What Mental Health Clinicians Need to Know About Cannabinoids: Psych Congress Elevate Session Preview

As cannabis becomes more widely legalized and used in the United States, experts like Jonathan R. Williams, DNP, PMHNP-BC, inpatient psychiatric nurse practitioner at the University of Wisconsin at Madison, and Andrew Penn, MS, PMHNP, clinical professor at the University of California, San Francisco, are urging clinicians and other mental health professionals educate themselves on substance usage and effects. In this chat, Williams and Penn discuss their upcoming Psych Congress Elevate session "Is it 4:20 yet? Successful Management of the Cannabis-Using Patient," where they'll elaborate on what clinicians need to know and how to meet patients where they're at. 

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Jonathan Williams, DNP, PMHNP-BC, is currently inpatient/consult liaison for UnityPoint Meriter Hospital psychiatric unit and services. Williams has worked for more than 6 years in the field of psychiatry, and prior to that worked extensively in acute care, trauma, and neurology. Prior to transitioning to inpatient psychiatry and consultation, Jonathan worked as an outpatient psychiatric provider for a Federally Qualified Community Health Center for underserved communities of Northern Wisconsin, Minnesota, and Michigan. Williams started studying cannabis in detail during his outpatient practice when he saw a huge increase in use in his patient panel. His goals were to not only educate patients in the effects of the substance but also other providers to assist in treatment and understanding. Jonathan's next goal is to obtain his PhD and further study the neurotransmitter effect of cannabis on the brain.

Andrew Penn, MS, PMHNP, is a clinical professor at the University of California, San Francisco, School of Nursing where his teaching has received the UCSF Academic Senate Distinction in Teaching Award, among other recognitions. He has practiced as a psychiatric/mental health nurse practitioner, treating veterans at the San Francisco Veterans Administration Hospital. As a researcher, he collaborates on psychedelics studies of psilocybin and MDMA in the Translational Psychedelics Research (TrPR) lab at UCSF. A leading voice in nursing, he is a cofounder of the Organization of Psychedelic and Entheogenic Nurses (OPENurses.org), advocating for the perspective of nurses in psychedelic therapy, he has published on psychedelics in the American Journal of Nursing, Frontiers in Psychiatry, and The Journal of Humanistic Psychotherapy. An internationally invited speaker, he has lectured at SXSW, Aspen Health Ideas Festival, the Singapore Ministry of Health, and Oxford University and can be found at Andrewpennnp.com

Read the Transcript: 

Jonathan R. Williams, DNP, PMHNP-BC: Thank you for joining me. My name is Jonathan Williams. I'm a psychiatric nurse practitioner for the University of Wisconsin. I work as an inpatient psychiatric nurse practitioner, and I also work as a consult liaison for the university and hospital.

Andrew Penn, MS, PMHNP: And I'm Andrew Penn. I'm also a psychiatric nurse practitioner, and I'm a clinical professor at the University of California, San Francisco School of Nursing and a member of the Psych Congress Steering Committee. So, Jonathan, we prescribe drugs all the time as psych NPs, and we generally have a pretty good idea of how they work. The typical antipsychotic binds to certain receptors has certain effects, but there is a drug that a lot of our patients use that many of us have no idea how it works. And that is cannabis.

Williams: That's right.

Penn: So you and I are going to be doing a talk at Elevate this June in Las Vegas about this very topic. We're going to be co-presenting on this. And so could you tell me a little bit about some of the highlights that we're going to be covering?

Williams: So you brought this up really well. A lot of people don't understand what's going on with cannabis, what it's doing in the brain. And the truth is a lot of our patients are using it. So how can we as providers, not only educate our patients but each other about what to do and what to expect. So in particular, we're doing our discussion on Delta 8, Delta 10, and HHC. A lot of people don't know about these particular analogs of THC.

Penn: Yeah, I heard about it for the first time from my patients.

Williams: Right. And in my state, cannabis is currently illegal, but Delta 8, Delta 10, HHC are legal.

Penn: So these are like workarounds around the existing drug laws.

Williams: Yes. They're considered supplements.

Penn: And it probably means that we don't know as much about them as well.

Williams: That is correct.

Penn: That's a challenge.

Williams: Yes, and so part of this discussion is these are these other things that are in circulation. How do we educate our patients about this? What do we watch out for? They work kind of in a similar manner that THC does but, like you said, we don't fully understand this. And in the old days, we would just tell patients, "Well, just don't do it."

Penn: Right. And we saw how well that worked, which was not very well.

Williams: Not super well.

Penn: And so from our discussions, and we're really taking a harm reduction approach that knowing that the patients are doing this, how do we really educate our patients to minimize the amount of harm that they might be incurring from the use of cannabinoids, both plant-based and synthetic analogs as well.

Williams: Yeah. You got to meet the patient where they're at. Like it's been said before in a lot of discussions, you can't do all or nothing.

Penn: Right. And that really is at the heart of nursing, right?

Williams: Yes, exactly.

Penn: And, as nurses, we really pride ourselves in meeting patients where they're at and starting the conversation from that place, and they may choose to continue using cannabis, but how can we help them use that in a way that is less deleterious to their physical or mental health. So we'll be covering some of that content as well.

A lot of people, for example, are really surprised to hear that we have receptors in our brain for cannabinoids, and that our brains make their own cannabinoids, that we make our own cannabis which is wild. When I learned that for the first time, it really just was quite astonishing to learn about that. And what role does that play in neuro transmission, we're going to talk about that as well. And how those exogenous cannabinoids can disrupt that system as well. So I think it's going to be a really exciting talk.

Williams: Me too.

Penn: And I know that when I've talked about this in the past, at Psych Congress, it's standing room only because clinicians really want to know this information. They really want to be able to best help their patients. And honestly, we didn't get taught this in school.

Williams: No, we didn't. And I've worked with a lot of residents at the university, and they say the same thing. It's like, "We didn't know about this." So I think we're doing not only the community, but our colleagues a service by sharing this information with them.

Penn: Yeah. Training at this point has really not caught up with the science in a lot of places. It's starting to, but we're hoping to bring our profession a little bit further in this field, and so that they can best help their patients to use cannabis. Excellent. Well, I'm looking forward to our talk, our conversation in Vegas. It's just a couple of months in June. Excellent. Thank you so much, Jonathan.

Williams: Thank you.