LIFESTYLES
OPPORTUNITY
EDUCATION January/Febuary 2016
EDITION
"HEALING THE WORLD"
Tikun Olam
International Issue honoring our Cannabis Nurses in other countries that are Leading the Way
Editor’s Letter
This past year has been absurdly amazing as I grow as a Cannabis Nurse leader in the industry of medicine. Who would of thought only six years ago that I would be the editor of a national magazine, Cannabis Nurses Magazine, after being introduced to Medical Cannabis for the first time ever in 2010. That’s right. The quest for truth brought me here today to assist in educating the people. Where ever I go I cannot help but think about medical cannabis as it is part of my everyday life. It has transformed me into thinking outside the box of traditional western medicine, full of harmful pharmaceuticals and money-making procedures, to a more holistic approach to healing including but not limited to: nutrition, exercise, mental and spiritual health, and a more natural and holistic approach to healing as a whole. Not everyone is as passionate as I am when it comes to this simple plant but there is one thing for sure. It has made me feel whole and has saved my life in more ways than one. The information and education Cannabis Nurses Magazine brings you today in this issue reflects the lives of other Cannabis Nurses from across the world. We as a staff, were honored to have the privilege to visit and learn from these Cannabis Nurses over the past year who are leading the world by example. In the United States, we are provided the knowledge by, Eloise Theisen MSN, NR, AGPCN-BC, “Why Nurses are Vital to the Medical Cannabis Community” and from, Carey S. Clark, PhD, RN AHN-BC, RYT, who provides us with a Holistic Approach to the Opiate Crisis: Solving the Complex Puzzle of Addiction with Cannabis. These articles alone are pivotal keys in creating and molding Cannabis Nursing as a specialty of Nursing. Which brings us to “New Year’s Resolutions: Goals for Nurses in 2016” which can assist in providing a guiding light for all who wish to step out of the box from traditional medicine and include Medical Cannabis Nursing as a future focus and these goals can apply to anyone. Across the globe we have, “Greetings from Australia”, from Mish Stanvic R.N., in the land down-under, who shares her experience of coming to Conference this last May 2015, to obtain her CEU’s of core training in: Basic Core Curriculum of Medical Cannabis Therapeutics from the American Cannabis Nurses Association (ACNA). It is here that I had the privilege of meeting this courageous Cannabis Nurse who traveled across the globe to fulfill the need for truth and knowledge and be around like-minded Nurses. She is a guiding light and example for Nurses to follow with the knowledge she has gained. I encourage all to pursue her vision and seek the truth of knowledge and learn the science behind the plant. The featured cover nurse story in this International Issue is, Inbal Sikorian R.N., the Cannabis Nurse from Israel who assisted in creating the first Medical Cannabis Nursing Clinic in Israel. The founder of Tikun Olam, Tsachi Cohen, realized and decided that it was necessary to provide the knowledge about their medical cannabis studies – its treatment, dosage, strains and safe use – to be taught and educated by professional medical staff, and Nurses were the key in filling the gap between patients and dispensary staff. We as Nurses have protocols in our nursing practice that assist us in being the guiding light and, Tsachi Cohen, by including Nurses in this vision, created a legacy within the nursing profession worldwide. They are teaching by example and “Healing the World”. In November 2015, at the 4th Annual Medical Marijuana Conference & Expo in Las Vegas, Nevada, we visited with Inbal Sikorin RN and Ma’ayan Weisberg BA, who traveled with their team from Israel and lectured and discussed the establishment of the Medical Cannabis Nursing Clinic in Israel, Tikun Olam. It was a packed room, standing-room only, full of inquisitive minds seeking the expert knowledge of these scholars. I was amongst greatness and I feel honored to be part of history in the making. It made me realize we all have so much to still learn. Today we share their personal stories with you and to the world. Included is the Father of Marijuana Research, Professor Raphael Mechoulam, who discovered THC and CBD in the 1990's and Nurses in Israel are working with him in this revolutionary paradigm shift in cannabis medicine. The journey of sharing this knowledge with our readers is stretching my growth as a Nurse and we have just begun. As we move forward, nursing will continue to evolve. But some some of the basics won’t change – basics such as advocating for patients, seeing how all the pieces fit together for the patient, and most importantly, caring for the patient as a human being. I am excited to now share the third issue with you today. Cannabis Nurses Magazine: International Issue. Where Nurses are leading the way with evidence-based education and sharing it with the world. We must Grow.
Julie Monteiro RN, BSK “Ask Nurse Juhlzie” Editor@Cannabis Nurses Magazine
Contributors January / February 2016
Publisher
Robert Herman
Managing Editor
Julie Monteiro RN, BSK
Creative Director
Tiffany Watson
Contributors Heather Manus, RN Leslie Reyes, RN Marcie Cooper, RN, MSN, AHN-BC Lisa Buchanan, RN ,OCN Mary Lynn Mathre, RN, MSN, CARN Jessica Aragona MS, RD, LDN Eloise Theisen MSN, RN, AGPCNP-BC Carey S. Clark, PhD, RN, AHN-BC, RYT Cannabis Nurses Magazine publishes the most recent and compelling health care information on cannabis health, studies, research and professional nursing issues with medical cannabis. As a refereed, clinical practice bimonthly journal, it provides professionals involved in providing optimum nursing care with the most up to date information on health care trends and everyday issues in a concise, practical, and easy-to-read format. Readers can view the magazine digitally for free online at: CannabisNursesMagazine.com or subscribe to a printed copy to be delivered to your door.
We are currently accepting articles to be considered for publication. For more information on writing for Cannabis Nurses Magazine, check out our writer’s guidelines at: cannabisnursesmagazine.com/writers-guidelines or submit your article to: editor@cannabisnursesmagazine.com 4780 W. Ann Rd., Suite 5 #420 N. Las Vegas, NV 89031 Editor@cannabisnursesmagazine.com Online 24/7 at: cannabisnursesmagazine.com
Heather Manus, RN Heather Manus is a native New Mexican and Registered Nurse specializing in all aspects of medical cannabis care. She is currently a board member of the American Cannabis Nurses Association, serving as Chairwoman for the ACNA conference committee. She also holds a certificate of completion for The Core Curriculum for Cannabis Nursing.
Leslie Reyes, RN Leslie Reyes, RN is a Board Member and the Secretary for the American Cannabis Nurses Association (ACNA). Leslie has worked as a Registered Nurse in Urgent Care, Psychiatric and Behavioral Health, and has been involved in cannabis patient advocacy for over nine years. She is a co-creator and co-author of the Core Curriculum in Cannabis Nursing owned by the ACNA, and is also on the committees for Communications and Media, Conference Planning, Certification, Events, Membership, Nominations, and the Executive Committee.
Marcie Cooper, RN, MSN, AHN-BC
Marcie Cooper is Board Certified as an Advanced Holistic Nurse and licensed as a Registered Nurse in Colorado. Originally from Memphis, Tennessee, she started her nursing career on a general med-surg hospital floor in 2004 and began a focus specializing in Oncology.
Lisa Buchanan, RN, OCN
Lisa Buchanan is an Oncology Certified Nurse (OCN) who has worked with the seriously ill and dying for more than 20 years. She a member of the Oncology Nurses Society (ONS), American Cannabis Nurses Association (ACNA), and the Washington State Nurses Association. (WSNA). She has earned certificates in the Core Curriculum for Cannabis Nursing and the Advanced Curriculum for Cannabis Nursing.
Mary Lynn Mathre, RN, MSN, CARN Mary Lynn (ML) Mathre, RN, MSN, CARN is the President and Co-founder of Patients Out of Time, a national non-profit organization dedicated to educating health care professionals and the public about the therapeutic use of cannabis, and the founding member of American Cannabis Nurses Association (ACNA).
Contributors Eloise Theisen, RN, MSN, AGPCNP-BC
is a certified adult geriatric nurse practitioner who specializes in cannabis therapeutics and has over15 years experience working in oncology, treating hundreds of patients with various ailments. She is the founder of Green Health Consultants in Lafayette, CA and on the leadership team of the American Cannabis Nurses Association (ACNA), working on advance certification and credentialing for medical practitioners in cannabinoid therapeutics.
Carey S. Clark, PhD, RN AHN-BC, RYT She has written about the nursing shortage and transformations needed in nursing academia and the profession. Following completion of a theoretical dissertation during her studies at the California Institute of Integral Studies, Dr. Clark has taught many online graduate nursing students for a variety of schools and she continues to write about the need for caring in nursing and nursing education. She is in a tenure track position at University of Maine at Augusta, where she has developed and implemented a caring-holistic-integral curricular framework for the RN- BSN program, which recently went through a successful accreditation site visit and won an award for Excellence in Holistic Nursing Education from the American Holistic Nurses Association. Dr Clark also teaches Reiki and Yoga with nursing students. Dr. Clark envisions a future world of academia where an integral and caring approach to education is the norm, and where nurses are empowered to create caring-healingsustainable bedside practices.
Mish Stanvic RN (Australia) Mish Stanvic RN is a nurse based in Sydney NSW, Australia. She is currently working in palliative care but her background is mostly in aged care. She has been a Registered Nurse since 2002. She has a passion for nursing who recently discovered Cannabis Nursing and traveled to the United States in 2015 to receive education in Cannabis Therapeutics. It is here where she attended and obtained the American Cannabis Nurses Association’s (ACNA) Course: Basic Core Curriculum in Cannabis Therapeutics in Florida during the Patient’s Out of Time Conference. She currently edits and manages the Facebook page: Australian Nurses Cannabis Support & Information Network.
Professor Raphael Mechoulam
Contact Information Publisher ND1Media Editorial Robert Herman
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Raphael Mechoulam was born in Sofia, Bulgaria on November 5, 1930. His father was a physician and head of a local hospital, while his mother "who had studied in Berlin, enjoyed the life of a well-to-do Jewish family". He attended an "American Grade School" until his parents were forced to leave their hometown because of anti-semitic laws and his father was subsequently sent to a concentration camp, from which he survived. After the communist takeover of hitherto pro-German Bulgaria in 1944 he studied chemical engineering, which he "disliked." In 1949 his family immigrated to Israel where he later studied chemistry. He gained his first research experience in the Israeli Army working on insecticides.[2] and is known as The Father of Marijuana for the research he discovered with THC and CBDs in Cannabis Research since the 1990's and we believe him to be the "Future" Nobel Prize winner for his great works.
