Potential Growth Opportunities in Cannabis

[Pacho From Cali]

I am not new. And I love the show Narcos!

How are pharmacists taking advantage of the current state of flux in the regulation of cannabis, especially in states where it is legal for recreational use? Are there any opportunities for growth in this sector considering the apparent flattening of the "traditional pharmacy growth curve"

I have always wondered about this during my day job. Patients ask me all the time what I think about using cannabis and quite honestly, I have no idea??? You get high and munchies

Hope to share and explore ideas. Cheers!

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[mustang sally]

It’s not legal here and probably won’t be anytime soon, so I don’t worry about it too much. Though I do have patients ask me about it on a semi-regular basis.

 

[GrapePropel]

I am not new. And I love the show Narcos!

How are pharmacists taking advantage of the current state of flux in the regulation of cannabis, especially in states where it is legal for recreational use? Are there any opportunities for growth in this sector considering the apparent flattening of the "traditional pharmacy growth curve"

I have always wondered about this during my day job. Patients ask me all the time what I think about using cannabis and quite honestly, I have no idea??? You get high and munchies

Hope to share and explore ideas. Cheers!

In the states that is it legal it is legally recreationally which I believe does NOT require a pharmacist to dispense. Would you need a pharmacist to dispense alcohol? no. By 2030 100% of the united states will have marijuana legal recreationally. So any possible gain in income/employment from marijuana will be limited.

 

[Sparda29]

I recommend it regularly to patients complaining of insomnia, nausea related to HIV drugs, pain management patients, depression patients.

 

[Abby Atwood]

I'm not opposed to marijuana, but I don't recommend it to patients. If you think of it as a medication, it is only moderately effective with a whole host of side effects. Unless the patient is maxed out on everything else, there are more effective and more tolerable treatments for nausea. It may be opioid sparing and there is a lower risk of dependence, but it appears to be only moderately effective for pain in studies. There are far more side effects than with non-opioid pain management. Although it's far from definitive, there is some data showing possible harm when marijuana is used for ptsd. Marijuana certainly wouldn't be my go to. I have zero opinion about recreational use.

 

[Chodronfan]

I looked into this on a cursory level. I also wonder about this during my day job! The CE credits I could get online to begin to understand medical marijuana use had dayglo lettering, glowing marijuana leaves and were from alternative sites that also advocated illicit drug use-not a lot of support from state board of pharmacies-although the Connecticut board of pharmacy offered a live course once and a few hundred registered pharmacists attended. So the continuing ed courses available did not appeal to me--I need more of a traditional "Pharmacist's Letter" format to consider the site legit. More importantly tho there is not a lot of EBM to support medical marijuana. That's what we do right? Follow evidence based medicine guidelines for the safest therapies. The JNC guidelines on Medical Marijuana are not out yet, so I don't think I can support the use of this any more than alcohol consumption.

 

[trailerpark]

Walmart just sent us all an email threatening termination if we have anything to do with it.

 

[WVUPharm2007]

The current administration does crazy, sudden things. I can easily imagine them raiding every dispensary in CA, WA, and CO under the force of federal law at some point. Until it goes off of sched I, I'm not mentioning it.

 

[vinny808]

Opportunities? Start your own edibles company. That's where the money's at. Unfortunately for me, I was never a fan of maruijuanna personally and I'm not a good baker/cook.

 

[Dred Pirate]

I support its use, and would recommend when off the clock, if I am currently working on the clock, or representing my employer, not gonna touch it in conversation, you never know who you are talking to and what they feel/believe, that can come back to bite your ass

 

[RxPreceptor]

So, yeah, could anyone imagine if opioids or BZDs were in brownie or edible form? Does not seem like a good idea, especially in "Mare-cuh".
I just can't look past this silliness & also the alternatives as well as lack of standardization.
Yes, I can see the view point of comparing marijuana vs. alcohol & that law does not always have to make sense; far too "grey" to ever say recommend.

 

[Seriously Serious]

I feel like cannabis is overrated, much like gluten-free products. All heat, no fire. Just my opinion until I see credible publications surface.

 

[CetiAlphaFive]

I feel like cannabis is overrated, much like gluten-free products. All heat, no fire. Just my opinion until I see credible publications surface.

Yup.

