Episode Transcript

Trevor: Kirk, we're Back. 

Kirk: Yes. Dr. Sealey. 

Trevor: Yeah, We have him on the other end of the age range. The last time we chatted with him, we chatted about kids and cannabis. And then I ran into him at a completely non cannabis related conference. Was actually about smoking cessation. And smoking harm reduction, I guess, is really more of the what we're talking about there and the organizers because I know one of them from way back is let us sort of sneak in the day's worth of talking about tobacco. We got to sneak in, you know, an hour worth of cannabis in there because, you know, it fits in everywhere. 

Kirk: It does. 

Trevor: So I got to do a quick blurb about the podcast a little bit that I've learned, and I was kind of the opening act for Dr. Sealey, sort of introducing a group of mostly pharmacists, some doctors, into sort of what he does in cannabis world. And because of that, I heard one of his favorite or most requested talks is Green is the New Gray. And I thought, well, that's a sure title I don't even have to come up with. That's perfect. And he agreed to come back and talk. Talk again. 

Kirk: Yeah. We first talked to him in Season Three, Episode Seven - Cannabis for Kids. He moved to Victoria in 1990. He was telling us back then my hometown as listeners will Know. Newlyweds. 

Trevor: Keep circling back to Victoria a lot, don't we? 

Kirk: Yeah, we do. There's lots of stories out of Victoria. Actually. I'm still following the Victoria Cannabis Buyers Club. They're getting screwed around. But. But yeah, like, So what is it? He newlyweds in the early dead. You know, he says that Victoria is a place where people come to retire with their, with their parents. 

Trevor: And move in with their parents. Yeah. 

Kirk: And it's so true, even when I was a kid. But, you know, he's an interesting, interesting guy. I think he is. He not the doctor that thinks he's the first one to ever write a Canadian prescription for cannabis. 

Trevor: Yeah, yeah. That came up during the other conference. He said it's not 100% certain, but if he's not the first, he's definitely, we'll say in the top five of literally wrote one of those medical documents for medicinal cannabis you know back in the day in the early 2000. So yeah, a little a little bit of history there. 

Kirk: He also he also had a radio show called The Wisequacks. 

Trevor: Yes, The Wisequacks. Yes. So you he not surprisingly, means he can talk and make a few jokes along the way. Like for all of us, you've been doing way more zoom than we thought of when I, you know, connected with him. You know, I assumed there was some sort of technical glitch going on as his lips were moving. I wasn't hearing a sound and now he was just yanking my chain by, you know, moving his lips, not saying anything to make me all nervous at my end. So, yes, he is fun to talk to. 

Kirk: Well, as I was listening and preparing for this episode, I was listening to his voice and going, He's got a real good radio voice. And then I remembered, right. He used to have his own radio show. Yeah. And he's also involved with the TOPS. We did the TOPS program Episode - 69, which is how cannabis decreases our pharmaceutical costs. He was involved with that study. So we've had him we've had him as a guest a couple of times. Yeah, well, this is the second time. But he's been involved with other cannabis. Yes. 

Trevor: And he was sort of also involved with the group, the Delphi group that you liked when they used the Delphi process to how to reduce opioids with cannabis. He was actually in that group that came up with those. And in a group that came up with the how to dose cannabis properly anyway, Cannabis Canada Dr. Sealey is probably has his fingers in it somewhere. 

Kirk: Do you want to move right into his discussion and we'll talk about afterwards?  

Trevor: Absolutely. He talks better about him than we do. So, let's listen to Dr. Sealey and then we'll come back. 

Trevor: Dr. Rob Sealy, Thank you. And welcome back to Reefer Madness podcast. As we were just discussing off air, I actually got to meet you in person weeks ago, so that was very cool. It's cool to put an actual face to a name and a voice. And while we were at that conference on completely unrelated, tobacco related things, we got to talk a little bit about cannabis and I got to hear that you have sort of a favorite, a crowd favorite talk on Green is the New Gray. So I thought it might be a good idea to bring you back and talk about geriatrics and cannabis. And I know you treat a lot of geriatrics and then you sort of had sort of a lot of experience with them. So I certainly am getting a lot of questions in the pharmacy from, you know, the 70 plus set about, you know, Mabel's been using this CBD stuff. What do you think about it? So I maybe I'll just start with so old people and pot. Good idea. 

Dr. Rob Sealy Thank you very much for that wonderful introduction. It was great to meet you in person the other day. And. And you shouldn't have screamed when you saw my face. That was. You're not very good at playing poker, by the way. Yeah. No. Seniors in medical cannabis are Green is the New Gray is one of my favorite talks. That idea of travel across wherever people will listen. And a lot of times where people won't care to listen, but who cares?  I'll try anyways. But I'm over here on Vancouver Island, so it's not unusual for me to come across a number of seniors. I mean, I like to mention that Victoria is the place that people come to retire, to live with their parents. You know, it's just like very much a senior oriented population. So when I have patients referred to me most of the time they're of the elderly niche. And of course as we get older, we get all sorts of conditions. We we gather them and as we go to the physician, we tend to get a lot of medications prescribed for every condition that we have. And next thing you know, there's more and more medications being added into our medicine cabinet, which as a pharmacist, you might appreciate, that's maybe a good thing. But it's not necessarily.  

