E84 - Assuage Suppository Trepidation with Sarah Roberts

Our co-host, Trevor has an unhealthy obsession with suppositories. You know that guy you never ask, "Hey, what is an NFT?" lest he talk your ear off? Well never ask Trevor, "Hey, what is a Rectal Rocket?" With that background, imagine our delight when we stumbled across Sarah Roberts and her company Cicatrix Labs. They make vaginal and rectal suppositories with cannabinoids in them! People have used these products to treat endometriosis, inflammatory bowel disease, hemorrhoids, pain during sex, and more. Even if you think suppositories are icky, after this conversation, you will find them obsession worthy too. Our My Cannabis Story is Dave Dormer of Cannanaskis, a cannabis tourism company.

Thursday, 28 April 2022 13:19

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Episode Transcript

Trevor:  Kirk, we're back. 

Kirk: Hey, Trevor, how are you? 

Trevor: Good. So, let's start with interesting stuff, Kirk, you're not even in Manitoba anymore. Where did you get off to? 

Kirk: I'm back in Lac La Biche. Small town, Alberta. We're on our way to Banff and we're on our way to Vancouver Island. We're taking VanHoot for a little spin to Vancouver Island for March and April. 

Trevor: Sounds nice. So I found an interesting CEO slash pharmacist slash ashes of several things on the LinkedIn. Sarah Robertson, you had to listen to the interview. What do you think about her and her company Cicatrix Labs.

Kirk: Yeah. So, you found yourself a kindred spirit. Someone else that's in the in the suppositories? 

Trevor: Yes. Don't read too much into this, but Sarah is a pharmacist. She's in that slightly divergent field from mine. She went through the hospital pharmacy world, but she is now the CEO of a company that's making cannabis products and the one sounds like they're doing other stuff, but right now they have suppositories. And as I've probably mentioned before, I think suppositories are awesome, and we've actually had several guests on previous episodes who have talked about how much suppositories are a good thing. Everyone from when you were talking to the Victoria Cannabis Buyers Club and they're teaching people to make suppositories to Kieley Beaudry has mentioned it in sort of we'll call it sexual health. We had even when we were talking to people about IBS and not just IBS, but all the inflammatory bowel diseases. We've talked to a couple of people, a couple of different spots. Yeah. Having cannabis go to that area is good. Yeah, I 

Kirk: I listened to the episode a couple of times and you had me back in my books. I don't think I've read as much about the route of administration of drugs as I have in the last couple hours. You know, and people have to realize that when you when you choose, you just use a suppository, you're using it for various reasons, right? The route of administration of medication directly affects the drug's bioavailability and how that means how you get it into your system. And health care practitioners need to make choices. Some drugs, you can take it orally, some drugs you can take rectally, but some drugs you can do both. And I guess the thing is, is that as practitioners decide when it is advantageous to take a drug rectally 

Trevor: and we have to remember, Cicatrix Labs is not just rectally, they have vaginal as well.

Kirk: And they also have, I think, dermal as well, Transdermal yeah?

Trevor: Where I said, we get back to Sarah when they've got some topicals because I like them. I like them too. For similar different reasons. Routes other than oral are very interesting to a pharmacist.

Kirk: Well, of course. I mean, as a nurse, you have to I'm the one administrating it. Yeah, as a as a pharmacist, you're sort of putting it into formulation in which I use. So, you know, how convenient is the drug? When do you want to use oral versus when you want to use rectal? What the patient is, the patient conscious, can they swallow? Sometimes you may want to give an unconscious, patient rectal medication because it's just easier once the onset you want from the medication. Is the patient cooperative. Excuse me, sir. Good morning. I have something for you. You know, the nature of the drug and how you want the drug absorbs is important. The age of the patients important and also the effect. So, one thing we should talk about maybe a quick definition. First pass metabolism. You want to a quick synopsis from a pharmacist. Sure. 