Special thanks to our Honorary Israeli Nurse, Inbal Sikorin R.N., and Head of International Relations for Tikun Olam, Ma'ayan Weisberg B.A., for their expertise, shared knowledge, and dedication in providing us with the insight on the Israeli Perspective of Medical Cannabis and the story behind the development of the renoun Cannabis Nursing Clinic in Tel Aviv, Israel. Exclusive interviews with Cannabis Nurses Magazine forged a light upon how we can grow in Cannabis Nursing Therapeutics within the United States and around the world. These great women are leading by example and I am proud to call them my colleagues and friends for life. Thank you, Inbal and Ma'ayan, for Being the Change! We are honored to bring you their guiding light of knowledge in the developing field of Cannabis Nursing. Where we believe, "Every Patient Deserves a Nurse". Cannabis Nurses Magazine ©
Ma'ayan Weisberg B.A. and Inbal Sikorin R.N. 4th Annual Marijuana Business Conference & Expo Las Vegas, NV | Nov. 13th, 2015
Table of
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Cannabis- The Israeli Perspective from The Father of Marijuana: Prof. Mechoulam
3 5
New Years Resolutions: Goals for 2016
3 6
From seed to Patient: The Establishment of a Nurses Clinic in Israel
3 8
Fashion: Clog Trends in 2016!
3 20
The Founding of Tikun Olam: The Beginning of Medical Cannabis in Israel
3 3
Greetings from Austrailia (NSW)
3 4
Why Nurses are Vital to the Medical Cannabis Community
3 26
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CannabisThe Israeli Perpective
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New Years Resolutions: Goals for 2016
3$*( 5 From Seed to Patient: The Est. of a Nurses Clinic in Israel
The Opiate Crisis: Solving the Complex Puzzle of Addiction With Cannabis and Holistic Approaches
3 30
The Top 9 Myths
3 32
Nursing Humor
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Dietitan's Corner
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3$*( 6 The Founding of Tikun Olam
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Cannabis – CannabisThe Israeli Perspective By: Raphael Mechoulam*
Abstract: Short overviews are presented on the historical uses of cannabis in the Middle East and on the more recent scientific and medical research on phytocannabinoids and the endocannabinoid system, with emphasis on research contributions from Israel. These are followed by examples of research projects and clinical trials with cannabinoids and by a short report on the regulation of medical marijuana in Israel, which at present is administered to over 22,000 patients.
Keywords: anandamide; 2-arachidonoyl glycerol (2-AG); cannabidiol (CBD); tetrahydrocannabinol (THC).
In memory of Professor Itai Bab, a close friend and dedicated researcher. ________ * Corresponding author: Raphael Mechoulam, Faculty of Medicine, Institute for Drug Research, Hebrew Univeristy, Jerusalem 91120, Israel, Phone: +972-2-6758634, E-mail: mechou@cc.huji.ac.il
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Historical background: The resin of cannabis, hashish, has been used in the Middle East as a medicine, as well as a psychotomimetic, since ancient times. It is mentioned in Avesta, the Sacred Book of Knowledge of the Zoroastrian faith (1000–600 B.C.). It was well known to the Assyrians. Qunnabu is mentioned in Assyrian royal correspondence from around the end of 8th century B.C. apparently for use in traditional rites. Amongst its numerous uses as a medicinal agent, cannabis fumes were also prescribed as a treatment for the ‘poison of all limbs’ (presumably arthritis). In ancient Egypt, it was used as incense as well as medication for ‘mothers and children’. Today, we can only guess the nature of this ‘disease’. The Scythians, who ruled parts of present-day southern Russia, went south to plunder large areas of the Middle East (around 700 B.C.). Herodotus describes their use of cannabis as part of funerary customs. Burning cannabis and inhaling the smoke made them ‘howl in joy’ [1].
Surprisingly, in ancient Judea, cannabis was apparently unknown. Or, if it was used as a medicine, it was ignored in the Bible, as it was part of the prevalent Assyrian customs and culture, which after the empire of Assyria disintegrated (around 6th century B.C.), the Judean leaders tried to suppress. However, it may be mentioned in the Bible as panag – an unidentified product exported to Tyre [2]. The Greeks and the Romans, who were in the Middle East for many centuries, were not aware of the psychoactivity of cannabis, but they used it as a medicinal agent, mostly for some types of pain and inflammations. However, Galen was aware that it produces ‘senseless talk’ [1]. In medieval Arab society, for over a millennium, hashish was widely used for its psychoactive effects, although it was formally prohibited [3]. Its medical use is supposed to have been marginal, but the Jewish religious scholar, philosopher and physician Maimonides (12th century),
who spent much of his life in Cairo, states that cannabis was amongst the most frequently used drugs [4]. And in a report, which obviously has modern-day implications, Ibn al-Badri tells that the epileptic son of the Chamberlain of the Caliphate Council in Bagdad was given hashish which cured him, but he had to continue smoking it throughout his life [3]. In the Middle East, since the Middle Ages and in modern times, hashish, although illicit, has continued to be widely used. Indeed, cannabis was introduced in Europe by Napoleonic soldiers returning from Egypt. Sporadic investigations on the chemistry, pharmacology and clinical effects of cannabis were reported throughout the 19th century. However, major advances had to wait until the 1930s when Cahn and Todd in the UK and Adams in the US initiated investigations in the chemistry and Loewe, initially in Germany and later in the US, in pharmacology [5]. Cannabidiol (CBD) and cannabinol were isolated in pure form, and the structure of cannabinol was elucidated. Some synthetic molecules, with cannabinoid-like activity, were synthesized. However, the active principles were not isolated in pure form [5]. Very little research was done in this field from the mid-1940s until the 1960s, mostly due to legal obstacles, which made work in academic laboratories extremely difficult.
Cannabis research – chemical and preclinical The long tradition of hashish use in the Middle East and the absence of well-based chemical and pharmacological data in the field led my colleagues, Dr. Yuval Shvo and Dr. Yehiel Gaoni, and I, in the early 1960s, to reopen research in this area. We were able to obtain confiscated Lebanese hashish from the police. Using (then) modern methods of chromatography, we were able to isolate numerous cannabinoids and to elucidate their structures [6]. These compounds were all tested for cannabinoid activity in monkeys by Dr. Habib Edery [7], and although all plant cannabinoids have closely related chemical structures, essentially only ∆⁹tetrahydrocannabinol (THC) – originally named ∆₁-tetrahydrocannabinol, which we first isolated in 1964 [8] – no other compound caused significant sedation. At that time, this effect was the only one that we followed. Two additional compounds showed some activity: cannabinol, which is considered today to be an artifact formed on oxidation of THC, and ∆⁸–THC, which may be present in negligible amounts. Most of the cannabinoids isolated by us from hashish were synthesized by us and by other groups and became available for pharmacological and clinical research [9]. In the meantime, illicit use of marijuana had spread widely throughout the world,
and a large number of investigators, particularly in the USA, initiated work on various aspects of cannabinoid effects. We learned a great deal on the metabolism, biochemistry and pharmacology of THC and to some extent also on CBD. However, again due to legal constraints, very little clinical work was reported. Even today we have to depend mostly on anecdotal evidence or evidence based on small clinical trials as regards the possible clinical value of cannabinoids. In spite of the advances in biochemistry, metabolism and pharmacology, the mechanism of action of THC, the major pychoactive constituent, remained elusive for nearly 20 years. It was originally believed that it acts nonspecifically on neural membranes. Gradually, pharmacological and chemical data surfaced, which were inconsistent with the nonspecificity of THC action. Indeed, in the late 1980s and early 1990s two specific cannabinoid receptors, CB1 and CB2, were identified [10, 11]. Stimulation of CB1 leads to the well-known marijuana effects; CB2 is apparently part of a major, new protective system [12]. It is generally assumed that receptors are not present just to transmit effects caused by plant constituents. They are part of biological systems in which they are stimulated (or inhibited) mostly by endogenous molecules.
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In the early 1990s, we initiated a project to identify such endogenous cannabinoid compounds. We assumed that while such compounds will not be chemically related to THC, they would be lipid molecules as THC. We initially synthesized a tritium labeled THC-type derivative, which was bound to the CB1 receptor and then analyzed brain fractions for activity – namely release of the labeled compound by an endogenous molecule. After considerable efforts, we identified a novel compound, which was as potent as THC in binding to the receptor. We named it anandamide, based on the Sanscrit name for happiness and the amide part of the new molecule [13]. Later, we discovered a second, chemically related molecule, 2-arachidonoyl glycerol (2-AG) in the periphery [14], and a Japanese group found it in brain [15]. Both anandamide and 2AG are arachidonic acid derivatives. The structures of THC, CBD, anandamide and 2-AG are presented in Figure 1. The cannabinoid receptors, the two endogenous cannabinoids (endocannabinoids) and the enzymes which synthesize and degrade them form the physiological endocannabinoid system (ECS), which is involved in a huge number of functions. Indeed, in a recent review [16], it was stated that ‘modulating ECS activity may have therapeutic potential in almost all diseases affecting humans, including obesity/metabolic syndrome, diabetes and diabetic complications, neurodegenerative, inflammatory, cardiovascular, liver, gastrointestinal, skin diseases, pain, psychiatric disorders, cachexia, cancer, chemotherapy-induced nausea and vomiting, among many others’ (with suitable references). This very strong statement indicates the importance of this new system.
The discovery of the ECS, coupled with the upsurge in cannabis use throughout the world, led to a major expansion of research in this field. Thousands of publications have appeared dealing with various aspects of the chemistry, biochemistry, pharmacology and, to a lesser extend – again mainly due to legal barriers – the clinical aspects. For recent reviews, see references [17–19]. In Israel, the advances and local experience in chemistry and biochemistry and the availability of both phytochemicals and endocannabinoids led many groups to expand their research into the phytocannabinoid and endocannabinoid areas. Some of these projects were undertaken in collaboration with our Jerusalem group. I shall try to summarize a few, very few, of the advances made by various groups in many of Israel's universities and hospitals.
Brain trauma A Hebrew University group in Jerusalem found that after closed head injury in mice, the level of the endogenous 2-AG was significantly elevated [20].
This effect was considered to be a protective reaction. Indeed, administration of synthetic 2-AG to mice after the injury was found to cause significant reduction of brain edema, better clinical recovery, reduced infarct volume and reduced hippocampal cell death. When 2-AG was administered together with additional inactive 2-acyl-glycerols that are normally present in the brain, functional recovery was significantly enhanced. This is another example of the ‘entourage effect’ noted previously, in which inactive brain constituents enhance the activity of endocannabinoids [21]. Later, it was found that the brain constituents arachidonoyl serine and palmitoyl serine, which do not bind to the cannabinoid receptors, also reduce head injury [22, 23]. Unexpectedly, this effect can be blocked by cannabinoid receptor antagonists and is not noted in CB2 knock-out mice.
