Feb. 15, 2021

Cannabis in Veterinary Medicine: A Critical Review | Dr. Trina Hazzah Deep Dive

Cannabis in Veterinary Medicine: A Critical Review | Dr. Trina Hazzah Deep Dive

There are thousands of published scientific articles about cannabis and its constituents. There are 50 states with 50 different sets of law about its legality. It’s still banned on the federal level. Yet, dog lovers are using it to help their dogs, and expecting their veterinarians to understand and advise them. Cannabis in Veterinary Medicine a Critical Review, a brand-new publication, helps professionals sort fact from fiction.

The still hazy legal status of cannabis makes advising clients about it darn near impossible. Dog lovers are left to figure out what to do on their own. With only product manufacturers to advise them, they can easily get bad, incomplete, or inaccurate advice. Cannabis in Veterinary Medicine a Critical Review, a brand-new publication, helps professionals sort fact from fiction.

One of the paper’s authors, Dr. Trina Hazzah, returns to discuss their work. She is an integrative veterinary oncologist and co-founder of the Veterinary Cannabis Society, a non-profit that helps veterinarians and pet parents access credible, realistic, legally sound advice around medical cannabis use.

In the paper, Dr. Hazzah and her co-authors lay out a road map of a sort for practicing veterinarians. They go over the description and structure of the endocannabinoid system, the pharmacologic effects of the active compounds, the potential uses, and the toxicities of cannabis.

The purpose of the paper, and of this show, is to help clinicians get an overview and grounded understanding of the compounds so they can help their patients without reading thousands of papers on PubMed. The authors also address the very real issues around legal status and offer feedback and ideas for how to work with clients safely and legally.

A must-listen show for anyone practicing veterinary medicine or asking their veterinarian about cannabis or CBD use.

Today’s show is sponsored by The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity by Dr. Demian Dressler and Dr. Susan Ettinger.


Links Mentioned in Today’s Show: 

The Veterinary Cannabis Society https://veterinarycannabissociety.org/ or https://vcs.pet

Dr. Hazzah’s paper, “Cannabis in Veterinary Medicine: A Critical Review,” can be found on the American Holistic Veterinary Medical Association (AHVMA) website: Cannabis-in-Veterinary-Medicine-A-Critical-Review-Vol-61_LR-3.pdf (ahvma.org)



About Dr. Trina Hazzah

Trina Hazzah was born and raised in Washington DC. She attended Tuskegee University School of Veterinary Medicine where she earned her Doctor of Veterinary Medicine in 2006. She completed her small animal internship at Red Bank Veterinary Hospital in New Jersey and a 3-year residency in medical oncology at the Veterinary Oncology and Hematology Center, in Connecticut. She has also completed the requirements to be a Certified Veterinary Chinese Herbalist from the Chi Institute of Traditional Chinese Veterinary Medicine.

Other Societies to which Dr. Hazzah belongs: https://www.cannabisclinicians.org/ https://www.cavcm.com/ http://vetcancersociety.org/ https://www.acvim.org/ https://www.ahvma.org/ California Veterinary Medical Association 

Her website is https://drtrinahazzah.com/


Dog Cancer Answers is a Maui Media production in association with Dog Podcast Network

This episode is sponsored by the best-selling animal health book The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity by Dr. Demian Dressler and Dr. Susan Ettinger. Available everywhere fine books are sold.

Listen to podcast episode for a special discount code.

