E85 - Cannabis for Headbangers with Dr. Patrick Neary

You've said the word concussion. You might even have had one. But do you really understand them? Did you know a concussion is a minor traumatic brain injury? Dr. Patrick Neary and his team got a grant from the NFL to study if cannabis can help prevent or treat concussions! Dr. Neary explains, you don't have to actually bang your head to get a concussion. We've often said you don't have to like cannabis to enjoy this podcast. But, if you listen to this episode while rhythmically shaking your mullet forwards and back, we think you'll elevate your knowledge about both.

Thursday, 28 April 2022 15:33

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Episode Transcript

Trevor: Kirk. We're back. 

Kirk:  We're back. How are you? 

Trevor: I'm really good. So, I am very excited about the conversation we've got coming up. But just because it's always interesting to say, Hey, Kirk, where are you right now? 

Kirk:  Today I'm in Campbell River on Vancouver Island. Michelle and I are touring around and VanHoot just sort of taking a break. We've been on the island for about seven weeks, visiting old friends and relatives and just taking a break from everything. Camping, spent some time on Denman and Hornby Island. Hopefully going to spend some time with our son. He's in is in Campbell River, going to school and just basically enjoying. 

Trevor: For those and for those of us who don't know where is Campbell River. 

Kirk:  Campbell River is, sort of midway up Vancouver Island on the east coast of Vancouver Island. Salmon capital of the world, apparently, is what they are known for. Yeah So, we're just enjoying some time away and maybe there is a blip in the in the waves and we're sort of doing it. We'll be home back in Dauphin last week of April. 

Trevor: Sounds fantastic. 

Kirk:  Yeah. 

Trevor: Okay, So, I know you've listened to the interview, but So, Kirk, we this actually made some headlines even sort of outside of the cannabis world. A researcher at the University of Regina got a bunch of money from the NFL to look at cannabis and concussions. 

Kirk:  Yeah. 

Trevor: What did you what did you think about that when you read it? 

Kirk:  Well, yeah. No, I remember what was about six or seven months ago. We were we were reading that the National Football League was Gridiron for those that are not in North America, we call it football here. They were putting out calls for tender for studies on cannabis and head injuries and trying to see if cannabis would help with concussions and a Canadian and a well-qualified one. I mean, the gentleman certainly has qualifications to do this. And he is he won he won the tender. So, that's very exciting. The study, the studies in progress. One thing I couldn't it was I think it's near the end of the conversation where he says you'll have some preliminary results in in by Christmas. So, he's already in the study. It's already happening. 

Trevor: I was a little unclear about that as well. And we can talk about more afterwards, but I think it sounds like Phase One is kind of starting. And So, Phase One and we'll talk about this more afterwards and he'll go into it is kind of the dosing study. If you remember, he even talked about dosing himself with CBD just to see what was going on. So, my understanding was by Christmas, maybe they'll have some more questions about or answers to what a good dose of CBD is. So, before I forget, because I promised him afterwards in an email that So, the gentleman we're talking about is Patrick Neary. He's an exercise physiologist at University of Regina, and he is also, with the Cannabinoid Initiative of Saskatchewan. He made me promise I would mention it. It's not just him, it is a huge team. And I said I would mention everybody. So, my apologies for poor pronunciation. But the team is Patrick NEARY, who were interviewing. Jane Alcorn, Robert Laprairie, who we have actually interviewed before in Season 2 Episode 5. Payam Dehghani, Bruce H. Bjornson, Thomas Hadjistavropoulos (sorry), Kim D. Dorsch, Cameron S Mang, Holly A Bardutz, Lanishen Bhagaloo, Zachary Walsh, Philip Ainslie, Michael Szafron, Jyotpal Singh and Elizabeth S. Thompson. And Elizabeth Thompson comes up in the story because it sounds like she was the original grad student who saw the original request for proposal and said, Hey, why don't you do this? So, I think the important bit is, and this is true with just about every worthwhile project, not just Patrick Neary, big team around him. 

Kirk:  Yeah. No, that's wonderful. It's also, interesting how what goes around comes around. We've interviewed, we start interviewing people who know who we've interviewed in the past. So, the cannabis industry is a small industry and we're meeting a lot of them. 

Trevor: Yes. And honestly, all of them are very pleasant, very knowledgeable and a lot of fun to talk to. You can't believe they all keep agreeing to talk to us. 

Kirk:  Well, no, they should be agreeing to talk to us because we have the best podcast on cannabis that's out there, So, why wouldn't they talk to us? And I mean, one of the conversations I had with the Compassion Club, which is a future episode coming, I was visiting the Victoria Cannabis Buyers Club and people remember that we did an episode with them called Healing Communities is just how kind and caring the cannabis community is and it sort of seems to fall over into the researcher as well. One of the things I wanted to do, just the start of the conversation, was maybe we should define what a concussion. Now he does that. 

Trevor: I should say. Patrick Neary: does a good job. But we'll do we'll do the pre-definition and then we'll let him sort of flesh it out. But concussion is and jump in when you think I'm going off is when your brain sort of sloshes around inside your skull. So, as he pointed out, you don't have to actually hit your head. So, the example he used was whiplash or even use a Sidney Crosby example from hockey. But something you do that makes your brain slosh around inside your head or maybe twist inside your head because your brain's kind of squishy and your skull is not. So, having your brain sort of slosh around inside your skull is a concussion. 

