By Janna Champagne, BSN, RN (Ret.)
As detailed in my article, Demise of Medical Cannabis in Oregon, our medical cannabis program in Oregon is failing to meet the needs of vulnerable OMMP patients, despite 24 years of legal Medical Cannabis access in our state. Medical professionals are lacking an understanding of cannabis science, which supports its therapeutic applications and harm reduction potential. Unfortunately, many barriers exist in improving receptivity of cannabis-naïve practitioners to learning about and utilizing cannabis in their practice, and the many contributors are detailed below.
Federal Schedule I placement is another deterring fear factor for medical professionals, who wrongly assume that cannabis (in the form of THC) meets these criteria for justifying harsh accessibility restrictions: 1. Harmful 2. Addictive/Potential for Abuse 3. No accepted medical use (1).
Then there’s the reality:
As early as 1988, we’ve had multiple federal judges rule in favor of descheduling cannabis, when presented with the above objective evidence that it doesn’t meet the criteria for Schedule I placement (7) . Yet here we are in 2022, with cannabis still under federal Schedule I restriction, effectively disallowing cannabis access for most patients in our country who might otherwise benefit. “When politics lack logic, follow the money” is the only clear rationale for this 34-year delay in patient justice.
Cannabis obviously competes with pharmaceutical profits, and from my experience educating thousands of cannabis patients, it’s common for patient success in medical cannabis therapy to concurrently reduce their reliance on prior pharmaceuticals. The leading contributor to politician recipients is pharmaceutical lobbyists, constituting more than double the next leading industry of oil and gas (8) This sure could explain why cannabis is still plagued by federal level restrictions, despite 60% of the country being pro-medical cannabis use (9).
Becoming a medical cannabis practitioner also requires overcoming the seemingly deliberate barriers to medical professionals service of cannabis patients. In Oregon, despite longstanding legal cannabis access for our patients, the medical and nurse licensing boards are notoriously discriminatory towards practitioners serving those who choose cannabis therapy (10). Ethical practitioners determined to serve cannabis patients must disregard the fear of possible licensure ramifications, and choose to follow their oath and serve patients without prejudice. Historically, many Oregon physicians and nurses have been subject to harassment, investigation, and even license discipline or retraction (11, 12). It’s for this very reason that I decided to retire my RN license this month (in good standing), to facilitate my ability to freely advocate without this inherent liability.
Oregon licensing boards are capitalizing on their own failure to adopt guidelines for their licensees working with medical cannabis patients, forcing ethical practitioners to operate in a licensure gray area. This entails risking licensure to abide by our ethical oath to provide nondiscriminatory service to patients in need. This situation exists in Oregon despite 24 years of legal patient access to medical cannabis, representing ample opportunity for our state’s licensing boards to support practitioner’s needs.
Here’s an example of the poor handling of this issue, by the Oregon State Board of Nursing (OSBN), which effectively placed a gag order on nurse education of Oregon cannabis patients in November of 2019. This decision effectively amplified the severity of the already critical educational gap experienced by our cannabis patients in Oregon. Nurses are uniquely qualified to provide patient education, and screen pharmaceuticals for possible interactions with cannabis, which represents the primary risk of cannabis therapy today.
This discriminatory OSBN cannabis nurse gag order increased the likelihood that medical cannabis patients would fail to meet reasonable therapeutic goals, or potentially suffer negative effects of combined pharmaceuticals (13). This ridiculous mandate resulted in Oregon nurses being legally allowed to administer cannabis to patients, meanwhile being strictly prohibited from educating these same patients about the substance being administered.
After 18 months of advocacy, OSBN adhered to forcible retraction by efforts of. My attorney Lee Berger, and the proven unlawful cannabis nurse gag order ceased in April 2021 (14). This was further supported by passage of HB3669 effective 1/1/22, which specifically protects nurses from license discipline for providing cannabis education to patients.
While this may appear as progress, we are effectively back to pre-2019 conditions, where Oregon nurses are forced to operate in a gray area, absent parameters to guide their patient health education practice, thereby risking their unencumbered license status. This, despite the 2018 release of National Counsel State Board of Nursing (NCSBN) guidelines, which specify the requirements of nurses education of cannabis patients, which were presented to every state board of nursing for adoption (15).
All of my attempts to educate or converse with OSBN board members on this topic since 2015 have been ignored, and deliberate ignorance and stigma are the main issue. The Oregon Medical Board is not handing this topic any better, and they have historically investigated and even rescinded cannabis physician licenses in response to their attempts to serve medical cannabis patient’s needs. It’s logical that these boards should accept some responsibility in lieu of pursuing disciplinary action, and instead examine how they are failing to support and guide the medical professionals ethical service of patients using cannabis.
Oregon boards’ refusal to examine the prolific medical cannabis education and science resources, and failure to adopt scope of practice guidelines for those serving this specialty cohort of patients, is a major contributor to the current failure to serve our vulnerable medical cannabis patient population. There is no excuse for licensing board’s discrimination against, and continued disenfranchisement of, our Oregon medical cannabis patients. We are bound by medical ethics, and patient autonomy and informed consent are both compromised as a result of our licensing boards’ cognitive dissonance.
Research supports the role of medical professionals to ensure cannabis patients achieve their health goals, and experience optimal therapeutic outcomes (16). It's time that we advocate for change, so that medical professionals may uphold our ethical duty to serve cannabis patients without prejudice or discrimination.
In 1998, Oregon was the second state in the US to legalize access to medical cannabis, when it launched our Oregon Medical Marijuana Program (OMMP). Despite our progressive beginnings, Oregon’s current protocols are failing to treat cannabis patients in accordance with our foundational medical ethics, and failing to meet their profound needs. As a result, many consumers opt to access cannabis through Oregon’s adult use/recreational access and pay the higher fees. Considering we are a destination for many “cannabis refugees”, and a trailblazer in cannabis legalization nationally, one would expect our program to be a highly effective example for duplication in newer legal states. Instead, our current regulations and barriers to ethical treatment of cannabis patients clearly exemplifies what must be avoided in order to ensure a success medical cannabis program.
