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E91 - Dementia in Long Term Care with Dr. Blake Pearson

What is the evidence? Where are the studies? There is no proof that cannabis can treat anything! Well…What if I told you there are lots of studies showing that cannabis has medical benefits? What if there was a study going on right now in Sarnia looking at Cannabis and Dementia in Long Term Care (LTC) homes? Dr. Blake Pearson and his partners in Lambton County are the epitome of “Think Global, Act Local”. They are tackling the pervasive problem of dementia in all LTC homes by seeing if cannabis can improve it in their local LTC system. Their study also measures if cannabis use in Dementia patients can help reduce Care Giver Burnout. This exciting research on the shores of Lake Huron is adding to the growing mountain of cannabis as medicine. We also take a left turn into “Green Washing”, but it is not what you think. Come have a listen.

Wednesday, 14 September 2022 10:15

Meet our guest

Dr. Blake Pearson

Research Links

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Don’t Stop Believin’ – Journey
Desiree Dorion
Marc Clement

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Episode Transcript

Trevor: Kirk.

Kirk: Hey. 

Trevor: We're back. 

Kirk: Good morning. How are you? 

Trevor: I am well. So, we've got to have another. 

Kirk: It's hot. It's hot and humid here.

Trevor: It is. We are in those dog days of summer. So, you know, that's a thing. 

Kirk: And I'm loving it. I'm out in my berry patch sweating. Well, I saw you cycling to work the other day and I said, Oh, look at that poor guy going off to work and I'm in my berry patch. 

Trevor: Yeah, well, I enjoy the cycle. The I'm trying. I tried my best not to whine about summer, but because it's so short around here. But I am. I'm one of those who does not love the heat. But, you know, on the other hand. 

Kirk: Bring it on.

Kirk: In January I dream about these days. So I'm trying hard not to complain. 

Kirk: Well, I'm the kind of guy that when we do our, you know, we do our winter getaway and we go, you know, typical Canadians, we go find us a southern beach or, ah, you know, a trip down to Cuba or something. I'm the guy that turns the air conditioning off and I like to acclimatize myself to the ambient temperature. Like when you when you get on the plane in Canadian winters, you're indoors and you get on the plane, you're with 100 people, people you know. And then you land on a hot, steamy Tarmac. You open up that the plane door and that heat wafts into the cabin I love that! 

Trevor: Well, good. You're in your element in Manitoba for the last week and hopefully into next week. But Kirk, other than our weather report,  

Kirk: You want to talk about cannabis. 

Trevor: Let us talk about canvas and we got another nice chat with Doctor Blake Pearson. And just before we were starting up, you were commenting on he seems to be a guy with a little bit of energy. 

Kirk: Oh, yeah, he's a game changer. What he's doing is a game changer. I've been on his Web page this morning and looking at the studies doing that, we're going to talk about absolutely a game changer. You know, no question about it. But I but one thing I want to put out real quick here for Dr. Pearson is that I was on your Web Page, buddy I don't see Reefer Medness. I don't see the fact that we've you know, he's got he's got all those lofty organizations like, you know, I don't know. Let's see here. What papers is he quoted here on his on his Web page? But I don't see I don't see any Reefer Medness. He's got to link our stories on that. 

Trevor: Absolutely. So, we'll let Dr. Pearson do most of the talking because he's good at that. But some of the things just I want people listen for ahead of time is, you know, like a lot of the other docs we talk to, we sort of came, you know, he's a primary care doctor and started looking after some older patients with cannabis and then, you know, has progressed a lot from there. And the fact he's the latest study we're going to spend the most of the time talking about this is in his local area which you know the whole think global act local he's really doing that within Sarnia. So, he's they've got Pearson Health, his group. Lampton College which is in the area and one of the local organizations that runs long term care have have partnered up on this dementia and cannabis study. So it is don't think that you it's really cool that he could do this in his local area. 

Kirk: Yeah yeah I know his I was reading up. Lampton College, Steeves and Rozema Nursing Homes. They got a three-year bursary of $360,000. It's a grant from the National Sciences of Engineering Research Council of Canada. So, he's got 360 grand to do this study over a three year period of time. But he told us that he should have results within six months. 