Kirk:  This is something that I used to be very involved with, with emergency medicine and paramedicine, and we used to refer to a concussion as a brain shaking. And what he was describing is what we call coup-contra-coup. And what that means is that when there's a force, for example, when a car hits a pole, a power pole, the car and the force of the car is into the human body. So, the car hits the pole. You hit the steering wheel, your brain hits the front of your frontal lobe. And now the contra-coup is when the brain sloshes backwards and hits the back occiput. And your car and you know, and you bounce back to the seat and the car bounces away from the pole. That's the coup-contra-coup. That's a brain shaking. What separates a concussion from a compression or a bleed is that there is no bleed. The skull the skull has only one hole to accommodate for swelling. So, when the brain swells, the only place it goes is down into the brain stem. But in the meantime, what we have is something we referred to as the PAD. The PAD is the pia matter, the arachnoid space and the dura matter. And the dura matter is where a lot of venous supply is. And what happens is that when somebody does hit their head and they've had a concussion, we have what's called the head protocol or the head injury protocol, and that is that the individual should be monitored and woken up every 2 hours. And they should be watched for nausea, vomiting and level of consciousness. And So, we've dealt with this lots and we deal with this lots in EMS. We do a lot with this in emergency medicine. So, a concussion is very is a brain shake and depending on how severe the shake is, is where the injuries occur. So, frontal lobe, occipital lobe, that sort of stuff. So, that's how I that's how I learned about concussions and how we deal with it. So, this is a this So, in this experiment, there is no hemorrhaging happening, right? There's a bruising of the brain. So, with bruising of the brain, there's not a lot there is a minor amount of swelling, but the swelling is being controlled because, of course, of the swelling is not controlled, the brain gets push down the brainstem and that's where you stop breathing and your heart stops because your cardiovascular control is in the brainstem. So, that's sort of a rundown from an emergency perspective. And, you know, you see movies where they're doing boreholes, boreholes are they saw into the skull to allow the brain to swell. And So, that's what the whole purpose of it is. But we're not we're not there here. 

Trevor: I think it's really good that you sort of put concussions on the continuum of traumatic brain injury, because he actually said, you know, a concussion is kind of a mild to moderate traumatic brain injury. And it's important to do that because most people, thankfully, haven't been in a car accident. So, you know, but a lot of people say playing contact sports, hockey, football, taekwondo, whatever, soccer. Have had concussions and, for years we considered them minor got your bell rung. A mutual friend of ours, you know somewhere in between our ages remembers playing high school football. And you know, in the first quarter he went out there was a play. He got his bell rung. They went to the sidelines and then got up and said, okay, coach, I'm ready to go back in the game. The coach looked at and said, that was the first quarter, the game's over. So, he just lost complete track of the entire game. And, you know, we all laugh about it. Ha ha ha. Got his bell rung. But you know, those are brain injuries, actual traumatic brain injuries. So, our understanding of concussion has come a long way since "Just got my bell rung." And for better or worse, the NFL has gotten into a little bit of trouble over the last few years about how their former players are managing now after years and years of concussions. The same thing with hockey with the NHL. So, anyway, it's all very pertinent and important that some research is being done on ways to protect the brains. 

Kirk:  Yeah, well, and also, multiple concussions. I mean, Muhammad Ali has Parkinson's and they suggest... 

Trevor: Had. 

Kirk:  Had? I've lost time. 

Trevor: He's gone. 

Kirk:  No ways. When did Muhammad Ali die. 

Trevor: I'd have to Google it. 

Kirk:  There was some there was some there was some thought there was some thought that it was caused by the multiple had head blows that he received. You know, he may have he may have danced like a butterfly, but he did get hit a few times. And there's other NFL guys that have now had, you know, in retirement are starting to have dementia and other brain related aging issues. One of the one of the contraindication, not contraindications, one of the contrarians out there. Think it was Malcolm Gladwell? No, I don't want to. I'm almost sure is Malcolm Gladwell. But I can remember reading an article about the concept of wearing helmets, and the suggestion was, if you take the helmets of hockey players, the game will change. So, it won't be as rough, right? So, so, So, there might actually be some science behind the concept if you want to get rid of concussions, take the helmets off. 

Trevor: Well, and he's not the only one. There's been a lot of will call it, quote unquote, hockey people who have said the same thing. Maybe, maybe not. In football, the reason helmets came in from no padding to those leather helmets to the helmets they have now is, yeah, you might have more concussions now, but back in the day you had a lot more on field, on field literal deaths from people having their skulls literally cracked. So, you know, it's I'm not saying it's completely ridiculous, you know, but I think I think the I think that the current NHL people would argue they put in a whole bunch more rules that say don't hit people in the head and that and concussion protocols and other things that we didn't have ten years ago. And that's more effective than taking padding off someone's head. 

Kirk:  Yeah, no. I get. I wonder and I wonder if we Google this and I guess we should have if you compare rugby to Gridiron football and how many concussions are in rugby. Because rugby is a whole lot different sport and a lot more tackling, a lot more grunting. And I mean, you don't get to quite the start and stop or the stop start as you do in football. But I wonder if anybody's ever done any comparative work on concussions in rugby players compared to Gridiron players. 

Trevor: I know Dr. Neary: actually has a lot of interest in rugby. Maybe, maybe, maybe it's if you're right, me, maybe it's worth an email and see if he can throw a two cents in here. 

Kirk:  That actually that actually would be that actually would be interesting. 

Trevor: Hi, it's Trevor: in the future here. So, to answer Kirk: 's question, I did get back a hold of Dr. Neary: and he sent me a nice little email. So, quoting from the email, 'there still are a significant number of concussions in rugby as there are in football. But I don't know if there's any more in one sport versus the other. However, rugby is typically considered a grab and tackle to the ground game where football is a hit, the player with high velocity and knocked them to the ground game." So, we don't know about any head to head studies about number of concussions in football versus rugby, but it sounds like they are still common in both. 

Kirk:  You know, we should we should go into the conversation. 

Trevor: And probably let him talk now. 

Trevor: Dr. Neary, let's start with tell me a little bit about your academic background and sort of how you got here. 

