Marijuana's Move to Schedule III

In this week's of GameChangers Podcast, we delve into the groundbreaking reclassification of marijuana to Schedule III. We discuss  impacts on the legal landscape, medical research, pharmacogenomics for CBD, and the role of healthcare providers.
 
The GameChanger
Marijuana's move to Schedule III will increase research opportunities, ease fear and stigma, and provide healthcare provider involvement in medical benefits and potential risks.
 
Host
Geoff Wall, PharmD, BCPS, FCCP, BCGP
Professor of Pharmacy Practice, Drake University
Internal Medicine/Critical Care, UnityPoint Health
 
Guest
Marry Vuong, PharmD, BCPPS
Clinical Pharmacy Manager
Perfecting Peds

Reference
UPDATE: DEA Moves to Reschedule Cannabis from Cannabis Business Times

NPR: Scientists welcome new rules on marijuana, but research will still face obstacles.

CEimpact Course for Reference:
Beyond the Haze: Pharmacist's Legal Insights on THC, CBD, and Medical Marijuana

Pharmacist Members, REDEEM YOUR CPE HERE!
 
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)


CPE Information
 
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Discuss the reclassification of marijuana from Schedule I to Schedule III.
2. Explain the potential benefits of the marijuana schedule change including its impact on medical research and patient access.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-180-H01-P
Initial release date: 05/27/2024
Expiration date: 05/27/2025
Additional CPE details can be found here.

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Transcript

Speaker 1: 0:08

Hey, ce Plan members from CE Impact. This is Game Changers. I have two guests with me today. First is our resident clinical conversation expert, jeff Wall. Good morning, jeff.

Speaker 2: 0:18

Good morning. How are you doing?

Speaker 1: 0:19

Great, great Thanks for being with us today. We have an exciting topic. Indeed, and also with us today is a special guest, mary Vong, who is the Clinical Pharmacy Manager for Perfecting Peds. Welcome, dr Vong.

Speaker 1: 0:35

Morning everyone Thank you for having me. Absolutely, we're so excited to talk with you today. So today we're talking about the DEA's recent announcement to move marijuana from Schedule 1 to Schedule 3. So there's a lot, I think, to unpack in this topic. I think we've got some of the legal stuff and just sort of where we've come from and where we're going, and then also some clinical things as well. So I'm excited to get into that. But before we do start that topic, dr Vaughn, can you tell us just a little bit about your background and practice so we can get to know you a little bit better?

Speaker 3: 1:12

Hi everyone. My name is Mary Vaughn. I am a pediatric clinical pharmacy specialist. There's not many of us in the country so you probably don't really know that much about what we do, but I went to the University of Florida where I got my bachelor's in nutrition. Then I stayed on and did my doctor of pharmacy degree there. I did a PGY-1 pediatric pharmacy residency at a freestanding children's hospital where I then stayed on as the neurology, neurosurgery and general pediatrics clinical pharmacy specialist for almost six years and then I transitioned on to this role as a clinical pharmacy manager of almost six years and then I transitioned onto this role as a clinical pharmacy manager of perfecting peds.

Speaker 3: 1:48

This topic is something that really interests me because I worked primarily in neurology and neurosurgery and a lot of these kids with intractable seizures really had no other options. Like at that point they had tried basically more than two medications constitutes failure. So at this point they had tried like two to eight medications failed. That went into diet and also failed that. So they tried modified Atkins, ketogenic diet, any sort of diet that the parents could try. Failed that nothing really worked. So they're candidates for surgery at this point if they have a focus and, like it's really last line if they have a focus and like it's really last line. And then Charlotte's Web, which was an over-the-counter CBD product, came and that kind of just created waves for the world of neurology. From there we had Epidiolex, which also has helped a lot of kids. So it's something that's like near and dear to my heart because I've seen it change a lot of lives. So I'm really happy to talk about this topic today.

