Canadian Consortium for the Investigation of Cannabinoids (CCIC) Deputy Director Dr Lynda Balneaves speaks to MCN about education, research and patient safety.
The Canadian Consortium for the Investigation of Cannabinoids (CCIC) was founded in 2000 with the aim of encouraging research and evidence gathering on medical and non-medical cannabis use, the endocannabinoid system; and the therapeutic potential of cannabinoids.
Through its open access Educational Platform the CCIC has made a range of resources freely available, including research and presentations from its annual conference.
Medical Cannabis Network speaks to CCIC Deputy Director Dr Lynda Balneaves, Associate Professor at the University of Manitoba’s College of Nursing, about education, research and patient safety.
What are the primary goals of the CCIC?
Our goals centre around promoting education in Canada, particularly related to medical cannabis. We also aim to provide a network for people conducting clinical and social science research on cannabis and cannabinoids, both in the medical and non-medical fields. It’s about trying to be an unbiased resource in our country, to really ensure that our clinicians and the public are making good decisions based on balanced information that is informed by evidence.
What is the purpose of the CCIC’s Educational Platform? How can up-to-date education on the science of cannabis and the endocannabinoid system help physicians and patients?
CCIC’s platform has given us a space, especially for those individuals that aren’t able to attend our annual conference. We can upload lectures by the most current researchers in this area, from across North America and beyond: that can provide an updated sense of where research is on medical and non-medical cannabis use, as well as boosting CCIC’s knowledge around the endocannabinoid system.
Canadians from across the country are able to access that information free of charge: many of our physicians or nurse practitioners and our patients have very limited understanding of the endocannabinoid system, it’s not something that has traditionally been taught within our health professional training courses; so by providing that education, practitioners are going to be able to have a much more informed conversation with patients. They also will be able to have a better perspective when they’re reviewing research or when they have patients coming to them with questions about the value of cannabis – they’ll be able to really reflect on what we know about the endocannabinoid system and whether something makes theoretical sense.
Teaching people about the latest evidence around using cannabis, understanding the risks and the potential benefits, will help physicians, nurse practitioners and patients to really have an informed dialogue around cannabis. By hosting this information on our platform, we are trying to make it available in an unbiased manner, not being informed by industry, being an independent non-profit in our country.
Is Canada’s regulatory landscape entirely beneficial for cannabis research and innovation? What policy changes would better enable researchers and academics to build and disseminate knowledge?
This has very much been in flux over the last year or so since legalisation has happened. To be honest, I have some grave concerns about the impact of current regulation on research, particularly medical cannabis research – we were not prepared for the amount of interest from researchers, as well as industry, in advancing our knowledge and doing that innovation research; so we’ve had a real delay in people receiving research licences. Some of the requirements and expectations around how that research will be conducted fly in the face of the fact that you can walk down the street and purchase cannabis products; and I understand that we need to have high standards for any type of basic or clinical research that’s being conducted on cannabis, but at the same time, it’s created an enormous barrier to researchers’ ability to do timely research on cannabis.
There has been an overt focus in research, until recently, on the harms of recreational cannabis; and those of us that have been very interested in the therapeutic potential of cannabis have really not had the same type of opportunities presented, in terms of funding. The other policy that we are awaiting – which I hope doesn’t come to pass, but I’ve understood that it will be coming down the pipe in the very near future – is that there will be strict limits in our engagement with cannabis industry partners in developing research. That includes such things as receiving product to conduct the basic research, as well as doing things like clinical trials; and it really presents itself as a double standar,d in the sense that those barriers are not in place for people doing pharmaceutical research. It suggests that a stigma is still attached to cannabis, and that organisations like the Canadian Institutes of Health Research (CIHR) are not looking beyond cannabis as a recreational substance and not considering it as a therapeutic agent; and that could really hamper our efforts in this country to do that type of clinical research on medical cannabis, because we do not receive sufficient funding to cover the costs of product.