Trevor: So, when you take something orally the first place, all the blood from the stomach and intestines go so it gets absorbed, leaves the GI tract. The first place it goes is the liver delivers many jobs, but one of his big jobs is it. It metabolizes it. It breaks down. It filters all the blood in the body. And so that makes sense that food goes straight to the liver because, you know, it sort of breaks it down into it, helps break it down to its component parts and sends it off to there all the right places. But in pharmacy world, that means that a lot of drugs or a lot of a drug, depending on the drug, will get broken down in the liver before it goes anywhere in the body. And we call that first pass metabolism, meaning you can lose a lot of the drugs affect before it goes anywhere, but if you if you do not go by via mouth, if you go say rectally or topically or injection or under the tongue, if you go not-by-the-mouth, you can skip that, go through the liver and break things down. So that can often mean you can get same effect with a lower dose if you can sort of skip the liver or skip that first pass metabolism. 

Kirk: Well, and I was telling you, you had me reading my papers and one of the things I was reminded about is that it's not just the liver right, it's also the intestines absorbs a little bit of the drug, the liver absorbs and also the lungs. So, there's sort of three components that you're going through when you when you take a medication orally. The other thing I had to be reminded about is that the upper rectum is different than the lower rectum. 

Trevor: Yeah, and I will and someone can complain that I have this little wrong. But in pharmacy school, they talked about it being two thirds of the drug that went rectally would go would skip the first pass metabolism and one third would go through the liver, making it a little more complicated. And the way it was explained to me was because different parts of the intestine have different blood flows and some go to the liver and some don't. So, that's how I understood it in pharmacy school. But when I eat, because, you know, that was a long time ago, I did a little bit of reading too. And places I read said somewhere between some said half onset a quarter, some sort of a third. So, we'll say some rectal stuff goes to the liver and some doesn't, because honestly, I'm not 100 percent certain on my pharmacy school, two thirds, one third number anymore, but I think I'm safe in saying some skips the liver. 

Kirk: Yeah, agreed. And that's I think in the lower part of the rectum, most of it skips the liver and some goes to liver. But if you put it up higher up into the rectum and you're starting to get more and more into the first pass mechanism, 

Trevor: Sarah does a great job, better job than us, explaining how her company came about and what they're doing and where they're going. So, let's listen to Sarah from Cicatrix Labs.

Sarah: So my name is Sarah, I'm a pharmacist by trade. I started out in hospital practice. I'm in the Interior Health area, but moved on to community practice and then worked in Long-Term Care. I've done a little bit of the research and development of products in the past, and just a little bit of everything. Kind of got a start into the cannabis industry working in an integrated health pharmacy. So, we're working through patients' medications and their natural health products and then including cannabis in that therapy. So really kind of coming from kind of a medical background. And then I got into Cicatrix Labs.

Trevor: and that was going to be one of my questions. So where we're going, it's pronounced Cicatrix Lab. 

Sarah: It is. Yes, I know it's a bit of an odd. 

Trevor: No, no, no. Once you get it, I think I think that sticks with you. So we're talking suppositories today because that's sort of where I first saw Cicatrix Labs.  And you on LinkedIn, also a pharmacist. And we in the past have compounded a bunch of different types of suppositories. So, I'm probably got an unhealthy obsession with suppositories. So, I love the I love the fact you were doing suppositories, but let's start with to make sure I pronounce it right. What is the brand name of your of your suppository?

Sarah: It's Assuage. So yeah, so give me a little bit of background on why we picked the name. So, of Cicatrix is actually. So when you have a cut and it starts to heal over. The first stage of healing creates, it's called a Cicatrix, so indicative of healing what we're kind of trying to focus on in our company. 

Trevor: And that's great. That's great name. 

Sarah: Yeah. The Assuage is to kind of lessen discomfort. So, you know, as we can see with the names, we're a very kind of medical focused company and we're specifically looking at kind of alternative formats that we haven't really seen on the market to try to give patients some different options. And so being a pharmacist, you know, when you had everything first came out and they were looking at flower and 30 milligrams per mill oils, that was kind of it. Now that, you know, we're starting to kind of evolve with the industry, we're able to get into some of these, you know, from a pharmacy point stand point more exciting types of formats and different pharmacokinetic profiles. And we're really just looking to give people some options. So, when we looked at kind of what's available on the market and what people were asking for, the first gap that we saw was really the suppositories. Where they're being used by patients across Canada most patients are making their own. So, to try to kind of make those available here, we've come up with a fairly kind of broad range of now what kind of THC and CBD products you know that you're not having to kind of mix by yourself and put them in the fridge and kind of get us to your potency and stability and your sterility, that sort of thing. So those just launched this week. 

