Chiropractic and Marijuana

Welcome!

Recognize groups and people of distinction

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Seminar objectives

Attendants will gain a good understanding of the new law and how it affects the healthcare delivery system.

Attendants will gain a deeper understanding of the complex nature of the human cannabis relationship.

Attendants will have a better grasp on a rapidly expanding body of research regarding cannabis and human ailments.

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Missouri Chiropractic Board of ExaminersDisclaimer

“Approval of this course in not acknowledgement or ruling by the Board that the methods taught in this course are recognized and approved by the board as the appropriate practice of chiropractic as defined in Section 331.010, RSMo.”

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Personal Disclaimer

Cannabis or medical marijuana remains a Schedule 1 Drug according to the Federal Government.

Senate Bill 420

This seminar is a guide only, and in no way grants any attendee license to practice outside their field of practice according to their state licensing board.

WHO Recommends rescheduling Cannabis 02/06/2019

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Darrel D Drumright DC, FASAChallenging Childhood

20’s - college, military, Chiropractic School

Acupuncture, Qi Gong, Mountain of Forever

Three oaths

Family and politics

Business model - ethics over profits - affiliations

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Definition of terms

Epigenetics - Epigenetics is the study of heritable phenotype changes that do not involve alterations in the DNA sequence. The Greek prefix epi-(ἐπι-"over, outside of, around") in epigenetics implies features that are "on top of" or "in addition to" the traditional genetic basis for inheritance.

Human Micro Biome Project - HMP The HMP has been described as "a logical conceptual and experimental extension of the Human Genome Project."[8] In 2007 the HMP was listed on the NIH Roadmap for Medical Research[9] as one of the New Pathways to Discovery.

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Definition of terms

Quantum physics The modern theory is formulated in various specially developed mathematical formalisms. The Wave form, Heisenberg’s uncertainty principle, quantum entanglement.

https://www.sciencealert.com/science-discovers-human-brain-works-up-to-11-dimensions

Calabi-Yau manifold - Planck’s scale

Chinese concept of Qi -

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Definition of terms

Chinese concept of Qi -

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Definition of termsDrug - Websters

1 a: a substance used as a medication or in the preparation of medication

b: according to the Food, Drug, and Cosmetic Act

(1): a substance recognized in an official pharmacopoeia or formulary (see FORMULARY sense 3)

(2): a substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease (i.e. prescription drugs, drugs for treating high blood pressure)

(3): a substance other than food intended to affect the structure or function of the body

(4): a substance intended for use as a component of a medicine but not a device or a component, part, or accessory of a device

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Definition of termsFEDERAL FOOD, DRUG, AND COSMETIC ACT [As Amended Through P.L. 115–271, Enacted October 24, 2018]

Food Drug and Cosmetics Act of 2018

Section 403(r)(6) of the Federal Food, Drug, and Cosmetic Act (the Act) (21 U.S.C. 343(r)(6)) requires that a manufacturer of a dietary supplement making a nutritional deficiency, structure/function, or general well-being claim have substantiation that the claim is truthful and not misleading.

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Definition of termsThe FDA - June 30, 1906 https://www.fda.gov/downloads/AboutFDA/History/FOrgsHistory/EvolvingPowers/UCM593440.pdf

Definition of herb - Merriam Webster

1. botany : a seed-producing annual, biennial, or perennial that does not develop persistent woody tissue but dies down at the end of a growing season

2. a plant or plant part valued for its medicinal, savory, or aromatic qualities planted parsley, basil, and rosemary in her herb garden.

The Cannabis Industry is Begging the FDA to regulate them

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Section 1 - Ethical Practices

Chiropractic and cannabis - above down inside out

Is cannabis a drug or an herb?

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History of humans and the herb Cannabis

Prehistoric evidence -

Global proliferation -

1937

1970

21st century

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History of humans and Cannabis

Prehistoric evidence - https://onlinelibrary.wiley.com/doi/abs/10.1002/jcp.27725 “We report through the centuries evidence of its use in numerous pathologic conditions especially for its anti‐inflammatory, antiseptic, and anti-convulsive properties that support the requirement to direct our present research efforts into the definitive understanding of its efficacy.”

The earliest evidence of Cannabis used by humans was 10,200 years old from Japan.

Emperor shennong 2737 BC in “The Great Herbal” to be helpful for constipation, gout, rheumatism and absent-mindedness.

