Ashley On - CBD Side Effects & Drug Interactions with Bryan Essenter

CBD Side Effects & Drug Interactions:

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Hello and welcome to the show. Today's guest is Brian a center. He's a registered pharmacist and from Connecticut really a great conversation. He Bryan spent 15 years working at Walgreens and his desire really was to help people and so he turned his back on that and went the Cannabis route medical cannabis route and has been in the dispensary business and Consulting and helping people for the past five years and it's you know, he's really genuine worries. My from some excited about this conversation will also be talking about CBD drug interactions and CBD side effects as they pertain to both those to CBD into cannabis, so great episode. Hope you enjoy the show.

Hello Brian. Are you doing Ashley? Good? How are you doing? All right.

Thank you. Nice to meet you and thank you for taking time to talk to us today happy to thank you. So to

give us a little bit of a background on yourself Brian and I know you're a registered pharmacist and you spent many years with you know, one of the big guys at Walgreens, right? Yep. Absolutely.

Do you know I guess just it would be really interesting to know you a little bit about that transition and and what you know, what kind of LED you to that? 

Yeah. I mean it was a situation where I think most pharmacists are at this point is you know, you you get to the point where every day is the worst day of your life and it's pretty miserable existence. You are busy arguing with doctors and insurance companies about what's covered and what isn't and why your arguing with patients about being a why it's taking so long and why it costs so much and you know, you're usually having discussions with your Corporate Offices about why they're taking hours away and expecting more out of you and everything else. It just it wasn't what we went to school for. We weren't helping patients. We weren't really, you know able to do what we set out to intended do and you know, you became a machine more than you were anything else, you know, any patient that wanted to ask a question. Usually, you know, you got a phone in one year and you're hanging around the corner trying to answer their question because you didn't have the time to devote to the patient's the way that you wanted to to truly help them out. So I had looked into the program when it first started. I had sort of discussed everything with my wife and in Connecticut, one of the great things for me personally. Anyway was that they mirrored the pharmacy program. So you had to be you had to have a pharmacist as your dispensary manager in order to open. So that just really kind of opened a very narrow door for myself.  But in the beginning it was back in 2014 when it passed we were a little skeptical. We didn't know how it was going to shake out what the national landscape was going to be if they would come in and shut everybody down or anything to so kind of decided to stay away for a little bit and I had talked to a few other friends that were Walgreens employees that I worked with before that ended up managing dispensaries and just said Listen, if anything comes up, let me know. I'm interested. I just you know, I wasn't ready to make the move before but I'm sure ready now and about maybe six months later. I got a phone call that there was an opportunity and I jumped at it. I didn't know much of anything at the time. I was you know, pardon the pun but very green and it was it became a labor of love so fast, it was so much fun. I legitimately knew next to nothing. I mean, you know the differences. Between sativas indicas and hybrids were still something. I was working on, you know, so it was a bumpy road at first but it's just so amazing how on a daily basis you have such a direct effect on patients lives and their outcomes and their quality of life and I legitimately get goosebumps on a daily basis. I mean, that's what I went to school for to begin with. That's why I went to pharmacy school was to help people and improve quality of life and everything and you know you Really had that taken away from you in the pharmacy world and it was given right back to us in the medical cannabis, you know seen so it really is awesome. I legitimately had a patient the other day that was in a horrible car accident had major neck and spine problems has been in a wheelchair for about two and a half years within three months. She's coming in with a cane not even a walker or anything. I mean, you know those and I said to her I was like legitimately. 'you are the people that I speak about all the time. You're the reasons that I do this like this is the Goosebumps that I'm getting Goosebumps. Just thinking about it, you know, and those are the kind of people that have just been kind of, you know, they're on all these pain meds and opiates and benzos and muscle relaxers and everything else just to help them be comfortable, but they would like to participate in their life. They're not barks happy just being comfortable anymore. So you know that for me was was the opportunity and where everything just changed and And it really became a just a passion more than an actual job.

So if you had anybody in your life that's been impacted personally with cannabis positively or just your desire to go and help people drew you into this?

