Cannabis and Inflammatory Bowel Disease

okay my name is Christina to bid my dad is from Quebec my mom is French French Acadian from Nova Scotia I was born in Moncton so I grew up as Chrissie noted bid now I live in Alberta so it's Christian to abide I have prescribed medical cannabis to 2,000 patients in my GI practice I probably have I'm gonna say maybe thirty patients on my own the 2,000 patients is was associated is associated with the medical cannabis clinic so I'm just gonna stick back here so you guys can see the screen here you're supposed to fixate on me and then read the screen to the left right so if I go here well it's not that I'm breaking the presentation rules here okay disclosures I do I'm a medical adviser for a company called true north agriculture and what we do is we we encourage Alberta farmers to switch some of their crops to hemp and then from the hemp we extract CBD oil and then we sell that CBD oil to licensed producers the company's three years old now I've also been a speaker for spectrum therapeutics as well so those are my disclosures so today we're going to talk about the endocannabinoid system the endocannabinoid system was developed in late 80s and the way that they found it was they exposed they were studying the cannabis and seeing what were they cannabis effects on the body and that's why they called it the endocannabinoid system cannabis does have an effect as you know just ask 22 year old surfer dude well cannabis does have an effect on several things your mood your sleep your pain perception so the endocannabinoid system as we're gonna see is a parallel system that is within you already you have cannibal cannibal you know cannabinoids compounds in you that are changing how you think changing your mood your sleep and whatnot and this system the endocannabinoid system that is win within you is working with you were like should I get up and should I go pee should I listen to this guy or you know it's it's changing how you think in your mood and you can take plant compounds cannabinoids from a plant such as the cannabis sativa plant marijuana plant or the hemp plant so these cannabinoids can go in your system and influence your mood your sleep your pain and whatnot so we're taking plant compounds to go into your own system okay so the outline of our talk today is we're going to overview the end of cannabinoid system we're going to talk very quickly on receptor distribution and physiological roles we're going to talk about medical cannabis safety very quickly on dependence overdose potential we're going to talk about medical cannabis efficacy so where does it work where should we take it which patients should be looking for the medical cannabis prescription chronic pain the opioid sparing potential and maybe some GI effects and then if there are any questions on dozing and administration so the endocannabinoid system that is within you already influences a lot of things they're mostly the brain and the central nervous system and also the immune system in the periphery so the brain the lungs the liver the bone the muscles the vascular system the spleen which is part of the immune system the pancreas digestive system the colon reproductive organs apparently you have better sex if you're high but that's a study that I read recently so that it would influence the reproductive system and then the immune system so the endocannabinoid system influences there's no pointer so the the way that like we have electricity in our brain and then this electricity then brings on biochemical reaction and the the chemical messenger between two neurons is called a neurotransmitter which has these red dots between the gap here so then the neurotransmitter which is dopamine serotonin you know like what I'm forgetting some but melatonin these types of thing these are brain chemistry neurotransmitters that we have in us that influences how you think your drive and whatnot so a teenager that just wants to watch TV all Dre has no Drive guess what low dopamine what dramatically increases dopamine cocaine you want someone extremely productive give them cocaine so brain chemistry influences how you think you have these chemists these blood chemistry's in you that are influencing your your reactions and then the cannabinoids then influence these chemistry so the cameras will then influence the dopamine the cannabinoids the THC in marijuana will then influence you know the serotonin so that's why you sleep better that's why you think differently so the brain chemistry the neurotransmitters are influenced by these plant cannabinoids compounds so then these are just the steps of the endocannabinoids so synthesis one as you see number one down there after the dopamine goes through then there's the release from the post receptor the the the lower receptor molecule then simulates the endocannabinoids and then they go back and influence whether if there's more more neurotransmitter or less that are produced so in the in the endocannabinoid system there's two cannabinoid receptors top left that's cannabinoid receptor one and this is an example of cannabinoid receptor 2 so cannabinoid receptor 1 cannabinoid receptor 2 in your body influences different things cb1 is more predominant in the brain and the central nervous system CB 2 is a little bit more predominant in the periphery which influences your immune system so we have cannabinoids in us already in the plant cannabinoids there's several cannabinoids over a hundred as you can see THC is the most the most famous one is the one we know the most CBD can have it cannabidiol CBD is another one is that a too boring for you dear or okay you didn't have to say that that's okay okay so cannabinoids there's over a hundred of them so if the plant has several cannabinoids THC is the most you know famous one of course but there's