Pain Management for Patients: Expert Cathleen Graham, RN, Shares Her Vast Knowledge re: Cannabis and More

Today we have Cathleen S. Graham RN, CHPN, the regional manager for one of the nation's largest hospice organizations and the CEO of CannabisNurse.com. Cathleen is also a partner with Leaf Medic, Michigan's first online vocational school to offer cannabis industry training. The information in this podcast should not be construed as medical advice. Please consult with your health care provider regarding your medical decisions and treatment. The listed resources are not intended to be endorsements.Cathleen suggests you look for unbiased scientific locations to learn more. Her suggestions include:Cannabis Nurse.com: https://cannabisnurse.com/American Cannabis Nurses Association: https://cannabisnurses.org/Cannabis Nurses Network: https://www.cannabisnursesnetwork.com/The Society of Cannabis Clinicians: https://www.cannabisclinicians.org/Dr. Sulak at https://healer.com/The debilitating medical conditions that qualify an individual for the medical use of marijuana include one or more of the following: CancerGlaucomaHIV PositiveAIDSHepatitis CAmyotrophic Lateral Sclerosis (ALS)Crohn’s DiseaseAgitation of Alzheimer’s DiseaseNail PatellaPost - Traumatic Stress Disorder (PTSD)Obsessive Compulsive Disorder (OCD)ArthritisRheumatoid ArthritisSpinal Cord InjuryColitisInflammatory Bowel DiseaseUlcerative ColitisParkinson’s DiseaseTourette’s DiseaseAutismChronic PainCerebral PalsyA chronic or debilitating disease or medical condition or its treatment that produces 1 or more of the following:Cachexia or Wasting SyndromeSevere and Chronic PainSevere NauseaSeizures (Including but not limited to those characteristic of epilepsy)Severe and Persistent Muscle Spasms (Including but not limited to those characteristic of multiple sclerosis)For every pro there is a possible con. For example, cannabis is said to help manage anxiety or symptoms of PTSD. However, if one takes too much cannabis it can cause anxiety and panic. Also, if one with PTSD obtains a cannabis chemovar that is high in pinene it can cause the symptoms of PTSD to become worse. Cannabis is also known to increase heart rate up to 50%.A recent study published in Forensic Science International this month declared “After exclusion of other causes of death we assume that the young men experienced fatal cardiovascular complications evoked by smoking cannabis.”These reports indicate that the need for education is paramount for the safety of the consumer. CBD is a great vasorelaxant and can decrease blood pressure as well as stabilize blood sugar levels. CBD does not activate CB1 receptors in the brain, and is devoid of the psychotropic actions of THC (meaning it will not get you high). Indeed, CBD may antagonize the psychoses associated with THC (meaning CBD decreases the effects of THC). The difference between cannabis oil and hemp CBD oil is the amount of THC that is allowed. Hemp CBD oil is allowed to have 0.3% THC along with all the other cannabinoids found in that particular plant. Cannabis oil has a lot more THC and very little CBD. A research study suggests that 96% of cannabis has no CBD in it at all. CBD is found mostly in the Hemp plant. CBD isolate is just that- only the CBD. This isolate does not have any other cannabinoids. CBD is the cannabinoid that has the most medicinal benefit- CBD alone is great at decreasing pain, inflammation, nausea, insomnia, and muscle spasms as well as many other symptoms too.  Also, CBD does not show on a drug screen test as they usually only test for THC. When you use full spectrum cannabis or hemp products you are getting the most medicinal benefit as they all work well to balance each other and create an entourage effect. It is important to remember that if you use a full spectrum hemp oil that you can fail a drug test as these products do have 0.3% THC. There are both pros and cons to the different methods of administration. Smoking the byproducts can cause serious diseases in a person. Vaping or dabbing can reduce those harmful byproducts by not combusting the product. Inhaling is the fastest way to get cannabis into your body-- it is also the shortest lasting-- meaning you have to use this method a lot more often to feel the medicinal benefits. Note: We caution you that vaping has been determined to be dangerous. Edibles or Medibles take a lot longer to feel the effects although the effects may last up to 8 hours using this method. When you eat cannabis it is important to remember that the Delta 9 THC converts to 11 Hydroxy THC which is 3-4 times more potent and psycho active than Delta 9 THC. 11 Hydroxy THC passes through the blood brain barrier easier and that is good news for Parkinson’s