Check out our latest issue focused on chronic pain

Cannabis Patient Care March/April

Meg is the Group Editorial Director for Cannabis Patient Care and Cannabis Science and Technology magazines at MJH Life Sciences.

 a leading multimedia platform dedicated to advancing medical research, education, and treatment in the cannabis industry, and Americans for Safe Access (ASA), the largest national member-based organization of patients, medical professionals, scientists, and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research, are excited to announce a partnership to share educational content and patient stories.

 launched in November 2020 and has already made a big impression in the medical cannabis community due to the quality of its content and the important message behind each issue," said Mike Hennessy Jr., president and CEO of MJH Life Sciences™, parent company of 

™. "We are thrilled to partner with Americans for Safe Access because we share their passion for education and for helping as many patients as we can."

As part of their agreement, ASA will by-line articles focused on patient and advocate experiences in upcoming issues of 

 will conduct interviews with various ASA chapters and highlight the work going on across the US to improve patient access and legalization efforts. All ASA members will receive a complimentary subscription to 

"As a patient-focused organization, we are honored to partner with 

™, a platform that focuses on the patient experience," said Debbie Churgai, executive director of Americans for Safe Access. "Through this partnership, we will be able to offer our members and supporters a trusted resource to learn about the latest medical cannabis research, benefits, and treatment options available for patients."

 magazine is an educational resource for patients, doctors, nurses, pharmacists, and caregivers on the latest research, benefits, and treatment options cannabis provides for a variety of illnesses. Its mission is to educate the medical community on the viable treatment options patients are experiencing with cannabis and the ongoing research into cannabis and cannabinoids worldwide. 

™, the largest privately held, independent, full-service medical media company in North America dedicated to delivering trusted health care news across multiple channels.

s mission is to ensure safe and legal access to cannabis for therapeutic use and research. ASA was founded in 2002 as a vehicle for patients to advocate for the acceptance of cannabis as medicine. With over 150,000 active supporters in all 50 states, ASA is the largest national member-based organization of patients, medical professionals, scientists and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research. ASA works to overcome political, social and legal barriers by creating policies that improve access to medical cannabis for patients. For more information, please visit: 

Articles

The partnership will focus on sharing patient and advocate experiences and educating the public on the medical benefits of cannabis.

Cannabis Patient Care™ and Americans for Safe Access Form Partnership

 conference—taking place September 29–October 1 in Pasadena, California—will feature an exciting full-day CannMed Medical Practicum organized by Bonni Goldstein, MD; Dustin Sulak, DO; Kevin Spelman, PhD, MCPP; and Eloise Theisen, NP, AGPCNP-BC. During this practicum, each of the presenters will share the latest research, their clinical experience, and practice guidelines related to cannabinoid therapeutics, inclusive of types of extractions, products, and optimal dosing of cannabinoids for various therapeutic scenarios. This course is approved by the California Board of Registered Nursing for 9.5 contact hours**

Can cannabis be used to get you off opioid addiction?

 There are numerous scientific articles that support the concept of cannabis as a substitute for opiates. In a 2017 survey of 2897 medical cannabis patients, 97% reported that they were able to decrease the amount of opiates they consumed when they used cannabis. Additionally, 81% reported that taking cannabis by itself was more effective for their pain than taking both opiates and cannabis together (1).

Another survey found that almost 15% of elderly patients were able to discontinue opioid use within 6 months of initiating medical cannabis (2). Additionally, cannabinoid-based medicines were associated with 17-fold higher odds of discontinuing opioid prescriptions within 21 months (3).

There is also some evidence that cannabinoids may help reduce opioid withdrawal. A 2020 report in the 

 found that cannabis alleviated the opioid withdrawal symptoms of anxiety, tremors and trouble sleeping (4). Evidence is also mounting for the use of cannabidiol (CBD) for opioid addiction. In a double-blind, placebo-controlled randomized trial of 42 patients addicted to heroin who were experiencing withdrawal, CBD significantly reduced craving and anxiety compared to those who received placebo (5).

 Yes, if used in conjunction with a proper protocol, cannabis has been used successfully for weaning people from an opioid addiction. 

: C Lots of data prove yes in chronic pain: 

https://healer.com/category/cannabis-and-opioids/

. Less data suggests it’s helpful in opioid use disorder, but I have seen this work in my patients.

 Studies suggest that cannabis is effective for chronic pain in adults. With more research demonstrating the effectiveness of cannabinoids for chronic pain, many patients are seeking ways to use cannabis to reduce or eliminate their opioids. Clinical studies have demonstrated a synergistic effect with cannabinoids and opioids, thereby allowing patients to manage their pain without the need to increase the opioids. And while there is a need for more clinical trials to demonstrate the effectiveness of cannabinoids for opioid addiction, many cannabis clinicians have successfully helped their patients eliminate their opioids.

How does cannabis interact with other prescription medications?

 Cannabinoids are metabolized (broken down) for the most part by enzymes in the liver, where many other medications are also metabolized. There can be competition between cannabinoids and other drugs when they are metabolized by the same enzyme, resulting in what is called “drug-drug interactions.” These interactions can result in the blockage of metabolism, leading to accumulation of the drug in the body, which can cause an increase in unwanted side effects. Conversely, the drug-drug interaction may result in an increase in metabolism of a drug, meaning that more drug is broken down faster, causing a decrease in drug levels leading to less efficacy. 

It is very hard to predict these drug interactions since there are many differences in the way that people metabolize medications. To avoid any undesirable consequences, the best approach for anyone taking pharmaceuticals who wants to use cannabinoid medicines is to speak with a physician, pharmacist, or other healthcare provider who is familiar with these types of drug interactions.

 While there are theoretical concerns of cannabis preparations negatively interacting with other drugs, clinicians are not observing drug-cannabis interactions. This is not unusual in that many of the theoretical drug-herb interactions have not been found to be of any clinical significance.

