What Does It Take To Be An Executive In The Legal Cannabis Industry?

It is no secret that there are enormous sums of money to be made in the legal cannabis business. Not surprisingly, compensation packages for the executives who run profitable cannabis-based business are also likely to be large. That said, because cannabis and its products are illegal in the US, the talent pool is relatively shallow for executives with previous cannabis experience. Consequently, most new cannabis executives are likely to be recruited from other industries including pharmaceuticals, agribusiness, consumer healthcare and tobacco.  This is because, like the cannabis industry, these industries are highly regulated and will be under intense scrutiny from state and even federal agencies.

Gilbert J. Carrara Jr, MD, who oversees retain recruiting services at Battalia Winston International, recently described the skills sets and characteristics that he believes will be required for successful cannabis industry executive. They include:

Tough Mindedness

Because of the state-to-state complexity of cannabis legislation and negative perceptions surrounding cannabis use, executives in this industry cannot be thin-skinned or easily discouraged. If a person cannot accept repeatedly being told “no” or “go away” then he/she is not likely to be executive material in the legal cannabis industry.

Flexibility

The legal cannabis industry is in its infancy and it will continue to evolve and grow in wildly unpredictable and unanticipated ways. At present, change is the norm in the cannabis industry executive who are flexible, can pivot on a dime and remain open to sometimes new unconventional ideas on a regular basis will do just fine.

Adaptability

Like executives in other industries, cannabis industry executives must be adaptable because they will be required to communicate with a diverse group of stakeholders. That said, cannabis executives must be comfortable discussing scientific and medical topics with government and healthcare officials and equally as comfortable addressing business concerns with consumers.

Passion & Drive

Unlike other industries, simply having a resume with the requisite college degree and executive skill sets may not be sufficient for success in the cannabis industry. Because cannabis and its products are not legal at the Federal level in the US, the road ahead for cannabis executives is likely to be a long and very rocky one. To that point, the success of the industry will likely depend upon executives who have the desire and passion to continue to push things forward even when the likelihood of success is not certain.

As a former professional recruiter, I can tell you that finding a qualified “right fit” candidate at the technical or executive levels is never an easy task. And a limited talent pool does not make things any easier.  But, even though the existing executive talent pool may not be a great one, cannabis industry executives are needed; so choose wisely!

 

 

Treating Patients: Integrating Cannabis into Clinical Cancer Care

There is a growing body of evidence that cannabis and certain cannabinoids may offer potential therapeutic benefits to cancer patients (1). Mainly, cannabis may be beneficial in the management of a wide range of cancer-related symptoms including neuropathic pain (2-4) chemotherapy induced nausea and vomiting (CINV; 5-9), anorexia (10), insomnia (11) and depression (12,13).

Unfortunately, most oncologists trained during the era of cannabis prohibition (1930s to present) have no knowledge of how to use cannabis and its products in routine medicine practice or clinical care.  More problematic is the lack of research and clinical data on which oncologist can base treatment decisions or make care recommendations. That said, what must be done before oncologists and cancer care professionals can feel comfortable using cannabis in cancer care and treatment?

First, rigorous basic research must be performed to clearly demonstrate that cannabis and cannabinoids indeed possess anticancer/antitumor properties. This will require a clear understanding of the mechanism of action of these compounds and the identification of the receptors/transcriptional factors etc that mediate their anticancer effects.

Second, once preclinical data are confirmed, rigorous double-blind, placebo controlled human clinical trials (with sufficient numbers of participants) must be performed to confirm or refute the effects of cannabis/cannabinoids on recognized and clearly defined  oncology indications  e.g., solid tumors, blood malignancies, etc.

Third, if cannabis and cannabinoids are to used for adjunctive cancer care and disease management purposes, than other large scale, well-designed clinical trials must be performed to demonstrate the safety and efficacy of these treatments.  Anecdotal evidence and results from small clinical studies are not sufficient for regulatory approval nor widespread acceptance of the use of cannabis and cannabinoids for cancer/chemotherapy symptom management.

Finally, for all of this to happen, cannabis and its products must be rescheduled from a Schedule 1 drug (illegal with no recognized therapeutic value) to either a Schedule 2 or Schedule 3 classification.  This would effectively decriminalize cannabis at the national level and allow federal funds and resources to be leveraged for basic research and clinical testing of cannabis and its products.

If all of these things should come to pass, then oncologists may be able to add cannabis and cannabinoids to treat and care for patients living with cancer.

