Episode Transcript

Trevor: We are back. 

Kirk: Hey. How's it going? 

Trevor: Good. So, yeah. News from around here. What about? I've been trying to solder things.

Kirk: Solder things. I am all things Apples. 

Trevor: Yeah. Yeah, you're doing things. Apple. I'm trying to solder some electronics together. I am not good at that. But I didn't actually burn my fingers this time. So we'll call that a win. You. You've got a bunch of apples off the apple tree, and what are you doing? 

Kirk: Well, I've been harvesting apples for the last three weeks and crushing them and squeezing them and making juice. I've got about 70 liters of apple juice fermenting and with various recipes to attach. My passion. True passion is fermenting things, and that's what I'm doing. And I'm in my back yard just pounding apples and listening to podcasts and talking books. 

Trevor: Excellent. And actually, that segues nicely into our current guest. So, Dr. Cody Peterson and we'll let him introduce himself in a second. But, you know, when you chat of before and after the interview, you know, he said, oh, yeah. So what podcast are you guys again. Ah, Reefer Medness. Hmm. Oh, is that the one with that nurse guy who worked up north? You know, he's quite a character. Yeah, I remember you. So, Kirk, the important part is with all your apples and fermentation and various stories about where you are and what you're doing, you make an impact on the listening public. Dr. Peterson had heard of us because of you. 

Kirk: Being called a character. I've been called worse. But character is good. I'll accept that. I accept that I'm definitely a character. This this episode. Trevor: this is one your, for our listeners. This is one-year geek one's right. This is this is definitely I mean, the guy calls himself a cannabis science expert. What he's got to he's got a Ph.D. in Pharmacology, a Master's in Cannabis Science. 

Trevor: Well, it's called a Pharm D just to keep things good and weird in pharmacy world. A Pharm D or Doctor Pharmacy, well that's even changing but it's a Pharm D is kind of a clinical thing. Well, I'll bore people with the back story. When I went to school many, many years ago, you get a Bachelor of Pharmacy and then you go work. And then if you wanted to sort of specialize, like, let's say you wanted to be the kidney pharmacist on a kidney dialysis unit or you want to be the cancer pharmacy on a chemo unit. You might go back and do more training and get a Pharm D, a doctorate in pharmacy in that sort of area. That was sort of the that the specialty thing. And that was separate from people who went off and got a Ph.D. and they were doing more research stuff. Now in pharmacy world is changing and in the U.S. I think almost everywhere and slowly coming in Canada you go into pharmacy school into what they call the entry level Pharm. D. So you don't come up with a bachelor a pharmacy.  Hang out there for a year or two more and you come up with this Pharm D, so I'm not saying it's bad. School isn't bad, but it it seems to sort of cheapen what used to be sort of a designation of almost a specialist, which Dr. Petersen is, you know, he does pediatrics in hospital, but, you know, does every pharm, not to degrade Walmart, but does every pharmacist who works at Walmart need a Pharm D in anyway? 

Kirk: Is that an example of Education Creep. 

Trevor: Absolutely. Absolutely an example of education creep. But you know that that's not what this one. 

Kirk: I think, if I'm going to if I'm going to make this fair for listeners, go back to Episode 80 when we were talking to the Australian researcher, Lindsay Anderson.

Trevor: Dr. Lindsay Anderson. Yeah. 

Kirk: Cannabis Drug Interactions. I think this would be Part Two of that interview, right. In a sense. 

Trevor: That's fair. 

Kirk: Because, because she's, she's the researcher and this gentleman is more of a practitioner. Like a clinician. 

Trevor: Yeah. Applying what people like Dr. Anderson learn in the lab, applying it to people. Yeah. Okay. I think that's fair. 

Kirk: So what are some of the highlights you want people to listen for? 

Trevor: Well, even though you don't think you're taking drugs all the time, you are. So you know what his quote was? 90% will go with that of us, you know, consume caffeine. So that is a drug you are taking right now. So chances are if you're taking cannabis, you might be taking it with caffeine. We're not saying that's bad, but just remember, another drug that a large percentage of us use regularly is alcohol. So yet another drug that you could be taking with your cannabis. Again, not saying it's bad. And then another one I like because I seem to see them all the time are like ADHD drugs. So some people are treating their ADHD for better or worse with cannabis. Now what happens if we add on an amphetamine type drug? So, you know, these were these these were of interest to me anyway. 

Kirk: Yeah. Well, let's get into it. Let's get let's listen and we we can discuss what we heard. 

Trevor: All right, Dr. Peterson, tell us a little bit about what you do academically and clinically. And then eventually we're going to get to interactions with cannabis. 