: Very few interactions except at high doses of cannabis. The blood thinner warfarin is a common one to watch out for—patients should have their blood checked after starting cannabis.

: Cannabis can either increase or decrease the effectiveness of other medications. In most cases, it is clinically insignificant and does not require patients to stop their cannabis treatment. Anyone using cannabis with other medications needs to be followed by a knowledgeable cannabis clinician who can adjust the medications accordingly and ensure that there are no contraindications.

Check back next month for part III of this series where our roundtable will discuss how cannabis is used to treat acute and chronic pain, anxiety, ADHD, and pediatric patients. To find out more about the

some of the clinical applications for medical cannabis and dosing information.

A. Reiman, M. Welty, and P. Solomon, “Cannabis as a substitute for opioid-based pain medication: patient self-report,” 

R. Abuhasira, L.B. Schleider, R. Mechoulam, and V. Novack, “Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly,” 

J.M. Vigil, S.S. Stith, I.M. Adams, and A.P. Reeve, “Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study,” 

C.L. Bergeria, A.S. Huhn, and K.E. Dunn. "The impact of naturalistic cannabis use on self-reported opioid withdrawal." 

Y.L. Hurd, et al. "Cannabidiol for the reduction of cue-induced craving and anxiety in drug-abstinent individuals with heroin use disorder: a double-blind randomized placebo-controlled trial." 

**CONTINUING EDUCATION CREDITS: This course is provider-approved by the California Board of Registered Nursing, provider number 16845, for 9.5 contact hours.

In this roundtable interview series, we speak to each of the organizers to learn more about them and what attends can expect from the practicum. Here in part II, they discuss how cannabis can be used stop opioid addiction and possible ways cannabis might interact with other prescription medications.

Medical Cannabis Insights, Part II: How Cannabis Helps Opioid Addiction and A Discussion on Interactions with Other Medications

Madeline Colli is the Associate Editor for Cannabis Patient Care and Cannabis Science and Technology magazines at MJH Life Sciences.

WeedMD, a federally licensed producer and distributor or medical-grade cannabis, recently announced in a press release (1), that they will be rebranding as Entourage Health Corp. (Entourage Health) over the next few months.

“This is truly an exciting and transformative time for our Company. WeedMD’s values and principles will always be at the heart of who we are—advocates for our patients, consumers, shareholders, and communities upholding a standard that delivers on quality, sustainability, and experience—now rooted in Entourage Health Corp.,” said George Scorsis, Interim CEO and Executive Chair in the press release (1). “Entourage Health represents WeedMD’s evolution - from its inception in 2013 as one of the first licensed producers, to its launch of award-winning brands, followed by the merger with Starseed Medicinal and pending addition of craft cultivator CannTX—we are a group of professionals who always put the consumer and patient first. We are now looking to develop and expand into new markets and our cannabis experts that make up Entourage Health will expedite and bolster our growth for years to come. I thank our employees, partners and most importantly our shareholders for their unwavering trust and commitment to our success.”

The rebranding was approved at the company’s recent shareholders meeting. In addition, shareholders re-elected the company’s’ board directors: Jason Alexander, Lu Cacioppo, Bruce Croxon, G. Edmund King, Gail Paech, and George Scorsis. The directors will hold office until successors are duly elected or appointed. Furthermore, in accordance with the rules and policies of the TSX Venture Exchange, shareholders re-approved WeedMD’s Omnibus Incentive Plan and re-appointed RSM Canada LLP, as the company’s’ auditor to hold office until the next annual meeting of shareholders or until its successor is appointed.

Additional information regarding the commencement of trading of the company’s common shares on the TSX Venture Exchange under the name Entourage Health Corp will be released at later date.

As WeedMD transitions their business under Entourage Health Corp., its Health Canada license will still continue under its wholly owned subsidiary WeedMD RX Inc.

https://www.globenewswire.com/en/news-release/2021/07/05/2257655/0/en/WeedMD-Inc-Announces-Intent-to-Change-Corporate-Name-to-Entourage-Health-Corp.html

WeedMD, a federally licensed producer and distributor or medical-grade cannabis, will be rebranding as Entourage Health Corp. over the next few months.

WeedMD Rebrands to Entourage Health Corp.

Following a traumatic accident, Otha Smith was inspired to venture on a medical cannabis journey to treat his ailments. Due to its illegal federal status, there aren’t many guides available to users to provide insight on the best cannabis products. Another issue facing patients is that everyone reacts differently to the various cannabinoids, terpenes, and other ingredients found in cannabis and cannabis products. These issues motivated Smith to create a mobile application—Tetragram—that allows users to anonymously track cannabis products enabling them to find the best products that suit their needs. Here, Smith discusses the app and his experiences with cannabis.

Can you tell us a little bit about your background? How you got interested in using medical cannabis as a treatment option?

 I’m originally from Southern Anne Arundel County, Maryland, located 20 minutes south of Annapolis, Maryland. I started my first company, Aggressive Detailing LLC while in high school. We provided car, boat, and motorcycle detailing services for residential and commercial customers and I was able to finance myself through college. In 2003, I was involved in a serious car accident that nearly took my life, resulting in a six-inch, 34-plus staple scar on the top of my head. After being released from the hospital, I was prescribed several different opioids to address my neck and back pain. After three years of using prescription pills, I decided I wasn’t going to use pills every day for the rest of my life and completely stopped use. Meanwhile, I had always been a fan of cannabis throughout high school and college, so I decided to put all my faith into cannabis to self-medicate rather than use pills. Once Maryland legalized cannabis for medical use, I hurried up and got my medical card, but I will never forget how overwhelmed I felt during my initial visit to a dispensary.

Did you have anywhere that you were able to reach out to for educational purposes on cannabis? Was there a lot of trial and error in finding the right products?

