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Oral presentation:

Amy Bachyrycz, Pharm.D.

Mikiko Takeda, Pharm.D.

Traci White, Pharm.D.

Poster presentation: Chaniece Doyle, Pharm.D. candidate

Natalie Herrera, Pharm.D. candidate

Outline Overview of cannabis use in New Mexico

Survey results

Q and A

Introduction of poster presentation

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Classification

CBD extracted from this type of cannabis plant!

HEMP MARIJUANA

THC < 0.3% THC > 0.3%

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ENDOCANNABINOID RECEPTORS

CBD, does not bind directly with either CB1 orCB2 receptors. Instead, it stimulates both types of receptors.

Cannabinoid receptors are responsible for regulating the balance of many everyday functions in the human body.

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Cannabinoid Receptor Distribution/FunctionCB1 Receptor (WidespreadDistribution Through the Body, But Expression Fluctuates in Many Conditions)

Brain Neurodevelopment/Neuroprotection, Motor Control, Learning/Memory/Cognition,Anxiety/Depression, Sleep, Appetite, Reward (Addiction)

Liver Lipogenesis, Fibrosis, Ascites, Insulin Resistance

Reproductive System Regulation of Fertility, Embryo Implantation and Development

Cardiovascular System Overall Cardiac Function, Vasodilation, Muscle Fiber Formation, Energy/Metabolism

Skeletal Muscles Muscle Fiber Formation, Energy/Metabolism

GI tract Motility, Enteroendocrine Functions, Intestinal Barrier Functions, Energy/Balance

Other Immune Modulation, Bronchodilation, Tumor Formation, Bone Remodeling, Nausea/Vomiting, Intraocular Pressure

CB2 Receptor White Blood CellsTonsilsSpleenThymusBrain/CNS (minimal)

Release of Cytokines and Modulation of Immune System, Reward (Addiction)

CBD ALSO HAS AN AFFINITY FOR OTHER RECEPTORS:

Dopamine Receptors➢ Emotion

➢ Movement

➢ Sensations of pleasure and pain

Serotonin Receptors➢ Mood & happiness

Opioid Receptors➢ Pain

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Overview of cannabis use in NM Cannabis has been widely used for various diseases

New Mexico Department of Health approves medical cannabis use for the following diseases:

Alzheimer's Disease, amyotrophic Lateral Sclerosis (ALS), autism spectrum disorder, cancer, Crohn's disease, damage to the nervous tissue of the spinal cord, epilepsy/seizure disorder, Friedreich's ataxia, glaucoma, hepatitis C infection, HIV/AIDS, hospice care, Huntington's disease, inclusion body myositis, inflammatory autoimmunemediated arthritis, intractable nausea/vomiting, lewybody disease, multiple sclerosis, obstructive sleep apnea, opioid use disorder, painful peripheral neuropathy, Parkinson's disease, post-traumatic stress disorder, severe anorexia/cachexia, severe chronic pain, spasmodic torticollis (cervical dystonia), spinal muscular atrophy, ulcerative colitis

https://nmhealth.org/about/mcp/svcs/

Overview of cannabis use in NM Quick overview of what this meeting is all about:

Agenda

What to expect

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Survey Why did we conduct the survey?

Presenters had cannabis consultations to discuss

Efficacy

Safety – adverse reactions, drug-cannabis interactions

Patients may not have correct information on cannabis

Cure diseases without adverse reactions or drug-cannabis interactions

Myth

Survey Why did we conduct the survey?

No cannabis survey among pharmacists to discuss

Efficacy

Safety

Others

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Survey Objective

To assess the confidence level of New Mexico pharmacists for clinical consultations, patient education, product knowledge, and safety concerns with regards to medical cannabis use among their patients.

Survey results Demographic information – age and practice setting

Community (168, 56.8%)

Hospital (49, 16.6%)

Ambulatory Care Clinic (39, 13.2%)

Consultant (16, 5.4%)

Academia (12, 4.1%)

Nursing home facility (5, 1.7%)

Hospice (3, 1.0%)

Opioid replacement therapy/Medication

assisted therapy program (2, 0.7%)

Other (39, 13.2%)

23.5%

17.1%

20.8%

20.5%

18.1%

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Survey results How often are you asked by patients and how often are you asked by

healthcare providers about cannabis?

