A conversation with Dr. Brad Ingram on cannabis research – Northside Sun

Dr. Brad Ingram of Jackson is director of the Pediatric Comprehensive Epilepsy Program and assistant professor of pediatrics at the University of Mississippi Medical Center. He grew up in Jackson where he attended First Presbyterian Day School and Jackson Academy. A graduate of the University of Mississippi who earned a bachelor’s degree in biology in 2001, Ingram earned his medical degree in 2005 from UMMC. He completed multiple residencies at UMMC and a one-year fellowship at Cleveland Clinic in Cleveland, Ohio, with an emphasis on epilepsy.

The first pediatric epileptologist in Mississippi, Ingram is principal investigator of a clinical trial of a drug derived from marijuana that may offer hope to children whose seizures are otherwise uncontrolled by other means.

When did your research begin?

“In 2014, the state Legislature passed a law that enabled research using cannabis, derived from the Natural Products Center at the University of Mississippi, to treat children with refractory epilepsy. It took quite a bit of manpower both from Oxford and from UMMC to get that through because technically all of that product belongs to the National Institutes of Health.”

Who in recent years nationally shed light on the use of cannabis to treat children with epilepsy?

“The conversation started with a Sanjay Gupta documentary, ‘Weed,’ in 2013. He covered the case of a patient named Charlotte Figi, who was a Colorado child who had a severe refractory childhood epilepsy. Her mom went to a marijuana dispensary and tried something new every month and found that CBD really seemed to help her daughter’s seizures. There was a national outcry that this was a medicine for children with severe epilepsy that that we weren’t using, that cannabis could be a real boon for our patients.

“The pediatric epileptologists of America were all very interested in researching this, but there is no panacea in medicine. The use of cannabis has to be looked at, evaluated and monitored for safety, especially when talking about use for kids. And we have to have a compound that’s consistent and reproducible month over month.”

How far back in history does the idea of using cannabis to treat children with epilepsy go?

“The modern history of using cannabis in children with epilepsy goes back to the mid-1800s, but it was first described as a treatment for seizures on Sumerian tablets in 1800 BCE . They called epilepsy ‘the Hand of Ghost Disease,’ meaning your hand would do something a ghost was making it do, and they described using cannabis. Using this compound in the treatment of epilepsy is not a new thing.”

How have laws and perceptions about the use of illegal drugs influenced this?

Marijuana in the 60s in America became a hot button. In the 80s came the War on Drugs, the criminalization of marijuana and the DEA re-categorizing it as a schedule one drug, meaning there’s no human research or potential for benefit human. That meant that American physicians really couldn’t do research with it.

“One of the challenges is the national conversation moved faster than the scientific conversation was able to move. There are a lot of kind of preconceived notions, but Facebook kind of ran away with it. The cultural zeitgeist was divorced from the scientific reality.

“Then you had probably the most concerning part, a geographical discrepancy. If you lived in Colorado or Oregon versus Mississippi or Virginia, that would determine whether or not you had access and what kind of access you had. That is still a problem in our country today.

“Medical marijuana laws are state laws. Technically, according to the federal government, all of this is still illegal.

“In the middle of all of that, we had the state law passed in 2014 that said, ‘We want research about this.’”

What is your research about?

“The original study was about safety—what happens if you take CBD for a long term when you’re on certain seizure medicines. We know that using marijuana in a developing brain before the age of 16 has impacts on long-term IQ and executive processing. One of the challenges is that I’m a pediatric neurologist and dealing with brains that are still undergoing development.”

How many patients are involved in your research?

“We started with 10 patients.We hope to add several more patients this summer as we start a new study that’s a bit different. We were approved last May by the FDA and our Institutional Review Board for two more years of research.”

How did you select the patients in your study?

“They are children who have severe epilepsy and were already on many other drugs that were not working to control their epilepsy. The vast majority of patients had already been on six to eight medications. These were patients who literally had no other options left.”

Does the cannabis used to treat patients in your research study come from the marijuana grown at the University of Mississippi in Oxford?

“Yes. The University of Mississippi is the only federally legal marijuana growing operation and it provides materials for research that meet the legal and safety requirement of both the DEA and the FDA. We get the cannabis-derived product from Oxford and then we put it into an oil. The patients take it twice a day.

“The National Center for Natural Products Research, which is based at the University of Mississippi School of Pharmacy in Oxford is a historical leader in this field and really has been really since the 70s. We never in a million years at UMMC could have done this study without their support and help and their long foundation of excellence in this realm.”

“What will the next phase of your research focus on?

“The next round will be more targeted to specific diagnoses in epilepsy. It’ll be more targeted at how does this work and who does it work in. We’ve learned so much from this initial study and continue to learn, but it was always designed primarily around safety. We need to move into a study that targets efficacy. We can put our experience to work. For instance, some patients may just need higher doses of cannabis than we allowed in the original study. That would part of a new study.”

Does the research require all of your time at work?

“There are weeks of my year where this is probably 50 percent of what I do and there are months where it may be 5 percent of what I do. We’ve gotten into the maintenance phase of research, so it’s leveled out a bit. In most of this part of my job it’s been a labor of love, squeezed in around my other responsibilities.

“I came back to Mississippi to treat patients with seizure and also to teach a whole generation of Mississippi physicians about epilepsy. Epilepsy is a disease that’s unpredictable and can be a part of health care everywhere from a primary care visit to a hospital to an ER. I’m passionate about our team offering cutting-edge options for Mississippi kids with epilepsy, but also having a whole health care system that isn’t scared of seizures and engages with epilepsy with knowledge and compassion.”

Are there other people at UMMC involved in this research project?

“I tried to do it by myself for a year and got nowhere. This is a massive undertaking that requires a connected multidisciplinary group. We have built a very efficient team of people that includes Angelena Sharp, our research nurse; Scott McKenzie, a research pharmacist here on campus; and a full-time Ph.D., researcher, Ingrid Espinosa, who monitors data and updates to three federal agencies. I frequently make the comment that I’m like the queen of England, and those three are Parliament.”

How long do you expect your research to continue?

“As long as Oxford has a supply, we are set up to do good research in the field of pediatric epilepsy around this compound. That’s pretty fantastic. I expect looking forward, this will move past epilepsy into other neurological and psychiatric diseases.”

How common is epilepsy?

“About 1 in 10 Americans will have a seizure at some point and about 1 in 26 will have epilepsy. It’s not rare. Epilepsy every year takes more lives than breast cancer in America.

“One of the challenges with epilepsy is that it has historically had so much stigma associated with it, and we don’t want to talk about it. It’s much more common than people recognize or realize. The only way for is for us to combat that is with more and more education.”

What made you choose epilepsy as your specialty?

“I was diagnosed with epilepsy when I was 16. When I was a student at Ole Miss, I got very sick and had to be airlifted to a medical center in Memphis. For the first time, I saw an epileptologist. She told me not to let it define me or what I could do. Because of her, I decided that I was going to med school and become an epileptologist.”

What made you decide to return to Mississippi to pursue your career?

“When I was at the Cleveland Clinic doing my fellowship, I had opportunities to go elsewhere, but I knew I would be the first pediatric epileptologist ever in the state of Mississippi.

“How do you make the world a better place when you’re just joining an existing program with a deep bench of doctors and resources? I have had such a rewarding career. I love working here and I love being back in Mississippi. I have such a rewarding job working with my patients and their families. I really think we have an opportunity to make the world a better place.”

Source: https://www.northsidesun.com/most-recent/conversation-dr-brad-ingram-cannabis-research

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