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>> Dr. Trina Hazzah: We're supposed to be the main support system and you can't cover our mouths and allow us not to help animals. And we all took an oath to help and do no harm. And I think the do no harm part is really important because it's a harm-reduction type strategy that we would be implementing. And many of these -- it's not going to necessarily be "use at this dose cause it will kill cancer." I don't think anyone can say that right now, but perhaps "use it at this dose so you don't hurt your pet." 
>> Announcer: Welcome to Dog Cancer Answers where we help you help your dog with cancer. Here's your host, James Jacobson. 
>> James Jacobson: Hello friend, and welcome to the show.  Today, we're lucky to have Dr. Trina Hazzah, someone I call a unicorn because she is that rare creature: an oncologist who practices integrative medicine. She's also co-founder of the Veterinary Cannabis Society, a non-profit aimed to help pet parents and veterinarians understand the uses of cannabis and its active components in animals.
She and her colleagues have just published a paper on cannabis aimed at veterinarians. And that is what we're talking about today. Here's our conversation. 
Let's turn to this scientific paper that you wrote with some of your colleagues for the AHVMA, which is the American Holistic Veterinary Medical Association, called Cannabis in Veterinary Medicine: A Critical Review.
So the purpose of the scientific paper is what? Who are the constituents? Who is it designed for? And what is it designed to do? 
>> Dr. Trina Hazzah: It's something that I think really needed to come out, which is basically a very accurate, I would say, almost a very accurate, concise -- something that's very understandable, I'm hoping? That's clinically relevant for veterinarians, because I think there's so much information out there and vets just don't know where to look to to get accurate information.
And there are so many publications, a lot of it's what we call preclinical information. And so where do you start? Right? There's thousands and thousands of articles. And so what we did was we really wanted to put together a review article that was understandable and that reviewed things like the description and structure of the endocannabinoid system.
What is the endocannabinoid system? And really understanding that prior to jumping into the plant itself and then understanding some of those pharmacologic effects of these biologically active compounds, THC, CBD and all the other phytocannabinoids, terpenoids and flavonoids. And then we even spoke a little bit about the potential clinical uses and toxicities, because I think that's important.
I think a lot of times it's, well now I have all this information, but how do I use it? How do I use it safely? What's the purpose of titrating and slowly increasing the dose that I think we spoke about the last time we spoke together and then some of the toxicities, like, what does it look like when a dog has had too much?
And why is that the case? Because you know, dogs have so many more of these, what they call cannabinoid 1 receptors in the brain that create that psychototoxic effect. It really helps kind of guide them from a clinical aspect as well. And then I think the other thing that is difficult, unless you're a nerd like me, that likes to go on and look and see what papers have recently come out is it gives them a really nice review of all the veterinary literature on cannabis that's ever been published.
We also reviewed some of the legal updates. I mean, that's another huge barrier for veterinarians is what am I allowed to do? Am I allowed to discuss it? Am I allowed to recommend it? And so we discuss kind of federally where things are on a state level -- I think speaking to your veterinary medical board is going to be essential -- and understanding the difference between "discussion" and what "recommendation" really means.
Can you write a "recommendation" just like a human practitioner can in veterinary medicine? And that's the goal of where we should really want to be at some point. 
>> James Jacobson: So you're not there yet. So, you're in California. I think your colleague, at least one of your colleagues, Gary Richter, is also in California -- are the other authors on the paper located in California, or no.
>> Dr. Trina Hazzah: No. Interesting. The other two are in Colorado. 
>> James Jacobson: Okay. So you're all in states that are cannabis-friendly. 
>> Dr. Trina Hazzah: Yes.
>> James Jacobson: Okay. So how is this helpful to your, you know, to veterinarians who are not in those states and more importantly to dog lovers and people who really want this information, but they don't live in a quote unquote cannabis-friendly state.
>> Dr. Trina Hazzah: Well, even if you don't live in a cannabis-friendly state, hemp is readily available. Hemp products are readily available, right? So that products that have less than 0.3% THC, which means it still has some THC and it has some, depending on the product you choose, has significant numbers of other cannabinoids, including large amounts of CBD, and turpenes and other molecules. And so people are ordering those online on a daily basis, right. A pet parents are doing that. And so the point of this is not to sway someone to do it or not do it. It's just to be a support and even a pet parent, like I've certainly shared this paper with a few pet parents and they always say like, Trina, I can't understand half of it, but what I do understand is it's really complex. And then like, it is, it is, it's not just as easy as, "Oh, it's, you know, a plant that can do some cool stuff." No, there's a lot of mechanisms and pathways and things that I think really support why we feel it does certain things and then there are certain, as we review some of the publications, there's some support to why it has shown to be helpful for diseases like osteoarthritis and seizures.
