An overview of the MMJ program in CT, cannabis' benefits in the treatment of parkinson's disease and an introduction to the world of medicinal cannabis.

1. A Presentation to Inform, Educate and Prepare Patients
By: James Van Geelen
Sponsored by Compassionate Care Center of Connecticut
Designed for Fairfield County Parkinson’s Disease Support Group
Medicinal
Cannabis
and
Parkinson’s Disease
Research
Treatment
Education and
Experience
The Process of
Certification

2. Compassionate Care
Center of CT
2 www.ccc-ct.com
PARKINSON’S DISEASE
Word Cloud
• The most common terms found
on the internet related to patient
concerns after being diagnosed with
PD
• Medicinal Cannabis is a “whole-
patient” medication, capable of
alleviating a majority of these
concerns

3. Compassionate Care
of CT
3 www.ccc-ct.com
THE CHALLENGE OF MEDICINAL CANNABIS
Before We Get Started: A Disclaimer
The “Once in High School” Patient
QUESTIONS AND ANSWERS
LACK OF CLINICAL TRIALS
THE LAW
Please hold your questions until the end, unless..
THE “M WORD”
TREATMENT AS TRIAL AND ERROR
SOCIALSCIENTIFIC
NATURE OF CURRENT RESEARCH

4. A SHORT ANIMATION BY DR. SANJAY GUPTA, CNN’S CHIEF MEDICAL CORRESPONDANT
THIS IS YOUR BODY ON WEED
www.ccc-ct.comCompassionate Care Center of CT 4

5. PLAYING INTO THE PARADIGM
THC, CBD AND PARKINSON’S
www. Ccc-ct.com
Compassionate Care
Center of CT
5
The Ideal Parkinson’s Medication
Modifies Disease Progression
Alleviates Motor Symptoms
Alleviates Non-Motor Symptoms
Tolerable Side-Effect Profile
Possibly MAOIs, Novel
Neuroprotective Drugs
Levodopa,
Sinemet,
Dopamine
Agonists,
Psychiatric
Drugs etc.
THC & CBD
THC
Very low-risk, tolerable
side effects, may reduce
the side effects of other
therapies
Evidence for Cannabis’ Use for this Purpose in Animal and
Anecdotal Studies
Examples of Current Medications
Very Few

6. WHAT WE KNOW, WHAT WE THINK WE KNOW
MODIFICATION OF DISEASE PROGRESS
www.ccc-ct.com
Compassionate Care
Center of CT
6
Is why. We have an idea, as Dr. Gupta mentioned in his video, THC has effects on dopamine concentrations. There are cannabinoid receptors all
over the brain, and these receptors seem to be concentrated in a region important to Parkinson’s disease, commonly referred to as the basal
ganglia. In fact, the globus pallidus and the substantia nigra pars reticulata, which are structures within the basal ganglia, are some of the most
densely packed cannabinoid (THC) receptor areas in the human body. However, we would need a long term study to monitor these types of
changes. In vitro, THC is directly neuroprotective, that has been established.
Long-Term Treatment May
Delay Progression
Explanation: Cannabis or
Antioxidant?
May prevent L-DOPA toxicity
Increase in Endocannabinoids
due to Compensation
The Safety of Cannabis Long
Term (Anecdotal)
Translation of Results
Cannabinoids are neuroprotective
against 6-OH-DOPA
Higher Endocannabinoid levels
in Untreated Patients’ CSF
The Endocannabinoid System
in PD is severely dysregulated
CB2 Agonists (CBD) Reduced
Nigrostriatal Neuronal Death
Cannabinoids reduce
excitotoxicity, glial cell
activation, calcium influx,
oxidative stress in animal
models
What we’d like to know
WE KNOW WE THINK WE KNOW

