-aminobutyric acid, N-methyl-D-aspartate, opioid and serotonin receptors
As listed above, Pennsylvania's Program are also affected.
includes a number of serious qualifying
conditions. As research studies evaluating MM in various conditions continue
to grow, societies such as the American
When critically reviewing published
Academy of Neurology have already MM research, trends are observed. First,
released position statements for utili- patients with neuropathic pain syndromes,
zation in specific neurologic conditions. central syndromes causing spasticity
Due to Federal Laws, physicians cannot (specifically those associated with pain),
"prescribe" but rather "certify" that our as well as spasticity and bladder issues
patients have a qualifying condition for related Multiple Sclerosis seem to benefit
its use. Patients and the community at the most. Preliminary evidence exists
large will expect healthcare providers to on the benefits seen in other conditions
become leaders in this movement. For this such as glaucoma. Although the published
reason, it is important for all healthcare evidence remains limited, the PA Program
providers, even those against MM, to requires the allocation of a portion of
understand the underlying mechanism, tax revenue raised for research efforts to
potential benefits as well as risks asso- improve our understanding of potential
ciated with its use.
therapeutic benefits and/or risks.

What we are learning

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VITAL SIGNS

Limitations with current research
include the method of administration,
THC:CBD ratios and frequency of use.
Most frequent routes of administration
studied are oral, ointments and liquids,
not cigarettes. Currently, frequency of
dose and proper ratios of cannabinoids
is determined during a titration period
by patients who rely on assistance from
those working at dispensaries.

Potential risks

Short-term effects include: confusion, impairments in memory, motor
coordination and judgment. Similar to
controlled substances being prescribed,
individuals should not drive after
administration. Serious concern exists
in long-term marijuana use amongst
adolescents and young adults, in whom
brain neuro-anatomy continues to
develop. Structural changes do occur in
these individuals when compared to age
matched controls; which is concerning
for effects on IQ. Marijuana is potentially addicting, as seen in up to 9% of
adults and 17% of adolescents. Although
not permitted by the MM Program in
PA, smoking marijuana has been found
to increase the incidence of chronic
bronchitis, respiratory tract infections
and pneumonia. Increased heart rate
and blood pressure can also occur. With
higher THC mixtures and chronicity of
use anxiety, mood and other psychiatric
disorders can be exacerbated.

Treating Chronic
Pain in the Opioid
Epidemic Era

Reviewing data from active MM programs, approximately 40-50% of all MM
is utilized by individuals living in chronic
NEPA Vital Signs - Winter Spring 2018

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