 Luckily for me, a dispensary opened literally five minutes from my house, I could ride my bike there. In Maryland, each dispensary is required to have a clinical director on staff, which was super helpful for me to learn more about cannabis. I became good friends with the clinical director at my local dispensary, Barbara Orchester, and she was instrumental in educating me on the medical benefits of cannabis. Barbara was the one responsible for making me aware of terpenes and cannabinoids and the effects associated with each. But consequently, since cannabis affects everyone differently, I didn’t feel comfortable with other people’s recommendations. Therefore, through a lot of trial and error, I eventually found the right product to address my needs. But the process of finding the right product for me, was a long and, at times, frustrating process due to the huge selection of products to choose from.

Can you tell us about your new app, Tetragram? Is it free for users? What inspired you to launch this digital journal? Are there any plans to expand it in the future?

 Tetragram is my baby, a true labor of love. As a patient myself, I can remember how frustrating it was to find the right cannabis product to address my medical needs. More importantly, I’ve worked in dispensaries and understand how challenging it is for doctors and dispensary staff to make accurate product recommendations to customers. Therefore, I built Tetragram. I vividly recall everyone I spoke with, whether they were a patient, worked at a dispensary, or a doctor; one thing that was constant in all my conversations was people recommending that I keep a journal. I noticed dispensaries would sell paperback journals and I met a few people that went as far as creating detailed excel spreadsheets to keep track of products they purchased and how it made them feel. That’s when I said to myself, there needs to be an app that makes the process of recording my experience with cannabis and cannabidiol (CBD) fun and engaging. Boom…Tetragram was born! Since cannabis is federally illegal there isn’t sufficient data or published studies for people to rely upon for guidance and since cannabis effects everyone differently the process of finding which product works best for you is a lonely road of self-discovery.

Tetragram is a smart, digital journal that empowers medical cannabis patients and recreational users with the ability to track, rate and share their personal experiences with cannabis through our mobile app. Tetragram is free and will always be free for consumers to download from the Google Play Store or the Apple App Store. Currently, we are developing V2 of Tetragram that will provide a host of new features and functionality not only for consumers, but for dispensaries, cultivators, and consumer packaged goods (CPG) companies as well as the medical community.

How many users are now signed up on the app? Are users able to remain anonymous or do they have to share personal data?

 Currently, we are close to reaching 8000 users, which is incredible considering we haven’t spent any money on marketing. Our growth has been solely organic. Myself, along with my two business partners, Julius Moore (CTO) and Lucas Roe (CDO), are each medical cannabis patients. Therefore, we take privacy extremely seriously, which is why Tetragram is HIPAA-complaint as well. Users will always remain anonymous on Tetragram unless they choose to share their reviews with others.

Did COVID-19 affect your plans for the app? Were users affected?

 Covid was good and bad for Tetragram. During Covid, people were placing a lot more attention on their physical and mental health. Cannabis consumption rose dramatically during the epidemic. Consequently, people were buying more products and paid closer attention on the effects associated with each product purchased. The only downside to launching Tetragram during the Covid-19 pandemic was that there were very limited options to make consumers aware of Tetragram. Cannabis companies have very limited options for marketing their products and services to consumers due to cannabis being federally illegal. Most cannabis and CBD companies rely heavily on conventions and tradeshows to reach consumers. As a country, we had to close all in-person events during the pandemic, which made it a lot more challenging to reach consumers. 

Can you explain a little about what terpenes are and how they are important with medical cannabis treatments?

 I personally think terpenes are the most fun aspect about cannabis. Terpenes are naturally occurring chemical compounds found in plants. They’re responsible for the aromas, flavors, and colors associated with each strain of cannabis. There are 10 top terpenes, and each provides a unique smell and effect. Some terpenes are known to promote energy while others are known to feel sedative. It’s refreshing to see more consumers shopping for products based on the terpene and cannabinoid profile rather than by tetrahydrocannabinol (THC) content.

How can Tetragram benefit medical cannabis patients, both novices and experienced?

 With each dispensary providing a Walmart selection of products to choose from, even the most experienced consumer still doesn’t know where to start in choosing a product. With Tetragram, we empower the consumer to take control of their personal journey with cannabis by providing them with a platform that makes it fun to keep track of each product purchased and its associated effect. By doing so, consumers will be able to draw conclusions more effectively on not only which product but understand which terpenes and cannabinoids and consumption methods are providing them with the most relief.

Is Tetragram adaptable to other states? Or is it only able to be accessed in one specific state? Does the varying state-by-state legislation affect the app at all?

 Yes, Tetragram is available nationwide. Luckily, we are not held to state-by-state regulations like plant touching companies.

How do users log their information about what strains they are consuming?

 After downloading Tetragram from the App Store or Google Play store, you will be prompted to create an account. After initially creating an account, you will be asked to verify your email. After verifying your email, you can login and start logging product information. We placed a lot of time on the user experience to make sure Tetragram would be easy to navigate. Once you open Tetragram, simply click on our logo and you can start logging away by first entering in the product information, then where you made the purchase, and how you consumed the product. From there, you can choose a medical condition from a list of default options or create your own symptom, rate the symptom before and after use, and leave any detailed notes associated with product.

Medical cannabis patients are very diverse in their options to take medical cannabis, whether it is smokable, edibles, tinctures, and so forth. Is Tetragram exclusive to one method of intake?

 Absolutely not, Tetragram provides consumers with the ability to choose from several different consumption methods, such as: inhaling, topical, or orally. After a user selects one of the three methods on consumption, sub-categories are listed below that allow the user to provide more detail regarding how the product was consumed. For example, after choosing inhaled, the user can select the device used “bong, joint, vape pen, etc.,” then another sub-category allows the user to select the form of the product “flower, hash, shatter, etc.,” and the unit of measurement under “inhaled” is measured in the number of “hits”.Since the cannabis industry is unregulated, have you seen poor products that claim they have specific terpenes and cannabinoids but do not really include accurate information on them in their products? How does Tetragram deal with accurate product information? Is there a requirement for products to be third-party laboratory tested?