Bone Effects
The group of the late Prof. Itai Bab at the Hebrew University initially found that both cannabinoid receptors are involved in the regulation of bone mass and bone remodeling, with the CB1 regulation taking place by
Figure 1: The structures of the main phytocannabinoids and endocannabinoids.
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modulating adrenergic signaling [24]. Later, it was found that the endogenous oleoyl serine (an anandamide-typemolecule) also modulates bone mass and remodeling [25]. In a recent publication which appeared after Bab’s death, it was shown that HU-433, a CB2 specific agonist, affects bone remodeling better than HU-308, another CB2 agonist, which, however, binds to the receptor with a much lower Ki, i.e. there is an inverse relationship between binding affinity and biological potency [26]. This observation, if shown to be of general nature, may be of major importance in understanding of the nature of receptor binding. Another publication by Bab, which also came out after his death, reports that CBD enhances fracture healing – an observation of possible major clinical importance [27]. For a review of Bab’s early work in the field of cannabinoids and bones, see reference [28].
Arthritis A collaborative effort of a Jerusalem group with a British one showed that in mice CBD ameliorated the clinical symptoms of arthritis induced by collagen [30]. CBD was equally effective when administered i.p. or orally. The dose dependency showed a bell-shaped curve, which is seen in many cannabinoid treatments. Clinical improvement was associated with protection of the joints against severe damage. Diminished IFN-γ production, as well as a decreased release of tumor necrosis factor by knee synovial cells, was noted. It was also found that CBD administration was capable of blocking the lipopolysaccharide- induced rise in serum tumor necrosis factor in C57/BL mice. Taken together, these data show that CBD, through its combined immunosuppressive and antiinflammatory actions, has a potent antiarthritic effect in collagen-induced arthritis.
Stress Diabetes Type 1 Another group in Jerusalem found that the administration of CBD to 11– 14 weeks old female NOD mice, which were either in a latent diabetes stage or with initial symptoms of diabetes, ameliorated the manifestations of the disease. Diabetes was diagnosed in only 32% of the mice in the CBDtreated group, compared to 86% and 100% in the emulsifier-treated and untreated groups. In addition, the level of the proinflammatory cytokine IL-12 produced by splenocytes was significantly reduced, whereas the level of the anti-inflammatory IL-10 was significantly elevated following CBD-treatment [29].
A group at Haifa University has brought additional evidence on the existence of a relationship between glucocorticoids and the ECS [31]. The ECS, which may be enhanced by stress, plays an important role in the downregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis activity in response to stress; glucocorticoids affect the ECS to cause negative feedback control on the HPA axis during stress. Cannabinoid CB1 receptors are abundant in limbic regions where they may cause emotional arousal effects on memory. The Haifa group found that enhancing cannabinoids signaling, in part by glucocorticoids, prevents the effects of acute stress on certain kinds of memory.
"Modulating ECS activity may have therapeutic potential in almost all diseases affecting humans"
Mechanisms of cannabinoid effects on the immune system
A group in the Weizmann Institute in Rehovot has shown that both THC and CBD potently reduce the Th17 phenotype, which is known to be increased in inflammatory autoimmune pathologies such as multiple sclerosis [32]. They found that reactivation of encephalitogenic T cells (cells that induce experimental autoimmune encephalitis when injected to mice), under certain experimental conditions led to a large increase in IL-17 production and secretion and that CBD and THC dose-dependently suppressed the production and secretion of both IL-17 and of IL-6, a key factor in Th17 induction. Pretreatment with CBD also resulted in increased levels of the antiinflammatory cytokine IL-10. Surprisingly, these effects do not seem to involve the CB1, CB2, PPARγ , 5-HT1A or TRPV1 receptors.
Protective effects of ultralow doses of THC A group in Tel Aviv University has found that a single ultralow dose of THC (0.002 mg/kg, several orders of magnitude lower than the conventional doses in mice) protects the brain from different insults, including inflammation, that cause cognitive deficits [33]. Mice received a single injection of low-dose THC; up to 7 days after treatment with lipopolysaccharide (LPS), THC protected the mice from the long-lasting cognitive deficits caused by LPS. The protective effect of THC was blocked by a CB1 receptor antagonist but not by a CB2 receptor antagonist. The authors suggest that ‘an ultralow dose of THC that lacks any psychotrophic activity protects the brain from neuroinflammation-induced cognitive damage and might be used as an effective drug for the treatment of neuroinflammatory conditions, including neurodegenerative diseases’. JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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Clinical research
Clinical research Epilepsy On the basis of animal trials, our group, in collaboration with a Brazilian group [34], over 35 years ago, evaluated the effects of high doses of CBD in epilepsy patients. Fifteen patients received, in a double-blind procedure, 200–300 mg daily of CBD or placebo for 4.5 months. Four of the eight patients that received CBD remained almost free of convulsive crises throughout the experiment, and three other patients demonstrated partial improvement. CBD was ineffective in one patient. In spite of these promising results, until recently no additional clinical work was reported. However, on the basis of a large number of anecdotal reports on the positive effects of CBD-rich marijuana on children with various pediatricepilepsies, several major trials have been initiated. Initial reports are positive. Why did we have to wait for decades?
Graft vs. host disease On the basis of the well-established effects of CBD on the immune system, a group at the Rabin Medical Center, asociated with Tel Aviv University, initiated a clinical study on the possible treatment of graft vs. host disease (GVHD) – a reaction of the body to the replacement of bone marrow in certain types of cancer patients [35]. Forty-eight patients received 200–300 mg/day CBD, and the results were compared to those of 101 historical control subjects given standard GVHD prophylaxis. The positive results were significant in both the patients that suffered from relatively mild and those with severe GVHD.
Post-traumatic stress disorder In a small open trial, a group at the Hadassah hospital in Jerusalem showed that 5 mg of THC, twice a day, as add-on treatment to the patient’s other drugs, led to significant improvement in sleep quality, frequency of nightmares and global symptom severity [36]. These results parallel related effects seen with a THC-like drug reported previously by a Canadian group [37]. They also give support to wide, illegal use of cannabis by post-traumatic stress disorder (PTSD) patients.
Crohn’s disease
A group at the Meir Medical Center in Kfar Saba, associated with Tel Aviv University, has reported that in a placebocontrolled study, 21 chronic Crohn’s disease (CD) patients showed a significant decrease in a CD activity index. Ten out of 11 patients on cannabis improved clinically, compared to four of 10 on placebo [38]. While complete remission was noted in only one of 10 patients in the placebo group, five of 11 patients fully recovered in the group receiving cannabis.
Parkinson’s disease A group at the Rabin Medical Center, associated with Tel Aviv University, assessed the clinical effect of cannabis on motor and non-motor symptoms of Parkinson’s disease (PD) [39]. Twenty-two patients with PD at a motor disorder clinic were evaluated at baseline and 30 min after smoking cannabis. Numerous scales were used to determine the clinical effects. Significant improvement was noted in tremor, rigidity, bradykinesia and sleep and pain scores.
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Legal use of Medical Cannabis Around 10 years ago, the Israeli Ministry of Health decided to open the doors to treatment of various diseases with cannabis under strict supervision. A single physician – who was head of a psychiatry hospital and continued his work as such – took upon himself to head this program. The administrative details changed over the years, but within 5–6 years, the procedure adopted was to allow only a specialist physician (not a general practitioner), treating a specific patient, to apply to the Ministry. The physician had to show that the conventional treatment that the patient had received previously was not efficient and that, on the basis of some published medical data, he/she believed that the cannabis treatment may be of value. Slowly, a list of ‘treatable’ medical conditions was compiled. It included chronic (mostly neuropathic) pain, some gastrointestinal conditions (including Crohn’s), pediatric onvulsions and some neurological symptoms (trembling) but did not include psychiatric and most neurological diseases. However, a special committee could approve additional uses in particular cases, such as asthma. At present, there is a unit at the Ministry that is in charge of the program. About 22,000 patients have received medical cannabis, mostly for pain conditions but also for epilepsy (particularly in children), some gastrointestinal conditions, post-trauma, Tourette syndrome and others. The growers are required to supply medical cannabis in several forms – dry material for smoking or inhalation and oil solutions for oral administration. They also have to offer medical cannabis with different THC:CBD ratios: high THC and low CBD, high CBD and low THC and also THC and CBD in approximately equivalent amounts. The physician has to decide the type of medical cannabis required. There are numerous problems associated with the administration of medical cannabis:
1.
Not all medical conditions can be treated with the same ratio of cannabis constituents or with pure compounds.Thus, in GVHD and in epilepsy, pure CBD is apparently preferable than a mixture; in PTSD, possibly pure THC is a useful drug. But there are no hard data published.
2.
CBD is not available as a pure compound. Children with epilepsies are administered medical cannabis with a ratio of CBD:THC of about 20:1 or less, which means that a child administered 200 mg CBD per day also gets 10 mg (or more) THC. We know essentially nothing on the effects of chronically administered THC to a child whose central nervous system (which is obviously affected by THC) is in a stage of development.
3.
Physicians are used to administer drugs at well defined levels, based on clinical trials. Most of them are not comfortable with the treatment of patients with a plant mixture, in most cases administered by smoking. Hence, many physicians refrain from getting involved in treatment with medical cannabis.
Concluding remarks Israeli scientists have been involved in cannabis preclinical research over 50 years, and clinicians have done clinical research and have treated patients with cannabis for over a decade. But we still have to learn and get additional experience, particularly in the clinic. However, with the vast knowledge already available, it should be pos sible to advance rapidly. I see at least two possible directions:
1. CBD is a nontoxic molecule which does not seem to cause side effects. However, the doses needed are high. Thus, in schizophrenia,
CBD has been assayed in the clinic with very positive results. But the doses needed are 800 mg/day due to low bioavailability. Many natural products have been chemically modified to obtain better drugs. I assume that research on CBD will follow the same route and novel CBD-type compounds with a better pharmacokinetic profile will be developed.
2. Clinical trials are badly needed. They should be undertaken not only with the pure constituents but also in well-defined mixtures, previously evaluated in animal models and based on the possible ‘entourage effect’
Author contributions: The author has accepted responsibility for the entire content of this submitted manuscript and approved submission. Research funding: None declared. Employment or leadership: None declared. Honorarium: None declared. Competing interests: The funding organization(s) played no role in the study design/ in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References 1. Mechoulam R. The pharmacohistory of Cannabis sativa. In: Mechoulam R, editor. Cannabinoids as therapeutic agents. Boca Raton, FL: CRC Press, 1986:1-16. 2.
Rabin C. Rice in the Bible. J Semitic Stud 1966;11:2-9.