Dr. Cody Peterson Yeah, absolutely. Well, you're talking to the right person. I am a pediatric pharmacist. Right. And I've been doing that for about a decade. And more recently, I've jumped in and really leaned into becoming a cannabis science expert. In fact, I've even gotten my master's degree in the topic from the University of Maryland School of Pharmacy. So I now have my PharmD and my master's in medical cannabis science.  And my primary role, what I what I'm really excited about right now is the work that I'm doing with the Cannigma, which is a science forward media company out of Israel who's trying to help cut through the smoke that you find on Google when you try to find the answers to your cannabis questions and really try to help people understand how to use cannabis the best. 

Trevor: That is, yeah, we definitely have the right person on the line. So as listeners may remember, you know, a little while ago we talked with Dr. Lindsay Anderson out of Australia. Now she was a clinical sorry more a bench researcher and she was actually looking at the sip I call the alphabet soup but cytochrome P450 enzymes and how they're interacting with 12 different cannabinoids, which is very interesting. But let's go a little bit higher, as I said, and I'll have a link to it in the show notes. You were part of a really nice article with Emma Stone with Leafly, and I thought you guys did a just a great job of sort of an overview of what things can interact with cannabis. And I think one of the first place I want to start, because it's where you guys started, is cannabis drug wise. It's not just one thing, is it? 

Dr. Cody Peterson It's very far from that. Right. And that's why historically we haven't liked it in medicine is because it isn't just one bioactive molecule. There's numerous and there can be. Right, let's say dozens or even hundreds of bioactive, meaning molecules that have effect in the body, just hidden in within one cannabis flower. Right. There's little inflorescence. Now that can be beneficial if we believe in natural products and this entourage effect where we can get multimodal effects, you know. But the flipside is true, too. Cannabis is an imperfect medicine. It's hard to really achieve your desired effect without dealing with at least one unwanted side effect. Right. And this is once again a fact of, yes, there's many molecules in cannabis which range from cannabinoids like THC and CBD. Terpenes or Terpenoid like Limonene or Myrcene, Pinenes. All the essential oils of the cannabis plants. And there's even more molecules in there, flavonoids and things of that nature that can actually interfere and interact with enzymes in our body. So as we will be talking about enzymes a lot today, there's no lack of molecules that can interact with the human body in that cannabis flower. 

Trevor: Thank you. Now, honestly, something that I'm not sure I think about enough as a pharmacist, but there's not even one type of interaction, is there? Yeah, especially in the article, you guys were sort of highlighting the difference between pharmacodynamic and pharmacokinetic interactions. Can you kind of run through that for us? 

Dr. Cody Peterson Absolutely. So for any pharmacist listening, this is a jump back to your early therapeutics class, right? When we're talking about pharmacology, the study of drugs, we can actually separate that into two specific sections of studying drugs. That's pharmacodynamics, studying what drugs do to your body, and pharmacokinetics the studying what your body does to the drug.  How does it transform it? How does it move it around? And then ultimately, how does it excrete it? Now what we see, especially focusing on cannabinoids when we talk about cannabis, because that's really the magic plant molecule here. Plenty of those other ones are bioactive, but we know that cannabis plant is one of only a few plants on the planet making these these specially shaped molecules that just so happen to interact with my favorite system in the human body, the endocannabinoid system. Now to to kind of dive into your specific question a little bit more. What we see generally is kind of what you would expect. But when we look at THC, we actually don't see that many what you would call drug-drug interactions in a traditional sense or drugs interfering with the metabolism of one another. This is how we often think of drug interactions. We think of fluconazole or we think of something inhibiting an enzyme. But what we do see with THC, and this is no surprise, is a psychoactive effect, right.  Almost an augmentation of many of the neurotransmitters in our brain. When combined with other substances, we can see a synergy. Right. And both the good effects, maybe this means enhanced pain control when you put cannabis or THC and opioids together. But it can also mean negative effects. Maybe you take some sort of atropine or some sort of anticholinergic. And we know that THC also causes dry mouth, dry eyes, etc... And now all of a sudden, you're dealing with a really bad case of red eye because you were rubbing your. So that's really about what we call pharmacodynamic interactions, right? The drug's effects are synergism or kind of working against each other. And then we also have pharmacokinetic effects and CBD is much more notorious for these. And these typically surround the metabolism of substances or maybe movement throughout the body being carried on on the same raft. So CBD is much more likely to interfere with these enzymes resulting in altered metabolism potentially of THC. Sure. But more importantly of your other pharmaceuticals could even lead to sort of increased exposure to the drugs and serious side effects in rare cases. 

