E58 - Greenly Heath with Dr. Blake Pearson

Many family docs spend part of their time looking after patients in long term care homes.  Two of the most common conditions in long term care are chronic pain and dementia.  We don't have great options in the standard pharmaceutical tool box to treat either of these conditions.  What if I told you a family doc in Sarnia, Ontario is having so much success treating both chronic pain and dementia symptoms in long term care that his colleagues are referring patients to him?  Dr. Blake Pearson is treating chronic pain, dementia symptoms, autism symptoms and others with cannabis.  His expertise is in such demand that he teaches other doctors how to use cannabis successfully in their practice.  Come have a listen.

Tuesday, 17 November 2020 17:43

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Episode Transcript

Trevor: Hey, Kirk, we're back.

Kirk: Hey, Trevor, how's it going.

Trevor: It's going well for the third or fourth false start there, I think we're doing great.

Kirk: Yeah, you know, it's interesting.

Trevor: So, anything new and exciting going on with you lately?

Kirk: Actually, I've been very busy. I finished a Controlled Substance course on because in my practice I have to give narcotics. So every three to five years, I think it's three years, it feels like five. It's of all the education I do, it's the one I despise the most. It's a Controlled Substance, opiate. OK, well, it's an opiate course, controlled substance course so that we can give narcotics in the north. And I find it a very difficult Webinar to do. And I've done it now probably about six times. Well, maybe it feels like six times many times. And I just finished it. And of course, this is the first course I've done since we've started Reefer Medness. And I found it really incredulous to start learning about how we're supposed to use pain control in primary care. And cannabis is still very low on the first line, second line, third line treatment list. So, the first question I want to ask you and we before we get into talking about Dr. Pearson, please explain to me as a pharmacist, what is a first line, second line, third line. When doctors are prescribing medication and they're on their first line versus the third line. Explain that to me. The reason why I'm asking you about first line versus third line is because he's using cannabis as a first line in an area that the recommendation is the third line.

Trevor: Well, now he didn't. He uses it. Now, I don't know that he specifically goes right to cannabis, but so really quickly first, it's just what it sounds like. So there is the drug you should use first and a lot of cases that is opioids, because frankly, that's no matter what you feel about opioids, we've got, you know, hundreds of years or at least one hundred years of experience using it. And we know what to expect. So, you know, neuropathic pain would probably be a good one where we don't have a lot of good treatments for it. And probably something like amitriptyline would be one of the first line treatments. And then after that, probably something like your favorite gabapentin / pregabalin, probably second or third line, and then opioids are probably fourth line.

Kirk: I'm looking at it right now.

Trevor: So what does your list say? Should be third, fourth, fifth line.

Kirk: So I did this pain management course and a lot of the referrals was the Canadian Pain Society. So the Canadian Pain Society has the first line, analgesic, second line, analgesic, third line analgesic and fourth line analgesic. First line is, is you tricyclic anti-depressants, your gabapentin, pregabalin.

Trevor: That's Amitriptyline. Sure.

Kirk: Yeah. You've got your serotonin is your second line and you've got third line.

Trevor: Antidepressant.

Kirk: Yeah. And your third line is your S.R. opiate analgesic.

Trevor: I wasn't too far off.

Kirk: No, no you're on it. And the fourth line is cannabinoids. What I liked about what this doctor was talking about is Dr. Pearson is he is using cannabinoids in fibromyalgia first line.

Trevor: Yeah. Now I think even he will say, though, usually kind of by default, maybe the people who come to see him or see the people he's talking to have already failed at first line, second line, third line. They're not usually I've got a diagnosis of fibromyalgia, let's try cannabis. I'm now I might be putting some words in his mouth, but the impression I got was usually by the time they're seeing Dr. Pearson, they have tried and failed it at we'll call it first and second line.

Kirk: OK, OK. And I think you're right there because he does talk about how he is how he has grown into a referral service. But I thought at one point and I was looking for it, at one point, he does talk about, he says, a small point, how he'll go to it first. And I thought that was brilliant.

