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Exciting Developments in the
  Medical Cannabis Movement:

Continuing Medical Education

                   Tanya Blasbalg, M.S.
              US Medical Education Liaison
  Canadian Consortium for the Investigation of Cannabinoids
The Need for Cannabinoid Education




MeSH search term: (Cannab*) AND (“xxxx/1/1” : ”xxxx/12/31"[Date - Publication])
Slide courtesy of Dr. Mark Ware
The Need for Cannabinoid Education
                                  USMLE Exam Prep Questions
What cannabinoid produces most of the effects of   Delta-9-tetrahydrocannabinol
smoking marijuana?
What type of receptor is associated with the 2     G protein-linked receptors
cannabinoid receptor subtypes (CB1 and CB2)?
                                                   - Inhibition of adenylyl cyclase opens potassium
                                                    channels and closes calcium channels
CB1 receptor location                              Brain

                                                    - Mediate the psychological effects of THC
CB2 receptor location                              Immune cells

Name the 2 cannabinoid ligands.                    Anandamide
                                                   2-arachidonylglycerol
Marijuana adverse effects (3/4)                    Increased heart rate
                                                   Decreased blood pressure
                                                   Reddening of the conjunctiva
                                                   Toxic psychosis at high doses
Dronabinol (Marinol) uses (2)                      Anorexia associated with weight loss in patients
                                                   with AIDS

                                                   Nausea and vomiting associated with cancer
                                                   chemotherapy (second line)
Knowledge Transfer:
How HCPs Keep Up With Science

                                       A Perfect World

 Self Study                                  Academia                               Patients




HCP = Health Care Practitioner, ie physicians, nurses, physicians assistants, etc
Knowledge Transfer:
      How HCPs Keep Up With Science
                     The Real World: Pharma Sponsorship

                                           Medical                                            Continuing
    Promotional
                                        Communications                                         Medical
•
•
    Drug Representatives
    Journal Ads
                                         •
                                         •
                                             Peer-to-peer programs
                                             Dinner meetings
                                                                                              Education
•   Conference booths                    •   Publications                                 •   Conferences
•   E-detailers                          •   Newsletters                                  •   Symposia
•   Direct mail                          •   Monographs                                   •   Enduring materials
•   Brand websites                       •   Advisory boards                              •   Online programming




      HCP = Health Care Practitioner, ie physicians, nurses, physicians assistants, etc
HCP Resources for Cannabinoid
Education




Slide courtesy of Dr. Jeffrey Hergenrather
CCIC: Bringing Credibility to
 Cannabinoid Medicine
 • Non-profit organization, formed in 2000 as an
   interdisciplinary research consortium
 • >200 members, primarily clinicians and scientists
 • Registered in Canada; global reach &
   membership

                          Mission
To promote evidence‐based education concerning the
endocannabinoid system and therapeutic applications of
cannabinoid agents to clinical audiences
CCIC: Providing Accredited
Cannabinoid Education to Clinicians
• >50 live CME programs
  – Dinner meetings, workshops, clinical
    symposia in Canada, Europe, and the US
• Reached nearly 2000 health care
  practitioners
• Feedback overwhelmingly positive
The Value of CME
•   Accreditation
•   Funding firewall
•   Unbiased
•   Evidence driven
•   Clinically relevant to HCPs
CCIC: Representing the Diverse
Field of Cannabinoid Therapeutics
                                  Expert Faculty
• Multidisciplinary board of      in the fields of:
  directors – physicians and   Oncology
  scientists                   Pain management
• Collaborations with          HIV/AIDS
  professional societies and   Neurology
  academic institutions        Multiple Sclerosis
• Management staff with        Pulmonology

  experience in medicine,      Psychology

  science, business, and       Pharmacology

  education                    Family Medicine
                               Anesthesiology
Challenge: Funding

• No multi-billion dollar pharma company
• State governments are broke
Challenge: Getting HCPs in the Room
                HCP Objections
• There is no data
• Cannabis must be smoked
  – “I would never tell my patient to smoke
    something”
• Cannabis = THC
  – “They can just take Marinol”
• Cannabis gets you high
• I have no intention to recommend, therefore
  this doesn’t affect me
• I can get arrested for recommending
  cannabis
Challenge:
       The Art & Science of Medicine