Trevor: Okay. That's a nice overview. Thank you. And like I said, unfortunately, I'll admit I am guilty as a pharmacist of not thinking about those sort of two groups quite enough. Now, let's talk about some groups of drugs that people are going to be familiar with. Let's start with stimulants. So, you know, things that people I've definite almost every on the planet has had caffeine and a good chunk of our listening public has had experience with things like ADHD, drugs, which are stimulants. What do the cannabinoids do, kind of in general with our with our stimulants? 

Dr. Cody Peterson Well, importantly, we've talked about as to sort of different stimulants. Caffeine, which, by the way, is probably the most commonly consumed drug on Earth. 90% of Americans are consuming this substance every day. And if you don't think you are, you probably are in a drink, a soda or some sort of caffeinated beverage you didn't realize. Tea, etc.. Now, caffeine is absolutely a stimulant, but it works very differently than the amphetamines, which we'll talk about in just a second. Caffeine and cannabis, you know, this isn't just personal preference. This is a match. This is a very commonly consumed combo that's again, a bit redundant. But what we see with cannabis and THC and caffeine is sort of an opposing effect. Right. We tend to see this upper effect from caffeine, a bit of a downer effect from THC. And we actually tend to see a little bit of evening out. Right. Maybe they counterbalance each other. And this is probably why so many people enjoy this combination, particularly early in the morning.  Where THC would normally cause a little bit of sedation. But if you kick it up a notch with caffeine, you tend to see a response in that. Now, this is different, right? And that drug interaction is definitely different than what's going on when you talk about stimulants like Adderall, Ritalin, Concerta, all of these is the brand name medications for amphetamines and they're derivatives. Now, these medications are very powerful and very excitatory. They can cause the release and inhibit the re-uptake of multiple neurotransmitters, including nor epinephrine, which is sort of the fight or flight molecule or related to it. And we also see a big dump of some serotonin and dopamine and we see the synapse kind of get rushed with these neurotransmitters. Now, THC has the potential to augment both of those transmitters on its own. So when we combine these stimulants and THC, we can often get quite a profound effect and almost augment the effects of the stimulant and in a naive patient, probably overshoot the therapeutic window and get off into maybe an anxious, a paranoia, just a hyper-stimulated state. And that's not uncommon. Right. So the combination of THC and let's say Adderall is highly discouraged among pediatricians just because there is A. increased abuse propensity. Right. We see that if you co-use Adderall and marijuana, you're more likely to abuse either substance later in life. But then the other the other thing is, is we just seem to get less adequate control in a lot of these patients who are taking both stimulants and cannabis. What we find is a lot of times these patients are using THC to manage their attention. Some patients do this extremely effectively. Other ones sort of learn and grow with the process. And the other students really struggle and they never really put two and two together, pun intended, that that we have, you know, sort of a polypharmacy problem. Where the THC is creating ups and downs and the stimulants is taking us too far, even higher and even lower. Right. So I think what we tend to see is, is an augmentation in a negative way. However, there are many, many patients with ADHD who report increased benefits of both. Right. So just like all of medicine, this is not a one size fits all. So the general consensus is avoid. However, what we can see is we can actually see these two synergize quite harmoniously with a patient who's very conscious about dose and really gives it the time and effort they need to fine tune their, let's say, study habits. 

Trevor: Okay. Now, just because it comes up now, not all the time, and they're usually young, healthy people, but Stimulant said young people, we do sometimes worry about cardiac issues and, you know, increase heart rate. And there has been some reports about increased heart rate with THC. Do we worry about any sort of cardiac problems with the two of them together? 

Dr. Cody Peterson It's a great question. And no doubt, I mean, I worry about cardiac issues with either medication alone. Right. We know that stimulants, anything with amphetamine in its name has the potential to increase heart rate and THC. It's not even a question. THC causes tachycardia. We know this because there's CB1 receptors inside of our cardiac myositis and when we stimulate them, we can cause increased contractility, a little more fast heartbeat for whatever reason, not for whatever reason. For a pharmacological reason that I can't remember is what the real answer is. Now, I'm very sure of this. So when we see these two together, we will absolutely see increased heart rate for at least that brief time. Right. Especially if you sort of peaking on both. Right. You've just smoked and you took your Adderall, let's say 90 minutes ago or an hour or 2 hours ago. So you certainly there's an increased risk. However, both of these medications should be avoided in anyone with severe cardiac disease and the combination should be considered. I mean, any patient who's on a stimulant should be thinking about their blood pressure and their cardiac rhythm, because we know that these medications can cause that. But to answer the question most directly, yes, Trevor, your patients should be thinking about their heart rate. Now, the flipside is, is it's unless you have, you know, sort of a poorly functioning ticker, the truth of the matter is a little bit of tachycardia probably won't hurt you. Now, please don't go run out the door and push it to the limit. But but the truth is THC's tachycardia is usually mild and it's very transient. It goes away. With edibles in a matter of a couple of hours and with smoking, usually within the matter of an hour, just by sheer distribution of the THC into the fatty tissues in the body. 