Further supporting our need to make improvements is the Americans for Safe Access 2021 State of the States report, which graded Oregon’s medical cannabis program at only 54.43% overall, awarding us 374 of 700 points possible. Most notably, Oregon scores only 50/100 in the category of patient rights and civil protections, and 45/100 for affordability (1). Considering our 24-year tenure as a legal medical cannabis state, we should be achieving stellar marks. Instead, our low score reflects that we have many issues to address should we endeavor to honor Oregon’s cannabis trailblazer beginnings, and a noble intent to serve patients in need.
Unfortunately, Oregon’s opportunity to provide a duplicatable program, or be a shining example to newer cannabis-legal states is quickly dissipating. Instead, our mishandling of OMMP patients’ needs provides a precautionary tale for newer states, and guidance on what not to do. The following overview includes detailed insights on the many root contributors to our current disarray in Oregon, with the hope of targeting and improving these circumstances through the legislative process.
I’m a cannabis patient who happens to be an RN (Ret.), and I became an OMMP patient in 2014, so I have a unique perspective on this issue. The following insights are based on my personal experiences as a participating OMMP patient, and a cannabis-specialty nurse pioneer, who endeavored to educate patients, provide solutions to their barriers, and follow their profound outstanding needs for nearly a decade.
In order to become a legal medical cannabis patient in Oregon, one must meet specific health criteria, and have current (<90 day old) documentation providing a qualifying OMMP condition from their primary physician (2). The medical cannabis certification process often requires a separate doctor appointment not covered by insurance ($250 average), with one of many clinics signing OMMP authorizations as an exclusive offering. I experienced this exact process myself a few times, before eventually finding a Primary Care Physician that would provide my OMMP certification. Using a PCP for certification enables insurance coverage, and reduced the cost of my OMMP certification to my insurance copay. Unfortunately most PCP’s are unwilling to facilitate this process, which may present affordability issues and restrict patient’s ability to afford OMMP participation.
While we have a few amazing Oregon physicians providing education to patients along with their certification for OMMP, more often this interface between OMMP doctor and patient spans less than 15 minutes, and the patient walks away with only a signature. This was consistently my experience, regardless of the physician or type of clinic used to obtain my OMMP certification, where a signature was my only takeaway.
A signature alone does not constitute a prescription as is required for pharmaceuticals, which always requires a specific product, and detailed dosing, timing, and method of administration. Patients prescribed pharmaceuticals have the option to request education from their pharmacist, who can advise about possible side effects and interactions with other medications. Cannabis patient’s do not have this option, and are left seeking this information from layperson dispensary budtenders, who are not required to have any specialty education.
Our current medical cannabis approach in Oregon can be likened to a doctor giving a patient a blank prescription note with a signature only, and leaving them to visit the pharmacy, guess which product might be appropriate from thousands of choices, and figure out how to use it without any medical guidance. This is not conducive to optimal cannabis therapy outcomes, nor does it provide for appropriate education regarding patient considerations and possible risk factors (4).
Comparatively, if we were treating medical cannabis patients using our standard medical ethics, they would receive evidence-based education, product guidance, and a full screening for individual considerations including pharmaceutical interactions (3). Competent medical care of the cannabis patient is linked with optimal therapeutic outcomes, and reduced risk factors (4). While I know some amazing budtenders, even the best of them aren’t qualified to deliver medical guidance such as screening for pharma interactions, yet in Oregon this role defaults to them as the primary resource, thanks to the deliberate absence of reputable medical supports.
The current methods in Oregon completely disregard cannabis patients’ basic needs, in full breach of our foundational medical ethics, which mandate that medical professionals disregard any prejudice in our treatment of patients (4). Instead, cannabis patients are left to make these vital decisions on their own, resulting in extended experimentation with multiple products, while facing many added barriers compromising their ability to meet the desired health goals with cannabis (3).
Further driving my staunch advocacy and cannabis science education is the reality that medical professionals in Oregon will inevitably interface with patients using cannabis. Ethically this requires they have at minimum a basic understanding of cannabis, to facilitate patient autonomy (right to choose from therapy options) and informed consent (right to be fully educated on all options). Yet there is no minimum required education for them in Oregon, and consequently many don’t understand that cannabis is a viable therapeutic option.
Complicating matters, neither doctors nor nurses learn the science supporting the therapeutic potential of cannabis in their formal training, even though this master regulator system was discovered in 1992 patients (5). Lack of cannabis science education spawns rampant stigma and misconceptions among our medical community, inhibiting their ability to support cannabis patients. Those practitioners who happen upon the therapeutic potential of cannabis must independently pursue medical cannabis knowledge and education.
Many practitioners hear cannabis is “good for everything” and automatically write it off as a snake oil, not understanding that cannabis activates our EndoCannabinoid System, resulting in promotion of balance or homeostasis in EVERY other system in the body. Medical professionals also fail to recognize that all chronic illnesses are linked to EndoCannabinoid Deficiency, (Russo), which creates imbalances contributing to the root cause of disease. This clearly explains why cannabis may be effective for many different medical uses, as it seamlessly fills a vital nutrient deficiency linked with all illnesses (6). Practitioners who read the objective scientific education discover the rampant stigma and unwarranted restrictions on medical cannabis objectively don’t apply, and the brave advocate to overcome this major hindrance to supporting patients properly. It’s important that medical professionals understand and review the 35K + valid research articles, presenting strong evidence that cannabis is a safe and effective therapy with potential to benefit dozens of conditions, and is especially useful as a harm reduction tool.
Ethical cannabis patient care includes weighing risk vs benefit of all therapeutic options, and when cannabis is objectively considered vs the risks of pharma, it’s typically the first logical choice for those suffering chronic illness. This is thanks to an unsurpassed safety profile, minimal side effects, and profound research-supported efficacy. Unfortunately there are many barriers to educating medical professionals on this topic, as detailed in my article: Mission: Educate and Advocate.
