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E34 - Sex and Pharmacy

Kieley Beaudry has so many facets to her cannabis knowledge, including Co-Founder of Parkland Flower Inc, President of the Alberta Cannabis Micro License Association, and parent of a child with Cystic Fibrosis (who uses cannabis).  But Kieley agreed to enlighten Kirk and Trevor on a delicate and often overlooked topic.  Kieley talks about cannabis as treatment for sexual dysfunction.  Kieley is not a health care professional, but is extremely well read and knowledgeable.  Kieley educates Trevor on topicals, suppositories and many other uses of cannabis especially as it pertains to female sexual health.  This episode is in no way graphic but it does acknowledge the existence of sex, so if you are listening with people with sensitive ears be aware.

Rahim Dhalla is a pharmacist and CEO of Hybrid Pharm in Ottawa.  Trevor constantly whines how he can't bring cannabis into his pharmacy to help patients.  Well Rahim has found a way.  Come listen to how Rahim helps patients with medical cannabis and he even compounds things like cannabis suppositories.  Rahim is dedicated to helping improve his patients' lives and he has found cannabis is an important tool in health care.



Episode Transcript


Trevor: Welcome back, everybody. 

Kirk: Welcome back. Hey, how are you? 

Trevor: I'm good. We are Reefer Medness - The Podcast. 

Kirk: Reefer Medness. You've got two stories to tell me. 

Trevor: I do. But before we do that, I'm Trevor the pharmacist. 

Kirk: Still? I was worried about you.  I'm Kirk Nyquist I'm the nurse. 

Trevor: So, Kirk, I've been talking to some interesting people. We've got Kieley Beaudry. She's in Alberta and she does a bunch of cannabis related stuff. But we have her there to talk. I can't even say it with a giggling. We're talking about cannabis and sex. 

Kirk: You know, you're telling me this. I was up north. I didn't have time to listen to the interview yet. 

Trevor: I think you're really like this one. 

Kirk: You're not giving me a chance to listen to it. 

Trevor: Well, how about, we'll let Rene play this one for you? 

Kirk: OK, so I'm going to listen in. So, tell me, what should we expect from this? 

Trevor: She's very knowledgeable, very, very clinical. Now, she'll be the first to say she's not a official clinician, but she's got lots of personal experience and she's sort of gone around to, you know, had... picture, you know, Tupperware parties. But for people interested in using cannabis to help with some sexual issues. 

Kirk: OK, so this is you want me to picture a Tupperware party without the Tupperware? And does she see couples? 

Trevor: It sounds like she mostly talks to women. 

Kirk: Groups of women. 

Trevor: It can be groups, groups and individually. Like I said, she's got lots of she's got lots of lived experience and lots of lots of reading behind her. Like she's very, very careful with what she says that she's not, she doesn't go into hyperbole at all. 

Kirk: OK, well, I'm intrigued. 

Trevor: She was very good. 

Kieley: Well, hi, I'm a mom of three, I have three kids. And I've been kind of working in the cannabis industry for the past year and a half and started it with cannabis when I was kind of in high school as recreation. And I think a lot of people kind of started out that way and just over the years got more and more interested in the medical side. And treating family members with cannabis has something that really peaked our interest and just learning more and more every day about it. 

Trevor: So, a couple things that we've sort of thrown emails back and forth. So, a couple of interesting things on the medical end of things. Your oldest child has cystic fibrosis. Were you using cannabis at all with the child with cystic fibrosis? 

Kieley: Yes, I do. She's currently on a low dose of CBD oil. I took her into specialized cannabinoid clinic. And I just basically wanted to I've done a lot of research and not just on cannabis, but I've done a lot of research on CF. I've spoken to a lot of adult cystic fibrosis patients that consume cannabis to help with some of their treatments, and they find a big reduction in the inflammation in the lungs. So, we're basically using that as a preventative treatment to help with that. She is on a lot of inhaled antibiotics to treat some different bacterial strains that they've been finding that CF patients basically get these bacterial films in their lungs and it creates a breeding ground for bacteria, which then causes a ton of inflammation. And so I've been treating her with CBD for that and also to help to with anxiety levels. Especially surrounding hospital stays. She's only eight-years-old and it takes us about two or three months to kind of get her down from that high anxiety level after she'd had a hospital stay. And we found great success with treating her like that. 

Trevor: Now, that's really good. One of the groups her volunteer with is the Kinsman Club of Dauphin.  Kinsman Canada have been raising money for CF research for a bunch of years now. And sort through my professional work as a pharmacist, I've run into a few families with CF. On the plus side, you know, it's a disease that kids didn't usually get out of childhood and now they're getting into their 20s and 30s. But it's still something we certainly don't have a cure for. So I'm really glad that CBDs is helping her with, you know, the anxiety and maybe some of the breathing problems. The other interesting, not that your whole family's not interesting, but you had some stuff with cannabis and I think it was your father-in-law. Tell us a little bit about him. 

Kieley: So about 2012, 2013, he woke up blind one morning. Just out of the blue, just hit him like a freight train and took him down to the hospital and they did a CAT scan, discovered that he had four tumors. Once they did, they removed some of them. And it was glioblastoma, which is pretty severe. It's difficult to treat a brain tumor. It's difficult to remove them. And they were able to take out two of the bigger ones, but they were afraid to work on the other two. So, then we went through rounds of radiation and chemotherapy and at that time when we approached his oncologist regarding cannabis and, you know, we had done a lot of reading about, you know, the anti-tumor effects and whatnot. His oncologist basically said, if you want to do to cannabis treatment, then find yourself a new oncologist, which was pretty disappointing. 