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History of humans and Cannabis

2700 year old weed stash

The Indian Hemp commission of 1894.https://en.wikipedia.org/wiki/Indian_Hemp_Drugs_Commission

“In regard to the physical effects, the Commission have come to the conclusion that the moderate use of hemp drugs is practically attended by no evil results at all.”

“In respect to the alleged mental effects of the drugs, the Commission have come to the conclusion that the moderate use of hemp drugs produces no injurious effects on the mind.”

“In regard to the moral effects of the drugs, the Commission are of opinion that their moderate use produces no moral injury whatever. “

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History of humans and Cannabis

Arabic medicine used hemp seed oil to treat ear infections, skin diseases, flatulence, intestinal worms, nerve pain, fever and vomiting.

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History of humans and Cannabis

Galen, the Greek physician warned us of the excessive consumption of cannabis seeds.

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History of humans and Cannabis

J.R. Reynolds, personal physician to Queen Victoria wrote in the lancet in 1890 “ in almost all painful maladies I have found Indian hemp by far the most useful of drugs.”

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History of humans and Cannabis

Early American - by decree of King James I in 1619, The Virginia Company made every colonist grow 100 hemp plants for export. Hemp was such an essential crop that farmers could be fined for not growing it, even jailed during periods of shortage in the mid 1760s. You could pay your taxes with hemp seed.

“Hemp is of first necessity to the wealth & protection of the country.” -Thomas Jefferson

“Make the most you can of the Indian Hemp seed and sow it everywhere.” -George Washington

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History of humans and Cannabis1937 Marijuana Tax Act - In 1937, the U.S. passed the first federal law against cannabis, despite the objections of the American Medical Association (AMA). Dr. William C. Woodward, testifying on behalf of the AMA, told Congress that, "The American Medical Association knows of no evidence that marijuana is a dangerous drug" and warned that a prohibition "loses sight of the fact that future investigation may show that there are substantial medical uses for Cannabis.”

Harry J. Anslinger “By the tons it is coming into this country — the deadly, dreadful poison that racks and tears not only the body, but the very heart and soul of every human being who once becomes a slave to it in any of its cruel and devastating forms. ... Marihuana is a short cut to the insane asylum. Smoke marihuana cigarettes for a month and what was once your brain will be nothing but a storehouse of horrid specters. Hasheesh makes a murderer who kills for the love of killing out of the mildest mannered man who ever laughed at the idea that any habit could ever get him.” ...[13] In 1930, the 38 year-old Anslinger was appointed the founding commissioner of the Treasury's Federal Bureau of Narcotics.

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History of humans and CannabisThe 1960s saw radical changes in our society that threatened the status quo.

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1970 - The Controlled Substances Act (CSA) established federal drug policy under which the manufacture, importation, possession, use, and distribution of certain substances is regulated.

History of humans and Cannabis

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It was passed by the 91st U.S. Congress as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970 and signed into law by President Richard Nixon.

It classified drugs into five schedules.

History of humans and Cannabis

Schedule I

These drugs are the most dangerous. They don’t have mainstream accepted medical uses and have a high potential for abuse. These drugs include heroin, LSD, marijuana, ecstasy, and peyote.

Marijuana was and remains classified as a Schedule I drug even though a majority of states have approved it for medical use. (end of alcohol prohibition)

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History of humans and Cannabis

Schedule II

These drugs have a high potential for abuse and are also considered dangerous. Examples include cocaine, meth, methadone, Demerol, OxyContin, Adderall, and Ritalin.

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History of humans and Cannabis

Schedule III

These drugs have a moderate to low potential for physical and psychological dependence. This schedule includes Vicodin, Tylenol with codeine, ketamine, anabolic steroids, and testosterone.

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History of humans and Cannabis

Schedule IV

These drugs have a low potential for abuse and low risk of dependence, and include Xanax, Soma, Darvon, Darvocet, Valium, Ativan, and Ambien.

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History of humans and Cannabis

Schedule V

These drugs have the least potential for abuse and contain limited quantities of certain narcotics. These medications are usually used for antidiarrheal, antitussive, and analgesic purposes and may not require a prescription. Examples include cough syrups with limited amounts of codeine, Robitussin AC, Lomotil, Motofen, Lyrica, Parepectolin, etc

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History of humans and Cannabis21st century

US Patent No.; 6,630,507 B1 - “Cannabinoids are useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic. age-related , inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as alzheimer's disease, parkinson's disease and hiv dementia.” https://goo.gl/images/GTaZMq

Next big thing?