Trevor: Yeah, and from some of the previous episodes we've had, I'm really glad that somebody is in the suppository area. Like we talked with the Victoria Cannabis Buyers Club and they've been sort of helping cancer patients for years make it our own suppositories at home. Listeners don't yell at me. But honestly, as a pharmacist, I was a little bit horrified to hear that people were making their own suppositories at home. Not that I don't think you can do it, but you know, that's kind of the whole point of pharmacy and the pharmacy is to sort of make things that the same every time and sterility as Sarah was just mentioning. So. So yes, I'm really glad of this. And then we've had other guests on previously from Kieley Beaudry, who has been talking about vaginal suppositories for sexual dysfunction issues, too. We've had people with Crohn's and colitis who have in the past had, we'll call it, cannabis related suppository. So, this sounds like a big, a big area you've gotten into. 

Sarah: It is. Yeah, I mean, I honestly, I had the same reaction when I saw both some of the homemade and kind of we had had some circulating around the area from Ontario kind-of-legacy market that sort of thing. And so unfortunately, it is a more complicated thing to make. I mean, if you're making one or two, it's not as big a deal. But if it's something you don't be using regularly, you know, the amount of testing that we have to do on each batch is just incredible. You know, everything is tested in terms of the inputs. For the pesticides, heavy metals, aflatoxins, all the rest of it. Plus, then we have a multi-step sterility testing and then plus the stability testing. So, looking at, you know, is it still sterile in three six months? So, you know, and especially at room temperature, so we've been able to kind of develop that process, you know, starting off with the compounding pharmacy base and then working it out to a truly kind of industrial process. And it is a bit more challenging because it is used for so many different things. So, we really wanted something that was kind of multi-use. So,we have gone for both, the rectal and the vaginal administration, which is it's actually very similar in terms of the product requirements, but then the testing requirements are quite different. 

Trevor: Well, that's I was going to say I had no idea what sort of differences in testing do you have to do a rectal versus vaginal suppository? 

Sarah: Mm hmm. The main thing is on the bacterial count. So, if you're going to be using the rectally, there's a reasonably wide kind of range in terms of your total aerobic count in your total yeast count that's dropped by a factor of 10 going to use and virtually plus when you have to do specific testing for certain organisms, both bacterial and fungal. Just to make sure that you're not going to be causing a problem. 

Trevor: Oh, that's very cool. I know it's not the same, but my pharmacist brain goes to ear drops and eye drops where you know it's OK to put an eye drop in the ear because it's more sterile, but don't put an ear drop in the eye. So, so a vaginal suppository is more sterile? 

Sarah: Yeah, they are. Yeah, it's like I said, it's kind of a factor of 10 dilution for how many bacteria and yeast are allowed. And we aim to go significantly below that with our personal standards within the company as well. 

Trevor: That's great. So actually, that segues nicely into so your different assuaged products that sort of have the print out here. You go everything from CBD only and frankly, up to some pretty strong CBD up to a THC only and kind of a mix. You want to talk about the different formulations you have.

Sarah: yes. So, you want to give patients an option just because there are so many different indications that people are using these for yourself, but anything from any kind of cancer patients who tend to be using quite high dosage right to kind of the recreational use. You know, if you look in the states, there's all sorts of recreational suppository brands. We just haven't seen the uptake here, which is quite surprising. So with the CBD, we have the option, I guess our lowest formulation is 50 mg straight CBD. We're coming out near the end of February with the extra strength and ultra-strength 100 and 200 mg, and those are still in the smaller suppository side. So just like the 1.3 mil and one point one gram. And on the THC side, we have started off with a one to three. So, the 10 mg THC and the 30 mg CBD and then coming up with a just straight kind of 10 mg THC just to kind of give people the option of where they want to start. You know, a lot of our patients will actually start with only half of the suppository, just especially when you're first trying out a CBD or THC product. If you're not as familiar with the format, it's it has that kind of comfort of, you know, our traditional mantra as pharmacies start low and go slow. 

Trevor: So, tell the listeners a little bit how so suppositories just in general, not just cannabis ones are different than pills on how stuff is absorbed and goes to the liver doesn't go through the liver. Do you want to just do a quick primer on that for someone that hasn't thought as much about suppositories as you before?

