Medical Cannabis in MarylandPresentation to

University of Maryland Medical SchoolQuarterly MeetingOctober 8, 2015

byDeborah MiranCommissioner

Maryland Medical Cannabis Commission

Medical Cannabis – An Update

Milestones of the Twentieth Century 1940- Cannabidiol (CBD) was identified as a constituent of the plant1964- Tetrahydrocannabinol (THC) identified and synthesized in Israel 1988-1993- Two cannabinoid receptors discovered-proof of

endocannabinoid system in body1992-1995- Two endocannabinoids discovered

Function of the Endocannabinoid System

• Regulation of functions which control eating, sleeping, relaxation, memory and movement• Endocannabinoid system is basic to all other systems in the body• Evidence that the endocannabinoid system begins to form within days

after fertilization.

Overview of Endocannabinoid System

• Cannabinoid receptors – Type 1-These are the most extensive receptors

-Found in the brain, spinal cord, peripheral nervous system, organs, and tissues.

• Cannabinoid receptors – Type 2 -Found in immune system

NIH Statement 2006

• In the past decade, the endocannabinoid system has been implicated in a growing number of physiological functions

• Modulating the activity of the endocannabinoid system turned out to hold therapeutic promise in a wide range of disparate diseases

• Ranging from mood and anxiety disorders, movement disorders such as Parkinson’s and Huntington’s disease, neuropathic pain, multiple sclerosis and spine cord injury, to cancer, atherosclerosis, myocardial infarction, stroke, hypertension, glaucoma, obesity, and osteoporosis.

Patient Experiences

In 2015, hundreds of comments have been received from patients

Conditions range from ALS, fibromyalgia, epilepsy, multiple sclerosis, neuropathy, cancer, chronic back pain, leukemia, and PTSD

Some patients are military veterans who are desperate to reduce their dependency on strong opioid pain killers

Safety Profile of Cannabis

• LD 50 is the Lethal dose which will kill 50% of the population• Ibuprofen 636mg/kg• Caffeine 192mg/kg• Nicotine 50mg/kg• Heroin 22mg/kg• Cannabis Essentially Zero*

*It would take 70kg man to smoke 1500 pounds in 15 minutes.

• 2013 Data from CDC on drug induced deaths• Total – 43,982

• Prescription analgesics – 16,235• Heroin - 6,235• Cannabis - 0

Cannabis for the Management of Pain Assessment of Safety Study

COMPASS StudyDr. Mark Ware

J. of Pain September 2015

1 year Prospective Cohort Study among subjects with chronic non-cancer pain.

• Risk of having at least 1 SAE was not significantly different between groups• Risk of having at least 1 AE did not differ significantly between cannabis user &

controls• Conclusion: Study suggests AES of medical cannabis are moderate and compare

to prescription cannabinoids. Results suggest that cannabis at an average dose of 2.5 g/d in current users may be safe as part of a carefully monitored pain management program

Evidence of Decreased Opioid Overdose Mortality in U.S.

• “States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate.” (Bachhuber, M.A. (2014) Journal American Medical Association)

Evidence of Decreased Use of Cannabis by Adolescents

• American Journal of Public Health and American Academy of Pediatrics California District reported no increased use and actual decreased use in states with well regulated medical cannabis laws.

What Makes Maryland Different

• Growing & Processing• Standardization of growing phase• Controlling valuables in the process • Documentation of the process• Validation of the process

• Testing• Independent accredited laboratories• Independent sampling required• Requirements include testing for potency, purity, and microbiology

• Inspection & Compliance• Extensive pre-license inspection by ASA trained team• Requirements for periodic as well as “for cause” inspections.• Commission has authority to suspend distribution and request product recall

Evidence of Physician Support

• 2013 New England Journal of Medicine poll of medical use• 76% of all votes* favor use of cannabis for medical conditions

*1,446 votes representing 72 countries an 56 states and provinces in North America

Evidence of Growing Supportfrom the Leukemia and Lymphoma Society

“LLS supports the medical use of marijuana by patients with serious medical conditions when it is prescribed by a health-care provider and permitted by state law. In a state where patients are permitted to use marijuana medically for serous and /or chronic illnesses and a patient’s physician has recommended its use in accordance with that state’s law and that state’s medical practice standards, LLS strongly urges that patients should not be subject to federal criminal penalties for such medical use.”