Clinical Trials available

Dr. Genester Wilson-King's new study with Standford 


CHOP: Children's Hospital of Philadelphia is looking into the use of CBD for kids under 18 with autism. Please call and see if your child qualifies!

Feb 2019

Medical literature

Alzheimer's and Parkinson's

image5

https://www.forbes.com/sites/abbierosner/2019/02/26/cannabis-for-parkinsons-and-alzheimers-diseases-an-interview-with-dr-ethan-russo/#5cb042d5dd67


https://www.ncbi.nlm.nih.gov/pubmed/24614667 

This research shows the in sleep and pain scores in patients with Parkinson's. 2014


https://www.ncbi.nlm.nih.gov/pubmed/25237116 

Improved quality of life with CBD in Parkinson's. 2014

2017:  Clin Neuropharmacol. 2017 -  edical cannabis was found to improve symptoms of PD in the initial stages of treatment and did not cause major adverse effects. 

 https://www.ncbi.nlm.nih.gov/pubmed/29059132 

Driving Impairment

image6

  Driving Impairment
Drug and Alcohol Crash Risk: A Case-Control Study
National Highway Traffic Safety Administration
Compton, et al, 2015 


  

Driving Impairment
Drug and Alcohol Crash Risk: A Case-Control Study
U.S. Department of Transportation
National Highway Traffic Safety Administration
Ramaekers et al, 2010 


 https://mashable.com/category/weed-wise/ 

Narcotic Reduction

image9

https://www.sciencedirect.com/science/article/pii/S0376871615000733?fbclid=IwAR0q7WnpPI0psqa3e_AyaxEd_VbHp28o_FG5gcFwO4LG1UCccnumnIEoe7o


 https://www.sciencedirect.com/science/article/pii/S0028390819301212?via%3Dihub 


 Emerging Evidence for Cannabis' Role in Opioid Use Disorder: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/


May 2019: CBD can help with anxiety/cravings in Heroin by Hurd et al


May 2019: Inhaled THC can help with opiate reduction in preclinical study. Ngyuen et al Neuropharmacology

More

Schizophrenia/Mania

image10

  

Am J Psychiatry. 2018 Mar 1;175(3):225-231. doi: 10.1176/appi.ajp.2017.17030325. Epub 2017 Dec 15.

Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial.


SSRI:  May increase episodes of mania 

Breast Cancer

image11

2017 - 

http://www.cannmedevents.com/wp-content/uploads/2017/05/Sean-McAllister-2017-02-28-CannMed-2017.pdf

2009 - Dr. Sean McAllister

https://beyondthc.com/wp-content/uploads/2018/12/CBD-for-Breast-Cancer-%E2%80%94McAllister-2009.pdf


2010 - Dr. Christina Sanchez: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917429/

 Conclusion: cannabinoids inhibit cancer cell proliferation, induce cancer cell apoptosis, and impair tumor angiogenesis.

2019 Review: 

 https://www.ncbi.nlm.nih.gov/pubmed/30987191 

Cardiovascular

image12

Small Study but consistent with my results: 10 Men with 600 mg dose CBD = drop in BP ~6 pts, but increase in HR ~7 bpm. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470879/


Coumadin/Warfarin interactions:   

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789126/ 


 https://www.asra.com/asra-news/article/150/is-it-time-to-add-cannabinoids-to-the-as 

Protecting Patients

image13

Arizona and Boston have now had legal cases protecting a patient's right to use Cannabis products. March 2019 in Arizona a lawsuit was brought against Walmart for an employee who tested positive for THC. It is currently in favor of the patient!


 https://arizonacannabismonthly.com/federal-court-affirms-amma-patients-protection/  


Long term effects on the Brain? None in recent 2019 study out of Arizona University. 

 https://www.sciencedirect.com/science/article/abs/pii/S0376871619302352?via%3Dihub&fbclid=IwAR3gZ7vCXC-XrIb6_OI_E2pOdLKlu-SGTI_tXkbxrn4gpQfrES3m7kIDzko 

Negative Side Effects

image14

Medication Interactions & Precautions:

Warfarin: THC and CBD increase warfarin levels (Yamaori et al 2012). Frequent cannabis use has been

 Warfarin: THC and CBD increase warfarin levels (Yamaori et al 2012). Frequent cannabis use has been associated with increased INR. 

Alcohol: Alcohol may increase THC levels (Hartman 2015). 

