FLOWER + BUN
Research deck DEPARTMENT
STUDENT
Graphic Design GR601
Monica Arellano 04395103 mctarellano@gmail.com
Fall 2017
INSIGHT ONE
Even experienced cannabis users may not fully understand the differences between strains, associated risks, and how cannabis compounds interact with the body.
OBSERVATION In an April 2017 interview with 12 women in my target audience, 75% of the women reported using or having used cannabis. Of those 9 women, only 2 were aware of the differences between strains, and none were fully aware of the risks.
Women who knew about the strains of cannabis
Women who had not used cannabis ever
Women who used or use cannabis
RESOURCES Survey of women in the target audience // 67 respondents // Released 9/25/2017 Lab Project 7: Person to Person Analysis Survey of women who used cannabis in their pregnancy // 103 respondents // released 10/6/2017
INSIGHT TWO
There is strong interest in qualified information about pregnancy and medical cannabis.
OBSERVATION When I did my group discussion in GR600, I was expecting to get push back on my topic. I was suprised to find out that even the most conservative participant was interested in more quality research on this topic.
8 | YES THEY WOULD 30 | MAYBE WITH MORE INFO 29 | NO THEY WOULD NOT
SURVEY QUESTION Q Would you consider medical marijuana to
treat severe symptoms of pregnancy?
I wish there was accurate information as to long term effects. All studies I have read on excluding the Jamaica studies were said to be inconclusive because of other variable like hard drug use & tobacco use were contributing factors in children found to have negative side effects.
SURVEY RESULT Out of 67 women in my target audience who were polled, 30 indicated they would consider medical marijuana to treat pregnancy symptoms if they knew more about it. 29 indicated they would not, while 8 said they would absolutely.
RESOURCES Survey of women in the target audience // 67 respondents // Released 9/25/2017 Survey of women who used cannabis in their pregnancy // 107 respondents // released 10/6/2017
INSIGHT THREE
Resources to understand prenatal cannabis risk exist, but they are often studies dense with medical terminology. OBSERVATION The medical studies peer reviewed or otherwise are extremely difficult to comb through and understand because of the terminology and the level of understanding one needs to make sense of the results and limitations of those studies. Below are several sources that I’ve referenced in my secondary research. A Dynamic word map a study on how the psychoactive compound of Cannabis sativa, 9-tetrahydrocannabinol (THC) inhibits the human trophoblast cell. RIGHT:
EXPERT QUOTE “As a clinical researcher, I’m not interested in exploring only the good or the bad, I’m only interested in the truth. That’s what our patients and our recreational users have a right to know and a right to expect from us. People are going to use it. It’s up to us to figure out the very best and safest ways in which they can do that.” —Staci Gruber, PhD Director of the Marijuana Investigations for Neuroscientific Discovery (MIND) program at McLean Hospital
RESOURCES Maternal Marijuana Use and Adverse Neonatal Outcomes: A Systematic Review and Meta-analysis Shayna N. Conner MD, MSCI; Maternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring Anja C.Huizink, Eduard J.H.Mulder https://www.researchgate.net/publication/278159893_The_psychoactive_compound_of_Cannabis_sativa_D9-tetrahydrocannabinol_THC_ inhibits_the_human_trophoblast_cell_turnover
INSIGHT FOUR
Accessible forms of information often use a visual language that fails to inspire confidence and uses anecdotal data that is compelling but lacks the legitimacy of a peer reviewed study.
OBSERVATION During my secondary research I found that man websites and publications had been created to inform and educate cannabis users.
Unfortunately these sites lacked the legitimacy of an unbiased source of information. On the positive side, they were formatted for easy user consumption.
RESOURCES https://marijuana/news/ http://hightimes.com http://www.cannabisculture.com
INSIGHT FIVE
Doctors are not always equipped to provide patients or pregnant women with the appropriate assessment or on-boarding for cannabis use.
OBSERVATION 90%
When I spoke with 12 women from my target audience, many of them shared experiences and doubts when it came to a doctors ability to consult them on medical cannabis use.
85% 66.7%
In my secondary research, I discovered that there is a lack of training and information available to doctors to provide effective guidance.
PUBLISHED INSIGHT Out of 258 residents and fellows who earned their medical degrees from schools in the U.S. before coming to WUS to complete their training, nearly 90% felt they weren’t prepared to prescribe medical marijuana, and 85% said they had not received any education about medical marijuana during their time at medical schools or in residency programs throughout the country. A survey of medical school curriculum deans at 101 schools in the U.S. revealed that they felt 66.7% of their graduates were not prepared to prescribe medical marijuana. A quarter of deans said their trainees weren’t even equipped to answer questions about medical marijuana.