other ones too you see CBD a cbn a so there's potential for research in the future maybe CBG helps sleep more than THC so this is a very exciting time for cannabinoid research and because it's been illegal for so long there hasn't been a whole lot of research but now that it's it's coming to the forefront we're going to be able to research it better also with the cannabinoids in the plant there's other compounds that are called terpene these are plant compounds that's the lemon smell that's the pine smell so maybe a bit more pine influences the cannabinoids to make you sleep better or maybe the lemon flag terpenes make you enjoy that tree with mac concert more you know so the the planck compounds influences the cannabinoids so the terpenes are also important okay those are the plant compounds what is the plant contributing to the cannabinoids other compounds their sugar alkaloids phenols things that only a chemist would understand so those are are also within the plant but just remember that there's many cannabinoids the most famous is THC CBD is next also plant terpenes can influence you know the compounds or not and that's the difference between most likely buying your product at on the street under a bridge downtown which likely has very high THC no balance with CBD and terpenes who really knows okay well these licensed producers that are vetted and are producing a consistent product know the terpenes that they have and also influence the terpenes for what you're trying to get so if you want a compound that can help you sleep that they have the correct terpenes in the compound and that's why medical cannabis through a licensed producer is more consistent to have the same result just like a drug THC THC is a partial agonist of cb1 and cb2 which means that it enters and influences the receptor of cb1 and cb2 those are the two receptors of the cannabinoid system it gives you a euphoric effect it's a mixture of stimulant and depressant effects analgesics anti nausea it stimulates appetite especially in HIV patients patients who are very sick don't have any appetite have cancer so it can stimulate appetite I can also have some muscle relaxant properties elevate mood relaxation increased appetite but can also have some side effects paranoia I specifically remember twenty-two years old a trip to Amsterdam I was particularly paranoid so that was not a great side effect for me depression the anxiety there is a mild side effect on cardiovascular system there can be some flushing there can be some heart rate issues CBD which is cannabidiol cannabidiol is a bit of a break on the system it's a reducer of the THC side-effects it doesn't actually work the same way that THC does it changes how the receptor chain works so it doesn't actually like fit in the pocket like a baseball does in a glove it changes how you catch the ball okay it changes the shape of the hand when you're catching the you know the baseball I just thought of that allergy right now but anyway works pretty good negative allosteric modulator these are chemistry words of cb1 receptor and it stimulates other things such as a t PR v1 t PR v1 is stimulated by spices capsaicin cream and things like that noe for ik effects so if you take CBD before going to a Fleetwood Mac concert it won't change how you proceed the concert so I likely would Mac a lot so I'm gonna refer to that so in CBD also opposes THC so if you buy your medical your if you buy your cannabis under bridge downtown it will likely be pure THC pure sativa plant which is what kids in the street want if you're trying to do that for medical purpose you will most likely get the euphoric effect with the side effects because there's no CBD to balance that out that's where the CBD is important to balance out the THC side effects okay CBD does have until anxiolytics neuroprotective I have a young girl two years old at the Children's Hospital she kept on having seizures and seizures and seizures the neurologists are contacted me I gave her a lot of pure CBD she was out of the neuro intensive ICU after three days of being on CBD very high dose but it did get to break her epileptic seizures it also has analgesic effects antiemetic and anti-inflammatory components the safety of medical cannabis so we're always afraid of you know overdosing and you can see here that marijuana has an extremely low low affinity for the brain stem which is where your breathing apparatus begins so there's a little girl in Edmonton that ate some I don't know why her dad just had gummies hanging around but anyway she took she overdosed on gummi bears that had marijuana in it she went to the hospital and she left the next day after being observed she didn't die she did she died why because you still have a heart rate you still have breathing even if you overdose on cannabis heroin has the worst brain stem affinity so when you take heroin a lot of it goes to the brain stem and guess what you stop breathing so overdosing on cannabis is extremely rare and we probably have more people die every year of prescription medication death than marijuana deaths 400 people die every single day in North America due to prescribed medications cannabis very little why because it doesn't influence your breath and your heart rate addiction risk cannabis has it's a drug there is very little addiction risk it does exist mostly in young people that consume too much don't forget you that your brain is being formed until the age of 25 I don't prescribe medical cannabis THC in anyone less than 25 your brain is still being formed that's why a baby comes into this world so fat and round it's because their brain is being formed you get your subcutaneous fat and you go into your brain and you're forming brain connections and whatnot okay a monkey comes into this world thin because their brain is already formed they don't