Understanding Medical Cannabis – 1. Cannabis Access: Cannabidiol in treatment resistant epilepsy 2. ABC: Jenny Hallam faces more drugs charges as SA Government commits to medicinal cannabis 3. HuffPost: This Family Of Doctors Wants To Change The Way You Think About Weed

1. Cannabis Access: Cannabidiol in treatment resistant epilepsy

February 09, 2018 0 1509

Cannabidiol in treatment resistant epilepsy
Cannabidiol (CBD), a non-psychoactive cannabinoid is currently under investigation as a potential therapy for severe, treatment resistant epilepsy. Unlike delta-9-tetrahydrocannabinol (THC), CBD does not cause the “high” often associated with cannabis.
Instead CBD has been found to have anticonvulsant and antipsychotic effects.
Anecdotes of cannabis’s ability to alleviate seizures have been around for over 100 years but its only recently that larger scale clinical trials have been performed.In a recent study published in the New England Journal of Medicine, Devinsky et al. investigated the effect of CBD in 120 children and young adults with Dravet Syndrome, a relatively rare form of epilepsy that is often refractory to anticonvulsant therapy (1).
In this randomized, double-blind, placebo controlled trial, CBD demonstrated significant improvement over placebo.

The median frequency of seizures per month decreased from 12.4 to 5.9 with CBD in comparison to 14.9 to 14.1 with placebo.
In addition, 43% of patients on CBD reached at least a 50% reduction in convulsive seizure frequency compared with 27% on placebo.Despite the very convincing anecdotal reports of individual patients who have had miraculous effects from taking CBD, (such as Charlotte Figi, a young girl with Dravet syndrome and the name sake of Charlotte’s Web, a high CBD low THC strain of cannabis), large scale, properly controlled trials are essential to verify the efficacy and safety of CBD in young children with epilepsy.

CBD is also known to interact with anti-epileptic drugs via cytochrome p450 metabolism and so it is important to for any parent that may be sourcing CBD for their child to inform their neurologist.In Australia, CBD (<2% THC and other cannabinoids) is classified as Schedule 4 and can be accessed via the Special Access scheme, please see blog on accessing medicinal cannabis in Australia for further information. In addition, Epidiolex, an oral CBD therapy from GW Pharmaceuticals can be accessed in NSW via a  canna.

To be eligible for this scheme the patient must have severe, intractable childhood epilepsy, be under the age of 18 and to have unsuccessfully trialed at least 5 anticonvulsant drugs.All in all, CBD is a very promising therapy for treatment resistant epilepsy however, more clinical trials with larger n numbers are needed to fully verify this.A quick search on ClinicalTrials.gov brings up 37 registered trials so hopefully more data will be available in the not too distant future.References
1.Devinsky, Cross, Laux, Marsh, Miller, Nabbout, Scheffer, Thiele, Wright, Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. 2017 N Engl J Med 376;21.

2. ABC: Jenny Hallam faces more drugs charges as SA Government commits to medicinal cannabis



As the use of medicinal cannabis takes centre stage in political debate, an Adelaide woman has appeared in court facing more charges over manufacturing the drug.
Earlier this week, police laid two additional charges against medicinal cannabis advocate Jenny Hallam relating to manufacturing and possessing cannabis resin.
The 46-year-old was already accused of supplying cannabis oil to terminally ill people.
She was previously charged with one count each of manufacturing and possessing a controlled drug, namely cannabis oil, after her home at Hillier in Adelaide’s north was raided by police in January 2017.

Ms Hallam formally entered not guilty pleas in the District Court on Friday and was committed to stand trial on February 11 next year.
Her arraignment came on the same day as the State Government promised to train more doctors in prescribing medicinal cannabis if re-elected.
The Federal Government has also moved to make it easier for patients in New South Wales to access medicinal cannabis.

Outside court, Ms Hallam said she was shocked by the additional charges as she was still holding out hope that the case against her would be dropped altogether.
“Basically they are charging me twice for the same offence,” she said

“They have ignored the public, completely gone against what the public have asked, and they have doubled these charges.”


Ms Hallam said a great number of her supporters had sent letters to the Director of Public Prosecutions asking for the charges to be dropped.

“There is nothing we can do about it except fight,” she said.

Prosecution ‘curious and extraordinary’, Xenophon says
Ms Hallam’s trial won’t be heard for another 12 months due to a backlog of cases in the District Court.