       • The folly of evidence-based medicine


        Effective patient care requires the free and unfettered
        exchange of information on treatment alternatives…
                                 - American Medical Association




American Medical Association. AMA Policy: Medical Marijuana. Report 10 of the Council on Scientific Affairs.
Available at http://medicalmarijuana.procon.org/sourcefiles/AMA09policy.pdf. Accessed 23 Feb 2013.
Limitless Opportunities

•   Live meetings (half day, full day)
•   Online CME
•   Grand rounds presentations (hospitals)
•   Medical school cannabinoid curriculum
•   Patient education materials
•   Risk evaluation and mitigation strategies
•   And on…and on…and on…
The Canadian Consortium for the
  Investigation of Cannabinoids

            www.ccic.net

          Tanya Blasbalg
     US Medical Education Liaison
          tanya@ccic.net

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Exciting Developments in Medical Cannabis Movement - Tanya Blasbalg

  • 1. Exciting Developments in the Medical Cannabis Movement: Continuing Medical Education Tanya Blasbalg, M.S. US Medical Education Liaison Canadian Consortium for the Investigation of Cannabinoids
  • 2. The Need for Cannabinoid Education MeSH search term: (Cannab*) AND (“xxxx/1/1” : ”xxxx/12/31"[Date - Publication]) Slide courtesy of Dr. Mark Ware
  • 3. The Need for Cannabinoid Education USMLE Exam Prep Questions What cannabinoid produces most of the effects of Delta-9-tetrahydrocannabinol smoking marijuana? What type of receptor is associated with the 2 G protein-linked receptors cannabinoid receptor subtypes (CB1 and CB2)? - Inhibition of adenylyl cyclase opens potassium channels and closes calcium channels CB1 receptor location Brain - Mediate the psychological effects of THC CB2 receptor location Immune cells Name the 2 cannabinoid ligands. Anandamide 2-arachidonylglycerol Marijuana adverse effects (3/4) Increased heart rate Decreased blood pressure Reddening of the conjunctiva Toxic psychosis at high doses Dronabinol (Marinol) uses (2) Anorexia associated with weight loss in patients with AIDS Nausea and vomiting associated with cancer chemotherapy (second line)
  • 4. Knowledge Transfer: How HCPs Keep Up With Science A Perfect World Self Study Academia Patients HCP = Health Care Practitioner, ie physicians, nurses, physicians assistants, etc
  • 5. Knowledge Transfer: How HCPs Keep Up With Science The Real World: Pharma Sponsorship Medical Continuing Promotional Communications Medical • • Drug Representatives Journal Ads • • Peer-to-peer programs Dinner meetings Education • Conference booths • Publications • Conferences • E-detailers • Newsletters • Symposia • Direct mail • Monographs • Enduring materials • Brand websites • Advisory boards • Online programming HCP = Health Care Practitioner, ie physicians, nurses, physicians assistants, etc
  • 6. HCP Resources for Cannabinoid Education Slide courtesy of Dr. Jeffrey Hergenrather
  • 7. CCIC: Bringing Credibility to Cannabinoid Medicine • Non-profit organization, formed in 2000 as an interdisciplinary research consortium • >200 members, primarily clinicians and scientists • Registered in Canada; global reach & membership Mission To promote evidence‐based education concerning the endocannabinoid system and therapeutic applications of cannabinoid agents to clinical audiences
  • 8. CCIC: Providing Accredited Cannabinoid Education to Clinicians • >50 live CME programs – Dinner meetings, workshops, clinical symposia in Canada, Europe, and the US • Reached nearly 2000 health care practitioners • Feedback overwhelmingly positive
  • 9.
  • 10. The Value of CME • Accreditation • Funding firewall • Unbiased • Evidence driven • Clinically relevant to HCPs
  • 11. CCIC: Representing the Diverse Field of Cannabinoid Therapeutics Expert Faculty • Multidisciplinary board of in the fields of: directors – physicians and Oncology scientists Pain management • Collaborations with HIV/AIDS professional societies and Neurology academic institutions Multiple Sclerosis • Management staff with Pulmonology experience in medicine, Psychology science, business, and Pharmacology education Family Medicine Anesthesiology
  • 12. Challenge: Funding • No multi-billion dollar pharma company • State governments are broke
  • 13. Challenge: Getting HCPs in the Room HCP Objections • There is no data • Cannabis must be smoked – “I would never tell my patient to smoke something” • Cannabis = THC – “They can just take Marinol” • Cannabis gets you high • I have no intention to recommend, therefore this doesn’t affect me • I can get arrested for recommending cannabis
  • 14. Challenge: The Art & Science of Medicine • The folly of evidence-based medicine Effective patient care requires the free and unfettered exchange of information on treatment alternatives… - American Medical Association American Medical Association. AMA Policy: Medical Marijuana. Report 10 of the Council on Scientific Affairs. Available at http://medicalmarijuana.procon.org/sourcefiles/AMA09policy.pdf. Accessed 23 Feb 2013.
  • 15. Limitless Opportunities • Live meetings (half day, full day) • Online CME • Grand rounds presentations (hospitals) • Medical school cannabinoid curriculum • Patient education materials • Risk evaluation and mitigation strategies • And on…and on…and on…
  • 16. The Canadian Consortium for the Investigation of Cannabinoids www.ccic.net Tanya Blasbalg US Medical Education Liaison tanya@ccic.net