Trevor: Okay. And I'd love to spend more time on all of these, but we've got limited time. Let's switch gears to depressants. So tell us a little bit about what depressants are, what cannabis does, and well, we'll sort of go off from there into epilepsy because the depressants and epilepsy kind of go together. 

Dr. Cody Peterson Yeah, it's a great question. And the truth is cannabis in itself is, THC anyway, is a bit of a depressant. Right. We see a higher dose is a sort of sedating effect and this is what most people are using cannabis for, at least when they're using it late at night. So this is no surprise. Now, when we say depressant, we're talking about a few different things. But the general class of medications that that come up to people's brains should be alcohol. Should be barbiturates, which are very uncommon now and benzos.  Now benzos are very common now, particularly Xanax, Ativan, Klonopin. And all of these substances are being abused, unfortunately, to some extent. On their own, benzos are sedating and relatively safe. They're actually rather difficult to overdose on. When combined with THC. We still see a rather safe medication. We do see an increase in sedation when we combine benzodiazepines with THC. But because THC and benzos, neither work directly on the respiratory part of the brain nor work strongly, it's slowing down the parts of the brain responsible for our other autonomic functions. A-OK. But be on the lookout for increased sedation when you're going driving when you're you know, please don't go driving on your benzos. But if you're walking around the house to get a munchie in the middle of the night, whatever you're doing be extra careful because definitely lightheadedness, sedation, grogginess, all of these can be enhanced just like we talked about that pharmacodynamic interaction. 

Trevor: So one thing with benzos, I can't because we have an older population here, you know, so benzo was a very common sleeping medication for better or worse. We won't get into that just but you know, if somebody was using a benzo for sleep and then, you know, maybe some CBD for their arthritis, do I have to worry more about them getting up in the middle of the night and breaking a hip? 

Dr. Cody Peterson Wonderful question as well. And in the case of CBD, right. Rather than THC, unless concerned about that specific issue. However, there's some other considerations. Right. We would need to discuss with the pharmacists. But, you know, certain benzos have the potential to interact with CBD in the way that we discussed. CBD can interfere with the enzymes, thus leading to more benzo exposure, which again maybe that means better sleep and no big deal, but maybe it also means you're feeling lightheaded, or maybe you're feeling hung over in the morning and groggy because of the way the CBD has altered the metabolism. So there is an interaction. Generally speaking, we are talking about increased sedation, but you're talking about something a little bit different that's a little bit more over the long term with CBD because it sort of happens over a course of time. As opposed to THC. You're really talking about those side effects in that acute sort of high period. So again, around smoking is a couple of hours and edibles a few. 

Trevor: Thank you and so I interact I interrupted you a you were telling us something else about I think benzos and depressants in general when I jump through my breaking hip. 

Dr. Cody Peterson No, I think it's great because you got me to talk about CBD. And CBD and THC are both going to interact with the next substance similarly. Right. And that's alcohol. Alcohol is very much a depressant. And in some ways it's I like to say this because people don't always realize it. It's actually a bit of a poison, right? THC has a very specific place in the body. It likes to go act. Alcohol does not. It's dirty. It floats into every nook and cranny and just causes havoc. Right. That's why you feel like shit in the morning. So anyway, alcohol and THC and cannabinoids in general do interact. Alcohol has this ability to disrupt this very important barrier in our bodies called the blood brain barrier. Turns out we all evolved to protect our brains from any of the stuff in the world. So you got this extra tight seal around our spinal cavity and our brain. Now that barrier gets disrupted when we start consuming even just one drink and it starts to get a little loosey goosey. And what we see is that one drink combined with one marijuana cigarette. That's what they study. They're what they called it when they studied it. Right. And they found nearly double the brain concentrations of THC in the rodents that they went and did this on. 

Trevor: Well, that's fascinating. 

Dr. Cody Peterson Right. And so when they when they evaluated these brain THC levels, they found that that penetrated much better with just one drink onboard. And that is a really important factor. Again, I'm reaching back to these studies. I can't remember this one wasn't a rodent study. It was a human study. But but again, because I can't remember all the details, I don't want to speak, but I promise across the board, what we see is alcohol increases THC concentrations, and with that, it also increases your likelihood of getting into an accident. We know that THC plus alcohol is more likely to cause an accident than either alcohol or THC alone. And obviously, if you compare those THC is down. Then alcohol alone. And then the combination. This isn't just about sort of oh, we found it in their urine. No, this is THC blood levels. And they found that this higher level of THC in the blood, along with alcohol, suggested a higher risk of having a car accident. So there is some real risk of of intoxication with this combination. And unfortunately, not as many people sort of respect I think this potential for getting a little looser than you think, right. This alcohol, because it's so it's so acceptable. 