Trevor: Yeah, I'd be crushable. 

Kieley: So instead of doing that, we just did it under the table, under cover. We obtained a few pounds of cannabis as high quality as you could kind of get on the street. And we started making Rick Simpson oil. And I mean, we were just following what we could find on the Internet and talking to other people that had treated their parents or another family member. There's not a day that goes by that I, I wish I had known what I know now, you know, just on how to make better products, you know, different remedies, I guess you'd call them remedies.  We basically just treated him. We used to just take the oil and put it kind of under his tongue and around his so he'd get that absorption in his mouth. And we used to treat him. We didn't tell any of the nurses this is what we were doing, but we'd have to sneak in there and give him his dose. And you know what it really helped with, he was already in palliative care by the time we'd even started cannabis treatment with him. So really, the antitumor effects, I think it was more to help him with his quality of life. You know, it helps with appetite, helped him sleep and definitely for pain reduction. As he got closer to the end of life, there was a lot of morphine and just enough to keep him comfortable. And so, cannabis really kind of helped him that way and just, you know, making sure that his exit out was more comfortable and he wasn't suffering as much. 

Trevor: Well, that's a bit of a harrowing story. But the not that those aren't, again, both really interesting. You've got so many things that was going to run out of time. But what I really want to talk to you about is a bit of a left turn from both of those, because you've talked and written and read about as a topic that we haven't dealt with here yet, and some people might be a little surprised. You have an interest in cannabis and sexual health, especially female sexual health. How did that how did you get interested in that? And what have you sort of discovered? 

Kieley: Well, I mean, I think as a lot of things happen, a lot of these things kind of happen by accident. But you start getting you know, I'm sure you get this a lot. You get family members and friends like, oh, you know, I have this friend who's got anxiety and wants help with this.  I started as I did all my research and started to learn more and more about cannabis and health effects and things. I actually just started hosting small educational sessions, mainly with women. You know, I come into somebody's home, I would talk to them about their endocannabinoid system. And as I started doing this, more and more women were coming up with, you know, oh, my gosh, I'm having these hot flashes and or I'm having a lot of pain when I'm having my period.  I started looking more into that and looking for studies and discovering that there's not a lot.  There's not a lot out there, except for all of this anecdotal evidence. Like there's so many stories of women using and consuming cannabis as a self-care treatment to help deal with some of the unique physical issues that women have.  Such as menstruation, birth, after birth, even pre-birth. Menopause. Endometriosis. I mean, these are our unique challenges that women have and there are lots and lots of studies out there, but we're not really looking at them as these are issues and that cannabis could be a treatment. In 2017, the National Academy of Science, Engineering and Medicine put out the health effects of cannabis and cannabinoids to identify the gaps. What we need to research and not one was listed with regards to women's health or men's health or sexual dysfunction or helping with acute menopausal symptoms. So, we've identified all these other gaps, such as anxiety and cancer treatments and epilepsy. And I think, you know, I just really want to kind of bring the awareness that it can treat so much more. 

Trevor: That's a huge topic at everything else. So we'll just quickly say, in case it wasn't clear, you're not a medical professional, but you have been doing a lot of reading, a lot of talking and have sort of a lot of anecdotal evidence to bring to people, which I think is very valuable. And I know our friends over at Strainprint are involved at trial right now with some researchers out of Israel on endometriosis. So, we're hoping. 

Kieley: Endometriosis. Yes, I'm following that study. 

Trevor: So, but how about for something that I'm not that endometriosis isn't common, but nearly everybody, once they get to a certain age, goes through perimenopause and menopause. What sort of things have you found about. Well, we'll start with hot flashes? Is cannabis helpful for those kinds of symptoms. 

Kieley: I've had women that started using a regime CBD, as well as using different teas, There was a company that started making an herbal tea with using cannabis. And I've had women use that tea. There's one woman in particular. She would get hot flashes three to four nights a week. She’d drink this tea on a Sunday evening. And then she wouldn't really consume anything else during the week. And she said just that one cup of tea on a Sunday evening just kind of helped me throughout the week. And then I'd have another one the next Sunday. And just even relieving. When a woman hits menopause, there's a lot of emotional aspects that happen. There's an anxiety. There's a lot of stress involved with it because your body body's kind of going, is it shutting down a system? And it can be painful. You experience a lot of things like vaginal dryness, which can definitely then create that the physical symptom that can then create an emotional issue when it comes to being in the bedroom or just in general and how you're feeling about yourself. So, I feel like cannabis is actually used to help with some of the psychological symptoms of menopause. I think it does help physical.  I can't say for sure because again, it's not studied. There's no real evidence out there that says this is happening. And that's where I'm promoting that some of these research institutes started looking more into that. There's a huge drive right now to find drugs that help with female sexual dysfunction. There's are six on the market right now for male dysfunction, but none for women. Only one just got approved and it will be available in September for a female. And it's first very specific disorder, the hypoactive sexual desire disorder or HSDD. That'll come in September. That'll be one of the first of its kind to help with the physiological symptoms. But I think really where cannabis is going to help is in relieving the anxiety and the stress. And then and now we've got a really interesting opportunity coming up when topicals come on board in October. And there are, you know, sexual lubricants that are coming out that are infused with THC and CBD. Suppositories that can help with pain relief or vaginal dryness. So, there's a lot of these products that are that are on the market right now in the illicit market that will hopefully be coming on board here in October. And we'll have an opportunity to study those. 

