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 conference—taking place September 29–October 1 in Pasadena, California—will feature an exciting full-day CannMed Medical Practicum organized by Bonni Goldstein, MD; Dustin Sulak, DO; Kevin Spelman, PhD, MCPP; and Eloise Theisen, NP, AGPCNP-BC. During this practicum, each of the presenters will share the latest research, their clinical experience, and practice guidelines related to cannabinoid therapeutics, inclusive of types of extractions, products, and optimal dosing of cannabinoids for various therapeutic scenarios. This course is approved by the California Board of Registered Nursing for 9.5 contact hours**

Can cannabis be used to get you off opioid addiction?

 There are numerous scientific articles that support the concept of cannabis as a substitute for opiates. In a 2017 survey of 2897 medical cannabis patients, 97% reported that they were able to decrease the amount of opiates they consumed when they used cannabis. Additionally, 81% reported that taking cannabis by itself was more effective for their pain than taking both opiates and cannabis together (1).

Another survey found that almost 15% of elderly patients were able to discontinue opioid use within 6 months of initiating medical cannabis (2). Additionally, cannabinoid-based medicines were associated with 17-fold higher odds of discontinuing opioid prescriptions within 21 months (3).

There is also some evidence that cannabinoids may help reduce opioid withdrawal. A 2020 report in the 

found that cannabis alleviated the opioid withdrawal symptoms of anxiety, tremors and trouble sleeping (4). Evidence is also mounting for the use of cannabidiol (CBD) for opioid addiction. In a double-blind, placebo-controlled randomized trial of 42 patients addicted to heroin who were experiencing withdrawal, CBD significantly reduced craving and anxiety compared to those who received placebo (5).

 Yes, if used in conjunction with a proper protocol, cannabis has been used successfully for weaning people from an opioid addiction. 

: C Lots of data prove yes in chronic pain: 

https://healer.com/category/cannabis-and-opioids/

. Less data suggests it’s helpful in opioid use disorder, but I have seen this work in my patients.

 Studies suggest that cannabis is effective for chronic pain in adults. With more research demonstrating the effectiveness of cannabinoids for chronic pain, many patients are seeking ways to use cannabis to reduce or eliminate their opioids. Clinical studies have demonstrated a synergistic effect with cannabinoids and opioids, thereby allowing patients to manage their pain without the need to increase the opioids. And while there is a need for more clinical trials to demonstrate the effectiveness of cannabinoids for opioid addiction, many cannabis clinicians have successfully helped their patients eliminate their opioids.

How does cannabis interact with other prescription medications?

 Cannabinoids are metabolized (broken down) for the most part by enzymes in the liver, where many other medications are also metabolized. There can be competition between cannabinoids and other drugs when they are metabolized by the same enzyme, resulting in what is called “drug-drug interactions.” These interactions can result in the blockage of metabolism, leading to accumulation of the drug in the body, which can cause an increase in unwanted side effects. Conversely, the drug-drug interaction may result in an increase in metabolism of a drug, meaning that more drug is broken down faster, causing a decrease in drug levels leading to less efficacy.

It is very hard to predict these drug interactions since there are many differences in the way that people metabolize medications. To avoid any undesirable consequences, the best approach for anyone taking pharmaceuticals who wants to use cannabinoid medicines is to speak with a physician, pharmacist, or other healthcare provider who is familiar with these types of drug interactions.

 While there are theoretical concerns of cannabis preparations negatively interacting with other drugs, clinicians are not observing drug-cannabis interactions. This is not unusual in that many of the theoretical drug-herb interactions have not been found to be of any clinical significance.

: Very few interactions except at high doses of cannabis. The blood thinner warfarin is a common one to watch out for—patients should have their blood checked after starting cannabis.

: Cannabis can either increase or decrease the effectiveness of other medications. In most cases, it is clinically insignificant and does not require patients to stop their cannabis treatment. Anyone using cannabis with other medications needs to be followed by a knowledgeable cannabis clinician who can adjust the medications accordingly and ensure that there are no contraindications.

Check back next month for part III of this series where our roundtable will discuss how cannabis is used to treat acute and chronic pain, anxiety, ADHD, and pediatric patients. To find out more about the

some of the clinical applications for medical cannabis and dosing information.

A. Reiman, M. Welty, and P. Solomon, “Cannabis as a substitute for opioid-based pain medication: patient self-report,” 

R. Abuhasira, L.B. Schleider, R. Mechoulam, and V. Novack, “Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly,” 

J.M. Vigil, S.S. Stith, I.M. Adams, and A.P. Reeve, “Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study,” 

C.L. Bergeria, A.S. Huhn, and K.E. Dunn. "The impact of naturalistic cannabis use on self-reported opioid withdrawal." 

Y.L. Hurd, et al. "Cannabidiol for the reduction of cue-induced craving and anxiety in drug-abstinent individuals with heroin use disorder: a double-blind randomized placebo-controlled trial." 

**CONTINUING EDUCATION CREDITS: This course is provider-approved by the California Board of Registered Nursing, provider number 16845, for 9.5 contact hours.

Articles

In this roundtable interview series, we speak to each of the organizers to learn more about them and what attends can expect from the practicum. Here in part II, they discuss how cannabis can be used stop opioid addiction and possible ways cannabis might interact with other prescription medications.

Medical Cannabis Insights, Part II: How Cannabis Helps Opioid Addiction and A Discussion on Interactions with Other Medications

 a leading multimedia platform dedicated to advancing medical research, education, and treatment in the cannabis industry, and Americans for Safe Access (ASA), the largest national member-based organization of patients, medical professionals, scientists, and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research, are excited to announce a partnership to share educational content and patient stories.

 launched in November 2020 and has already made a big impression in the medical cannabis community due to the quality of its content and the important message behind each issue," said Mike Hennessy Jr., president and CEO of MJH Life Sciences™, parent company of 

™. "We are thrilled to partner with Americans for Safe Access because we share their passion for education and for helping as many patients as we can."