Trevor: I just to say and it's very common for someone to have a beer in one hand and get it legal now. So beer on one hand and a joint in the other is a very common thing. And you're right, I don't think most people appreciate that the effects that both of those are having together. 

Dr. Cody Peterson Yeah, together. And the same thing can happen with CBD. It will penetrate the brain better. This disruption still happens, but CBD is not overtly and not even overtly. It's not intoxicating, right? It is psychoactive. It does change the way your brain works, but it is not intoxicating. So that's one. And then there's other sort of downers that you could go and try to pick them out, but you're going to see very similar reactions, right? THC is going to augment any sort of sedative or intoxicated effect and then you're going to and potentially even the addictive effects, because there's a dopamine tickle from THC and then CBD has this potential for pharmacokinetic interactions, altering the metabolism, usually reducing the metabolism. 

Trevor: Okay. And so I don't go over time, I better be a good pharmacist and ask about red flags. Absolutely. Don't combine these with cannabis or be very, very careful for color any sort of red flags? Hold the phone, let's not do this kind of medications we should be worried about. 

Dr. Cody Peterson Absolutely. So I can't give you an extensive list. Right, because there's a lot of drugs out there. But any drug you might consider narrow therapeutic index. Right. So this is the Tacrolimus is in the Sirolimus in the world. Anything you get levels. Right. That's not just fully clear, like an aminoglycoside. You really should be thinking about this. Any blood thinner. Anything having to do with coagulation except for maybe aspirin. I'm very conservative with and once again, when we're talking about this generally we're talking about CBD. THC usually has this pharmacodynamic and can cause more sedation, but the CBD really has the potential to adjust the levels of other pharmaceuticals. And I think that's where it gets most scary. And just to give a little case report that did come up in the literature. There was a patient who was taking Meloxicam for a long time for their arthritis, and then they opted for CBD in addition to. Right. And seemed pretty reasonable. Sure, they were on the Meloxicam for many years, started the CBD and over the course of a few weeks, over the course of a few weeks, they titrated up the CBD oil. And what ended up happening is the patient got a very serious skin disorder known as Stevens-Johnson syndrome.

Trevor: Well, that's nasty. 

Dr. Cody Peterson It's very nasty. And it can be life threatening. Now, what's interesting here is CBD doesn't cause Stevens-Johnson syndrome, but CBD does interact with the metabolism of the Meloxicam. And the Meloxicam level therefore was increased, which therefore put the patient at higher risk of developing a Stevens-Johnson syndrome. So now you can kind of see how pharmaceuticals plus CBD can, in rare cases, become problematic. And again, this isn't directly dose dependent. I cannot tell you what dose, but we do know drug interactions are highly dose dependent. Depends on how much you're taking, which cannabinoids, how often all of that. 

Trevor: Dr. Peterson, this has been really interesting. Was there anything you'd wish I'd asked or which the audience needs to know about? I know drug interaction is a huge topic and this was more an overview than anything, but it's been really good. Anything else you wish I'd asked or think the audience really needs to know. 

Dr. Cody Peterson Yeah, I think the audience needs to know where to get the answers to the rest of their questions. So they need to do it www.cannigma.com.  That's Cannabis enigma kind of conjoined into one word. And the idea is we don't know all these answers and we need health care professionals to be engaged answering them, not just SEO content writers. And that's what you get at that, the Cannigma. So I can't I can't wait to just see your face on the website. 

Trevor: That is a fantastic plug for Cannigma. My we will definitely have a link to that in the show notes as well. Thank you very much, Dr. Petersen. This has been great. 

Dr. Cody Peterson Looking forward to the next one, Trevor. 

Trevor: Before we talk more about interactions, which of course I like, but I might be boring people. You were digging more into the Cannigma website. What are you thinking about this or what? One of the it seems like one of the many things that Dr. Petersen is involved with. What do you think about Cannigma? 

Kirk: Well, Cannigma, I aspire to be Cannigma. Their web page is amazing. And not to drive people away from our Web page, but from our Web page, we'll link this Web page. This is a really stunning resource for cannabis. And but, you know, in some ways, it might be mistaken, is very commercial in the sense that it's, gosh, it's like a Rolling Stone magazine for music or People's Magazine for entertainment. It really does have all things cannabis in here. You know, Cannabis 101.  Discussing how to grow cannabis. The regulations in Europe and USA. They seem to focus on Europe, USA and Israel. So are there other countries listening to us may not see value there. That's the regulations. But they go on the strains. They go on to the science of cannabis.  Cannabis and children. Cannabis and attention deficit. Superbugs and CBD. Recipes. How to make your own oil. How to smoke a bowl. How to make kif. They review products. They have a whole medical section. It's it is truly a brilliant resource and I think I've bookmarked it on my page. 