Speaker 1: 2:52

Oh great. Well, we are so excited to tap into your expertise. So thank you again for being with us. I am going to kick it over to Jeff and to you, mary, to have this conversation. So, jeff, give us a little bit of background, sort of where we've been in this topic and sort of where we're going and why this is really landmark and, I think, really exciting in a lot of respects.

Speaker 2: 3:13

I agree and I appreciate Dr Vong's perspective. I in my world, you know, we occasionally see some of these young adults admitted to my ICU with intractable seizures and I mean, yeah, I mean you know some of these congenital syndromes like Lennox-Gastaut syndrome and stuff, I mean, yeah, they're just, they're just, you know, terrible, and you know, whatever it takes to help these people is really important.

Speaker 2: 3:39

So as everyone knows, you know, marijuana or some of its derivatives have been used for thousands of years. I follow Ryan Marino on Twitter or X or whatever the hell we're calling it now, and you know he's a. He's an addiction medicine specialist and a toxicologist, and I think he does, you know he. He points out that, you know, again, psychoactive substances have been part of human beings as long as there have been human beings, and so it isn't like something just came up out of nowhere. I mean, you know, this has been used for religious purposes, for pain purposes, for all sorts of other things since the dawn of mankind.

Speaker 2: 4:17

Where we kind of get into this role, of course, is in the early 20th century, where we saw, you know, the scheduling or the ban of the use of a wide number of substances, including marijuana. And if you've ever seen the classic documentary, which I'm sure is free on YouTube, it's got to be passed. It's a public domain date, it's something called Reefer Madness's, it's a. It's a documentary that came out in the 1970s and that really points out the fact that that uh, there, you know, there was all sorts of propaganda about how marijuana was, you know, causing, you know, you know, mental breakdowns and people to murder each other, which, if anyone's ever actually done marijuana, we'll tell you that's the last thing they're going to be doing.

Speaker 1: 5:03

So I hear want to be clear about that.

Speaker 2: 5:08

You know, you know, and what it really kind of boiled down to in the end was was a fairly racist program because, you know, at the time when, when marijuana became, you know, banned or you know, was basically outlawed in most states and territories in the United States, and then federally, you know, people of color were the ones who tended to use this more, and they're the ones, of course, and this was another bludgeon that could be used against them, to arrest them.

Speaker 2: 5:39

And even now in, you know, in the 21st century, you know, the proportion of people who are in jail for simple possession of marijuana is far disproportionate to persons of color.

Speaker 2: 5:50

So, you know, basically there's a pretty black history, I think, of the use of marijuana in the 1970s and they decided to, you know, basically come up with a scheduling system that every pharmacist and every provider knows. They made a classification of Schedule 1, which is basically drugs that have a high addictive, supposedly potential and have no medical, no medicinal purpose, and they put marijuana in that, in that schedule, and that's where it's been ever since. So, you know, fast forward to 50 years later and, as everybody knows, there's been a growing awareness of the decriminalization of marijuana for both medical use and recreational use in a why, in a variety of states, and you, of course, federal law does trump a state law. But so far it seems as if largely the federal justice and law enforcement agencies have largely, you know, turned a blind eye to this and have decided not to, you know, to prosecute or to go forward with things along those lines.

Speaker 2: 7:02

Now, the problem with marijuana, of course, is that it is purported to have a wide number of therapeutic uses, including as an anti-epileptic. But it is almost impossible to do research to find out what will work for these medications if it's a schedule one drug, and you know it is. You know again, you can't just, you know, go to a drug company and say, hey, can I have some of this stuff? Do a randomized you know phase three study. Well, who are you going to go to? You know, go go to some guy who's growing this stuff in the back, in his backyard.

Speaker 1: 7:36

And I mean you know it.

