Cannabis And Pain Modalities - Exploring The Potential Of Medical Cannabis - Part 2

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Episode Transcript

(00:01):
From the WA and M Studio onthe campus of Florida A and M University.
This is Mariforum Radio, a weeklyconversation on the education and research or
a medical marijuana being conducted at BMWHI. I'm Heidi Otway, your host
for this Conversations on Cannabis Virtual form, brought to you by the Medical Marijuana
Education and Research Initiative at Florida andM University. In this conversation, we're

(00:26):
talking about cannabis as a treatment forpain management. So let's talk and learn
about this subject with our guests.Doctor Terrell Newton is a medical director for
Total Pain Relief, where he createscomprehensive care plans for acute and chronic pain
patience. He also serves as aFlorida medical director for True Leaf. Doctor

(00:47):
Newton is good to have you backon the forum. Great. Great,
I'm excited to talk to you todayand this is one of my favorite topics,
cannabis and pain management, so I'mlooking forward to I'm ready to dive
in, all right, right,And we also have Abby Folsom who is
a certified nutrition specialists and licensed dietitianwho's conducted clinical research on chronic pain and

(01:08):
medical cannabis. Abby, Welcome backto the forum. Thank you so much
for having me hide. I havea small virtual and in person nutrition practice,
so I do clinical nutrition and Isometimes provide education and coaching given my
clinical research background and clinical experience inprimary care and cannabis. All right,

(01:32):
so to everyone joining us on thislive program, please share posts and tag
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we want you to send us yourquestions in the comment box, and
we'll do our best to have ourguests to answer them. We also want

(01:53):
you to tell us what you thinkabout this forum by completing the survey that
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your name will be entered into adrawing on July thirteenth, twenty twenty three
to win a one hundred dollars giftcard provided by one of Mary's partners.
Now, let's get started with thisconversation on cannabis. Doctor Newton, I'm

(02:15):
going to start with you. Tellus about your professional experience recommending medical cannabis
as a treatment for pain. Iknow you've moved, You've started as a
qualified physician here in the state ofFlorida, and now you've been elevated to
this directorship with True Leaf. Sotalk about your experience recommending medical cannabis.

(02:38):
Did we lose doctor Newton? Unfortunately, Newton, you are going in and
out. We have lost you.So I think you're going to have to
restart your computer and join us backagain, sir, Thank you. All
right, so Abby, we're gonnatake it away. Tell us about your
professional experience recommending medical cannabis as atreatment for pain. And I know you're

(02:59):
not qualified physician, but I doknow in your practice when it comes to
nutrition and cannabis use, you docounsel your patients. So tell us a
little bit about that. Well.I came by it honestly working for doctor
John mess and his primary care clinic, and his population is of all ages,
some of them a bit older.And because I have disabilities, they

(03:20):
were comfortable disclosing their pain, theirmedical cannabis use. And a lot of
times the patients within my wheelhouse cometo me for gi discomfort associated with long
term opioid use that can cause constipatientI myself can relate to long term inset
use such as celebrax or biax causingour biox causing intestinal bleeding and ulcers and

(03:46):
lots of GI pain. So sometimesI get chronic pain patients who think that
a food is causing this problem whenit's really a pharmaceutical side effect. So
I've heard lots of tantales about peopleand their experiences as they manage their medications
differently and perhaps use cannabis to tryto decrease their opioid use or decrease their

(04:11):
inset use. And then I wenton to work for a clinical psychologist,
doctor Nikki Ennis at FSU College ofMedicine, and help her implemented some clinical
cannabis research and did chronic pain researchfor her. So being able to synergize
these topics on the Mariform radio showis amazing. So thank you. Okay,

(04:33):
wonderful. So I want to talkabout dosing because you know, one
of the things that we hear whenwe're doing this program, we have folks,
you know, asking how much doI take? And Doctor Newton,
you just kind of touched on thatwhere you say you could take different ones
or you know, at different timesfor different symptoms. So can we talk
a little bit about dosing. Yeah, one thing I would like to see

(04:54):
is more conversations on potencies. Youknow, I think we did a wonderful
job. We're talking about CBD andTC. But when we when we think
about potency, Let's say we have, for example, a bottle, right
a thirty email bottle with three hundredmilligrams. If that bottle is CBD only,
that's going to have a different potencythan if it's TC. So CBD

