Don't Get High….. Get Well

Archive for the ‘medical marijuana’ Category

I just received this email from a patient, responded to her and decided to post my feelings on the “Simpson Oil”. Here is the patient question and my response:

PATIENT:

Dr. Frankel, I was wondering if you did any research on rick simpson’s hemp oil . I read so much good things but never from local doctors around here. Thank you

My Response:
I have had a number of contacts with this product and have sadly watched nearly a dozen patients die while using the oil. I am not saying the oil hurt them in any way, but it certainly didn’t help them. I can’t even say they felt better and there were a few patients who sacrificed the cannabis they loved and had felt better with.

I am saying that it has frankly never made sense to me that this should be a “cure for cancer”. The majority of people making this form of hash, which is all that it is, somehow believe they are creating an anti cancer product and are now even making claims – at times – that it is the CBD, or cannabidiol, in the oil that is helping the cancer.

I have had it tested a number of times to confirm, but there is no CBD in any production oil I have tested. The products I have seen are so rough that testing and even using the very gooey stuff is impossible.

For this reason, I would rather see a patient take a lot of CBD directly through a tincture, spend the same money perhaps, but end up with at least a product that is being supported in part by the National Cancer Institute.

I do not like to see the “Simpson” oil climb on the back of CBD, as ultimately, at least in my opinion, the Simpson Oil Will be shown not be very helpful. Of course I could be wrong, but for now, this is my position. Again, I am a huge fan of CBD and have encouraged some patients to use larger mg of CBD for their cancer; here I still feel on shaky grounds, but at least am following the mainstream science.

So, there. That is a whole lot more than I thought I would write. I think I will just go ahead and turn this into a blog.

I have been discussing a new potential CBD delivery method with members of our science team, YES, we actually have a science team.

Although I love tinctures and dosable cannabis medicine, I have been working with a couple of our chemists on a method to place some fixed dose of CBD/THC/Terpenes into a capsule that is stable.

We have experimented with all sorts of capsules but when you have terpenes and true whole plant present, the caps always ultimately melt. Even the Bovine Caps melt.

We are developing a desiccation method by which to dry out the extract and place it into the capsules already “powderized?.

So, consider the following:
1. A caplet that contains perhaps 10 – 20 mg of CBD and 5 mg THC in an oral preparation
2. As we are well aware, CBD delays the excretion of THC by 4-5X and CBD has a long duration of
action to begin with
3. In an oral form, the first pass through the liver will hydroxylate the CBD and the THC which
then increases the duration by another 4 fold.

So, would a once a day capsule work? Once every two days for pain/anxiety?

Extended Release Capsules where our bodies perform all the magic without the help of plastic, etc

Good, Dr. Frankel–yesterday afternoon I had a bit of euphoria and sleepiness, but I noticed a reduction in my visceral sensitivity almost immediately, was able to eat two meals without nausea or vomiting; also my sense of taste seems less finicky. I’m pleased and excited and so is Kate (my wife). HG

Hey sorry I didn’t send this yesterday, but here is a followup about my experience with the tincture
4pm – I took the tincture and felt effects during our consultation. The sensory pain I feel on my skin was completely gone and the muscle pain/tightness in my forearm muscles was greatly reduced. I noticed this especially during my usual stretch routine.
4:45pm – drive home went fine. Still feeling great!
8:30pm – sustained relief through the afternoon and I did not medicate again. I started lifting weights and the pain returned (normal even when medicating)
thanks again! CH

I’m just getting over being sick for 3 weeks (I ran out and wasn’t able to go out for more) but can finally pick some up tomorrow. I definitely missed it.
The CBD was great. I still had pain but it was just sort of there – I almost went without taking any norco the few days I used it.
It really helped my stress reaction and I even managed to fall asleep without pills one night (I did wake up a few hours later in pain). I had to take a higher dose, but I feel like it has huge potential to help me cut down on the many medications I’ve been taking (Ambien, Adderral, Klonopin, Norco among others).
Anyway, Thanks so much for seeing me and I’d love to keep in touch about this. It’s difficult for me to type much but I live in the neighborhood, so I’m happy to come by and discuss sometime. With all the stuff I have going on, my body has become like my personal research project :) NG

