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Elisabeth Mack, RN, BSN, MBA, discusses her a mission and how cannabis has become one of her guides.
Elisabeth Mack, RN, BSN, MBA, is on a mission. And cannabis has become one of her guides.
She is one of those all-around nurses, a practitioner with an administrator background, who has always had a keen interest in better patient health and well-being. She has been a nurse for 35 years, working in hospitals along the way where she specialized in psychiatry and diabetes, always looking for better ways of helping patients.
Mack founded a nursing group, Holistic Caring (1), in 2016 to help connect traditional and cannabis medicine through education, guidance, and supportive care for patients. “The mission of Holistic Caring is to bridge the gap between conventional and cannabis therapeutics for patients and professionals through targeted programs, and one-on-one patient care services,” Mack said. “Holistic Caring works with all patients, not just post-traumatic stress (PTSD) or chronic pain, but also for patients suffering from Alzheimer’s Disease, Parkinson’s Disease, multiple sclerosis, autoimmune conditions, autism, epilepsy, mental health, cancer, and pain.”
What she has seen over recent years as more interest in cannabis as medicine has advanced in the medical community is a sort of grand and growing experiment in using cannabis without good medical practices and guidelines in place. “People are making (cannabis) medicines, and people are selling medicines,” she said. “But nobody’s interpreting how to use them clinically for patients. That’s what we do.”
Mack said that she spent her early years in hospitals working in VA psychiatry, serving veterans. “But it’s not just veterans struggling with PTSD,” she said. “We all have some as we navigate through life. How many people really understand (the PTSD struggle)? When you’re living consciously, you have awareness of what you’re thinking. How am I responding to other people, my work, my relationships, and using my personal time? Am I living with trauma responses? Most of us don’t ever wake up. We’re not conscious to it. We’re just in that default mode network (a network of interacting brain regions ) that is just spinning, and we are not tuned into cause and effect of what we’re doing.”
Cannabis helps you be present and brings you to a level of awareness by quieting the mind, she explained. “When we activate CB1 receptors within the hippocampus and amygdala that help us to reprocess memories and trauma to find that level of awareness,” she added.
CB1 receptors (3) are G-protein coupled receptors (GPCRs) abundant in neurons, in which they modulate neurotransmission. The CB1 receptors influence memory and learning to activate ways to heal. Disease states associated with CB1 receptors are observed in addiction disorders, motor dysfunction, schizophrenia, as well as in bipolar, depression, and anxiety disorders.
Mack told the story of how she crashed her bicycle in 2014, and from that accident, was introduced to cannabidiol (CBD) through a topical massage to help treat her injuries. She then tried some internal CBD, tinctures, and oils. “I got a full extract cannabis oil (FECO) syringe of CBD and as I started to dose that I was able to wean down the inflammation in my body,” Mack said. “I started to heal 20 years of injuries with the CBD, but I really started to heal my mind with micro-doses of THC.”
Mack describes the way she approaches her work as having “one leg in healthcare and one leg in cannabis.” She also has an MBA in healthcare administration (4). “So, I really do see things from a system building level and want to change the paradigm for others.”
One of her patients was Joe, who had been on psychiatric medicines for 30 years. “He was one of my favorite patients,” she recalled. “He had a lot of traumas when he was growing up. But now he has Parkinson’s too, so he came to me with tremors, pain, rigidity, and sleep issues. Through my full assessment, and review of systems, I asked what pharmaceuticals he was taking. We discussed his goals and objectives with respect to cannabis. Then I asked; 'How are you eating? How are you sleeping? How are you relaxing? How are you connecting with other people meditating and praying?' We talked about nutrition, and about movement and using cannabis as a bridge towards health.”
Joe started using a 3:1 tincture every day. “We’re able to sort of balance out GABA/Glutamate (5), which is the excitatory inhibitory.” Glutamate is the excitatory, and GABA is the inhibitory neurotransmitter in the mammalian cortex. “Glutamate may cause excessive firing, causing the tremors. So, we started working on reducing the tremors first.”
In her follow up calls four weeks later with Joe, she asked him about how he was sleeping, and about his level of anxiety. “I then asked him if he felt like he was able to better socialize. We started to work through all these different layers, because when you’re working in cannabis therapeutics, it’s almost as if you’re peeling back an onion or a clove of garlic. You see all the other things that you get to deal with. And one by one, you start bringing those to the awareness of the patient.”
Mack said that a lot of people don’t realize any of the mental health issues they may have. “Joe was on medicine for depression and anxiety, taking benzodiazepines and Prozac, and his goal actually was to come off the Prozac due to side effects,” Mack said. “We got him down to 10 milligrams a day from 40. We created more awareness and a sense of calm, and now that anxiety and depression could be aided by cannabinoids,” Mack said.
