Good morning, Academy members. I'm Dr. Mitchell Pryweas, Session Director and Moderator for this live Q&A discussion on medical cannabis. We hope that you had an opportunity to view our on-demand session, and if not, I hope that you will. We're looking forward to your questions today relating to the science, practice, medical, legal, and regulatory issues surrounding cannabis. We will take questions in the form of the chat, so if you have questions, please place them there and we will try to get to them as we can. We only have 45 minutes and there's quite a lot of discussion, I'm sure. But before we begin, I'd like to briefly introduce our esteemed panel. First, our guest lecturer, Dr. Russo, who's one of the world's leading researchers on medical cannabis and cannabis therapeutics. He's a board-certified neurologist, well-published, and was the Senior Medical Advisor to GW Pharma for the clinical trials that brought to market cannabis pharmaceuticals, Sativex, for the treatment of MS, as well as Epidiolex for childhood seizures disorders. Good morning, Ethan. Well, thanks for having me again. It's nice to be joining physiatrists in this. I'm glad you're allowing interlopers. It's true to say that some of my best friends are physiatrists, so. I'd also like to welcome back our esteemed colleague, Dr. Greg Carter, who has been with us since the inception of this journey five years ago. Greg has been involved in research related to clinical applications of cannabis for over 25 years, with a specific focus on neuromuscular disorders. He was the first investigator to note a potential role of cannabis in the treatment of ALS, and he's currently examining the endocannabinoid system as a possible source of biomarkers in this disease. Welcome back, Greg. It's so wonderful to have you back. And also, Dr. Glassman, who needs no introduction to the academy. He is, I guess, our medical, legal, and regulatory expert, and Dr. Glassman is involved with the AMA's Cannabis Task Force, and if we have time, maybe we'll hear more about what he's up to. So I'm gonna look at the questions as they come in, but one of the things that I'd like to discuss, if it's okay with the panel, is something that comes up as a private practitioner in Connecticut, and I'm sure all of you have patients who are bringing in CBD products and asking, what do you think, doc? Should I be taking this? Should I not be taking it? And I think it was the Farm Bill, my understanding in 2018, that kind of allowed the legal use of growing hemp throughout the country. I know in Connecticut, there's hemp farms all over, and the question is, what do we know about these products? We know that, legally, it's not allowed to be marketed as CBD. It's a hemp-related product, but the FDA has made it clear that you can't make medical claims. You have to be very careful, but I think the problem is the enforcement of this, and we're seeing it in beverages now. We're seeing it in just about everything, and I wanted to start the discussion on how do we handle this with our patients, and what should we be telling them about the effects of CBD? I'll probably start with Dr. Russo, and then maybe, Stu, if you want to chime in about the medical, legal, and certainly, Dr. Carter, if you have some input, too, so. Sure. Well, thanks, Mitch. Yeah, this is one of those situations I really sympathize both with the public, who is totally flummoxed with the number of preparations out there, and the poor physicians trying to advise them, because it is the Wild West right now. What we can say is that CBD, cannabidiol, is a very versatile compound, very safe, but it's not very potent, so a lot of these materials are isolates, meaning, hopefully, pure CBD with little else, and unless there's a large number of milligrams, it's unlikely that there is going to be a lot of therapeutic effect. My advice to consumers is to find something that seemingly, if possible, is backed by science. At minimum, we want to make sure that the material is safe, and that should come in the form of a COA, Certificate of Analysis, that tells the person what is actually in it, and hopefully will also include data about its safety, that it's been screened for heavy metals, that there are no pesticide residues, no solvent residues, and fortunately, this kind of thing is not mandated at most physical points of sale, let alone the internet, so it really is a morass out there, and good luck to trying to make sense of a lot of these products. Right, you know, it's interesting, I even saw consumer reports, and also, what was it? Some other resources that were actually giving recommendations that I look for, in addition to some of the things that you mentioned, and that's what I pretty much tell my patients. You know, if it can go under the same scrutiny that a production plant in Connecticut goes through, in terms of Certificate of Analysis, then you know it's probably going to be a fairly safe product, but in terms of therapeutics, you know, 0.3%, which is what they've said, it can't have less than 0.3% of THC. What can we tell our patients about potential therapeutics? What can they expect? I mean, I often tell patients, look, you know, the CBD you're going to get at Bed Bath & Beyond is not going to take care of your migraine headache, you know, let's be clear here. So, but patients who are getting good quality products, full spectrum, organic, Certificate of Analysis, they're taking 30 to 60 milligrams of CBD, not as an extract, as a pure product, you know, full concierge effect. What recommendations