Medical uses of Marijuana - Dr. Rajbir Bajwa, Coordinator of legal medical marijuana sales, from the 2020 Conservation Tillage and Technology Conference, held March 3-4, 2020, Ada, OH, USA.

1. The Facts: Marijuana as Medicine
Rajbir S. Bajwa, MD FAAP
Medical Cannabis of Northwest Ohio

2. A Short History of Marijuana
Most ancient cultures didn’t grow the plant to get high, but as herbal medicine, likely starting in Asia around
500 BC
In the early 1600s, the Virginia, Massachusetts and Connecticut colonies required farmers to grow hemp.
Hemp fiber was used to make clothing, paper, sails and rope, and its seeds were used as food. Because it’s
a fast-growing plant that’s easy to cultivate and has many uses, hemp was widely grown throughout colonial
America and at Spanish missions in the Southwest.
In the 1830s, an Irish doctor, Sir William Brooke O’Shaughnessy, found that cannabis extracts could help
lessen stomach pain and vomiting in people suffering from cholera.
By the late 1800s, cannabis extracts were sold in pharmacies and doctors’ offices throughout Europe and the
United States to treat stomach problems and other ailments.

3. A Short History of Marijuana
Scientists later discovered that THC (tetrahydrocannabinol) was the source of marijuana’s medicinal properties,
mainly to lessen nausea and promote hunger. It was also discovered to have psychoactive properties.
In the United States, marijuana wasn’t widely used for recreational purposes until the early 1900s. Mexicans
that immigrated to the US during this time, post Mexican Revolution, introduced the recreational practice of
smoking marijuana to the American culture.
During the Great Depression resentment of Mexican immigrants propagated public fear of the “evil weed.” As
a result—and consistent with the Prohibition era’s view of all intoxicants—29 states had outlawed cannabis by
1931.
The Marijuana Tax Act of 1937 was the first federal U.S. law to criminalize marijuana. The Act imposed an
excise tax on the sale, possession or transfer of all hemp products, effectively criminalizing all but industrial
uses of the plant.
Industrial hemp continued to be grown in the United States throughout World War II, and the last U.S. hemp
fields were planted in 1957 in Wisconsin.

4. A Short History of Marijuana
As part of the “War on Drugs,” the Controlled Substances Act of 1970, signed into law by President Richard
Nixon, repealed the Marijuana Tax Act and listed marijuana as a Schedule I drug—along with heroin, LSD
and ecstasy—with “no medical uses” and a high potential for abuse.
In 1972, a report from the National Commission on Marijuana and Drug Abuse released a report titled
“Marijuana: A Signal of Misunderstanding.” The report recommended “partial prohibition” and lower penalties
for possession of small amounts of marijuana. Nixon and other government officials, however, ignored the
report’s findings.
Marijuana is still illegal under U.S. federal law, and still listed as a Schedule I drug, to this date.

5. The Tide is Shifting
California, in the Compassionate Use Act of 1996, became the first state to legalize marijuana for medicinal
use by people with severe or chronic illnesses.
Colorado became the first state in 2012 to legalize recreational marijuana. Washington State followed shortly
thereafter.
Medical marijuana is now legal in 33 states (including the District of Columbia) and legal recreationally in 11
states

6. Ohio House Bill 523
● Became effective on September 8, 2016.
● Legalized medical marijuana in Ohio creating a program called the Medical Marijuana Control
Program (MMCP). Gave the state 2 years to create the framework of the program.
● The MMCP will allow people with certain medical conditions, upon the recommendation of an Ohio-
licensed physician certified by the State Medical Board, to purchase and use medical marijuana.
● Creates a standard of care for the State Medical Board physicians who are Certified to Recommend
(CTR).

7. The Endocannabinoid System
● The endogenous arachidonate-based lipids, anandamide (AEA) and 2-arachidonoylglycerol
(2-AG); these are known as "endocannabinoids" and are physiological ligands for the
cannabinoid receptors.
● The enzymes that synthesize and degrade the endocannabinoids, such as fatty acid amide
hydrolase or monoacylglycerol lipase.
● The cannabinoid receptors CB1 and CB2, two G protein-coupled receptors that are located in the
central and peripheral nervous systems.
The neurons, neural pathways, and other cells where these molecules, enzymes, and one or both
cannabinoid receptor types are all colocalized collectively comprise the endocannabinoid system.

8. The Endocannabinoid System

9. What are “Phyto” Cannabinoids
Phytocannabinoids are secondary plant metabolites that bind to and activate cannabinoid receptors.
Delta-9-tetrahydrocannabinol (THC) is the most widely studied compound.
THC is a partial agonist with high affinity to CB1 and CB2 receptors
CBD (Cannabidiol), another hemp plant metabolite, does not bind with high affinity to, or significantly
activate either cannabinoid receptor directly.
Other plants produce cannabinoids: Echinacea purpurea, Piper nigrum, and Magnolia grandiflora (non-
psychoactive compounds)

10. The Effects of the Cannabinoids on the Body
Analgesic
Antiemetic
Antioxidant
Neuroprotective
Neuromodulatory
Control of Cell Growth and
Differentiation
Mood Enhancing
Sedating
Anti-inflammatory Appetite Stimulating

11. State of Ohio’s Qualifying Conditions
●AIDS/Positive status for HIV
●Amyotrophic lateral sclerosis
●Alzheimer’s disease
●Cancer
●Crohn’s disease, inflammatory
bowel disease, and ulcerative colitis
●Chronic traumatic encephalopathy
●Epilepsy or another seizure
disorder
●Fibromyalgia
●Glaucoma
●Hepatitis C
●Multiple sclerosis
●Pain that is either chronic and
severe or intractable
●Parkinson’s disease
●Post-traumatic stress disorder
●Sickle cell anemia
●Spinal cord disease or injury
●Tourette syndrome
●Traumatic brain injury

12. Forms and Methods of Administration
Vaping
Edibles
Tinctures
Patches,
lotions,
creams
Plant material, oils or solid preparations
SMOKING is not allowed under Ohio law
Gummies, butters, capsules, drinks, hard candies, sprays or oils
Can be used sublingually. Usually more concentrated
Transport across the aqueous dermis is a rate-limiting step as
cannabinoids are hydrophobic. Yet to show therapeutic benefit.

13. Process to Obtain an Ohio Card
Schedule an appointment with a CTR physician (Certificate to Recommend)
Get together documents validating your qualifying medical condition
They will review your OARRS report, review medications, perform a PEX and
go through the Risks and Benefits of MMJ
If they agree that the benefits of MMJ outweigh the risks, they will enter you
on the Ohio registry
You will get an email from the Ohio Pharmacy Board asking you to set up a UN
and PW and how to submit payment ($50/patient, $25/caregiver)

14. Medical Cannabis of Northwest Ohio
www.MCNWOH.com
419-738-MCNW (6269)
Rajbir S. Bajwa, MD FAAP
Only full-time CTR physician in the area
Ethical, local, evidence-based