The Cannabis Boomer Podcast is for baby boomers and all adults who are interested in the science of cannabis. Key words for the podcast in general are: baby boomers, cannabis, boomers, marijuana, THC, CBD, health, wellness, science, and aging.

For this particular episode, key words are: cannabis, pain management, marijuana, THC, CBD, terpenes, acute pain, chronic pain, and cannabis testing.

The Cannabis Boomer Podcast discusses cannabis use for pain management, emphasizing it as one tool among many, including exercise and meditation. The episode highlights the importance of understanding pain types, distinguishing between acute and chronic pain, and the effectiveness of cannabis for neuropathic and inflammatory pain. It also explores the role of cannabinoids and terpenes in pain relief, recommending a one-to-one CBD-THC ratio and specific terpenes like beta-caryophyllene and myrcene.

The entourage effect suggests that various compounds in cannabis interact to produce unique effects, but strong evidence for this phenomenon is lacking. Despite this, researchers are investigating individual compounds like terpenes for their potential therapeutic benefits. The cannabis market offers a wide variety of formulations, but the lack of scientific evidence behind many claims highlights the need for further research to support consumer choices.

Cannabis products vary in regulation and testing, with FDA-approved products like Epidiolex being the most regulated. While cannabis can offer pain relief, it’s important to be aware of potential side effects, especially from THC, such as altered mood, dry mouth, and in rare cases, more severe reactions. Combining cannabis with other pain management strategies like exercise, sleep, and a healthy diet can be beneficial, but it should not be the sole approach.

Cannabis, particularly the terpene beta-caryophyllene, shows potential in enhancing opioid analgesia while blocking addiction. However, cannabis products with THC are classified as Schedule I drugs, limiting their legal prescription and research. There is a need for more education on cannabis use in medical curricula, as well as research on its efficacy and safety, especially in pain management.

Research is being conducted on terpenes, focusing on their pain-relieving properties and potential to modulate the effects of other drugs. The study aims to understand the mechanisms behind terpene-induced pain relief and their impact on reward and addiction potential. The research will culminate in a clinical trial to evaluate the effectiveness of terpenes in a scientifically rigorous manner.

The potential of cannabis as a treatment for neuropathic pain is discussed, highlighting the need for further research on mechanisms and identifying responsive patients. A study on medical cannabis use in older adults found immediate relief from pain, depression, and anxiety, but no direct improvement in sleep. The study suggests that cannabis may improve sleep indirectly by reducing anxiety.

The Cannabis Boomer Podcast is for baby boomers and all adults who are interested in the science of cannabis. Key words for the podcast in general are: baby boomers, cannabis, boomers, marijuana, THC, CBD, health, wellness, science, and aging.

For this particular episode, key words are: cannabis, pain management, marijuana, THC, CBD, terpenes, acute pain, chronic pain, and cannabis testing.

And now your host, the Cannabis Boomer, Alex Terrazas, PhD.

The panel coming up later on the program emphasizes that you shouldn't think, Hey, cannabis is my pain management program. Rather, you should consider cannabis to be, but one cool. Other tools include exercise, meditation, and non-steroidal anti-inflammatories among others. Both panelists emphasize the need to consider what types of cannabis to use, and equally important how you consume the cannabis.

Be it smoking, vaping, edibles, making sure that you put under your tongue or in the form of topical creams and balms. The take home message from this first episode is that you are the only person who knows what works for you, and that means some work on your part. First, we need to understand what kind of pain you are experiencing.

We need to distinguish between acute and chronic pain. Acute pain tends to have a clear cause like injury or surgery, and resolves once healing occurs. Chronic pain, on the other hand, persists beyond normal healing time.

Neuropathic pain is often described as a burning or tingling sensation. Unlike pain that serve as protective warning signals, neuropathic pain can occur without any apparent tissue damage, common sources of neuropathic pain, and. Include neuropathy due to diabetes, infectious diseases like shingles and inflammatory neuropathies.

Cannabis to treat neuropathic pain has one of the best bodies of scientific evidence. Much of that evidence comes from studies of pain in patients with multiple sclerosis or MS. Cannabidiol. TEHC combinations are effective in treating neuropathic pain and ms. What works for MS patients is likely to work for other types of neuropathic pain.