Trevor: Well its not good for the patient, you know. 

Dr. Rob Sealy Not good for the patient. 

Trevor: Polypharmacy is never, never a good thing for the patient. 

Dr. Rob Sealy Exactly. But I mean, it's a situation that a lot of seniors get themselves into. And so I do a sort of an approach when I speak to my seniors patients and the audiences on the Green is a New Gray and that there's a lot of seniors out there that are interested, curious. They're really driving the the interest in the use of cannabinoids or medical cannabis for their own conditions. They I mean, they're big crowds source or I mean they talk among themselves at the at they're bridge groups etc. and they and you know, Mabel or Norman are certainly having experiences using cannabis. They might not necessarily have the best information and they might be fending for themselves, but they're certainly not, you know, scared to chat among themselves and try various products. So I think it's it is the number one demographic that is pushing the use of cannabis for therapeutic purposes. You know, definitely the younger crowd tends towards the recreational intent, but for a as using it as a medicine, certainly seniors are very interested and are certainly keen on learning more about this information. 

Trevor: I want to jump in on that just because it's come up in several last talks. How, because it looks like Health Canada is trying to maybe move all cannabis into recreational stores and sort of skip the whole medicinal side. So the older set that you see, do you think that's a good idea if they just go talk to their local bud tender about, you know, their arthritis. I assume that's not with the direction you think Health Canada should be going with cannabis. 

Dr. Rob Sealy Unless there's really good training of these individuals. I think that if that was built into it and I mean certainly easier access would be better for individuals of all demographics, including seniors. But unfortunately, the information that patients are getting at their local dispensary can be quite varied. Some of it's good. Some of it's really, really kind of scary, to be quite honest. And I think that they're hampered the local dispensaries because they're not allowed under federal regulations to really give that information. So quite often it's a very hush hush nudge, nudge, wink, wink, try this, try that. But not a lot of information is being dispensed along with it. And again, whether it's from either lack of education, comfort level or the fact that they can't actually really give that information, I always mentioned to patients, it's kind of the way the set-up is right now. You wouldn't go into your local liquor store and say, which bottle of Marlow should I use for my arthritis? It's kind of akin to the way the recreational set up is now. I mean, certainly people appreciate the fact that they can access it. You can see it, you can feel it, you can touch it, and you've got an individual right there with you. But again, there's all of these barriers and you have to think of, again, that the intent of why those dispensaries are there is definitely in the recreational side of things. And most of the individuals that that are working in those stores tend to have their own experiences. And when you say, well, this is a you know, this mango pineapple is fantastic taste and it gives me the right mellow feeling. But again, how does that, you know, parlay into inflammatory arthritis? There's a big jump, you know. 

Trevor: No, thank you. Like I said, it seems to come up in the last two or three people we interviewed seemed to we seem to keep circling around the difference between the medical and the rec side. So it was it was nice to hear that part. So when you're older patients are coming to talk to you, what sort of condition are they trying to treat with cannabis? 

Dr. Rob Sealy Well, not surprisingly, the number one condition would be chronic pain, and that's pain from all types of avenues, whether it be arthritis, which is probably the most common, but from previous trauma, inflammatory arthritis, different types of autoimmune diseases, you know, all a diabetic neuropathy, peripheral neuropathy, so pain of all sorts. So chronic pain by definition, any pain that lasts longer than three months, I think Fair Game. That's what people are looking to use cannabis for. They've been through the gamut of trying their anti-inflammatories and acetaminophen, and certainly we're looking at other options other than opiates these days. So when we look at the guidelines of how we should be treating pain, cannabinoids are certainly in those guidelines. So individuals are not thinking too far out of the box anymore when they look at, you know, potentially using cannabis as treatment, especially for chronic pain. But we know individuals right behind that are looking for help with insomnia, for instance, or anxiety, mental health symptoms, depression. The evidence is less so as far as double-blind placebo controlled randomized clinical trials. But certainly we know a lot of individuals are saying that it's effective for their sleep and their anxiety, etc... So but chronic pain is nice because it fits not only for what we use it the most for, but it's the one we have the most evidence and it's one that's incorporated in guidelines. So that one's kind of a check all the boxes. But like I say, behind that very close is anxiety, insomnia, which are often co-morbid symptoms, when people have chronic pain. So yeah.

Trevor: No good, and maybe a little off to the left and probably with less evidence. But it seems to be a question we hear more about how about cannabis and different types of dementia, your Alzheimer's, the kind of things is that something that's coming up? 

