Cannabis for RDNs (Who Don t Know their CBD from their THC!)

Transcription

1 Cannabis for RDNs (Who Don t Know their CBD from their THC!) Janice Newell Bissex, MS, RDN Holistic Cannabis Practitioner Today s Talk What is cannabis? History of use Components of cannabis Condi@ons cannabis may treat Administra@on, dosing, and side effects Poten@al drug interac@ons Legal issues My story from culinary nutri@onist to holis@c cannabis prac@@oner Why should YOU care? 55 million US adults use cannabis It s a $9.7B industry - $24.5B by 2021 Your clients will ask If you don t know, they ll find someone who does 53% over 65yo experienced pain in last month Tenfold increase in cannabis use over 65yo Sanjay Gupta, MD David E. Newell You may be thinking this but increasingly this is the face of cannabis. 1

2 3/2/18 History of cannabis as medicinal herb 4000 BC Chinese medicine 1840s Queen Victoria 1937 Marihuana Tax Act 1942 Removed from Pharmacopeia 1970 CSA Schedule I classifica@on 1996 CA first to approve med cannabis 1999 IOM report on medical use, synthe@c Marinol schedule III 2003 US govt patent: Cannabinoids as An@oxidants and Neuroprotectants Cannabis versus hemp Hemp and cannabis = cannabis sa@va L plant Indica vs. sa@va? Look instead at cannabinoid profile Tetrahydrocannabinol (THC) Ac@ve components of cannabis Cannabinoids Terpenes Flavonoids CBD (non psychoac@ve) THC (psychoac@ve) CBN, CBG, CBC, THCa, CBDa Myrcene, linalool, limonene, beta caryophellene, pinene Catechins, querce@n, cannaflavin- A Cannabidiol (CBD) Pain Relief An@- inflammatory An@- seizure An@- nausea An@- depressant An@- anxiety Neuroprotec@ve Terpenes Psychoac@ve Pain Relief An@- inflammatory An@- spasm Appe@te S@mulant Muscle Relaxant Bronchodilator 2

3 Entourage Effect Whole plant is greater than the sum of its parts Cannabinoids and terpenes work together BBC Documentary - THC alone vs. with CBD Endocannabinoids: Anandamide (bliss molecule) 2- AG (neuroprotec@ve) CB1 receptors (brain, spinal cord) CB2 receptors (immune cells, organs) Enzymes: FAAH breaks down anandamide MAGL breaks down 2- AG Medical uses of cannabis Pain - neuropathic, arthri@s Cachexia of AIDS and cancer Side effects of cancer treatment Mul@ple sclerosis Fibromyalgia IBD, IBS Mental health: PTSD, depression, anxiety Insomnia Other: migraines, acne, other skin issues Athle@c performance Approved medical condi@ons in MA Cancer Glaucoma HIV/AIDS Hepa@@s C ALS Crohn s Parkinson s MS Other debilita@ng condi@ons causing pain nausea, cachexia, weakness 3

4 3/2/18 Modes of Timing of Relief Tincture Topical Creams Transdermal Capsules Edibles Suppositories Raw juice Dosing: Start low and go slow! Cannabis vs opioids Not a gateway drug rather an exit herb 2016 study giving cannabis to opiod addicts decreased opioid use by 44% Legal marijuana states have a 31% decrease in opioid mortality 3 ways to use For pain control to decrease opiod dosage Use during withdrawal to manage symptoms Preventa@ve to avoid addic@on in place of opioids Possible Cannabis- Drug Interac@ons Legality and S@gma May increase effects of some drugs. Be cau@ous if taking a drug where grapefruit is contraindicated when inges@ng cannabis. Check with MD. Synergy with some meds (SSRIs) Tricyclics: possible enhanced seda@on, hypotension, tachycardia Alcohol- THC may increase CNS impairment NSAIDs antagonize THC effect less high Zolor: may cause nausea, agita@on Prilosec/Tagamet: may need less cannabis Medical marijuana legal in 29 states (including Massachusess) Adult use ( recrea@onal ) legal in 9 states, including Massachusess 64% of Americans support legaliza@on Cannabis remains a Schedule I drug, so federally illegal. Hemp (<0.3% THC) is legal. 4

5 Access to cannabis Medical marijuana Obtaining a medical marijuana card Visi@ng a dispensary Legal hemp/cbd products What to look for Pes@cides/Solvents (hexane, butane) Independent lab tes@ng - - cannabinoid profile Whole plant/organically grown Country of origin In a perfect world The s@gma around cannabis use diminishes Cannabis loses schedule 1 status and becomes legal Cannabis research is allowed in US Medical cannabis is available to all RDNs become cannabis competent Resources Holis@cCannabisAcademy.com Ellementa.com Leafly.com Herb.co Revolu@onaryClinics.org UnitedPa@entsGroup.com Cannabis.info JannabisWellness.com Ques@ons? Janice Newell Bissex, MS, RDN jnbissex@gmail.com 5