Category: Blog

In July of this year, Headcount released a report that looked in depth at the turnover rate of cannabis retail associates, otherwise known as “budtenders”. It was found that 55% of budtenders across the United States and Canada who worked at any point over the previous 12 months had left their place of employment by the end of the time period. In both countries nearly a quarter of all budtenders hired in 2021-2022 did not even complete one full month of work.

 

The report had found that the better performing the budtender was, the more likely they were to stay in their position. But what are potential reasons for why they leave?

 

Expectations

 

Budtenders have been compared to coffee shop baristas and bartenders; when, in reality,  working as a budtender is a unique role of its own. Among the five most popular questions that budtenders receive, per cannabis.net, the one that sets budtenders on a different level than nearly all other professions in the retail industry is: how do I dose my cannabis? Budtenders are faced with difficult questions from customers seeking medical or legal advice. 

 

Determining therapeutic amounts of cannabis often needs individualized attention, where comprehensive training is required to provide such information. Budtenders may be equipped with the knowledge to assist, but there are two main reasons for why they cannot provide that assistance to their customers. First, it might not be possible to find the time to offer appropriate guidance when they are serving over 100 customers per day. Secondly, for those without a medical license or a disclaimer to protect them, they are prohibited in certain dispensaries from offering specific dosing advice. One may be left with the feeling that reasonably fulfilling the needs of every guest who walks through the door is unachievable. Lack of control or unclear expectations can quickly lead to burnout. 

 

Support (or lack thereof)

 

Is leadership providing the support needed to fulfill the demands of the job? An online survey published in 2016 evaluated the training, knowledge, attitudes, and practices of medical and non-medical dispensary staff. It was found that 94% mentioned providing specific cannabis advice to patients, while 20% reported receiving medical or scientific training. While providing dosing may be problematic, budtenders can still offer non-medical, educated recommendations to their customers. 

 

Findings from the study emphasized the importance of consistent, evidence-based training of dispensary staff who provide specific recommendations for patient medical conditions.  Therefore, budtenders should be offered educational opportunities to support their role. 

 

Legitimizing the work

 

When it comes to cannabis, it’s not just that we need to legitimize the therapy, we need to legitimize the work. Policies are changing but the stigma remains. Lack of social support is another cause of job burnout, where feeling isolated or in constant defense, can lead to stress. 

 

Being a budtender is a difficult job. It takes an endless amount of energy, patience, and intelligence to stand on the other side of the counter. A budtender is expected to know enough to direct the novice in the right direction as well as keep up with the well-read cannabis connoisseur. 

 

Budtenders also carry the heavy burden of the industry. Statistics lead to findings that state: 

 

Budtenders quitting hinders the cannabis industry. 

 

Retail sales go down with turnover. 

 

For a budtender, on one side you have a group in society that does not take your job seriously and on the other hand you have a group blaming you when the industry is hurting. While we still may be a long way off of eradicating the stigma that was created decades ago, we can recognize that without budtenders there would not be a $33 billion dollar industry. 

 

Changing the way we look at the profession

 

The first solution in uplifting budtenders experiencing burnout may be to offer ample opportunities for them to excel in their position. Realm of Caring (RoC) care specialists can offer two things to dispensaries: consulting budtenders on how to carefully answer difficult questions, and offering a place for customers to go to if they need free, research-backed guidance, from product selection to dosing advice. RoC is an ally in the field, lean on us for the support you need. 

 

How do I know I’m burned out?

 

Project Helping identifies the main signs of burnout. These include: 

 

• Chronic fatigue
• Insomnia
• Forgetfulness
• Headaches or chest pain
• Increased illness
• Loss of appetite
• Cynicism
• Increased irritability
• Loss of interest in activities

 

Mayo Clinic shows that job burnout can result from various factors, including:

 

• Lack of control. An inability to influence decisions that affect your job — such as your schedule, assignments or workload — could lead to job burnout. So could a lack of the resources you need to do your work.
• Unclear job expectations. If you’re unclear about the degree of authority you have or what your supervisor or others expect from you, you’re not likely to feel comfortable at work.
• Dysfunctional workplace dynamics. Perhaps you work with an office bully, or you feel undermined by colleagues or your boss micromanages your work. This can contribute to job stress.
• Extremes of activity. When a job is monotonous or chaotic, you need constant energy to remain focused — which can lead to fatigue and job burnout.
• Lack of social support. If you feel isolated at work and in your personal life, you might feel more stressed.
• Work-life imbalance. If your work takes up so much of your time and effort that you don’t have the energy to spend time with your family and friends, you might burn out quickly.

 

When on the verge of, or experiencing, burnout there may be several helpful techniques to help you overcome the burden. Leadership in the cannabis industry can help by outsourcing support from within the industry. 

 

Who is Realm of Caring?

 

Founded in 2013, Realm of Caring (RoC) is an independent 501c3 non-profit organization. They serve anyone in need of more information about cannabinoid therapies. Through revolutionary research, innovative education, and empowering global community connections, RoC seeks to facilitate and encourage the mainstream acceptance of transformative, plant-powered therapies to benefit individuals and families and serve healthcare providers as well as the hemp and cannabis industries.

 

Since becoming a formal non-profit in 2013, RoC has cherished a vision that has remained unchanged: the belief that the quality of life matters.

 

If you want to reach out to our care team to discuss anything cannabinoid therapy related one on one – we are here for you! You can call our free hotline at 719-347-5400, email info@realmofcaring.org, or schedule an appointment. 

