Endocannabinoid Medicine
Endocannabinoid medicine is a novel and unique specialty in the practice of medicine. Three significant reasons make endocannabinoid medicine novel and unique: Few physicians have been educated about the endocannabinoid system (ECS) and its significant role in modulating the underlying pathologies of over 300 diverse patient populations. Secondly, various cannabis constituents have different pharmacodynamics and -kinetics that must be understood to realize precision effects, predictability of effects, and mitigate any potential side effects. Thirdly, the relevant scientific literature is vast, with over 40,000 entries alone on PubMed (using the keyword marijuana), which is not organized to support clinically relevant decisions.
The CannaKeys360 Platform
To meet these challenges, we created the CannaKeys360 platform. Since its inception in 2018, the CannaKeys (CK) platform has employed what our team of researchers and science analysts have determined to be the most elegant method to harvest the complex scientific literature and organize the information so physicians can quickly learn about the involvement of the ECS for each of the different patient population that may benefit from it. Furthermore, CK highlights the different pharmacodynamics and -kinetics of the key cannabis constituents, making it easier to reach for precision effects, prevent adverse effects, and be aware of any cannabis-to-pharmaceutical drug interaction potential.
Treatment Algorithms for the Clinical Setting
Optimizing patient outcomes. Treatment algorithms are one of the most important tools for managing the complexity of the ECS and the use of optimal cannabinoid-based therapeutics. A treatment algorithm for cannabinoid-based therapeutics refers to a systematic approach that physicians can use to make evidence-based decisions when prescribing cannabis-based treatments to patients. These algorithms consider various factors such as specific aspects of the patient’s medical history, the primary symptom they wish to address, the preferences about what kind of cannabis experience they wish to have, and, of course, the specific condition being treated. The goal is to develop a customized treatment plan that optimizes the therapeutic benefits of cannabis-based constituents while minimizing any potential side effects.
The algorithm utilizes only those aspects that can be controlled in the clinical setting, such as starting with low doses and gradually increasing them until the desired therapeutic effect is achieved. In addition, the algorithms also consider the evidence for the use of a primary or secondary cannabinoid and the ideal ratio between them, the ideal form of the remedy for each patient, along with the use of other synergistic cannabis constituents like terpenes or other supportive components such as modulators of the endocannabinoidome (eCBome) like nutraceuticals, mind-body approaches, dietary considerations.
Regular monitoring and adjustment of the treatment plan may be necessary to ensure optimal patient outcomes. The algorithms and the practical considerations associated with each may also include counseling and education recommendations on cannabinoid-based therapeutics to ensure patient safety and compliance.
How to Best Use a Treatment Algorithm
By following the algorithm, physicians can align evidence- and expert-based information with a patient’s specific circumstances, needs, and preferences. The algorithms have been designed to guide the treating physician through all the pertinent factors. It commences with the screening process, where you swiftly eliminate potential contraindications for the utilization of cannabis-based medications, such as a history of psychosis or pregnancies, for instance. The next step involves obtaining patient input regarding their desired cannabis experience. Do they want to undergo cognitive changes or not? What is their level of comfort with a higher, moderate, or lower risk of adverse effects? Their previous choice determines where they would land on the starting dose and titration ranges. What are the maximum daily dosages? What does the existing literature suggest about approaches specific to different forms? What are this patient’s needs or preferences regarding form, such as inhalation versus ingestion, and what are the expected effects regarding duration? Which primary and secondary cannabinoids have been emphasized in scientific research, and what is their optimal ratio? What modulators of the eCBome can be utilized to create potential treatment synergies? Are there any potential interactions between drugs and cannabis constituents that should be taken into consideration?
To maximize optimal patient outcomes and mitigate potential adverse effects, each cannabinoid-based use benefits from an individualized approach. Since it is impossible to account for all variables, we present six different approaches that can be used as a point of departure and be adjusted depending on individual needs, effective analgesic effects, and the presence and intensity of adverse effects, if any.
The CK Insomnia Algorithm presents six evidence-based approaches that make allowances for patients’ preferences that can be used as a starting point and be adjusted depending on each individual initial needs, realized sleep-improving effects, and the presence and intensity of adverse effects, if any.
