Pediatrics & We are family! This program is dedicated to my - - PDF document
10/10/2019 The story of courageous Jackson. Little wonder & typically developing, Jackson Leyden, with his dad John, prepping for baby brother! Courageous Jackson with mom, Lisa. On the journey with epilepsy. Pediatrics & We are
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Little wonder & typically developing, Jackson Leyden, with his dad John, prepping for baby brother!
Courageous Jackson with mom, Lisa.
On the journey with epilepsy.
Paula Querido Kahn, MS, OTR/L
Elevate OT Consultants
Medical Cannabis Education, Counseling, Advocacy Silver Spring, Maryland
We are family! This program is dedicated to my loving family.
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Disclosure: My husband, Rabbi James Kahn, works on the national level for Liberty Cannabis, which has humble beginnings here in the DMV.
In today’s presentation: We will learn about medical cannabis history, chemistry, pharmaceuticals, effects, clinical implications, how to gain access in our state. We will learn about the relationship between development, academic learning and medical cannabis in pediatrics. We will address OT and PTs role in working with pediatric clients using medical cannabis.
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In my experience working as an OT in rehabilitation and then with medical cannabis patients of all ages in Washington DC… Clean, professional, warm, welcoming, accessible environment Dependable, high quality services and relationships over time Adaptive equipment for individual needs A listening ear Respect and care Language, atmosphere, and action that are free of judgement
“A mark of shame or discredit: Stain”
According to Merriam-Webster.com.
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When other known pathways have been exhausted. When the risks of pharmaceutical or surgical intervention are too high. When the risks of not doing anything are too high. When they learn of the benefits and limited side- effects.
Educate
Educate
Use compassionate language and action.
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➢Cannabis is a genus of flowering plants that includes
species, Cannabis sativa, Cannabis indica and Cannabis
industry, HYBRIDS are the preferred choice in MEDICINAL formulations.
Cannabis is One of Nature’s Most Versatile Plants
COMPILED FROM JEFFREY FRIEDLAND'S BOOK, MARIJUANA: THE WORLD’S MOST UNDERSTOOD PLANT.
26
15th Century BC: Cannabis written about in medical texts:
Chinese Emperor Shen Nung, “the father of Chinese medicine,” is credited with discovering cannabis’ healing properties – lived around 2700 B.C. 1000 BC: Documented use in India as an anesthetic, to lower fevers, to aid sleep, and to cure dysentery 700 BC: Documented medicinal use in Persia 200 BC: Documented use in Ancient Greece for inflammation and eye treatments
COMPILED FROM JEFFREY FRIEDLAND'S BOOK, MARIJUANA: THE WORLD’S MOST UNDERSTOOD PLANT. 27
18th Century: Dr. William O’Shaughnessy wrote The Memoranda on India Materia Medical, the first English text on Indian medicinal plants O’Shaugnessy created a cannabis extract that reduced the spastic symptoms of tetanus and rabies, the pain of rheumatoid arthritis, and infant convulsions 1850: “Cannabis Indica” is listed in the Pharmacopeia of the US as a treatment for pain, alcoholism, opiate addition, and more. It started to be added to medicinal products Cannabis became an ingredient in “patent medicine,” along with secret ingredients like cocaine and opium 1889: an article in The Lancet described the use of cannabis to treat opium and choral hydrate withdraw symptoms
1850s.
Cannabis in Western Medicine
COMPILED FROM JEFFREY FRIDLAN’DS BOOK, MARIJUANA: THE WORLD’S MOST UNDERSTOOD PLANT.
The movement to ban cannabis in the United States
30
Cannabis is removed for the U.S. Pharmacopeia
1942
Roosevelt issues executive order allowing for hemp to be grown for the production of military necessities – lasts until the end of WW II
1942
Narcotics Control Act classifies cannabis as a narcotic
1956
The Controlled Substances Act classifies cannabis as a Schedule 1 narcotic
1970
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The Species Problem in Cannabis
by Ernest Small (published in1978)
hemp
legal frameworks are built upon today regulating hemp and cannabis:
This is what continues to cause the confusion between hemp and cannabis today.
Russo, E.B. 2008. Cannabinoids in management of difficult to control pain. Therapeutics & Clinical Risk Management 4(1):245-259.
Cannabinoids: 3 Varieties
➢THC was discovered by Dr. Raphael
Mechoulam in Israel
➢Until the discovery and isolation of
Delta-9 tetrahyrdrocannabinol, scientists did not understand what caused the psychoactive effect in Cannabis.