As part of their agreement, ASA will by-line articles focused on patient and advocate experiences in upcoming issues of 

 will conduct interviews with various ASA chapters and highlight the work going on across the US to improve patient access and legalization efforts. All ASA members will receive a complimentary subscription to 

"As a patient-focused organization, we are honored to partner with 

™, a platform that focuses on the patient experience," said Debbie Churgai, executive director of Americans for Safe Access. "Through this partnership, we will be able to offer our members and supporters a trusted resource to learn about the latest medical cannabis research, benefits, and treatment options available for patients."

 magazine is an educational resource for patients, doctors, nurses, pharmacists, and caregivers on the latest research, benefits, and treatment options cannabis provides for a variety of illnesses. Its mission is to educate the medical community on the viable treatment options patients are experiencing with cannabis and the ongoing research into cannabis and cannabinoids worldwide. 

™, the largest privately held, independent, full-service medical media company in North America dedicated to delivering trusted health care news across multiple channels.

s mission is to ensure safe and legal access to cannabis for therapeutic use and research. ASA was founded in 2002 as a vehicle for patients to advocate for the acceptance of cannabis as medicine. With over 150,000 active supporters in all 50 states, ASA is the largest national member-based organization of patients, medical professionals, scientists and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research. ASA works to overcome political, social and legal barriers by creating policies that improve access to medical cannabis for patients. For more information, please visit: 

The partnership will focus on sharing patient and advocate experiences and educating the public on the medical benefits of cannabis.

Cannabis Patient Care™ and Americans for Safe Access Form Partnership

 conference—taking place September 29–October 1 in Pasadena, California—will feature an exciting full-day CannMed Medical Practicum organized by Bonni Goldstein, MD, (the practicum’s originator); Dustin Sulak, DO; Kevin Spelman, PhD, MCPP; and Eloise Theisen, RN, MSN, AGPCNP-BC. During this practicum, each of the presenters will share the latest research, their clinical experience, and practice guidelines related to cannabinoid therapeutics, inclusive of types of extractions, products, and optimal dosing of cannabinoids for various therapeutic scenarios. This course is approved by the California Board of Registered Nursing for 9.5 contact hours.**

In this roundtable interview series, we speak to each of the organizers to learn more about them and what attendees can expect from the practicum. Here in part I, they share some of the clinical applications for medical cannabis and dosing information.

What are some of the clinical applications for medical cannabis?

 Medical cannabis can be useful for numerous conditions, including managing symptoms of neurodegenerative disorders, inflammatory gastrointestinal conditions, symptoms from cancer and cancer treatment, chronic pain, sleep disorders, and some psychiatric disorders. Because of the widespread distribution of the cannabinoid receptor, we know that the endocannabinoid system plays a role in almost every physiologic process and therefore can be utilized as a target for treatment.

 Anxiety, seizure disorders, pain, mood disorders, sleep issues, and autoimmune disorders.

: Chronic pain, insomnia, PTSD, nausea, and vomiting are certainly the most common, but a typical cannabis practice is full of refractory conditions from every other field in medicine, for example, psychiatry, gastroenterology, oncology, neurology, rheumatology, and so forth. Overall, cannabis is often an effective treatment when everything else has failed.

 According to the National Academies of Sciences, Engineering and Medicine report on the health effects of cannabis and cannabiniods, there is moderate to substantial evidence to support the use of cannabis for chronic pain in adults, sleep disorders, chemotherapy induced nausea and vomiting, and muscle spasms in multiple sclerosis. Additionally, we are seeing more clinical data to support the use of cannabinoids for anxiety, depression, and PTSD.

How is medical cannabis dosed and what methods are being used by patients?

 Medical cannabis is different than most pharmaceutical medications, meaning there are no specific dosing recommendations for the vast majority of conditions being treated. Patients are advised to “start low and go slow” to customize their dosing regimen. The reasons for this include a wide inter-individual variation in absorption, metabolism, and excretion of the cannabinoids and other compounds in the plant. However, a clinician knowledgeable in cannabis dosing can help a patient negotiate dosing for the many products on the market, helping to personalize the patient’s dosing regimen. Methods of use include inhalation, ingestion, sublingual, topical and transdermal applications. Each of these has advantages and disadvantages that can help patients choose their preferred method, although many patients use multiple methods of use depending on symptoms, time of day and cost.

 Dosing has a high interindividual variability. Best to start at very low doses and work up so the optimal "physiological" dose can be found (versus a "pharmacological" dose)

: Cannabis is highly versatile and allows for individualized treatments that can often be fine-tuned to allow for all benefit and no adverse side effects. This fine-tuning includes delivery methods (oral, oromucosal, inhaled, topical), numerous varieties of cannabis with distinct properties. You can find more info at: 

https://healer.com/using-medical-cannabis-delivery-systems/

: Cannabis is best when it is individualized to the patient's condition and goals of care. It is important to take a thorough health history and discuss the plan of care with the patient. Some patients may need low doses to achieve relief and others may need higher doses and that usually cannot be determined without considering many factors like age, gender, other health conditions, medications and previous or current cannabis experience. In some cases, patients may need multiple methods of administration to effectively treat their condition.