Trevor: Oh, yeah. And he does. And I like so much what he said. But when we're talking about pain control, I like how he's talking about how and he goes specifically through it, how opioids really are a bad choice in chronic pain.  You so there you have chance of overdose. You they don't work particularly well. They got a bunch of side effects and he goes through a better, but they aren't you and but the problem has been to give doctors and pharmacists, nurses their due chronic pain is hard and we didn't have a lot of good options. Now he's one of the people who are sort of leading the charge to, we know we have all these problems with the opioids, but if we use cannabinoids, we can often get less opioids on board, which should be good for everybody.

Kirk: Well, once again, this is very timely. This is a very timely episode. National Guidelines for 2012, Canadian Guidelines for Diagnosis and Management of Fibromyalia syndrome. What is the treatment strategies? Cannabinoids is considered a recommendation: Trial prescription of pharmaceutical cannabinoids may be considered in a patient with fibromyalgia, particularly in the setting of important sleep disturbances. But you know what they're recommending.

Trevor: What's that?

Kirk: Nabilone.

Trevor: OK, well, yeah, and that is a cannabinoid. I know if you're truly in the green culture, you're probably anti-Nabilone. But for those of you not familiar now, Nabilone is almost THC. It's THC with just a little bit of a chemical tweak and that little bit of a chemical tweak allowed a drug company to patent it so it can be patented and sold as a pharmaceutical. And honestly, the fact it can be sold through a pharmacy like a regular pharmaceutical, frankly, makes a lot of doctors more comfortable with it, too.

Kirk: And I guess this is where we should start our conversation. We had a wonderful discussion with Dr. Pearson. It was it was a neat discussion. And I find it interesting that once again, we talk to our health professional that organically found cannabis through his patients.

Trevor: Yes. No. And let him get more into it. Maybe I'll talk more about at the end. But the range of conditions that he's treating with cannabis surprised me a lot. Like, you know, we talked about dementia. We talked about autism spectrum disorder. We talked about pain. And I think the reason we didn't talk about more conditions is I didn't have an infinite amount of time to interview them. But this was a this was a really good one.

Kirk: And again, I listen to the conversation several times because you guys you guys hit so many topics and it's hit and you move and you hit and you move and it's like, wow, wow. That that is an episode in itself. That is an episode in itself. That is an episode in itself. I'd like to move on right now to the episode. So let's people hear what he's talking about and then we can talk about what he said.

Trevor: Sure. Let's hear from Dr. Pearson.

Trevor: Dr. Pearson, thanks for being with us. Tell us a little bit about yourself and how you got involved with cannabis.

Dr. Pearson: Sure. Thanks for having me. I got involved as a family physician with treating my own patients initially. So that's kind of where it all started, treating older patient population with chronic pain sleep disorders. So, it kind of happened organically with with some of my patients where, you know, a different medication, one, two might have failed. And we we kind of moved to that cannabinoid option. And then once I did my toes in the water, then I became really intrigued, started to read up more, go to a number of different conferences and really incorporate it into my practice. And then after seeing these positive results, started to take referrals from local docs and kind of the next thing you know, that that's what I decided to focus on because I really enjoyed the practice. So that's a little bit about the clinical side. And through that, I had kind of some interesting jobs, one with our provincial government, where we know that a lot of physicians aren't comfortable with cannabinoid medicine. We have an Opioid problem. So, the job was to create an educational package for physicians within our province and teach them how to incorporate cannabinoids into practice to reduce opiates. So, it was part of the opiate reduction strategy that our provincial government did. So, I was happy to have a little piece of that as well.

Trevor: Oh, that's fascinating. And we'll get back to opioid reduction because we're all interested. But it's especially one Kirk, my co-host passions. But I want to start you do so many different things. I want to start with long term care. Like I was involved with long term care as a pharmacist for 15 years until our provincial government decided to take long term care away from small town pharmacies and give it to enormous central fields and went not bitter about that at all. I don't think it's at all useful that, you know, I knew the patients before they went into the Care Home and could continue that care in. I don't think that was at all useful. But anyway, I'm not going to whine about that today.

