Category: Blog

For many suffering from debilitating conditions such as chronic pain, conventional treatments often fall short, leaving them in search of alternatives. While cannabis has emerged as a promising natural remedy, fear of legal repercussions can be a significant barrier. In this blog, we’ll explore how to safely and effectively integrate cannabis into your pain management routine while addressing the legal landscape.

 

The appeal of natural relief for chronic pain

 

Research has pointed to cannabis being “superior to” and having “fewer side effects” than some prescription medications. Participants in observational studies have claimed that when compared to traditional medications, cannabis improves their quality of life by helping with multiple conditions. 

 

Relief from chronic pain is among the most common conditions reported by patients for the medical use of cannabis. It is considered one of the most debilitating conditions, yet there is a lack of consensus from the medical community on the best diagnostic and treatment method. Currently, opioids are the most commonly prescribed drugs for pain, which in 2016 accounted for 259 million prescriptions. Recent reports suggest that a number of pain patients are replacing the use of opioids with cannabis. A 2014 study found that states with medical cannabis programs reported significant reductions in opioid overdose mortality and a 2018 study found these same states saw significant decreases in opioid prescriptions among Medicare-enrolled individuals. A 2011 study found that combining cannabis with opioids decreased pain significantly without affecting opioid plasma levels; which led researchers to suggest the potential for opioids to be prescribed at much lower doses when cannabis is also consumed, resulting in fewer side effects. 

 

Cannabis as an alternative to other “treatment-resistant conditions”

 

A treatment-resistant condition/disease may be identified as a diagnosed condition/disease that was not improved after attempting use of two different pharmaceuticals, in separate occasions, at the proper dose. Several qualitative study results show that medical cannabis patients believe cannabis to be a promising substitute for traditional pharmacotherapies. In 2022, responses from 808 individuals were reviewed in one qualitative study, which highlighted that 51% of participants were motivated to use medicinal cannabis based on beliefs that traditional treatments were ineffective and/or had intolerable side effects and 21% showed a preference for “natural” treatments over pharmaceuticals. Among these participants were parents of an 11-year old with obsessive compulsive disorder (OCD), who responded to their reason for making the switch as:

 

“He tried two different SSRI [selective serotonin reuptake inhibitor] medications. One made him have severe suicidal ideations. The other one increased his OCD compulsions and the distress became unbearable. When the psychiatrist gave us another prescription for a 3rd SSRI, we, the parents, decided that we could not put him (and us) through that again.” (Garcia-Romeu et at., 2022). 

 

Of the participants, 77% attributed positive effects to the medicinal use of cannabis, including reduced pain (28%), improved sleep (18%), seizure reduction (18%), reduced anxiety (22%), and improved mood (11%). Problems associated with medical cannabis use were cited by 41% of respondents, which included lack of information or medical support (16%) and legal concerns (10%). 

 

Legal Considerations

 

In the same 2020 qualitative study, 10% of respondents cited legal concerns as a problem for their medical cannabis use. One participant explained that “the stigma and continued illegality of cannabis products in our state causes undue stress and unnecessary effort to help our family.” (Garcia-Romeu et at., 2022). A parent reported “I am so grateful for what this oil has done for my son. I am however nervous of the uncertainty of the legality of it. It needs to be fixed at the federal level, not just the state.” (Garcia-Romeu et at., 2022). 

 

Stigma and legal concerns may prevent travel, those with federal benefits to join state medical cannabis programs, discussions with doctors about cannabis or hemp use, and trying plant-based therapies that have the potential to increase one’s quality of life. A caregiver for their 74-year-old spouse with metastatic prostate cancer explained it “took quite a bit of time, over a year, to decide to try this modality. Reluctant due to social stigma and legality concerns.” (Garcia-Romeu et at., 2022). With how often laws change around cannabis and hemp products each legislative session, current patients are also faced with the uncertainty of whether or not the products they are currently using will be available in subsequent years. 

 

A large population of patients suffer as a result of ambiguity in cannabis and hemp law. It likewise causes confusion for dispensaries, law enforcement, medical providers, and caregivers. Unclear laws also create loopholes and allowance for synthetically derived cannabinoids to be sold, which may be unsafe for consumers. With the lack of federal oversight for cannabis and hemp products, it is up to the consumer to check on the accuracy and safety of the product being sold. 

 

How to get started safely

 

Cannabis and hemp are not one-size-fits-all approaches. Including both or either into your medical journey can depend on the zip code you live in, the condition you are suffering with, what medications you are taking, and more. It is overwhelming, but it doesn’t have to be. Whether you have questions on legality, are seeking resources for how to talk to your doctor, or want data-driven answers to your questions about cannabinoid therapy and symptoms of various health conditions, the Realm of Caring Care Team is here to assist with free, one-on-one support.

In today’s world, the abundance of treatment options can be both a blessing and a curse. With so many choices, from pharmaceuticals to supplements, it’s easy to feel overwhelmed and unsure of the right path. But what if there was a way to simplify your approach to health and wellness? In this blog post, we’ll explore how safe, non-addictive, plant-based alternatives like cannabis can help you cut through the noise and find a solution that works for you.

