The Emerging Role of Medical Cannabis
Dr. Blake Pearson
Greenly Medical Consulting
In the fourth episode of our fifth season, our host Peter Brenders talks with Dr. Blake Pearson, Founder of Greenly Medical Consulting, about emerging research on medical cannabis, medical coverage and access, and the need for more education of the endocannabinoid system
From the Chronicle Podcast System, this is the NPC Podcast of the National Pharmaceutical Congress for August 11, 2021. The NPC Podcast was created to discuss and consider the purpose, process, and people of the pharma industry during the year of Covid. And today, we're continuing the healthcare conversation by answering questions from listeners, just like you.
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Our guest today is Dr. Blake Pearson of Greenly Health in Sarnia, Ontario. Dr. Pearson is an authority on cannabinoid medicine. He'll be offering insights on medical cannabis with your host, Peter Brenders.
But first, here is Mitch Shannon, the CEO of Chronicle Companies. Mitch, set us up please.
MITCH SHANNON (MS):
Liona, for one terrible moment, I was afraid you were going to say light us up please.
It was 20 years ago that Canada legalized cannabis for medical purposes. That's an entire generation. So you might think that medical science would have gathered plenty of medical evidence regarding the safety and efficacy of medical cannabis for certain conditions. But you'd be wrong. Even after 20 years and some ongoing research efforts, marijuana is still far from the mainstream of medicine. Our guest today is trying to change that. He's a prominent and persuasive advocate for the clinical use of cannabinoids in patient care.
Here's Dr. Blake Pearson in conversation with Peter.
PETER BRENDERS (PB):
Welcome to the NPC Podcast I'm Peter Brenders, your host. In our continuing look at the purpose, process, and people in pharma in Canada, this episode takes a look at medical cannabis. Specifically, we're going to talk about the ongoing needs related to medical cannabis. From research to education to access.
We're delighted to have Dr. Blake Pearson, board certified medical doctor in the US and Canada, practicing physician and international medical educator. Dr. Pearson specializes in the use of cannabinoid medicine and is the founder of a specialized medical cannabis clinic, Greenly Health.
Welcome to the NPC Podcast, Blake.
DR. BLAKE PEARSON (BP):
Blake, I think we've got much to cover and probably not enough time to talk about all things related to medical cannabis. So let's start with setting the stage though.
So what's special about medical cannabis? I mean, when anyone can just order cannabis online or walk into their local cannabis store? Isn't it all the same?
Yeah, so interesting question. And the breakdown goes like this. So basically, think of it if you're treating a medical condition, an underlying medical condition, that's when you want to talk to someone a physician or nurse practitioner and use a cannabinoid medicine, because we're using specific doses of THC and CBD to manage conditions.
So I treat a lot of dementia patients, we're using CBD and THC to manage their behaviors. So you need targeted doses, these patients, of course, can't walk in and speak to the local budtender, you know, and get their prescription that way.
Another example. So that's kind of end of life, if you will. Early on, it is kind of cradle to grave for cannabinoid medicine. So in our pediatric population, same thing, you're managing refractory seizure disorders, for example. So very specific diagnoses where you need high amounts of CBD to manage their seizures. So same story, you need a physician or a nurse practitioner involved to do that, as opposed to, again, navigating the OCS or talking to a budtender about a serious condition like refractory epilepsy. So hopefully that kind of paints a picture of the difference between the two.
Yeah, it does. And I learned the phrase ‘budtender’. So, probably should have known that. But anyway, so we're talking about medical needs versus recreational use, what does the science say about the efficacy in treating these needs?
That's where when I'm teaching other physicians, or certainly when I started to use these molecules in, in practice, we needed some evidence to do that. So there's a body of evidence that exists for specific conditions. Where's the bulk of the evidence at the moment?
Good evidence around chronic pain. So that's been well studied, documented in the National Academies of sciences, engineering and medicine in the US did a great review, looking at 10,500 different studies to form these conclusions. So you have chronic pain. There's evidence for MS spasticity, so THC is a good antispasmodic. We talked about refractory epilepsy, so there's a body of evidence there and that is where a CBD medication called epidiolex was even approved by the FDA to manage that particular condition. So pain, MS, refractory epilepsy, chemotherapy induced nausea and vomiting is another area and then that's where the good quality evidence.
And then where more evidence is starting to mount now that we can study this is you're seeing more evidence in autism spectrum disorders, you're seeing more evidence around sleep. The first study to show using cannabinoids in primary insomnia came out from Western Australia. So you have those core where the body of evidence is, and emerging diagnoses now where more and more evidence is mounting.
