Lots of love, from Dr. Danielle, your HG Pharmacist
About Dr. Kane:
Dr. Melani Kane (Bersten) graduated from the Philadelphia College of Pharmacy and returned to Minnesota as a Cannabis Pharmacist in a pharmacist-led dosing model. After spending countless hours researching the endocannabinoid system and phytocannabinoid pharmacology, Dr. Kane created Prepcann, an e-learning platform designed to prepare healthcare professionals for their role in cannabinoid medicine. Prepcann has courses for various medical backgrounds including caregivers and dispensary staff to encourage evidence-based recommendations and experimentation with approved Cannabis products.
Dr. Kane co-founded The International Society of Cannabis Pharmacists to Define Cannabis Care and inspire pharmacists to provide their unique perspective and expertise on the subject. The society connects pharmacists around the world on the shared belief that Cannabis is medicine and pharmacists should be educated and involved.
Dr. Kane’s current role at Prime Therapeutics provides comprehensive medicine reviews to Medicare members across the United States. Dr. Kane is passionate about educating and empowering patients to be actively involved in their own health and wellbeing.
Hyperemesis Gravidarum and Cannabis
Most of the patients in the dispensary have conditions so severe that they are willing to try anything – even Cannabis! So, as a Cannabis Pharmacist(1) I am able to recommend a relatively-safe (dose-dependent) and moderately-effective (condition-dependent) medicine that is easy to use given the proper education. In my experience, Cannabis is a quality-of-life saving medicine that works best when patients are instructed to target specific symptoms like pain or nausea. If you have a diagnosis of Hyperemesis Gravidarum (HG) then it is likely your doctors have ruled out every other condition that could possibly contribute to your symptoms. When dietary and lifestyle changes aren’t enough to prevent HG, Cannabis might be the alternative medicine that reduces nausea and vomiting while simultaneously increasing appetite.
Cannabinoids are FDA approved for severe chemotherapy-induced nausea and vomiting in synthetic forms like Dronabinol (Marinol®) or Nabilone (Cesamet®). These synthetic cannabinoids that mimic THC or tetrahydrocannabinol are formed in a lab and are legally available for doctors to prescribe. There are notable disadvantages to using synthetic Cannabis compared to botanical sources, including increased side effects and decreased effectiveness. Botanical sources are still federally illegal in the USA, although many states are adopting medical (34 states) and adult-use programs (12 + DC). These synthetic versions are only available in pill-form, which requires intestinal absorption, and doesn’t work if you’re vomiting and can’t keep anything down. Dronabinol was recently approved in a new formulation as Syndros ® – a synthetic liquid version available for over $1,000 for a month’s supply. Dronabinol is not recommended during pregnancy and has limited studies in animals. Only one survey(2) of 86 women using Cannabis in morning sickness, a far less serious condition than HG, was published back in 2006. Although this study indicates some benefit to Cannabis in morning sickness, there was no way to verify the products or doses used and the presence of long term risks that may appear later in life. There is a canyon-sized gap of information when it comes to drug safety in pregnancy AND Cannabis. Technically speaking, we don’t have good information on most drugs when used in pregnancy because it’s so difficult to study.
The flexibility in botanical Cannabis formulations is an advantage for those who cannot keep their pills down. Cannabis is commonly available in concentrated liquid form to allow for sublingual absorption (under the tongue) or vaporization (through the lungs). As a pharmacist, I do not recommend smoking Cannabis. Burning organic matter always produces toxic byproducts that have direct effects on the human body. If you are in a legal state(3), I recommend reviewing the product’s lab results (Certificate of Analysis or COA) to ensure it has been quality tested. Trust your pharmacist when I say you don’t want to ingest or inhale lead, pesticides, or mold.
Cannabis can also be formulated in a topical preparation like a cream or ointment to provide local relief, but may not be effective for nausea/vomiting, mood or insomnia.
In my professional practice, I typically recommend against starting Cannabis(4) in a pregnant woman who has never used Cannabis before. It’s important to remember that botanical Cannabis products are not FDA approved for ANY condition, and its use is extremely experimental. Cannabis can have variable effects that some people love while others hate, and it’s something we can neither predict nor control. Typically these patients have tried everything without success and they’ve already received a recommendation from their doctor. After we discuss possible side effects or complications of Cannabis use including damage to the developing fetus and worsening of current symptoms, or even its own cyclical vomiting called Cannabis Hyperemesis Syndrome, and after the patient, overseeing OBGYN, and primary provider sign my consent forms- we can begin discussing personalized Cannabis recommendations.
The initial Cannabis dose should be between 1 to 2.5 mg THC, and may not be enough to effectively manage symptoms. This conservative dosing principle provides the user with greater control of the mind-altering effects. The dose is slowly increased over a few hours or days (depending on the form), until symptoms are gone and there are no interrupting mental effects like feeling sleepy, anxious, confused or dizzy.
With Cannabis- less is more.
It’s all about finding the right dose that relieves symptoms while maintaining mental clarity. Previous Cannabis users may tolerate higher doses with minimal side effects. Depending on the form and recommended administration route (swallowed, under the tongue, or vaporized), effects may not be seen until 5 to 180 minutes. Other factors that may affect dosing include inhalation technique, before or after meals, and your body’s personal metabolism. I had a patient who could only take CBD every 3 days or it would make them feel wired/hyper and they were able to isolate their reaction to the timing of CBD. Keeping a journal to track triggers, doses, and effect (good and bad) is fundamental to finding your individual “sweet spot” of relief.
Cannabis medicine is personalized medicine as patients are expected to self-manage their symptoms based on their severity and previously identified response. There is no magic dose that will affect everyone similarly or good resources for doctors to use so it’s also more of an art. Although not life-threatening, the mind-altering effects that accompany THC can be very discomforting and are easier to prevent that to treat. And the only true remedy for THC-induced anxiety or impairment is time!
For more information on science and evidence supporting medical Cannabis, visit prepcann.com and save $5 using code: HG19