 

The Problem of Overwhelm

 

Decision fatigue is “the idea that after making many decisions, your ability to make more and more decisions over the course of a day becomes worse. The more decisions you have to make, the more fatigue you develop and the more difficult it can become,” explains Dr. Lisa MacLean. Characteristics of decision fatigue include mental and physical exhaustion, which may lead to stress and anxiety. 

 

This overwhelming feeling for patients may arise as they seek solutions for their health. Information may come from various online forums, through recommendations from family and friends, as well as advice from a medical professional. Weighing the pros and cons of cost, side effects, and simply knowing where to start based on all of the information available may lead to avoidance, procrastination, or impulsivity, which can all have consequences for our overall health and well-being. 

 

The Desire for Simplicity with Plant Extracts

 

Published research in 2013 reported the tremendous increase in herbal medicinal products and supplements with no less than 80% of individuals worldwide relying on them for a portion of primary health care. Now, in the wake of the COVID-19 pandemic, a global aging population has developed an even more heightened awareness around personal health and is a driving force of consumer interests towards herbal and natural health products. 

 

The factors responsible for increased self-medication with herbal medicines include:

 

• Various claims on the efficacy or effectiveness of plant medicines;
• Preference of consumers for natural therapies and a greater interest in alternative medicines; Belief that herbal products are superior to manufactured products;
• Dissatisfaction with the results from pharmaceuticals and the belief that herbal medicines might be effective in the treatment of certain diseases where conventional therapies and medicines have proven to be ineffective or inadequate;
• High cost and side effects of most modern drugs;
• Improvements in the quality, efficacy, and safety of herbal medicines with the development of science and technology;
• Patients’ belief that their physicians have not properly identified the problem; hence the feeling that herbal remedies are another option; and
• A movement toward self-medication.

 

The Risk of Unregulated Products 

 

When faced with the decision to use a plant-based medicine, a common fear is not knowing whether or not to trust a product that is being marketed to you. The more you take a deep dive into plant-based medicines, the more you may learn how they are often widely unregulated and some may be not just of low quality, but unsafe. 

 

Strict quality control is extremely important in the hemp and cannabis industry. However, a variety of methods of consumption and rise in popularity leaves many opportunities for unsafe products to exist on the market. At Realm of Caring, many of our staff and families struggled with the same question. Over time, we learned to ask specific questions to discern quality products and placed those questions in a guide for you. 

 

Why Plant-Based Alternatives? 

 

Cannabis and hemp have been valued for centuries for pain-relieving, anti-inflammatory, and calming properties. Research has shown that medicinal cannabis users report significantly less utilization of healthcare than non-cannabis using controls to include prescription medications, emergency department visits, and hospitalizations. Additional published data indicates that patients with a wide array of health conditions have reported significant physical and mental health benefits associated with medicinal cannabis, which are not evident in patients who do not use medicinal cannabis. For many, finding a product that is efficacious without side effects can vastly improve health and quality of life. 

 

How to Incorporate Plant-Based Therapies into your Routine

 

First, this is not a decision you have to make all on your own. Realm of Caring is here to offer free support. From how to talk with your doctor about incorporating hemp or cannabis into your routine, to product selection, dosing guidance, and understanding what the research says, our knowledgeable and dedicated care team are here for you. By focusing on safe and natural products you can take control of your health journey and potentially move towards a more simplified, effective, and fulfilling approach to wellness.

 

In recent years, cannabis policy has become a hot-button issue in American politics. As the 2024 presidential election approaches, it’s crucial to understand where the candidates stand on marijuana legalization and reform. Let’s take a closer look at the evolving positions of two key figures: Kamala Harris and Donald Trump.

 

Kamala Harris: From Prosecutor to Proponent

 

A Shifting Stance on Cannabis

 

Kamala Harris’s position on cannabis has undergone a significant transformation over the years:

 

1. Early Career as San Francisco DA:
   • Defended medical marijuana use
   • Oversaw 1,900+ cannabis-related convictions
2. 2010 Attorney General Campaign:
   • Opposed recreational marijuana sales
   • Cited concerns about the medicinal marketplace
3. 2014 Attorney General Re-election:
   • Maintained opposition to recreational use
4. 2019 Presidential Campaign:
   • Reversed position, supporting marijuana legalization
   • Admitted to past cannabis use

 

Recent Advocacy for Cannabis Reform

 

In 2024, Harris has taken a strong stance on cannabis policy reform:

 

• Criticized federal classification of marijuana as more dangerous than fentanyl
• Called for ending prohibition altogether
• Urged DEA to expedite cannabis rescheduling

 

Donald Trump: A Mixed Bag on Marijuana Policy

 

Presidential Administration (2017-2021)

 

