Clinical Podcast: Cannabis within Healthcare | Jeff Konin
Welcome to the I am clinical podcast your host Dr John Childs and Dr Mark Shepherd. We'll be bringing you interviews with cutting edge forward thinking physical therapy clinicians and leaders the goal to further your knowledge base and bridge the gap of what was to what will be are you ready. Let's go welcome to to the EM clinical podcasts where we talk with diverse individuals within the healthcare environment and beyond. I am joined today by my co host Dr John Childs today. We are talking with Dr Jeff Conan Jeff is a PT ATC by training and is currently the clinical professor and director of the doctor of Athletic Training Program at Florida International University Jeff has worked with a number of athletes all over the country. He's also been an uneducated for many years at several different institutions and just to give the listeners some context jeff and I go way back actually to when I was in undergraduate the program at James Madison University where Jeff really served as a mentor to me before I started pt schools so it's Great Jeff to have you back and to discuss an interesting interesting topic today so welcome to the show. Thank you mark John. It's a pleasure reenact especially with this case mark. Yeah awesome awesome to see how paths continuously tenuously Cross and gravy on the show and it's funny because I look back number at gm you and L. things change over the years. I remember when we were working together. You are really into the concussion kind of domain and and it's interesting to see now where your focus is within the topic of cannabis within healthcare of care so I'm really interested to see how did you get interested in this line of Education and interest so ironically it actually came from concussion and I was out west teaching a concussion workshop and one of the participants who is a physical therapists from San Francisco California Post posed a question and he said many of my patients smoke marijuana recreationally in. I'm curious what your thoughts are Jeff if I'm treating them and they have posted cussin' symptoms should I encourage them to stop smoking so that I can have a better accurate assessment of their memory Marie perhaps of their gaze of their balance and I thought to myself never had to come up in a question before but sure it made logical sense to me. You want to do everything you can answer. Get good accurate assessment thought I was off the hook there but he asked are two of his question and the question was would about those who don't smoke and they have post cussin' symptoms that relate to migraines anxiety difficulty falling staying asleep he said should I encourage them him to try a little bit of cannabis in the field. I wasn't as comfortable answering that question and I really had no foundational education background to answer the question so I promise it when I got back home I would look this up summit reconnect with him and I became fascinated and I started to look at literature so I shot him a note back. I wrote what a blog about this and the more I read the more I became more fascinated. I started getting more questions about it. Then dawned on me that medicinal marijuana marijuana is legal in thirty three states and CD cannabis is now becoming more and more accessible throughout this country and there's another world out there where it's being used so I just really got excited and fascinated to learn about this and learn about how it works and what the differences excellent and most importantly how does it impact what we do from a clinical care perspective of our patients and one thing led to another. I put in a couple of proposals to speak on the topic. Jordan have been accepted now. I'm receiving invitations to speak on the topic and educator on this topic. My goal is is to help the practitioner understand how this fits into the realm of care. If in fact it does at all that's interesting Jeff. I mean it's kind of a hot topic topic here you know candidates within healthcare and I'm kind of wondering have you had any like criticism of getting into this line within our profession and maybe the realm home of course I had criticism starting in my house for my family and so what has gotten into you. What are you doing. What are you up to and and when I talk to our colleagues majority of them are a little bit skeptical aunt. What I simply say is. Let me chat with you for about ten minutes in all all. I'M GONNA do is share with you. How I got into this and what I'm learning about it and trying to figure out what's happening around us because quite frankly it's his big elephant the room and most of only know what we know from our perceptions of growing up from our hearsay. CETERA ET CETERA and there's an awful lot of aces out there in fact you know what's really interesting to me is the population that seems the most interested in this. Are The elderly folks there on fixed incomes but they're really tired of using a dozen plus pills that are very expensive and they're talking to their neighbors. They're using Google in their figuring hang out ways to try things in granted. They're certainly placebo effects a lot of what we do but it can't be coincidence that so many of them are saying. I I feel better and I've been trying all these other approaches and I found something that's helped me so while an N. of one is really not high level. Oh evidence a lot of ones that you hear over and over and over again just had me thinking about what is actually happy and surely I'm not the only one in and yes I still have some critics and again. I'm not really promoting the use of any form of cannabis whether it be t h C C CBD ham boils. I'm