Dr. Pearson: I'm with you on that, though. One hundred percent. And I see it every day in long term care.

Trevor: But some of the stuff I was reading, you're talking about patients being on on average nine meds when they get in. That's absolutely true. And you know what that might be on the low end. So tell me a little bit about what you've been doing with long term care, how cannabis works in and how that might reduce the number of meds they're on.

Dr. Pearson: OK, so again, through kind of organic process, you know, you have older patients and then naturally some of these patients go into long term care facilities. So luckily locally, the other family physicians were all pretty collegial. So they saw some of the benefits to cannabinoid medicine with older patient populations, whether it's my patients or theirs. I was getting referrals to continue that on in long term care. There's probably a few areas that that we're focusing on are a few different diagnoses. So long term care, you have a lot of patients with chronic pain, though. So right there we're using various concentrations to manage pain and in that setting, reduce opiates. So, we have some good case studies that I presented at the ORCA conference and things like that where we've lowered opiates. So that's one thing in long term care, chronic pain, polypharmacy reduction, but probably even now more the bigger part of my practice and long-term care and I'm lucky that we can see patients virtually over OTN. So, I'll see patients from Windsor to Sudbury.

Trevor: And you are base of Sarnia, right?

Dr. Pearson: Yeah. Yeah, So, I'm in Sarnia and what I was trying to say about the kind of the other area is on the dementia side. So, a lot of these patients have responsive behaviors, agitation, calling out and traditionally you'd use something like an antipsychotic.

Trevor: Oh, absolutely. And I would teach little drug courses to the long-term care nurses. And the answer always was, yes, it's off label. Yes, there's a whack of side effects. Yes, it might even reduce their life expectancy, but we don't have any other options. And it looks like you found other options.

Dr. Pearson: Yeah. So, the good news is there are other options and with evidence and now there's different trials from Sunnybrook. There's a good trial from Switzerland, not large trials, but good randomized controlled trials. But so clinically, yes, there is other options. We're using cannabinoids to either, in place of neuroleptics or antipsychotics or if they're on, add cannabinoids in with the goal of weaning down. So, compared to an antipsychotic, the side effect profile of cannabinoids are much far superior than the antipsychotics. And we're having good efficacy as well.

Trevor: And so just so we're clear, maybe just so I'm clear, so is the cannabinoids, are you finding the cannabinoids is doing anything for the dementia itself or just kind of the aggressive behaviors when, you know, you have a lot of people with dementia living in a small space, unfortunately, bad things happen. So, is that what is reducing or where are the cannabinoids doing in dementia?

Dr. Pearson: Yeah, so it's more on the behaviors side of things. And you can imagine now like these patients with dementia, like you said, already in a different territory, not their house. That's one thing. But now with Covid not being able to leave the rooms, not being able to visit, wearing masks. There's a lot of things that are increasing these behaviors as a result of the pandemic. So, to answer your question, it is dealing with the behaviors and again, a much more reasonable option than a neuroleptic to simply reduce behaviors. On the other kind of side of actually treating dementia, we can't say that however, there are some research out there and it just depends if you kind of feel that dementia has an inflammatory component to it, which, more and more research is showing that, yeah, perhaps there is an underlying inflammatory mechanism to this and with that, one could hypothesize that, hey, if CBD inhibits the migration of the micro glial cells, the inflammatory cells in the nervous system, then if we're reducing inflammation in the brain, potentially that could have positive outcomes on the dementia disease state. But that is just kind of a hypothesis at this point.

Trevor: Still fascinating because yet again, back when I was in the care home, yes, using risperidone on a little old lady who's got dementia, we had to do something because she was a danger to herself and others, but you know, it was a terrible option because, you know, literally showed that study showed it probably reduced her life expectancy. Had a whack of side effects. And, you know, it really was hitting a fly with a sledgehammer. So, I'm very excited by using dementia, using cannabinoids for dementia in care homes. That sounds like a great way to go.