Trevor: Yeah, it completely unrelated, but just I was an NSERC student a million years ago back when I thought I was going to be a physicist. But yeah, NSERC huge organization, that funds stuff, all sorts of stuff all across Canada. So it is very cool. 

Kirk: But hold on, say that again, you are a what student. 

Trevor: So the group that's funding them, it's called NSERC.

Kirk: Yes. 

Trevor: And not health care related at all. But a million years ago, I was a physics student working at a particle accelerator in B.C. and I was an NSERC student. But, you know, that was a different lifetime pre-pharmacy, pre-cannabis. Back when I thought was going to be a physicist. 

Kirk: You're pretty bright. Like a bulb.

Trevor: Just the haircut. Okay. I got a lot of stuff to say about Dr. Pearson, but you know what? Let him. He introduces himself well. Speaks well. Let's have let him talk and then we'll come back out to the other at the other end. 

Trevor: Dr. Pearson. Welcome back. Um, just so in case people didn't see your first episode. Give us a little bit of how you got into cannabis and what your regular practice is. And then we'll get into a very exciting study that you guys are involved with. 

Dr. Blake Pearson: Okay. So, I got into cannabinoid medicine about seven years ago now and my background is primary care. Family physician. Started using cannabinoids with my older patient population. Originally, things like chronic pain, insomnia. Proved to be quite effective. So, then I did a lot more research on my own. Went to a lot of conferences and kind of grew my knowledge base and then started to take referrals. So, I then started to take referrals from some of my colleagues. And after a couple of years of doing 50:50 cannabinoid medicine, family medicine, I went full time into cannabinoid medicine. And I've been doing that practice now for the last four or five years exclusively. And it's now, it started out like I said, with insomnia, chronic pain. But now that I'm more comfortable with things, more evidence is emerging. We see a variety of diagnoses now. Things like refractory epilepsy in the pediatric patient population. Severe autism. Some of these kiddos will self-harm. We use cannabinoids to reduce these behaviors. Possibly reducing the antipsychotics they're on. And on the opposite end of the spectrum have an interest in dementia. And of course, we'll talk about that shortly. But so in dementia, we see patients all across the province virtually in long term care homes. And really the goal is with the dementia patients, we use cannabinoid medicines to improve the behaviors or agitation, physically responsive, verbally responsive behaviors and in the process ween them off of more harmful medications like antipsychotics. 

Trevor: That's great. And then it's a nice segue into the study we're going to talk about. I've told the story before, I'll repeat it again. That was kind of the genesis of this podcast is we had a family physician who was in charge of a care home and she was getting requests to get cannabinoids into the care home. So, we thought, sure, if we you know, we look after everything from chemotherapy to fentanyl patches going into this care home. Of course, we can we can do that. And then it turned out we cannot. Pharmacies were not allowed to touch cannabis at all. And the best we could do was help fill out some of the paperwork for the doc. But the cannabis had to go straight from the licensed producer to the care home patient or back in the old days, maybe even to the family member who brought it in, which was all a very weird system. It's gotten slightly better now, but still a weird system. But let's talk about long term care and dementia. I know, now it's been a several years since I've been in a care home, but back then, you know, four or five years ago, you know, I'd say at least half the people in there have some form of dementia can be higher. So just give people an idea about how much dementia there is in care homes. 

Dr. Blake Pearson: Yeah, well, you nailed it. Really, it's about half the population is a pretty good rough estimate. And traditionally, again, antipsychotics were used and now we know the black box warning on these medications. We know the harmful side effects. And really, it's just it's kind of finding a better way to manage the behaviors. So these behaviors in long term care, you know, when you were when you were in the care homes a few years ago, I'm sure you saw some of those behavior. Right. And what people need to understand is with the pandemic, right. A lot of those social activities, that meeting in the dining hall for dinners was gone. Everybody wearing masks was a big kind of barrier for the dementia patients that rely on facial expressions and really kind of common scenarios. So loved ones visiting was very limited. So, you can kind of start to understand how not only do we have a lot of patients with dementia in long term care, but in elevation in these responsive behaviors because a lot of things were changing and there was a lot of isolation. So that's why even I was practicing cannabinoid medicine and long-term care pre-pandemic. But certainly, the need has gone up as a result of the pandemic. And then that really kind of dovetailed nicely into getting the funding for the study where we're about to do, we're currently doing. 

