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Exploring the Science and Myths of Medical Cannabis 

TAFP has published these two CME courses to educate physicians on the endocannabinoid system, hemp and cannabis, qualifying conditions for medical cannabis in Texas, and prescribing medical cannabis to improve lives.

Release Date: July 29, 2024
Expiration Date: July 29, 2025

Cost of activity: There are no fees required for participating in or receiving credit for this online enduring CME educational activity. 



Part 1 – The Endocannabinoid System and Hemp and Cannabis

By the end of this education activity, participants should be better able to:

  1. Discuss the basic functions of the endocannabinoid system.
  2. Identify the structural and functional components of the endocannabinoid system.
  3. Describe endocannabinoid receptor mechanisms of action, locations, densities, and functions.
  4. Explain the types of cannabinoids (endo- and phytocannabinoids) and how they can modulate the endocannabinoid system.
  5. Define the legal status of hemp and compare hemp’s legal status to cannabis.
  6. Discuss the importance of the 2018 and 2024 Farm Bill.
  7. Explain the roll of terpenes and compare the different types of terpenes in cannabis vs. other plants.
  8. Discuss some of the pharmacological activity of terpenes in cannabis and cannabis products.

Faculty

Courtney Benedetto, PT, DPT
Acute Care Physical Therapist
Seymour, Connecticut

Tesserae LaSalle
Medical Cannabis Extraction Technician, Alternative Compassion Services
Bridgewater, Massachusetts

Faculty biography and disclosure

Courtney Benedetto, PT, DPT is a licensed Physical Therapist in the state of Connecticut since 2006. She received her Bachelor of Science degree in Health Science and Master’s of Physical Therapy degree from Quinnipiac University in Hamden, CT. She went on to complete her Doctor of Physical Therapy degree at Temple University in Philadelphia, PA and completed her Master’s of Science degree in Medical Cannabis Science and Therapeutics at the University of Maryland in May of 2024.

Ms. Benedetto disclosed she has no financial relationship with any ineligible organizations or commercial interests.

Tesserae LaSalle has a Bachelor of Science in Chemistry with a concentration in Biochemistry and a minor in Biology from Bridgewater State University. She recently completed her Master’s in Medical Cannabis Science and Therapeutics from University of Maryland. Her interest is in research of natural intercalator nogalamycin using optical tweezers and structural interaction between DNA and Polymerase Kappa. At the height of the pandemic in 2020, she worked in the Covid testing sector of Broad institute MIT & Harvard Genomic Platform.

Ms. LaSalle disclosed she has no financial relationship with any ineligible organizations or commercial interests.

Planner disclosures

TAFP staff and planners disclose they have no financial relationships with any ineligible organizations or commercial interests.

The AAFP has reviewed Exploring the Science and Myths of Medical Cannabis Webinar: Part 1 – The Endocannabinoid System and Hemp and Cannabis and deemed it acceptable for up to 1.00 Enduring Materials, Self-Study AAFP Prescribed credit(s). Term of Approval is from 07/29/2024 to 07/29/2025. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Part 2 – Qualifying Conditions for Medical Cannabis in Texas: Therapeutic Guidelines and Contraindications and Prescribing Medical Cannabis to Improve Lives

By the end of this educational activity, learners should be better able to:

  1. Identify conditions which may qualify a resident of the state of Texas to receive a prescription for medical cannabis from a certified provider.
  2. Construct and implement therapeutic protocols that utilize cannabis as a core facet of patient treatment for qualifying conditions in the state of Texas.
  3. Identify contraindications that should prevent a patient from receiving medical cannabis.
  4. Recognize how cannabis was presented as a danger to the public at large and discuss which entities opposed its criminalization and why.
  5. Discuss the CURT program and how it aims to assist the needs of the Texas patient population.
  6. List which receptor groups and enzymes interact with cannabinoids, describe roughly the effects of cannabinoid receptor activation, and interpret receptor distribution and density throughout the body.
  7. Discuss the major therapeutic constituents of cannabis and how they interact with the endocannabinoid system (ECS) to help achieve therapeutic outcomes.
  8. Compare and contrast the differences between “hemp” and “cannabis” as specified in the 2018 farm bill, list commonly found terpenes within hemp and cannabis, and discuss some of the pharmacological activities and utilizations of terpenes.
  9. Construct and implement therapeutic protocols that utilize cannabis as a core facet of patient treatment for specific qualifying conditions.
  10. Identify major contraindications to cannabis usage, recognize problematic cannabis use in patients who use cannabis, and explain how problematic use can be detrimental to therapeutic objectives.