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FDA ApprovalsDronabinol, a pure THC isomer, is available as a prescription drug (Marinol, Syndros) as a schedule III drug for anorexia and wasting in AIDS and nausea/vomiting in chemotherapy patients.

Nabilone (Cesamet) in a schedule II synthetic cannabinoid with therapeutic us as an antiemetic and as an adjunct analgesic for neuropathic pain.

April 19, 2018: FDA advisory panel recommended Epidiolex for two forms of childhood epilepsy.

FDA is evaluating Sativex, a mixture of THC and CBD for spasticity of Multiple Sclerosis.

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History of humans and Cannabis21st century

California approves medical - 1996 proposition 214

Timeline of Cannabis laws

Next big thing?

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History of humans and CannabisAmendment 2 - Missouri 2018

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Section 1 - Sections of Article XXVI

Constitutional amendment via public petition

After years of attempting to get the legislature to pass appropriate laws, the people moved to the ballot initiative to pass amendment 2. This amendment was one of three medical marijuana initiatives on the ballot. Amendment 2 passed with nearly 75% while both of the other two failed to pass.

This is a wonderful testament to modern communication technologies helping people make informed choices at the ballot box.

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Section 1 - Sections of Article XXVI

The regulatory body that will govern this newly created branch of state government is the Department of Health and Senior Services.

Department of Health and Senior Services

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Section 1 - Sections of Article XXVIMarijuana defined by law -”Marijuana” or “Marihuana” means Cannabis indica, Cannabis sativa, and Cannabis ruderalis, hybrid of such species, and any other strains commonly understood within the scientific community to constitute marijuana, as well as resin extracted from the plant and the marijuana-infused products. “Marijuana” or “Marihuana” do not include industrial hemp containing a crop-wide tetrahydrocannabinol concentration that does not exceed three-tenths of one percent on a dry weight basis, or commodities or products manufactured from industrial hemp.

https://www.sos.mo.gov/CMSImages/Elections/Petitions/2018-051.pdf

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Section 1 - Sections of Article XXVI

“Marijuana-Infused Products” means products that are infused with marijuana or an extract thereof and are intended for the use or consumption other than by smoking, including, but not limited to, edible products, ointments, tinctures, and concentrates.

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Section 1 - Sections of Article XXVI

“Medical Marijuana Cultivation Facility” means a facility licensed by the Department to acquire, cultivate, process, store, transport, and sell marijuana to a Medical Marijuana Dispensary Facility, Medical Marijuana Testing Facility, or to a Medical Marijuana-Infused Products Manufacturing Facility.

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Section 1 - Sections of Article XXVI

“Medical Marijuana Dispensary Facility” means a facility licensed by the Department to acquire, store, sell, transport, and deliver marijuana, marijuana-infused products, and drug paraphernalia used to administer marijuana as provided for in this section to a Qualifying Patient, a Primary caregiver, another Medical Marijuana Dispensary Facility, a Medical Marijuana Testing Facility, or a Medical Marijuana-Infused Products Manufacturing Facility.

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Section 1 - Sections of Article XXVI

Testing facility

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Section 1 - Sections of Article XXVI

Physician and Physician certification

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Section 1 - Sections of Article XXVI

“Primary Caregiver”

Link to latest DHSS instructions for home grow.

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Section 1 - Sections of Article XXVI

Qualifying medical conditions - To be covered in depth in module 3

Cancer, Epilepsy, Glaucoma, Intractable migraines, unresponsive to other treatment, A chronic medical condition causing severe, persistent pain or persistent muscle spasms, including but not limited to those associated with multiple sclerosis, seizures, Parkinson’s disease and Tourette’s syndrome, Rehabilitation psychiatric disorders, including but not limited to, post traumatic stress disorder, if diagnosed by a state licensed psychiatrist, Human immunodeficiency virus or acquired immune deficiency syndrome, a chronic medical condition that is normally treated with a prescriptive medication leading to physical or psychological dependence, which a physician determines medical use of marijuana could be effective in treating and would serve as a safer alternative to the prescription medication Any terminal illness. In the professional judgement of a physician, any other chronic, debilitating or other medical condition, including but not limited to: Hepatitis C, Amyotrophic lateral sclerosis, Inflammatory bowel disease, Crohn's disease, Huntington’s disease, Autism, Neuropathies, Sickle cell anemia, Agitation of Alzheimer’s disease, Cachexia, Wasting syndrome.

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Patient Cards

PATIENT REGISTRATION

STEP 1: Get Physician Certification http://thegreenclinics.com/

A document signed by a physician stating

in their professional opinion, their patient

suffers from a qualifying medical

condition.