In addition to neuropathic pain, cannabis has shown effectiveness in the treatment of rheumatic pain, headache, and as an adjuvant therapy and cancer pain. If you wish to use cannabis for these pain conditions, a good place to start would be C-B-D-T-H-C. Ratios of one to one, the Lesser Cannabinoids, cannabigerol, or CBG, and Cannabinol, or CBN, can also be added to the mix.

One can experiment with what I call the anti neuropathy terpenes led by beta caryophyllene, and myrcene. The details are spelled out on the Cannabis Boomer website@www.cannabisboomer.com. Inflammatory pain is a second type of pain where cannabis may be helpful. The mix of cannabis is very similar to that. For neuropathic pain, evidence suggests cannabigerol. Again, CBG, our old friend, CBD, low dose THC, make a good mix for this type of pain. The anti-inflammatory terpenes include. beta caryophyllene . Alpha pinene provides anti-inflammatory effects and may help with tissue healing.

The bottom line is that for neuropathic. And inflammatory pain. Consider taking a one-to-one CBD-THC product. I recommend tinctures, vaporizing, or smoking. I believe edibles are among the best method of delivery, but only after you have figured out the mix of cannabis and terpenes that work for your particular pain.

If you choose edibles, make sure you follow the three hour rule. That is take a small amount and wait a. Full three hours before taking anymore. Set a timer so that you follow that rule closely. The tinctures are the easiest to control. Just place a drop or two under your tongue. You can increase the number of drops to optimize your dose.

The effect starts to be felt in 15 to 45 minutes, so wait that long before you add more.

So I'm primarily what's called a basic scientist. So I primarily study sort of the molecular mechanisms trying to get into the real science and understanding of how this stuff works. But I don't see patients, right? So there's kind of these two elements, uh, to, to successfully treating someone. So to your question, there's an entire system in the body that's evolved over millions of years to respond to our own cannabinoid signals.

The endocannabinoids that are produced by our brain that helps regulate the brain, and that includes pain. So there's these pain pathways that send pain information, like you stub your toe, you hit your head. Send that pain information to your brain for it to be processed and understood. And then among that, for every yin there's a yang, there's a system that damps down that pain signal and brings it back down.

And the cannabinoid is system is one of those systems in your brain. And so when you inhale cannabis, when you take THC, when you take terpenes or some of the other things we might talk about, those interact with that system in your brain and damp down that pain signal that's coming from the rest of your body. Helps tune down the temperature as it were. So like anxiety, sleep, and so on. Pain makes those worse and then you know you're not sleeping well. That makes the pain worse, which makes the sleeping worse, which makes the pain worse. It's like this awful cycle and allowing you to break that can even if it's not the, a pain reliever, if you can break the other side of it, like the anxiety and the depression and the bad sleep and all of that, that alone can help relieve pain.

This is a simplistic construct just thinking about treating pain as opposed to treating the patient. Which chronic pain conditions show the most promising evidence for cannabis treatment? Um, I will add there's at least some evidence from limited clinical studies, but also from preclinical studies with animals and other, other tools.

So cannabis could be effective for what's called neuropathic pain. This is a really difficult kind of pain to treat that's due to nerve damage. So you're a cancer patient, you've taken the chemotherapy, you know, or a patient with diabetes. We have the, the inflammation that causes nerve damage and, uh, or even like trauma and injury, like a physical trauma and injury.

All of these cause neuropathic pain, this burning, shooting pain and like your extremities and so on. There's good evidence that cannabinoids can treat that. There's good evidence for migraine. So those are probably the two most common ones that I see. And the preclinical literature, but they, it's been tested in a variety of pain models and they seem to be at, at least, at least potential for effectiveness in many kinds of pain.

And that may be different strains of cannabis even that have different components in them. Could have. Different effects from each other. So that's the idea. Um, my work still is not provided strong evidence that that's actually happening when you take a puff of marijuana or you know, a vape, vape hit or something like that.