need to have some formation of their brain during their okay enough of the monkeys and stuff but back back back to cannabis cocaine alcohol heroin and nicotine nicotine is the number one gateway drug nicotine is pound per pound the most addictive substance that exists yeah nicotine I didn't say ordain dangerous this is addiction yeah so a limited series of adverse effects with cannabis cannabis cannabinoid based medicines 141 users of cannabis cannabis CBD based medicines 12.5 percent THC versus 215 controls with chronic pain for one year no increase in serious advance versus control no difference in cognitive function bio chemistry hematology non serious adverse events increase in cannabis users over after one year there was a significant improvement in the levels of pain remember that symptom distressed mood and quality of life so this was 141 cannabis users versus 216 controls THC adverse events very common dizziness drowsiness fatigue dry mouth I'm gonna say dry mouth is the most frequent coughing in phlegm especially if you smoke it which I don't recommend anxiety those are side effects if you don't balance out with CBD cognitive effects I did have an elderly gentleman that his Alzheimer's dementia worsen I'm not sure if it's the THC or just Estate euphoria blurred vision headache extremely rare the cardiovascular events orthostatic hypotension paranoia depression ataxia dis coordination tachycardia cannabis hyperemesis we do see each gastroenterologist probably sees 2 or 3 a year now it's usually young people that consume a great deal and too much of it for a long time and they do respond to capsaicin cream by stimulating the TPR v1 receptor and the emerge doc will give them Haldol which breaks it right then and there I don't recommend Haldol but you can also put some capsaicin cream which is a very spicy cream on there Valene also works ethicacy so in this review of the evidence national cannot academic of sciences and engineering in medicine there is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults so really pain is where medical cannabis works the best that's why I started prescribing it for my patients quality of life pain control and sleep review of the evidence Health Canada there is more consistent evidence of the efficacy of cannabinoids smoked vaporized cannabis or other forms of THC in a box now box see malls drone prescribed THC and treatment of chronic pain of various etiology especially in cases where conventional treatments have been tried and failed the Society for neuropathic pain this is for chronic pain you see that they suggest gabapentin tricyclic antidepressants which has a half-life of 36 hours by the way so you never really get rid of the drug you just keep on accumulating it half-life means it takes 36 hours to get rid of half of the drug I don't know if you notice but there's 24 hours in a day so the dosage in your body just keeps on growing so snr eyes those are antidepressants so they suggest gabapentin tricyclics or antidepressants tramadol opioids and then next cannabinoids most likely in the future cannabinoids are going to go up above opioids or tramadol for pain control cannabinoids are effective for reducing neuropathic pain this is for neuropathic like pins and needles either drug-induced chemotherapy induced or you know if you have like pins and needles all day long so tricyclic antidepressant opioids and these are the number needed to treat cannabinoids 3 point four so three point four people need to be treated with medical cannabis in order to have one person relieved of their neuropathic pain number needed to treat you saw that the Society for chronic pain suggested gabapentin first six people need to be treated with gabapentin so that one person will benefit the reason that cannabis is not higher up it's just because we don't have a history with it we're just starting to it just legalized doctors have been able to prescribe it for such a short time we don't have a lot of history but you see that just by looking at the number needed to treat the SSRIs and the gabapentin are actually much more difficult to treat seven people need to take it so that one person will benefit cannabinoid three-point-four people need to take it so that one person will benefit cannabinoids may have opioid stairing sparing effects heroin addicts that smoke pot consume less heroin because they're happier they don't need as much heroin to change their state very famous study in the 1970s called rat Park there's a psychologist from BC that gay brats full like you know amusement park and they could run they could play they could do over what they wanted and he gave them a choice of water or morphine and they chose water and then he put rats in a cage in a bunch of cages all they did all day was sit right there and he gave them water and morphine and guess what they took the morphine till they died so it's not the drug itself it's the conditions that we were replacing ourselves Portugal had a drug problem in 1991 and legalized all forms of drugs so they didn't victimize the drug users right they didn't make them evil they tried to help people understanding that it's the circumstances okay if you have twenty Bauman's a day you've got chronic pain it's going to wear you down for sure it's the environment so my thought process was let's not victimize people let's give them some quality of life people that have chronic pain and take opioids take less opioids if they also consume cannabis efficacy cannabis can impact the brain gut access to alter gut function through actions of the enteric nervous system the cb1 cb2 receptors they work in the gut function the the immune system of the gut the intestinal permanent barrier strength so through different actions that's how the cannabis can impact the brain gut access access through the enteric nervous