It's like a pro-bear crowd clamoring that bears can dance or ride bicycles.
Yes, they can, but not well.

 

[PharmDBro2017]

So, yeah, could anyone imagine if opioids or BZDs were in brownie or edible form? Does not seem like a good idea, especially in "Mare-cuh".
I just can't look past this silliness & also the alternatives as well as lack of standardization.
Yes, I can see the view point of comparing marijuana vs. alcohol & that law does not always have to make sense; far too "grey" to ever say recommend.

The current strains are standardized and list THC/CBD content down to the 0.01%, third party verified by lab analysis. Sounds standardized to me. Everything I see out of CO has this listed on it.

I feel like cannabis is overrated, much like gluten-free products. All heat, no fire. Just my opinion until I see credible publications surface.

Dr. Borgelt (Pharmacist and associate dean of University of Colorado) presented some very interesting research on opioid reduction with the utilization of cannabis as a breakthrough pain medication at the APhA 2016 conference. I wish I had the powerpoint slides... the results were significant.

Hell, anything that can decrease opioid use (including abuse and addiction) is a viable option and shouldn't be disregarded. If opioid addicted patients are claiming it works and are willingly decreasing their opioid intake... that says a lot anecdotally. I understand the need for more published literature, and we'll have to wait for that I guess.

 

[carbonex30]

University of Maryland School of Pharmacy had already drawn out a curriculum to train those within the medical marijuana industry and then later got spooked legally and cancelled the program just recently.

 

[CetiAlphaFive]

University of Maryland School of Pharmacy had already drawn out a curriculum to train those within the medical marijuana industry and then later got spooked legally and cancelled the program just recently.

That's sad.

 

[yungnaira]

University of Maryland School of Pharmacy had already drawn out a curriculum to train those within the medical marijuana industry and then later got spooked legally and cancelled the program just recently.

That is sad. I agree with the Schedule 1 fear, but I can help but see how many busy dispensaries are just giving out BS medical advice. Or they may be just serving a product to "patients" or maybe pharmacists should have a footprint of some sort in this industry. I guess that goes back to the idea of more "legit" literature, not holographic maryjane plants from an angelfire website

 

[Unchained]

You would be hard pressed to find a cancer patient who is not using cannabis as whole plant or extract medicinally. It aids in relief of their pain, stimulates appetite and gives their mind a break from the reality of their situation. You can continue to wait for studies and your patients will suffer in the meantime. The feds have their hands full with the Heroin/opioid epidemic. They are not chasing down pharmacists who recommend cannabis. Neither is your employer.

Abby Atwood, common side effects of cannabis include red eyes, euphoria, dry mouth, and occasional coughing. Compare this with the other meds you dispense and the SE's are mild.

The Cannabiz is an entrepreneurs dream space and pharmacists should be involved as most others HCPs are. It provides jobs, tax revenue, a tested safe product and relieves patients' suffering.

 

[Abby Atwood]

Abby Atwood, common side effects of cannabis include red eyes, euphoria, dry mouth, and occasional coughing. Compare this with the other meds you dispense and the SE's are mild.

I was more thinking of euphoria, sedation, intractable vomiting with sustained use, and ~10% addiction rate + the side effects that you listed. Compare that to acetaminophen or ondansetron. Again, other meds are better tolerated and I would max out those first. What meds were you thinking of?

 

[zelman]

I was more thinking of euphoria, sedation, intractable vomiting with sustained use, and ~10% addiction rate + the side effects that you listed. Compare that to acetaminophen or ondansetron. Again, other meds are better tolerated and I would max out those first. What meds were you thinking of?

Disregarding all others and just speaking about patients with chronic opioid prescription use: I will trade a 10% cannabis addiction rate for a 24.8% reduction in opiate overdose all day.

 

[owlegrad]

I know many people aren't going to believe me but it is possible to have cancer and not use cannabis. You won't be 'hard pressed' to find such a patient.

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[Zelda840]

I was pretty surprised when my sister starting using it after her cancer diagnosis. She's very wary of all drugs (doesn't like taking anything unless absolutely necessary), only eats organic, etc. but she said the oil is helpful for her.

