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Welcome to Healthcare Redefined: Advocating for Aging Adults and Their Families, where we empower families to navigate the complexities of aging and healthcare. Presented by Your Nurse Advocate Consulting, we share real stories, expert advice, and practical tools to help you and your loved ones confidently navigate aging with dignity.
We explore topics like creating collaborative care plans, demystifying Medicare, handling healthcare crises, and preparing for the future. Join us as we transform uncertainty into understanding.
Pam Dunwald: [00:00:00] Well, welcome to Redefining Healthcare: Advocating for Aging Adults and Their Families. We are already on episode eight this week, and it's titled Cannabis and Care: The Truth About CBD, THC, and Aging Well. Hi, I'm Pam Dunwald.
Linda Kritikos: [00:00:14] And I'm Linda Kritikos. Today we're tackling a really important topic that's on a lot of minds: medical cannabis and its use for pain, sleep, and chronic conditions in aging adults.
Pam Dunwald: [00:00:26] You know, we're excited to welcome our guest, nurse practitioner Susan Marks, also known as the Cannabis Nurse. Susan has been consulting on one of our clients with MS and we wanted to share what she does and bring light to this topic. So Susan is an expert in medical cannabis counseling and has helped countless families navigate the evolving landscape. She also coaches and mentors others that would like to become knowledgeable on this field. So let's share a little bit more about Susan. So Susan is a board-certified family practice practitioner who specializes in cannabis medicine. She's a native of California, and currently lives in Nevada and has clinical experience in adult medical surgical practice, pediatric oncology, hematology, home care, case management, disease management, quality improvement, and risk management. So Susan has been around all the arenas of healthcare. So Nurse Susan has been a cannabis nurse and a member of the American Cannabis Nurses Association for almost ten years. She educates health professionals and works with medical patients who want to include cannabis therapeutics in their health management program. So with this knowledge, medical patients, they can really make an informed decision about their cannabis regimen. So Nurse Susan works with patients really in all legal cannabis states. And we'll talk a little bit more about that. So Nurse Susan is passionate about the therapeutic benefits of cannabis. She's a medical cannabis patient due to a progressive neurological movement disorder cannabis. Cannabis, when we're talking about high CBD and low THC, has allowed her to wean off her anti-seizure medication and the intolerable side effects, and also be able to manage her tremors without the use of pharmaceutical drugs.
Linda Kritikos: [00:02:11] So, Susan, what is your story? How did you become a medical cannabis patient and then a cannabis consultant and educator? Oh, it's gotta be interesting.
Susan Marks: [00:02:22] It. Well, it's, you know, it's one of those life events that you go into it kicking and screaming and moaning and hating it, you know, and I'm speaking specifically of essential tremor, which is a progressive neurological movement disorder that just gets worse over time. And I'd already had it for years. And it just got to the point where I was very limited in what I was able to do. I couldn't drink out of a glass without spilling water everywhere. I couldn't put on my eye makeup, you know, it just became so intrusive. So following my neurologist's advice, I went on primidone, which is an anti-seizure medication. And I'm telling you, going from no pharmaceutical drugs to anti-seizure drugs, you're like, holy cow. It's like you become a stranger to yourself. Your brain doesn't work the way you're so used to it working. And I knew I just, I couldn't go on, you know, managing the tremor using that protocol because my older brother, who's ten years older than I am, there are eight kids in the family. Six of us have essential tremor. My brother Jeff is the worst. And basically, what happens is they keep increasing the dose of the anti-seizure meds as the tremors get worse. And then when it gets toxic levels, then they discontinue that and put you on a different anti-seizure med. So he'd been through all of the medications and he had just had deep-brain stimulation to help manage his tremors. So I was looking at my future, and it was very depressing to me. And I knew I had to find an alternative. So as a nurse, I do what most nurses do. I went on PubMed. I started, you know, researching remedies for Parkinson's disease, for essential tremor, for seizure disorders. Anything that I could think of. And cannabis kept coming up and I'm like, what the heck is this? You know, being a nurse for 40 years, nobody was talking about cannabis use, you know, for these types of things. And, you know, the more I dove into it, the more I was kind of hopeful thinking this might actually work for me.