But so even if you don't live in a state that is, let's say marijuana- or high THC cannabis-friendly, it doesn't mean that a paper like this can't educate, right? We read things all the time that are just educational. So it allows us to have better tools and have more confidence when speaking to pet parents.
And I think for pet parents, it gives them a little bit more information as well. I mean, this could be read by many different people, right? Even industry leaders that are out there making products. Read through this paper, make sure you're understanding, especially the safety perspective of it. Right? We want to make sure that pets are receiving really safe products.
>> James Jacobson: The fact that it was published in the American Holistic Veterinary Medical Association Journal, what has been the reception from more, you know, not holistic veterinarians, more allopathic vets?
>> Dr. Trina Hazzah: I would say, um, so far I've gotten really good feedback. "Thank you so much. This is really much needed. I can't wait to read it."
So, so far I've had a lot of really positive support. I think many of the authors on the paper have also had that type of support. I've not heard anything negative yet, because again, we're not pushing it. We're not saying every patient should be on it. We're just giving you the facts and then you take it as you do.
I mean, it comes from a nonjudgmental place. We don't judge anyone from. Wanting to use it in their patient population, or not using it, but if there's a fear associated with using it, the hope is that at least you have more facts to kind of either support you in supporting the pet parent to start using it, or just having the knowledge base.
I think sometimes just having lack of knowledge, creates fear. Right. And so having more knowledge for that veterinarian may be able to help support the pet parent a little bit better. That's all. 
>> James Jacobson: Okay. So a common question that we get here is "I just need like a cannabis for dummies book. I just need a way to understand all the differences and the advantages."
Is that something you can speak to in the context of this paper? 
>> Dr. Trina Hazzah: I think this paper is actually a little too complex for the typical pet parent. It's even complex for some veterinarians, because you have to remember in vet school, not one veterinarian ever learned about the endocannabinoid system. So it's not like we're touching on something that they're very familiar with.
Certainly because the endocannabinoid system is part of many systems we've learned about like, the neurosystem the cardiovascular system, the, you know, the immune system, right? I mean, certainly there's overlap between all the other systems in the body, but this is brand-new information. So even veterinarians -- teaching them in a way that I think is, um, digestible --
and again, not judgmental -- I think is very important. And certainly I think is easier for a veterinarian because they have medical school behind them. Right. Just to understand some of the language, but it still is brand-new. For a pet parent, I do think it would be a little bit over the top. Certain pet parents have medical backgrounds, and may understand this a little bit better, but I think this might be a little much.  There was an article I wrote for Great Pet Care on CBD, like what is CBD. And I think that would be a really good one. I'll share the link with you after this. 
>> James Jacobson: Great. And we'll put them in the show notes for this episode.
>> Dr. Trina Hazzah: Yeah, cause it really is nice. It talks about the difference between, you know, what is cannabis? What is marijuana? What is hemp? And I say, it's basic, but it's really not. You hear a lot of people talk about, "I just want CBD," but what is CBD? CBD isn't necessarily cannabis and marijuana. They all mean different things.
CBD is just one molecule out of the 700 molecules within the cannabis plant. And I think terminology can be really difficult to understand. And so I think that article would be a little bit better suited for pet parents. Certainly. So I'll provide that for you. 
>> James Jacobson: OK, that's awesome and you know, actually this is a good time for us to take a break so that we can pay some bills here at Dog Podcast Network.
We'll be right back with Dr. Trina Hazzah and doctor, when we get back, I want to step into the future with you into the next decade. So polish up your crystal ball, we'll be right back.
Welcome back. So it is a new year, 2021. The world is changing. What do you see? What do you see for 2021 more as it relates to cannabis use, but CBD use, et cetera in the veterinary world. 
>> Dr. Trina Hazzah: Great question. I'm hoping that there'll be some fairly large strides. I really do. I think that, um, yeah. I think from a legislative perspective, certainly there's going to be some new bills that hopefully will be passed that will support veterinarians being much more open with pet parents, supportive without really, I would almost say it's like removing the gag.
