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Read thing blog installment looks at the research on the use of cannabis for pets

Overview of Cannabis for Pets

Read the blog on ensuring the safety and efficacy of cannabis products

Elevating the Green: The Crucial Role of Quality Control and Testing in the Cannabis Industry

On this special edition episode, we are joined by Bill Nichols, the Technical Director at Biotrax Testing Laboratory in New York

Podcast Ep 19: Rebuttal to NY Cannabis Testing Article

Learn more about the role of the ECS and the gut-brain axis

The Role of the Endocannabinoid System in the Mind-Body Connection

Historical references to the use of cannabis to treat animals tend to focus on horses. In a recent paper in 

by De Briyne and colleagues (1), they state: “[Ancient] Greek writers reported the use of cannabis for dressing sores and wounds in humans and horses,” and “until relatively recently, cannabis was found in a large number of veterinary medications designed to treat colic, spasmodic colon, and other ailments in equine patients.”

In more recent times, clinical studies of the pharmacology, safety, and efficacy of cannabis for animals tend to be conducted mostly on dogs. The research in this area shows that when compared to studies of other animal species, dogs have a higher density of CB1 receptors in their cerebellum. This makes dogs more sensitive to the effects of tetrahydrocannabinol (THC). Furthermore, dogs metabolize cannabinoids differently than humans, and researchers still don’t know which cannabis metabolites are active for dogs. As a result, most cannabis therapeutics for pets focus on cannabinol (CBD) rather than THC. Finally, the few clinical studies that have been performed on dogs generally examine the use of CBD to treat osteoarthritis or epilepsy, and the studies tend to find CBD to be effective in treating these conditions (1,2).

More generally, CBD may provide benefits for dogs and other animals in the treatment of, for example (3):

When it comes to cannabis and animals, the European Union (EU), Canada, and the United States (US) all distinguish between two primary uses of cannabis for animals, either as a source of nutritional benefits or as a source of therapeutic benefits. Let’s take a closer look at each of those uses.

On the one hand, hemp seed products provide nutritional benefits when used in animal food and livestock feed.

The EU, Canada, and the US all recognize this potential. At the same time, however, an overriding concern is the potential for people to become “unintentionally exposed” to cannabinoids used for animals “through meat, milk and eggs”(4). Consequently, both Canada (1) and the US (4) prohibit using hemp products in livestock feed. In contrast, the EU does allow the use of hemp seed products in animal feed as a source of “crude protein and essential fats” (1).

On the other hand, cannabinoids (such as CBD and THC) have the potential to provide therapeutic benefits when used in health and wellness products.

In the EU, despite a lack of government approval of any cannabis animal products for therapeutic uses, many companies are currently selling such products with wellness claims (1):

There are many companies in the EU marketplace today selling ‘nutritional supplement’ cannabis-derived products for dogs, cats, and horses, some of which make what clearly appear to be therapeutic feed claims. These products are being promoted as aids for itching, anxiety, nausea, poor appetite, seizures, cancer, digestive problems, inflammation, immune disease, and reduced mobility due to joint pain in animals. It is against the law to make therapeutic feed claims about nutritional products.

None of these products are approved for therapeutic use; so, legally, veterinarians cannot “offer scientific advice on the effectiveness of a nutritional product to treat a disease” (1). Presumably, the government is simply not enforcing the laws regarding wellness claims in marketing. It’s not clear whether or not the government is enforcing laws against veterinarian advocacy for these products either.

Canada allows cannabis-derived veterinary health products (VHPs) only when derived from the seeds of the plant and when containing minimal amounts (< 10 ppm (mg/kg)) of THC (1). Notably, by precluding use of hemp flower products, the Canadian government is also limiting the amount of CBD that can be cost effectively included in cannabis VHPs.

Regardless of the recognized potential for cannabis’s therapeutic benefits, the fear that human food products may be contaminated through animal consumption of cannabis has led to a ban on their use in the US (1): “Accordingly, as of this writing [2021], there are no hemp- or marijuana-derived foods, drugs, or supplements approved for use in animals in the US.” Furthermore, the position of the American Veterinary Medical Association (2) is that there is not enough scientific evidence to support any therapeutic benefits of CBD for dogs (3). Nevertheless, some US states have passed laws loosening the federal restrictions on cannabis pet products (1).

Veterinarian laws in the US ban veterinarians from prescribing cannabis products for animals. At the same time, however, “veterinarians may be permitted to discuss cannabis with pet owners or recommend cannabis to companion animals, depending on state law.” Yet, laws vary dramatically by state, “and there could be real consequences for veterinarians who run afoul of these laws, including a loss of their DEA [Drug Enforcement Administration] registration. Before discussing cannabis with clients, veterinarians should ensure they are aware of all relevant information in the state where they practice.” As a point of clarification, cannabis-derived products for pets are illegal, which means veterinarians cannot sell these products. Yet, recommending cannabis products for pets is not against the law (4) (see 

Despite tight international laws on the use of cannabis products for animals, the market for CBD products for pets is relatively large and quickly growing. Grand View Research reported (5) that in 2022 global CBD pet products generated $196 million in sales, and the market “is expected to grow at a lucrative compound annual growth rate (CAGR) of 31.8% from 2023 to 2030.” The report further indicates that the largest market segments were as follows (5):

The largest revenue share by pet type was that for dogs, since they have a larger pet population and a larger number of medical applications, including osteoarthritis, hip dysplasia, and chronic diseases.

