Comprehensive Ensuring the Sustainable Future of the Cannabis - - PowerPoint PPT Presentation

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Comprehensive Ensuring the Sustainable Future of the Cannabis - - PowerPoint PPT Presentation

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Cannabis Sustainability Symposium 2019 Comprehensive Ensuring the Sustainable Future of the Cannabis Industry in All Phases Dr. Rachel Knox, MD, MBA October 4, 2019 Background The Knox Docs are a family of physicians with backgrounds in

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Comprehensive

Ensuring the Sustainable Future of the Cannabis Industry in All Phases

Cannabis Sustainability Symposium 2019

October 4, 2019

  • Dr. Rachel Knox, MD, MBA
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Background

The Knox Docs are a family of physicians with backgrounds in Emergency Medicine, Anesthesia, Family Medicine, Integrative Medicine, and Preventive Medicine. Founders of the American Cannabinoid Clinics and ADVENT Academy Pioneers of Functional and Integrative Endocannabinology

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New Terms

Cannabinology (kuh-nab-uh-nol-uh-jee): The study of the pharmacology of cannabinoids and cannabimimetic substances Endocannabinology (en-doh-kuh-nab-uh-nol-uh-jee): The study of the endocannabinoid system (ECS), its dysfunction, and modulation by cannabimimetic practices Functional and Integrative Endocannabinology: The application of integrative medicine to correct ECS dysfunctions at their root causes using natural medicines and alternative health modalities

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Why am I uniquely positioned to talk about sustainability in the cannabis industry?

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Experience

Oregon Cannabis Commission Chair

  • Design a new framework for medical cannabis in Oregon
  • Develop long-term strategies for medical research and assuring cannabis

remains accessible to patients Portland Cannabis Policy Oversight Team Teammate

  • Advise Portland City Counsel and develop policies that support equitable

access and outcomes Minority Cannabis Business Assoc. Medical Chair; Medical Committee Chair

  • Consumer and patient (and Industry) awareness
  • Define health equity in the context of social equity

Oregon Cannabis Clinicians Group Co-founder

  • Create a intradisciplinary voice representing the interests and advice of

clinicians in support of cannabis medicine

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The supply and demand chain ends in my office.

Cultivatio n Processing Distribution Retail Consumers Clinicians

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The cannabis industry of our dreams is already unsustainable.

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What are the industry’s blind spots?

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1 in 2 American adults are “sick with something.”

1. Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001– 1006. 2. https://www.nami.org/learn-more/mental-health-by-the-numbers 3. University of Pennsylvania School of Medicine. "One in four Americans develop insomnia each year: 75 percent of those with insomnia recover." ScienceDaily. ScienceDaily, 5 June 2018. 4. American Psychological Association, American Institute of Stress. Research Date: 7.8.2014 5. https://www.cdc.gov/diabetes/data/statistics-report/prevalence.html 6. https://www.who.int/news-room/fact-sheets/detail/headache-disorders1

Heart disease Cancer Chronic pain Mental illness IBS Insomnia High BP Pre-diabetes Headache Diabetes* Stress

Blind Spots

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Products on shelves often don’t match clinical (or wellness) needs.

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The industry is currently flooded with “stuff.”

Blind Spots

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Emotional Stress Chemical Insult Poor Diet Rx Drugs Genetics Aging

Contributors to Disease and Illness

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Our society is sick.

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Why do these blind spots exist in cannabis?

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#1 Our view of the cannabis supply and demand chain is too narrow.

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“From seed to sale”

The Narrow Model

  • Limited stakeholder contemplation
  • Promoted and marketed with “good

science,” but not informed by science

  • Just put CBD in “everything”
  • Lacking social responsibility
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Economic Capital Money/currency Human Capital Health, education, skills, knowledge, leadership and access to services that facilitate these. Environmental Capital (Natural Capital) Water, land, air, minerals and ecosystem services; their preservation improves human welfare. Social Capital Investments and services that create the basic framework for society. Total Sustainability is the Sum of All Parts

1. Goodland, Robert. Sustainability: Human, Social, Economic and Environmental. World Bank, Washington, DC, US. 2002

Unmet sustainability needs

The Narrow Model

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#2 Bifurcation has proven problematic.

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New Frontier Data, 2016

Short-Sighted Bifurcation

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Patients are Consumers and vice versa.

Short-Sighted Bifurcation

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#3 Brutal Capitalism

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Where making millions is the mission.

Brutal Capitalism

Image Credit: iPad Screenshot

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#4 Cannaphobia

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Overregulation is rooted in fear

Cannaphobia

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#5 Cannabis tax revenue is not being reinvested into the industry.

