A Presentation to Inform, Educate and Prepare Patients

By: James Van GeelenSponsored by Compassionate Care Center of Connecticut

Designed for Fairfield County Parkinson’s Disease Support Group

Medicinal Cannabis

and

Parkinson’s Disease

Research

Treatment

Education and Experience

The Process of Certification

Compassionate Care Center of CT

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PARKINSON’S DISEASE

Word Cloud

• The most common terms foundon the internet related to patientconcerns after being diagnosed withPD

• Medicinal Cannabis is a “whole-patient” medication, capable of alleviating a majority of these concerns

Compassionate Care of CT

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THE CHALLENGE OF MEDICINAL CANNABIS

Before We Get Started: A Disclaimer

The “Once in High School” Patient

QUESTIONS AND ANSWERS

LACK OF CLINICAL TRIALS

THE LAW

Please hold your questions until the end, unless..

THE “M WORD”

TREATMENT AS TRIAL AND ERROR

SOCIALSCIENTIFIC

NATURE OF CURRENT RESEARCH

A SHORT ANIMATION BY DR. SANJAY GUPTA, CNN’S CHIEF MEDICAL CORRESPONDANT

THIS IS YOUR BODY ON WEED

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PLAYING INTO THE PARADIGM

THC, CBD AND PARKINSON’S

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The Ideal Parkinson’s Medication

Modifies Disease Progression

Alleviates Motor Symptoms

Alleviates Non-Motor Symptoms

Tolerable Side-Effect Profile

Possibly MAOIs, Novel Neuroprotective Drugs

Levodopa, Sinemet, Dopamine Agonists, Psychiatric Drugs etc.

THC & CBD

THC

Very low-risk, tolerable side effects, may reduce the side effects of other therapies

Evidence for Cannabis’ Use for this Purpose in Animal and Anecdotal Studies

Examples of Current Medications

Very Few

WHAT WE KNOW, WHAT WE THINK WE KNOW

MODIFICATION OF DISEASE PROGRESS

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Is why. We have an idea, as Dr. Gupta mentioned in his video, THC has effects on dopamine concentrations. There are cannabinoid receptors all over the brain, and these receptors seem to be concentrated in a region important to Parkinson’s disease, commonly referred to as the basal ganglia. In fact, the globus pallidus and the substantia nigra pars reticulata, which are structures within the basal ganglia, are some of the most densely packed cannabinoid (THC) receptor areas in the human body. However, we would need a long term study to monitor these types of changes. In vitro, THC is directly neuroprotective, that has been established.

Long-Term Treatment May Delay Progression

Explanation: Cannabis or Antioxidant?

May prevent L-DOPA toxicity

Increase in Endocannabinoids due to Compensation

The Safety of Cannabis Long Term (Anecdotal)

Translation of Results

Cannabinoids are neuroprotectiveagainst 6-OH-DOPA

Higher Endocannabinoid levels in Untreated Patients’ CSF

The Endocannabinoid System in PD is severely dysregulated

CB2 Agonists (CBD) Reduced Nigrostriatal Neuronal Death

Cannabinoids reduce excitotoxicity, glial cell

activation, calcium influx, oxidative stress in animal

models

What we’d like to know

WE KNOW WE THINK WE KNOW

WHAT WE KNOW, WHAT WE THINK WE KNOW

ALLEVIATION OF MOTOR SYMPTOMS

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Eric Mandzuk is a patient at Compassionate Care Center who we have grown close with. He has had tremendous success using high CBD medicinal cannabis to treat his dystonia. He has come off of two medications, Sinemet and Baclofen, and has experienced an increase in quality of life that we wish we could promise to all of our patients. He has joined us tonight, please hear his story.

May reduce L-DOPA induced motor deficits

Anecdotal Reports from our Patients

Increase in Endocannabinoids due to Compensation

The Safety of Cannabis Long Term (Anecdotal)

Translation of Results

Cannabinoids reduce L-DOPA induced dyskinesia

Increased EndoCB Levels = Reduction in Tremor (Rats)

CB Receptors Decreased in PD

CBD is an antispasmodic and relieves muscle rigidity

A CLINICAL TRIAL!! (Vanderova 2004)Out of 45: 39 patients described substantial alleviation, 26 showed improvement of rest tremor, 38 had improvement in bradykinesia, 32 had alleviation of muscle rigidity

Our Friend Eric: An “Anecdotal” Report

WE KNOW WE THINK WE KNOW

WHAT WE KNOW, WHAT WE THINK WE KNOW

ALLEVIATION OF NON-MOTOR SYMPTOMS

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Chronic illness is, perhaps, one of the most psychologically taxing things a human being can go through. Being able to control the symptoms both caused by Parkinson’s Disease and the psychological reaction to it has been an astounding feat we have watched many of our patients achieve. Cannabis, unlike benzodiazepines or SSRIs or opioid painkillers, offer treatment for the many symptoms of PD such as anxiety, depression, fatigue, pain, insomnia and GI upset without the risk of inevitable withdrawal, further neurological damage or potentially lethal drug interactions.