Dr. Pearson: It is. And it's nice because more are getting comfortable. We know as far as in this new Covid world, virtual medicine, you don't have to put hands on a dementia patients for this diagnosis. So I'm able to see the residents or see their care teams from all over the province and initiate therapy. And the reality is we have seen good outcomes. We've seen reduction in antipsychotics. But some patients and you know, this, too, can won't respond to high doses of antipsychotics. It's the same thing. They could be on Max olanzapine or Seroquel. We add cannabinoids in and nothing's touching some of these patients whose dementia is so severe, but certainly in the mild to moderate cases, again, it's it's a very reasonable option.

Kirk: If we ended the interview there, my new thing for today. But before we do that, let's go back or circle back to opioid reduction with cannabinoids. So are you just talking, treating people with pain or are we talking about people with opioid use disorder? What what can cannabinoids do in sort of the opioid world.

Dr. Pearson: In opiate and the opioid world, no doubt we've got into kind of this mess because there was a lot of patients with kind of everyday chronic pain that were given opiates. And certainly, there's not really a whole body of evidence to support the use of opiates in the chronic pain setting. Then you combine that with the risk of addiction, overdose, potentially cardiorespiratory depression. So, there's a number of reasons why they don't make sense for chronic pain. So that's typically where I'm using them is in that I'm using cannabinoids in that chronic pain setting, which is where all the evidence is in the literature is chronic pain, also chemotherapy drugs, nausea, vomiting, spasticity. Right. Some of those diagnoses. So, picture a patient with fibromyalgia, patient with maybe diabetic neuropathy. You kind of insert chronic pain diagnoses. We're using cannabinoids before going to an opiate. And then certainly we have patients who have been referred because they're on opiates already. Maybe they're not having a great therapeutic outcome. Maybe their doctor wants to reduce their morphine equivalents, which we're all under pressure from the CPSO to get the morphine equivalents down. So we use it in those cases, too, as an adjunct to help lower the dose.

Trevor: OK, and as a pharmacist, I'm probably slacking here. I should have probably done this earlier. How are you getting the cannabinoids into everybody is it's all oral oil or what's your what's your route of getting into patients?

Dr. Pearson: So, for me primarily it's using the oils or capsules. So ingestible forms because we can have a specific dose, you can titrate up by a specific amount. Land on a specific dose, it's really just kind of regular medicine. And when you think about the patient population I deal with primarily it's older adults, seniors, and again, they don't want to be inhaling something. Like dose matters. And when you think about the actual conditions you're treating, again, if we're talking chronic pain. Well, because when you ingest the duration of action might be six to eight hours. Much better. So, you only have to dose once, twice a day versus inhalation, which you'd be constantly doing every hour or two.

Trevor: Felt good. Again, I should probably make sure I talk about that now before we start talking about Greenly Health, which is what companies are involved with, any other sort of interesting treatments, patient groups or disease groups that you've treated lately with cannabis, that the most of us wouldn't have thought of was, well, throw that one out at you.

Dr. Pearson: Sure. We touched on the dementia side of things, and that certainly is an area where people aren't aware that cannabinoids are a reasonable option with some evidence. Another area that would kind of fall into that, where there is some mounting evidence and people don't hear much about it is in the area of autism spectrum disorders. So almost similar to the dementia patients where some of these kiddos self-harm, agitation, self-injuries. And they too, believe it or not, I get a lot of referrals or they're on some type of antipsychotic for reducing behaviors. So very kind of similar. And we're using CBD dominant formulations in those patients to help improve some of these behaviors.

Trevor: But that is and Kirk and I happen to be involved in a nursing seminar a couple of days ago and questions kept coming up about do we dose kids how we do with those kids. Now, obviously, we chat to a general. Here's what we do with kids. But let's say we have a 10, 12-year-old boy with his 120 lbs. and he's got his on the autism spectrum. What would you how would you start introducing cannabis into his regimen?