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Patient Cards

STEP 2: Patient Registers with DHSS

Once certified, patients register with the

state and receive a MMJ card allowing them

to meet with a dispensary / patient care

specialist (PCS).

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Patient Cards

STEP 3: Dispensary Recommends

Dispensary / PCS recommends form,

strain, dose and frequency based on the

qualified condition being treated

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Patient Cards

STEP 4: Participate in Follow Up

As health advocates, Physicians may

choose to participate in a feedback loop

from the patient to monitor and guide

treatment results.

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June 4, 2019, DHSS must have application forms available for individuals who wish to become “qualifying Patients”

July 4, 2019, DHSS must begin accepting these applications

The application for a qualifying patient must be accompanied by a physician certification that is less than 30 days old.

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Section 1 - Ethical Practices

4% Veterans benefits

Chiropractic care, access to medical marijuana.

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End of Section 1 -

The year of Hemp 2019

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Section 2 Bioactive Components

The cannabis plant has 100s of unique molecules that likely have active properties in the human biome. This section will cover 14 or so of the most understood components.

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Section 2 Bioactive Components

Strains - indica vs sativa

Historical definitions -

Sativa - the fiber type of cannabis with less than 1% THC

Indica - cannabis with THC from 1% upwards of 30%.

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Section 2 Bioactive Components

Strains - indica vs sativa

In common parlance: both words refer to THC bearing strains.

Sativa - narrow leafed and taller from tropical climes. Brings you up.

Indica - broad leafed and shorter from Afghanistan and Pakistan. Brings you down.

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Section 2 Bioactive Components

I agree with a growing cadre of academics that recommend we begin using these categories of cannabis going forward.

Type I - Primary CBD little to no THC

Type II - hybrid strains that contain both THC and CBD

Type III - Primary THC, little to no CBD

Terpenes, flavonoids and other components of cannabis are going to become more important as the science evolves.

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Many complex molecules

THCA, THC, CBDA, CBD, CBGA, CBG, THCV, CVN,

Terpenes - Alpha-pinene, Beta-myrcene, Beta-caryophyllene, Linolool, Terpenolene, Ocimene.

Flavonoids - Quercetin, catechins, Cannflavin A and B

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Section 2 Bioactive Components

THCA

The acidic form of THC that is non-psychoactive shown in both animal studies and anecdotal human reports. The limited research on THCA has demonstrated anti-inflammatory properties via decreased production of tumor necrosis factor alpha (TNF-a4) and inhibition of COX enzymes, and anti-nausea properties in mice at doses much lower than it’s neutral counterpart, THC. THCA does not appear to stimulate the CB1 or CB2 receptors, but some of its activity may be indirectly dependent on their function.

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Section 2 Bioactive ComponentsTHC

Delta-9-tetrahydrocannabinol (THC) is the most well-known and studied phytocannabinoid. THC is responsible for the psychoactive effects of cannabis, as well as many of the medicinal properties. THC works by interacting with the endocannabinoid systems CB1 and CB2 receptors. By stimulating these receptors, THC can mimic the function of the endocannabinoids our bodies produce to regulate physiology and maintain health.

Like endocannabinoids, the effects of THC vary in different bodily tissues. In the brain, THC can protect neurons, promote cell growth, regulate neuroplasticity (a process involved in learning and forgetting), and cause psychoactive effects including euphoria, changes in memory, mood, coordination, and perception.

THC has been shown to have numerous medicinal effects, including relief of pain, inflammation, spasticity, nausea, anxiety, itching, seizures, and much more. Due to decades of government oppression, most strains of medical cannabis contain predominantly THC and very low levels of the other cannabinoids, though breeders have been working hard to produce strains that contain higher levels of the other cannabinoids and their medicinal properties.

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Section 2 Bioactive Components

CBDA - Like THCA, scientists have not thoroughly explored the physiologic effects or therapeutic potential of cannabidolic acid (CBDA). CBDA has demonstrated anti-nausea properties in mice at very low doses and anti-inflammatory effects via COX enzyme inhibition. CBDA is a potent inhibitor of the COX-2 enzyme, the same mechanism of action as the drug Celebrex. It is likely that CBDA shares some of the diverse mechanisms of action and pharmacologic properties with its neutral counterpart CBD.