Faculty

Angela Porter, PharmD
Pharmacist (retired) and Clinical Herbalist
College Park, Maryland

Will Kolbrener, MS
M.S. in Medical Cannabis Science and Therapeutics Student
University of Maryland Baltimore School of Pharmacy
Pittsburgh, Pennsylvania

Faculty biography and disclosure

Angela Porter, PharmD received her Master’s Degree in Medical Cannabis Science and Therapeutics from the University of Maryland in May 2024. She has degree in pharmacy and her main focus is in Vitalist herbalism. During Covid, she completed coursework for a Master Gardener’s Certification in Prince George’s County, Maryland. Her passion is for the plants and their medicines to pharmacy students through various mentorships in Texas while working at Cancer Therapy & Research Center at UT Health San Antonio, UT MD Anderson Cancer Center, and the University of Colorado, Boulder.

Ms. Porter disclosed she has no financial relationship with any ineligible organizations or commercial interests.

Will Kolbrener, MS graduated from Penn State University in 2020 during the height of the pandemic Magna Cum Laude. He was also the Student Marshal for the graduating class of the College of Agricultural Sciences in 2020. He recently received his Master’s Degree in Medical Cannabis Science and Therapeutics from the University of Maryland.

Mr. Kolbrener disclosed he has no financial relationship with any ineligible organizations or commercial interests.

Planner disclosures

TAFP staff and planners disclose they have no financial relationships with any ineligible organizations or commercial interests.

The AAFP has reviewed Exploring the Science and Myths of Medical Cannabis Webinar: Part 2 – Qualifying Conditions for Medical Cannabis in Texas: Therapeutic Guidelines and Contraindications and Prescribing Medical Cannabis to Improve Lives and deemed it acceptable for up to 1.00 Enduring Materials, Self-Study AAFP Prescribed credit(s). Term of Approval is from 07/29/2024 to 07/29/2025. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

All materials are included with permission from all parties. The opinions expressed are those of the faculty and are not to be construed as those of the Texas Academy of Family Physicians.

This educational activity was planned and produced in accordance with the ACCME Accreditation Criteria, Policies, and Standards for Commercial Support. Recommendations involving clinical medicine in a continuing medical education activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.

This activity is intended to meet the educational needs of family physicians and other primary care clinicians including internists, family physicians, nurse practitioners and physician assistants who are seeking education on screening for therapeutic guidelines and contraindications for medical cannabis, prescribing medical cannabis, and understanding Texas law for prescribing.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the main page. To receive AAFP Prescribed Credit, you must complete the post-test and CME evaluation survey. Your full name, designation, and email address must be completed within the post-test and CME evaluation survey.

To receive CME credits, you must read the learning objectives, faculty and staff disclosures, target audience, and accreditation statements. You must watch the webinar in its entirety. Opportunities for additional questions for the faculty will be provided in the CME evaluation survey. Access the CME evaluation survey by clicking the button below.

CME certificates will be sent via email by TAFP after you complete the CME evaluation survey. If you need a certificate email, please contact Heather Osborne.

Part 1a – The Endocannabinoid System Courtney Benedetto, PT, DPT, MCST

An D, Peigneur S, Hendrickx LA, Tytgat J. (2020). Targeting cannabinoid receptors: Current status and prospects of natural products. International Journal of Molecular Sciences, 21(14), 5064.  

de Brito Siqueira ALG, Cremasco PVV, Bahú JO, Pioli da Silva A, Melo de Andrade LR, González PGA, Crivellin S, Cárdenas Concha VO, Krambeck K, Lodi L, Severino P, Souto EB. (2023). Phytocannabinoids: Pharmacological effects, biomedical applications, and worldwide prospection. Journal of Traditional and Complementary Medicine, 13(6), 575–587. 

dos Reis Rosa Franco G, Smid S, Viegas C. (2021). Phytocannabinoids: General aspects and pharmacological potential in neurodegenerative diseases. Current Neuropharmacology, 19(4), 449–464.

Fakhoury M. (2016). Role of the endocannabinoid system in the pathophysiology of schizophrenia. Molecular Neurobiology, 54(1), 768–778. 

