Why Should Healthcare Professionals Seek Additional Training in CBD and Cannabis Therapies?
The question we have posed above is, clearly, the wrong question. Over the past decade, the medical use of CBD, THC, and other derivates of cannabis has increased exponentially in the U.S. Well over half the states have enacted laws in some form to allow physicians to prescribe marijuana medically—and by 2021, all 50 states may have laws allowing medical marijuana in some capacity.
At the same time, scientific knowledge among medical professionals about the use of cannabis is, to put it mildly, severely lacking. It is not something that was or is taught in medical school. And even if it were, research was, until very recently, hard to come by. Owing to the fact that cannabis sativa has been, and still is, classified by the U.S. government as a Schedule 1 drug, no research has been done in the U.S.
“As a person who has been recommending cannabis products for the past five years, I can say healthcare professionals have got to know what’s going on,” said Betty Wedman-St. Louis, Ph.D., a licensed nutritionist and environmental health specialist based in Pinellas Park, Florida. “You can go on PubMed and you’ve got over 5,000 endocannabinoid articles, most of them just in last five years. If healthcare professionals aren’t tuned into this, they’re really out of it. And medical students I’ve talked to say there’s no course in it. So we’ve really got to start bringing everybody up to speed.”
Dr. Wedman-St. Louis said U.S. sales of hemp-based CBD products grew from $150 million in 2017 to $300 million in 2018, and is projected to be $3 billion by 2023. “So those of us in the healthcare profession have got to start paying attention.” Patients, she said, are far ahead of doctors. “We need a better understanding of the neurological implications,” she said. “Whether you see Crohn’s disease patients, or IBS patients, or autism spectrum patients, or Parkinson’s patients, or anything like that, they already believe in it and have seen some improvements with it. So it’s now heatlhcare professionals who have to catch up and realize that medical research is only at the tip of the iceberg, but we have to start that educational process.”
All the emphasis so far has been on epilepsy and seizure control, says Dr. Wedman-St. Louis, but there are other disorders of the body that are just as affected by the endocannabinoid system. “We’re just now beginning to say the microbiome is influencing the brain. It’s looking at the full body system along with the endocannabinoid system,” she said. “You’ve got patients that are already using it for their anxiety, their pain, their sleep; in order for you to be aware of what they’re doing and add any improvement, you have to know what’s going on.”
“We’ve got to do more from an educational standpoint,” said Dr. Wedman-St. Louis. Right now, in states where medical marijuana is legal, those writing prescriptions are often people you make an appointment with online, who in several states have completed a 4-hour online course that allows them to write a medical cannabis prescription.
Some states that are ahead of the curve, such as Colorado, have a little better educational process, said Dr. Wedman-St. Louis, “but that still leaves the general practitioner and the patient who feels comfortable with that physician, behind the eight ball, because they don’t have a clue. In order for healthcare professionals to know who to even recommend to write the prescription, they need to know more.”
“Personalization and understanding the endocannabinoid system and recommending the right product is very critical,” Dr. Wedman-St. Louis said. “But we have to start somewhere. The only thing that many of my medical students know anything about is the PPAR-gamma decreasing inflammatory responses in the body. That’s really as far as we’ve gone in trying to relate some of our medications to the inflammatory process. We need to enlarge on that, especially now that cannabis is right before our eyes. That means we have new vocabulary we have to learn, and it is a lot of biochemistry; we have to learn about ligands, we have to learn fatty acid enzymes, and things like that. You’ve got vocabulary that can be creatively taught so you can at least read the literature. I spent almost an hour talking to two AMMG attendees that heard me speak in the spring, just to bring them up to understanding why they needed to make sure their patients were using full-spectrum cannabis.” Pharmaceutical companies, she said, are not going to put any effort into full-spectrum, because they can’t patent it, so they’re only looking at treating very specific conditions.
A big problem, she said, is that patients are essentially self-treating, because they don’t know where their physician stands on using cannabis—and even if the physician agrees to it, does not really have the education needed to be a qualified partner in treatment. Education and training is clearly what is needed.
Eric Mitchell, M.D., whose practice is in Livermore Falls, Maine, agrees. “When I went to the University of Pennsylvania Medical School in the early 1970s, the endocannabinoid system wasn’t even discovered,” he said. “But cannabis sativa L. had just been made a Schedule 1 drug.” Dr. Mitchell talks about how in 1940, chemist Roger Adams at the University of Illinois isolated CBD from hemp. “But it was 23 years later that Dr. Raphael Mechoulam in Israel talked about the body’s own cannabinoids that it naturally makes—THC, CBD, CBC, and many more have been discovered since then. But none have been fully investigated because since 1970 could not do any work with Schedule 1 drugs; if you did you’d lose your DEA license, so it would have a large financial consequence.”
As a result, he said, medical schools have not taught anything about cannabinoids. “Ninety percent of allopathic medical schools still do not teach it, because it could put you in danger of losing your funding,” Dr. Mitchell said. For that reason, he went to China to continue his studies. “Naturopaths and osteopaths are probably more familiar with the endocannabinoid system,” he said.
“I think every member of AMMG will benefit from our lectures,” Dr. Mitchell said. “We’re in the renaissance; the cover has been blown off because the Farm Bill of 2018, classified cannabis sativa L. with less than .3 pct THC as Hemp.” He sees this as a sign that the dam is about to break.
“We have a long way to go,” Dr. Mitchell said. “We are just at the precipice, of discovering all these elements of cannabis. But there is already a whole new industry, and this is why practitioners need to learn.”
Right now, noted Dr. Mitchell, medical cannabis is legal in 33 out of 50 states, with five to seven more states looking to create an education program. “The DEA has been standing in the way, but I think we’ve reached the tipping point,” Dr. Mitchell said. “When they lift the ban, it will create a geyser.” He pointed out that baby boomers are the largest users of cannabis. “The front cover of AARP magazine this month has a Special Report: Marijuana and Your Health.”
So the question we should have asked at the top of the page was really, how can healthcare professionals NOT seek additional training in the use of CBD and cannabis therapies?
AMMG will present a pre-conference track on Thursday, Nov. 7 at the Clinical Applications for Age Management Medicine Conference in Tucson, Arizona, on CBD, THC and Cannabis Derived Therapies for Age Management Medicine. Dr. Mitchell and Dr. Wedman-St. Louis are among the speakers. See more information at www.agemed.org.