Dr. Pearson: So it really is all individualized. And I want to point out to that it's not a first line therapy. And so really, it all depends on the patient in the case. But where we treated patients are in that kind of treatment resistant category where they've tried X, Y, Z, they're not getting there, then potentially that patient may be a candidate. And dose wise, it's similar. We start kind of the cliché, but low and slow. And there is ranges where most of these kiddos fall into. But it is individualized. But the thing is, it's really why I like the practice, whether we're talking dementia or whether we're talking kiddos with autism or even in the general population, it's individualized medicine. So, we are working with the parents in the autism cases, closely monitoring every week during the titration to make sure we're on track and setting the goals because sometimes parents might have unrealistic expectations. So, it's important to really get the goals clear and be on the same page, which kind of these titrations allow you to check in at multiple points.

Trevor: Thank you. That is great. So, I've ticked off most of my boxes. We should probably talk about Greenly Health. So, what is it and what are you guys what are you guys doing?

Dr. Pearson: Yeah, so Greenly Health is our company that we primarily educate physicians but also do a lot of educations with education with RPN, PSW of course NP's because they have the ability to use cannabinoids in practice. But really it is it's something I really like to do is teach other physicians. So, when I'm not seeing patients, I'm zooming like this with other physicians and we're going through kind of cannabinoid 101 stuff if we need to, or we're moving into specific cases if they're more advanced and want to kind of take their training to the next level. But it's enjoyable for me because now I get to teach other docs and then we talk about the cases that they start their patients on. It's really nice to then hear positive effects from other docs with cannabinoids. And that's what I really like about it. And really fun for me too, is started out with training physicians and nurse practitioners in Canada, but now working in Australia. Working in Germany. So, it's really it's really cool for me.

Trevor: That would be a great. Now a question we get all the time, including, frankly, in this nursing seminar we in a couple of days ago, is I'm a patient or I'm a nurse. I'm in a small town, rural Canada. My local doctor, nurse practitioner isn't even interested in talking about cannabis. We now there are some services where you can sort of telehealth into a doctor and they'll prescribe. Since you train the doctors, do you have any sort of advice for a patient who wants to maybe get their doctor up to speed or are things that they could gently tell their doctor, hey, you know, maybe this is something you should consider?

Dr. Pearson: It's a good question. And it's a touchy subject because for whatever reason, it can be polarizing. Certainly, working with thousands of physicians now, some just have flat out biases against it based on previous misinformation. So, if it's a physician like that, it might be tough to there might not be any anything you could say. And that's where some of those services might be beneficial online. Ideally, though, that's why I do what I do with Greenly Health, because ideally, every physician should have this as part of their toolkit. Right. That shouldn't be a traumatic experience for the patient to talk to their doc about this and go through Greenly Health more and more docs are coming around and I see it all the time. So that's encouraging. But as far as what to say, just say, hey, look, I've done my research. It's a reasonable option. I've heard there's a favorable side effect profile. And just leveling with the physician or the nurse practitioners is generally your best bet. And if no luck, well, then there are some other options. But continuity of care is so important because oftentimes we have success, right, so then the treating physician would need to be lowering other medications, weaning down certain things, so if you can keep it within your circle of care, then that's always best.

Trevor: Oh, absolutely. Like, for example, you take a diabetic, you know, my family doctor has been doing a great job managing my diabetes for the last 10 years. It's not great for the patient's care if now they have to talk to a different doctor about their neuropathic pain because they want to use cannabinoids would be much better if that family doctor sort of oversaw the whole bit. They know the patient. What do they say? Family doctors, we specialize in you. So that's that would be great. If it's really good you're doing what you're doing because we'd like more family doctors to be comfortable with cannabis.

Dr. Pearson: Yeah, and that's and that's what we kind of strive to do. It can be intimidating because it is a whole other physiological system we didn't learn about. But really through the training, it's getting comfortable with a few different concentrations. And again, the big thing is on the polypharmacy side, you will see patients come off medication. So that is where the GP should be involved. Again, if you think coming off a sleep medication at night, coming off possibly an SSRI, coming off an opiate, you have opportunities for polypharmacy reduction. And again, if the family can do that, then that's great.

Trevor: So, I think you've covered at least the majority of my questions. Was there anything you thought I was going to ask you about, but I didn't cover or anything that you wished I'd cover before we start wrapping things up?

