Cannabis: Medical Aspects

Contents
Foreword
	Medical cannabis: To use or not to use?
	1Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada, 2Division of Adolescent Medicine and Young Parents Program, Kentucky Children’s Hospital, UK Healthcare, Department of Pediatrics, University of Kentucky College of M...
	Introduction
	References
Section one: Introduction
Plants as medical tools
	Introduction
	Current plant extracts used as pharmaceuticals  and used in pharmaceutical production
		Medicinal plants
	History of plant extracts used as pharmaceuticals
	Current status of natural products (NP) including medicinal plant extracts
	Plant extracts widely used in pharmaceutical production
	The opioids story
	The aspirin story
	The evolving cannabis story
	Comparison of current pain medications
	Conclusion
	References
History of medical cannabis
	MedReleaf Corp, Markham Industrial Park, Markham, Ontario, Canada
	Introduction
	History of cannabis use
	The genetics and selective breeding of cannabis
	Modern methods of cannabis consumption
		Oral administration
		Other methods of consumption
	Conclusion
	Acknowledgments
	References
Cannabis or marijuana
	1Department of Pediatric and Adolescent Medicine,  Western Michigan University School of Medicine, Kalamazoo, Michigan, US
	2National Institute of Child Health and Human Development, Jerusalem, Israel
	3Office of the Medical Director, Health Services,  Division for Intellectual and Developmental Disabilities,  Ministry of Social Affairs and Social Services, Jerusalem, Israel 4Division of Pediatrics, Hadassah Hebrew University Medical Center,  Mt Sco...
	6Center for Healthy Development, School of Public Health,  Georgia State University, Atlanta, US
	Introduction
		Prevalence
		Consumption of cannabis (marijuana)
		Cannabis and other drug use
		Cannabinoids
		Endocannabinoid system
		Use of medical cannabis
		Synthetic cannabinoids (cannabinoid designer drugs; cannabimimetics)
	Cannabis lab testing
	Medical adverse effects
		Cannabis hyperemesis
		Dental effects of cannabis
		Pulmonary effects
		Cannabis and cancer
		Cardiovascular effects
		Motor vehicle accidents
		Sports doping
	Adverse effects: Psychiatric
		Cannabis and neurodevelopment effects
		Cannabis and ADHD
		Cannabis dependence
		Cannabis withdrawal syndrome
		Addiction
		Cannabis and psychosis
	Management
		Behavioral therapies
	Pharmacologic therapies
	Cannabis intoxication
	Cannabis withdrawal
	Cannabis-associated psychosis
	Cannabis dependence
		Oxytocin
		NAC
		Others
	Conclusion
		Medical cannabis
	Acknowledgments
	References
Section two: Plant pharmacology
Pharmacology of cannabis
	Introduction
	Phyto-cannabinoids
	Mechanism of action
	Endocannabinoids
	Absorption of cannabis
	Distribution
	Metabolism and elimination
	Detection and analysis of cannabis
	Synthetic cannabinoids
	References
The pharmacological properties of cannabis
	MedReleaf Corp, Markham Industrial Park, Markham, Ontario, Canada
	Introduction
	Structure, expression and production  of known cannabinoids
	Known cannabinoids and their effects on cellular and system physiology
	Inhalation versus oral consumption and bioavailability
	The cocktail versus the individual compounds
	Terpene biochemistry and free radical scavenging
	Conclusion
	Acknowledgments
	References
Section three: Clinical applications
Medical cannabis use in an outpatient palliative care clinic
	Introduction
	Our study
	Findings
	Discussion
	Conclusion
	References
Four patient perspectives  on medical cannabis
	Introduction
	Case story 1
	Case story 2
	Case story 3
	Case story 4
	Conclusion
Safety concerning medical cannabis
	Introduction
	Medical cannabis and its uses
	Canada’s forthcoming legalization of cannabis
		1) Formalize naming and removal of recreational terms
		2) Standardize dosing
		3) Establish monitoring guidelines
	Conclusion
	Acknowledgments
	References
Medical cannabis in the treatment of chemotherapy-induced nausea and vomiting
	Introduction
	The endocannabinoid system
	Synthetic cannabinoids versus medical cannabis
	Oncologist perspective
	Pharmacist perspective
	Patient perspective
	Future directions
	References
Medical marijuana, cancer anorexia  and cachexia
	Introduction
	Our review
	Findings
		Study findings
	Discussion
		Route of administration
