Cannabis

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Cannabis

  1. 1. Cannabis Drugs Marijuana/Hashish Preparations & Administration Pharmacology
  2. 2. Introduction <ul><li>Controversy </li></ul><ul><ul><li>Psychoactive and abused </li></ul></ul><ul><ul><li>Promoted as therapeutic agent </li></ul></ul><ul><li>Gateway drug debate </li></ul><ul><ul><li>Lynskey et al. 2003: early marijuana use shows 2-5 fold increase in risk of later use of alcohol and other drugs </li></ul></ul><ul><li>Street Names: Pot, weed, reefer, joint, Acapulco gold, hash, quarter moon </li></ul>
  3. 3. A Brief History in Time <ul><li>Hemp woven fabrics 7000 BC </li></ul><ul><li>Analgesic from seed juice 5000 BC </li></ul><ul><li>China general anesthesia </li></ul><ul><li>India ritual </li></ul><ul><li>US Pharmacopeia 1850 to 1942 </li></ul><ul><li>Early 20 th century developed notorious reputation </li></ul><ul><li>US regulation in 1937 </li></ul>
  4. 4. Cannabis sativa <ul><li>Hemp plants </li></ul><ul><ul><li>Tetrahydrocannabinol (THC) </li></ul></ul><ul><li>Hashish </li></ul><ul><ul><li>Powdered form of plant’s </li></ul></ul><ul><ul><li>resin, 7-12% THC </li></ul></ul><ul><li>Ganja, sinsemilla: </li></ul><ul><ul><li>Dried tops, 5 - 8% THC </li></ul></ul><ul><li>Marijuana, bhang: </li></ul><ul><ul><li>Remainder, 2 - 5 % THC </li></ul></ul>
  5. 5. Potent Form of Cannabis--Hashish
  6. 6. Administration of Cannabis <ul><li>Pulmonary route most potent </li></ul><ul><ul><li>Pipes, cigarettes, water pipe minimizes acrid & irritating smoke </li></ul></ul><ul><ul><li>Rapid effects </li></ul></ul><ul><ul><ul><li>Onset 15 minutes </li></ul></ul></ul><ul><ul><ul><li>Lasts 1-4 hours </li></ul></ul></ul><ul><ul><li>4 times more tar > tobacco cigs to lung </li></ul></ul><ul><li>Powdered hashish & marijuana mixed w/foods and ingested </li></ul><ul><ul><li>Peak in 4-6 hrs; Duration 5-12 hrs </li></ul></ul><ul><ul><li>Hashish oil IV </li></ul></ul><ul><ul><ul><li>High mortality </li></ul></ul></ul><ul><li>Effects Sought </li></ul><ul><ul><li>Mental relaxation & euphoria </li></ul></ul>
  7. 8. Pharmacokinetics <ul><li>Peak within minutes of smoking </li></ul><ul><li>THC metabolized by liver- 80+ metabolites </li></ul><ul><ul><li>Elimination route bile and feces </li></ul></ul><ul><li>Affect metabolism of other drugs </li></ul><ul><ul><li>Ethyl alcohol, barbiturates, amphetamines, cocaine, opioids </li></ul></ul><ul><li>Elimination half-life </li></ul><ul><ul><li>THC 10-13 days </li></ul></ul><ul><ul><li>Some metabolites 50 hours to 6 days </li></ul></ul><ul><ul><li>Positive urinalysis in heavy users for 1 month </li></ul></ul><ul><li>Accumulation dosing </li></ul>
  8. 9. Marijuana Detection Time based on usage period for urine, blood & saliva. Hair test period up to 90-120 days 49-63 days Daily Usage 33-48 days Usage at 5-6 times/week 23-35 days Usage at 2-4 times/week 11-18 days Usage at 2-4 times/month 5-8 days Usage at 1 time only
  9. 10. High resolution scanning electron micrograph of a cannabis leaf showing cannabinoid rich structures protruding from the surface
  10. 11. Pharmacodynamics <ul><li>Cannabinoid Receptor 2 Types </li></ul><ul><ul><li>CB1 in brain critical for neurological and psychological function (basal ganglia, cerebellum, cerebral cortex) </li></ul></ul><ul><ul><li>CB2 found in the periphery, immune system </li></ul></ul><ul><li>Binding to receptor causes a disruptive effect on the cell membrane </li></ul><ul><ul><li>May inhibit K+channels & glutamate release </li></ul></ul>
  11. 12. control 3 day THC <ul><li>7 day THC 14 day THC 21 day THC </li></ul>