Speaker 2: 7:37

Just, it's going to be very, very difficult. There is a federally mandated marijuana farm and I believe it's in Missouri or Kansas and it's and it actually is is the only like totally legal place to grow marijuana and that is has been the supply that has been used for research. There's also a small number of patients who actually have a federal pass to use marijuana, for a variety of reasons, as you might imagine. It is almost impossible to get that, you know, but other than that, it's just it's been almost impossible to research. So it's hard to say what marijuana and its various constituent products can do if we can't do research on it. And it is difficult because the plant, you know, cannabis sativa, has numerous pharmacologic chemicals and some of them are psychoactive, like Delta H and Delta nine. Some of them aren't, like CBD and, and you know again, it really is a fascinating, fascinating plant.

Speaker 2: 8:41

And for those older pharmacists out there who had to take pharmacognosy, or when I was in school we called it weeds and seeds, you know we learned a lot about it. But we also learned that we, you know, don't know really much about it because it's hard to do research. So the moving of schedule one to schedule three I think has some pretty important connotations, primarily for research. So I think that's, that's kind of the background. So you know, mary, you say this is kind of a sort of near and dear to your heart. You know, what do you think are some of the possible therapeutic uses of the chemicals derived from cannabis? And you know, what do you think has already been looked at and where do you think we go from here as far as research?

Speaker 3: 9:24

Yeah, so when you look at the plant itself, the cannabis sativa plant, it is like divided into two, so you have your THC and then you have your CBD. So when you're thinking about it, the CBD is the anticonvulsant and that's the reason why Epidiolex is cannabidiol. Thc is more psychoactive. It's actually a proconvulsant, but it has other uses. So if you think about cancer and pain and things like that, there are drugs out there, like Marinol, that are THC. So I think that with the research there's so much room to like learn more and to just investigate more, and that's something that I saw a lot in the hospital. So the CBD side is a great anti-seizure medication for a lot of our epileptic patients. There's also a lot of research right now going into treating infantile spasms and even some of the aggression with autism, so it's kind of like a calmer in that sense.

Speaker 3: 10:17

It calms the brain down.

Speaker 3: 10:19

The THC component, I think, has helped a lot of our Hemon kids. So I think one of the scary things like working in the hospital is that these parents are so desperate and they'll come in with these like injectables and like all of these different products. They're all THC products and you kind of have to like think about yourself ethically, like do I take this away from them because it's it's, it's a little, it's scary, I don't really know much about it. Or do I just like kind of let them have it and like do a don't ask, don't tell kind of thing, because you know that it's helping them so much. You know that they're desperate and it's kind of last line, it's the only thing that's helping their child with their nausea and vomiting.

Speaker 3: 10:58

So, with that being said, I would say that the CBD is great for seizures and neurological conditions, and then the THC I would put into research for more, like cancer, pain and then also GI. So I know that that's been a big hot topic to see if it works for like IBS or IBD, especially since there's such a rise. So I think that like this is where we kind of have to put the negative connotations aside and just put on our creative hats and think like, what can we do with this plant?

Speaker 2: 11:26

Right? No, I agree, and and you know it's a shame that it's taken, you know, 5060 years to change to even start to change that mindset and and and you know, say okay, you know, you know let's take.

Speaker 2: 11:39

You know plant that has medicinal properties. You know, I mean you know obviously we have a you know, you know hundreds of years history, even in Western civilization, of using plant derived pharmaceuticals and this should be really no different than than any any of the others. So, yeah, I completely agree with that. You know you mentioned, you know CBD. You know helping as an anti epileptic. Have in your research have you seen where it's been used for anything else? I, anecdotally, we have patients come into us who swear it helps with sleep. You know it helps for insomnia and I have to kind of take them at their word for that. But you know what about you have you? Have you heard about other areas where this may have some role?

Speaker 3: 12:30

I definitely see it help a lot with sleep and anxiety. I know a lot of people also would rather go the more natural route, so they stick to like a CBD product for anxiety and it helps them more. But then I would also kind of be aware of that because it could have an opposite effect. I have seen it cause someone to be super paranoid. So this is kind of where I love pharmacogenomics and some of the panels will actually screen for, like, your cannabinoid receptors. Before trying, I would say get screened, get a PGX test and see where it'll help you.