		Patient inclusion criteria
		Dosing inconsistencies
		Cancer cachexia versus HIV-wasting
		Weight gain significance
		Current use in practice
		Study limitations
	Conclusion
	References
Medical cannabis dosing strategies  in pain related conditions
	Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
	Introduction
	Our review
	Findings
		Vaporizing and smoking
		Smoked cannabis
		Pain relief outcomes
		Dosing frequency
		Vaporized cannabis
		Other dosage forms
		Other edible forms
		Brownie
		Cannabis oil
	Discussion
		Limitations of clinical trials
		Oral administration versus inhalation
		Smoking versus vaporizing
		Standard inhalation protocol versus reality
		Dose-response relationship
		Dosing recommendation
		Limitations of the scoping review
	Conclusion
	References
How to administrate cannabis and efficacy
	Introduction
	FDA-approved cannabinoids
	Medical marijuana
	Smoking
	Edibles
	Concentrates
	Dabbing
	Cannabinoid (CBD) oil
	Potency and labeling concerns
	Dosing
	Conclusion
	References
Cannabis and pain
	Pain Research Unit, Department of Anesthesia and Pain Medicine,  Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
	Introduction
	Our review
		Eligibility criteria
		Selection process and data abstraction
	Findings
		Nabiximol oromucosal spray
		Cannabis extract capsules
		Smoked cannabis
	Conclusion
	Acknowledgments
	References
Medical cannabis for pain in adolescence
	Introduction
	Chronic pain in adolescence
	Data supporting efficacy of cannabis in treating pain
	Adverse health effects
	Medical marijuana legislation
	Utilization of medical cannabis
		Health department statistical reports
		Medical cannabis surveys
		Youth risk behavior surveys
	Considerations in the use of cannabis  for pain in adolescents
	Summary
	Conclusion
	References
Section four: Policy, ethics and social commentary
Medical cannabis from the pain  physician’s perspective
	Pain Research Unit, Department of Anesthesia and Pain Medicine,
	Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
	Introduction
	Patient case
	Approach to the patient with neuropathic pain requesting medical marihuana
	Phytocannabinoids and pain modulation
	Approach to prescribing phytocannabinoids for pain
	Populations that may benefit from medical cannabis
	Conclusion
	References
Ethical and policy implications concerning medical cannabis
	Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;  Joint Centre for Bioethics, Toronto, Ontario, Canada
	Introduction
	Indications for medical marihuana
	Discussion
		Locus of administration
		Routes of administration
		Security
		The therapeutic relationship
	Ethical issues
		Harm principle
		Harm reduction
	Policy options
	Limitations
	Conclusion
	References
Adverse effects of cannabis use
	Introduction
	Adverse effects
	Conclusion
	References
Cannabis and the role of our schools
	Division of Adolescent Medicine and Young Parents Program,  Pediatrics Behavioral Health Clinic and Division of Pediatric Genetics and Metabolism, Kentucky Children’s Hospital, Lexington, Kentucky, US
	Introduction
	Memory, attention, learning capability  and school performance
	Behavioral and physical health
	The role of school
	Types of programs and delivery system in school
	Drug abuse prevention and early intervention
	programs classification
	Effective programs and practices within MTSS
		Tier 1
		Tier 2
		Tier 3
	Conclusion
	References
Canada and medical marijuana
	Introduction
	Accessible for certain medical conditions
	Legalizing cannabis recreationally
	Acknowledgments
	References
Medical cannabis and palliative care
	Introduction
	Managing physical symptoms: Efficacy and safety
	Psychological aspects of care: Empowerment and hope
	Social aspects: Stigma and beyond
	Conclusion
	References
Section five: Acknowledgments
About the editors
About the Rapid Response Radiotherapy Program at the Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
	Contact
About the National Institute of Child Health and Human Development in Israel
	Mission
	Service and academic activities
	Research activities
	National collaborations
	International collaborations
	Targets
	Contact
About the book series “Health and  human development”
	Contact
Section six: Index
Index
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