Dr. Rob Sealy Absolutely. So I work with a number of long term care facilities here on Vancouver Island, and I often mentioned that we can use cannabis for the behavioral symptoms of dementia. Often the agitation, the irritability, the physical harm to themselves and staff members along with pain, anxiety, insomnia. These are symptoms that we've got a pretty good track record of using medical cannabis for, of course, the Holy Grail that family members want to know is could it actually slow down the progression of the dementia itself? And I like to mention that there's some pretty interesting signals in that regard in the fact that we have pre-clinical research, you know, animal models. I jokingly say if we're at all related to mice and some people are more related to rats, then you know, you got a pretty good shot at this could actually potentially help. And that word potential is actually being bandied about by, you know, the National Institutes down south, the organizations that have actually patented the potential benefits of using cannabis for neurological conditions, including Alzheimer's, as sort of a great antioxidant for damaging neurons in our brain, whether it be post-concussion, post stroke, whether it be in Parkinson's Disease, maybe in MS, and certainly in Alzheimer's. So there's some really interesting research going in that direction. But at this point, I am concentrating using it for the behavioral symptoms, I would much rather and now again, I'm biased because this is what I do all the time is cannabinoid medicine. But I think most people would agree I would much rather use, you know, cannabinoids in the form of CBD, maybe some THC mixed in then this current standard. Quote unquote pharmaceuticals like the psychotropics in the long term care facilities that have a long track record of either ineffectiveness or certainly a large increased risk of potential side effects, of which some of them include, you know, very severe, including mortality and, you know, and morbidities, of course. So I've had great success with that in substituting for the current therapy. And usually the word spreads through the long term care facilities and that the nurses start to say, you know, wow, this is a really remarkable change in Mabel or Norman and they start to mention it to other family members as they come and visit their loved ones. And next thing you know, it spreads like wildfire through the facility. So it's I think it's a really good success story. Whether we'll ever get to the point where we're using it actually as a therapy. The research is suggesting it's working better, again in mice than what we currently have when we compare it to the current medications of the pharmaceuticals. It has great potential, but we're not there yet in the protocols of applications of dosing for Alzheimer's itself. 

Trevor: No, and that's good. And just throw my pharmacist  two cents just in case people aren't aware, like the standard Alzheimer's medications that we give to a lot of people in care homes. None of them fix Alzheimer's, none of them make them get better. And they're kind of expensive. They can be hard on the stomach. And the absolute best we can hope for is to kind of slow the progression a little bit maybe. And like you said, what we do most often is just try to keep, you know, Mabel or Norman safe and not hurt themselves or others. So like you said, we right now we tend to just sort of snow them with antipsychotic. Medications designed to treat schizophrenia. And as you listed, yeah, that might snow them. That might keep them calm and quiet maybe, But so many extra side effects when compared to cannabinoids. It seems like a no brainer to switch from one off label thing to a safer off label thing. 

Dr. Rob Sealy Isn't that interesting that that that's become a standard therapy is using off label antipsychotics. How did we ever get there? I don't know. 

Trevor: Yeah, that seems to be a wrong left turn. 

Dr. Rob Sealy Here we here we go. Criticizing cannabis for not having evidence and using it off label. And yet there's so many examples in medicine today that we use medications that were not designed for one purpose, but they commonly get used in that direction and more so than the original intent. 

Trevor: So we've covered, you know, like you said, probably the most common ones. We've got chronic pain, we've got sleep with, got depression, anxiety. Thank you for going the left turn into dementia. Any other sort of surprising things that that our geriatric population is interested in using cannabis for that you know maybe we weren't too thought of. 

Dr. Rob Sealy Well one of the other conditions that unfortunately is fairly common in the elderly and more so in Canada and northern climates is Parkinson's Disease. And so that's another reason I get a fair amount of inquiries and Parkinson's is a frustrating condition and it's frustrating to treat both with standard therapies and with cannabinoid medicine. If you talk to most of my colleagues in this that do this type of medicine, they'll say that it doesn't follow the rules. In other words, we're pretty good about predicting how people react to different cannabinoids, THC or CBD, when we're treating pain or anxiety or insomnia, sort of the common ones. But Parkinson's seems to be all over the map. Some individuals will respond more to the CBD dominance. Others require more THC. Most people will require oral, but some require inhaled or rapid acting.  I think it's yeah, in fact, it's all over the map. And so I always usually start with like normal with most other individuals, whether it be pain, anxiety, insomnia, it start with an oral formulation of a CBD dominance. But I don't hesitate to to jump into having to add more THC or looking at the rapid acting formulations to sort of supplement. And it seems like that's often required in Parkinson's patients. What we have more success with is the non-motor components of Parkinson's. So again, the pain, the sleep, the anxiety. People with Parkinson's and family members will mention if they notice that their loved one with Parkinson's sleeps better, they're less anxious then their motor components of their, you know, slow movement, their tremor will naturally improve. But when we're trying to treat the tremor, which is the thing that most people will recognize as the main feature of Parkinson's. Tremor is harder to manage, and that's where you might need the higher doses. And that's where we think that the rapid acting or the inhaled might achieve that more effectively. You'll see these amazing, of course, videos on YouTube, not the cat videos that you watch, but the ones that are the Parkinson's and patients that when they're shaking so bad or they have the dyskinesia, which is the abnormal movement secondary to some of the Parkinson's medications as a side effect. So those are horrible movements and writhing movements and these sort of things. Usually inhaled cannabis can help shut that down in some individuals. And you'll see again, remarkable on off features when cannabis is inhaled. And I think you need that extra boost. It's like a roller coaster. You need that quick up and then come back down again to solve those kind of symptoms in Parkinson's. That's where it makes it more challenging. But Parkinson's is one of those conditions that seniors get a fair amount of referrals for and it can be difficult to manage. You've got to factor in all of those variables. 