It’s well past time that Oregon legislators, patients, and medical professionals advocate for medical cannabis patients and those bravely serving their profound unmet needs. This entails providing best practice guidelines to medical professionals, and allowing them to provide non-discriminatory service as dictated by medical ethics, without fear of retaliation. Lacking this progress, the ones who suffer most from stigma are underserved medical cannabis patients.
By Janna Champagne, BSN, RN, Autism Mom
Tens of thousands of parents in the US choose to administer cannabis to their child with Autism, a seemingly risky prospect considering the complex legalities of medical cannabis, and often punitive regulations. I’m one of those parents using cannabis to treat my daughter with Autism, and I can personally vouch for the angst and hope that often follows this decision. Fear often strikes while parents maneuver dark gray areas, in an attempt to improve our Autism children’s overall existence. In many of these cases, the benefits outweigh any hesitations, and cannabis wins as the preferred treatment approach.
As a holistic nurse focused on natural alternatives to pharma, residing in a cannabis-legal state, learning about medical cannabis therapy was a logical decision for me. Cannabis quickly became a major life passion, after saving my own teen daughter with Autism from out-of-home placement, due to a sudden onset behavioral crisis with puberty onset. Safety concerns arose with her high-level behaviors, including self-injury, aggressive attacks, and property destruction, and can attest that there’s nothing more helpless than watching your child suffer to the extent of injuring themselves and others in a blind rage.
Since witnessing the life-improving results in my own child with Autism, I have personally educated thousands of cannabis patients with a goal of optimizing their therapeutic outcomes. For most of my Autism clients, cannabis has provided safe and effective symptom relief, and eased many family’s crisis situations. As an added bonus, many have replaced potentially harmful mental health pharmaceutical medications, some of which have daunting side effects. When parents learn that cannabis, used as medicine for thousands of years, has an unsurpassed safety profile, and mild if any side effects, it’s often a far more appealing option.
Currently only two pharmaceuticals are FDA approved for Autism, both Antipsychotics named Abilify and Risperdone. In addition, many pharmaceuticals are prescribed as off-label use, including antidepressants (SSRI’s), Anxiolytics/Benzos (Ativan), Stimulants (Ritalin, Adderall), and Anticonvulsants (Lamictal). The mainstream pharmaceutical approach is risky, especially considering these drugs are not approved for use in children, and we have no clue what the long-term effects may be. The declared pharmaceutical side effects are bad enough, with potential to threaten quality of life (male breast development, extrapyramidal symptoms), or be life threatening (suicidal ideation, NMS, SJS) (1, 2).
In addition to positive patient outcomes, and desirable safety profile, the research also supports cannabis as an optimal approach for addressing Autism symptoms. Endocannabinoid System (ECS) Deficiency is a condition termed by Dr Ethan Russo MD which predisposes Autism (3). ECS Deficiency means the body is unable to produce enough endocannabinoids, known as vital nutrients that promote a state of optimal health balance (aka homeostasis). In addition to producing endocannabinoids, our ECS has receptors to uptake endocannabinoids throughout our bodies. In response to an imbalance, the ECS will produce extra endocananbinoids, and receptor activation intelligently rebalances whatever is out of skew (4, 5).
This includes some important areas for treating Autism such as neurotransmitter balance, immune modulation, and decreasing inflammation (6, 7, 8, 9). Amazingly, when our bodies can’t produce enough endocannabinoids to remain in balance, phytocannabinoids from the cannabis plant seamlessly and safely replace the deficient endocannabinoids. One contributor to Autism is EndoCannabinoid Deficiency, which may help explain why cannabis is a highly effective therapeutic option (10), by targeting root imbalances. In addition, cannabis may relieve common symptoms of Autism, including anxiety (11, 12), pain (13), and inflammation (14).
I hope this article helps expand your paradigm on this important topic of cannabis for Autism harm reduction, and I hope you will join me in advocating for improved legal access and expanded use of cannabis for Autism families in need.
Free list of optimal FLOW quality cannabis brands and free nurse guidance: www.cannabisnurseapproved.com
To learn more about Nurse Janna and her roles in the medical cannabis industry, please visit: www.jannachampagne.com
By Janna Champagne, BSN, RN
As a holistic nurse who specializes in application of medical cannabis therapy, knowing which formulations are optimal for targeting patient’s health goals comes with the territory. After years of working with thousands of clients using a variety of cannabis products, I began noticing a trend: that the various cannabis products are not created equal in achieving optimal therapeutic results. This prompted intensive research into different types of cannabis formulations, so I could objectively advise my clients to optimal products, which led to creation of the following FLOW criteria. Please know I do not benefit from the sales of any products, so my perspective is completely objective and without profit-bias or personal gain.
In order to understand the FLOW criteria, it’s helpful to know a bit about the Endocannabinoid System (ECS). Many people, including fellow medical professionals, have never heard about this master control system in our bodies, much thanks to our recent cannabis prohibition in the US. Now that cannabis is becoming more readily accessible for research, we have learned that it contains vital nutrients needed to support optimal health balance. Cannabinoids found in the cannabis plant, such as THC and CBD, attach with ECS receptors in our bodies, which promotes internal homeostasis or balance. We know that the underlying cause of disease is imbalance, so this balancing “Entourage Effect” or synergy of cannabis may be profoundly therapeutic for improving the root cause of symptoms (4).
Following are the FLOW criteria, all of which my nurses and I deem important for safe and effective medical cannabis use. We educate these criteria to every client we serve, since our goal is ensuring that cannabis patients find the highest-quality products available.
Flower-Derived: The most potent spectrum of cannabinoids and synergistic components is found in formulations derived from cannabis flower. Since industrial hemp is sparse in flowers, often producers source oil from less optimal parts of the industrial hemp plant, such as the stalks and stems. While industrial hemp has many applicable uses, including textiles, bioaccumulation (cleans soil), building materials like Hempcrete, when it comes to medicinal potency, industrial hemp leaves a lot to be desired (9).