Speaker 2: 13:00

That's interesting and I did not know about that. So could you expound on that a little bit? I had no idea there was genomic implications for that. Yeah, please, if you wouldn't mind expounding on that a bit.

Speaker 3: 13:14

It's not every lab that does it, because I would say that every lab has the different receptors that it tests, but there are a few labs I know, especially like the Canadian labs, that test for it. Interesting which makes me excited because it makes me feel like everyone is more open to it and everyone's more open to using it therapeutically.

Speaker 2: 13:27

All right, that's fascinating because you know again, as anyone, as I've heard, as anyone who uses these medications will tell you, they get different effects. Some people do get super paranoid, some people don't. Some people have, you know, intense psychoactive reactions, some people don't you know. It would be fascinating if we could validate a genomic test that says okay for you, cbd, you know, or THC, will work for these, should work for these therapeutic issues, but you are less likely to be super paranoid, you're less likely to, you know, to do all that. So, yeah, that would actually be really fascinating if genomics could come to the rescue there.

Speaker 2: 14:10

You know, I'm always I as my students will tell you, I'm always a bit of a genomics nihilist, just because you know it's, it's had a lot of promise for a lot of things and then a lot of times it doesn't seem to really live up to the promise. But this could definitely be an area Cause, again, there's no, there's no easy way to dose the drug, you know, and, and with different strains and different amounts. You know you. Just, you know you don't know what you're getting. I, you know, I would argue, even in in places where medical marijuana is, you know, available my state of Iowa, it is there's, you know it is that legal in in in medical dispensaries.

Speaker 2: 14:43

You know, I would assume, I mean none of that stuff's FDA approved, of course. So I mean I would assume you know you don't know what you're getting. You know it says is it doesn't have what it says on the tin and I'm not sure that you know you can really say that. So, yeah, that's, that's fascinating. I hadn't, I hadn't heard of the genomic connections. That's kind of interesting. So you know, in your opinion, you know, again, this is historic do you think we'll go as far as research? Where do you think you know if, if a, if a physician says, okay, so this doesn't mean I can prescribe this stuff. I mean what you know, what, what. What do we tell prescribers?

Speaker 3: 15:19

I think, so I think there's a lot of legal implications for it. I actually had to write the medical marijuana hospital policy for my hospital because in 2018, american Academy of Pediatrics recommended that. They recommended to not have a don't ask, don't tell culture and to really have a medical marijuana task force that will oversee, like, how it's being given in the hospital, who's giving it, and then also the drug interactions. So that's. What was cool, too, is that AAP endorsed having a pharmacist on this care team to check for drug interactions, because there are drug interactions that we may not know about, and then, if you do put it into a drug interaction checker, you can actually put in cannabidiol, marijuana, cannabis, and it'll be able to run with whatever data we have so far. So I think, legally, we definitely just have to make sure that the prescriber is a registered provider and then also that the patient has one of the like conditions that are listed that are legal within the medical marijuana space.

Speaker 3: 16:20

Practically, I think we're very far away from really knowing the practical things because we don't really know the dose. If you really think about it, every product has a different milligram strength and then there is absolutely no dosing out there, so you're kind of just eyeballing and like, oh yeah, one milligram is fine, but you don't actually know. So having a PK lab and having someone really check to see what a good dose is because the pharmacokinetics of marijuana are so interesting will definitely help practically, and then also just having a way of regulating. So right now, when you get a medical marijuana product from a dispensary, if it's a legit, like very established dispensary, they should come with a certificate of analysis which basically tells you the percentage of THC versus CBD, which basically tells you the percentage of THC versus CBD. But then again like who's, like what is that called? Who's? Double checking and making sure that that's actually true. So this is where the FDA really should come in and regulate and I think it would be a great place to start All right, I mean, it's interesting.