Hinweis der Redaktion

  1. This is an issue you’ve been hearing about during the conference. I’m here to discuss a solution
  2. 2036 Cannabinoid science is lagging behind other medical sciences Lipid chemistry took longer to develop than hydrochemistry The endocannabinoid system is harder to study than other physiological systems
  3. USMLE 1/3 of HCPs live in states with medical marijuana laws. Arguably, none of them learned how to administer cannabis in medical school http://quizlet.com/12565059/psychiatry-pharmacology-usmle-flash-cards/
  4. We’d like to think that this is how all our HCPs learn everything
  5. But this is the truth of it Mainstream, speak their language, my role and expertise Accreditation Requirements for CME Providers Requirements for Recognized Accreditors Enduring Materials: Definition and Requirements Because there is no direct interaction between the provider and/or faculty and the learner, the provider must communicate the following information to participants so that they are aware of this information prior to starting the educational activity Principal faculty and their credentials; Medium or combination of media used; Method of physician participation in the learning process; Estimated time to complete the educational activity (same as number of designated credit hours); Dates of original release and most recent review or update; and Termination date (date after which enduring material is no longer certified for credit). Providers that produce enduring materials must review each enduring material at least once every three years or more frequently if indicated by new scientific developments. So, while providers can review and re-release an enduring material every three years (or more frequently), the enduring material cannot be offered as an accredited activity for more than three years without some review on the part of the provider to ensure that the content is still up-to-date and accurate. That review date must be included on the enduring material, along with the original release date and a termination date. Sometimes providers will create an enduring material from a live CME activity. When this occurs, ACCME considers the provider to have created two separate activities – one live activity and one enduring material activity. Both activities must comply with all ACCME requirements, and the enduring material activity must comply additionally with all ACCME policies that relate specifically to enduring materials.   ACCME Note:  This policy describes ACCME requirements with regard to the ACCME-defined activity type, enduring materials. The ACCME defines enduring materials as CME activities that are printed, recorded, or accessible online and do not have a specific time or location designated for participation.  Rather, the participant determines where and when to complete the activity. Examples: online interactive educational module, recorded presentation, podcast.
  6. Local resources developing in different areas
  7. DOH, exec director of medical society 35 cannabis-niaive physicians
  8. Accreditation = motivation
  9. State governments ar our natural partners
  10. Nice thing about HCPs is they are often open to sound, rational perspectives supported by data. I’ve come out of the closet What I have been finding is that HCPs sometimes think they have an informed opinion, and those opinions keep them from getting in the door to hear the evidence Smoked cannabis causes lung disease and cancer Euphoria is an adverse side effect
  11. Despite all the data, at the end of the day every physician must rely on their own clinical judgment for their treatment decision. That judgment is formed by weighing not only the scientific evidence, but also personal clinical experience and guidance from colleagues. For some reason, to many physicians the art of medicine doesn’t apply when in comes to cannabis.
  12. When pharma has a problem, you better believe we put our heads together and come up with unique, creative solutions, and lots of them. There is no reason we can’t do the same for cannabis.