Chapters Transcript Updates in palliative care Alrighty, we are going to talk about the role of cannabinoids and palliative care. Um I sadly have no financial relationships. Everything I talk about today is going to be off label but I have a couple other disclosures. I do certify patients for medical cannabis in my practice. I do have patients in my practice who are using medical cannabinoids and I struggle every day with when to say yes and when to say no and this is hard for me. Two and so I hope we can talk about this a little bit rationally and I hope you leave with a little more knowledge than when you came in. The objectives are really to understand why therapeutic cannabinoid research is so complex and confusing to recognize symptoms for which cannabinoids may benefit to list potential harms related to medical cannabinoids and to rationally discuss the pros and cons with patients. Because if you are out there right now thinking this doesn't impact my practice, you are wrong. Um There are only two states in the nation that do not have some legalized cannabis, medical cannabis or otherwise. And I guarantee you in those two states, Nebraska and Idaho your patients are taking over the counter cannabidiol. So it's out there are patients are taking it when we talk about the cannabis sativa plant, there are over 4000 compounds in this plant. But the really the two that we're going to focus on today and the two that have the most interest medically our good old fashioned THC and cannabidiol. There are also two strains of cannabis sativa plant, there's marijuana strain that has relatively higher doses of THC and lower doses of cannabidiol. And then there's hemp And hemp by definition has less than 0.3% THC but can have anywhere from 15 to 40% cannabidiol. Why is this important? This is important because in 2018 hemp was removed as a Schedule one substance, making it legal to grow and cultivate and crow and cultivate people did and they extracted the cannabidiol from hemp plants. And so after 2018 you probably have noticed that uh cannabidiol dispensaries and stores selling cannabidiol products have exploded across the nation um and flooded the market with cannabidiol products. There are lots of products out there and I just want to go through this really quickly and I want to think about these as products that are THC dominant products that are CBD dominant cannabidiol dominant and products that are mixed and then there are pharmaceutical grade prescription products, their extraction products and there are whole plant products. And when we think about the THC dominant ones, that's really Marinol which is a synthetic THC prescription medication a knave alone um which is also a synthetic THC analog knave alone is unavailable in the U. S. It is available in Canada and europe. When you look at the CBD products, there is a pharmaceutical grade purified cannabidiol produced by a company from Britain name called Epidiolex. And this has actually been FDA approved in the United States in the United States to treat certain childhood cancer syndrome or childhood seizure syndromes. And then there are balanced products that balance the THC and the CBD. And from a prescription sand standpoint this is no biggie smalls and it's an oral mucosal stray spray that unfortunately is also not available in the U. S. Although is available in Canada and europe. But it's important to know about because a lot of the studies use it in their studies. The extraction products are what you see in most of the medical cannabis dispensaries. They come in a variety of different ways and they cross the board THC CBD and balanced and the whole plant products are largely what you get on the street and there is virtually no CBD dominant whole plant product there they are either THC dominant or mixed. So why is interpreting this literature so confusing? So the first reason is the heterogeneity of products tested. Is the product being tested THC dominant CBD dominant or is it balanced? And if it's balanced which is the drug that's actually helping? Is it a pure pharmaceutical product? Or is it a whole plant product? And if so what is actually in it? And what are we testing Published Created by