(05:15):
is going to be more what wecall a week so that's going to be
more like a cta menifin more likeyou know, out of profan, whereas
the TC is going to be strong. That's going to be more like oxycodon
where you're dosing at like five milligramsper dose and things like that. But
what if it's half and half,so we call that a one to one.
So if there's equal parts CBD andTC, if it says three hundred

(05:36):
milligrams on the bottle, one hundredand fifty is going to be CBD and
one hundred and fifty is going tobe TC. So we could have different
potencies. And so when you're discussingstarting cannabis, it's always important to start
low and go slow. You know, whether you're talking about CBD, whether
you're talking about a one to one, or whether you're talking about TC only.

(05:56):
And that's the one of the greatthings about cannabis is that you can't
overdose on it, meaning that it'snot going to suppress your breathing because there's
no what we call receptors in abrainstem. Whereas with muscle relaxants that can
suppress your breathing, with anti inflammatoriesthat can cause aulcerations in your stomach,
and we don't see that with CBDTCor any cannabinoid based medicines. And then

(06:19):
also looking at sleep aids, soif you take a sleep aid and you
drink alcohol, you can overdose onthat, but with cannabis you won't overdose.
Now, the other thing to rememberis that cannabis can be excitatives,
so you don't want to mix itwith alcohol, you don't want to mix
it with other medicines until you knowhow it affects you. So usually when
we start something new, we startit by itself, and we start it

(06:42):
low so we know what this isdoing. So let's say a patient,
you know, if they get arecommendation for a muscle relaxant and for CBD
in general, that will start oneat a time to know how that affects
them rather than starting both simultaneously.Yeah, Abby, What about the nutritional
aspects of consuming cannabis for pain andthen what you eat? Well, it

(07:02):
does kind of annoy me that theedibles are so sugar based or heavily sugar
based, especially in Florida, becausefor those who are trying to stay away
from sugar, perhaps the tinctures wouldbe better, which are the oil soluble
cannabis products. You can certainly addthat to your food, your regular meals,

(07:26):
as long as it's not flavored.What do you think, doctor,
you well, I think the greatthing is that you know, there's more
awareness about what's going on with diabetes, and it's really overtaken a country,
and you know, with the increasingin the United States, there are a
lot of products that are available thatare sugar free, so you can still
take an edible, but the sugarcontent is no sugar in the actual product.

(07:53):
The other wonderful thing about the flexibilityof cannabis is that with the oil,
you know that's taken orally, sowhether that's added to food. You
know, a lot of the oilsare already mixed with either olive oil or
an MCT oil that's immediate chain chucklissrots such as coconut oil, So that
actually increases your absorption of the medicine. So that's why I would promote the

(08:15):
Mediterranean diet and eating lots of naturallyoccurring essential fatty acids to enhance your oral
doses of cannabinoids. And if you'reeating a high fat, fast food,
westernized diet that's heavy and omega sixes, you might actually be diluting that cannabinoid
concentration that you're going for. Andfor bigger people need more, Smaller people

(08:39):
may need less. Leaner body masstends to have more circulating receptors, whereas
you might actually need to increase thedose for greater body mass. Would you
say so, doctor? And theother wonderful thing about these different healthy oils
is that they reduce inflammation, andso traditionally we might think that all oils

(09:01):
are bad, but that's not true. There's actually is shown that there's many
oils that reduce inflammation and that they'rehealthy for our bodies. And I think,
as Abby mentioned, you know,getting that balance your omega three omega
six balance is very important. That'swhy it's great to be followed by a
nutritionist so that way make sure thatyou're not getting too much of one type
or not enough of one type,and that's optimizing your icosonoid metabolism and ultimately

(09:26):
your pain pathways. So yes,there is definitely a nutertional component to that.
Yeah, we got a question fromsomeone who sents a question in before
the program, and her question wasabout how what strains how does that impact
someone who is looking to use cannabisfor pain management and there a diagnosis associated

(09:52):
because pain pain is such a bath. But you know, the main thing
with looking at cannabis is a certificateof labinalysis to confirm what is actually in
the medicine. So when you're evaluatingthe different types of medicine, the certificate
of labinalysis tells you what's actually inthe bottle. And so there's one one