Not anybody personally in my life, but that was really it was really my desire to go and help people. You know, I mean as a college kid, I had, you know experimented in everything. I knew there were medical benefits that came. I'm from it, but you know didn't really know much more than that. And I just knew that this was something new this was something natural. This was not just chemicals that were isolating and putting in our body and you know, just putting up with side effects just because you know, I mean the the safety profile the you know, and just how people believe in and how positive it's bad and all the stories that you hear. I just had to see for myself and you know, I didn’t expect it to become the Of my life and such a passion that I you know, really am very much an advocate for until I got involved and realized how much it can help and I think that was more impactful for me for seeing other people than it is. Sometimes seeing your own family members, you know, because you know what they're going through the people out in public and you know, I say to all of our co-workers and everything all the time, you know, the people that you see in the dispensary you're seeing them on their good. Days, you know the last three days they may have been laid up in bed and not able to get out not able to do this that the other thing so, you know, we have to respect that what people are going through in their own personal lives can be very different from what we see and that's very true in the pharmacy world as well. You know, I mean they come in and you see him for 30 seconds and they’re filling their you know, blood pressure meds and this and that but you don't you don't know what else is going on there why they happen to be cranky today or not or whatever the case may be. And you know for our patients it's a little easier to see there's much more chronic, you know disease and conditions that they're dealing with and and I feel like we all kind of respect that a little bit more of what they're going through and they're not just a number at the counter when they're coming through. 

So tell me about what you're you know, you were a pharmacist and then did you go into a dispensary as a kind of learn learn the ropes and as behind the counter so to speak and then now you're acting as a consultant a patient advocate sort of role or tell us a little bit more about exactly what it is you're doing. 

Yeah, absolutely. So, you know when I started out I was just managing the dispensary, you know counseling patients Consulting with them and everything and it was awesome. It was absolutely an unbelievable experience. I learned so much from them, you know, and I believe that the end they were learning a lot from me as well. But sitting down and having those conversations were such an amazing. Part of it for me to learn how they were being affected by the medication and everything too. But what I also learned was that, you know in Connecticut, especially there's a lot of patients that just want to know if this can help them. Is this something that is appropriate for me. They don't, you know, we have to spend, you know, typically around a hundred fifty two hundred dollars for a doctor's office visit plus the state requires another $100 fee just to become a part of the program. They Haven't purchased any product or anything like that? It's usually a good, you know, four to six-week process minimum for them to even get into the dispensary and they've spent all this money and they don't even know if it's appropriate for them.

A lot of them are freaked out by you know, whatever stereotypes they have or stigmas that have been attached to it. And you know, a lot of them are just worried about getting high but you know, their kids told them that it was better than the opiates and they don't want to be on the opiates anymore. So what I felt And what I see happening in a lot of the legalized States as well. I had gone out to Oregon. It's for a conference out there and I got there early. So I went to about five different dispensaries. I just wanted to wander around and talk to people just kind of learn what they're doing, you know, everybody on just like Pharmacy practice differently on the west coast the East Coast the north to south whatever so I wanted to what are you doing that we're not doing you've been doing this longer. I found out in the first two dispensaries that essentially nobody's doing anything. If there are nobody to counsel patients, they don't really have a lot of patients. They just have customers that's a problem because those customers our patients and you know, this is regardless of whether they're using it for whatever adult use. They think they are they're medicating. No different than you have a couple of drinks at the end of a night to calm down from a long day. That's a form of medicating, you know, so to be able to have conversations with people on an appropriate level and you know, especially your patience. Are having serious medical conditions cancer Parkinson's Ms. That are really looking for help. They need somebody to speak to and there's not that resource out there. So I wanted to get ahead of the game in Connecticut. We haven't legalized here. But I know once that happens you're going to lose a lot of medical professionals from the industry and patients are going to need to answer the answer to have questions answered. Sorry, and I you know right now I have the opportunity to Counsel patients just if they're not getting the help they want at the dispensary.