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Section 2 Bioactive ComponentsCBG and CBGA

Cannabigerolic acid (CBGA) is the precursor cannabinoid that is later converted into THCA, CBDA, or CBCA. Like the other cannabinoids, CBGA is decarboxylated into CBG by heat and time, but few cannabis strains have any significant amount of CBGA in the mature flowers. Some strains have been identified that lack the enzyme which converts CBGA into the other cannabinoids, and some growers have discovered techniques of early harvesting common strains to increase the yield of CBGA.

Very little research has explored the effects of CBG, and even less CBGA. CBG has low activity at the cannabinoid receptors, stimulates TRPV1, TRPA1, and a2-adrenergic receptors, and inhibits the uptake of the neurotransmitters serotonin, norepinephrine, and GABA. CBG has also been shown to relieve pain, erythema, and inhibit lipoxygenases, enzymes that produce inflammatory molecules, more potently than THC.

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Section 2 Bioactive Components

CBC

Cannabichromene (CBC) is also rarely found in substantial quantities in mature cannabis flowers. It has been shown to decrease pain and inflammation and to have strong antimicrobial effects. CBC also activates the TRPA1 receptor and weakly inhibits the reuptake of the endocannabinoid anandamide, but has very little activity at the CB1 or CB2 receptors. It causes sedation in dogs and rodents, but has not been shown to cause any psychoactive effects in monkeys or humans. There is some evidence that co-administration of CBC with THC could increase the effects of THC.

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Section 2 Bioactive Components

THCV

Tetrahydrocannabivarin (THCV) is also rarely found in substantial quantities in cannabis flowers, though some breeders have developed strains that emphasize this cannabinoid. On its own, it is considered 25% as psychoactive as THC, with a faster onset and shorter duration. In rats it has been shown to block the effects of THC at the CB1 receptor at low doses, but stimulate the receptor at higher doses, and is a partial agonist at CB2. It is being studied as a treatment for obesity and diabetes due to its effects on decreasing food intake and increasing energy expenditure.

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Section 2 Bioactive Components

CBN

Over time, THC oxidizes and is converted into cannabinol (CBN). Ultraviolet light and heat may accelerate this process. CBN is much less psychoactive than THC, and due to its lower potency, it has not been the subject of much recent research. Some patients report they prefer CBN-rich products for promoting sleep or relaxation without impairment, though others have infrequently reported higher concentrations of CBN associated with a stimulating effect. These reports are likely complicated by the breakdown and evaporation of other compounds in the herb, so without more research it is difficult to discern the therapeutic value of CBN itself. Even when cannabis is stored in ideal conditions, THC will gradually convert to CBN, and the medicinal effect will change over time.

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Terpenes

A category of bioactive non-polar volatile molecules found in cannabis and many other herbs and spices.

Pinenes, myrcene, caryophyllene, linolool, terpinolene, ocimine, are among the most researched among these.

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Pinenes

Alpha-pinene - C10H16

is a clear colorless liquid with a turpentine odor. Flash point 91°F. Less dense than water and insoluble in water. Vapors are heavier than air. Used as a solvent. Found in pine, this terpene may protect the brain from short-term memory effects of THC. Potent bronchodilator with antibiotic and anti-inflammatory. Has antitumor activity.

https://www.leafly.com/news/cannabis-101/what-is-pinene-and-what-are-the-benefits-of-this-cannabis-terpene

Jack Herer, Dutch Treat, Romunan, Blue Dream, Island Sweet Skunk, OG Kush, Strawberry Cough

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Beta-myrcene - C10H16

is a yellow oily liquid with a pleasant odor. Flash point below 200°F. Insoluble in water and less dense than water that is also found in hops, this terpene is an antioxidant, a muscle relaxant, a potent analgesic, and enhances the effects of sedative drugs.

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ACDC, Godfather OG, AK-47, Purps, Grape Ape, Chem #4

Limonene - C10H16 - https://pubchem.ncbi.nlm.nih.gov/compound/___-Limonene#section=Top

Limonene is an oral dietary supplement containing a natural cyclic monoterpene and major component of the oil extracted from citrus peels with potential chemopreventive and antitumor activities. Although the mechanism of action has yet to be fully elucidated, limonene and its metabolites perillic acid, dihydroperillic acid, uroterpenol and limonene 1,2-diol may inhibit tumor growth through inhibition of p21-dependent signaling and may induce apoptosis via the induction of the transforming growth factor beta-signaling pathway. In addition, they inhibit post-translational modification of signal transduction proteins, resulting in G1 cell cycle arrest as well as differential expression of cell cycle- and apoptosis-related genes.

