Louisiana “Prescription” Cannabis-Based Products – “Medical Marijuana”

 

The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship.  Readers are advised to seek professional guidance regarding the diagnosis and treatment of their medical concerns.

 

Marijuana: Medical Use Overview

The use of marijuana for medical purposes remains highly controversial and is fraught with a lack of good quality evidence regarding the specifics of clinical effectiveness and the details of treatment including dosing frequency, amount and duration. The following information is provided as an introduction to what is believed to be true about medical uses of marijuana. There will surely be more information to come.

Terminology

Cannabis:

The terms “cannabis” refers to marijuana the plant, including the varieties Cannabis Sativa and Cannabis Indica, as well the cannabis variety known as hemp, a variety of Cannabis with very low THC content cultivated for non-drug use.

Medical Marijuana:

This term is in popular use but it is imprecise.  It generally refers broadly to dried marijuana (cannabis) dispensed or otherwise obtained and used either for supervised medical purposes or for self-medication. The term can also be used to refer to the physician-recommended use of cannabis-based products to treat disease or improve symptoms.

Prescription Cannabinoids

Cannabinoids are compounds found in the marijuana plant and are the most abundant constituents used for medical purposes. The term “prescription” as related to cannabis-based products is limited to FDA-approved medications that require a prescritption from a physician. The term “prescription cannabinoids” refers to products containing one or more marijuana plant-derived or synthetically manufactured cannabinoids that are available by prescription only. Currently in the U.S. only three prescription cannabinoid medications are FDA-approved and legal to be prescribed in all states.

Cannabis-based products containing more than 0.3% THC are now legal for medical use in Louisiana but require specific written “recommendations” (not “prescriptions”) from a Louisiana-certified physician. These “recommended” medical marijuana-based products in Louisiana are not FDA-approved and are not covered by insurance. Furthermore, the possession of these products may not be legal in other states.

Pharmaceutical Cannabis-Based Products:

The term “pharmaceutical cannabis” refers to products that are derived from the marijuana plant and manufactured under controlled commercial conditions. Which of these products are available without a prescription varies state by state and the quality of manufacturing may also vary significantly from one product to another, with little to no regulatory oversight over the manufacturing process.

In Louisiana, the only pharmaceutical cannabinoid currently legal and available without a prescription or legal “recommendation” is cannabidiol (CBD), and only if it is 100% pure and manufactured from cannabis (hemp) stems or seeds, not leaves or flowers. While technically this is true, it appears that cannabis-based products derived from either whole plant or aerial (above ground) parts of the plant are available OTC locally as long as their THC content is <0.3%.

 

See:

Marijuana – Legislative Update for Louisiana

Marijuana – Medical Use Overview

“Medical Marijuana” – Getting Started

Marijuana (Cannabis): Potential for Harm 

Marijuana (Cannabis): Side Effects and Drug Interactions

Marijuana (Cannabis): Dosing

Marijuana vs Hemp

 

Cannabis-Based Medications:

Over-the-Counter Cannabinoid Medications:

Marijuana – Cannabidiol (CBD)

 

Prescription Cannabis-Based Medications:

FDA-Approved Prescription Cannabis-Based Medications

Louisiana Prescription Cannabis-Based Products – “Medical Marijuana”

 

Clinical Applications of Cannabis:

Cannabis – Anxiety (coming soon)

Cannabis – Fibromyalgia

Cannabis – Headaches (coming soon)

Cannabis – Inflammatory Bowel Disease (coming soon)

Cannabis – Neuroinflammation (coming soon)

Cannabis – Pain (coming soon)

Cannabis – Sleep (coming soon)

 

The Medical Science of Cannabis:

The Endocannabinoid System

Marijuana – Botanical

Marijuana – Pharmacokinetics

Marijuana – Inhaled (Smoked and Vaporized)

Marijuana – Cannabinoids and Opioids

 

Cannabinoids:

Cannabidiol (CBD)

Cannabigerol (CBG) (coming soon)

Cannabinol (CBN) (coming soon)

Tetrahydrocannabinol (THC) (coming soon)

Tetrahydrocannabivarin (THCV) (coming soon)

Terpenes:

Terpenes – An Overview


See also:

Marijuana – Discontinuing Use

Marijuana Addiction – Cannabis Use Disorder (CUD)

 

Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

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This section continues to be edited for accuracy and completeness.

 

Legal Over-the-Counter Cannabis Products

In Louisiana, the only pharmaceutical cannabinoid currently legal and available without a prescription is cannabidiol, and only if it is 100% pure and manufactured from cannabis stems or seeds, not leaves or flowers. While technically this is true, it appears that cannabis-based products derived from either whole plant or aerial (above ground) parts of the plant are available OTC locally as long as their THC content is <0.3%. 

(See  Cannabidiol (CBD).

 

Prescription Cannabis Products

Louisiana has now legalized prescription cannabinoids including THC but, at least initially, they are to be provided in the form of  liquid tinctures only. These tinctures are described below, with three versions based on the ratios of THC:CBD. Oral capsules or lozenges and topical preparations are anticipated to be available in the future. These prescription cannabis-based products are expected to become available in LA in lmid-late August, 2019.

 

For more information regarding cannabis product dosing, see: Marijuana (Cannabis): Dosing

For information on FDA-Approved prescription cannabis-based medications, Clickhere.


Louisiana GB Science Products

 As of July, 2019 the preliminary cannabis-based products to be available in Louisiana are limited to GB Science products, tinctures only. They differ by their concentrations and ratios between THC and CBD. The contents of other cannabinoids and terpenes are unknown.