Dr. Frankel,
Thank you, after one day the CBD has not only alleviated my anxiety, but also has relieved my joint pain/inflammation. My knees are now safe from threat of pain, inflammation, and you (since I emailed you like you asked)
I will send an update on how my treatment is going next week. Thanks again, hope all is well. JT

I acquired a small bottle of CBD from a dispensary and have been using a half dropper dose on a daily regimen. Administering just around dinner time.

I’m finding this to be a much more effective way to dose the medication as the dips and valleys of administering the medication have all but disappeared. There is a steady through line which I noticed on my first day which lasted well past 6 hours.

Being one who primarily seeks relief for sleep, I will have to report back once I’ve had a week or so under my belt to see just how this treatment affects my ability to quickly drop off to sleep.

Thus far I am very impressed with the CBD Tincture as it is very calming and doesn’t have the side affect of nervousness or anxious thoughts which smoking can some times result in. OS

Hey Allen,

I don’t believe I spelled tinkture correctly, but interesting feedback.

It helped me not crave a cigarette for a long time, in fact I lit a
cigarette and threw it away 1/2 done when I got home from your office.
Not sure if there is a correlation there, but found it very
interesting.
Thanks!

Hi Dr. Frankel,
Sorry it’s taken so long to respond – I try to avoid the computer with all my joint stuff but I’m happy to discuss or even come by sometime – I live closeby : )
The CBD was great. I still had pain but it was just sort of there – I almost went without taking any norco the few days I used it. It really helped my stress reaction and I even managed to fall asleep without pills one night (I did wake up a few hours later in pain) and I did feel like I needed to up the dose or play around with complementary herbs. It did upset my stomach a bit (Mark said the same thing), but for me it was worth it.
Now if I can just find some more in stock! I’m curious if the benefits will increase with continued use. Anyway, Thanks so much for seeing me and I’d love to keep in touch about this. With all the stuff I have going on, my body has become like my personal research project :)
take care. NG

Hello! HE has been good all day!!! I just gave him his nighttime dose. I am hoping we have another night of sleep.
THANK YOU SO MUCH!
Best, GG

Hi. He slept!!! Thank you SO much!!!

Throughout the day had an amazing meal, didn’t worry about my ankle at all. There was no pain: when I went to class I watched the little mermaid and still didn’t have any pain. My body had the symptoms of being high without the head trip and they visual qualities of being high. I like this stuff.

P.S.
Told you I’d email.

MANY MORE TO COME, Allan
Best,

I am certain that when all of you take a pill, whether by prescription or OTC, you know what dose it is. You know that a 500 mg Tylenol is different than one at 325 mg. You know what your thyroid replacement dose is and you know that if you take too little or too much, things don’t work quite as well. Your dose of Insulin can be life saving or life threatening. Cardiac meds? Blood Pressure meds? On and on.

We have come to count on dosing and dosing schedules. How much and how often to medicate? Will two puffs every 3 hours work? What’s the strain? Are you sure? Indoor or outdoor? Organic? Every puff is different. Do you use matches or a lighter? Do you inhale fully, or stop with 1/2 breath and fill the balance of your lungs with air to reduce coughing? These and other factors make it impossible to say “a puff is a puff”.

The same goes for vaporizing; although you avoid the tar, your dosing problems are no different.