And we still haven't really shown that yet. But in a sense, it doesn't matter because we've investigated some of the individual components like terpenes shown. They have pain relieving and other beneficial effects. Then you're like, well that doesn't, does that really happen when I take a puff off the, the marijuana cigarette?

Well, like that doesn't really matter. 'cause we can make whatever we want in terms of a therapeutic for a patient. We can make a high terpene, vape cartridge type formulation that someone could take directly. I work with folks that do oral formulations, like a tincture that you could take under the tongue. That's a high dose terpene. So in a sense, it doesn't really matter if it happens for real in like the plant because we can make it happen by, formulating a therapeutic that does whatever we want it to do.

Part of the problem is they're kind of making big promises. They're saying, you take this blend, it's gonna make you sleep better. It's gonna, you know, do this kind of pain versus that blends gonna do something else. There's not really any solid evidence to make those claims, and that's where we in the scientific field, have failed, honestly, to stay ahead of the market, but we need to catch up as Kevin said, it's been criminalized and hard to do. But, we need to catch up and get some real evidence behind some of these claims to help people out.

Produce or associated with, uh, best sleep effects or pain relieving effects or whatever it might be. And then there can be some meat in the middle where there's a bi-directional flow from what people are actually doing. Does that lend itself to the plausibility of which tur or cannabinoid mixture to test in the basic science lab and vice versa? So it it's a really dynamic and fascinating Yeah. Uh, space to be in

And as you talked about earlier there, the individual preference that goes into it. Woven together and synthesized with what we know about these compounds, CB\D and THC, the effect onset of the different groups of administration. You know, eating, taking a couple hours to take full effect. Versus smoking which takes effect immediately and then the specific symptoms that you're working with.

And it is possible to weave that together in a thoughtful way, I believe.

I'd say kind of like a rule of thumb that, uh, I often use when talking to, uh, physicians and patients at this point, and some of this is obviously dependent on the state. The products that tend to have the most regulation are obviously those that have gone through the FDA approval process. So like Epidiolex, which is, only for specific indications, but the purified CBD product which are, which is synthetic THC.

Both of those are available to be prescribed, not for pain, but could be off-label. Below that, there's the state level legal marketplaces, because for most states, I mean certainly in Michigan, the products that. Sold in the licensed, cannabis retailer, they have to have undergone some amount of safety and potency. Testing. Now, how much varies by state, but those tend to have at least some. Then once you go to like gas station or online products, some of those. It's the wild west out there. You gotta do your complete due diligence. And if you're doing that, going to that, those sorts of lists that John is talking about, making sure that those products have a QR code that you can assess what is in this. Is it tested by your reputable lab? reputable companies tend to, uh, have a QR code that can take you directly to the testing result on every product that they sell. That sort of stuff can set different companies apart. beyond that, like there's pretty much no testing after, after a certain point.

If you have a buddy who grows cannabis, which many people can do, happens in, in, you know, many of the states that have legal and, and medical and adult use, cannabis consumers are allowed to grow their own. that's kind of the hierarchy that, uh, I often share with physicians and patients about like, if you go from the most regulated and tested down to the least.

But then there's of course the psychological, um, profile as well. So altered mood and sensation change in cognition. All of these in the short term because of those, you don't want to get behind the wheel of a car. You don't wanna operate heavy machinery. That is one of the ways to greatly increase one's risk of injury.

All of these have shown up. They tend to be very uncommon and they tend to be, if people take way too much or very, they're somebody who you know is unlucky and has some kind of individual reaction to it. I just want to note this because it's something really important and I see it all the time, is. If you are eating a product, wait the full amount of time to make sure you're getting the full effect before you have any other cannabis.

So especially if you're new to it, wait two to three hours, especially if it's something you've never taken before and take up small amount because there have been, at this point in my life, just hundreds, if not thousands of different times that I've heard of people saying, well, I, I took a bite of this cookie. Then I waited 30 minutes. Yeah. Uhhuh, I took elected this cookie. I waited 30 minutes. It was a tasty cookie also, and I didn't feel anything. So I had another bite and then an hour, like 30 minutes after I felt a little bit. So I was like, okay, I'll take another bite. And then they just end up locked to a couch.

