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What you need to know about medical marijuana presented by @drosielle #CAPCSeminar19
This is our space: Consider who is giving our patients advice about cannabis if not us. While you don’t have to prescribe you can provide education and safety information #CAPCSeminar19
CBD is not benign it can cause sedation. Contrary to popular belief CBD will probably not cure the world of its ails. CBD has not received a lot of research attention and we are early in the process. #CAPCSeminar19
Medical cannabis programs are widely variable. No insurance coverage of medical cannabis even though it is being treated like medicine which seems unjust especially when SDOH are considered #CAPCSeminar19
The legality of CBD is confusing with different bureaucracy departments weighing including FDA, DEA, different state laws, etc. most CBD sales are being tolerated given legal grey area. #CAPCSeminar19
Interpreting cannabis research is a total mess and involves various methods, formulations, major generalizability problem #CAPCSeminar19
We need FDA drug development on cannabis. While there is not generalizable research, you also cannot say there isn’t evidence of benefit. #CAPCSeminar19
Nabilone: synthetic cannabinoid FDA approved for refractory CINV. Expensive with #60 costing $2000 #CAPCSeminar19
Nabiximols: not available in US outside of research. Oral mucosal spray. Approved in Canada for MS related spasticity. Studies show some benefit for CINV, cancer pain, ongoing #CAPCSeminar19
Clinical evidence for cannabis: broad evidence for CINV, some for analgesia for chronic pain, modest effects for spasticity for MS. #CAPCSeminar19
Cannabinoids as antineoplastics: there is lab research suggesting some anti tumor effects but there are no human clinical trials showing evidence. #CAPCSeminar19
Do cannabinoids reduce opioid use for pain? We really, really don’t know yet but is being studied. #CAPCSeminar19
Hot topic now: Can cannabinoids help with OUD? Unclear and needs more investigation. Never forget we have effective evidence-based therapies for OUD. #CAPCSeminar19
Cannabis harms: THC has well known short term intoxicating effects. Long term effects LFT elevation with high dose CBD, no well established drug-drug interactions, inhaled cannabis smoke not yet associated with cancer or lung disease but it also hasn’t been studied #CAPCSeminar19
Important to remember there are profit-seeking entities who want people to believe that cannabis will help everything. #CAPCSeminar19
Cannabis harms: dependence, chemical coping, impairment, psychosis in adolescents. Being promoted as a “health product” long term effects not yet know, this can be concerning. #CAPCSeminar19
CBD marketing: it’s “natural, healing, healthy cure-all for wellness”. This is irresponsible and we must educate our patients about concerns, it is not benign #CAPCSeminar19
Recent developments of harm include 100s with severe ALI related to vaping THC products and people are dying. Hot take: no one should be vaping anything. #CAPCSeminar19
Approach with patients: normalize, empathize with them when they ask, start low and go slow (some are already using illegally), some don’t realize CBD is intoxicating educate about driving safety, falls risk, no vaping, recommend against “OTC” CBD products #CAPCSeminar19
Approach with patients cont: don’t mix with alcohol or benzos, recommend lower doses if side effects intolerable. Empathize if they ask about anti tumor effects #CAPCSeminar19
Monitoring for safety: routine discussions about education, side effects, safety. #CAPCSeminar19
Your management of CBD is individual for your personal practice based on your state laws and institutional policy. If your organization disallows participation you can still normalize, empathize, and educate! #CAPCSeminar19
Audience member (anesthesiologist) shared experience of patients who inhale marijuana having interactions with propofol (requires much more propofol) and recommends encouraging patients to be honest about marijuana use due to safety concerns #CAPCSeminar19
In summary: cannabinoids have potential to reduce symptoms for seriously ill patients, risks are real, even with broad legalization we should medically approach discussing risk/benefits, guide them, demand FDA approved drugs that are affordable #CAPCSeminar19
“If not us, then it’ll be the Cap’n Crunchy CBD Cereal Puffs people guiding our patients about cannabinoids” #CAPCSeminar19
Great presentation @drosielle! This will definitely be helpful for my practice as I have many patients who share they use cannabis/cannabinoids and I didn’t know what to do with that information. #CAPCSeminar19
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