176: Freedom Series – Cannabis Stigmas and Evidence
Eloise Theisen, Chief Nursing Officer at Leaf411, addresses the stigmas associated with cannabis and the evidence that shows results in senior adults usage of cannabis.
Lucas: Josh, I’m excited about the month of July and our Freedom Series, where we’re bringing on people to talk about diverse topics related to the freedoms that we have and celebrating the freedoms that we have. And also talk about some of the challenges today’s episode is with Eloise Thiesen. She’s the Chief Nursing Officer at Leaf411. Josh, we’re going to talk about weed.
Josh: Yeah we are, and we’re going to get in the weeds because this is a topic that you don’t hear discussed very often, but we should be talking about it. So what we’re hopeful is that our listeners today come into this with a little bit of an open mind, and listen to this great discussion. It’s thought provoking. The fact of the matter is, the generation that is coming into senior living, this is a very relevant topic. So regardless of how you feel about it, what you think about it, you better be talking about it because it’s coming to your senior living community. And so today we’re opening up the dialogue. This will be the first of many discussions, just like the freedom series on this topic. So you can help your community be prepared and know how you’re going to have the conversations with people around this topic as they ask about it, when they are looking at your community and as team members are wanting to work in your community, and they’re wanting to talk about this. So be prepared. This is a great conversation, Lucas. I’m glad that our guest has taken time for us, very busy and leading the conversation on a national and international level. So we’re blessed to have her.
Lucas: I’ll tell you, I learned a lot on this. Call me a square. This, I felt a little bit like a fish out of water, just transparency. This is not really something that I knew a lot about, and I had no idea the level of demand and just all the things related to this. So we were able to kind of peel back the onion, kind of some myths around it. Talk about some misconceptions around it. I learned a lot, man. I think our listeners are gonna really enjoy this. So enjoy this great conversation. As you lean into the Freedom Series on the Bridge the Gap Network.
Lucas: Welcome to Bridge the Gap Podcast, the senior living podcast with Josh and Lucas and an exciting and in-depth episode on a very important topic, something you’re gonna want to lean into. We want to welcome our guests Eloise Thiesen, she’s the chief nursing officer at Leaf4 1 1. Welcome to the show.
Eloise: Thank you so much for having me.
Lucas: Very glad to have you on. You know, Josh and I have anticipated this talk for a while. And I think that this is going to be very enlightening to a lot of different people and this is centered around older adults and cannabis, a very important topic to go into to tell us more, as we dive into this, tell us more about Leaf 411, and what is the organization all about?
Eloise: Yeah, Leaf411 was started in 2018 and went live with a free cannabis nurse hotline in 2019, where consumers can call in and get quality evidence-based education on how to use cannabis safely and effectively. So our mission really is to help educate the consumer so that we can decrease adverse events and make sure that they’re having good outcomes and improved quality of life.
Josh: So Eloise, help us no pun intended bridge the gap here. So I was introduced to you when I was working with a group of nurses that were kind of scattered around the country, but they really were studying and researching cannabis and using that as therapy and treatments and so forth specifically in the older population. Now I realize even describing that I probably butchered it. I’m not going to begin to name that association. I’ll let you do that, but can you also tell us about the work of this very impressive association that you’re part of?
Eloise: Yeah, absolutely. So we were connected through Stephanie Mocha and she’s a member of the American Cannabis Nurses Association, which I’m the current president of and will remain the current president through the end of this year. And then I go into my past presidency through 2022. We’re a national nonprofit nursing organization and in our 11th year. And our mission is to educate, advocate, collaborate and help with policy development and research around cannabis. And we now have over 1400 nursing members in all 50 states. So it’s really exciting. And that’s what you experienced was nurses coming together from all over the country to talk about cannabis use in the older adults. And how can we, you know, have a call to action to start having this conversation and making sure that older adults can use it safely and effectively?
Josh: Well, you know, Lucas, I can tell you I’ve been very impressed with this group as I have been exposed to them in their work. You know, first of all, I felt like I kinda knew what was going on in the world of research. And then they started telling me about all that they’re doing. I’m like, nobody’s talking about this. I haven’t heard anything about this in our industry. I’ve not heard anything about this at any of our events, but you know, I’ll tell you Lucas, me and you have talked about this when we kind of frame up at all of these events that we go to. And these providers across the industry and senior living that we talked to, there’s this discussion about we’re transitioning from serving the greatest generation through the silent generation, to the boomer generation.