Cannabis may help with GI symptoms in PD patients

Cannabis relieves stress

Cannabis relieves depression

The Safety of Cannabis Long Term (Anecdotal)

Genetic mutation in CB Receptors in PD may predispose to depression

CBD offers a non-psychoactive psychiatric answer

THC and CBD are both proven anti-inflammatory drugs

CB2 Agonists (CBD) Reduced Nigrostriatal Neuronal Death

Cannabinoids reduce excitotoxicity, glial cell

activation, calcium influx, oxidative stress in animal

models

Cannabis is the Safer Alternative

WE KNOW WE THINK WE KNOW

WHAT WE KNOW, WHAT WE THINK WE KNOW

TOLERABLE SIDE-EFFECTS

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Investigators at Tel Aviv University, Department of Neurology evaluated Parkinson’s disease symptoms in 22 patients at baseline and 30-minutes after inhaling cannabis.Researchers reported that inhaled cannabis was associated with “significant improvement after treatment in tremor, rigidity, and bradykinsea (slowness of movement). There was also significant improvement of sleep and pain scores. No significant adverse effects of the drug were observed.” Some of the symptoms of reduction were described as being caused by current treatment.They concluded: “[T]his observational study is the first to report an amelioration of both motor and non–motor symptoms in patients with PD treated with cannabis. The study opens new venues for treatment strategies in PD especially in patients refractory to current medications.”Israel has permitted for the licensed production and distribution of the substance for therapeutic purposes since 2011.

Cannabis may alleviate the side-effects of other meds

No recorded drug interactions

All of the benefits of dopaminergic modulation, none of the gambling or risky sex behavior?

Quality of Life is the most consistently significant increased finding in medicinal cannabis related research.

The Safety of Cannabis Long Term (Anecdotal)

There have been no direct lethal overdoses due to Cannabis

Cannabis elicits very little permanent change on the body

Only 3 out of 45 patients in that trial dropped out

Even if cannabis doesn’t replace your current

treatment, which it most likely will not, it may save you by

enabling dose reduction

Some Non-USA Data (Lotan, 2014)

WE KNOW WE THINK WE KNOW

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THE PROCESS OF MEDICINAL CANNABIS IN CT

GETTING CERTIFIED

You’ll Need

With your Physician

To Register Online Have these ready:

Confirm the:Qualifying patient must be a Connecticut resident.Qualifying patient must be at least eighteen (18) years of age or older.Qualifying patient cannot be an inmate confined in a correctional institution or facility under the supervision of the Connecticut Department of Corrections.

Government ID x 2

Proof of Residency

Bill, Mail etc.

Passport Photo

Physician BizNet

Physician -> Patient Responsibility

Begin Your Registration

Meet the Reqs

Discuss with your Doctor,

then

Consult with our Pharmacist

Get Your Card

THE RECIPE

USING CANNABIS AS A MEDICATION

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Once you have received your card in the mail and come to our dispensary, our skilled pharmacist will assist you in taking these steps to optimize your treatment plan with medicinal cannabis. This can be the most important step in your treatment plan, and it is important to go through it alongside your physician, dispensary and with subjective reports to find out exactly what works for you.

THE RECIPE

USING CANNABIS AS A MEDICATION

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Starting your Treatment

CHOOSE STRAIN

Inhaled

CBD

Sativa

Trial and Error

Orally administered cannabis lasts longer, has a more potent effect and may be better for those who wish to start on a treatment plan focused throughout the day.

Inhaled cannabis is for breakthrough symptomatic relief, and acts very quickly. We typically recommend vaporization over smoking.

Educated Guesses (being honest here!)

Indica

CHOOSE METHOD

Taken Orally

Indica strains provide a very relaxing effect that is helpful in treating general anxiety, body pain, and insomnia.

Sativa strains provide an uplifting, energetic effect, increasing feelings of well-being, stimulating creativity and, fighting depression.

THC

WE’RE AWARE THE PROCESS, THE INFORMATION, EVEN THE GENERAL IDEA CAN BE OVERHWLEMING. YOU’LL FIND IN YOUR FOLDERS HANDED OUT PLENTY OF RESOURCES – THE MOST IMPORTANT OF WHICH IS OUR PHONE NUMBER.

CHRONIC ILLNESSES SUCH AS PARKINSON’S ARE LIFELONG STRUGGLES THAT LEAVE PATIENTS OFTENTIMES FEELING LOST. NOBODY SHOULD EVER HAVE TO FEEL THAT. ADDITIONALLY, NOBODY WHO TAKES THE OPINION THAT ANY MEDICATION WHICH MAY HELP IS “FOR STONERS” SHOULD BE TAKEN SERIOUSLY – THIS IS A POINT OF VIEW LACKING SYMPATHY AND MORAL INTEGRITY (SOUND HARSH? I KNOW – BUT IT’S THE TRUTH IN OUR EYES).

AT COMPASSIONATE CARE CENTER YOU WILL FIND A TEAM OF HEALTHCARE PRACTICIONERSDEVOTED TO NOT ONLY YOUR HEALTH BUT YOUR WELLNESS. IF YOU SO DECIDE TO PROCEED, PLEASE STAY IN CONTACT WITH US. WE CAN’T WAIT TO KNOW YOU, AND HOPEFULLY GET YOU, BETTER.

QUESTIONS? WE HAVE ANSWERS, BUT FIRST…

CCC WANTS YOU TO BE KNOW THE FOLLOWING:

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