By restricting all partnerships with cannabis industry, that is going to really limit our potential to develop the field. The government has allowed the alcohol and tobacco industries to completely invade the cannabis industry in this country, and I do understand their reservations of us receiving any type of support from those types of industries – and it flies in the face of our missions and goals as a Canadian health research community. But that that is something that government should have taken into account: they should have more clearly separated medical from recreational cannabis; and there should have been limited engagement from those industries that we know are very much geared towards promoting problematic use, in the sense of promoting cannabis use recreationally.
It’s a very tricky landscape right now. There have been some positives in the sense that instead of having individual researchers apply for research licences, they’re now supporting universities in getting a single licence which will apply to all their researchers, so hopefully that will streamline the process and speed things up. I just wish that there had been more dialogue with the research community to make the policies much more real world, to reflect the availability and the reality of medical cannabis use in this country.
Are there any side effects or safety issues associated with medical cannabis or CBD that patients may not be aware of?
It varies on the population. A lot of individuals may not actually be aware of the potential for a cannabis drug interaction; and we’re still trying to unpack what the true effects are, looking beyond the theoretical potential for interplay because of the pathway that cannabis is processed through. Patients really need to be having dialogues with their pharmacists in particular, about whether any of the medications they are on could be impacted by their use of medical cannabis or CBD.
For some people, particularly if they’re taking a pharmaceutical form of THC, it can actually have a very severe effect on things like anxiety. It can make people incredibly fatigued. When I talk to older adults, they’re not aware of the impact of high THC products on the cardiovascular health – we’ve had some case studies from Europe where we’ve seen young males have sudden heart attacks, following the use of high THC products. Moreover, we’ve seen some real issues with people that have pre-existing cardiac heart disease, and then are using a high potency product.
We hear a lot of news and concern around brain development and overuse; and the higher risk attached to dependency in patients who use cannabis at a young age, particularly with high potency products and frequent or daily use, but we don’t look at the other end of the spectrum, with elderly patients who may have a range of other health conditions, including heart disease, where cannabis could be dangerous. If you’re starting any type of cannabis or cannabinoid therapy, you need to have a conversation with your doctor, not only about any drugs that you’re taking already, but also any other health conditions you may have. Our biggest growth in cannabis users in Canada has been the 65-plus group: those are individuals that are already more prone to things like falls, confusion, delirium; and so when you throw cannabis on top of that, they may not be aware of the additional risks they’re placing on themselves. I think we need to be making sure that information is being communicated to those groups.
Are there any recent developments or issues within the field of cannabis research that you would like to highlight?
For me, speaking to the Canadian audience, it’s about being aware that we are really at the beginning stages of doing cannabis research. A lot of the research, because of the illegal status of plant-based cannabis, has really been focused on the pharmaceutical form; and we can’t directly translate what happens with a pure THC derivative to the cannabis plant and the various ways in which people consume it. For that reason, a lot of physicians, nurse practitioners and other clinicians are really hesitant to talk about plant-based cannabis or to recommend it, because we really have a dearth of research.
It’s important that we recognise that there needs to be a real influx of funding into this area, because we know so many Canadians and people around the world are interested in the therapeutics of cannabis. But we have a long way to go to get up to speed, and to have that type of evidence that can lead to practice guidelines, which is really going to change what happens at the point of care.
There’s a lot of exciting research coming out around troublesome health conditions, like epilepsy. There’s some fascinating research on the role of cannabis in substance use disorders, whether it can support some people moving into withdrawal and abstinence. I think we also need to be looking at the role of cannabis in pain management, as a substitute for some of the problematic substances that we use a lot in society like opioids. As we unpack the endocannabinoid system, I think we’ll see a lot of new innovation and care that could be offered through cannabinoids. My hope is that we can get the funding and the support and the policies that will really allow that cannabis research to flourish.
Lynda Balneaves RN, PhD
Canadian Consortium for the Investigation of Cannabinoids