system altering pain transmission possibly altering got barrier function also the immune like I mentioned and through the gut microbiota people that smoke pot even if they eat more or thinner in general because they changes their gut bacteria pot smokers eat more refined carbohydrates they snack more but in general they're thinner because it changes their gut their gut bacteria medical cannabis and GI cannabis and its derivative have been used in the treatment of GI motility IBD GI pain disorders reduced appetite such as cancer and HIV nausea vomiting again this National Academy of Sciences and engineering there is insufficient evidence to support or refute the conclusion that THC is an effective treatment for the symptoms of IBS irritable bowel syndrome at the University of Calgary we have applied for a grant a research grant to look at the specific IBS irritable bowel syndrome pain and diarrhea and CBD oil and a touch of THC at night so it's coming there is no evidence to either say yes or no so we want to answer that question Canadian Association of gastroenterology my good friend Chris Andrews he was the lead author evidence that use of cannabis is associated with objective measures of reduced inflammation is largely lacking so we're looking at inflammation here is lacking and limited to small studies with insufficient power to detect clinical relevance difference okay cannabis and cannabinoids may be helpful in GI symptoms to control especially short term use of refractory nausea vomiting diarrhea abdominal pain where conventional therapies have failed the European pain Federation cannabinoids based medicines can be considered as an individual therapeutic trial if established treatments have failed and careful analysis with multidisciplinary assessment you should have a talk with your doctor to see if this is right for you Crohn disease was statistically superior to placebo for pain relief but not in the induction of remission but this was a small trial low dose oral cannabinoid cannabidiol was not statistically superior for placebo for pain relief so CBD in a very small study has been not shown so we don't know CBD doesn't really work or if if just the dosage was wrong and my gut feeling get it no my gut no my gut feeling is that the dosage was very very small and that's why we did not see as any statistical significance so this is the the the trial on Crohn's randomized control trial THC smoked eight weeks placebo controlled only twenty-one patients the primary outcome was the Crone disease activity index did not induce complete remission but there was a statistically statistically I can't speak today I have a dry mouth significant clinical response I was up early at my daughter's hockey rink today and I just like I need coffee is like plus I've been on call for three weeks so there you go what was mean all that so so IBD clinical response there was a drop in the CDA I intend patients versus for patients in the placebo group and this was statistically significant no change in CRP there was no reduced pain better appetite better sleep so again quality of life indicators pain sleep and appetite no significant side effects no lasting clinical improvement though but there was no endoscopic assessment Cochran the Cochran is the way that you know a bunch of very savant doctors get together and decide whether Joan and I are going to move forward on a certain treatment recommendation the effects of cannabis and cannabis oil on Crohn disease and you see are uncertain thus no firm conclusion regarding efficacy and safety of cannabis and cannabis oil and adults with active CD or you see can be drawn IBD there was a nationwide study in the United States using diagnostic codes from 2002 to 2014 3.3 million patients with IBD 1% had cannabis use disorder or consume too much cannabis users increased from point three to one point two almost two percent over time mortality was actually less and cannabis users colectomy removing your colon was less in users blood transfusions actually last I have no idea why cannabis users required less blood transfusions hospital stay was the same for whether you smoke cannabis or not so you actually died less if you smoked cannabis in this nationwide study CBD in IBD 19 patients 11 were men oral CBD all 20 milligrams per day this was the dosage that I was saying that was non significant likely 20 milligrams per days is not enough in our IBS study we're gonna look at 20 milligrams twice a day so you see that we're not really sure we don't have a lot of studies cannabis was scheduled substance ride-alongs cocaine and heroin for the longest time so we didn't really study we didn't really have an opportunity to look at it I mean for the longest time you could drive to the liquor Depot go outside and drink yourself to death in the parking lot but if you had one gram of marijuana on you you'd go to jail I don't really understand this world sometimes I mean five major banks admitted to fixing the price of silver paid six hundred fifty million dollar fine and no one goes to jail but if you leave this building with ten grams of marijuana you're gonna go to jail there is currently no evidence to support the use of CBD in the treatment of IBD and low dose it does appears to be not harmful in IBD patients in higher dose acutely in healthy controls it may reduce intestinal permeability that's extremely high dose this is the study looking at intestinal permeability oral CBD 600 milligrams you remember that study that was non powerful enough 20 ml mm this is 600 milligrams that showed a decrease in intestinal permeability but 600 would be extremely expensive GI motility there is currently no evidence to demonstrate any benefit of cannabis in IBS or other GI sensory motor disorders recreational cannabis and bowel function this was a national health study again 