To clarify, many CBD producers have a USDA hemp license allowing them to legally produce and distribute hemp throughout the United States, because their cannabis flower products meet the federal hemp regulations (less than 0.3% THC). A new term, “Medical Hemp”, was recently coined by optimal CBD oil producers, to differentiate their products derived only from CBD hemp flower, the best choice for optimal quality. Medical hemp products have the added convenience of shipping legally anywhere in the United States.
Lab tested: Oregon is one of a few states that are fortunate in this regard, as they require every product on a dispensary shelf to be lab tested by a state-certified facility. Lab testing is important to know cannabinoid content, potency or strength, and to rule out contamination with toxins. Lab testing allows clients to consistently dose with improved accuracy, which is important when using cannabis for health purposes. Labs are the only conclusive method for knowing exactly what’s in a formulation, without reliance on strain name (which may not be accurate) to know which components are present.
Terpene lab results reflecting the cannabis strain’s profile are not as commonly available. When available, having this information is optimal to predict a cannabis product’s therapeutic benefits, and the terpene profile is also used to determine whether a retail product is categorized as sativa (energizing) or indica (sedating) (11).
Organic: This may seem like an obvious requirement, for those who understand the harm that toxins may cause. Unfortunately, USDA Organic certification is not yet available for all forms of cannabis farming/processing, so we rely on labs to rule out any toxic pesticide, fertilizer, mold, or heavy metal contamination. We know, especially with already sick patients, that adding toxic exposure may be harmful to their health, and could potentially negate the benefit received from cannabis. The recent theory linking Cannabis Hyperemesis Syndrome, or excessive nausea, vomiting and abdominal upset, with Neem pesticide toxicity (same symptoms) further supports the importance of using lab testing to ensure product is clear of toxins, and verified safe for medical use (10).
Whole Plant Spectrum: Products concentrating the cannabis flower as nature intended, with little to no loss, are the best option for therapeutic cannabis use. Cannabis formulations extracted using food grade ethanol or infusion methods are preferred to meet these criteria. Whole plant spectrum formulations conserve and contain hundreds of flower-derived cannabis ingredients, most of all of which remain intact in the final product. In comparison, CO2 processing nets around a dozen compounds (isolate cannabinoids + terpenes), and isolate contains only one compound (one cannabinoid). These lesser methods are popular despite research and patients outcomes clearly supporting that the Gestalt theory applies: the whole cannabis flower is truly greater than the sum of its parts (2).
Cannabis is a very complex plant, containing over 140 cannabinoids, 200 terpenes (similar to essential oils), bioflavonoids, chlorophyll, essential fatty acids, and antioxidants (1). Research supports that synergy between all of the 500+ compounds enhances the "Entourage Effect" experienced by the consumer, defined as the ability of cannabis to promote homeostasis. Many of the new and popular cannabis extraction methods in today’s cannabis industry, such as CO2 extraction, isolation, or fractionation, remove many of these ingredients contributing to the Entourage Effect (8).
It’s the balancing effect (homeostasis) that we specifically seek when the patient's goal is improved health outcomes that reach beyond superficial symptom management (4). Research comparing the efficacy of whole plant spectrum vs isolate cannabis clearly reflects that isolates, even with added terpenes comparable to CO2 and "Full Spectrum" products, aren’t as effective for exerting the balance we seek for optimal health outcomes. Research reflects that whole plant spectrum works as well or better than isolate CBD at 20-25% of the dose of isolate (or co2), thereby improving health outcomes for far less cost to the patient. Research also reflects that isolate and co2 extractions exert a bell curve response, narrowing the therapeutic dosing range, and risking little to no benefit with intensive dosing as indicated for serious conditions like cancer. In comparison, whole plant spectrum exerted a more predictable response, increasing anti-inflammatory response with higher dosing (2, 3, 6).
Another emerging issue is the increased risk of using human-altered cannabis products. This insight follows a tragic event in February 2020, when a patient using CBD for two years switched to a human-altered liposomal formulation, and immediately suffered onset of Stevens-Johnson Syndrome, a known adverse effect of her long-time medication, Meloxicam. It’s important to note that this patient did not experience any interactions between meloxicam and the first CBD formulation, despite a shared metabolic pathway (CYP450). Upon switching to a liposomal CBD, that same medication was potentiated to such an extent that she died only two days later.
Now that CBD is freely available for purchase, and most consumers don’t understand that it may interact with pharmaceuticals, this situation could repeat. This is another reason to ensure your product's effects are predictable, since we don't yet understand how our tampering with whole spectrum changes bioavailability and metabolism of cannabis with concurrent pharmaceuticals. When it comes to optimal therapeutic quality, based on my experience and the research, whole plant spectrum cannabis is the frontrunner.