Please note also that the cannabis-based products approved and to be distributed in Louisiana are NOT FDA-approved and therefore will not be covered by insurance. Additionally, they would be considered illegal in states or countries that do not have appropriate laws legalizing marijuana, so caution should br exercised if traveling with these medications.

Each of the three tincture products listed below are dispensed in 30 mL bottles with a 1 ml dropper designed to provide dosing of the medication in increments of 0.1 – 1 ml.

1) THC-RICH (100% THC) SUBLINGUAL TINCTURE (GBSL-THCR-TI)

Potency: 300mg THC/30mL (10 mg THC/mL).

Initial recommended starting dose:

Naive patients start with a sublingual dose of 0.25 mL (2.5mg THC) 1 time per day for 1 week.

Experienced patients start with a sublingual dose of 0.5 mL (5.0 mg THC) 1 time per day for 1 week.

If desired therapeutic effect is not achieved after 1 week:

Patients may take initial dose 2 times per day for 2 weeks.

If desired relief is not achieved after 3 weeks:

Patients may take initial dose 3 times per day for 2 week.

For greater relief:

Naive patients may increase initial dose in a stairstep manner by adding 0.25 mL to initial dose for a 2-week period until desired relief is achieved (e.g., progress from initial dose of 0.25 mL to 0.5 mL to 0.75 mL to 1.0 mL).

Experienced patients may increase initial dose in a stairstep manner by adding 0.5 mL to initial dose for a 2-week period until desired relief is achieved.

(2) BALANCED THC:CBD (1:1) SUBLINGUAL TINCTURE (GBSL-1:1-TI)

Potency: 150 mg CBD:150 mg THC/30 mL (5 mg CBD:5 mg THC/mL).

Initial recommendation:

Naive patients start with a sublingual dose of 0.5 mL (2.5 mg CBD:2.5 mg THC) 1 time per day for 1 week.

Experienced patients take 1.0 mL (5 mg CBD:5 mg THC) 1 time per day for 1 week.

If desired relief is not achieved after 1 week:

Patients may take initial dose 2 times per day for 2 weeks.

If desired relief is not achieved after 3 weeks:

Patients may take initial dose 3 times per day for 2 weeks.

For greater relief:

Patients may increase initial dose in a stairstep manner by adding 0.5 mL to initial dose for a 2-week period until desired relief is achieved.

(3) CBD-RICH CBD:THC (20:1) SUBLINGUAL TINCTURE (GBSL-CBDR-TI)

Potency: 1200 mg CBD:60 mg THC/30 mL (40 mg CBD:2 mg THC/mL).

Initial recommendation:

Pediatric patients take 0.25 mL (10mg CBD:0.5 mg THC) every 8 hours for 2 weeks.

Adult patients take 0.5 mL (20mg CBD:1mg THC) every 8 hours for 2 weeks.

For greater relief:

Patients may increase initial dose in a stairstep manner by adding 0.25 mL to initial dose for a 2-week period until desired relief is achieved.

Resources:

National Academy of Sciences

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

 

www.Healer.com

This website appears to be good resource for exploring medical marijuana.

 

References:


Medical Marijuana – Prescribing Guidelines

  1. Simplified guideline for prescribing medical cannabinoids in primary care – Canadian Family Physician – 2018
  2. Physician Recommendation of Medical Cannabis Guidelines Calif Medical Assoc – 2011
  3. Prescribing smoked cannabis for chronic noncancer pain. Preliminary recommendationsCanadian Family Physician – 2014


Medical Marijuana – Opioids

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
  7. The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
  8. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
  9. Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
  10. Cannabis and the Opioid Crisis – 2018
  11. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
  12. Cannabinoid–Opioid Interaction in Chronic Pain
  13. Synergistic interactions between cannabinoid and opioid analgesics. – PubMed – NCBI
  14. FDA approves CBD drug – Epidiolex – The Washington Post

Medical Marijuana –Misc

  1. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  2. Cannabis and cannabis extracts – greater than the sum of their parts? – 2001
  3. Medical cannabis and mental health: A guided systematic review. 2016 – PubMed – NCBI
  4. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. – PubMed – NCBI
  5. Cannabis-conclusions – 2017 Natio
    nal Academy of Sciences
  6. Cannabis-chapter-highlights – 2017 National Academy of Sciences
  7. Cannabis-report-highlights – 2017 National Academy of Sciences
  8. Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Bene ts of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?-2004
  9. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. – PubMed – NCBI
  10. Cannabis use and cognitive function: 8-year trajectory in a young adult cohort. – PubMed – NCBI
  11. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. – PubMed – NCBI
  12. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI Pharmacogenetics of Cannabinoids – 2018
  13. Systematic review of systematic reviews for medical cannabinoids – 2018
  14. Adverse effects of medical cannabinoids – a systematic review – 2008
  15. Cannabimimetic effects modulated by cholinergic compounds. – PubMed – NCBI
  16. Antagonism of marihuana effects by indomethacin in humans. – PubMed – NCBI
  17. Pharmacokinetics and pharmacodynamics of cannabinoids. – PubMed – NCBI
  18. Clinical Pharmacodynamics of Cannabinoids – 2004
  19. Affinity and Efficacy Studies of Tetrahydrocannabinolic Acid A at Cannabinoid Receptor Types One and Two. – 2017
  20. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
  21. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. – PubMed – NCBI
  22. Pharmacology of Cannabinoids
  23. Current-status-and-future-of-cannabis-research-Clin-Researcher-2015
  24. Therapeutic potential of medicinal marijuana – an educational primer for health care professionals – 2018

Emphasis on Education

 

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