can we make for them regarding anxiety potentially, if not some pain relief? Well, again, it really depends on the preparation. You know, my personal feeling is that CBD, as well as other cannabinoids, work better in concert with other ingredients, what's called the entourage effect. And I referred to this in my talk that hopefully people have seen or will see. But again, who is formulating and on what basis? And this is all hampered by the fact that only structure activity claims can be made. For instance, it supports gastrointestinal function, not that it treats inflammatory bowel disease. Now, a lot of this is the fault of the government. You know, either they're too heavy handed or they haven't had enough regulatory oversight to really help the consumer in this instances. And CBD has fallen into this gray zone right now. The FDA really doesn't wanna have anything to do with it and only intervenes in situations in which there's a specific complaint or there's false advertising about the composition of a particular preparation. And let's add that the industry is at fault too, because the level of quality control is totally lacking for most preparations. They don't have enough agents to go out there. It's almost like the ephedra situation until there's actually something that actually occurs, then they're gonna act and pull it from the market. Do you have any input on this, Dr. Glassman? Yeah, definitely. So a couple of years ago, the FDA issued some letters concerning the marketing of CBD and the fact that there were false claims that were being made, but outside of that, like you said, they're not gonna send agents to your local gas station or your Bed Bath & Beyond to pull stuff off the shelves. And, you know, I see in the chat from Hallie Robbins, the question of, are dispensaries a better place to consider getting a product? Because in theory, they are screening, and when they put a COA on your items for sale, in theory, it has been screened for adulterants or impurities and things of that nature as well. So certainly you'll probably end up getting a better product from the dispensary than you will anywhere else, but ultimately it's so hard to be able to know what will work for what, you know, disease diagnosis, because again, we still are lacking in a lot of the research for CBD that we would really want as clinicians for sure. Yeah, and I think along with that, even if you get a product from a dispenser, let's say it's for adult use recreational, my question, and this came up on a panel that I was on in Colorado, a medical cannabis conference, was who is educating people in these adult recreational dispensaries? I mean, we're very fortunate, as I mentioned in my talk in Connecticut, that we have a pharmaceutical model where we have pharmacists that are at least reviewing every patient who comes in and screens them and goes over their medications and is knowledgeable to some extent about medical cannabis, but the average person who goes into a recreational dispensary, you know, they're being seen by what are called bud tenders, and, you know, their experience with the product is so variable. It could be, you know, almost nothing to whatever the owner of the dispensary has provided for them. And so that's a major concern because some of these products have THC levels that are incredibly high and, you know, can really cause problems for patients. And I've even seen that sometimes in our state with the pharmaceutical model, they may take too many products and, you know, they may become not quite psychotic, but quite nearly that. So that is a question, I think, on a state-by-state level, who is the best person to educate the individual when they go into a dispensary, whether it's for medical, you hope that you have more supervision, but more and more of the medical facilities are now going recreation. I know in our state, in Connecticut, next year, they're going to open, we have it legal, but next year, they're going to open it up to adult use. And I have great concerns about this because I understand from the state, they're gonna open it up now to food and beverage licenses and all of these other things. So I think there's great concern about who's educating who about these products. So, yeah, so one of the parts of the talk that I've given that's recorded is the whole issue of education for physicians and licensed independent practitioners about cannabis, you know, as a medicine, and some of the master's programs that are out there so that we have, hopefully, at least the knowledge of the buy tender, if not more. And yet, remember, you know, we're not prescribing cannabis. We are certifying them for their state program. There was a question in the chat about, you know, physicians prescribing it. It is a schedule one. You cannot prescribe marijuana, no way, no how. You can certify someone to be able to access it, but we're not prescribing it at all. But yes. I mentioned that in my talk as well, Stu, that doctors do not prescribe. And as a result of not prescribing and registering, in other words, we have at least three criteria in the state. We've got to establish a doctor-patient relationship. We can't kind of phone it in. You have to make sure that, you know, the patients have at least tried traditional treatment before they're, it's not a first line treatment for most individuals in our state. And also that, you know, there's an understanding about this. You know, it is a drug and people have to understand that as well. Greg, I wanted you to comment because Dr. Glassman