Sarah: Yeah. So, we have kind of an odd regulatory framework with it. So, the THC suppositories are kind of limited to 10 milligrams per unit right now because they fall under the extract class. There's preliminary evidence that shows that especially with the rectal suppository, that you're probably going to be bypassing the first pass metabolism. So, metabolism is quite different. Now we honestly, we need more studies on this kind of long term in terms of how that actually translates into use. And we know anecdotally that when you're looking at how people are using these, they're tolerating much higher THC doses with the rectal format than they have been with oral, and they're using them in a different way. So, they're there's definitely some evidence that there's probably a different pharmacokinetic mechanism. There is different absorption and we're hoping to be able to get some clarity on exactly how that actually translates into effect for some of these conditions that are being used, that's being used for. What we're seeing on the other side of that is what it's not being used for systemic conditions like pain, it is being used really for its local effects. 

Trevor: OK. 

Sarah: So, most of the patients that we've seen that have been knocking on our door try to get ahold of these products. You know you're looking at things like endometriosis. We are looking are cysts, ovarian cysts. As I said before, the kind of the sexual dysfunction. So, there's, you know, there's obviously a need there. There's kind of a historical usage and now that we're kind of bringing this into a legal product that allows us to get that data out in a safe way where we know that the products are not contaminated. We know that they're being overseen by a physician and a pharmacist, and it can start to kind of come into that more medical light or we can start treating it like another natural health product. You know where it is really part of a generalized therapeutic plan? 

Trevor: Cool. You just you'd mentioned in the US there being a lot of recreational or at least some recreational suppositories. Is your product going to be strictly medicinal? Is it going to be available in rec stores, I guess? How would somebody get their hands on one if they thought this was something they wanted? 

Sarah: So, we're starting off in the medical market. We are hoping to expand to the recreational market, after that. But to get that kind of preliminary data, we did want to start, you know, in a more, some where people have better access to information. So, one of the problems that we have with the recreational stores, of course, is the budtenders aren't allowed to tell you anything about product. 

Trevor: Right. 

Sarah: So, in an area where these haven't been used before, you know as much, or they've been using for their own homemade, you know, it's, there's a bit of a learning gap there. So, we wanted to when the patient comes in, one of them had access to that information. You know, how do you use these having to store these, how to use them safely? How do you integrate it with the rest of your therapy? And really, you know, that needs to be in the medical market. Now once that's kind of available and again, once you start moving more into the recreational side of it, which also has quite a large following, then we will be kind of moving into the recreational side of provincial stores as well. 

Trevor: Cool. So now I want to ask about usage, but just sort of honestly, this is an honestly, I don't know. In traditional pharmacy world, we have indications. Stuff that we're allowed to say, you know this, this drug is good for X.  Can you, are you allowed to say your product has an indication or how does that work? And then even if it doesn't, what do you what sort of things do you think people are going to be using it for? 

Sarah: Well, the word indication that it's a little bit difficult when it comes to cannabis. I mean, there are official indications for cannabis. They're quite limited. Generally speaking, you're looking at studies that were done for chronic pain, for nausea/vomiting, with chemotherapy or for dystonia. Those are really the only kind of official indications now. That said, that's not what we see in real life. 

Trevor: Right. 

Sarah: These are the what's the actual usages and how people have been benefiting from them hasn't really been followed by the literature because unfortunately, the studies just haven't, haven't been done yet. And luckily, since legalization, those studies are now starting to happen. So, we're seeing some very interesting kind of preliminary data, both on suppositories and on topical side. So, in terms of true indication, at the moment, I probably would not be, but I'm fairly conservative. I probably wouldn't use that word yet. 

Sarah: Fair enough. 

Trevor: That said, what we're seeing used for, you know, on an anecdotal level thing that they, you know, they do work for, it tends to be that pelvic pain. You know, we have people using them for cancer, for the rectal route. We have some fairly good evidence that CBD has anti-inflammatory sources that used for Crohn's disease. Ulcerative colitis.  Even like IBS and hemorrhoids, seems to be a fairly common one as well. On the vaginal side, we're seeing it used for painful sex tends to be a big one. We're seeing CBD has an anti-inflammatory. It has a blood flow effect. So, it's a logical thing to say to setting it to be using. In terms of other kind of pelvic pain. And we have very, very limited treatments for things like ovarian cysts and for endometriosis. I mean, you basically, you know, you've got some hormonal therapies and then you've got NSAIDS and, you know, some pain treatments. And after that, you're really out of options. You know, you start to get into things like major surgeries, which then have their own issues and cause, you know, fibrosis and scarring. And you know, there really is a huge need for another line of therapy. 