Trevor: And not to belabor the black box warning, but for those of you who don't know, like I taught a little polypharmacy and long-term care to nurses who are starting to get well into long term care. And, you know, one of the things that we're always shocked them is, yes, we have these behaviors that, you know, bad for the patients, bad for the people around them. And we don't have any real way to treat it. But, you know, we give them antipsychotics, which is not intended to treat this and increases their chance of dying. And everyone's a little shocked, say, well, you know, we don't have a lot of options, but the options we do have might make them die faster. And, you know, that's none of that is good. 

Dr. Blake Pearson: No, no. It's like that's pretty, pretty wild to think, oh, yeah, we're going to use this medication. But there are some side effects, one being death. Kind of the worst side effect you could think of. Yeah. You mentioned the key term as to like when it comes to cannabinoid medicine in long term care. You mentioned polypharmacy. And when I'm working with other physicians, pharmacists, nurse practitioners, that's really one of the key points I like to identify is you can use one class of medications, cannabinoids, as opposed to a medication for sleep. So then we take them off the monster Zipoclone long term care. They probably have some pain as well, so we'll ween them off a gabapentin or an opioid. They might be on a SSRI for mood or anxiety. ween them off that. So when you're talking about seniors or talking about long term care, one of the biggest benefits is the ability to reduce polypharmacy in that setting. 

Trevor: Yeah, and that's, like you said, good for everybody, including regulators, if you're listing. The bottom line, because each of those medications cost something. 

Dr. Blake Pearson: Yeah, yeah, yeah. That's really what. I think we'll move the needle and trying to raise as much awareness. There's just the basic this is better for the patients. What do you think should win the day with the argument but it doesn't in, you know, insurance world and obviously in medicine. But what I think we'll get this over the line is that other part you mentioned the pharmaco economic reasons. Once we start seeing the pharmaco economic data that you actually help patients, but also it's more cost effective, then we're going to see some widespread coverage hopefully. 

Trevor: Okay. So, let's get into this study. I was reading your little blurb here. There's lots of people involved. So, tell us who is involved and what are you guys trying to do? 

Dr. Blake Pearson: Okay. So, it's a nice collaboration between local community partners, which is really exciting to be a part of. To be in my hometown and able to do research that hopefully will be viewed on a global scale. We have my team at Pearson Health and that's my clinic. We have Lampton College, that's our, our local institution that is affiliated in this particular study. And then we have a industry partner in Steeves and Rozema, which is one of our local long term care home chains. Also, they have some retirement residents as well, but that's the partnership. So it's it's ourselves, Lampton College, Steeves and Rozema. And the official title of the study is Exploring the Impact of Cannabinoid Therapy on Persons with Dementia in Long Term Care. 

Trevor: Okay. And what are you is there a control group? Is there a treatment group? How this set up? 

Dr. Blake Pearson: So, it's really more of a social study at the at the core. It's not a randomized controlled, double blind trial because clinical research, obviously, there's a lot of steps, unfortunately, a lot of hoops to jump through. We've been using cannabinoid medicine in practice for years, certainly safe and seeing good results. So, this is actually more of a social study in that. Yes, the patients are going to be on cannabinoid therapy because they're referred for me from the House physicians to manage behaviors. But there's also an element of the social interaction, social index scores. Behaviors. We're looking at the neuro psychiatric inventory. Dementia mood picture. So, mood. Responsive behaviors. Social indicators. So, there are some quantitative scales. The nice thing about having a robust research project like this and funding for NSERC is we can have some qualitative measures too. So, the research team is going to be doing interviews with POAs caregivers because a big part of dementia as well is caregiver burnout. So we're going to be looking at that through some qualitative measures and they'll be 20 residents on therapy and your ask out control group. And there's also a control group as well. 

Trevor: Okay, so you know, not double-blind control, but there is a control group and a treatment group. And I think it's fascinating. I never even thought about that, that you're looking at caregiver burnout because, I don't know, as days gone by lately that they haven't been talking about a ER or something shut down because they have no staff. So caregiver burnout is a big deal. 

Dr. Blake Pearson: Big deal. Big deal. So, caregiver burnout, the measured I mentioned. And then, of course, and we have some good retrospective data that we're going to publish on this. But one of the key elements in cannabinoid therapy and long-term care reduction in polypharmacy. So certainly, we're going to be looking at the reduction in antipsychotics and benzos and things of that nature. 