Dr. Neary: Yeah, well, thanks, Trevor, very much for having me today. I'm really excited about this opportunity to share some of the information about our NFL grant. I'm an exercise physiologist. So, therefore I study the effects of exercise on the body. I'm a faculty member and professor in the Faculty of Kinesiology and Health Studies at the University of Regina. And I've been here for approximately 15, 16 years, and prior to that I was at the University of New Brunswick, and then prior to that I was on Vancouver Island at what's now called Vancouver Island University. So, my background is exercise physiology. And I have a passion and a love for teaching, exercise physiology and studying the effects on the body. 

Trevor: That is very interesting. And that leads us nicely into what I assume we're going to spend a lot of time today is when people hit their head. So, all of us have said the word concussion. I heard the word concussion. Several of us have probably even had one. Can you tell us what a concussion is? 

Dr. Neary: Yeah, Trevor, a concussion is the actual movement of the brain inside the skull. And as a result, you do not need to hit your head in order to get a concussion. So, a whiplash, as an example, with the head moving forward and backwards, sideways can actually create that movement of the brain inside the skull. And that's why we end up with this neuronal damage or damage to the neurons. And if you take in a Sidney Crosby as an example, when he got his concussion back in about 2010, 2011, whatever it was, he was hit in the shoulder. He wasn't hit on the head initially, but he was hit in the shoulder. And he had a whiplash movement that rotated his head from left to right or right to left. And that itself will create a concussion. And a concussion is actually along the continuum of a minor or a mild traumatic brain injury. And then from there, it can go to a moderate traumatic brain injury and then certainly into a severe, depending on what the situation is. 

Trevor: Oh, that's good. And just to just continue on that just a little bit, because it's it's counterintuitive when you say you don't have to hit your head to get a concussion. So, I've heard things like people saying your brain sloshing around in your skull, your brain is twisting. Are those sort of accurate descriptions of what's going around? 

Dr. Neary: They really are. It's, you know, that sloshing of the brain inside the skull really reflects what can happen to that to the brain tissue. And brain tissue is very, very soft and it's very pliable and as a result, what happens then is if, for example, you do get a whiplash or you actually do hit your head, then the brain moving forward bumps up and hits against the very, very front frontal brain lobes. And then, of course, then it moves to the back and then it sloshes back to the posterior aspect of the skull as well. So, yeah, those terms are very much in line with what a concussion actually is. 

Trevor: Okay. So, concussions, for better or worse, leads us very nicely to the NFL. So, tell me a little bit about there is a project involving the NFL. They were looking for proposals. Yours got accepted to do with concussions and cannabis. And how about you sort of start with how did you find out about this potential NFL project and sort of what's happening now? 

Dr. Neary: Well, So, back in June of this past year of last year, one of my graduate students, Elizabeth Thompson, had stated and sent an email and said, Hey, Patrick, can you believe this? The NFL is actually giving out money to look at medical cannabis cannabinoids for pain management and seeing whether or not it can be used not only for pain management, but also, to help individuals get off of opioids or prescription medications. And So, Elizabeth and I put our heads together and thought, yeah, I'm going to apply for this grant. We're going to propose looking at certain formulations of CBD or cannabidiol, as it's called, as well as the THC, which is the component of the marijuana plant that makes you high or can get you high if used in high doses, and that is THC tetrahydrocannabinol. And So, as a result, we got started, put this grant together and then submitted that at the end of July. And the whole idea was, can we actually use the cannabinoids that are found in the marijuana plant and CBD and THC that I just spoke about for, not only the pain management, but can we also, use it for concussion? Because there's some research to suggest that cannabinoids are anti-inflammatory. And we know that any type of an injury that is related to trauma, whether it's a physical or a mental trauma, can potentially lead to this inflammatory response within the body. And if I can just take that a tiny bit further. 

Trevor: Oh, yeah, please. 

Dr. Neary: When we do any physical training and as an example, if we do resistance training, we're doing weight training. The body responds to the changes in the muscle, which are just micro traumatic events because the muscle tissue is being squeezed and moved apart and torn up a bit, for lack of better terms. And that leads to an inflammatory response, which is a good thing because the body. Then brings in the necessary chemicals to repair any of this micro trauma or these small changes in these tears in the muscle. 

Trevor: All right. So, that that's why a beer league hockey players like me feel sore the next day. 

Dr. Neary: Exactly. Because you have that those micro traumas that are going on. So, that's the body's natural inflammatory response. And Trevor, we have within our bodies something called the endocannabinoid system. A lot of people don't realize this. So, we have our own basically cannabis producing system within our body. It helps to to create what we call a homeostasis. It helps to get the body back to its normal balance. And So, by taking in these CBD and THC that are found in the marijuana plant, we can actually then help to reduce that inflammation and then help the body get back to a homeostasis or a baseline much quicker. 

Trevor: Okay. So, I assume then you think that things like the CBD and the THC, well, maybe maybe jumping the gun, do we think they get all the way into the brain because they're nice, big, fat, soluble things that might get through the blood brain barrier? Or do we think they're doing something to the immune system outside the brain? Or is that stuff to be discovered? 

Dr. Neary: Yeah, excellent question as well. And So, the CBD and the THC, they have specific receptors within the body. There are receptors within the brain. There are receptors in the heart. There is receptor in the kidney, the liver and the periphery as well. So, these different receptors that pick up the CBD and the THC are found throughout the body. And that's why they have been used in a great number of research projects of late, especially over the last sort of ten, 5 to 10 years, there's been a huge increase in the amount of research looking at CBD and THC as a neuroprotective. And I'll speak more about that when we talk about the neuroprotection that CBD can actually, we believe, help. And we've illustrated that in different rodent models, mice and rats. But not only that, it's been shown to be helpful in anxiety and depression. And as a result, there more and more research now starting to look at avenues such as post-traumatic stress disorders, those with anxiety and depression. And So, it's an opportunity to really look at how we can actually use this natural product, these natural components found in a plant that that's been provided to the planet that we can actually use in some way, shape or form. And for about the 10, for about the last 10,000 years that we've been in existence, this plant has been surviving. And it has been used to look at how it can be used as a medicinal property. 

