CannMed 2022: Medical Practicum Organizers Share Their Insight, Part III and IV: Dr. Dustin Sulak and Eloise Theisen

The upcoming CannMed conference—taking place May 3–5 in Pasadena, California—will feature an exciting full-day medical practicum organized by Bonni Goldstein, MD, (the practicum’s originator); Kevin Spelman, PhD, MCPP; Dustin Sulak, DO; and Eloise Theisen, NP, AGPCNP-BC. During this practicum, each of the presenters will share the latest research, their clinical experience, and practice guidelines related to cannabinoid therapeutics. This course is approved by the California Board of Registered Nursing for 9.5 contact hours.**

In this interview series, we speak to each of the organizers to learn more about them and what attendees can expect from the practicum. Here, Dr. Dustin Sulak and Eloise Theisen share some of the clinical applications for medical cannabis, dosing information, how cannabis can be used to stop opioid addiction, and more.

What are some of the clinical applications for medical cannabis?

Dustin Sulak, DO: Chronic pain, insomnia, post-traumatic stress disorder (PTSD), nausea, and vomiting are certainly the most common, but a typical cannabis practice is full of refractory conditions from every other field in medicine, for example, psychiatry, gastroenterology, oncology, neurology, rheumatology, and so forth. Overall, cannabis is often an effective treatment when everything else has failed.

Eloise Theisen, NP, AGPCNP-BC: According to the National Academies of Sciences, Engineering and Medicine report on the health effects of cannabis and cannabiniods, there is moderate to substantial evidence to support the use of cannabis for chronic pain in adults, sleep disorders, chemotherapy-induced nausea and vomiting, and muscle spasms in multiple sclerosis. Additionally, we are seeing more clinical data to support the use of cannabinoids for anxiety, depression, and PTSD.

How is medical cannabis dosed and what methods are being used by patients?

Dustin Sulak, DO: Cannabis is highly versatile and allows for individualized treatments that can often be fine-tuned to allow for all benefit and no adverse side effects. This fine-tuning includes delivery methods (oral, oromucosal, inhaled, topical), numerous varieties of cannabis with distinct properties. You can find more info at: https://healer.com/using-medical-cannabis-delivery-systems/

Eloise Theisen, NP, AGPCNP-BC: Cannabis is best when it is individualized to the patient's condition and goals of care. It is important to take a thorough health history and discuss the plan of care with the patient. Some patients may need low doses to achieve relief and others may need higher doses and that usually cannot be determined without considering many factors like age, gender, other health conditions, medications and previous or current cannabis experience. In some cases, patients may need multiple methods of administration to effectively treat their condition.

Can cannabis be used to get you off opioid addiction?

Dustin Sulak, DO: Lots of data prove yes in chronic pain: https://healer.com/category/cannabis-and-opioids/. Less data suggests it’s helpful in opioid use disorder, but I have seen this work in my patients.

Eloise Theisen, NP, AGPCNP-BC: Studies suggest that cannabis is effective for chronic pain in adults. With more research demonstrating the effectiveness of cannabinoids for chronic pain, many patients are seeking ways to use cannabis to reduce or eliminate their opioids. Clinical studies have demonstrated a synergistic effect with cannabinoids and opioids, thereby allowing patients to manage their pain without the need to increase the opioids. And while there is a need for more clinical trials to demonstrate the effectiveness of cannabinoids for opioid addiction, many cannabis clinicians have successfully helped their patients eliminate their opioids.

How does cannabis interact with other prescription medications?

Dustin Sulak, DO: Very few interactions except at high doses of cannabis. The blood thinner warfarin is a common one to watch out for—patients should have their blood checked after starting cannabis.

Eloise Theisen, NP, AGPCNP-BC: Cannabis can either increase or decrease the effectiveness of other medications. In most cases, it is clinically insignificant and does not require patients to stop their cannabis treatment. Anyone using cannabis with other medications needs to be followed by a knowledgeable cannabis clinician who can adjust the medications accordingly and ensure that there are no contraindications.

How is cannabis used to treat acute and chronic pain?
Dustin Sulak, DO: Cannabis is very effective at treating chronic pain and associated symptoms. It can be useful in acute pain, but it also has the potential to intensify acute pain, especially in people who are new to cannabis. Despite this, one study showed that administering tetrahydrocannabinol (THC) to trauma patients in the hospital, including those with no prior experience using cannabis, improved their symptoms and decreased their requirements for opioids.

Eloise Theisen, NP, AGPCNP-BC:Treatment with cannabis is best individualized to the patient’s personal needs. There are many factors to consider when developing a treatment plan for acute and/or chronic pain. Some patients may benefit from a variety of cannabinoids and routes of administration when treating pain. Cannabinoids can help reduce inflammation, shift the dysphoria associated with pain, and boost opioid analgesic effects.

How is medical cannabis being used in pediatric patients? Is there clinical evidence for using cannabis to treat anxiety and attention deficit hyperactivity disorder (ADHD)?

Dustin Sulak, DO: Small studies have shown benefit in anxiety and trauma-related disorders with THC, an analog of THC called nabilone, and cannabidiol (CBD). There’s even less data for ADHD. Anecdotally, I have seen cannabis help these conditions in hundreds of patients. These are both great examples of conditions cannabis clinicians successfully treat all the time but are lacking peer-reviewed clinical studies.

To find out more about CannMed’s medical practicum, please visit: https://cannmedevents.com/practicum/

**CONTINUING EDUCATION CREDITS: This course is provider-approved by the California Board of Registered Nursing, provider number 16845, for 9.5 contact hours.