Check back next month for part II of this series where our roundtable will discuss the role medical cannabis can play in stopping opioid addiction and how it might interact with other medications. To find out more about the CannMed Medical Practicum, please visit:

, a medical practice devoted to educating patients about the use of cannabis for serious and chronic medical conditions. Dr. Goldstein was a Clinical Instructor in Pediatrics at USC School of Medicine in Los Angeles, Emergency Transport Attending Physician at Childrens Hospital Los Angeles, and Emergency Medicine Attending Physician in the Pediatric Emergency Department at Los Angeles County-USC Medical Center. A frequent speaker nationally and internationally, Dr. Goldstein was awarded “2017 Healthcare Professional of the Year” by Americans for Safe Access, a non-profit that promotes safe and legal access to cannabis throughout the nation. She is on the board of the International Association for Cannabis as Medicine and is also on the Medical Advisory board of Whole Plant Access for Autism, a non-profit that provides education and resources to families of individuals with autism. Dr. Goldstein’s first book, 

, was awarded “2017 Semifinalist Book of the Year” by the American Botanical Council. Her latest book, 

, was published by Little, Brown Spark in September 2020. She is the medical advisor to 

 is a researcher, clinician, educator and industry consultant that has advised the White House and the Department of Defense on natural products for regulatory guidelines and research on effective battlefield hemostatics, respectively. Dr. Spelman studied brain cancer, as well as CB1 and CB2 receptor binding as a Postdoctoral Fellow at National Institutes of Health and was the first researcher to elucidate cannabinoid ligands in Zanthoxylum spp. He has also carried out malaria and natural products research as a Marie Curie Research Fellow in the European Union and has focused on molecular techniques to elucidate the pharmacology of phytochemicals on human physiology and has 27 peer reviewed publications on medicinal plants. He has also been a senior R&D executive for multiple companies over the last decade. Dr. Spelman has considerable experience in medicinal plant, nutraceutical and cannabinoid research and has coordinated new product development, analytical and QC guidelines, research activity and educational curriculums for industry and universities over the last 30 years. 


Dr. Dustin Sulak is an osteopathic general practitioner whose clinical practice focuses on treating refractory conditions in adults and children with an individualized, health-centered approach. Dr. Sulak received undergraduate degrees in nutrition science and biology from Indiana University, a doctorate of osteopathy from the Arizona College of Osteopathic Medicine, and completed an osteopathic rotating internship at Maine-Dartmouth Family Medicine Residency. Dr. Sulak is a founder of Integr8 Health, a medical practice in Maine that follows over 8,000 patients using medical cannabis, a cofounder of 

, a medical cannabis education resource, and serves on the board of directors of two non-profits, the Society of Cannabis Clinicians and Patients Out of Time.


Eloise Theisen is a board certified Adult Geriatric Nurse Practitioner who specializes in cannabis therapy. For over 20 years, Eloise has worked primarily with cancer, dementia and chronic pain patients. In the last 6 years, Eloise has focused her efforts on cannabinoid therapies. Since then she has worked with over 6000 patients to help them effectively treat age-related and chronic illness with cannabis. Eloise is a co-founder and the Chief Executive Officer of 

 and Radicle Health Clinician Network. She is the current president of the American Cannabis Nurses Association (2020-2021) with over 1350 members nationally. Eloise also serves on the editorial board of the 

American Journal of Endocannabinoid Medicine

, a journal dedicated to educating healthcare professionals on the subject of medical cannabis through research, independent medical studies and evidence based data. In 2019, Eloise co-wrote 

Pain Free with CBD: Everything you need to know to safely and effectively use cannabidiol

. She is currently teaching the accredited medical cannabis certificate program at Pacific College of Health Sciences.

In this roundtable interview series, we speak to each of the organizers of the CannMed Medical Practicum to learn more about them and what attends can expect from the practicum. Here in part I, they share some of the clinical applications for medical cannabis and dosing information.

Medical Cannabis Insights, Part I: CannMed Medical Practicum Organizers Discuss Clinical Applications and Dosing

One of the most common statements people hear about medical cannabis use in the United States is that there needs to be more research, clinical trials, and studies on the plant’s long-term effects. What people don’t often hear is that research in the US has been substantially limited and restricted due to the Federal government’s stance that cannabis is a schedule I drug making it illegal. Despite this, there has been research both in the US and in other countries. While we still have a long way to go to understand this plant medicine and how it can best serve people, one public health doctor is taking the initiative to gather as much information as possible now. Dr. Marion McNabb has been conducting surveys related to medical cannabis for about five years and her most recent endeavor is to gauge the knowledge, interest, and understanding of medical cannabis in healthcare professionals. Here, she shares her plans for this latest study as well as her background and key insights into the medical cannabis industry. 

Can you tell us a little bit about your medical background and how you became interested in the cannabis industry?

 Yes, I am a public health doctor by training. I have about a 20-year career in global public health. My background is working in HIV/AIDS, family planning, and maternal child health, mainly in low-income countries such as in Africa and Haiti. I worked on training healthcare providers in a new clinical area. I worked with doctors and nurses around HIV in a country where that was a new disease area and new treatment that clinicians needed to learn. I developed continuing medical education courses and different job aides for doctors and nurses to deal with HIV in clinical care settings and do research and using digital technologies to help. For example, using mobile applications, SMS technology, and clinical decision support tools for doctors, nurses, pharmacists, lab techs, and so on.

About five years ago, when it became legal for adult use cannabis in Massachusetts, I left my global public health career to basically transfer a lot of the skills and tools from global public health to the cannabis industry. Because cannabis is still federally illegal, it's been restricted and difficult to research the plant and research the plant in human and clinical populations. I set out to advocate at the design of the industry in Massachusetts for the research license that is now operational here and integrating cannabis education into institutions of higher education and conducting research studies.

A couple of years ago, I partnered with the University of Massachusetts-Dartmouth (UMass Dartmouth), and we have now conducted five different research studies together related to cannabis from a medical cannabis use perspective, as well as an adult use perspective. I've also been involved in developing a number of cannabis education programs, together with Holyoke Community College and Boston University as well as other universities such as UMass Dartmouth.

