Cannabis for the Hospital Clinician-Slides

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This comprehensive document by Dr. Ryan Buck offers an extensive overview of cannabis from its historical roots to current medical applications and challenges for hospital clinicians. Cannabis has a long history dating back 8,000-10,000 years with medicinal uses documented in ancient China, India, the Middle East, Europe, and the Americas. Its medical acceptance in the U.S. spanned from 1851 until restrictive laws like the 1937 Marihuana Tax Act and the 1970 Controlled Substances Act classified cannabis as Schedule I, limiting research and medical use despite opposition from medical authorities.<br /><br />Pharmacologically, cannabis acts via the endocannabinoid system, involving CB1 receptors (mainly CNS) and CB2 receptors (immune cells), regulating functions including pain, appetite, mood, memory, sleep, and immune responses. The primary active phytocannabinoids are THC (psychoactive) and CBD (non-intoxicating), along with others like CBN, CBG, and CBDA, each with distinct actions and therapeutic potentials.<br /><br />Routes of administration include inhalation (rapid onset), edibles (long duration), sublingual tinctures, topicals, and transdermals, each with pros and cons regarding dosing accuracy, onset, and side effects. Dosing typically starts low with slow titration to avoid adverse effects such as anxiety, dizziness, or psychoactive symptoms. Safety considerations emphasize avoiding driving, alcohol, and certain drug combinations, especially perioperatively.<br /><br />The evidence supports medical cannabis use for pain, nausea/vomiting, and anorexia, particularly in conditions like cancer, multiple sclerosis, epilepsy, and chronic pain syndromes. Studies show cannabis may be as effective as opioids for chronic non-cancer pain and can reduce opioid use. Adverse effects are mostly related to THC’s psychoactivity, including impaired cognition and cardiovascular risks, especially in high doses or cannabis use disorder. Cannabis hyperemesis syndrome (CHS) is a notable complication managed primarily by cannabis cessation and symptomatic treatments such as topical capsaicin and dopamine antagonists.<br /><br />Drug interactions predominantly arise from CBD’s inhibition of cytochrome P450 enzymes affecting drugs like tacrolimus and warfarin. Clinicians must monitor levels and timing to mitigate interactions.<br /><br />In summary, cannabis presents potent therapeutic benefits with evolving evidence and regulatory status but requires careful dosing, awareness of adverse effects, contraindications, and potential drug interactions for safe clinical use. Reputable free resources cited provide further guidance for clinicians.
Keywords
cannabis history
medical cannabis
endocannabinoid system
THC and CBD
cannabis administration routes
cannabis dosing and safety
medical indications
cannabis adverse effects
drug interactions
clinical guidelines