 

Cannabis hangovers, also referred to as “weed hangovers,” refer to the range of effects that may take place the day after consuming cannabis products. These unpleasant sensations, which range from feeling drowsy and fatigued to headaches and nausea, might ruin the experience or discourage someone from using cannabis.

 

Research is limited in understanding the consumer complaint of cannabis hangovers. While one report shows that undesirable, residual effects of cannabis consumption can be felt the day after smoking, another reports that any effects are minimal at most. Regardless of the available data, consumers tend to blame the product formulation or overconsumption.

 

Why is it that some products may leave us feeling sluggish the next day, and how might we avoid it? For further information, we got in touch with Michael Backes, Cofounder and Chief Product Officer of Perfect, and the author of Cannabis Pharmacy: The Practical Guide to Medical Marijuana.

 

“I believe that old cannabis products, such as old vape cartridges, can lead to hangovers. Fresher cannabis products appear to produce fewer lingering effects,” says Backes.

 

The combination of freshness and terpenes may contribute to reducing any negative consequences the next day. 

 

Terpenes are compounds found in all known life forms, including fruits, trees, herbs, and a range of other plant species that are responsible for determining their distinct scents. They have an impact on individual and population survival. The compound squalene, for example, belongs to a larger class of terpenes present in both plants and animals. Squalene is secreted by the liver and sebaceous glands in humans. In the human body, squalene serves as a precursor for steroid hormones and cholesterol.

 

How Terpenes Help Eliminate the “Hangover”

 

“A rich terpene entourage reduces the likelihood of cannabis hangovers,” continues Backes. “A traditional Moroccan remedy for cannabis hangover includes a glass of cold, fresh lemonade with black pepper sprinkled on top. This works because of its terpene entourage of limonene from the lemons and beta-caryophyllene from the pepper. Both limonene and beta-caryophyllene possess potent anti-inflammatory activities.” 

 

Limonene has also been studied for its anti-nausea, anti-vomiting, and uplifting properties, reported to boost mood and metabolism while decreasing stress and anxiety. 

 

Myrcene, on the other hand, is a terpene known for its sedative effects. Considering that terpenes are so vast they account for nearly one-third of all compounds in the Dictionary of Natural Products, research is still in early stages. However, evidence remains that they work in synergy with other cannabinoids, and there is a consensus among consumers regarding their different properties.

 

If you want to avoid residual feelings of grogginess the next day, it may be best to pay attention to the terpene content, quality of the product, and how much you are consuming. 

 

“Sip, Don’t Rip”

 

Backes explains, “Most consumers inhale too rapidly. Reducing the intensity of inhalation also reduces the combustion temperature, which results in a smoother, less harsh experience. I advise taking a gentle inhalation (sipping) rather than hitting hard (ripping).”

 

Starting low and increasing slowly enables one to find their therapeutic dose at the lowest amount possible. Finding your individual threshold can also help to prevent effects that carry over into the following day. While you may have a good indication as to where to stop with smoking cannabis, it may become more difficult with edibles given the slow rate at which they will metabolize in the body. 

 

When in Doubt, Get Support

 

Realm of Caring is here to help with lingering questions about finding the most success from your cannabis experience. From quality product selection in your area to dosing guidance along the way, our care team is available. ​​You can call our free hotline at 719-347-5400, email info@realmofcaring.org, or schedule an appointment. 

 

On October 26th, 2022 at 4pm MST, Michael Backes will participate in a webinar hosted by Realm of Caring. Beforehand, send any questions by email to info@realmofcaring.org. Register using this link! 

This November, several individuals in the United States will have the opportunity to change cannabis laws. Currently, four states have secured the necessary number of signatures to place their measures on the ballot. Decisions will also need to be made at the local level, affecting laws around recreational sales and depenalization of personal possession. 

 

Before you fill out your ballots, it may be helpful to have a deeper understanding on the terms that will be presented.

 

Depenalization vs Decriminalization vs Legalization 

 

Depenalization can be defined as the reduction of the use of existing criminal sanctions, which may be considered a de facto intervention because it does not require a large change in legislation. In Ohio, for example, the November ballot measure would eliminate penalties for the possession of misdemeanor amounts of cannabis. 

 

Decriminalization means that possession of cannabis is still illegal, however individuals are subjected to less harsh punishments, such as a civil fine or drug education versus jail time. When drugs are decriminalized, the production and sale is still prosecutable by law. Some believe that it is a positive path to legalization. 

 

Legalization makes cannabis legal, whether that be by state or federal law. When legalized, cannabis becomes a regulated product in a legal market, whether that be for recreational or medical use. Rules and directives are established largely by government agencies who create a framework for how cannabis will be legalized, manufactured, and distributed. 

 

Federal Law vs State Law

 

When both the House of Representatives and Senate pass a bill that is then signed by the President, it becomes federal law. State law is enacted by each state legislature, signed by the governor. State law exists in parallel and sometimes in conflict with United States federal laws. In cases of explicit conflict, federal law overrides state law. 

 

For example, the 2018 Farm Bill changed federal law by removing hemp from the Controlled Substances Act, legalizing hemp under certain restrictions. Hemp was further defined as the plant species Cannabis sativa L. with a delta-9 tetrahydrocannabinol (THC) concentration of no more than 0.3 percent on a dry weight basis. Bills state by state varied widely in response to the new federal policy. 