 

[CetiAlphaFive]

You would be hard pressed to find a cancer patient who is not using cannabis as whole plant or extract medicinally. It aids in relief of their pain, stimulates appetite and gives their mind a break from the reality of their situation. You can continue to wait for studies and your patients will suffer in the meantime. The feds have their hands full with the Heroin/opioid epidemic. They are not chasing down pharmacists who recommend cannabis. Neither is your employer.

Abby Atwood, common side effects of cannabis include red eyes, euphoria, dry mouth, and occasional coughing. Compare this with the other meds you dispense and the SE's are mild.

The Cannabiz is an entrepreneurs dream space and pharmacists should be involved as most others HCPs are. It provides jobs, tax revenue, a tested safe product and relieves patients' suffering.

I recommended Marinol to a patient with really, really bad nausea that nothing helped with.
Wrote down brand / generic name so they could tell the MD at next appt.

Patient's wife called me back and told me the nurse said "they don't prescribe that kind of thing"

I faxed them the file for dronabinol and wrote something along the lines of, "Patient stated Nurse Broomhilda stated you couldn't prescribe this as a prescription.
This is a C3 prescription medication. Does your prescriber not have an active DEA number?"

 

[PharmDBro2017]

I was more thinking of euphoria, sedation, intractable vomiting with sustained use, and ~10% addiction rate + the side effects that you listed. Compare that to acetaminophen or ondansetron. Again, other meds are better tolerated and I would max out those first. What meds were you thinking of?

Lol at being addicted to cannabis. What a joke. Intractable vomiting comes from not knowing ones limits and then surpassing those limits in regards to consumption of cannabis.

The US is addicted to fuking fast food and cheeseburgers , do we ban that sh1t food? We are approaching statistics that reflect 1/2 people being obese. Maybe we should make McDonald’s C-I.


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[CetiAlphaFive]

Lol at being addicted to cannabis. What a joke. Intractable vomiting comes from not knowing ones limits and then surpassing those limits in regards to consumption of cannabis.

The US is addicted to fuking fast food and cheeseburgers , do we ban that sh1t food? We are approaching statistics that reflect 1/2 people being obese. Maybe we should make McDonald’s C-I.


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It sounds like you're emotionally invested in your stance on this issue.

Why do you say it's a joke?

Xanax has no mechanism for dependence either.
Are you saying that cannabis there's more robust evidence for cannabis than benzos?

 

[Abby Atwood]

Lol at being addicted to cannabis. What a joke. Intractable vomiting comes from not knowing ones limits and then surpassing those limits in regards to consumption of cannabis.

The US is addicted to fuking fast food and cheeseburgers , do we ban that sh1t food? We are approaching statistics that reflect 1/2 people being obese. Maybe we should make McDonald’s C-I.


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I don't completely disagree with you. It's kind of like you are responding to a totally different post from the one I wrote. Most of my patients would rather take an ondansetron tab than vape marijuana. Nothing in your response addresses the issue of greater side effect potential compared to more benign FDA approved meds. Since the relatively large number of side effects associated with marijuana use is my main issue with marijuana, I'm having trouble following your train of thought and how that train of thought connects with the evils of McDonald's. ????

As I pointed out earlier in this thread (someone else brought it up again recently as well), marijuana may be opioid limiting. That's one of the few uses I would consider; however, as previously stated, I would consider non-opioid pain management options first.

 

[PharmDBro2017]

It sounds like you're emotionally invested in your stance on this issue.

Why do you say it's a joke?

Xanax has no mechanism for dependence either.
Are you saying that cannabis there's more robust evidence for cannabis than benzos?

Benzos aren’t addicting? They have physical dependence and withdrawal symptoms associated with their use. Obviously you know this too.

If you’re addicted to weed you’re just a loser. You’re not physically addicted like opioids and benzos. Lettuce be reality....


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[CetiAlphaFive]

Benzos aren’t addicting? They have physical dependence and withdrawal symptoms associated with their use. Obviously you know this too.
If you’re addicted to weed you’re just a loser. You’re not physically addicted like opioids and benzos. Lettuce be reality....
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... Are you joking?

WHOOPS, just double checked myself.

Apparently benzos do have a mechanism for physical dependence.