Okay, so it sounds like you're convinced that science is certainly demonstrating the benefits of the use of medical cannabis. But so why isn't medical cannabis used more? Like I don't hear it as a common piece in a classic physician's practice?
There's a few reasons to say the least. So naturally, the stigma is probably the first reason. Years, decades of, you know, hearing it's bad for you. It's gonna cause harm. All the research was looking at so called harms. So you have this stigma. That's probably number one.
And then you put that with, you don't learn about the endocannabinoid system, right? So the physicians that, when I went through med school and still to this day, only 3% of US schools teach about the endocannabinoid system, you don't know the physiology of the endocannabinoid system. That's another huge barrier. And we can talk a little bit more about that too, if we want. But that would be the second one.
And then then you have things like, it's not as simple as writing the script going to the pharmacy, you have to understand how the medical system works here in Canada, so another barrier because physicians, we're all we're all busy, you know, certainly with everything going on. Another step or something just right, there is a non-starter for some docs.
And then lastly, cost. So there's no provincial drug coverage. So a lot of the physicians won't bother because they're no coverage. They know the patient can't afford it. Okay, moving on kind of thing.
You're listening to Dr. Blake Pearson on the NPC Podcast.
I'm curious about the medical education aspect. And you said, docs aren't taught about the cannabinoid system out there. So what are the gaps with physicians and understanding medical cannabis better? Is it just that?
That is a huge part. Yes. Yeah. In med school, I think we spent a lecture on drugs of abuse. And that's your, your basis for your cannabis knowledge. So you don't go into the physiology, which right there, I do believe if more physicians knew about this, which is crazy. It's like leaving out the digestive system or the respiratory system in your learning and it's crazy.
So that endocannabinoid system is abundant in us, it's one of the most abundant G coupled protein receptors in the body, the whole system. So it's everywhere. It's abundant in the central nervous system. But that basis, to me, is where we're falling short. And that's where it's really enjoyable for me to then teach physicians about the physiology first, and then we move into the diagnosis, what formulations would we use, and lately I was teaching at where I did my residency at Wayne State in Detroit. So nice, small little wins to start teaching the med students in the residents about the endocannabinoid system.
Get the docs on side, they'll understand it more, they'll start to be able to talk to their patients more, but like he said, it's sort of not insured, right? So like any drug on the market, patient does not have insurance, doctors simply just don't prescribe it, or doesn't even come into their list. And is that because maybe we're used to a health system that pays for everything, right? And so people don't take it seriously. But what can we do about this?
So that's where I like to call it my life's work because I know it is going to be kind of a long fight here. But what can we do is raise awareness, really demand better. We started the Cover Cannabis Project that is solely designed to hopefully one day get provincial coverage for kids with seizure disorders. For the kiddos with autism. For the dementia patients, these vulnerable patient populations shouldn't have to pay out of pocket for medication that works for them.
So Cover Cannabis Project is literally I interview patients and tell their stories, we share it on the different social platforms, we tag different MPs, MPs, encourage other patients to tell their stories, share their stories, use the cover cannabis hashtag with the whole goal of banging on enough doors, that finally we make change because not enough people understand what's being treated and who these patients are. So shining a light on that is what we're trying to do.
Is there more to do than just shine a light on that one? Is there a healthy skepticism on the payer side too? Are they looking for more research and what would that look like for them?
I'd like to tell you to come down to just efficacy and what's helping patients because right there, slam dunk. This is wonderful. We're weaning off opiates, we're weaning off anti-psychotics, harmful anti-psychotics in dementia populations, these are good things and alone would be reason to cover it. But as you know, that doesn't always tell the story.
We do need more pharmaco-economic data. So yes, this helps a lot of people. But is it going to save the payers of the provinces money? That is the big thing, what's it going to cost? And there is an argument and I actually am going to publish some data in the fall that shows this, but there's a cost saving effect. Because if you're able to wean an opiate, and then a lot of those folks can't sleep, so you wean their sleep medication, a lot of those folks are on SSRIs, or antidepressants, sometimes you're able to wing in three, four different medications. So there is a cost benefit to this as well. And once the provinces and the payers understand that, then again, hopefully, there'll be some more coverage.
We're a small piece of the world on this one. And as much as we do some work, I was wondering like, you know, our big neighbor to the south, if they were working on this, wouldn't this be more compelling? So how much is Canada hampered by the US laws blocking such research?
Canada's hampered, the world's hampered, medicines hampered, we're hampered now. It's delayed things by a century with all the prohibition in the US, things are finally changing. So there's the good news, Canada is doing research, Israel does research Australia is doing research, a lot of countries are really doing more and more research. The US still, federally it's illegal. So there's still a lot of shackles, it's a Schedule 1 still in the US. So that hampers things.
