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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 

Medical Minute

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

Medical Minute with Nurse Jordan

January 2020

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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 why people age 65 and over are turning to cannabis. Read on as we explore some commonly asked questions about seniors using cannabis.

What specific ailments can seniors use cannabis for? 

Before we talk ailments, let’s talk retirement. Generally speaking the senior population has extra time on their hands. One of the most amazing things about cannabis is its ability to enhance daily activities. The mundane becomes the enjoyable, all thanks to a plant. A common complaint for the aging population is pain,1 and cannabis is a known pain reliever. Relief from conditions like arthritis may be found from a cannabis topical and a tincture taken by mouth. Anxiety and depression can also be a part of the aging process. Cannabinoids such as THC, CBD, and CBC (cannabichomonene) may contribute to the mood-elevating effects of cannabis.2 

As I continue to age, what is the best way for me to consume cannabis? 

Not all seniors are savvy smokers, nor do they want to be. Smoking cannabis provides the quickest response, however, it also fades the fastest. Experimenting with edibles and tinctures may provide the most long-lasting effects. It is important to try different methods and cultivars. Keep a journal to document everything you try. Include the time of day, what you try, amount you take, and effects felt after how much time has elapsed. This way, if you enjoy the feeling of a particular product you will know what it was and how much you took, so you can try to duplicate the effect. 

Are there any risks to any of my pharmaceutical medications? 

Because the majority of medications are metabolized3 by the liver and the same enzymes that break down pharmaceuticals also break down CBD, many medications may not be able to reach their full potential if using CBD. It is important to be honest with your doctor about your desire to use cannabis and to verify if any of the medications you are on can interact with CBD or THC. 

There are a few pharmaceutical medications that are causing interactions with cannabis. One of those medicines is Coumadin or Warfarin.4 This is a medication to thin the blood. It is contraindicated because it increases the risk of bleeding. Another medicine commonly used for asthma is a bronchodilator called Theophylline.4 Some research has shown cannabis interferes with the effectiveness of the drug. There are also some interactions with CBD5 and calcium channel blockers and beta blockers so cardiac patients should be sure to speak with their doctor. 

Where can I purchase cannabis? 

This answer is dependent on where you are. As of late fall 2019, there are 33 states with medical marijuana and 11 states with recreational cannabis available. Several countries have now adopted cannabis legislation as well. If you live in a legal or medical location then a quick search will get you started. If you are not sure about the laws where you live, visit the website for NORML6 – the National Organization for the Reform of Marijuana Laws. They are the longest standing consumer advocacy group in the nation. Click the tab that says “States,” and then click on your state. 

If you are in a medical state, first, you will need to register as a medical patient using a state approved physician. Chances are your primary care physician can not write this recommendation. Federally, cannabis remains a Schedule 1 substance so it is not possible for doctors to write “prescriptions” for cannabis because a Schedule 1 can not be prescribed. Doctors receive special certification from the state they live in and can then write “recommendations” to patients. When you are at the office obtaining your card, ask them for referrals to local dispensaries where you can then purchase your cannabis products. If you are in a legal state all you need to do is search online, “dispensaries near me” and you will find the closest dispensary to your current location. Simply show your ID at the door and be sure to ask questions to your “budtenders,” (budtenders are dispensary staff behind the counter who assist you with your purchase). They are there to help guide your experience.

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. https://www.ncbi.nlm.nih.gov/pubmed/28983880 “Cannabis and Cannabinoids for Chronic Pain.” Current Rheumatology Reports, November 2017
2. https://www.sciencedirect.com/science/article/pii/S0091305710000730 “Antidepressant-like effect of Δ9-tetrahydrocannabinol and other cannabinoids isolated from Cannabis sativa L.” Pharmacology Biochemistry and Behavior . June 2010
3. https://www.huffpost.com/entry/cbd-medication-interaction_l_5c9271efe4b08c4fec336ff 2 “CBD May Possibly Interfere With Your Daily Medication” Julia Ries. March 21,2019
4. https://www.mdlinx.com/internal-medicine/article/4695 “Rx drugs that don’t mix with CBD, THC, and marijuana” John Murphy, MD Linx. October 9, 2019
5. https://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Medical%20Ca nnabis%20Adverse%20Effects%20and%20Drug%20Interactions_0.pdf “Medical Cannabis Adverse Effects & Drug Interactions” Government of the District of Columbia, Department of Health
6. https://norml.org/states NORML, Working to Reform Marijuana Laws

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