educating so people understand why patients are looking into this and what the research shows and how we need to get involved in the biggest concern I have if we turn a blind eye to what's around us if our patients come in to clinical setting and save you a marker John. What do you think about CBD if you don't know or your answer is completely against it it my gut senses. Dave already looked into it they may in fact already using it and this is an issue of them with your trust and if they don't feel like corre board or you don't know enough about it. They're not going to tell you what they're doing. They're going to go back and Google Sophomore and asked to France neighbors and I think that it's important that we understand stand the light which we can speak to that. Here's the facts that are out there. In fact let's be proactive and let's have patient education information that we can provide to them and say a here's what you should know about this unhappy to answer your questions. If I don't know the answer I'll look it up and I'll get back with you but think about this. If you are commuting somewhat you WanNa know what medications are on. You want to know if they're seeing other practitioners and if you don't have this knowledge because if they're taking cannabis in a medicinal format they're seeking different physician more than likely so now they're getting care from multiple physicians. We know so. I think it's a trust issue. I think it's also an issue of our quality of care to have a comprehensive background knowing everything that can impact the patient's illness or injury that we're managing Jeff. This is is a really timely. I mean as an entrepreneur get pitched. That seemed like a day goes by something doesn't come across some deal network on investing in some cannabis cannabis related business so clearly this is an emerging area and even within our own profession. We're starting to talk about within physical therapy educational circles all about whether cannabis education should be included in the curriculum and as you probably know jeff from being actively involved in this discussion. The House of delegates actually considered a motion at the next meeting in Chicago for Abtei to develop materials physical therapists could use as resources for educating patients since about you know the use of cannabis related to healthcare now that motion I think was narrowly defeated but nonetheless at least the first time to my knowledge. I think especially on the docket so I guess my question is you know as you look across sort of healthcare and you'll look into. Let's say the physical therapy profession or athletic training. Where are we in this discussion. Are we progressive in the fact that we even had this on the docket or in other healthcare professions. They're widely talking about this and we're way behind as Rehab professionals and just give me your thoughts on sort of where we are in thinking about this issue in terms of being ahead or behind the curve. That's a great question and John. I was actually in the Gallery in Chicago when the discussion slash debate occurred in the house of delegates this was RC for C. Sixty seven dash nineteen in an actually did pass past fifty one to forty nine and it was really interesting dialogue back and fourth. I have to tell you I had to be restrained in this gallery because the motion wasn't about advocating at behalf again it was about putting a worker together to develop resources for members for cannabis. I was really mind boggled why we would be opposed to that and honestly as I listened. He was like Oh Qasem of WANNA travel speak about this individuals practicing in states where there's significant get access to this were at supports and said he look. It's not coming year. I see this with patients every day. It would be really really a fault if we had a body of our membership helped together. All the resources and then others were in states where perhaps they don't see this much or perhaps perhaps her personal beliefs are against this fought against it and so it came to a really narrow vote but it wants proof but in discussions afterwards. I had certain people it did feel like even though it was approved it was going to be a priority our agenda of developing these resources anytime zip. I have had only two of my proposals to speak on this topic not accepted what was for the upcoming combined sections meeting and what was for the upcoming Educational Leadership Conference both physical therapy now. Maybe they weren't well written abstracts attracts. Maybe they didn't fit into the theme of the meetings. I don't know but your question about where this fits into. The curriculum is a really fascinating one for me. It can it at the very beginning as we try to understand. The physiology anatomy of the Endo can happen weight system which is not very well studied and really is all a band around since the early nineties at guessing most of us went to school with a number of anatomy and physiology classes and don't remember sea. Is that our books or studying. I think this could possibly fit into physical agents. You know this could be topical is could be adjusted. Tincture is lots of different ways to put this in your body. I think perhaps maybe most importantly it can fit in the ethical legal classes that we have a lot of different places where this falls across the curriculum and I think it's a great I talked to out of disgust not to take over the curriculum out to dominate the curriculum but what you talk about learning across curve this happened at the very beginning that one's education all the way into their clock a practice because it's real and it's here and so I think when you