 I personally haven’t witnessed products that state a certain amount of THC or terpenes and cannabinoid content that was false. But I’ve heard stories of people who have had products retested and the new test results don’t match what the label states. It’s unfortunate to know there are some bad players in the industry making false claims. Each state that has medical or adult-use programs require each product to be tested by a laboratory, but the testing requirements vary from state-to-state. This is the reason why we aim to get the Certificate of Analysis (COA) directly from the cultivator to make sure the information presented on the label matches the COA. But the problem is much bigger than just blaming the manufacturer: for example, testing facilities have been caught taking more money from companies to increase the percentage of THC on the COA. This is why we need standardization across the country to ensure each laboratory across the country is following the same testing requirements.

Where can interested users find Tetragram? Is the app available to both recreational

 People can find us on social media, for 

Are you involved in any educational efforts for those looking to use medical cannabis?

 Often, I give presentations on the benefits of cannabis and CBD consumption at the University-level and with multi-state operators (MSOs) that provide education webinars for their customers.

Do you have anything further you would like to add?

 I would like to say that I feel blessed in knowing that my partners and I have built something that is improving people’s quality of life, and that means the world to us—which is why our slogan is “Built for patients, by patients.”

https://www.capitalgazette.com/maryland/bowie/ac-cn-tetragram-app-0818-20200820-rxy2bfr5qbfb3hjhkrm464pmnm-story.html

https://www.greenmarketreport.com/tracking-medical-cannabis-strains-with-the-tetragram-app/?fbclid=IwAR1BVSOBxiToGxOkOX_U0sUmYRKygR3ux5H6kkDzR-vSTjd3yTb5-nkALCY

https://www.safeaccessnow.org/take_control_of_your_medical_cannabis_with_journaling?utm_campaign=asa_news_aug2020&utm_medium=email&utm_source=americansforsafeaccess

Here, Otha Smith discusses the Tetragram app, which allows users to track cannabis products enabling them to find the best products that suit their needs.

New App Shines Light on Product Guidance for Users

One look at suburban moms, Gina Dubbé and OBGYN Dr. Leslie Apgar, wouldn’t give you the impression that they were involved in the cannabis industry or that they were successful owners of the medical cannabis dispensary Greenhouse Wellness. These two innovative women have dug their way through the male-dominated cannabis industry with the goal of assisting patients seeking relief of their various health ailments through cannabis. They help patients suffering from a variety of conditions such as chronic pain, anxiety, inflammatory diseases, sleep disorders, and many other issues. Here, they share their history and plans for the future.

Can you tell us a little bit about yourselves?

 We first met about 20 years ago as back door neighbors. Gina is a serial entrepreneur, venture capitalist, and engineer by training, and I am a board-certified OBGYN who also owns a successful medical spa. 

How did you get started in the cannabis industry?

 We were approached by someone in the industry who was interested in bidding my credentials and looking for capital investment, which is why Gina was brought in. Unfortunately, the interactions were short as it was clear we weren’t going to be taken seriously. So, Gina got irritated after being mansplained to, and looked up the requirements to bid then called me to announce we were just going to bid by ourselves. Much to our surprise and delight, we not only won one of the coveted licenses, but we got our first choice of district. 

What made the medical cannabis sector your main focus?

 It is so rewarding to see patients from all walks of life improving before our eyes. They are getting off their pharmaceuticals and living their best lives. Some are returning to the work force or continuing in the work force whereas they may have had to stop due to their chronic conditions. We are grateful every single day, and humbled.

As two suburban moms, did you face more criticism for getting involved in the medical cannabis industry?

 Absolutely, we did. In fact, Gina lost a friend of more than 30 years over it. I was heavily criticized by my medical colleagues, but today they are happily referring patients and seeing me or participating in the program themselves or sending their loved ones.

Do you experience any stigma surrounding cannabis? If so, how do you handle it?

 Education is the key to changing the stigma. Yes, it’s still there, but it is so much less than it was four years ago. When patients, friends, and the community are armed with information, attitudes start changing. I give free lectures to the community and medical field, as well as daily consultations with patients who are interested in entering the cannabis program, or who would like guidance once they are accepted into the program. We also distribute informative emails and participate in podcasts and educational programs all over the country. 

The cannabis industry has been known as a male-dominated field, what has it been like to enter the industry as women?

 As with most industries, cannabis is dominated from the male attitude and perspective. This was challenging in the beginning as we were not afforded the same deals as others within the boys’ club. Once we gained attention for our best business practices and sound results, we gained a more level playing field, which has been nice, but the problem is a never ending one. We constantly have to fight for a seat at the table, and a voice that is recognized because we are female. When we entered the space, we saw an obvious void of products directed at women and we sought to change that with our female cannabis line, Blissiva. It has been incredibly well-received and we are delighted that so many women (and men) are seeing its benefits!

What are some of the health conditions you treat (for example, cancer, chronic pain, anxiety, PTSD, etc.)? Are there some ailments that are more popular than others that patients come in to treat?

 We treat all inflammatory ailments, and that includes almost anything you can imagine. Chronic pain, inflammatory bowel disease, anxiety, and sleep disorders are very popular complaints, just to name a few. We have a lot of patients who are treating side effects from their traditional cancer therapies as well as treating their cancers directly. Some patients are on low dose maintenance therapies for their chronic conditions, including cancer. 

What are some of the benefits you have seen from medical cannabis with your patients? Are there any stories you can share with us?

 We have seen cannabis prolong meaningful and quality of life for those struggling with advanced metastatic cancers. We have seen folks get out of their wheelchairs and lose their canes. We have seen patients return to the work force (or stay when they thought they’d have to leave). We have seen patients declare that they would have committed suicide had it not been for cannabis. Patients have declared that we gave them their lives back, saved their marriages, or their sex lives, etc. The list goes on and on...

Why do you believe cannabis is a viable and validated option to be used as medicine?