So, we need dosable cannabis medications. Right? We need to know how much of what cannabinoids and ultimately terpenes we need for our specific problem and how often to take them. So, what do we need to be able to accomplish this:
1. organic and measured cannabis plants
2. organic and predictable extraction methods
3. creating a dosable tincture, or drops under the tongue

So, when we smoke, vape or use edibles, we rarely, if ever, know what we are medicating with. Not a bad thing necessarily with social or recreational cannabis, but for medical cannabis, that is the name of the game: DOSABLE CANNABIS MEDICATIONS

We all have experienced the “placebo effect”. It has been very clear to me practicing as a physician for over 33 years that the placebo effect is something we all count on. In the past, and still to some who live in the past, this placebo effect meant that the patient did not have anything real; i.e. if they respond to the sugar pill, they are faking it. Well, this has been shown to be false for years, but we still have not had much of a clear idea as to how the placebo effect worked.

Well, in a recent report, it seems that at least in a number of situations, it is the endocannabinoid system that responds and releases Anandamide and other internal “cannabis” molecules that we ourselves make.

So, “POT” is always making us feel better. I KNEW IT!! :)

I have been asked a number of times about the issue with using alcohol as an extracting compound.

There is no cannabis-specific law re: alcohol, but instead a general Penal Code statute that criminalizes the use of “chemical processes” (the wording may vary slightly) in the production/manufacture of any illegal drug. When the California Legislature created the medical cannabis exceptions to other drug-related statutes (e.g. cultivation, possession), it did not include an exception to this statute. As a result, any extraction process with a solvent other than water is technically a problem.”

In many/most herbal medications, using alcohol is not an issue as they are “legal”, while cannabis is not considered legal.

I am, in fact, additionally concerned about using alcohol from a “judicial” perspective when/if any of us are called to the mat by authorities for “manufacturing” medicines. If we are using the same standards as the pharmaceutical industry, i.e. co2 extraction, we can argue a much, much better case than using alcohol.

The entire issue with “manufacturing” which IS BEING PROSECUTED, is going to be a much tougher sell with alcohol; it just will be.

Finally, 70% alcohol should just not be a part of any medicine. With a tincture that is nearly 60-70% alcohol, a dropper-full taken under the tongue, or sublingually, will give you a feeling of being slightly intoxicated from ALCOHOL. Also, your breath smells like alcohol.

Finally, although in theory a fine extracting solution, I have yet to see a CBD tincture that truly measures out to be 10 mg/cc. I have purchased many and tested them all……still waiting

ASA, Americans For Safe Access, just filed a new ballot initiative to Regulate Control and Tax Medical Cannabis and it looks like it will incorporate the other two ballot initiatives into ONE….I hope as they and the State of Ca want to create a statewide bureau to to oversee Medical Cannabis in California with a 21 member board comprised of people from in and outside the industry including:

“Six Members with experience in the areas of dispensary operations, infused product manufacturing, cultivation practices or lab testing… two members with experience in medical cannabis policy and regulations … licensed physician and nurse … one member with extensive experience on scientific or therapeutic research…”

Section 11362.88 Check out the link and attached document.

http://ag.ca.gov/initiatives/activeindex.php

I would LOVE to be involved with this one.

I am continuing to see, and at times, testing and evaluating, new cannabis tinctures that have a range of effects. Allow me to summarize what is beginning to become available locally and soon through StateWide Collective and Community. (Again, please go there and sign up. If nothing else you are supporting my efforts, and will VERY soon have options with regard to your health insurance. I digress.)

So, there are some fairly balanced CBD/THC tinctures out there:

1. One has around 4.5 mg/cc of THC and CBD and seems to be effective for anxiety and pain, particularly neuritic. There are, however, perhaps 20% of patients where it appears this amount or ratio of CBD/THC is just not high enough. There will soon (a week at most) be available, thanks to ProjectCBD and the catatonic strains, tinctures where the CBD is more than 2X the THC and depending upon lab results I get later today, perhaps??? even a greater value for the CBD/THC.  These tinctures have a psychoactive scale of 6. (remember psychoactive scale from 0 – 10)

2. There has been and will again soon be available THC of 11 and CBD of 2. This was very popular and was better for sedation and a better anti-depressant for others. There was/is some moderate psychoactivity in this group of tinctures and their PsychoActive Scale is around 6.

