Summary Of Slovenian Cannabis Presentation At The Medical Faculty, University Of Zenica 2023
By Prof. Tamara Lah Turnšek
Invited by Semine Djeraković Siniković, nurse from the Zenica Cantonal Hospital, Vice-Dean for Scientific and Research Work, Assoc. dr. sc. Mirza Oruča and the dean of the Faculty of Medicine in Zenica, prof. dr. sc. Harun Hodžić.
Content of the Symposium:
David Neubauer presented his lecture on Use of cannabinoids and medicinal cannabis in severe neurological disorders of children. First he presented the trajectory of medicinal cannabis through centuries/millenia since it has been first used in Chinese pharmacopeia some 5000 years back, and until the recent events when cannabis was prohibited for nearly 100 years and nowadays when again his excellent treatment properties are being scientifically studied. Then he presented some new studies (some of them evidence-based) on use of cannabinoids in children with severe, resistant epilepsies/developmental encephalopathies in children and some other severe problems during childhood, like cerebral palsy and autism. In the last part of his talk he has presented own experiences with such treatment; namely the publication of cannabidiol (CBD) treatment for resistant epilepsies from 2018, where 20% of children were completely seizure-free after add-on introduction of cannabidiol and compared his study with some similar studies in systematic review articles, where other authors presented similar results. At the end he has presented some new on-going studies where medicinal cannabis with a ratio of cannabidiol (CBD) and 9-delta tetra hydro-cannabidiol (THC) – CBD:THC 10:1 has been used for severe forms of cerebral palsy (level IV and V) and severe behavioural problems in autism and neurodevelopmental syndromes, where also very good results are promising that this will be in the future one of the best therapy for such cases, where no other treatment option is available and effective.
David Neubauer, MD, PhD, Paediatrician and Child Neurologist, University of Ljubljana, Medical Faculty and University Medical Centre Ljubljana, Children’s Hospital, Department of Child, Adolescent & Developmental Neurology, Bohorićeva 20, 1000 Ljubljana
Tamara Lah Turnšek lectured on Cannabinoids in Cancer Treatment and presented the research, carried out at National Institute of Biology on the potential treatment of brain tumors, specifically on most aggressive glioblastoma with cannabinoids.
She started with the introduction on the discoveries of the “Godfather” of cannabinoid discovery, Dr. Raphael Mechoulam saying that the research on Cannabis, thousands of years old plant, opened are an undiscovered pharmacological treasure cannabinoids, and revealed physiologically important endocannabinoids system(ECS) that regulated our normal functioning- homeostasis. Endocannabinoids, synthetic and plant cannabinoids, the most important components of various species of Cannabis Sattiva L. bind to various body cells through specific receptors CB1 and CB2 and less specific ion transport receptors to influence cellular processes autophagy, apoptosis, the immune response, and stimulate neurological response.
The second part of the talk addressed the development, progression and hallmarks of cancer, how these processes are related to the disease and affected by cannabinoids that specifically kill cancer cells, moreover most malignant cancer stem cells. Trying various cannabinoids and their combinations on isolated cells from patients fresh tumours – glioblastoma, the scientist at NIB found a novel activity of less known cannabinoid, cannabigerol CBG, that alone and even more so in combination with cannabidiol (CBD) represents a novel, yet unexplored adjuvant treatment strategy for glioblastoma. Not being hallucinogenic, this cannabinoid can replace psychoactive 9 delta tetra hydro-cannabidiol (THC), having potential side effects on normal brain activity in complementary therapy of brain and possibly other tumours.
Prof. Tamara Lah Turnšek,PhD, Chief Science Officer The Talman Group.com. Cigaletova 7, 100 Ljubljana.
Jasna Kovač, lectured on “What and why a nurse should know about the medical use of cannabis and cannabinoids”. She showed the “Guidelines for Nursing Care of Patients Using Medical Cannabis the MEDCA association – an association of Slovenian nurses and other medical professionals, published by the National Council of State Boards of Nursing in the USA.” As the Chair of the “MEDCA association – an association of Slovenian nurses and other medical professionals” she introduced the association and the field of cannabis treatment. The MEDCA association updated the American Guidelines for Nursing Care of Patients Using Medical Cannabis Slovenian nurses. The first guideline is that the nurse shall be acquainted with the current state of legalization of medical and recreational cannabis use. In Slovenia from 2014, cannabis was re-categorized within the Decree on the classification of illicit drugs Stage II and has been permitted to be used for medical purposes. Other guidelines she mentioned were: (1) The nurse should have a general understanding of the endocannabinoid system, cannabinoid receptors, cannabinoids, and the interactions between them. (2) The nurse should have an understanding of the research associated with the medical use of cannabis. (3) The nurse must be familiar with the possibilities of prescribing and administering medical cannabis in their country. (4)The nurse should know the signs and symptoms of medical cannabis side effects on patients. (5) The nurse should report findings related to cannabis(6=is therapy to other healthcare providers and record them in the patient’s documentation. (6) The nurse should approach the patient without judgment regarding the patient’s choice of treatment or preferences in managing pain and other distressing symptoms. She ended the lecture by explaining why a nurse should have this knowledge. Here, she highlighted the importance of patient integrity, autonomy – the ability to make decisions, and the role of the nurse as their advocate, protector, and teacher.