The largest revenue share by indication was joint pain, accounting for more than 20% of the market. At the same time, the fastest growth rate (more than 31%) is expected for anxiety and stress.

The largest purchase venue (more than 42%) was online.

The largest purchase region (more than 40%) was North America.

Surveys of pet owners and veterinarians indicate that CBD use in pets has largely been driven by pet owners and CBD companies (6–8). Notably, most pet owners who use CBD for their pets also use CBD themselves (8), and their motivations for using CBD products rather than more traditional veterinary products is that they believe CBD is more natural and more effective (9). Most users are using CBD products to treat veterinarian-diagnosed problems, but they did not generally start using CBD products on the recommendations of their veterinarians, and they’re not necessarily discussing their use of CBD products on their pets with their veterinarians (6–8). The most common conditions being treated with CBD include seizures, cancer, anxiety, and arthritis(7).

In short, these surveys are showing that therapeutic cannabis use by pets is similar to therapeutic cannabis use by people in that:

Cannabis use for both people and pets is not uncommon even when it’s not legal

Cannabis is being used to treat similar types of health problems in both people and pets

Cannabis use for both people and pets is often not being discussed with doctors

Finally, most pet owners purchase their pet products online, or alternatively in pet stores, and most pet owners feel they lack sufficient information on appropriate CBD usage and dosing for their pets (6).

In 2019, Lori Kogan and Regina Schoenfeld-Tacher published an insightful survey of US veterinarians on their experiences with cannabis for pets (10). In states that have legalized recreational cannabis use, more than 60% of veterinarians receive daily or weekly inquiries from pet owners about CBD for pets. In non-legal states, that frequency drops to less than 25%. The most common condition for which pet owners seek advice is pain, but inquiries about CBD for anxiety and seizures are also common.

Of course, over time veterinarians have become more comfortable—relatively speaking—in discussing cannabis use for pets. Yet, while a larger majority of veterinarians (roughly 70%) feel comfortable discussing CBD for pets with other veterinarians, a smaller minority (roughly 55%) feel comfortable discussing it with patients. In fact, only about one in four of veterinarians will “advise” clients about CBD use for their pets, less than one in five veterinarians will recommend CBD, and less than one in 10 will prescribe CBD. The reasons given for not advising, recommending, or prescribing cannabis was (in decreasing frequency): lack of knowledge by veterinarians, lack of CBD efficacy, lack of legality, and potential toxicity.

While most veterinarians have little clinical experience with CBD products for pets, most perceive it as being very or somewhat helpful for a variety of conditions, including pain, anxiety, seizures, storm or firework phobia, motion sickness, and vomiting. Yet, a majority of veterinarians feel their state veterinary organizations have not provided them with sufficient guidance on the use of CBD or cannabis for pets for them to feel comfortable practicing within state or federal laws.

In 2022 cannabis products were listed on the American Society for the Prevention of Cruelty to Animals’ (ASPCA’s) top 10 list of pet toxins for the first time, coming in at number 10 (11). Importantly, it was noted by Brutlag and Hommerding (12) that “ingestion or inhalation of THC carries a high morbidity but low mortality rate.” As we might expect, two-thirds (66%) of calls to the Pet Poison Helpline involve pets eating edibles (12).

Nancy De Briyne and colleagues provide a wealth of information regarding marijuana toxicosis in pets (1): In addition to THC, other ingredients in cannabis products, including chocolate, raisins, or xylitol, may cause problems for pets. At the same time, CBD products may also be toxic, especially if they contain products other than CBD. The onset of signs of cannabis toxicosis in dogs typically occurs within 30–90 minutes of exposure and can last up to 96 hours. The most common signs of excess cannabis exposure in dogs and cats include:

The authors state (1): “Because no antidote has been described to date, the treatment of cannabis toxicosis consists of supportive care. Because of the wide margin of safety of most known cannabinoids, toxicosis is rarely fatal.” And finally, “Recovery may take 24 to 72 h, or longer (up to 5 days), depending on the ingested dose.”

Documented early historical use, together with more recently established mechanisms of action, support clear applications for using cannabis to treat pets. And given the prevalence of pets in society (more than half of Americans own cats or dogs) and the devotion of owners towards their pets (in 2022 owners spent roughly $125 billion on their pets) (13), it’s no surprise that owners are preempting both the laws and their doctors’ ability to guide them in treating pets with CBD. It’s also no surprise that early users of CBD for pets are owners who have used CBD for themselves.

