Dr. Tishler will review the Endocannabinoid system, the basis for why cannabis works as medicine, with special emphasis on practical aspects of treatment of patients with chronic pain. He will touch on key topics of dosing, administration, preparations, and bioavailability. He will also review other illnesses amenable to cannabis therapy.

1. The Endocannabinoid System:
Master of Homeostasis, Pain
Control, And So Much More
Jordan Tishler, MD

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The Endocannabinoid System
(ECS)
Complex signaling pathways
Receptor and non-receptor
mediated
Connected to
Prostaglandins & Cytokines

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ECS and Peripheral Pain
Post-synaptic cells shut off
stimulation via ECS
ECS paracrine function from
glia
ECS paracrine function to
histiocytes, macrophages

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ECS and Central Pain
Descending pain system to
shut down stimulation
CB1 receptor tightly
coupled to µ receptor
Thalamic and cortical CB1

6. Pain is the #1 presenting complaint
Pain is a Big Problem
Pain is the #1 complaint patients feel is not
properly addressed
This is a demand-side problem, not supply

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Current Approaches to Pain
Management Cause Problems
Only 3 drug classes
Opiates not very effective
Opiates very dangerous

8. Teresa
(not her real name or photo)

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Routes of Administration
Smoking
Rapid onset, relatively short duration
Cheap and effective
May yet prove to be bad for lungs
Vaporizing
Not cheap, needs machine
Easy to titrate
Presumably better for lungs: no combustion
Eating
Long onset, long duration
Calories!
Make your own or buy
Hard to titrate
Tincture
BS: Sublingual or transdermal
Cumbersome to make
Unreliable delivery
Topicals
Good for skin
No evidence for deeper penetration

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PO Vs. INH
Not either/or - complementary
PO = long acting
INH = rapid onset
Remember the whole patient

11. Not

12. Let’s save paper! Go to http://bit.ly/
canna-refs
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References
www.inhaleMD.com
Offices in Brookline and Cambridge
Email me at doc@inhaleMD.com