 Science is proving it every single day, and more importantly, we are seeing it live, in action. I have seen things in the cannabis space that exceed my scientific brain’s ability to explain using traditional medications and methods. The endocannabinoid system is probably one of the greatest medical discoveries of all times, and its implications in creating new treatments based on plant or synthetic cannabinoids and on their receptors in the body will result in a change in the way we practice medicine forever.

How do you think cannabis can be used to fight the opioid epidemic?

: It’s already fighting the opioid epidemic. We have published case reports of cannabis getting people off of opioids, and we are in the process of publishing another one involving a patient who is now off her suboxone for over a year with the help of cannabis. There are studies showing the benefit of both THC and CBD and their ability to potentiate the effects of opioids and decrease the withdrawal and cravings that go along with an opioid taper or wean.

Can you tell us about Blissiva and also Greenhouse Wellness (2,3)? Where are they located?

 Greenhouse is located in Ellicott City, Maryland, in a wellness facility that includes a full-service imaging center, an apothecary, and compounding pharmacy, and integrative health care practitioners. Blissiva is the female-focused line that Gina and I started. The first line, Balance, is a 1:1 CBD:THC low potency disposable vape pen designed to treat anxiety and difficulty falling asleep. It comes in two flavors—cucumber-lime and vanilla—and is discreet, and able to be used any time of the day or night. The second line, Soothe, is a 1:3 CBD:THC medium potency disposable vape pen that is lemon flavored and designed for daytime pain relief, while keeping patients focused on their daily activities. 

 We have flower, pre-roll joints, oil cartridges, disposable vapes, a myriad of edibles, pills, capsules, concentrates, topicals, and even bath salts. 

Are there any requirements to come to your facility?

 In Maryland, the cannabis program is solely medical at this time and there are requirements as listed on the MMCC.maryland.gov website

How do you research the medical cannabis you sell at Greenhouse Wellness?

 Happily, Maryland has done a great job of doing seed to sale tracking and implementation of a robust testing program by third party vendors. There is a certificate of analysis available for review on every single product available for Greenhouse Wellness to purchase and these are available for patients to view as well. We have more than 300 products on our menu, so there is definitely something for everyone. Our buyers do a fantastic job scouting what’s available and buying in quantity to pass savings on to our patients. 

High Heals: How Two Women Found Their Footing in the Medical Cannabis Industry

 was a response to the questions asked and answered above. Everyone wants to know how we got started, what hurdles we surmounted, and what’s next? It was written as a love letter or a cheer to other women who are considering starting their own businesses and to inspire women of all ages to be more, be better, and achieve their dreams wherever possible. 

 is available on Amazon and other booksellers and on audiobook as read by Gina and myself. 

Are there any educational resources that you recommend for those looking to use medical cannabis as a treatment?

 contains a brief primer on medical cannabis at the end, but there are a myriad of books available on the internet. Start with something pretty basic, and know that you are going to have to learn a new language, so be patient with yourself. The learning curve is steep and soon, you will know much more than your collective group does and you will be teaching them!

What would you like to see change in the cannabis industry in the future? Are there any regulations or legislations that affect your work currently?

 Cannabis needs to be descheduled so we can finally start the long overdue process of establishing robust randomized controlled trials involving cannabis so we can get the data to prove what we are seeing anecdotally. There is much to learn about cannabis and the endocannabinoid system, and we are excited to move into a more holistic approach to wellness and healing using cannabis as one of our tools. Because of its schedule 1 status, we are working in a federally illegal enterprise. Even though it is legal in Maryland, we are penalized by the taxes we pay, we can’t work with banks, write checks, or accept credit cards. In fact, banks have tried to “fire” each of us from their personal banking institutions because they know we are involved in cannabis. Everything in business is harder because of the laws surrounding cannabis. We hope the safe banking law will pass the Senate and we sincerely hope the feds will come to their senses and legalize cannabis finally.

How has the COVID-19 pandemic affected your work?

 We went to a strictly curb-side model and got all of our employees vaccinated. We installed cough guards and put out loads of hand sanitizer. We stopped doing in-person consultations which were limited to 30 minutes, and instituted telephone and Zoom consults which are not time limited, but by appointment with staff and myself. Our business grew exponentially during Covid, which is quite sad as it speaks to the ridiculous uptick in anxiety and depression that we now see. Also, with more time on their hands to reflect on their medical conditions, and overall quality of life, many more patients joined the cannabis program, and are continuing to join every day as they seek better treatment solutions than traditional medicine can offer.

What is next for your Greenhouse Wellness dispensary, Blissiva brand, and also for yourselves?

 We are preparing for Greenhouse Wellness to grow when recreational is passed here in Maryland. We are looking at increasing our footprint and expanding into educational opportunities all over the world. We are currently looking for a partner who can make Blissiva in multiple other states. Because cannabis cannot cross state lines, we cannot make Blissiva here in Maryland and send it to others across the country, despite the patients who plead for it daily. Gina loves starting businesses and helping them thrive so she looks forward to continuing her consulting side of things. My true passion is education, so you will see me branching out into opportunities that have a bigger reach. Together, we are passionate about lifting women up, and that continues to be our overarching goal.

As successful owners of the medical cannabis dispensary Greenhouse Wellness, Gina Dubbé and OBGYN Dr. Leslie Apgar share their history and future plans.

Two Suburban Moms Take on the Medical Cannabis Industry

 conference—taking place September 29–October 1 in Pasadena, California—will feature an exciting full-day CannMed Medical Practicum organized by Bonni Goldstein, MD, (the practicum’s originator); Dustin Sulak, DO; Kevin Spelman, PhD, MCPP; and Eloise Theisen, RN, MSN, AGPCNP-BC. During this practicum, each of the presenters will share the latest research, their clinical experience, and practice guidelines related to cannabinoid therapeutics, inclusive of types of extractions, products, and optimal dosing of cannabinoids for various therapeutic scenarios. This course is approved by the California Board of Registered Nursing for 9.5 contact hours.**

In this roundtable interview series, we speak to each of the organizers to learn more about them and what attendees can expect from the practicum. Here in part I, they share some of the clinical applications for medical cannabis and dosing information. 