Jasna Kovač, nurse at Clinics of Cardiology University Medical. Centre, Zaloška 2, 1000 Ljubljana
Roman Štukelj, presented his lecture on “Active compounds in cannabis; extraction and analytics.” First, in the introduction to the lecture, he presented the current activities (organization of educational seminars and research work) related to cannabis at the Faculty of Health. In the second part, he explained the potential therapeutic applications of cannabinoids and terpenes, as well as the methods for extracting them to obtain full-spectrum, broad-spectrum, or isolated products. In the last part, he presented the analytical results of the “Slovenian monitoring of cannabis product.” The samples for monitoring and cannabinoid analysis were collected by the Research Nature Institute. These samples were labeled and taken to the Faculty Analytical Laboratory for cannabinoid profiling. A total of 290 samples were collected over two years. For the study, 286 samples were used, as four of them were excluded due to their small quantity. The samples were categorized according to the recommendations of the United Nations Office on Drugs and Crime. Statistical calculations revealed that the majority of the analysed samples were cannabis oil (74%), followed by dried herbal cannabis (11%), and 3% were cannabis resin (sometimes referred to as “pollinators” or “ice-o-lators.”Additionally, suppositories, tinctures, and salves were received and grouped as “other” (12%). The origin of the monitored samples showed that the vast majority were from the self-sufficiency group of unknown origin (referred to as the “black market”) and the industry (72%, 23%, and 5% respectively). The average total concentrations of Δ-9-THC and CBD in the samples from the industry were all CBD-rich samples. Seven of them were in herbal form, while six were oils. The average values of the total Δ-9-THC in this group of samples were 18.8 mg/g, and 129.7 mg/g for the total CBD. In the population of unknown origin (referred to as the “black market”), the average value of the total CBD was 117.2 mg/g, and the average total Δ-9-THC was 371.1 mg/g. Samples from self-sufficient patients were in the form of oils, herbal products, and others (151, 23, and 34, respectively). Out of these, 34 of the samples had CBD as the dominant cannabinoid, three samples had a ratio of 1:1, while the others had Δ-9-THC as the dominant cannabinoid present in the sample. In conclusion, it was found that in Slovenia, the majority of cannabis patients prefer THC as their primary option, often in the form of extracts. Since the contamination by unwanted substances and potency of the products varies greatly, there is a need for further monitoring at a national level.
Roman Štukelj, Ph.D, Researcher at Analytical Laboratory Faculty of Health Sciences at University of Ljubljana, Zdravstvena pot 5, p.p. 397, 1000 Ljubljana
Božidar Radišič, the founder of the Research Nature Institute, an institution known for organizing scientific conferences in Slovenia and overseas for over a decade, emphasized the pivotal role of education in the integration of cannabis into medical practice. This underscores the importance of medical faculties and other professional organizations taking the lead in educating individuals in this field. The packed auditorium at the college stands as a testament to the enthusiastic desire among young people to acquire knowledge about cannabis in the context of medicine. Furthermore, it’s noteworthy that cannabis is experiencing a significant resurgence in Šharmacopoeias and medical practices worldwide, USA, Canada, Australia also including some states in the European Union, i.e. Germany. With any luck, thanks to today’s event, this resurgence will also extend to Bosnia and Herzegovina.
Lastly, it’s crucial to acknowledge the dedicated efforts of individuals such as Semine Djeraković Siniković, a nurse from the Zenica Cantonal Hospital, Assoc. Dr. Sc. Mirza Oruča, the Vice-Dean for Scientific and Research Work, and Prof. Dr. Sc. Harun Hodžića, the dean of the Faculty of Medicine in Zenica. We express our sincere gratitude to them.
Božidar Radišič. the Research Nature Institute. Mala ulica 8, 1000 Ljubljana
