Cannabis Empirical Facts for Medicals

byProf. Dr. Musri Musman, M.Sc.

Professor of Natural Products ChemistrySyiah Kuala University, Banda Aceh

Presented at the Annual Scientific Meeting of Perhimpunan Dokter SpesialisKedokteran Jiwa Indonesia (PIT PDSKJI),

7-19 November 2018Indonesia Convention Exhibition, ICE, BSD, Tangerang.

Chemicals of Medical Cannabis 1269 known chemical compounds in/on Cannabis Cannabinoids (144 known in Cannabis) THC, CBD, CBN, CBG, CBC, THCV, etc. THCA, CBDA, CBGA, CBCA, etc. Diverse array of therapeutic effects

Terpenes & Terpenoids (150 known in Cannabis) Limonene, Linolool, Pinene, Myrcene, b-Carophyllene Smell attributes and diverse therapeutic effects

Flavonoids (50 known in Cannabis) Apigenin, Cannflavin-A, Kaempferol, Vitexin, Orientin Very strong anti-oxidants – diverse therapeutic effects

Most Common in Compositions

Cannabinoids THCA, THC, CBDA, CBD, CBGA, CBG, CBN Some on plant ratios of 2:1, >20:1, 3:2 Edibles = array of ratios, common 1:1 THC:CBD

Terpenes & Terpenoids Limonene, Linalool, Pinenes,

β-Myrcene, β-Caryophyllene Diverse effects – modulates cannabinoids Ensemble Effect – they are all important

Whole Plant is Superior Medicine Single chemical entity not very effectiveMarinol® (Dronabinol) – only THC

Two chemicals have better effect than just 1 Sativex® - approximately 1:1 THC:CBD

Cannabis Plant has many compositions!MORE THAN JUST THC and CBD!! Ensemble Effect hugely important

What is the Cannabis CompositionMore than 1+1 = 2 – Synergy FactorWildly different from product to product

Cannabinoids – A Broad TermPhytocannabinoidsCannabis sativa L. ProducedTHCA, CBDA, CBGA, CBCA, etc.

Cannabinoids – A Broad TermProcessed CannabinoidsDecarboxylation has occurredProcessing, Storage, Vaporization

O

OH

HO

OH

HO

OH

HO

O

CBG

THC CBD

CBC

Plant Production of CannabinoidsOH

HO

OH

O

Olivetolic Acid (OVA)

OPP

Geranyl Pyrophosphate (GPP)

Geranyl pryophosphate:olivetolic acid geranyltransferase (GOT)

HO

OH

OH

O

Cannabigerolic Acid (CBGA)

Plant Production of Cannabinoids

Decarboxylation With Heat

THC Oral Metabolism

O

OH

O

OH

11-Hydroxy-THC

HOTHC

O

OH

11-Nor-9-Carboxy-THC

HO O

•Swallowed(not felt)

•Feltpsychoactive

•ExcretedNon-psychoactive

Broa

d Ba

sed

Med

ical

Util

ityN

umer

ous

pote

ntia

l ailm

ents

can

be

alle

viat

ed

Izzo, et. al., Trends in Pharmacological Sciences 10, 515-27 (Oct 2009)

Preclinical research identifies a range of possibletherapeutic effects from phytocannabinoids

Cannabinoid Intoxicates? Possible Medicinal Application

THC √ Nausea and Vomiting, Muscular Spasms, PTSD, Pain,Cancer, Inflammation,

CBD x Epilepsy, Psychosis, Anxiety, PTSD, Addiction,Dementia, Cancer, Insomnia

CBDA x Epilepsy, Nausea and Vomiting, CancerCBDV x EpilepsyTHCA x Nausea and Vomiting, EpilepsyTHCV x Diabetes, Obesity, Pain, Inflammation, EpilepsyTHCVA x Under investigationCBG x Glaucoma, Cancer, Inflammation, Anxiety,

Huntingdon’s DiseaseCBGA x Under investigationCBN x Anxiety, Insomnia, Epilepsy, Anti-bacterial effectsCBC x Pain, Inflammation, Cancer

Cannabis for medical treatment:1. alcohol abuse

2. attention-deficit hyperactivity disorder (ADHD or AD/HD)