Susan Marks: [00:05:00] And sure enough, ten years ago, I was able to wean myself off of the anti-seizure meds. I've been taking cannabis every day for the last ten years. And I had to go through the same process that I take all of my patients through, which is basically trial and error. Because I was never a cannabis user, I had no idea how it was going to make me feel or how much I needed or what, you know, what combination of the cannabinoids and terpenes, which are the different compounds in the plant. I didn't know exactly how I would respond, so I had to do some trial and error. And that's basically what I help my patients go through to figure out, you know, which cannabinoids work best for them, which terpenes work best for them, at what dose? How to adjust it as your health status changes. And it has been extremely rewarding. I went from hating the fact that I had essential tremor, and that my future looked rather bleak, to being like, okay, I've got my tremors under control. I have people asking me to help them. I kind of started up my whole new practice, just helping people use cannabis for all kinds of things. So, you know, it was really kind of one of those life events that make you go, you know, you're going straight ahead and all of a sudden you turn a drastic right, and now I'm on this different path, and it's been one of the best things that's ever happened to me.
Susan Marks: [00:06:44] And I have seen so many incredible stories and so many incredible outcomes for patients. Anything from Alzheimer's to multisystem atrophy to pain management. People who have been hooked on opioids for 15 years. Being able to bring it from way too high of a dose down to something that completely takes the risk of a fatal overdose off the table. That's a huge accomplishment. Being able to work with seniors who are on 18 or 20 pharmaceutical drugs, and being able to just wean them off one after the other, after the other. Because cannabis is so effective for so many different diseases that you can take, like, I take my one dose of cannabis and it manages my tremors, it helps me with my sleep, it helps me with my arthritis pain. And I'm not taking three and four and five different medicines to do those simple things. So.
Pam Dunwald: [00:07:50] That's awesome. And yeah, no. And we're going to, we're going to talk a little bit more about that because that's all really important. And before we get into more about the benefits and the uses, you know, I'm sure people are already thinking too, there's a lot of confusion and a lot of stigma around, you know, cannabis and healthcare. What are some of the biggest myths that you encounter?
Susan Marks: [00:08:14] Well, most people are afraid of cannabis. We have been bamboozled to think cannabis is this really scary thing. It's a gateway drug. We're all going to be on heroin if we start using cannabis. And it couldn't be further from the truth. In fact, we're using cannabis now to help people get off of opioids and reduce their risk of fatal overdose and be able to manage their pain with a substance that has much fewer side effects. Even people, you know, they take ibuprofen every day, or they take Tylenol every day, and they think it's safe. We've kind of been lulled into this thinking that anything that's over the counter really is basically safe when it's not. I mean, 600,000 people are admitted to the E.R. with hemorrhaging as a result of taking your over-the-counter Motrin and Aleve and all of those different drugs, and they're just simply trying to manage their inflammation and their pain. Whereas if they were to use cannabis for that, they're going to get anti-inflammatory effects, analgesic effects, anti-spasmodic effects. So any muscle tension and muscle spasms that are often associated with chronic pain, that gets reduced. The muscle, you know, it's a muscle relaxant. It helps you to sleep. Most people who have chronic pain and other issues aren't sleeping well, so it's kind of this very holistic approach where you take one substance and it deals with like a whole myriad of different issues, health issues.
Linda Kritikos: [00:10:04] So in saying that, and in looking at that, how can cannabis be so effective for so many medical diagnoses? As you said, it's one substance. Such as like, how can it be effective for like Parkinson's? And I know you said it was very effective for your seizures, but like for cancer and autoimmune diseases, it really almost sounds like it's too good to be true. So in your experience, what benefits have you seen for pain and sleep or these chronic conditions, especially with the aging adult population who are using these types of products?