For more information on FLOW criteria and a list of certified suppliers, please visit: www.cannabisnurseapproved.com
1. Echo (2017). Other compounds in cannabis. Retrieved from: https://echoconnection.org/other-compounds-in-cannabis-terpenes-chlorophyll-etc/
2. Blasco-Benito (2017). Appraising the entourage effect. Retrieved from: https://www.ncbi.nlm.nih.gov/labs/pubmed/29940172-appraising-the-entourage-effect-antitumor-action-of-a-pure-cannabinoid-versus-a-botanical-drug-preparation-in-preclinical-models-of-breast-cancer/
3. Pamplona (2018). Potential clinical benefits of CBD-rich Cannabis extracts over purified CBD in treatment-resistant epilepsy: observational data meta-analysis. Retrieved from: https://www.biorxiv.org/content/biorxiv/early/2017/11/01/212662.full.pdf
4. Russo, E. (2001). Cannabis and cannabis extracts: greater than the sum of their parts? British Journal of Pharmacology. Retrieved from: http://cannabis-med.org/data/pdf/2001-03-04-7.pdf
5. Echo (2017). Major and minor cannabinoids in cannabis. Retrieved from: https://echoconnection.org/a-look-at-the-major-and-minor-cannabinoids-found-in-cannabis/
6. Gallily (2015). Overcoming the Bell-Shaped Dose-Response of Cannabidiol by Using Cannabis Extract Enriched in Cannabidiol. Retrieved from: http://www.scirp.org/Journal/PaperInformation.aspx?PaperID=53912#.VP4EIildXvY
7. Fundacion Canna (2017) Cannabis bioflavonoids. Retrieved from: http://www.fundacion-canna.es/en/flavonoids
8. Echo (2017). CBD Alcohol or CO2 Extraction. Retrieved at: http://www.cbd-hemp-oil-drops.com/articles/57-cbd-alcohol-or-co2-extraction
9. Price, M (2015). The difference between hemp and cannabis. Medical Jane. Retrieved online at: https://www.medicaljane.com/2015/01/14/the-differences-between-hemp-and-cannabis/
10. Mishra, A., & Dave, N. (2013). Neem oil poisoning: Case report of an adult with toxic encephalopathy. Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 17(5), 321–322. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841499/
11. Cannabis Safety Institute (2014). Standards for cannabis testing laboratories. Retrieved online at: http://cannabissafetyinstitute.org/wp-content/uploads/2015/01/Standards-for-Cannabis-Testing-Laboratories.pdf
12. Han Y et al. Commercial cannabinoid oil-induced Stevens-Johnson Syndrome. Case Reports in Opthalamological Medicine. 2020.
by Janna Champagne, BSN, RN
In the winter, boosting your health can make the difference between chronic bouts of illness and staying well. The fall and winter months can be especially hard on our health, between the weather shifts, having less sunlight exposure, and the holiday stress. The following are 5 simple tips for supporting optimal wellness:
1. Support Your Lymph System: Our lymph system is like a drain that helps to remove waste and balance the immune system. Daily care of the lymphatic system helps the body work better and keeps the immune system operating the way it should. Consider the following supports:
a. Daily Detox Tea Recipe (and it tastes amazing!): https://draxe.com/recipe/secret-detox-drink/
b. Daily Rebounding Session: https://www.wellbeingjournal.com/rebounding-good-for-the-lymph-system/
2. Limit Incoming Toxins: Our immune system functions best when we limit our exposure to environmental toxins. Toxins can contribute to inflammation and suppress our immune system, making us more vulnerable to infection and illness. Consider the following strategies to limit environmental toxin exposure:
a. Consume Primarily Organic foods
b. Use personal products that are free of parabens, sulfates, or synthetic perfumes. For healthier scented products, look for those with essential oils in the ingredients, or purchase unscented and add your own favorite essential oil or blend.
c. Filtered Water: Depending on where you live, water may have high levels of contaminants. Using filtered water can make a big difference, both in drinking/cooking and in the bath/shower. Filter prices vary, and even the most affordable options are worth the investment.
3. Stress Management: The holidays often create extra levels of stress, for various reasons. Stress is a major factor in illness, so it’s important to seek strategies to alleviate stress during the more chaotic times. To better stress management, the first step is to be aware of its impact. We often can’t control the external sources of stress, but we can learn to control our own response. The next time you feel stressed, try to notice the tension in your body and make a conscious decision to decrease that response. Practice stress-relieving strategies that appeal to you, whether it’s deep breathing, meditation/prayer, or something like exercise or reading. Find what is meaningful, and what works best for you, and use it at every opportunity.
4. Consider Cannabis Supplementation: CBD is a non-intoxicating component of cannabis that has far-reaching immune benefits supported by research, including balancing the immune system, decreasing inflammation, and killing bacteria as strong as MRSA. Not all cannabis formulations are equal for medical use and knowing what to purchase can be confusing. Here’s our blog article on optimal cannabis formulations for guidance on choosing the best product options (we don’t benefit from ANY product sales): http://www.integratedholisticcare.com/blog
5. Emergency Response: If you start to feel sick despite your efforts to stay well, there are immediate interventions that may help to reduce the length and severity of illness. At the first sign of a cold/flu, taking supplements like Vitamin D3, Vitamin C, Zinc, and Virastop enzymes can offer a substantial immune boost. Other options include medicinal teas (Yogi is a reputable brand), and food-sourced support like Elderberry syrup or Echinacea lozenges. Most importantly, listen to your body. Winter is the season we are supposed to slow down. So try to honor the times you feel extra rest is needed, or shorten your to-do list if possible. You’ll feel better in the long run.
All of us at Integrated Holistic Care wish you all the best wellness possible this winter solstice, and hope the above suggestions are helpful for optimizing your health!
By Janna Champagne, BSN, RN
I was first introduced to the topic of epigenetics in 2008 at a conference in Florida, and as a medical professional I was immediately intrigued. Epigenetics is defined as the environmental impact on gene expression, which explains how genes can be influenced to alter our genetic health expression, sort of like an on/off switch. Depending on exposures, environmental interaction with genes may result in positive or negative impacts on our health. Pretty exciting, since this exemplifies that our overall health is not determined solely based on what our parents contributed. Instead, we as individuals have the ability to positively affect our inherited risk factors for familial diseases (1).
Correctly applied Nutrigenomics (genetically-individualized nutrition) is a positive environmental factor with the potential to improve genetic predisposition to illness, by slowing or halting many contributors to disease (1). This supports what we’ve known for a long time: that given what it needs, the body can balance and heal itself.
Over the years of helping clients optimize their health through nutrigenomics and other alternatives to pharma, I’ve seen some amazing results like successful weaning off harmful pharmaceuticals (with physician oversight), and reversals of difficult to treat conditions like cancer and autoimmune disease. knowledge of genetics has since crossed over another area of passion: medical cannabis therapy.
Contrary to it’s abhorrent social reputation in the last century, cannabis is proving to be a source of vital nutrients needed to maintain balance in the body, and is therefore a perfect compliment to almost any nutrigenomic regimen. Of course, unique varieties of cannabis exert varying effects on individuals, an issue that may be resolved through a new process allowing for genetic guidance of cannabis therapy.