3. Rosenthal F. The herb hashish versus medieval Muslim society. Leiden: E J Brill, 1971. 4. Maimonides M. The medical aphorisms. In: Rosner F, Mutner S, editors. New York, NY: Yeshiva University Press, 1971:100 and 123. * Further References listed online at: www.cannabisnursesmagazine.com JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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New Years Resolutions:
ethod
“If you can think it, you can do it.” Walt Disney
By: Julie Monteiro RN, BSK
The end of 2015 harkens times of deep reflection of the past and hope for the future -- not only for ourselves, but for so many others who are caught up in the whirlwind of daily life of Western Medicine. As this year closes and a fresh start nears, there is something about being a nurse that makes us look at this "clean slate" a bit differently than we used to especially when it involves Cannabis Nursing. This brings us to the following: New Years Goals for Cannabis Nurses in 2016. Nursing as a career is a journey and it's dynamic. It can become even richer when we actively seek challenges that build knowledge, skills, and competencies. These might traditionally include educational advancement, specialty certification, active involvement in a professional organization, presentation of a poster or lecture at a conference, or maybe writing for publication. Other opportunities could involve taking a leap into leadership responsibilities for a workplace project, committee, or a community or national organization such as American Cannabis Nurses Association (ACNA). The real puzzling question is how do we incorporate Cannabis Nursing into a world that considers it taboo and illegal at the Federal level? Many nurses work for corporations who are money driven and their driving force focuses on profits instead of true healing. We are told to refrain from speaking about Medical Cannabis in the work place as it is entangled into the Federal Schedule 1 classification and many medical professionals, knowing and understanding the medical benefits, are uncomfortable and/or prohibited from discussing it with patients at the work place. This in itself is absolutely ludicrous when we are taught as nurses to be the voice for patients. True advocacy has its risks and each nurse must make their own decision of where they stand in today’s paradigm shift.
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We know, once we are properly informed and educated, that Cannabis Nursing is the answer to the surge of chaos in the design flaws of legislation and our current medical care system across the nation and world. Nurses throughout history have been the guiding light forging in new territories of medicine despite our oppositions. So, what do we as Nurses do now? How do we get involved? How can we be the change?” The answer is: It’s time to set your goals that reflect the goals and attributes of Cannabis Nursing and these goals can apply to anyone.
The following is a List of Goals Nurses can Encompass into their Daily Lives: 1.
Pursue the Truth- Learn and understand the science behind the plant: The Endocannabinoid System (ECS) from an accredited source of knowledge. Obtain accredited CEUs in Cannabis Therapeutics from a reliable source. It is up to you to seek out the truth of knowledge.
2.
Know the Law- Understand and respect your state and federal policies surrounding Medical Cannabis and be a prime example for others to follow.
3.
Be a Resource- Inform and educate patients, caregivers, legislature, and your community about the evidence-based knowledge you have gained. Nurses are the number one most trusted medical provider in the nation for well over twelve years now. Patients know and trust nurses to be their guiding light for information and education. With your evidence-based foundation of knowledge you have a powerful tool to teach the world of the truth about Medical Cannabis.
4.
Get Involved- You are a nurse with a specific skill set that others are seeking. Be the change and get involved within your local community and state. Inform other nursing organizations about Cannabis Nursing (being in its infancy) and be the educated expert in your area. Join memberships (ACNA), sign up for subscriptions (CNM), attend or lead meetings (ACNA State MeetUp Groups), conferences (Patient’s Out of Time: April 2016), lectures, symposiums, join subcommittees, and be the face that defines Cannabis Nursing in your area.
5.
Be the Voice and Advocate for Patient’s Rights- Demand Safe Access and Safe Product Delivery Systems for all patients. Pledge to fight for freedom of choice of treatment options and advance the QUALITY and SAFETY of patient care.
6.
Assist Legislation- on creating proper laws for medical cannabis patients which focuses on: Whole Plant Cannabis Non-Solvent Extraction with both THC & CBD (eliminate CBD-Only laws). Policies related to health human resources must be evidence-based, and nurses have a key role to play at policy tables, especially if you are properly educated on Cannabis Therapeutics. Get involved in legislation either at the state or national level. They need our expertise.
7.
Become a Leader- it’s not easy to lead but someone has to do it to create positive change. If there is not an ACNA State MeetUp Group in your area then start one. If there is not a community resource center or a monthly patient meeting group then create one. You are a Nurse and have the tools from your education, job experiences, and the philosophy of nursing to succeed. Establish Medical Standards of Practice- Integrate Nurses into Dispensaries and fill the Gap between Patients & Dispensary staff. Nurses understand physiology, pharmacology, and disease states and can play an intrical role in being educators within dispensaries. ACNA’s Motto: Every Patient Deserves a Nurse.
8.
9.
Be Positive and surround yourself with like-minded people who are positive influences in your life by creating a network
10.
Believe that there are No Limitations- There are no limitations to what you can do and be as a nurse as we follow our
of professionals who understand Medical Cannabis. Positive energy is contagious and will be the guiding light.
nursing practice. Nurses are stepping out of the box from traditional corporate medicine within hospitals and facilities and becoming business owners and leaders in the Cannabis Industry charting undiscovered waters. The Universe is your limit!
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From Seed to Patient
The Establishment of a Nurses Clinic in Israel By Inbal Sikorin R.N., Head Nurse and Patient Care, Tikun Olam Ltd. Israel.
I
n 2009, during my role as Head Nurse at Hadarim Nursing Home, we were using all the conventional tools that traditional medicine could provide alongside a large team of professional staff. We managed to prolong life but not to improve the quality in the elderly life. A family of an elderly woman, who was suffering from severe agitation due to her untreatable dementia, was in a lot of pain and suffering and the medication available was not providing the right relief. The family asked if I could try to treat her with medical cannabis after them seeing Zack Klein's first movie, "Prescribed Grass". This was very strange to me, I did not learn about this medicine [Medical Cannabis] in nursing school and all my attempts to find out more about the plant from my colleagues were fruitless. I had no resources at this time. I contacted the leading Medical Cannabis supplier in Israel, "Tikun Olam", and together we went to, Professor Raphael Meschulm, and found five common symptoms from clinical literature to be effective on the following: Pain, Agitation, Appetite, Sleep and Polypharmacy. We conducted a small observational research, based on the five common symptoms in the nursing home, using "Erez", Tikun Olam's first Indica strain. I am still excited when I look back at the results of this small but groundbreaking research we initiated, and the possibilities of the research's impact on elderly lives around the world. We found that "Erez" Indica 23% THC was prominent in improving many symptoms such as pain, increasing appetite, managing nutritional values, improving ataxia and movement disorders in Parkinson's patients, reduction in daily medication consumption and most importantly, improving their overall quality of life. The department became quiet, the nurses could work, and the families could visit their relatives in a calm and relaxing environment that was normally full of tension and suffering. One of our patients, Moshe Roth, a Medical Cannabis patient in the old age home, was our number one advocate for the elderly with his success with Medical Cannabis. He passed away this last year in 2015 at the age of 83, but though our grief of his departure, he left a legacy by appearing in numerous international news channels (Germany, Japan, BBC, CNN, ZDF, CNBC and many more‌) and sharing his beautiful success story with the world.
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Ticun Olam's Nurses Clinic in Israel
Moshe Roth, a Medical Cannabis Patient
He received "Erez", an Indica strain for his movement disorder after suffering from a stroke, which was the treatment that gave him back his hands and he could continue to write and paint until his last days. Moreover, he was a Holocaust survivor from France and his medical cannabis treatment stopped his reoccurring nightmares from his childhood, he could sleep and deal with his Post-Traumatic Stress Disorder (PTSD). Today his legacy still lives. Tikun Olam has also been the world leader in developing high CBD strains (low THC) such as "Avidekel", "Midnight", and "Raphael", which provided patients in our project, the ability to treat the patients suffering from different inflammatory disorders. The results of these strains used were astonishingly positive.
During this joint project of providing access of Medical Cannabis treatment to the elderly in a nursing home, Tsachi Cohen, the founder of Tikun Olam, realized and decided that it was necessary to provide the knowledge about the study (its treatment, dosage, strains and safe use) to be taught and educated by professional medical staffwhich included Nurses! As Nurses, we are known to be the leading and most trusted source for medical information and education for patients in the field of medicine. Nurses have protocols in our nursing practice that assist us in being the guiding light and, Tsachi Cohen, by including nurses in this vision, has created a legacy within the nursing profession worldwide. So, in 2010, when the Israel government changed the regulations and set a cap price for the Medical Cannabis treatment (around $100 no matter the dosage or the product), Tikun Olam opened the first and only Nurses Clinic in Israel and started providing consultations to patients. Tsachi's vision was to have a clinic in the center of Tel Aviv, accessible to disabled patients. He believes that if patients are part of society then, our society will be more compassionate towards others suffering - which is part
of the "Tikun Olam" Goal: Healing the World. In our Nurses Clinic, we have two treatment rooms for adults led by experienced nurses from the emergency and oncology departments. Our third treatment room painted specially for our pediatric patients and their families, and is led by a nurse from the children's hospice department. In the Nurses Clinic we continued to collect patient data and create one of the biggest accumulated patient data in the world. This data collection enables the Nurses to recommend certain strains and dosages to treat different symptoms and conditions, resulting in a 95% success in guidance and treatment. These tools are in the process of analysis under a clinical trial so I am hopeful to share the knowledge as soon as possible.
All communities will have to manage this continuing change, especially when it comes to health, healthcare, and healthcare providers. Inbal Sikorin R.N., Head Nurse and Patient Care
Until then, we can only hope to be the guiding light for nursing practice here in Israel and to the world as Medical Cannabis is becoming more widely accepted and Nurses are integrated into this newly developing field of medicine. Thank you.
"Erez" Ticun Olam's First Indica Strain 23% THC
Medical Cannabis Oil set at $100/Month Cap
Ticun Olam's Grow Facility in Tel Aviv, Israel. "Healing the World" JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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Clog
Trends Kayla - Good Vibes
Footwear Trends for 2016 come as varied as the nursing population itself…
2016
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Lewiston By Alegria - Mens - Lewiston Collection. This ankle high slip on shoe features double-sided goring for comfort, removable footbed with cork & mem-ory foam; hand sewn leather lining, arch support and a roomy toe box. Priced starting at $149.99
Debra By Algeria. The Debra slip-on features a handcrafted sole and a 1.5 inches heel, leather for durability, contrast stitching edges, foam footbed for comfort, elastic goring for easy slip-on and slip-off. Priced starting at $68.99
Professional Lindsey By Koi (Sanita) - This shoe features a patent upper, rocker bottom, skid resistant outsole, reinforced padded instep, absorbent insole, and roomy toe box for comfort. Priced starting at $129.99
The Founding of Tikun Olam:
The Beginning of Medical Cannabis in Israel By Ma'ayan Weisberg B.A., Head of International Relations
The Company’s
founding vision continues to drive us to work hard to provide patients with unparalleled treatment alternatives through the development of industryleading professional standards for growing and treating patients with the highest quality medical grade cannabis available.