Limonene is a solvent that dissolves light grade plastics and should not be stored or shipped in plastic.65

Super Lemon Haze, Durban poison, Jack Herer, Barry White

Uplifting and stress relieving

Beta-caryophyllene C15H24

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2449371/

This pale yellow oily liquid with an odor midway between odor of cloves and turpentine is also found in black pepper, oregano and copaiba, this terpene is functions as cannabinoid and activates the CB2 receptors. Strongly anti-inflammatory.

In 2008, the Swiss scientist Jürg Gertsch documented beta-caryophyllene’s binding affinity for the CB2 receptor and described it as “a dietary cannabinoid.” It is the only terpenoid known to directly activate a cannabinoid receptor.

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Girl Scout Cookies, Deathstar, Original Glue, Candyland, Bubba kush, Durban poison

Linolool

Colorless to pale yellow liquid Odor similar to that of bergamot oil and French lavender that is found in lavender, Cinnamon, Mint leaves, Birch trees, Goldenrod, Rosewood, Mugwort, Some fungi

this terpene has analgesic, anti-anxiety, sedative, and anesthetic effects. Recently showing some anticancer properties.

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Pure Kush, Pink Kush, Amnesia Haze, Lavender, LA Confidential, and OG Shark

Terpenolene - https://pubchem.ncbi.nlm.nih.gov/compound/11463

TERPINOLENE is a water-white to light amber colored liquid. Insoluble in water and less dense than water. Used to make plastics and resins. Also found in allspice, tea tree, blackcurrant buds, and juniper. This terpene shows preclinical evidence of antibacterial activity and possible antitumor effects.

https://www.leafly.com/news/cannabis-101/benefits-of-cannabis-terpenes-ocimene-terpinolene-and-guaiol

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Jack Herer, Pineapple Jack, J1, Super Jack. Lemon Sour Diesel, Afghani, and Jean Guy.

Ocimene

Also found in sweet basil, allspice, mint, parsley, mangoes, orchids, oregano and tarragon, ocimene is commonly used in perfumes and fragrances. This terpene is a potential antibacterial, although its pharmacology is uncharacterized. It is associated with strains that are considered uplifting.

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Golden Goat, Strawberry Cough, Chernobyl, and Space Queen. At Tilray, strains currently displaying high concentrations of ocimene include OG Kush, Elwyn, and Lemon Sour Diesel.Asian fantasy, In the pines.

Entourage Effect

Understanding the entourage effect is critical to proper clinical practice with medical marijuana.

video

https://en.wikipedia.org/wiki/Entourage_effect

Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects Ethan B Russo

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Section 2 Bioactive Components

Delivery Systems

Inhalation - Onset 1-5 minutes Duration 1-4 hours

Tinctures - Onset 5-30 minutes Duration 1-6 hours

Topicals - Onset within 1 hour Duration 6-12 hours

Engestables - Onset 2-3 hours Duration 6-8 hours

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Section 2 Bioactive Components

Delivery Systems

Inhalation - Onset 1-5 minutes Duration 1-4 hours

According to a University of Mississippi study, cannabis smoke contains 1,500 different chemicals including some known carcinogens.

However, Donald Tashkin of the University of California, LA found long term chronic cannabis smokers did not have increased incidence of head, neck, or lung cancers. Cannabis cigarettes only deliver 27 percent of it’s available THC.

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Section 2 Bioactive Components

Delivery Systems

Inhalation - Onset 1-5 minutes Duration 1-4 hours

To get a minimum dose of THC requires 2.5 mg. To get this dose at a 25% efficiency you will need one third of a gram of cannabis containing 15% THC.

In other words 1 gram of 15% THC will provide 3 minimal doses if you smoke it.

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Section 2 Bioactive Components

Delivery Systems

Inhalation - Onset 1-5 minutes Duration 1-4 hours

Vaping - Vaporizers heat cannabis to a temperature at which the active ingredients boil off and form a vapor, (Hazekamp demonstrated optimal temp is 393 degrees) but below the temperature at which the these ingredients combust thus preventing many of the carcinogenic chemical created during combustion.

Care must be taken using vaporizers, because the taste is more tolerable it is easy to over medicate.

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Section 2 Bioactive Components

Delivery Systems

Tinctures - Onset 5-30 minutes Duration 1-6 hours

Typically created by soaking cannabis in grain alcohol then pressed. Cannabis tinctures can reach concentrations of 100 mg of cannabinoids per milliliter when dissolved in sesame oil. This makes them extremely potent. Great care must be used to prevent over medication.