(10:16):
degree of knowledge you get from justlooking at the bottle and that's actually what's
labeled as And the good thing aboutFlorida is that all the products are tested
and so it's highly regulated, asregulated as a pharmacy, and so when
you have that bottle and it saysthree hundred milligrams of CBD. That's actually
what's tested by a third party andactually what's in there now. When you

(10:37):
talk about strains, there are somedifferent categories. Some of those categories can
be indica and sativa, where indicais more of a relaxing type of cannabis
and sativa is more uplifting. Youcan have hybrid that is in between.
And when you're looking at a particularname of a product, the most accurate
information is going to be on thecertificate rather than what is the name itself

(10:58):
of the product, right, whichis ahead, go ahead. One of
the reasons I'm a fan of howtransparent the Toccoon alarm products are at by
de CAN is not only are theyevidence based and backed by research. And
in Israel you can read that certificateof analysis and know what it says is

(11:20):
what you're getting at our authorized dispensers. That's true for every dispenser that has
license in Florida. The products haveto be labeled and you know as far
as like you know, looking atyou know research, that's the wonderful thing
as well. There's a lot moreresearch. There's literally an exponential increase in
research on cannabis because now we haveabout forty states that has a legal for

(11:41):
medical use. There's research that's doneoverseas, but there's even more increasing research
that's done in the United States.So we have a question that just came
in from a viewer on YouTube.Let's pull it up pieces or I don't
know the gender. But if youare taking questions, I would like to
ask, say, I have afifty year old man who has neuropathic pain.

(12:03):
He does not want a psychoactive agent. What would you recommend? Well,
first, what is it from?So with neuropathy, it can be
from diabetes, so getting control ofthe diabetes that might be enough to treat
the neuropathy itself. The other thingis if it's from let's say chemotherapy,
chemo and radiation, and that mightindicate that it could be temporary, you

(12:24):
know it meaning it resolves once thechemo stopped, or in some cases unfortunately
it continues. You know. Treatingthe underlying cause, I would say,
is the number one thing to discusswith your physician. Now, if you're
talking about looking at cannabis in general, you would want to start with a
high CBD, low TC product becausec is psychoactive whereas CBD is not.

(12:50):
And there's a variety of ways toactually take that. So one could be
topically, so putting it on thefeet when you have the most symptoms,
putting it on that night to absorbthrough the skin, and you're not getting
as much systemic absorption, so you'remuch lessly to have different types of psychoactive
effects. Even if the product isa one to one you putting it on

(13:11):
topically, you're much less likely tohave any psychoactive effects even when there is
te seeing that product. The otherthing to look at with neuropathy is nutritional
deficiencies, so B twelve B sixthose vitamin deficiencies, unfortunately also calls neuropathy.
And then there's different treatments that canincrease the blood supply to the nerves.
So one of those is largentine,so that's an menal acid that gets

(13:35):
converted to a vasal dilator that canincrease the circulation to the nerves and facilitate
healing. Then there's different what wecall physical modality, so you can actually
put a device on the feet tostimulate the healing of the nerves, and
it's basically like giving a workout forthe nerves. There's one treatment that we
have in our Jacksonville office called neurogenics, where it actually stimulates the nerve.

(13:56):
It looks like the modified TENS unit, but it's a much more sophisicated electrical
signal. So there's a lot ofthings that could be done to complement the
treatment for neuropathy that can all benon psychoactive. Thanks Panhandle Direct Care.
One thing I would add to throwdown on that is make sure they are
supplementing with magnesium and are sufficient andhydration and basic minerals. I would also

(14:20):
increase their fats in their diet toplant based oils, and make sure they're
not just taking beats well, buttaking a methyl covaloment because cyanocobalamin is not
readily absorbed. Yeah, doctor didnonWe're getting more questions from folks asking for
recommendations. Do you want to providea disclaimer? Oh? I can't because

(14:41):
I'm the medical director of a dispensary. I no longer directly do recommendations.
I did for a number of yearsin Florida, but I'm highly involved in
my own research project and also Ihave one I recently completed in another one
I'm about to start for cancer patients, and I also do education in other
states, travel and I try tofacilitate and encourage physicians to consider cannabis.