Susan Marks: [00:10:42] Yeah. So with all of the kind of this renaissance and interest with cannabis to be used medically, scientists discovered the endocannabinoid system. So everybody knows they have a nervous system, they have a GI system, they have all these different systems. Most people have never even heard of the endocannabinoid system. But scientists identified that back in the 90s. So it's been around for 25, 30 years. And basically, the endocannabinoid system is the body's largest neurotransmitter system. So we have receptors in different parts of our body that the cannabinoids, which are the compounds in the plant, they interact with those receptors. And that's how cannabis is able to be effective for Parkinson's as well as, for example, sleep issues or pain, is because the endocannabinoid's job is to maintain homeostasis. The definition of disease is a lack of homeostasis. So homeostasis is balance. So the endocannabinoid system, like I said, it's a neurotransmitter system. And it's retrograde, meaning that it signals back to the neuron to, for example, stop producing glutamate. So if you have a head injury and your body is overproducing the glutamate that's going to cause even more of a damage in the brain, that is bringing things back into homeostasis. If you have pain, it brings that down. It brings it back into homeostasis. So when you have a substance that you're basically giving the body the raw materials that your endocannabinoid system uses to bring everything back into balance on a very holistic level. Pharmaceutical drugs are more of like a hammer on a nail. It's a harsher kind of a approach to healing, whereas the endocannabinoid system is very internal, holistic, it's like your body knows what it needs to keep everything in balance. The problem is, when you have a chronic illness, when you have a lifestyle where you've got a lot of stress, you are not eating properly, you're not sleeping well. Your body's ability to produce its own cannabinoids, they're called endocannabinoids, so your body's ability to produce the raw material that your endocannabinoid system uses to bring everything back into balance, it's just, it doesn't produce enough. So then we supplement it using cannabinoids from the plant. So you're basically providing supplements to the body to holistically bring whatever is out of balance back into balance.
Pam Dunwald: [00:14:05] You know, that's a great point. And that really leads into our next question. So Susan, can you just take a minute and explain the key difference between, we talked about, you know, what gets you high or stoned, but could you tell us the difference between CBD, THC-A and THC, and why is it important for families and older adults to understand those distinctions?
Susan Marks: [00:14:28] I'd be happy to, because a lot of patients are afraid of that stoned feeling. And it's very easy to avoid it because there are literally hundreds of compounds in the cannabis plant. Only one creates that psychoactivity, that intoxicating effect. People say, oh, I got stoned. That's only caused by THC, which is one compound in hundreds of compounds in the plant. So if we want to avoid that stoned feeling, we either eliminate any THC out of our protocol or use just a little. I prefer using just a little. Not enough to create the psychoactivity, but when THC and CBD are together, they complement each other, and they accentuate their effectiveness on the healing that they're doing. So you can use just a little bit of THC to kind of boost the effectiveness of the protocol. So THC is intoxicating, CBD is non-intoxicating, so I often explain it as THC works from the neck up and CBD works from the neck down.
Susan Marks: [00:15:48] So we can't say that CBD is non-psychoactive because it's a muscle relaxant. It can reduce anxiety. It can elevate the mood. Whereas THC is very intoxicating. And if you take too much of it, you will become very uncomfortable. So that's why we always start with a very low dose and increase it to, we get to the point where they still feel good and are getting the effects of the THC. So if we're using CBD, I like, again think of it from the neck down. So it's a muscle relaxant. It is a very strong anti-inflammatory. So if you have joint pain, if you have, you know, any kind of inflammatory disease, whether it's autoimmune disease with lupus or any of those kind of inflammatory conditions, CBD is very helpful with bringing that down. THC-A, which you mentioned, is actually the best compound for inflammation because it is actually an immune system modulator. So THC-A comes from raw cannabis. So the reason why people smoke cannabis or they bake with it is because THC-A converts to THC in the presence of heat or sun. THC-A is non-psychoactive, but when you heat it, you cook with it, you smoke it, it becomes THC and it becomes very psychoactive. So we can, and there are products out there, luckily, in California and in Nevada we probably have the best access to all of these different cannabinoids.