 

As it currently stands on a federal level, all cannabis that does not fall under the definition of hemp remains illegal. The federal government still classifies marijuana as a Schedule I drug, meaning there is a high potential for abuse and little to no medical benefit. This is an example of the conflict between state and federal laws, as residents may purchase marijuana, whether recreational or medical, in compliance with their state law but violating federal law. 

 

Medical vs Recreational

 

A state who has legalized medical cannabis, requires individuals to follow specific steps before purchasing. This involves becoming a patient with the state’s medical marijuana (MMJ) program, after qualifying with an eligible condition. Medical cannabis is available to patients 18 years or older, patients under 18 must have a legal guardian register as a caregiver. Medical cannabis is typically more cost-effective than recreational as it is distributed for medical purposes and taxes are much lower. Medical patients may also have access to cannabis with higher potency levels and some states permit growing plants at their residence. Telehealth services have made it a more seamless process in many states to receive an MMJ card. 

 

Legalized, recreational cannabis requires that an individual be 21 years old for purchasing. Recreational consumers are subjected to higher taxes and limits on THC per serving or per package. Fully legal cannabis offers economic opportunity by increasing tax revenue to the state and decreasing enforcement and incarceration rates. 

 

Curious to know more about potential changes? 

 

Click below to find out more in your area:

 

Colorado Springs, Colorado: Recreational legalization

 

Lapeer, Michigan: Repeal recreational sales

 

Petoskey, Michigan: Licensing for recreational marijuana retail businesses

 

Granite County, Montana: Recreational sales, local sales tax

 

Ohio: Municipal depenalization measures (towns: Corning, Helena, Hemlock, Kent, Laurelville, Rushville, and Shawnee)

 

Rhode Island: Local recreational dispensary ban

 

Texas: Local depenalization for personal amounts (cities: Denton, Elgin, Harker Heights, Killeen, San Marcos)

Sleep disorders affect up to 70 million Americans each year. Causes may vary from person to person, but can include life stressors, unhealthy lifestyles, depression, chronic pain, and neurological disorders like Alzheimer’s or Parkinson’s disease. 

 

As more people turn to cannabis as an alternative healing modality, it’s important to understand the benefits terpenes may provide in the process. 

 

What are Terpenes?

 

If you’re wondering what terpenes are, you’re not alone! Like the terms cannabinoids, cannabidiol, and cannabigerol, terpenes are also compounds found in cannabis. In fact, there are about 400 known terpenes in the cannabis plant, but researchers have only begun to dive into the specific effects of a small fraction of them. Terpenes can cause different aromas, tastes, and even colors in a cannabis plant. But they aren’t limited to the cannabis plant alone. Fruits, other plants, herbs – these are all things that also have terpene profiles. Picture the smell of a forest. It’s distinct, it can be piney. This is an example of terpenes in action! The same goes for different cannabis strains. Some have a citrusy smell, while others smell more like woodsy herbs. 

 

Many consumers are looking to terpenes as a way to help predict a strain’s effects, similar to considering whether it is Sativa or Indica. Because terpene profiles work hand-in-hand with cannabinoids, they can produce different experiences even if the strain has the same THC content. 

 

Some popular terpenes include, but are not limited to: 

• Pinene
• Limonene
• Linalool
• Caryophyllene
• Terpinolene
• Myrcene

 

Can Terpenes Help Fight Insomnia?

 

Many advocate for the use of cannabis, CBD, and other cannabinoids as a sleep aid, and further research shows terpenes have their own set of helpful effects. Because each terpene has a unique chemical structure, some are considered better for sleep aid than others. If you’re looking for terpenes to help fight insomnia, try strains high in one of the following, known for their sedative effects. 

 

Terpinolene 

 

Terpinolene is a less common terpene, estimated to be found in around 1 of 10 cannabis strains. It is known for its woody, piney smell mixed with floral citrus aromas. Typically, this terpene is found in sativa strains with higher THC content. Because it interacts with the central nervous system, Terpinolene exhibits sedative effects that may promote drowsiness.

 

Other places you can find Terpinolene include lilac, rosemary, apples, and nutmeg. 

 

Linalool 

 

Linalool is a commonly-found terpene known for its characteristic intense lavender scent, and has a lot to offer in terms of healing properties. This terpene has been shown to reduce symptoms of anxiety and depression, often a cause of insomnia. Similarly, Linalool has been used in ancient medicinal practices as both a sedative and pain reliever. These benefits help to put you in the proper state for a good night’s sleep.

 

Other places you can find Linalool include over 200 types of plants, spearmint, oregano, and limes.

 

Myrcene

 

One of the most abundant terpenes, and often the dominant of all per strain, Myrcene produces very calming effects. While not just present in cannabis as a sleep aid, this terpene can also be found in lemongrass herbal teas as a sedative and muscle relaxant. Myrcene contains such sleep inducing properties that if a strain contains more than 0.5% of it, it is often considered an Indica. If you have experience with cannabis strains that keep you glued to the couch, and leave you feeling extra drowsy, these are probably high in Myrcene content. 

 

Other places you can find Myrcene include beers, lemongrass, ylang-ylang, and mangoes. 

 

Finding What Works For You

 

Understanding the varying effects each terpene may possess can help improve your smoking experience. While research around terpenes is still in its early stages, there aren’t as many definitive claims about their impacts on humans. However, there still remains evidence that they work in synergy with other cannabinoids, and there is a consensus among consumers regarding their different properties. Through trial and error you can find a strain and terpene profile that works for you and your goals! 