patients. Sublingual is the easiest to micodose and is often used by the pediatric patients the most. Topical products are not psycho active and work at the site where it is applied.Medical marijuana may affect the effectiveness of medications taken to control GVHD (tacrolimus, cyclosporine, steroids) as well as anti-depressants and potentially antibiotics and antifungals: What we do know from our knowledge is that it does have some effect on post-transplant medications so there is some effect on mycophenolate, tacrolimus, cyclosporine or steroids so many of the medications a patient might receive post-transplant, these agents may inhibit them and cause increased levels of the drug which may result in toxicity. Also, it can inhibit our antidepressants which would again increase our level of toxicity with those drugs. We can see some potential drug-drug interactions with our antibiotics, as well as our antifungals which many transplant patients will receive. We do worry about these because things like Voriconazole, Posaconazole, any of our azoles. Many of our mycins, erythromycin, clarithromycin, antibiotics may be affected by these.There are concerns about infection in transplant patients who use marijuana: From an infection standpoint, we do have concerns. Especially with smoking marijuana in our patient population. We have concerns with fungal infections. There are some case reports looking at patients who are smoking marijuana or who have smoked marijuana or who are immunosuppressed post-transplant who have developed severe fungal infections and have died from those fungal infections. That could be a result of mold spores that may be contained in the buds that are smoked, as well it could be a result of increase in inflammation and causing infection risk in the lungs. Again, when we have patients who are immunosuppressed, who have too few white blood cells, we really do advise them NOT to use smoked products. We really advise them to use edibles or tinctures of some other nature.Microbe contamination of marijuana products is a concern: There's no standard manufacturing, so we worry about microbe contamination just like we would worry about smoking those natural products with mold spores.Micro contamination, we worry about pesticide contamination from how the crops were raised. With that, in our immunosuppressed patient population this is a real concern because patients can be more susceptible to these types of toxicities. Then there is just an unmonitored chain supply. Again, with FDA approved drugs as they go through quality control - we do monitor where the drugs are and what temperatures they are and when they have been where. In this situation, there really is an unmonitored chain supply so we do not know where there might be potential places for contamination to occur as the product is being prepared for patient use.Small studies suggest that marijuana may help in control of Graft Versus Host DiseasePlease remember: this is an overall, general education. Again, we want to stress that with laws differing so much state to state regarding the use of cannabis or CBD, it is very important you learn the laws for YOUR state. We also are working with what is legal at the time of this recording, in June 2020. Please consult your doctor should you have personal questions or concerns, applicable to your care plan.For more from the National Bone Marrow Transplant Link, visit us online at nbmtlink.org or call us at 800-546-5268.This season of Marrow Masters is sponsored by the nbmtLINK, Jazz Pharmaceuticals and The Leukemia & Lymphoma Society.nbmtLINK website: https://www.nbmtlink.org/The Leukemia & Lymphoma Society: https://www.lls.org/ National Bone Marrow Transplant Link - (800) LINK-BMT, or (800) 546-5268.nbmtLINK Website: https://www.nbmtlink.org/Check out our valued nbmtLINK resource books, some for sale, some free as downloadable, https://www.nbmtlink.org/shop/nbmtLINK Facebook Page:  https://www.facebook.com/nbmtLINKFollow the nbmtLINK on Instagram! https://www.instagram.com/nbmtlink/The nbmtLINK YouTube Page can be found by clicking here.This content is provided for informational purposes only and is not intended to substitute for professional medical advice, diagnosis, or treatment.  It is crucial to consult directly with a qualified healthcare professional regarding any medical conditions, treatment options, or other health concerns.The views and opinions expressed by the speakers are their own and do not necessarily reflect the official policy or position of the nbmtLINK.  Unless otherwise stated in an official policy, the nbmtLINK does not endorse any specific treatments, products, or services mentioned by the speakers. 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