Very uncomfortable physically, sometimes psychologically as well. Um, and I think it's in those cases that there tends to be people who are like. I didn't expect this to happen, and it's not going away like it's been a couple hours and it's not going away. I'm gonna go visit the emergency department because I'm so scared of this reaction and this feeling in myself, which in and of itself tends not to be physiologically dangerous. For some people You get. that panic feeling, and that can be very, very challenging.

There's a couple other things that I want to point out real quick. We are getting more and more emerging evidence of, um, that I think are worth talking about. It's also not well diagnosed in the medical community. And can be both terrible on one's body to be vomiting all the time. The the only ways to treat it are to stop using cannabis, in the acute phase to like take a hot shower. And then, of course, things like psychosis, which I'd say the causality is not well established. But there seems to be some association between chronic heavy use of high potency THC products especially, and then people who may have a predisposition to psychotic illness or disorders. There can be a higher risk of that, especially when initiated, in adolescence. So again, we don't know if people who have that predisposition are using cannabis to treat those symptoms or causes them to emerge.

Also we know CBD seems to be more helpful in some of these psychotic, uh, disorders, but these are places that I think there's a lot of justified public health concerns related to cannabis products that are more like thinking about millions of people using cannabis. There's a subset, but it's a meaningful subset who is greatly impacted.

By these issues as well as, you know, especially if it relates to like abuse and addiction of cannabis, which you can be addicted and dependent on cannabis. It's not the same as opioids or nicotine or even alcohol, but it's totally possible and should not be brushed aside.

They're not showing any reward in addiction liability in the tests that we've run. They're sedative, which may be what you want, but they don't seem to do any of the other intoxicating or other sort of affiliated side effects that you would expect from A THC. I've seen products now that don't have any THC in them that are just other cannabinoids or even terpenes, um, side effect profile's gonna be different. And I think at least for terpenes better, right? Um,

And it's important. The value of things like sleep, hygiene, exercise, diet, um, noting the quality of one's thoughts and emotions and how those relate into our pain symptoms. Incredibly important. So there's a lot of self-understanding, uh, as well as, you know, understanding of our body's inputs, how we use our body for things like movement and exercise that are integrally related to how effective one is managing their pain.

And I say this as somebody who both studies pain and has a lived experience with pain. Uh, I was diagnosed with fibromyalgia when I was 21. I've used cannabis for pain. It's been helpful at different points, but the things that are the most sustainable and helpful are yoga practice that I've developed over the past many years. My meditation practice, um, eating well, sleeping well, working on those things. And then thinking of medications like cannabis as a sort of chemical nudge when I just really need some help. Uh, if I'm. Recovering from an injury or I'm in a bad space for whatever reason, like thinking of medications in those contexts to help me continue with the practices that I know are going to move me in a better direction. Health wise,

Um, you know, and we've also shown that for terpenes, specifically the terpene beta caryophyllene that we've been testing, we show that that enhances, you know, in. Preclinical studies. Caveat, caveat, but that enhances opioid, uh, analgesia while completely blocking the addictive potential of the opioid.

And of course there needs to be a lot more work to really figure out what's going on there. but there's a lot of potential there for the combination therapy with different sorts of analgesics and opioids are kind of what I study.

And then, oh, okay, we've tried several different medications, they've all failed. We'll bring out opioids. Clearly cannabis could go in those treatment steps before opioids. In fact, most cannabis products from a lethality standpoint are lower in lethality than any of like nobody dies of, of cannabis overdoses.

They can contribute to all kinds of morbidity and other issues in other different ways through things that we've already talked about. Hyperemesis. Perhaps increased risks of vehicle accidents, which could lead to lead to mortality. But if you think of something as simple as Tylenol and ibuprofen, these cause hundreds of thousands of hospitalizations a year, and actually a large number of death when people take them in a daily chronic way because they interact with some of our organ systems in ways that can cause toxicity.

