Is Cannabis Right for You? Opioid Alternative Pilot Program (OAPP)

Is Cannabis Right for You?/Opioid Alternative Pilot Program (OAPP) Dr. Nick Salamie PharmD, RPh

Cannabis Prohibition • Henry Jacob Anslinger • US Drug Czar 1930-1962 • Major Role in War on Cannabis • Spread False Information • Marihuana Tax Act of 1937 • Implemented an Excise Tax • Destroyed Hemp Industry • Opposed by AMA • Richard Nixon • “War on Drugs” • 1973 DEA Creation

Facts • No deaths from Cannabis ever! • ~44 deaths from RX Opioids a day • Does NOT cause respiratory depression • Used as a Medicine for 1000s of years

Endocannabinoid System • Found in all animals • CB1 and CB2 receptors • Located all over body • Anandamide and 2-AG • Balance In the body • Pain Modulation • Phytocannabinoids as treatment • THC • CBD

THC • One of the major therapeutic cannabinoids • Beyond the psychoactivity (High) • Anti-inflammatory • Analgesic • Neuroprotective • Increased Potency via Gastrointestinal absorption • Side Effects • Anxiety • Dizziness • Rapid Heartbeat • Go LOW and SLOW!

CBD • Second most prevalent therapeutic cannabinoid • NO prevalent psychoactivity (High) • Eliminates some of THC’s adverse effects • Sedation • Hunger • Anxiety • Therapeutic value • Anti-inflammatory • Anti-convulsant • Anxiolytic • Side effects • Headache • Diarrhea • Agitation • Sedation • CBD more effective with THC: “Power Couple” • Hemp vs. Whole Plant CBD

First PDI Visit • Goals • Increase Quality of Life • Drug Interactions • Assess Patients Cannabis Experience • No or little cannabis experience • Intermediate cannabis experience • Advanced Cannabis Experience • Tapering Strategy if Necessary • Product selection and initial strategy • Minimum Effective Dose • Follow Up

Dosage Forms • Inhalation • Combustion • Vaporization • Ingestible • Edibles • Oils (RSO) • Tablets/Capsules • Sublingual/Buccal/Oromucosal • Topical • Transdermal

AIDS • Alzheimer’s Disease • ALS • Arnold-Chiari Malformation • TBI and Post-Concussion Syndrome • Cancer • Cachexia • Causalgia • Chronic Inflammatory Demyelinating Polyneuropathy • CRPS • Crohn’s Disease • Dystonia • Fibromyalgia • Fibrous Dysplasia • Glaucoma • Hepatitis • HIV • Hydrocephalus • Interstitial Cystitis • Lupus • MS • Muscular Dystrophy • Myasthenia Gravis • Myoclonus • Nail-Patella Syndrome • Neurofibromatosis • Parkinson’s • PTSD • Reflex Sympthetic Dystrophy RSD • Residual Limb Pain • RA • Seizures • Sjogren’s Syndrome • Spinal Cord Disease • Spinal Cord Injury • Spinalcerebellar Ataxia • Syringomyelia • Tarlov Cysts • Terminal Illness Prognosis • Tourette’s Syndrome

Getting Your Cannabis Card • Formal Diagnosis of 1 of the 41 qualifying conditions • Completion of Physician Written Certification Form by a Licensed Physician • Fingerprint/Background Check • Completion of Online Registration and and Payment • Provisional Registration

Opioid Epidemic • Rx Painkillers highly abused drugs • Americans consume 80% of the world’s opioids • Difficult to discontinue: WITHDRAWAL • Anxiety • Insomnia • Sweating • Gooseflesh • Runny Nose • Muscle Spasms and pain • ~44 deaths per day

Opioid Epidemic • How did it get this bad? • Pre-1986 • WHO Pain Ladder • Special Interests • Regulatory Action too late

Cannabis In Place of Opioids • Opioid Dependence • Endocannabinoid System • CBD • Pain • Endocannabinoid System • THC • Opioid Treatment Duration • Chronic Vs Acute • Opioid Dose reduction

Opioid Alternative Pilot Program • MCPP vs OAPP • Eligibility • Current Rx for Opioid or could be prescribed an Opioid • 21 or older • No CDL or School Bus Permit • Cannot change dispensary during 90 day period

OAPP: Step 1 • Physician Certification (PC) • Licensed MD or DO • In-office visit required • Certifications via ICTS • PC submission completed before patient submission • Patient has 30 days to use PC • Renewal of the PC

OAPP: Step 2 • Patient Registration • ICTS Portal • Registration assistance • Valid E-mail address • MCPP excluded • Additional Requirements • Valid IL ID • Proof of Residency • Passport Photo • $10 co-pay

OAPP: Step 3 and 4 • OAPP Registration Issued • Card via E-mail • No hard plastic card • IDPH QA Process • Validity of Registration

OAPP: Step 5 • Re-Enrollment • Another in person office visit • New PC online by doctor • Updated registration • $10 co-pay

Resources • Backes, Michael, et al. Cannabis Pharmacy: the Practical Guide to Medical Marijuana. Black Dog & Leventhal Publishers, 2017. • “Harry J. Anslinger.” Wikipedia, Wikimedia Foundation, 20 Mar. 2019, en.wikipedia.org/wiki/Harry_J._Anslinger. • Howard, Michael E. “Opioids and Marijuana.” Opioids & Marijuana. Opioids & Marijuana, 6 Feb. 2019, Naperville, Embassy Suites. • Jenison, David. “Was Harry Anslinger a Racist?” PRØHBTD, prohbtd.com/was-harry-anslinger-a-racist. • “Marihuana Tax Act of 1937.” Wikipedia, Wikimedia Foundation, 11 Mar. 2019, en.wikipedia.org/wiki/Marihuana_Tax_Act_of_1937. • Moody, Conny M. “Opioid Alternative Pilot Program.” Webinar. 8 Jan. 2019. • Moody, Conny. “Opioid Alternative Pilot Program Physician Information.” Webinar. 30 Jan. 2019. • Russo, Ethan B., and Jahan Marcu. “Cannabis Pharmacology: The Usual Suspects and a Few Promising Leads.” Cannabinoid Pharmacology Advances in Pharmacology, 2017, pp. 67–134., doi:10.1016/bs.apha.2017.03.004. • Salamie, Nicholas PharmD, RPh. “Alzheimer’s Disease and the Alternative to Opioids Act.” Powerpoint File. • Thompson, Dennis. “Medical Pot: Elixir for the Elderly.” Chicago Tribune, 27 Mar. 2019. • “War on Drugs.” Wikipedia, Wikimedia Foundation, 22 Mar. 2019, en.wikipedia.org/wiki/War_on_drugs.

Questions • https://etk.icts.illinois.gov

Is Cannabis Right for You? Opioid Alternative Pilot Program (OAPP)