As you may have already guessed, genetically guided cannabis is very cutting edge, and a bit complex. It’s the overlap of several emerging sciences: the endocannabinoid system, human genetics, cannabis genetics, and botany are all in the mix. If this intrigues you, then you’re definitely a kindred cannabis nerd.
Here’s a little background info: All humans have a master control Endocannabinoid System (ECS), which is so important that it’s widely argued that life would not be possible without its balancing influence (1). The ECS produces endocannabinoids that interact with our body’s receptors, and when activated they promote balance throughout the body systems. (4) Since the role of the ECS is homeostasis or balance, and the underlying cause of most chronic illness is some sort of imbalance, it makes sense that endocannabinoid deficiency (lacking what’s needed to maintain homeostasis) is linked to chronic illness (5). Since plant derived phytocannabinoids exactly mimic our internally-made endocannabinoids, cannabis supplementation can help fill the EC deficiency gap, and promote the balance necessary to recover health. (3)
This explains how medical cannabis therapy may benefit those suffering chronic illness, and many report cannabis is more effective than pharmaceuticals sans the dangerous side effects. Cannabis is very safe overall, and since it promotes underlying body balance it’s also a powerful tool for targeting the imbalances causing many diseases. (3) Very few pharmaceuticals exert a curative effect, making cannabis a far superior intervention for chronic illness.
Endocannabinoid deficiency is especially prevalent in today’s society, thanks to nearly a century of cannabis prohibition (lacking phytocannabinoid accessibility) combined with human ECS pathway mutations that may impair our ability to produce endocannabinoids. (5) Every individual has a unique genetic profile, and mutations may reflect predisposition to ECS deficiency, along with many other contributors to imbalance. The cannabis plant contains many medicinal components, including 140+ phytocannabinoids and 200+ terpenes, thereby providing a broad spectrum of the components needed to fill an individual’s ECS deficiency profile (4).
Assessing an individual’s genetics specific to the Endocannabinoid System (including other system pathways that overlap) can help to guide cannabis therapy, which is proving useful to decrease the “trial and error” phase upon starting cannabis, and provide more consistently positive health outcomes. There are several pathways assessed to determine which cannabis components might best fit an individual’s needs, and genes considered include those from the following pathways (6):
-Serotonin/Dopamine and GABA/Glutamate -Neurotransmitter pathways (cannabinoid profiling, terpene guidance) 9
-Vitamin d3/gcmaf (ECS receptors affected) 10
-Choline pathways (mutation predispose ECS deficiency) 11
-Immune system pathways (for targeted cannabinoid therapy) 12
-AKT1/Schizophrenia predisposition-only known contraindication to THC (13)
-Methylation pathways (addressing mutations mitigates risk factors) 7
and many more...
The process of genetic screening is especially important in pediatric applications of cannabis therapy, because methylation pathway mutations predispose neurodevelopmental risks with child/adolescent use of cannabis (7). Methylation mutations are linked to many chronic illnesses, and sickness is the main reason most seek cannabis therapy for a minor child, reflecting that neurodevelopmental risk factors may be inherent in treating with cannabis (8).
TO BE VERY CLEAR: This doesn’t mean that children and adolescents (even with methylation mutations) shouldn’t use medical cannabis when it’s indicated. Instead this supports that methylation should be optimized with targeted supplementation (nutrigenomics) to mitigate this risk factor, in addition to following medical standards of balancing possible benefit and risk of any intervention.
Genetics are important, but it’s equally imperative to work with a medical professional that understands the basis of an individual’s condition(s), plus other unique cannabis considerations such as medication interactions, etiology of symptoms, and lifespan risk factors. Mitigating as many contributing factors as possible, balancing risk vs benefit, and assessing client goals as a holistic process reinforces optimal medical outcomes. Luckily there are knowledgeable practitioners available to assess genetic cannabis risk factors, and optimize health further through nutrigenomics.
In addition to screening genetics to improve cannabis therapy, full genome assessment and applied nutrigenomics may help address other pathway mutations implicated in chronic illness. My favorite analogy to describe the potential of combining nutrigenomics and cannabis therapy is a sink that’s overflowing with imbalances, thereby causing chronic illness symptoms. Starting cannabis therapy helps the body start balancing, and can be likened to taking the plug out of the drain in this overflowing sink scenario. Applied nutrigenomics can slow or turn off the running faucet. This is a powerful duo for chronic illness indeed.
My hope is to spread knowledge about this very pertinent issue, so that patients and medical professionals alike are aware of the power of using human genetics to guide cannabis therapy. I truly believe this approach represents the future of medical cannabis, and offers a viable option for comprehensive healing of the widespread chronic illness found in our society today.