1. States’ Rights Approach:
   • Generally maintained respect for state cannabis laws
   • Criticized AG Jeff Sessions for rescinding Obama-era guidance
2. Farm Bill
   • Signed the Agriculture Improvement Act of 2018 into law
   • The bill legalized the cultivation and sale of hemp at the federal level, effective January 1, 2019
   • Hemp was removed from the list of federally banned drugs under the Controlled Substances Act
   • The legislation defined hemp as cannabis plants containing less than 0.3% THC
   • It allowed for the broad cultivation of hemp, not just pilot programs for research purposes
   • The bill permitted the transfer of hemp-derived products across state lines for commercial purposes
   • Hemp farmers gained protections under the Federal Crop Insurance Act
   • The legislation paved the way for the first federally-sanctioned commercial hemp grows since World War II
   • While it didn’t fully legalize CBD, it opened pathways for hemp-derived CBD products to be legally marketed under certain conditions
3. Bipartisan Support:
   • Tentatively endorsed bill to codify federal respect for state marijuana laws
4. Mixed Signals:
   • Released signing statements reserving right to ignore medical marijuana protections

 

2024 Campaign Rhetoric

 

• Claimed Harris jailed “thousands” of Black people for cannabis offenses.

 

The Bottom Line: Cannabis Policy in 2024

 

As voters consider their options, it’s clear that cannabis policy remains a complex and evolving issue:

 

• Harris has recently taken a clear pro-legalization stance
• Trump’s current position is less defined, focusing more on criticizing Harris’s record

 

For those interested in cannabis reform, it’s crucial to stay informed about the candidates’ positions and track any policy developments as the election approaches.

 

Stay tuned to Realm of Caring for more updates on cannabis policy and its impact on patients and families.

 

Brief History

 

Functional mushrooms have seen various therapeutic applications in ancient civilizations for millenia. Both Lion’s Mane and Reishi (also known as Ling Zhi) mushrooms were regularly used in ancient China for thousands of years to treat various ailments. In Traditional Chinese Medicine, Lion’s Mane was often used to treat gastrointestinal problems, improve cognitive function, and mental health conditions like anxiety, depression, and insomnia. Reishi was used in Traditional Chinese Medicine to treat ailments related to the heart, lungs, liver, kidneys, and mental health. It was especially common as a medicine for cough and asthma. Similar uses of these mushrooms have been documented across ancient civilizations. However, despite this long documented history of therapeutic application, empirical research on functional mushrooms remains more limited than one might expect. Here’s what we know.

 

Therapeutic Applications

 

Lion’s Mane

 

Neuroprotective/neuroregenerative effects: Lion’s Mane has repeatedly demonstrated strong potential in treating neurodegenerative diseases such as Alzheimer’s and Parkinson’s. The mushroom contains components that are neuroprotective and promote neuroregeneration.

 

Cognitive benefits: Lion’s Mane has been found to improve cognitive performance among multiple populations: older adults ages 50-80 with mild cognitive impairment, healthy older adults (55+), and healthy adults. Lion’s Mane has also been found to improve memory. These improvements are likely caused by the substance’s well-documented neuroprotective and neuroregenerative properties.

 

Improvement in hearing: Lion’s Mane improved hearing among geriatric adults with hearing degeneration. It especially improved the ability to hear high frequencies and speech recognition.

 

Neurotrophic effects: Lion’s Mane has therapeutic potential to treat mood and sleep disorders. Studies have shown that Lion’s Mane can reduce depression, relieve anxiety, and improve sleep.

 

Anticancer: Lion’s Mane has been found to have antitumor properties. Constituents of the mushroom inhibit tumor and cancer cell growth.

 

Other effects: Lion’s Mane has therapeutic potential to treat gastrointestinal disorders by regulating gut microbiota and reducing inflammation. It has also been found to improve cholesterol by reducing the amount of lipids in the blood. Additionally, anti-aging properties have been observed. 

 

Reishi

 

Anticancer: Reishi has been found to have strong synergistic effects when used in tandem with chemotherapy or radiotherapy. A review found that patients including Reishi in the treatment were 1.27 times more likely to respond to chemotherapy and radiotherapy.

 

Anticonvulsant effects: There’s some evidence that Reishi has antiepileptic properties. Studies have shown that Reishi spore powder reduces seizure frequency by reducing accumulation of calcium, a primary characteristic of epilepsy.

 

Immunomodulatory effects: A clinical trial found that Reishi increases the number of immune cells present in peripheral blood among healthy children, and this finding was later corroborated in healthy adults. Reishi’s immunomodulatory activity contributes to its effectiveness in assisting with cancer treatment.

 

Cardiovascular effects: Reishi is commonly used to treat cardiovascular disease because it targets common risk factors. Reishi’s antioxidant, hypotensive, anti-inflammatory, metabolic effects work synergistically to treat and prevent cardiovascular diseases.

 

Metabolic effects: Reishi has been found to be effective in treating Chronic Fatigue Syndrome (CFS) by promoting the metabolic process in a way that allows the body and brain to utilize energy more effectively. Reishi has also been reported to have anti-diabetic effects.

