Medical Experiences with Phytocannabinoids

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Medical experiences with Phytocannabinoids By: Bruce Hertz, MD & Robert Beutelspacher Disclosures NONE Biography Bruce Hertz, MD Robert Beutelspacher A&H Family Med, PC Medical Cannabis Advocate who produced and Niles, IL created educational cannabis show based out of Illinois - "Cannapics." Robert also worked in the President and COO Illinois Cannabis Industry in 2016 and the CBD 31 years in private practice Industry in 2017. Robert does ultrasound Licensed in Illinois and Indiana modeling for students at Americans College - Chest Physicians and at RSNA for various manufacturers including GE & Siemens. Robert Certified by American College of Sports interviewed Raphael Mechoulam in 2016 and Medicine gave a speech on medical Cannabis at Elgin Certified by Association of Ringside Physicians Community College in 2017. Lectured at Illinois State University October 2019. Ringside Physician: UFC, Bellator, Strikeforce, and various Pro and Amateur Boxing and MMA events in Illinois and Bachelor of Fine Arts -Visual Effects & Motion Indiana Graphics 2006 -2010 Team USA World Kickboxing Championship in Portugal Certificate from The Cannabis Career Institute Lectures: 2011 Several informal cannabis lectures(2016 -2019) Budtending Certifying Medical Cannabis patients for 5 Cultivation years Dispensary management Lectured at Illinois State University October Edibles operation 3 2019. Cannabis business management NPR Radio Interview Jan 2020 Special Recognition To: Leslie Mendoza Temple MD, ABOIM Medical Director, Integrative Medicine Program NorthShore University HealthSystem Clinical Associate Professor of Family Medicine University of Chicago Pritzker School of Medicine

Objectives

1. History of Cannabis 2. Types of Cannabis 3. The Endocannabinoid system a. Conditions treated b. Endogenous Cannabinoids 4. Terpenes and Cannabinoids - including CBD oil a. Difference between various Cannabinoids b. Difference between various Terpenes c. Benefits d. Side effects 5. Health & safety concerns 6. Illinois State laws 7. Certifying Medical Cannabis patients

6 History of Cannabis Prohibition

“ It is of Great Value to the wounded and feeble, and That it is Harmless.”

7 Ulysses S. Grant History of Cannabis Prohibition

“ I wish it was in my power to place it ( Cannabis) in the pocket of every soldier, because I am convinced that it speedily relieves debility, fatigue, and suffering.”

8 Robert E. Lee The Union: The Business Behind Getting High (2007) History of Cannabis Prohibition

Democrat. Elected 1912. WWI breaks out July 28. Britain joins the conflict Aug 4, ▰ 1914. ▰ Dispatched Gen. John Pershing to capture Pancho Villa. Re-elected 1916 ▰ War declared by congress April 4, 1917 ▰ War ended 11/11/1918 ▰ Paris peace talks and treaty of Versailles 1919. ▰ Approached by a young Asian man, to support his call for ▰ independence from French colonial Rule. ▰ Ignored this mans’ repeated requests.

▰ 10 Woodrow Wilson History of Cannabis Prohibition

Vietnam’s Revolutionary Leader Inspired by Woodrow Wilsons’ 14 points, Paris 1919. ▰ Rebuffed. Turned toward Marxism -Leninism. ▰ Founded Viet Minh, and Viet Cong. ▰ Wrote Vietnamese Declaration of Independence upon the ▰ Japanese surrender 1945. Modeled after the Colonial ▰ Americans. Treated by a US Medic for Dysentery and Malaria. Led guerilla campaign against the French 1946 - 1954 ▰ PM and President. ▰ American War 1955 - 1975. ▰ ▰

11 Ho Chi Minh History of Marijuana Prohibition

1937 Marijuana Tax Act. Cannabis became illegal in the U.S. First Commissioner of the Federal Bureau of Narcotics, a new ▰ division of the Treasury Dept. ▰ 1930 – 1962 Appointed by Andrew Mellon (his wife’s uncle). He testified ▰ before congress by saying : ▰ “ Marijuana is the most violence causing drug in the history of mankind… Most marijuana smokers are ▰ Negroes, Hispanics, Filipinos, and entertainers.” “Marijuana is an addictive drug which produces insanity, criminality, and death.” ▰ The primary reason to outlaw marijuana is its’ effect on the degenerate races. ▰ 12 Harry J. Anslinger 1970 Controlled substance act ▰ History of Marijuana Prohibition continued

Hated Mexicans Lost 800,000 acres of Timberland to Pancho Villa ▰ Didn’t want competition from Hemp industry, as he had a ▰ financial interest in the wood pulp industry. ▰ Spreading Cannabis misinformation sold newspapers. Supported by DuPont Chemical company ▰ Pharmaceutical companies could not standardize ▰ Cannabis dosages. ▰ “Users of marijuana become STIMULATED as they inhale the drug and are LIKELY TO DO ▰ ANYTHING. Most crimes of violence in this section, especially in country districts are laid to users of that drug.” 13 William Randolph Hearst –William Randolph Hearst The New Normal - A Short by Spike Jonze Modern medical research has confirmed the “ beneficia l u s es of ca nna bis in tr ea ting or alleviating the pain, nausea, and other symptoms a s s ocia ted with a va r iety of debilita ting medica l conditions , inclu ding ca ncer , mu ltiple s cler os is , and HIV/ AIDS.

