An interview with Dr. Keyur Patel, Chief Medical Officer of Compassionate Certification Centers, host of the 2017 World Medical Marijuana Business Conference & Expo on April 21-22 in Pittsburgh, PA.
Q: How did you first get interested in doing research in concussions?
A: Working in the emergency department, we saw a large variety of head injuries from adolescents to sports-related injuries, to elderly people just falling, to car accidents. There isn’t much we can do to diagnose these injuries or predict the downstream events that may pop up. In the last ten years, the public has become more aware of the issue. We get a lot more parents asking questions like ‘What are the side effects of this?’ or ‘How long are they going to last?’ We need to educate ourselves and our fellow physicians in diagnosing and managing these injuries appropriately.
Cannabis and Inflammation
Q: What do we know about the relationship between cannabis and the inflammation that occurs in concussions?
A: We know that when people undergo a concussion, their neurotransmitter pathways are disrupted, are thrown off. There is swelling and inflammation in the intracellular pathways of the brain. We’ve been finding out through some studies that cannabinoids are able to decrease the intracellular calcium, decrease the inflammation and swelling on the brain. The endocannabinoid pathway is going to be the key to showing the evidence.
Q: So would you say we are at the infant stage in understanding how it works?
A: Correct. Even in concussion-related research, because of the restrictions placed on cannabis research by the FDA and DEA, the number of studies has been limited, and only a small percentage have been double-blind, placebo-controlled — the most efficacious studies possible — and even in those the patient volumes have been very limited. We need to open the gates so we can do large scale studies with thousands of patients rather than hundreds of patients to get more scientific proof of the benefits.
Q: Is there good evidence that cannabis can be an effective tool for concussions?
A: There is. At the University of California, and in San Diego, and the Canadian Medical Association — all have done some studies that have shown significant improvement with traumatic brain injury in terms of reducing inflammation and protecting the brain.
Secondary to that, there are symptoms we see with concussions that show promise with cannabis treatment — especially headaches and dizziness, but including photophobia, light sensitivity, mood and emotional instability, disrupted sleep cycles. These studies have shown improvements in peoples’ sleep cycles and also in their levels of anxiety and depression following a concussion, which is one of the undiagnosed sequelae that we see now.
Q: So it’s not just treating the condition but also addressing quality of life issues?
A: Correct.
Q: Concussions are not specifically a qualifying condition in most states, including Pennsylvania. Is there enough evidence to show that it should be?
A: The primary goal of our organization is to present the best and most recent research so that physicians and policy makers have the most accurate scientific data on hand as they make decisions about cannabis. Right now concussions are a qualifying condition in Illinois1 and as more research is performed and evidence is built, we would expect and hope for expansion into the other states and potentially universally.
More Tools for the Toolbox
Q: How did you first become interested in cannabis for concussions?
A: Initially it was almost a side effect of working in the emergency department and seeing large amounts of opiates prescribed. That is what we were taught coming up through residency. The way to treat people’s pain is through opiate medications and this is pushed from all different directions when anti-inflammatories don’t work, or when over-the-counter medications don’t work. The only choice you really had was to go to opiates. But as you know, we’ve seen a huge growth in the amount of mortality and morbidity of these overdoses in the last few years. It is a national epidemic. This is the perfect time to develop another tool in the toolbox to deal with pain.
Q: Was there anything you learned that encouraged you to start exploring cannabis more seriously?
A: Seeing the states legalize it and seeing how fast it’s progressed in the last five years from Colorado being an outlier and now with 25-26 states approving some form of medical marijuana, and within the next five years it’s going to be in all 50 states. This is a pioneering event in a whole new classification of medicine being developed from this plant, so it’s exciting to be on the cutting edge.
Top Shelf Curriculum
Q: Why did you choose The Answer Page to provide the medical curriculum for your conference?
A: As we looked at the educational opportunities out there, we saw that New York state had used The Answer Page as the CME required course that they want their physicians to go through, and other states will be requiring this as well. The information is concise and very informative, and at the same time, not horribly time intensive as physicians spend only four hours to get certified through this process. In addition, they are getting up-to-date research and the CMEs required.
Q: Twenty two and a half CMEs is quite a lot for a conference.
A: It is! That’s an excellent amount of credits. Being able to do that in one to two days is hopefully going to be a great draw for physicians and physicians in training.
Attitude is Everything
Q: When do you think we’ll see this kind of information taught in medical schools?
A: With the pace things are moving forward … I would have said twenty years down the line two years ago, but now I think within five to ten years medical schools will have caught up, and the research should flourish. Once the research flourishes, the medical community will follow behind.
Q: So you’ve seen a noticeable shift in the last couple years in the attitudes of doctors?
A: Definitely. Physicians, patients, and educators in terms of the widespread acceptance of cannabis as a legitimate medical form.
Q: How is Pennsylvania doing as a model of how to work with physicians in a professional way?
A: So far we’ve seen that they are taking lots of input and are being very interactive with the medical community in organizing the laws to ensure it suits the patient first.
Not Just for Advocates
Q: This Conference is not just for physicians who are pro-cannabis, or even just on the fence, this is for all doctors because all doctors will have patients asking about or using medical cannabis. Is that about right?
A: Correct. It’s going to be a form of medication that is going to be available to all patients in Pennsylvania, so every physician, like it or not, needs to be up-to-date on the current scientific literature, the prescribing habits and what it is indicated for. Even if they don’t feel comfortable with it or agree with it, they should at least be informed on what it provides, as opposed to opiates or other medications out there.
Q: Any last point about your Conference that you would like to make?
A: We are very excited about having the first event in Pennsylvania. I think this is a groundbreaking event that will be drawing participants from across the nation. I think it will put Pittsburgh on the map for CBD and medical cannabis research. We want to be on the cutting edge of this.
1 While Illinois is the only state to address concussions specifically, in Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment. In addition, a number of other states will consider allowing medical marijuana to be used for the treatment of post-concussion syndrome with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).
About the Author, Sven Hosford: Currently the Editorial Director for the Pennsylvania Medical Cannabis Society, Sven Hosford has decades of experience reporting on integrated, natural, and holistic medicine.