The biggest threat cannabis poses for pets appears to be the same as that for children: unwitting consumption of THC products, which may cause cannabis toxicosis. The good news, though, is that most accidental overdoses are temporary in nature, with no long-lasting effects. Similarly, the biggest challenge cannabis poses for pet patients appears to be the same as that for human patients: having the laws and doctor education catch up to human and pet use.

De Briyne, N., et al, Cannabis, Cannabidiol Oils and Tetrahydrocannabinol—What Do Veterinarians Need to Know? 

https://www.avma.org/sites/default/files/2021-03/APH-CannabisResources-Report-20201207.pdf

Morrison, B.J., CBD Oil for Dogs: What You Need to Know. 

https://www.petmd.com/dog/general-health/CBD-for-dogs-what-you-need-to-know

Wightman, C., Recommending CBD and Hemp Products for Pets: Legal Considerations for Veterinarians. 

https://vicentellp.com/insights/recommending-cbd-and-hemp-products-for-pets-legal-considerations-for-veterinarians/

CBD Pet Market Size, Share & Trends Analysis Report By Animal Type (Dogs, Cats), By Indication (Joint Pain, Anxiety/Stress, General Health/Wellness), By Distribution Channel, By Region, And Segment Forecasts, 2023 – 2030. 

https://www.grandviewresearch.com/industry-analysis/cannabidiol-pet-market

Alvarenga, I.C., et al, Assessment of cannabidiol use in pets according to a national survey in the USA. 

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jsap.13619

Kogan, L.R., et al, Consumers’ Perceptions of Hemp Products for Animals. 

https://calmhorseacademy.com/wp-content/uploads/2019/12/CBD-fuer-Pferde-Pferdepellets-erfahrungen.pdf

Dorbian, I., Pet CBD Product Sales Estimated to Rack Up $629 Million This Year, Says New Report. 

https://www.forbes.com/sites/irisdorbian/2021/05/05/pet-cbd-product-...ed-to-rack-up-629-million-this-year-says-new-report/?sh=41a8ed12298e

Wallace, J.E., et al, Motivations and expectations for using cannabis products to treat pain in humans and dogs: a mixed methods study. 

https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-020-00045-x

Kogan, L., et al, US Veterinarians’ Knowledge, Experience, and Perception Regarding the Use of Cannabidiol for Canine Medical Conditions. 

https://www.researchgate.net/publication/330288361

https://www.aspca.org/news/official-top-10-pet-toxins-2022

Brutlag, A., and Hommerding, H., Toxicology of Marijuana, Synthetic Cannabinoids, and Cannabidiol in Dogs and Cats. 

https://mybestbudca.com/wp-content/uploads/1-s2.0-S0195561618300871-main.pdf

Sprinkle, D., The US pet market: an update. 

https://globalpetindustry.com/article/us-pet-market-update

, is a systems design researcher and analyst. She analyzes markets to determine how environments shape outcomes. She is co-founder of CannDynamics, and author of The Medical Cannabis Primer and Winning the Hardware-Software Game: Using Game Theory to Optimize the Pace of New Technology Adoption. Dr. Fisher has worked in the technology and healthcare sectors on behalf of technology companies, early-stage researchers, physicians, and technology start-ups.

Articles

This blog installment looks at the use of cannabis for pets. Topics covered include the history of cannabis use in veterinary medicine, current laws on cannabis for pets, market size and segment, reported experiences from both pet owners and veterinarians, and pet toxicology.

In November 2023, the Senate approved a bill that, if signed into law, would allow doctors at the department of Veterans Affairs (VA) to recommend cannabis as a treatment, but only in states where cannabis is legal (1). The Fiscal Year 2024 (FY24) Military Construction, Veterans Affairs, and Related Agencies (MilConVA) measure passed with a vote of 82 -15, with the amendment concerning veteran access to medical cannabis added earlier this year (1). The MilConVa provides “support for critical housing, infrastructure, and facilities for U.S. military forces and their families, as well as increased funding for veterans health care and benefits,” (2).

The cannabis amendment in the Senate bill states (1):

Sec. 260. None of the funds appropriated or otherwise made available to the Department of Veterans Affairs in this Act may be used in a manner that would—

interfere with the ability of a veteran to participate in a medicinal marijuana program approved by a State;

deny any services from the Department to a veteran who is participating in such a program; or

limit or interfere with the ability of a health care provider of the Department to make appropriate recommendations, fill out forms, or take steps to comply with such a program.

Several months ago, the House passed its MilConVa bill, also with a medical cannabis amendment, though with different wording (1). Before the final version of the bill can be enacted into law by the president, the discrepancies will need to be resolved (1).