Grinspoon PM. (2021). The endocannabinoid system: Essential and mysterious. Harvard Health.

Gülck T, Møller BL. (2020). Phytocannabinoids: Origins and biosynthesis. Trends in Plant Science, 25(10), 985–1004.

Howlett AC, Abood ME. (2017). CB 1 and CB 2 receptor pharmacology. Cannabinoid Pharmacology, 169–206.

Kaczocha M, Haj‐Dahmane S. (2021). Mechanisms of endocannabinoid transport in the brain. British Journal of Pharmacology, 179(17), 4300–4310.

Lowe H, Toyang N, Steele B, Bryant J, Ngwa W. (2021). The endocannabinoid system: A potential target for the treatment of various diseases. International Journal of Molecular Sciences, 22(17), 9472.  

Lu H-C, Mackie K. (2016). An introduction to the endogenous cannabinoid system. Biological Psychiatry, 79(7), 516–525. 

Maccarrone M. (2020). Phytocannabinoids and endocannabinoids: Different in nature. Rendiconti Lincei. Scienze Fisiche e Naturali, 31(4), 931–938. 

Pertwee RG. (2006). Cannabinoid pharmacology: The first 66 years. British Journal of Pharmacology, 147(S1). 

Rezende B, Alencar AK, de Bem GF, Fontes-Dantas FL, Montes GC. (2023). Endocannabinoid system: Chemical characteristics and biological activity. Pharmaceuticals, 16(2), 148. 

Rodriguez de Fonseca F, Del Arco I, Bermudez-Silva FJ, Bilbao A, Cippitelli A, Navarro M. (2004). The endocannabinoid system: Physiology and pharmacology. Alcohol and Alcoholism, 40(1), 2–14. 

Russo EB. (2016). Clinical endocannabinoid deficiency reconsidered: Current research supports the theory in migraine, fibromyalgia, irritable bowel, and other treatment-resistant syndromes. Cannabis and Cannabinoid Research, 1(1), 154–165. 

Taylor BN. (2023). Cannaboinoid Antiemetic therapy. StatPearls [Internet]. 

Zamberletti E, Rubino T, Parolaro D. (2021). Therapeutic potential of cannabidivarin for epilepsy and autism spectrum disorder. Pharmacology & Therapeutics, 226, 107878. 


Part 1b – Hemp and Cannabis – Tesserae LaSalle, MCST

Wills M. JSTOR Daily; The Return of Hemp. July 25,2021. 

Coop A, MCST 608 Cannabis Genomics and Pharmacognosy 01 Module 1 lecture 2 History of NIDA and Lecture 2 Hemp.

Wilson W, Urbas A, Scott F. Study Reveals Inaccurate Labeling on Marijuana as Hemp. National Institute of Justice. October 17, 2022. 

Small E, Cronquist A. A Practical and Natural Taxonomy For Cannabis. Wiley Online Library. August 1976. 

Vector stock overview of Cannabis Sativa Linnaeus Genus. Accessed February 25, 2024. 

Commissioner Sid Miller. Texas Industrial Hemp Program. Texas Department of Agriculture. 2018 Farm Bill. Accessed February 25, 2024. 

Huchelmann A, Boutry M, Hachez C. Plant Glandular Trichomes: Natural Cell Factories of High Biotechnological Interest. Plant Physiol. 2017 Sep;175(1):6-22. doi: 10.1104/pp.17.00727. Epub 2017 Jul 19. PMID: 28724619; PMCID: PMC5580781.

Tanney C, Backer R, Geitmann A, Smith D. Frontiers Journal: Cannabis Glandular Trichomes: A cellular Metabolite Factory. September 19, 2021. 

Ninkuu V, Zhang L, Yan J, Fu Z, Yang T, Zeng H. Biochemistry of Terpenes and Recent Advances in Plant Protection. Int J Mol Sci. 2021 May 27;22(11):5710. doi: 10.3390/ijms22115710. PMID: 34071919; PMCID: PMC8199371.

The press club: Boiling Points of terpenes by Todde Philips.

Terpene Chart created by BPG October 5, 2020. 

Linalool- Lung inflammation and anti- anxiety Myrcene- increase speed and amount of THC crossing BBB MCST 602 Module 6 Entourage Effect with Dr. Andrew Coop.