Susan Marks: [00:17:54] We can get THC-A, which is really only raw plant material. We can get THC, we can get CBD, CBG, CBC, you know, you name it, all of the different cannabinoids. Not every state has that, unfortunately. I don't know if anybody has heard of the you know, when cannabis was really kind of having its renaissance, parents were actually moving to cannabis states like Colorado because they had kids, for example, with Dravet syndrome or Lennox-Gastaut, where they're having 300 seizures in a week, and nothing is working except for CBD. So if they're in a non-legal state, they have to move to a legal state in order to get access to it. So luckily in Nevada and in California, we have all of these things available. The 2018 farm bill has allowed what's called hemp. That's another big question that people usually have. What's the difference between hemp and cannabis? The only difference is the amount of THC. It's more of a legal definition. It's the same plant. The plant that has very, very, very little THC is called hemp. The other plants that they breed to have very high levels of THC is cannabis. So luckily with the 2018 farm bill, even if you live in a state that does not allow cannabis, you can still get hemp. So you can get access to some of these cannabinoids without THC, because that's cannabis, but you can use hemp products to help with a lot of health issues.
Pam Dunwald: [00:19:40] You know? And we got to know each other a little bit better in working, you're consulting, actually, on one of our clients. And one last question before we move on is, do you have to be aware of any risks or side effects or other drug interactions when you're using cannabis?
Susan Marks: [00:19:58] Yes you do. So cannabis is broken down in the liver by the cytochrome P450 enzymes, which is a very common kind of pathway that drugs are broken down. So there are certain drugs like Coumadin, like beta blockers, where they're both broken down by the cytochrome P450. But since cannabinoids, since the molecule is basically a molecule that our own body produces, our liver favors that over a pharmaceutical drug, which is a foreign molecule. So our liver breaks down the cannabis before it will start breaking down the pharmaceutical drugs. So if you're constantly taking cannabis at the same time you're taking Coumadin, and your liver never gets around to breaking down the Coumadin or metabolizing it, the levels of Coumadin go up in your blood. And anybody who's on Coumadin knows you go and you get labs done to make sure you aren't getting into toxic levels. So that's not really an interaction, it's just the body prefers cannabinoids over pharmaceuticals. So the pharmaceutical drugs can accumulate in the blood. So you have to be careful.
Pam Dunwald: [00:21:22] Okay. That makes a lot of sense.
Linda Kritikos: [00:21:24] So let's get into some legal and safety considerations here. Laws around cannabis, they vary like state by state. You know, one state they don't have it legalized at all, other states may have it just legalized for medicinal use. So how important is it for families to know their state laws? And why is a critical to consult a physician before starting any cannabis product, even CBD oil, because there's so many products out there, even being sold at gas stations.
Susan Marks: [00:21:54] Mhm. Yeah, yeah. That's the one thing you really need to be careful with. And I'm going to tackle this before I get into the legal stuff. So just the personal use of over-the-counter hemp products that you buy at Whole Foods, you can buy it in gas stations, you can buy it on the internet. And so those are hemp products. They have less than 0.3% THC in them. However, unfortunately, they don't require any third-party testing for hemp. They absolutely require it for anything that's sold out of a dispensary. They have to test it for any kind of microbes, for fungus, for heavy metals, for pesticides, because we're talking about plants, plant-based medicine. So one of the things about the hemp and the cannabis plant is they're known as bioaccumulators. So they clean the soil. So they planted a lot of hemp after Chernobyl because the soil was so toxic. And the hemp pulled all those heavy metals out of the soil. Well, you need to test to make sure that those aren't the plants that they're using to create medicines out of. And the only way to know that is to have them lab tested. Unfortunately, for whatever reason, they don't require that same lab testing for the products that you can buy at Whole Foods or on the internet or in a gas station. However, there are some medical-grade hemp products that I use, all that I use it for myself, I use it for my patients, that are tested, you can go on to their website. You can see the, it's called the CoA, a Certificate of Analysis. It will tell you the exact concentration of all the different cannabinoids. Sometimes they'll include the terpenes which are the essential oils which also have medicinal effects. They test, like I said before, for the bacterias, for the fungus, for the heavy metals, for the pesticides, so that you know the medicine that you're taking is clean. So please, anybody who's listening to this, don't just buy some willy-nilly CBD product. A lot of them really don't even have CBD in them. They're kind of faking it. And there are other ones that are kind of dirty. It's like dirty medicine. So you really need to be careful about that.
Pam Dunwald: [00:24:35] How do they know if it's a good product?