Now, I’m excited to be leading to research studies together with UMass Dartmouth and about 15 different colleagues. One study is around COVID-19 in medical cannabis and adult use cannabis consumers and the impact of COVID-19. And the second is called the “Healthcare Provider Knowledge, Attitudes, Practices Related to Medical Cannabis Research Study” that we are doing together with Medicinal Genomics (1,2).

I think what's exciting about medical cannabis and adult use cannabis is that there's more opportunity for not only research, but implementation. We know that medical cannabis is providing relief for a number of health conditions and symptoms. Not only should we continue to study the plant, but I think we should also design clinical implementation protocols and dosing protocols to help healthcare providers integrate this into their simpler regular practice.

Can you tell us more about the “Healthcare Provider Knowledge, Attitudes, Practices Related to Medical Cannabis Research Study”? What inspired you to form this informative research entity? How can healthcare professionals take part in the study?

 Yes, it started as a result of the launch of the 

 magazine and the webinar event that we did online on Veterans Day (3). Actually, because of that event, one of the attendees was from Medicinal Genomics—who are leaders in cannabis science and research from the genomic plant side of the category and have been colleagues and friends of the Cannabis Center of Excellence, the nonprofit I founded, which has been running research studies for quite a while. So, they attended that webinar, which was part of the launch of the 

 magazine and shared some valuable information from the Veterans Study that I conducted. Medicinal Genomics reached out to me afterwards. They organize and run the annual CannMed conference, which brings together researchers, clinicians, and experts from the medical cannabis and adult use fields every year. They also offer continuing medical education credits and different educational courses throughout the year as well as podcasts related to the science around cannabis. They reached out with an interest in understanding more about healthcare providers’ current knowledge and training related to medical cannabis and what they would be interested in learning in the future.

My nonprofit, the Cannabis Center of Excellence (COE), is very much interested in medical cannabis and advancing the field of not only using data that we collect to provide advocacy and move it forward, but also to really provide evidence-based background for training and educational purposes. So, Medicinal Genomics reached out to run a research study. We put together this anonymous survey, which basically asks any kind of healthcare provider what their knowledge and training and current practices are related to medical cannabis. What they are interested in learning about in the future and how they're interested in learning that. The study launched in May 2021 and will be running through August 2022. We'll be presenting the preliminary results this year at the CannMed conference in early October. We will also share results in the spring of 2022 at the 15th annual clinical conference on cannabis therapeutics run by Patients Out of Time. Final results will be presented at CannMed 2022. Sign up and stay tuned.

If you're a healthcare provider, you can take the survey. It’s about 10 minutes to take and you'll be entered to win a free pass to the 

, including the CME portion of it, which is an $820 value. And you'll also be entered to win an Amazon gift card for participating. Check out the COE website for regular updates on data collected through the study.

In addition to presenting at the CannMed conference, we’ll also over time be sharing the results back out with the clinical community just to encourage awareness about the importance of topics such as the endocannabinoid system or medical cannabis in pre-service, healthcare provider education as well as nursing, pharmacy, clinician, doctor, and dentist educational programs.

What do you hope will come out of the “Healthcare Provider Knowledge, Attitudes, Practices Related to Medical Cannabis Research Study”?

 What I hope will come out of the study—what we're really trying to do this year—is not only engage healthcare providers and respondents to the research study, but also to carry the idea and the information forward to their colleagues.

What I'm hoping is that by taking the research study, it will raise awareness among healthcare providers about the topic and encourage them to reach out and share the research study with their fellow clinicians, one to help get more opinions and ideas. But also, to start a behavior change campaign.

. We have T-shirts and hats and different swag that really works, that has fun slogans on it that aim to destigmatize medical cannabis and cannabis research. We've developed a specific line for healthcare providers and raising the awareness of this alternative medicine of medical cannabis. If folks take the research study, they can also continue to support the research by buying one of the pieces of swag, which helps fund our work and continues to raise awareness.

What I hope, again, what I will get out of this is information from healthcare providers about what their knowledge is, about what they want to learn, and how they want to learn it so that we can move the field of medicine forward in an innovative way by including medical cannabis as an alternative.

I would like to also really thank our study sponsor, Supercritical Labs and Chris McElvany. Without his financial support, we couldn't make this study possible. And we're also looking for additional study sponsors and partners. Please feel free to reach out (contact 

). We really appreciate the support. Couldn't do this kind of work without our partners.

Again, to circle around what I'm what I'm hoping for is continued awareness raising among the healthcare provider community that patients are using medical cannabis. It’s available and becoming more increasingly available in states. And I feel the healthcare providers can learn more about the topic.

Do you think there should be more research into the medicinal properties of the cannabis plant and its interactions with the endocannabinoid system?

 Yes, I think there's enough research to integrate cannabis as a first-line or second- or third-line therapy for several symptoms right now. But I also believe that we can continue to do more research around the medical benefits.

Specifically, around different combinations of cannabinoids and terpenes and how those impact specific conditions and demographics, people profile, so to speak. I also think there's really a good opportunity to understand more of the endocannabinoid system, as you mentioned, within our own bodies.

What endogenous cannabinoids are in play? Cannabis can have a positive impact, but also understanding what the risks are associated with integrating medical cannabis, particularly with a patient who is taking several medications. There are polypharmacy patients. It's important to understand drug–drug interactions and the side effects that may happen by introducing cannabis and certain cannabinoid profiles. Particularly, in those patients with a pharmacy cocktail, such as opioid or fentanyl.

There is evidence that cannabis can be a good treatment alternative to help people reduce the use of opioids or other harmful substances such as alcohol and tobacco. But I think those need to be done under clinical supervision and there's opportunity to continue to research in those areas.

Have you encountered hesitancy or judgment in the medical community to viewing cannabis as a potential medical treatment?

 Yes, lots. And I think that stems from the fact that the medical community and in all types of education from physician, nursing, and pharmacy, the endocannabinoid system and the value of medical cannabis is removed from education. Also, it’s worthy of noting that medical cannabis was included in the 

Our medical education in the last several decades has been squarely focused on pharmaceutical and chemical-based interventions as primary care treatment options. So, the understanding of the medical community around medical cannabis is limited right now.