Because cannabis products that have more of a 0.3% THC, weight by volume are considered Schedule one drugs, which have no accepted medical use,they cannot legally be prescribed. The way that state medical cannabis laws get around this is you typically need a physician authorization that says that you have a conditioner symptom that under state law allows you to possess cannabis and purchase cannabis in the state legal marketplace. Now, oftentimes that's the extent of the physician interaction. It's like, yep, I certify that. Good luck. There's definitely some physicians who won't do that at all, and some institutions who have said absolutely not, no.

None of our physicians are allowed to talk about cannabis, are allowed to authorize cannabis. Again, authorize not prescribed cannabis. Um, but you know, physicians can have those conversations. Heck, even in the VA, physicians are allowed to discuss cannabis use with their patients. they can help them use it in ways that are safer, as in give recommendations to help them use it in ways that are safer.

But they cannot pre prescribe and they can't, they typically don't authorize, like those medical cannabis licenses. So there's a lot of variability. I will say like in the medical school training side of things, there's not much information that physicians are given on how to. Use cannabis, uh, for with their patients in therapeutic context, like how to give those sorts of recommendations for harm reduction and benefit maximization. That's still a place that sufficient education is lacking in most medical school curricula.

I think it's even worse than that. So I, I am a medical school professor. That's my day job. Pain is one of the cardinal symptoms, right? It's one of the primary reasons people go to see their doctor.

You would think that might have a significant place in the medical school curriculum. Some do, most do not. the lowest I've ever seen was two hours of education on pain, just in general, right? So forget cannabis, just pain. Which is why a lot of really bad practices sometimes over time, particularly in relation to the opioid crisis and so on, were stemming from this inadequate training of, primary care and other physicians that just didn't have the training in the background in chronic pain and its management.

Um, there are specific pain programs, like there's a pain fellowships, uh, there are specific pain doctors. If you as a person have a chronic pain. There's no one I would suggest better than a, than a pain specialist. They tend to be wonderful people. Like, uh, some of my colleagues, Moha Ibrahim at the University of Arizona, who has a wonderful pain clinic that helps a lot of people, but that's not your average physician.

when you get into the pharmacology, I mean, forget cannabis, just like the pharmacology of treating your patients doesn't tend to have a huge amount. Then, uh, for medications like opioids and so on, even less. And then like way down at the bottom, there might be a chrome or two of, of information on cannabis.

if your physician knows a lot about cannabis, it's usually because they've educated or even pain, it's usually because they've took it on themselves to educate themselves on it.

Um, and it's actually open to anybody who leaves lives in a state with legal adult use cannabis. Um, so we're just super excited about this study. Um, our pilot showed, uh, pretty great results. Um, but we're really excited about this because it. Avoids many of the legal challenges associated with, uh, FDA regulated and DEA overseeing research because we're not dispensing or prescribing cannabis.

These are people making their own decisions, but we're helping them figure out how to do this in a thoughtful way that minimizes, however, and maximizes benefit. We avoid a huge. Legal quagmire and challenge as well as are allowing people to use the products that are available to them in their own commercial marketplace.

So to me, this is one of, one of those the studies I'm, I'm most excited about. Uh, we also have a large scale study looking at like self, uh, titrated. CBD is Epidiolex versus placebo. So kind of a classic parallel. Group design study. There haven't been a lot of studies with C, B, D, but so many people use it for pain.

So this is, if, if it's all hype or if it's all placebo, we should know that because otherwise people are just wasting a ton of money, um, trying to use CB, D for some of these things. And so if e either, uh, the thing I like about this study is no, even if we have a negative result, we'll save a bunch of people, a bunch of money.

We have a positive ol, we will have a robust low risk option that could potentially, um, be brought into the treatment paradigm. CBD is clearly safer from things like even NSAIDs that are over the counter. So providing some evidence, showing whether that might be effective, I think is just incredibly valuable.

I think part of the problem though is sort of that the gas station market, if I can, uh, call back to what Kevin said earlier you've got a lot of, I think probably low quality CBD products and that's probably gonna muddle things.

I think there's potential there and certainly it's not intoxicating, right? Then in my own research we're really interested in, uh, terpenes, other things too minor. We've done some work on the minor cannabinoids, like cannabinol and so on. But our, our main work is on terpenes and we have a few directions we're heading in moving forward.