What are some of the clinical applications for medical cannabis?

 Medical cannabis can be useful for numerous conditions, including managing symptoms of neurodegenerative disorders, inflammatory gastrointestinal conditions, symptoms from cancer and cancer treatment, chronic pain, sleep disorders, and some psychiatric disorders. Because of the widespread distribution of the cannabinoid receptor, we know that the endocannabinoid system plays a role in almost every physiologic process and therefore can be utilized as a target for treatment.

Anxiety, seizure disorders, pain, mood disorders, sleep issues, and autoimmune disorders.

: Chronic pain, insomnia, PTSD, nausea, and vomiting are certainly the most common, but a typical cannabis practice is full of refractory conditions from every other field in medicine, for example, psychiatry, gastroenterology, oncology, neurology, rheumatology, and so forth. Overall, cannabis is often an effective treatment when everything else has failed.

According to the National Academies of Sciences, Engineering and Medicine report on the health effects of cannabis and cannabiniods, there is moderate to substantial evidence to support the use of cannabis for chronic pain in adults, sleep disorders, chemotherapy induced nausea and vomiting, and muscle spasms in multiple sclerosis. Additionally, we are seeing more clinical data to support the use of cannabinoids for anxiety, depression, and PTSD.

How is medical cannabis dosed and what methods are being used by patients?

Medical cannabis is different than most pharmaceutical medications, meaning there are no specific dosing recommendations for the vast majority of conditions being treated. Patients are advised to “start low and go slow” to customize their dosing regimen. The reasons for this include a wide inter-individual variation in absorption, metabolism, and excretion of the cannabinoids and other compounds in the plant. However, a clinician knowledgeable in cannabis dosing can help a patient negotiate dosing for the many products on the market, helping to personalize the patient’s dosing regimen. Methods of use include inhalation, ingestion, sublingual, topical and transdermal applications. Each of these has advantages and disadvantages that can help patients choose their preferred method, although many patients use multiple methods of use depending on symptoms, time of day and cost.

Dosing has a high interindividual variability. Best to start at very low doses and work up so the optimal "physiological" dose can be found (versus a "pharmacological" dose)

: Cannabis is highly versatile and allows for individualized treatments that can often be fine-tuned to allow for all benefit and no adverse side effects. This fine-tuning includes delivery methods (oral, oromucosal, inhaled, topical), numerous varieties of cannabis with distinct properties. You can find more info at: 

https://healer.com/using-medical-cannabis-delivery-systems/

: Cannabis is best when it is individualized to the patient's condition and goals of care. It is important to take a thorough health history and discuss the plan of care with the patient. Some patients may need low doses to achieve relief and others may need higher doses and that usually cannot be determined without considering many factors like age, gender, other health conditions, medications and previous or current cannabis experience. In some cases, patients may need multiple methods of administration to effectively treat their condition.

Check back next month for part II of this series where our roundtable will discuss the role medical cannabis can play in stopping opioid addiction and how it might interact with other medications. To find out more about the CannMed Medical Practicum, please visit: 

, a medical practice devoted to educating patients about the use of cannabis for serious and chronic medical conditions. Dr. Goldstein was a Clinical Instructor in Pediatrics at USC School of Medicine in Los Angeles, Emergency Transport Attending Physician at Childrens Hospital Los Angeles, and Emergency Medicine Attending Physician in the Pediatric Emergency Department at Los Angeles County-USC Medical Center. A frequent speaker nationally and internationally, Dr. Goldstein was awarded “2017 Healthcare Professional of the Year” by Americans for Safe Access, a non-profit that promotes safe and legal access to cannabis throughout the nation. She is on the board of the International Association for Cannabis as Medicine and is also on the Medical Advisory board of Whole Plant Access for Autism, a non-profit that provides education and resources to families of individuals with autism. Dr. Goldstein’s first book, 

, was awarded “2017 Semifinalist Book of the Year” by the American Botanical Council. Her latest book, 

, was published by Little, Brown Spark in September 2020. She is the medical advisor to 

 is a researcher, clinician, educator and industry consultant that has advised the White House and the Department of Defense on natural products for regulatory guidelines and research on effective battlefield hemostatics, respectively. Dr. Spelman studied brain cancer, as well as CB1 and CB2 receptor binding as a Postdoctoral Fellow at National Institutes of Health and was the first researcher to elucidate cannabinoid ligands in Zanthoxylum spp. He has also carried out malaria and natural products research as a Marie Curie Research Fellow in the European Union and has focused on molecular techniques to elucidate the pharmacology of phytochemicals on human physiology and has 27 peer reviewed publications on medicinal plants. He has also been a senior R&D executive for multiple companies over the last decade. Dr. Spelman has considerable experience in medicinal plant, nutraceutical and cannabinoid research and has coordinated new product development, analytical and QC guidelines, research activity and educational curriculums for industry and universities over the last 30 years. 


Dr. Dustin Sulak is an osteopathic general practitioner whose clinical practice focuses on treating refractory conditions in adults and children with an individualized, health-centered approach. Dr. Sulak received undergraduate degrees in nutrition science and biology from Indiana University, a doctorate of osteopathy from the Arizona College of Osteopathic Medicine, and completed an osteopathic rotating internship at Maine-Dartmouth Family Medicine Residency. Dr. Sulak is a founder of Integr8 Health, a medical practice in Maine that follows over 8,000 patients using medical cannabis, a cofounder of 

, a medical cannabis education resource, and serves on the board of directors of two non-profits, the Society of Cannabis Clinicians and Patients Out of Time.