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Cannabis Tax Revenue

Lack of Reinvestment

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#6 Our understanding

  • f health is too narrow.
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Our health is a function of our ecosystem

The Narrow Model

Emotional Stress Chemical Insult Poor Diet Rx Drugs Genetics Aging

  • An ecological problem
  • An industrial complex problem
  • Cannabis as medicine will not solve
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What is the solution?

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#1 Build for sustainability by looking at the big picture.

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Human Capital Health, education, skills, knowledge, leadership and access to services that facilitate these. Economic Capital Money/currency Environmental Capital (Natural Capital) Water, land, air, minerals and ecosystem services; their preservation improves human welfare. Social Capital Investments and services that create the basic framework for society. The Ecosystem of Sustainability

1. Goodland, Robert. Sustainability: Human, Social, Economic and Environmental. World Bank, Washington, DC, US. 2002

The big picture: the 4 pillars of total sustainability

The Ecosystem Model

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Exhaustive Stakeholder Contemplation

The Ecosystem Model

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#2 Lead with science.

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Lead With Science

ECS-Literacy and Cannabis Competency for All

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The Endocannabinoid System (ECS)

Decades of research have revealed an intricate system integral to homeostasis and health.

Image Credit: Wai Natural

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Image Credit: John Karapelou for Phytecs

A retrograde signaling system at the synaptic junction provides feedback to help the body “relax, eat, sleep, forget, and protect.”

Di Marzo V (1998) ‘Endocannabinoids’ and other fatty acid derivatives with cannabimimetic properties: biochemistry and possible physiopathological relevance. Lipids and Lipid Metabolism 1392: 153–175.

ECS Function

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Anandamide

N-arachidonoylethanolamine (AEA)

Endocannabinoids

(Endogenous Cannabinoids)

The “bliss” molecule Multiple additional targets Made on demand when needed to maintain homeostasis (i.e. self- modulation)

2-AG

2-Arachidonoyl glycerol

Stronger agonist at CBRs than AEA Made on demand when needed to maintain homeostasis (i.e. self- modulation)

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ECS Dysfunction

ECS Excess (↑ eCBs/CBRs)1

Obesity Diabetes Rheumatic disease Cancer

ECS Deficiency (↓ eCBs)2

Migraines Fibromyalgia Irritable bowel syndrome Post Traumatic Stress Disorder

1. Pacher, P . and Kunos, G. (2013). Modulating the endocannabinoid system in human health and disease - successes and failures. FEBS Journal, 280(9), pp.1918-1943. 2. Russo, E. (2016). Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment- Resistant Syndromes. Cannabis and Cannabinoid Research, 1(1), pp.154-165.

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The Major Phytocannabinoids

(Exogenous Cannabinoids)

THC

Tetrahydrocannabinol

CBD

Cannabidiol

Analogous to anandamide (AEA)

  • Euphoric,

intoxicating* Blocks AEA breakdown by FAAH

  • Increases available AEA
  • Activation at 65 different

non-CBRs and enzymes

  • Also psychoactive
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Cannabimimetics Exocannabinoids Endocannabinoids

McPartland JM, Guy GW, Di Marzo V. Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid system. PLoS One. 2014;9(3):e89566. Published 2014 Mar 12. doi:10.1371/journal.pone.0089566

Modulating the ECS

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1. Kumar, A., Premoli, M., Aria, F . et al. Cannabimimetic plants: are they new cannabinoidergic modulators? Planta (2019). https://doi.org/10.1007/s00425-019-03138-x 2. McPartland JM, Guy GW, Di Marzo V. Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid

  • system. PLoS One. 2014;9(3):e89566. Published 2014 Mar 12. doi:10.1371/journal.pone.0089566

3. Hu B., Bai F ., Xiong L., Wang Q. The endocannabinoid system, a novel and key participant in acupuncture's multiple beneficial effects. Neuroscience and Biobehavioral Reviews, 77 , pp. 340-357, 2017. 4. Andrew D. Vigotsky and Ryan P . Bruhns, “The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review,” Pain Research and Treatment,

  • vol. 2015, Article ID 292805, 11 pages, 2015.