pose the question are we behind. I think we're behind hind in understanding and educating in one of the reasons I was supportive of this is that it's not really easy to find good quality resources and the argument made against this. RC passing was that we are all individually capable of doing our own research and sharing this education with our patients. The argument for for was the SE. Les Speak With one voice. Let's have common factual educational materials. Perhaps educational links that we can send people to that are being updated because this is a fast in fact. It's the fastest growing industry you mentioned. Entra parochialism fastest growing industry United States and there are universities Anna Community College. I just learned for example Miami Dade Community College. They are starting full degrees in the concept of cannabis degroot gooseberries. You can specialize in the cultivation of agriculture of the plant itself you can focus into the healthcare setting you can focus into the business setting setting whether it be the tax laws or banking industries and so to a certain extent. Yes we are way behind but with that said. I'm not not an advocate of rushing and getting behind this one hundred percent because I think if we go fast too soon we WANNA be obviously be careful of our credibility. Which is why live is fully support factual information coming out with what voice from an association. That's good historical perspective there you know on where parts fit in within the really physical therapy and you know. I like your thoughts about how this could fit into the curriculum because I think you know as educator Educator Myself. You know there's always this idea behind curricular creep. You know I it always seems every every year. Isn't it that we're always always like this would be great to add in you. Just start getting almost like bombarded with areas and topics that can be added in whether it be dry needling or this the topic. We're talking about now or something else you know. It's just it always seems like it's something and so it's nice to hear that you don't feel like you have to basically rewrite your curriculum to fit this in because obviously it's a part of many different systems that cannabis you know relates to infects so it makes complete sense that it doesn't have to be a major component on it but we need something in order to start learning about it otherwise we're like you said patients are. GonNa come in and we're going to have our own bias or perceptions or things along those lines so just good points to bring up in curricular creep is real and it doesn't unfortunately a company things that we remove typically so we're constantly putting more and more into the curriculum as of now a two hour presentation can't really provide a good solid foundation for clinicians to understand doc what it is. It's happening around now. We can expand that to a full day workshop and really have people get caught up to speed as it relates to the laws yes for example because as I travel around and speak to individuals of different states also tailor the presentation to their state however it's important to understand understand that regardless of your own state law you need to be aware of your surroundings straight loss because if individual can travel two hours across the lion and have a better opportunity to access with looking looking for certainly they will so. It's really important to know even if it's not legal in any form in Iran state in their pockets of the country where it's not it will be naturally. We're seeing some really interesting things everywhere. State laws are overriding federal laws and I think one of the interesting things is going to be the next national election cycle e costs. Let me give you greg's apple. I alluded earlier to how the largest population that's pushing his seems to be the senior citizens in Florida where I am in the last election in two thousand sixteen the President won the state of Florida by about one hundred twenty or so thousand votes vote's not a lot of votes right soon after that our governor was elected in our commissioner of agriculture was elected both on on a grow cannabis platform there are now three hundred fifty or so thousand medical marijuana carb users Florida Florida in it is estimated by the next election. There will be about a half a million. If you're a anti cannabis running for president candidate handed it you will not with the State of Florida which is a swing state in a national election. That's how powerful this issue is right now. Just in this state the state you're seeing similar. Events of other states where banking laws are changing industry is changing in. There's job creation as a resulted this it really what's happening is this has moved so fast that the state government are simply trying to figure out ways to regulate number want which is a good idea from safety perspective but in all honesty exit number two because what's really interesting in this business right now is technically a majority of it is still illegal. You cannot markets for example. THC It's still a schedule want illegal drug in the United States. However are you still pay taxes so you're allowed to run a business but this'll wanting allowed to have a dispensary you cannot take tax write offs S. You cannot deposit your money in a bank because they are. FDIC shirt and they can't take illegal drug money but you pay taxes to the government so it's like the wild wild west right out every aspect of this but we can't slow this down. This is moving at a speed unlike anything anything we have ever seen before and ultimately the laws will catch up federal regulation will standardize a lot