Trevor: And I agree. And as a pharmacist who compounds we, I've made all sorts.  With varying degrees of success, topical creams for, like you said, everything from vaginal dryness to, you know, we've even done things like put Viagra into a cream to see if it helps things like clitoral engorgement and with varying degrees of success. Tell me about have you talked to anyone who've used any of these sorts of topical THC or other cannabinoid creams for sexual dysfunction, and if it worked well for them. 

Kieley: Absolutely. Personally, I have used them. After having three children, there's a lot of healing that happened down there. And after having children, you know, it can take it can take three months and it can take over a year for a woman to really kind of bounce back and not have pain during sex. And I personally have found great success with using THC infused lubricant. And I do have a lot of friends. I compounded them myself, you know, just making them out of different oils and stuff and using them that way. I found products on the market. Other women have used them and they're like, it's like night and day. Because THC is a vasodilator, it does help bring the blood to the surface. And that's usually one of the issues when a woman is trying to be or trying to get aroused is increasing that blood flow. And that also helps with the elasticity. So, it's not just a sexual dysfunction that helps with those menopausal system symptoms when you begin to bring that blood flow and help with the elasticity. And yeah, there's definitely been, like I said, a lot of anecdotal evidence that that it does work and then there's even just consuming it mindfully to help relax the body and help relax the muscles, because it's also, you know, when you have that vaginal dryness or tightness down there, especially after childbirth, being having something that can relax the muscles down there and also relax your body, relax your mind really helps with boosting the chances of getting aroused. It involves a lot of foreplay and those types of things. But this is just kind of a little boost, just kind of boosted up a little bit. 

Trevor: I'm going to jump in real quick. Because someone I know someone's going to ask either now or later. So, THC in the lubricant vaginally is, you know, in pharmacy world is fantastic way to absorb stuff into the rest of the body. So, someone's going to ask me eventually, do people get high off of using a THC infused lubricant? Do we think it's just a local effect or do you sort of feel something in the rest of the body? Have you noticed or is any of that we've talked to noticed? 

Kieley: That is a really great question. Now, I myself have never gotten high from a topical. I have talked to people who feel like they got high or they feel like they got a little like a little tingly or a little buzz. I did find a study last year that basically ruled out that cannabinoids don't absorb into the bloodstream topically. And that's why using suppositories, you know, there's been evidence using suppositories, especially in children high dose. You know, you got depositary that are in upwards of 500 milligrams of THC to help treat some cancer symptoms. And they're using them on kids because it doesn't do that first pass to the liver. It's basically a topical.  Anything you use rectally or vaginally is actually topical. It's not an ingestible. Doesn't do that first pass through the liver. However, I will warn that if you use a THC lubricant and your partner then performs oral sex, they will get high. So, something to be aware of, especially when you've got women in menopause and their husband has a heart condition or anything like that. It's something to be aware of that if you do ingested in that way, you just need to be aware of that. The other thing is that a lot of the products on the market are infused in an oil. They're not water-based solutions. And so, especially in high risk populations or, you know, if you're concerned about sexually transmitted infections or worried about becoming pregnant, is that these oil based lubricants do not play nice with latex. 

Trevor: Well, that's important. Yes, very important to mention where we go over that and a lot in the pharmacy. Make sure you use water-based lubricant. So this is not one of those. 

Kieley: Yeah. So you want to make sure that you're using like a polyurethane condom if you're worried about getting pregnant and use other forms of contraception. But yeah, it's oils do not play nice with latex. And I'm interested to see the type of formulations that are going to come out with nanoparticle technology and with using isolate and being able to suspend cannabinoids in a water-based solution. That would alleviate that issue, you know, it's going to come for sure, but and the other thing is, cannabis lubricant, I don't know about you, but I feel like I want to go buy a lubricant, I want to go to my local drugstore where I buy all my other sexual health products. I don't want to walk into a dispensary and talk to a budtender. I don't know how anybody else feels about that. And I feel like that's something that. 

Trevor: I'm so happy to mention that. 

Kieley: I'm sure, because, I mean, we have such a big opportunity right now with this consultation on potential market for cannabis health products with Health Canada. We have right now until September 30 to give our opinions. And I invite all Canadians to go online and fill out that form. If you've ever used a cannabis product for any of these types of issues, let Health Canada know, because that's where these research studies are going to come from. That's where the research funding that are going to be put into. But we have to let them know. And so, all Canadians, not just medical professionals or people in the cannabis industry, just everyday Canadians can go on to Health Canada website right now and they can go to that consultation. I'm sure you guys have probably posted it in some of your content on your page. 

Trevor: We'll make sure we post it. We'll make sure we post it on this this one for sure. And yeah, I'll do I'll do my usual rant. Of course, these things that go through pharmacies, I'm not taking anything away from the dispensary. But yeah, people know people are comfortable talking to us. People are comfortable talking to their pharmacist about frankly, we talk about sexual dysfunction relatively often. You know, as people get older, you know, men and women over 50, it's pretty common. So why wouldn't you talk to the pharmacist. 