 

As with any cannabis therapy effective dosing varies widely by individual and condition. Our specialists at Realm of Caring are here to help you find a product and dose that works for each of us! If you would like to reach out to our Care Team (719-347-5400 option 1), they would be so happy to help you individualize your therapy and find a product that is right for you.

 

There is a lot of conflicting information out there about cannabis strains. Some say strains don’t matter, others say strains may help you achieve a specific feeling or benefit. When used to describe a cannabis plant or product, the word strain is used interchangeably in different contexts. To gain an understanding on what a cannabis strain is, let’s first take it back to the botany of one of humanity’s oldest crops.

 

Cannabis Botany

 

The Cannabaceae family includes about 12 genera and 170 species. A genus (singular for genera) is a classification below a family and above a species. Some conclude that the genus cannabis comprises a single species, Cannabis Sativa (C. sativa). It is proposed by others that the cannabis genus consists of three species, C. sativa, C. indica, and C. ruderalis. Others will even include a fourth species that can be identified as any hybrid between the aforementioned three. Sativa-types are characterized by their tall and narrow leaves, widely believed to produce a stimulating, cerebral psychoactive effect. Indica-types are short with wide leaves, reported to produce sedative and relaxing effects. Ruderalis is thought to be a descendant of indica, although adjusted to the climate where it originates, resulting in a shorter and stalkier plant. 

 

A 2015 study found a “moderate correlation between the genetic structure of marijuana strains and their reported C. sativa and C. indica ancestry and show that marijuana strain names often do not reflect a meaningful genetic identity”. The different species may have more to do with the structure of the plant alone, rather than an effect that may be produced. 

 

Indica, Sativa, or Hybrid?

 

Despite the debate among the scientific community, dispensaries and brands may still stick to three classifications for delta-9-tetrahydrocannabinol (THC) products: indica, sativa, or hybrid. Hybrid strains are thought to combine the effects of both indica and sativa. But if these don’t speak to the effect, rather just the genetic structure, how do you know what effect to expect from the product you are purchasing? Well, while indica and sativa speak to the species, taking a deeper look at the chemical profile will speak to the strain. 

 

Dr. Ethan Russo has stated, “the sativa/indica distinction as commonly applied in the lay literature is total nonsense and an exercise in futility. One cannot in any way currently guess the biochemical content of a given cannabis plant based on its height, branching, or leaf morphology…It is essential that future commerce allows complete and accurate cannabinoid and terpenoid profiles to be available”.

 

Cannabinoids and Terpenes

 

There are an infinite number of strains out there. Taking a look beyond the indica, sativa, hybrid classifications to the mix of cannabinoids and terpenes can give us more insight into what effect may be produced. 

 

Cannabis contains over 100 compounds called cannabinoids, the major ones being THC and cannabidiol (CBD). They may each provide different benefits. You may have observed products that are labeled as having a ratio of the two major cannabinoids, THC and CBD. These could be described as THC dominant (high THC, low CBD); CBD dominant (high CBD, low THC); or an equal balance of THC and CBD in a 1:1 ratio. Percentages of additional cannabinoids are also present in certain strains, as they may provide even further benefits. 

 

Terpenes are compounds produced by plants such as fruits, trees, herbs, and a variety of other plant species that are responsible for determining their distinct scents. Terpenes are so abundant in nature that they form the largest group of plant chemicals.

 

Plants use terpenes as a defense mechanism to protect themselves from the environment and predators. They release a strong odor and flavor that is intended to ward off certain insects or herbivores. Not only do they play a role in protecting plants, but research shows terpenes to have multiple health-promoting properties in humans.

 

Terpenes may enhance health benefits alone or synergistically with other terpenes and cannabinoids of the cannabis product, however little data is available to support an entourage effect directly through our cannabinoid receptors. Most research on the effects look at individual terpenes, rather than how they work in combination; therefore additional research is needed to allow us to understand further therapeutic potential of various cannabis strains and products. 

 

Do strains mean anything? 

 

When considering the biochemical components, strains do matter. Understanding the quantifiable amounts of cannabinoids of your product is an important step in knowing the quality of your product. Differences in observed effects can be attributed to terpene content. For example, it might not be the fact that a strain is labeled indica as to why one feels sedated. That feeling may actually be attributed to myrcene, a terpene with researched, sedative effects. 

 

It is equally important to recognize that a strain’s effects on one person could trigger a different outcome for someone else. Factors such as ailments, genetic predispositions, tolerance level, setting, consumption method, and others are all worth consideration in determining the result a product may have. Thankfully there are many resources more readily available to navigate the world of cannabis consumption. If you want to reach out to our care team to discuss anything cannabinoid therapy related one on one – we are here for you! You can call our free hotline at 719-347-5400, email info@realmofcaring.org, or schedule an appointment. 

 

The menopausal transition most often begins between ages 45 and 55, and usually lasts around 7 years, but can be as long as 14 years. Perimenopause and menopause can cause a number of symptoms that greatly affect quality of life. During this time, hormones go haywire, temperature regulation becomes more difficult, and mental clarity vanishes. Some symptoms may cause discomfort and others may leave women feeling emotionally unstable. As a result, an increasing number of women are turning to cannabis to alleviate menopause-related symptoms, according to new survey data. 

 

86% of participants reported presently using cannabis, and 78% endorsed the use of medical cannabis for symptoms associated with menopause, e.g. hot flashes, sleep disturbance, mood changes and vaginal dryness or pain. The top related symptoms women reported treating with cannabis in the survey were sleep disturbance and mood or anxiety issues. A majority of the participants smoked cannabis for their symptom relief (84%), while 78% reported they used edibles to treat ailments. 

