Clinical trial supply

History of cannabis as a medicine for cancer•First reported medical use > 3000 years ago•Siberian Ice Maiden: 5thcentury BC•Traditional Indian medicine•Analgesic, sedative, anxiolytic, appetite Introduced into UK by O’Shaughnessy in 1842•British physician working in India•Analgesic, anti-convulsant•Fell out of favour in 1930s•Plant material too variable•Shelf-life short and unpredictable•Replaced by pure opiates and more reliable synthetic drugs•Removed from UK/US Pharmacopeia 1932 & ’41•Prohibition 1930shttp://siberiantimes.comKalantPain Res Manage 2001

Resurgence in interest in cannabis as treatment for cancer over last 20 years•Non-legal use in community: anecdotes•Research since 1980s (esp. Israel)•Identified endogenous cannabinoids with influence on neurologic, immune, gastro-intestinal systems•Synthetic THC developed•FDA approved: nausea and vomiting due to chemotherapy•Dronabinol 1986 (also AIDS anorexia, Nabilone 2010)•Compassionate use allowed•California 1996 … … NSW 2014 (terminal illness)•Clinical trials launched in NSW 2015•Medicalprescribing permitted in Australia 2016

Medline-indexed publications on cannabis or cannabinoids AND cancerhave increased dramatically since 1970020406080100120140160Number of papersYear

•THC (psychoactive)•high affinity for CB1/CB2•plant: wide variation in concentration•Cannabidiol (CBD)•low affinity for CB1/CB2 (agonist/antagonist)•counteracts psychoactive effects of THC•anxiolytic, anti-psychotic, analgesic (? due to anti-convulsanteffect)•Both highly lipid solubleCannabis contains over 400 chemical compoundsKalantPain Res Manage 2001Kramer Ca Cancer J Clin2005> 60

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