Trevor: So, yeah. Absolutely. 

Sarah: You know, the first option that's been available for a while, so, you know, we do want to get this into the hands of physicians and into hands of patients and to start to be able to track, you know, how it's being used. What the benefits are. How it's kind of being taken up and to this to the rest of their therapy and then just kind of start to narrow it down. Why does this work? How does it work so that we can start to kind of build those algorithms that are more use, like what we're used to as pharmacists and physicians? Or you can look at, you know, your indications and your contraindications and, you know, really start to integrate it into these, you know, therapeutic guidelines and pathways that we're all used to using. 

Trevor: That's good. And I can hear Kirk chirping in my ear as well. I know what he'll ask you. He would be asking, So, are there any actual ongoing studies or beginnings of studies, let's say, on endometriosis and suppositories possibly that you're involved with? 

Sarah: We we're just getting started on that. We have some stuff in the works, but I can't quite get into details about that as yet, unfortunately. 

Trevor: Fair enough. It means we might have to get you back on later. 

Sarah: So, you know what's to take so long to get through the regulatory process? And now that we've got everything kind of in place, we're hoping that things move quite a bit faster. We can start to kind of get these things going. But we are going to be kind of right off the bat tracking usage and indication. And some of that kind of preliminary data on this kind of how long's that, how these are being used, who's using them? Why are they using them? Which then helps to narrow down some of our more advanced studies? 

Trevor: OK. And we'll see if that, but I should be a good pharmacist. I was reading through your sort of how to use things. So let's talk about lube, condoms and panty liners. So, what's a good lube if we're going to be using your suppositories? 

Sarah: Honestly, they're fairly easy to use. We put that in there just because it's, you know, some people are a little bit intimidated by the format. Now this is part of the reason why we went with the smaller format. We're looking at. It's 1.1 gram. So it's the traditional kind of child size. So, they're not nearly as unapproachable as some of the ones that we've seen, kind of especially on the legacy market. 

Trevor: I understand we used to come up on something we literally called a rectal rocket. It was enormous, but it had a big flared end. So it sort of stay read at the anal sphincter for hemorrhoids. I know I like suppositories way too much. OK, so, so, so lube. Probably not such a big deal, but any water-based lubricant, I assume, would be fine if that's what someone is interested in. 

Sarah: Exactly. It's basically it's just to help with insertion, or you can just kind of warm them up or even just use water just to start that melting process just so that they're a little bit easier to put in. But yeah, generally speaking, we have we haven't had any really main kind of issues with that. The main thing to be aware of is they are basically an oil base. And so, you know, any kind of latex, you're absolutely going to run into some issues. So that's in terms of any condoms or toys or anything like that. So just kind of the long-term breakdown, and that's the case with any oil based lube or suppositories. But yeah, we're hoping to kind of come up with a more kind of complete line of products. That kind of thing, and we will expand on of that sexual health market because it is fairly limited at the moment.  In terms of the panty liners and that sort of thing, again, because it's such a small volume, it hasn't been as much of an issue as with the larger ones. It is because it is, you know, it's only 1 mil, but it's one of those things. Nobody wants to get anything ruined. So, it's always a good idea to especially the first time you use them; just in case. 

Trevor: No, those are all great because I think I would have thought of the lube. Honestly, I probably wouldn't have thought of latex condoms, so that's bad on me. And I definitely the panty liner wouldn't have occurred to me. So, yes, if I'm talking to anyone in a professional capacity, I will remember those. Those sound like fantastic counseling tips. So, I've covered, Now, there's lots more going on with your company and these products, but I think I've covered the basics. Anything you like, wish I'd ask or thought I was going to ask are really wanted our listeners to know. 

Sarah: No, that's kind of the main points on them. I mean, it's such a I guess I heard a broad indication for your use in terms of, you know, what we're seeing between the rectum and the vaginal use. I think they really have the opportunity now to help a lot of people. And we're hoping to kind of have the full product line available within the month and then we're starting on some very interesting topicals next. 

Trevor: So, sound, sound great. Oh, I probably should. So, if so, you have a patient who's interested is the way they get them now. Go to their doctor, then their doctor fills the medical form on your website and it goes that way. How does it actually get to somebody? 