Dr. Pearson: I would I would just say, too, like when we're talking about dementia and we're talking about autism spectrum disorders or other diagnoses with patients with disabilities, we haven't touched on cost.

Trevor: Yeah, that's a good thing to talk about. Yeah, stuff from the LP's licensed producers is expensive.

Dr. Pearson: Yeah. And to me that that's a conversation that needs to be happening right now. It's Alzheimer's Awareness Month. There's a lot of focus on dementia right now. And I'd love to get more awareness around the fact that these families are buying this out of pocket for their loved ones, whether it's the dementia side or disabilities. They're paying, you know, fairly substantial sums of money when this should be covered for these vulnerable populations. So, there's not a lot of coverage. If you have certain insurances, there's coverage. But I think if you could get more awareness, especially on the government side, reimbursement side for these vulnerable populations, that would be a great start, because if we're using that over an antipsychotic, which is better for the patient, then why isn't it covered.  So hopeful if we kind of create enough awareness that that will start to move the needle with respect to that.

Trevor: And that's another one of my bugaboos. I'll try to go on too long, but I really think obviously biased that medicinal cannabis should go through pharmacies. At the moment, it doesn't. And one of the things I've heard from accountants and a few other things is when people try to claim their medicinal cannabis through their income tax because it doesn't go through a pharmacy and doesn't have a DIN number on it, that seems to make life extra difficult for them as well. So coverage, I think, is yet another reason why they should go through pharmacies. I think we'd have easier time getting the different insurance companies and government programs to cover it if it went through a pharmacy like your like everything else would for dementia and Alzheimer's.

Dr. Pearson: Yeah, yeah. And I mean, you can so there is some small silver lining with like you can claim it on your income tax. If you have a health spending account, you could use that money. Some insurances are covering it, but there's a long way to go. And on the pharmacy side of things, that's how it is in Australia through the pharmacy and seems to be a good a good model there as well.

Kirk: You know Trevor, as a nurse, our first practicum, our first clinical placement in my training, and this is back in 1980, so that's how old I am. Our first practicum was the PCH, what they call personal care home, an old folks’ home, long term care, whatever you care to call it. It would be a long-term care home. And in my time, I was nursing First World War vets.

Trevor: OK.

Kirk: That's how that's how long ago I was nursing in a in a long-term care home. And it was really just a practicum. And then and later in my career, I became a manager of a long-term care placement area as part of my overall hospital responsibilities. So, I won't say that I am a long term care, personal care nurse. I'm just don't have that sensitivity. And those nurses that work in that environment, god bless them. They're special people. Nursing, our elderly is a special skill set. It doesn't draw me out. I don't like it. But I can tell you something back in the day and I was wondering.

Trevor: I really liked long term care. Yeah. I spent 15 years being in charge of depending on the year one to five long term care homes. And I really enjoyed it because the elderly are different. Like one of the ones that surprised me when I learned about it was just things like bladder infections and a bladder infection and a little old person, you know, they don't complain about frequency and urgency. They go bananas. They you know, they kind of lose their minds for a bit. We give them some antibiotics and they come back. And there's just so many other little things about treating the elderly. I really enjoyed it until as I complained about the episode, the government took it away from us. But that's not what I'm here to complain about today. But I was fascinated with Dr. Pearson was talking about because dementia and the elderly is a huge deal, especially the care homes. And I taught this course called Pieces. I taught a piece of Pieces to long term care nurses and Pieces was basically how to deal with dementia in the elderly. And I talked to drug section. And my couple-hour long talk consisted of saying we're going to use basically drugs designed for schizophrenia, drugs, anti-neuroleptics, they got lots of names and right in the monograph says, don't give this old people. And if you'll look at the literature, it probably reduces life expectancy in the old people. And this is what we're using, this is sort of state of the art and what we're using, but because we didn't have anything better and it kind of blew my mind that cannabis might be something better.