(15:03):
I'm not saying that it may fitevery physician in their practice, but at
least educate yourself because there is adeficit in knowledge. This is not taught
in medical school. So most ofour education is after medical school, where
we're doing the research on our own. We're talking to me, we're talking
to other doctors, we're attending conferences. You know, organizations like FAM,
you and then Mary have been amazingfor my body of knowledge. And also

(15:26):
I would encourage anyone that's looking toelevate and come to that next level of
knowledge. Check the website. There'svideos and education for physicians, for nurses,
for pharmacists, for our consumers,the folks who are watching right now.
Because we have another question for you, Actually you don't go ahead and
pull it up. It's tremendous theamount of resources that you all have there

(15:48):
on your website. I see itgrowing every every year and every month.
Is amazing. A lot of love. Thank you. Let's bring up Ken's
question, So what cannabinoids as cannabinols, and at what doses would you recommend
for chronic arthritis knees and elbows thatrequires a double dose of NSAID to somewhat

(16:11):
control. You know, that's definitelya medical question. So anyone want to
respond to that. Yeah, Well, the great thing about you know,
letting our medicine and our food beone and the same is that there's a
lot of foods that can be eatenthat reduced inflammation. For example, red
onions, um, they have somethingcalled cursetin which is a very potent anti

(16:33):
inflammatory. There's green tea, there'scruciferous vegetables, there's as Abbey had mentioned,
the healthy oils and getting that ratiocorrect. And you know, as
you discuss your nutrition with your provider, with with your nutrition, with with
your your nutrition is also discuss youknow what else can be done from an
activity standpoint for arthritis, Right,so physical therapy, applying ice, all

(16:56):
those things, even before going tocannabinoids. I just want to be thorough
and make sure that we're covering thatthere's other treatments in addition to it.
Now, to get more specific,I think about potency. So if you're
a new two cannabis and just starting. You want to start with something that
is not quite as potent, sofor example, a CBD product or a

(17:18):
twenty to one so a product thathas twenty times more CBD than TC,
because CBD and the precursors to CBDare potent anti inflammatories, so you can
get five to ten anti inflammatories inone cannabis medicine. Because you have the
various cannabinoids, you also have terpeneswhich gives the cannabis is scent and colors.
So applying that topically to those areascan give amazing relief and in some

(17:41):
cases patients can even see relief withintwenty four hours. And taking it sublingual
so you can get more absorption sublingually, as Abby had mentioned, taking it
orally sometimes you have a lot ofthe medicine metabolizing the liver. And the
wonderful thing about the cannabis medicine isthat there's a variety of ways to take
it. So you can have topical, you can have sublingual, you can

(18:03):
have orally, and when you takeit with healthy fats and oils, you
can absorb up to five times asmuch medicine. So it is a variety
of ways. But you know,with authritis, you definitely want to be
involved in physical therapy to increase youractivity. You definitely want to focus on
weight loss and healthy nutrition because allthose things can prevent the aggravations and the
exacerbations of the authritis. So tosupport that, our pharmaceutical and nutraceutical alternatives

(18:29):
to opioids are more promising with medicalcannabis orthobiologics and optimize mineral supplementation along with
an anti inflammatory diet. And forme, the endocannabinoid diet is high and
those omega three fratty acids, polyphenolsor phytonutrients including fatty fish, seeds,
seed based oils, nuts, legumes, natural products with an anthosan in hue

(18:53):
that's that red purple blue that wesee in fruits and vegetables. Coffee,
ginger, and turmeric are all knownfor being anti inflammatory. Can I clarify
something real quick? Absolutely? Youhad mentioned orthobiologics. I just want to
explain real quick what that is.So there's different types of ways to regenerate

(19:15):
tissue, and one of those iscalled stem cells, and so orthobiologics is
a reference to regenerative medicine to rebuildthe tissue. There are stem cells that
can be taken from the patient's ownbody and injected into the injured area.
There's also something called PRP platelet richplasma where you can take a sample of
the patient's blood, concentrate the growthfactors, and then injected into that area

(19:37):
to stimulate healing. And I can'tsay one of these is better than the
other. This is what we're talkingabout when we say a whole picture or
holistic approach is using orthobiologics and anoptimized diet, optimized mineral supplementation along with
medical cannabis. Am I right,doctor Newton? I think the combination gives
you a new type of enter effects. So cannabis by itself has an entourage

(20:02):
effect, but then also increasing yournutrition, focusing on weight loss, meditation,
reduce your stress hormones. All ofthis can combine and be an additive
even a more than additive effect.That was so good. So I want
to give you all an opportunity tokind of like give like some closing comments
when it comes to those who areconsidering using medical cannabis for their pain management.