“It's a mistake to assume veterans aren't turning to cannabis for pain relief and putting their benefits at risk in return,” stated Andrew Freedman, Executive Director of the Coalition for Cannabis Policy, Education, and Regulation in a recent opinion piece (3). “Today, 83% of U.S. veterans support medical cannabis programs – with 68% of U.S. voters supporting federal cannabis reform. It's a shame our nation's bravest must seek treatment discreetly, concealing it from their own doctors for fear of losing benefits. Yet, they lack the research-backed products they deserve. We must advocate on their behalf, as many feel they cannot admit use or seek help openly.”

Jaeger, K. Senate votes to allow VA doctors to recommend medical marijuana to veterans, similar to house-passed version 

https://www.marijuanamoment.net/senate-votes-to-allow-va-doctors-to-recommend-medical-marijuana-to-veterans-similar-to-house-passed-version/

Senate committee approves FY24 Milcon-Va appropriations bill: United States Senate Committee on appropriations 

https://www.appropriations.senate.gov/news/minority/senate-committee-approves-fy24-milcon-va-appropriations-bill

Freedman, A. Empowering veterans: The case for federal cannabis reform 

https://www.newsweek.com/empowering-veterans-case-federal-cannabis-reform-1841327

The Senate recently passed a bill that would enable veterans to discuss and be recommended medical cannabis by Veterans Affairs doctors.

Senate Approves Bill That Would Allow Medical Cannabis Recommendations from Veterans Affairs Doctors

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

Medical cannabis is gaining momentum and attention for its medicinal properties. Ireland is preparing to open the first medical cannabis clinic in Ireland which will cover all therapy areas since medical cannabis became legalized in 2019 (1).

Medicann, an award-winning medicinal cannabis clinic, will be launching the first medical cannabis clinic. The company is accepting patients interested in knowing their eligibility for treatment (1). Medicann’s Ireland clinic will be able to cover all medical conditions treatable with the medicinal plant. This also includes health conditions not recognized by the Medical Cannabis Access Programme (MCAP) in Ireland.

Users will be able to use a secure telehealth portal during a virtual appointment to learn if they are eligible for a medical cannabis prescription. Products can vary in types of consumption such as, oils, topical creams, and flowers.

In 2019, Medicann opened their first clinic (1).

Gary Whipp, CEO of Medicann Ireland mentioned (1), "When medicinal cannabis first became legalized in the UK back in 2018, early on I saw the potential it had to improve the quality of life for patients, and we have been providing access to this natural medication for patients that are eligible for the last 4 years. As the first clinic to launch in Ireland, we know patients have been waiting for local access to this medication, and we are very much looking forward to helping patients manage their condition better, and improve their quality of life under the guidance and help of our specialist Doctors here at Medicann.”

Over the years, medical cannabis has been proven to be a significant tool in several health conditions. It has been helpful for both physical and mental conditions such as, endometriosis, chronic pain, multiple sclerosis, mental health, and sleep issues.

As of August 2023, patient are able to register their interest in medical cannabis via 

Limited, M. Ireland’s First Medicinal Cannabis Clinic “Medicann” is Now Open for Patients 

https://www.prnewswire.co.uk/news-releases/irelands-first-medicinal-cannabis-clinic-medicann-is-now-open-for-patients-301974796.html

Ireland opens up their first medical cannabis clinic.

Medicann Pioneers Ireland's First Comprehensive Medical Cannabis Clinic, Expanding Access and Treatment Options

The National Institute of Health (NIH) National Cancer Institute (NCI) has awarded the University of Buffalo (UB) $3.2 million to study cannabis’s medicinal effects during immunotherapy for cancer treatment (1), including learning if cannabis can lower health disparities.

One of University of Buffalo’s psychiatrists was awarded the research grant funding, and it will be utilized in a year-long study where they will examine how a patients’ cannabis use affects common cancer treatment. Thomas Jefferson University and Oregon Health and Science University will be partnering with the University of Buffalo on this study. Each educational institution will recruit 450 cancer patients that are being treated with immunotherapy. This form of treatment causes fewer side effects than the more widely known treatment, chemotherapy. Immunotherapy is used to improve the natural defenses in the body to protect healthy cells (1).

Reported by the University of Buffalo (1), it is estimated that 40% of cancer patients utilize cannabis as a treatment option as a sleep aid, improve their mood, and relieve pain. The federal health agency is awarding researchers $3.2 million to study the effects of using cannabis while receiving immunotherapy for cancer treatment, as well as whether access to marijuana helps reduce health disparities.

Principal investigator Rebecca Ashare said in a recent press release (1), that there are “virtually no long-term studies evaluating its potential benefits and harms for persons treated with immunotherapy for cancer, despite cancer and its treatments being qualifying conditions in most of the 37 states and Washington, D.C., that have legalized adult use or medical cannabis.”

Some cannabinoids found in cannabis contain anti-inflammatory properties but may also suppress immune function. ““There are concerns that cannabis might reduce the efficacy of immunotherapy,” Ashare commented (1). “The demand for evidence is clear and this project represents an important first step in that process as both immunotherapy and cannabis use are becoming more widespread therapeutic options in oncology, accepted by many patients and physicians.”