-The National Academy of Sciences' Institute of Medicine in March 1999

15 Medical Costs

Approx $165 million decrease in spending on Health Care for Anxiety Depression ▰ Nausea ▰ Acute and Chronic Pain ▰ Seizures ▰ Insomnia ▰ Osteoarthritis Bradford▰ A, Bradford D. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare▰ Part D. Health Aff July 2016 35:71230-1236c 16 Debilitating Conditions

Post-Concussion Syndrome Hepatitis C Post-Traumatic Stress Disorder (PTSD) Autism Hydrocephalus ▰ ▰ Reflex sympathetic dystrophy Agitation of Alzheimer’s disease Hydromyelia ▰ ▰ ▰ Residual limb pain HIV/AIDS Interstitial cystitis ▰ ▰ ▰ Rheumatoid arthritis Amyotrophic lateral sclerosis (ALS) Irritable bowel syndrome ▰ ▰ ▰ Seizures (including those characteristic of Anorexia nervosa Lupus ▰ ▰ ▰ Epilepsy) Arnold -Chiari malformation Migraines ▰ ▰ ▰ Severe fibromyalgia Cancer Multiple Sclerosis ▰ ▰ Sjogren’s syndrome Cachexia/wasting syndrome Muscular Dystrophy ▰ ▰ ▰ Spinal cord disease (including but not limited to Causalgia Myasthenia Gravis ▰ ▰ ▰ arachnoiditis) Chronic inflammatory demyelinating polyneuropathy Myoclonus ▰ ▰ ▰ Spinal cord injury is damage to the nervous Chronic pain Nail-patella syndrome ▰ ▰ tissue of the spinal cord with objective Crohn’s disease Neuro -Bechet’s autoimmune disease ▰ ▰ ▰ neurological indication of intractable spasticity CRPS (complex regional pain syndrome Type II) Neurofibromatosis ▰ ▰ Spinocerebellar ataxia Dystonia Neuropathy ▰ ▰ Superior canal dehiscence syndrome Ehlers -Danlos syndrome Osteoarthritis ▰ ▰ ▰ Syringomyelia Fibrous Dysplasia Parkinson’s disease ▰ ▰ ▰ Tarlov cysts Glaucoma Polycystic kidney disease (PKD) ▰ ▰ ▰ Tourette syndrome ▰ ▰ ▰ Traumatic brain injury ▰ 17 Ulcerative colitis ▰ http://www.dph.illinois.gov/topics-services/prevention-wellness/medical-cannabis/debilitating-conditions ▰ Old Certifying Process

http://www.dph.illinois.gov/sites/default/files/forms/medicalcannabisreviewinghealthcareprofessionalwrittencertification19.pdf Current Certifying Process

http://www.dph.illinois.gov/sites/default/files/forms/medicalcannabisreviewinghealthcareprofessionalwrittencertification19.pdf Cannabis species NOT African Broccoli, Bobby Brown, Bongo, Chronic, Chebba, Cabbage, Dope, Doobage, Dro, Fire, Ganja, Grass, Goofy boots, Giggle Bush,Devil's Lettuce, Hydro, Jazz Cabbage, Mota, Mary Jane, Nug, Pot, Herb, Reefer, Reggie Miller, Schwag, Snickle -Fritz, Sticky -Icky -Icky, Stank, Sweet G, Trees.. & ESPECIALLY NOTMarijuana. Cannabis Ruderalis

Native to Asia/Europe/Russia Short life span - flowers regardless ▰ of light exposure. ▰ Some classify Ruderalis with Sativa. ▰ Can vary in THC & CBD production

21 ▰ Cannabis Sativa

Native to Eastern Asia Grown at low altitudes ▰ Can vary in THC & CBD production ▰ Hemp falls under both Sativa and ▰ Ruderalis ▰

22 Cannabis Indica

Native to India Grown at high altitudes ▰ High THC production ▰ Fractional CBD production ▰ ▰

23 Certified Cannabis Patient

Reasons PTSD ▰ GI system ▰ Lower back ▰ Asthma ▰ Illinois Medical Cannabis patient for 3+ years ▰ Certifying Process ▰ 2 visits to Therapist ▰ 2 visits to Psych ▰ Typical Daily Usage ▰ AM 30 -75mg of THC (Via smoked flower) ▰ AM 24 -50mg of CBD (via full spectrum Tincture) ▰ PM 20mg -100mg of CBD (via full spectrum Tincture) 24 ▰ PM 100 -350mg of THC (Via smoked Flower,concentrate, edible) ▰ ▰ What is the Endocannabinoid system & why is it important? CB1 Receptors

Our bodies are made up of a network of two Cannabinoid receptors

CB1 Receptors CB1 Receptors Mainly found in the central Typically follows with nervous system and various psycho activity or parts of the lungs impairment.