Trevor: Okay. And yes, I want to get back to neuroprotective eventually, too. But how about. So, you I'll do the big reveal. You guys did get the grant from the NFL. So, let's talk about your specific study and then we'll go even farther afield into potential neuroprotective effects. So, what it's going to happen in the study that the NFL's funding. 

Dr. Neary: So, what happened with this NFL study and I know I didn't completely answer your question there, Trevor. So, we submitted our application and then it came back that we were shortlisted to one out of ten. And then the information that came from the NFL was that they were going to find somewhere around 3 to 5 projects. And then in the long run, what they actually did, they funded two projects. They funded our project and another project from Southern California, and that was out of 106 applications worldwide. 

Trevor: congratulations. 

Dr. Neary: Yeah. So, we feel very privileged and fortunate that the team that we've got together to look at this neuroprotection, this pain management, and the control and potentially the reduction of opioid medications. So, we feel very, very fortunate that way. And I think there's a couple of reasons for that. I think we've got an excellent, excellent research team of academics and professionals from across western Canada that are going to be involved in this research. So, moving forward, the NFL came back to us said that they'd love to fund our research and we're out of the $1 million that they were putting forth, we ended up getting S537,000 USD in order to conduct this research over the next three years. The first study, Trevor: is actually going to look at, is there an optimal dose of CBD or that cannabidiol that we can use on a daily basis to alleviate or mitigate the inflammatory responses? Because of my training and performance in contact sports and we're going to do this by using what we call a dose escalation study. So, we're going to start our athletes on a very low dose of CBD, and they'll take that for two weeks. Then we're going to bump that up and double the concentration of CBD for the next two weeks. And then there again, that'll be a doubling again and again and again to try and determine from a blood biochemistry and looking at what what we call the pharmacokinetics, how much of that CBD is actually used in the body and how is it used in the body and whether or not we can actually come up with this again, optimal ideal formulation for these athletes So, that we can then use that in a season of football or use that in a season of ice hockey or any of these other contact sports, boxing, rugby, you know, European football or soccer, as we call it here in North America. So, that's the very first study that we're going to look at. 

Trevor: Cool. Now, as a pharmacist, it's an obsession of mine. So, how are you getting the CBD into the patient? I assume they're not inhaling it. How is it getting in? 

Dr. Neary: So, what we're going to do is we're going to use capsules and the capsules will contain the CBD in specific concentrations. So, for example, and I've actually got some capsules here at home and I'm going to be doing a very small little pilot project on myself to look at the bioavailability of some of these study medications, if you will. And they come in in different capsule formulations. For example, the ones that I have are 100 milligrams of CBD. And my plan is to use three or 400 of those a day to then take a look at what's the bioavailability of that? How much are we actually getting into the body So, that it can be used? 

Trevor: Well, that's cool. Pharmacists can't resist. When we talk to people about cannabis capsules because it's such a fat-soluble thing and the capsules are So, small, we encourage them to take it with like a fatty meal, like, you know, chocolate milk or peanut butter or whatever. I assume you're going to be controlling for what the participants are eating when they take the capsules to try to make sure that everyone has the same absorption of their stomach. 

Dr. Neary: Yes, exactly. And you're exactly right. There's some good research out to show that if you have a fatty meal or a meal with a higher concentration of fat in it, as an example, because depending on what type of CBD and how it's formulated, is it formulated with an oil based? Is it an isolate? Is it a water soluble depending on how it's incorporated or administered into the body that'll have an effect on how much is actually consumed as well. So, we will we'll be asking the athletes to have a diary, a log book, to give us some indication of what they're actually putting into their bodies. And we'll do a three or a five day food analysis as well, So, that we have a good idea of exactly what they're incorporating into their bodies as far as food goes. 

Trevor: Oh, very cool. Okay. So, now that you've gone through the resistance training found an optimal dose, what's Phase Two? 

Dr. Neary: So, the next stage in the next study that we're going to look at is we're going to then take that, quote unquote, optimal formulation and we're going to incorporate that into a season of football. And it'll be what we call a randomized double-blind cross-over designed study. And really what that means is Trevor, if you and I are in the study, you may end up getting the CBD first for the first four weeks and then you would go to a placebo which would have no CBD in it. I might start with a placebo and then I would then go to the CBD for the second part of the season. So, that way we'll be able to determine whether or not the CBD is having an effect on the neuroprotective properties that we think it does. And then and So, the whole objective for that second study is to see whether or not we can actually reduce the number of concussions or can we mitigate or reduce the severity of the concussions. 

Trevor: Cool. Which football players what like are these NFL players, these university players? Who's who is getting them? 

Dr. Neary: Yeah, these are going to be university and junior football players. For example, the University of Regina, the Rams, University of Saskatchewan, the Huskies. We're going to use the Regina Thunder. Saskatoon Hilltops. And also, this is a multicenter study in which we will be doing some of the research at the University of British Columbia, in the Okanagan in Kelowna. And So, we're going to use their athletes. We're going to use the Kelowna Suns. We're also, looking to UBC Thunderbirds in Vancouver as well because some of the research and in particular when I talk about the third study, we'll be doing some fMRI research on brains of those who have had post-concussion or chronic pain. And So, B.C. Children's Hospital is also, a part of this project as part of UBC as well. So, those are the athletes that we're going to be using they're varsity, as well as junior football players who've elected to, you know, not go to school for whatever reason and take up, you know, jobs in the communities that still love to play football. 