7. WHAT WE KNOW, WHAT WE THINK WE KNOW
ALLEVIATION OF MOTOR SYMPTOMS
www.ccc-ct.com
Compassionate Care
Center of CT
7
Eric Mandzuk is a patient at Compassionate Care Center who we have grown close with. He has had tremendous success using high CBD
medicinal cannabis to treat his dystonia. He has come off of two medications, Sinemet and Baclofen, and has experienced an increase in quality
of life that we wish we could promise to all of our patients. He has joined us tonight, please hear his story.
May reduce L-DOPA induced
motor deficits
Anecdotal Reports from our
Patients
Increase in Endocannabinoids
due to Compensation
The Safety of Cannabis Long
Term (Anecdotal)
Translation of Results
Cannabinoids reduce L-DOPA
induced dyskinesia
Increased EndoCB Levels =
Reduction in Tremor (Rats)
CB Receptors Decreased in PD
CBD is an antispasmodic and
relieves muscle rigidity
A CLINICAL TRIAL!! (Vanderova 2004)
Out of 45: 39 patients described
substantial alleviation, 26 showed
improvement of rest tremor, 38 had
improvement in bradykinesia, 32 had
alleviation of muscle rigidity
Our Friend Eric: An “Anecdotal” Report
WE KNOW WE THINK WE KNOW

8. WHAT WE KNOW, WHAT WE THINK WE KNOW
ALLEVIATION OF NON-MOTOR SYMPTOMS
www.ccc-ct.com
Compassionate Care
Center of CT
8
Chronic illness is, perhaps, one of the most psychologically taxing things a human being can go through. Being able to control the symptoms both
caused by Parkinson’s Disease and the psychological reaction to it has been an astounding feat we have watched many of our patients achieve.
Cannabis, unlike benzodiazepines or SSRIs or opioid painkillers, offer treatment for the many symptoms of PD such as anxiety, depression,
fatigue, pain, insomnia and GI upset without the risk of inevitable withdrawal, further neurological damage or potentially lethal drug interactions.
Cannabis may help with GI
symptoms in PD patients
Cannabis relieves stress
Cannabis relieves depression
The Safety of Cannabis Long
Term (Anecdotal)
Genetic mutation in CB Receptors
in PD may predispose to depression
CBD offers a non-psychoactive
psychiatric answer
THC and CBD are both proven
anti-inflammatory drugs
CB2 Agonists (CBD) Reduced
Nigrostriatal Neuronal Death
Cannabinoids reduce
excitotoxicity, glial cell
activation, calcium influx,
oxidative stress in animal
models
Cannabis is the Safer Alternative
WE KNOW WE THINK WE KNOW

9. WHAT WE KNOW, WHAT WE THINK WE KNOW
TOLERABLE SIDE-EFFECTS
www.ccc-ct.com
Compassionate Care
Center of CT
9
Investigators at Tel Aviv University, Department of Neurology evaluated Parkinson’s disease symptoms in 22 patients at baseline and 30-minutes after
inhaling cannabis.
Researchers reported that inhaled cannabis was associated with “significant improvement after treatment in tremor, rigidity, and bradykinsea (slowness of
movement). There was also significant improvement of sleep and pain scores. No significant adverse effects of the drug were observed.” Some of the
symptoms of reduction were described as being caused by current treatment.
They concluded: “[T]his observational study is the first to report an amelioration of both motor and non–motor symptoms in patients with PD treated with
cannabis. The study opens new venues for treatment strategies in PD especially in patients refractory to current medications.”
Israel has permitted for the licensed production and distribution of the substance for therapeutic purposes since 2011.
Cannabis may alleviate the
side-effects of other meds
No recorded drug
interactions
All of the benefits of
dopaminergic modulation,
none of the gambling or risky
sex behavior?
Quality of Life is the most
consistently significant
increased finding in medicinal
cannabis related research.
The Safety of Cannabis Long
Term (Anecdotal)
There have been no direct lethal
overdoses due to Cannabis
Cannabis elicits very little
permanent change on the body
Only 3 out of 45 patients in that
trial dropped out
Even if cannabis doesn’t
replace your current
treatment, which it most likely
will not, it may save you by
enabling dose reduction
Some Non-USA Data (Lotan, 2014)
WE KNOW WE THINK WE KNOW