Trevor: That all sounds really good. I am flipping back through the blurb of how long that's going to be going on for. 

Dr. Blake Pearson: So it's a six-month study and the measures are going to be, you know, we have a baseline measures. We're going to repeat the measures at two months and six months. 

Trevor: Okay. Though, that sounds good. And, you know, because I am impatient. When do we get to hear how it turned out? 

Dr. Blake Pearson: Yeah. Well, the nice thing is robust enrollment. Because our practice is fairly well known and again, we're getting pretty reasonable results and long-term care. There's been a number of referrals. So right now we're in basically the first phase. So a number of residents have been seeing baseline measures have been done. So kind of a rolling enrollment, I would think 2023 at some point will we'll be able to get those results out. 

Trevor: But that's pretty quick. I have a kid graduating from high school in 2023 which, you know, seems like not that went way too fast. So, this will come up quickly, too. 

Dr. Blake Pearson: Oh, you know it. Yeah, it will fly by. 

Trevor: So this is and we have another topic to get to. But before we sort of wrap up with this study, anything else I missed on this study? Are you wanted the audience to know? 

Dr. Blake Pearson: No, I think I think that pretty much covers it. I think everybody should know that it's something we've been using in practice. Certainly, I have for years now in long term care. And again, when you compare the safety profile of cannabinoids to something like an antipsychotic, it really is, in my mind, a no brainer. And we're hoping that with more knowledge dissemination, more physicians, more pharmacists in long term care will get comfortable because ultimately, it's a much better option for those residents. 

Trevor: I think that's a great place to wrap it up. All right. Switching gears here a little bit. We saw a tweet from you a little while ago, and I'll just do a real quick overview of the tweet. I'm usually a pretty easygoing guy, but this has got me fired up, trumping physician expertise and forcing us to start patients on several potentially harmful meds before covering candidates. It's unethical at best and dangerous at worst. Dr. Pearson, you want to share with everyone what got you all fired up? 

Dr. Blake Pearson: Sure. So, yes, and fired up is accurate because it just it blows my mind this day and age. And in that Tweet, I mentioned unethical that we know this option, cannabinoid therapy. There is evidence. It's certainly a very safe compound, especially when you break it down to the CBD and THC. The fact that if I want someone to have coverage from a major insurance company, we won't name names today. But suffice it to say, a well-known company, the hoops to jump through are two, not one, two opioids. You have to try that. Clearly, states must buy two different opioids, which now our guidelines do not say opioids before a duloxetine or pregabalin or even cannabinoids according to health quality Ontario and just common sense you would it doesn't make sense. Then if you fail two opioids you must try either a Gabapentin, then Pregabalin or Duloxetine, but suffice it to say, four different options must be shown to be ineffective, even though all of those medications from a side effect profile, much more side effects compared to a CBD formulation, before they will even entertain the idea of coverage. That doesn't mean they will cover it. That just means these are the hoops. And then you finally get through the gate to have the possibility of coverage. So why I'm fired up is because it's completely unethical. And it also doesn't make much sense because those options, including Gabapentin, there is no body of evidence to support their use in pain. We use it off label. It's an anti-seizure medication, but it's interesting how that's the algorithm. And to me I'd like to ask them what does that based on. 

Trevor: Know and it's a pet peeve of Kirk's but I'll try to talk for Kirk: here. I'm sure it's something to say in the wrap up, but Kirk: hates Gabbies. I once had a physician give a talk to a bunch of us and she did some bunch of work with the coroner's office. And she her stress was if a medication has a cute nickname, that's a bad, bad thing. Because, you know, she was telling us about people who had died of overdoses. So if your patients come in asking for Gabbies, that's a bad sign. So, yes, Gabbies, for those of you who haven't heard of Gabapentin, unfortunately, does seem to have a relatively high abuse potential, addiction potential. And like Dr. Pearson said, there's just not a lot of we you it's another one of those especially neuropathic pain, we use it because neuropathic pain is hard to treat. So, you know, if you get relief from Gabapentin, great. But it's one of those we don't know what to throw at you. We'll throw Gabbies at you. But you know, Dr. Pearson, are there better options than Gabbies? 