Then she added the idea of a 1-to-1 vape, Mack said. “These (cannabis) products can be stacked into the treatment plan, each doing something a little different. We teach the patient how and when to use each of them, and how best to personalize this medicine. Somebody struggling with PTSD and other physical conditions needs to understand that they can get behind the wheel. They develop agency, saying ‘You know, I can tune into my own body and determine some cause and effect. So, when I take this 1:1 vape, I can use that to stay calm and say to my wife, yes, I can have that dinner party on Friday, I’ll take a puff.’ Over time, Joe started to become empowered, and didn’t need to shut himself off anymore,” Mack said.
“I do believe that cannabinoids were game changers, giving him that momentary release of anxiety—as well calming his nervous system. Over time, you start changing those behaviors so that their life can become full again.”
Mack recalled another patient, a woman with severe depression, stuck in a traumatized living situation. She felt trapped. She was in bed 20 hours a day. “It was social anxiety and depression,” Mack said. “And over time, she was able to wean down the drugs she was on, such as benzodiazepines and Lamictal (6), an anticonvulsant medication used alone or with other medications to treat seizures, and used to stabilize mood in adults with bipolar disorder (manic depression). I think that drug kept her in bed with fatigue, and was not treating her panic,” Mack said.
Mack took that patient on a six-month journey through cannabis therapy. “We used some really good CBD oil, a 10:1 ratio, or 10 parts CBD to one part THC. She needed some THC to really work with the fight or flight in the amygdala and hippocampus. But she was able to wean down the Lamictal and improve her quality of life, and eventually stopped the benzodiazepines as well. So now she’s literally just on cannabis oils.”
Now that patient is volunteering again at the church. She’s happy, and only sleeping eight hours a day
When Mack trains either patients or clinicians, she said, she talks about body-mind-spirit (7). “When you are taking these cannabinoids, it is not just a single molecule pharmaceutical that’s activating a receptor to cause a specific effect in the body. Cannabinoids don’t only activate one receptor. We’re not targeting one function in the body. We’re targeting many things at once—it is pleiotropic.”
With Joe, for example, balancing out GABA and glutamate to help him feel better and have less tremors also helped his brain. “We have a lot of neuro inflammation, which causes depression. It alters that fight or flight dysregulation in the HPA axis (the stress response system that consists of the hypothalamus, the pituitary gland, and the adrenal glands ). CBD can help bring that system back to balance, softening inflammation and correcting signaling,” Mack said.
Mainstream pharmaceutical ways of treating PTSD include benzodiazepines, Xanax, and other heavy tranquilizers. “PTSD patients are taking antipsychotics because some of their thinking becomes distorted,” Mack said. “A lot of these veterans who have been in combat have chronic pain. So they might be on opiates, or they might be on muscle relaxants. They’re going to have digestive issues, so they take pills for that. Some take a cocktail of a dozen different drugs a day. And they’re not getting any better. In fact, they’re getting worse on those drugs. It’s a very vicious cycle.”
Cannabinoids are unique in the way they work on various body mind-spirit levels, Mack said. “We urge patients to just tune into their body, quiet their mind, and to start developing that awareness.”
She also educates people on what discussions they need to be having with their doctor, which can be a hit or miss proposition. “In my dreams, I have a provider that actually calls me and says ‘Hey, we have a common patient. This patient is telling me that they’d like to start reducing their pharmaceuticals with the goal to take very little of them.’ And the provider says, ‘Are they crazy?’ or ‘Can this really work? And then I confirm, ‘Yes, it can work’ and ‘No, they’re not crazy,’” Mack said. “But that doesn’t happen. The providers, the physicians, are not willing to do this just yet.”
Providing the pathways to better use cannabinoids has been a long one for Mack. “I’ve been writing programs for healthcare professionals and nurses for the last five years,” she said, adding that she first wrote her book Cannabis for Health: Become a Coach (9).
“The reason I called it ‘become a coach’ is because I want nurses to understand that this is something very different than just sitting there following orders,” Mack said. “Nurses have the best role to play in developing this industry with us, the most complete runway. And the reason why is because we’re educators, we’re compassionate healers, and we’re smart, right? Nurses are the ones that can really be that bridge between conventional healthcare and cannabis in a way that I think is going to give them something that they’ve never even known before; autonomy. We have the ability to work in something that is revolutionary, that can truly heal people, as opposed to running ragged following orders and seeing people just get sicker and sicker and sicker,” Mack said. “I’ve been a registered nurse for 35 years, and I’ve never enjoyed it like I do now.”