And it’s funny how we start talking about all the changes coming, and sometimes you’ll hear about cannabis or marijuana or different terms. And all of a sudden the discussion just kind of goes dark and no, no one talks about it anymore. And you know, I don’t know if that’s something that you run into Eloise, but I think the, one of the reasons why we wanted to have you on the show is just to highlight the work that you’re doing. And maybe you could tell us some of the things and reasons why maybe people aren’t talking about this, but then transition is to some of the reasons why you think people should be talking about this.
Eloise: Yeah, thank you. That’s such a great way to, to set me up to talk about this. And I appreciate that. I appreciate you guys having me on this show to have this conversation. And cannabis has been a schedule one drug since the seventies and it has a lot of stigma associated with it. So as healthcare professionals, we haven’t been able to prescribe it. It’s been very restricted federally, and now we’re seeing this huge boom in states, allowing for medical and adult use cannabis programs. And with that has come a huge increase in the older adult, looking to use cannabis to either replace some of their medications to treat age-related and chronic illnesses like anxiety, insomnia, chronic pain. And I think that because we’ve been largely uneducated as healthcare professionals and probably in the older adult communities, we’re afraid to talk about it. And we don’t have policies and procedures in place to guide us and help us navigate. It’s a very complex topic. The science is very complex and it’s always rapidly evolving and emerging and to stay on top of it. I do think that people really need to be experts in their field. Just like if you were going to work in oncology or respiratory cardiac issues, right? You really want to make sure that you’re an expert in that field and with the increased use. Again, I think having this conversation is important because we do expect federal legalization to happen in the next couple of years. We also have, 37 I believe, states now that have medical programs for cannabis use. And we have, I believe 17 states that allow for adult or recreational use and in 2018 hemp, which is where we’re seeing a lot of these CBD products come from, was D scheduled. So, consumers and patients are using it at a pace that is very rapid and healthcare professionals just are unprepared to deal with it. So it’s really important that we recognize our patients are using it and we need to be educated and prepared to help guide them through the process.
Josh: So, we know consumers, there’s an increase in the usage of various, I guess that’s even a whole nother discussion. What is the usage and how are they using it? Why are they using it all that, which I’d love to dive into, but I think this is an important discussion because like many issues that are new issues or maybe have been taboo discussions or difficult conversations because we’ve never had them. I think it’s important because in our industry and I don’t, I’d love to know Lucas and Eloise your opinion on this, but it seems to me we’re a state regulated industry. There are some federal regulatory types of things across the industry, but for the most part state regulated and how things typically happen in our industry is legislation is passed. The regulatory agencies then interpret and create rules, and then the operators respond or react. And it seems like that is almost backwards. In many cases, it seems like the providers that are on the front lines, providing the care and meeting the resident and their family’s needs at the doorstep in real time should be able to craft policy and best practices that inform legislation that shapes regulation. And it’s like, we haven’t really gotten to that point in our industry broadly yet. So I love having this conversation. So I think a couple of things I would love to see this conversation go to touch on is let’s talk about the uses currently, how you’re seeing uses specifically, because this is the senior living podcast. How are you seeing the use in geriatrics?
Eloise: Yeah, so in my eight years in cannabis specifically, I’ve seen over 7,000 patients and the average age of my patient is 76 and they’re predominantly female and about 90% of them are what I consider cannabis naive, meaning they’ve never used it before. And they’re certainly looking to use it as, like I mentioned earlier, either a replacement or an addition to other medications or treatment modalities that they have on board to try to help manage these symptoms. And so again, it really comes down to what does the evidence say right now? We have some pretty good evidence to support that cannabis or cannabinoids are effective for treating chronic pain. And we’re seeing more evidence come out around using it for anxiety and depression as well as sleep disturbances. And I think those are the three most common conditions that people come to see me for.
And I do have a subset of patients that I work with and their family members who want to use cannabis to treat some of the neuropsychiatric symptoms associated with late stage dementia. And that’s where I’m seeing some tremendous results and improved quality of life and decreased healthcare costs. I mean, I think that’s another topic that doesn’t really get brought up as we could really be using cannabis right now to reduce some of the health care costs that we’re seeing in some of these assisted living and skilled nursing facilities and cannabis can be an effective treatment and help reduce, like I have a patient right now where we’ve been able to get rid of the sitter because cannabis has been so effective at controlling his behaviors. So that’s been a huge cost savings for their family.