For more information about genetically guided therapy and nutrigenomics assessment, please visit our website at: www.integratedholisticcare.com
1. Watters, E.(2008) DNA is not destiny. Accessed online at: http://www.geneimprint.com/media/pdfs/1162334912_fulltext.pdf
2. Piomeli, Daniele (2002). The molecular logic of endocannabinoid signaling. Nature Reviews Neuroscience 4, 873-884 (November 2003). https://www.nature.com/nrn/journal/v4/n11/full/nrn1247.html
3. Department of Chemistry, Kennesaw State University, 1000 Chastain Road, Kennesaw, GA 30144, USA (2002). Endocannabinoid structure-activity relationships for interaction at the cannabinoid receptors. Prostaglandins Leukot Essent Fatty Acids. 2002 Feb-Mar;66(2-3):143-60. https://www.ncbi.nlm.nih.gov/pubmed/12052032
4. Grant, I., & Cahn, B. R. (2005). Cannabis and endocannabinoid modulators: Therapeutic promises and challenges. Clinical Neuroscience Research, 5(2-4), 185–199. http://doi.org/10.1016/j.cnr.2005.08.015
5. Smith, SC, Wagner, MS(2014). Clinical endocannabinoid deficiency (CECD) revisited: can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuro Endocrinol Lett. 2014;35(3):198-201. https://www.ncbi.nlm.nih.gov/pubmed/24977967
6. DiMarzo, V., Lutz. B.(2014). Genetic dissection of the endocannabinoid system and how it changed our knowledge of cannabinoid pharmacology and mammalian physiology. http://onlinelibrary.wiley.com/doi/10.1002/9781118451281.ch4/summary
7.Neuroscience & Biobehavioral Reviews. High times for cannabis: Epigenetic imprint and its legacy on brain and behavior. Neuroscience & Biobehavioral Reviews, May 12, 2017. http://www.sciencedirect.com/science/article/pii/S0149763417300659
8. Lertratanangkoon K, Wu CJ, Savaraj N, Thomas ML. Alterations of DNA methylation by glutathione depletion. Cancer Lett. 1997 Dec 9;120(2):149-56. https://www.ncbi.nlm.nih.gov/pubmed/9461031
9. Sammit, S., Owen, MJ, Evand, J., et al (1995). Cannabis, COMT and psychotic experiences. Br J Psychiatry. 2011 Nov;199(5):380-5. https://www.ncbi.nlm.nih.gov/pubmed/21947654
10. Siniscalco, D., Bradstreet, J., et al (2014). The in vitro GcMAF effects on endocannabinoid system transcriptionomics, receptor formation, and cell activity of autism-derived macrophages. Journal of Neuroinflammation 2014, 11:78. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996516/
11. Basavarajappa, B. S. (2007). Neuropharmacology of the Endocannabinoid Signaling System-Molecular Mechanisms, Biological Actions and Synaptic Plasticity. Current Neuropharmacology, 5(2), 81–97.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2139910/
12. Cabral GA1, Staab A.(2005). Cannabis effects on the immune system. Handb Exp Pharmacol. 2005;(168):385-423. https://www.ncbi.nlm.nih.gov/pubmed/16596782
13. DiForti, M., et al (2012). Confirmation that the AKT1 (rs2494732) genotype influences the risk of psychosis in cannabis users. Biol Psychiatry. 2012 Nov 15;72(10):811-6. https://www.ncbi.nlm.nih.gov/pubmed/22831980
By Janna Champagne, BSN, RN
The role of the Endocannabinoid System in our body, which is activated by cannabis intake, is to maintain balance within the systems of our body. Depression and bipolar disorders signify that underlying imbalances exist, specifically in neurotransmitters (i.e. dopamine and serotonin), and this imbalance is what causes debilitating mental health symptoms. Upon appropriate intake of medical cannabis, the body is activated to intelligently balance what is askew. Of course, it’s always best to work with a medical professional experienced in mental health disorders to individualize cannabis recommendations, since some formulations may actually exacerbate mental health symptoms. Unfortunately, some clients seek my services after failing to find relief using generalized cannabis supplier protocols, or after blindly following the recommendations of a dispensary employee lacking both a medical understanding of individual disease mechanisms and the potential for cannabis-medication interactions. I urge anyone who is seriously considering medical cannabis therapy to pursue expert medical oversight, for which cannabis nurse consultants represent a viable option for obtaining optimal client outcomes.
By Janna Champagne, BSN, RN
As cannabis progresses toward government deregulation, and more domestic research is allowed and supported, we can better understand the potential of cannabis to replace pharmaceuticals in a manner that is condition-specific. Many patients rely on anecdotal testimonies or case studies when seeking support and knowledge about using cannabis effectively. Cannabis nurses are on the forefront of learning optimal formulations, and appropriate clinical application of cannabis’ numerous components, as we guide individual clients through the process of discovering their optimal medical cannabis regimen. Once cannabis research is openly allowed in our country, the patient outcomes we witness first-hand will be objectively supported, representing a positive stride toward mainstream acceptance of cannabis as an alternative to pharmaceuticals.
by Nurse Janna, RN, BSN, Holistic Nurse & Warrior ASD Mama
In the Autism Parent community, word spreads FAST. If you’ve been paying attention, you’ve surely heard the stories about seemingly miraculous results from a parent who discovered cannabis for their ASD child. I’m one of those parents, and can personally vouch for the extreme positive potential of this most controversial herb. *Disclaimer: Legally accessed and administered*
As a holistic nurse focused on natural alternatives to pharma, residing in a cannabis-legal state, learning how best to apply medical cannabis therapy was a logical decision for me. Cannabis quickly became a major life passion, as this amazing plant was integral in saving my own ASD teen daughter from out-of-home placement. I thought of doing what many consider unthinkable (foster placement), due to safety concerns when my daughter suffered a major puberty crisis, with high-level behaviors including self-injury, aggressive rages, and property destruction. I can attest: there’s nothing more helpless than watching your child suffer to the extent of injuring themselves and others in a blind rage.
The trauma of puberty crisis is experienced by an estimated 50% of Autism families, and is therefore an exceedingly common presentation during many a child’s coming-of-age (1). Having been there myself, I completely empathize and offer hope of resolution upon connecting with kindred ASD parents. After recovering my own daughter from her ASD puberty crisis, my resulting passion turned our trauma into purpose: to help other families.
I’ve since personally guided many ASD parents through optimal application of cannabis therapy. For most it has provided safe and effective relief, and eased their family crisis. As an added bonus, many using cannabis have successfully weaned off harmful mental health pharmaceutical medications, some of which have permanent side effects (google extra-pyramidal symptoms, not a good scenario). *Disclaimer: I highly recommend medical oversight for pharmaceutical weaning.*
The only shame of this process is how many parents don’t consider cannabis therapy until every other option to manage their ASD child is completely exhausted. No judgment by the way. It’s lack of education about cannabis that prevents consideration of this safe and effective option. Now that word is spreading, many parents are using cannabis as a crisis prevention strategy (sometimes well before puberty) and the ASD biomed treatment addage “the earlier the better” certainly seems to apply.