Speaker 2: 17:25

I've done a little reading on this and, of course, you know, there are large and small, um, business people like that there's probably a better way to phrase that who have you know, who are, are manufacturing, you know, cannabis in sometimes small areas and sometimes really large areas, um, you know, um, uh, and and I'm from iowa, so you know, I don't know if I'm sorry to say this or I'm happy to say this tom arnold, remember rosanne bar's ex-husband, who, uh, he actually is from iowa and he has, has, has, has completely shifted gears and is now producing. He's now the head of a gigantic marijuana farm in California, where, of course, it's legal. And you know, you're right, I think it's going to be very interesting that you know, you know we'll, we'll, we'll in. You know he offer, now that it's schedule three, it's like, look, just prescribe this stuff, or will he go? You know, hey, you know I don't want, you know, I don't want this to be prescribed, I want it to be available to everybody, right? You know I, you know, I think, if you're a recreational person, I think you go. You know, you know I don't want this schedule period, right, because I just want to be able to go get the stuff or grow the stuff and use it myself.

Speaker 2: 18:37

But if you're a researcher or I think I think if you're you know, you know someone where you're like, as you pointed out, look, we need to know the right strain, we need to know the right dose, we need to know all that stuff. You know there has to be some control, right? I mean, you know we unfortunately, without FDA approval, you know it'll fall into the category of herbals where, okay, you know, we have no idea, you know what we're taking, how much is it, you know, and all that other stuff. A business perspective to people who are already basically growing the stuff and selling it for either medicinal purposes or for recreational purposes. I think some of them are going to be like, okay, well, you know, this is nice, but we really should just completely decriminalize it. And I think there's. I think other people are like no, no, we really need to look at CBD and look at that. We need to, you know, have some controls over it, you know. So, yeah, so I agree with you. I think it's going to be very interesting to see you know where that goes.

Speaker 2: 19:46

Of course, dea and I'm sure FDA were probably just as surprised as anybody else was by the rule to back it up. I mean, though the DEA did this. I mean it was the Biden administration who said, look, we need to do this, and and, and I, you know I, my guess is they're scrambling even as we speak to try and go okay, now, what do we do? You know, I mean, what exactly is this, does this mean? And so I guess you know, my next question would be then, you know I, if, if a, if a prescriber were to come to you, one of your pediatricians were to come to you and you said, you've already kind of written your protocol for antipalsy procedure for its use in your hospital.

Speaker 2: 20:23

But let's say, you run into a general pediatrician who is, you know, an ambulist and sees kids in the clinic and says, you know, this has been all over the news, et cetera, et cetera. And you know, I practice in a state where you know I practice in a state where you know even medicinal marijuana isn't legal, you know, and there are a few states out there where even medicinal marijuana is illegal. You know, what do we tell them? I mean, do we say, okay, well, schedule three. Now it's perfectly fine for you to prescribe. I'm still hazy about what to do with that. So you know what's your opinion on on that.

Speaker 3: 20:57

I honestly think I'm still a little hazy, because schedule three, I think, changes things, but then there's also a missing piece that needs to be addressed and it's the authorized prescriber versus not authorized prescriber. So with changing it to schedule three, are they going to take that out of the miracle medical marijuana laws or, like what's happening? Will it be universal?

Speaker 3: 21:18

so I think that that's something that the da um and, like the federal government, really has to hash out before opening it up to everyone yeah, I totally agree, you know because I think that you need like a lot of background knowledge and you probably would need some sort of certification, um, because it can't just be like a random pediatrician prescribing it when you don't really know the dose, you don't know the pharmacokinetics.

Speaker 3: 21:42

If you think about the pharmacokinetics it's really interesting because smoking it the onset is like within minutes and it's very quick to start, but then if you ingest it it takes more, like an hour for the onset and then three to four hours to really hit the peak. So then knowing that that should adjust your dosing because you don't really want to go with like a super high dose, because then your patient will be intoxicated really fast, which could actually lead to like hyperemesis syndrome, which is something that we would see a lot cannabis hyperemesis which you treat with treat with capsaicin, which is very interesting that research came out of Colorado yeah, because it like simulates a hot shower but just like knowing all those little implications I think are really important because it's not your everyday run of the mill drug.

