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Medical Marijuana: What does it all mean?

Medical Marijuana is now legal in Pennsylvania!  It is now an obtainable option for the management of many chronic medical conditions, which affect the quality and health of patients in need. In April of 2016, Governor Tom Wolf signed into law the legalization of medical marijuana for 17 specific medical conditions.  This began the creation of a process by which growers, processors, distributers and pharmacies could legally distribute the product to patients.  In addition, physician education and certification has been put in place that would allow a patient to be medically evaluated by a certified physician for the appropriateness of use and qualify a patient for the recommended use of this class of medication.

Patients often ask….”Why is medical marijuana different?  How can it help me?”  Well, the answer is actually very complicated and depends on a number of factors.  It can be dependent on the patient and the disease that is being treated.  It can vary based on the strain of the medical cannabis chosen and the delivery system. It can vary by a patient’s genetic makeup and how the body reacts.  It can be affected by the other medications a patient takes and by other medical issues the patient is managing, especially if there is organ impairment such as renal or liver impairment.

It is NOT a one size fits all drug and should not be regarded as such.  Like most medicine, identifying the right prescription of medical cannabis is an ART and not simply a mathematical formula that one follows.  In developing and fine tuning the prescription, the pharmacist and the patient’s medical team need to encourage the patient not to become discouraged if results are not as positive as hoped with the first experience, as often adjustments and modifications are warranted.

First, let’s begin with an understanding of some basic chemistry. Cannabis, or medical marijuana, contains several key compounds, also known as cannabinoids that target the endocannabinoid system of the brain to produce different effects, such as how we regulate pain, mood, memory, appetite, sleep, etc.   CBD (cannabidiol) and THC (tetrahydrocannabinol) are two compounds that are the most well-known and best understood as to how they work within the endocannabinoid system in the brain.

The endocannabinoid system of the brain is comprised of cannabinoid receptors, the best studied of which are CB1 and CB2.  These compounds, when absorbed by the brain, target the cannabinoid receptors, CB1 and CB2, either directly, as in the case of the THC, or indirectly as with the CBD to effect a change in the brain chemistry.  The greatest concentration of the CB1 and CB2 receptors is found within the central nervous system; however, due to the widespread location of these receptors and neurotransmitters, various forms of the medical marijuana will work including topicals, oils, orals and vaporized forms. (This topic will be further discussed later in the article.)

There are typically over one hundred substances or cannabinoids within the average medical marijuana plant.  The significance of many of these remains unknown and is still being discovered and researched.  As noted above, CBD, which is one of the most well-known and researched cannabinoid, has anti-inflammatory effects. There have been additional studies that suggest that it can help with anxiety, chronic pain syndromes, and medical conditions including seizures and migraines.  The other well-known cannabinoid substance, THC (tetrahydrocannabinol), is the chemical that has been linked with the psychogenic effects of marijuana.  There have been many case reports of patients noting improvements in their appetite, sleep, and overall anxiety when using the combined CBD/THC formulations.

Other lesser known, yet chemically effective compounds include CBG (cannabigerol) and THCV (Tetrahyrdrocannabivarin).  CBG has been shown to assist with glaucoma patients in helping with reducing eye pressures.  THCV also has been shown to be helpful in patients with metabolic disorders including diabetes as well as neurological disorders such Parkinson’s.

Another important question that patients often ask is. “How will I know what kind of medical marijuana to ask for?”  Once securing the medical card qualifying them as a candidate for medical cannabis, the patient should identify goals for treatment such pain management, insomnia, appetite stimulation, etc.  Entering the pharmacy with these goals in mind, the pharmacist will be better able to make recommendations for choosing not only the medical marijuana delivery method, but also the strength and strain.

Medical marijuana falls under the plant genus Cannabis.  There are 3 main species that are derived from this genus, C. sativa, C. indica, and C. ruderalis.  From these strains, the growers create different varieties, with different ratios of CBD and THC targeting different effects and systemic symptoms.  One of the keys to the success of this therapy is finding the right fit for the patient, so as the process evolves, growers and processors continue to refine the product to effect better outcomes with greater benefits.   The feedback that a patient and pharmacist provide in this process is crucial and considered important in the success of this program in the short and long term for not only that patient but also for those to follow.