And so the first decision we made was to study deeper rather than broader, because there are like 500 or so terpenes, um, depending on what plants you look in. And, uh, that's a lot. So you could spend an entire career just testing each one in turn. Right. But we tested about five, six depending on how you count.

And rather than broadening that, we want to go deeper and figure out more details and how all this works. And so the, the first branch of that is to figure out exactly how they relieve pain in your body. Because that was really, I mean, there were a variety of studies that would say, you give these terpenes, you get pain relief in animals and in humans.

Very few or very little information on how, like, how that's actually happening. And we've made an interesting discovery that at least part of that answer is through what's called the adenosine A two A receptor, which all of you listening this know about even if that name sounds very strange because it's the target of caffeine, caffeine hits this receptor.

Terpenes hit this receptor. It's in a different way, but that's the same target and it's relieving pain through that mechanism. So we're going figuring out more detail, what neurons is it in, in your brain and your spinal cord? How is that actually achieving pain relief? And what are the side effect profiles and so on. Like really digging into that aspect. Uh, and then the next branch is to study in more detail the effects on reward and addiction potential, not of the terpene itself, but how they can modulate other drugs of abuse. And so we've now shown that they can block opioid. Reward. Now we wanna, again, figure out why, like, dig into the details, figure out what's really going on there. And then the last branch is translation. Really giving this into the hands of someone like Kevin or, you know, your, or my mom or your friend down the street, so that they can actually try this out and see if it works for them in a, scientifically backed and justified way.

We're looking into greater detail in the side effect profiles, dosing, routes of administration, and then we want to culminate that in a clinical trial, we're doing that now with one of my commercial partners, NA Priva.

We have a product, uh, oral dosing product, and we're setting up the clinical trial now. We show that it works in animals. We're setting up that clinical trial. 50 patients. Hopefully we'll have it rolling here in a few months and really show that this is effective in a rigorous way.

Tim from Santa Cruz, California writes, Hey, cannabis Boomer. Why do edibles make you so high compared to smoking it?

The THC arms race has produced products that are frankly dangerous for some people. Try to include at least some CBD with your THC. Low and slow is the best advice I can give you. Start with a small amount, like a single puff of a joint, a couple of drops of tincture, or a small portion of a gummy or cookie, and wait to see how the drug affects you.

If you are trying an edible, adhere to the three hour rule that is set a timer for three hours and do not have more until the time has passed. Make sure you keep edibles in a clearly marked bag or pouch, and keep it away from unsuspecting adults, children, and pets. Finally, try the cannabis in a safe location and avoid driving at all costs.

First up is Dr. Wayne CarterPhD from the University of Nottingham where he is Associate Professor and Group Leader of the Clinical Toxicology Research Lab.

Dr. Carter completed his PhD in Biochemistry at the University of Southampton and was a post-doctoral research scientist at Cambridge Universitythe Imperial College of London, the University of California, and Oxford University. He is an elected Fellow of the Royal Society of Chemistry.

Dr. Carter and colleagues just published a timely review in the journal Biomolecules entitled: Are Cannabis-Based Medicines a Useful Treatment for Neuropathic Pain?-A Systematic Review.

Impacts that could be beneficial things, but also some toxic agents like pesticides and alcohol, but also how they can be mitigated in terms of their toxicity. One of the agents that can mitigate that are general sort of plant chemicals, phytochemicals, uh, but also we focused in this case specifically on cannabinoids and their potential benefit.

But in this case, focusing on treatment for neuropathic pain. Obviously at the moment there's lots of interest in CBD cannabidiol. It's in lots of different products. Mm-hmm. With proposed benefits, should we say? Not necessarily as a result of, of clear clinical trials, I. In this review, what we wanted to do is to consider what is the clinical trial related results for the beneficial use of cannabinoids.

Um, it's good to also publish negative results, so if you don't get a positive result, it should still be something that is worthy of publication. And unfortunately, generally within the scientific field, we have this pressure of looking for significant changes and sometimes not seeing a change is an important result as well.