Kieley: Absolutely. And when you go to a pharmacy now, I mean, gosh, the amounts of sexual products like sexual health products, I mean, there's a massive; almost an aisle now.  Right on down to two specific devices that can be used during sex and to help stimulate the vulva and the clitoris. And so, I think, you know, this is a that's the place for these types of products. Not going walking into a cannabis retail store to buy these products. That is the place that they're going to be available right now. Let's be honest, that is where Canadians are going to be able to get them. That's kind of the service that I provide for women, is saying, you know. It would be awesome if it was in the pharmacy, but this is where you can get them, you know, this is where I hope to see them in the future. But you'll be able to get them right now. And the thing is, you can actually take your legal oils that you get right now. So, I mean, if you buy a cannabis oil from a retail store or even if you buy it from a medical, you know, you get a prescription and you get a medical, you can use that topically. You can actually mix that with even just an almond oil or an avocado oil and use that as well as sort of a something in the meantime. And people don't realize that that they can do that. And I talk a lot about that in the education sessions that I give. 

Trevor: So many good topics. Because Kirk will tease me, if I don't mention suppositories more, it seems to come up every episode. So, we talked a little bit about the lubricants.  Suppositories, especially dealing with the sort of the sexual health end of things. When do when do they come in handy? What are they what when are people talking about using and I'm assuming we're talking about vaginal suppository, right? 

Kieley: Well, for vaginal suppository, they come in, you know, when you're about to get your period. Well, gosh, I mean, you know, every month you build up this, this and endometrial tissue and then we sluff it off every single month. And it's not a pleasant experience to go through. Some women are lucky enough to that. They don't get cramping, but it's no different than uterine contractions after you've had a baby. So, when your body basically cuts off the blood supply to this tissue and basically kills it off, I mean, that doesn't sound that pleasant. And some women have debilitating pain when it comes to this. I mean, there's it's being talked about more that maybe women should be given a couple more health days, you know, to allow themselves to get back to work and things like that. Doctors are starting to confirm that some of these contractions can be similar in the pain level as a heart attack. 

Trevor: Oh, my. 

Kieley: Oh, you know, if you're going through this on a on a monthly basis where you're having debilitating pain and you're popping Ibuprofen and Tylenol or even stronger pain relief medications, the suppositories are localized and they get right to, even just rubbing a topical on your lower abdomen to help, and maybe it's a psychological thing, but I firmly believe that it does relieve that pain. A lot of women consume cannabis for pain, you know, whether it's vaping or smoking or ingestible. But for the suppositories, the nice thing about it is that you can do a much higher dose and not get high. So, you can still use THC and be able to go to work and play with your kids. You can you can drive. You can function. Now, I don't want to say that for everybody because there's not enough studies on it. I don't want you to go and take a two hundred fifty milligram THC suppository and then go try to drive to work. I mean, it's something that you should test out and see how your body reacts to it before you do anything like that. I'm always erring on the side of caution, but that is the great thing about using a suppository is that it's localized, it gets right to the source and you don't have the same psychoactive effects that you do from ingestible. 

Trevor: Thank you again. Very, very well thought out and well researched. Anything else that we should sort of talk about on this or the sexual health end of cannabis or frankly, if you've got any sort of favorite rabbit holes, you want to go down cannabis related, go, go right ahead. 

Kieley: Well, I mean, if we think of this is even this look at the names of the endocannabinoids that we produce in our body like an anandamide, at the root of that word is Sanskrit for joy and bliss. And it's thought right now and again, the more evidence we need more research that women actually have more CB1 and CB2 receptors than their male counterparts. And a lot of those are focused in the reproductive system. There's room for study. Even when you look at the amount of nerve endings that are attached to the clitoris, I mean, you know, the male penis is on the outside. With women, our uterus is on the inside. But even where the clitoris is so small, there's thousands and thousands of neurological receptors there and they get way more sensitive during hormonal fluctuations. Even cannabis can affect us different ways if we're in a different part of our cycle. So, you know, if you're coming up on your period or you're ending your period, cannabis may affect you differently in your mood. And a lot of other pharmaceutical drugs can affect you differently as well for any woman that's ever got a bikini wax and the difference between how it feels if you're on your period or if you're not on your period. It is substantially different. Your pain level tolerance is way down when you're in that period part, the menstruation part of your cycle. So, there's so much room for research and using you know, I'm learning more about how this amazing plant can help us kind of balance. You know, that's what the endocannabinoid system is about. It's all about balancing and bringing homeostasis to the body. And sexual health is a big part of that, not just for sex, but just for health in general. So, I just want people to be more aware of that and using cannabis mindfully, not just for self-care, but for helping their sexual wellbeing. 

Trevor: Kieley, this was fascinating. And I feel we could keep talking about this and have some of the other stuff you've been reading for hours and hours. But we are running a little short on time before I forget to ask about it. Your company is called Parkland Flower Inc. What do you guys do? 

Kieley: We are an advocate for cannabis cultivation. Was going to be a micro cultivation facility. We are specifically looking to breed and search out cultivars that are specific for topical use and for helping with different things that we've discussed here. We really are on the recreational side. Unfortunately, I don't have the millions of dollars to get us on the medical side. But you never know. We'll get maybe get scooped up by a big company that wants to study more of that. And that's kind of our goal, is that we just we just want to help people. We grow for a couple of medical patients as well under ACMPR licenses and help the community that way. And that's kind of our vision, is to just bring love and light and a great quality cannabis to people who need it. 

Trevor: Kieley, that's been fantastic and fascinating conversation.  Thank you so much for your time. I got the feeling we may touch base with you more down the road when we have more questions. Thank you very much. 

Kieley: I would absolutely I would absolutely love that. And this is a pleasure. Great questions. I have to say, I love your podcast. And, you know, I'm a user of Strainprint. I have it on two different apps, one for myself and one for my daughter. And so I'm excited to see the amount of research and the data that they're going to provide and it'll be very interesting down the road. I would very much welcome having any other conversation about this topic or any other topic. Thank you so much Trevor. 