Tikun Olam
consistently sets the benchmark for the medical cannabis industry in Israel and throughout the globe.
I entered the Israeli Medical Cannabis world when I was a Bachelors of Arts (BA) student majoring in Media and Political Science. During my second year, a friend of mine told me about a young man named, Tsachi Cohen, who had established "Tikun Olam", the first Medical Cannabis Company (privately held and Philanthropic) in Israel, and was looking for volunteers to work with patients. This was in the beginning of 2009 and the Israeli Medical Cannabis Program was just starting to expand and gain awareness. Tikun Olam supplied a few hundred patients with Medical Cannabis every month free of charge under the "Dangerous Drugs" Agency directed by, Dr. Yehuda Baruch, a Psychiatrist. Tsachi Cohen, had pursued and received the first national license in Israel in 2007, to grow and provide Medical Cannabis to patients, after several committees and long investigations with the Ministry of Health and Internal Affairs. I arrived at a small apartment in Tel Aviv, Tsachi's home, where he welcomed and treated patients with an authorized license from the Ministry of Health. Patients from all ages suffering from different diseases and conditions would come once a week to receive their medication. In this small apartment, I fell in love with Tsachi's vision to "Heal the World" with Medical Cannabis and provide an alternative treatment to the suffering. The more I researched and learned about this incredible plant, its history and science, and witnessed firsthand its medicinal effects on hundreds of patients, I felt obliged to take on the mission of becoming a dedicated advocate. Our team of volunteers, mostly patients and advocates, would receive the new patients and educate them about the plant and its possible medical benefits and side effects, ways of consumption and daily use and safety. New patients would meet experienced patients and an intimate community came to life, which included advocates in the government, press and medical staff. "Tikun Olam" succeeded in developing new strains including the first Israeli medical cannabis strain, "Erez", named after one of our first patients whom past away after fighting cancer for several years. "Erez" is an Indica 23% THC, cultivated by Tsachi's mother, Dorit Cohen, in her house in the north of Israel, and has successfully treated many different conditions such as but not limited to: Parkinson's
Cannabis Nurses Magazine ©
4th Annual Marijuana Business Conference & Expo Las Vegas, NV | Nov. 13th, 2015 From Left: Robert Herman CNM Publisher, Ma'ayan Weisberg B.A. (Israel), Nurse Juhlzie R.N. (NV) , Prof. Zvi Bentwich M.D. Chief Scientist of Tikun Olam, Nurse Heather R.N. (CA), Nurse Inbal R.N. (Israel)
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JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
Disease, Post-Traumatic Stress syndrome (PTSD), HIV, Cancer, Phantom Pain, Chronic Pain, and Crohn's Disease. One of our goals was to learn the effects of "Erez” on our patients in clinical trials with Doctors and hospitals to prove the advantages of the treatment and expand its uses.
Tikun Olam began the first clinical survey examining the
effects of Medical Cannabis treatment on Crohn's Disease with
the Gastroenterology Department at Meir Hospital. In 2010, the number of patients increased, and Tsachi turned to
"Maccabi", one of the national health insurance organizations, to try to persuade them to subsidize the treatment due to its
success in reducing medication and treatment for patients and therefore, saving the government money in patient care.
Even though the organization was positive towards the proposal,
the government did not support this initiative to fund the
treatment and decided to create a cap price ($100) for all
patients to pay the growers directly for a month's treatment, no matter the amount or form of Medical Cannabis provided. From that moment on, Tikun Olam became an established company, and opened one of the biggest and most advanced cultivation
our vast experience , we developed the capacity to overcome the challenges inherent to treating the elderly population with cannabis successfully.
In addition, the company’s mission, to provide treatment for vulnerable population segments, drove us to develop products especially for children. These products are easy and safe to consume. We set up a Pediatric Nursing Department with experienced professionals that oversee our younger patients and make sure that they receive the highest level of care and relief possible. Tikun Olam has built one of the world’s largest medical cannabis treatment databases that has optimal strain and dose information for many different diseases and information about the reduction of conventional medicines. All of the information is stored anonymously and discretely and forms the basis of our professional nursing staff’s ability to help patients choose the strain and dose that is right for them. Over the years, Tikun Olam, has fostered relationships with physicians, researchers, hospitals, and nursing treatment facilities throughout Israel and abroad. Ma'ayan Weisberg B.A., Head of International Relations Tikun Olam LTD Israel
facilities in the world.
I had just graduated from University and now could devote
myself to changing public awareness and sharing the knowledge that I learned with the world. The company’s founding vision continues to drive us to work hard to provide patients with
unparalleled treatment alternatives through the development of industry-leading professional standards for growing and
treating patients with the highest quality medical grade cannabis available. Tikun Olam has developed a unique range of
proprietary cannabis varieties and innovative products based on unique world-renownedproduction techniques that focus on increasing the efficacy of the active compounds (THC, CBD,
CBG…) in the plant. Our unique varieties have made waves
throughout the world and have garnered attention from the
international media. We utilize our varieties in various clinical medical trials based on their safety and efficacy and provide relief for thousands of patients.
We believe that an integral part of medical cannabis treatment is
empowering patients with access to the professional knowledge to effectively and safely choose and consume the right dose and the right variety customized per patient. To set the patient care
standard, we have created the world’s first Nurse Clinic, led by
Inbal Sikorin R.N., where trained Nurses [in Cannabis Therapeutics and the Endocannabinoid System] guide patients throughout their treatment course.
Tikun Olam founded the first project of its kind in the world to
treat elderly patients in the “Hadarim” Nursing Home at Kibbutz Na’an with Medical Cannabis. With a dedicated staff,
professional knowledge, appropriate medical equipment and
Cannabis Nurses Magazine ©
Tikun Olam is the exclusive partner of Medreleaf Corp. in Canada and is currently establishing a strategical partnership in the United States to bring our knowledge to the different states in 2016. We can only hope our knowledge is accepted and embraced despite the hurdles we face- please, God.
We continue to believe the most important aspects of our work is our involvement in dozens of research studies that examine the application of our cannabis strains and products in treating patients with various conditions and symptoms. Our research initiatives published in professional medical journals with the goal of sharing knowledge and spreading awareness about the benefits of medical cannabis treatment, such as Cannabis Nurses Magazine, and our belief in the importance of professional transparency and open collaboration.
Tikun Olam has appeared in hundreds of news and media outlets, and we invest great effort and resources in outreach to increase awareness amongst doctors, nurses, patients and the public about the potential benefits of treating patients with Medical Cannabis. The company continues to challenge itself to raise the bar and set the standard of treatment to reach every patient that could benefit from Medical Cannabis as a real alternative to conventional medical treatment. We at Tikun Olam know we are “Healing the World”. JANUARY/FEBRUARY 2016
CANNABISNURSESMAGAZINE.COM
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Mish Stanvic
Registered Nurse - Sydney (NSW) Australia Greetings from Australia, I am a Registered Nurse. Currently, I am one of the editors of a Facebook page Australian Nurses Cannabis Support & Information Network. I am in my last year of completing a research based Master of Palliative Care in Aged Care. I have had an interest in Medical Cannabis going on about 2 years (since 2014). My interest in cannabis medicine [Medical Cannabis] started after I became rather disillusioned by the amount of poly pharmacy and the side effects my residents [patients] were experiencing. It was around this time I started researching cannabis which led me to The American Cannabis Nurses Association (ACNA) and subsequently, involved me in travelling to the United States (US) and meeting like-minded Nurses who were lucky enough to be able to be using cannabis therapies. In 2015, I had the privilege of attending the Patients Out of Time Conference in Florida and completing the Core curriculum in Cannabis Nursing thanks to the scholarship provided by the American Nurses Cannabis Association. I found my experiences to be invaluable however, unfortunately none of these experiences have translated very well here in Australia. This is due to a number of factors including an overly conservative culture combined with a medical-centric model of care and our political climate. I have also experienced first-hand some rather underhanded tactics used by other cannabis activists here in Australia, in part due to different ethical stances and viewpoints. However, on the flip side I have met some amazing and positive people from all walks of life who I believe really want to make a difference to the lives of others.