Trevor: Kind of what we want to be when we grow up. 

Kirk: When Reefer Medness - The Podcast grows up. We aspire to have this web page. Yeah, but you know, one thing I want to I want to touch on, what he was talking about is attention deficit syndrome. I found that area of the conversation you had with him very interesting, because I think, people of my generation back before Ritalin became popular. Now Ritalin became popular around the nineties. I'm thinking like it was it's been out there since 54 or 44. It's been out there a long time. 

Trevor: And it seemed to become because, we talked about this a lot. I'm not really outing it. My friend's older brother, you know, in grade seven was in the principal's office like he had a run of, you know, being in the principal's office every day for half a year because he, you know, he was the ADHD kid. He just couldn't sit still. He was always bored, has always disrupting everything. And I guarantee if Joe was in school today, he would be on Ritalin like that. Joe is now a obstetrician gynecologist who does teaching on the side. You know, he's just, you know, but he has to have a few projects going at a time. And then but, you know, it's a super smart person who, you know, you kind of you kind of forget that, you know, the disruptive kid. I'm not saying all disruptive kids in grade seven are necessarily going to go on to become Joe. But there, I agree. It seemed like when I got out of pharmacy, which was 97, it really started taking off that we were putting more and more kids on the Ritalin.  And the other amphetamines because we \ used the word amphetamine during the conversation. So Ritalin is an amphetamine. 

Kirk: Yeah. I grew up I grew up with a poem. You know what little boys made of little boys made of snips and snails and puppy dog tails. That's what little boys are made of. And what a puppy dog tail's doing. 

Trevor: Movement at all times. 

Kirk: They're, always moving, right? So I mean, I grew up in the sixties and seventies when my school was happening and little boys were always, you know, getting detention and straps and I think as we became adolescents, a lot of us self-medicated, and that's what kept us focused in the classroom. So I found it interesting that, you know, there's some information about those of us that are still self-medicating who may now have Concerta. Is that what's the what's the trade, the brand name? 

Trevor: Well, Concerta is one of the types of Ritalins. That's a long acting one. 

Kirk: Yeah. So, I mean, these things are being passed out. Sorry, but like candy in the nineties and little boys and you know what? God, I've seen parents that have had wonderful, wonderful reactions to little boys that have been put on Ritalin and being able to focus. I get it. There's a purpose. But I've also seen I've also seen little boys put on Ritalin because somebody can't control them. So I think it's interesting to see that a lot of people, our generation, my generation and although you always consider yourself the old one on the team, you're actually the puppy. Yeah. You're just the one still working. But but my point is, is that I guess there's a lot of guys, my generation, that could still be, you know, self-medicating to keep themselves a little small in anxious situations. And I think, you know, a lot of us turned adolescence and we found ourselves, you know, tired of being yelled at by teachers and may have discovered cannabis. And I think I was one of those young kids. I discovered cannabis as a teenager, and I found myself able to go to a classroom and actually focus. So I found it interesting in talking about the interaction of Ritalin and cannabis. I should give you room to speak on that. 

Trevor: No, no, no, no. And I thought that's a really good segue way because and Dr. Petersen made it really well. So think about what's probably happening. That's our prototypical 13 year old boy. You know, he has, you know, teachers, parents, doctor have put him on Ritalin and that's helping. But on the side, he's also discovered cannabis. And that's helping. 

Kirk: Yeah. Yeah. 

Trevor: But do you think the 13 year-old boy has told the parents and doctor about the cannabis? Absolutely not. And what would just if you were that 13 year-old boy? Right now, we're not saying you can't do both, but at very least tell your doctor, pharmacist about it because they don't always play nice. We're not saying.

Kirk: Well, according to the law, as a 13 year-old boy is allowed to listen to our podcast, I. 

Trevor: Don't know. But. 

Kirk: I mean, as we're trying to be teachers I hope they are. But it's that's a different that's a different podcast. 

Trevor: But it was just a really interesting point is, you know, it is probably two completely different worlds and let's just let's just bring that together a little bit. 