I mean, you know, we all know that no different than a pharmacy where you go and you're just like I don't trust the pharmacist that I'm talking to their or whether it's a doctor whoever, you know, I'm there to help answer questions. I've been doing this quite a while now, you know, I've been speaking all around and just to give a different perspective, you know, and one of the great things is everybody’s menu is online. I've talked to you know patients out in California, New York, Pennsylvania. You know Florida that all I need to know is what dispenser you're going to I can go to their website and I can get you you know, specific products of what they actually have in stock that we can go through, you know dosing we can go through strains and effects and time of day and delivery methods and all of that and really get them a regimen and you know even have follow up with them, you know, oh, they don't have that anymore. What am I supposed to do now? You know, that's probably the biggest thing is I can get you started but when they go Back for their next visit those meds aren't there anymore, you know, they are there at a different dosing or you know, strength or something too. So they're like well now how do I do this? I don't know what to do and they're all freaked out and say okay. We got this. We just need to do a little math and figure out how to adjust the dosing, you know, and that's really given patients so much more freedom in it. I think probably the biggest disservice I do to myself is sometimes I educate the patients a little too much so they don't need my help anymore, but I'm okay with that.

There's plenty of patients out there and I just want them to have the knowledge that you know, listen, you can adjust your dose and you can you know, make the changes that you need because you know, we're not 20 milligrams of Paxil depressed every single day, you know, our pain is not 20 milligrams of Oxycodone every single day. t changes we should be able to adjust our dosing of our medication so that we can function better or you know, get some more rest or whatever it is that we need throughout that day as well and they're really Lee learning the way to go about doing that and helping themselves with it. So, how do how do your patients find you so my website is one of the easiest ways I am currently managing managing a new dispensary in New Haven. So through the whole Consulting thing. I've been Consulting for businesses and dispensaries as well and I got connected with another company that was putting in an application that we were fortunate enough to win. So I've been managing a dispensary in New Haven, Connecticut And my email is brianessenter@gmail.com. If anybody wants to contact me there.

I'm always happy to help been really working on a lot of advocacy at the you know the state house here in Connecticut. Trying to get legalization approved as you know, that seems to be Be coming very soon, but we still have a lot of people that just don't have information that they need. So I'm just trying to make sure to provide them with as much accurate information as we can right now to so, I mean, those are the really the main things that I've been working on and you know the advocacy and everything is really been a big thing. Just because you know, like I said about you know, Oregon and you know, a lot of those States up there that are considering eliminating their medical program altogether in favor of adult use for tax purposes. They’re going to need people like myself out there. So, you know, once legalization comes through it’s just going to be you know, hopefully more opportunity for me as well. But I want to make sure that when it's done it's done properly. It's done with proper oversight and testing and making sure that you know, the reputation of our medical program is, you know, followed through right into our adult use program and everything as well. Yeah, certainly, you know, one thing I comes up a lot.

When I talk to people is a concern about you know, CBD or cannabis with egards to drug interactions, right? And so being a pharmacist at are there certain I guess conditions that require certain drugs that people should be more concerned about or is there any generalizations there that you can provide? 

Yeah. It's really more generalizations, I guess than excuse me than anything. You know CBD is it does affect your cyp enzyme system? So there's a lot of medications that are also broken down by those same enzymes depending on the medications. They can end up allowing levels to build up higher. They can allow them to be, you know, broken down faster and eliminated faster as well. So typically the groups that you're looking at are going to be some of your anti epileptic drugs and stuff too.

So Keppra on fee and Depakote are three of the big ones they're really for Patience and you know, we have so many people that especially, you know, those epileptic patients that just want to use CBD to get things under control and you know, it's safe for kids and this and that and absolutely I think it's a great adjunct but you definitely want to make sure that your doctors are aware, you know, and you want to make sure that obviously we have all the third party testing and everything to to make sure there's no you know other contaminants of any sort that are affecting your other medications some of the other things some of your blood thinners. Be affected by CBD as well, not overly significant, but it's something that you want to be aware of. Typically Coumadin is the biggest one there. I know most doctors are trying to get away from Coumadin using it very sparingly just because of its, you know, very difficult and small therapeutic range that they have but they do start a lot of patients out on that. So if you're using CBD, you want to make sure that you know, your doctors are aware, especially if anything is changing there but a lot of times, you know patients. It's have been using it. Anyway, whether it's cannabis, whether it's just CBD, whatever happens there and because of the safety profile of it in general. It's really something that the doctors can be aware of just through blood testing and everything is their starting medications adjusting dosing of medications. I would say one of my biggest concerns is when patients start either cannabis or CBD or whatever. They think they can just stop all their other medications and that's going to be you know, okay, and that is the