➢Since then, multiple components
including THC, CBD, CBC, CBG, not to mention terpines and flavonoids have been identified within the cannabis plant.
THC Discovered in 1964
Raphael Mechoulam - Father of Cannabinoid Research http://www.beyondthc.com/wp-content/uploads/2012/07/eCBSystemLee.pdf Delta-9 Tetrahydrocannabinol
➢In a study published in 1990, researchers
were able to clone a CB1 brain receptor, after much hypothesizing that there must be receptors in the brain for cannabinoids.
➢Since then, research has expanded to
include cloning CB2 receptors, understanding complex interaction of cannabinoids with our CNS, immune system and organs.
➢Dr. Kano and his colleagues in Tokyo
reported in 2009 about the influence of endocannbinoids on synaptic transmission.
Cannabinoid receptors in brain discovered in 1990.
Kano M1, Ohno-Shosaku T, Hashimotodani Y, Uchigashima M, Watanabe M. Endocannabinoid-mediated control of synaptic transmission. Physiol Rev. 2009 Jan;89(1):309-80.
Delta-9 Tetrahydrocannabinol
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How Cannabis Interacts with Our Bodies Methods of Ingestion:
By mouth via eating, ie. oil, butter, capsules, dummies, sprays, alcohol/oil based tinctures. By mouth via sublingual use of sprays or tinctures. By inhaling via smoking or vaporizing into lungs. By applying via topicals to skin. By suppository via rectal insertion.
From ProjectCBD.org
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Some other important cannabinoids:
pressure and seizure occurrence.
sedative effects.
antimicrobial properties, may decrease eye pressure.
diabetes and related metabolic disorders.
From National Center for Complementary and Integrative Health
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Visit PROJECT CBD
www.projectcbd.org/how-to/cbd-drug- interactions for EDUCATIONAL PRIMER ON CANNABINOID-DRUG INTERACTIONS
for any age. Cannabis acts as an adaptogen in the
dose opposite effect, just right dose leads to therapeutic effects.
Excerpt from ProjectCBD.org
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From National Center for Complementary and Integrative Health
Information gathered from article by Zerrin Atakan: Cannabis, a complex plant: different compounds and different effects on individuals. Ther Adv Psychopharmacol. 2012 Dec; 2(6): 241–254.
Effect THC CBD References
Receptor/nonreceptor effects
CB1
++ ± Rhee et al. [1997]; Iwamura et al. [2001]; Hayakawa et al. [2008]
CB2
+ ± Rhee et al. [1997]; Showalter et al. [1996]
Anti inflammatory
+ + Juknat et al. [2011]
Immunomodulatory
+ + Costa et al. [2007] CNS effects
Anticonvulsant
+ ++ Wallace et al. [2001]
Muscle relaxant
++ + Lakhan and Rowland [2009]
Anxiolytic
± ++ Zuardi and Guimaraes [1997]; Crippa et al. [2009]
Psychotropic
++ − Russo [2001]; D’Souza et al. [2004]; Borgwardt et al. [2008]
Antipsychotic
− ++ Zuardi et al. [1995]; Moreira and Guimaraes [2005]
Short-term memory problems
+ − Hayakawa et al. [2008]; Morgan et al. [2010]
Distortion of perception of time
++ − Karniol and Carlini [1973]; Anderson et al. [2010]
Neuroprotective antioxidant
+ ++ Juknat et al. [2011]
Antiemetic
++ ++ Parker et al. [2011]
Sedation
+ − Nicholson et al. [2004]; Russo et al. [2007] Information gathered from article by Zerrin Atakan: Cannabis, a complex plant: different compounds and different effects on individuals. Ther Adv Psychopharmacol. 2012 Dec; 2(6): 241–254.
Effect THC CBD References
Cardiovascular effects
Bradycardia
− + Benowitz and Jones [1981]
Tachycardia
+ − Gorelick and Heishman [2006]
Hypertension
+ − Batkai et al. [2004]
Hypotension
− + Gorelick and Heishman [2006]
Appetite/GI/metabolic Appetite
+ − Pertwee [2009]
GI motility (slowed)
++ + Di Marzo and Piscitelli [2011]
Metabolic/diabetes
+ − Di Marzo et al. [2011] Anticarcinogenesis
Glioma (apoptosis)
+ + Torres et al. [2011]
Lung cancer
+ ++ Athanasiou et al. [2007]; Ramer et al. [2012] Ophthalmological
Intraocular pressure (reduced)
++ + Green [1998]
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How Cannabinoids Effect Our Bodies
Terpenes: Scents & Therapeutic Effects
From National Center for Complementary and Integrative Health
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Medical Cannabinoids in Children and Adolescents: A Systematic Review
Shane Shucheng Wong, Timothy E. Wilens
Pediatrics
November 2017, VOLUME 140 / ISSUE 5
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Visit www.acog.org for more information and extensive research reference list.
