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Standard Powerpoint Template Dr Graham Associate Professor Gulbransen David Caldicott General Practitioner Emergency Physician Kingsland Family Health Centre Calvary Hospital Auckland Clinical Lead Australian Drug Observatory 8:30 - 10:30 WS #1: Medicinal Cannabis Workshop 11:00 - 13:00 WS #8: Medicinal Cannabis Workshop (Repeated) Medical Cannabis- A Primer for Clinicians Associate Professor David Caldicott B.Sc (Hons), MBBS(Lond.), FRCEM, Dip.Med.Tox australian medical cannabis observatory The Australian Medical Cannabis Course Associate Professor David Caldicott B.Sc (Hons), MBBS(Lond.), FRCEM, Dip.Med.Tox australian medical cannabis observatory Who the hell are you? “Jack of All Trades…” “Plant for All Seasons…” Beginnings… australian medical cannabis observatory Beginnings… Beginnings… No financial disclosures, associations or political affiliations “Why not…?” Lachenmeier DW, Rehm J. Comparative risk assessment of alcohol, tobacco, cannabis and australian other illicit drugs using the margin of exposure approach. Sci Rep. 2015 Jan 30;5:8126. medical cannabis observatory So I went looking… Lesson 1 I needed to learn more, because I was taught nothing real on this subject in medical school australian medical cannabis observatory Lesson 2 There is already an awful lot already known about using cannabis for medical purpose (just not by doctors) australian medical cannabis observatory ‘Where’s the evidence…?’ Practice Guidelines Systematic Review / Meta-analysis Randomized Controlled Trial Controlled clinical study Retrospective / Prospective Cohort Study Case Reports / Case Series Expert Opinions The Historical Human Experience This is not an academic ‘Terra nullius’ John Boyd Macdonald Lesson 3 There really does seem to be some benefits associated with medicinal cannabis australian medical cannabis observatory Lesson 4 There could also be harms associated with medicinal cannabis australian medical cannabis observatory Lesson 5 Regardless of benefits or risks, patients see it as a way of taking control of their conditions australian medical cannabis observatory The Machine vs The Garden “Slow Medicine” australian medical cannabis “content, context, and community” observatory 2 major camps Cannabis Cannabis is Is great Dangerous- for Much more everyone, Us Work Needs always- To Be now. done australian medical cannabis observatory Interpreter Diffusion of Innovation Adoption Profile Innovators Early Early Majority Late Majority Laggards Adopters Conservatives Psychographic Technologists Visionaries Pragmatists Skeptics Critics & Joiners & Social Inactives Technographic Creators Collectors Spectators After Cialdini, Everett Rogers, Forresters, and Moore & Gladwell Diffusion of Innovation C T h h a e s Adoption Profile Innovators Early Early Majority Late Majority Laggards Adopters Pragmatists Conservatives Skeptics Psychographic Technologists Visionaries m Critics & Joiners & Social Inactives Technographic Creators Collectors Spectators After Cialdini, Everett Rogers, Forresters, and Moore & Gladwell • Globally, ongoing debate surrounding – Legalisation – Decriminalisation • Borrowing a term from Israeli approach, we support the… Medicalization of Cannabis Medicalization of Cannabis • Appropriate approach for doctors • Medicalization of Cannabis – Development of indications and practice – Standardization of product • Cultivation • Compounding • Distribution australian • Delivery medical cannabis observatory Mandatory Disclaimer • Course is for educational purposes • Does not constitute medical advice for any specific medical case, condition or patient australian medical cannabis observatory Today, we’re going to touch on… • A bit of History… • A bit of Science… • A bit of Medicine… australian medical cannabis observatory A Little Bit of History… How did we get here? australian medical cannabis observatory Medical Cannabis- Ancient History • Probably originated in Central Asia • Use predates writing in human evolution Trade routes of broad leaf drug variety throughout the Central Asian region. Medical Cannabis- Ancient History • Hemp was one of the first plants ever cultivated • Extensively used for food and fibre • Probably quickly followed by medicinal use Çatalhöyük, 8000BC australian medical http://www.catalhoyuk.com/ cannabis observatory Medical Cannabis- Ancient History Ancient Chinese had their own symbol ‘da ma’ australian medical cannabis observatory Medical Cannabis- Ancient History • The Ramesseum III Papyrus (1700 BC) • Eber's Papyrus (1600 BC) Hieroglyphs Demotic • The Berlin Papyrus (1300 BC) "Shm-Shm-Tu" or "sm-sm-t” "The Medical Marihuana Plant” • The Chester Beatty VI Papyrus (1300 BC) australian medical "An Ancient Egyptian Herbal” By Lise Manniche, cannabis British Museum of London / University of Texas 2006. observatory