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Medical Minute

Cannabis + Kids

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Let’s clarify; no one advocates for the recreational use of cannabis for children. I think everyone would agree that it is not a good idea to use any brain-altering substance in a growing and developing brain, including nicotine, alcohol, and high fat and sugar foods. However, if a child has a condition that needs medical intervention, then all the tools in the toolbox should be considered, and a parent/caregiver must assess each of the risks and the benefits before choosing any intervention. That includes every medication, not just cannabis medicine. We will also agree that there is no such thing as a panacea. We are all individuals, and everyone responds differently to the same treatments.

In order to make an informed decision, we need to understand what science and research provides. With the understanding that cannabis is medicine, the results of its use are quickly evolving.

What Do We Know?

Tetrahydocannabinol (THC) is the most well-known molecule of over 400 molecules in the cannabis plant. Its popularity is mostly based on its ability to be intoxicating or cause a “high.” That does not mean that THC is not an important medicine, nor does it mean that all amounts of THC cause that intoxicating feeling. Synthetic THC—called dronabinol—has been FDA approved and available in all 50 states since 1986. In 2003, the World Health Organization (WHO) recommended transferring THC from a schedule I or II drug to schedule IV, citing its beneficial medical uses and low abuse potential when used for medical conditions.

As the cannabis plant grows in nature, it actually makes THCA—the acid form of THC. Parents of children with epilepsy discovered that this non-intoxicating cannabinoid could help reduce their child’s seizures, along with traditional anti-seizure medications, when they found CBD to be ineffective. 

THC and THCA have been found to reduce pain and inflammation and decrease chemotherapy-related nausea and vomiting. In 2017, the National Academy of Science, Engineering and Medicine found that cannabis is very effective for these indications.

The question is if a child is being treated with chemotherapy does it make sense to use cannabis to reduce nausea and vomiting and improve appetite? The National Academy report found three studies involving children treated with chemotherapy. Comparing the response of cannabinoids against standard anti-nausea and vomiting treatment: two of the three studies showed cannabinoids were better than standard treatment, and the third showed no difference in benefit. 

There are some physicians who have reported success with treating autism using an integrated approach including a diet change and small doses of THC. See Dr. Christian Bogner’s lecture on autism, the endocannabinoid system and THC: https://www.slideshare.net/ChristianBogner/endocannabinoid-signaling-in-autism

Let’s clarify; no one advocates for the recreational use of cannabis for children.

Cannabidiol (CBD) has become very popular since the Dr. Sanjay Gupta report highlighting this cannabinoid for its anti-seizure properties and that it doesn’t cause the intoxication or “high” like THC. GW Pharmaceuticals received FDA approval for the indication of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. The WHO recently reported that CBD is safe and well-tolerated in humans (and animals) and is not associated with any negative public health effects or potential for abuse. Since that report, CBD is now readily found almost everywhere—from food and beverages to room air fresheners! 

However, that doesn’t mean CBD should be used without discretion. Just like grapefruit, CBD does interfere with metabolic pathways and may interfere with the breakdown of other medications. 

CBD is being investigated for treating children with autism. THC may not work for everyone. Studies in animals and preliminary studies in Israel suggest that CBD may work for some autism patients and with less side effects than other treatments. 

CBD is also being studied for treating children with ADHD or anxiety symptoms that often accompany ADHD. Patient reports suggest that CBD successfully reduces the anxiety related to ADHD. 

CBD is being used for various painful conditions. There are patient reports that show CBD to be effective in children for the treatment of pain. The use of CBD could reduce or replace other pain medications that may have more serious side effects. 

These are but a few examples of how cannabis or cannabinoids may play an important therapeutic role in the treatment of children with certain medical conditions. Of course, more studies need to be conducted so we can understand more clearly how to use cannabis in children and for which conditions. Until then, my advice is to seek out a physician to partner with who will help create a therapeutic strategy for your child. Start low and go slow is the cannabis treatment mantra. It
really does take patience and may take some examination to discover an effective medicine for your child. 

