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Marijuana Use - Medical, Health, and Legal Issues (III)

Marijuana Use - Medical, Health, and Legal Issues (III)

August 15, 2019

William J Stilling, BS Pharm, JD - Founding Partner, Stilling & Harrison, PLLC and Clinical Associate Professor, Department of Pharmacy Practice at the University of Utah College of Pharmacy - talks to us about some of the legal issues related to the medical and recreational use of marijuana.

Key Lessons:

  • Marijuana (in its raw form) is a schedule I substance under Federal Law.  However, the US Congress has prohited the Department of Justice from using its funds to enforce Federal law superceding State laws related to marijuana.
  • Medical marijuana is typically legal to use under State laws only in specific "use cases" or "qualifying conditions."  Physicians and other prescribers can't legally prescribe marijuana because it would violate their DEA issued license but may "recommend" or "authorize" the use of marijuana.
  • Healthcare instutitions need to consider the use of marijuana for therapeutic purposes by their patients and develop clear policies and procedures on how marijuana use will be accommodated in their facility.
  • Pharmacists and pharmacies are subject to oversight by the board of pharmacy and most state boards require pharmacists to abide by Federal laws.  Thus, pharmacists who use marijuana, even for "legal" therapeutic purposes, may be subject to sanctions and lose their license to practice.
  • Employers may terminate a pharmacist or health professional for marijuana use because it is a violation of Federal law.
  • The FDA is unlikely to approve marijuana (in its raw form) for medical indications because it can not be easily studied or standardized.
  • The legal status of marijuana in the years to come will be significantly impacted by political and economic forces.

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Marijuana Use - Medical, Health, and Legal Issues (II)

Marijuana Use - Medical, Health, and Legal Issues (II)

July 18, 2019

Laura Borgelt, Pharm.D., BCPS - Professor, Departments of Pharmacy Practice and Family Medicine at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - talks to us about the recreational use of marijuana and its potential health consequences.

Key Lessons:

  • Cannabis (marijuana) use has increased substantially in the past decade.  Young adults are the most likely to report using marijuana in the past year or month but use among older adults (age > 65 years) is growing as well.
  • Its important to ask patients in a non-judgmental, open-ended manner about their cannabis use including the intended purpose(s), frequency of use, and forms used.
  • Numerous cannabis products are available. Inhaling (smoking or vaping) remains the most common method for use.  Edible products are available in a wide variety of food-like delivery systems (e.g. baked goods, candies).  Topical products are more commonly used for medical purposes.
  • The THC concentrations found in cannabis products today are much higher than years ago. This has resulted in higher rates of unintentional overdoses leading to paranoia and psychotic symptoms. Overdosing is most common with edible products due their delayed absorption.
  • There are several short-term and long-term health consequences related to marijuana use. Regular cannabis use can lead to neurocognitive effects including impaired memory. Cannabis use is more likely to have a detrimental impact for adolescents and young adults. Cannabis use during pregnancy also appears to have detrimental neurocognitive effects on children.
  • There are several potential drug-drug interactions with THC and medications metabolized through CPY2C9 and CPY3A4 as well as receptor interactions.
  • Pharmacists have an important public health role by screening for cannabis use, educating patients about the potential risks associated with marijuana use, and identifying potential drug-drug interactions.

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Marijuana Use - Medical, Health, and Legal Issues (I)

Marijuana Use - Medical, Health, and Legal Issues (I)

June 18, 2019

Kari Franson, Pharm.D., Ph.D., BCPP - Associate Dean for Professional Education at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - talks to us about the medical use of marijuana, THC, and CBD.

Key Lessons:

  • Cannabis plants have been used for medical, recreational, and industrial purposes for thousands of years.
  • The two active ingredients in cannabis plants include tetrahydrocannabinol (THC) and cannabidiol (CBD) - collectively known as cannabinoids.  They have distinctly different pharmacological properties.
  • Cannabis plants that contain less than 0.3% of THC by dry weight are legally classified as hemp.  Cannabis plants can be cultivated to have more (or less) THC and CBD content.
  • Prescription products containing THC have been available for more than 30 years. A buccal spray containing THC + CBD has been approved (but not in the United States) for the treatment of muscle spasms/stiffness associated with multiple sclerosis.  A purified CBD product was approved by the FDA for the treatment of rare childhood seizure disorders in 2018.
  • There is a long list of claimed medical uses of marijuana (typically contains high concentrations of THC).  Not all claims are supported by sufficient evidence and some have been refuted by the evidence.  Far less is known about the medical uses of CBD.
  • Cannabinoids are erratically and slowly absorbed from the GI tract.
  • There are substantial legal barriers to studying cannabis and its health consequences in the United States.

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