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Section 2 Bioactive ComponentsTinctures - making your own tincture

1. 1 oz high quality cannabis flower ex. 15% THC.2. Place flower in a bowl and put in freezer for 24 hours to dry it.3. Tightly seal dried cannabis in aluminum foil pouch of about .74 inches thick.4. Place pouch on a cookie sheet in the oven at 315 degrees for 7 minutes.5. Finely grind cooled cannabis.6. Place cannabis in mason jar and cover with 1 pint high proof alcohol.7. Place jar in freezer for three hours, then shake and repeat regularly for a few days.8. Stain through a coffee filter squeezing out the ethanol.9. Store in light proof bottle in the refrigerator.

10. You can add a couple Tablespoons of honey to help with the taste.

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Section 2 Bioactive Components

Delivery Systems

Topicals - Onset within 1 hour Duration 6-12 hours

Topicals

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Section 2 Bioactive Components

Delivery Systems https://healer.com/

Ingestibles - Onset 2-3 hours Duration 6-8 hours

Gastro-uptake edibles have a bioavailability of between four and 12 percent with an average of around 6 percent. This means that only about six percent of a product's total cannabinoid content will get absorbed into the bloodstream.

This method of absorption takes longer for the effects to be felt sometimes up to an hour or more due to all the processing it must endure, the experience typically lasts longer, making it ideal for those dealing with chronic pain

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Literature review of therapeutic effect if cannabis.

Section 3

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Section Three American Psychiatric Association, 2013 DSM-5 - Cannabis Use DisorderUse for at least 1 year with at least 2 of the following symptoms accompanied by significant impairment of functioning and distress

1. Using larger amounts over longer periods, 2. repeated failed efforts to quit, 3. spending much of their time dealing with pot, 4. cravings, 5. continued use despite adverse consequences, 6. use in dangerous situations, abandoning other life priorities to smoke, 7. Use with chronic health issues attributed to use, 8. Increased tolerance, 9. Withdrawal.

2. Mild - 2-3 symptoms, moderate 4-5 symptoms, severe >6 symptoms

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Opioid Crisis

https://www.webmd.com/pain-management/news/20100830/marijuana-relieves-chronic-pain-research-show#2

NSAIDS - cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke. This risk may occur early in treatment and may increase with duration of use. GI includes bleeding, ulceration, perforation of stomach and intestine, can occur at any time, elderly are at higher risk. Long=term administration has resulted in renal papillary necrosis and other renal injury as well as hyperkalemia even in the absence of kidney disease. Never take with ACEI - diuretic, hepatotoxicity, fetal toxicity

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Opioid Crisis

https://www.webmd.com/pain-management/news/20100830/marijuana-relieves-chronic-pain-research-show#2

Dunn (2010) Ann Intern Med, Jan 19; 152(2): 85-92 There is no completely safe opioid dose.

The Sadler family

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Section Three - Conditions treated

The research is coming in fast and furious. Decades have been lost for valuable research into the medicinal benefits of this plant. The following is a list of human issues that have been studied to some degree.

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Section Three - Conditions treated

Seizure Disorder - 30% of epilepsies do not respond to currently available drug treatments. Epilepsia. 2014 Jun; 55(6): 791–802. Cannabis and Δ9-THC are anticonvulsant in most animal models but can be proconvulsant in some healthy animals. CBD is anticonvulsant in many acute animal models but there is limited data in chronic models. Studies in the U.S. of Epidiolex (a plant-based CBD formulation) have been ongoing for a number of years. Data from these studies has helped provide evidence that led to the FDA approval of this product on June 25, 2018.

Tourette’s SyndromeResults from this study corroborate previous data suggesting that in patients suffering from TS, treatment with Delta(9)-THC causes neither acute nor long-term cognitive deficits.

Recommended strain: ACDC, Harlequin, Dance World, Sour Tsunami, Linalool terpene is anticonvulsant84

Section Three - Conditions treated

Cannabis Kills MRSA

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Section Three - Conditions treated

Glaucoma Although marijuana is thought to lower eye pressure, its effects are short lived at only 2-3 hours, which means around the clock lowering of pressure would results in consumption 6-8 times daily, which could be costly, time consuming or simply unreasonable.

Recommended strain: OG Kush, Hashplant Haze, LAPD, Mad Dawg

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Section Three - Conditions treated

Intractable Migraines Cannabis has been used to treat migraines for centuries. Between the years of 1874 and 1942, it was among the most prominent remedy used by physicians.