brought up the concept of education. And I know you were president of the American Academy of Medical Cannabis Association. And there's also a society of medical cannabis clinicians, which also provides education in addition to the master's programs that Dr. Glassman is talking about. So there's greater education. Could you maybe just say a few words about these organizations and what they do since you've been actively involved with that for many years? Sure. Thanks, Mitch. I did want to say that my wife loves Bed Bath and Beyond. So anyhow, yes. Thank you for mentioning the American Academy of Cannabinoid Medicine and the Society of Cannabis Clinicians. I think one thing those organizations do is provide a library of resources. And I do want to give a nod to Dr. Russo who has really written some excellent material books. And he did a paper years back, which I still always reference. It's called Taming THC, which really talks about the entourage effect. We really should not be looking at these things as isolates. Anything you can add to that later if you want. But I think that's where a lot of people get off track. The entourage effect is very, very important. The AACM and the Society of Cannabis Clinicians, you can Google those. And if anybody's interested in joining, reach out to any of us. Thanks. No, good. I think we should make those resources available for our academy members, both those organizations and the one that Dr. Glassman, because educated physicians, what we're aiming for in doing these talks to begin with. I'm going to see if I can take some questions that we were getting in. Someone asked about recommendations, tips, cautions, opportunities, educational materials for use acutely and crudely after TBI, including differences perhaps for a 16 year old versus a 45 or 80 year old. Dr. Russo, do you have any? Yeah, this has always been one of my interests. When I was in practice in Missoula, Montana, I tended to see all the concussions and post-concussion syndromes. And cannabis really has a role here. It's not what people would think. What is actually needed are tiny doses of THC seem to be extremely effective in treating symptoms, including brain fog, nausea, certainly, agitation, anxiety, all the things that go along with post-traumatic syndrome. One of my papers, which is available, I put in the chat a link at ethanrusso.org. It's just my personal page. At the library tab, all of my writings are there. I hope people avail themselves of. There's a paper in there called, let me think if I can get the name right, Cannabis Therapeutics Neurology or something along these lines. And there's a whole section on chronic traumatic encephalopathy, as well as other disorders, specifically Alzheimer's, epilepsy, of course. Cannabis Therapeutics and the Future of Neurology is, I think, what it's called. See, it takes a while for the neurons to connect. But also in there, there are a lot of questions about preparations and dosing. I'd recommend another article there with Caroline McCollum, which is on cannabis dosing and administration. I think people would gain some insight there into how to sift through what's available, what starting points are, et cetera. In general, 2.5 milligrams of THC is like a threshold dose. Most people will feel it, some will not. Five milligrams is a moderate dose. 10 milligrams at once is too much unless the person has some tolerance. But these are basic guidelines and they also are affected by other components, which may allay THC-associated side effects. So it is a complex business. It's really not amenable to the 15-minute appointment with a patient. And this is a reason that if you don't feel you're equipped at this point, perhaps there's someone in your community that's tuned into this. And there are dedicated cannabis clinicians. Listing is available through the Society of Cannabis Clinicians, scc.org, I think. And those people can be a good resource because they have spent the time digging in on available literature. And sometimes the review articles really come up short in supporting the therapeutic potential of cannabis. And a lot of this, again, I would blame on the government. There've been tremendous roadblocks to research in this country on cannabis that have made it almost impossible to do useful randomized control trials with standardized material. That's been impossible and remains so. This is a reason I've worked for foreign companies for most of the last 25 years. So anyway, off the soapbox for a moment. That's great. Related to that, we discussed earlier before our presentation about the concept of endocannabinoid tone. I wonder if you could address that. And also this concept of endocannabinoid system deficiency. Sure. I find that concept very fascinating, especially as it relates to chronic patients like fibromyalgia. I wonder if you could give some comment to that. Sure, briefly. Yeah, so this is how things work. THC works among other things on cannabinoid receptors. CB1 specifically in the brain is responsible for modulating the effects of all the neurotransmitters. And almost every aspect of physiology is affected by the endocannabinoid system, which is the master homeostatic regulator of physiology. So it has a role in every aspect of how we function. So the endocannabinoid system has three components. Those are endogenous cannabinoids, endocannabinoids themselves that work analogously to THC for the most part as weak partial agonists at the CB1 receptor. Then we have the receptors themselves, which actually encompass a