Medical Cannabis in Australia is in its infancy and I believe everyone is still feeling their way through this emerging world and finding their place. In my interactions with other healthcare professionals the response to the introduction of Medical Cannabis is met with a wide array of responses from genuine interest, to eye rolling, to concerns regarding side effects, and others who embrace it as a treatment option. I guess what is the most positive for me is that the conversations have only just begun. This is really exciting for me as a health professional because it means people are starting to wake up and open their minds. In 2016, I hope to complete the Advanced Curriculum class offered by the ACNA on-line. I would like to improve networking with other healthcare professionals and improve education in cannabis medicine by continuing to have “conversations� with patients and fellow colleagues. Mish Stanvic RN (Australia)
10th Annual Patients Out of Time Conference West Palm Beach, FL | May 21-23, 2015 Eloise Theisen RN, Mish Stanvic RN, Inbal Sikorian RN, Ma'ayan Weisberg BA
JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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10th Annual Pa
tients Out of Ti
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CANNABISNURSESMAGAZINE.COM
me Conference
Why Nurses are Vital to the —
Medical Cannabis Community Cannabis has been gaining momentum as a viable and safe medical treatment over the last several years. More and more people are seeking cannabis to treat a variety of ailments. Most are hoping to replace or reduce the use of pharmaceuticals. And why not? Prescription medications can come with a long list of side effects, some of which are deadly. In addition, to an extensive list of side effects, many people report minimal effectiveness from the prescription medications. Not surprising since most pharmaceuticals are studies in white 60 year old males. As it now stands, cannabis is a last resort for many. Only after failing multiple traditional treatments do people find their way to cannabis. I often hear “What do I have to lose?” My response- Nothing! And there is much to be gained when incorporating cannabis. Coming to cannabis can be a big ordeal for many. The stigma is very much alive and well. People fear judgment, retaliation, rejection, and/or shame for even considering cannabis as a medicine. In fact, today I had a patient tell me, “I can’t believe I have resorted to using this.” Sad, but it’s not the first time I have heard a patient say something of that nature. So when someone has made the decision to use cannabis, who can they turn to for guidance? If that person is fortunate enough to live in a medical or adult use state, they can seek advice from a dispensary. Dispensaries are similar to pharmacies in that dispensaries house and dispense the medicine. The difference though, is that patients get most of their advice from the dispensary staff. When a patient enters a dispensary, they rely on the staff to provide them with appropriate cannabinoids, delivery methods, and dosing. We certainly would not have this same expectation at a pharmacy. Patients do not go to their local pharmacy and ask the staff which anti-depressant or blood pressure medication is best for them. So why do we have this model at dispensaries? My guess is that dispensaries have had to fill a big need. In general, patients have not been able to talk about cannabis with their health care professionals [Due to it Federally being a Schedule 1 Drug]. In Western Medicine, physicians and nurses do not receive education on the Endocannabinoid System (ECS) while in school. Many of them are not equipped to discuss cannabis as medicine with their patients. So patients rely on the people selling the medicine. And since there are no standards in training or education for dispensary staff, knowledge can vary from individual to individual. In some cases, the treatment can be pretty straight forward. Maybe someone suffers from insomnia and is looking to use cannabis. Often they don’t need too much in-depth advice. For those who are not so cut and dry, navigating
through the therapeutic applications of cannabis alone can be frustrating. My experience has been that patients who are coming to cannabis for the first time have complex medical histories. Some have tried everything under the sun, with little to no relief. Others are taking a long list of medications, including over the counter and supplements. While cannabis has one of the best safety profiles, there is still potential for drug-drug interactions. There are also a group of patients who find cannabis to be so effective that they want to come off their prescription medications. Since they have not told their physicians about using cannabis, many feel lost, not knowing who to turn to for further guidance. Patients end up in limbo. This is where nurses can come in and provide a service that is severely lacking in the medical cannabis community. Nurses can fill the gap between patients and dispensary staff. As a profession, we are trained to look at the whole picture and treat the patient holistically. We take an oath to do no harm and to advocate for the patient’s rights. Nurses are altruistic by nature and seek to relieve the suffering of others. Our training compliments cannabis medicine perfectly. The challenge comes when nurses want to help patients use cannabis medicine. Where do they get their training? Luckily, there is an American Cannabis Nurses Association (ACNA) dedicated to educating nurses and patients on the Endocannabinoid System (ECS) and the therapeutic applications of cannabis. Nurses still need a training program dedicated to cannabis medicine. The ACNA has a long term goal of credentialing nurses in Cannabinoid therapeutics. In the meantime, many nurses are asking how they can get involved. Personally, I would like to see a nurse in every dispensary. Patients would be followed throughout their treatment, keeping track of what worked and what did not. Nurses can help patients navigate through the ever changing, confusing world of cannabis medicine. Treatment is not a one size fits all and nurses are able to individualize the care. Nurses could make the difference between success and failure for a patient. It’s time to bring more nurses to cannabis medicine. Article: “Why Nurses are Vital to the Medical Cannabis Community” By: Eloise Theisen, MSN, NR, AGPCN-BC Original Publication: United Patient's Group.com
JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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The Opiate Crisis: Solving the Complex Puzzle of Addiction With Cannabis and Holistic Approaches By Carey S. Clark, PhD, RN, AHN-BC, RYT
The United States has found itself in the midst of an opiate crisis, with senseless loss of life occurring on a daily basis. From 2001-2013, there has been a three-fold increase in deaths from prescribed opioid pain relievers, including methadone and other synthetic narcotics and a five fold increase in the numbers of deaths from heroin (National Institute on Drug Abuse (NIDA), 2015). This article will explore a holistic-complex approach to addiction treatment and the role cannabinoids and cannabis can play in this process.
Addiction: Anyone Can Become Addicted Addiction science is a young and evolving field. Researchers and scientists are moving beyond the concept of addiction as a moral failing or as a specific personality trait, and toward a more complex understanding of how childhood trauma, temperament, metabolism genetics,and epigenetics foster addiction (Szalavitz, 2015). We can define addiction as a “chronic, relapsing brain disease that is characterized by compulsive drug seeking and use despite harmful consequences. It is considered a brain disease because drugs change the brain- they change its structure and how it works� (NIDA, 2014). Moving toward understanding addiction as a neurobiological process or brain disease can help us to find better treatment options for those who suffer from this illness, and potentially lead to treatments that prevent deaths and save costs. It also helps us understand that all humans have the capacity for addiction, and as such, compassion and care should be the guiding principles in treatment of addiction.
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Cannabinoids and Addiction Treatment: Harm Reduction: An article entitled “Cannabis as a substitute for alcohol and other drugs” was published in the Harm Reduction Journal(Reiman, 2009). The article pointed toward the beneficial practice of medical cannabis patientsconsciously substitutingharmful medicationsubstances (such as opiates and alcohol) with less harmful medical cannabis. Those struggling with addiction were able to recognize that cannabis provided better symptom management; they had fewer withdrawal symptoms and side effects than other treatment options, and cannabis was more socially acceptable than other treatment options. Reiman concluded that the issue of selfdetermination is of key importance, and individuals should be able to choose the treatment they find to be less harmful. Substitution may be more realistic than abstinence that is required by many addiction treatment options, including Alcoholics/Narcotics Anonymous. Other researchers have found similar considerations with addicts using cannabis to substitute for harmful addictions (Lucas et al, 2012; Lucas, 2012) and doctors in Boston are already using cannabis to help decrease the risk for death by opiate overdose and support healing from addiction. http:// www.bostonherald.com/news_opinion/ local_coverage/2015/10/ doctors_pioneer_pot_as_an_opioid_subs titute While harm reduction is important, could it be that cannabis truly supports healing from addiction in addressing the neurobiological roots of addiction?
The Endocannabinoid System and Addiction: We know that endocannabinoid receptors are found throughout the body. In particular CB1 receptors are abundant in the brain’s reward circuitry; opioids and cannabinoids have similar effects such as analgesia and stimulation of brain circuitry and both cannabinoid and opioid receptors are coupled to G-protein receptors (Parolaro, Vigano, Realini, &Rubino, 2007). Cannabinoids have been shown to reduce morphine and methadone withdrawal symptoms (Parolaro et al), and this may be due to the “cross talk”,with the synergetic effect of cannabinoid and opioid ligands in multiple brain functions related to addiction (Befort, 2015). Elevating endogenous cannabinoids reduces opioid withdrawal in mice, and rather than management or symptomatic treatment of withdrawal signs, increasing endocannabinoids may alleviate or reduce abstinence signs through direct action on signaling machinery in the brain areas linked with opiate dependence (Ramesh, 2012).
Complexity and Addiction Treatment: Healthcare providers and concerned citizensneed to start considering the current opiate crisis from a complex stance; we need to remain open to different ways of viewing addiction, particularly considering a more physiological-mind-body-spirit viewpoint versus a criminal perspective. 1. Identify at risk folks: in addition to the current prescription monitoring program in many states, we need to identify early on who is at risk for opiate addiction, and make community based strides toward preventing addiction. We
know that childhood trauma relates directly to increased risk of addiction. While the effectiveness of programs like DARE is highly questionable, we can educate those at risk with a greater sense of compassion, and primary care providers can begin to use tools like the Adverse Childhood Experiences Score to determine who is at higher risk for addiction related to the childhood trauma they have experienced, and the resultant impact on the body’s psychoneuroimmunological system. (http://traumasensitiveschools.org/ ), thereby starting preventative efforts early on.
Alternative approaches and 2. cannabis: NIDA is beginning to look at non-opiate alternate forms of prescription medications to treat pain. Of great promise are the cannabinoids (cannabis) and their ability to treat pain and support the person’s process of overcoming addiction: http://www.drugabuse.gov/ about-nida/legislative-activities/ testimony-to-congress/2015/americasaddiction-to-opioids-heroin-prescriptiondrug-abuse 3. Integrative modalities: communities with proper funding can make widely available the integrative model of treatment for addiction, which includes medications, cognitive based therapies, and holistic –healing therapies (such as acupuncture, yoga, meditation, EMDR, etc). This more holistic approach supports actual physiological transformation of the brain’s structure and healing of the bioneurological system in ways that other singular treatment approaches do not. http:// addictionblog.org/treatment/treatmentcenter-interviews/what-is-the-integrativecare-model-of-addiction-treatment/
"Cannabis is being used as a harm reduction tool for opiate addiction" JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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4. Pharmaceutical company responsibility: Purdue Pharma is the company that makes oxycontin, which is a strong prescription opiate based medication that, even when prescribed for pain in an appropriate manner, is often the “gateway� to eventual opiate and heroin addiction. Kentucky has recognized that this company bears responsibility for the opiate addiction crisis and they have filed a lawsuit against the company (http://theweek.com/articles/541564/how-american-opiateepidemic-started-by-pharmaceutical-company). Purdue Pharma has made billions of dollars from the current opiate crisis, and they could be held financially responsible for this issue. Should other states join Kentucky in this lawsuit, so that funding for an integrative model of treatment is available?
Conclusion While there are no easy answers to the complex issue of addiction, there is hope that we can compassionately support the healing of individuals, families, and communities suffering the consequences of this opiate crisis epidemic. Studies focusing on enhancing endocannabinoids in mice have shown great promise for the treatment of opiate and other addictions. While the scientific and research body of evidence around use of cannabis to treat opiate and other addictions in humans is lacking, we can also consider how evidence-informed practice comes to play in this issue; this helps us to realize that what we see in practice as effective may be just as helpful or useful to our patients regardless of whether a full body of human based evidence has fully emerged. We know that many addicts self-medicate with cannabis to ease withdrawal symptoms and we know that total abstinence from all substances is not a goal of many addicts. By considering cannabis as a harm reduction tool for opiate addiction, one that can save lives and support the well being of addicts, families, and communities, we could be striving toward using cannabis as an aspect of the complex management of the neurobiological implications of addiction.
References: Befort, K. (2015). Interactions of the opioid and cannabinoid systems in reward: Insights from knockout studies. Frontiers in Pharmacology, http://dx.doi.org/10.3389/ fphar.2015.00006 Lucas, P. (2012). Cannabis as an adjunct to or substitute for opiates in the treatment of chronic pain. Journal of Psychoactive Drugs, 44(2), 125-133. Lucas, P., Reiman, A., Earleywine, M, McGowan, S.K., Oleson, M., Coward, M.P., & Thomas, B. (2012). Cannabis as a substitute for alcohol and other drugs: A dispensary-based survey of substitution effect in Canadian medical cannabis patients. Addiction and Research Theory, 21(5). National Institute on Drug Abuse (NIDA). (2014). Drugs, Brains, and Behavior: The Science of Addiction. Retrieved from http:// www.drugabuse.gov/publications/drugsbrains-behavior-science-addiction/drugabuse-addiction National Institute on Drug Abuse (NIDA). (2015). Overdose Death Rates. Retrieved from http://www.drugabuse.gov/relatedtopics/trends-statistics/overdose-death-rates Parolaro, D., Vigano, D., Realini, N., &Rubino, T. (2007). Role of endocannabinoids in regulating drug dependence. Nueuropsychiatric Disease Treatment, 3(6), 711-721. Ramesh, D. (2012). Elevating endogenous cannabinoids reduces opioid withdrawal in mice. Retrieved from http:// scholarscompass.vcu.edu/cgi/ viewcontent.cgi?article=3660&context=etd Reiman, A. (2009). Cannabis as a substitute for alcohol and other drugs.Harm Reduction Journal, 6, 35. doi:10.1186/1477-7517-6-35. Szalavitz, M. (2015). Genetics: No more addictive personality. Nature, 522, S48S49.doi:10. 1038/522S48a
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“The inherent benefit of this is getting more people to purchase marijuana here locally to help drive up revenues for the city and state.�
the top These are all misconceptions commonly heard by doctors and it puts an end to them once and for all – or at least we hope it does! We're sure you have your own favorite myths.