Dr. Blake Pearson: Of course. And the interesting thing is, often times when I'm working and teaching other physicians, they'll say, it's an excuse and I am not ragging on any of my colleagues here. But it is it's an excuse to say there's not enough evidence for cannabinoids when there is some evidence. And clearly a lot of reviews show that. But then in the same time. But I'll prescribe Gabapentin. So it's just often like to highlight that double standard because of the long term or long time stigma related to cannabis. It's still out there, but that's one of the key examples I use when speaking with other providers. 

Trevor: No, that's a good one for us to keep in mind. Any other things that we didn't talk about that you want to bring up for our audience today? You've been very concise so far. Which is which is excellent. 

Dr. Blake Pearson: Good, good. Well, it's pretty clear messaging these days, you know, and I think I guess anything else that I would say is, is that the good news is things are changing. More physicians, nurse practitioners, pharmacists are getting comfortable. I just did, I do a lot of work with other physicians and having them basically incorporate cannabinoids into their toolbox. And it is a bit of a process because like you mentioned, we're not used to it. It doesn't go through the pharmacy. It's a new process. So that is another barrier. In addition to the stigma and bias that we just talked about, this process sometimes will alienate providers. But the encouraging part where I was going with that is I just did a webinar on Tuesday night and had I think we had 150 physicians register, 100 showed up, which has been the best turnout that I've seen over the years. So, I guess some encouraging signs that physicians are starting to be proactive in registering for these events as opposed to just, you know, I'm going to I'm going to go because there's a free dinner and this was a webinar at night that, you know, they signed up for no kind of reimbursement, if you will. And great questions, great engagement. I worked with a younger physician yesterday. Really exciting for me to work with someone who's just out of residency because the reception was wonderful. They were open to learning. They were keen to incorporate into their practice. And the message is always not that you need to use it on every patient and it's works for every indication. It's simply this needs to be in your tool belt here. This needs to be something you can use when appropriate, and that is becoming more mainstream. 

Trevor: I think that is a very positive thing to end on. So, Dr. Pearson, you had one more thought on greenwashing? 

Dr. Blake Pearson: Yes. So, this is a term that originally has to do with the climate crisis and big organizations that are saying, you know, they're doing things to promote climate and they're working and donating money to different organizations or different groups that are supporting climate change. And really, that term greenwashing is getting used because major corporations are making this claim. But when you dig deeper, like more so for PR reasons. 

Trevor: Right.

Dr. Blake Pearson: Specifically, some of the big banks, Wall Street type banks, a lot of them have had funds that are, say, eco-friendly or, you know, making claims. And actually, the SCC is coming down on these companies because they're not actually doing anything. It's just a trendy right, a trendy thing. So we're doing our part, but really it's just a PR move and they're actually getting fined by the SCC for doing this thing. So the greenwashing is happening. And what I'm seeing, we're talking about the insurance companies, same kind of thing, greenwashing in a different sense. So they're saying we do have coverage. Yes, our plans, cannabis is covered in its greenwashing in a different sense. They're not telling you that it's covered, but the physician has to try multiple opioids, gabapentin, pregabalin only to get denied. So it's an example of greenwashing in a different sense. And it just, you know, it's kind of a nice coincidence that cannabis green but certainly it's frustrating because you'll hear this what we have coverage for our plan members or sponsors, but really when you drill down on it, there is no coverage because there's so many hoops to jump through. 

Trevor: No, unfortunately, just like people who, you know, buy carbon credits instead of retrofitting their building, you know, the yes, we cover cannabis, but don't read the fine print. I agree. That's definitely something we should gently or not so gently push the insurance companies on. 

Dr. Blake Pearson: Yes. Yes. So we'll be certainly doing that, not so subtly, hopefully in the near future. 

Trevor: Kirk: up. Let's start with Poke the Bear, Kirk, Gabapentin. How. How much do you love the Gabapentin? 

