All for One and One for All: A Discussion on Integrating Cannabinoids in Medical Care
This was initially published in the first Issue of CBD Health & Wellness Magazine published in 2019 and is being shared for educational purposes on this blog. Please cite as Bone, CB “All For One and One For All: Discussions on Integrating Cannabinoids in Medical Care” CBD Health & Wellness Magazine, Volume 1, Issue 2 August/September 2019.
Some of the earliest advocates of “compassionate care” cannabis legalization were individuals suffering from intractable ailments, from cancer to AIDS. The current landscape for legalization includes medical cannabis of some variety in around 30 countries with federally regulated and approved cannabinoid pharmaceuticals available in the United States. The progress we have made in improving the quality of care for those with severe illnesses has soared in a brief time, and the prospects for the future remain even more optimistic. With regulatory winds and public attitudes shifting, it is worth taking stock on the current field of cannabinoid medical care with an eye toward how future changes in hemp markets and cannabis policy will affect patient care and product accessibility.
The current best practice with cannabinoid care treatments is an integrative model that sees cannabis as a component of a robust treatment modality aimed at holistic wellness. At the heart of this framework is the belief in the importance of maintaining a healthy Endocannabinoid System (ECS) to global health. While there is still much to discover about the ECS, advocates for this integrative cannabinoid care model point to the synergistic overlap between other core bodily systems. From pain and diet management; to sleep and skin health the potential pre-clinical implications of ECS modulation are significant. [1] Medical cannabis and hemp-derived CBD products represent the forefront of some of the novel therapeutic interventions. However, as safe access remains slow to change; while overall product reliability and treatment knowledge continue to develop, consumers and patients are left in limbo.
At the CBD Northwest Expo in Seattle, this past June thought leaders from across industries gathered to address these dynamics and discuss what the future of integrative cannabinoid care looks like. Present were respected manufacturers, doctors, and researchers including Dr. Karyemaitre of Charlotte’s Web; Dr. Julian Grove of Physicians Choice CBD; Dr. Randy Fink of Slyngshot Health; and Dr. Adam Abodeely of Adirondack Health. Topics addressed included: Logistics with coordinating care with medical institutions, the private sector, as well as consumers, patients, and caregivers; navigating the multiplicity of treatment goals, expectations, and experiences; as well as educating stakeholders and developing various, effective treatment modalities.
Integrative medicine is typically a concept brought up when talking about cancer, given the multitude of symptoms and differences in underlying pathology. Research supporting the incorporation of cannabinoid therapies into hard-to-treat illness comprise “Compassionate Care” modalities that have expanded in focus since legalization efforts have picked up in earnest. [2] Regardless of the ailment though, integrative care models aim to adopt a new paradigm of health that takes the role of holistic wellness seriously. Empiricism matters, but dogmatism is dangerous, and according to Dr. Fink, “Every body is different and everybody is different”, necessitating approaches that address individual health. Integrative care approaches allow us to work to enrich the quality of existing treatments with new information and developments.
One of the most important, yet overlooked, considerations for all of these matters, whether it is developing new paradigms of wellness or treating intractable cancer, is the role of the ECS, agreed with the panelists. Targeted interventions involving different products for different illnesses attuned to individual needs is a kind of care that is both crucial for patients and capably administered, argued Dr. Abodeely. This approach emphasizes the bio-psychosocial aspects of health, clarified Dr. Grove, which underscores the need for integrative care. The role of the ECS in regulating bodily functions that impact our physical well-being and mental health makes it a prime source for treatment and monitoring when working to improve patient health outcomes.
With an increasing body of cannabis-related research, we are indeed on track to being able to see ECS integrative therapies becoming pervasive. Dr. Grove and Dr. Abodeely’s practices coordinate care with other medical institutions and product manufacturers to make this a reality, while also creating protocols and research that contribute to shifting attitudes around cannabis. [3] Important to remember during this shift is the relatively brief window in which the current health paradigm has been hegemonic, chimed in Dr. Karyemaitre. Both the criminalization of cannabis and the advent of the PharmaceuticalInsurance-Medical Complex is a relatively recent phenomena, and while the convenience of strict dosage guidelines being hand-fed to doctors is convenient, it overshadows the far more sustained and involved process of caregiving that underlies contemporary medicine. Recognizing the role of patients and their advocates in leading the charge and guiding our research was a sentiment echoed by all, and reflects the values of integrative medicine that rely on practical experience to craft better care alternatives.
Elaborating on the theme of patient advocacy and individual care as tenants of integrative cannabinoid medicine, Dr. Karyemaitre pointed specifically to the failures of the western disease model in helping us develop more robust protocols for wellness. The costs of modern health care are unsustainable and the curative approach trades off with a health paradigm that respects different wellness modalities. Normalizing ECS monitoring and care pushes us towards a global health paradigm, continued Dr. Karyemaitre, understanding that this requires complicating our understanding of universally consistent care. As our goals and outcomes become less unified, consistency must become a factor in our decision-making and methodology. This approach centers on the experiences of patients and is the appropriate starting point for compassionate care, as opposed to the broader interests of healthcare providers and pharmaceutical companies, added Dr. Fink. With the downsides to cannabis being quite manageable and historically non-fatal, there is certainly credence to rolling the dice when integrating cannabinoid therapies into an increasing number of treatments and wellness plans. While research on integrative cannabis care continues, so does support from the medical community for these methodologies. Evidence indicates that there is growing support from a multitude of different medical practitioners for integrative cannabinoids into treatments.