Speaker 2: 22:28

Absolutely. And yeah, I mean, I saw you, I agree with you. I think we're a long, long ways away from when, you know, even in a state where it's not, you know, legal at all, you know, for you know regular provider to say, okay, you know one joint three times a day, I don't know one gummy twice a day. You got me how they're going to do that. But I think suffice it to say that we were talking before we started recording. Yeah, I don't think Walgreens or CBS are going to start carrying gummies anytime soon, it would be my guess. So, yeah, so yeah, no, I agree with you. This is a fascinating development and it'll be very interesting to see where we go from here. And hopefully this opens the floodgates to other substances.

Speaker 2: 23:13

And you know, the other one, of course, that comes to mind is psilocybin, which you know is showing incredible promise for depression, anxiety, ptsd and early studies. That you know the results are just, I mean, they're, they're incredible, you know, way better than anything we've ever seen before. But again, you know I have no doubt that that you know people are suffering from those conditions. Or even now, you know, you know, talking to somebody about getting a tab of LSD and it's like no, hold it a second. You know that.

Speaker 2: 23:41

You know that's not the same thing. We don't know the dose. We don't. You know, with this is always done with, with intensive counseling, at the same time that you're you're you're taking the dose, you know. You know, unfortunately, patients, as you point out, you know we're desperate and they will definitely take matters into their own hands. And I think, as pharmacists you know you're right we, our job is to is to basically help them as much as we can make sure that whatever they're doing is safe and effective. So, yeah, I totally agree with that. Any things you want to wrap up with?

Speaker 3: 24:09

I think that this is something that's really exciting and we kind of just have to be a little bit more open-minded in this sense, cause I feel like there have been so many negative connotations with marijuana just because it's been used recreationally and like all the racial disparities with it. But this is exciting. This means that we're opening the door for so much research. So whether you're a parent, a patient that's looking for a solution because you're kind of at your wit's end, or if you're a doctor, a medical researcher, someone who just wants to expand this like it's a very exciting time. I would say.

Speaker 3: 24:42

From a pediatric perspective, I would not recommend recreational marijuana for anyone under 25, because at that point your brain is still developing and the studies show that it does cause a lot of like negative effects to the brain, especially a growing brain, so trouble with memory, recognition, like things like that. And even if you smoke it during pregnancy, like the offspring usually will have these effects. So I definitely don't recommend recreational use. But for pediatric patients, where there is a therapeutic use, I'm all for it, I'm all for using it, especially if it's like last line and it's working. So I guess, to close, I would say yes for research. No for recreation for pediatric patients.

Speaker 2: 25:27

Sounds like a plan. Speaking of peds, you know you mentioned that you're with perfecting peds. Can you tell us a little bit more about that?

Speaker 3: 25:33

So perfecting peds makes my heart sing.

Speaker 3: 25:35

It is so near and dear to my heart because it brings exactly what I did in the hospital to the outpatient space and I feel like it fills so many gaps. So, working in the hospital, I would see the same rotating like lists of patients back and forth and we called them our frequent flyers and I it kind of was like sickening and it was because these kids who are on like 25 medications are taking care of fine in the hospital, because you have one pharmacist really overseeing everything and kind of speaking and acting as a liaison between all specialists. But these kids typically will have like 13 specialists outpatient and it's not really easy for everyone to communicate and to be on the same page. So for pregnant feeds brings these pediatric pharmacists to the outpatient space and we act as a liaison not only for the parents but for the providers. So I think it's something really special. We offer it through digital health platforms so we're basically available anywhere at any time for our families and it's it's honestly just been a beautiful process and I'm excited to see it grow.