References

  1. Abrams, DJ. Integrating cannabis into clinical cancer care. Curr Oncol. 2016; 23:S8-S14
  2. Deshpande A, Mailis-Gagnon A, Zoheiry N, Lakha SF. Efficacy and adverse effects of medical marijuana for chronic noncancer pain: systematic review or randomized controlled trials. Can Fam Physician 2015; 61:e372–81
  3. Andreae MH, Carter GM, Shaparin N, et al. Inhaled cannabis for chronic neuropathic pain: a meta-analysis of individual patient data. J Pain 2015; 16:1221–32.
  4. Wallace MS, Marcotte TD, Umlauf A, Gouaux B, Atkinson JH. Efficacy of inhaled cannabis on painful diabetic neuropathy. J Pain 2015; 16:616–27.
  5. Chang AE, Shiling DJ, Stillman RC, et al. Delta-9-tetrahydrocannabinol as an antiemetic in cancer patients receiving high-dose methotrexate. A prospective, randomized evaluation. Ann Intern Med 1979; 91:819–24
  6. Duran M, Perez E, Abanades S, et al. Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. Br J Clin Pharmacol 2010; 70:656–63
  7. Tramer MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2001; 323:16–21.
  8. Machado Rocha FC, Stefano SC, De Cassia Haiek R, Rosa Oliveira LM, Da Silveira DX. Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: systematic review and meta-analysis. Eur J Cancer Care (Engl) 2008; 17:431–43.
  9. Smith LA, Azariah F, Lavender VT, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev 2015; 11:CD009464.
  10. Strasser F, Luftner D, Possinger K, et al. on behalf of the Ca nnabis-In-Cachex ia-Study-Group. Compa rison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia–cachexia syndrome: a multicenter, phase iii, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. J Clin Oncol 2006; 24:3394–400.
  11. Russo, EB, Guy GW Robson PJ. Cannabis pain and sleep: lessons learned from therapeutic clinical trials of Sativex®, a cannabis-based medicine. Chemistry and Biochemistry 2007; 4:1729-1743
  12. de Mello Schier AR, de Oliveira Ribeiro NP, Countinho DS, et al. Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compounds of Cannabis sativa. CNS Neruol Disord Drug Targets 2014; 13:953-960
  13. Bricker JB, Russo J, Stein MB, Sherbourne C, Craske M, Schraufnagel TJ, Roy-Byrne P Does occasional cannabis sue impact anxiety and depression treatment outcome?  Results from a randomized effectiveness trial. Depress Anxiety 2007; 24:392-398

Cannabis and PTSD: A Clinical Trial Update

The Marijuana for Symptoms of PTSD in US Veterans clinical trial being conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS, a Santa Cruz-based 501 (c)(3) a private non-profit research organization)  is believed to be the first randomly controlled clinical trial to evaluate medical marijuana as a treatment for post-traumatic stress disorder (PTSD) in US military (1).  Officially, the study title is “Placebo Controlled, Triple Blind, Randomized Crossover Study of the Safety and Efficacy of Four Different Potencies of Smoked Marijuana in 76 Veterans with Chronic, Treatment-Resistant Posttraumatic Stress Disorder (PTSD)”.  The study protocol with inclusion and exclusion criteria can be found here .

The principal investigator of this federally-approved study is Sue Sisley, MD with help from Marcel Bonn-Miller, MD (coordinating PI formerly of the University of Pennsylvania) and co-investigator Paula Riggs, MD (University of Colorado) and the project is funded by a $2, 156, 000 grant from the State of Colorado. Although the project was approved in 2014, it has been plagued by a variety of political and legal issues.

First, the National Institute on Drug Abuse (NIDA) which is the only legal source of marijuana for federally sanctioned research in the US has been unable to provide the Cannabis required for the study. Incidentally, the only legal grower of Cannabis in the US is the University of Mississippi. The university was awarded that license in 1968. However, recent reports suggest that the Cannabis provided by the university is contaminated with lead, yeast and mold which could raise concerns about efficacy and safety if used in the trial (2). Also, the university has not established testing guidelines for the Cannabis that is produces.

Second, the study was initiated in Phoenix, Arizona because the city’s VA hospital has a very high density of treatment resistant PTSD patients (those who continue to experience symptoms despite undergoing VA-sanctioned treatment and/or therapy) and Dr. Sisley was on the faculty at the University of Arizona. Unfortunately, Dr. Sisley was fired from the university for political reasons. This delayed the start of the study and has subsequently slowed its progress.

Finally, Phoenix VA hospital administrators have been slow and unwilling to provide Dr. Sisley with the data that she and her team need to identify patients to complete enrollment for the study. At present, 22 patients have been enrolled and treated. Investigators must screen 6,000-8,000 veterans to identify the remaining 54 patients to complete the study (3).

The MAPS trial has the support of most veteran groups including the American Legion, Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars and Disabled American Veterans.  However, the Trump administration has clearly its distaste for all things Cannabis and, despite anecdotal evidence that Cannabis can help treat PTSD and traumatic brain injury (4), the current political climate has made it difficult to conduct this very important clinical trial.  According to Dr. Sisley, “All we get from them [VA hospital administrators] is polite responses about marijuana being federally illegal.” (3)

To put PTSD in perspective, America loses an estimated 15,000 veterans each year to drug overdoses and suicide. It is a shame that the federal government will not allow a scientifically-designed clinical trial to be conducted to help determine whether or not Cannabis is a safe and effective treatment for PTSD.  Thankfully, PTSD can be treated with Cannabis in many states that have already legalized medical marijuana.

References

  1. http://www.maps.org/research/mmj/marijuana-us
  2. http://www.pbs.org/newshour/updates/scientists-say-governments-pot-farm-moldy-samples-no-guidelines/
  3. http://www.thecannabist.co/2017/08/29/veterans-administration-ptsd-marijuana-study-enrollment
  4. https://www.nytimes.com/2017/09/01/opinion/marijuana-legalization-veterans.html?ref=todayspaper