Sarah: Yeah. So, there's a few different ways to do it. So, it is through the kind of medical cannabis program which doesn't require the physician authorization. So that can either be through your family doctor or specialist that you're seeing, or you can go through some of our providers. So, they have some amazing physicians that are very informed about cannabis. And sometimes a little bit more comfortable to some of the family physicians. You know, when you're when you're first looking on in the medical authorization, I think as a family physician, it's a bit intimidating. It's such a different process. You're used to just writing out your drug in your dose and your administration, and you know you bring it to the pharmacy. It's very simple. Because it's an authorization for use and you still have to write it in grams per day, even though, like the equivalences. 

Trevor: Yeah, it does. It doesn't make any sense for suppositories, but it's still on there. 

Sarah: No, no, it has. And it has nothing to do with the strength of the product whatsoever. So either the physician can kind of fill out the authorization forms and send it in to either of our or medical providers, or they can refer on to one of the cannabis clinics. And that's kind of all online. And you have a meeting with one of the cannabis physicians. They go through your medical history and provide any information. And do they actually they do a wonderful follow up. So if you do have any questions, you know, they're always kind of available, you know, either kind of on your time or there's just give them a call and they'll answer any questions you have. 

Trevor: I think that's a great place to wrap it up. Thank you very much. This was very interesting. And yeah, when you come up with topicals and or more studies on endometriosis, we'd love to talk more. Thank you very much for your time, Sarah. 

Sarah: Perfect tool. Thank you very much. 

Trevor: Kirk, I... You know, like you said, maybe a kindred spirit. I talked to somebody for, you know, 20, 20, 30 minutes about suppositories, and she's a pharmacist and she has her own company, and maybe I'm a little jealous. Anyway. So I, of course, just love that conversation with Sara. What to do? What did you think about what they're doing? 

Kirk: I thought it was kind of cool. Like I said, it forced me to get back into my books. I liked the fact that as another route in which you can use your cannabis. I went to her web page and I was trying to figure out how small are these that she doesn't have anything to comparison. They must be very tiny. 

Trevor: She did actually say in there. Now you probably seen this, maybe people out there. So, it made sense to me. But the I think the key for people to hang their hats on is this is sort of a child sized suppository. So, if as a parent, you've ever given a child like a child size glycerin suppository or a child size Tylenol suppository or so it's little. Ballpark? Sort of the tip of my little finger, but skinnier. So, I've got fat fingers. So, so like she said, they intentionally went with, I think she I'm not going to work as well as hers, but less intimidating size. So, yeah, like and I'm sorry, I got to mention again, we used to make something called rectal rockets, which are forking huge. And yes, people were intimidated by them. But that was kind of the whole point is they had sort of a flared end at one end. So, it's just sort of held up there in the in the rectal sphincter. So yes, people kind of their eyes got real big when you showed them the rectal rocket for the first time. No, it's not as bad as you think. But anyway, this is a much, much smaller suppository. So, should be far less intimidating to use for the first time 

Kirk: And using a water based lube. I have a question for you. When you made, when you compounded suppositories back in the day. Did you use glycerin or did you use fat? I mean, I'm wondering in her, did she get into did she get into this use glycerin is using lipids, lipids?

Trevor: She actually. I flipped through some of her. Yeah. So I've got her sheet here. So they're using glycerides which are a type of fat 10 to 18 length, like the chain fatty acids. So basically, it's a fat. And she and it says specifically on there do not use if allergic to coconut oil. So, it's a fat. It's probably not exactly the same, but one of the bases we use was called MBK, which was just a fatty, fatty thing. Way back to pharmacy school, we used to make a lot of suppositories with cocoa butter, which was interesting. Trying not to bore people, but remember suppository; fascinating. So why are we like cocoa butter is because it melts at body temperature, right? So, that makes sense for a suppository. But the complicated part about making them is so when you make a suppository, you heat up the base, you put your ingredients in and they cool it off in a mold, right? Makes sense. But with cocoa butter, if you heat it up too much while you're making it, you actually change its melting point. So now it would not melt at body temperature, so it screwed it up just in the making if you heat it up too much. So, what I made that was in pharmacy school. When I made them in real life, never use cocoa butter. We always use something called MBK or something very similar because it didn't have that sort of dual melting point problem. But anyway, yeah, people don't need to care about all the ins and outs of baking suppositories. But yes, it sounds like a similar sort of based. So basically, a fatty base and oily base is what they're using. 

