4.4.4 Introducing Dr Kate Welch, Pharm D

Hello, Graywolf’s Lair Readers:

It is fantastic to be back and to have a revived space for medical cannabis information from the people who helped start it all. I am Kate, a pharmacist who specializes in compounding pharmacy and teaches pharmacology (see my bio for more information).

Graywolf has generously ceded a little space here in his corner of the internet where I will be writing about all things fascinating with regard to cannabis pharmacology that may be of special interest to the medical cannabis community.  I am always scanning the professional cannabis media for hot topics, as well as the published scientific research to see what is being investigated and uncovered, and I look forward to being able to pass along a little of what I read and know here.

I started collaborating with Eloquentsolution in 2015, where I first encountered and began to learn about medical cannabis processing.  I was able to lend my compounding pharmacy knowledge to the process, and together we discovered a mutual goal of improving cannabis delivery for medical cannabis patients. This was under the old OMMP cardholder system, and I was just giving technical advice, but the process helped me learn more about what medical patients were going through, and what they needed, and the basics of how their medication was made.

I had not had the opportunity to think much about cannabis medically until 2012, when two things happened: the peak of the reckoning of the medical community with regard to the overuse of opioids for pain, and the legalization of medical cannabis dispensaries in Oregon.  I was working at a rural community pharmacy that served a lot of chronic pain patients. Since we had reduced their doses of opioids based on the new guidelines and our new understanding of how opioids had big limits in improving quality of life for these patients, many of them started obtaining cards and asking me about medical cannabis.

I admit I was a bit stumped at first. Of course I had never had an issue with a cardholding patient using cannabis to treat their qualifying condition, but I was unprepared to help them navigate the preparations that I had never heard of before and were suddenly available to them, and all the questions they had for me. Would this interact with their other medications? Would it make them sleepy?  Cannabis is not FDA approved to treat any indication, and as a medical license holder, it would not be ethical of me to suggest a particular dose or dose form of cannabis to a patient as being effective for treating any condition.

What I knew I had to do, however, was educate myself about the medical cannabis research and landscape of preparations available for them to try, in order to keep my patients who chose to use medical cannabis safe.  What the current clinical studies on cannabis do tend to show is that patient experience of cannabis can be idiosyncratic and unpredictable. The whole plant, full-spectrum forms of cannabis that most medical patients prefer contain hundreds of compounds besides THC.  How it is prepared can also influence patient experiences, as does the form in how it is taken which plays a big role in how quickly or slowly cannabis compounds enter circulation. The impact of other medications a patient may be taking can also play a role. 

We don’t have all the answers by a long shot, but we do have growing research and individual patient clinical experiences to help patients who want to try cannabis be able to use it more safely.  And, this being the age of the Internet, there is also a lot of misinformation, deception, and desires for profit over patient health and safety out there too.

So, I plan to write about topics to further our understanding of medical cannabis like: the current use and possible future of cannabis medications in modern pharmacy; the pharmaceutics of various dosage forms that patients may typically encounter in a dispensary, and how this may impact patient experience and use; and health claims about cannabis and cannabinoids and what the science really says.

I also invite Lair readers to comment and submit questions about cannabis pharmacology for future topics! Please comment below if you have any suggestions!

Dr. Kate


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