26 ! CB2 Receptors

CB2 Receptors CB2 Receptors Are found everywhere follows with ZERO psycho else in the body - Skin, activity or impairment with bones, joints, muscles, application. tendons.

27 Endogenous Cannabinoid Anandamide

AEA (Anandamide) “Bliss molecule” - body’s endogenous version of THC Binds to CB1 receptors (a full agonist) - can even give natural high aka the “runner’s high.” Produced every time your body does a physical activity Also when consuming dark chocolate. What are the consequences if your body is 28 deprived or the molecule is absent? Endogenous Cannabinoid 2-Arachidonoylglycerol

2-AG (2-Arachidonoylglycerol) Our body’s endogenous version of CBD Produced in breast milk The brain In peripheral tissues What are the consequences if your body is deprived or unable to process such?

29 Phytocannabinoids Cannabinoids have a various life cycles depending on if they’re decarboxylated with heat or just oxidized naturally.

(RAW)

30 Phytocannabinoids Possible Medical Benefits CBG (Cannabigerol)

● Non intoxicating ● Anti- inflammatory CBC ( Cannabichromene) THCV (Tetrahydrocannabivarin) ● Anti- Epileptic ● Appetite suppressant ● Anti- bacterial ● Non intoxicating in small amounts ● Neurological protector ● Analgesic ● Anti- inflammatory ● Bone stimulant ● Bone stimulant ● Anti- Epileptic ● Bone stimulant

https://www.ncbi.nlm.nih.gov/pubmed/7298870 CBE (cannabielsoin) CBL (Cannabicyclol) https://www.ncbi.nlm.nih.gov/pubmed/1806944 https://pubchem.ncbi.nlm.nih.gov/compound/Tetrahydrocannabivarin https://pubchem.ncbi.nlm.nih.gov/compound/cannabicyclol ● Non intoxicating ● Non intoxicating https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021502/ ● Anti- inflammatory

31 Phytocannabinoids Possible medical benefits Continued CBD/CBDA (Cannabidiol) ● Medication approved 2018 ● Non intoxicating ● Antipsychotic THCA (Tetrahydrocannabinolic acid) Δ9 THC ( Delta 9 Tetrahydrocannabinol) ● Small doses helps focus ● Non intoxicating- unless heated ● Intoxicating effects ● High doses acts as a Sedative ● Anti- inflammatory ● Anti- inflammatory ● Anti- inflammatory ● Anti- Epileptic ● Anti- oxidant ● Anti- Epileptic ● Appetite stimulant ● Appetite suppressant ● Neurological protector Δ8THC ( Delta 8 Tetrahydrocannabinol) CBN (Cannabinol) https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we- ● Oxidized/aged version of Delta 9 THC ● Oxidized/aged/heated version of Delta know-and-what-we-dont-2018082414476 https://pubchem.ncbi.nlm.nih.gov/compound/delta_9_- ● More sedative than Delta 9 THC 9 THC Tetrahydrocannabinolic-acid https://www.cancer.gov/publications/dictionaries/cancer- ● Still Intoxicating not as much as Delta 9 ● Non intoxicating drug/def/cannabinol THC ● Anti- insomnia https://pubchem.ncbi.nlm.nih.gov/compound/Cannabinol https://www.cancer.gov/publications/dictionaries/cancer- 32 ● Analgesic drug/def/delta-8-tetrahydrocannabinol Benefits and Side Effects of CBD Oil from a Clinical Perspective Cannabidiol (CBD) & Hemp Oils

Derived from Hemp 2014 Agricultural Act Distinguished between Hemp and Marijuana Legality for the first time Delta – 9-THC content of no more than 0.3 % 2018 Farm Bill - Hemp is no longer a controlled substance. Still subject to FDA and DEA rules 3 States - Idaho, S. Dakota, and Nebraska consider CBD and Hemp oils illegal. Can’t sell, nor consume

34 Typical Side Effects of THC

Sedation Slowed pupillary response to Dizziness light Dysphoria \ Paranoia Decreased blink rate Decreased coordination Decreased tear flow Ataxia Decreased visual perception Altered sense of time Reddened sclera. Dry mouth

35 Terpenes The oils any plant secretes -At least 20,000 different terpenes in existence (aka what one smells and tastes). Terpenes and Cannabinoids create a synergy or entourage effect. Terpenes Geraniol