I think, additionally, in the last 50 years or so, there was a “Reefer Madness” campaign which was a structured, engineered public awareness campaign that really looked to demonize cannabis. And that alongside a war on drugs that targeted people of color and arrested folks for cannabis has jaded, so to speak, the medical community.

So, I think there's room to continue to educate the medical community around where the current research efforts are and where the evidence stands and work to break the stigma that was created through the the war on drugs and the “Reefer Madness” campaigns.

When cannabis was taken off the USP back in the early 19th century, was there an outrage from medical professionals? Is there any documentation of that, that people that were using it were upset that it was taken off?

 Yeah, that's a good question, I'm going to open this book that my friend gave me here. Yes, the American Medical Association (AMA) reached out at the time. I'm looking at this book, 

There was outrage. There was outrage by the American Medical Association that was upset by the removal of this from the US Pharmacopeia and the tax on cannabis. To quote the book from the section titled “Did Anyone Consult the AMA?” (4): “The AMA doctors had just realized ‘two days before’ these spring 1937 hearings, that the plant Congress intended to outlaw was known medically as cannabis, the benign substance used in America with perfect safety in scores of illnesses for over one hundred years.”

The AMA was brought in at the end and they did not accept really their testimony and moved on. There was a lot of political pressure associated with the removal of this. The AMA and drug companies testified against the 1937 Marijuana Tax Act because cannabis is known to have so much medical potential and never caused any observable addictions or death by overdose.

Twenty-nine years passed, however, before American scientists could begin to even look at the cannabis medicine again. And that's when Dr. Raphael Mechoulam in Israel discovered and isolated THC delta-9 in 1964. And it's worthy of noting marijuana was America's number one analgesic for 60 years before the rediscovery of aspirin, around 1900. From 1842 to 1900, cannabis made up half of all medicines sold with virtually no fear of its high.

Clearly, cannabis has been used as medicine in the United States and then removed from the pharmacopeia. But it's also been used as medicine around the world for thousands of years.

Do you recommend any educational resources for healthcare professionals seeking to learn more about the benefits of medical cannabis?

 Yes. I would say if you're interested in learning some of the research results we have from our observational self-report studies over the last couple of years around how cannabis patients, consumers and veterans are reporting using medical cannabis you can go to www.cannabiscenterofexcellence.org and check out some of our research results. We’ll be having more educational videos and resources for download soon.

And then additionally, Medicinal Genomics, as I mentioned, runs CannMed and it's an excellent conference. It's going to be held September 29–October 1 this year in Pasadena, California, with speakers from around the world as well as clinicians and researchers in the cannabis industry. They will also offer continuing medical education credits and we'll be presenting the preliminary results from this research study. CannMed will be a great place to learn more about the latest and greatest clinical and research in cannabis.

There's also another group called Patients Out of Time that's very worthy of following. They just had their 14th annual clinical conference on cannabis therapeutics last month. I was honored to be a part of it as well. They offer of continuing medical education credits every year too and offer great educational opportunities.

And then out of the study, the healthcare provider knowledge, attitudes, and awareness study, we will be developing good, targeted content for healthcare providers based on what they report they want to know. Stay tuned. And if folks are interested in being a content contributor, writer, or being part of this effort in a deeper way, we welcome that. Please definitely feel free to reach out to me directly, 

With the growing interest and increased legalization in cannabis, do you believe it will become a more sought out treatment option by healthcare professionals?

 Yes, I do. I think when legalization happens cannabis will be more sought out if it is reimbursed by health insurance. And as part of the mainstream medical system. In terms of the health insurance, what we're finding in the research studies that I've run is that more than 70% of people report using medical cannabis to reduce the use of prescription or over-the-counter medications. Often those prescription or over-the-counter medications have side effects that are unwanted by these respondents. By shifting to medical cannabis, it relieves some of the side effects of those medications. Therefore, improving the quality of life, ability to return to work, improves family relationships, and so forth.

All those factors come into play when you want to reimburse a treatment option. Health insurance should look more towards reimbursing medical cannabis because of the benefits of return quality of life, and therefore a reduction on the cost of the insurance company to keep covering medications or one medication that covers the side effects of another medication. If you think about somebody who's on a cocktail of 10 or 12 medications, the cost to the insurance company for long term chronic care is a lot. But if somebody is introducing medical cannabis to reduce that, you could see the cost savings and improve quality of life.

Anyway, I think that is something that would be attractive to healthcare providers. I think also, we have done a disservice to our healthcare providers by not including this education around the endocannabinoid system, which is a fundamental system in our body that interacts with every other system—the endocrine system, the nervous system, the immune system. It’s unethical to not include this, especially when you're talking about medicine and research. I think our healthcare providers deserve to know about this. And once they start to learn about it and start to feel more comfortable that they know as much or more about medical cannabis than their patients, then they'll want to see it as an option.

The other barrier that exists, I think, for medical providers is the lack of guidance around dosing and types of cannabis for different types of health conditions. Really drilling down into those nuances of dosing by health condition, by age, and understanding what drugs may interact by dose and what titrations you should do and what tolerance levels exist in certain patients, what delivery mechanisms are best, all of those. I think providing some clinical tools around that for healthcare providers will help them feel more comfortable in the future, integrating medical cannabis as an option.

Do you think healthcare professionals would feel more comfortable if there was more of a pharmacy model where their patients have a real prescription and then they go and get it filled rather than going to a budtender? Do you think something like that would ever come to the US?

 Yes, I think it already has in some ways. Some states are tending towards the pharmacy model. Georgia, as an example, will be licensing pharmacies to dispense low THC oil and products. I think there is. Canada has the purchase from that model. I think there are going to be examples of where physicians are going to feel more comfortable.