Be well,
Dr. Deb

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Medical Minute with Nurse Jordan

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In this column, our readers have the opportunity to ask our staff nurse anything they want to know about using cannabis plant medicine. She will provide quick and concise answers to big questions. In this month’s column, we researched Parkinson’s disease and how those suffering might be able to use cannabis for relief from their symptoms. Due to the abundance of cannabinoid receptors in the brain, the endocannabinoid system might turn out to be a direct delivery system for the relief of some symptoms experienced by patients who have Parkinson’s, according to a study published in Innovations in Clinical Neuroscience in January 2019.1

Parkinson’s disease affects the body’s movements by attacking the nervous system. The disease begins gradually and progresses over time. Sometimes, it begins with a simple hand tremor, others might experience less expression in the face, or speech might slow or soften.2 Pharmaceuticals have been the way patients have sought symptomatic relief until now. Thanks to the advancing laws surrounding medical and recreational cannabis, patients have more options than ever. 

What are the best methods of consumption for Parkinson’s patients? 

In states that have medical marijuana or recreational cannabis laws enacted, different products are available at dispensaries. One of the main symptoms caused by the disease is tremors. Some patients have had success with taking cannabis in an oil taken orally. Cannabis oil may contain THC and CBD and is often sold in blunt-tipped syringes or in bottles with a dropper, making self-administration of the cannabis plant medicine easy for the patient. 

In a study done by the British Association for Psychopharmacology, patients who received 300 mg of CBD a day showed a significant improvement of symptoms compared to those given a placebo.4 In another study done by the Movement Disorder Society, doses as low as 1.5 mg CBD: 2.5 mg THC up to 300 mg of CBD were given daily.5 Symptom relief was noted in patients with higher doses. Although there are still no set dosing parameters and more research is needed, do not let that get you discouraged. 

An open-label study of smoked marijuana decreased tremor and slowness in 22 people with PD.6 Improvement in patients’ sleep and pain scores were also observed. Some patients may prefer using an oil or tincture, others may feel more comfortable smoking. You may find a combination of delivery methods is what works best for you. Keep a journal and document your journey so if it works, you can duplicate what you did. 

What states list Parkinson’s as a qualifying condition?

A qualifying condition is a disease/disorder/symptom that a state has approved for a patient to use medical cannabis. Permission is received from a recommending physician and paperwork is filed with the state registry. According to the National Organization for the Reform of Marijuana Laws (NORML), there are 17 states in the U.S as of early 2020 that list Parkinson’s disease as an approved diagnosis.3 In addition to listing Parkinson’s disease, patients may also receive approval for persistent muscle spasms/spasticity.

Parkinson’s Disease

Connecticut
Florida
Georgia
Illinois
Iowa
Louisiana
Maine
Massachusetts
Michigan
Missouri
New Hampshire
New Mexico
New York
Ohio
Pennsylvania
Puerto Rico
Vermont
West Virginia
Virgin Islands

Persistent Muscle Spasms/Spasticity 

Arizona
California
Colorado
Delaware
Maryland
Michigan
Minnesota
Montana
Nevada
Oregon
Rhode Island
Utah
Washington

Treating Physician Decision

Arkansas (if approved by the Dept. of Health) Kansas
Oklahoma
Washington D.C
Wisconsin


What else should patients with Parkinson’s know? 

If you have not yet taken the time to view a video of a Parkinson’s patient using cannabis, then I highly suggest you take the time to do so now. As people often say, “seeing is believing.” One of the best videos available to see how quickly the effects of the cannabis plant medicine take place can be found on YouTube. By typing in “Ride with Larry” in the search bar of YouTube, you will find videos of a former police officer turned cannabis user. His tremors begin to calm within a matter of minutes after using cannabis oil. 

Researching at home can feel daunting. Some reports can be conflicting. If you want to try cannabis for your symptoms, it is important that you speak with your doctor, and don’t forget to document your journey.


Do you have questions for nurse Jordan?

Please submit any questions to [email protected]
Your question may be published in an upcoming issue.


REFERENCES:

1. Mohanty, D. & Lippmann, S. Innovations in Clinical Neuroscience, 16 (1-2). 2019.

2.  Mayo Clinic. Parkinson’s Disease. www.mayoclinic.org

3. NORML. Medical Marijuana. Information for each state. norml.org

4.  Chagas, M.H.N., et al. Journal of Psychopharmacology Sep. 18, 2014. doi: 10.1177/0269881114550355

5. Kluger, B. et al. Movement Disorder, 30(3). 2015. doi: 10.1002/mds.26142

6. Lotan, I. et al. Clinical Neuropharmacology, 37(2). 2014. doi: 10.1097/WNF.0000000000000016

7. Medical Marijuana and Parkinson’s Part 3 of 3. November 21, 2016. Ride with Larry. www.youtube.com

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Medical Minute with Nurse Jordan

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In this issue, we are learning all about Multiple Sclerosis (MS) and diseases that mimic its symptoms. The cause of MS is unknown. It is a disease that affects the central nervous system,1 which controls the majority of functions for the mind and body. Read on as we explore some commonly asked questions about using cannabis for MS.