 

Other effects: A variety of effects have been attributed to Reishi including: antiviral, antibacterial, prebiotic properties. Reishi has also been shown to improve high-fat diet induced obesity; by altering the gut biome, mouse models have shown reduced obesity and weight gain characteristics.

 

Functional Mushrooms for Epilepsy Study

 

For the past year, Realm of Caring, Unlimited Sciences, and Lily’s Lighthouse have been working in collaboration on an exciting mixed methods case study with multiple cases to highlight the therapeutic potential of Lion’s Mane and Reishi mushrooms for treating epilepsy. Data collection for the study has recently closed, and our research team has been excited to see reported improvements across various epilepsy and seizure types. In fact, 90% of participants reported a mild to strong belief that functional mushrooms have had a positive impact on the way seizures affect their life. Stay tuned for our publication detailing improvements in epilepsy symptoms and quality of life among those with epilepsy using functional mushrooms!

 

Flavonoids are compounds found in several parts of plants including the root, stem, and leaves. They play a variety of biological activity and are abundantly found in products of plant origin such as fruits, vegetables, tea, flowers, grains, and cannabis. Just as terpenes provide plants their smell, flavonoids provide plant their color while functioning as UV filters, signaling molecules, detoxifying agents, plant heat acclimatization and as a freezing tolerance. Currently around 6,000 flavonoids have been discovered. Through research, flavonoids have been considered an absolutely necessary component in a variety of nutraceuticals, pharmaceutical, medicinal, and cosmetic applications due to their broad range of health-promoting properties. 

 

Flavonoids in Cannabis

 

More than 20 flavonoids have been identified in cannabis Sativa. Cannabis is not a singular compound, rather it encompasses a vast and complicated molecular profile. The interaction of cannabinoids, terpenes, and flavonoids make up the “entourage effect” phenomenon, producing enhanced therapeutic effects. 

 

Full-Spectrum CBD Products

 

Hemp (industrial hemp) is a class of cannabis sativa, which is grown for industrial use and consumable use. Cannabidiol (CBD) products are derived from hemp and are considered full spectrum if all extracts from the plant are utilized including CBD, <0.3% delta-9-tetrahydrocannabinol (THC), other minor cannabinoids, terpenes, essential oils, and flavonoids. Broad spectrum is similar with the exception that there is not a detectable amount of THC found. Isolate products only contain the CBD molecule from the plant. 

 

When utilizing full-spectrum CBD products, the included flavonoids offer potential health benefits, such as antioxidant and anti-inflammatory effects. They work with cannabinoids and terpenes, contributing to CBD’s complex impact on the body.

 

Identified Potential Health Applications

 

Flavonoids have shown promise in various health applications that may contribute to overall well-being.

 

Inflammation and Pain Management

 

Flavonoids show anti-inflammatory properties, potentially managing pain. Cannflavin A may enhance the pain-relieve effects of CBD and THC through synergistic interaction.

 

Neuroprotective Properties

 

Several flavonoids exhibit neuroprotective qualities that may benefit brain health. Cannabis flavonoids luteolin and apigenin show promise for cognitive health. Luteolin may protect the brain, enhance memory, and combat brain fog. Apigenin potentially treats Alzheimer’s and offers sedative and muscle-relaxing benefits for mental well-being.

 

Cardiovascular Health

 

CBD flavonoids may benefit heart health. Anthocyanidins potentially prevent heart disease and manage blood pressure. Quercetin protects against oxidative stress. Kaempferol’s antioxidant properties may reduce cardiovascular risks. These compounds support overall heart function.

 

Key Flavonoids Found in CBD

 

Full and broad spectrum CBD products may contain various flavonoids that contribute to their unique properties and potential health benefits. Here are some of the key flavonoids you may find in your CBD:

 

Quercetin

 

Quercetin is known for its antioxidant and anti-inflammatory properties, which may have positive effects on heart health, cancer prevention, and allergy relief. 

 

Kaempferol

 

This natural substance has potent antioxidant properties, even surpassing vitamins C and E in effectiveness  in combating oxidative stress and inflammation, making it a potential candidate for treating disorders associated with chronic immune activation .

 

Luteolin

 

It has been found to have potential benefits in reducing oxidative stress and inflammation in various conditions may help alleviate allergy symptoms, reduce inflammation in multiple sclerosis, and even have anti-cancer properties.

 

Apigenin

 

Apigenin, an antioxidant bioflavonoid, has anti-anxiety effects and potential cancer-fighting properties.

 

Cannflavins

 

Cannflavins (A, B, C) are flavonoids partially unique to cannabis sativa. We say partially unique because Cannflavin A has also been identified in Mimulus bigelovii, a plant in the Phrymaceae family. Cannflavin A may offer neuroprotection, potentially benefiting Alzheimer’s disease.

 

Flavonoids synergize with other cannabis compounds, enhancing CBD benefits via the entourage effect. Cannflavin A and B show promise as an anti-inflammatory as they were about 30 times more effective than aspirin when studied in human rheumatoid cells.

