Cannabioids.pdf

Cannabinoids - Cannabis contains approx. 500 molecules. - > 100 cannabinoids. - Additional components include terpenoids and flavonoids. - Di=erent cannabis strains have di=erent cannabinoid profiles. - Rimonabant (a CB1 receptor agonist) made it to market as a novel treatment fo...

Cannabinoids - Cannabis contains approx. 500 molecules. - > 100 cannabinoids. - Additional components include terpenoids and flavonoids. - Di=erent cannabis strains have di=erent cannabinoid profiles. - Rimonabant (a CB1 receptor agonist) made it to market as a novel treatment for obesity. - Several positive phase III trials in 2005 showed it reduced body weight, waist circumference, and improved the metabolic syndrome and insulin sensitivity. - Post-marketing surveillance increases incidence of psychiatric side e=ects including depression (2-fold increased risk) - Withdrawn from the market in 2008 due to serious psychiatric side e=ects. The major phytocannabinoids. - Derived from cannabis plant. Medicinal cannabis safety - Medicinal cannabis is generally well tolerated when dosed appropriately. - Need to consider carefully the THC and/or CBD content of the products. - CBD is not intoxicating and has fewer safety concerns than THC. - THC-containing cannabis products should not be prescribed to individuals who have a history of psychosis. How does cannabis work? - E=ects on our bodies natural cannabis system. - Involved in: o Sleep o Positive mood o Appetite and metabolism o Stress coping. o Analgesia THC is a partial agonist at CB1 and CB2 receptors. Endocannabinoids - Cannabis-like molecules in our brains and bodies. - - Paracetamol boosts the endocannabinoid system. In the brain, endocannabinoids act as retrograde messengers regulating the release of glutamate and GABA via CB1: maintaining equilibrium. How does CBD work? - Diverse pharmacological e=ects. - Not a CB1/CB2 agonist - Endocannabinoid booster. - 5-HT1A agonist - GPR55 antagonist - CBD as a pro-drug for an active metabolite. - PD and/or PK interactions with other drugs? - CBD increases inhibition via GABAA receptors. o GABA decreases neuron excitability. o Target of known anxiety and epilepsy drugs. Cannabis regulation: a focus on Australia - Cannabis is the most widely used illicit drug in the world. Cannabis-based therapies: a clash of ideologies - Conventional drug approval pathway. - Often single molecule. - Solid scientific foundation. - E.g. Sativex and epidiolex. - Direct pathway to market. - Multi-molecules. - science needs to catch up. Accessing medicinal cannabis in Australia. - The only registered cannabis-based medicine are Sativex (Nabiximols) and Epidiolex (CBD). - Since 2016 unapproved medicinal cannabis products can only be accessed through the TGA via: o 1. Authorised Prescriber Scheme (a doctor applies to TGA to prescribe to a class of patients) o 2. Special Access Schemes § (a) Category A (for terminally ill patients, notification only). § (b) Category B (requires doctor to apply to TGA and for an individual patient)