10 to almost ten thousand respondents cannabis users was 12% constipation patients were non cannabis users were actually more constipated than patients that use cannabis diarrhea was the same in both groups there was a 30% reduction in constipation adjusted for age sex BMI education socioeconomic status tobacco use alcohol and other factors so it seemed to help constipation dozing and administration medical cannabis is contraindicated remember that the brain is being formal until the age of 25 so no THC if you consume too much THC too young for too long you start having language disorders and you start having you know less desire to move forward breastfeeding history of cannabis hyperemesis history of cannabis use disorder psychiatric unable a mood disorder if you have any psycho psychiatric illness like schizophrenia or psychosis you should not use cannabis untreated substance use disorders you're addicted to opioids but we've seen that patients that are on opioids you consume less opioids if they do take cannabis but if they have another substance abuse disorder we don't want to put another abuse disorder so that's why we screen it and we don't usually recommend it we recommend you being sober for six months before we start it thank you for the water relative contraindication and use of central nervous depressants having said that gabapentin is a central nervous system disorder depressant and we use it all the time for neuropathic chronic pain so this is relative cannabis use disorder just like any other disorder you're asking for more and more drugs most of the patients asking for medical cannabis aren't looking to get high aren't looking to escape reality they're looking for resolution of their quality of life do you want to sleep a little bit better so they're not asking for more and more and more and more one gram is correct me if I'm wrong about 2.5 joints most patients don't even take a joint they take half a joint in equivalent I suggest oils you can vaporize it as well but I suggest oils or you know other forms of absorption so if you're taking if you're asking for more and more your social network is saying that hey man you're consuming way too much here this is costing a fortune difficulty reducing the use you've got anxiety you've got problems when you withdraw you can't perform at work you can't perform at school you've got poor social functioning then you've got a disorder you're consuming too much alcohol you know other forms of medications so that is a problem and that's something that we screen for when we we prescribe it driving for hours after inhaling it six hours after consuming the oil you should not within those six hours you should not drive I tell that to patients so you take your cannabis THC at night at ten o'clock and then you drive the next day at 7:00 or something like that if you haven't at least six hours then you should be okay to drive if you don't feel like you should drive like you still feel dizzy and you're just starting out you probably took too much so then you should just call an uber it's not safe just like you're going to a party and you should pace yourself depending on your BMI at about one drink per hour you know if if you're on call at the hospital you don't drink at all so we all live with these we all you know take precautions when we we drive or when we're responsible for other people's lives travel advisory I wouldn't recommend traveling with it you can leave the Canadian border with your prescription you can travel anywhere in Canada with your medical cannabis prescription I wouldn't recommend going to the United States it usually depends on the hosting country but it's a pain in the butt so I wouldn't do it I wouldn't travel I don't recommend it but you can travel within Canada with your medical cannabis prescription if I have a patient on mecco cannabis and then they go to the United States they don't bring it with them and sometimes they go to states that are legal like in Arizona or Nevada and then they purchase it down there how does it work you go see your you go see your practitioner either your practitioner is comfortable prescribing medical cannabis or you go to a medical cannabis clinic harvest medical a 4/20 clinic in Englewood so these people are medical cannabis clinics or your doctor your doctor will then authorize a medical document saying this patient has chronic neuropathic pain this patient has chronic pain due to Crohn disease they've got difficulty sleeping they press they prescribe a medical document with a an amount so one gram per day up to one gram per day that medical document is then sent to a licensed producer spectrum cannabis Aurora broken coast these are companies that are approved by the government to produce medical cannabis for your benefit you then register with this company one prescription one licensed producer okay you can't take your prescription and or your medical document and go to 5/5 producers you go to one producer with one prescription so we usually give two prescriptions so that they can register with two companies because marijuana is cyclical sometimes that the product can go can go down so then you have the option to go somewhere else once you're registered the licensed producer will then send the product to your house that's how it works practitioner medical document registering with the license producing company and then the licensed producer will send a product to your house thank you [Applause] you

Channel: Crohn's and Colitis Canada

Views: 9,370

Rating: 4.878788 out of 5

Keywords: Cannabis, cannabis and IBD, Cannabis and Crohn's, Cannnabis and Colitis, Cannabis and Crohn's Disease, Cannabis and Ulcerative Colitis, Cannabis and Crohn's and Colitis, marijuana, weed for ibd, cbd, ibd

Id: TIMh2R49HgQ

Length: 36min 56sec (2216 seconds)

Published: Tue Dec 03 2019