 

Conclusion

 

Flavonoids offer diverse health benefits, complementing cannabinoids and terpenes. They influence inflammation, neuroprotection, and heart health. Compounds like quercetin, kaempferol, luteolin, apigenin, and cannflavins contribute to CBD’s complex effects. Ongoing research may lead to more targeted CBD formulations, exploring specific mechanisms and optimal compound combinations.

Medicinal use of cannabis for chronic pain has been reported across a number of conditions. Although not researched as often, cannabis is widely used for abdominal pain and mounting evidence suggests that compounds of the plant may play a therapeutic role. 

 

Abdominal pain

 

Stomach pain may refer to pain experienced in any one of the organs or muscles within the digestive system, abdominal wall, or abdominal shell. There is a broad range of diagnoses for abdominal cramping and pain and most everyone has experienced one form of it at some point in their lives. As some over the counter pain medications are not recommended for abdominal pain, due to the potential to worsen symptoms, alternative therapy options with lessened side effects are needed. 

 

The ECS and the digestive system

 

Increasing our understanding of the endocannabinoid system (ECS) helps to define new treatment options for various conditions. Evidence suggests that dysregulation of the ECS may have a role in intestinal disorders including inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). One of the many physiological roles the ECS fulfills is regulation of gastrointestinal function, therefore it is a logical target for the treatment of these conditions. Additionally, endocannabinoids are known to modulate pain through regulation of pain sensation and anti-inflammatory actions, which may further provide symptomatic relief. 

 

Cannabis use and pain

 

Cannabis use is commonly seen in patients looking for symptomatic relief from conditions associated with abdominal pain; such as IBD, endometriosis, IBS, ulcerative colitis, and gastroparesis. Patients have noted reduced pain coming from bloating, cramping, and inflammation. The most often used cannabinoids from the cannabis plant are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). 

 

Researched findings are revealing that these cannabinoids have a protective effect on the gut, which decreases inflammation and bloating, and further inherently suppress pain receptors serving as a “natural painkiller.” 

 

A 2021 published review looking at completed research on cannabis compounds for IBD found that there is a “great therapeutic potential” in this setting, particularly as potential treatments for abdominal pain and pain-modifying issues like diarrhea and nausea.  

 

Neuropathic pain is often difficult to treat and a symptom of gastroparesis. Due to limited treatment options and the neuromodulating ability of cannabinoids, researchers looked at the effect of prescribed cannabinoids on gastroparesis symptoms in a 2018 published study. Patients were prescribed either cannabis, the cannabis synthetic, Dronabinol, or a combination of both. When analyzed, all methods showed statistically significant improvement in abdominal pain scores.

 

When observing gut inflammation in biopsies from patients with ulcerative colitis and in rodent models with intestinal inflammation, researchers in 2011 concluded that CBD is a potent compound, able to modulate gut inflammation via the neuro-immune axis. 

 

Terpenes for gut health

 

In addition to cannabinoids, specific terpenes have shown to have intestinal anti-inflammatory activity as well as block oxidative stress, combat dysbiosis, and restore intestinal permeability. 

 

Among those researched terpenes that are also found in cannabis varieties are:

 

Alpha-Phellandrene/Phellandrene

 

This common monoterpene is found in several essential oils for a good reason. It shows extensive biological activity to include anti-inflammatory, anti-cancer, antidepressant, and analgesic properties. Historically used in Chinese medicine for digestive issues, this monoterpene is also found in turmeric and eucalyptus.

 

Strains of cannabis with phellandrene: Jack Herer and Trainwreck 

 

Borneol 

 

Used in traditional Chinese medicine, Borneol has shown pharmacological activity as an anti-inflammatory, vasorelaxant, and neuroprotectant. 

 

Borneol is considered a secondary terpene in cannabis due to minor amounts, however is found in Sour Diesel, OG Kush, and Amnesia Haze.

 

Carvacrol

 

This monoterpene has several pharmacological activities such as antioxidant, antibacterial, anti-inflammatory, cardioprotective, antinociceptive, and gastroprotective. Findings from one study indicated that administration of carvacrol reduced inflammation and oxidative damage in the model studied. 

 

Strains of cannabis with Carvacrol: Gorilla Glue and Chemdawg/Chemdog.

 

Geraniol

 

Found in essential oils of aromatic plants, including Cinnamomum tenuipilum and Valeriana officinalis, Geraniol holds antioxidant and anti-inflammatory properties, gastroprotective activity, and gastric healing. Results from a study showed that when administered daily, Geraniol was a powerful antimicrobial agent, able to prevent dysbiosis associated with colitis and reduce the inflammatory profile of colictic animals. 

 

Strains of cannabis with Geraniol: Harlequin, Lemon G, Strawberry Diesel, Tahoe OG, Dutch Hawaiian, Kimbo Kush

 

Limonene

 

Limonene is one of nature’s most common terpenes, found in orange, lemon, mandarin, lime, and grapefruit, it can decrease oxidative stress and inflammation, has potential benefits for colon cancer, antibacterial activity, and anti-nausea properties. 