Speaker 2: 26:37

That's terrific. And yeah, I mean, there's definitely areas of medicine where we need patient advocates and we need caregiver advocates, and I think we all try to do that, but it's difficult to do when you're super busy, it's difficult on an outpatient basis. So, yeah, this sounds like an exciting project and an exciting, exciting company. So I wish you nothing but the best. I have no doubt that you'll be very successful. So, thanks for being with us.

Speaker 2: 27:07

I suspect we'll be calling on you again for your expertise in pediatrics and other areas, because I did my residency in adult internal medicine for several reasons, but that's definitely one of them is I'm not good at dealing with the little ones.

Speaker 3: 27:20

So yeah, I love the little ones, so happy to join anytime.

Speaker 2: 27:26

So go ahead, Jen. That's where we're at.

Speaker 1: 27:27

Yeah, I was going to say we've got some other topics coming up with, some of the perfecting peds people, so we're excited about that. I think it's a really, really cool company. A couple of things I wanted to go back to because I'm like, oh, chomping at the bit to get in, but I didn't want to interrupt your conversation. So one of the things I thought was interesting that you're both talking about is, you know, just the deregulation and the impact of taking away the stigma. We had a few podcasts ago.

Speaker 1: 27:53

We had Karen Baker, who is from the dental college at the University of Iowa and she was talking about, you know, when people come in there they don't say I'm taking marijuana, like there's. You know, there's just such a stigma. And then that relates then to some of these dental procedures and you know there's just a lot of impact there. So I think that this is cool in that hopefully, it gives people a little bit more permission. You know whether they're using it recreationally or medicinally. I think there's been a stigma about it. So I think, just from a healthcare perspective not just, you know, just in prisons and all of you know that whole like legal standpoint but I think from the healthcare perspective. I think it's exciting as well, and hopefully we'll reshape, I guess, the way that we think about that. So I don't know if you have any comments about it, but that was one thing that that struck me.

Speaker 3: 28:43

Yeah, I agree. I think it's something that we should be so open with because it's important to know not only from a pharmacy perspective, like thinking of how they're taking it, what drug interactions are present and just side effect management, all that, all that stuff, cause a lot of times kids would come in just throwing up, throwing up, throwing up, and they, we, we didn't know why. So we would work them up for like chronic hype, like hyperemesis, or we'd work them up for like IBD or something like that, and the missing piece is that this child was smoking and didn't tell anybody and they actually had cannabis hyperemesis syndrome. So it was actually a very easy fix hot shower, capsaicin, anti-emetics if needed, fluids and you're good. But it's just like releasing us from that don't ask, don't tell culture and just being open about it will help just the health system as a whole.

Speaker 1: 29:32

Yeah, yeah, that's a great example, yeah. So that was one thing I thought of. And then I think the second thing is you know, kind of tag happen in a business where people who aren't in health care are in that business has been so frustrating, because it is pharmacy, we do understand it, we learned it in school. We should know all of that and it should be in the health care space because of all the things that you've talked about. So I think that is so exciting that it brings it back to the healthcare space. Hopefully, hopefully, it gives all of us permission to learn about it. I mean, that's one of the things as an education company, you know, for more than 10 years.

Speaker 1: 30:30

It's like we need to do some things in the space and it's like, well, how do we find the right people that have been doing the research and understand it? And then what can pharmacists do with it? Anyway, like you know, if they're educated about it, they can't. There's nothing that they can do in their practice. So I think that's also the exciting thing.

Speaker 1: 30:45

And you know, when you talked about genomics, I mean that just tells me that if we're able to, you know, do some of those tests and then we know how to help people choose. I mean, that's something that can't really be done outside of the healthcare space. So maybe we can kind of take back control of some of these dispensaries and I just think that's a really exciting opportunity that hopefully we'll have the chance to show what we know about medications, because there are drug interactions, like you said there's you know, there's a genomic component. There's just so many things where pharmacists should be involved and instead it's just somebody who's decided they want to get in this business and they open a dispensary and they're the expert, not us.