Trevor: Yeah. No, no, that's very exciting. Like, you have no idea how many times we hear, well, you know, but there wasn't some double-blind placebo controlled trial and you're doing a double blind placebo controlled trial with a crossover. So, this is very exciting. 

Dr. Neary: Thank you. And I think, again, you know, probably part of the success of our grant was the way we put together the actual application as well as how we were going to how we designed the project.

Trevor: Okay. So, Phase Two is done. What's what happens in Phase Three? 

Dr. Neary: So, then in Phase Three, you know that the grant and the advertisement from the NFL came out that they were very interested in looking at pain management and a lot of contact sport athletes, not just football players, but later on in life and even during their playing days are in significant pain. And, you know, as you just mentioned, you know, beer league hockey player. 

Trevor: Yeah, you shouldn't call me an athlete. We're a class by ourselves. 

Dr. Neary: Yeah, yeah. No, yeah, no worries. I, I still play hockey on Thursday mornings myself. And So, I know what it's like, you know, just getting up the next morning as well. And So, these athletes, because they're putting it because it's such a physical stress, what is actually happening again as we talked about that immune response and it can it can lead to chronic pain if it's not taken care of in the right way. And again, unfortunately, a lot of these athletes will use prescription medications in order to get through their day. And opioids, of course, and I don't need to remind you or the listeners or, you know, those viewing this today of the dangerous and detrimental effects of opioids. And So, is there a method that we can use that's natural to get you away from that? And So, that was also, part of the NFL's advertisement. Can it be used for pain medication in and trying to mitigate or reduce the amount of opioid use that these athletes actually use. So, in the third study, we're going to take again that optimal formulation of CBD, which again is neuroprotective and it's anti-inflammatory and etc.. But we're also, going to use some of the THC, and the THC is what gives you the high. If you were to take it either in a gummy or in a soluble form or smoke it or ingested, and somehow that would that can potentially give you the high. But the amount that we're actually going to use is just a very, very small amount, as in let me just give you some approximations. If we were to give the CBD as a formulation and let's say we're giving a thousand milligrams per day. And you take 500 in the morning, 500 in the evening, we're also, going to get these individuals who have had who have chronic pain or post-concussion syndrome, you know, they haven't been back to work because of this complication related to their concussion. We're going to give them also, very small doses of the THC and probably somewhere around about 5 to 6 or seven milligrams is what they're actually going to take in as well. So, the last study is going to be what we call a Latin square crossover design. 

Trevor: Okay. Off to explain that to us. 

Dr. Neary: Yeah, I'd be very happy to. And so. And So, what we're going to do is we're going to take between 35 and 40 individuals who have chronic pain, post-concussion syndrome. And we're going to put them through all of the different formulations that we're going to include as part of this study. So, for example, if we're going to use CBD, we're going to use THC. We're going to use a placebo. We're going to use a combination of CBD and THC together. And So, what would happen is that we're actually going to give those 35 to 40 athletes, all of those at different times. So, as an example Trevor, you might start out with the CBD.  I might start out with the CBD and THC combined. And then after one month, you're going to be switched to the placebo and you'll be randomized. So, you won't know and I won't know. And So, it's what we call a double blind. So, neither the athlete nor the researcher knows what you're actually getting. And So, you and I will for the next four or five months, we're going to go through every one of those different formulations that we think that can help with the pain management. And what we want to do is we want to see whether or not the CBD is any better than the CBD and THC together. Or do you only need THC or do you need another pharmaco, some sort of a nutraceutical of some sort? And we're going to look at those as well, potentially some omega oils, some amino acids, etc., to see whether or not we can create what we've called an entourage. By adding a couple of these, you know, the CBD and the THC and and maybe nutraceuticals together. Does that create even a better effect? Is that does that stimulate those cell receptors to take in the CBD and the THC in a better way? And there's some research to suggest that there is this entourage effect. 

Trevor: Yeah. No, we've had other people on talk about the entourage effect with some of the other phytochemicals that are in the cannabis plant. So, if there isn't yet another entourage effect with the cannabis compounds and say omega three fish oil, that would be that kind of blows my mind a little bit. That's very interesting. 

Dr. Neary: And you spoke about it earlier Trevor, about, you know, are we going to be recording the diet and how are we going to control for food, etc.? And certainly, you know, with the addition of those oils that we're planning on using as well, does that help to get the CBD in a better way and into the system? 

Trevor: And you said in this third phase is this one, you're shoving people in that terrible little tube to do the fMRI's 

Dr. Neary: We are. We are. And potentially also, in the second part of it as well. If some athletes end up with concussion and we know that anywhere from about 10 to 15% of athletes entering competitive sport will end up with a concussion. And that's it's quite well known in the literature that, for example, we assess all of the university athletes here at the University of Regina, and we assess at the beginning of the season baseline testing, somewhere around about 300 athletes. And every year we end up with somewhere between 30 and 50 concussions with our athletes. 

Trevor: That's alot. 

Dr. Neary: Yeah, it really is. And So, we're going in the second part of our project, that's what we'll do is we'll actually put some of these into the magnet. The fMRI and we'll take a look to see what is the effect of this CBD on the athletes’ brain before and after concussion. And, and to our knowledge, this really hasn't been looked at that what, what is actually going on in the brain with a concussion when you've got when somebody is on CBD and is are there changes that are happening from one region of the brain to the next region of the brain. And something that that we believe and something that that we think is going to happen. Is there going to be changes in what we call functional connectivity is. 

Trevor: And what is that? 

Dr. Neary: Yeah. How does the front of your brain interact with the back of your brain? How did how does the right side of the brain interact with the left side of the brain? And So, we think that there's going to be a synergy related to that when we look at fMRI and cannabis. 