I want to be clear that the goal of medical cannabis use for ASD isn’t for parents to get their kids “high” to mellow them out. Instead, the goal is to improve internal balance and optimize function, through individualized microdosing and experimenting to find the “sweet spot” titration. The experimentation process is needed because individual cannabinoid needs vary greatly. With successful medicinal cannabis titration, even with use of psychotropic components such as THC, a “high” is rarely discernable.
Now for the science supporting cannabis therapy for Autism. First and Foremost: Endocannabinoid Deficiency Predisposes Autism (2). Read that a few times and let it sink in for a minute. For those who are brand new to the Endocannabinoid system (ECS), think of it as the motherboard that manages the interactions within and between our body’s organ systems. The role of the endocannabinoid system is homeostasis (maintaining balance) throughout the rest of the body. In response to an imbalance, the ECS will intelligently rebalance what’s out of skew. This includes some important areas for treating ASD such as neurotransmitter balance, immune modulation, and mitigating inflammation (3). In fact, one cause of ASD is genetic Endocannabinoid System receptor mutations which lead to ECS deficiency (4). The cannabis plant has the most prolific source of phytocannabinoids available to supplement what is lacking in the ECS of those with ASD. This explains why cannabis can have such a profoundly positive impact as an intervention for Autism.
So, how exactly does cannabis benefit one with Autism? Well, let’s start with symptom management. Cannabis is very effective at minimizing or completely stopping extreme Autism behaviors before, during, or after puberty. The anxiolytic (5), pain-relieving (6), and anti-inflammatory (7) effects of cannabis seem to come in particularly handy for managing Autism behaviors. In addition, cannabis is considered very safe with much milder side effects compared to its pharmaceutical alternatives (8). Hence the symptom management piece that is renowned for alleviating harsh situations in ASD families, even when at or near their breaking point.
In addition to its symptom management efficacy, cannabis also promotes balance of some underlying issues that cause Autism...hence my inclination to call it potentially “curative”. Biomedical ASD 101: Autism is caused by a combination of genetic and environmental impacts that result in pervasive imbalances, predominantly in the gut, brain, and immune systems (9). When cannabis activates the Endocannabinoid System, the effect includes balancing of all three of these major organ systems gone defunct in ASD. Cannabis is immune modulating (10), neurotransmitter balancing/neuroprotective (11), plus anti-inflammatory to the gut and brain (12), to name a few of the profound curative effects. Cannabis itself has definitely been one of the “big hitters” in recovering my own ASD daughter, who made more progress between the ages of 11-14 (post cannabis) than in the biomed-heavy decade prior.
If you have a child with Autism who you believe may benefit from cannabis, but are unsure where to begin, I highly recommend connecting with Mother’s Advocating Medical Marijuana for Autism (MAMMA). I urge you to seriously consider this safe and effective therapy if you have a child with Autism.
In the next blog I will review optimal starting formulations and cannabis components that are especially helpful for individualizing cannabis therapy. I hope this information is helpful for those new to cannabis for Autism, in understanding the powerful potential of this amazing plant to improve what is often considered untreatable by mainstream medicine.
For more information about my consultation services, please visit:
Ballaban-Gil, K. et al (1996). Longitudinal examination of the behavioral, language, and social changes in a population of adolescents and young adults with autistic disorder. Pediatric Neurology, 15(3):217–223
Chakrabarti, B., Persico, A., and Battista, N.(2015). Endocannabinoid signaling in autism. Neurotherapeutics, 12(4): 837–847.
De Petrocellis, L., Cascio, M. G. and Di Marzo, V. (2004) The endocannabinoid system: a general view and latest additions. British Journal of Pharmacology 141, 765–774.
Dilja, D., Krueger, N. (2013) Evidence for a common endocannabinoid-related pathomechanism in autism spectrum disorders. Neuron: 78(3):408–410.
Blessing, E., Steenkamp, M., Manzanares, J., Marmar, C., (2015). Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics: 12(4):825-36.
Russo, E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and Clinical Risk Management, 4(1), 245–259.
Nagarkatti, P., Pandey, R., Rieder, S. A., Hegde, V. L., & Nagarkatti, M. (2009). Cannabinoids as novel anti-inflammatory drugs. Future Medicinal Chemistry, 1(7), 1333–1349.
Medical Marijuana vs. Traditional Pharmaceuticals (2016). Medicinal Marijuana Association, accessed online at: http://www.medicinalmarijuanaassociation.com/medical-marijuana-blog/infographic-medical-marijuana-vs.-traditional-pharmaceuticals
Caroline, G., Lopes, S., Silva, P., et al (2011). Pathways underlying the gut-to-brain connection in autism spectrum disorders as future targets for disease management. European Journal of Pharmacology, 668:S70–S80.
Thomas, W., Klein, L., Newton, C., Larsen, K., et al (2003). The cannabinoid system and immune modulation. Journal of Leukocyte Biology. 74(4): 486-496
Hampson, J., Grimald, M., Axelrod, J., Wink, D, (1998). Cannabidiol and tetrahydrocannabinol are neuroprotective antioxidants. National Academy of Medial Sciences, Vol. 95, pp. 8268–8273.
By Janna Champagne, BSN, RN
As a holistic nurse focused on natural alternatives to pharma, also residing in a cannabis-legal state, learning about medical cannabis was a logical decision for me. Cannabis quickly transformed into a major life passion, as this amazing plant spared my teen daughter from out-of-home placement from safety concerns during her Autism puberty crisis. This puberty crisis situation is exceedingly common, affecting an estimated 50% of children with Autism (ASD), when parents are suddenly confronted with intense behaviors which may include self-injury, aggressive rages, and property destruction. Cannabis is effective for calming ASD behaviors, and our suffering and transcendence provided a new life purpose: to teach others about the healing potential of cannabis. My current work is very rewarding, as I educate and support many clients through successfully adopting a medical cannabis regimen, which in most cases improves their situation and avoids potentially heart-breaking scenarios.