Nurse educates the public on the health benefits of cannabis
Wendy Gibson, cannabis nurse, first became interested in the medical marijuana field by taking the opponent’s side. Granted, it was just an academic exercise — it was an assigned debate in nursing school — but it stuck with her. To win the debate, she threw out a few stock arguments about potential risks to patients. That was back in 2005. Gibson, 55, did not believe those arguments then — through her 20 years in health care, including four years as a medical-surgical nurse — and certainly not now.
As the field organizer for both the Drug Policy Forum of Hawaii and one of its projects, the Medical Cannabis Coalition of Hawaii, she spends much of her time working to educate people about cannabis.
That’s the preferred term, she said, adding that marijuana was a derogatory slang that attached in the 1930s, when there was an industrial crackdown on what had been folk medicine throughout history. Gibson was among the speakers at last weekend’s Hawaii Cannabis Expo, as the state ramps up for its first dispensaries. She’s doing other talks at 3 and 5 p.m. Thursday at 1188 Bishop St. (details are available via email, email@example.com).
“I have to acknowledge, there are people who overuse and overdo it, and are very much looking forward to legalization,” Gibson said. “But the primary intent is to get medicine to our patients that’s tested and labeled so we know what it is and can dose it.”
QUESTION: Why is cannabis needed as medication for pain, nausea and other ailments? ANSWER: Cannabis is one of the most effective and safest medicines available — especially when compared to opioid pain medicines. It targets the mechanisms in the body that control pain and nausea.
Q: What is its advantage over other treatments?
A: Some of the active ingredients in cannabis, the cannabinoids, are similar to the chemicals our own body makes to heal. These endocannabinoids are well-tolerated chemicals, very effective and non-toxic to any of our organs, including the liver. This is unique among medicines.
With whole-plant medicine the many chemicals in the plant work synergistically to produce the desired effects and serve to buffer the side effects of others. … Most of the side effects are usually predictable, minimal, easily treated, and they diminish over time as the patient develops a tolerance.
Q: What would you consider its limitations as a medication?
A: Like any medication on the market, it doesn’t work well for everyone. We need to see the chemical compositions … to best help patients find the right medicine, delivery system and dose. Once lab-tested medicine is available in our dispensaries, dosing will become more precise. Ideally, we would team up with pharmacists for custom compounding.
One of the biggest limiting factors is the lack of education about our endocannabinoid system in medical schools, nursing and pharmacy schools. Add to that the stigma that resulted from our misguided war on drugs, and there is a lack of acceptance in allopathic medicine. We say we want personalized medicine, but when it comes to cannabis that goes out the window. Patients are limited by where they can use their medicine. For example, patients who are hospitalized may be denied access to their medicine. Some patients have had to choose between keeping their job and using their medicine because of drug testing in the workplace.
Q: Are there patients who especially would not benefit?
A: Any human without an endocannabinoid system. Truly, every disease humans suffer from involves their endocannabinoid system. Knowing the chemical composition of your medicine is key to getting results. If you have quality, independent lab testing of products and know the chemical profiles patients can get medicine that works for them without unwanted side effects.
Q: Senate Bill 174 would expand the list of ailments for which a patient could get cannabis authorization, including lupus, epilepsy, multiple sclerosis and autism.
Can you give an example of how cannabis relieves symptoms of these? A: Lupus is a devastating autoimmune disease where a patient’s immune defenses begin attacking their body. This can involve lungs, kidneys, and the brain. Cannabis-based medicines help reduce the destructive immune response, reduce and repair the inflammation it causes. Epilepsy: Cannabis is very neuroprotective and helps normalize the erratic electrical signals of seizures caused by epilepsy. It does so with a unique neurotransmission process called “retrograde neurotransmission.” Multiple sclerosis: The most effective medicine known for safe relief of spasticity is a plant based formula, Sativex that combines THC and CBD (cannabis compounds). In the U.S., cannabis is patented as a neuroprotective agent and possibly slows the progression of this disease. Autism: The autism spectrum disorder can cause severe brain dysfunction resulting in disabling symptoms. Both Dr. Bonnie Goldstein and Dr. David Sine — who has teamed up with a pharmacist to create customized formulas for pediatric patients — say that it calms and normalizes most patients with ASD.
Q: SB 173 would include edibles among the forms to be sold. Good idea?
A: Yes. Great idea. Many patients need long-acting medicines. Inhaled medicines last about three hours. Edibles can give the longest-lasting pain relief and enhance deep sleep, the most healing phase of sleep. I would prefer to see healthy edible choices rather than sugary sweets.
Q: Do you think the appeal of edibles to non-patients such as children should be a concern?
A: Yes, and if edibles become permissible, every precaution will be taken so that it doesn’t have to be a concern. Precautions will include the standard patient education with labeling, … and products will be sealed in childproof packaging.
Q: Do you think there’s enough progress at regulating dosage? A: Yes. We know from history. In the U.S., 10-milligram doses of whole plant medicines were sold in pharmacies from 1850 to 1937. Dronabinol (Marinol) which is 100 percent THC is sold in 2.5, 5 and 10 mg capsules. We can calculate the milligrams from labtested products. Once lab tested medicine is available, dosing will become more precise. Some dispensaries are partnering with dosing experts. We have good data from doctors and scientists, thousands of case studies and more than 500 scientific, preclinical and clinical studies. We have learned how to start low (with the dose) and go up slowly with the titration — like we do with many other medications. We can also teach patients how to buffer the effects of THC using CBD or Terpenes — the essential oils found in plants. For example, the terpene Beta-Caryophyllene, found in black pepper can help reduce unwanted side-effects of THC.
Q: Are there dosing standards Hawaii can use?
A: Yes, in fact we just brought dosing experts to the first CME (continuing medical education) program for physicians — from Spain and California — to train our doctors and nurses. They have been researching this for years. … We’re hopeful that dispensaries will collect data about which doses and chemical compositions work the best for our now more than 15,000 patients.
Q: How do you answer critics who say many medical marijuana users are just recreational users, that all this is just preparation for broader recreational distribution?
A: Skeptics likely don’t understand how the human body produces and uses chemicals similar to those in the plant. They simply find it hard to believe that it is therapeutic for so many diseases. Most patients are trying to stay functional, and get well — not high. “Recreational users” may be self-medicating pain, stress, anxiety, insomnia, and more. Adult-use is at least safer than other substances such as opioids or alcohol in that it does not carry the “side-effect” of death. … Many health-care professionals (including myself) feel that cannabis should not be viewed as a gateway drug but as a potential EXIT “drug” from more harmful substances. There is a growing body of evidence that support this idea.