RESOURCES http://www.pbs.org/newshour/rundown/doctors-feel-completely-dark-medical-marijuana/ http://www.futurity.org/doctors-marijuana-medical-school-1545142/ Lab Project 7: Person to Person Analysis
INSIGHT SIX
The majority of women in my audience believe cannabis has positive medicinal qualities. OBSERVATION 58 | YES IT DOES
I observed a strong change in attitude towards cannabis as a medicinal plant when I spoke with my audience. This is influenced strongly by the evolving legal landscape and the amount of information and understanding that exists today about cannabis.
7 | NO IT DOES NOT 29 | I DON’T KNOW
SURVEY QUESTION Q Do you think cannabis has medicinal qualities?
SURVEY RESULT Out of 67 women in my target audience who were polled, 58 believe cannabis to have medicinal qualities.
RESOURCES http://www.sandiegouniontribune.com/news/health/sd-me-weed-poll-20170418-story.html Survey of women in the target audience // 67 respondents // Released 9/25/2017
INSIGHT SEVEN
The majority of women polled use the internet as a source to learn about traditional or holistic medicine. OBSERVATION
68.66%
After I realized that women are using the internet as a primary source to research information, knew one of my planned deliverables would need to take that form to be most effective.
INTERNET
47.76% FAMILY OR FRIEND
SURVEY QUESTION Q Do you think cannabis has medicinal qualities?
SURVEY RESULT I asked my audience to rank their preferred sources for learning about traditional and holistic medicine. The internet was the majority vote but family friends, publications and Primary care doctors came close.
32.84% PUBLICATIONS
23.86% OB/GYN / PCP
RESOURCES http://www.sandiegouniontribune.com/news/health/sd-me-weed-poll-20170418-story.html Survey of women in the target audience // 67 respondents // Released 9/25/2017
INSIGHT EIGHT
As women learn more about maternal cannabis use, they are more likely to consider it a legitimate option. SURVEY RESULT 30 out of 67 women polled from my target audience indicated they would consider maternal cannabis use if they understood more about the topic to make a decision.
I was able to make it through a very rough pregnancy with the help of marijuana. I didn’t need to take prescription pills such as zofran and worry about defects. It helped me to have a more pleasant pregnancy.
PUBLISHED INSIGHT According to the study, back in 2002, 2.4 percent of women between the ages of 18 and 44 admitted to using marijuana while pregnant, and in 2014 that number rose to 4 percent. While that jump seems high, it’s actually in line with an overall marijuana-use trend in America: The study reports marijuana use among U.S. adults more than doubled during the same period.
RESOURCES https://www.usnews.com/news/news/articles/2016-12-19/us-women-increasingly-use-pot-during-pregnancy-study-finds https://www.vice.com/en_us/article/ypv497/why-more-women-are-smoking-weed-while-pregnant Survey of women who used cannabis in their pregnancy // 107 respondents // released 10/6/2017https://www.glamour.com/ story/smoking-marijuana-while-pregnant-is-apparently-becoming-more-popular
INSIGHT NINE
If they needed to discuss medical marijuana use, women indicated that they would approach their doctors or an experienced community of women. SURVEY RESULT Women in my primary research ranked who they would discuss medical marijuana use with. Doctors and a community of experienced women ranked highest.
PRIMARY CARE DOCTOR A COMMUNITY OF WOMEN DOULA OR BIRTHING COACH OTHER
*Women who indicated other write
in Ob/Gyn and Naturopathic doctor.
FAMILY NO ONE OTHER*
RESOURCES Survey of women in the target audience // 67 respondents // Released 9/25/2017 Survey of women who used cannabis in their pregnancy // 107 respondents // released 10/6/2017
INSIGHT TEN
Because cannabis is still a federally illegal schedule 1 illicit drug, women don’t always know if they can trust their OB/GYN or Midwife with questions or concerns about cannabis use out of fear of legal repercussions.
SURVEY QUESTION Q Did you seek advice from your OB or Midwife about your
prenatal cannabis use? What did they say?
SURVEY RESULT Women in my primary research ranked who they would discuss medical marijuana use with. OB/ GYN and a community of experienced women ranked highest. Cerclage, also known as a *cervical stitch, is a treatment for
Yeah, I told my midwife because the zoforan wasn’t working AT ALL, so she asked me what I was doing then to make myself better and I said I smoked weed. That prompted them requiring I have a drug test at 25 weeks, which I passed, but then the hospital wanted me to do it each time I came in, and I was in a few times because I had an incompetent cervix so I had a cerclage procedure and then a removal of that cerclage*.
cervical incompetence or insufficiency, when the cervix starts to shorten and open too early during a pregnancy causing either a late miscarriage or preterm birth.
