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Guideline Perspective
August 6, 2015

Medical marijuana
Between a plant and a hard place

August 2015 issue
5 (4) 281-284

Abstract

Medical marijuana (MMJ) is a multifaceted and complicated issue involving far too much information to convey in a single review article. In this article, we touch on points that we hope will help the practitioner make more informed decisions about the use of MMJ in the field of neurology. In particular, we discuss the systematic review published in Neurology® and describe the 2 agents that have been approved for general use by the US Food and Drug Administration (FDA). In addition, we address quality assurance, prescribing, and legal concerns and provide information about the use of Epidiolex, a liquid formulation of highly purified cannabidiol (CBD) extract, as a treatment for various orphan pediatric epilepsy syndromes.

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Supplementary Material

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REFERENCES

1.
Koppel BS, Brust JC, Fife T, et al. Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2014;82:1556–1563.
2.
Armstrong MJ, Miyasaki JM; American Academy of Neurology. Evidence-based guideline: pharmacologic treatment of chorea in Huntington disease: report of the guideline development subcommittee of the American Academy of Neurology. Neurology 2012;79:597–603.
3.
Proal AC, Fleming J, Galvez-Buccollini JA, Delisi LE. A controlled family study of cannabis users with and without psychosis. Schizophr Res 2014;152:283–288.
4.
US Food and Drug Administration. “Off-label” and investigational use of marketed drugs, biologics, and medical devices—information sheet. Available at: http://www.fda.gov/RegulatoryInformation/Guidances/ucm126486.htm. Accessed February 20, 2015.
5.
Hazekamp A, Ruhaak R, Zuurman L, van Gerven J, Verpoorte R. Evaluation of a vaporizing device (Volcano) for the pulmonary administration of tetrahydrocannabinol. J Pharm Sci 2006;95:1308–1317.
6.
Jones RT. Human effects: an overview. In:, Peterson RC, editor. Marijuana Research Findings: 1980. Rockville, MD: National Institute on Drug Abuse; 1980:54–80. NIDA Research Monograph 31, June 1980.
7.
McConnell BV, Applegate M, Keniston A, Kluger B, Maa EH. Use of complementary and alternative medicine in an urban county hospital epilepsy clinic. Epilepsy Behav 2014;34:73–76.
8.
Jusko WJ, Gardner MJ, Mangione A, Schentag JJ, Koup JR, Vance JW. Factors affecting theophylline clearances: age, tobacco, marijuana, cirrhosis, congestive heart failure, obesity, oral contraceptives, benzodiazepines, barbiturates, and ethanol. J Pharm Sci 1979;68:1358–1366.
9.
Devinsky O, Cilio MR, Cross H, et al. Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia 2014;55:791–802.
10.
Conant v Walters (9th Cir 2002) 309 F.3d 629, cert denied Oct. 14, 2003.
11.
US Department of Justice, Office of the Deputy Attorney General David W. Ogden. Memorandum for selected United States attorneys: investigations and prosecutions in states authorizing the medical use of marijuana. Published October 19, 2009. Available at: http://blogs.justice.gov/main/archives/192. Accessed June 29, 2014.
12.
US Department of Justice, Office of the Deputy Attorney General James M. Cole. Memorandum for all United States attorneys: guidance regarding marijuana enforcement. Published August 29, 2013. Available at: http://www.justice.gov/iso/opa/resources/3052013829132756857467.pdf. Accessed June 29, 2104.
13.
US Department of Justice, Office of the Deputy Attorney General James M. Cole. Memorandum for all United States attorneys: guidance regarding marijuana related financial Crimes. Published February 14, 2014. Available at: http://www.justice.gov/usao/waw/press/newsblog%20pdfs/DAG%20Memo%20-%20Guidance%20Regarding%20Marijuana%20Related%20Financial%20Crimes%202%2014%2014%20(2).pdf. Accessed June 29, 2014.
14.
Vialpando v Ben's Auto. Servs., 2014 N.M. App. LEXIS 50 (N.M. Ct. App. May 19, 2014).
15.
Porter BE, Jacobson C. Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy. Epilepsy Behav 2013;29:574–577.

Information & Authors

Information

Published In

Neurology® Clinical Practice
Volume 5Number 4August 2015
Pages: 281-284

Publication History

Published in print: August 2015
Published online: August 6, 2015

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Disclosures

D. Gloss serves as an evidence-based medicine consultant to the American Academy of Neurology; is a Level of Evidence Associate Editor for Neurology; and receives publishing royalties for Neurology for the Specialty Boards (Lippincott Williams and Wilkins, 2006). E. Maa has received funding for travel or speaker honoraria for a NINDS clinical trial methods course. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

David S. Gloss, MD
Department of Neurology (DSG), Geisinger Health System, Danville, PA; Department of Neurology (EHM), University of Colorado, Denver; and Denver Veterans Affairs Medical Center (EHM), Denver, CO.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Neurology, LOE Associate Editor
Patents:
1.
NONE
Publishing Royalties:
1.
(1) Neurology for the Specialty Boards, Lippincott Williams and Wilkins, 2006
Employment, Commercial Entity:
1.
(1) Geisinger Medical Center, Danville, PA 17821
Consultancies:
1.
(1) I am an Evidence-based medicine consultant for the American Academy of Neurology
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Edward H. Maa, MD
Department of Neurology (DSG), Geisinger Health System, Danville, PA; Department of Neurology (EHM), University of Colorado, Denver; and Denver Veterans Affairs Medical Center (EHM), Denver, CO.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NINDS clinical trial methods course
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to: [email protected]
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

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Cited By
  1. Cannabinoid-Based Medicines and Multiple Sclerosis, Cannabinoids and Neuropsychiatric Disorders, (111-129), (2020).https://doi.org/10.1007/978-3-030-57369-0_8
    Crossref
  2. More Research Is Underway for Cannabinoids for Neurologic Disorders, Neurology Today, 19, 6, (1,20-21), (2019).https://doi.org/10.1097/01.NT.0000554703.36617.bf
    Crossref
  3. Traditional Uses of Cannabinoids and New Perspectives in the Treatment of Multiple Sclerosis, Medicines, 5, 3, (91), (2018).https://doi.org/10.3390/medicines5030091
    Crossref
  4. National Board Offers Guidance for Doctors Prescribing Medical Marijuana, Neurology Today, 16, 18, (17-19), (2016).https://doi.org/10.1097/01.NT.0000502833.81504.d7
    Crossref
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