 

Previous surveys, such as those here and here, have estimated that one-third of women consume cannabis for purposes of managing menopause-related symptoms. 

 

Some effects of perimenopause (e.g. depression, anxiety, mood swings, lower libido, and difficulty sleeping) may happen in response to lower levels of estrogen. Estrogen is an important part of the endocannabinoid system because it regulates fatty acid amide hydrolase (FAAH) and is responsible for breaking down certain endocannabinoids. This is why extra doses of cannabinoids, such as those received when using medical cannabis, may help with common menopause symptoms.

 

A primary cause for sleep disturbance during the menopausal transition is hot flashes, and one of the biggest triggers of hot flashes is anxiety. “When a woman finds herself in a high-stress moment, she may start to sweat and flash,” says Dr. Melanie Bone, Ob-Gyn. “This is often ameliorated with cannabis. I find that higher-CBD products are best to reduce anxiety, but years of practicing have taught me that every patient is unique and there are women who respond best to higher doses of THC to help mitigate anxiety.”  

 

While cannabis is often used to treat anxiety across a number of ages, there is a specific science behind the benefits among menopausal women. Our amygdala is the region of the brain considered the integrative center for emotions, behavior, and motivation. During menopause, these are especially heightened, and cannabis helps to suppress the negative responses, causing less anxiety and depression.

 

Products like cannabis-powered vaginal suppositories and topicals have also been mentioned by women to provide soothing relief for issues of vulvar dryness. Why choose a suppository? Unlike edibles, which go through the digestive system and become metabolized before entering the bloodstream, suppositories surpass the digestive tract and liver, and solely depend on body temperature in order to be absorbed by the surrounding skin. In addition, the female reproductive system has its own cannabinoid receptors that can interact with the suppositories.  This eliminates the variables of body weight, metabolism speeds, and stomach contents that come into consideration with edibles.

 

There are also other factors to consider, such as whether to treat symptoms with THC or CBD. THC can act as a sedative for some, while others report stimulating effects, particularly for those who are new cannabis users or take greater amounts. In these instances, the THC could cause further sleep disruption, whereas CBD, especially taken in larger doses, may induce sleepiness. 

 

Presently, there have been no peer-reviewed clinical studies of women in menopause using cannabis and so there is currently no one-size-fits-all approach, or can it be considered a proven therapy for menopause. This goes the same for replacing Hormone Therapy completely with cannabis to treat menopause symptoms. Some doctors report a dose reduction in hormones in a lot of women who use cannabinoids, and others urge cannabis be used in conjunction with hormones for best results. 

 

As with any cannabis treatment, effective dosing varies widely by individual and condition. Our specialists at Realm of Caring are here to help you find a product and dose that works for each of us! If you would like to reach out to our Care Team (719-347-5400 option 1), they would be so happy to help you individualize your therapy and find a product that is right for you.

Palliative Care can be defined as an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.

 

The majority of adults in need of palliative care have chronic diseases such as cardiovascular diseases (38.5%), cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%) and diabetes (4.6%).

 

Pain and difficulty in breathing are two of the most frequent and serious symptoms experienced by patients in need of palliative care. The search for therapeutic strategies is ongoing as poor symptom control and/or intolerable adverse effects are attributed to opioids and other medications currently utilized among palliative care patients.

 

Current guidelines

 

It has been stated by Dr. Claude Cyr that “if we are going to integrate cannabis products into medicine, palliative care is the best port of entry”.

 

Integrating cannabinoid based therapies into palliative care has been delayed by limited clinical research data, little knowledge in dosing guidelines, conflicting regulation, and stigma. Surveys in recent years have shown that a decent majority of US oncologists view cannabinoid therapies as a helpful adjunct to standard pain management strategies. In 2019, the Dutch government agreed to fully reimburse medical cannabis for terminally ill patients. 

 

There is a disconnect between substantial research and interest by patients and families, making it difficult for healthcare professionals when it comes to recommendations and support. Because of this, there is a sense of urgency to understand the pharmacology, mechanisms of action, and available research to support cannabis use in these circumstances. 

 

Pain

 

Definition of clear, clinical objectives with patients and their families is incredibly important among palliative care. The focus is often pain. 

 

Cannabis use for pain can be traced back thousands of years. Observationally in research, the response to pain in individuals has been favorable when compared to baselines or controls. 

 

A review of literature published through June 2017 examined trials regarding cannabinoid use for pain in patients with neuropathy and malignant diseases. Out of 18 trials, 15 demonstrated a significant analgesic effect of cannabinoids as compared to placebo, the reduction in pain intensity was considered clinically significant. The most commonly reported adverse effects were well tolerated. 

 

To date, however, the widespread use of medical cannabis is still controversial even in palliative care settings mostly because the plant may produce both therapeutic and psychoactive effects. There is strong evidence suggesting that the non-intoxicating cannabinoids, such as cannabidiol (CBD), can also alleviate chronic inflammation and pain in animals. CBD has been characterized as an ideal therapeutic agent for inflammation and neuropathic pain as it may suppress both without causing significant intoxicating side effects or analgesic tolerance. 

 

Difficulty breathing

 

This is another topic of major concern among the palliative care population. Based on the neurophysiology of labored breathing and the distribution of cannabinoid receptors within the central nervous system, it has been hypothesized that the unpleasantness of breathlessness will be relieved in humans by cannabinoids. Observational studies have shown some promise among individuals with Chronic obstructive pulmonary disease (COPD). However, there is still a need in clinical trials to observe significantly positive or negative effects on airway function and exertional breathlessness in adults. 

