SAGED

When chronic pain from repeated injuries forced legendary basketballer Lauren Jackson into retirement, her journey to recovery became a complex challenge. But Lauren defied the odds, returning to the court to play in the Australian squad for the FIBA Women's Basketball World Cup in 2022. This case study explores the challenges faced by female athletes in high-impact sports, including the prevalence of bone stress and joint injuries, the impact of hormonal factors, and the complexities of chronic pain management. It also addresses how medical cannabis was incorporated in Lauren's treatments. Healthcare practitioners will gain insights into: The pathophysiology of common injuries in female athletes, including bone stress and joint injuries Potential benefits and limitations of medical cannabis in managing chronic pain and aiding recovery Considerations for incorporating medical cannabis into treatment plans alongside conventional therapies. Strategies for discussing medical cannabis with patients while prioritiding safety and minimising risks Explore the evidence and evaluate how medical cannabis might fit within a broader approach to managing chronic conditions and sports-related injuries. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Explain the pathophysiology of common conditions and impact-based sporting injuries for female athletes and identify common management strategies Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of chronic sporting injuries and recovery from surgery Discuss the potential benefits and limitations of medical cannabis as a treatment option for symptoms of endometriosis Explain how medical cannabis treatment may integrate into and influence prescribed opioid treatment outcomes and effects Identify suitable candidates for medical cannabis treatment Devise treatment plans that consider patient safety and minimise risk Facilitate clinical discussions with patients around medical cannabis as a therapeutic option in the management of chronic conditions, impact-based sporting injuries and recovery from surgery Disclaimer: Lauren has a financial interest in a medicinal cannabis company. Lauren is not receiving any financial remuneration from SAGED for her involvement in this case study.

This course is an intermediate-level exploration of how to tailor medical cannabis treatment for patients by considering their prior exposure to cannabis (medical or otherwise). With a focus on identifying patients' exposure levels, doctors will learn to customise care and treatment to safely and effectively unlock the therapeutic benefits of medical cannabis. Over the course of 7 modules, discover cannabis’ interactions with the body, as well as the key identifiers, considerations and recommendations for offering safe and effective treatment. Examine the biological composition of cannabis and its pharmacological interactions with the body, gaining insight into how prior exposure affects tolerance and experience. This course forms part of a comprehensive learning path covering factors to consider when offering medical cannabis care and treatment. Preview this course by watching the video above. Estimated Duration: 6 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify cannabis’ biological constituents and explain their effects on the body Explain how the endocannabinoid system (ECS) maintains homeostasis and describe cannabis’ interactions with the ECS, including how exposure affects endocannabinoid tone Identify the 2 dimensions of prior cannabis exposure, and explain how to identify them in patients Explain how prior exposure may impact treatment goals and discuss considerations and recommendations for setting personalised treatment goals based on prior exposure Identify and describe common medical cannabis products and explain the considerations and recommendations for product selection based on prior cannabis exposure Discuss general recommendations for dosage and titration based on patient’s prior cannabis exposure

This course is an intermediate-level exploration of how to tailor medical cannabis treatment for patients by considering their prior exposure to cannabis (medical or otherwise). With a focus on identifying patients' exposure levels, nurses and nurse practitioners will learn to account for patients’ prior cannabis exposure when offering care during medical cannabis treatment. Over the course of 7 modules, discover cannabis’ interactions with the body, as well as the key identifiers, considerations and recommendations for offering safe and effective treatment. Examine the biological composition of cannabis and its pharmacological interactions with the body, gaining insight into how prior exposure affects tolerance and experience. This course forms part of a comprehensive learning path covering factors to consider when offering medical cannabis care and treatment. Preview this course by watching the video above. Estimated Duration: 6 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify cannabis’ biological constituents and explain their effects on the body Explain how the endocannabinoid system (ECS) maintains homeostasis and describe cannabis’ interactions with the ECS, including how exposure affects endocannabinoid tone Identify the 2 dimensions of prior cannabis exposure, and explain how to identify them in patients Explain how prior exposure may impact treatment goals and discuss considerations and recommendations for setting personalised treatment goals based on prior exposure Identify and describe common medical cannabis products and explain the considerations and recommendations for product selection based on prior cannabis exposure Discuss general recommendations for dosage and titration based on patient’s prior cannabis exposure