3. amyotrophic lateral sclerosis

4. collagen-induced arthritis

5. rheumatoid arthritis

6. Asthma

7. Atherosclerosis

8. Autism

9. bipolar disorder

10. childhood mental disorders

11. colorectal cancer

12. Alzheimer

13.skin tumors

14.depression

15.diabetic retinopathy

16.dystonia

17.epilepsy

18.digestive diseases

19.gliomas

20.hepatitis C

21.huntington's disease

22.hypertension

23.urinary incontinence

24. leukemia

25.morning sickness

26.methicillin-resistant Staphylococcus aureus (MRSA)

27.parkinson's disease

28.pruritus

29.posttraumatic stress disorder (PTSD)

30.sickle-cell disease

31.sleep apnea

32. lung cancer and chronic obstructive pulmonary disease

33.breast cancer

34.HIV/AIDS

35.brain cancer

36.opioid dependence

1. Acute Gastritis; Adenomyosis; Alzheimer’s; Amyloidosis; Amyotrophic Lateral Sclerosis (ALS); Anaphylactic or Reaction;Angelman Syndrome; Anorexia; Arthritis; Arthropathy (Gout); Asperger Disorder; Asthma; Attention Deficit Disorder (ADD);Autism.

2. Back Pain; Bell's Palsy; Bipolar Disorder; Bruxism; Bulemia.3. Cachexia; Cancer; Carpal Tunnel Syndrome; Cerebral Aneurysm; CFS; Chronic Pain; Cluster Headaches; CMT Disease;

Colitis; Colitis/Ulcerative Colitis; Colon Diverticulitis; Crohn's disease; CVS; Cystic Fibrosis; Cystitis/Urethritis.4. Darier's Disease; Depression; Diabetes; Diarrhea; Dravet Syndrome; Dupuytren's Contracture; Dyspepsia; Dystonia.5. E. T.; Eczema; Ehlers Danlos; Emphysema; Endometriosis; Epilepsy/Seizure Disorder.6. Felty's syndrome; Fibromyalgia; Friedreich's Ataxia.7. GastroEsophgeal Reflux Disease; Glaucoma; Graves' disease.8. Hemophilia A; Henoch-Schonlein Purpura; Herpes; HIV / AIDS; Hydrocephalus; Hypertension (High Blood Pressure);

Hyperventilation; HYPOGLYCEMIA-MMj Treatment.9. Incontinence; Inflammatory Bowel ; Insomnia; Interstitial Pneumonia; Irritable Bowel Syndrome.10. Limbic Rage Syndrome; Liver Disease; Lupus; Lyme Disease.11. Macular Degeneration; Marfan Syndrome-; mastocytosis; MD; Medical Marijuana as Pain Treatment for Patellofemoral

Pain Syndrome; Medical Marijuana Treatment for Addiction; Melorheostosis; Meniere's Disease; Menopausal Syndrome;Migraines; Motion Sickness; Movement Disorders; MRSA; Multiple Sclerosis (MS); Muscle Spasm; Muscle Spasms; MyofascialPain.

12. Nausea; Nephritis; Neurodegenerative Disorders; Neurofibromatosis; Neuropathy; Nightmares; NPS.13. Osgood-Schlatter; Osteogenesis imperfect.14. Palmar Hyperhydrosis; Pancreatic Cancer; Pancreatitis; Panic Attacks; Panic Disorder; Pectus carinatum (Pigeon

breast/chest); Pemphigus; Peptic Ulcer; Peutz-Jehgers; Polyarteritis Nodosa; Polycythemia vera; Porphyria—AlternativeSymptom Treatments; Post Concussion Syndrome; Post Traumatic Stress Disorder; PPS-Post Polio Syndrome; ProstateCancer; Pruritus.

15. Psoriasis; Pylorospasm reflux.16. Radiation Therapy; Raynaud's phenomenon; Reactive Arthritis; RLS-MMj Treats Symptoms.17. SAD; Schizophrenia(s); Scleroderma; Scoliosis; Selective mutism; Shingles; Sinusitis; Sjogren's Syndrome; Sleep Apnea; Spina

Bifida and Medical Marijuana; Sturge-Weber; Syringomyelia.18. Tenosynovitis; Testicular Cancer; Testicular Torsion; Thoracic Outlet Syndrome; Tic Douloureux; Tietze’s Syndrome; Tinnitus;

Tourette Syndrome and Cannabinoids; TTM.19. Wolff-Parkinson-White Syndrome.

Con

ditio

ns tr

eate

d w

ithca

nnab

is(1

39, m

edic

alm

ariju

ana.

com

)