Trevor: So how do you like Kieley Boudreau? 

Kirk: Well, I'm a visual kind of guy. Yeah, I thought that was good. Interesting about how people use their medicine. 

Trevor: Yes. And you like the part where I was a little flabbergasted, but it makes perfect sense, but yes, again, 13-year-old boy came out. So, if you use a cannabis oil vaginally or more specifically on the clitoris, you're not, according to Kieley, and it actually is going to come up a little bit more in our next interview. You're not going to get high because it doesn't get metabolized through the liver. But what happens to your partner if you've used it on your clitoris and there's some oral sex going on. 

Kirk: And he needs some medicine? 

Trevor: Well, I guess maybe the important bit is to communicate with your partner ahead of time. So, he knows he or she knows what they're getting themselves into. 

Kirk: Yes. Yes.  I'm reminded of one of the early, and this may segue into the next episode, a pharmacist we interviewed in the first season, he was talking about when people take their medicine, you should not get high. 

Trevor: Well, yeah, you know, and he was absolutely right. That was that was Michael Boivin, had a moment there. Mike Boivin. Yeah. What he was saying was, even if you were, let's say, vaping high THC thing, if you were getting high, if you're having a lot of the psychoactive effects, basically the dose is wrong. Right. But now this is a slightly different thing that if you take it topically, vaginally, rectally, it doesn't go through the liver. And so one of the metabolites that makes you high after taking an edible, either you don't get any or don't get as much. 

Kirk: OK, but you do get you do get high when you ingested in the gastrointestinal tract. 

Trevor: Right. So, the idea behind that is go everything you eat. First place it goes is the liver and then to the rest of your body. So, if but if it goes sort of through the skin, we'll call it topically, rectally, vaginally. It avoids, topically, it should avoid the liver altogether.  Rectally because again, I'm obsessed about suppositories, it's about one third through the liver, two thirds, not. 

Kirk: But suppositories work through the absorption of water, the large bowel. Right. That's how you get the absorption. 

Trevor: Well, sometimes. But remember, the cannabinoids are really big, what we call fat soluble molecules. In fact, they've even some of the reading where at one point called false cholesterol. So, they are going to get absorbed directly through the lining of either the vagina or the rectum. And they're going to go literally through the fat, into the blood there. 

Kirk: Into the tissues that need the medicine. 

Trevor: Well, yeah, they're got to get into the blood carried around by some lipoprotein in the way we go,. 

Kirk: Because the purpose of a suppository for someone with Crohn's is to take away the contractions rights, the cramping. 

Trevor: Right. So that's one of the neat things about and this is still kind of anecdotal, but we've talked to enough people that seems to make sense is, we're basically putting the medicine where we need it. 

Kirk: Where you need it. So, when it does get absorbed into the liver, if you got the proper amount of medicine, THC, CBD combination, you should not get high anyways. Right. So that's so. 

Trevor: Yeah, no, no. And that's true. But the argument is since not very much of it is getting through the liver, changing into one of the metabolites that makes you high. Where there is even less chance of you getting high off of a THC suppository. 

Kirk: OK, so I guess the lesson learned here is if you're taking cannabis recreationally. 

Trevor: Don't put it off your butt. 

Kirk: Don't put it up your butt. OK, now it's Trevor getting back to the sex one, you can put it in the vaginal vault, but make sure your partner knows. So that ten, twenty minutes down the road, he doesn't realize, love is high. You get high off love. 

Trevor: Yes. So yes. Like everything else, we communicate well with your sexual partner. 

Kirk: It just takes a whole different point of getting high off your lover, I guess. 

Trevor: I guess so. 

Kirk: OK, so tell me about this pharmacy. 

Trevor: That's great segue, Thanks

Kirk: You're giggling like a schoolboy. Yeah, I wish I was here for that one. It was a good interview. 

Trevor:  It was. But you were here when I talked to Rahim Dhalla. So, Rahim, I've kind of been following him for over a year now. I showed you a little pharmacy magazine where he's gracing the front cover. He's got a very cool pharmacy in Ottawa called Hybrid Pharm. And they deal with cannabis. Which kind of blew my mind when I first read about it, because I have been told by my college of pharmacy that I can't do that. 

Kirk: OK, let's review a little bit of this academically. We both belong to provincial colleges and national colleges. 

Trevor: I'm not. There's no national college really for pharmacy. 

Kirk: So there's no.  Where do you get your practice insurance through your provincial college? OK, so that's where you get your practice. So, they're the ones that dictate your practice. 

Trevor: All my licensing is provincial. All pharmacies are regulated provincially. That being said, we all wrote a national exam when we first got out of school. But after that, there's nothing really there's no real national. There are pharmacy advocacy groups that are national, but no real, quote unquote, licensing bodies nationally. 

Kirk: OK, so the national advocacy groups. What are they saying about cannabis? 

Trevor: Our national advocacy group, the Canadian Pharmacists Association, is actually quite pro cannabis. 

Kirk: OK, so that's good to know. And in our provinces and territories, how many of them are anti how many of them are pro? 

Trevor: I don't know, other than just talking to their pharmacists. It sounds like my province, Manitoba, seems to be particularly anti. 

Kirk: OK, so this Rahim is in Ontario, right? OK, so let's hear his story. So, what are the key points you want me to listen to? 

Trevor: You know what happens to a patient when they walk in there, the sort of the kind of patients they deal with and frankly, how pro-cannabis and pro-patient he is, listen for talk of the petition he started. 