That is their status quo. They write a prescription then you go to a pharmacy and pick it up. I mean, I think that that should be available and would help the clinician. I just want to make sure that wouldn’t box out anybody from having access to cannabis. I'm a proponent of making sure that the community can have access to it. So having dispensaries that are medical dispensaries that are available and accessible to patients that have discounts that ensure that cost isn't a barrier, all those things are very important to me. I think having a clinical model of going to a pharmacy is important, but then also ensuring that that doesn't limit access.

People should also be able to grow their own medicine at home, which is something that I promote. But back to what would help healthcare providers feel more comfortable. I think what's interesting and a real opportunity in medical cannabis is that it is personalized medicine. So, compounding and formulations for particular conditions become very important.

Think about, in advanced cancer, say, one type of breast cancer. Dr.Dedi Meiri who's a professor in Israel who I greatly admire, has been doing quite some significant research and trying to understand different cannabinoid formulations and profiles on different cancers and different types of cancers. What he's found is that there are unique circumstances in cannabinoid combinations, in terpene combinations that affect particular cancers. One strain may affect one breast cancer type, but may not affect another breast cancer type. It's that personalized.

When you walk into a dispensary now that has only 10 different options or types of cannabis, it's limiting because you may not have that particular profile that may impact your particular health condition. It goes back to how can we get into this personalized medicine? Is that through a pharmacy route? Hey, pharmacy, can you create this formulation where we have a CBN, CDC, and THC at a 3:2:1 ratio, that's a tincture. Because that’s the personalized medicine that we need for that patient? Or are we trying to, like, step back up and create sort of generic broad-spectrum types of medical cannabis? If this makes sense, that may impact a variety of conditions and have great opportunities for all different types of formulations.

I think in the cannabis industry, not limiting the farmer and not limiting the cultivator or the processor will be your best bet because there’s so many ways that you can cultivate or formulate or manufacture processed cannabis. If we move only to high level multi-state operators (MSO), mass-produced quality and mass-produced mid-level quality, we're really missing out on the natural benefits of the plant and sacrificing that for profit. It'll be interesting to see how the pharmacy model plays out in Georgia and other states versus a dispensary model with the budtender.

That is primarily the delivery in some states. The last thing I would say is the delivery with the budtender—there are opportunities to educate that budtender and that patient advocate. Not everybody needs to be a healthcare professional necessarily in medical cannabis to deliver counseling. We have lots of experiences in healthcare that you have lay counselors in HIV, for example. Those are the primary first frontline workers for an HIV patient, and they are not actually healthcare providers. I think let's not shame the patient advocates or the budtenders because they do know a lot about cannabis. I think they could also learn more about medical cannabis, especially in states where adult use is legal and not lose the focus of medical. But stay tuned. The Cannabis Centre of Excellence will be coming out with some materials around that.

What do you hope will change in the cannabis industry? Where do you find the most difficulties and how do you deal with them?

 I guess the change I would like to see is in two places, social justice and the race for money. Right now, in the cannabis industry, I think there is some push in Massachusetts and in other states to really work towards restorative justice, to right the wrongs of the failed drug war. And I think that's very important. It's something that's been a cornerstone of my work for the last five years—advocating and working towards the area of social justice in the industry. And what that means is, I believe, big industry and small business participating together. Providing opportunities for those who've been negatively impacted to have priority access to the cannabis industry and fair and transparent business deals to happen for industry grow and success for both small and big business.

Dr. Marion McNabb has been conducting surveys related to medical cannabis for about five years and her most recent endeavor is to gauge the knowledge, interest, and understanding of medical cannabis in healthcare professionals. In this interview, she discusses her latest study as well as her background and key insights into the medical cannabis industry.

Research Abounds: How Dr. Marion McNabb is Looking to Take the Medical Cannabis Industry to the Next Level

A committee formed in 2019 by the National Football League (NFL) and the National Football League Players Association (NFLPA) announced plans to award grants to researchers who are researching the therapeutic benefits of cannabidiol (CBD), cannabis, and other opioid alternatives for pain management (1,2). The committee—called the NFL-NFLPA Joint Pain Management Committee (PMC)—plans to award up to $1 million in grants.

Dr. Kevin Hill, co-chair of the PMC, commented on how the federal policy unfavorably impacted the level of research permitted in the US, especially with the ongoing prohibition of cannabis as a Schedule I drug. Hill specifically recognized how the lack of funding in cannabis research also affected future advancements in research and that a lot of companies and states who significantly profit from the sale of cannabis and other cannabinoids do not contribute to science (2).

The PMC announced it is turning its attention to identifying potential research opportunities through a formal Request for Proposal (RFP) process (3). The goal of this funding opportunity is to request proposals from researchers who have the ability to conduct studies that will help supplement the PMC’s knowledge on athletic performance and pain management in football players. The league is particularly interested in proposals on the following areas:

the effects of cannabinoids on pain in elite football players (post-surgical or in daily pain management);

the effects of non-pharmacologic treatments on pain in elite football players (postsurgical or in daily pain management); and

the effects of cannabis or cannabinoids on athletic performance (for example, psychomotor, reaction time, cardiorespiratory function) in elite football players.

The deadline for applications to be submitted prior to proposals is July 31, 2021 (3).

In 2020, the joint panel held CBD informational forums. These discussions brought the determination that the nonintoxicating CBD compound, has medicinal properties in the treatment of various forms of pain. Although, the committee agreed that there was not enough existing research and information on the benefits of opioid alternatives for both chronic and acute pain.

The NFL’s policy is that players in the league will not face suspension from games based on positive test results from any substance, including cannabis. The policy was recently updated and reflects a shift in the NFL’s approach to the use of drugs by players, with the agreement highlighting the need to center on treatment and evaluation rather than penalties. Players who self-refer themselves, display behaviors indicating misuse of drugs, or test positive for drug use, are now required to enroll in an intervention program, where they can be evaluated and receive a treatment plan.

