Physician Education

DocMJ is Florida’s largest Network of Medical Cannabis physicians. Our compassionate and caring mission is what
sets us apart from other clinics. Our goal is to empower patients with the tools they need to live happy and healthy lives. Since medical marijuana was legalized in Florida in 2016 there have been many questions, fears and misinformation surrounding its benefits, risks and legal implications. Our 25 physicians are dedicated to providing clarity surrounding these fears and qualify patients for medical marijuana where the benefits outweigh the risks.

Medical Marijuana is an additional tool in a physician’s armamentarium to offer patients suffering from chronic illnesses. If you feel you have a patient that may benefit, they can schedule a no risk appointment on-line or by calling any of our 22 locations across the state.

L.E.A.R.N. WITH DOCMJ

LISTEN-ENGAGE-ASK-RESPOND-NETWORK

A newsletter dedicated to creating awareness and education regarding Medical Marijuana in the State of Florida.

Medical Marijuana

The medical benefits of marijuana have been documented for thousands of years, it is only in the past few decades that science and medicine have started to scratch the surface of how this medicine works and the incredible benefits these plants can provide.

Marijuana contains hundreds of cannabinoids, of which there are two primary compounds that are active and have medicinal properties, THC and CBD.

Tetrahydrocannabinol (THC) is the more well-known cannabinoid that gives a psychotropic “high” feeling, but it has also been shown to have numerous medicinal effects when taken with the other cannabinoids in the plant. These effects include: pain relief, reduction in inflammation, drowsiness, sense of well-being, and appetite stimulation. Many patients report significant improvement in regard to chronic pain, nausea, mental health including anxiety, increased appetite, anti-convulsant, anti-inflammatory, and other therapeutic effects.

Cannabidiol (CBD) is another cannabinoid but provides therapeutic benefits without producing psychotropic effects. Our knowledge of CBD and its medicinal benefits have exponentially increased over the past few years, with more therapeutic uses becoming apparent, as research has broadened. CBD has been associated with reducing inflammation, seizure frequency, muscle spasms, anxiety and pain. Most recently the FDA approved a synthetically produced CBD for the treatment of seizures.

Endocannabinoid system: CB1 and CB2

Qualifying Conditions

  • Post-traumatic stress disorder (PTSD)
  • Chronic Non-Malignant Pain
  • Cancer
  • Epilepsy/Seizure Disorder
  • Glaucoma
  • HIV and/or AIDS
  • Amyotrophic lateral sclerosis (ALS)
  • Crohn’s disease or Ulcerative
  • Colitis
  • Parkinson’s disease
  • Multiple sclerosis (MS)
  • Medical conditions of the same kind or class as or comparable to those above A terminal condition diagnosed by a physician other than the qualified physician issuing the physician certification
  • Chronic conditions where standard therapies have failed, and/or we are just treating symptoms

The endocannabinoid system is made up of 2 endogenous (primary) cannabinoids: 2ag and anandamide. These bind to CB1 and CB2 receptors located in the central nervous system, peripheral nervous system, immune system and gastrointestinal lymphatic system. Activation of the CB1 and CB2 receptors by our endogenous cannabinoids have been shown to modulate mood, memory, appetite, and pain-sensation in the body, revealing the importance of this system in human physiology. Surprisingly, this has only been recently discovered over the last 20 years.

CB1 receptors have been isolated predominately in the central nervous system; specifically, within the basal ganglia and the limbic system, including the hippocampus. They are also found in the cerebellum and in both male and female reproductive systems. CB1 receptors are absent in the medulla oblongata, the part of the brain stem responsible for respiratory and cardiovascular functions. Thus, there is not a risk of respiratory or cardiovascular failure as there are with many other drugs. CB1 receptor activation is responsible for the euphoric and anticonvulsive effects of cannabis. They have been identified on the pre-synaptic neurons, and receptor activation via allosteric binding, results in modulation of neurotransmitters. Examples include inhibition of the release of glutamate and GABA. Activation of receptors modulates neurotransmitters release in a manner that prevents excessive neuronal activity, reducing pain and inflammation.

 

Cannabidiol (CBD) and Tetrahydro cannabinol (THC) activation of CB1 and CB2 receptors influences biochemical pathways resulting in the following physiologic affects:

 

  • Serotonin – activates 5-HT1A serotonin release
  • Vanilloid receptors – pain perception, inflammation, body temp GPR55
    – orphan receptor antagonist
    – Cerebellum – modulates blood pressure -and bone density
    – Inhibits osteoclast function and bone reabsorption Inhibits cancer proliferation
  • PPARs – anti proliferative effect and tumor regression, degrades amyloid plaques, insulin sensitivity, and lipid uptake
  • Anandamide reuptake and breakdown
    inhibitor
  • Negative allosteric modulator of
    CB1 – changes CB1 conformation that
    weakens THCs binding affinity

CB2 receptors have been isolated on monocytes, macrophages, Bcells and Tcells of the immune system as well as the peripheral nervous system. CB2 receptor activation appears to be responsible for anti-inflammatory affects by binding with the TRVP-1, a protein receptor couple responsible for regulating body temperature, pain, and inflammation.

Activation of CB2 receptors appears to modulate the intestinal inflammatory response, gut motility and analgesic affects in the peripheral nervous system.

Potential Side Effects

Cannabis hyperemesis syndrome. Although the majority of patients experience an antiemetic affect with cannabis, there are a small percentage of patients where cannabis causes nausea and vomiting. These symptoms resolve with cessation.

 

Medical cannabis does not influence the respiratory centers of the brain. Despite its ubiquitous use over the last 3,000 years there have been no known reported cases of death from cannabis use. Medical cannabis has been shown to have a low dependency potential when compared to alcohol, nicotine and opioids.

 

Contraindications:
– Active psychosis
– Pregnancy and/or Lactation

Drug Interactions

Warfarin THC and CBD increase warfarin levels with frequent use (Yamaori et al 2012)

Smoking cannabis can decrease theophylline levels (Stout and Cimino 2014)

Smoking cannabis has NO effect on Indinavir and nefinavir (Abrams et al 2003)

Clobazam in children treated with CBD for epilepsy, CBD increased clobazam levels (Geffrey et al 2015)

Legal Requirements:

In person exam every 7 months with a Cannabis Certified Physician (MD or DO) Legal guardian required if under age 18 Patient must be deemed to have a qualifying medical condition Florida resident or a seasonal resident defined as living in Florida for 31 consecutive days or more For more information visit the office of medical marijuana use at:

http://www.flhealthsource.gov/ommu/

Learn More:

Visit www.pubmed.com

www.flhealthsource.gov/OMMU

www.DOCMJ.com/FAQ

“The health effects of Cannabis and Cannabinoids”

The current state of evidence and recommendations for research. By The National

Academics of Sciences-Engineering-Medicine “Cannabis Pharmacy” by Michael Backes