Kirk: Well, just like I said, every so often we get we get like-minded people. Gabbies when I worked Corrections, working as a nurse in Corrections, Gabbies were a misuse substance. I've always thought it was ironic that all that many of the doctors that were poo poo cannabis therapies are very quick to, you know, to prescribe and I guess nurse practitioners. But I don't see it too often with nurse practitioners. But they'll prescribe Gabapentin for modalities that only even on the on the list. So yes, I'm glad that he I'm glad that he raised that. I mean, we I forget which the episode was. Pain management, I think where cannabinoids are what fourth or third fourth on the list. And insurance companies, insurance companies won't fund won't fund cannabis unless you've tried opioids and it kills me. We have more research should how do I word this we've got so much research on the damage opioids have done. I mean, I've said over and over, go over and over again in this podcast that I've been nursing 40 years. I started I started nursing in 1980 as a student, graduated in 82 of that Diploma, went on to get all sorts of academic paper that I can paper wall with it. Besides that. Nursing for 40 years, first aid before that, I was involved with first aid and stuff before that. But I can remember, I can remember going to in-services and conferences where doctors, experts stood up and said nobody should live with pain. And they were promoting pain management analgesics, pumping it out. And I can remember sitting there with my doctor, my medical director at the time I was in EMS in those days and my medical director was sitting there and we were talking to him say so. So everyone gets opioids, you know, is that is that the new plan? Is that the new way to go? And 30, 30 years later. Oh, by the way, we may have misrepresented some of the studies, you know, from Smiths. What is it. Parker Smith.  Let's name names. 

Trevor: Purdue. Purdue Pharma is the one who there they were the OxyContin people. 

Kirk: That's the family, right? That's that family. 

Trevor: That's the Sackler family. 

Kirk: Yes. 

Trevor: Purdue Pharma. They I'm not saying other people didn't do bad things, but they seemed to be high up on the list. 

Kirk: They lied. They lied. 

Trevor: Oh, yeah. 

Kirk: They lied. And they've addicted. And we've got this we've got this huge problem with opiate addictions in our culture because of physicians. And I'm going to put the blame on them because that, you know, so, Dr. Blake Pearson, I support what you doing man.  This like this is okay. I'm going to stop ranting because I've got to. Okay, go ahead. 

Trevor: No. So a couple of things I want to point out. And they're relevant to the study. So getting people off of antipsychotics who are have dementia. I know, sounds maybe like, oh, that, that doesn't make a lot of sense. But yeah, I talked about a little bit the interview I'll just mentioned again now. When someone has dementia, we just don't have a lot of treatments right now to deal with the acting out, you know, maybe self-harming, maybe harming others, maybe wandering, maybe, you know, maybe, you know, singing or screaming for hours on end. There's, you know, lots of problematic behaviors that we just don't know how to treat. And at the moment, when we can't do anything else, we reach for antipsychotics. And they're not a great treatment because, again, they're another off label thing and they increase the chance of death. You know, that's not a good treatment like and I'm not blaming other people. I, you know, I was involved in long term care for 15 odd years, and I absolutely dispensed this to people in the we didn't have any other good options. So it'd be really, really, really good for this study to add to the list of things that cannabis is good for and give us some, you know, safe and effective options because we just don't have a lot right now. 

Kirk: You know? Agreed. Absolutely agreed. In my career, I haven't spent a lot of time in long term care. Of course, as a nursing student, one of our first field placements is in a long-term care facility. That would have been 1981 for me. And I was nursing First World War vets. And, and so I, I did that. And then later in my career, I became a manager of long-term care locally here. So I am aware of what goes on. And I got to tell you right now, when you consider the work that nurses and nursing aides and practical nurses are doing inside these long-term care homes. You're talking about one RN, potentially LPN, depending on if they're if they can if they can give meds. I think most LPNs can now or practical nurses. But then you've got one aide or maybe even two aides, if you're lucky, when you. Walking through a long-term care home. It's very discouraging. There's a lot of people snowed. There's a lot of people angry. There's a lot of acting out. So what I liked about what he was talking about is the polypharm. Now let's think about what nurses have to do. Registered nurses, practical nurses. They are responsible for doling out the meds. And as you know, the amount of meds that some of these elderly people are on are astronomical, like a handful of pills. Now, as a nurse, I have to dispense those pills. So I dispense them. Now there are new dispensaries and health regions that have money might actually have candy machines that dispense them, but most of the rural systems do not. So the nurse has to go into a cupboard, find the patient's meds, dispense them into an individual cup for, let's say, 30 patients. That's going to take that nurse 45 minutes. Yeah, right. And then she's got to go around the hallway and deal with giving it to the patients. Then she's got to go back and document it. So you're talking about 2 hours, depending on the size, right? Of just doing the first course. Now, if somebody is on TID meds, which is three times a day or QID, which is four times a day, so that's 8 hours, a nurse will work 8 to 12 hour shifts. So the majority of the time of the nurse is doling out the pills or the syrup or giving the needles. What he's suggesting is a game changer. Absolutely. 