Kirk: And the more orderly bass, the longer the release. 

Trevor: Well, there's a couple of things going on. And Sarah, if I am speaking out of turn, you know, email me and I'll put out an apology. But, so oil good because cannabinoids oily. So we got to have something that holds it. Oil good because it, like, if it's water soluble, it's just not going to last sort of as long. When we put it into the rectum, most suppositories are sort of in an oil base that's just kind of the standard. That's just kind of how they hold together the best. And with the fatty things, you can adjust the melting point. Again, in a perfect world, it should be solid at room temperature, but melt at body temperature. And that's actually not that far apart. But because there's different lengths of fatty acids, you can you can play with that a lot more. So that's some of the reasons we like, quote unquote oil-based stuff. 

Kirk: OK. Yeah, because I was looking at again from the article and learning relearning the whole route of medications was that the fattier, the lipid that makes the drug also how it absorbs. And I think it's more how it absorbs through the intestines than maybe the rectum. One of the other things I wanted to remind myself about and I couldn't find it. Maybe I indirectly answered the question. When you absorb medication through the rectum compared to the through the intestine, higher doses to the rectum usually. 

Trevor: no... What we're hoping what we're hoping is you can actually get away with a lower dose versus oral. And again, that's the whole missing the liver. That's the whole missing, the first pass metabolism. And I just want to throw in just two more... A: remember, they also do vaginal stuff and this I know even less about. But the reading I had didn't have any of the vaginal absorption going through the liver at all. So not that two thirds one third of the rectum. So as far as I can tell, you should get sort of 100 percent miss the liver vaginally. And the other thing is, sometimes we want a local effect, not a systemic, not the whole body. So especially with some of the vaginal suppositories, if the problem really was just painful sex, we want the we want the effect locally. So, we're kind of less worried about how much gets absorbed in the rest of the body. But if you were using it for inflammatory bowel disease, you'd want it to be absorbed to the whole body because it's, it's more than your bowels that are inflamed, but yeah, sometimes we're shooting more for a local effect and sometimes we're shooting more for a systemic effect. And Sarah mentioned it, but I just wouldn't be a good pharmacist if I didn't mention. Oily suppositories, don't play well with latex condoms. So just do you have got to keep that in mind, especially if we're doing this vaginally, let's say, for painful sex while so you know that's an important precaution to throw out there. Latex doesn't like oily stuff. 

Kirk: OK, I want to do just a little bit remind listeners that this is not the first time we've discussed endometriosis in this podcast. 

Trevor: That was interesting. 

Kirk: Season three, Episode two -  Canna Curious. We were talking to David Berg about the Strainprint endometriosis study, which I sent to you and we read, but I thought it had something to do with suppository or it doesn't. It's more oral use, but cannabis use for endometriosis and there's some positive effects. I'm wondering, I'm wondering if we haven't already attached it to Dave's. Maybe we'll attach it to this in the web page. 

Trevor: No, I think that would be a great idea. And again, future episode. Maybe it would be really cool if some of Cicatrix Labs suppository studies on Endometriosis come to fruition, and we can ask later about, hey, how did that go? But yeah, I don't know how to nicely segue away from butt stuff to cannabis tours. But Kirk, we also have a My Cannabis Story, 

Kirk: Another one from Calgary, I presume,. 

Trevor: Another one from Calgary. So Cannanaskis tours now Cannanaskis is spelled differently. So, from you, from the Alberta area, you know, Kananaskis is a beautiful mountainous area just outside of Calgary. I happen to have even gone there and done some hiking many years ago. Beautiful area. But there is a guy we met at HempFest in Calgary who will start you off in this in the city proper and take you on a tour. And I think he describes it better than we do. 

Kirk: Yeah, let's listen to another My Cannabis Story from Calgary. 

Trevor: Hi. So again, we're at Hempfest and we are at Cannanaskis for cannabis tourism. First, introduce yourself and tell me a little bit about what you do. 