Trevor: And my guess is the answer is we don't know, but I'll ask anyway. So, you know, my pharmacist brain is just going so, most of the things we do in Parkinson's is we're trying to affect dopamine, a small little chunk of the brain called the substantia nigra. And usually we're trying to get it lasting longer and longer. So, you know, they don't get these on off symptoms. And usually we go from short acting things to longer acting things as Parkinson's gets worse. So it's just kind of making my brain spin a little bit that a fast, fast on fast off that's something like an inhaled high THC cannabis would make that much of a difference. Do we have any idea if the cannabinoids are doing something with dopamine or if it's related or an adjunct? Or what do we know? 

Dr. Rob Sealy Again, if we ask the mice, if we ask the ones that are programed. The programed mice with genetic predisposition to Parkinson's. It turns out that the mouse brain and again, this is what we assume in our substantia nigra, that part of the brain in individuals with it are lacking the neurotransmitter dopamine, right? So it all comes down to dopamine. The transport of dopamine to the areas of the brain that are responsible for movement and the endocannabinoid system, that beautiful system that I'm hoping you discuss every time you get a chance. Is that system that's integrated to kind of hardware determine all the parts of our body, Are we functioning in sector six or eight now? It's kind of like the chief operating officer of all of our functions, and it is definitely involved in the supply of dopamine in that area of our brain. They've been able to demonstrate this through all sorts of mechanisms. So if we know that the endocannabinoid system is responsible for the regulation of dopamine and many other factors and a whole bunch of neurological conditions, then it would make sense that if we need to supplement and help out that system, protect ourselves, increase the dopamine supply that replacing it with the cannabinoid from a plant and fitting into those same receptors might be the answer. Now, the question you mentioned is the on off effect. Short acting, long acting. I think it's in most individuals probably going to be a combination of both. You know, you need those high levels, but I don't think people could tolerate those high levels long term. And so I think having a long acting, you know, oral, it's kind of like how we treat pain. It's kind of a break through symptoms. I would think that oral is going to give us the most settling, but if we really are agitated, the tremors are going on, then you need that extra boost and something like an inhaled where we can get that quick in to settle those symptoms would be another way to administer the cannabinoids and get the response that we're looking for. 

Trevor: That's fascinating. Now, because I should do this. I do this every time and I'm just careful of our time. So older people, you know, they can be smaller, they can be frailer, they can, you know, we don't want them falling over and breaking hips. So I should probably circle all the way back. So how are you dosing and what are you dosing our, your older patients with? Like is this an oral. Let's go back to our more common chronic pain, insomnia person. What how do you treat them. What do you treat them with. What sort of doses are you aiming at? 

