CEimpact Podcast

The Truth About Cannabis and Pregnancy Outcomes

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As cannabis becomes more widely available and socially accepted, so does the misconception that it's safe to use during pregnancy and lactation. This course reviews updated guidance from the American College of Obstetricians and Gynecologists (ACOG), highlighting the evidence behind the risks and outlining how pharmacists can address misinformation and counsel patients effectively. You will learn how to support safe, informed decision-making that promotes the health of both parent and child.

HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Clinical Editor, CEimpact
Lead Editor, Pyrls

GUEST
Kevin Shea, PharmD
Pharmacist 
Vytal Options 


PRACTICE RESOURCE
Purchase this course to receive the exclusive downloadable practice resource handout to use as a reference guide to the podcast.

 
CPE REDEMPTION
This course is accredited for continuing pharmacy education! Click the link below that applies to you to take the exam and evaluation:


CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify current ACOG recommendations regarding cannabis use during pregnancy and lactation.
2. Describe pharmacist strategies for screening, counseling, and reducing risks associated with cannabis use during the perinatal period.

Rachel Maynard and Kevin Shea have no relevant financial relationships to disclose.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-377-H01-P
Initial release date: 12/29/2025
Expiration date: 12/29/2026
Additional CPE details can be found here.

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SPEAKER_01:

Here on Game Changers, we're all about helping you stay ahead of pharmacy practice. But why stop at listening? You can earn CE credit for this episode and hundreds more by visiting CEimpact.com and logging into your account or creating a new one. Get credit, get inspired, and make your learning count. Hey CE Impact subscribers, and welcome to the Game Changers Clinical Conversations Podcast. I'm your host, Rachel Maynard, and our topic today is a fascinating one. I think we've all seen over the past couple of decades that cannabis has become more widely available, socially accepted, and more states are legalizing its use. And this increasing use and access may lead people to think that cannabis is safe to use during pregnancy and lactation. In fact, the largest consumers of cannabis are people of reproductive age. Plus, the prevalence of cannabis use ranges from about 4 to 16% in people who are pregnant or breastfeeding. So the American College of Obstetricians and Gynecologists, or ACOG, has released a new clinical consensus statement on cannabis use in pregnancy and lactation to help increase awareness of this issue and provide clear evidence-based guidance. And many of their recommendations also tie in nicely with our role as pharmacists and how we can optimize patient care. So to help us dig into that guidance a bit more, our guest today is Dr. Kevin Shea. So welcome, Kevin.

SPEAKER_00:

Thank you, Rachel. Pleasure to be here.

SPEAKER_01:

Yeah, great to have you. And maybe you can just share a little bit about your background and your current role and why this is of interest to you.

SPEAKER_00:

Yeah, well, I've been a pharmacist for about 15 years now. And I started off in community and made my way into the cannabis the last eight years or so. And in the cannabis industry in Pennsylvania, we have a medical program. So patients can receive their card and come in and then they get to chat with the pharmacist on what products to utilize. And we can give, we can get their background and give information on product recommendations, how to start, how to escalate their dose and troubleshoot along the way. So that's what I currently do in my role. Patients come in and I offer those consultations in addition to educating staff and just being up to date on what's happening new in the cannabis industry. I also precept Appy students for my alma mater, Wilts University, and teach a class there as well for their one of their cannabis courses that they have going on. So try to spread the word and educate uh future pharmacists as well, since it is a new and developing industry. So just trying to be agile and you know offer pharmacist services since it's really needed in in this uh developing industry as well.

SPEAKER_01:

Absolutely. I think you I think you have, as you said, a very interesting practice setting and a sort of niche expertise. And so yeah, really looking forward to having your perspective on this topic because I think, like you say, it is something we don't really learn about in pharmacy school. And so to have have some additional background and learning as we go, I think is great. So thank you for taking the time to be with us today. Really appreciate it.

SPEAKER_00:

Thank you for having me.

SPEAKER_01:

And to that end, I guess we'll start off with, you know, you mentioned your your practice setting currently, but I I would love to just get us all on the same page and and think about some of the terms that we hear when it comes to the use of cannabis. And, you know, I I think there's a lot of different terms. It's sort of a murky area, you know, we might hear different different uh items thrown around and names. And so just to take some baby steps before we sort of jump into the the topic about pregnancy specifically. So maybe we can just learn from you, you know, how would you define cannabis versus CBD versus THC and marijuana and and all of these sort of terms that may get blended together? Maybe we can just lay those out clearly and what they each mean.