10. Compassionate Care
Center of CT
10 www.ccc-ct.com
THE PROCESS OF MEDICINAL CANNABIS IN CT
GETTING CERTIFIED
You’ll Need
With your Physician
To Register Online Have these ready:
Confirm the:
Qualifying patient must be a Connecticut resident.
Qualifying patient must be at least eighteen (18) years of age or older.
Qualifying patient cannot be an inmate confined in a correctional institution or
facility under the supervision of the Connecticut Department of Corrections.
Government ID x 2
Proof of Residency
Bill, Mail etc.
Passport Photo
Physician BizNet
Physician -> Patient Responsibility
Begin Your Registration
Meet the Reqs
Discuss with
your Doctor,
then
Consult with our
Pharmacist
Get Your Card

11. THE RECIPE
USING CANNABIS AS A MEDICATION
www. Ccc-ct.com
Compassionate Care
Center of CT
11
Once you have received your card in the mail and come to our dispensary, our skilled pharmacist will assist you in taking these steps to optimize your
treatment plan with medicinal cannabis. This can be the most important step in your treatment plan, and it is important to go through it alongside your
physician, dispensary and with subjective reports to find out exactly what works for you.

12. THE RECIPE
USING CANNABIS AS A MEDICATION
12
Starting your Treatment
CHOOSE STRAIN
Inhaled
CBD
Sativa
Trial and Error
Orally administered cannabis lasts longer, has a more potent
effect and may be better for those who wish to start on a
treatment plan focused throughout the day.
Inhaled cannabis is for breakthrough symptomatic relief, and
acts very quickly. We typically recommend vaporization over
smoking.
Educated Guesses (being
honest here!)
Indica
CHOOSE METHOD
Taken Orally
Indica strains provide a very relaxing effect that is helpful in
treating general anxiety, body pain, and insomnia.
Sativa strains provide an uplifting, energetic effect, increasing
feelings of well-being, stimulating creativity and, fighting
depression.
THC

13. WE’RE AWARE THE PROCESS, THE INFORMATION, EVEN THE GENERAL IDEA CAN BE
OVERHWLEMING. YOU’LL FIND IN YOUR FOLDERS HANDED OUT PLENTY OF RESOURCES – THE
MOST IMPORTANT OF WHICH IS OUR PHONE NUMBER.
CHRONIC ILLNESSES SUCH AS PARKINSON’S ARE LIFELONG STRUGGLES THAT LEAVE PATIENTS
OFTENTIMES FEELING LOST. NOBODY SHOULD EVER HAVE TO FEEL THAT. ADDITIONALLY,
NOBODY WHO TAKES THE OPINION THAT ANY MEDICATION WHICH MAY HELP IS “FOR
STONERS” SHOULD BE TAKEN SERIOUSLY – THIS IS A POINT OF VIEW LACKING SYMPATHY AND
MORAL INTEGRITY (SOUND HARSH? I KNOW – BUT IT’S THE TRUTH IN OUR EYES).
AT COMPASSIONATE CARE CENTER YOU WILL FIND A TEAM OF HEALTHCARE PRACTICIONERS
DEVOTED TO NOT ONLY YOUR HEALTH BUT YOUR WELLNESS. IF YOU SO DECIDE TO PROCEED,
PLEASE STAY IN CONTACT WITH US. WE CAN’T WAIT TO KNOW YOU, AND HOPEFULLY GET YOU,
BETTER.
QUESTIONS? WE HAVE ANSWERS, BUT FIRST…
CCC WANTS YOU TO BE KNOW THE FOLLOWING:
www.domainname.comLogo Company 13