1
MISSING CONTACTS
Most of us probably know at least one person who claims to be walking around with a contact lens stuck permanently behind their eye. The good news is that it is impossible for a contact lens to get stuck there, because there is no cavity behind the eye. So if you think you have lost your lens – the most likely places to find it are either tucked into a ball in your eyelid or on the bathroom floor where you tried to remove it!
2
Medical
Myths
Commonly
Believed
Rumor has it that you can catch the flu from a flu shot. Well – rumor be damned – you can’t. Flu shots are made of viruses that has been deactivated or killed. Despite the virus not being alive, your body is still able to recognize it for what it is and try to do something about it.
STAB THROUGH THE HEART
Pulp Fiction, an entertaining film, perpetuates an untruth that you can inject a person directly into the heart in order to provide them with drugs as quickly as possible. Regrettably this is entirely false. Doctors never, ever inject a person directly into the heart – adrenaline is delivered in the case of heart attack, but it is delivered directly to a vein. Also, adrenaline is not used to treat a heroine overdose, as in the film, narcan is.
3
ELDERLY SLEEP
The myth goes like this: the older you are, the less sleep you need. But it is just that – a myth. In fact, the rate of sleep needed is fairly constant throughout our adult life, but once we get over the age of sixty-five we need a little extra sleep. The most likely reason for this myth is that old people can have more difficulty getting to sleep and this reduces the overall quantity taken.
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5
CHOCOLATE ACNE
FLU SHOTS
Many are the number of kids berated everyday with the warnings against eating too much chocolate or greasy food with “you will get acne!” In fact, there have been very carefully done scientific studies that show an extremely low probability of acne being caused by either of these things. But don’t forget: too much of either will make you fat.
6
SNEEZE ATTACK
This is a myth that at least has some basis in real observations. The belief that the heart stops when you sneeze is false, but the reason that this myth has come about is that in some cases a sneeze can cause a slightly erratic heartbeat. This is merely due to a change in pressure inside the chest.
7
SUCK A WOUND
It's very probable that everyone reading this list has, at least once in their life, cut their finger and stuck it straight in their mouth. This is bad because the mouth is full of bacteria. Sticking one’s finger in one’s mouth after cutting it is an open invitation to infection.
8
9
CONCUSSION SLEEP
Again we have the movies to blame for this one. Falling asleep after getting a concussion is not life-threatening, and you don’t need to slap your children repeatedly in the face to keep them awake if they knock their head. Concussion almost never leads to a coma. If you or someone you know does have a severe knock to the head, take them to the doctor so they can be sure that everything is okay.
CONTAGIOUS ULCERS
If you have ever had a cold-sore you know how agonizing they can be and they are extremely contagious. But unlike cold-sores, mouth ulcers are not contagious though many people wrongly think they are. The cause of mouth ulcers is likely caused by disturbances in the immune system – but viruses and bacteria have been ruled out.
By: Jamie Frater | Founder of listverse.com JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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Nursing Humor
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Resources
Recommended Books and Movies Marihuana, the Forbidden Medicine By Lester Grinspoon & James B Bakalar
In this important and timely book, two eminent researchers describe the medical benefits of marihuana, explain why its use has been forbidden, and argue for its full legalization to make it available to all patients who need it. Highly praised when it was first published in 1993, the book has been expanded to include new examples of the ways that marihuana alleviates symptoms of cancer chemotherapy, multiple sclerosis, osteoarthritis, glaucoma, AIDS, and depression, as well as symptoms of such less common disorders as Crohn’s disease, diabetic gastroparesis, and posttraumatic stress disorder.
Your Complete Guide for Medical and Personal Marijuana Cultivation by Ed Rosenthal and David Downs The all new Marijuana GrowerOCOs Handbook shows both beginners and advanced growers how to grow the biggest most resinous, potent buds! This book contains the latest knowledge, tools, and methods to grow great marijuana ? both indoors and outdoors. Marijuana Grower's Handbook will show you how to use the most efficient technology and save time, labor, and energy. Ed Rosenthal is the world's
How We Got Into This Mess and How We Can Get Out by Mike Gray Over the last fifteen years, American taxpayers have spent over $300 billion to wage the war on drugs--three times what it cost to put a man on the moon. In Drug Crazy, journalist Mike Gray offers a scathing indictment of this financial fiasco, chronicling a series of expensive and hypocritical follies that have benefited only two groups: professional anti-drug advocates and drug lords.
Genetics, Processing & Potency Describes the psychoactive constituents of cannabis and the effects on potency of growth conditions, genetics, harvesting techniques, and processing. Includes variations in THC and CBD content, species differentiation, seeds, grafting, cloning, bonsai marijuana, growing techniques, extraction of THC, preparation of hashish and hash oil, smoking vs eating, testing for THC and CBD, as well as legal concerns. Illustrated.
foremost expert on marijuana cultivation and this is the official course book at Oaksterdam University, the leading cannabis trade school. With 500 pages of full color photos and illustrations, the book delivers all the basics
Prescribed Grass Zach Klein A poignant and sobering documentary by Zach Klein on the medicinal use of cannabis in Israel. https://vimeo.com/74898012
JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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DIETITIAN'S CORNER
Dietitian's Corner: Tips for a Healthy Winter Season
Jessica Aragona, MS, RD, LDN
The holidays are a great time for celebrating with friends and family over food and drinks. With just a little preparation, you can keep off the extra holiday pounds and still enjoy all that the season has to offer. Reduce Calories Without Sacrificing Taste: Try swapping a few ingredients in your favorite recipes: Using two egg whites in place of one egg to cut cholesterol but keep the same tasty result. Use low-sodium, vegetable broth in mashed potatoes to add flavor instead of butter or margarine. Substitute applesauce for oil, margarine or butter when baking to make you cakes, breads and muffins less fattening but more moist. For dips, sauces and pie toppings use fat-free Greek yogurt, sour cream or vegan mayonnaise. Sliced almonds make a delicious, crunchy topping in place of fried onion rings. Pack your Shopping Cart with Plenty of Fresh Vegetables: Stock up on sweet potatoes, winter squash, broccoli, carrots and green beans. Apples, cranberries and pears combine easily for a tasty salad or fruit crisp. If you are a Guest at a Gathering, consider these tips to keep your night healthy, happy and safe: If you plan on treating yourself later, start your day with a small meal that includes whole grains, fruit, low-fat or fat-free dairy and protein like eggs, ham or peanut butter. Don't starve yourself beforehand, instead eat a small, lower-calorie meal or snack such as fruit or a bagel so you aren't tempted to overdo your calorie intake for the day. Choose carefully between foods you definitely will eat, those you will sample and those you will skip. Don't rush to eat. Socialize and settle into the festivities before you eat. Move away from the food table- this will help minimize any unconscious nibbling.
Satisfy your Thirst: Before having an alcoholic drink and start with a zerocalorie beverage like seltzer or water with lemon. Drink Responsibly: Moderate alcohol consumption is defined as one drink per day for women and two drinks for men. Be Safe: Keep in mind, just one drink can change your reflexes. If you plan to drink, keep your holidays happy and safe for everyone by designating a driver.
Winter Quinoa Salad Tired of the same old heavy holiday side dishes? Not sure what to make at your next potluck dinner? Or maybe you just need something quick, easy and healthy to keep you energized as you finish up shopping for those last minute gifts. Winter quinoa salad is the perfect combination of delicious, nutritious ingredients to keep you fueled up and ready to go all season long. The base of this recipe is quinoa, a naturally gluten-free grain that is loaded with vitamins, minerals and complete protein to help keep you fuller longer. Red kidney beans kick up the nutrition notch, providing even more protein and a healthy dose of fiber to keep your digestive system moving smoothly. Fresh cannabis leaves and flowers along with chopped celery, green bells peppers, dried cranberries and sweet pimiento peppers give this dish a crisp texture and extra fresh taste. Topped off with zesty lemon vinaigrette, this dish is sure to please any Time of year. Winter quinoa salad is gluten free, vegan, and dietitian approved! ~This recipe is non-psychoactive as conventional cold pressed hemp seed oil does not contain THC. So, you can't get high! Ingredients: (For the most nutritious food, choose organic products when possible) 2 c. Water 1⁄2 c. Red Quinoa 1⁄2 c. Rainbow Quinoa 1⁄4 c. Dried Cranberries 1 c. fresh chopped celery (about 3 stalks) Handful fresh celery leaves 1⁄2 c. chopped green bell pepper 2 tbsp sweet pimiento peppers with juice 1⁄2 c. cooked kidney beans, drained and rinsed (look for non-metallic containers) 1⁄2 c. fresh chopped cannabis leaves and flowers Zesty Lemon Vinaigrette 3 tbsp lemon juice 3⁄4 c. red wine vinegar 1/3 c. cold-pressed organic hemp seed oil 1 tbsp fresh chopped garlic Salt and pepper to tastejuice
Directions:
1. Add water and quinoa to a saucepan and bring to a boil 2. Reduce heat to simmer and cover with a lid for 15-20 minutes 3. Remove from heat 4. Keep covered and let sit for 5 minutes 5. Remove cover and fluff quinoa with a fork 6. Let quinoa Cool for at least one (1) hour before adding the remaining ingredients. Add all remaining ingredients and the zesty 7. lemon pepper vinaigrette dressing and stir until dressing is evenly distributed 8. Cover and allow the salad to marinate for at least one (1) hour before enjoying
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VEGETARIAN & Vegan
One Step Beyond…. The Vegan Diet A vegan diet means avoiding any food or drink taken from animals, birds and even bees, but a quick look around your local health store will show you there are plenty of tasty vegan substitutes – creams, spreads, gelatine alternatives, yogurts and desserts, ‘bacon’ and ‘sausages’, to name a few. Make sure these nutrients are included for a balanced vegan diet: Vitamin B12: Found in yeast extract and fortified breakfast cereals, or taken as a supplement. Iodine: Found in seaweed condiments/foods and kelp tablets for example. Calcium: In foods such as fortified soya milk, almonds and hazelnuts, or take a calcium supplement. Omega 3: From flaxseeds, flaxseed oil and algae supplements.