As personal experiences and successes with integrative care spread and research grow, it is clear that phytocannabinoids and ECS interventions are here to stay. And while the promise to treat a variety of ailments with greater efficacy is certainly evident, there are still limitations with cannabinoid integrative care. Dr. Abodeely pointed out how, drug interactions may impede certain demographics from access without critical tradeoffs, citing the known negative interactions between certain blood thinners and cannabis. Dr. Grove continued, that further information about treatment pharmacology is still being developed, which is a lengthy and expensive process. While there are risks with cancer treatments, such as side effects like cannabinoid hyperemesis and documentation of adverse mental health in certain populations [4], there are still tremendous opportunities for a more holistic approach to care.
Understanding the patient is the starting point of care, and developing products consumers want and need is crucial. As Dr. Abodeely professed that product lack of reliability is an issue for patients, as it is difficult to manage symptoms without doctors and patients having confidence in the treatment. Dr. Grove elaborated by referencing the empirical findings of contamination in many CBD products [5] and calling for stricter regulation and enforcement to improve consistency for patients. Product quality is an issue that affects the legitimacy of all cannabinoid therapies and therefore is a fundamental concern to advocates and regulators alike. Standardization of product forms and concentrate types, along with better testing and manufacturing protocols will go far to reduce these threats, however, there also must be a shift of regulatory barriers to aid research and treatment development more broadly. Despite the support, the Schedule I Classification of Marijuana (THC Cannabis) stunts research into the plant as a whole. The fragmented hemp market and regulatory ambiguity make coordinating care difficult in the status quo. [6]
As Dr. Grove pointed out, collecting the data from cannabinoid integrated care treatments is work that is underway, referencing his personal pain management practice in Arizona and data they have used to help lobby for reform in Arizona’s medical cannabis program. However, barriers to coordinating care between institutions limit the scope of much of this work. Dr. Abodeely, discussed in reference to his work with Cancer Centers in Upstate New York how educating and collaborating with certain healthcare professionals can be difficult when a large majority are employed by federally funded Hospitals and thereby prohibit Cannabis education. Lobbying for change and working with advocates to continue liberalizing cannabis policy is crucial to maintain momentum. As Meta-reviews indicates that there is tremendous potential with integrative cannabinoid care, removing barriers will help accelerate developments and access. [7]
As the medical cannabis and industrial hemp markets continue to grow the opportunities for integrative cannabis care models to take hold to become increasingly evident. “With wide availability, there will be massive potential,” proclaimed Dr. Karyemaitre when concluding the panel. Certainly, the potential for developing more conspicuous consumption and better health paradigms seems likely as CBD begins appearing on shelf stores across the globe, and more and more individuals are taking to taking. We must be patient but persistent in our advocacy and development of better cannabis products, reminded Dr. Fink. Diligence will allow us to rise to the occasion, and collaboration can ensure we all make it. The future of integrative cannabinoid care is hopeful, and—so long as we continue to progress as we have been—obtainable.
References
[1] Mouslech, Zadalla & Valla, Vasiliki. (2009). “Endocannabinoid System: An overview of its potential in current medical practice” Neuro-Endocrinology Letters. 30. 153-179.
[2] Prof of Pot. “Trends in Clinical Trials of Medical Cannabis.” Prof of Pot, 24 Oct. 2018, profofpot.com/ clinical-trials-medical-cannabis-trends/.
[3] Federation of State Medical Boards, Marijuana and Medical Regulation Workgroup Reportback (2016). Model Guidelines for the recommendation of Marijuana in Patient Care. Adopted as policy.
[4] Nugent SM, Morasco BJ, O’Neil ME, Freeman M, Low A, Kondo K, et al. “The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms: A Systematic Review” Ann Intern Med. [Epub ahead of print 15 August 2017]167:319–331. doi: 10.7326/M17-0155
[5] Kuehn B. Synthetic Cannabidiol Poisoning. JAMA. 2018;319(22):2264. doi:10.1001/jama.2018.7219
[6] Boxer, Richard J. “Medical Marijuana: Research Not Anecdotes.” Medical Marijuana: Research Not Anecdotes - The ASCO Post, 25 Aug. 2018, www.ascopost.com/ issues/august-25-2018/medical-marijuana-research-notanecdotes/.
[7] Hauser, W., Welsch, P., Klose, P. et al. Schmerz (2019). “Efficacy, tolerability and safety of cannabisbased medicines for cancer pain” https://doi. org/10.1007/s00482-019-0373-3