Absolute wrong thing to do. You want to make sure you're working with your doctor's that you're slowly adjusting dosages that you're tolerating everything well, but you want to get stable with your CBD or you cannabis first before you go adjusting any other medications, you know, and if the doctor is aware that you're going to be adding CBD or you know entering a medical McKenna this program, then you know, they need to be aware so that they can monitor your blood work make sure that you're not having any additional side effects whether it's the medication or the Cannabis but it's you know, typically a lot of our patients have used cannabis for a while before they you know came to the dispensary anyway, so, you know, a lot of the times that they're using these medications the doctors have adjusted for it without even knowing, you know, the patients were to using it didn't disclose that information to the doctor and the doctor was dosing accordingly and if they're doing their blood testing and everything as they should and as appropriate to make sense, they should be able To you know adjust accordingly and see those Trends that’s the makes total sense. Thank you for sharing that. What do you in terms of patients and and Trends right? What do you typically see? I mean, I know the Cannabis and CBD both kind of span the gamut of all kinds of things that could help with but anything that just overwhelms you in terms of like it's so frequent that that surprises you. Prizing I don't know if I'd say anything is really surprising at this point. I think the biggest surprise to me honestly was the amount and more a generalization in the beginning but it was more the amount of people that are so uncontrolled on their typical prescription medications and that’s regardless of whether they're suffering from PTSD.

They're going through cancer and chemo their epileptic there. Whatever the case may be there. They're just not controlled. Well on their prescription medications, they are having significant side effects. It's not doing what they needed to do, you know, whatever or they're just bouncing around for medication to medication to medication and they just don't know what's going on there. So I feel like you know, the the bigger thing there is that they’re able to start to get that consistency from their medication. They get a little bit more stability. And that is you know, I mean cancer patients number one, you know trying to deal with the pain of the chemo the nausea the vomiting. I think that's our number one because people see CBD and cannabis as really being best for those type of things. Anyway, just recently in Connecticut.

We approved chronic pain and I think the chronic pain is probably going to be our biggest one is we're seeing most everywhere just because patients want other options. There's so sick and tired of the opiates and the Enzo's and just walking around in a fog all of the time and it's not working and they know they're addicted and they you know, they can't get what they need when they need it and their family wants them off of it for one reason or another so, you know, I'd say those are the biggest things, you know, a lot of Parkinson's patients have a ton of benefit from it too. Especially early onset, you know that are younger with just some Tremors and stuff like that that are just, you know, embarrassed at the young age to have those kind of things. You know, those are the people that I would say we see the majority of you know, the ones that are just kind of fed up with your typical Western medication and Healthcare System and they want to be more active participants in their life. They don't want to be comatose stand and flatlined and everything anymore. They want to feel things they want to you know, go to the grocery store and be able to finish a trip or whatever simple things nothing extreme, you know, they're not Going to go run a marathon or anything. They just want to live right now.

That's great. And thank you again for for your passion for what's going on and what you're doing and and your focus. What's next for you? What do you what's exciting that you're looking forward to in 2021? 

Well right now the dispensary that I'm at were actually working with one of our producers and Yale on a study. There's a couple others that were supposed to be working on in the next couple of years to hear that there are starting to You know really use more more specific cannabinoid, but within more full spectrum stuff that's on that with some of the producers here in Connecticut. They've really gotten very scientific with it and just seeing a lot of what they're doing is really got me excited, you know, they're very interested in in whole plant full spectrum, you know cannabis, but they also have these, you know, individual cannabinoids that they're doing that their lab testing everything right there in the facilities.