CB1, CB2, TRPV1 and other TRP channels. And this is a expanding concept. And we have the enzymes that make and break down the endocannabinoids. So the concept of endocannabinoid tone would say, how many receptors are there? Are they active? Does the patient have tolerance to THC already or not? So this is an important concept, but one that we can't easily measure, short of doing cerebrospinal fluid exams on our patients, which isn't ethical, or doing PET scans at $10,000 a crack. So as you might imagine, although this is theoretically possible, it's not practically possible. So otherwise, we have to go at endocannabinoid tone by very slowly and carefully titrating patients up on their THC. As I'm fond of saying, the correct dose is the lowest dose that addresses the clinical problem, whether it be pain, spasticity, or whatever else, without introducing adverse events of its own. So that's always the best policy. And short of having a meter from Star Trek to measure endocannabinoid tone, we're not quite there yet. OK, let's leave it for continued research. Sure, and briefly, I have hypothesized that various disorders that we see a lot, particularly fibromyalgia, migraine, and irritable bowel syndrome are related to what I call a clinical endocannabinoid deficiency. So I first posited this in 2001, but subsequently in the literature, there's been a lot of support for the concept, also applied to post-traumatic stress, autism, and other disorders. And there are resources for that we could view. Yeah, again, in the library at ethanruso.org, there are two articles specifically addressing clinical endocannabinoid deficiency. Another topic that's come up in the feed here, and it's also a very popular topic, and I have a paper in front of me, which I'm sure you're familiar with, is about a cannabis role in opiate use disorder. I have many patients I've registered who are on opiates. Some of them have been able to get off of their opiates. I mean, you mentioned Dr. Sulak's research in working with those patients. But there are many patients, and I think there's one question here, who are not able to divorce themselves from opiates and yet remain on both cannabis and opiate. And I guess there is somewhat of a synergy between the two. And I've also heard it said, and I don't know if this was someone on CNN talking about it, but they say that cannabis can actually, if you're able to get off of the opiates, it can promote some healing in the brain. Is that also part of the picture that we see with patients who have opiate use disorder, that there's many times damage that's been done from the use of chronic opiates? And once they're able to use cannabis as a substitution, some of that healing can take place. I wonder if you could comment on that. Is that for me, Mitch? Yeah, sure. OK, why don't you dive in there. Sure, well, cannabis and opioids have been used in conjunction by thousands of patients. And generally, the results are positive. There have been two phase two trials of opioid-resistant cancer pain patients. Unfortunately, phase threes didn't read out, mainly because the Eastern European patients were far too sick, far too long in their disease progression to be positively affected. But there are a lot of observational studies from Israel that show opioid sparing and reductions or even elimination of opioids. The way that they work is complementary. Obviously, there's a direct effect of opioids on pain pathways. There is as well with cannabinoids, but it's much more effective in treating the affective component of pain. What patients will say is, I still have the pain, but it doesn't bother me the same way. However, that is key to a patient's appreciation of pain, how they cope with pain, and their ability to function in their daily life. So the two are complementary. And most commonly, we do see reductions being possible. As to healing, well, the thing I'd point out for sure is we know that opioids are counterproductive in a lot of neuropathic pain syndromes. It can even introduce neuropathic pain. So certainly in that situation, cannabinoid treatment becomes a viable alternative and likely a highly desirable one. There is some information to support the idea of cannabinoids producing neurogenesis in the brain. But right now, that's more of a theoretical concept than one that we can really sink our teeth into, so to speak. I have your hand up, Stu. Is that you? Yeah, I do want Dr. Carter to speak first if he has any input before I go. I just want to remind everybody that there were a few papers going back about three or four years now showing a lower rate of opioid use and opioid deaths in states that have medical marijuana laws. Right, that was in JAMA, I believe. Yeah. Great. Yeah, and in the chat, there was a whole discussion on some of those outcomes. So I'm putting on my medical review officer hat here, sort of one of the other things that I do. So it's important to remember that ideally, if cannabis is helping for chronic pain issues, then you would want to see that opioid use does go down, maybe not completely, but it decreases. Now, in your pain management agreement, there probably is something written in there that if they're prescribed opioids, they can't use marijuana. So you may have to update your pain management agreement to reflect the fact that you're aware of their certification for cannabis or using it if you're in a state where they're not able to get it through a program. But you're going to want to do routine drug testing to see what the levels of opioids are, to see