As mentioned earlier, medical marijuana has a variety of delivery systems available through pharmacies in Pennsylvania.  These are inhaled vaporizers, topicals, tinctures, oral capsules or tablets, and oils.  The pharmacist can work with the patient and determine what symptoms one is seeking to address and then choose the best product for the patient.  Typically, the best way to begin using these products is to “start low and go slow,” titrating up on the medication to achieve the symptom management and control the symptoms that the patient is seeking to treat.  It is important that the patient have open lines of communication with the pharmacist as well as with their physicians, making them aware of any side effects or symptoms that they may be experiencing in order to limit and avert any potential issues or cumulative drug side effects.  For example, it is very common for patients to experience dry eye and dry mouth, which can be exacerbated when using a number of other prescription medications.  When knowing this, proper counseling can help manage this side effect.

In summary, medical marijuana remains a very controversial and complicated topic spanning many social, medical, ethical and physical realms.  There are varying opinions about the efficacy of medical marijuana as a form of medicine.  Regardless of personal opinions as to its ethical or legal appropriateness, it is important for potential patients to become educated on the topic itself and understand how it works, what effects it can have,  both positive and negative on the medical conditions for which people seek treatment, and what impact it may have on the future of medicine which continues to evolve day by day.

 

“PA.GOV.” PA.Gov, Commonwealth of PA, www.pa.gov/guides/pennsylvania-medical-marijuana-program/.

 

Schatman, Michael E. “Medical Marijuana: The State of the Science.” Medscape , Medscape, 2 Feb. 2015, www.medscape.com/viewarticle/839155_13.

Pollio, Antonino. “The Name of Cannabis: A Short Guide for Nonbotanists.” US National Library of Medicine National Institutes of Health, U.S. National Library of Medicine, 1 Oct. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5531363/.

 

Wilcox, Anna. “10 Best Medical Cannabis Strains You Should Be Using.” HERB, HERB, 2 Nov. 2017, herb.co/marijuana/news/10-best-medical-cannabis-strains.

 

DePietro, MaryAnn. “Medical Marijuana | Definition & Patient Education.” Healthline, Healthline Media, 21 July 2016, www.healthline.com/health/medical-marijuana.

 

Jikomes, Nick. “What Is the Endocannabinoid System and What Is Its Role?” Leafly, Leafly, 21 Dec. 2017, www.leafly.com/news/science-tech/what-is-the-endocannabinoid-system.

 

“THC vs. CBD: What’s The Difference?” Leaf Science, 22 Nov. 2017, www.leafscience.com/2017/11/22/thc-cbd-difference/.

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Burick Center Staff MemberTracy Koval

Office Manager

Tracy joined the Burick Center for Health & Wellness in June of 2016 to help patients by managing various aspects of the office. Tracy brings more than three decades of medical office experience as the former office manager of a multi-specialty group and also works on a part-time basis as a Patient Service Rep at a local urgent care center.

Tracy’s favorite part of working in a medical practice is the opportunity to make a difference in someone’s life by helping them navigate through the maze of health care. She loves being part of the dynamic team at the Burick Center.

Tracy likes to spend time with her family. She has two sons, Mason, who is living and working in Philadelphia as a Sr. Analyst for a marketing firm, and Spencer, who works at Hershey Entertainment & Resorts.

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Strategy Officer

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Burick Center Staff MemberRena Geesaman

Patient Coordinator

Rena Geesaman is a Registered Medical Assistant who enjoys providing attentive and caring client service. She is very happy to be part of the Burick Center team where patient care is our number one focus.

Her goal is to do everything within her power to ensure every interaction leaves you feeling well cared for and perhaps even delighted.

Rena volunteers by serving as board treasurer for Carlisle Christian Academy. She also helps facilitate a program at River of God Church for single, pregnant girls which provides practical, emotional and spiritual support.