  12. 13. General Pharmacology <ul><li>All cannabis act as CNS depressants </li></ul><ul><ul><li>Depress higher brain function which releases lower centers from inhibitory influences </li></ul></ul><ul><ul><li>Classified as a sedative hypnotic anesthetic or psychedelic </li></ul></ul><ul><ul><ul><li>Alters perception, thought, feelings </li></ul></ul></ul><ul><ul><ul><li>As dose increases proceed from relief of anxiety, inhibition, excitement to anesthesia, vasomotor depression and collapse </li></ul></ul></ul><ul><ul><ul><li>Sedation and Analgesia---Mellow! </li></ul></ul></ul><ul><ul><ul><li>High doses may produce an anxiety reaction </li></ul></ul></ul>
  13. 14. CNS Systems Effect <ul><li>Mind Altering Properties </li></ul><ul><li>Anxiety free state, well-being </li></ul><ul><li>Time & space distortions </li></ul><ul><li>Ideas flow, disconnected, Impaired memory, perception </li></ul><ul><li>Gaps in thought similar to absence seizure </li></ul><ul><li>Palpitations, lite head, floating </li></ul><ul><li>Weakness,tremors,hypotension, </li></ul><ul><li>Incoordination, amotivational </li></ul><ul><li>Hallucinations as high doses </li></ul><ul><li>Dissociative Phenomena (mental processes become separate from normal consciousness) </li></ul><ul><li>Subjective altered state of consciousness </li></ul>
  14. 15. Marijuana and Driving <ul><li>Impairs ability to drive safely </li></ul><ul><ul><li>Tracking </li></ul></ul><ul><ul><li>Perception </li></ul></ul><ul><li>Versus alcohol? </li></ul>
  15. 16. Adverse Effects Of Marijuana <ul><li>Immediate tachycardia </li></ul><ul><ul><li>160 beats/minute </li></ul></ul><ul><ul><li>CV risk MI </li></ul></ul><ul><li>Postural hypotension </li></ul><ul><li>Delayed hypotension, bradycardia, GI </li></ul><ul><li>Conjunctival vascular congestion (red eyes) </li></ul><ul><li>Dry mouth, throat </li></ul><ul><li>Enhanced appetite & flavor appreciation </li></ul><ul><li>Possible damage to lungs, heart, reproductive & immune system </li></ul><ul><li>Interferes with psychological maturation </li></ul><ul><li>Psychological & physiological dependence </li></ul>
  16. 17. Serious Psychological Effects <ul><li>Fear, panic, paranoia </li></ul><ul><li>Disorientation, memory loss, confusion, </li></ul><ul><li>Acute psychotic reactions </li></ul><ul><li>Toxic psychoses </li></ul><ul><li>Long term anxiety, schizophrenia, depression with regular use </li></ul>
  17. 18. Potential Clinical Uses <ul><li>Anti-emetic </li></ul><ul><li>Anorexia </li></ul><ul><li>Pain </li></ul><ul><li>Muscle Spasms </li></ul><ul><li>Neuro-protection </li></ul><ul><li>Glaucoma </li></ul>
  18. 20. Prescription? <ul><li>Dronabinol (Marinol) </li></ul><ul><ul><li>THC in sesame oil </li></ul></ul><ul><ul><li>Prophylaxis of nausea in cancer patients </li></ul></ul><ul><ul><ul><li>Superior to placebo </li></ul></ul></ul><ul><ul><li>Stimulate appetite (AIDS patients & Anorexia) </li></ul></ul><ul><ul><ul><li>Inconsistent weight gain </li></ul></ul></ul><ul><li>Nabilone (Cesamet) </li></ul><ul><li>Delta9-THC (Sativex) </li></ul><ul><li>Rimonabant (Acomplia) </li></ul>
  19. 21. Mechanisms of Vomiting <ul><li>Cerebral Cortex </li></ul><ul><ul><li>Anticipatory stimulation </li></ul></ul><ul><li>Vestibular </li></ul><ul><ul><li>Motion </li></ul></ul><ul><ul><li>Inflammation </li></ul></ul><ul><li>GI Tract </li></ul><ul><ul><li>Peripheral receptor stimulation </li></ul></ul><ul><li>Control with </li></ul><ul><ul><li>Antihistamines </li></ul></ul><ul><ul><li>Benzodiazepines </li></ul></ul><ul><ul><li>Barbiturates </li></ul></ul><ul><ul><li>Phenothiazines </li></ul></ul><ul><ul><li>Anticholinergics </li></ul></ul><ul><ul><li>Cannabinoids </li></ul></ul>
  20. 22. Symptoms of Use <ul><li>Sweet, burnt odor </li></ul><ul><li>Neglect of appearance </li></ul><ul><li>Loss of interest, motivation </li></ul><ul><li>Possible weight loss </li></ul>
  21. 23. Withdrawal Symptoms <ul><li>Physiological </li></ul><ul><li>Insomnia, anxiety, irritability, restlessness may persist for weeks </li></ul><ul><li>Drug Craving intermittently for months </li></ul><ul><li>Support Care </li></ul><ul><li>Non-pharmacologic interventions </li></ul>

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