So a lot of that is really what's been exciting for me is just being involved in the science and the research end of things, you know, personally just being an advocate and you know helping with the legalization process here in Connecticut as well and educating our legislators and everything. Those are some of the things that I really enjoy doing and I'm also been participating with the international cannabis pharmacist Association. We have conference that We're doing annually now to just to help educate other pharmacists, you know, get them an idea as to what’s going on. You know, I know in Connecticut the when they took cannabis and they made schedule to in Connecticut, so they completely discouraged jeweled it what that means is that doctors and pharmacists can now see that patients are using medical marijuana when they look at their prescription monitoring program and see what other medications they’ve picked up. So you have pharmacists that I'm getting call from a lot of other. Leagues and school friends and everything. What do I do about these patients that are asking me about CBD and about, you know, they're how their medical marijuana is going. And how do I adjust and what do I talk to the doctors about and everything? So, you know, I found a lot of a lot of those conversations have been happening because of all of this to and and I think that's really exciting is just being able to educate my peers in ways that there is no schooling for there's minimal see he's for and everything to Tony even at that to get good information. His is not easy, you know, there's there's a lot of either misinformation or old information which old could mean two weeks ago in our industry. So, you know, and and that's one of the biggest things I tell them to is, you know, look this is what I know today. It could be very different tomorrow. So please just take it all with a grain of salt and understand that we are learning as we go we've never been in a situation like this and in medicine so, you know actively studying while we are you know, And everything to or certifying and dispensing so, you know, I think those are some of the more exciting ends of things right now and where I'm really looking forward o the direction that the industry setting. Okay.

Thank you. And one last thing just came to up to mine any side effects like these. Do you see anybody that has side effects with CBD or cannabis that Beyond getting high right? I mean, that's the obvious one. But anyone that did anything people should be looking out for?

Not really, you know CBD is pretty innocuous. As far as side effects are concerned, you know high doses it can get, you know, more sedating and drowsy, you know, and by high doses were talking, you know, 300 milligrams and up, you know, if people are really interested in side effects on CBD. One of the best resources is just looking up the drug information on Epi dialects, you know, they actually did all of the studies and everything there. You know and but part of my concern with that is, you know, they always list the diarrhea and the nausea and the vomiting just because a lot of people had that to begin with, you know, it wasn't necessarily a part of the medication itself. It is very good for those things. So you do have to take some of those with a grain of salt as well. And as you said if you know you get very high doses in those trials as well, which most people don't typically need exactly and you know, your typical dose of CBD is going to be probably 15 to 30 minutes. Milligrams not 300 milligrams. So, you know, you don't have those sedating effects or anything from your CBD. So and one of the great things about CBD that we explain to patients all the time is it really can help with the the intoxicating effects of THC? So, you know, one of the side effects of CBD is decreasing that intoxicating effect of THC. So, you know having them together is really, you know you go again you go back to whole plant and decreasing Side Effects by having CBD with your THC.

So you Don't you know it's still possible to get to that uncomfortable high place with THC and CBD together. You're still going to feel THC at some point or another but that CBD can really help to mitigate that uncomfortable feeling that high that you know, I don't want to be here. I don't have control or whatever. So, you know, that's typically it but otherwise your side effects are just you know too much is what's going to cause the paranoia with THC and cause that uncomfortable feeling, you know Edibles are Nine out of ten times what's going to lead people down that path as well? Just because they take so long to kick in somebody's used to smoking. It's you know, that's almost immediate. This is you know an hour or more before it might kick in so I don't feel anything take more. Oh, I don't feel anything take more before, you know it. These are the kids that are looking to jump off a bridge because they're paranoid and losing their mind in their, you know, Skin's crawling and everything else, you know, so just being aware of your dosing and being Just of how you're reacting making sure you're not, you know dosing again before you should be just because you think you can handle it, you know, listen to your medical professionals and that sense. It's not going to do you any good to just go blasting through your tolerance or your you know, where that Comfort level is, you know, one of the ways we always deal with it and what I always explain to my patients is it's very possible that you get high before you get the relief you're looking for. That's okay.

That's to be expected a lot of times. Dealing with this. It just means we have to peel it back a little bit work on a little bit of Tolerance and then we will slowly progress through that but you know, this is not a miracle drug just like opiates or not and a lot of the other ones. It's a process and it's not easy to get to that relief, but I promise you we can keep you functional while doing it if you're willing to go on that path with me.

Let's great perspective Brian. Thank you so much for your time today and really great to meet you and I really appreciate and respect all the work that you're doing and help. People out, so it's with great intentions and good luck and to you as you continue forward.

Thank you so much. I appreciate for having me. Take care.

Thank you.

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