“It just gives us a year longer to get all of the evidence together, so I think it’s worse for them because in that time we are going to have so much more medical evidence coming through,” Ms Hallam said.”

“People like myself do not take breaking cannabis laws lightly, we do so to save lives and to give back quality of life when it has been taken away.

Premier Jay Weatherilll today committed $1 million towards education, training and research programs for doctors prescribing the drug.
Mr Weatherill said he wanted to ensure doctors could make informed decisions when prescribing medicinal cannabis.

“We’ve freed up the process of doctors prescribing medicinal cannabis for South Australians that have healthcare needs that demand medicinal cannabis,” he said.

“The difficulty is though there is a lack of understanding, a lack of familiarity and a lack of information and training for the prescribing doctors.

“We have removed the state barriers, the only barriers that exist now are at a federal level.”

SA Best Leader Nick Xenophon said he found it “curious and extraordinary” that Ms Hallam was being prosecuted.

“Why is it that Jenny Hallam is being prosecuted for dispensing medical cannabis when there are ice dealers out there that aren’t being raided … despite that complaints are being made on a regular basis?” he said.

Topics: drug-usecourts-and-trialsdrug-offencescanna

RELATED STORY: ‘The people were in need’: Medicinal cannabis advocate to stand trial
RELATED STORY: Supporters rally around medical cannabis advocate facing drug charges
RELATED STORY: Cannabis oil charges ‘puzzle’ lawyer as public debate grows
RELATED STORY: Medical marijuana access in SA a ‘farce’





3. HuffPost: This Family Of Doctors Wants To Change The Way You Think About Weed

The Canna MDs

From left to right, Drs. Jessica, Janice, David and Rachel Knox operate a cannabis therapeutics clinic in Oregon.

Dr. Janice Knox was several years into retirement in Oregon when she was asked to fill in at a “card mill” ― a facility where patients can be diagnosed with conditions that qualify them for a medical card to buy cannabis.

This was a few years ago, and public sentiment about medical marijuana wasn’t quite what it is today.

“I had the mindset that most people had at the time ― ‘marijuana is a terrible drug, it’s just a drug,’” Knox told HuffPost.

When she arrived at the clinic, the makeup of the waiting room was “not who I was expecting,” she said.

“There were businesspeople, doctors, lawyers, moms, dads, grandmothers, grandfathers. I just couldn’t believe who I saw,” Knox said.

“They were coming because conventional medicine had failed them. They wanted a better quality of life.”

“People were coming in with their last dime to get a card,” she added. “I was stunned.”

Equally surprising to Knox was how she, a practicing anesthesiologist for 35 years, had been taught so little about the mechanisms and effects of cannabis ― a substance that people said eased their suffering, even from symptoms related to chronic diseases.

“I knew nothing about this medicine.
I felt so embarrassed as a physician that that’s where I was.
So I really made it a point to learn everything that I could about it,” Knox said.
Since then, she’s tried to “change the narrative” about who uses cannabis and why.

The Canna MDs

Dr. Janice Knox grew the American Cannabinoid Clinics from her existing wellness clinic.

In 2014, Knox founded the American Cannabinoid Clinics from her existing wellness clinic in Portland, Oregon, where marijuana has been legal for medical purposes since 1998 and legal for recreational use since 2015. Other than Knox, there are very few U.S. medical professionals who specialize in cannabis therapeutics.
Fortunately, three of them are members of her family.
Knox’s husband, David, is a former emergency room doctor.
Their two daughters, Rachel and Jessica, are physicians who received both medical and business degrees from Tufts University.
At his wife’s urging, David Knox also visited the “card clinics” where his wife had been providing care.
Like Janice, he was struck by the diversity of patients and conditions for which the plant seemed to offer relief.
“It was an eye-opener. The potential is just incredible,” he said, adding that he’s seen patients successfully reduce or eliminate their use of opiates for chronic pain after beginning cannabis therapeutics.
(Federally funded research has also found this result, which could have meaningful implications amid America’s ongoing opioid crisis.)

People were coming in with their last dime to get a card. I was stunned.

At their clinic, the Knoxes practice what they call “integrative cannabinoid medicine.”
They counsel new and experienced cannabis patients alike on the best treatment options for their conditions, the best way to deliver the medicine (e.g. vaping, topical, ingesting), and how to mitigate undesired effects.
These are all aspects of cannabis medicine that a general practitioner might not know as much, or indeed anything, about.