But the states themselves now are organizing a little bit more, and now starting to do research themselves and kind of go around the federal level. So that's encouraging. Would getting cannabis off Schedule 1 make sense? Yes. Does it need to happen in the US? Yes. And hopefully it will, because the knock on cannabis would be there's not enough research for certain indications. And the only way to kind of dispel that is to do the studies. And if we can change the scheduling, it'll be massive.
You're listening to the NPC Podcast, I'm Peter Brenders, your host.
In the pharma world, in the classic pharma world, that research is essentially driven by pharma by companies themselves. In the cannabis world, where does the responsibility fall on that one? If it's gonna fall on companies? In my mind, I'm wondering, how are they going to recoup their costs if the results show that medical cannabis works and makes a difference? Well, how do you differentiate it between products that are out there? I mean, one does research, all suppliers get the benefit, I'm trying to understand what that model might look like.
Yeah. And that's why there still isn't enough going on. And I've found that the licensed producers have even kind of scaled back now as opposed to maybe a few years ago. But it's because of exactly what you're talking about. You can't patent THC and CBD. So whoever invests the money in doing the research is basically doing it for the greater good. And, as you know, these companies are publicly traded, and they have boards and they have shareholders to answer to. So a lot of them are really focused on the bottom line and the ROI. So it's kind of this tough spot where they're not investing because they can't get that ROI they want for spending that money.
So it's going to be tough to change the status quo is what I'm hearing because it's not driven by the industry. You’re looking for the charities to drive.
The companies are one side, there's institutions that are taking this on. So the nice thing is there's the school in Hamilton, Mac's doing great stuff to DeGroote Medicine there. They have their own cannabinoid team. There's the Lambert Initiative at the University of Sydney, doing good research. Again, Israel is doing a ton. So the academic side of it, it's coming along. And then there's grants from the government. So we were awarded a grant to do some research on dementia and cannabinoid medicine, a three year grant. So the government's funding, some institutions are, so collectively hopefully, we can keep building that body of evidence.
Why do you think governments aren't pushing this alternative more if that can help solve the opioid crisis?
I think the government's, they're kind of led by the mainstream maybe in medicine, maybe older physicians that aren't aware of what's going on with cannabinoid medicine with the real patient. So that is part of Cover Cannabis too is awareness again, around what's going on. I think that has a lot to do with it.
There's no magic button or magic pill for the opiate crisis. But to your point, this is kind of tailor made for it can help right, it is a tool we should be leveraging. I was employed by the Lyn locally here in our area, Erie St. Clair. And what we did was we trained physicians in using cannabinoid medicine get it in their toolbox, not saying use it for all patients, but have it available. And the whole goal was then to reduce the opiate prescriptions and lower morphine equivalents. And surprise, surprise, that happened in a number of family health teams, the numbers didn't lie.
So at the pilot level, that has legs, we've seen the research out of BC, also showing the opiate sparing effect. So hopefully, we can get through to some of the medical leads of the different provinces and again, make some change.
Okay, so what's your prediction for the future of medical cannabis?
Prediction is, it's going to be possibly the biggest breakthrough in medicine that we've seen. I'm still not bullish on physician uptake being massive in the next couple years. There's this lagging argument that there's not enough evidence when there is, we're seeing it, it's just really a decision to start using it. I think you'll see it more and more. I think in dementia specifically, you're going to see a lot of patients in long term care on cannabinoid medicine moving away from the anti-psychotics because the side effect or one of the risks of anti-psychotics is death. A terrible side effect and a very risky class of medications. That's to manage behaviors of dementia.
There's no research published yet but start to see cannabinoids used as dementia prevention as well, because CBD reduces inflammation in the brain, right, that contributes to dementia. THC can reduce excitotoxicity, which kills neurons. So those two things alone is, one could hypothesize that might be beneficial for dementia prevention. So that's where I see it going.
That's a great summary. We have been speaking with Dr. Blake Pearson on the NPC Podcast. Thank you for listening.
Thanks to Blake and Peter.
You can learn more about and from Dr. Pearson at greenlymed.com. Send your follow up questions about today's conversation via Twitter. We're @2021NPC. If you prefer, you can send us an email at email@example.com or leave a message on our comment line at 647-873-6995.
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This is Mitch Shannon of Chronicle Companies. The Podcast Producer is Jeremy Visser assisted by Aria Empakeris. The announcer was Leona Spracken, the musical theme is performed with aplomb by the NPC Podcast Orchestra under the direction of Maestro Yahudi Millbrook.
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