(20:26):
And we will also want to encouragepeople to go to the Florida Department
of Health Office of Medical Marijuana usedto learn if you're based in Florida,
how to legally obtain a medical marijuanacard. And from the conversation we're having
today, a lot of the symptoms, the qualifying conditions for a legal card,
we've kind of touched on those today. So we definitely want to encourage

(20:48):
people to definitely visit that website tolearn how they could obtain a legal medical
marijuana use card here in Florida.So, doctor Newton, I'm gonna start
with you just to give some closingcomments for you know, just what folks
should be thinking about or you know, overall narrative on thinking through using cannabis

(21:10):
as a treatment. Yes, yes, and I'm going to do this from
the perspective of a recommend dation orreally just an educational tool that I like
to use called neumonics. And sowith neumonics, they can help us remember
different things. So if somebody's dealingwith pain, anxiety, depression, I
want to give you a pneumonic towrite down and take an approach to discuss

(21:33):
with your nutritionists, with your physician, with your nurse, with people in
your support group. So that pneumonicI want to give you is called happy
is h appy. So in thebeginning of the day, you want to
hydrate yourself so that way you're replenishingsome of the electrolytes that you've lost throughout
the previous day and throughout the night. The aids for attitude, so you
want to approach with a happy attitude, a very positive attitude. We have

(21:55):
gratitude when you start your day.The first pe is you want to prepare,
So prepare yourself mentally for the day. That might consist of meditating for
about five or ten minutes. Thesecond pie is proper sleep. So proper
sleep is very important for all thesethings because you don't want to get into
a vicious pain cycle, and ifyou're not sleeping, your pain can be
worse. And the last letter ofthe Y is you. So just like

(22:18):
when a plane loses his cabin pressure, you have to give yourself the oxygen
first before you give it to someoneelse. So focus on you, and
it's okay to focus on yourself.And it's important because the better that you
function, the better you can helpother people. So try to be happy.
So hydrate, have an attitude that'spositive, an attitude of gratitude,
prepare for the day, by meditating, get proper sleep, and then you

(22:41):
focus on yourself and then focus onhelping others. That's really good Abby,
Thank you doctor Darton. And sometimesthe only thing you can do about chronic
pain is fix yourself a cup ofhot tea and a nutritious meal and plan
for the next steps because it's hardto take medication on an empty stomach and
not well. Ify is not havingenough blood sugar can certainly exacerbate pain and

(23:03):
symptoms. Being chronically dehydrated in portercan exacerbate pain symptoms. So I'm all
about the basics. And doctor Newtonhandled that well, which is happy to
monic. Well, this was sucha great and rich conversation I have.
Abbie and I were both writing happywhile you were talking to hundredings, so
I know that our viewers and ourlisteners will be doing the same. And

(23:26):
I want to thank you both forbeing guests on this Conversations on Cannabis Virtual
form, brought to you by theMedical Marijuana Education and Research Initiative at Florida
and University. Thank you to everyonewatching this program. Tell us what you
think about this form by completing thesurvey that will be posted in the comment
boxes. On YouTube and Facebook afterthis live program. If you complete the

(23:49):
survey, your name will be enteredinto a drawing on July thirteenth, twenty
twenty three to one a one hundreddollars gift car provided by one of Mary's
partners. We also again want toencourage you to go to the Florida Department
of Health Office of Medical Marijuana Usedwebsite to learn how to obtain a legal
medical marijuana card in the state ofFlorida. And we also encourage you to

(24:11):
go to Florida and M University's Marriedwebsite to learn more about this initiative,
it's educational programs and additional information aboutcannabis use in Florida. Thanks everybody.
The views and opinions of our invitedguests are not necessarily the views and opinions
of Florida Agricultural and Mechanical University orthe Medical Marijuana Education and Research Initiative.