Outside of the office Rena enjoys hiking, traveling, tending to her flower beds, hosting meals on their back deck, enjoying time with dear friends, loving on her little dogs, and best of all spending time with family. Being fairly new grandparents, she and her husband Don are always happy to share pictures of their little grandson, Lucas. Feel free to ask! She considers herself amazingly blessed!

Burick Center Staff MemberDr. Peter Lu

Acupuncturist

Dr. Peter Lu trained and worked in New York City for 15 years and recently moved to central PA. He studied pre-med at Brooklyn College and attended medical school at SUNY Downstate in Brooklyn. Thereafter he worked in the inner city hospitals of New York City, and lastly had the honor of caring for people with his sister in Stamford, Connecticut.

Dr. Lu greatly appreciates open lines of communication as it pertains to questions you may have about your ailment and how acupuncture could help in the healing process. His intention to address your needs to the best of his ability.

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Burick Center Staff MemberLee Morand

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Lee has had the sincere pleasure of working in the Greater Harrisburg area for over 20 years. She relocated to Harrisburg in 1990 after completing her undergraduate degree in Nutrition Pre-Med at Cornell University. Lee received her first Master’s Degree from Shippensburg University. Her second Master’s Degree, as well as Doctorate, were both from Philadelphia College of Osteopathic Medicine.

She uses a Cognitive-Behavioral approach to guide her work with clients across the lifespan. She strongly believes research has shown that changing your thoughts does change your life. Her primary focus with clients is to reduce symptoms by assisting clients to achieve skills they can utilize in their professional, academic, and personal lives.

Burick Center Staff MemberHeather Motter

LMT, Massage Therapist and Back Desk Coordinator

Heather Motter joined the Burick Center team in 2018. A graduate of YTI Career Institute, Heather prides herself on using her highly developed skills to maintain the balance between mind and body. As a licensed massage therapist, she specializes in Medical Massage, Lymphatic Drainage, Trigger Point Therapy, and Oncology Massage.

Heather has a vast amount of experience working with a variety of patients. From a simple relaxation massage to a patient dealing with chronic pain, Heather is able to facilitate treatments uniquely designed for each patient’s individual needs.

Heather insists that massage is not just a relaxation luxury. Instead, her philosophy is that massage helps lead to a healthier, happier lifestyle. She encourages everyone to take the time to meet with her to develop a care plan to enhance their overall wellness.

Heather is a resident of Carlisle, where she resides with her fiancé, two sons, and four dogs. When she’s not at work, she can be found outside working on her back yard oasis, or volunteering at Speranza Animal Rescue.

Burick Center Staff MemberFelicia Miller

Nutritionist

Felicia Miller is a Registered Dietitian and Licensed Dietitian Nutritionist who provides nutritional counseling and education to patients of the Burick Center for Health & Wellness.

She takes the science of nutrition with her extensive knowledge of food and coaching skills to create an easy-to-follow actionable plan for her clients to follow.

Recognizing that there are multiple components to creating a successful wellness plan, she looks at the whole person – their concerns, lifestyle, personality, family, and career. Listening to her patients allows for Felicia to find the root cause of their issue and not simply the symptoms.

“Being healthy goes beyond diet, food is just one of the pillars of a happy, healthy person.” Felicia goes beyond the traditional diet education- she coaches and supports her patients as they learn how to make changes in their day-to-day life.

“I’m passionate about whole foods and healthy living I strive to inspire you to make positive food and lifestyle changes – at any age.”

Burick Center Staff MemberAshley Weibley

Registered Nurse

Ashley is a nurse at Burick Center for Health & Wellness. Her nursing philosophy is one of holistic care. She is a patient advocate committed to clear communication, education and applying critical thinking and decision-making skills to help patients achieve better outcomes. She enjoys providing the highest quality nursing care in a respectful, healing environment. She has a personal commitment to life-long learning through formal education and hands-on experience. She appreciates that compassion along with innovative care is what the Burick Center for Health & Wellness is all about.

Ashley has an Associate’s Degree from Harrisburg Area Community College and a Bachelors Degree from Penn State University.

She is married and has twin boys, She enjoys spending time with her friends, family and pets. She has owned and shown Quarter Horses all of her life and continues to compete in her spare time.