SPEAKER_00:

Yeah, let's get a good foundation to start. You know, cannabis is an umbrella term used for the plant and all the derivatives that are in the plant. So cannabis is the more scientifically viewed term to use versus marijuana. Marijuana is a term that typically is used for stronger plants, you know, higher in THC, more psychoactive, but also has a racial bias and you know, a really strong history. So a lot of times we like to stick with the more scientific term, the cannabis term. And then the cannabis plant itself produces cannabinoids, which are chemicals that interact with our own endocannabinoid system, a system that our body has. And so those cannabinoids can be THC, tetrahydrocannabinol, which is psychoactive and can produce medicinal effects, but can also produce side effects for patients. Um and CBD, uh cannabinol, excuse me, cannabidiol. So uh CBD, cannabidiol is non-intoxicating, has medicinal effects as well, but that is more regulated in the United States and more widely available versus THC is a lot more restricted to medicinal states and recreational states. And so different types of products that could be used by patients, but understanding the difference between cannabis and marijuana or THC and CBD makes a big difference in the type of products that patients are purchasing and utilize.

SPEAKER_01:

And so, okay, so I think there's a few things that you really clarified there. So cannabis is the term for the plant, and that is sometimes used interchangeably with marijuana, but I think cannabis, as you said, is the more preferred term now because it is the more scientifically appropriate term, really referring to the plant versus some of these potentially stigmatized and and other marijuana is a more stigmatized stigmatized term, I think. And then as you said, THC and CBD are the cannabinoids that are just two that of the many cannabinoids that may happen from the plant and and the cannabis.

SPEAKER_00:

Absolutely.

SPEAKER_01:

Okay, okay.

SPEAKER_00:

Yeah, yeah, there's many more cannabinoids that the plant produces and that have many different effects and or interactions in our body. Yeah, so it's not just THC and CBD, those are just the two most widely used products that that the plant produces.

SPEAKER_01:

Okay. And so when we're talking about cannabis use in pregnancy or lactation or in general, how are people typically getting it and using it? And what therapeutic benefits are they using it for? And that I think would tie into your practice setting specifically. Like how are people using it and what are the typical uses?

SPEAKER_00:

Yeah, there's four main ways to consume cannabis medically and you know, recreationally. And a lot of people mix the two terms, recreational cannabis and medical cannabis. It's utilizing the same type of products, but maybe in a different way. A medical, more intentional to help with symptom relief versus recreational, looking for stronger effects. So, you know, understanding that there may be different ways that patients utilize the medication is one big thing right off the bat. Um, but the four main ways to consume inhalation, which is fast acting. So that could be smoking, vaping, dabbing, you know, inhaling it through the lungs, fast absorption, quick action versus ingestible products. So I'm thinking cookies, gummies, capsules, tablets, uh, things that you swallow. They take an hour, maybe an hour and a half to be absorbed and they last a lot longer in the body. So, you know, much more potential to be in the system for a long, a long time. But also overconsuming can have side effects for a lot longer too. And so different types of products, fast acting, and think of, you know, in the in the pharmacy world, why those fast acting products would be important to utilize. So I think of asthma inhalers or I think of anti-anxiety medicines that work really quickly. And so the patients who utilize cannabis and utilize inhaled products use them for you know fast onset symptoms like anxiety or nausea vomiting or flare-ups of pain, right? So inhaled, quick acting, and it's good for those quick onset of symptoms versus the edible products. They last long in the symptom in the body, and so they help to control symptoms a little bit better. And for symptoms like pain or sleep, where longer periods of that symptom relief are preferred. So in inhaled is quick acting, ingestible is long lasting. We have topical, and that doesn't get into the bloodstream. That's typically where the effect is where it's applied. So great for pain, um, but not going to help with anxiety, not gonna help with nausea or vomiting or anything along those lines. And then we have sublingual, things that are put under the tongue that have a little bit faster action than our edible products. And so good for those quick onset symptoms. But a lot of times there's variability in that absorption. A lot of those under-the-tongue products, like tinctures, are made of oils. And so there's some absorption under the tongue and some absorption when it's ingested. So some patients have a tough time tracking that consistent dosing with those products because they're getting a little bit of action quickly and a lot more of the action delayed. Um, so for patients who have pregnancy, or excuse me, let me restart that. So for patients who are pregnant, they may have been utilizing cannabis already to help control anxiety, pain, nausea, insomnia before they got pregnant and are now may need to utilize that continuing or find another alternative, which is preferred. Or they may have new onset symptoms when they become pregnant, like lack of appetite or nausea and vomiting or insomnia or anxiety. And so if they've known cannabis to be effective in the past, they may feel comfortable turning to cannabis. Cannabis is really widely available. And since more it's much more popular in our country, a lot of people find that it's a safe alternative, that that popularity means safety. Um, but there's really not evidence in uh in our medical community to uh to offer advice for patients to continue that or to go down that route. And so us as pharmacists have the option and the ability to offer alternatives for these patients.