Susan Marks: [00:24:37] So the best way is to go on to the brand's website. So for example, if you were to go find some off-the-shelf product at your local gas station and you go onto their website, if they don't say front and center, you can look at our COAs, you can review the lab results, do not take it because it's not being tested. There's anything could be in there that you don't know about. So that's really the only way to know if it's a really good medical-grade product, is to go onto the brand's website, look for that CoA and review it, because it will have it by lot number on the bottle of the medicine. So you know that they're matching up and you can actually read, and it helps as a clinician to dose it because there are different strengths. You know some are more concentrated than others. So when you look at the lab results, it will tell you how many milligrams, for example, of CBD or THC or THC-A that are in that product. And then you can dose it accordingly.
Linda Kritikos: [00:25:56] I have one more question on that. What about like, there's a lot of essential oil products out there through different entities, and a lot of them use or have a product that's a CBD oil that they say can be ingested internally or can be diffused or can be used topically with a carrier oil. I mean, do you need to look for those COAs on those products also?
Susan Marks: [00:26:23] I would if they have any kind of hemp compound in them, whether it's CBD or CBC or CBG, anything that comes from a bioaccumulating plant that may be exposed to pesticides that may have not dried thoroughly and now it has fungus growing on it. So any time you have a hemp compound in a product, you should only use it if you can see the lab results.
Pam Dunwald: [00:26:56] So what about the legal issues? Should, how, where should people be about what the laws are in their state?
Susan Marks: [00:27:04] It's very easy to figure out what the laws are. With artificial intelligence, you can find out just about anything. You can go on to Grok and you can say, I live in, you know, Illinois, I live in Mississippi, what are the laws here about, you know, using intoxicating cannabis versus hemp? Grok will tell you everything that you need to know. Things are changing all the time. They change on the federal level. They change on the state level. Trying to keep up with everything isn't always easy, but it's really the amount of THC that distinguishes whether it's an over-the-counter medicine, which you can buy on the internet, you can go to these reputable companies, brands, and buy these lab-tested products and have it sent to you. If it has more than 0.3% THC, they cannot do that. They will arrest. That's considered a federal crime, so they will arrest the person who sent it and the recipient. So you gotta know. And the other thing is, most people think, well, I'm in California, I'm going to go to Yosemite and I'm going to smoke a joint. Wrong. National parks are National federal land. So that's federal. You will end up in federal prison.
Pam Dunwald: [00:28:35] So, all those people in their RVs that are going to these parks to smoke and stuff, just shouldn't be doing it unless they know.
Susan Marks: [00:28:42] Exactly. Yes. So that includes national parks, post office, railroad stations, airports, all of those federal land entities, all, you know, nothing state law applies to them. It's all federal law. And federally, THC is considered a schedule one drug, and therefore you could face prosecution for that.
Pam Dunwald: [00:29:12] Gotcha. You know, I was just thinking I had never experienced any kind of patients that have used any, you know, form of cannabis. And when I was a hospice nurse a few years ago, I had a patient who had a brain tumor. He was in his mid 40s. He had three children, you know, all, you know, younger, you know, high school and younger. And he, I remember I'll never forget, he spent eight hours in the emergency room one day because they could not control his seizures, and he went home and he was on all the seizure medicine. And the wife was very distraught because he was never awake or alert enough to be able to interact with his kids. And so she told me one day she says, Pam, I don't know if I'm supposed to do this or not, but I talked to a friend. I got some CBD oil from Colorado. They kind of helped me, you know, choose what we should try. And I'm going to try it. And I said, you know what? You go, you know, go right ahead. You know, and by cracky, he was able to get off his seizure medicine, he was more alert, he never had another seizure again up until the, you know, again when he even up until when he passed, he had no more seizures. So it really opened my eyes, so to speak. And so with that being said, Susan, is there any other story that you want to share? You know, as far as seeing results with using the cannabinoids?