 

Other Symptoms

 

Many patients in palliative care may want to address other common symptoms at end of life, such as anxiety, depression, nausea, anorexia, or insomnia, which may all be relieved by cannabinoid therapy. Others may be looking to reduce or stop altogether certain medications, specifically opioids with serious adverse effects. 

 

An Israeli study published in 2018 on cannabis use in nearly 3,000 cancer patients showed significant improvement in the control of common symptoms other than pain, including sleep disorders (70.8%), fatigue (55.9%), anxiety and depression (74.1%) and nausea and vomiting (54.7%). 18.7% reported a good quality of life prior to treatment initiation while 69.5% reported good quality of life after 6 months. 

 

These findings align with published results from Realm of Caring’s observational research registry, where cannabis users self-reported significantly better quality of life, greater health satisfaction, improved sleep, lower average pain severity, lower anxiety, and lower depression compared with controls. Therefore, cannabinoid therapies may be beneficial across a broad range of symptoms realized in palliative care settings, beyond pain management. The argument may then be made that the role of cannabinoid therapy should not only be under consideration for a palliative care setting, but earlier in the course of palliative care strategy. 

 

Preclinical evidence and case studies have shown the potential for cannabinoids to have disease-modifying effects. Several studies have demonstrated their anti-tumoral, anti-inflammatory, and neuroprotective properties, for example. However, more clinical research is necessary to provide evidence necessary to fully support disease-modifying effects.

 

Opioid-sparing effects

 

When it comes to pain management, opioids in particular have considerable side effects, including constipation, impaired sleep, and respiratory depression. In recent decades, we have witnessed an increase in the prescription of opioids – therefore an increase in opioid use disorders and opioid-related mortality. Therefore, the need has increased to discover combinations of medications that complement each other’s actions for maximizing pain-alleviating responses to allow lower doses of each. The endocannabinoid system represents an ideal target because it is a key endogenous system in modulating pain-processing pathways. 

 

It has been observed that CB2 receptors indirectly stimulate opioid receptors located in the central nervous system. Therefore, in addition to having direct pain-relieving effects on their own, cannabinoids may work synergistically to enhance opioid effects. 

 

A published review looked at 28 studies providing data relating to the potential opioid-sparing effects of cannabinoids in the context of pain management. Most of the pre-clinical studies examined reported reduced opioid requirements when co-administered with cannabinoids. Two controlled clinical studies found no effect of cannabinoids on opioid dose requirements. One case provided low quality evidence and few controlled clinical studies measured opioid sparing as a goal, so findings relating to pain management were mixed. Controlled clinical studies demonstrated some beneficial effects of co-administration on outcomes of pain, sleep, and functioning in chronic pain patients. 

 

Despite the potential for cannabinoids to reduce opioid dose requirements and extend pain relieving effects, it is recommended that increased studies be carried out and observed as there is inconsistent data thus far. Future study considerations should carefully document adverse effects from co-administration to better understand potential harms and examine dose range and tolerability.

 

Spiritual and Existential Suffering

 

Cannabinoid therapy approaches may offer unique potential benefits known more through traditional medicinal and cultural uses and shown through anecdotal reports from patients and caregivers. Mild euphoria, sensory enhancement, and overall sense of well-being could play an important therapeutic role for patients faced with the despair of terminal conditions and the loss of function that tends to accompany it. 

 

Patient’s right to access

 

In cases where individuals expect medical cannabis to be presented as a strategy for their advanced health condition, this leads into a topic of palliative care that deserves to be mentioned: personal autonomy in medical decisions for alleviation of pain and suffering. The facilitation of a patient’s right to access experimental treatments and therapies in line with their wishes and beliefs, is something to be considered as research continues to evolve in this specific area of care.

 

Questions that remain

 

Finding support with cannabinoid therapy and palliative care can be difficult, but that is where Realm of Caring may step in to help. Our care specialists are trained to help with product and practical administration suggestions – whether you be an experienced user or novice. In general, cannabis is safe but responsible use and guidance, as well as oversight by a healthcare professional, are always recommended. We are here to help start and facilitate those conversations along the way through these extremely difficult times. 

 

If you want to reach out to our care team to discuss anything cannabinoid therapy related one on one – we are here for you! You can call our free hotline at 719-347-5400, email info@realmofcaring.org, or schedule an appointment. 

 

What is Polycystic Ovarian Syndrome? 

 

The U.S Department of Health and Human Services (HHS) defines Polycystic Ovarian Syndrome (PCOS) as a lifelong hormonal and metabolic imbalance. This condition affects approximately 5-15% of people with ovaries, after the onset of puberty and persisting beyond menopause (Walker et al., 2019). Most people diagnosed with PCOS experience menstrual cycle irregularities, abnormally high levels of androgen hormones and ovarian cysts. The risk of developing PCOS is higher for people that are obese, and for those with a family history of the PCOS (HHS, 2017). 