This course is an intermediate-level exploration of how to tailor medical cannabis dispensing for patients by considering their prior exposure to cannabis (medical or otherwise). With a focus on identifying patients' exposure levels, pharmacists will learn to account for patients’ prior cannabis exposure when dispensing medical cannabis products to patients. Over the course of 7 modules, discover cannabis’ interactions with the body, as well as the key identifiers, considerations and recommendations for safely dispensing medical cannabis products to patients. Examine the biological composition of cannabis and its pharmacological interactions with the body, gaining insight into how prior exposure affects tolerance and experience. This course forms part of a comprehensive learning path covering factors to consider when offering medical cannabis care and treatment. Preview this course by watching the video above. Estimated Duration: 3.5 hours Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Identify cannabis’ biological constituents and explain their effects on the body Explain how the endocannabinoid system (ECS) maintains homeostasis and describe cannabis’ interactions with the ECS, including how exposure affects endocannabinoid tone Identify the 2 dimensions of prior cannabis exposure, and explain how to identify them in patients Explain how prior exposure may impact treatment goals and discuss considerations and recommendations for setting personalised treatment goals based on prior exposure Identify and describe common medical cannabis products and explain the considerations and recommendations for product selection based on prior cannabis exposure Discuss general recommendations for dosage and titration based on patient’s prior cannabis exposure