Dr. Rob Sealy In my practice, I'm extremely conservative. I mean, I do sometimes take into occasion, you know, a person's experience. I mean, if they camped out at Woodstock for the entire week and they've continued partying since then, then, you know, I might give them a bit of leeway towards the THC. But for most individuals, senior components, multiple comorbid conditions, multiple medications. I'm going to err on the side of safety. So I'm going to use an oral.  So a long acting, sort of slow onset. Long acting. So you don't get that real peaks and valleys. And I'm going to use an oral oil typically that's maybe a 1 to 25 ratio. And by that I mean one part or one milligram THC and 25 milligrams of CBD. Now, a lot of seniors will say, well, I've heard from my grandson, the THC is the stuff that's going to make me dance. You know, I don't mind dancing, but I don't want to fall down. And I'll go, you know, you're absolutely right. All of the potential side effects of impairment, euphoria, anxiety, palpitations are related to that THC component. It's dose dependent. But I always like to say I want to hide that milligram of THC in amongst the abundance of CBD, and by doing so that you won't feel that THC. But we really believe that we need that THC to get the CBD started. To ignite it, to get it robust. So think of it this way we want CBD. I'm going to start people on CBD, but I'm going to hide in a fraction of THC just to get some bang for our buck. I'm very conservative and that I'll start people on 0.25 Milliliters. Maybe in the morning and 0.25 at Night, and I only adjust that dose once a week. Some people go faster. I'm just slow and steady. We're going to eventually win the race. I go 0.25 morning and evening of a 1:25 oil, and then each week I increase it by another 0.25. So second weeks 0.5, third weeks 0.75 morning and evening. Taken with food or milk. Swallowed. Some of my research has suggested that it takes CBD anywhere from 5 to 7 days to kind of settle the endocannabinoid system. So I don't rush in and adjust the doses too quick. I tell patients to be patient and let it do its thing. What's interesting, the elderly, if you start people towards really conservative doses. Again, you're unlikely to backfire and get side effects. But even in people that are younger, I'll still starting with that same low dose because some people, their endocannabinoid system is extremely sensitive and they seem to respond to very low doses. To me, a dose doesn't depend on a person's body size or age, depends on their receptors. And if their receptors are really eager to get some help, it seems like they respond at very low doses. So it would make sense why the old mantra start low and go slow, Start people at the very lowest and gradually increase. It'll never bite you. If you go that way, you won't get surprises. You won't get side effects that way. Go very, very slowly and eventually people will find their dose, which is their sweet spot, and then they tend to maintain it. Down the road. If anything, their dose tends to reduce. We don't see tolerance and dependance and studies have suggested this. My own practice suggested this. And I think my own fanciful way of thinking is that it's probably our endocannabinoid system finally gets a break and starts to relax and starts to say, okay, thank you and people don't need to supplement it as much. And I mean, that's my own imagination. But I certainly it's a way of thinking of why we don't necessarily have to keep escalating doses like opiates and everything else. 

Trevor: No, And that's I really like that. And we've seen that in things like the TOPS studies and stuff. But I'm just it reminds me, I just talking to this guy 2 hours ago and he can't sleep and his Harvard trained Toronto doctor used to have them on like four tablets a day of Zopiclone. and for non-pharmacists, that's way too much. And he's mad at his current doctor. His current doctor won't go that high. But just the point was he they kept going up and up and up and got he developed obvious tolerance like to all our sort of quote unquote normal benzodiazepines Zopiclones, Z drugs, for all these sleeping type things we all seem to get tolerance and also for the opioids. So it's again making my pharmacist head spin a little bit that why doesn't cannabis do that isn't cool that cannabis doesn't do that.  I don't quite understand why, but it's fascinating that it seems to be completely different. 

Dr. Rob Sealy Yeah, it's completely different. And how I've seen that in my practice is that people will go away somewhere. They'll still travel to Cuba or somewhere that they can't take their cannabis with them. So they stop there quite often CBD oil, they don't get the withdrawal, they don't feel it, you know, addiction and all these other things. CBD is not addictive and they stop it and then they come back and they say, well, I'm going to restart it at a lower dose because I'll start again. And they realize, Oh wow. This time around, the lower dose, I don't need as much. So they often their dose might be cut in half. Or down the road, people will say to me, Rob, you know I'm doing so well. What would happen if I reduce it? Then go try. Try reducing it. See if you need as much. And of course, naturally, some people will just say, well, you know, this is getting a bit costly. I wonder if I need as much. So their own curiosity asks them to to reduce their dose. But we don't see the tolerance and escalation of dose typically, which is phenomenal. 

Trevor: Well, I promise to keep this to around half an hour. So we're getting close to that half an hour stage. So I'll, I'll go with. Is there anything in sort of we'll call it geriatrics or older population of cannabis. I missed anything you wish wished I'd added. 

