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MEDICAL YEAR
IN REVIEW

There are also “Botanical” stores nation- antagonist, ap-
wide and of course internet sales sites. Buds peared as a
and flowers or the entire marijuana or hemp promising anti-
plants are rendered both physically and by obesity drug
distillation to purify the active chemicals and during clinical
often sold as an oil or resin as the plants trials but it also
yield terpenes (natural plant oils) and was implicated
cannabinoids. Legality remains a question in as a cause of
some states. This is a complicated issue in suicide. As a re-
Texas as all compounds containing THC are sult, the US
illegal, but hemp-based CBD is sold without Food and Drug
prescription or prosecution, subject to DPS’ Administration
Compassionate Use Regulations. did not ap-
The plant (or “weed” as some know it) prove Rimona-
has been cultivated and used by humans for bant for use in
recreational and medicinal for centuries and the US. Its sale
on many continents. More recently, the was also suspended across the European have substantial evidence supporting
study of cannabinoids has not been govern- Union in 2008. Recently, a clinical trial related cannabinoid efficacy. While herbal cannabis
mentally allowed or supported and its ther- to fatty acid amide hydroxylase (FAAH) in- has not met rigorous FDA standards for
apeutic value has been scientifically assessed hibitor, was discontinued due to the occur- medical approval, specific well-characterized
in only a few maladies. rence of serious adverse events in the cannabinoids have met those standards.
Research on the endocannabinoid system participating subjects. (ref 1-3) In Texas, where medical cannabis is legal
and substances that affect these biochemical Research is being carried out to explore for only certain diagnoses, physicians must
reactions and receptors reveal a system with and establish the therapeutic targets for both consider important patient selection criteria
possibly great potential to influence body cannabinoid receptor agonists and antago- such as failure of standard medical treat-
systems. Presently, it is known that endo- nists despite some negative effects in clinical ment for a debilitating medical disorder.
cannabinoids have a role in the pathophysi- trials related to drugs acting on endo- Medical cannabis patients must be informed
ology of many disorders. Conditions such cannabinoid system. One challenge is to de- about potential adverse effects, such as acute
as emesis, pain, inflammation, multiple scle- velop drugs that target only cannabinoid impairment of memory, coordination and
rosis, anorexia, epilepsy, glaucoma, schizo- receptors in a specific tissue, and another is judgment, and possible chronic effects, such
phrenia, cardiovascular disorders, cancer, to invent drugs that act selectively on as cannabis use disorder, cognitive impair-
obesity, metabolic syndrome related dis- cannabinoid receptors located outside the ment, and chronic bronchitis. In addition,
eases, PTSD, Parkinson's disease, Hunting- blood brain barrier. In addition, develop- social dysfunction may result at work or
ton's disease, Alzheimer's disease and ment of the suitable dosage forms with school and there is increased possibility of
Tourette's syndrome might be treatable by maximum efficacy and minimum adverse ef- motor vehicle accidents. Novel ways to use
drugs modulating the endocannabinoid sys- fects is also warranted. (ref 4) the endocannabinoid system are being ex-
tem. Presently, cannabinoid receptor ago- Cannabis sativa is used to alter conscious- plored to maximize benefits of cannabinoid
nists like nabilone and dronabinol are used ness. It contains over 500 distinct chemical therapy and lessen possible harmful effects.
for reducing chemotherapy-induced vomit- compounds, but the one of primary interest Marijuana has been used widely as an ap-
ing. Sativex (cannabidiol and THC combi- related to substance abuse is δ-9-tetrahydro- petite stimulant and antiemetic. Pure THC
nation) has been approved for use in the cannabinol (THC). In some people, it is the major active ingredient in marijuana,
UK, Spain and New Zealand to treat spas- causes hallucinations which may be debili- is the most psychoactive and is available by
ticity due to multiple sclerosis (in the US it tating. While some more randomized clini- prescription as dronabinol. In doses of 5–
is under investigation for cancer pain). cal trials are needed for some medical 15 mg/m2, oral dronabinol is effective in
Another drug, Epidiolex (cannabidiol), is conditions, other medical disorders like treating nausea associated with chemother-
also under investigation in the US for child- chronic cancer and neuropathic pain as wells apy, but it is associated with central nervous
hood seizures. Rimonabant, CB1 receptor as certain symptoms of multiple sclerosis, system side effects in most patients. Strains
continued on page 28
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