SPEAKER_01:

Yeah, and so I again I think you made a few really critical points there. First, the concept that you know natural does not necessarily mean safe. And so that's sort of some, you know, a mantra that we've thought about as pharmacists for years, and applying that to this setting in population is is, you know, right on with what we would do with other supplements that people may think of as natural and therefore safe, helping to clarify that misconception. Um, and also to your point that people may use cannabis in a number of different ways for a variety of different reasons, some of which could have been pre-existing before getting pregnant, or actually potentially thinking about starting for symptoms that arise with pregnancy. And that's why I think this statement from ACOG is so critical because it allows us to have an opportunity to remind, remind about the importance of having these conversations with patients, even if they were not pregnant and were using cannabis in the past and now are pregnant, or even people who may not be thinking about pregnancy yet but are of, you know, of the age, reproductive age, you know, being aware of those risks because I I saw that, you know, in this statement they say that cannabis is most frequently used during the first trimester. And so whether that's because of symptoms they're having in the first trimester or because they didn't realize they were pregnant and were using cannabis, being aware of that sort of critical time period is is super important, I think.

SPEAKER_00:

Um, so yeah, you and there's time that, and I apologize for uh interrupted, but there's time that patients need to get off the medication as well. Um so if you're you've been using cannabis and now all of a sudden you find out you're pregnant, there can be withdrawal for just stopping them, right? There's cannabis withdrawal syndrome. And so patients can uh feel anxious about that or need some training on how to offload that medication in a proper way. Um, so in the first trimester, certainly more symptomatic can just need help with that titration, or that that person could be on other harmful substances and they may feel comfortable of use utilizing cannabis to help aid in that dependence of the other substance. And so, you know, that's that patient doing some harm reduction on their own. Um, but us as clinicians, I think have that opportunity to ask the questions, to find out, you know, what's going on with this patient in front of me, how do I approach this in a non-judgmental way and be able to bridge that conversation because it's it's happening. And so if we can figure that out for our patients and and help them along and just understand that, I think we're we're delivering better care.

SPEAKER_01:

Absolutely. So and I think part of those conversations is going to need to be helping them understand potential risks. And so maybe we can get a bit more granular with that. And so, what are the potential risks and specifically in pregnancy of the use of cannabis? What kinds of risks should patients and us as clinicians be aware of when talking with patients?

SPEAKER_00:

Absolutely. And right now, the the problem with cannabis is there's not a ton of as it evidence that's out there, right? There's evidence that shows a lot of associations, but there's not a ton of causation. And so uh we have a lot of patterns concerning patterns that show up. And so for the guidelines, they're the they're wanting to make sure that the let me restart that. I apologize. I'm just losing my trade of thought.

SPEAKER_01:

Um the so I can start, I'll I can go back to the other. Yeah, I'll go back to the idea of you know thinking about having these conversations with patients and sort of individualizing these discussions. It's really important to be able to have a good background and understanding of what the potential risks are for cannabis so that they can really personalize it and think about how it might impact their journey. And so, what would you how would you describe what those potential risks are in using cannabis and pregnancy? And that can help us all make sure we're we're conveying that risk appropriately to patients.