Eloise Theisen is a board certified Adult Geriatric Nurse Practitioner who specializes in cannabis therapy. For over 20 years, Eloise has worked primarily with cancer, dementia and chronic pain patients. In the last 6 years, Eloise has focused her efforts on cannabinoid therapies. Since then she has worked with over 6000 patients to help them effectively treat age-related and chronic illness with cannabis. Eloise is a co-founder and the Chief Executive Officer of 

and Radicle Health Clinician Network. She is the current president of the American Cannabis Nurses Association (2020-2021) with over 1350 members nationally. Eloise also serves on the editorial board of the 

American Journal of Endocannabinoid Medicine

, a journal dedicated to educating healthcare professionals on the subject of medical cannabis through research, independent medical studies and evidence based data. In 2019, Eloise co-wrote 

Pain Free with CBD: Everything you need to know to safely and effectively use cannabidiol

. She is currently teaching the accredited medical cannabis certificate program at Pacific College of Health Sciences.

In this roundtable interview series, we speak to each of the organizers of the CannMed Medical Practicum to learn more about them and what attends can expect from the practicum. Here in part I, they share some of the clinical applications for medical cannabis and dosing information. 

Medical Cannabis Insights, Part I: CannMed Medical Practicum Organizers Discuss Clinical Applications and Dosing

A committee formed in 2019 by the National Football League (NFL) and the National Football League Players Association (NFLPA) announced plans to award grants to researchers who are researching the therapeutic benefits of cannabidiol (CBD), cannabis, and other opioid alternatives for pain management (1,2). The committee—called the NFL-NFLPA Joint Pain Management Committee (PMC)—plans to award up to $1 million in grants.

Dr. Kevin Hill, co-chair of the PMC, commented on how the federal policy unfavorably impacted the level of research permitted in the US, especially with the ongoing prohibition of cannabis as a Schedule I drug. Hill specifically recognized how the lack of funding in cannabis research also affected future advancements in research and that a lot of companies and states who significantly profit from the sale of cannabis and other cannabinoids do not contribute to science (2).

The PMC announced it is turning its attention to identifying potential research opportunities through a formal Request for Proposal (RFP) process (3). The goal of this funding opportunity is to request proposals from researchers who have the ability to conduct studies that will help supplement the PMC’s knowledge on athletic performance and pain management in football players. The league is particularly interested in proposals on the following areas:

the effects of cannabinoids on pain in elite football players (post-surgical or in daily pain management);

the effects of non-pharmacologic treatments on pain in elite football players (postsurgical or in daily pain management); and

the effects of cannabis or cannabinoids on athletic performance (for example, psychomotor, reaction time, cardiorespiratory function) in elite football players.

The deadline for applications to be submitted prior to proposals is July 31, 2021 (3).

In 2020, the joint panel held CBD informational forums. These discussions brought the determination that the nonintoxicating CBD compound, has medicinal properties in the treatment of various forms of pain. Although, the committee agreed that there was not enough existing research and information on the benefits of opioid alternatives for both chronic and acute pain.

The NFL’s policy is that players in the league will not face suspension from games based on positive test results from any substance, including cannabis. The policy was recently updated and reflects a shift in the NFL’s approach to the use of drugs by players, with the agreement highlighting the need to center on treatment and evaluation rather than penalties. Players who self-refer themselves, display behaviors indicating misuse of drugs, or test positive for drug use, are now required to enroll in an intervention program, where they can be evaluated and receive a treatment plan.

With the NFL’s new stance on supporting cannabis research, it will be exciting to see if other major sport leagues will follow suit.

https://www.cannabisnewswire.com/420-with-cnw-nfl-funds-cannabis-research-despite-continued-prohibition-hindering-research/

https://www.marijuanamoment.net/nfl-funds-marijuana-research-saying-federal-prohibition-adversely-impacts-studies-into-opioid-alternative-for-players/

https://www.nfl.com/playerhealthandsafety/health-and-wellness/medical-research/nfl-nflpa-pain-management-committee-accepting-applications-for-1-million-in-rese

NFL-NFLPA Joint Pain Management Committee (PMC) plans to award up to $1 million in grants to CBD and cannabis researchers.

NFL Defies Prohibition to Fund Cannabis Research

Dr. Jeff Konin currently serves as a Clinical Professor and the Director of the Doctor of Athletic Training Degree at Florida International University (FIU, Miami, FL). At FIU, he leads a team of faculty, staff and students on cannabis research and educational initiatives and also sits on the Global Strategy Leadership Group.

Dr. Konin is the Founder and President of PHD420, Inc, a 501©3 which focuses on cannabis research and education to healthcare providers around the world. He is also a co-founder of The Rehberg Konin Group and Sport Safety International, firms specializing in providing expert safety advice. In addition, he serves as a consultant in both the sports medicine and cannabis industries. Dr. Konin teaches a 4-hour Cannabis Healthcare Educator Certificate program throughout the United States.

Dr. Konin has held various academic and clinical leadership positions and is also an internationally recognized speaker. He is considered a leader in sports medicine, having served as an expert consult for medicolegal cases, academic program development, curricular review and assessment, and clinical practice operations. Dr. Konin’s clinical experiences have included the United States Olympic Training Centers in Lake Placid and Colorado Springs as well as serving on the medical staff for the 1996 Olympic Games in Atlanta. He has also served as a medical coordinator for the USA Wheelchair Rugby Paralympic Team, provided care for NASCAR, Professional Rodeo events, and the Disney World Marathons.

Dr. Konin is an accomplished author having written over 25 academic textbooks of which some have been translated into foreign languages. Additionally, he is a frequently sought-after public speaker having given over 500 presentations throughout the United States and in Australia, New Zealand, Italy, Norway, Romania, England, Netherlands, Germany, Spain, Japan, and Austria. He has been recognized with some of the highest honors given in his profession of athletic training and physical therapy. He is a Hall of Fame inductee in the National Athletic Trainers’ Association (NATA) where he was also recognized as an Academic Fellow, recipient of the International Service Award, and the Continuing Education Excellence Award. Dr. Konin serves as chair of the Cannabis Task Force for the NATA. He also holds the title of Academic Fellow within the American College of Sports Medicine (ACSM).