Susan Marks: [00:30:35] Yeah, I mean, I could spend hours talking to you about the things that I've seen that are just so... They bring so much hope. To me as a clinician, to actually see somebody get better, it's like mind-blowing. Now, what I would recommend is, because to me, seeing something and, you know, the actual person means more than hearing a story about them. So I would recommend anybody who's at all interested, whether you're a patient or a clinician, and you really want to know a little bit more about cannabis as medicine, Sanjay Gupta did a six-part documentary on cannabis and how it's used in many, many different scenarios medically. So you can go on to YouTube and put in Sanjay Gupta Weed, W E E D, that's the name of his documentary, and you will see Charlotte Figi, who was the little five-year-old with Dravet syndrome that really blew the lid off using CBD for seizure disorders. You're going to hear from a veteran after he tried to commit suicide from PTSD, and how he now uses cannabis to manage all of, you know, the sequela of being a veteran and being in combat. He goes into using cannabis for pain, using cannabis for CTE, for football players. And, you know, these people who end up getting these, you know, kind of chronic head injuries. He goes through so many different, some pretty obscure things like a spasming diaphragm. I mean, things that you would never even, I'd never even heard of it as a nurse. And here, you know, they use cannabis to help manage what I've never even heard of before. So if you want to see in real time, real lives, you see them using the cannabis, you see them before and after they dose themselves. It's really quite eye-opening. And it really will bring a lot of hope that there may be a solution out there. Because, you know, when I was, when I was looking for an alternative to the Primidone, it's a pretty lonely, sad place to be when you're just like, kind of at your wit's end and nobody has anything to offer you. And so to be able to see something that you would never thought of before, and you see people actually benefiting from it, it really is amazing. And I see it, like I said, every day in my practice. But you know, anybody who's interested can go onto YouTube, and there are plenty of different... There's another YouTube that sometimes I will show when I'm doing a presentation. It's a young girl with cerebral palsy and autism who's very self-injurious, and she's slugging herself in the face over and over and over. And the meds, the pharma drugs don't really help, but the dad puts a mask with the vapor of cannabis, and she slows down, and then she stops. She gets up, she starts dancing around the house. I mean, the impact that it has on the patient, let alone the family. I mean, these families are going through hell, and there really are no solutions. And this may be a perfect solution.
Linda Kritikos: [00:34:33] We'll make sure that we put those, especially the information on our show notes so that people will be able to access YouTube. So we'll make sure we put that in there. And as, and also, we talked about, you know, how they can learn more. Susan, we have all the ways to be able to contact you or reach out to you. So we will make sure that we put those in the show notes as well. Is there anything that you would like to mention before we kind of wrap things up? Anything that we missed that you feel is important for you to share?
Pam Dunwald: [00:35:07] Well, I would say if you're a patient, stay open-minded. We've been bamboozled. You know, we've been sold a bill of goods. Cannabis was the most widely prescribed medicine before 1934. The American Medical Association testified before Congress when they were considering prohibiting it, and basically begged them not to prohibit because they use it for everything. They don't know why it works, but it works. So anyway, we have been kind of bamboozled to think cannabis is something that it's not. That it's something scary, it's something dangerous. So if you're a patient, stay open-minded. If you're a clinician, please be open-minded to your patients who are using this and trying their best without getting guidance from the medical community, which, to me, is ridiculous. We should be the one helping them to dose it, to choose the right cannabinoids, to create the right protocols for themselves. So if you are a clinician, stay open-minded to your patients who use it, and maybe consider learning something, you know, about it that can help you help your patients.
Linda Kritikos: [00:36:20] Well, Susan, thank you so much for sharing your experience and helping us separate, helping us separate fact from fiction on cannabis.
Susan Marks: [00:36:32] Oh, I'm so happy. And I love being on these shows, because the more people that know about this, it's just another tool in the toolbox that could really be a game changer.
Pam Dunwald: [00:36:42] Absolutely. And you know, everyone, if you found today's episode helpful, you know, please consider sharing with a friend. Subscribe, leave us a review. And again, please check the show notes for resources that we talked about during today's episode, as well as Susan's contact information. And remember, always consult your health care provider before exploring new treatment options.
Linda Kritikos: [00:37:02] Thank you, Susan.
Susan Marks: [00:37:04] And don't be afraid to tell your doctor. A lot of times my patients are like, oh my gosh, should I tell my doctor that I'm doing? I said, absolutely, the doctors need to know everything. So don't be afraid.
Linda Kritikos: [00:37:16] Yep. So everybody just join us next time as we continue to bring you real talk and practical advice for navigating health care with your aging loved ones. And until then, take care of yourself and take care of your aging adults. We'll see you soon. Bye-bye.