SPEAKER_00:

Yeah, that that's a that's a great question. And and I kind of want to preface that the the evidence that out that's out there shows association, but not causation. Um, and so we see a concerning pattern with the risk of cannabis use, and we want to really advocate that for our patients of that that it's that's a risk. We know that there's that association that's there. So we know that there's potential low birth uh low birth weight or fetal growth restriction. We know that there's preterm birth. Um, so especially with heavy, frequent use, there could even be stillbirth or uh increased ad NICU admission. So for babies that are being born, it's not starting them off on the on the best foot for their first uh for their first day of life. It can be further than just at birth as well. Um, there is the neurodevelopmental risks as well. And so we we're much more concerned that neonates show altered patterns of excitability, of different regulation and when they're born, right? So they're not responding as someone that has not been exposed with cannabinoids. So there's risks to the fetus, there's risks to the newborn, and then there's risks to the developing child in the long term. Uh, how is memory, cognition, attention affected? And so if we know there's that association that's there, we need to be able to advocate that for our patients and let them know that there is that risk. And if we don't know, we know other alternatives that are safer that we can go to.

SPEAKER_01:

Yeah, I think that's a really important point. So to your point, we're never going to do sort of randomized controlled trials to see if there is or isn't risk because that would not be ethical. So we have these associations that have been observed. But the other tricky part of this, I think, is that with cannabis, there's different routes. As you said, there's different doses, there's different formulations and durations of exposure too. So people may be using it consistently or not. And so all of that I think ties into sort of the messiness of the data and how we have, you know, we have these associations, but it's hard to say potentially for one patient with one particular use pattern what what their individual risk is. But as you said, knowing that there are these risks that we've seen and that there are safer alternatives for some of the symptoms we may be trying to manage, that I think is a really important take-home message. Would you agree with that? Just sort of summarizing. Absolutely. Yeah, yeah.

SPEAKER_00:

Yeah, and and we know THC and CBD crosses the placenta. We know that it gets excreted in the breast milk. We know that there are receptors in the five-week five-week old developing fetuses, right? So there is that interaction that's happening. Um, if we don't know the consequences of that reaction, we we want to avoid that if possible and and and do it in the safe way.

SPEAKER_01:

Right. So we still have a lot to learn, but the the punchline really is that ACOG says that providers should educate patients that there are no medical indications for cannabis use in pregnancy and lactation, that we as clinicians should know about what the risks are and educate patients about those risks. And as you said, find other ways to address those concerns because we don't want unmet concerns, we want to be sure we're providing alternatives, but there are safer alternatives that we can we can suggest. And they go on with a very strong and clear recommendation to say that clinicians should advise cessation of cannabis use during pregnancy and lactation. So that's a pretty, a pretty clear message. And so if we get into some of the recommendations from ACOG in a bit more detail and how to help support patients in this process of cessation, one of the big changes that they now recommend is this universal screening for cannabis use during the pre-pregnancy, pregnancy, and postpartum periods. And so maybe you could tell us a little bit more about that recommendation and and you know where that's coming from and how and whether that's something we as pharmacists can be doing in our practices.

SPEAKER_00:

Yeah, ACOG is recommending universal screening for everyone who is planning to become pregnant, who's pregnant or who's postpartum, and screening for the use of cannabis. Um, now they're very careful to describe how that should be done. Because, you know, initially when I started reading this, I thought, well, we're gonna do urine screens or hair tests, and they are not recommending that. They're recommending against that. It sets patients up for a whole host of legal issues, child custody issues, um, and racial bias, unfortunately. So that's one thing that is not recommended. The universal screening is having a set amount of questions to ask each patient in a non-judgmental way. Understanding that as a provider, if I ask someone about their cannabis use, they may shut down, they may not really want to answer forthcomingly. Um, and so we need to find a strategy that opens up that line of communication and finds, you know, does that person use and why are they using? That's really the main reason to figure out, to find out for these patients is why are they using this product? We have the ability then to offer other alternatives that we know are safer. Um so I think that's the purpose of the screening, really, is to think figure out are these patients utilizing cannabis and can we find safer. Ways for them to use it. But patients are pretty reserved in opening up on that. And the stigma behind cannabis makes patients not want to open up to providers. And so I do believe us as pharmacists, being that really trusted healthcare provider, have the opportunity to have those conversations with our patients and start educating them about the potential harm, the evidence that's out there, and alternatives.