Kirk: Well, but this goes back to normalizing cannabis. I mean, you know, how hard is it for us to normalize cannabis? I've discussed this.  I will freely, I'll freely talk about my habit in fermentation and how I've been doing it 35, 40 years, making mead and, you know, Melomels, beers and wines and growing fruit trees for the specifics of fermenting it. But I'm very cautious talking about the fact that I'm a medicinal cannabis user, learning how to grow cannabis. Right. And I find that interesting because why should I be afraid of saying that? Well, I live in a province where they don't allow recreational cannabis growth. So the stigma attached to that. But, you know, we don't talk about our medicinal cannabis use. And a lot of people a lot of people in the green culture, you know, the people that the laws seem to have forgotten about, the guys that have been growing cannabis for decades that that missed the jump or the bridge to the commercial side. These guys are still very paranoid and don't share their knowledge and their experiences with cannabis. And I'm saying this, Trevor, because I sometimes find myself there too. You know, I've got 45 years experience, with cannabis and as much as I've been outspoken over the decades, as being a nurse. You don't always broadcast it in a forum like a podcast, you know. 

Trevor: Absolutely, but I'm going to I'm going to go back to your fermentation because it's something I literally had, you know, a lot of some or all of what Dr. Peterson had said I had heard parts of before. But one of the ones that took me completely off guard, it makes sense, but I never thought about it was alcohol.  And alcohol disrupting something called the blood brain barrier, so. Pharmacology 101 there's the brain is designed to keep stuff out of it. Like it's hard to get drugs into the brain if we need to. That's good. But, you know, it's so it's got these really tight junctions that sort of doesn't let stuff in. We call it the blood brain barrier where alcohol loosens that blood brain barrier and could let more THC in. So you could get more effect of the THC because the alcohol is disrupted that blood brain barrier. You know, and like I said to him, you know, how many people haven't had a joint on one hand and a beer in the other and had, you know. So just for our people out there using cannabis. We're not saying you can't, but just it's more be aware. 

Kirk: Well, that's and I guess that's what we're trying to do in this podcast is make people aware and becoming more aware ourselves. And like I say, you know, 90 episodes ago I thought I knew what I knew about cannabis. Now I know what I don't know about cannabis which is a lot, you know, we meet up with a guy with a PharmD and a master's in cannabis science. I'm thinking, God, I'm feeling really small now. I'm feeling like, my goodness, knowledgeable man. It was a it was a good conversation. And it goes to show you that, you know, it's sort of going back to our other our other episode about cardiology, you know, everything in moderation. And if you're going to if you're going to do cannabis, be aware that it's not a benign drug. 

Trevor: No. And last, before we get on to our my cannabis stories, I know we got a good one this time around. And this is not a Trevor: trying to scare everyone. This is a keep your health care professional in the loop if you're using cannabis. 

Kirk: Yes. 

Trevor: So he had a Meloxicam CBD case study. Meloxicam is a very common we'll call it arthritis drug. Painkiller anti-inflammatory. Lots of people are on it. But we had somebody who was taking Meloxicam for their arthritis and then they added CBD, which is also could be good for arthritis and that them together and they got Stevens-Johnson syndrome, which is a terrible and frightening condition. It's kind of like an allergic reaction where you can have like a rash all over your body and then really serious things like literally sloughing off godly awful chunks of your skin. And it's nasty. 

Kirk: It sounds like a Harry Potter curse. 

Trevor: Yeah. Like it can be. You know, there's serious and not serious versions, but the serious ones are really bad. So no, not everyone who gets takes the CBD and the Meloxicam together is going to have this. It wasn't the CBD is fault. Meloxicam and I've given up hundreds probably thousands of prescriptions of Meloxicam. And I've never, ever seen Stevens-Johnson syndrome, but it's one of those rare side effects of Meloxicam. But because of the CBD kind of increase the amount of Meloxicam in the body, that's what they figured led to it. So, not trying to scare any one away from using cannabis, but just if you're someone using cannabis and a prescription medication, keep your health care team in the loop. And if you are a practitioner pharmacist say and weird side effects start popping up. Think about cannabis is something that might be involved. 