Medical Cannabis- Colonial History • British Empire ran a very successful colonial distribution • Hemp was at heart of British naval power, in the Age of Sail. • Every first rate man-of-war in British navy needed 60 tons of hemp for – Sails – Uniforms Took 140 hectares of – oakum Cannabis spp. to – rope produce this amount! Medical Cannabis- Colonial History • Americas – George Washington – Thomas Jefferson australian medical cannabis observatory Medical Cannabis- Colonial History • Australia • More ‘cannabis colony’ than ‘prison colony’ • Came on First fleet Medical Cannabis- Colonial History “From a pint of hemp-seed, sent from India in 1802, I have now sown 10 acres for Government.” Seems to have grown quite a THC rich strain… Phillip Gidley King “Trying to make rope out of dope” 3rd Governor of Australia The Origins of Medical Cannabis Enter the Irishman… – Irish physician – Polymath • used IV fluids for cholera • helped roll out telegraph in India – First to systematically report on the medical use of cannabis in India – ? treated Queen Victoria’s dysmenorrhoea William Brooke O’Shaughnessy 1809-1889 On The Preparation of Indian Hemp Cannabis Indica in 1839 of Medicinal Cannabis australian medical cannabis observatory of Medicinal Cannabis (1840-1937) australian medical cannabis observatory William Osler • acknowledged father of modern medicine • stated of migraine treatment: "Cannabis indica is probably the most satisfactory remedy. Seguin recommends a prolonged course." • This statement supports its use for both acute and prophylactic treatment of migraine. Osler, W. and McCrae, T., The Principles and Practice of Medicine, Appleton and Co., New York and London, 1915, 1225 pp. Indian Hemp Drugs Commission Report 1894 • 3,281-page, seven-volume report on the marijuana ‘problem’ in India by the British concluded: • "Viewing the subject generally, it may be added that moderate use of these drugs is the rule, and that the excessive use is comparatively exceptional. The moderate use produces practically no ill effects." Nothing of significance in the report's conclusions has been proven wrong in the intervening century.” Cannadonna cigarettes Age (Melbourne, Vic. : 1854 - 1954), australian medical Monday 5 March 1928, page 5 cannabis observatory Cigares de Joy From The Chronicle SA, Thursday 29th March, 1934, Pg 56 The Origins Of Medical Cannabis • The Fall from Grace – Did it fall…? • Patent medicine industry? • Development of better alternatives? australian medical cannabis observatory The Origins Of Medical Cannabis • The Fall from Grace – Did it fall…? • Patent medicine industry? • Development of better alternatives? – Or was is it pushed…? australian • Anslinger medical cannabis observatory Patent medicines • Aka ‘nostrums’ • proprietary medicine made and marketed under a patent and available without prescription Not all candy sprinkles… australian medical cannabis observatory Smith's Weekly, Saturday 27 May, 1922 p 12 Questions were being asked… • variability in its effects among patients • variability among different preparations of cannabis • pharmacologically ‘active principles’ – not known – not quantified • Importantly, safety was never a matter of discussion – never been a case of poisoning recorded from medicinal use Kynett, H., ed. (1895) Cannabis indica. Medical and Surgical Reporter (New York), 72, 1895, 562. The Pure Food and Drug Act of 1906 • regulated the labeling of medical preparations containing Cannabis, for the first time australian medical cannabis observatory Harry J Anslinger Commissioner of Federal Bureau of Narcotics (1930-1962) australian medical cannabis observatory Harry J. Anslinger "There are 100,000 total marijuana smokers in the US, and most are Negroes, Hispanics, Filipinos and entertainers. Their Satanic music, jazz and swing, result from marijuana usage. “ australian medical cannabis observatory Harry J. Anslinger “This marijuana causes white women to seek sexual relations with Negroes, entertainers and any others.” “ Reefers make darkies think they are good as white men" Marihuana Tax Act (1937) • Introduced at specific request Harry Anslinger • prescribed the payment of a US$1 tax for each business deal regarding Cannabis for medical or industrial use and of • US$100 for all the other purposes, • Incidentally, this was effectively the start of Prohibition V2 australian medical cannabis observatory Musto, D.F. (1972) The Marihuana Tax Act of 1937. Arch. Gen. Psychiatry 26, 101–108 Marihuana Tax Act (1937) • law did not forbid the use of Cannabis, but.. – purchase was so expensive – violations to the rules so punitive, with fines up to US$2000 or even 5-year imprisonment • all research / use about the medical use of Cannabis was discontinued. australian medical cannabis observatory
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