In addition to the NATA and ACSM, Dr. Konin has held membership in the Society of Cannabis Clinicians, the American Cannabis Nurses’ Association, the American Medical Marijuana Physician’s Association, the Olympic Sports Medicine Society, and many other reputable organizations.

Dr. Konin earned his Bachelor of Science (BS) degree from Eastern Connecticut State University in Physical Education in 1988, a Master of Education degree (M.Ed.) in Sports Medicine from the University of Virginia in 1989, a Master’s degree in Physical Therapy (MPT) from the University of Delaware in 1994, and a PhD in Physical Therapy from Nova Southeastern University in 2004.

™ Editorial Advisory Board please visit: 

https://www.cannapatientcare.com/editorial-board

Cannabis Patient Care™ is pleased to announce the addition of Dr. Jeff Konin to its editorial advisory board (EAB).

Cannabis Patient Care™ Welcomes New EAB Member—Dr. Jeff Konin

New innovations in technology are constantly changing the cannabis landscape. For example, Demetrix, a biotechnology company, has engineered yeast to make specific molecules that are used in a fermentation process to produce cannabinoids. Here, Maria Enquist-Newman, PhD, Director of R&D Program Management at Demetrix, delves into the specifics of fermentation-produced cannabinoids and how this method can benefit the cannabis industry.

Can you tell us about Demetrix and some of the work you do there? Why use fermentation to produce cannabinoids (1)?

 Demetrix is a biotechnology company that believes in the power of science to make the world a better place. The company produces safe, legal, and effective health and wellness products backed by science, including rare, high-purity cannabinoids for pharmaceutical and consumer applications.

Demetrix has a team of industry-leading experts across Research & Development (R&D), production, regulation, and commercialization, with deep experience bringing fermentation products to market. The company is pioneering the study of the more than 100 rare cannabinoids and their interactions with the human body.

We use regular baker’s yeast to produce natural molecules that natively are made by the cannabis plant. By engineering our yeast to make specific molecules, we can get access to very rare cannabinoids in an affordable and sustainable way.

How do you use baker’s yeast and fermentation to produce cannabinoids?

 Our team has rich experience bringing fermentation products to market, across R&D, manufacturing, and commercialization. We use biotechnology to engineer the DNA in baker’s yeast to produce rare cannabinoids. This method is more sustainable, socially responsible, scalable, and consistent than obtaining these ingredients from agriculture. More than 1000 yeast cells would fit on a single trichome on the cannabis plant, which gives a sense of the sheer scale at which cannabinoids can be produced via fermentation. Also, while our cannabinoids are the same as those found in the plant, it is important to note that we don’t use any part of the plant to produce our cannabinoids.

How did you get started working with cannabinoids?

 I joined Demetrix in 2019, and that was when I stared working with cannabinoids. I was very excited to join the Demetrix team as I strongly believe in this approach to produce cannabinoids—it is a sustainable and affordable method. It is a rapidly evolving field, and I was very impressed with Demetrix’s groundbreaking fermentation technology.

Due to the stigma on cannabis, do you feel that this limits the potential to find out more about the medicinal properties of the plant? Are there fewer research opportunities?

 The fact that no one has even been able to do research on this interesting family of molecules until recently definitely means that the field has been held back. What we are doing is providing the needed access to these compounds so that proper research can be performed to uncover their potential to improve health and wellness.

How does your company plan to expand cannabinoid research and what is your role in that?

 Our work is focused on making rare cannabinoids available at commercial levels at affordable prices and in a sustainable way. The first molecule we are bringing to commercial scale is cannabigerol (CBG). We are going to continue to expand our portfolio of rare cannabinoids and our foundational research to learn more about how each one can safely, legally, and effectively promote human health and wellness.

Can you tell us a little about the research you uncovered in the recent article title “

A pathogenesis-related 10 protein catalyzes the final step in thebaine biosynthesis

 This work that I was part of at my previous company also involved introducing plant genes into yeast with the goal of producing molecules via fermentation. Thebaine is a precursor in the morphine pathway and we were aiming to produce thebaine via fermentation in a more sustainable and controlled fashion than its normal production method from opium poppy. As we introduced the long and complex thebaine pathway into yeast, it became clear that there was a missing step in the pathway: the last step that converts (7S)-salutaridinol 7-O-acetate to thebaine has for long been presumed to be spontaneous. However, as we were looking closer into this, through a nice collaboration with an academic laboratory, we discovered a novel enzyme that catalyzes this step, subsequently named “thebaine synthase.”

Can you tell us about some the work related to the article “

Efficient ethanol production from brown macroalgae sugars by a synthetic yeast platform”

Did you use any of those methods to produce synthetic cannabinoids?

 This work was part of my first job at a synthetic biology company. Also at this company, as we do at Demetrix, we used yeast to make a natural process more efficient and sustainable. In this case, we engineered yeast to be able to utilize kelp (brown macroalgae) to make ethanol. Kelp can be farmed, and since it grows in the ocean, there is no “food versus fuel” dilemma. There is no need for watering, and not even a need for fertilizers. Kelp does, however, contain some unusual carbohydrates that native yeast can’t utilize. We therefore had to introduce some non-native genes into yeast that allowed it to break down kelp. Yeast would then utilize these building blocks and turn them into ethanol (native product of yeast).

Since this was addressing the “feedstock” (alternative ways for yeast to take up carbon), this could in theory be paired up with any downstream pathway engineering, including making cannabinoids.

In this interview, Maria Enquist-Newman, PhD, Director of R&D Program Management at Demetrix, delves into the specifics of fermentation-produced cannabinoids and how this method can benefit the cannabis industry.

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