SPEAKER_01:

And I think the concept of universal screening can be, I mean, it can sound daunting because we're talking about screening all patients. And this is an obstetrician and gynecology association. So, you know, their primary audience is OBGYNs, and that's a different, you know, sort of setting. But when we think about universal screening, sort of in general, the intent is to screen all patients, regardless of any perceived risks or potential for use. And I think it makes sense in our context as pharmacists because we've talked about how common this is generally now, how common cannabis use is across the country. It is available so much more widely than it has been in the past. It's something that people are using. And so just having it be sort of a standard part of conversation that it's something we assess for as part of our routine interactions with patients, the same way we would ask, you know, about alcohol use or or tobacco smoking, or, you know, this these are questions that we ask everyone. This is not anything specific to you. It's just a universal sort of assessment process and framing it in the perspective of a safety concern rather than a punitive angle. You know, this is something we're trying to make sure we're caring for your health. And one of the ways that we do that is by talking about use of everything you're using, whether it's cannabis or supplements or medications. So yeah, I think it's just interesting. I think it's a helpful perspective for ACOG to have this recommendation because it does allow it to become a routine part of practice. And there are tools, quick tools that the patient or clinician could offer and just answer a few questions, and that can help guide that for the conversation. So it does, to your point, it does seem like something we could be incorporating into our practices too as pharmacists.

SPEAKER_00:

And I appreciate the ACOG guidelines because they give specific examples of the tools that we could utilize. They they really detail the reasoning for these guidelines and break it down. So it's worthwhile read for anybody who's listening if you're more interested in like why these recommendations are put out there. Yes. But there are, you know, the TAPS assessment, the craft assessment, the five Ps assessment. These are substance use assessments and they covered slightly different angles, but they all sort of have the same result, right? Assessing is this patient a suspect or a potential for substance use or um cannabis misuse? And if that pops up as being the case, then you know we have an opportunity to take care of that patient and offer alternatives.

SPEAKER_01:

So we've talked about more specifically pregnancy, and I do want to touch on the lactation side of it too, because the the guidance does address both pregnancy and lactation. And that statement I gave earlier about advising cessation is for both pregnancy and lactation. So maybe you could talk a bit more about any potential concerns of cannabis in lactation and sort of where the guidance comes out with with that side of the coin.

SPEAKER_00:

Yeah, there's a little more nuance to the lactation guidance from the BACOG guidelines. And you know, I'm gonna quote it says they we encourage avoiding cannabis during breastfeeding, but our goal is to support the parent-infant bond, not create barriers. And so instead of having the patient cease cannabis used as soon as we find out, they're okay with the physician finding alternatives or coming up with a plan with that patient and not having them immediately cease cannabis because that may mean immediately ceasing the breastfeeding as well. And they don't want to go as far as to stop that bond between mom and baby. And so they want the cessation, but there's more room for a plan. So there's not the cessation of breastfeeding, since that benefit is so great for the infant.

SPEAKER_01:

Right. And so you had mentioned before, you know, THC passes and passes through the placenta, passes into breast milk. And so it is a it is a risk to be aware of. And it is still, you know, they still do come out and say that cessation is this is the recommendation. But to your point, the benefits of breastfeeding are it's it's always a risk-benefit decision, right? So with anything in healthcare, it's always a risk-benefit. And in this case, there are known benefits to breastfeeding, including, you know, that bond, lower, you know, lower rates of infection and asthma. And so, yeah, they they are a bit more, it's not a contraindication to breastfeeding, and breastfeeding should not be discouraged. But there are, you know, it's there are risks with it potentially too. Uh, it's the same sort of issue too, in terms of the the study qualities and you know, the the lack of evidence, limited evidence that we have around the potential risks. So again, it's that sort of risk-benefit analysis. And then, you know, one other I when looking into this topic a little bit, I I looked at Lact Med too, which is sort of one of our standard references for medication use in breastfeeding. And they point out that cannabis should not be smoked by anyone in the vicinity of infants because of the risk of inhaling the smoke. So that's another consideration too. And again, really comes down to that individual's discussion, you know, how they're using it and pros and cons to consider. So very, very nuanced discussion there, as you said.

SPEAKER_00:

Yeah. And, you know, that even the the smoked portion of cannabis, right? In Pennsylvania, Pennsylvania, we sell products that can be smoked, flour and things along those lines, which could be consumed in the traditional cannabis way. But Pennsylvania says no, it's not legal to consume it that way. We want you to vaporize it. So to reduce the harm and even how it's consumed, right? To minimize the carbon monoxide and all the other carcinogens that are produced. But yeah, like the the name of the game in cannabis right now is harm reduction. And there is that lack of evidence uh in everything with cannabis. And so like that's that that's the line, unfortunately, but goes to the federal illegality cannabis. And you know, it's just really hard to research and get grants and and get that trusted, uh, they'll get those trusted studies started, unfortunately. And so it's just a landscape until something moves.