Dr. Rob Sealy Well, I think the only thing that I can think of at this point is, is we touched on the polypharmacy right. And the number of individuals, seniors, as again, as they collect their conditions, they collect as many medication. And as we add more medications, typically we add more side effects with each individual medication. Let alone the potential for drug interactions. And there's this, you mentioned the term polypharmacy, and there's different definitions of polypharmacy. But the one that's probably accepted the most is if an individual is taking more than five different drug classes. Why is that important? Because as we take more medications, there's the risk of, again, all those potential side effects and the risk of hospitalization because of adverse drug reactions. As we add more medications above five, of course, there's a direct correlation with more hospitalizations; falls, etc. The interesting part about cannabis is because it works through the endocannabinoid system, I should get a plug from every time I mention endocannabinoid system, I should get payment from their manufacturer. I don't know. You know, I feel like that every time I but I always am a booster of the endocannabinoid system. But if we think that how cannabis works in multiple regions in our body and how we can use the same sort of ingredients and tailor, you know, a prescription in a way. I know it's not a prescription, but tailor the cannabinoid ratios in doses so that it works for their pain and their anxiety and their insomnia at the same time. Then we don't have to use all those multiple medications. And so we can substitute. The great substitution effect of using cannabis because of its multi-modal aspects, how it can interact in so many different ways in our body and clean up the medicine cabinet. I mean, to me that's another novel form of harm reduction. I mean, we talk about substitution for sleeping pills like your benzos. A substitution for opiates, but substitution for a lot of multiple medications, whether they be, you know, Gabapentin is used for pain off label again. All of these other medications, if we can clean up the medicine cabinet, people are going to be feel better. It's going to be potentially financially better as well, economically. And that's something insurance companies, I think, should look at when they're looking at potentially covering cannabis. You know, might be a business case for insurance companies, but certainly it's a case for people's own, you know, physical health, mental health to, you know, simplify things, use less drugs. I think is a really good form of harm reduction. And then, like I say, when we start looking into, well, the conference we were at last week looking at how the potential we could substitute for tobacco or we could substitute for illicit substances or substitute for alcohol, I mean, there's a whole bunch of potential because of I'm going to say it again because I get a dollar every time I say this, the endocannabinoid system. Right. So I think that's a fascinating aspect of of how you can incorporate medical cannabis into our practice. 

Trevor: That is a wonderful place to end because like you said, our geriatrics just kind of by definition come with a bag full of pills. And you're right, many, many studies say that the more number of pills in that bag, the more likely you are to crawl across the street to the hospital. And we want to avoid that. So this has been another fascinating chat. I really appreciate it. I know the listeners do to thank you very much for your time. 

Dr. Rob Sealy Thank you. 

Trevor: Kirk. Lots of things they talked about, you know, the things he sees most often chronic pain, sleep, anxiety. We talked about dementia and long term care, but not that those aren't fascinating. And we have touched on all of those before. But I think when he sort of took me into, oh, I didn't know that territory was Parkinson's. So, you know, Parkinson's. So and not to restate it, but in pharmacy world, what we're always thinking about is increasing amount of dopamine in your brain, in the substantia nigra and, I didn't understand really how cannabis might fit in there. And he laid out one of the, you know, the possible routes is the endocannabinoid system might be one of these overarching systems in the body that actually helps control the amount of dopamine released in the body. So, you know, if you get the endocannabinoid system back in sorts, back to sorts, back to balance, back to whatever you want to call it, then your body might actually be able then to release more of its own dopamine or create more of its own dopamine. And that might help with the Parkinson's. So that was just a you know, yeah, I made my brain explore it a little bit. 

Kirk: Yeah. I that's the thing that I'm. Again, the endocannabinoid system and I love how he kept looking for a little royalties every time he says it because the endocannabinoid system is still not taught medical schools and what the research is telling us is that it is the control center of everything that keeps us in homeostasis. Right. I believe when I went to school with the endocrine system, we talked about the hormones and we talked about we talked about, you know, the fight and flight syndromes. And those things kept us kept us balance. But what we're learning is the endocannabinoid system is the foundation of homeostasis. So that the thing that I find fascinating is how we're not discussing that in medical schools or nursing schools or pharmacology schools yet. 

Trevor: Well, and another I don't know if makes me a good or bad pharmacist. I was talking to a bunch of medical residents, family, medicine residents just before Christmas. One of our local docs, she well, Dauphin has sort of a training center for rural family medicine docs. So, you know, they spend time in certain clinics, do certain things, but they also have like education days. So this is one of their education days. And this was a chunk of time where they were talking about palliative care and specifically use of cannabis in palliative care. So it just turned into you, you know, an hour, hour and a half of cannabis. So Dr. Matheson, thankfully, it's invited me back twice to talk with her, two of them about cannabis. And you're absolutely right, long winded way of saying that's one of the first questions kind of surprised me this time is. So what does that cannabis stuff do in the body? Oh, I didn't know. I had a few slides and a few handouts. I didn't actually put an endocannabinoid system slide in there, like, because they literally and I'm not blaming. So I didn't know this in school either. Hell, I'm still learning it now. But they really had no idea what cannabis, the cannabinoids did in the body. Like just just no concept of what did what, where. So yeah, I fell down a little as a pharmacist by not having an endocannabinoid system slide in my little presentation. 