In other words, there could be cohorts of patients that cannabinoids can have a benefit for, but there could also be cohorts of patients with certain diseases or conditions that might not be, uh, responsive to those medications

What you find with people using in the real world is that they use a variety of mechanisms of delivery. Variety of different cannabinoids and terpene combinations.

They were allowed to dose themselves with the medication up to a point, um, at which they may have felt some of the adverse effects. Because as with any drug, mm-hmm. It may have a, a beneficial window. Too much of the drug can be toxic, and that's true for, for any drug. Being able to find the right window, which is sometimes quite an individual thing, can be of benefit, but as you say, generally in the broader population, but those people that smokers or, or users of, of cannabis, then they may have a, a sort of more broader chronic usage.

These, these are some of the limitations of the randomized control trials is that they don't have the longitudinal, um, analysis that, that some people might have in it on an individual basis.

So what do you think the biological plausibility of cannabis as a treatment for neuropathic pain is?

A dentist gives us lidocaine, which we know affects specific channels like sodium channels, and then therefore provides a relief by a kind of known mechanism of stopping us perceiving pain. But cannabinoids have many broad effects, and some of those aren't well documented, but they can also affect inflammation and some types of pain have high levels of inflammation.

We've got the potential for pain treatment in neuropathic pain, but in those individuals that perhaps are, um, responsive, and it's about also trying to find out who those responsive, uh, people are. So I think there's work to do in terms of understanding more about a mechanism. Testing that hypothesis that you're talking about as to finding, uh, responsive patients and understanding why they're responsive.

Vaporization perhaps might have the benefit of not having additional chemicals. 'cause one of the kind of concerns of course, that we have with the general smoking of cannabis is that, that typically that cannabis will be mixed with tobacco and the, the potential harm associated with tobacco. There are sprays, IV effects is a common spray, which is typically used in, in the majority of those trials.

But there are also other pill like forms. Uh, the difference is of course, that they will have, as you mentioned there, different potential for the quickness by which they could provide some pain relief.

We have participants answer surveys on their phones every few hours throughout the day. We ask them every few hours, have you used any medical cannabis? We ask them for their pain, sleep, and anxiety and depression ratings. And what we found is that in the moment, on the days when people are using more medical cannabis, they're getting immediate relief of.

Pain, depression and anxiety after they've used, but medical cannabis didn't seem to be directly improving their sleep. Instead, we found something interesting, which was that to the extent that the medical cannabis was improving anxiety, people then had improved sleep. So anxiety was sort of this mechanism that was helping to improve sleep rather than medical cannabis directly.

What are the implications of your study and where does that lead you for future research?

Our study answers the question that. People are getting this immediate relief, but leaves unanswered the questions of what might happen in the longer term? Are you gonna get lasting relief for your mental health symptoms or your pain symptoms?

Is there any potential that you can become dependent on cannabis? We've also learned through this study that medical cannabis may not be as effective for sleep as we thought it was, or maybe it is effective for sleep, just to the extent that it is affecting anxiety. So the big question we are trying to answer here with this line of research is.

For whom is cannabis effective and under what circumstances in the future? I think we're gonna start looking more at the 65 plus range. 'cause you run into the issue where, you know, a 55-year-old surely doesn't look the same as a 75 or an 85-year-old. How

I was taking her class and one of the professors played this video of an older adult who had Parkinson's disease. The video showed his symptoms of tremor and then talked about how medical cannabis was. Gonna improve that tremor and showed kind of a before and after of this older adult with Parkinson's disease, having a lot of tremor symptoms, pre medical cannabis, and then the tremors being completely reduced after taking THC.

And I thought maybe this is something that could really be useful for older populations. And then come to find out, I start doing a little more research and medical cannabis actually doesn't have a lot of evidence for being effective for Parkinson's disease at all. I was kind of confronted with this idea that maybe it could be useful for some people.

Also, it seemed like there's a lot of misinformation out there. My advisors and I have so far published a couple of papers from this first data collection funded by the Consortium for Medical Marijuana Clinical Outcomes Research. So we really appreciate that support. We have one or two more papers coming out of that study looking at how do different medical cannabis use motives affect people's resultant symptoms.