Speaker 3: 31:25

Yeah, to prepare for this podcast, I was talking to my best friend last night and he owns an independent pharmacy and he's like, wait, so it'll be schedule three and like what I can have it in the pharmacy or is it just in the dispensary? I'm like, well, I think it's so great, like I don't think we've outlined that yet. But if we really think about our profession, like we should take charge and own it because it is a drug.

Speaker 3: 31:49

So if it's a drug, it should be in the pharmacy and not it's funny, they're called blood tenders the people yeah, yeah, the people who own dispensers are called blood tenders yeah, but like if you think about the education of a pharmacist versus a blood tender, it's a no-brainer that it should go to the pharmacy space yeah, I.

Speaker 2: 32:07

I suspect most bud tenders have become bud tenders from personal trial and error. If I had to take a wild guess, I doubt it's because they attended a whole bunch of school on things right, so yeah, yeah, yeah, but it's, but it's absolutely right.

Speaker 1: 32:21

I mean, it's a drug and there are, you know, so many of the, you know the drug interactions and I, just when you said you know that had a pharmacogenomic component, just like Jeff, I didn't really realize that, and so that I think that right there opens up a lot of opportunities. So I would just encourage all of us to start getting more education in this space, because I think it is coming, I think it is still you're right, mary, so gray, and you know there's the legal component. It's like the. You know the dispensaries don't have to be registered as a pharmacy and so they didn't have to follow, you know, the same rules that we do. So it's like we're held to a higher standard, yet they can do it. So it's been just such this crazy environment, I think, for the last 10 to 20 years, and hopefully this move will really change some of that. So it's exciting in that space. So, Mary, you didn't mention your name, that they called you in your practice because're so well-versed in this space.

Speaker 3: 33:22

It was a funny, it was a funny nickname. So I did grand rounds on just cannabis, medical marijuana and cannabidiol and the difference between like FDA regulated so our products are like Marinol and Epidiolex and then just like the kind of gas station stuff where they sell over the counter. So I did a full grand rounds on that because I felt like it was needed for the hospital because we were getting so many patients. So they either called just like fun, just to be funny. People called me like marijuana or like they're like Mary Jane, like your name is perfect for you and like every every department in the hospital would reach out to me. They're like, oh, can you redo the grand rounds, but from like this perspective for my group or this or that, because like they found the education so valuable, because there is like such a taboo behind it, so it was nice like kind of being the controversial one and bringing in like this topic no, no, I I have no doubt that, that you know.

Speaker 2: 34:09

You know because I've seen that too, where where a colleague of mine here at Methodist, you know know, had really kind of immersed himself in the literature and come up with a very well done kind of a module on the project, and he was I mean, he must have given that module 30 times to people all over the state because, you're right, there's a huge dearth of knowledge and we need to deal with that.

Speaker 1: 34:29

So yeah Well, we've had a reason to not, you know, be educated in the space, and now I think that reason is gone. So we, I think we need to jump back in and I'd encourage all of us to do that. So thank you so much for being with us today, mary. I appreciate it and hopefully it's not the last time that we see or hear from you. So it's been a pleasure getting to know you, and your practice and your company and all of you at Perfecting Peds are great. So hopefully we'll hear from some of you again. So I appreciate it, thank you.

Speaker 3: 35:03

Thank you for having me. This is my first podcast ever, so I was really nervous, like studying.

Speaker 2: 35:08

You knocked it out of the park.

Speaker 1: 35:11

Yeah, absolutely, it was great. I would never guess that, so thank you. Thank you and Dr Wall. As always, great to talk with you, so this was a really great topic. I appreciate both of you being with us today and with that, that's it for this week. If you are a CE plan member, be sure to claim your CE credit for this episode by logging in at CE impactcom. And, as always, have a great week and keep learning. We'll talk to you next week.