Kirk: It's I think we take it for granted, Trevor:, because we've been doing this for five years now and, and immersing ourselves in cannabis that doesn't everybody know what we know? And unfortunately they still don't. They're not studying it. What I found interesting, what Dr. Sealey was saying and this and this goes to pretty much many of the medical doctors we talked to his how cannabis, is not the cure all. Cannabis isn't known to cure anything. Right. It's not going to go out and cure Parkinson's. It's not going to go out there and cure M.S. It's not going to cure cancer. Though, though, there is some study suggesting that it might actually help prevent getting cancer. However, I digress. What I found interesting is he kept talking about the symptoms and, you know, sleep. You think about how important sleep is. Our gen, my generation, your generation, I've got about ten, 11, 12 years on you. But how many people in my cohort of friends and acquaintances that are having difficulty sleeping, how many how many people are waking up in the middle of the night? We've got we've got a mutual friend who basically is quite blatant and says he doesn't sleep. He watches television till he passes out and he wakes up in the middle of the night and goes to bed and he can't sleep. And how cannabis cannabis helps people sleep. So if we can agree that cannabis, you know, depending on how you're doing, the CBD or your THC levels or if you believe in indica or Sativa or whatever. If you find the strain, the cultivar or whatever you want to call it, if you find it, you will find that cannabis will help sleep. Now, when you look at chronic diseases such as Parkinson's and M.S., what does cannabis do for them? It helps people settle. It helps people sleep. When do we heal? When do we here, when we're sick, Sleep. I mean, the medical field puts you into an induced coma if you have brain swelling. You mean if you've got a cold like I have? I've been sleeping a lot lately. We heal when we sleep. If we don't get sleep, our body reacts to it. So if cannabis does one thing and one thing only, it will help people sleep. So people with chronic diseases. You know, there's still such a stigma about cannabis. I know people I have relatives who have chronic diseases that refuse to consider cannabis because it's weed, its marijuana. Right. But you say to them, find the strain, find the cultivar, get in a good night's sleep, man, and see how you feel when you get up. And that's what I liked about. Oh, yeah. 

Trevor: No, no, I really like that. And he talked about, you know, whether it was dementia in long term care or some anxiety and depression in Parkinson's, how it sort of helped this stuff around the around the chronic disease. And as a pharmacist, of course, I have to circle back to polypharmacy. Yeah, it's make me make fun of the pharmacist for, you know. Yeah. The people on five drugs are more, you know, make me money. Yeah, true. But it's not it's definitively not good for the patient. You know that magic, we got to have a cut off somewhere. So most of the studies have, you know, drugs from five, five classes or more. You're just much, much more likely to end up in the hospital. If we can do one thing that reduces the number of pills you're on, you're just healthier. That just, you know, it's like, you know, if you eat more vegetables, you'll be more healthy. What we do is the number of drugs you're on, you'll be more healthy. And I like what you call it, the cannabis being the great substitution. You know, if we can take cannabis and reduce, you know, your anxiety pill, your depression pill, your sleep pill, your opioid. You know all of that's good. 

Kirk: Yeah. Yeah. No, This is a familiar rant that our listeners will hear. My rant is that, you know, as a young nurse, bubble packs and doling out pill.  I spent, I spent most of my shift in the or in the old folk’s home. In the PCR, PCH doling out pills and like you said if you have five different classes you're now taking drugs to offset the side effects of the other drugs that are being used off label to deal with an issue that these drugs like you said you're hitting it with a sledgehammer when you can just give them a joint man.

Trevor: And let's hit it from a different angle because he touched on it. But it's worth mentioning if, say, in long term care you gave more cannabis, it would actually save nursing time. 

Kirk: Yes. 

Trevor: Because they don't they don't need to give it out. So that actually saves you money and manpower. And in outside of institutions, if you have, you know, your geriatric person living at home, if you gave more cannabis, they would be on less other drugs that would save money for, you know, the provincial pharmacare systems and the insurance companies like for because we've been beating a dead horse on it is better for you. Let's talk about you know manpower in institutions and money outside of it like there are lots of good arguments for cannabis. 

Kirk: Cannabis. Episode 91 with Dr. Peterson. He discussed it. He's doing a study that I can't help to wait. We know that doctor, Dr. Shelley Turner is doing a study on sleep. So, you know, when we get over this 100 number that we're coming up to in our episodes, I hope to have those people come back and discuss those studies with us. When were the system when will the system catch up to the rest of us right. I mean, and you touched on it with the whole medical cannabis and what Health Canada is doing right now, moving more into a provincial brick and mortar. You know, they're discussing getting rid of the online medical cannabis system. Now. They're alluding to it in the way they were asking questions right in the review. But I mean, for crying out loud, cannabis consider what was that? That was episode 69. The TOPS that you go back to that saves pharmaceutical costs, saves, saves time on staffing, less side effects, no lethal dose you know. Kumbaya. You know roll a joint, get on your Tied Dye I put on some put on some Pink Floyd and just give those 80-year-old a reefer and see what happens. That's what I found interesting. Also, without getting off my soapbox when Dr. Sealey was saying about inhaling cannabis and how that was helping people with immediate, immediate symptoms. 

Trevor: Relief of Parkinson's. 

Kirk: Yeah, Yeah, Parkinson's. I found that fascinating. I want to explore that.

