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 1931-2017 You may be thinking this but increasingly this is the face of cannabis. 1
3/2/18 History of cannabis as medicinal herb 4000 BC Chinese medicine 1840s Queen Victoria used @ncture 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
Entourage Effect Whole plant is greater than the sum of its parts Cannabinoids and terpenes work together synergis@cally 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
3/2/18 Modes of administra@on Timing of Relief Tincture Topical Creams Transdermal Capsules Inhala@on 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
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 JannabisWellness.com @JaniceBissex 5