Medical Cannabis and OMT - WVOMA - Home Cannabis and OMT.pdfMedical Cannabis and OMT David R....
Transcript of Medical Cannabis and OMT - WVOMA - Home Cannabis and OMT.pdfMedical Cannabis and OMT David R....
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Medical Cannabis and OMT
David R. Beatty, DO
Professor of Osteopathic Principles and Practice, WVSOM
November 4, 2017
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Objectives
• At the completion of this presentation the attendee should be able to:
1. Cite the pharmacological mechanisms of action of cannabis
2. Know the established efficacy of medical cannabis
3. Prescribe medical cannabis to complement OMT
4. Apply seated thoracic/rib HVLA, seated rib 1 HVLA, and C1 HVLA
I have no financial conflicts of interest for the presentation of this material.
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Female Cannabis sativa bud From http://herb.co/2016/03/25/male-vs-female-marijuana-plants/ with permission
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Cannabis (Cannabis sativa, C. indica, C. ruderalis)
• Parts used: buds, leaves
• Uses
• Actions: analgesic, antiemetic, appetite stimulant, sedative, hypnotic
• Specifics: chronic pain, spasticity, insomnia, Tourette syndrome, AIDS wasting, chemotherapy nausea, glaucoma
• Dose
• Whole plant: up to 120mg q 30days
• Tincture: 5-10 drops SL BID-QID
• CBD oil: 5-15 drops PO BID-QID
• Risks: mental illness, sedative use, seizure disorder, machinery operation
• Efficacy: systematic review (Whiting 2015), biochemistry, empirical
http://www.publicdomainpictures.net/view-image.php?image=91240&picture=cannabis-sativa-plant
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Cannabis mechanism of action
Tetrahydrocannabinol (THC) • Serotonin release
• Catecholamine increase
• Parasympathetic inhibition
• Prostaglandin inhibition
• Brain high
• Antispasmodic
Cannabidiol (CBD) • Activates 5-hydroxytryptamine receptor
• Activates vanilloid receptors
• Inhibits adenosine reuptake
• Body high
• Analgesic
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Efficacy of medical cannabis (Whiting 2015, 79 studies)
• “There was moderate-quality
evidence to support the use of
cannabinoids for the treatment of
chronic pain and spasticity.”
• Mean reduction in both number of
patients with decreased pain (37%)
and in pain rating (-.46) significantly
greater than for those taking a
placebo
• “There was low-quality evidence
suggesting that cannabinoids were
associated with improvements in
nausea and vomiting due to
chemotherapy, weight gain in HIV
infection, sleep disorders, and
Tourette syndrome.”
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Prescribing Medical Cannabis
Legal States
• Dried plant legal
• Up to 120mg q30days
• Medicinal products only
• Tincture 5-15 drops SL BID-QID
• Dispensary agents help patients select form and strength
Illegal States
• CBD oil (industrial hemp)
• 5-15 drops PO BID-QID
• Dronabinol (Marinol)
• 5mg PO q2-4hr up to 6 doses/day
• Increase in 2.5mg increments up to
15mg/dose
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Cannabis species/strains (Leafly.com)
High THC
• Cannabis indica strains
• Bruce Banner
• Death Star
• Kosher Kush
• C. sativa/hybrid strains
• Girl Scout Cookie
• Ghost Train Haze
• Gorilla Glue
• Red Dragon
• White Fire
High CBD
• Cannabis ruderalis
• C. indica strains
• Dark Star
• Pennywise
• Remedy
• C. sativa/hybrid strains
• ACDC
• Charlotte’s Web
• Dance World
• MediHaze
• Zen
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Cannabis products legal in WV 2019 https://www.mpp.org/states/west-virginia/west-virginia-medical-cannabis-act/
http://medcanwv.org/
Oil (vaporizer) http://www.thecannabist.co/2014/12/22/best-2014-vape-pen-reviews-portable-vaporizers/25747/
Tincture https://kayacollective.org/menu/
akasha-care-thca-cannabis-tincture/
Salve, gel, ointment, cream http://budrub.com/
Pill (capsule) http://www.ismokemag.co.uk/homemade-thc-pills-5-easy-steps/
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Cannabis and OMT
• Pre-treatment muscle relaxant
• Facilitates forceful techniques
• Post-treatment analgesic
• Co-treatment for chronic pain
Seated thoracic/rib HVLA
(image from Beatty 2011)
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Techniques facilitated by pre-treatment cannabis
Rib 1 HVLA seated C1 HVLA
(image from Beatty 2011)
(image from Beatty 2011)
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References
• Beatty D. Prescribing herbal medicine to complement OMT for chronic pain and dysfunction. AAO Journal (in review) 2017.
• Beatty DR, Steele KM, Li TS et al. The Pocket Manual of OMT 2nd Edition. Lippincott Williams & Wilkins, Baltimore 2011.
• Leafly catalog of cannabis strains. https://www.leafly.com/
• West Virginia Medical Cannabis Act: https://www.mpp.org/states/west-virginia/west-virginia-medical-cannabis-act/
• West Virginia Office of Medical Cannabis: http://medcanwv.org/
• Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA 313(24):2456-73. 2015.