So we're actually allowed to not just discuss, but recommend certain products and help support them in dosing and strategy and goals and all of those really important aspects in many States like in, well, I'll say in California, and now in Michigan, Michigan just passed a bill a few days ago, allowing veterinarians to discuss cannabis, but it doesn't really go into detail about "recommend."
And I think sometimes it's difficult, right? Because how do you discuss and not recommend? Right? 
>> James Jacobson: And then the other States where still, veterinarians are petrified of losing their Schedule I license to use drugs, right? 
>> Dr. Trina Hazzah: Oh, totally. Yeah. They're terrified just losing their veterinary license, they forget DEA right? They're -- they don't know how much can they say, can they not say, but the problem and the biggest issue I have is pet parents are trying to figure it out themselves. And they're going to these, you know, bud tenders at dispensaries or online sites that are just very focused on selling products and making claims that aren't necessarily founded.
And they're using advice from people that have no real knowledge about the dog, the cat, you know, whatever animal they're using it in. And so that's where it really, really needs to be open for veterinarians to be that main support system. Which, by the way, we've always been, I mean, that's who we are as veterinarians.
We're supposed to be the main support system and you can't cover our mouths and allow us not to help animals. And we all took an oath to help. And do no harm. And I think the do no harm part is really important because it's a harm-reduction type strategy that we would be implementing. And many of these -- it's not going to necessarily be "Use at this dose because it will kill cancer." 
I don't think anyone can say that right now, but perhaps "Use it at this dose so you don't hurt your pet." 
>> James Jacobson: Got it. 
>> Dr. Trina Hazzah: What a big difference. 
>> James Jacobson: Major difference. And there's so many other applications beyond cancer. Do you think that in the United States we are trailing other countries? I mean, you guys at the Veterinary Cannabis Society, I've looked at this, how does the U.S. compare with other countries?
>> Dr. Trina Hazzah: I mean, I think actually other countries are fairly slow to start, too. The only country that I know that has actual cannabis veterinarians, and they're promoting themselves as such, is in Australia. But there really aren't, even in Israel, there's a school there that has veterinarians that have been working with some of the cannabis companies there, to my knowledge, just kind of chatting with them a little bit.
I don't even know if they're doing any clinical trials. Australia is the one that's done some of the clinical trials through one of the companies there. You know, who's starting to get really big and interested in cannabis is Mexico and Latin America in general, Columbia, Brazil. Some of those countries are becoming very, very interested in, so I'm hopeful with Veterinary Cannabis Society, our nonprofit that we started, that we'll be able to branch out to other veterinarians throughout the world and perhaps even have chapters, right? Where, why reinvent the wheel. If we create some information, let them join and we can all work together and you may not have access to certain products and you know, or, we may not have access to something you have access to.
So let's work together. And I think if we can do that, research will be much more robust, right? We'll be able to get many more cases together. We'll be able to share experiences in a much larger platform, a global platform. I think that would be tremendous. When you think about like the vision of VCS, it's really an educated and empowered global veterinary medical cannabis community.
I mean, that is the vision, which means it encompasses the entire world. There's pets everywhere that need the assistance of this. 
>> James Jacobson: Are you reaching out to government partners and potential corporate partners and international partners as you grow? 
>> Dr. Trina Hazzah: Yeah. Well that is a goal for sure. So we've started to reach out to corporate sponsors and corporate partnerships, for sure, because I think it's just a win-win for the industry leaders and the folks that are interested in more of an alternative approach.
Where we do a lot of the education, the advocacy, and we're supporting their mission as well. I think as long as the missions align, I think it's super important that we partner with as many people that can help support us as an organization as well. Internationally, we really haven't reached out to too many.
I know there's, um, the advocacy committee who I'm not part of meets every six weeks I believe. And they've certainly reached out to many different government organizations and other organizations that are nonprofit in the human space and kind of collaborating with them to find ways to make sure that there is a voice for veterinary medicine in the cannabis kind of legislative agendas.
>> James Jacobson: Does it start with Congress here in the U.S., or is the FDA or DEA involved at all.
>> Dr. Trina Hazzah: I think at some point, right, the FDA is going to have to make some statements that I know they're working on, creating some guidelines and so forth. But I think there's, I mean, if you even think about it from a state to state perspective, even just trying to speak to the veterinary medical boards to help allow vets to be guided better because the vets are afraid of losing their licenses because of their veterinary medical boards of their state.