Kirk: Yeah it's it's it's incredibly important to ensure that everyone knows. Yeah. I mean I'm starting again normalizing cannabis use. I'm starting to be a little bit like when I go someplace. Are you on a medication? No, but I do smoke cannabis. I like flower. I went to.  Digressing. I went to a garden party last night, a house concert out in a garden. People, Dauphinites, old time Dauphinites. People that I know from a while back and catching up with them. And you know, I'm sitting there, I got my beer. I'm thinking, do, do I bring my flower out? Do I do I have a puff? And as I'm having my puff, I, you know, I ask anybody wants to join me because that's the natural thing to do is, you know, do you want to join in this? No, no, I'm on gummies. And the other guy says, oh, yeah, I'm on cookies. And and as I'm sitting there, everybody's on cannabis. They've all eaten it. And I'm the only one smoking, I think, Oh, it's a cannabis party, but no one's talking about it. And until someone asks the question, would you like would you like a puff? No, I'm taking gummies. So normalizing cannabis, I mean, the person beside you at the concert seguing, the person beside to the concert could very well be on cannabis. You don't know it. And here's my segue to the My Cannabis Story. All right. I was at a concert at the Watson, the Watson Art Centre, which people well know that I've discussed often on this podcast. And Desiree Dorian was playing with Emma Peterson and Quentin Blair, and they, they were doing it in the round. Now, again, things are you know, things are always close in small town, Desiree Dorian does our theme song to Soul Back Jack thing. So she was there. Who should I meet was Aaron Benham. And who is Aaron Benham? He was episode three, the lawyer. So I asked him, Hey, Aaron, how's your cannabis practice going? And this is what he's told. 

Aaron Benham Well, I can say for one thing that, you know, any of the fears of, you know, there being sort of a big growth in cannabis use and crimes committed under the influence of cannabis; that is simply not happened. What I can say is that I haven't seen any criminal cases come to me that involve cannabis. So some might be surprised by that because there are still criminal charges that involve cannabis. I haven't seen any come across my desk and I have a large rural practice in western Manitoba. I haven't seen anything involving the possession of too much cannabis. I haven't seen anything involving the illegal selling in cannabis. I haven't seen anything involving the selling of cannabis to minors. I haven't seen anything involving driving under the influence of cannabis. And I haven't seen any cannabis tickets. I really haven't seen anything involving cannabis.  Now, our police agencies are still going after cannabis issues? I'm sure they are. I can't speak to what's going on in Winnipeg, for example, according to police service, but I think I have a decent idea of what's going on in rural Manitoba with the RCMP and what I can say is that's not their focus anymore. 

Kirk: Essentially, the sky did not fall. 

Aaron Benham It absolutely didn't. 

Kirk: And compared to your practice before 2018, cannabis is not a big part of it. 

Aaron Beddome: Like I said, I think that there's been a drop off in focusing on cannabis. I can't speak for police agencies, but I would imagine that they are thankful that they can now focus on other, more harmful drugs rather than spending their time on cannabis. Again. I can't speak for them, but that would be my impression. 

Trevor: So I am fascinated. And Aaron says a couple of times it doesn't mean that he's got the end all be all about cannabis in Manitoba. But it's interesting for someone who has a largish practice in western Manitoba. Cannabis just isn't a thing anymore. 

Kirk: Well, off camera I was discussing with him, you know, he was a very young lawyer. What is it? Four years ago when we interviewed him? Five years ago we interview. So he's got five years experience and he's got lots more experience and cannabis is not a part of it. I thought that was fascinating. And again, it's just a blurb, right? It's a My Cannabis Story in this criminal lawyers practice. Cannabis is not an issue. The sky did not fall. Reefer mildness is what I've been hearing about Canada's legalization of recreational cannabis. But where we got to start working on my friend in medicinal cannabis rights.  And there is a whole bunch of stuff happening in the medicinal side. So I think we got again, yeah, more to do, more to do on our blog. And I've got some stories coming up that I'm looking at doing. We've got a new extraction plant in Dauphin. I hope to go to talk to go talk to those guys. And I hope to also talk to a young lady that works for one of the cannabis companies as a medicinal guide. Medicinal cannabis guide. She helped people obtain medicinal cannabis. So we're going to have a few more stories out on the medicinal cannabis coming. 

Trevor: That sounds great. So I guess I should say I'm Trevor: Shewfelt. I'm the pharmacist.

Kirk: I'm Kirk: Nyquist. I'm the registered nurse. And we are Reefer Medness - The Podcast. And yes, you know what I'm going people. Webpage. Reefermed.ca. It's a great Webpage. Not a magazine yet, but it's definitely a great webpage. All of our references are there. Also, please, I encourage you to give us a reference or a evaluation on the podcast platform. If you're on Spotify, tell Spotify. The best podcast is Reefer Medness - The Podcast.  Give us a rating. Send us an email. 

Trevor: Sounds good. And we'll talk to everyone next to Cheers. 

Rene Well, that was another good one, guys. That's Rene here back in the studio. And it's my role as it is traditionally to get into the song request from our guest. We'll get into that in a moment. But first, Reefer Medness - The Podcast wants to acknowledge that we produce our shows on Treaty two territory and the Homeland of the Metis. We pay our respects to the First Nations and Metis ancestors of this land, and we reaffirm our relationships. And the song that we are going to end the program with today is a song that Cody Peterson has chosen because he said it won't leave his head lately. So it's revolution and lay my claim.