Trevor: Yeah. And a slight sidebar, because I don't know why it didn't occur to me. Probably should have. So I stopped physically going into care homes pre-COVID. It just never really occurred to me how much worse patients were getting during COVID because everything you know, it, most care homes will have some sort of activity going on in the afternoon. It might be bowling, it might be bingo. It might be having a musical. So, you know, they have activities in the afternoon and they all meet together in the for meals, usually three times a day. And, you know, and there'll be family members coming back. So a care home, properly set up and properly run, can be a relatively pleasant, stimulating place and. 

Kirk: Busy, busy place and. 

Trevor: Can be a busy place. And, you know, people care homes in general. I'm not saying there's not problems, but it can get a bad rap. Oh, I'd never want to be there. I never want to place Grandma there. I've seen grandma who, you know, was living in her apartment at home, you know? You know, we say tea and toast. But, you know, she was actually living on tea and vodka and she basically went to the care home and dried out. You don't think about it and suddenly, you know, remembers things again and knows who the grandkids are. And like care homes can be a really nice place for your final days. Yeah, but you know, now you throw in COVID and there's no activities, there's no family visits, there's no group meals. There's, you know, I don't have dementia. And I'm sure my mental health would suffer greatly if you locked me in my room all day. You know, I never thought about how much worse dementia got in these care homes in or the symptoms during during COVID. 

Kirk: Well, but now think what's happening now and I'm a statistic. I'm right. I'm one of those nurses that left the field. Right. I'm I am I have like I don't know if I've announced this on Reefer Medness. I've retired, I've quit my job and they call it retirement. I call it retreading because I'm looking for other work. But I've quit. I've remove myself from the environment because it's so toxic. 40 years ago, 40 years ago, I can remember being in a conference, I think I was a student. We were talking about demographics and we're talking about bubbles and we're talking timelines and we're looking at the future. And I can remember I was a student. I remember the instructor telling us that we will be the future leaders, we will be the ones in the future who has to prepare for the health care system for our retirement. Right. So in my career, I've been management. I've been you know, I've been bottle washer, I've been all over the place for my career. Right. But but I can always remember being in situations where we need to talk about retention. We got to talk about retention. And most organizations will spend money on recruitment and spend nothing on retaining the employees they have. So I'm getting to my point, but the point is that post COVID, we have burnt nurses out. I'm one of them. I'm done. I'm toast. I, I couldn't affect change when I was in nursing as an active participant. I'm now out because of this. So you think of what's happening in personal care homes now. They're short staffed. The nurses are burnt. Man, I've said this before. People that work on long term care, they're saints. I can't do that work. They're saints. So now care homes. Oh, God, man. I feel for the health care workers that are in care homes. Dr. Pearson's study. Game changer. I'm going to say it several times if you know. 

Trevor: And another nice segue to that rant is they actually have a component of the study when they're looking at caregiver burnout, which is, again, another thing that I didn't think I didn't think about in a cannabis study. But sure, if you can. Like you were outlining earlier the workload in a care home while on any medical or any quote unquote medical ward is, you know, it's a lot.  If you could do anything to, you know, from the pharmacy point of view, if you can do anything that reduces the amount of pills the pharmacy gives, that reduces the nursing workload, that reduces burnout. Like, it's it's one of these synergistic effects. 

Kirk: Well, it's one of it's one of the conflicts in health care. You know, I think I've said this before, a doctor's practice medicine. Most doctors, most times you see a doctor, is that when you're sick, you're not feeling well. You need to go see a doctor. Nurses are wellness practitioner's. Our job as nurses, when you are in the care home, our job is to keep you well. When you're in the medicine department, post-surgery, you know, nurses are there to help you get well. But what happens, ironically, is that the acute care model, the long-term care models, the sickness model, the health care system we have today is built on sickness. You know, a community is going to want a CATT scan, you know, where it will spend $1,000,000 on a CATT scan rather than spend $1,000,000 on preventing people from getting sick. We'll spend it on the CATT scan. So so when you look at what he's doing here, if he can reduce the nurse's time, doling out meds by giving somebody some THC you know, to settle them down, some CBD for the inflammatory processes. And there's one or two pills that come out of one bottle opposed to four bottles. You've just cut down minutes for every patient. And now the nurse can go back to practicing wellness and helping people be well and live the life that you talked about. 