Lucas: I would imagine that the pharmaceutical companies don’t like to hear that, that’s probably one of the reasons why. Off that topic, so let’s go more into the weeds a little bit because we’re seeing, I see, like when I drive down the street CBD there’s stores and shops and all this stuff, what are the actual forms that they are using this for, for the cannabis naive? I mean, would it be safe to presume that this is not grandma and grandpa lighting up a joint inside their room? Is that safe to presume?
Eloise: Yeah. I mean there are many routes of administration that are available now and smoking is often the route that people do not want to try. It’s an option and sometimes the benefit may outweigh the risks, but most people are consuming tinctures or what we call oils, edibles like gummies or other candies. And then we do have topicals and transdermal patches even to help people consume cannabis
Josh: Lucas, so I can see the curiosity in your eyes and those of our YouTube Watchers, even our listeners, you should just go watch this cause I like watching Lucas’s face during this, this topic. And no pun intended when you said, and we’re going to jump into the weeds on this. Did you mean to say that that was hilarious by the way, I almost laughed out loud.
Lucas: I’m very smart Josh, I’m very, very creative.
Josh: So here’s where I would like to go next because I know our listeners are going to be asking all kinds of questions. And we’re going to get all kinds of feedback on this, but let’s talk practically right now. You have a lot of patients across the age spectrum, but you do have patients that are in the elder population and even some in communities. Obviously this is not a broad usage in the senior living industry right now. A lot of people have never even heard this topic for senior living. And this is going to be a big eye-opener episode. I’m sure. What are you, and what is your experience actually helping residents currently or in the past that are battling these kinds of symptoms, but that want to use cannabis? How are you seeing it being used effectively in senior living now?
Eloise: Yeah, it helps control their symptoms better. Of course not all the time. I mean, we don’t have a hundred percent success rate. So we may see it work as an alternative to other pharmaceuticals that have been ineffective or may have side effects that really do drastically affect someone’s quality of life. So, for example, I have a hospice patient right now in an assisted living community whose wife didn’t want him to get the morphine. I mean, he just became very somnolent from it. It was very distressing for her. We got him off the morphine and put them on cannabis and she said, oh my gosh, he’s laughing and making jokes and the staff is really enjoying him. His personality has come out again. So again, it really does help with that quality of life in the late stages of their life, that palliative care component. And you know, I think, again, the conversation for me that what I really want to see is allowing these older adults to have freedom of choice if they would like to have cannabis or THC instead of morphine, that should be their choice and they should have a healthcare professional and a facility that supports that guides them through that use.
Josh: So are you seeing that as states are adopting this right now, do you know how many states where it would be legal to work with someone like yourself and in a senior living environment? So if that senior living operator is listening right now thinking, gosh, I don’t even know whether I can do this or not. Is the resources, can you all help them understand that?
Eloise: Yes, certainly can help guide and help people navigate that process and how to determine if this is a viable option in their state with hemp being descheduled at the federal level that can be offered to almost all 50 states. There are still a few states that don’t allow CBD completely to be sold and distributed within those states. But I think we’re at 48 out of 50 now. So it’s certainly worth exploring if you’re in the other, the other component is where we have 37 states that allow for medical use. Not all conditions may be a qualifying condition for them. So for example, if they had extreme anxiety at the end of life that may not qualify them to use medical cannabis.
Josh: Do you think there will be a demand over the coming years where seniors will be looking for communities that address this through their policies to have someone on board and policies created that would allow this type of therapy.
Eloise: Absolutely. I think it can definitely be a differentiator for some of these communities to help set themselves apart. Because I mean, I see it here in California where the communities that do allow it are very open about it and we’ll even approach some of their residents to say, we have other residents using this and that’s been successful. Would you like to consider it? Or we do have some families who’ve started medical cannabis prior to going into the facilities. And they’re specifically looking for facilities that have the process in place to allow it to continue.
JOsh: Wow. So I think it’s important for our listeners, what you just said. There’s actually senior living communities that you work with today that are actively using these therapies in California, maybe even in other states, I’m not sure but actively and so therefore they most likely have policies addressing this issue.
Eloise: Yes. Hopefully I think like you kind of mentioned before, I think it’s definitely the legislation that passes and then it sort of has all these competing priorities they’re kind of kept trying to catch up and get these policies in place.
Josh: So would it be fair to say that members of your organization, these nurses, these 1400 nurses and 50 states, part of that organization in those resources, is that a resource that would be available through that association or through Leaf411 to help educate and to also help to craft policies? Is that going too far for that organization or is that what you guys were set out to do?
