Page 5 - INFORMATION FOR HEALTH CARE PROFESSIONALS

TABLE OF CONTENTS

Page
List of figures and tables .................................................................................................................................................................. 1
List of abbreviations ........................................................................................................................................................................ 2
Authorship and acknowledgements ................................................................................................................................................. 7
Overview of summary statements .................................................................................................................................................. 11

1.0 The Endocannabinoid System ............................................................................................................................................... 18
1.1 Cannabis ............................................................................................................................................................................ 22
1.1.1 Chemistry and composition ....................................................................................................................................... 22
1.1.2 Other constituents ..................................................................................................................................................... 22
1.1.3 Stability and storage .................................................................................................................................................. 22

2.0 Clinical Pharmacology........................................................................................................................................................... 24
2.1 Pharmacodynamics ............................................................................................................................................................ 24
2.2 Pharmacokinetics ............................................................................................................................................................... 29
2.2.1 Absorption ................................................................................................................................................................ 30
2.2.1.1 Smoked cannabis ........................................................................................................................................... 30
2.2.1.2 Vapourized cannabis ..................................................................................................................................... 30
2.2.1.3 Oral ............................................................................................................................................................... 31
2.2.1.4 Oro-mucosal and intranasal ........................................................................................................................... 33
2.2.1.5 Rectal ............................................................................................................................................................ 33
2.2.1.6 Topical .......................................................................................................................................................... 33
2.2.2 Distribution ............................................................................................................................................................... 34
2.2.3 Metabolism ............................................................................................................................................................... 34
2.2.3.1 Inhalation ...................................................................................................................................................... 35
2.2.3.2 Oral ............................................................................................................................................................... 35
2.2.4 Excretion ................................................................................................................................................................... 36
2.3 Pharmacokinetic-pharmacodynamic relationships ............................................................................................................. 36
2.4 Tolerance, dependence, and withdrawal symptoms ........................................................................................................... 39
2.5 Special populations ............................................................................................................................................................ 43

3.0 Dosing ..................................................................................................................................................................................... 46
3.1 Smoking ............................................................................................................................................................................. 48
3.2 Oral .................................................................................................................................................................................... 51
3.3 Oro-mucosal ...................................................................................................................................................................... 52
3.4 Vapourization..................................................................................................................................................................... 52

4.0 Potential Therapeutic Uses .................................................................................................................................................... 54
4.1 Palliative care ..................................................................................................................................................................... 56
4.2 Quality of life ..................................................................................................................................................................... 57
4.3 Chemotherapy-induced nausea and vomiting .................................................................................................................... 59
4.4 Wasting syndrome (cachexia, e.g., from tissue injury by infection or tumour) and loss of appetite (anorexia) in
AIDS and cancer patients, and anorexia nervosa ..................................................................................................................... 62
4.4.1 To stimulate appetite and produce weight gain in AIDS patients ............................................................................. 62
4.4.2 To stimulate appetite and produce weight gain in cancer patients ............................................................................ 63
4.4.3 Anorexia nervosa ...................................................................................................................................................... 64
4.5 Multiple sclerosis, amyotrophic lateral sclerosis, spinal cord injury and disease ............................................................... 64
4.5.1 Multiple sclerosis ..................................................................................................................................................... 65
4.5.2 Amyotrophic lateral sclerosis .................................................................................................................................... 70
4.5.3 Spinal cord injury (or spinal cord disease) ................................................................................................................ 71
4.6 Epilepsy ............................................................................................................................................................................. 72
4.7 Pain .................................................................................................................................................................................... 78
4.7.1 Acute pain ................................................................................................................................................................. 80
4.7.1.1 Experimentally-induced acute pain ............................................................................................................... 81
4.7.1.2 Post-operative pain ........................................................................................................................................ 82
4.7.2 Chronic pain .............................................................................................................................................................. 82
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