Ferber SG, Namdar D, Hen-Shoval D, Eger G, Koltai H, Shoval G, Shbiro L, Weller A. The "Entourage Effect": Terpenes Coupled with Cannabinoids for the Treatment of Mood Disorders and Anxiety Disorders. Curr Neuropharmacol. 2020;18(2):87-96. doi: 10.2174/1570159X17666190903103923. PMID: 31481004; PMCID: PMC7324885. 

Ninkuu V, Zhang L, Yan J, Fu Z, Yang T, Zeng H. Biochemistry of Terpenes and Recent Advances in Plant Protection. Int J Mol Sci. 2021 May 27;22(11):5710. doi: 10.3390/ijms22115710. PMID: 34071919; PMCID: PMC8199371. 


Part 2a – Qualifying Conditions for Medical Cannabis in Texas: Therapeutic Guidelines and Contraindications – Angela Porter, PharmD, MCST

Abu-Sawwa R, Stehling C. (2020). Epidiolex (Cannabidiol) Primer: Frequently Asked Questions for Patients and Caregivers. The Journal of Pediatric Pharmacology and Therapeutics: JPPT: The Official Journal of PPAG, 25(1), 75–77. 

Badowski ME. (2017). A review of oral cannabinoids and medical marijuana for the treatment of chemotherapy-induced nausea and vomiting: A focus on pharmacokinetic variability and pharmacodynamics. Cancer Chemotherapy and Pharmacology, 80(3), 441–449. 

Barchel D, Stolar O, De-Haan T, Ziv-Baran T, Saban N, Fuchs DO, Koren G, Berkovitch M. (2019). Oral Cannabidiol Use in Children With Autism Spectrum Disorder to Treat Related Symptoms and Co-morbidities. Frontiers in Pharmacology, 9, 1521. 

Bar-Lev Schleider L, Mechoulam R, Saban N, Meiri G, Novack V. (2019). Real life Experience of Medical Cannabis Treatment in Autism: Analysis of Safety and Efficacy. Scientific Reports, 9(1), 200. 

Bar-Sela G, Zalman D, Semenysty V, Ballan E. (2019). The Effects of Dosage-Controlled Cannabis Capsules on Cancer-Related Cachexia and Anorexia Syndrome in Advanced Cancer Patients: Pilot Study. Integrative Cancer Therapies, 18, 153473541988149. 

Bellocchio L, Soria-Gómez E, Quarta C, Metna-Laurent M, Cardinal P, Binder E, Cannich A, Delamarre A, Häring M, Martín-Fontecha M, Vega D, Leste-Lasserre T, Bartsch D, Monory K, Lutz B, Chaouloff F, Pagotto U, Guzman M, Cota D, Marsicano G. (2013). Activation of the sympathetic nervous system mediates hypophagic and anxiety-like effects of CB 1 receptor blockade. Proceedings of the National Academy of Sciences, 110(12), 4786–4791. 

Cohen N, Conry J, Schreiber J. (2020). Keep Off the Grass: Artisanal versus Pharmaceutical Cannabidiol in Pediatric Refractory Epilepsy Patients (710). Neurology, 94(15_supplement), 710. 

Crippa JAS, Zuardi AW, Hallak JEC. (2010). [Therapeutical use of cannabinoids in psychiatry]. Revista Brasileira De Psiquiatria (Sao Paulo, Brazil: 1999), 32 Suppl 1, S56-66.

Dupuis LL, Boodhan S, Sung L, Portwine C, Hain R, McCarthy P, Holdsworth M. Pediatric Oncology Group of Ontario. (2011). Guideline for the classification of the acute emetogenic potential of antineoplastic medication in pediatric cancer patients. Pediatric Blood & Cancer, 57(2), 191–198. 

Gorzo A, Havași A, Spînu Ștefan, Oprea A, Burz C, Sur D. (2022). Practical Considerations for the Use of Cannabis in Cancer Pain Management—What a Medical Oncologist Should Know. Journal of Clinical Medicine, 11(17), 5036. 

Haddad F, Dokmak G, Karaman R. (2022). The Efficacy of Cannabis on Multiple Sclerosis-Related Symptoms. Life (Basel, Switzerland), 12(5), 682. 

May MB, Glode AE. (2016). Dronabinol for chemotherapy-induced nausea and vomiting unresponsive to antiemetics. Cancer Management and Research, 8, 49–55. 

Meng H, Dai T, Hanlon JG, Downar J, Alibhai SMH, Clarke H. (2020). Cannabis and cannabinoids in cancer pain management. Current Opinion in Supportive & Palliative Care, 14(2), 87–93. 