To procure the data needed for the study, half of the participants will be able to use their own products while the other half will consist of non-cannabis users. Researchers will the investigate “medical records, patient outcomes and blood samples at six different times over a one-year period,” (1). They will also view the “role of neighborhood disadvantage on outcomes related to cannabis use and immunotherapy,” (1).

“We want to see if access to cannabis reduces health disparities,” Ashare mentioned (1). “We have a strong multidisciplinary team with expertise in cancer symptom management, medical cannabis, health equity, oncology, immunology, and substance misuse. Overall this research will have a sustained impact on the science of cancer symptom management and ultimately improve patient care and safety.”

The National Cancer Institute has expressed that they are interested in supporting research that analyzes cannabis’s relationship with cancer treatment which will hopefully help healthcare professionals be able to recommend cannabis as a tool in their patients’ treatment plans.

Jaeger, K. Federal Health Agency Awards $3.2 Million Grant To Study Impact Of Marijuana On Cancer Immunotherapy Treatment 

https://www.marijuanamoment.net/federal-health-agency-awards-3-2-million-grant-to-study-impact-of-marijuana-on-cancer-immunotherapy-treatment/

The University of Buffalo has received a grant from the NIH National Cancer Institute to research cannabis’s medicinal effect on cancer immunotherapy treatment.

NIH National Cancer Institute Grant Awarded to Help Study Cannabis’s Medicinal Effect on Cancer Immunotherapy Treatment

1,207 Americans recently partook in a EO Care, Inc., study. The company is “the first clinically guided cannabis health and wellness solution for employers,” (1). Participants in the study needed to be employed, either full-time or part-time, and reside in the US where cannabis is legal in most states for medical or recreational use.

According to EO’s press release (1), the key takeaways from the study are:

18 % of respondents have used cannabis for health reasons in the past year, 19 % have used cannabis for recreational reasons, and 14 % have used it for both.

The top three reasons for their cannabis use are anxiety, pain, and sleep.

88 % of medical cannabis users say it reduced their use of prescription drugs, alcohol, or both.

51 % said they would be likely/very likely to use cannabis if it were offered by their health plan.

65 % of respondents said they would feel more comfortable using cannabis if it were screened and dosed by a clinician.

“Finding clinical guidance for medicinal cannabis is difficult because most doctors lack the knowledge and retail dispensaries are not equipped to provide medical advice,” said Sean Collins, co-founder and CEO of EO Care (1). “As a result, we have tens of millions of Americans using cannabis for health reasons without guidance on specific product recommendations, dosage amounts, possible drug interactions, or consideration of their health history and other potential health risks. Given that sales of cannabis for health reasons is far higher than most prescription drugs, this is a highly concerning situation for healthcare generally.”

Through EO Care, members are able to gain access to healthcare professionals through their employers that offer the program, who can create a personal cannabis care plan such as, what products to use and at what dose based on the patients’ medical history and needs (1). Through the clinician, they will also be put in contact with a member of local dispensaries who are able to fill the order. The most common conditions patients are seeking care for are chronic conditions. For example, cancer treatment symptoms such as nausea, neuropathic pain, seizure disorders, and Parkinson’s disease (1).

A part of the survey, employee sentiment related to employer cannabis policies was studied (1):

56 % of respondents said they would be more likely to take a job at a company whose health plan offered cannabis care.

44 % would reconsider applying for a job at a company that tested for prior use of cannabis use or prohibited cannabis outside of the workplace.

“94 % of Americans live in a state where cannabis is legal in some form,” mentioned Collins (1). “And we know a large percentage of Americans have used cannabis in the past year, so this is definitely impacting employees and health outcomes. With the right medicinal cannabis guidance employers have an opportunity to help their employees, improve health outcomes and be progressive leaders in offering this important benefit that employees will come to expect.”

New EO Care Survey of 1000+ Finds 18 Percent of Americans Use Cannabis for Health Reasons Today, but 65 Percent Would Use If Guided by a Clinician 

https://finance.yahoo.com/news/eo-care-survey-1000-finds-130000751.html

A survey conducted by EO Care, Inc., showed that Americans would be more inclined to use cannabis to treat their health conditions if they were guided by a clinician.

EO Survey Shows 65% of Americans Would Use Cannabis If Guided by A Clinician

On October 19th, 2023, the Canadian Paediatric Society (CPS) released a position statement on medical cannabis and children under 18 years of age, noting the lack of studies about the dosing, safety, and efficacy used in clinical practice (1). According to its website, the mission of the CPS is to promote the health of youth through its education, advocacy, and research (2). As indicated in the Abstract of the recently released “Medical cannabis for children: Evidence and recommendations,” the statement is intended to provide recommendations for pediatric medical cannabis, based on reviews of current evidence (1).

In Canada, medical cannabis can be available to pediatric patients through authorization from physicians and nurse practitioners (1). “Given the widespread use of medical cannabis in Canada, paediatricians should be prepared to engage in open, ongoing discussions with families about its potential benefits and risks, and develop individualized plans that monitor efficacy, reduce harms, and mitigate drug−drug interactions,” stated the authors in the Abstract (1).