Trevor: Yeah. No, no, that's good. And just before someone writes and yells at me, I called it a terrible little tube. I will declare my bias. I'm mildly claustrophobic, So, I definitely would need to be sedated before I put in an MRI. That's one of my, but anyway, fMRI are fantastically interesting things that just for me the idea being stuffed in that little tube sounds terrible. So, I would definitely need to be sedated. But that's why I called a terrible little tube. 

Dr. Neary: Right? Yeah. No, I'm glad you clarified that, because you're absolutely right. Some individuals are claustrophobic and they actually cannot go into that. 

Trevor: So, now, obviously, there is much more involved. But I think you gave us a good overview of what's going on in these three phases. And I know I promised about 40 minutes, So, we're getting close to the end. So, just before I was there anything else you wished I'd asked or anything else sort of about the neuroprotective effects or anything else about cannabinoids in the brain and concussions you wished I'd wished I'd covered or you think the audience should hear about? 

Dr. Neary: Yeah, actually, there are there's a couple of other things that that I think the audience should be interested in. First off, not only is the NFL providing, you know, the grant funding for this, but there's also, another company by the name of My Next Health. And My Next Health has come to the table, and they're going to provide up to $400,000 in kind towards the purchase of the cannabinoids, as well as they're going to undertake genetic analysis. We're going to analyze what we're going to do is we're going to collect not only the blood samples that are going to be analyzed at the University of Saskatchewan to look at what's the that pharmacokinetics or how it's actually used in the body. But we're also, going to do some gene sequencing. We're not going to sequence the whole DNA molecule. But what My Next Health is actually going to do is we're going to collect saliva samples from our participants. Those saliva samples will be analyzed for metabolic genetic markers. And how do those metabolic genetic markers relate to what we call the phenotype? What's the expression of as it comes out in an individual? So, for example, I'm going to spit in a tube, I'm going to send my samples off to My Next Health, which are going to analyze my genes. And they're going to give me some indication of what my genetic markers are, my genetic genes, metabolic genes are. And then I'm going to try and relate that to my muscle tissue. Fast twitch, slow twitch. All right. My ability to perform sport or inability. If you will. And So, this is going to be a really exciting aspect of the project. And I'm So, thankful that My Next Health has come forth to provide not only this in-kind funding, but also, this service to look at these genetic markers. So, it's going to be really an exciting part of the project as well. 

Trevor: That that's amazing. All You know, I never even thought about the fact you might be linking this to that to the genetics of the participants. So, there's going to be just reams and reams of good info out of these studies. 

Dr. Neary: It is. And we're and as I said, you know, we're really ecstatic about this. You know, when it was first announced, we were inundated with calls from So, many different individuals across the globe and Canada in particular. And, you know, both wanting to help in some way, shape or form, you know, individuals like yourself coming forward to, you know, very interested in helping us get the message out on what we're trying to do here. And So, we're really excited about that the next three years of this project. And we're hoping that by Christmas time we're going to get some preliminary data out So, that we can start to share that with the research community and the National Football League as well. 

Trevor: That's amazing. Well, you've been very generous with your time. You're obviously very excited about this really interesting project So, that it's been a fantastic interview. Any final, final words before we let you go? 

Dr. Neary: Yeah, I know. I think, Trevor, you did a bang-up job with that. And I'm very appreciative. And as I said, I'm more than happy to get this information out and help those. And, you know, I think that's what it comes down to is that, you know, many of us in research really want to give back. And that's the message here is that. We really want to give back and whether or not this is going to be able to filter down not only from, you know, the NFL is paying for this, you know, and thank goodness for that. But can this be filtered down to children? And maybe I'll just leave that the listeners with one final thought. A number of years ago, I met a psychiatrist by the name of Dr. Lester Grinspoon. And actually, there's a pot plant named after Lester. And he and Lester just passed on. And unfortunately, and I had the good fortune of meeting him in Boston when I was at a conference. And Lester's goal and he had written a number of books on medical marijuana and what I want Lester's goals was, is to be able to see on the kitchen table a jar full of cannabinoids. And mom and dad saying, Johnny, Sally, take your cannabinoids out. Take your cannabinoids, and then go out and play. And So, I'm going to try and follow through and continue that dream for him and see whether or not we can actually do that, whether we can actually have a jar full of colored cannabinoids that you would actually take prior to you going out and playing. 

Trevor: Okay. So, Kirk, I just want because I think it's important and I'm trying not to bore people, but you know, how many times we get told, well, there's no studies. So, I want to talk about the three phases of the studies that are going on here. So, we have Phase One, which sounds like it might even be starting now, which we're looking at optimal dose. So, that's important. And that's like sort of the pharmacy end of things. We're trying to see what doses the people should have and what we call the pharmacokinetics, like how fast it goes through the body and how fast it's excreted. And one of the things that kind of blew my mind a little is and it's good that they're doing this, but they're talking about going up to doses, 3 to 400 milligrams of CBD, maybe up to a thousand in a day. And just to put that into perspective, that's kind of seizure doses right now. Like we have in the States, a CBD product called Epidiolex, where we can go into that large a dose of CBD. But in Canada in will call it pain patients are usually, people are in kind of a specialist I talked to or give a little talk that I go to they're usually talking about treating pain with, you know, 20 to 60 milligrams of CBD, possibly with some THC added on. And these guys are talking about testing up to 1000. So, you know, as a pharmacist, I'm just fascinated to see, you know, what is that magic dose? And the other interesting thing about CBD. CBD at those large doses tends to be really expensive. You know, that's a complaint that the epilepsy the seizure people talk about all the time is, you know, if I'm going to take enough CBD to work, it's going to cost me a lot. So, that's cool. So, Phase Two is the actual maybe meat of it. So, this one, they're actually giving football players and this is sort of their university levels. They're actually in university football are kind of the equivalent outside of university football. In Winnipeg, it's called like the Winnipeg Rifles. So, they're about university age, but they're not in university and still playing football. So, they're So, this is a double blind, placebo-controlled crossover study. So, meaning if you Kirk are a participant, you know, for part of the season, you'll be getting the CBD dose. For part of the season, you won't be. And at the end, we'll check to see how many concussions you got. And I suppose what one of the things we're trying to see is did you get more concussions when you were on the placebo than not? And they're looking for to reduce the number and or severity of the concussions. So, that's obviously what we want to know. And then Phase Three, pain control and reduction of opioids. So, that's mostly in patients who are sort of post-concussion and or chronic pain. So, this is, you know, your retired athlete or possibly someone still playing but could be a retired athlete. And this one I hadn't heard of this before, but makes sense when you think about a Latin Square crossover. So, they have a CBD dose, a THC dose, a combo of THC CBD and a placebo. And then over the course of the trial, you, the participant, will randomly be given one of those until you are given all of them and see how that affects your pain and or your opioid use. So, yeah, this is you know, there's no study. This is a study. This is a well done study. 