Kirk: Well, and from my perspective, the reason why I didn't care for long term care nursing is that the bedside nursing and it wasn't what intrigued me. I mean, if you come into my emergency department bleeding, I gotcha. If you come into my clinic with public health issues, I got you. But long-term care is a real commitment and one of the issues I had with it is dementia is so difficult to deal with. I can remember now, this is this is decades ago. And being a very young man and a nubile nurse wondering to myself, look at all the medications that I have to study. As a nurse my job is, now you're a pharmacist this is embedded into your DNA, but as a nurse, I'm the one giving the meds. And I have to know as much about the pharmaceuticals as you do in some situations. What contradicts each other, because I'm the one actually physically giving it. I can remember the polypharmacy and remembering all these meds and I'm thinking to myself, what are all these people getting all these meds for? Why don't we just why don't we just give them a spliff. Now, this is going back decades and me being a silly bastard and I admit this, but it's so interesting to hear now an M.D. a doctor talking about using cannabis for dementia. I think it's what a fabulous idea, because, again, you know what it does Trevor? It goes back to the side effects. What's the worst thing that can happen to an elder if we were to give them cannabis?

Trevor: Well, that's it. Probably not very much adverse. More to your polypharmacy. You're absolutely right. You know, when he was talking about the patients he's seeing being on average of nine drugs, that's absolutely what I saw. You know, nine, 10, 15, 20 drugs in the care home. And honestly, one of the things that I don't know, we'll call it good or we'll call it Elders' know best. Every so often you get a little old person in the care home. And I'm not saying everybody should do this. So just, you know, don't cite me to the college. But honestly, in the care home, every so often we get, you know, little old Mrs. Smith just had it said, you know what, I don't want take any more pills. And we go no Mrs. Smith, you've got to keep taking them. You know, this is what's keeping you alive.  Mrs. Smith would stop. That's it. I'm not taking another freaking pill. And she go from 15 pills to zero and she would get better. And, you know.

Kirk: Imagine that.

Trevor: Yes, obviously, too many medications was not good for Mrs. Smith. And we saw this several times. So, anything we can do to reduce the number of pills and if cannabis is the magic bullet, why not?

Kirk: Well, and this is what I liked about this. And it's interesting, isn't it? I mean, we finished that webinar and look at how much we're learning, more that we could have introduced in that webinar about the elderly through this conversation you had with Dr. Pearson. I mean, this is why working with the elderly is so difficult for me. I mean, a simple electrolyte imbalance can throw them off. And as a nurse, you know, you'll phone the doctor and again, again, it's so hard not to paint everything with a white brush, but your phone a doctor and give them your history. And sometimes the doctor will say, well, give them a pill, when actually what I'm looking for is I just want to draw blood and send their pee and check their electrolytes, you know, and sometimes that's all you need to do is that their electrolytes are off. But yet we just you know, we've got a pill for the pain, which causes constipation. So now we give them a pill so they can poop and then we give them a pill because they've had gastro a couple of days ago. So now we've got that and they just get multi layers.

Trevor: Oh yeah. And then you have the pharmacist who gives them their water pill because they're getting fluid around their heart, but that throws off their potassium because that's just what that pill does and and and and.

Kirk: That's throws them into dementia. I know it's craziness and I guess that's one of the reasons why I'm not a doctor, because I don't know if I get to hold all those thoughts. But what I liked about this is that they're using cannabinoids in the long-term care home. And my little brain four decades ago. Isn't that scary. Four decades ago. Made a thought in my head thinking, what would happen if we gave these First World War vets a spliff instead of giving them sleeping pills? And and I can remember walking out of my practicum asking that question and obviously, being a nubile young nurse in those days, geez, I could have lost my license for asking those kind of questions because cannabis was just say no, right? This is your this is your brain on drugs. The fried egg kind of thing. So I thought it was interesting.

Trevor: Yeah. And I just a couple to get off that one for just a sec because a couple of other really interesting things that I thought he was doing. So Greenly Health, I hope I got the name right. So we've talked to a couple other services who, you know, you can telehealth into as a patient and they'll sort of see you virtually and get you a prescription and you'll get your cannabis that way. His he works a little differently where he wants to teach the docs and the nurses and the nurse practitioners more about cannabis. So your family doc, is now comfortable enough using it. So, you know, they've looking after everything else about you now. They can feel comfortable with your cannabis. And I think that's a great service.