The CPS statement provided information—including dosages used—on several trials and studies that tested the effectiveness of medical cannabis in epilepsy, autism, other neurological conditions, and cancer and palliative care, while also explaining gaps in evidence, the most prominent one being that clinical trials with medical cannabis and cannabinoids do not include children (1).

The statement covered recommendations for safety and family and caregiver considerations, including side effects and cost (1). Also included are several considerations for clinicians when authorizing medical cannabis for children (1). The statement recommended that counselling should (1):

help parents make informed, shared decisions about their child’s care,

alert parents to the risks and implications of accessing cannabis through recreational sources.

As the last in the list of five recommendations, the CPS noted that, “given the already widespread use of medical cannabis, unbiased education for clinicians wanting to learn more about how THC, CBD, and other cannabinoids work, along with potential risks and benefits for children and youth, should be developed (1).”

Medical cannabis for children: Evidence and recommendations. 

The recent statement highlighted a lack of research, provides recommendations, and called for unbiased education for clinicians.

 Canadian Paediatric Society Publishes Recommendations on Medical Cannabis Use in Children

What would you like to see change in the next 5 years in the cannabis industry?

 Rescheduling Schedule I. Allowing the banking industry to take over and access the dispensaries. Let growers have access to the banking industry and federal legalization. And the big thing for me is the federal legalization because on the social justice side of things some opportunistic law enforcement agencies are using this as an opportunity to do civil forfeiture possession of cars that are driving from Oregon or Washington through Idaho. For example, that's a completely illegal state and they just targeted you because you're coming from a different state. Then when they get out there, they created a reason to get the dog out and then that causes them to point at the car and then they take whatever money you've got and the car, seize it, and sell it, and they make you go get a lawyer to get it. Say that there wasn't anything in there in the dark. You have to go through the process of talking about how canines can be triggered to point at something and that they weren't reacting to anything that was in the car, I mean this the unscrupulous corrupt they're using that. This has been documented, it's been

, all these articles on this and they're letting that happen throughout the United States that's why I don't drive through the South and Idaho.

 Federal legalization would be great. I don't think that that's going to happen. Before that though, if they could somehow or another figure out the banking that would be huge. We are an ancillary. We touch cannabis but we don't sell cannabis and we definitely don't collect taxes on it. We still have a very challenging time with banking. We've been rejected by several banks because we are nonprofit. The word cannabis they don't like. The patchwork of laws so you know that people can get Delta-8 all over the place instead of you know, here and there, and there are still places where cannabis is illegal, and people are still going to jail for it. That's got to change. It is a plan so, those are those are my hopes over the next five years.

 I would add to that that all healthcare curriculum includes cannabis. Jeremy and I have just recently attended an online 2-day symposium by Stockton University. There were presentations on medical cannabis, on legal cannabis, all done in university, community, education, or university settings, classes so there's movement in that. It's happening a lot of on the East Coast. Cornell, some in New Jersey, Stockton's in New Jersey, Robert Mejia, I think his name is, so we're going to get involved with that. We'll be part of doing a talk maybe in the next quarter when they have it but, it was wonderful to see all the people talking you know all these educators talking about what's happening in their area and how they can grow hemp and what the communities response to it is, what the colleges response, and the university and how law schools are teaching about cannabis law.

Stay tuned for further featured moments from this exciting interview!

Cannabis Patients Pacific Northwest (CPPNW) co-founders, David Benedicktus and Jeremy Robbins, discuss what changes need to be made to the cannabis industry to allow it to thrive. 

What Needs to Change in the Cannabis Industry: Thoughts from CPPNW

Announced earlier this month, a new clinical trial is underway to study the effects of cannabis on glioblastoma, a form of brain cancer (1,2). According to a recent press release (1), the Phase 1, open-label trial will be supported by a collaboration of several organizations and researchers. Canadian cannabis producer Tilray Medical will supply a THC:CBD 1:1 extract for the study, which will be conducted by scientists from the Spanish Research Group of Neuro-Oncology (GEINO) and the Complutense University Madrid (1). Laboratory research from the Cannabinoid Signalling Group team at the Complutense University Madrid has reportedly indicated that a combination of the cannabinoids THC and CBD can inhibit the growth of cancer cells (2). Thirty patients from eight specialized neuro-oncology medical facilities will receive the cannabis extract in combination with temozolomide and radiotherapy to treat their glioblastomas (1).

The trial, which is being conducted in Spain, began on September 5th, 2023 and is being led by coordinating researcher Dr. Juan Manuel Sepúlveda Sánchez from GEINO and the Hospital Universitario 12 de Octubre in Madrid (1,3).