Theophylline: Smoked cannabis can decrease theophylline levels (Stout and Cimino 2014).

Indinavir or nelfinavir: Smoked cannabis had no effect (Abrams et al 2003). 

Docetaxel or irinotecan: Cannabis infusion (tea) had no effect (Engels et al 2007).  

Clobazam: In children treated with CBD for epilepsy, CBD increased clobazam levels (Geffrey et al 2015)

SSRI:  May increase episodes of mania 

CBD: can cause problems with Tacrolimus levels or other immunosuppresants. 

AVOID in Sogren's Patients due to increase drying effects of mucosal areas. 

Site Content

Pancreatic Cancer

image15

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352507/ 

Summary:  Cannabinol receptors have been identified in pancreatic cancer with several studies showing in vitro antiproliferative and proapoptotic effects. Their effects are predominately mediated through, CBR-1, CBR-2, and PR55 pathways. In vitro studies consistently demonstrated tumor growth-inhibiting effects with CBD, THC, and synthetic derivatives. Synergistic treatment effects have been shown in two studies with the combination of CBD/synthetic cannabinoid receptor ligands and chemotherapy in xenograft and genetically modified spontaneous pancreatic cancer models. There are no clinical studies showing treatment benefits in patients with pancreatic cancer. 


If you have pancreatic CA and are treating with cannabis - a new research project with Dr. Ana Jewitt at UCLA may be linked to a cure!

Glioblastoma

image16

 This data suggests that CBD may, via modulation of EVs and PHB, act as an adjunct to enhance treatment efficacy in GBM, supporting evidence for efficacy of cannabinoids in GBM. 

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314156/ 


 Preliminary Data shows double the life expectancy with Cannabis (sativex) + Temzolomide (TMZ) chemotherapy

S Short, C Little.  

Abstract Neuro-Oncology, Nov 2017

Poster SNO 2017

Cancer & Chemo Related Side Effects Treatment

image17

Starts in 1975: For chemo associated nausea/vomiting: https://www.ncbi.nlm.nih.gov/pubmed/1099449 

C Diff?

image18

 Cannabidiol improved Clostridium difficile toxin A-induced damage in Caco-2 cells, by inhibiting the apoptotic process and restoring the intestinal barrier integrity, through the involvement of the CB1 receptor. 

 https://journals.sagepub.com/doi/10.1177/2050640617698622 .

Can I fly with cannabis/hemp?

image19

Many of my patients ask if they can fly with Cannabis/Hemp products. As a reminder, Cannabis is still federally ILLEGAL. Airlines are governed by federal rules, so therefore, flying with cannabis products is illegal. BUT in a huge turn of events this weekend, due to the new Federal Farm Bill which allows for Hemp derived CBD, the TSA is allowing for HEMP CBD on airlines.

This article does a very nice job describing the details of the change

 https://www.marijuanamoment.net/tsa-updates-marijuana-rules-to-allow-hemp-derived-cbd-on-flights/ 

Anesthesia

image20

 

The client should notify their doctor and/or anesthesiologist that they are taking CBD.


At the Dravet.org Conference this past weekend, one of the doctors researching mitochondrial disorders mentioned a case study of a Dravet Syndrome child on CBD who went in for routine surgery. After extreme difficulty waking her up post surgery (hours – not just a little difficulty), it was realized that the CBD acts on the same Complex 1 enzyme in the electron transport chain in the mitochondria that the anesthesia does, and thus the child was given roughly 5 times the proper amount of anesthesia. Complex 1 shuttles electrons from the bottom of the primary chain to the “top” of the secondary chain, and as the electrons “fall” down the chain, energy (ATP) is generated for the cell. If this process is interrupted, the cells are devoid of energy and cannot function. I just wanted to make sure parents whose kids are on CBD are aware of this interaction should any surgeries (planned or emergency) come up. Had there also been a mitochondrial disorder with Complex 1, this could have been even more serious than it was. Before this doctor’s presentation, I had no idea this was a potential issue. It just underscores the importance of all of the medical professionals who come into contact with our kids being aware of the alternative therapies we’re using, even if they’re not overseeing them.

They used less anesthesia and monitored his sedation level with a BIS monitor

Reputable reference websites

image21

UCSD CMCR, UCLA Cannabis Initiative, UC Berkely (coming soon)

Society of Cannabis Clinicians

Dr. Dustin Sulak

FAQs

coming soon