SPEAKER_01:

Right, right. And again, to the point about the variability and products and formulations and doses and all of these things also adds to that murkiness and the the cloudy sort of black hole we sometimes can go into and think about.

SPEAKER_00:

But and there's not even a right way if if it there is a determination where the physicians find there's no other alternatives, and this patient should be using cannabis, or you know, that that that's uh something to go down the road. There's not even a right formulation to recommend to the patient because if it's an inhaled formulation, they get a really strong dose right off the bat and they get a high blood concentration of THC or CBD. And so their exposure is really strong after that dose versus an edible, their exposure is over four, six, eight hours or so. So it's in the body a really long time. And so even if there was that determination of that this is uh an option for the patient, it's completely murky of well, what are the options? What's the right dose? What's you know, how do we proceed with this? And so uh there's a lot to be learned in the industry right now.

SPEAKER_01:

And probably very state-specific to I would imagine, like you said, your example with vaping in Pennsylvania is the preferred approach for inhalation, I guess. So yeah, that's it's gonna vary by your state to even what what options you might have available. So very interesting. So, Kevin, you talked a little bit about some of the or the concern about withdrawal when stopping cannabis is a potential consideration and something to be aware of and how to help patients with that. So let's get into more of the cessation side of things. Now that we know that the bottom line from ACOG is generally to recommend cessation, how do we help patients with cessation? And what are some strategies that we can provide when talking with them about that?

SPEAKER_00:

Yeah, when I have patients who come in who want to do tolerance breaks and tolerance breaks where they want to offload cannabis and stop using it for a week, two weeks. Um, and when they anticipate withdrawal symptoms, taking less and less of the medication and titrating it down is the safest way to go, not just stopping it. When you just stop it, patients could feel anxious, irritated, they can feel sweaty and just uncomfortable. And a lot of times that leads to the patient consuming again and not really going through that cessation. Um, and so knowing that there is withdrawal and there that needs to be managed is key. Utilizing other cannabinoids like CBD instead of THC helps to avoid those withdrawals. And so if you can use a product that has that's non-psychoactive, that's a that's a good start. And then titrating that dose down slowly over a week or two period, and then monitoring for the withdrawal symptoms is is the is the preferred method. Utilizing products that are short acting rather than long acting in the system. Um so the receptors in the body have some of that drug-free period is key as well. And so switching from ingestibles and tinctures to inhaled products will help to help them to uh shorten that time and and make it a little bit more or less less withdrawals, uh more individualized for that patient so they can use as needed then. But yeah, the minor cannabinoids is another key piece. So a patient isn't having those psychoactive effects, but they're also uh minimizing the withdrawal symptoms because there is still that the active cannabinoids in their system.

SPEAKER_01:

And I would imagine that really varies depending on the duration of use and the amount of use, whether or not those symptoms are likely, those withdrawal symptoms are likely. So I imagine somebody who has you know only occasional use and either is planning to become pregnant or finds out they're pregnant, if it's minimal or sporadic, they may be able to stop altogether. Would you say that that's oh yeah, absolutely.

SPEAKER_00:

And and for those patients, arming them with alternatives is key. And so if it's anxiety, cognitive behavioral therapy, could it be meditation? Could there be other things incorporated for that patient to use the service for or as a as a tool for nausea vomiting? Could it be ginger, could it be little smaller meals, more frequent meals throughout the day? Um, what are some of the things that us as pharmacists are know, like the back of our hands, that we can help our patients with? So they feel like they're not without anything that they have something else that they can turn to to help them with their symptoms.

SPEAKER_01:

Right, right. And so that to your point, that goes back to some of those things that we think of, you know, generally when when counseling a patient in pregnancy is trying to stick with non-pharmacological options first as much as we can, um, but then helping with appropriate pharmacotherapy when when needed. And again, that's going to be a very patient-specific discussion based on what their symptoms are that they're trying to manage and what they're comfortable with, and maybe what they've tried in the past, all of those, you know, one-on-one conversations that we have. But I think tailoring those discussions is going to be the key because it's going to be so variable by person. So what I'm taking away from your point though is that we need to decide, help with the pa work with the patient to figure out if withdrawal might be a concern depending on their pattern of use in the past. And depending on that, we may need to transition them off or we might not, depending on the level of use, and then transition them to something else potentially that is going to help manage whatever symptoms they have. And that's going to rely back on our on our standard recommendations and pregnancy in general, right?