“We’re looking at the whole patient, and how to use cannabis optimally, so the patient can get the best benefit from the minimal dosage without side effects or complications,” David said.

Rachel Knox, 35, wasn’t particularly surprised by her parents’ new career path.
She and her mother share an interest in natural medicine.
For Rachel, this interest only grew stronger in a medical school and residency environment where emergency treatments for the most urgent symptoms of chronic illness were rarely followed up with meaningful conversations with patients about maintenance and prevention.

“We weren’t being taught how to prevent or reverse chronic illness in our medical education,” she said.

“We had this longing for more. My curiosity for natural medicine grew out of that frustration in conventional medicine.”

“My sister and I really felt like if we were going to pursue medicine, we should do something different with it,” she went on.

“When my mom and my dad said they had started writing cannabis authorization for patients, that fit right into the natural options I wanted to investigate for patient care.”

The Canna MDs

Dr. Rachel Knox’s involvement in cannabis therapeutics grew out of her interest in natural medicine.

Cannabis provides therapeutic effects mainly through its impact on the endocannabinoid system, which regulates various processes throughout the body such as organ function and immune response.

Last year, the National Academies of Sciences, Engineering, and Medicine produced a sweeping report on the health effects of cannabis and cannabinoids, concluding that restrictions on possession and consumption have made it difficult to develop research-based consensus on its medical utility.

The barriers to conducting meaningful research on the effects of a federally prohibited substance are considerable.
Trials involving cannabis have to be approved by three government agencies and an independent review board, the Knoxes said.
After that, there’s the matter of procuring the cannabis itself.

“Right now you can’t ship cannabis across state lines, so you have to rely on a secure source within that state to do that,” Rachel said.

The American Medical Association has long referred to cannabis as a “public health concern” ― but it recently issued a policy update calling for a review of the plant’s Schedule I designation, which categorizes marijuana as a drug with no medical benefits and restricts its availability for research.
Heroin and bath salts are also Schedule I substances.

SAEED KHAN via Getty Images

The U.S. still officially considers cannabis a Schedule I substance with no medicinal value.

Given the limits on research and accessibility, many doctors are reluctant to discuss cannabis-related treatment options with patients.
Many of the Knoxes’ patients come to the clinic because they’re not sure whether their general practitioners condone medical cannabis, or even know very much about it.
The Knoxes have seen more than 3,000 patients at the American Cannabinoid Clinics.
Very few, they said, have any interest in getting high. In fact, many would prefer to avoid it.

“Patients will tell me eight or nine times, ‘I don’t want to get high,’” David said.

Many patients, especially seniors, come in asking for CBD, or cannabidiol, a non-psychoactive component of cannabis, Rachel added.

“What surprises the patients most who say that is when we come back and tell them, ‘This condition that you have actually will respond better with some THC on board, let us talk to you about how to use THC to avoid those adverse effects,’” she said. “I had a patient today who was surprised to hear that she could use THC without getting high.”

Patients are also “shocked” to learn they don’t have to smoke the cannabis to feel better, Janice said.

“People have this image of a smoker smoking the joint, and when you tell them, ‘No, you don’t have to do it that way, you can use it incrementally and won’t get a THC high’ ― I think that’s really shocking to them,” she said, adding that placing medicine under the tongue, rubbing it into the nares septum (inside the nose), and delivering THC through a rectal suppository are all effective and in some cases superior alternatives to smoking cannabis.

Patients will tell me eight or nine times, “I don’t want to get high.”

Though based in Oregon, the Knoxes see patients from neighboring states such as California and Washington.
Rachel Knox is vice chair of the Oregon Cannabis Commission, which oversees the state’s medical marijuana program, and serves as the medical chair for the Minority Cannabis Business Association.
Janice Knox sits on the board of Doctors For Cannabis Regulation, which promotes safe practices and improved quality of medical cannabis products.
Through their clinics and ancillary work in the industry, the Knoxes hope to help more medical practitioners integrate cannabis therapeutics into their practices and promote more specialization in cannabinoid medicine.
They plan to launch their own training program for medical professionals later this year.

“We need to be helping trained clinicians in the practical implementation of cannabis therapeutics in the same way we do it at the clinic,” Rachel said.

“Patients should feel comfortable that the doctor they’re talking about cannabis with is knowledgeable about this medicine.” 

Leave a Reply

Your email address will not be published. Required fields are marked *