Research suggests that cannabis’ effectiveness for migraine relief can be attributed to the cannabinoids contained in cannabis. Cannabinoids interact with the CB1 and CB2 receptors of the body’s endocannabinoid system, which in turn inhibits responses of the trigeminovascular system and restricts the inflammation that causes migraine pain.

Recommended strain:

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Section Three - Conditions treated

Chronic medical condition with severe pain or muscle spasm.

Lee et. al. DOI: 10;1016/j.pain2012.09.017 A brain imaging study at the University of Oxford performed a small scale interventional study, (60 participants) were participants actively consumed 15 mg tablets of THC after receiving a chemical burn with capsaicin. With THC people reported experiencing the same pain level, but the pain bothered them less. The change in pleasantness of pain was matched with a suppression of activity in the anterior mid-cingulate cortex. This structure is implicated in the emotional aspect of pain. An increased activity of the right amygdala primed by pain correlated well with THC’s change in effect of experienced pain.

Lyme’s Disease

Recommended strain:

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Section Three - Conditions treated Debilitating psychological disorder

Anxiety Disorder

Attention Deficit Hyperactivity disorder

Autism spectrum

Bipolar Disorder

Depression

Post Traumatic Stress Disorder

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Section Three - Conditions treated

Autoimmune Disorders

HIV/AIDS alternative to both routes might be a smokeless inhaler that delivers cannabinoids in an easily absorbed aerosol spray. Such devices, which are already used to administer antihistamines and asthma medications, might allow people with AIDS and other chronic conditions to benefit from marijuana's active ingredients.

Recommended strain:

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Section Three - Conditions treated A chronic condition usually treated with addictive medications

Arthritis - Cannabidiol, extracted from Cannabis sativa, selectively inhibits inflammatory hypermotility in mice

Chronic Fatigue Syndrome

Fibromyalgia The endocannabinoid (eCB) system is involved in processes as diverse as control of appetite, perception of pain and the limitation of cancer cell growth and invasion.

Neuropathy

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Section Three - Conditions treated Any terminal illness

Alzheimer’s - The Potential Therapeutic Effects of THC on Alzheimer's Disease

Amylotropic Lateral Sclerosis

Cancer watch video

Harvard University Finds Cannabis Cuts Tumor Growth in Half in Three Weeks

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Section Three - Conditions treated Any terminal illness

Multiple Sclerosis - It is well known that endocannabinoids regulate neurotransmission, phytocannabinoids memic endocannabinoids and regulate the dysfunctional neurotransmission that underlays spasticity.

No evidence that cannabis cures MS, but it is very helpful for symptom relief.

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Section Three - Conditions treated Any terminal illness

Br J Pharmacol. 2011 Aug; 163(7): 1495–1506

Parkinson’s Disease - symptom-relieving and neuroprotective effects of the phytocannabinoid Delta 9-THCV in Animal Models of Parkinsons's Disease

CONCLUSIONS AND IMPLICATIONS

Given its antioxidant properties and its ability to activate CB2 but to block CB1 receptors, Δ9-THCV has a promising pharmacological profile for delaying disease progression in PD and also for ameliorating parkinsonian symptoms.

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Section Three - Conditions treatedAny other condition in the professional opinion of a physician

Stress - 2017 study at U Illinois found THC is small quantities between 0 and 7.5 mg lessened the stress of a public-speaking task, while increasing the dose to 12.5 mg lead to abrupt increase in anxiety as provoked by a public speaking task.

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Section Three - Conditions treated

Dosing - complex nature of the plant requires a good understanding of the entourage of each strand. This is seriously a work in progress.

Patients must be involved in finding their optimal dose. Good records at the dispensary will be invaluable aide in this process.

Optimal dose and method of application will give the desired effect for adequate duration with the fewest side effects.

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Bidirectional Effect

Each patient must be monitored carefully during the initial phase of treatment. Finding optimal doses and entourage blend will take some trial and error.

Different patient have the potential to react in completely opposite directions with the same strain.

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Where do we go from here?

Chiropractors are natural leaders in the revolution of plant based medicines.

Dr. Weaver

Cannabis is a powerful and safe herbal supplement that every chiropractic physician should have a good understanding of.

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Seminar objectives

Attendants will gain a good understanding of the new law and how it affects the healthcare delivery system.

Attendants will gain a deeper understanding of the complex nature of the human cannabis relationship.

Attendants will have a better grasp on a rapidly expanding body of research regarding cannabis and human ailments.

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Hidden Easter Egg about Cannabis

Thank my staff and vendors.

hypnosis

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