Cannabis Patient Care - November 2021

Cannabis Patient Care November Issue

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22 nurse focus cannabis patient care | vol. 2 no. 3 cannapatientcare.com However, they were all in agreement that more research was called for—ideally, clinical trials. Wohlschlagel pointed out that re- search on that level has been slow to come by because of the fed- eral status of cannabis as a schedule I drug in the US. She continued on her own path of interviewing as many patients as she could to gather anecdotal evidence and learn as much as she could. Educating Patients and Medical Professionals By 2017, Wohlschlagel was getting contacted every day by people who were curious about the benefits of cannabis for their cancer treat- ments. "It wasn't an officially endorsed thing, but I knew it was import- ant because I realized that people were lost out there," she said. The best-case scenario was when a patient's doctor also got on a call with her. "When it was really good, it was because their doctor was willing to get on the call with me. Their doc- tors would sometimes send people to me and ask me to talk to them about cannabis," explained Wohlschlagel. "I spoke to doc- tors and patients from around the world. But the key here is that I tried to do my best to learn from all the patients and the can- nabis medicine makers who would share their stories." In her current role, Wohlschlagel usually takes on more of a safety discussion related to medical cannabis. She explained that there is a benefit to a team approach with their doctors and if the patient wants to talk about cannabis as an anti-cancer therapeu- tic, she reviews and discusses it with the doctors first whenever possible. "I never claimed that medical cannabis was an antican- cer therapeutic miracle drug from God," she explained. "But pa- tients ached to have guidance, especially to understand safe use for symptom management. In the case of people running out of treatment options or perhaps putting all their eggs in the alterna- tive basket, I explain to them more about their cancer, what they might be missing in conventional treatments, some new break- throughs—risks and benefits as best as I can assess and educate. But if there is anecdotal data and at least some research showing the type of cancer may be at least somewhat vulnerable to canna- bis therapies, I do discuss it with them. Reviewing both risks and potential benefits so they can then make an educated decision." Wohlschlagel felt strongly about the role medical cannabis could play in cancer symptom management rather than as a re- placement for all conventional treatment options. "In the realm of symptom management, if we can help someone reduce their need of opiate pain medicine by using carefully dosed THC formu- lations, maybe with a little CBD, that is very beneficial," she said. "I saw people that were able to repeatedly reduce the amount of opioid pain relievers they needed as well as spasm reducing med- icines like muscle relaxers, sleep aids, and nausea medicines." She further explained that just like every pharmaceutical we ef- fectively use, there are going to be side effects and cannabis is no different. "It's just that sometimes, cannabis' side effects are mak- ing you sleepy, relaxed, or forget about your worries. Some peo- ple experience that consistently," she stated. "That can be a gift for a patient going through cancer or cancer treatments. If they can sleep, forget about their worries and their pain or disease and their nausea, and then they get up in the morning. They might even be a little hungrier than they would have been, and they're going to eat again. That's a wonderful gift. And it doesn't take a lot of cannabis medicine to do that." "Cannabis medicine was profoundly helpful in at least reducing, I would say, generally 30–50% of a patient's pharmaceutical use if they got good support from a doctor or nurse," said Wohlschlagel. Again, she stressed that medical cannabis is not a cure-all for breast cancer specifically, or cancer in general. Every patient and every type of cancer is different. "When it comes to cancer treat- ments, I have witnessed tumors shrink on cannabis. I have witnessed patients get worse with tumors growing rapidly on high doses of can- nabis," Wohlschlagel said. "There's no test that I can offer patients to find out if their tumor is vulnerable to THC or not. It's complicated and when I would see patients who were successful with the use of cannabis, it typically was in a form of cancer where researchers had already indicated so in what we call preclinical research." Wohlschlagel explained that preclinical research means testing that's before human trials, usually on animals or cells in dishes. In some of that research, there was evidence that a particular type of cancer might be vulnerable to THC—meaning the tumors could potentially shrink. "When I saw that over and over in certain sub- types of cancer, I looked and I kept track. And if it was successful, the patients needed to use approximately 80 to 100 milligrams of THC a night," she said "That's about 20 times more than most peo- ple would comfortably use at night to go to sleep. So, there was a lot of variability in the journey a given patient got to or took be- fore they got to that dose." Questions of product quality and consistency also played a role in a patient's experience. How were the products made? Were they low or high potency? Was the product you purchased last week the same as the one you'd get next time? These were all impor- tant questions that patients might not even realize they should be asking. When Wohlschlagel tried to broach these subjects on the social media groups she often was met with backlash and ac- cused of being a "pharmaceutical shill" or worse, so she ultimately left most of those groups. However, Wohlschlagel has not been deterred from sharing her information with others despite the trolls on social media. "When I presented at the Cannabis Science Conference, I met with scien- tists, doctors, and pharmacists and we all agreed that cannabis could be so beneficial for people for symptom management. But that if we didn't start educating about drug interaction risk and im- munosuppression risks with immunotherapy cancer treatments, that cannabis could be locked up again as unsafe," she said. Indeed, the risk of cannabis use with immumotherapy is scary, es- pecially if patients are unaware or afraid to be open with their doc- tors about adding cannabis to their treatment regime. "Doctors Mitzi and Prakash Nagarkatti had already documented the cannab- inoids could be useful in autoimmune diseases and some leukemi- as. They also showed that it reduced the immune attack," explained

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