Kirk:  Well, they're in the process of doing the study, So, it's not completed yet. What I what I'm finding fascinating is that the more and more I talk to people and I understand the medical side of cannabis versus the recreational side of cannabis, and this goes back to our future. Our future Compassion Club conversation I just had is that the medical doses of cannabis is So, way above ten milligrams. I mean, the Owen Smith Supreme Court decision allowed us to have edibles. And it was again the courts telling the medical community that cannabis works, but they're using like 200 milligrams, you know, suppository. You know, they're using huge doses that, you know, the compassion clubs work outside of the law as it is. But the doses that the government is allowing us to have don't meet the needs of medical people. I think in the future we've got to spend more time really focusing on what's happening in the medical cannabis field. People that use cannabis as medicine are being forgotten. And it's really something that I think we as Reefer Medness have to get more into and I hope to in the future because this is a perfect example where they're using doses that don't follow government standards. 

Trevor: Or at least exploring what they should be. You know, they're starting with the what should the dose be? I don't know. Let's start from zero and go to huge and see where the right dose is. 

Kirk:  But I wonder how that works in ethical studies because the government standard, which is arbitrary, is ten milligrams. So, they must somehow get permission. 

Trevor: Well, no, they did talk about that. So, they are the CBD dose will be big. And I forgot to mention good that you brought it up in the Phase Three. They will be adding on THC, but the THC will be small, it will be in the 5 to 7 milligrams. So, that is in the magic government's under ten milligram thing. So, whether the government said they had to or they picked it because of a literature search, I don't know. But, their THC dose is in the under ten milligrams zone. 

Kirk:  Okay. And that's true. I seem to have forgotten that the government doesn't really give us a maximum dose of CBD. Is it just the THC? 

Trevor: Yeah, it's some other things that just kind of blew my mind a little. So, they have another partner besides the NFL called My Next Health and My Next Health is going to be helping them with other stuff, including possibly adding some nutraceuticals like omega threes and some other stuff. And one of the things that might happen or they're looking for anyway is an entourage effect. And now the only time I've heard of Entourage effect is the stuff actually in the cannabis plant, like  and other phytochemicals in the cannabis plant. Wouldn't it be amazing if or fascinating? I don't know the right word if, you know, fish oil had an entourage effect with cannabinoids, you know, a plant and a fish together, boom. There you go. Like, it's I whether it works or not, I think it's very cool that they're looking at it. And the other thing that they. 

Kirk:  They may just take they may just realize that some of these natural medicines are better than pharmaceuticals.  

Trevor: And other ones that just sort of blew my mind a little is they're looking at the genetics of the participants. 

Kirk:  Yes. Yeah. So, I picked I have that in my notes as well. Genetic markers of the athletes. This is something that Dr. Shelly Turner talked about that she does with her patients, that she because she takes genetic markers So, that she can figure out what people are predisposed to. I mean, that revolutionizes medicine right there. 

Trevor: Yes. Well, they've been talking about that since I've been in school. You know, wouldn't it be great if and now you know, with the 23 and me type technology out there, it's now not tens of thousands of dollars. It's now down to hundreds of dollars to do that sort of test on a patient. So, it's not free, but it's not ridiculous. So, I obviously and it's funny, when he first started talking about genetic testing, I just assumed he was talking about genetic testing, the plants, not the participants. So, you know, I just I got I got myself a giggle on that one. Another that just kind of blew my mind a little is they've been doing concussion testing on U of R athletes, not a surprise. And they get 30 to 50 few of our athletes get a concussion every year. 

Kirk:  Yes. 

Trevor: That's a lot. I remember when my kids were playing hockey, frankly, especially my daughter, when she got into the higher levels, they did concussion testing on them at the beginning of the year. And, you know, a handful of girls on the team every year got a concussion. 

Kirk:  What's what is concussion testing? What is that? 

Trevor: Well, that's I was never good at it. Again, another mutual friend of ours, physiotherapist, recently retired Greg Loucks would do some of it. We'd actually, you know, you'd actually have to email him and he could tell us what he does for concussion tests, but he would do apparently a series of tests on them at the beginning of the year and then. So.

Kirk:  So, it must be neurological balance, eyes? 