“Biological evidence has been accumulating for more than 15 years that cannabinoids have anti-tumor activity in the most aggressive brain tumors, glioblastomas,” stated Dr. Sepúlveda (1). “However, no clinical trials have been conducted to prove this hypothesis in patients. With this clinical trial, we can finally study the effect of cannabinoids on tumors that have not received active treatment. With this trial, we are helping to give our patients a new option, but also to open a therapeutic avenue.”

Funding for the trial was provided by the Medical Cannabis Bike Tour, a charity which began raising funds for Complutense Madrid University team in 2013 (1).

“What makes this extra special is that this trial is a special collaboration between the medical cannabis community and the scientific sector, for the benefit of science,” the Medical Cannabis Bike Tour stated on their website (2). “This first trial will test that the treatment is safe, monitor response and survival rates (compared to traditional treatments), and measure improvements to quality of life.”

Tilray Medical Supports New Clinical Trial to Study Medical Cannabis in Glioblastoma Cancer Treatment. 

Cycle powered cannabis clinical trial starts! 

https://www.medicalcannabis-biketour.com/cycle-powered-cannabis-clinical-trial-starts/

GEINO 1601: a clinical trial begins to study the effect of cannabinoids in patients with glioblastoma 

The 18-month trial will study the effects of a cannabis extract as part of treatment for brain cancer.

Clinical Trial in Spain Will Investigate the Role of Cannabis in Glioblastoma Treatment

Facing growing pressure from various groups such as, elected officials, cross-party parliamentarians, doctors, and scientists, France’s Minister for Health, Aurélien Rousseau, still held his ground and refused making a commitment to rolling out medical cannabis access throughout the country this year (1). However, Rousseau has confirmed that the path to pursue medical cannabis access for patients will continue in the country. He blames the issue on the “lack of commitment” (1) for a fully established medical cannabis program which he believes is in part due to poor “European marketing authorization” (1). Rousseau is hopeful that this could be ready by 2025 (1).

In the European Union (EU), 17 members, including, the United Kingdom (UK) and Switzerland, have legalized medical cannabis which industry stakeholders and medical cannabis advocates aren’t afraid to mention (1). Rousseau was interviewed on this matter during a Social Affairs Committee of the National Assembly meeting that took place on October 11, 2023. Weeks before this meeting, the Social Security Financing Bill (PLFSS) was published by the government. This piece of legislation dictates the up coming year’s budget allocations (1). Individuals involved in the cannabis industry were disappointed to find no references or mentions of the medical cannabis experiment in the PLFSS bill. Parliamentarians will now decipher sections of the bill and vote on amendments before it officially goes into effect.

Going back on his stance of European marketing authorization, he mentions the possibility of it not being granted by 2025. Rousseau offered an idea that the government would “switch to so-called compassionate access”, which is a “special scheme used to enable patients to access certain drugs still in development,” (1).

During the meeting Rousseau assured that the government will support action and “present an amendment so that obviously all the beneficiaries of this experimentation can continue to benefit from it’, thanks to an ‘adapted status that will then allow us to see over time” (1).

Although the air surrounding the medical cannabis experiment is still unclear, it is believed to be able to continue past it’s due date of March 2024.

Stevens, B. France’s Health Minister Promises Continued Access to Medical Cannabis for Patients 

https://businessofcannabis.com/frances-health-minister-promises-continued-access-to-medical-cannabis-for-patients/

Aurélien Rousseau, the Minister for Health of France, promises to roll out medical cannabis access to patients throughout the country.

Health Minister of France Strives to Maintain Medical Cannabis Access for Patients

 (ENS) is a web of neurons, embedded in the walls of the gastrointestinal (GI) system, that serves as the information collection and control system that moderates digestion. The ENS has been estimated to contain more neurons than the spinal cord (1), and it is often called the “second brain” for two reasons. First, it involves so much neurotransmitter activity—95% of serotonin and 50% of dopamine activity in the body come from the gastrointestinal (GI) tract—and second, the ENS operates independently from the 

 (CNS), the only organ in the body capable of doing so (2).

Within the cavity of the GI tract lives a vast system of microorganisms, called the 

, which operates in symbiosis with the body. The 

, the second largest nerve system in the body, connects the ENS to the CNS and could be said to be the information superhighway at the heart of the mind-body connection.

Putting these four systems of activity together, the set of interactions between the ENS, the CNS, and the microbiome, which are all interlinked through the vagus nerve, has been termed the 

). The GBA is the physical underpinning for the mind-body connection, which may very well be central to human health and well-being.

Interestingly, the endocannabinoid system (ECS) has been found to be active in moderating activity in the ENS, the CNS, and the vagus nerve, and it has been found to be active in moderating communications between the microbiome and the host. The ECS has previously been described as being central to human health as its role in serving as the master regulator of homeostasis in the body (3). It could then further be said that the ECS is central to moderating human health through another avenue: the mind-body connection.

Let’s explore these connections in a bit more detail.