Right. And so really reaching out to them first and having a conversation with them and then local state legislative agendas and going toward that and saying, how can we get veterinary medicine up on the agenda and really speak about how veterinarians need to have more of a role. And then there's going to be clearly, the federal government effect, we're going to have to reach out to them. And I'm the worst person to ask on this, just because I don't know how much the advocacy committee has done. I know they've done a lot so far and we've only been God, we've only been in existence since March of this year. We have amazing committee members on the education and advocacy committee. We all feel very strongly about the cause. And we're hoping to be actually open for membership where we can get veterinarians and pet parents and industry folk to all be, you know, become members of the society. And I do think together we'll be able to make this society such a robust, really powerful society that will make a very large impact globally.
Right. I really do, but I think it needs to be a lot of us together to do it. And we have a lot of really smart minds working on it. And advocacy wise, I think they're targeting Virginia, Florida, and Michigan right now. The advocacy committee is supposed to be working on those. I believe. 
>> James Jacobson: So if listeners want to get involved and support what you're doing at Veterinary Cannabis Society, how do they do that?
>> Dr. Trina Hazzah: You know, you actually just go right onto its vcs.pet. You just click vcs.pet and you'll go right to our website, or you can type in the whole name, which is veterinarycannabissociety.org. You'll go right to that website. And then there's a way that says, please get involved. Also, we are desperately looking for donations to help support the education front and the advocacy front as any non-profit or startup, right?
We need the finances and the support, and it doesn't even have to be financial support. It can just be support because you want to come in and maybe, um, volunteer some of your time or your skill set. If you have financial bookkeeping type qualities, if you are a digital design or website, like anything that might be able to help, we are open and really supportive of having people come on and help, because I do believe it's going to take a village to try to really get the word out there, you know, and ensure the safety of cannabis and pets through all of the avenues, the education, the advocacy, and promoting product standards. It's going to take a lot of us. 
>> James Jacobson: You guys are doing great work 
>> Dr. Trina Hazzah: Thank you. 
>> James Jacobson: And we are delighted to help support it and to share the journey with our listeners.
And we'll put again, the links to VCS.pet although that's pretty easy to remember in the show notes. Dr. Trina Hazzah, thanks for being with us today. 
>> Dr. Trina Hazzah: Thanks for having me. 
>> James Jacobson: Awesome. Thank you as well. I always enjoy speaking with you, Dr. Trina Hazzah. 
And thank you, friend, for joining us today to listen in on our conversation with Dr. Hazzah. Her important new paper aims to help veterinarians understand the basics of cannabis, the current literature, how to use it in a clinical situation, and how to think about the still hazy legal environment. You can find the link to the paper and other papers that she mentioned as well, as many more resources in the show notes for today's episode on dogcanceranswers.com.
And if you're a veterinarian and I know a bunch of veterinarians do listen to Dog Cancer Answers, I hope you will read it and reach out to the Veterinary Cannabis Society as a resource as necessary. And if you're a pet parent, it might be useful to read, but even more useful to bring it in, and have it at the attention of your own veterinarian on your next visit. 
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We read them all and we look forward to hearing from you once again, our thanks to Dr. Trina Hazzah for her time, and for her new paper on cannabis and thanks to you, friend, for listening without you, we would have no reason to do what we do. Hopefully it serves you and your dog well. Until next time I'm James Jacobson, and from all of us here at Dog Cancer Answers and Dog Podcast Network, we wish you and your dog, a very warm, aloha.
>> Announcer: Thank you for listening to Dog Cancer Answers. If you'd like to connect, please visit our website at dogcanceranswers.com or call our Listener Line at 808-868-3200. And here's a friendly reminder that you probably already know: this podcast is provided for informational and educational purposes only. It's not meant to take the place of the advice you receive from your dog's veterinarian. Only veterinarians who examine your dog can give you veterinary advice or diagnose your dog's medical condition. Your reliance on the information you hear on this podcast is solely at your own risk. If your dog has a specific health problem, contact your veterinarian.
Also, please keep in mind that veterinary information can change rapidly. Therefore, some information may be out of date. Dog Cancer Answers is a presentation of Maui Media in association with Dog Podcast Network.