So for example, if you are using to treat your anxiety versus if you're using to treat your pain or nausea or something like that. What are the long-term implications and it seems that there are some differences. And then another line of study we've got on the horizon involved how different neurocognitive profiles might impact one's medical cannabis use or their result in mental health after using medical cannabis. And then we've got one more area of research looking at how we can promote safe use among individuals using medical cannabis.

[00:51:05] Madison Maynard: Yep. Thanks so much for having me.

Welcome!

The main research question for our study was what's the prevalence of cannabis use in older adults, older veterans in this case? In particular, we were interested to learn how many people are currently using cannabis in what forms they're using cannabis, whether they're smoking vaping, cannabis are using cannabis edibles.

We were also interested in looking at the frequency of cannabis use, whether they report cannabis use from time to time on, or they are quite frequent or daily users, and we wanted to know what are the reasons of cannabis use. Whether people were using cannabis medically or recreationally, and for which specific medical reasons they were using cannabis.

And also we were interested to see whether there were any people who would qualify to meet criteria for cannabis use disorders. It has become one of the most common substance use disorders in the United States. So for our study, we recruited more than 4,500 older veterans. They were on average 73 years old, but the age ranged from 65 to 84.

They were all patients of Veterans health administrations. What we have found was that current cannabis use was way more common, that we previously thought one in 10 participants who were using cannabis in the past months. Over half of those current users were frequent users.

They may not be employed or they may not have retirement. They differ from the general population with worse physical and mental health. So we'll usually see more chronic. Diseases and disabilities in this population, and we will see more mental health concerns and conditions. Uh, things like depression, anxiety.

PTSD is higher and it may be attributed to their military experiences and combat exposure. For instance, you know, some of the participants were Vietnam veterans. They would report they tried the first time in Vietnam.

Or the doctor's notes, so we can actually see whether they're gonna develop any chronic diseases that will be related to their cannabis use. In what forms, how frequent. So we can have very detailed information that we can five years from now, 10 years from now, 20 years from now, we can actually examine whether using cannabis was associated with any medical conditions that they would develop in the future.

Our first paper was descriptive. It was telling what's the prevalence of cannabis and what are the pets of cannabis use. And one of the articles that we have is to look at the five four follow up years to see whether cannabis use. Was associated with any cardiovascular and mental health conditions among this cohort.

Some people would report CBDA smaller percentage of of our participants would report CB, D only product.

There are people who report that cannabis is very effective for pain management. Or as a sleep medication. There are some who report that it doesn't work as well as they thought it would. I think that cannabis helps people, but maybe it, it doesn't help everybody. It may help specific people. So that's one thing.

Another thing to think about from a public health perspective is a harm reduction standpoint. Some are using cannabis medically, and more people actually, including older people who used to have negative perceptions of cannabis use before legalization has expanded so much. Now older people are using it for self-medication, including for pain management, management of mental health concerns.

For one standpoint, it helps for some people. On the other hand, we have to be careful. I think that right now, because localization is growing, healthcare providers need to start having discussions with their patients about cannabis use. They need to know what's the dose, uh, that is right for them. Right?

How to use cannabis, how to avoid cannabis use in such a way that it, it develops, uh, addiction in the future. What we saw in our respondents, in our population of older veterans is that it's inhaled cannabis use that was likely to be associated with cannabis misuse compared to, for example, using cannabis only.

We see that that relationship between inhaled use and, and development of cannabis use disorder is because usually, you know, people who are smoking vaping that they inhale highly concentrated. You know, it hits you faster. You get high faster compared to, for example, using edibles that, you know, maybe in the digestive form you, you can't feel the effect that fast.

And looking at their medical records, whether they report any cardiovascular outcomes, mental health outcomes. You know, cognitive impairment is one of the big things right now. So these are the questions we don't know and we want to answer. Uh, the other. Question that is also very interesting is whether cannabis is a substitute for tobacco.

The lab in data study, and they saw that adults perception of cannabis is that cannabis smoking is elsewhere. It's safer than tobacco smoke.