Unlocking the Therapeutic Potential of Medical Cannabis
While not currently legal everywhere, the use of medical cannabis has been expanding rapidly. So far, 33 states have approved medical cannabis programs. Medical cannabis in legal states can be provided to patients for purposes such as pain relief, to control nausea, and stimulate appetite. Medical cannabis has been made legal in the states surrounding Wisconsin, such as Illinois, Michigan, and Minnesota. Currently, products containing cannabidiol (CBD) without psychoactive levels of tetrahydrocannabinol (THC) are legally sold in Wisconsin, making it likely that healthcare providers will encounter patients who are consuming CBD “over-the-counter.”
On November 14, the Medical College of Wisconsin School of Pharmacy hosted a professional development seminar focusing on medical cannabis. The program, “Medical Cannabis: Unlocking the Therapeutic Potential from THC to CBD,” was attended by over 90 people. The seminar provided an overview of the therapeutic potential of medical cannabis, along with the current evidence supporting its use and its current legal status. The presenters focused on the main endocannabinoids, or chemical compounds, in cannabis, which are THC and CBD.
“The story starts with the cannabis plant. It has been used for many thousands of years and before recorded history for pharmaceutical uses in Eastern culture and in India,” says Cecilia J. Hillard, PhD, Associate Dean for Research and Professor and Director of the Neuroscience Research Center at the Medical College of Wisconsin. Dr. Hillard gave an overview of the cannabis plant and THC, with its currently available preparations and potential uses. THC is the phytocannabinoid responsible for cannabis’ psychoactive effects. THC is used to reduce nausea in patients receiving chemotherapy and to reduce spasticity associated with multiple sclerosis. However, research has shown that THC may not have much efficacy. “At the moment it’s hard to stand up and say as a pharmacologist that THC has a lot of therapeutic benefit,” says Dr. Hillard.
“The FDA approval of Epidiolex, a purified form of CBD, was followed by the emergence of a one billion-dollar cannabidiol-based industry. With the markets flooded with various CBD-based products, it is crucial for health care professionals to be educated on the therapeutic potential of CBD, available evidence for its effectiveness, reported adverse effects, as well as drug interactions. Such knowledge is vital for guiding the public using these widely available products,” says Abir T. El-Alfy, PhD, MS, Associate Professor in the Department of Biopharmaceutical Sciences at the Medical College of Wisconsin School of Pharmacy, who presented on the topic of CBD. There is evidence for CBD’s neuroprotective and anti-inflammatory activities. Dr. El-Alfy told a story about a multiple sclerosis patient who reported improvements in her symptoms from a CBD-based kombucha before her doctor prescribed her a CBD oil. But one major problem is the subjectivity of patients’ symptoms and to the difficulty of telling what improvements could be due to a placebo effect. However, CBD has been shown to be an effective therapy for Dravet syndrome and Lennox-Gastaut syndrome (LGS). There are also approximately 200 ongoing human clinical trials, which will likely reveal more potential applications.
Dr. Hillard and Dr. El-Alfy both concluded that more research and clinical evidence are still needed to fully understand the therapeutic benefits, adverse effects, mechanism of action of phytocannabinoids (or cannabis-based products).
“As more states are legalizing recreational and medicinal cannabis, pharmacists need to be aware of the implications on patient’s health especially with the recent deaths from vaping and use of THC. Also, due to the increasing availability of CBD, pharmacists need to be become aware of the potential drug interactions and side effects to keep our patients healthy,” says Karen J. MacKinnon, BPharm, RPh, Director of Outreach Programs and Assistant Professor in the Department of Clinical Sciences at the MCW School of Pharmacy.