Trevor: Me too. I'd never, never heard I thought about that before because, again, in traditional pharmacy world, we're always trying to get people with Parkinson's longer and longer acting medications. So, you know, they'll have symptom free for longer parts of the day. And if I was understanding what you're saying right. Is. One of the reasons that inhaled can be good is kind of like in pain. You know, we have long acting painkillers and then breakthrough painkillers. Will this, you know, a joint they might be the breakthrough. I'm having a really shaky moment. I'm really having a really stiff moment or having a really anxious moment. You know, the fast in, fast out of inhaled might be might be the way to go. And honestly, it just never occurred to me that that might be a good, good idea. 

Kirk: Well, you know, from Mable and Norman. Yeah. If we're talking about harm reduction and I think I discussed this in the last episode how I'm doing some work with Nunavut right now in their Tobacco and Smoking Act. 71% of Nunavummiuts consume combustible tobacco cannabis vape shisha and how we're we're trying to build a plan on harm reduction. So you know if people talk about inhaling cannabis as harmful for your lungs although there's no there is no quantitative study that says it's true, we just think it intuitively is bad. Then buy yourself a vape, right? Get a vape and use a vape for that, for that immediate result or a gummy. As New Years. It is finding again, I think I've discussed this before going out to socials. We're up at Northgate for New Year's this year and hanging out with some friends. Northgate and once again, you know, there wasn't a lot of flower around anywhere. It was all gummies people. People were having gummies and brownies. And I'm the only guy with this flower. I still like my flower. And I just found it interesting. 

Trevor: Well, and circling back to what you said, and not to go too far away from cannabis again, but you know it's our show. We can do it. The the conference that Sealey and I were at previously spent a lot of time talking about. Even with tobacco, if you don't burn it, they called heat-not-burn tobacco. So even if you're using tobacco, but you heat it. To get the nicotine out instead of burn it. It's less harmful. And as soon as I was shown one of these little devices as heat-not-burn devices, I immediately thought of my vape because that was the whole point of my vape. Is it You put the flower, I've got a one. You recommended it. I put a I put the flower in there, it heats it up. I get the cannabinoids out of it, but it doesn't burn, it doesn't smell it. I quite like it. But yeah, if. You know, and studies, etc., etc.. But yeah, if you are worried about burning the cannabis, yeah, there are product, there are things that heat the cannabis instead of just burn it. 

Kirk: What do you think about New Zealand? What New Zealand's done right? They've outlawed tobacco for anybody who's born between 2008. 

Trevor: Yeah, I talked about that at the conference. 

Kirk: Yeah. I don't know how that's going to work because one of the very first things I recommended for Nunavut, was that if you can't just ban this stuff. I mean, look, they tried to do prohibition with cannabis. It didn't work. Try to do prohibition with alcohol. It didn't work. So it's kind of funny. I'm working with the tobacco coordinator up there. And he his vision is that nobody consumes. And I and I kind of said, you know, that's an unrealistic expectation. So one of the very first things I recommended in the plan is to come up with designated consumption sites, because now, now you are recognizing the physiological and the psychological systems of substance abuse and substance misuse, people that have tobacco or cannabis misuse disorders, this is psychological. It's physical. You have to recognize it. So one of the first things I recommend in the plan was to have designated consumption sites, and it goes completely against the grain. Right. But you have to allow people, the vice, so you can educate them on how to harm reduce it. Right. 

Trevor: So harm reduction, not prohibition. 

Kirk: Right. And I mean, I've been talking about this for years. You've seen me on my soapbox about Cigarettes. I mean, next to the soda pop, which I think kill more people than Cigarettes, but that's a different issue. But, but, but cigarettes are manufactured. There's you know, there's not a lot of tobacco in Cigarettes. So I have told my smoking friends, have a cigar, right. Have a cigar and enjoy the tobacco and get your nicotine that way so you're not breathing it into your lungs. And the first thing they say to me is, Yeah, but I'll suck that into my lungs and I'll kill myself. I say, Well, then smoke a pipe, because again, the pipe tobacco has less additives to it. So if you don't want that thing, go to the tobacco vape. Right now we're off cannabis here. But it's but it's still the same thing with cannabis. You know, if you're afraid of the flower, then go to a vape, you know, or go to your gummy. 

Trevor: So I'm going to now circle away from tobacco because we went down another rabbit hole. Anything else that we've missed? 

Kirk: Well, we're coming up to 100, which is kind of exciting. There's conferences are coming back. We should try to see if we can get ourselves involved with some of those conferences. Maybe they need an MC. Maybe. Yeah. And I'm Kirk Nyquist. I'm a registered nurse, and we're Reefer Medness - The Podcast, and we have no script. 

Trevor: I'm Trevor Shewfelt, I am the pharmacies. 

Kirk: What is our web pages. reefermed.ca. Good reference page. I often use it to find things that I've forgotten about. All the transcripts are up there, our resources are all up there. It's a good it's a good reference for cannabis.