 

Strains of cannabis with Limonene: Dosidos, Gush Mintz, Jet Fuel, Kush Mints, LA Kush Cake, Pink Runtz, Sour Diesel, Strawberry Banana, Wedding Cake

 

Cannabinoid Hyperemesis Syndrome

 

Cannabinoid Hyperemesis Syndrome (CHS) is a condition that leads to repeated and severe bouts of vomiting. It seems “paradoxical” that a medicine used as an antiemetic for several conditions could be responsible for vomiting episodes, however the hypothesis stands that an overstimulation of endocannabinoid receptors may be responsible for development of CHS. Over time, the market has seen an increase in the content of THC compared to other cannabinoids and terpenes. This is believed to be a factor in the genesis of CHS because the body builds a tolerance to THC. So, as tolerance increases, the amount of THC consumed increases, and therefore overstimulation of receptors may take place. 

 

If you feel you have taken too much THC, there are options available to you to help remedy the situation. At times a tolerance break may also be beneficial if you feel your current dosage is more than you would like to be consuming. 

 

Finding Support 

 

There is a lot to consider when starting cannabinoid therapy, but, as always, a Realm of Caring care specialist is here to help with free one-on-one support to answer your questions. Contact us today by calling (719) 347-5400 or emailing info@realmofcaring.org.

As of April 2024, recreational marijuana is legal in 24 states, or nearly half the country, according to the Pew Research Center and medical marijuana is legal in 13 states. This can indicate that many mothers may be questioning the safety of using medical or recreational cannabis while breastfeeding. The official guideline is that breastfeeding women are advised against using cannabis, due to insufficient research to determine “safe amounts” of cannabis use during breastfeeding. The emphasis is on caution due to the unknowns surrounding the transfer and effects of THC through breast milk. This article aims to dissect the most recent research on THC transfer to breast milk. 

 

The Biology of Breastfeeding

 

Breastfeeding is a complex biological process that provides essential nutrients and antibodies to infants. According to the American Academy of Pediatrics (AAP), breastfeeding is recommended exclusively for the first six months of life, followed by continued breastfeeding along with appropriate complementary foods for up to one year or longer, as mutually desired by mother and infant. The AAP emphasizes that breastfeeding offers numerous health benefits for both the mother and the baby, including reduced risks of infections, chronic conditions, and certain types of cancers.

 

Breast milk composition is influenced by the mother’s diet and health, making it crucial to understand how substances like cannabis can affect breast milk and, subsequently, the infant. A recent study indicates that only minimal amounts of THC, the psychoactive component in cannabis, transfer into breast milk. Research from Colorado involving eight breastfeeding mothers shows that, on average, just 2.5% of the THC consumed by the mother reaches the baby.

 

Key Findings:

 

1. Low THC Concentration: Only 2.5% of the mother’s THC dose is passed through breast milk, with an even lower bioavailability rate in the baby’s system.
2. Rapid Decline Post Consumption: Peak THC concentration in breast milk occurs one hour after consumption, dropping significantly after four hours.

 

Practical Recommendations for Breastfeeding Mothers:

 

1. Timing of Consumption: Consuming cannabis immediately after breastfeeding can minimize the baby’s exposure to peak THC levels.
2. Use of Pumped Milk: Utilizing previously pumped breast milk or formula for the first feeding after cannabis consumption can further reduce exposure.
3. Strain Selection: Choosing cannabis strains with higher CBD and lower THC content can reduce overall THC exposure.
4. Consider Edibles: Edibles may produce a longer-lasting but lower-intensity THC exposure compared to inhaling.

 

Considerations for Mother’s Using Cannabis

The discussion around cannabis use while breastfeeding should focus on compassion and understanding. Raising children is demanding, and many mothers might seek relief through cannabis, which can calm anxiety and reduce stress.

 

Key Points:

 

• Risk and Benefit Analysis: Rather than simply advising against cannabis use, it’s essential to help mothers weigh the risks and benefits, based on their unique situation.
• Stress and Cortisol: Maternal mental health significantly impacts the well-being and development of the infant. Elevated stress levels can harm both mother and baby, as cortisol is transferred through breast milk.
• Breastfeeding Benefits: Extended breastfeeding has significant health benefits that may outweigh the minimal transfer of THC when usage is carefully timed and managed.
• Informed Decisions: Providing mothers with accurate data and risk mitigation strategies supports them in making responsible choices.

 

Understanding that many mothers already use cannabis, offering guidance on minimizing risks is a more practical approach than outright prohibition. This empowers mothers to make informed decisions that best suit their individual situations.

 

Pharmaceuticals and Breastfeeding

 

It is essential to note that many pharmaceuticals also pass through breast milk and can have side effects on infants. Common medications prescribed for postpartum depression, anxiety, and other health issues are known to be present in breast milk to varying degrees. Healthcare providers often weigh the benefits of these medications for the mother’s health against potential risks for the infant. This same consideration should be applied to cannabis, particularly when it is used for therapeutic purposes.