With the NFL’s new stance on supporting cannabis research, it will be exciting to see if other major sport leagues will follow suit.

https://www.cannabisnewswire.com/420-with-cnw-nfl-funds-cannabis-research-despite-continued-prohibition-hindering-research/

https://www.marijuanamoment.net/nfl-funds-marijuana-research-saying-federal-prohibition-adversely-impacts-studies-into-opioid-alternative-for-players/

https://www.nfl.com/playerhealthandsafety/health-and-wellness/medical-research/nfl-nflpa-pain-management-committee-accepting-applications-for-1-million-in-rese

NFL-NFLPA Joint Pain Management Committee (PMC) plans to award up to $1 million in grants to CBD and cannabis researchers.

NFL Defies Prohibition to Fund Cannabis Research

Hydroponic and organic growing are gaining popularity in the cannabis industry for cultivation. Michael Salaman, co-founder and president of GrowGeneration, discusses these two methods and also the changing trends in cannabis during the COVID-19 pandemic.

Can you tell us about GrowGeneration? How did the company get started? What is the role you play in the cannabis industry? How many locations do you have?

 GrowGeneration is the nation's largest chain of specialty hydroponic and organic garden centers, with 55 retail locations throughout the United States. Our primary focus is on cannabis cultivation, where we serve everybody from the nation’s largest multi-state operators (MSOs) to hobbyists growing in their own homes. Roughly 70% of our business is commercial, selling licensed cannabis operators the equipment and products they need to grow their cannabis. 

For a novice to cannabis cultivation, can you explain the difference between hydroponic and organic growing? What are the benefits of one compared to the other?

 The USDA actually has certifications for organic hydroponic growing – it can be both simultaneously. Because consumers and the market are maturing and want more organic options, we take pride in offering organic solutions for hydroponic and in-soil growing. So, when we refer to hydroponic and organic growing, what we are saying is that we carry everything from the latest high-tech hydroponic equipment to grow without soil to the simplest pots and planters to grow in soil right in your backyard.

Overall, we are focused on providing the highest quality and most sustainable products to our customers, regardless of how they intend to grow.

What is the most popular equipment and technology being used in cannabis cultivation right now?

 One of the things we are most excited about, as evidenced by our recent 

 (4), is coco coir growing mediums. Rockwool has been the go-to medium for a long time, but as the industry focuses more on sustainability in its cultivation practices, coco coir, made from the highest-grade coconut fiber available, is becoming increasingly popular within the space. It is 100% biodegradable and compostable and provides cultivators with a much more eco-friendly medium to grow their plants.

How do you keep track of the latest equipment and technology in the cultivation industry?

 One way that we keep track of new equipment and technology is by attending various trade shows and conferences around the country. We attend all the major industry events, along with various digital conferences. Our team is always keeping an eye out for new products and any innovation in the industry to stay current or ahead of the trends.

Have you noticed any changing trends in what your customers are purchasing?

 The biggest change we’re seeing is that people are buying a lot more of everything. As the licensed cannabis marketplace continues to open up and demand for cannabis products have spiked due to increased consumption during the COVID-19 pandemic, cultivators are scrambling to keep pace. For example, we had a 62% increase in same store sales from 2019 to 2020 alone due to the increase in demand. We’re also seeing cultivators invest more in cleaning supplies and equipment than ever before due to the pandemic.

Additionally, we are seeing a noticeable trend towards eco-friendly purchasing. This includes more efficient LED lights as well as biodegradable coconut fiber-based planting mediums. 

For beginner cultivators, what do you feel is most important for them to know? How does your company help them start their cultivation journey?

 GrowGen has the expert level knowledge to help the customer get started, no matter how big or small. The most important thing that we want to tell first-time growers is not to get discouraged; growing is a science and an art, and that it will take time to perfect it. The staff at GrowGen is very educated on all different types of growing methods and we are available to help everyone.

What are your future plans for the company?

 We will continue to be aggressive in acquiring best-in-class businesses in mature cannabis markets. Additionally, you will see a more concerted effort to open our own stores in newer markets, particularly in New York, New Jersey, Pennsylvania, and Mississippi. These markets are newer or less developed, so there aren’t really businesses to acquire there. In these markets, we are figuring out where the growers will be based and are looking to build stores close to them.

Additionally, you will see us build out our private label business more. We’ve just begun to scratch the surface of this, but we feel it is a way to capture a lot more value for the company and give growers exactly what they want.

https://ir.growgeneration.com/news-events/press-releases/detail/116/growgeneration-acquires-colorado-based-grow-warehouse

https://finance.yahoo.com/news/growgeneration-acquires-san-diegos-leading-130000858.html

https://www.prnewswire.com/news-releases/growgeneration-acquires-char-coir-301247244.html

In this interview, Michael Salaman, co-founder and president of GrowGeneration, talks about the trends in cannabis during the COVID-19 pandemic and more.

Hydroponic and Organic Growing in Cannabis Cultivation

A study released in the scientific journal 

 explained that when combining neurotechnology with saliva testing, it can drastically reduce the chances of falsely claiming cannabis impairment due to tetrahydrocannabinol (THC) residual detection (1). The research from this blind study was performed by KGK Science on behalf of Zentrela.

Not much is known on the effects of the brain caused from cannabis psychoactive properties or how accurate those effects can be measured. Saliva, blood, and urine have been the traditional methods used by law enforcement and employers to detect and quantify THC-compound levels. It is well recognized that there is no direct correlation between THC concentration levels in bodily fluids and if an individual is experiencing psychoactive effects associated with THC. This creates an issue because employers and law enforcement agencies are unable to confirm impairment in an individual, which leads to the possibility of inaccurate determinations of cannabis impairment. False determinations can negatively affect the reputation and employment of individuals who may be consuming legal cannabis products responsibly.