Kirk: I really like that question you asked of him. How can you encourage your doctor, the one who should be caring about you? How do I incorporate cannabis into my care? And, you know I had that conversation with my doctor and it was an interesting conversation. So, you know, if your doctor says that he doesn't feel comfortable or she doesn't feel comfortable with offering it, then you can listen to our other episodes where we talk about services are out there. But wouldn't it be nice if primary care doctors listened to their patients like the ones we seem to be meeting a lot of? Yeah, you know, they listen to the patients and learn about it.

Trevor: And one thing that I was kind of embarrassed as a pharmacist that he brought up that I forgot to ask was cost. If you do everything legally and properly and through the licensed producers, this is not a knock against the likes of producers, just a fact. If you buy, you know, legal cannabinoid oils, which is what most medical patients are going to be taking, it's expensive and not covered and that's been brought up in previous episode and tax.

Kirk: And double taxed.

Trevor: So really something that needs to be worked on.

Kirk: S2E6.

Trevor: Thank you. That really needs to be something that, you know, anyone from the Government of Canada out there. This is one of the reasons to put it to pharmacies, to make it more accessible to insurance companies. I know it sounds silly, but that's where they're set up to deal with and more importantly, I think provincial health programs. So, obviously biased. But if we got this through pharmacies, I think it would be easier to get more coverage.

Kirk: There's no reason why medical cannabis shouldn't be going through pharmacies. It's already happening with Shoppers Drug Mart. I'm surprised that I'm surprised that your pharmacy isn't pushing for it. What a great opportunity to help your patients. Well, I'm surprised, man. I mean, whoever makes the decisions in your pharmacy should be looking at it as a revenue stream and it helps the patient. And isn't that our job as health care professionals is find ways to help the patient? I have a question for you. And before you ask me,.

Trevor: Sure.

Kirk: What about that Ontario government? How about that Ontario government?

Trevor: Yeah, no, no, I really like that he specifically said he was on a task force about that, of course, you know, it's one of those for us anyway, of course, moments. But, you know, and I don't want to cast dispersions on you know, Doug Ford versus Premier Pallister, but come on, it's not like Mr. Ford isn't a conservative as well, there I think that's the nicest way to say that.

Kirk: He might have a little bit more experience with that with drugs, though, than than Mr. Pallister.

Trevor: I was just going to say maybe we should just steer clear of that part. But the fact that the Ontario government is looking into at least on paper, reducing opioid crisis through cannabis seems like seems like a good way to go.

Kirk: Oh, no kidding, man. No kidding. I mean, really, we're in the middle of a opioid crisis. We got we're in the middle of a pandemic. People are dying in Vancouver with opiate crisis. And I think I think the B.C. government is on tune, but I don't know if I have a reference for that because, I mean, we did an episode on that in the Nanaimo of the group doing it in the Nanaimo. So the fact that they're still doing it would suggest the government is turning a blind eye but in Ontario, they actually asked for a task force. Bring it on, man. Let's demonstrate how cannabis can get people off opioids, brilliant.

Trevor: I think that's a good place to wrap up this week, so I don't have any music recommendations from our guests. Do are you going to drag up some music or do you want us to throw that to Rene again?

Kirk: Well, let's throw it to Rene.  He's there. He always comes up with something interesting. Certainly.

Trevor: So, on that sort of slow burned out. Maybe we'll wrap this one up. And I think your Kirk Nyquist, the nurse.

Kirk: You are Trevor the pharmacist.

Trevor: I really enjoyed Dr. Pearson's talk. Dr. Pearson, thank you very much. Hope everyone else enjoyed as much as we did. And we'll see you guys all next time.

Rene: All right, guys, I guess it's my turn now. So as I'm listening to this episode and so many of the others over the whole of the last couple of years, actually, one thing occurred to me, and that is that there are so many roads to go down on the topic of legalized cannabis and you're going down them. And so, I thought it would be suitable to perhaps play the song So Many Roads by the Grateful Dead. This is from 1995.

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