SPEAKER_00:

Yeah. And you know, cannabis is used in the moment as needed for most patients, uh, for a lot of patients. And so if they have anxiety and they're turning to something in that moment of anxiety or that moment of nausea, they're going to want something else to turn to. And so breaking that routine that they're that they're into with the medication is key. Right. Yeah. And then the the frequency and what type of product and the dose, all of that is a consideration and that individualized plan for that patient because they took the time and effort and individual route to figure out that routine for themselves and to figure out uh because cannabis is an individualized uh medication, when you consume it, you get a certain effect. And you have to make your choices based off of that effect. Do you want stronger? Do you want weaker? Do you want different? And so every person who's going to walk in that has used cannabis is going to have a different regimen, routine, dose, and all that. And so factoring all that into for the patient and then how to titrate down is is key. Us as pharmacists may have a hand on that, especially in the dispensary setting. Patients may come in and say, hey, this is going on. I had a conversation with my OBGIN. How can I, how can I uh get off this medication? Um, and so dispensary pharmacists may have those conversations. I appreciate the ACOG guidelines that it asks OBGINs to do the screening and it puts that earnest on them because each date is completely different on how patients access cannabis. And sometimes it's with the pharmacists, sometimes it's in a dispensary where someone could walk in. So sometimes the pharmacist isn't the best touch point for that patient to screen and to have those conversations with. But all our patients who are pregnant are going to have the visit with the OBGYN. So it, and for me, it makes sense that they're being screened there, but we still meet may need to provide that support for those patients if they're walking into our dispensaries or pharmacies to kind of continue that conversation. Or we're really good at educating and arming our patients to have those conversations with their providers. And so we may be able to be that just talking point to help them frame that so then they can have a more informed conversation with their OBGYN.

SPEAKER_01:

Right, right. I think that's a really important point too, even if we're not doing the screening, starting those conversations, having those conversations, just getting started and thinking about, you know, safe use of medications broadly in pregnancy is something we would want to be talking to all of our patients about, regardless. And so whether that's cannabis or any other medications they might be getting regularly at the pharmacy, those are the opportunities that we have to to initiate those conversations and encourage that follow-up from their other providers too. So I think that's that's a great point. And I also think it's really interesting to think about, you know, as you said, sort of the setting is going to vary on where these conversations fit in. But you can really, I I'm thinking about it like smoking cessation, tobacco cessation, and how, you know, there's all kinds of strategies, but but patients sort of know their bodies, they know how they've used tobacco in the past and how when and how they have their triggers. And so again, that's a very we tailor our recommendations to that patient's experience. And it's no different with cannabis, right? I mean, it's gonna be something like you said, they they know what might trigger them to want to use at a specific time, use it, and you know, we can help provide specific recommendations around those triggers too. So yeah, it seems like a would you would you agree? It's sort of a similar sort of thought process in terms of tobacco cessation and some of the strategies we use there.

SPEAKER_00:

Yeah, and I I think about that for even the screening tools, like the five key screening tools asks, you know, specifically is developed for pregnancy, but asks about environmental factors, you know, what is your use around or your your parents' use or your use around your parents or your peers or your partner, your past, and in and in pregnancy. And so it's asking all of those factors. The craft uh screening tool asks, do you have use in your car when you relax alone with friends? Right. And so that's how people, how a lot of people utilize cannabis is in certain moments, in certain times of day. And so if we can uh frame it in that and better understand that, we can better understand how to help that patient. So yeah, I agree. And I think of it as uh sometimes patients use it and not for good, but habitually, they just find these certain times where it's you get in the car, you take your dose, or you you get out of the car and you go into your your whatever the next place is, the supermarket, um, because that's an anxiety-ridden place for a lot of patients. They have their routines and it's just like going about their regular day-to-day. And so if we can identify those moments, then we can identify alternatives for those touch points to help that patient along the way and frame it in a different way.