what the levels of THC are. So it's more than just saying, OK, you can go on marijuana now. You really want to follow the sort of specific data outcomes in science to see if it's improving. Ask them things. Are they doing more acute? Are they more functional? Are they working? Are they doing other things as well? And along with that, Stu, I would add that it's very important for individuals. I know when I register patients in Connecticut to differentiate between dependency on opioids and addiction. I will not register a patient who has a known addiction. I just won't because I think they've got to deal with the addiction first before I'm willing to consider adding another potentially dependent medication. And I would also want to know that they're being counseled regarding their addiction or at least receiving treatment for their addiction. And we had some issues with this on our medical advisory board. It took us a long time to approve opiate use disorder as a diagnosis for which we would register patients. I think New York had it first, and so we followed them. But we had a difficult time as a panel differentiating patients who actually had addictions, who were not receiving treatment for those addictions and wanted to be on cannabis because we just didn't want to add another drug to the mix until that was all sorted out. So I think that's really important. And I think that's why a lot of pain management doctors are doing the urine screens because they want to make sure that the patients aren't abusing the drugs. I have another question. I know we're getting a few more in, but the question is regarding the use of Delta 8. We're seeing a lot more of this now. I'd like Ethan to comment on this. It is, from what I understand, a much lower psychoactive than tetrahydrocavanol-9, but it is apparently in very small amounts in hemp products. And I don't know what the FDA is doing about this, but there have been on their FDA website some cases of people having problems with it and ending up in emergency rooms and so forth. So I wanted to address this because it's not regulated. It seems like it's not regulated, and I'm seeing more of this. So I want to comment on that. Yeah. OK, so Delta 8 is actually a small concentration and natural component of some forms of cannabis. So it's quite similar to Delta 9 THC in structure. It may be somewhat less psychoactive, but they've never been tested head to head. There was actually a study in Israel in the 90s where Delta 8 was used to treat children undergoing chemotherapy to treat nausea, and it was quite successful. That's the good news. The bad news is the profusion of Delta 8 THC that we see on the market now is just another dodge by manufacturers to sell something that really technically shouldn't be legal at all. What they're doing is not isolating natural Delta 8 THC from cannabis, but rather taking They have huge amounts of CBD at their disposal because it's a glut on the market, and they're transmogrifying CBD into Delta 8 THC through chemical means. So the Delta 8 that's produced may not be such a problem on its own. What is a problem is none of these preparations that have been tested are pure. Rather, they have additional isomers, Delta 10, Delta 6 THC, plus impurities. And we know even less about what those do, particularly the impurities, which could be toxic. Also, make no mistake. If someone gets enough Delta 8 THC in the system, they're subject to all the same kinds of side effects they would get from too much Delta 9 THC, whether it be anxiety, paranoia, or even a toxic psychosis. These things happen. The DEA has just weighed in this week to say that they don't think it's illegal. Well, fine, but that's not to say safe or encouraged or anything else. So in fact, Delta 8 may be a useful therapeutic compound. I can't endorse any product out there currently because of the way they're made and the lack of quality control and transparency. Very interesting. Very interesting. Anyone else have any comments about Delta 8? One of the questions I have botanically, this has been a learning process for all of us. And we understand the concept of marijuana being the female flowering part that has the trichomes where the psychoactive component is. But I'm hearing about hemp products that produce flower and they're being sold with these constituents, some of them even to Delta 8. How is that possible? I've always thought of hemp as an industrial product, almost like the male species that doesn't flower. But yet, there's products on the market that have hemp flower available with some of these constituents in it. Yeah, well, they're spiked. So I mean, it's just as artificial as putting it on parsley. So they may have some cheap hemp flower, again, glut on the market. And they spike it with something that to them makes it value-added, at least financially. But again, I blame the government. This kind of thing should be regulated. Regulated and legal, I would add, is the path forward, not keeping things clandestine and encouraging the Wild West, because that's what we have right now. I have a question here regarding the pulmonary and cardiovascular risks of cannabis smoking. I know myself, I try to discourage, especially in the wake of COVID, smoking, using either vaporized forms or tinctures, mostly with my patients. But what should physicians advise their patients on the delivery systems of smoking, and those who want to indulge in it, especially in the face of cardiopulmonary issues? Anybody want to take that? Well, yeah, well, certainly for anyone