Trevor: I, I yeah, we could, I'm sure if we asked Greg, he could tell us what they do... Trevor: in the future here again. Okay. Kirk: , I got a hold of Greg Loucks, the local physiotherapist who's done a lot of concussion testing over his career. One of the tests he did once was called Impact, which is kind of like a video game using an iPad. And So, there's a few different testing protocols. But the one he uses, he's used most often is called the Sport Concussion Assessment Tool or SCAT. And this is SCAT 5. So, this is like the fifth edition. So, it's been through a bunch of different editions over the years. And there were there were lots. He said and rather than describe it to me, why don't I put you through it? So, you know, there's lots of different questions, all ranging from physical questions like, do you have neck pain or you dizzy to he made me do some memory tests, some which I did well, some not. Like he'd give me a list of numbers, like a three-digit number 4 9 3 and then I've got to beat repeat it back 394 and reverse order, which is easy at three digits, but at four or five and six digits was way harder. And then a list of words I had to memorize at the beginning and then repeat at the end. I did terribly at that, which I was a little embarrassed. And then he So, a bunch of sort of neurological tests like that. And then he made me do a bunch of actual physical walking and standing on one foot with my eyes closed and that sort of thing. And those frankly were funny enough that I recorded them. And I will put a link to the YouTube video of making me look stupid while doing the SCAT5 test for people to see. But yeah, So, a variety of mental tests and physical tests and symptom tests to decide if you had a concussion and these all work best if you do the baseline. So, like before the season and then after either after the season or after a potential concussion and see if the score is worse after the potential concussion. I hope that helps... And when you start calling them concussions and start calling them sort of minor traumatic head injuries or brain injury as you go, all you know, yeah, we really should try to minimize these because, you know, brains, we need them. 

Kirk:  We to just stop sports anyways and just put all the money into arts. 

Trevor: Fork you and the arts. I mean the arts are really important. 

Kirk:  Yes. we need the Arts

Trevor: Yeah. That's what I mean. That's what I'm trying to say. But my last little blurb before I let you comment because again, I really like this one. So, Kirk: , how cool was it that that Dr. Patrick Neary wanted to finish off his interview talking about an interaction he had with Lester Grinspoon? And how Lester Grinspoon said, you know, wouldn't it be cool if we could have a jar full of cannabinoids on the table and you just tell your kids, take your cannabinoids and go out and play? So, for those who missed it, Peter Grinspoon, Dr. Peter Grinspoon, who is a medical doctor and really into cannabis, was a guest of ours on Episode 66. So, yeah, again, it just keeps coming around and around and around. 

Kirk: Once again, Dr. Shelley Turner always said everyone should take their multivitamin and their CBD every day. I mean, it's sort of it's that's her that's her theory. And I mean, I haven't I haven't gotten into that yet. I take my multivitamins, but every day a CBD tab. So, isn't that cool? Yeah, it is funny. It's funny how certain themes seem to come around. You know, we've done we've done over 80 episodes and there's a lot of themes that reoccur. So, I guess we should introduce ourselves. I'm Kirk: . I'm the registered nurse. 

Trevor: I'm Trevor. She felt, I'm the pharmacist and.

Kirk:  This is Reefer Medness - The Podcast and we encourage everybody to get to www.ReeferMed.ca. We have a very comprehensive web page that basically breaks everything down. All the research is there. 

Trevor: And Kirk:  I do. I am going to sneak in a My Cannabis Story. So, we're going again back to Calgary, to Hempfest. But this was an interesting guy and I thought a sort of a different end. So, from the pure research end of things. When we were in Calgary, I snagged the M.C. before they let him up on stage, and his name was Barry Davidson, and he described myself as a policy and regulations wonk, and he talks about stuff like farmgate. So, let's have a listen to Barry... Hi. We're still at Hempfest and we've got a we're going to call him a policy and regulation wonk to chat with us. Please introduce yourself. 

Barry Davidson Hey there, it's Barry Davidson. I'm with Davidson Global. I'm actually with a couple of firms, Davidson Global, David Hyde and Associates cannanavigators. We've been working within the realm for the last many, many years, helping people get licensed and operate. 

Trevor: And everybody needs that. Everyone needs a friend when they're going to go deal with government people. So, you've been dealing with policy and regulations and cannabis world for a while. What do you think is the most interesting or controversial policy out there right now? 

Barry Davidson Well, I guess twofold. At a federal level, I'm really watching and enjoying the evolution of the federal regulations as they come out. And with the election on, I'm curious to see what next year is going to bring. Out a much more interesting and direct level. I love watching what Ontario is doing with their farmgate. We've worked on a few facilities out there now that are building a retail facility right out front of their grow or their production facility. That's very interesting. B.C. Is doing some very cool things if they can put it to ground around that area. So, I'm hoping over the next year we're going to get to see some of not just the big guys but some craft growers being able to actually start selling through their own doors. 

Trevor: Yeah, we hear interest in that a lot that we'd love to be able to have people visit the farm just and, you know, purchase, you know, kind of like if I was going on a wine tour. And So, that's getting close in Ontario and B.C. ish. 

Barry Davidson Well, the operation of that is getting close. I think we're a long ways away from being able to tour the Vineyard. Just because of the way Health Canada's got those regulations. It's going to be that'll be a long-ways away. But knowing that the product came from the place, you're going to buy it and being able to support your supplier like it sort, I feel like it takes us back to the old black-market days of you've got your favorite dealer who is probably someone you know well. And you know what you're getting from them. Well this allows us to transfer that into the legal realm and start actually supporting in a lot of cases it'll be the craft growers as they as they evolve into that and being able to be face to face with their own customers. 

Trevor: That would be fantastic. So, thank you very much. We know you've got some MC duties to do. Thanks for taking the time. 

Kirk:  So, I didn't get to see Berry this time. I hope to I hope to see him at some point in the next couple of weeks. So, hopefully he's listening. 

Trevor: Good. And I be the thing that I always forget that you had asked me about off air is did you remember to ask him for a song? I remember to ask Patrick Neary for a song, and he sent a very lovely email back. "In regards to a song. I'm a big Rod Stewart fan. I have gone to many of his concerts, including one in Winnipeg about five years ago. My favorite song is Maggie May and would love it if you could play that song." Renee, do you think we can do that for Patrick? 

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