Don't Get High….. Get Well

Archive for July, 2010

Proposition 19 or “Tax and Regulate”, is not really true legalization of cannabis. To me, “real” legalization means that it is treated the same as alcohol. It would mean that it was readily available. It would mean that as a physician, I could openly do clinical trials at GreenBridge. It would mean that I could open a lab and run as many tests as I wanted on as many strains as needed. I would be able to legally do genetic testing, analytic testing and correlating this data with the associated clinical conditions.

With Prop 19, none of these will be the case. So, this ballot initiative is just a step. Nonetheless it means a lot. It means that nobody is ever arrested. It means, our jails will begin to empty and it means anybody can grow at home in a 25 sq ft area. That will take care of most people’s needs.

With regard to Medical Cannabis, if the physician visit offers nothing more than a signed Recommendation Letter, they will in fact go away. We never needed, and will never need physicians to supervise recreational use of cannabis. We all know it is silly and to me, Prop 19′s other significant contribution is formally setting a boundary, even if vague and gray, between medical and recreational use of cannabis.

As I have said before, if my blood pressure medication made me feel better and more social, I very well might take it at breakfast with friends and share the good feelings. Would that make my blood pressure pill a recreational medication? Of course not.

I am sure many of you are beginning to hear about CBD (Cannabidiol). It is one of approximately 70 Cannabinoids, the most famous being THC. CBD is an amazing compound and I will have many future blogs about the non-psychoactive properties of CBD, but also how it can and will be used to treat chronic pain, anxiety and other mood disorders, as well as being a neuro-protectant and a very help anti-cancer drug.  For today, let’s talk about CBD’s value in treating chronic pain.

CBD works against pain primarily in the peripheral nervous system. It does not work like typical pain meds by effecting the central nervous system; it works at the neuro-synapse.  When we sustain injuries, often the pain is acute and disappears completely. Other times we have persistent or intermittent pain, but it is still not that big of a deal. However, with many disorders the pain is either part of the underlying problem itself (Multiple Sclerosis, Rheumatoid Disease, etc ) or the pain becomes a syndrome of it’s own. In other words, the pain takes on a life of it’s own and is now crippling the patient. A certain level of pain is of course protective, but we all know the difference.

In a recent Scientific American article, chronic pain and CBD are discussed in a very creative way that fits with my clinical experience. When an injury takes place, increased Glial cell production forms around the neuro junctions. These Glial cells produce Cytokines which are chemical transmitters spreading inflammation and signaling pain. When a molecule of CBD binds to the Glial cell, the cytokine production decreases and the patient feels a marked decrease in pain. This would also explain why some patients have pain relief that lasts way beyond the theoretical effect of the CBD.

I suppose we are all just a bit low on CBD; but there is a cure.

I heard a great story from a patient yesterday. He was pulled over for DWB (driving while black) and had 2 grams in his car. His Recommendation had expired and he was cited. In court, he was given the choice of going to 12 AA meetings or getting his Rec renewed with me within 5 days.

Have things changed or what? Impressive.

Four years ago when I started GreenBridge, any patient on probation was at risk when/if I gave them a Rec. Now every probation officer I speak with promotes their clients getting and using medical cannabis. They know it is safer. It is simply a matter of harm reduction.

I rarely get very political, and this is probably obvious to many. I had little idea that the money seized at raids, at least the federal ones, is used to finance more raids.

This is really bothersome, as the task force survival depends upon raiding and stealing money. I know this is time old stuff, but I am just a simple country doctor. :)

Last night I attended a Young Physicians meeting in Santa Monica. By definition, you must be under 40 to join, but they seemed fine with my visiting. In fact, speaking with approximately 15 young docs was invigorating. They totally get it and are very anxious to work it into their practices. Their specialties included internal medicine, rheumatology, orthopedics and more. It seems that physicians are becoming more and more open to considering use of cannabis tinctures.

We can’t expect physicians to take a positive support role on smoking and they also have a bit of a difficult time with edible dosing. In other words, they really get it and are looking to help all of us. Please spread the word regarding Young Physicians; they are rapidly becoming the future and so will cannabis medicine.

Once physicians fully accept cannabis as a legitimate drug, all issues will rapidly evaporate. Yeah!

One problem all of us humans have in common is excessive and irrational worrying.

If we just worried about issues we really need to focus on, it would be fine. However, we all worry about issues we have no control of – much of the time. We are often told we are worrying for nothing and making ourselves ill. We all know this. We are quite aware that our worrying is giving us many physical symptoms. The most extreme result of uncontrolled worrying is can be suicide. I have seen this in my Internal Medicine Practice, but not in my cannabis practice.

There is no doubt that I am speaking in generalizations, but I bet everyone reading this blog will identify with it. We lay awake for hours just obsessing about stuff we have no control of. We want to “let go”, but we can’t.

Is this excessive worrying simply a manifestation of anxiety? Perhaps. For sure, neurochemistry is involved.

We have all commented that our pets really have the life. They have nothing to worry about, no jobs, plenty of food and shelter. No doubt, this is enviable, but I don’t think it is their lack of responsibility. Look at pets that are service pets; they have a huge responsibility and work hard. What about special animals trained to work with police and firemen? They work hard and have emotional experiences that are very upsetting. However, I have never heard of one not being able to sleep and eat – unless they themselves become depressed. On the other hand, we all know wealthy and healthy people who really by most standards should have nothing to worry about, but they certainly do worry as much as any of us. I.e. Security and safety don’t seem to help much.

So, Why did evolution leave us humans with such a destructive and useless issue with worrying?

Endo-cannabinoid deficiency states have been well documented in the literature. Please see my page on educational material. The science is pretty clear. I have now seen hundreds of patients who have used certain cannabis tinctures, who tell me that their worrying goes away and their mind left 100% clear, with low dose and controlled dose of sativa tincture.

Here goes my personal beliefs………I believe that we are now able to treat this mild cannabinoid deficiency. With virtually the same dose of tincture, nearly all patients become calm, totally clear and focused and are able to control their worrying and make better and clearer decisions.

Here goes the real leap of faith. It is my hypothesis and I offer no proof, only perhaps some limited understanding. During the past 100,000 years or so of our own evolution, our brain cortex has grown tremendously in size and function. For this solar system, we would win every spelling bee. However, perhaps the natural selection advantage for a better thinking brain just didn’t consider the comfort of that brain. I believe that our proven hungry cannabis receptors, until medicated keep us from this level of comfort.

The primary reason I feel this way, is why else would virtually the same tincture dose work so well for so many different patients of different size, gender and prior cannabis use? In my opinion, it is a replacement dose. In my years of practicing Internal Medicine, I saw this primarily in the hormone replacement field, as although our doses are different, it is in a very narrow range.

So, yes, I believe small doses of the correct cannabinoids help with many of our problems, including our pathological worrying.

Thoughts?

As discussed in prior blogs, the strains of cannabis have very different effects. One of the classic Indica effects is to increase appetite. Cannabis physicians use this effect with many very ill patients to increase their caloric intake.

However, it is rarely mentioned that many patients have a very different effect from some Sativa strains. I have been hearing this from patients for four years and it is something that needs a lot more study. It has been my experience, that many patients notice decreased sugar cravings from some Sativa strains. Why? I have no idea.

I would love to hear from any of you that have noticed this interesting and quite beneficial effect of Sativa.