 

Conclusion

Cannabis use during breastfeeding should be approached with caution. Informed choices, careful timing, and consulting with healthcare providers can help mitigate potential risks. Mothers must weigh the benefits and risks, with more support and compassion needed to help them make the best decisions for their unique situations.

Before undergoing anesthesia for surgery, it is important to have discussions with your healthcare team about what medications and supplements you are taking that may interact with or disrupt any point of perioperative or postoperative care; cannabis is no exception. While limited in scope, there is an understanding that interactions between cannabinoids and anesthetics take place. 

 

Anesthetics and Endocannabinoids

 

Before we get into plant cannabinoids, it may be valuable to understand how anesthetics interact with the endocannabinoids found in our body and brain. Two of those well-known endocannabinoids are anandamide and 2-arachidonoylglycerol (2-AG). A study published in 2003 discovered that a sedating dose of the anesthetic propofol produced a significant increase in the whole-brain content of both anandamide and 2-AG. Researchers have hypothesized that propofol leads to sedation indirectly; as the anesthetic increases anandamide content and then anandamide activates Cannabinoid receptor 1 (CB1) sites. For decades anandamide has been researched for its ability to induce sleep by binding to CB1 receptors. 

 

An additional study published in 2006 suggested that sustained anandamide signaling by propofol contributed to unique associations with the anesthetic such as reduction in postoperative nausea and vomiting. Alternatively, the anesthetic sevoflurane leads to a decrease in anandamide; postoperative nausea and vomiting were witnessed in groups observed with this anesthetic.

 

Cannabis Compounds and Their Interaction with Anesthesia 

 

The interactions between cannabinoids and general anesthetic agents, as well as the impact on patient care have been mostly reported in preclinical studies and are not yet fully understood.

 

Cannabis: THC Considerations

 

One of the major cannabinoids of the cannabis plant, delta-9-tetrahydrocannabinol (THC), is mainly metabolized in the liver through the Cytochrome-P450 (CYP450) complex, as are many anesthesia drugs. Therefore, there is potential for pharmacokinetic drug interactions. 

 

Some research suggests that patients who regularly use cannabis may require larger initial and/or maintenance doses of anesthesia, depending on the type used. 

 

A retrospective study published in 2020 assessed the impact of preoperative cannabis use in patients undergoing open reduction and internal fixation of tibia fractures. Among the cohort of 118 patients, more than 25% reported cannabis use prior to surgery, meaning they self-reported that cannabis products were used in the month prior to surgery. There was no significant difference in total propofol, dexmedetomidine, etomidate, ketamine, desflurane, midazolam, and fentanyl doses administered between those who used cannabis prior to surgery and those who did not. The only anesthetic where a significant difference was observed was sevoflurane, where a significant amount more was administered during surgery to the group of cannabis users. 

 

There is a lack of current literature in providing clinical guidance as well as support for the association between cannabis use and increased anesthetic doses to reach adequate sedation. Postoperatively, there have been reports that cannabis users are more likely to report higher pain scores, poorer sleep, and need more pain relieving medications in the immediate postoperative period than non-users. While more well-designed studies are needed to help providers mitigate potential perioperative risk and manage postoperative pain, anesthesia professionals would benefit from understanding the current perioperative considerations that exist for patients who use cannabis, whether medically or recreationally. 

 

Cannabis: CBD Considerations

 

Just as THC, the other major cannabinoid found in the cannabis plant, Cannabidiol (CBD), is a lipophilic compound metabolized by CYP450 enzymes and has the potential to interact with pharmaceuticals metabolized in this way. 

 

Few studies have taken place with CBD and perioperative care, however one anesthetic, isoflurane, was observed in rodent models in a study published in 2022. Animals were pretreated with various amounts of CBD to understand anesthetic induction time and recovery time. A shorter induction time was realized if they were pretreated with 20 mg kg−1, however it took longer for the anesthetic to kick in at 2 and 10 mg kg−1, leading to the hypothesis that the dose was too low to affect the course of isoflurane anesthesia. At 100 mg kg−1 the induction period was not much different than that of the control group. 

 

When it came to the recovery period, the CBD doses of 100 mg kg−1 and 2 mg kg−1 showed a longer recovery time which researchers believe is a result of the longer induction time compared to the 20 mg kg−1 dose. A longer isoflurane exposure during the induction time is expected to lead to a longer recovery time as isoflurane is a highly lipophilic compound. 

 

While CBD products are less studied in perioperative care, more research is taking place to understand its potential role in postoperative care as patients are often swapping pain medications for CBD.

 

In a study published in February 2024, CBD has been shown to positively affect the pain and satisfaction of patients immediately following arthroscopic rotator cuff repair. Anesthesiologists are currently working on the largest clinical trial of its kind to “determine whether administering CBD before and after surgery can reduce the need for opioids following total knee replacement.”  