Kirk: alright let us hear a bit of this 

Rahim: Thank you so much for having me, guys. I really like your show. So again, my name's Rahim. I'm a pharmacist out here in Ottawa. And I have started a Hybrid pharm, which is a Cannabis Specialty Compounding Pharmacy. 

Trevor: So that's interesting. So, and I think we'll get more into this later. I'm a compounding pharmacy here in Manitoba. My college has gone out of its way to say thou shall not have any cannabis or cannabis related products. In fact, they scared a couple of my colleagues. I've been talking to a couple of my colleagues who are actually afraid to talk to patients about cannabis because they're afraid of what the college will do even if we talk about cannabis. So how does someone in Ontario start a cannabis pharmacy and what do you guys do there? 

Rahim: I know that sounds like that's a shame that the college is really putting that much restriction on pharmacists able to discuss cannabis because, you know, at the end of the day, it's a medicine. The way the way we started. I mean, we are a traditional pharmacy. We do have regular prescriptions, methadone, compounding as well. And even a little bit of a front of the store with natural over the counter health products. So, I really wanted to dive into the medical cannabis aspect because as we know, this is a medicine and we need to treat it as such. And I feel like, as a pharmacist, we are best suited for giving patients proper advice and education on it. 

Trevor: OK, so Rahim, I'm a patient. I've just walked into Hybrid Pharm. I don't know anything about cannabis, but, you know, I have you know, I've I'm getting older, so my knee hurts because I still think I'm a cyclist and I say, you know, my knee hurts. And what what can you guys do for me? I think cannabis might be something I'm interested in. What would happen when I walk into the store. 

Rahim: We do have a clinic as well in here. We do see patients on a weekly basis with their nurse practitioner. So, we will help you get you set up and get you to do an intake form, as well as give us some brief medical history, as well as some of the medications you may be taking currently or have taken in the past. When we do our initial assessment and see if cannabis would be right for you. And then from there, we will advise on which products to get, how much to use and give you a full dosing schedule and titration schedule and just give you a little pamphlet on what to look out for, what to monitor for, and just really, you know, really treat it as any other medication. 

Trevor: So, who's who? Is evaluating me, is it a pharmacist or is it the nurse practitioners or someone else who would usually talk to a new patient? 

Rahim: Well, the nurse practitioner would be the ones evaluating and determining whether a prescription, whether it's right for you or not. And then myself or you have a couple of my colleagues here. Certified cannabis consultant would be the one to sit down and go over, you know, Strain selection and even take a step further. I would sit down with the patient and give them a whole dosing schedule and Titration sheet. 

Trevor: Good. OK, so I've got my sort of a prescription, but a medical document from the nurse practitioner.  Does it still have to be sent off to a licensed producer and have the product be mailed back to me? Or is that is that not what gets to me? 

Rahim: That's the realm we live in right now in terms of medical access. Patients are subjected to ordering online to direct through a License Producer. Unfortunately, we cannot compound. We cannot dispense or even sell products at our retail store front. 

Trevor: OK, no, that's similar to how it is here. Now, you must get this question, because I do all the time. Someone has walked into a recreational store, talk to a budtender, got stuff, then walk into my pharmacy and go, can I take this my other medication? Does that sort of fall into things you guys deal with on a daily or weekly basis? 

Rahim: That probably happened half an hour ago, but that's a regular occurrence. Or patients walk in asking can I get weed here, because our pharmacy doesn't look like your typical pharmacy. We have a mural on the wall, looks a little more relaxed, a little bit more clinic style. So they think it is a dispensary. And some patients have gotten even as far as to say that your pharmacist, what's behind the counter there.  I have a full conversation behind my counter and they ask is that a pharmacy with all those bottles back there. So, you know, that is still very much a stigma attached to cannabis. But, yeah, we would help them with dosing. They would come in with their products. We've had a bunch of patients actually come in with what they thought was legal products. And first and foremost, they were edible. And they're like, yeah, that's not available right now, technically speaking. So they, you know, a little bit of education and to be involved in guiding patients. 

Trevor: But, you know, that's fascinating now because you and I both compound. I want to kind of get into the compounding end of things. So, I'm I feel comfortable that I'm not spilling any personal health information because she tells us all the time and including on our podcast. So we have one of our favorite listeners and contributors, Jacqui Childs. She does a lot sort of in the we'll call the influencer realm. And she say she has Crohn's disease.  She was telling us on the podcast how she's had suppositories made for her, for her Crohn's disease, which, you know, pharmacologically makes a lot of sense. But again, and I know it's different from province to province.  In my province, as far as I'm aware, I can't go into my compounding lab and make her a CBD/THC suppository. Can you do something like that or how would you help out a Crohn's patient like Jacqui Childs if she was to contact you? 

Rahim: It's a little bit of a run around in the sense where you have to, you know, cross the T dot all your I. The patient has to sign off as your individual person responsible. So there are a lot of loopholes you have to jump through. But in the case of and I'm going by like the Ontario College of Pharmacy Strategy and what they've been doing and what the strategy is listed right now is saying that you're not allowed to combine recreational cannabis.  This is coming from a medical side and coming from directly from a licensed producer. So, we have tracking and traceability attached to that. And then we are able we are becoming the person responsible for the patient and we are able to make it into a dosage form that is appropriate for their health care needs. So, it actually reducing harm and it is actually preventing harm because if someone needs a cream versus taking something orally, going topical is a lot more, you know, safer dosing administration. 