3. Group of tinctures where there is minimal or no CBD, but have all terpenes present in the plant. So, these are very psychoactive and are placed in the range of psychoactive value of 8.

http://www.greenbridgemed.com 

http://www.certifiedcannabismedicine.org  

http://www.statewidecollective.org

Dear Patient,

I suppose I have no shame, but I must ask your help with two issues.

1. StateWideCollective.org and
2. Dosable Cannabis Medications For All Of Us.

There are closures of stores on a daily basis and it may be getting worse. There are many forces working against providing safe, affordable and dosable cannabis medicines. What happens if the Feds and local governments continue? Who is going to stop them? Are the stores really doing what they should be doing to provide a professional, safe and medical environment? If you are uncertain, as I am, to the answers, please read the opposing column carefully and help us out.

So, as I said there are two things to do:

1. StateWideCollective.org – Please go there and sign up. It is our “Plan B”. SWC has already been launched and committed to Dosable and CBD-Based Medicines. This is what I am committed to. This is what GreenBridge Medical and our 501C3 is committed to. It is at risk and our save dosable medications are at great risk; pharmaceutical companies are driving this entire effort.

2. So, after signing up with the g of StateWide Community, please help us with as little as $5 at:
StateWideMedicine.org

YOU AND I HAVE NO OTHER CHOICE!

Thank you so much,

Allan

Every month I pay around $850 to Blue Shield. I have a pretty typical PPO plan, which means it sucks and it is way too expensive. I have previously blogged on StateWide.EVERYTHING as a Collective, Co-op, or community. In reality, it seems to me we are quickly on our way to completing the community part and already have dozens of patients signed up; we need thousands.

So, yes, even as a physician, I am stating that I advise as a “backup” or “Plan B”, STW as being necessary. Also, SWC has no down side that I can see. I am not “supposed” to advise on a collectives, and rarely do I recommend one; however, this is an exception and a huge part of this exception is based upon the title of this blog. I can now easily see a way in which, with under 100 members of the “community”, we can obtain 50% discounts on our typical high end PPO insurance plans. This is something that must be done and can be done. Linking with a collective just begins making it into a total health care delivery system. As a physician, I see a monumental opportunity for my patients. How can I not advise this? I discuss personal “reimbursement” below, as this is a potential issue.

If the group were to grow to 1000, it is possible that we could get rid of deductibles and/or the patients cannabis medications could be included on a monthly basis! Over time, if our “risk profile” improves, our cost savings will be passed to “The Community” or we will ultimately just self-insure. This makes sense to me. Doesn’t it make sense to you?

Our health care system has failed and the same system is trying to take away our dosable “Real” or “CBD” based cannabis medicines; this is a certainty. So, with one easy signup, you plan on:

1. TAKING a big step towards cutting your health insurance costs in half

2. HOPING to make a statement that the “group” is critical now and we must organize in some manner

3. HOPING TO to protect our medicine even as storefronts are closing daily

4. WISHING TO exploring endless other ways of integrating this huge community.

While we are wishing and hoping; please do the right thing for the medical cannabis community and:

1. Continue to support your local collective

2 Signup with Statewidecollective.org and be certain to enter your email address

You can trust that this entire subject is one I have given much thought to over a very long.  This is an aggressive position for a physician to take but I have studied the subject well. I have been to 37 patient pre-trial hearings and trials, always pro-bono. I have been attacked by the State Of California and the Medical Board and have prevailed. I am entirely committed to helping this effort and I believe in the end there is no possible jury to convict a physician for “aiding and abetting” when he never gains by one cent, is improving his patients’ medications and trying to protect them. I owe it to all of you and myself to not participate in any cash flow; EVER. This gives us all great protection. So, to explain this:

Any and all of my efforts, other than seeing patients directly as part of my daily practice, will not be reimbursed in any manner; you can trust this.