 

People often go undiagnosed until they experience infertility. Most symptoms are complex issues that need a variety of different treatments. People with the ability to become pregnant that desire to do so, should disclose that information to their health care provider in order to develop the most suitable treatment plan, and avoid anything that may contribute to infertility or cause harm. PCOS presents with a multitude of signs and symptoms, some of these may include (Walker et al., 2019): 

 

• Ovarian cysts 
• Infertility 

○ PCOS is the leading cause of infertility 

○ It is still possible to become pregnant with PCOS 

• Metabolism syndromes 
• Abnormally heavy periods 
• Amenorrhea (no menstrual periods) 
• Oligomenorrhea (infrequent periods) 
• Anovulation (absence of ovulation, bleeding may still occur) 
• Obesity, weight gain, and/or difficulty losing weight 
• Hirsutism (excess hair typically on the face, chest, belly, and upper thighs)
• Pelvic pain, ranging from tolerable to debilitating 
• Severe and persistent acne 
• Excessively oily skin 
• Inflammation 

 

Furthermore, the Centers for Disease Control (CDC) and HHS claim that people who have PCOS are at an increased risk for: 

 

• Stroke 
• Miscarriage 
• Insomnia 
• Gestational and Type 2 Diabetes 
• Cardiovascular Disease 
• Obstructive Sleep Apnea 
• Endometrial hyperplasia 
• Endometrial cancer 
• Thinned scalp hair and baldness 
• Mood disorders including depression and anxiety 

 

The Endocannabinoid System (ECS) and Hormones in PCOS

Research suggests that the endocannabinoid system of someone with PCOS may be dysfunctional (DiBlasio, 2013). The endocannabinoid system regulates homeostasis and is involved in regulating appetite, food intake, and glucose metabolism. The ECS can affect ovarian function by modulation of pathways involved in homeostasis and metabolic regulation (Juan et al., 2015). 

 

Obesity is associated with menstrual irregularities, including oligomenorrhea and anovulation, and infertility (Juan et al., 2015). Many people with PCOS also suffer from insulin resistance, causing increased androgen production, increased appetite, and acanthosis nigricans, a condition that presents thickened and darkened patches of skin in certain areas especially in any folds or creases (HHS, 2017). The ECS may influence insulin resistance and obesity (Walker et al., 2019). Limited data from research using animal models suggests a relationship exists between obesity and the dysregulation of the main endocannabinoids produced by the body, N-arachidonoylethanolamine (AEA) and 2-Arachidonoylglycerol (2-AG) (Maccarrone, 2005). 

 

Many of the most common PCOS symptoms are due to increased androgen and low estrogen hormone levels. An excess of androgens may lead to cyst formation in ovarian follicles, increased hair growth and acne on the face and body, and may even interfere with brain signals that initiate ovulation. It should be noted that not every person with PCOS develops ovarian cysts (Walker et al., 2019). 

 

Data from a PCOS and ECS centered study using non obese participants suggests the menstrual cycle’s proliferative and secretory phases show a significant reduction of fatty acid amide hydrolase (FAAH) levels in the endometrium of infertile participants with PCOS, compared to infertile participants without PCOS (Cui et al., 2016). FAAH is an integral enzyme involved in metabolism of endocannabinoids AEA and 2-AG. The absence of these catabolic reactions involved in degradation, suggest that high levels of AEA may be indicative of PCOS (Cui et al., 2016). Lack of endocannabinoid degradation causes high endocannabinoid levels and insulin resistance, often causing hepatic stress and injury (Luschnig, 2019). A study using non obese participants with PCOS found that a combined treatment of antiandrogens, antiestrogens and an oral hypoglycemic, significantly reduces high AEA levels (Cui et al., 2016). 

 

The cause of PCOS is unknown but science suggests that both genetic and environmental factors contribute to the development of the disease. Dysregulation of the ECS is also involved (Luschnig, 2019). PCOS is incurable but some options for treatment may include cannabinoid therapy by balancing the ECS to provide relief from pain and inflammation. Additionally, lifestyle changes including weight loss, oral contraceptives, insulin sensitizing agents, antiandrogens, hair removal and acne treatment may be incorporated. 

 

As always, we recommend speaking with a licensed medical professional before starting a new cannabis regime. To learn more about the potential benefits of cannabinoid therapy, please reach out to a member of the Realm of Caring team! 

 

By: Jazmin Oliver / Cannabis Science Consultants

 

References 

1. U.S Department of Health and Human Services (HHS). Polycystic Ovary Syndrome (PCOS). Jan 2017. https://www.nichd.nih.gov/health/topics/pcos.
2. Centers for Disease Control. PCOS (Polycystic Ovary Syndrome) and Diabetes. March 2020. PCOS CDC.
3. Cui, N. et al. Decreased Expression of Fatty Acid Amide Hydrolase in Women with Polycystic Ovary Syndrome. Gynecological Endocrinology. Sept 2016. Doi: 10.1080/09513590.2016.1269742.
4. Cui, N. et al. Restored Plasma Anandamide and Endometrial Expression of Fatty Acid Amide Hydrolase in Women With Polycystic Ovary Syndrome by the Combination Use of Diane-35 and Metformin. Clinical Therapeutics. April 2017. Doi: 10.1016/j.clinthera.2017.02.007. 
5. DiBlasio, A. et al. The Endocannabinoid Pathway and the Female Reproductive Organs. Journal of Molecular Endocrinology. Feb 2013. doi: 10.1530/JME-12-0182.
6. Duma, M. Is Cannabis a Natural PCOS Treatment? We Asked an Expert. Sept 2018. Leafly.
7. Juan, C. et al. Endocannabinoid System Activation may be Associated with Insulin Resistance in Women with Polycystic Ovary Syndrome. Fertility and Sterility. July 2015. doi: 10.1016/j.fertnstert.2015.03.027.
8. Luschnig, P. et al. Cannabinoids in Gynecological Diseases. Journal of Medical Cannabis and Cannabinoids. May 2019. doi: 10.1159/000499164.
9. Maccarrone, M. et al. Up-regulation of the Endocannabinoid System in the Uterus of Leptin Knockout (ob/ob) Mice and Implications for Fertility. Molecular Human Reproduction. January 2005. doi: 10.1093/molehr/gah130
10. Walker, O. et al. The Role of the Endocannabinoid System in Female Reproductive Tissues. Journal of Ovarian Research. Jan 2019. doi: 10.1186/s13048-018-0478-9.