24.0%

30.8%

11.0%

6.2%

2.4%

25.7%

Survey results What is your confidence in discussing medical cannabis with patients?

23.9%

36.7%

28.4%

11.1%

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Survey results What information resources do you use when discussing medical

cannabis with patients and health care providers?

39.0%

33.3%

33.3%

34.4%

27.3%

Survey results How confident are you in your knowledge on all the different

formulations of medical cannabis?

37.1%

36.7%

19.4%

6.7%

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Survey results What kind of disease states have you ever consulted with for medical

cannabis? Mark all that apply.1. Severe Chronic Pain (142, 51.6%)2. Cancer (132, 48.0%)3. Painful Peripheral Neuropathy (95, 34.5%)4. Epilepsy/Seizure Disorders (88, 32.0%)5. Hospice Care (77, 28.0%)6. Post Traumatic Stress Disorder (68, 24.7%)7. Inflammatory autoimmune-mediated arthritis (56, 20.4%)8. Glaucoma (54, 19.6%)9. Intractable Nausea/Vomiting (51, 18.5%)10.HIV/AIDS (36, 13.1%)

Survey results Do you ever ask patients they are taking medical cannabis?

35.4%

64.6%

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Survey results Do you have patients that you know are taking medical cannabis?

77.4%

22.6%

Survey results Have you ever encountered a case between potential cannabis

interactions with prescription medication (e.g., simvastatin, warfarin, etc.)?

81.3%

18.8%

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Survey results Please rank your concern in regards cannabis safety.

1. Drug-Drug, Drug-Herb, Drug-Disease interactions

2. Short term effects (e.g., toxicities, withdrawal, driving)

3. Long term effects (e.g., IQ, respiratory, weight gain)

4. Packaging and distribution of product (e.g., child safety, product labeling, quality testing)

5. Abuse/Misuse

Survey results At your current practice setting, is it allowable by your facility policies

for patients to bring and use their own medical cannabis?

1.5%

61.8%

36.6%

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Survey results Do you feel patients should be able to bring their own medical cannabis

for use or education while in your practice setting?

I would accept this situation (143, 56.3%)

I would NOT accept this situation (111, 43.7%)

Survey results Select all the reasons you would not accept the scenario of the patient

bringing their own cannabis into your practice setting in the previous question (top 5 reasons)1. For patient safety, I wish I could discuss with the patients. However, I am

concerned about my knowledge of cannabis. (103, 46.8%)2. I would be concerned about this situation, because cannabis is categorized as

Schedule I Control Substance. (87, 39.5%)3. For patient safety, I would discuss with my patients about cannabis and educate

patients on pharmacology and pharmacokinetics of cannabis, drug-herb interaction, etc.) (73, 33.2%)

4. Personally, I would be more than happy to discuss and to provide cannabis education, however, it is against our institutional policy. (43, 19.5%)

5. I would not discuss with the patients, because cannabis is not a medication and is not approved by US FDA. (27, 12.3%)

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Survey results Are you currently precepting pharmacy students?

74.8%

25.2%

Survey results What is your confidence in education/discussion with pharmacy

students in regards to medical cannabis?

25.2%

Slight confidence 36.9%

Moderate confidence 35.4%

High confidence 6.2%

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Survey results How involved do you think pharmacist should be in the management

of cannabis in patient care?

Not involved at all 5.8%

Not so much involved 6.6%

Somewhat involved 17.9%

Involved 32.3%

Very involved 37.4%

Survey results Are you in favor of New Mexico residents being allowed to use

cannabis for medical purposes?

8.9%

91.1%

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Survey results Are you in favor of patient use of medical cannabis under the

management of a provider?

8.2%

91.8%

Survey results Are you in favor of patient use of medical cannabis under the watch or

counsel of a cannabis dispensary?

56.3%

43.7%

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Survey results According to BOP regulation 16.19.4.17.D.(5), pharmacist clinicians are

prohibited from writing recommendations for the use of medical cannabis. Do you feel that pharmacist clinicians (with appropriate DEA and CS registrations) should be allowed to recommend medical cannabis for patients who meet the approved conditions identified by the Department of Health?

80.4%

19.6%

Summarize NM pharmacists are supporting cannabis use.

The majority of NM pharmacists feels less confidence when discussing cannabis with patients.

The majority of NM pharmacists feels their cannabis education was not enough.

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Questions?

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