Either way, it seems like you skipped the class that taught definitions for dependence, addiction, and dudeweedlmao

 

[smoke4joy]

As far as I know, you need to use only special medical marijuana strains, like MK Ultra. So that you reduce your chances of getting opioid use disorder. But you should recheck that information.

 

[Pacho From Cali]

Can we re-visit this topic? I swear every dispensary I go to, nobody knows wtf they are talking about. But clearly there are patients out there that derive benefit from cannabis. The whole medical vs recreational argument is complete BS to me... just a way to collect higher prices.

If you don't have a medical card you are limited to the amount you can receive as a recreational user and they also charge 2x prices in such instances..

Is anyone worried about drug-cannabis interactions. Does it differ if you consume it differently (inhale vs PO)? What is the mechanism of action for those terpenes everyone keeps talking about?

 

[Unchained]

Can we re-visit this topic? I swear every dispensary I go to, nobody knows wtf they are talking about. But clearly there are patients out there that derive benefit from cannabis. The whole medical vs recreational argument is complete BS to me... just a way to collect higher prices.

If you don't have a medical card you are limited to the amount you can receive as a recreational user and they also charge 2x prices in such instances..

Is anyone worried about drug-cannabis interactions. Does it differ if you consume it differently (inhale vs PO)? What is the mechanism of action for those terpenes everyone keeps talking about?

There is no standardization of training unfortunately. A few that are respectable are Oaksterdam University, Cannabis Training Institute, Americans for Safe Access and Hempstaff. I've taken Hempstaffs courses a few times and it's a solid intro course for budtenders.

There is a difference in route of admin. Inhalation whether vaping or flower acts in 5-10 minutes, and has a duration usually around 4 hours.
Edibles can be tricky because the onset of action can be anywhere from 30-90 minutes and can last from 4 to 8 hours. Patients may become impatient and take another dose thinking that it was strong enough and then overshoot their ideal dose. Much depends on the individuals hepatic enzymes and the presence of food in the GI tract. The metabolite 11-hydroxy THC is also several times stronger than delta 9.
I usually recommend the sublingual route because the action is quick and is easier to dose.

Considering terpenes I read an article by Ethan Russo, an experienced cannabinoid research scientist, about their mechanism of action and he has not found that any of them are pharmaceutically active by themselves on a receptor. They do interact with the cannabinoids in some fashion to enhance or modulate their effects. More research needs to be conducted probably in Israel. It is known that myrcene, the most abundant terpene, allows THC to cross the BB barrier faster allowing for a faster onset.

As far as drug interactions there are minor interactions but for most of the population there are no major interactions. We have thousands of years of usage to rely upon.

 

[BidingMyTime]

There should be an "other" option. I neither recommend nor discourage people form medical marijuana. Outpatient, I have had a couple of people ask about it, I recommend they follow up with the area's medical marijuana dispensary. Inpatient, we have had admits on it, they do not receive marijuana while in the hospital (no smoking allowed, and other forms are not approved by the FDA.) Personally, I think it's a good option for some people, but I don't know enough about it to recommend it in any specific case.

 

[Pacho From Cali]

American Society of Cannabis Pharmacists - American Society of Cannabis Pharmacists | DEFINING CANNABIS CARE

 

[gwarm01]

It feels like the winds are shifting on cannabis. I wouldn't be surprised to see it legalized federally within a decade, maybe much sooner. At the very least, it will seem silly to keep it federally illegal if the current trend continues and the majority of states have legalized it either medically or recreationally. I wonder how long these medical dispensaries will stay in business? When your options are going to a recreational store for pleasure, or to a standard pharmacy for an FDA approved product, why would you go to a medical shop?

 

[Unchained]

It feels like the winds are shifting on cannabis. I wouldn't be surprised to see it legalized federally within a decade, maybe much sooner. At the very least, it will seem silly to keep it federally illegal if the current trend continues and the majority of states have legalized it either medically or recreationally. I wonder how long these medical dispensaries will stay in business? When your options are going to a recreational store for pleasure, or to a standard pharmacy for an FDA approved product, why would you go to a medical shop?

Same reason people go to independent pharmacies: better service, more personalized service. I think the pharmacies would carry the mass produced low quality products which may be good for a portion of users. I see the industry advancing much like the craft brew industry. You may see the major chains buy the medical shops. It's a solid exit strategy that many are planning on.