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Medical Marijuana: It's Not How High, But How Far We Can Go
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Carey Clark discusses Medical Marijuana: It's Not How High, But How Far We Can Go at ONS Congress 2017. For the ability to view on your mobile phone please visit us at

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Greetings. My name is Dr. Carey Clark. I'm an associate professor of nursing at University of Maine at Augusta, and I'm president-elect of American Cannabis Nurses Association. I'm here at the Oncology Nursing Society National Congress today to do a presentation on medical marijuana. It's not how high, but how far we can go.

Our objectives for this are to really start looking at the oncology nurse's role around cannabis and the palliative medicine, to review the nursing process with medical cannabis, and to consider the safety, ethical and legal concerns with medicinal use of cannabis.

We also need to start looking at the need for education around the human endocannabinoid system. Most of you have probably not heard of the endocannabinoid system, but our bodies have some very special compounds that they make, namely 2-AG and anandamide. These compounds are very similar to cannabis.

Our body also has specific receptors, CB1 and CB2, where these endocannabinoids 2-AG and anandamide interact. As our body makes these cannabis-like compounds, it also breaks them down so that we have to keep making them. We make them, and we break them down.

What does the endocannabinoid system do? Well, its main role is to help maintain homeostasis. It controls the central and peripheral nervous system and all sorts of other physiology in our body, such as energy uptake, immune responses, inflammatory responses, processing and storage and reproduction and our cellular fate. It even impacts our blood sugar levels, our blood pressure, and our hormone levels.

Here's a great slide about the endocannabinoid receptors in your body. CB1 is a receptor that's found mostly in the brain, and CB2 receptors are found mostly within the immune system. CB1 and CB2 receptors, here is a great table about this. It shows you where anandamide and 2-AG work at each of the receptors, and you can see your whole body relies on the endocannabinoid system for homeostasis.

Cannabis is what we would call an exogenous cannabinoid. It comes from outside our body, but it interacts with our CB1 and CB2 receptors in our body. Two of the main exogenous cannabinoids that you may have heard of, or just learning about now, are THC and that one reacts primarily with the CB1 receptors in the body. It leads to that sort of high feeling in the brain if THC is ingested.

The other cannabinoid you'll hear a lot about is CBD and it works primarily with immune system to create homeostasis and with the inflammatory response. It does not have psychoactive effect, but it also helps to modulate THC.

There are all kinds of other cannabinoids that can come from our exogenous cannabinoid source, which is cannabis. It's too much to go into depth here, but there are about 85 different cannabinoids within cannabis, and they all interact with our endocannabinoid system to help support us in maintaining our homeostasis.

What about cancer patients and cannabis? Well, I think we would all agree that early palliation for anyone undergoing oncological treatments is really key. Cannabis can help with things like pain and nausea, sleep issues, nutritional issues, depression, anxiety.

There also is a minimal body of scientific evidence that's really looking at human cancer and how it might be able to be cured by cannabis. I say minimal because most of the studies have been done with animal or mice studies, in vitro and in vivo. While these studies are really promising, they also have not been moved forward to really being done on humans. That's the sort of thing we need to do to figure out if cannabis can really help cure cancer.

It does seem to enhance the effectiveness of chemotherapy. There was one small study done where they looked at glioblastoma multiforme and it seems to be very receptive to cannabis as a treatment because of the concentration of CB1 receptors in the brain and the affinity for THC for those receptors.

What about nurses? Well, your role in supporting patient in the use of cannabis is really important, so I urge you to download the rest of the slide deck and learn more about your role as an oncology nurse in supporting patients with the use of cannabis for palliation. Thank you.