What states have approved MS as a qualifying condition?

Qualifying conditions to receive your medical marijuana card vary from state to state. It is important to make sure your state has approved the condition you have. In the case of MS, some states specifically approve MS2 as a diagnosis and several states use the term “persistent muscle spasms or spasticity.” Since that is a primary symptom of MS, approval would most likely be provided.

Multiple Sclerosis

Alaska
Arkansas
Connecticut
Florida
Hawaii
Illinois
Louisiana
Maine
Massachusetts
Missouri
New Hampshire
New Jersey
New Mexico
New York
North Dakota
Ohio
Pennsylvania
Utah
Vermont
West Virginia

Persistent Muscle Spasms

Arizona
California
Colorado
Delaware
Maryland
Michigan
Minnesota
Montana
Nevada
Oregon
Rhode Island
Utah
Washington

Treating Physician Decision

Oklahoma
Washington D.C.


What are the best methods of consumption for MS patients? 

In my professional opinion, after working with several MS patients performing cannabis massage, I can say that one of the best methods of consumption for MS patients is high quality topicals, like the organic ones we designed for our patients.3 Because this condition can have a detrimental effect on the muscles, self application or application done by a licensed therapist can be a total game changer. The relief that is felt often takes place within minutes of application. Re-application can be done as needed. 

Studies are showing that cannabis may be effective for the pain and spasticity felt by MS patients.4 Another method of consumption that can assist with the discomfort being felt is by using a cannabis oil or tincture. The difference in an oil and tincture is how the plant is extracted: either by using alcohol as a solvent or by using an oil. Either method is great for internal absorption. Thanks to the body’s ECS,5 we have receptors throughout the body waiting to be activated by cannabinoids. THC and CBD bind to the body’s receptors and assist in relieving the spasms and pain felt by MS. 

If you are on other medications and you want to try using cannabis, speak with your doctor. Be honest in your desire to understand the plant and check to see if there are any contraindications of your medications. Safety first.

Are there any MS support groups or organizations offering guidance or more resources?

A quick google search for “multiple sclerosis local support groups” will provide you with any groups near you. The National MS Society6 offers guidance for patients. You can find this information by visiting their website – www.nationalmssociety.org click on the tab that says treatment, then where it says “Complementary and Alternative Medicines.” You will see several alternative treatments listed and Marijuana (Cannabis) is the second. They provide comprehensive information about cannabis plant medicine as a whole.7 

With no surprise, “there’s an app for that.” If you are a tech savvy person and you and/or your caregiver prefer that route, there is an interactive application from Healthline called MS Buddy:Multiple Sclerosis.8 It can be found in the app store on any smartphone. This is another great resource for patients. Members can communicate with fellow patients for inspiration and advice. It is important to note, this is not a medical app. This is a platform designed for support, not medical answers. Those types of questions should still be asked of your primary care physician.


Do you have questions for nurse Jordan?

Please submit any questions to [email protected]
Your question may be published in an upcoming issue.


REFERENCES:

1. “Definition of MS” https://www.nationalmssociety.org/What-is-MS/Definition-of-MS
2. NORML, National Organization for the Reform of Marijuana Laws, State Info. https://norml.org/states
3. Primal Healing, cannabis topicals.
http://www.primalhealing.com
4. Nielsen S. Et al. Current Neurology and Neuroscience Reports.  2018 Feb 13,18 (2):8.  doi: 10.1007/s11910-018-0814-x
5. Pacher, P. Et al. Pharmacol Rev. 2006 Sep; 58(3): 389–462. doi: 10.1124/pr.58.3.2
6. Frequently Asked Questions. National MS Society. https://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Marijuana/Marijuana-FAQs
7. Cameron, M. & Rice, J. National MS Society. https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Professionals/Cannabis-and-Multiple-Sclerosis.pdf
8. MS Buddy: Multiple Sclerosis. Social support health chat. Application for smartphones.