of what we see at which will be faced with just a slightly different statute in each state but the neighboring states if they're equivalent of their statutes you will see people flock from one state to the other and we're seeing saying that now with Florida. I'm sure Branson Arizona. We see a lot of snowbirds that come down and they're trying to figure out if you will how they can access some more reciprocity so that they can do whatever they do. In the state. They're coming from at just transferred across state lines or Florida truly fascinating to hear that perspective give in to switch gears a little bit here Jeff. You know I've heard these different terms being used. I mean you hear about CBD. There's hemp medical marijuana and obviously recreational marijuana. What are the differences between these because I think it's important. It seems like it's important to know what that is right. That's a great question so so I guess to start is understand that this is a plant we're talking about. It's not a drug unless it's made separately as an a synthetic for but it's an actual plant in the plant is grown in many places it can be grown in Colombia can be grown up Portland Oregon in so the plant a- as it grows can come in different force and what are the forms that engrossing is CD and CD is a non you've four component of the plant and the other side you'll see is the thc or the virtuous marijuana which does have the euphoric effect act and what are the greatest concerns about the THC nowadays particularly from a recreational perspective is that it's a lot stronger than it used to be so if you go back into the sixties seventies in advocates say well. There's really no reason why this can't be legal adult recreational use. We used to do it way back. Then Cetera et Cetera or the concerns medically right now is that the growth of the THC in the plant is significantly higher than ever used to be almost three times higher than it was huck aids ago itself itself is actually THC however it's an incredibly low dosage of TAC's point three percent point three percent of of marijuana's count it so it doesn't have a thc in it to create a fork effect in fact the farm bill that was passed in December of this past year was passed because hemp is at natural plant product that is used around the world at any other countries to develop things like from industrial-style paper various forms of Colognes at lotions rope natural gases and so what we found here United States was at there's there's an argument to separate him out of the rest of the plant particularly out of the THC capone and use that to create jobs allow allow farmers to have opportunities to grow and export these products in why this became where it is today was decades ago through the Nixon mm-hmm and the Reagan administrations there was an original we call drugs schedule classification in the classification marijuana as the global term was scheduled in the first classification schedule one that was alongside of heroin and LSD in so one of the reasons why we don't have a lot of good studies on this right now is we're not allowed to study marijuana just like we're not allowed to study. LSD or a heroin. It's not likely it's going to pass an institutional review. Board objects can write whatever the government has created pathway for this at so through a number of different applications fair amount of money to apply for these applications and a couple of years you can get approval through the government to you perform your studies if thc is involved with a significant amount of restrictions and typically it limited forms of the type of thc they have and and again as I mentioned if they have one grow planters university in this country that has federally approved grow plants and that's the issue that we usually studies but the ground in Mississippi versus Portland Oregon versus Columbia is completely different in that's a really important point because if somebody asked you this where are patients typically say quite frankly. This is what a lot physical therapist asked me to is. CBD good does it work that sequence me asking you do you like micro beer tastes snack many different products and there's actually studies that have shown where individuals have gone up and down the streets of communities where they've been selling cbd various stores and they pull those out and go testament elapsed they find out there's actually no. CB Dan those products whatsoever and you can see that type of situation all the way to everything from CBD infused beer to obviously CBD gummy as an out as their golf courses in Canada that encourage you to come there so that you can enjoy CBD at each hole Ashok. Our various parts of the country is a significant arguing a recruitment tool in early. One of the biggest opposition to this industry streep was the beer industry but they maxi not one eighty and now there are some of the biggest investors because they were concerned that the people found usage Dan either recreational or St D. that they would stay all the burs so instead they found a match if you will and now you see microbreweries with CBD coming up all over the country Jeff. This is really just a fascinating discussion and I know one. That'll be super interesting for our listeners and an issue that you know on kind of the leading edge of where we're heading in healthcare as we move towards a close I wanNA throw one little SORTA curveball and maybe take us back to quote unquote more traditional sort of Rehab but you obviously have a dual role of having been very actively involved in both physical therapy education an and athletic training education in dual credential than so you've seen over the many years