We work with: Early intervention Students Families Communities And other client groups
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Occupational Therapy and Physical Therapy Services: Focus on improving reported symptoms (OT: in order to foster independent engagement in life’s occupations; PT: in order to promote the ability to move, reduce pain, restore function, and prevent disability.) Respond to questions about medical cannabis in our state. Some patients may be using it already. OTs frequently educate about medication benefits and drawbacks, and integrating medications into daily routines. OTs and PTs should monitor and document effects, physical, cognitive, emotional and communicate this with families and
individual child. Occupational Therapy and Physical Therapy Services:
In my experience with minors enrolled in DC’s medical cannabis program:
Medical cannabis use that is monitored by parents and healthcare practitioners and purchased from licensed dispensaries, can lead to improvements in academic learning, from early childhood through high school and into college. In speaking with a college-aged minor himself, using medical cannabis has made all the difference in anxiety levels and focus as he pursues his higher education.
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Christopher T. Campbell, PharmD, Marjorie Shaw Phillips, MS, and Kalen Manasco, PharmD, J Pediatr Pharmacol Ther. 2017 May-Jun; 22(3): 176–185.
Families report increased social engagement, eye contact, academic improvements with pediatric use of cannabis as medicine. You may advise to family to administer medicine before treatment, like we might suggest for other pain relieving medications. Work with your interdisciplinary team to support the child and family. Low and slow with dosage.
In speaking with parents of minors who use medical cannabis, they report…
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Educate yourself. Educate
Use compassionate language.
Conduct research! Participate in the emerging industry. Bring awareness to colleagues, families in your practice settings. Knowledge: decreases stigma. Understand: the political landscape regarding medical cannabis. It can be very challenging for families making choices about children’s lives. Children change so dosage changes! Help families go with the flow of life. Do what you always do! Be great communicators and professionals!
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Benefits of Legalization & Regulation of Cannabis as Medicine
harmful additives.
local fresh produce. Helps the consumer to be on the right side of the law. Improved education, research & public policy. Decreased STIGMA
Benefits of Legalization & Regulation of Cannabis as Medicine Recent and upcoming studies of pediatric patients: Epilepsy Behavioral Conditions Perinatal Brain Injury Neuroblastoma Chemotherapy and Oncology
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From National Center for Complementary and Integrative Health
IMPORTANT Maryland allows patients to obtain medical cannabis for ANY medical condition which is severe and for which other medical treatments have been ineffective
Children (under 18) can participate, but must have a caregiver assigned Currently, only MD residents can participate Insurance does not cover medical cannabis certification
Mailing cannabis is illegal...patients w. limited mobility should designate a caregiver Takes 2-5 weeks to become certified, but Hospice patients will be processed immediately Patients are limited to two ounces of flower or its equivalent on a rotating 30-day basis
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*Requires basic computer skills, like uploading a pic of your photo ID and using an email account
STEP 1: Create a patient account with MMCC at mmcc.maryland.gov STEP 3: Visit a MMCC registered provider (List available at medchi.org/medcan) STEP 2: (wait 2 – 4 weeks) Receive 16-digit patient ID # by mail STEP 4: Visit any MD dispensary w/ patient ID # and ID card
Certifying Providers Registration
Maryland
Certified Nurse Mid-Wives, Podiatrists and Dentists
and other medical professionals interested in learning about the clinical uses of cannabis. For more info, visit themedicalcannabisinstitute.org
Jackson is 16 now. He still has seizures. His shoulder has sustained
hiking our mountains each day.
Jackson is 16 now. He still has seizures. Currently, he is on a break from his cannabis medicine and is on Keppra and Dilantin. A surgical committee is reviewing his case to see if he is a candidate for surgery. Mom says he probably is not a candidate. He will soon get off the Dilantin and go back to a whole spectrum CBD cannabis oil, instead of the pharmaceutical grade cannabis option that had stopped working.
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On the front line, fighting for the rights of families around the country.
Knowledge is Power. Knowledge reduces stigma. Educate yourselves. Listen to families. Educate families. Educate other professionals. Provide access to local resources. Support the child and family the way you always would. Keep doing the incredible work you do!!!
Contact:
Elevate OT Consultants
Paula Querido Kahn, MS, OTR/L 301.244.9228 paula@elevateotc.com www.elevateotc.com