who has any cardiopulmonary comorbid issues, inhaling is certainly always going to be a concern, not just because of the particles, but the impurities, even if you get it from the dispensary, let alone if you're getting in the black market, because it's cheaper than getting it from the dispensary. So certainly, that's a big concern for any patient, cardiac or pulmonary comorbidities. And even without them, there may be some longer-term concerns of inhaling. So the whole point of different methods of delivery access is important. Salves, tinctures, topicals. So yes, I think it's something you definitely want to be thinking about in your screening for your patients. And on your certification form, you may want to put down, consider non-inhaled routes of administration. Was there a paper recently about the effects of smoking cannabis on patients with cardiovascular disease? Someone had mentioned it, and I don't know. Are you familiar with that, Ethan? Yeah. Unfortunately, these kinds of retrospective studies are really poorly performed. I agree with everything that Stuart said. Basically, we don't encourage people to smoke anything for therapeutic reasons. Vaporization is better, and as you mentioned, even better oral things. Usually, we're dealing with chronic illnesses here, particularly in the physiatry realm. And for that reason, you want something that's going to be safe. Also, lasts longer. Inhalation produces rapid peaks, PK peaks, and rapid offset. So people have to dose every two or three hours. We really want something orally where two or three time a day dosing is going to be more reasonable. Now, back to the question, if we really look at public health measures, there is no useful correlation between cannabis smoking and an increase in coronary artery disease. Yes, individuals do get rapid heart rate from smoking and might be at increased risk if they have a pre-existing problem. But over the last 40 years, there's been a big increase in cannabis usage. There has not been a corresponding increase in coronary artery disease. So yes, I don't encourage it, but to say it's the cause of someone's specific heart attack is usually spurious. And in the history of cannabis, there's never been anybody who has developed lung cancer related to smoking cannabis. Am I correct? Again, it's true to say that there are polyaromatic hydrocarbons that are potential carcinogens in cannabis smoke. However, THC itself actually helps prevent development of lung tumors. And Dr. Russo didn't say it's OK to smoke. What Dr. Russo said was, in cannabis only smokers, you don't see, you actually see a lower incidence of lung cancer. And so it doesn't have the same association with tobacco smoking. But I never recommend smoking therapeutically. We only have a few minutes left. Is there any specific issue that you guys would like to address? I've been given the three minute warning here. The discussion has been great, and I would love to continue longer. But I'm looking through the questions. There's nothing specific here. While you're looking, I'd just say I really welcome this opportunity. I applaud people for being here. I hope they'll avail themselves of the resources that are out there to educate themselves further on the subject. Yeah, and I did want to mention that myself, I'm part of the Corporations Committee for the Academy. And myself, Dr. Pryor, Dr. Carter, we're starting to have discussions about looking at this whole aspect of cannabis medicine in a much bigger way for our Academy and for physiatrists, given the diversity of our specialty, the diversity of patients we treat, and the fact that we may be able to bring in a lot of collective knowledge to bring some rational thought to this entire field. So we are certainly looking at in detail. And as I put in the chat, we will send out some questions through this forum about the establishment of a member community for cannabis medicine for physiatrists. But I think we could potentially be a thought leader amongst many other specialists and primary care physicians in this space. Yeah, I would agree. I apologize if we don't get to everybody's questions. As I said, we could go on easily for another hour or more talking about this. I want to thank all of you, especially Dr. Russo, for joining us this year. It's been a really delight and a pleasure. And I want to thank Dr. Carter for his association with you and bringing you to us. I think we've opened up the minds and hearts of so many physiatrists and doctors in general who don't know about this area. And our main focus is to educate, especially in helping our patients. And I think, as Dr. Glassman mentions, I think we have been on the forefront of looking at alternatives, therapeutic alternatives, to help our patients and be less dependent on opiates and other surgeries and all of these other things. So I want to thank you, Ethan. I want to thank you, Stu. I want to thank you, Greg. And I'm looking forward to next year. I'm just going to put it out there to our membership. If you have some ideas, if you have things that you would like us to discuss, perhaps we could create a larger forum. Maybe the Academy would give us a half a day on this in Baltimore. And we can invite more speakers like Dr. Russo on a panel to discuss this further. Again, I want to thank you all so much for this. This has been really great. Thank you. Cheers.

medical cannabis

CBD products

advising patients

scientific research

Certificate of Analysis

individualized treatment

traumatic brain injury

opiate use disorder