5. Johannes Fuss, Jörg Steinle, Laura Bindila, Matthias K. Auer, Hartmut Kirchherr, Beat Lutz, Peter Gass. A runner's high depends on cannabinoid receptors. Proceedings of the National Academy of Sciences Oct 2015, 201514996; DOI: 10.1073/pnas.1514996112

Exercise Massage Meditation Acupuncture

Cannabimimetics

Practices Substances

Foods Herbs Spices Essential Oils

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Cannabimimetic Practices

Exercise Massage Meditation Acupuncture

Increase circulating eCB levels

  • The “Runner’s high”
  • Analgesic effects
  • Anxiolytic effects

Other practices:

  • Grounding
  • Deep Breathing
  • Prayer

1. McPartland JM, Guy GW, Di Marzo V. Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid

  • system. PLoS One. 2014;9(3):e89566. Published 2014 Mar 12. doi:10.1371/journal.pone.0089566

2. Hu B., Bai F ., Xiong L., Wang Q. The endocannabinoid system, a novel and key participant in acupuncture's multiple beneficial effects. Neuroscience and Biobehavioral Reviews, 77 , pp. 340-357, 2017. 3. Andrew D. Vigotsky and Ryan P . Bruhns, “The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review,” Pain Research and Treatment,

  • vol. 2015, Article ID 292805, 11 pages, 2015.

4. Johannes Fuss, Jörg Steinle, Laura Bindila, Matthias K. Auer, Hartmut Kirchherr, Beat Lutz, Peter Gass. A runner's high depends on cannabinoid receptors. Proceedings of the National Academy of Sciences Oct 2015, 201514996; DOI: 10.1073/pnas.1514996112

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Emotional Stress Chemical Insult Poor Diet Rx Drugs Genetics Aging Contributors to ECS Dysfunction

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#3 Make products (and services) with purpose that are designed with the ECS in mind.

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#4 Utilize cannabis innovations to address ecological problems too.

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What is the connection between cannabis, reparations, and ecology?

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The War on Drugs

Social Equity

  • Disenfranchised communities of color
  • Disrupted the nuclear family
  • Perpetuated poverty
  • Perpetuated mental health problems
  • Perpetuated recidivism
  • Justified disproportionate allocation
  • f resources into communities of color
  • Stunted capital growth out of pace

with the majority population

  • Made patients of color fearful of using

cannabis as medicine

Image Credit: greenlining.org

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#5 Follow through with research.

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#6 Design an infrastructure.

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A Bird’s Eye View

The Ecosystem Model

  • Intra-agency
  • Collaborative
  • Productive
  • Informative
  • Inclusive
  • Equitable
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#7 Develop an industry productive

  • f and informed by

data - now.

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Human Capital Health, education, skills, knowledge, leadership and access to services that facilitate these. Economic Capital Money/currency Environmental Capital (Natural Capital) Water, land, air, minerals and ecosystem services; their preservation improves human welfare. Social Capital Investments and services that create the basic framework for society. Equitably Distributed

1. Goodland, Robert. Sustainability: Human, Social, Economic and Environmental. World Bank, Washington, DC, US. 2002

Total sustainability is measured by data.

“The part can never be well unless the whole is well.”

The Ecosystem Model

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A new view with an ecological goal

The Ecosystem Model

ec·o·sys·tem /ˈēkōˌsistəm/

noun: ecosystem; plural noun: ecosystems; noun: eco-system; plural noun: eco-systems

1. a biological community of interacting organisms and their physical environment. ○ (in general use) a complex network or interconnected system.

The new cannabis industry is an ecosystem driven by and productive of data. This is an ecosystem that prioritizes research and social equity above all else, fueled by a robust economy built to include and protect the spirit of compassionate giving, patient and consumer rights, and locally grown businesses. It is an ecosystem proud of its product integrity and sustainable practices, cannabis competency and informed policy making through which sound cannabis regulatory practices can be established and scaled as we look ahead to the anticipated future of interstate and international trade, and health tourism opportunities.

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Call To Action

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Recognize that the ECS is paradigm shifting.

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The ECS connects us all

The ECS Difference

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Establish accountability.

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Some steps to success

  • Understand the 4 pillars of total sustainability
  • Decide to take action in your business, community, city, and/or state
  • Advocate; create and join coalitions for a sustainable industry
  • Map out a sustainable ecosystem for your state and take it to

legislators.

  • Fight for industry and community reinvestment with retail tax

revenue

  • Think well beyond sustainability to regeneration wherever possible.
  • And if you’re starting from scratch...

The Ecosystem Model

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Legalize One Plant.

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The cannabis ecosystem is a roadmap to a sustainable world.

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Ensuring the Sustainable Future of the Cannabis Industry in All Phases

Cannabis Sustainability Symposium 2019

October 4, 2019

@racheldocknox

Comprehensive