From the Editor: From Munchies to Tolerance

It’s impossible to think munchies without thinking cannabis. Stereotypes tell us the two go together like … well … pepperoni and pizza. And while stereotypes may be based on exaggeration or even falsehoods, there’s a kernel of truth to many, as contributor Marissa Fratoni points out in her piece on the science of munchies. Cannabis is known to stimulate appetite. It’s even used clinically to help combat malnutrition. Yet research suggests that cannabis users tend to be thinner than their nonindulging counterparts. Does that mean it will help us lose weight? Not necessarily. Fratoni explores the paradox and details the role of the endocannabinoid system.

Another potential side effect of cannabis use is tolerance. Individuals who gain medical benefit from cannabis over time and after regular use may find the benefits diminished and ultimately eliminated. As with the munchies, an explanation for the phenomenon goes back to the endocannabinoid system. When there’s disequilibrium in the system, tolerance develops. Katherine Golden, a cannabis nurse and CEO of Leaf411, the nation’s first cannabis nurse hotline, explores the causes and consequences and provides guidance for practitioners who may need to recommend “tolerance breaks” for their patients.

Our features in this issue cover concerns that are certain to be important to members of your patient population. Women of childbearing age may be confused about the pros and cons of cannabis use during pregnancy and lactation. Contributor Bonnie Johnson looks at the science. And while many of your patients may struggle to get a good night’s sleep, Jamie Santa Cruz reports that although cannabis does appear to have some ability to improve sleep, particularly for those kept awake by pain, the jury isn’t in yet on its efficacy. Pharmacist Mark Coggins looks at an issue of special importance for older adults—the role of cannabis in stemming polypharmacy, and Emily Kyle looks at the promise of cannabis for autoimmune disease patients who get inadequate relief from traditional approaches.

Our contributors in this issue also address practice matters. Michelle Deppe explores key legal concerns for cannabis practitioners, and Lindsey Getz looks at some of the challenges in setting up a cannabis practice.

We’d like to hear from you. Tell us what issues concern you most.

— Kate Jackson
CRXeditor@gvpub.com