Dave Hi, my name is Dave Dormer. I am the owner and operator of Cannanaskis. Basically, I have been a journalist for the last twenty-three years. I've been a stoner for the last 22. I put those two things together and I made Cannanaskis. It's Alberta's first fully legal, fully licensed cannabis tourism operation. What I do is I teach the history of cannabis. I pick people up in Bridgeland, Calgary. It's in the northwest part of the city, and the first stop is we make at a dispensary. Because legally, I can't provide cannabis because I'm not a retailer. I am a tour operator. So, we start by partnering with Five Point Cannabis in Bridgeland. We stop there. People can bring their own cannabis from home if they want or else they can buy from Five Point, which is a cannabis art gallery and dispensary. I think it's kind of a neat thing here today. You guys can't see it because this is an audio podcast, but we have the art of McKenna Prather. She is the featured artist right now at five point, so we have some of her stuff here, so we make a stop there. And then I have kind of two tours that I do. One, I take people to Kananaskis country, and that's spelled with a K. That's just west of Calgary. It's a very popular mountain area where we have lunch, which is provided by Butterfan catering. And on the drive out, I teach you the twelve-thousand-year history of cannabis. And when we get out to the mountains, it's it's one of the most beautiful smokes spot you'll ever see. And we have lunch and I have a bunch of artifacts that you can see and touch and we can talk about the history of cannabis where it comes from, why the words are the way they are, how things got to be, the way they are. And then we spend a day in the mountains and then we come back. And also do a, which is really popular. It is the same tour, but it is at Heritage Park and it's at dinner tours in the evening. It's from six to nine p.m. on Wednesdays through Saturdays and basically the same thing. I pick you up in Bridgeland. We make a stop at Five Point Cannabis and then I try to take everybody to Heritage Park, where they allow me to set up and operate. And what I do is I set up, call it a mini cannabis museum. I have all my artifacts. I have the handwritten court record of the first Canadian or one of the first Canadians to get caught as a as what would be considered a major dealer. I have, you know, photos of some of the first major dealers. I have a copy of the Sheng-nung Pen-ts'ao Ching  It's the first, the earliest book that ever mentions cannabis. It written in 2700 BC. A copy of the McFarland Thai-English Dictionary was dictionary that's the earliest written reference to the word bong. So, you know, we talk about sort of like why cannabis is the way it is, where the word cannabis comes from, you know, how would it hash get invented or how did it get created? How did cannabis spread around the world? And so, it's a really it's a fun night for people that enjoy cannabis to learn about. 

Trevor: Kirk that sounded awesome. I'm I was a little sad. We weren't in Calgary long enough to go on one of those tours, and then my next thought was. There should be something like that around Riding Mountain, like close to where we live.

Kirk: Unfortunately, in Manitoba, you can't smoke cannabis or consume cannabis anywhere but your home. 

Trevor: But the Riding Mountain is a national park, 

Kirk: And you cannot consume cannabis in any national park in Canada. I've posted, I've posted signs on this and on Instagram. You can follow my Instagram account. 

Trevor: Apparently, I missed that episode, but anyway, that would so be anyway. There's got to be. We've got to find a loophole. There's got to be a loophole because, well, that's 

Kirk: that's the thing about that's the thing about cannabis in this country. You got to know the rules about where you consuming and what you're carrying. And we speak to that in our blog on Reefermed.ca. So yeah, we discussed that in there. But where do you consume cannabis in this country? 

Trevor: Apparently not in Riding mountain

Kirk: Not in Riding Mountain National Park, 

Trevor: but if you're in the Kananaskis area, you could you could 

Kirk: Provincial Park. I don't know the rules. We'd have to know the rules of, you know what I mean or the rules this week because I'm going down into a provincial park for maybe I'll find out. 

Trevor: All right. So that was another good one. I think unless you've got some burning music request, I think we'll let Rene pick one. So I'm I'm Trevor: Shewfelt. I'm the pharmacist 

Kirk: and I'm still Kirk Nyquist the registered nurse and we are Reefer Medness - The Podcast. You can find us on all your social media or on Spotify. We're on run iTunes or Stitcher. We're on YouTube. We have a YouTube channel now and we're also on the internet there that www.reefermed.ca. Just give us give us a review and, you know, support the podcast. If you're interested in supporting the podcast, you can go to our Relationship Page and we discussed there how you can help us with this passion project. We're looking for advertisers and you can buy yourself a hoppy pillow, which we can Segway into now.

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