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Today we have the pleasure of reading an interview with Sasha Weedowitch from Bosnia-Hercegovina. Sasha has a long professional background as a mental health nurse. He works as a private healthcare provider in Bosnia, implementing various endocannabinology interventions in order to help his patients reach their goals. We are excited to share that Sasha will come to Stockholm Medical Cannabis Conference 2023 on August 30, where he will present an illuminating talk about how his endocannabinology approach is helping his patients suffering from various neurological or mental disorders.
Can you help our readers by providing a definition of what endocannabinology is about, and how an ‘endocannabinology approach’ differs from a ‘medical cannabis approach’?
Certainly! Endocannabinology is a field that focuses on the Endocannabinoid system (ECS) and its balance, which is essential for maintaining mental and physical health. Initially, when I became fascinated by cannabis like many others, I used the term “cannatherapy.” However, as I delved deeper into the research related to the ECS, I realized that the system has little in common with cannabis itself. The ECS is a lipid signaling system that developed over 500 million years ago, whereas the cannabis plant appeared only 20 million years ago. Therefore, my approach shifted to focusing on the physiology of the ECS.
I have created the concept of endocannabinology with important support from Dr. Kristina Ranna. She helped me to make necessary corrections and make the concept more comprehensive. However, the latest knowledge has led me to move beyond this concept, just as I did with cannatherapy, and advocate for a Homeostatica approach, which is emerging now.
In my understanding, the endocannabinology approach emphasizes lifestyle as a key factor in maintaining ECS balance. It is a multidisciplinary field that utilizes coaching, education, mentoring, and cognitive behavioral therapy. The approach includes interventions such as nutrition (with an emphasis on the Mediterranean diet), effective supplementation, moderate physical activity, stress and sleep management, and fostering strong interpersonal relationships. It aims to find a comprehensive solution for ECS imbalance, with cannabis being considered a last resort option in my approach.
It’s important to note that my definition and approach to endocannabinology differ from the Uruguayan and Dr. Rachel Knox’s understanding. They consider cannabis as an essential part of the concept, while I view it as only a marginal option.
Can you describe how your journey led you to approach mental health nursing with an endocannabinology perspective?
I have always been passionate about mental health nursing and innovation. One of my early innovations, which may seem trivial, was serving food with forks and knives instead of just spoons on an acute psychiatric ward for aggressive patients. Little did I know at the time, this change aligned with the principles of endocannabinology, where social interactions and dignity are recognized as factors influencing the balance of the endocannabinoidome. This perspective was in place before I even knew about the ECS, back in 1993. Although the ECS wasn’t included in my education then, recent findings have shown that practically everything in our lives can impact the balance of the endocannabinoidome. Interestingly, when I recently trained a team of clinicians, including a nurse with a fresh Master’s degree, they had learned nothing about the ECS during their professional training.
The endocannabinoid system (ECS) is often referred to as the body’s “universal regulator.” Can you elaborate on how this concept integrates into your practice as a mental health nurse?
The ECS, being a lipid-based regulatory system, plays a critical role in both general and mental health. It is increasingly recognized in the context of the metabolic theory of mental health. While many people associate the importance of the ECS for mental health with neurotransmitter release, there is more to it.
Certain mediators, such as palmitoylethanolamide (PEA) and oleoylethanolamide (OEA), which are endocannabinoid-like molecules, serve as biological markers and therapeutics for mental health. These are fatty acid metabolites, highlighting the significant impact of nutrition and fatty acid intake ratio on the balance of the ECS.
What intervention/interventions do you recommend to start with when adopting an endocannabinology approach to health and disease? What interventions have the most scientific backing?
When adopting an endocannabinology approach, I recommend starting with lifestyle interventions as the foundation of care. These include nutrition, supplementation, physical activity, stress management, and fostering strong interpersonal relationships. The Mediterranean diet, in particular, has shown promising results in supporting the balance of the endocannabinoid system (ECS). Effective supplementation with specific endocannabinoid-like molecules, such as PEA and OEA, can also be beneficial.
To determine the interventions with the most scientific backing, I refer to Dr. Broselid’s table of lifestyle interventions and the strength of evidence supporting them. Additionally, I encourage the download of my endocannabinology Manifesto, which provides a comprehensive overview of evidence-based interventions. Clinical guidelines, such as the Clinical Practice Guidelines for Mood Disorder by the Royal Australian and New Zealand College of Psychiatrists, also play an extraordinary role in guiding treatment decisions. These guidelines recognize the importance of lifestyle interventions as an essential part of care.
Can you comment on the risks and benefits of using cannabis-based medicines as a part of a comprehensive mental health treatment plan?
I must clarify that as a mental health nurse, my perspective on this topic is subjective and not that of a psychiatrist. Currently, there is limited evidence regarding the use of cannabis-based medicines in mental health treatment. However, certain cannabis-based medicines like Cesamet and Nabilone have shown effectiveness in treating post-traumatic stress disorder (PTSD).