The Endocannabinoid System and Clinical Care: Relevance Beyond Cannabis Published: July 2025 While many healthcare professionals are familiar with well-established physiological systems such as the sympathetic nervous system, which governs the body’s fight-or-flight response, fewer are aware of the more recently identified endocannabinoid system (ECS).1 The ECS has been increasingly recognised for its role in a range of regulatory functions, including pain modulation, immune response, stress and emotional regulation, appetite, body weight, and the control of nausea and vomiting.2 Yet, the ECS is not traditionally covered in medical education as highlighted by the Chief Scientific Officer of the Australian National Institute of Complementary Medicine: “I gave a talk at a hospital in Queensland late last year where I asked everyone in attendance—some 130 nurses, doctors, et cetera—whether they had had any training in the endocannabinoid system during their undergraduate training, and not one hand was raised.”3 Why isn’t the ECS taught in medical school? The ECS is relatively new in the context of medical science. The primary cannabinoid receptors—CB1 and CB2—were only identified in 1988 and 1993, respectively.4 Similarly, the two most well-characterised endocannabinoids, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), were discovered in 1992 and 1995.4 This recency has contributed to its omission from traditional medical curricula, which can take years to evolve. Cannabis, which interacts with the ECS,5 has a long history of medical use, dating back over 5,000 years.6 However, by the mid-20th century, it was no longer viewed through a medical lens but instead reclassified as a prohibited substance under the United Nation’s Single Convention on Narcotic Drugs.6 This shift in legislation didn’t just criminalise its use—it also severely limited research.6 With tight restrictions on access to cannabis for scientific purposes, progress on understanding its potential therapeutic benefits, including its interaction with the ECS, stalled for decades. So what exactly is the ECS — and why it matters The ECS is a cell-signaling system composed of three primary components:Endocannabinoids—such as AEA and 2-AG—are lipid-based messengers naturally produced by the body that activate cannabinoid receptors.5 Cannabinoid receptors—CB1 and CB2—are primarily located in the central nervous system and the peripheral immune system, respectively, though both are also found in other tissues throughout the body.5 Enzymes—fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL)—are responsible for breaking down endocannabinoids.5 Endocannabinoids are released on demand by the body in response to physiological stimuli.7 Such stimuli may include: stress, obesity, food presentation, exercise, inflammation and tissue injury.2 The figure below outlines various stimuli reported to influence endocannabinoid levels and their observed effects from clinical studies: In neurons, endocannabinoids are released in response to stimuli (such as those mentioned above) and exert their effects through a process called retrograde signalling.12 They are synthesised in the postsynaptic neuron and travel backward across the synapse to bind to receptors on the presynaptic terminal, where they inhibit further neurotransmitter release.12 Emerging research suggests that deficient endocannabinoid signalling, collectively referred to as clinical endocannabinoid deficiency syndromes, may be involved in the pathogenesis of some diseases, including migraine, irritable bowel syndrome, depression, multiple sclerosis and Parkinson’s disease.13 This has led to growing interest in strategies to modulate levels of AEA and 2-AG, including targeting the enzymes that degrade them.13 Pain and inflammation A study by Ramsden et al. offers intriguing insights into the relationship between diet, endocannabinoid tone, and headache severity.14 In participants with chronic headaches, increasing omega-3 intake while reducing omega-6 fats led to lower circulating levels of 2-AG.14 Interestingly, this shift was accompanied by a reduction in headache hours, hinting at the ECS as a potential therapeutic target in managing chronic headaches.14 Stress and anxiety Research into the ECS and psychological trauma has revealed a complex picture.  Hill et al. found that individuals with post-traumatic stress disorder (PTSD) following the World Trade Center attack had low circulating levels of 2-AG compared to healthy controls.15 In contrast, Hauer et al. found the opposite trend in war refugees with PTSD, observing elevated levels of 2-AG compared to controls.16  These differing results suggest that the ECS may respond to psychological trauma in distinct ways depending on the context and intensity of the experience.16 While short-term ECS activation might serve as a protective mechanism during acute stress, prolonged or overwhelming trauma could lead to dysregulation—either depletion or overactivation—of this system.16 Looking ahead Although historically overlooked in medical education,3 the endocannabinoid system is now recognised as one of the key regulators of physiological balance—with roles spanning pain, inflammation, stress, mood, appetite, and immune function.2 As the clinical relevance of endocannabinoid signalling continues to be uncovered, research is rapidly advancing into ECS-targeted therapies—offering novel options for managing complex and chronic conditions, particularly amid growing patient interest in cannabis-based treatments.1,6,7 This evolving understanding carries practical implications for clinical care. While some patients may benefit from cannabis-based treatments, others may experience side effects or find them unsuitable.17 A deeper understanding of the ECS may allow healthcare professionals to identify alternative or adjunctive strategies, and support patient-centred decision-making.3,18,19 As with all areas of clinical science, ongoing research, cautious interpretation of emerging data, and patient-centred dialogue will be key to integrating ECS knowledge into thoughtful, responsible practice. Learn more about the ECS and its clinical implications with this fundamental module or our flagship accredited Medical Cannabis Fundamentals courses for doctors, nurses and pharmacists.

This module explores the endocannabinoid system (ECS) and its critical role in the effects of medical cannabis. It examines the discoveries that shaped our understanding of the ECS, its primary components—such as CB1, CB2, and TRPV1 receptors—and the mechanisms of retrograde cell signaling, which underpins how cannabinoids influence physiological processes. Participants will learn about the role of ECS ligands and non-ligand mediators in cannabis pharmacology, the concept of endocannabinoid tone, and factors that can affect it. Clinical considerations are addressed to provide a deeper understanding of how the ECS informs the safe and effective use of medical cannabis in patient care. Preview this module by watching the video above. Estimated Duration: 1 hour Access Duration: 12 months from date of purchase Learning Outcomes Upon completion of this module, you’ll be able to: Describe the discoveries that shaped today's understanding of the endocannabinoid system (ECS) Explain the functions of the ECS, its main components, and how they interact Discuss the function and benefits of retrograde cell signalling Outline the roles and functions of cannabinoid receptors CB1 and CB2, and vanilloid receptor TRPV1 Identify ECS ligands and non-ligand mediators and describe their role in ECS function Define endocannabinoid tone and its influencing factors Discuss clinical considerations related to the ECS