the sort of the rivalries scope of practice issues all the sort of been fighting whatever you WANNA call it between tease. ATC's and you know most recently I think it was at the next conference the President of the Athletic Training Association as well as Sharon done the president of Ta got together and it seems that our professions are finally starting to realize we're not each other's enemies but perhaps we're actually colleagues in this whole pursuit of a less invasive non-surgical less Pharma less imaging sort of future of healthcare both of which pt and athletic trainers owners. I think fit perfectly into that strategy so my question is what are your thoughts on this. What I think is a renewed sense of collaboration between our professions and where. Where do you see it headed going forward? Why Gye certainly hope you're right on that. This isn't New Era Tori Lindley came out to Chicago and shared a stage took Sharon done and then Sharon actually came out to Las Vegas for the athletic training and shared a stage with Tori. I think on the national level the leaders are on the Saint Age and what's really going to be important is that at the state and local levels we see similar relationships developing in many places they already are developed upped but from a political standpoint I served for three years many years ago as a liaison between two organizations nationally and I probably a las a fair amount of friends from both sides because we were at each other's throats at that point in time in the truth of the mattress scope of practice perspective you know if you look at Asu the AP Ta for example the percentage of membership that actually work in the sport setting it overlap with athlete trainees what they do. It's not a large percentage pitch so many physical therapists that are active are not even aware of this. They don't even know who or what athletic trainers aren't what they do. This is a non issue for them but there's so so much that we can do together to share it particularly nowadays whether it relates from the beginning of the classroom setting with interprofessional education alway to interpersonal actors is an teamwork in the settings that I've been. It's always been a hallmark for me for everybody to work together and I really hope we're seeing a renewed relationship here. Because many any of us are either Dole credential or were very good friends with each other. We do a lot of similar things together both of the job setting anything outside the job setting and so I'm excited to see that it would be really nice. If we could show the patients don't care they don't understand but if we could show the rest of our healthcare communities that here's a way to work together other including at the lights statute level. Would we each these things to change. You know I know down here in Florida. Physical therapists are not able to drive Adl and it it was because of the acupuncture board in fact that fought that well you know it'd be nice to have support with each other there and have another organization stand behind you to see positive legislation legislation. Go through in an effort to improve your practice so I'm glad you brought that up. I'm certainly an advocate behind those relationships it all religions for that matter. I mean charcoal is to get the patient better. There are certain things that we do that none of us all in a technique if you will but we share some commonalities this is a great opportunity charity right out with two basic leaders to do away and stuff to the rest of us to follow a great perspective great wrap up there. Jeff and thanks again for your time today a day just going through what you know about cannabis and how it relates to health care particular in our kind of backyard with the Rehab professionals but we look forward to hopefully having you back on the show soon and thanks again for everything. Thank you gentlemen. I really appreciate the time of the opportunity great to have you jeff. Wow what a great episode with Dr Jeff Cohen who is a dual credentialed physical therapist athletic trainer and would really had a good time I think uncovering a new very progressive topic on the area of cannabis education it certainly being discussed within healthcare in general and weather and win it should be the included in healthcare education specifically we talked about the physical therapy profession and the recent passing albeit narrowly of the RC the motion to develop resources for AP TA to develop resources that therapists can use an educating their patients about medical. Marijuana and cannabis use discussed a lot of the You know misconceptions you know in any new area whether it's a new treatment technique or something like marijuana that has been sort of previously illegal well in many states and now becoming more legal and mainstream in just all the truth fact fiction around its use in its potential benefits and healthcare so jeff is certainly a very valuable valuable resource and I know our listeners will enjoy connecting with him online about the use of of cannabis in healthcare so as always you can find us on the blog the evidence in motion blog at EAE MTM is our social media handle whether it be facebook instagram or twitter we always appreciate state your feedback and mark and I are always open to ideas about a guest that we might have on the show so without further do thanks as always for listening and we look forward worked to having you again on the show thanks for listening to the EM clinical podcast ast with Dr John Childs and Dr Mark Sheppard for more information on the podcast guests and the latest and physical therapy visit. 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