In KGK Sciences’ study, the data illustrates how Zentrela’s Cognalyzer neurotechnology can detect and quantify the psychoactive effects of cannabis. The data further highlights that neurotechnology, when combined with an oral fluid test used for detecting and assessing THC levels, immensely improves the accuracy of testing and decreases the chances of falsely claiming cannabis impairment due to THC residual detection.

Zentrela will now be collaborating with strategic research partners to correlate its objective cannabis psychoactive effect scale with cognitive performance data used to specify a psychoactive effect level which indicates when it is not advisable for cannabis consumers to work or drive a vehicle.

“The ability to definitively measure the psychoactive effects of cannabis allows us to begin addressing the problems related to cannabis consumption that affect the industry and the broader community,” said Dr. Dan Bosnyak the Chief Science Officer at Zentrela (2,3). “A scientifically objective cannabis psychoactive-effect test has endless applications for cannabis producers and product manufacturers, for law enforcement, and for employers in many industries.”

Having an accessible scientific database of cannabis product effects also solves one of the many challenges plaguing producers and brands in the recreational cannabis industry, which is the availability of regulatory-compliant cannabis effect data.

“Without this information, producers cannot differentiate their products and inform consumers about the different effects created by their recreational cannabis products, retailers cannot meet their CANCELL mandate to educate consumers and promote responsible cannabis use and, of course, consumers are missing out on the information that they require to make more accurate and informed decisions about recreational cannabis consumption,” said Israel Gasperin the CEO of Zentrela (2,3). “The data we are generating will give retailers and producers access to a centralized source of scientifically-derived product effect information, which will benefit the entire cannabis industry value chain.”

Gasperin further added that until now there has not been an accurate, scientific-based test for quantifying the psychoactive effects of cannabis. “We have clearly demonstrated that neuroscience powered by artificial intelligence (AI) can accurately detect and quantify the psychoactive effects of cannabis,” said Gasperin. “This represents a huge potential for Zentrela to become the definitive source for specific, science-based data on cannabis product effects for the entire industry. And we are still at the beginning of our journey. There is no reason we cannot apply this proven neurotechnology to other drugs and industries.”

By combining neurotechnology and saliva testing, it will help ease some of the conflict that arises for not just law enforcement and employers, but consumers as well.

https://link.springer.com/article/10.1007/s12325-021-01718-6

https://finance.yahoo.com/news/neurotechnology-combined-saliva-testing-boosts-140500087.html

https://www.news-medical.net/news/20210407/Neurotechnology-combined-with-saliva-testing-improves-accuracy-in-measuring-psychoactive-effects-of-cannabis.aspx

A recent study revealed how combining neurotechnology with saliva testing can reduce the chances of falsely claiming cannabis impairment due to THC.

New Study Shows Neurotechnology Combined with Saliva Testing Increases Accuracy in Detecting Cannabis Psychoactive Effects

The Cannabis Center of Excellence, Inc., Medicinal Genomics, and UMass Dartmouth Charlton College of Business (North Dartmouth, MA) (1-3) recently announced the formation of the “Healthcare Provider Knowledge, Attitudes, Practices Related to Medical Cannabis Research Study.” The intention of this study is to collect information from healthcare providers in both the United States (US) and Canada about their experiences with medicinal cannabis in their practices, prior education around the topic, and interest in future clinical education related to medical cannabis. Participants personal information will not be collected from healthcare providers in the study.

“The basics of the endocannabinoid system, medical cannabis benefits and risks, and approaches to integrating medical cannabis use are hardly taught in mainstream medical, nursing, dental, public health, emergency medicine, addiction and recovery, and other healthcare education and training programs,” said Dr. Marion McNabb, President, Cannabis Center of Excellence. “With more evidence of its efficacy emerging every day and increasing numbers of medical patients and veterans using cannabis for treatments, this study seeks to hear from healthcare providers themselves about what they know and want to know about medical cannabis, and how its use can be integrated into their practices.”

The Healthcare Provider Knowledge, Attitudes, Practices Related to Medical Cannabis Research Study has been approved by the UMass Dartmouth Institutional Review Board (IRB). Healthcare providers completing the survey will be entered into a lottery to win a $100 Amazon gift card or one free full pass to CannMed 2021 (4), which is a conference that hosts the world’s leading experts in medical cannabis research and clinical care. CannMed is organized by Medicinal Genomics and will be held September 29–October 1, 2021 at the Pasadena Convention Center in Pasadena, CA. The study is financially supported by Supercritical Labs and additional study sponsorship slots are available. For more information, please contact: Rachel Bacon 

Principal investigator, Dr. Marion McNabb, President of Cannabis Center of Excellence, Inc. and Chief Research Officer of Georgia Atlas, is joined by 15 co-investigators that include researchers, clinicians, and veterans representing a variety of backgrounds, diversity, and expertise. Co-investigators include:

Kevin McKernan, Medicinal Genomics Founder and Chief Science Officer;

Dr. Steven White, Professor, UMass Dartmouth;

Dr. Staci Gruber, Director, Cognitive and Clinical Neuroimaging Core, Director, Marijuana Investigations for Neuroscientific Discovery (MIND) at McLean Hospital, & Associate Professor of Psychiatry at Harvard Medical School;

Dr. Jessica Knox, The American Cannabinoids Clinics, Pivital EDU;

Blue Quisquis, National Native American Cannabis Association;

The Cannabis Center of Excellence, Inc., Medicinal Genomics, and UMass Dartmouth  have established the Healthcare Provider Knowledge, Attitudes, Practices Related to Medical Cannabis Research Study to help better understand the experiences of healthcare providers have seen with medical cannabis.

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