CBD shows promise in managing conditions such as anxiety, nicotine addiction, and potentially obsessive-compulsive disorder (OCD) or some developmental mental health disorders. However, it is important to note that CBD has not yet been approved as a medicine for these indications.
In the Czech Republic, the only approved psychiatric indication for cannabis-based medicines is Gilles de la Tourette syndrome. It is worth mentioning that while some psychiatric patients may try to manage their symptoms with marijuana, similar patterns can be observed with substances like tobacco and caffeine.
On the other hand, I have seen cases where cannabis use has triggered psychotic or affective disorders in some individuals. Therefore, further research is needed to better understand the potential harms and benefits associated with the use of cannabis-based medicines in mental health treatment.
Can you discuss the role of non-THC cannabinoids, like CBD, BCP, or others, in your therapeutic strategies for managing mental health conditions?
As part of my approach, I incorporate effective supplementation, including non-THC cannabinoids like CBD and BCP, in my therapeutic strategies for managing mental health conditions. Isolated cannabinoids are my preference, chosen based on their specific molecular target activity.
For example, CBD acts as a negative allosteric modulator of CB1 receptors and an agonist of CB2 receptors, while BCP shows CB2 agonism. Understanding the molecular target activity allows for a more targeted intervention compared to using full or broad extracts.
When using a full spectrum of biologically active cannabinoids, terpenes, flavonoids, and other substances, the therapeutic approach can resemble carpet bombing rather than targeted therapy. Therefore, isolated cannabinoids provide a more focused and precise approach to therapy.
What are the challenges in implementing an endocannabinology approach in mainstream mental health nursing, and how do you see the future of this integration playing out?
Surprisingly, the main challenge in implementing an endocannabinology approach in mainstream mental health nursing is not education, as one might assume. The shortage of nurses is a significant obstacle in many healthcare sectors, including mental health.
However, I believe that the field of mental health is receptive to this approach. With the increasing prevalence of mental health disorders among the population, accessing appropriate mental health services has become a challenge across Europe. Except for acute emergency services, waiting months to visit a psychiatrist or psychologist is not uncommon.
The integration of homeostatica-oriented mental health coaching can help address this issue. It provides easy accessibility to services for both clients and professionals. Soon, I plan to launch a training program to produce the first Homeostatica Mental Health Coaches. This training will be available to individuals with at least a secondary education degree. The program will be supervised by clinicians and will incorporate standardized, clinically confirmed self-assessments. After the evaluation process, Mental Health Coaches can provide coaching programs, recommend more suitable services if available, or refer individuals to mental health emergency services.
I intend to involve as many peer coaches as possible, especially in the areas of stress, anxiety, depression, and trauma coaching. Informal patient peer support groups have proven to be highly effective in supporting individuals with their conditions. Therefore, I am excited about the prospect of having peer coaches as part of the team.
Could you talk about your approach to monitoring patients’ responses to interventions and what kind of measures you use to track progress?
In monitoring patients’ responses to interventions, I utilize standardized and validated self-assessment scales such as the Depression, Anxiety, Stress Scale (DASS), and the Burnout Assessment Tool (BAT), among others. These scales allow for the tracking of progress and provide valuable insights into the effectiveness of the interventions.
Additionally, I incorporate goal-related evaluations, where clients create their own goals and evaluate their progress based on those goals. This client-centered approach empowers individuals to actively participate in their own healing process and provides a meaningful way to track their progress.
One aspect that is currently lacking in monitoring is the measurement of endocannabinoid levels. More research and development are needed to fully understand the importance of these measurements for health and how they can be integrated into monitoring and tracking progress.
In an ever-evolving field like endocannabinology, how do you stay updated with the latest research, and how does it influence your practice?
Staying updated with the latest research is crucial in the field of endocannabinology. I regularly perform keyword searches on PubMed every Monday to keep abreast of the newest findings. By staying informed about the latest research, I can integrate evidence-based knowledge into my practice and ensure that my approach aligns with the most current understanding of endocannabinology.
What is the biggest misconception about the physiological system commonly referred to as the ECS?
The biggest misconception about the endocannabinoid system (ECS) is that it is dependent on or developed solely due to the cannabis plant. In reality, the ECS is a fundamental regulatory system found in all living organisms. Its origins can be traced back to over 500 million years, predating the existence of the cannabis plant by millions of years.
It is important to understand that the ECS is a lipid-based regulatory system, and its significance lies in the balance of lipid signaling and homeostasis. While cannabis can interact with the ECS, it is the underlying lipid components that play a critical role in maintaining health and balance. Therefore, the focus should be on the broader understanding of the ECS beyond its association with cannabis.
Stefan Broselid, Ph.D.
Editor-In-Chief, Aurea Care Medical Science Journal