Trevor: And that's two other nice segues. One is. Yeah, keeping you people well, that's fine. But from the pharmacy point of view, if we reduce them from five pills to one or five pills to two, that could greatly reduce costs. And that should, like you said, should actually get the attention of some of the powers you would think. 

Kirk: You would think. Right. 

Trevor: And I think that nicely segues into two of Dr. Pearson sort of rants in there getting insurance companies to pay for cannabis. So, I actually first I'll give insurance companies a bit of a plug. The fact that they're even talking about it, you know, five years ago, they weren't even talking about paying for cannabis. Now they are. And, you know, his first rant was that was is a very easy-going guys you can hear talking to him. But you know this rant on Twitter about, you know, this is unethical that he's got to give them all two opioids, gabapentin or Pregabalin and do oxy like four different things before they'll even consider paying for cannabis. He thinks it's a terrible idea. And, you know, obviously we agree. But, you know, maybe things like this study will push the insurance companies a little more because if it's you know, if the guidelines are now saying that it makes sense for cannabis come in earlier and the studies are now saying and you can go to the insurance companies and, hey, you know, you don't have to pay for four things before the cannabis. You know, that's let's talk about not paying for the four things before the cannabis and then the other one he I never even thought I've heard of greenwashing when we're talking about company’s environmental record. But I hadn't thought of greenwashing in the insurance world where we say our company pays for cannabis and the fine print if you go through these 18 hoops, I never even thought about that. 

Kirk: Yeah, well, well, think about a tick box here. Let's just go through the tick box. Oh, opiates kill you quickly. Right. Cannabis. There's no lethal dose. You can't die. Right? So. Even if you're going to give somebody cannabis, what's the threat? Right. They're not going to die. So if you give them cannabis and it settles them down, that's a good thing. Right. And so you've decreased the amount of you decrease the cost of the opiates. You've given them a safe supply of cannabis. You've decreased the workload of nurses doling out the meds. I don't see anything negative in this. Now, again, you know, there's always going to be those guys and, you know, there's not enough studies. Well, as as Dr. Pearson was saying, there are studies as most of our medical and research and guests have said to us, the studies are there, man, they're there. 

Trevor: And Pearson is working on one right now. 

Kirk: And I'm excited for him. And I can't tell you how cool this is like this. This truly is cool. And I was looking at his Web page and he's working with the nurse practitioner. He's using the same language as our friends in Gimli. Dr. Shelly Turner uses. She's offering a patient experience. He's got a cool web page, except it is lacking a Reefer Medness icon. Just saying, but yeah, I'm all over this physician and I support him. I think it is fantastic, man. Let's and I think I said this before I got myself in trouble as a nursing student when I worked in these care homes as a student. And I and I was doling out the meds and I said, why don't we just all give him a reefer? And my nurse instructor said, I did not hear you say that. 1981, right? I didn't hear you say that, Kirk. Okay. But I don't understand. Why would why is this guy getting six pills? And my responsibility is to know all of the side effects and all of these side effects nausea, vomiting, tired, death, nausea, vomiting, tired, death, all of them. And then my nursing instructor said, Yeah, but what's the benefits? I said, You, I don't see any benefits here. And I got in trouble for that because obviously I didn't know enough about pharmacology. I'm still a little weak on pharmacology, but but still, I just even back then, I didn't understand why we're snowing these old people. People that lived in trenches, people that had bombs flying all over them when they're 18 years old and we're now snowing them. And when they're in their eighties and nineties and I'd never understood it. So 40 years later, I can finally sit here and go, hey! 

Trevor: I guess we should end with I am Trevor: Shewfelt I'm the pharmacist. 

Kirk: Kirk: Nyquist the Registered Nurse and we are Reefer Medness - The Podcast soon to be found on Dr. Pearson's Web page, I imagine.