I believe my readers by now trust that I am very serious in this blog and that I am very serious with regard to being 100% financially detached from all potential $$ benefits. To begin with, I really don’t care; I just really don’t.

However, in addition, I must remain neutral on two levels and they are eternally interconnected:

1. The search for the best dosable cannabis medicines is a goal that is just way above money – at least in my world.

2. In fact I do have some self interest; if dosable cannabis medications were to disappear, I truly do not believe I could continue doing what I do every day. Once I entered the dosable world, there is just no going back. I would have to leave and do something else and I just don’t want to do that. I do not mean to slight any physicians practicing cannabis medicine and doing great work. I think I was doing great work before CBD, but I am doing much better work now and how does one go back? Should I go back? Should a physician be forced to go back to a poorer treatment plant? I don’t think a jury will find me guilty of aiding and abetting or “medicine manufacturing” for just helping all the right things happen.

Today, I was able to discuss with a patient over the phone, their CBD/THC ratios on two different tinctures he had obtained as well as that increased Mercine, a Terpene, will make him drowsy. When I hung up the phone, I felt a new world had opened up; I had discussed the dose of a Terpene and the mg/spray of his tincture. WOW!

This is worth saving. I can’t think of anything better to do. I believe patients who take dosable cannabis medications seriously and are serious about their health insurance and other SWC potential benefits, should go to:

http://statewidecollective.org and sign up

AND AGAIN

TO DONATE TO A 501C3 putting every penny into research and improving and guarding dosable medicines, please help all of us.

Thank you all so much. We now have a volunteer social worker helping us.

I just spoke with a health insurance broker who informed me that if there are over 100 patients in a group, the policy that I PERSONALLY HAVE, would drop with Blue Shield from my current $850/month to under $400/month.

I will be meeting with a few more insurance underwriters and get back to all of you. If any of you specialize in this area, let me know and perhaps we can work together?

Another great reason for StateWide Collective or “co-op”

There is a patient of mine who is very ill and is stuck in the system. He is, I believe, clearly entitled to both Medical/SSI or Medicare and full disability.

I am offering all the medical care and follow-up work for no charge.

Any social worker out there available to help us?

Thanks,
Allan

Dean,

I am sure your assistant mentioned that I had called. Anyway, one of my patients saw you last year because I would not give him an illegal “grow certificate”, but you were happy to do so for 99 plants for over $200.

So, of course, now he is in trouble. He SHOULD have known better than to trust you and the ridiculous grow certificate, but he didn’t . However, for certain, you should have known and you in fact do know better. I can imagine you as greedy, but I can’t imagine that you are so ignorant of the laws that you truly believe YOU have the right to give any patient the right to grow 99 plants.

I have no right to expect any reply from you, as you have never been anything but rude to me. However, as you can see, I have copied a few of my friends who would also be interested in such illegal and unethical behavior. (in my prior email to Dr. Weiss)

I do hope you respond to us that you were “unclear about the law” and that you will never do that again. Well, I have not heard anything,so I am sharing my information. I redacted the patient information, but the patient requested I post this.

This is not a threat. This is a warning; if you stop what you are doing, I will back off. Frankly, I have felt like posting it all day, but am going to wait until the morning.

The reason I am so disgusted with you, is that I had to spend most of the weekend with this patient hopefully getting him a good lawyer and help with his defense.

BTW, I do the legal work pro bono.

This is definitely not slander, as it is true and I will post the “Nine-nine” note you wrote on this patient’s Rec. It is redacted and I have his written permission and actual encouragement as he trusted you.

You should really be ashamed, but I presume you are laughing. That is fine, as at least a few more of my friends and the 25,000 that read my blog every month, will know what kind of person you are.

Allan I Frankel, MD

Here is PDF of Rec with “Permission for ninety-nine plants)weissrecgrow