 

In 2022, an online survey was distributed to members of the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America to assess baseline knowledge and opinions regarding CBD. Afterwards they received an educational component and then follow-up questions assessing whether the respondents’ opinions had changed after learning more about CBD. After collecting 101 responses, the results showed that “most respondents believed that there is a role for CBD in postoperative pain management (76%), acute pain and inflammation after an injury (62%), and chronic pain (94%). Most respondents admitted that they were not knowledgeable about the mechanism of action (89%) or their state’s laws (66%) concerning CBD. A minority (25%) believed that CBD has psychoactive properties. While most respondents (76%) did not believe that they would be stigmatized if they were to suggest CBD to a patient, only 48% had ever suggested CBD.”

 

Cannabis: Terpene Considerations

 

Select terpenes from the Cannabis sativa plant are found to be efficacious in relieving neuropathic and inflammatory pain in rodent models. They have been shown to consistently lack reward liability, enhance opioid pain relief, and produce an equivalent antinociceptive tolerance to morphine. 

 

Specific terpenes are known for sedative effects and some (like pinene) have vasodilatory effects, and for that reason may need caution when combined with anesthesia to avoid over-sedation and/or heart complications. Those terpenes that are known to have sedative and/or anesthetic effects based in research are:

 

• Linalool 
• Myrcene
• Citral
• Pinene
• Nerolidol
• Caryophyllene 

 

Concluding Thoughts

 

Cannabinoids are fat-soluble and accumulate in the fatty tissue, meaning that elimination may take place several days after consumption. Therefore, it is a currently recommended practice to cease the use of cannabinoids several days if not several weeks before surgery is scheduled. Your best bet is to consult with your healthcare provider well in advance of any planned surgical procedures.

Cannabis has garnered attention for its numerous health benefits, with people using it for pain relief, anxiety management, and various other medical conditions. However, as its popularity continues to rise, a pertinent question remains: what impact does cannabis have on fertility? In this article, we will explore both the positive and undesirable effects of cannabis on fertility, drawing from current research and medical insights.

 

Cannabis and Female Fertility

 

Cannabis consumption can potentially have both positive and adverse effects on female fertility. This section explores the research findings on how cannabis impacts the menstrual cycle, ovulation, and overall reproductive health.

 

Menstrual Cycle and Ovulation

 

On the positive side, some studies suggest that cannabinoids can help balance hormones and reduce menstrual irregularities. According to a study published in the Journal of Ovarian Research, the endocannabinoid system plays a crucial role in maintaining ovarian function, and cannabinoids may support this system, potentially enhancing fertility.

 

However, other studies have shown that chronic use of THC, the active compound in cannabis, may interfere with the release of gonadotropin-releasing hormone (GnRH), affecting the menstrual cycle. It was also found that THC use in conjunction with tobacco use suppressed the luteinizing hormone (LH), shortening the luteal phase of menstruation. Irregular cycles and anovulation (lack of ovulation) have been observed in women who consume cannabis regularly, which may lead to difficulties in conceiving.

 

Reproductive Health

 

Cannabis might improve reproductive health by reducing inflammation and oxidative stress, creating a healthier reproductive environment essential for successful conception. However, the same properties of THC may disrupt the endocannabinoid system’s balance, negatively impacting ovarian function.

 

For more detailed insights, the article from Contemporary OB/GYN provides an in-depth look at the effects of marijuana on female reproductive health and pregnancy.

 

Cannabis and Male Fertility

 

The impact of cannabis on male fertility is equally complex, with studies showing both potential benefits and drawbacks. This section explores how cannabis affects sperm production, motility, and overall reproductive hormones.

 

Sperm Production and Motility

 

Some research suggests that cannabis may increase sperm count and motility, potentially enhancing fertility. The National Institutes of Health report highlights that moderate cannabis use is associated with improved semen quality in some cases.

 

Conversely, other studies have shown that chronic THC use may negatively influence sperm count, motility and lead to testicular shrinkage. Lower sperm count and reduced motility may decrease the chances of successful fertilization, as highlighted by various research findings.

 

Hormonal Balance

 

Cannabis may support the hypothalamic-pituitary-gonadal axis, helping to maintain a healthy hormonal balance that is critical for reproductive function. This can improve libido and erectile function. However, THC can also disrupt this balance, leading to decreased testosterone levels and reproductive health issues.

 

The article from Denver Urology elaborates on how marijuana use impacts male fertility and reproductive health.

 

Weighing the Pros and Cons

 

While cannabis offers numerous health benefits, its impact on fertility is a nuanced topic with both positive and potentially undesired aspects. More research is needed to fully understand the extent of these effects, but current findings suggest that cannabis can influence both female and male reproductive health in various ways. As with any medication or substance, understand that cannabis is not a one-size-fits-all approach and dosing in moderation is essential. Consult with a healthcare professional to make informed decisions based on your unique situation and, as always, a Realm of Caring care specialist is here to help prepare you for that discussion.