) is a principal component of the GI system (“the gut”) and runs from the esophagus to the rectum. Food enters through the mouth and as it passes along the GI tract, the food is broken down and nutrients are absorbed, and at the end of the tract any waste is eliminated from the body. A healthy GI tract is essential for ensuring the body is amply supplied with the nutrients it needs to fuel all its various activities.

The GI tract is essentially a set of concentric layers or tubes (see 

) that create a path along which food travels as it’s being digested (5).

At the center of the GI tract is the lumen, the cavity where food flows. The lumen is also home to the 

, a system of trillions of microorganisms distributed throughout the GI tract. Each person’s microbiome is unique, and it’s “influenced by multiple factors, including mode of infant delivery and feeding, aging process, diet composition, geography, medications, and stress” (6). While there’s still much to learn, researchers have discovered enough to know that it lives in symbiosis with the body and plays a “vital role in normal metabolism, nutrition, immune function, physiology and prevention of disease” (7). Dysregulation of the microbiome, or dysbiosis, may cause symptoms including (8):

Notably, “increasing evidence supports the notion that the gut microbiome interacts with the ECS and that the latter plays a significant role in mediating enteric microbiota–host interactions” (9).

 is the tissue layer around the lumen that serves as a barrier between the lumen and surrounding body tissue. The epithelium plays two roles. First, it determines which particles pass through the body versus which are absorbed, and second, it mediates between gut microbiota and host tissue (10). The intestinal epithelium contains CB1 receptors, that is, the ECS helps modulate the separation and host–microbiome communication functions performed by the intestinal epithelium (11).

The submucosa is one of the layers outside the lumen. Embedded in the walls of the submucosa, together with blood and lymph vessels, is the 

. The submucosal plexus is a neuronal web that modulates activity within the GI tract. As with the intestinal epithelium, the submucosal plexus also contains CB1 receptors (12). One of the submucosal plexus’s principal functions is to regulate mucus secretion and renewal to ensure the barrier between the lumen and the surrounding tissues remains intact. Dysregulation of this process, that is, the infiltration into areas outside the lumen by unwanted particles, contributes to GI symptoms (13,14).So, in the gut, the ECS helps moderate mucus secretion and renewal, thereby helping to prevent GI symptoms.

Among the outermost layers of the GI tract are two sets of muscles (the longitudinal muscle and the circular muscle) whose contractions propel food down the tract through a process called 

(15). Embedded in the walls of the circular muscle layer is the 

, another neuronal web that controls the muscle contractions—peristalsis—that move food along the GI tract (16). The myenteric plexus contains CB1 receptors, so the ECS also modulates GI motility (17). As with dysregulation of the mucus layer, dysregulation of peristalsis—motility disorders—can cause GI symptoms (18). Common GI symptoms and conditions include, for example (19):

While the ENS functions independently from the CNS, the two systems are interlinked through the 

, another principal component of the digestive system (see Figure 1) (20).

The vagus is the second largest nerve system (that is, a set of neural pathways) in the body—only the spinal column is larger—and it functions to inform the brain about the state of the heart and the digestive system (21). The vagus is a bidirectional system that originates in the medulla oblongata (on the lower part of the brainstem), and helps manage, for example (22):

The vagus nerve contains CB1 receptors (23), making it yet another effectuator in the digestive process through which the ECS moderates activity.

) is the system that involves bidirectional communication between the central and enteric nervous systems; the central nervous system and the microbiota; and the enteric nervous system and the microbiota.

The abundance of neurotransmitter receptors in the brain and gut link—via the vagus and ECS—nausea, abdominal pain, and other GI disorders in the gut to anxiety, depression, and other mood disorders in the brain. Cross-talk between the microbiome and, respectively, the gut and the brain create additional links between disorders of the mind to those of the body.

Most people probably think of the GI system as being solely responsible for moving food through the body. However, once we understand its functioning, its interplay with the microbiota, and its role in the GBA, we see that it’s actually fundamental to both physical and emotional well-being. In fact, the GBA can be said to be the mind-body connection that explains why mood disorders can cause digestive disorders or vice versa. And central to gut and GBA information processing is the ECS.

https://www.physio-pedia.com/Enteric_Nervous_System_(ENS)

Sabater V (2021, Nov 15). The Enteric Nervous System: The Second Brain. 

https://exploringyourmind.com/enteric-nervous-system-second-brain/

Lowe, H et al, The Endocannabinoid System: A Potential Target for the Treatment of Various 

https://pubmed.ncbi.nlm.nih.gov/34502379/

https://www.nicepng.com/png/detail/78-789281_clipart-free-library-gastrointestinal-tract-human-anatomy-human.png

Tresca A (2021, Feb 22). The Anatomy of the Enteric Nervous System. 

https://www.verywellhealth.com/enteric-nervous-system-5112820

Cresci G and Bawden E (2015, Dec). The Gut Microbiome: What we do and don’t know. 

This blog installment takes a look at the mind-body connection and how the endocannabinoid system (ECS) plays a key role. Topics covered include the gut, the vagus nerve, the gut-brain axis, and more.

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