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Medical Minute with Nurse Jordan

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In this column, our readers have the opportunity to ask our staff nurse anything they want to know about using cannabis plant medicine. She will provide quick and concise answers to big questions. In this issue, we dive into pain of all kinds and why people are turning to cannabis as an alternative treatment or in conjunction with their current therapy. 


Pain is often broken down into two categories, acute and chronic. Acute pain tends to last a short period of time, up to 3 months, and is sharp and severe. Whereas chronic pain can last forever and can be an intense hurt or a constant dull ache. According to a study1 done in early 2019, chronic pain is currently and historically the most common qualifying condition reported by medical cannabis patients. 

Currently there are 50 million2 Americans suffering for various reasons. Many suffer in silence, taking countless pharmaceuticals only to feel new compounding symptoms from the use of too many OTC (over-the-counter) or prescription pills. Read on as we explore some commonly asked questions about making the switch to using cannabis for various types of pain. 

inhaled cannabis reduces self-reported headache severity by 47.3% and migraine severity by 49.6%

What are the most common reasons people use cannabis for pain? 

Pain can come from a variety of things including the common headache. A recent study released in November 2019 by Washington State University showed, “inhaled cannabis reduces self-reported headache severity by 47.3% and migraine severity by 49.6%.”3 This is fantastic news for chronic migraine and headache sufferers. Another common cause of pain is neuropathy, and science is showing great use for cannabis with this type of pain as well. A 2018 study4 by the University of California showed that using cannabis via vaporization or oral delivery was an effective treatment for pain caused by neuropathy. 

Another common reason for using cannabis is the daily pain caused by arthritis. One in four adults report they experience pain from arthritis.5 The question of whether or not cannabis is effective for arthritis pain is so common, the organization that represents the voice and needs of those suffering, The Arthritis Foundation, now has a dedicated tab6 on their website offering guidance.

What products or methods of application/consumption are recommended for general pain? 

In my personal opinion, one of the best ways to receive cannabinoid therapy is through our largest organ – the skin, via the use of topicals. We have been offering cannabis massage using topicals in Colorado for six years at Primal Therapeutics, and we have helped thousands of patients feel relief. Using topicals focuses on the health aspect and not the high sometimes associated with using cannabis plant medicine. Infused topicals can be an effective treatment for several types of pain. 

Other methods of consumption include smokeables such as using a vapor device or consuming the flower or bud in a joint, bong, or cannabis pipe, or consuming various forms of hash, now commonly called concentrates, for the very high concentration of THC they possess. A great consumption method can be ingestibles. These products can be purchased in almost all medical cannabis dispensaries in legal states and come as tinctures, capsules, and edibles. CBD manufacturers make these products as well. 

Pharmaceuticals, specifically those used for pain come with high addiction rates and countless side effects, including death.7 Cannabis has never caused a death, ever. This means experimenting with the plant in its various forms can cause little detriment. However, on occasion there can be a contraindication for using CBD with certain pharmaceuticals, so it is best to check with your doctor to see if you are on one of those medications. 

Can I receive the benefit of pain relief from cannabis without the high? 

Absolutely. As mentioned above, topicals are a great option for wanting to receive all the benefits of plant medicine without a psychoactive experience. Another way to use the plant for pain is to work with various cannabinoids. Not all cannabinoids make you feel high. Science has shown us that THC is the part that makes us feel “high.” To avoid that feeling, there are other great ways to use cannabis plant medicine. Tinctures, edibles, or capsules that are high in CBD with little or no THC may provide exactly the relief you seek. 

Experimenting with cannabis plant medicine may provide relief to those suffering. It is important to remember, pain is a general term, and it’s difficult to measure. Everyone has a different pain tolerance and what may cause great distress to one, may feel like a minor ache to another. Judgement should not be felt by those in pain. The feeling is difficult for many to express and communicate to those they love. Be patient with yourself and anyone you know who suffers from pain. 


Do you have questions for nurse Jordan? 

Please submit any questions to [email protected]

Your question may be published in an upcoming issue.


REFERENCES
1. Health Affairs. February 2019.
2. Center for Disease Control. 2016.
3. Journal of Pain. November 2019.
4. University of California. February 2018.
5. https://www.cdc.gov/chronicdisease/resources
publicationsfactsheets/arthritis.htm
6. https://www.arthritis.org/living-with-arthritis/painmanagement/chronic-pain/arthritis-foundationcbd-guidance-for-adults.php
7. Division of Drug Risk Evaluation, Food and Drug Administration. 2007 

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