No. I did not feel safe discussing it with them (OB/GYN).
RESOURCES Survey of women in the target audience // 67 respondents // Released 9/25/2017 Survey of women who used cannabis in their pregnancy // 107 respondents // released 10/6/2017
INSIGHT ELEVEN
Women generally perceive edibles to be the safest delivery method for cannabis. SURVEY RESULT In my primary research, 20 out of 67 women indicated that edibles seemed like the safest option when it comes to taking medical cannabis.
RESOURCES https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260817/ https://www.michiganmedicalmarijuana.org/articles/health/ingestion-methods/
INSIGHT TWELVE
OB and birth professionals are often unable or unwilling to answer specific questions about cannabis use during pregnancy. SURVEY QUESTION Q What resources were
available to help you to use medical
The Jamaican study and personal experiences from friends who used while pregnant.
cannabis for your pregnancy?
SURVEY RESULT In a survey of 97 women who used cannabis during their pregnancies, many of them expressed the lack of support they felt when they faced this difficult choice.
Local dispensaries.
Absolutely none. The subject is considered taboo to my OB.
RESOURCES https://www.cdph.ca.gov/Programs/DO/letstalkcannabis/Pages/pregnantbreastfeedingwomen.aspx https://www.colorado.gov/pacific/sites/default/files/MJ_RMEP_Pregnancy-Breastfeeding-Clinical-Guidelines.pdf Survey of women who used cannabis in their pregnancy // 107 respondents // released 10/6/2017
INSIGHT THIRTEEN
Published and peer reviewed studies on cannabis often fail to separate the effects of cannabis from compounding lifestyle factors during a pregnancy.
OBSERVATION Peer reviewed studies would seem to be the most reliable source when it comes to a topic like cannabis and pregnancy. Unfortunately I discovered that laws which prohibit the controlled testing of prenatal cannabis means that many studies are based on mixed longitudinal data that often fail to rule out other possible causes for negative birth outcomes. I did notice that if you rule out for factors like alocohol, ciggarettes, or other illicit drugs there are no significant signs that cannabis is harmful to a developing fetus or child.
PUBLISHED INSIGHT Before making any adjustments for tobacco use or frequency of marijuana use, infants born to women who used marijuana were more likely to arrive early or have a low birth weight: 15% of marijuana-exposed newborns compared to 10% of newborns whose mothers didn’t use marijuana. But this increased risk dropped to statistical insignificance when the authors made either of two adjustments: distinguishing between women who used marijuana less than once a week versus those using it more often, or adjusting for tobacco use along with marijuana use. In both cases, using marijuana less than weekly or without tobacco did not lead to a greater risk of per-term birth or low birth weight. Using marijuana at least once a week doubled the risk of per-term birth or low birth weight.
RESOURCES https://www.learngreenflower.com/courses/52/Cannabis-and-Pregnancy-Is-It-Safe-Or-Not https://www.forbes.com/sites/tarahaelle/2016/09/09/so-does-marijuana-use-in-pregnancy-hurt-a-baby-or-not/#7f890baf7cec
INSIGHT FOURTEEN
Unlike western medicines, medical cannabis lacks standardization. QUESTION Q What challenges and
concerns did you faced when deciding to use cannabis?
My biggest challenge was finding sound science on that matter. My partner and I both have advanced degrees in different scientific fields (his is in medicine), and I could only find a handful of studies about cannabis use during pregnancy, most of which had big confounding factors--mothers using other drugs in addition to cannabis, no controlling for other environmental or socioeconomic factors that might impact fetal outcomes, etc.
The source. You don’t really know what you’re getting or who it’s coming from when you have to buy off the street because it’s illegal.
EXPERT QUOTE
“The cannabis we see today isn’t the cannabis of 10 or 20 years ago. The THC is much stronger, and that concerns me. My recommendation to mothers is to start low and take it slow. Also, know where your cannabis is coming from, get it tested.” —Dr. Stacey Kerr M.D.
RESOURCES https://www.livescience.com/24558-marijuana-effects.html https://www.learngreenflower.com/courses/52/Cannabis-and-Pregnancy-Is-It-Safe-Or-Not#reviews Survey of women who used cannabis in their pregnancy // 107 respondents // released 10/6/2017
INSIGHT FIFTEEN
Lack of regulation for growth and processing presents a risk to pregnant women who use cannabis. OBSERVATION
THC TIME LINE
During my research I discovered that since 1972 the THC content in marijuana has seen a dramatic increase. Each strain can have it’s own varying content and each growth as well. It’s important for women to be aware of these nuances to ensure the best outcome of use. My research also revealed that pathogens like cladosporium, aspergillus, and botrytis often found in tested samples of cannabis.