Trevor: And that makes a lot of sense. But to back up a bit. So back when we had care homes, we had little old people in the care home who were on cannabis. And sometimes what would happen, depending on the care home, sometimes the care homes didn't want the cannabis to be mailed into the care home to the patient. We will dispensed with why that was silly. But anyway, it's, you know, it's their home. But what would happen is in the forms that the doctor or the nurse practitioner filled out, somewhere on there, they would designate, you know, my great nephew, Alex is my caretaker.  So, then the cannabis would be mailed directly to Alex and then Alex would physically bring it into the care home to the patient. So, you're saying that somewhere in those forms, instead of saying Great-nephew Alex, it would say Hybrid Pharm and you're now sort of the caretaker of that patient? 

Rahim: Absolutely. And even as some patients are getting their medication delivered to us.  On all the LP forms, they are allowed to deliver to the health care practitioner. So, our NP has taken on that role of accepting cannabis-based products delivered from LPs to be able to be in the pharmacy. And that just goes well to more accessibility for patients. Some of them don't have the home, some of them are never home. Some of them don't want it to be delivered to their house. So there's a lot of different reasons why they would want to have it delivered to pharmacy. 

Trevor: OK, and then and again, not trying to stir up too much trouble, but just because I'm really curious again. So, when you are now compounding with their cannabis product, are you a pharmacy at that point or are you sort of the equivalent of some uncle mixing up something in their kitchen and sending it to them? Is this something that's in from your college's point of view, it's then OK for you to compound with cannabis? If you're a sort of designated as the caretaker of this patient? 

Rahim: That's how that's how it reads via their strategy, then. Yes, I am I'm not some uncle like being like, OK, let's make this that. But we are taking those appropriate measures. We're giving them an actual prescription label with a certain dosage of THC/CBD that's found in that compounded form. 

Trevor: That's fascinating. And again, people have heard me rant about it before, but wow, is that a lot of hoops that you have to jump through to get stuff to the patient? 

Rahim: I just believe, it's needed right now. Like, imagine a world where you can actually take all the cannabinoids that we've discovered that 120 of them and start actually manipulating it to the advantage of the disease you're trying to treat. And that's where I think it should be going. And I think we should be having more rights as a pharmacy and as a medication expert to be able to handle cannabis.  Because we're handling ketamine. We're handling fentanyl.  We're handling opioids. Cannabis is by far a lot less severe than any of those other medications that we've been accustomed to do over the years.  I think it's just a very new concept for everybody and it was kind of still sitting back scared, but I don't know. And from where I'm sitting, the practice of starting to build, we just to see so much benefit effect from patients and helping them get on cannabis and giving them appropriate dosing and dosage forms. It's just fascinating. 

Trevor: Well, and from the medical cannabis patients I've talked to who have dealt with you, they're really happy that you're there offering that service. So, I've got some actual suppository questions. Kirk thinks have a bit of a fixation than maybe I do. So, when I've been talking to some medical patients about cannabis suppositories, I've heard from more than one of them that they can't or don't get high off of THC in a suppository. In my pharmacist mind, that doesn't make sense. But, you know, I'm not doubting what they're telling me. What have you found about we'll call it the psychoactive effects of THC suppository? 

Rahim: So, THC, obviously it's psychoactive component of cannabis. When you are using it locally, so either rectally or vaginally or even topically, you are bypassing the liver. And the reason why that makes it into a more active metabolite called the 11-hydroxy tetrahydrocannabinol. And that's what makes it that long acting effect. That's what makes it when you eat a brownie, for example, you are converting THC into 11-hydroxy, which gives it like a seven to eight-hour effect, which gives you a lot more, you know, stoned, so to speak. So, suppositories yes, there may be some that is getting absorbed systemically, but most of it is getting them sort of locally. 

Trevor: OK, so then just get my head wrapped around. But if I smoke or vape cannabis, it's getting absorbed through my lungs. As far as I know, that's avoiding the liver too. But I definitely get psychoactive effects. Is something different going on there? 

Rahim: I want to take that to the onset of effects because if you, when you're vaporizing or inhaling, you're going to get to the bloodstream via lungs. So yeah, it will get metabolized eventually to liver. But the onset of the affect is a lot greater versus going topically or rectally or vaginally. 

Trevor: Oh cool. 

Rahim: So, that's my understanding. 

Trevor: No. No. That's good, I've got my pharmacology lesson of the day, though, that was fantastic. So, you've made vaginal and rectal suppositories, have made topicals. How about just because I like compounding what's kind of one of the weirder things that weird types of dosage forms you've made in your compounding lab that contain cannabis? 

Rahim: So, what's another one that's really cool is the Crohn's, colitis, IBS patients. And when you're finding with all the oil that exists on the market, it does cause a lot of gastric upset. That's a very major common side effects of diarrhea. Some patients can tolerate to the point where they're like, I'd rather not take this because I'm just going to the bathroom every second. So, there are some companies that are making decarboxylated flower. So, they take the cannabis, decarboxylate it in an oven and grind it up to a fine powder. And we are actually encapsulating that at certain dosing ratios and patients are having a better time, less side effects with it, and it's helping treat their Crohn's and colitis issues. 

Trevor: Oh, cool. So you're making a Decarb ground up flower capsule.  I wouldn't have thought of that. I wouldn't have thought about how the oil as a carrier might really upset someone's GI tract. So, no, that's very cool. 

Rahim: You know, a lot of these patients are, you know, especially if you're using high dose CBD where we're only restricted to oils right now. And there has to be taking a large amount of oil. And I don't know if were eating too much olive oil one night at an Itailian Resturant. But, yeah, you're going to find, you know, maybe get the runs and maybe get like a lot of acid reflux. But it's very common.  The decarb is coming from the Licensed Producer is already activated. So it's a lot better absorption wise. 