Eloise: Well, the American cannabis nurses association? No, but at Leaf411, yes. I mean, we work on education and training for healthcare professionals, consumers, industry folks as well in cannabis. And we work on helping with policy and procedures and providing that consulting component as well as that resource for the communities, if they wanted to support the Leaf411 and the membership, then they could the residents, the family members, even the staff could call and get their questions answered around cannabis.
So I want to go again, back to more practical applications. You talked about dementia, and in our industry, as you know, that’s very prevalent just like in the entire population. But since we’re in the aging, senior living industry, the memory care communities, but not even the memory care, even in assisted living and some of the independent living; forms of dementia are pretty prevalent. How impactful do you think these therapies can be? Because I know we constantly are talking and you hear legislators talking and policy makers talking about reducing the use of psychotropic drugs. You are constantly hearing people talk about just different things surrounding drug use and prescription medications and narcotics. Where do you think this legal use of cannabis falls in line with a therapy to combat some of the negative things that we see now currently prescribed very widely in the senior living community?
Eloise: Yeah, I think it really, you know, of course I’m going to be a little bit probably biased in my response, but I do think cannabis has the potential to reduce harm around some of the pharmaceutical side effects that we’re seeing especially with some having the black box warnings. Some of the, you know, I see tremendous results with aggressive behavior where, you know, kind of going back to the stigma around cannabis is that, you know, particularly THC. We’ve studied it as a drug of abuse for decades. And one of the side effects with THC is euphoria and so people really do feel fear euphoria, we’ve termed it euphoria phobia in our industry because people are so scared of that quote unquote high, but in very low dosages that euphoric effect again, can have a response to that.
I mentioned in that other patient they’re laughing, they’re giggling, they’re less agitated. They’re more open to assist activities of daily living. They’re not resisting showering or hygiene. They’re improving their appetite, they’re eating more, they’re sleeping better. I mean, you just can see some really, you know, miraculous changes and then we get them off their pharmaceuticals as well. And a lot of times we can manage their symptoms with just cannabis instead of multiple medications. So it helps reduce their harm and improve their quality of life. And it really helps the families too, because as we know with dementia, it is such a hard disease to watch your loved one go through.
Josh: So you mentioned kind of the term dosages and the right dosages, the smaller dosages and prescribed I would imagine, and obviously I don’t have a medical background and don’t claim that at all, but it seems like any of the drugs that are available today that are being prescribed, if they weren’t prescribed in the right dose dosage, they can be lethal, they can be harmful, they can be addictive, they can be all these negative things if they weren’t prescribed in the appropriate dosage. So, I mean, my common sense is kind of saying, trying to draw a line here to say is this another a form of medicine, so to speak or treatment or therapy, or insert the proper term there that if prescribed or recommended appropriately in the right doses, it can be very therapeutic, but obviously like a lot of things, if it’s not appropriate in the, not in the right setting and not in the right way, it could be harmful as well, correct?
Elose: Yes. And, you know, we don’t have the luxury of having the gold standard, double blind placebo studies with cannabis to determine standard dosages and standard of care. So a lot of it is best practice based on some of the research and the clinicians that are out there actually working with patients right now. And we use the go low and slow mantra and cannabis has this, by phasic or bi-directional effect. So just like you were mentioning, Josh, low doses may produce that euphoric effect and a higher dose may actually cause paranoia. So, being educated on proper dosing and side effects and medication interactions really helps to improve the end user’s experience and making sure that they’re having that safe outcome
Johs: Lucas, man, we’re just beginning to scratch at the surface of this topic. I could talk about this for a long time, just because it’s something that we haven’t talked about much and I’m so curious. I know our listeners are going to want to connect to learn more about this topic. Do you have any thoughts on this? I mean, you are out there with a lot of different providers. Is anybody talking about this? Do you ever hear anything about this?
Lucas: Not much, but I imagine that this is a conversation that is going to be continued, especially as an alternative to pharmaceuticals, which I think is very, very good. People are struggling with different dementias and cognitive neurological issues. And it sounds like there’s a lot of good benefits that people should definitely be researching here. So Eloise, we’re gonna make sure that we put all of your information in our show notes and people that are listening, they can go to BTGvoice.com to download this episode, connect with us on social and also get the transcripts if you, so please, so Eloise, thanks for taking time with us to discuss this very important topic today.
Eloise: Thanks for having me and for opening up the opportunity to have more conversations around it.
Lucas: And I’m sure it won’t be our last, so thanks to all of our listeners for listening to another great episode of Bridge the Gap.