Mushroom Stroganoff
SERVES 4 This easy, low cost vegan recipe serves 2 portions as a main meal or 4 portions as an accompaniment. 1 medium red onion, cut into strips 2 cloves of garlic, crushed 2 tbsp olive oil 500g chestnut mushrooms or mixed mushrooms, halved 500g Provamel soya plain yogurt alternative 1 tbsp creamed horseradish Salt and ground black pepper to taste Good handful of flat leaf parsley, roughly chopped
1
Gently sweat the onion and garlic in the olive oil over a gentle heat for 10 minutes until soft but not browned.
2
Add the mushrooms and continue sweating for a further 10 minutes until the mushrooms are just soft.
3
Stir in the Provamel soya plain yogurt alternative and seasoning. Bring to a gentle simmer and serve.
Keeping your New Year’s Resolutions A new year means new goals for health, fitness, nutrition and overall wellness. Once you have decided to make a change, it can be easy to get off track and feel discouraged.
Follow these Easy Tips for Success to Stick to your New Year’s Resolutions
Be Realistic: Take things one day at a time and don’t expect immediate changes overnight, new healthier habits take time to develop. It’s a process. Making healthy behavior changes takes many small steps, if you accept your resolution as a process that takes time you will be more likely to stick with it. Be Specific: Set goals that are specific, saying that you “want to lose weight this year” is vague. Try setting a goal more like, “I want to lose 10lbs by March 31st, 2012”, this way you have a time line and number scale to measure you goal. Prepare Yourself: If your New Year’s resolution is to exercise four times a week, then make sure to have you workout clothes and sneakers with you so there is no excuse for not hitting the gym! Reward Yourself: When you reach a milestone, reward your success with non-food items. Get a new pair of sneakers, go see a movie or enjoy time out with your friends. Don’t be too Hard on Yourself: The final key to success is to learn from your mistakes or setbacks, accept them and move. Every day is a new day and you can start over, allow yourself a moment of failure and then start back on your journey to success. JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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recipes
By LAURIE WOLF for OREGON LEAF | PHOTOS by BRUCE WOLF
CHOCOLATE BARK WITH NUTS & SEEDS 1 ) In the top a double boiler melt the chocolate along with the Cannabutter. Stir until it all melts. 2) our the chocolate onto parchment paper and spread with a rubber scraper until somewhat even. 3) op the still wet chocolate with all of the remaining ingredients and allow to set in the fridge for at least 30 minutes. Break into pieces to eat or package.
INGREDIENTS
2 cups chopped bittersweet chocolate 1-2 tablespoons Canna-butter ¼ cup pepita seeds ¼ cup sliced almonds
Homemade treats can make for the best gifts. This year I am giving all my card-carrying friends some medicated butter and oil for Christmas. That way people can make their own medicated magic. I made this butter with the powerful Chem Dog strain, a personal favorite. I have four pounds of Chem Dog butter that I am going to turn into hundreds of holiday cookies!
¼ cup chopped cashews Sprinkle with sea salt
TASTY TIP: There is no such thing as too much aged balsamic vinegar, or a year’s supply of Mama Lil’s Peppers. Enjoy these tasty ingredients abundantly.
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JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
CANNA PARFAIT
Pump up your experience by sautéing the two bananas in a tablespoon of canna-butter or oil. Mmm!
*
INGREDIENTS
2 tbs. canna-butter/cannacoconut oil 2 cups low-fat Greek vanilla yogurt 1 ½ cups granola 2 bananas, thinly sliced 1 tsp. lemon juice (toss with bananas) 2 tbs. honey
1)
Place 4 parfait glasses on your count .
2)
In a medium saucepan, heat the butt or oil. Sauté the granola for 5-6 minutes, coating evenly. Remove from the heat and set aside to cool.
3)
Place some yogurt in each of the glasses
top with granola and then sliced bananas. Drizzle with honey and repeat the process. Serves 4.
CANNABACON DATES This combination of flavors and textures is pretty spectacular. If you are not a blue cheese fan, use goat cheese or even a sharp cheddar. 1) Cut open dates horizontally and set aside 2) Mix cheese & canna-butter in a small bow 3) Stuff dates w/ cheese mixture & press closed.
4)
Wrap each date with half a slice of bacon.
5)
Bake dates til bacon is crisp, ~ 3 min. Drain on paper towels or cloth. Serves 6.
INGREDIENTS
12 pitted dates 2 tablespoons blue cheese 4 teaspoons canna-butter 6 strips bacon, cut in half
JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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Job Opportunities Perm & Travel
Cannabis Nurse Job Board has over 2,000 job opportunities in all nursing specialties. Make sure to tell them Cannabis Nurses Magazine referred you! Code: CNM411
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Emerald currently provides travel nurses to hundreds of hospitals and currently is offering assignments in every major specialty (ICU, L&D, ER OR, TELE PACU, PICU, NICU, and PEDS). Contact Emerald at any time at 1-800-917-5055, or respond to this message via E-mail or you can also visit us on the web at: www.emeraldhs.com
Needs: ICU, CVICU, LDR, MS, Tele, Neuro ICU, ER, LDR, & OR RNs!
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Apply Today!
1- 877-447-3376 x709
Nightingale, a nationally recognized leader in travel healthcare professionals, has Immediate and Exclusive needs for all Nursing Specialties with excellent pay. If you are available for consideration, please reply to this email and a recruiting specialist will contact you as soon as possible. Call us immediately: 800-591-7860 or scan the QR code To complete a full application, please scan the QR code
Apps for Health-Care Professionals Smartphone apps and web-based tools are increasingly important resources for health-care practitioners. Check out these great tools and put a wealth of health-care information in your pocket.
01
NURSING CENTRAL
06 EPONYMS
Nursing Central is the complete mobile solution for nursing produced by Unbound Medicine. The app includes disease, drug and test information for nurses. http://goo.gl/XWglb
A browse-able and searchable app that provides short descriptions of more than 1,700 obscure medical eponyms. http://goo.gl/BKP0H
02 LIPPINCOTT NURSING
07
DRUG HANDBOOKS
Keep over 300 outstanding anatomical flash cards on your device. This app enables you to carry the popular Atlas of Human Anatomy (4th edition) and its detailed anatomical illustrations on your phone or tablet. http://goo.gl/jr9Th
This app provides up-to-date drug information on your device, including contraindications, nursing considerations, patient teaching and integration of the nursing process. http://goo.gl/em9E1
03
MANAGEMENT GUIDELINES FOR NUSING PRACTITIONERS WORKING WITH ADULTS The app is a best-practice guide for health-care professionals who work with adult patients. Other apps in the series provide guidelines for working specifically with women, with children, with older adults or in family practices. http://goo.gl/o2hC6
04 JOURNAL WATCH This tool from the Massachusetts Medical Society notifies you about new papers published on topics of your choice. http://goo.gl/dxbrd
05 3M PREP This app provides a detailed rationale for selecting surgical prep solutions. You can view how to correctly apply solutions while listening to a detailed set of instructions. http://goo.gl/QGwsY
NETTER’S ANATOMY FLASH CARDS
08 CNOR EXAM PREP The Competency and Credentialing Institute, the governing body of the Certified Nurse Operating Room (CNOR) credentialing program, has created the CNOR exam prep app to help perioperative nurses prepare for the CNOR exam. The app helps individuals assess their exam readiness and develop critical thinking skills; it also provides tips for success, reviews knowledge related to the CNOR exam and can enhance test-taking confidence. http://goo.gl/n1DMo
09 EPOCRATES Rx The app includes a drug guide, formulary information and a drug interaction checker. This product also includes continual, free updates and medical news. Additionally, the app works on your device when you are offline, so you can look up information without a wireless connection. http://goo.gl/fqchG
10
MACEWAN LIB
The MacEwan University Library app simplifies searches for books and articles. It allows you to place a hold on library catalogue items, renew items, download full-text resources and perform many other tasks. http://goo.gl/YAUQe
JANUARY/FEBRUARY 2016 CANNABISNURSESMAGAZINE.COM
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Nursing Conferences
2016
Come meet the Nurses of ACNA at these future Events!
February Conferences
The Annie Appleseed Project 10th Annual Complementary and Alternative Cancer Therapies Conference Feb. 25-27, 2016 | West Palm Beach, FL http://www.annieappleseedproject.org/cancer-clinics
March Conferences American Academy of Hospice and Palliative Medicine & the Hospice and Palliative Nurses Association (AAHPM) March 9-11, 2016 | Chicago, IL http://aahpm.org/uploads/footer/AAHPM16_EXPR_Application_Form_a_fillable_locked.pdf
April Conferences The Tenth Clinical Conference on Cannabis Therapeutics: "Cannabis: A Botanical Medicine" Patient’s Out of Time Conference April 14-16, 2016 | Baltimore, Maryland http://www.medicalcannabis.com
May Conferences
ACNA's Workshops for Nurses: Future CEU's Available Online. Look for ACNA Workshops in your area in the near future by visiting: http://americancanabisnursesassociation.org/Events
Take Note!
American Holistic Nurses Association (AHNA) May 31st- June 5th, 2016 | Bonita Springs, FL http://www.ahna.org/Conference/Sponsors-and-Exhibitors
September Conferences
Association of Pediatric Hematology/Oncology Nurses (APHON) September 29-Oct 1, 2016 | Indianapolis, IN http://www.aphon.org/meetings/confindex.cfm
If you know of other Conferences available that are based on Cannabis Therapeutics that you wish to be listed in future issues please email us at: editor@cannabisnursesmagazine.com
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By advertising in Cannabis Nurses Magazine, you’ll be able to reach the most targeted audience available for Nurses, Doctors, Health Care Providers , patients, caregivers, businesses, organizations, and the public alike in obtaining a Nurses perspective to Cannabinoid Therapeutics.
We offer a wide range of advertising and sponsorship packages, as well as graphic design and video production services, to supplement your marketing strategy. With all of our flexible options, you are sure to find the perfect solution.
Our services are competitively priced so you can keep more of your hard-earned money in your pocket. In addition, our attention to quality and detail will give you the highest probability of return, making every dollar well worth it.
Contact Us
Please email us at any time or call us during regular business hours, PST, Monday through Friday (excluding national holidays) at: ads@cannabisnursesmagazine.com If you have a Story you would like to submit for evaluation, please refer to our Cannabis Nurses Magazine submissions page online or email us at: editor@cannabisnursesmagazine.com.