EXPERT QUOTE
“Infection with the pathogens we found in medical marijuana could lead to serious illness and even death, inhaling marijuana in any form provides a direct portal of entry deep into the lungs, where infection can easily take hold.” —Joseph Tuscano, UC Davis Professor of internal medicine
RESOURCES https://www.livescience.com/24558-marijuana-effects.html http://herb.co/2017/04/26/smoking-moldy-weed-sick/ http://www.laweekly.com/news/marijuana-is-not-safe-to-smoke-researchers-say-7927826
INSIGHT SIXTEEN
Women are afraid to ask questions or raise concerns to their OB/GYN or midwives about prenatal cannabis use because of potential legal risk.
SURVEY QUESTION Q What resources were
available to help you to use medical cannabis for your pregnancy? I researched a lot personally, before going to my midwife and talking to her. I knew many women who sought help through cannabis while pregnant, and everything was perfect. My midwife gave me the go ahead, but I couldn’t do it legally, since there isn’t enough information and studies done on pregnant women.
PUBLISHED INSIGHT The American College of Obstetricians and Gynecologists advises clinicians to ask pregnant women about marijuana use and to urge them to quit. Medical staff were more likely to warn patients that child protective services might be called if they used marijuana, the researchers found, than to advise them of potential risks. When mothers-to-be admitted to marijuana use, almost half of obstetric clinicians did not respond at all.
RESOURCES https://www.nytimes.com/2017/02/02/health/marijuana-and-pregnancy.html Survey of women who used cannabis in their pregnancy // 107 respondents // released 10/6/2017
INSIGHT SEVENTEEN
One of the most effective uses of prenatal cannabis is for moderate to severe nausea symptoms and HG. OBSERVATION Even though women reported using cannabis for nausea and acute hyperemesis gravidarum, I also spoke with audience members who used cannabis as a replacement for their mental health prescriptions due to a high risk of birth defects.
NAUSEA AND VOMITING DURING PREGNANCY 80% of all pregnant women in the United States Will experience nausea and vomiting during pregnancy ranging from moderate to severe. Roughly 3% of women will also be diagnosed with Hyperemesis Gravidarum (HG), a chronic nausea and vomiting that can be life threatening for mother and baby.
ADDITIONAL ARTICLES https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174692/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC113747/
INSIGHT EIGHTEEN
Women are not familiar with the endocannabinoid system in their bodies.
SURVEY RESULT Q Do you know what the
endocannabinoid system is?
SURVEY RESULT 85% of the women who responded to my survey indicated they did not know what the endocannabinoid system was.
ENDOCANNABINOID SYSTEM The endogenous cannabinoid system, named after the plant that led to its discovery, is perhaps the most important physiologic system involved in establishing and maintaining human health. Endocannabinoid and their receptors are found throughout the body: in the brain, organs, connective tissues, glands, and immune cells. In each tissue, the cannabinoid system performs different tasks, but the goal is always the same: homeostasis, the maintenance of a stable internal environment despite fluctuations in the external environment.
RESOURCES Survey of women in the target audience // 67 respondents // Released 9/25/2017 http://norml.org/library/item/introduction-to-the-endocannabinoid-system
STRATEGY
INSIGHT
STR ATEGY
DELIV ER ABLE
TOPIC AREA
AUDIENCE
OUTCOME
Cannabis + Pregnancy
Women 21-40 + birth experts
Increase positive birth experiences.
Women are afraid to ask questions or raise concerns to their OB midwives about prenatal cannabis use because of potential legal risk.
OB and birth professionals are often unable or unwilling to answer specific questions about cannabis use during pregnancy.
The medical marijuana industry lacks standardization.
Provide a safe mechanism for women to seek support for maternal cannabis use and build awareness of that tool.
Empower knowledgeable OBs and midwives with tools that allow them to safely and discreetly advise women about maternal cannabis use.
Create industry standards that help increase positive maternal cannabis use experience.
BLOSSOM
HAND IN HAND
FLOW ER + BUN
A cross between Green Flower Media and Oov Life, Blossom Buddy will be a safe mechanism for women to ask questions, learn, and build a network of support.
Flower + Med will be a brand extension to Flower + Bun that empowers OB/ midwives to provide safe evaluations and recommendations to patients and affiliate as cannabis advisors.
A comprehensive guide for moms that sets the gold standard of safety for maternal cannabis use; a cross between Green: A Field Guide To Marijuana and Mary Jane: The Complete Handbook for Women.
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