 

 

The link between cannabis use and the development of a psychotic disorder is a controversial topic and often misrepresented in research. While there is consideration among the medical community of a causal relationship between exposure to chronic cannabis and the development of psychosis, there is also a frequent co-occurrence between serious mental illnesses and cannabis use. Therefore, it is difficult to determine if there is a definitive cause and effect. 

 

What we are aware of is that there is a resemblance between euphoria as both a byproduct of psychosis and from consuming cannabis that has high concentrations of specific intoxicating cannabinoids.

 

Euphoria and Psychosis

 

Euphoria can be described as a heightened, exaggerated, or extremely positive sense of happiness or well-being. This experience has been witnessed among those who suffer from psychiatric disorders such as schizophrenia and bipolar depression. In this context, euphoria may coexist with additional symptoms such as restlessness, hallucinations, confusion, paranoia, disorientation, and/or mood swings. 

 

THC and Euphoria

 

Cannabis has several mechanisms of action within the body. When the cannabis consumed contains high amounts of delta9-tetrahydrocannabinol (THC), it has been shown to produce euphoric effects in some cannabis users (it is important to note that every individual may have a different experience). Additional psychotropic and somatic short-term side effects that have been experienced by cannabis users may include anxiety, perceptual changes, disorientation, nausea, and/or headache. These intense experiences when consuming large amounts of THC could be defined as acute psychosis. 

 

Research is still uncovering exactly what is happening while the euphoric effects take place. What we do know is that there is a high binding affinity of THC with the CB1 receptors that are densely present in the brain and appear to mediate changes in mood, consciousness, memory processing, and more.

 

It is worth noting that the effect THC may have on any one individual is both dose-dependent and the administration method should be considered. Inhaled cannabis versus oral consumption may produce very different effects. Once processed by the liver, there is potential for a more powerful experience. Our care team is available to you with free one on one support in determining a product, administration, and dose. 

 

THC and CBD use

 

Cannabidiol (CBD) has been shown to have anxiolytic and antipsychotic effects, therefore may offset some adverse effects of THC.

 

In addition to CBD’s researched benefits, there is a molecular mechanism by which CBD may block THC-related side effects. CBD has shown in animal models to block the role of a molecule in the brain’s hippocampus called extracellular-signal regulated kinase (EKR), which triggers the neuropsychiatric effects of THC. If THC cannot overstimulate the ERK pathway, then negative side-effects may be prevented. 

 

Vulnerable populations 

 

Severe or persistent psychotic reactions to THC are rare, dose-related, and are more likely to occur in individuals with a preexisting psychiatric condition. Self-reported studies have suggested that those with schizophrenia use cannabis to mitigate negative symptoms ranging from social anxiety to side-effects of antipsychotics. Those who are psychosis-prone may be more likely to experience positive, negative, and cognitive symptoms to a greater degree relative to healthy individuals. While it is hypothesized that this is due to cannabis’ effects on dopamine, Gamma-aminobutyric acid (GABA), and glutamatergic neurotransmission; the precise mechanism is yet to be discovered. 

 

How do I know if I am psychosis-prone?

 

Medical research points to genetics for determining if we may be prone to a psychotic disorder. Certain mental illnesses tend to run in families, however even if a close family member has a diagnosis, it does not necessarily mean you will develop one. There are resources in the cannabis community that may also help. For example, a DNA report may predict which individuals are most likely to develop schizophrenia; however, knowing if you have a specific gene variant does not mean you are destined to develop any one disease. What this testing does do, is allow you to make informed decisions for your health based on conditions you may have a predisposition to. 

 

Is there a confirmed link? 

 

The short answer is no. Despite some support through research for a causal hypothesis between cannabis use and psychosis, most individuals who use cannabis do not develop a psychiatric disorder and most individuals with a psychiatric disorder have never used cannabis. As it stands in research, the link between cannabis use and developing a psychiatric disorder is not confirmed. It is becoming more clear that cannabinoids may produce symptoms associated with psychosis in healthy individuals and possibly exacerbate symptoms in those diagnosed or with a predisposition to a psychiatric disorder. 

 

While struggling with any condition, it is important to talk with a medical professional about your options. Complementary therapies and a strong focus on wellness may improve cannabinoid therapy results as well as decrease symptoms further. If you would like to discuss more about the potential benefits of cannabinoid therapy, please reach out to our care team!

 

 

 

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Disclaimer

 

 The Realm of Caring Foundation specifically invokes the first amendment rights of freedom of speech and of the press without prejudice. These statements have not been evaluated by the food and drug administration. The products discussed are not intended to diagnose, cure, prevent or treat any disease. Realm of Caring always recommends when and wherever possible that licensed local healthcare professionals be consulted.

 

 The Realm of Caring Foundation is an independent nonprofit with its own governing board. We do not produce or sell cannabinoid products, nor do we receive funds from the sale of other company’s products.