SPEAKER_01:

Yeah, absolutely. And again, a lot of what you're saying just resonates with me in terms of tobacco cessation and some of those things and considerations we're asking about with tobacco cessation. And yeah, in that ACOG guidance, too, you know, they mention motivational interviewing and assessing for social determinants of health. And again, these are things that we think about with our patients for all kinds of other reasons. And so the importance of individualizing those recommendations to the patient and encouraging those behavioral therapies when possible, or peer support, or you know, text messaging, all of those things we may think about for tobacco cessation also would apply here too. So yeah. Any any other sort of tips or tricks we want to wrap up with in terms of supporting that cessation process specifically or or harm reduction when thinking about cannabis use in pregnancy or lactation or yeah, I think the the harm reduction piece for me is key.

SPEAKER_00:

Um, some patients use cannabis to reduce harm for other substances, alcohol, opiates, and things along those lines. But in this circumstance, I think it's our job to reduce the harm and educate patients so they understand that although cannabis is seemingly everywhere now, at least in Pennsylvania, it's it's you know not recreational, but you can go into a vape shop and buy hemp-based products and all of that. So framing it for the patient to understand, though, although it seems like it's safe and everywhere, in a lot of circumstances it's not. So we um uh need to go back for our for our patients and help them understand that. So I think the education and the reducing of harm, although with cannabis, there's a lot of good with that and a lot of potential, um, I think in this circumstance, it's best to avoid and cease use.

SPEAKER_01:

Right. In pregnancy and lactation, I specifically, yeah, as the population. Yeah. And again, I think that just aligns with the message, the general message from the ACOG recommendations. And that's where even just having it be published at this time is a good sort of cue to start having those conversations because patients may have heard about this in the news. And, you know, it just increased an awareness about the the potential risks of cannabis impregnancy and lactation is just a great starting point to have those conversations. And so using it as a as a as one of those conversation starters is critical.

SPEAKER_00:

So and we need more of this. We need more guidelines and standards, specifically with cannabis. It's easy to say there's not enough evidence, there's not enough studies and research out there, right? Like that's the easy line to fall back on, but we still are in that environment, we're still working with it. It's our patients are still utilizing it. And so, how can we, as healthcare professionals, consistently give the best care possible? And so, although this addresses that there's a lot of unknowns, we still have a plan that we can act on and help our patients with. So I think we need a lot more of these guidelines and standards out there across the medical. Community.

SPEAKER_01:

Absolutely. I love that. And leveraging what we can when we can at the right point in time. And I think, again, that's where pharmacists really often come into play, is just because of our unique roles and being so accessible with patients. So to wrap up our discussion, Kevin, we always ask, you know, what is the game changer about this topic? It's the Game Changers podcast. So what would you say is the game changer that you want people to walk away with from this discussion?

SPEAKER_00:

Cannabis is a very stigmatized and sensitive subject, but it's important that we still have conversations with our patients and so approach those conversations in a non-judgmental way, offering support and help and finding how we can best help our patients, I think is the best way to go about it, whether that's a patient who's pregnant, which we're talking about in this circumstance, or just patients in general. I think that's the best approach. Patients want to be treated with dignity, treated like human and not being judged. And especially with cannabis, people automatically feel judged already. So we really would do our patients a service by looking at them as a person and not being judgmental for them.

SPEAKER_01:

Absolutely. I couldn't agree with you more. And considering the fact that it is so widely available, it you know, it's being used by more of our patients. And it's just sort of, you know, a fact of life now. It is, you know, we have to be aware. It's just like anything else. We we need to be accepting and empathetic of our patients and providing them.

SPEAKER_00:

We can't ignore it. You know, now it's, I think uh we have the opportunity to learn. And and now that it is so out there, I think we have the duty to at least have a little foundation of how cannabis works in our body, how it interacts, yeah, and who it can help and who maybe should avoid it. And so, you know, uh uh hopefully our listeners get a lot of great uh information on this and it just scratches the surface on their uh on what what they want what they can learn on cannabis.

SPEAKER_01:

Yeah, I think you mentioned before we started the session that you know it's something we all are needing to constantly learn about and continue to to keep up with because it's such an evolving area. So hopefully we'll have you back on again in the future and and talk about some new aspect to tackle.

SPEAKER_00:

Cool. That's great.

SPEAKER_01:

Thank you so much, Kevin. Really appreciate your time.

SPEAKER_00:

Yeah, yeah, thank you, Rachel. Appreciate it.

SPEAKER_01:

So, listeners, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpact.com. And as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week.