Trevor: Cool. Kirk was just asking about insurance plans. We were talking when we're in Saskatoon about a guy who, you know, insurers, basically dispensaries. So we'll do a two pronged insurance thing. Did you have to get any sort of special insurance on your shop that you wouldn't normally have because  you have cannabis in it. Then on the flip side, how have how a patient's health insurer has been on paying for cannabis products? 

Rahim: No special insurance on my end as a regular pharmacy, because at the end of the day, that's what we are. And again, because we're not housing products, we don't actually have patients' products here. But on the patient's side of things, it's been mixed reviews. Most of them are saying, no, we're not covering it. You need special authorization. You need certain ailments such as like palliative care, cancer, seizures. So it has been a lot of hoops patients have to jump through. The patients have to go through in order to even get this, even talked about, or even covered by any means. And if they are getting covered, it's not even the full percentage of it. It's usually around, you know, like 50 to 60 percent coverage as if they are getting it. So it is a big, you know, another big point for patients lacking access and lacking affordability, because I truly believe right now we are totally under dosing CBD and it's because we can't afford it. It's so expensive and it shouldn't be that way. 

Trevor: Rahim, I think we could talk all day, but we to let you get back to actually serving your patients anything else you'd like to add? 

Rahim: No, we actually have we have a petition going here at the pharmacy that has been tabled at the House of Commons to amend the Cannabis Act to allow pharmacists and pharmacies to dispense medical cannabis. And I think that's where we're going with this and it should be going that way. And it's very passionate about that because, again, like lack of patient accessibility. I just had a patient before I came to talk to you that is in palliative situation. And obviously they need their medication now. But going to the point of order online. Wait for delivery. There's just a lot of aspects that are really burdening patients right now. And that's what we're trying to change it. We're trying to help patients. I was here at a Hybrid Pharm. And trying to do our best for what we have. So I appreciate that taking the time for listening to us. And if anyone in Ottawa, by all means, stop by the pharm and come inside our petition because we'd love to get your signature and your support. 

Trevor: We will, yeah. So anyone in Ottawa go visit Rahim, and sign the petition. So, Rahim that was fantastic. Thank you very much for for taking the time. And yeah, we hope keep in contact with you because seems to be lots of interesting stuff going on there. 

Rahim: Absolutely. 

Kirk: All right. So Trevor, explain a little bit here for me. I was trying to follow the conversations, also trying to read the pharmacy article that is in there as well. The process is. I live in his community and I medinical user of cannabis, I can have my LP send my cannabis to him. 

Trevor: Yes. And you can do that anywhere. And the idea, the example I use. 

Kirk: Can you do that here in Dauphin? 

Trevor: I don't, without getting trouble with my college, I don't know. But let's ignore the fact I'm a pharmacist for a second. Let's just say I have an uncle who gets medicinal cannabis. So my Uncle Frank needs medicinal cannabis. And so if Uncle Frank doesn't want it to ship to his house or maybe Uncle Frank has a long distance trucker, so he's never at home or Uncle Frank is homeless. There was a provision built in from the beginning that whoever writes the prescription nurse practitioner or doctor, whoever can specify somewhere else for the medication to go, And so if Uncle Frank wants it to be delivered to my place that's in. 

Kirk: There to your pharmacy. 

Trevor: Well, no, at this point, I'm not a pharmacist. 

Kirk: I'm talking about Rahim's business. 

Trevor: Rahim's business. They specify that the patient's cannabis goes to his pharmacy, that he's sort of the caretaker. 

Kirk: He becomes the caretaker. Now, he then talks to these people as a caregiver and a consultant. And a nurse practitioner. And they decide, I want this particular brand or cultivar of cannabis made into a suppository. So he now takes that with with, I'm assuming, consentual agreement with the patient and creates the creates the compound. And then he gives that compound to them like he would a prescription. 

Trevor: Yes. So so can I do that in Dauphin. I don't know, to be honest. 

Kirk: What's stopping you from trying. A job.  

Trevor: It's an excellent question. And again, one of the many reasons I'd love to have the head of my college on here. I don't know why. It makes sense to me. It sounds like something that would patients. 

Kirk: Let's start our own petition. Every pharmacist that listens to this podcast, write your registrar and ask them why cannabis isn't in pharmacies. 

Trevor: Because it sounds like Rahim is helping a lot of people. And I think more people could be helped if they could get information and or cannabis at their local pharmacy. 

Kirk: It's a good story, I think. I think in two years time we'll be doing it, too. 

Trevor: I hope so,. 

Kirk: Yeah. So this is an unsponsored episode. 

Trevor: So, yeah, if you like what you hear, we have some really, really canna-positive listeners who would like spending money on products and services. You should sponsor this podcast. 

Kirk: You want to have your products sold, bring it to the nurse and the pharmacist. 

Trevor: Absolutely. So, Kirk, did you bring us music today? 

Kirk: No. 

Trevor: Rene, please help us out here. What do you what have you got? 

Rene: OK, well, I've got Ryan Cowan. Ryan Cowan is from Roblan, Manitoba, just down the road from Dauphin, Manitoba, where we produced this show. And so how about a song called Guilty as Charged by Ryan Cowan? And now all you have to do is say goodbye. 

Kirk: Those are good interviews. 

Trevor: Thanks for it was another good one. 

Kirk: It was another good one. 

Trevor: Everyone come back.