Noyes R, Brunk SF, Avery DH, Canter A. (1975). The analgesic properties of delta‐9‐tetrahydrocannabinol and codeine. Clinical Pharmacology & Therapeutics, 18(1), 84–89. 

Rudroff T, Sosnoff J. (2018). Cannabidiol to Improve Mobility in People with Multiple Sclerosis. Frontiers in Neurology, 9, 183. 

Sexton M, Garcia JM, Jatoi A, Clark CS, Wallace MS. (2021). The Management of Cancer Symptoms and Treatment-Induced Side Effects With Cannabis or Cannabinoids. Journal of the National Cancer Institute. Monographs, 2021(58), 86–98. 

Seymour-Jackson E, Laird BJA, Sayers J, Fallon M, Solheim TS, Skipworth R. (2023). Cannabinoids in the treatment of cancer anorexia and cachexia: Where have we been, where are we going? Asia-Pacific Journal of Oncology Nursing, 10, 100292. 

Silva EA da, Medeiros WMB, Torro N, Sousa JMM de, Almeida IBCM de, Costa FB da, Pontes KM, Nunes ELG, Rosa MD da, Albuquerque KLGD de. (2022). Cannabis and cannabinoid use in autism spectrum disorder: A systematic review. Trends in Psychiatry and Psychotherapy, 44, e20200149. 

Tazi E, Errihani H. (2010). Treatment of cachexia in oncology. Indian Journal of Palliative Care, 16(3), 129–137. 

von Wrede R, Helmstaedter C, Surges R. (2021). Cannabidiol in the Treatment of Epilepsy. Clinical Drug Investigation, 41(3), 211–220. 

Wissel J, Haydn T, Müller J, Brenneis C, Berger T, Poewe W, Schelosky LD. (2006). Low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity-related pain: A double-blind placebo-controlled cross-over trial. Journal of Neurology, 253(10), 1337–1341. 

Zajicek JP. (2005). Cannabinoids in multiple sclerosis (CAMS) study: Safety and efficacy data for 12 months follow up. Journal of Neurology, Neurosurgery & Psychiatry, 76(12), 1664–1669. 

Zhou ES, Nayak MM, Chai PR, Braun IM. (2022). Cancer patient’s attitudes of using medicinal cannabis for sleep. Journal of Psychosocial Oncology, 40(3), 397–403. 


Part 2b – Prescribing Medical Cannabis to Improve Lives – Will Kolbrener, MS, MCST

Beedham W, Sbai M, Allison I, Coary R, Shipway D. (2020). Cannabinoids in the Older Person: A Literature Review. Geriatrics, 5(1), 2. 

Campeny E, López-Pelayo H, Nutt D, Blithikioti C, Oliveras C, Nuño L, Maldonado R, Florez G, Arias F, Fernández-Artamendi S, Villalbí JR, Sellarès J, Ballbè M, Rehm J, Balcells-Olivero MM, Gual A. (2020). The blind men and the elephant: Systematic review of systematic reviews of cannabis use related health harms. European Neuropsychopharmacology, 33, 1–35. 

Ghasemiesfe M, Ravi D, Vali M, Korenstein D, Arjomandi M, Frank J, Austin PC, Keyhani S. (2018). Marijuana Use, Respiratory Symptoms, and Pulmonary Function. Annals of Internal Medicine, 169(2), 106–115. 

Jacobson MR, Watts JJ, Boileau I, Tong J, Mizrahi R. (2019). A systematic review of phytocannabinoid exposure on the endocannabinoid system: Implications for psychosis. European Neuropsychopharmacology, 29(3), 330–348. 

Lucas CJ, Galettis P, Schneider J. (2018). The pharmacokinetics and the pharmacodynamics of cannabinoids. British Journal of Clinical Pharmacology, 84(11), 2477–2482. 

Page RL, Allen LA, Kloner RA, Carriker CR, Martel C, Morris AA, Piano MR, Rana JS, Saucedo JF. (2020). Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation, 142(10), e131–e152. 

Patel J, Marwaha R. (2022). Cannabis Use Disorder. In StatPearls. StatPearls Publishing. 

Questions?

Jessica Miley, CHCP, TAFP Director of CME and Compliance
(512) 329-8666
jmiley@tafp.org
www.tafp.org

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