Don't Get High….. Get Well

Posts Tagged ‘md’

Peanut Butter   9 and counting

Marijuana           0

Please refer back to my recent post on “Open Source Cannabis” for background on this concept.

One of the most challenging issues facing cannabis research is where to begin to understand how or even which chemicals in cannabis cause an effect on symptoms. Unfortunately, at least at this point in time, medical cannabis for clinical trials is just not available. I can only hope this will change, but in the meantime, I believe we can get started with an intermediate survey type study – Open Source Cannabis.

The idea is to create a database of information that crosses patient testimonials on how strains treat their symptoms with the chemical breakdown of that strain from a Gas Chromatography machine.  Regrettably, it takes weeks to get the results from a Gas Chromatography machine.  During this time, the strain usually is distributed from the dispensary resulting in patients being unable to use the GC analysis information. Perhaps in the future, the market will require all growers to perform their own analysis on their strains or send them in for analysis, but as with research into this subject, that will not soon happen.

So, as to a solution for the time delay, what if when any strain is delivered to the dispensary, it is assigned a random ID by a database program. With this database, the dispensaries can logon to the system and get the ID for the strain and send it off for GC analysis.

When patients find a particular strain that really works very well for them, they logon to the database and enter basic symptom questions as well as the strain ID that would be stamped on the label.

Over time, as the GC results come back, they are tied back to the strain IDs.

This will enable two things:

1.As individuals have entered data on strains that work very well for them, they can see what combination of Cannabinoids and Terpenoids work best for them. Over time, they would select their medications based upon this information and not just a name such as “bubble gum kush” – which can mean anything.
2.The patient community data should yield interesting results as well. As patients give feedback on strains analyzed by a GC, I suspect we will begin to see some trends of cannabinoid and terpenoid benefits that we cannot even currently imagine.

I would really appreciate feedback on this one.

I don’t know how I missed this letter from Congress to the DEA. I generally don’t cross the “political” boundaries as a physician, but I really thought this would put a smile on your face. As you will find in the article below, Congress has sent a very tough letter to the DEA. Congress is waiting for a response from the DEA, but will be holding hearings regardless. It seems that our Congress is not very pleased with how the DEA has been handling itself in California.

I am very hopeful.

http://www.greenbridgemed.com/wp-content/uploads/2009/01/Conyers_DEA_Letter-1.pdf

Although not the first such study, researchers in Milano, Italy, recently presented a study on whole plant extracts of Cannabis formulations to treat neuropathic pain. If you’d like to read the study, please see the reference at the end of this blog.

After reading the results, researchers learned that extracting a single active ingredient from cannabis does not produce the ends desired. This is one more well designed, although “rat-based”, study encouraging us to realize that including all genetic variations of the whole plant in medications will probably produce better and safer drugs than extracting one cannabinoid at a time.

Researchers might not be achieving the effects they desire, but this might be the result of ignorance in the knowledge of manipulating cannabinoids, or it might be that the whole plant is in fact “the medicine”.  Certainly the ratio of the various cannabinoids in different strains will greatly vary, but at the very least we can say that overall, cannabis is an extremely safe medication.

http://www.ncbi.nlm.nih.gov/pubmed/18618522

I recently saw a 70 y/o male as a new patient. He appeared in all ways to be a street person and seemed a bit out of place. However there was something in his eyes that got my attention. His body seemed much older than his stated age, but his eyes reflected something still very much alive and I escorted him to my exam room.

He was arrested 33 years ago in the State of Georgia for possession of 1 gram of marijuana. He showed me his prison admission form as well as discharge papers. He spent 32 years in prison and was beatup on so many occasions that he had become crippled. We discussed his options with medical cannabis and he left.

He returned last week just to say thanks and show me how much better he was feeling. He didn’t say that this new freedom made up for his lost 32 years, but he did say it took a bit of the sting out of it.

I am pleased to hear that, at least in California, non-violent criminals are going to be released in larger number for financial incentives. Whatever the reason, I am grateful. Often very good things happen for the wrong reasons, but this is an acceptable compromise. :)

Most patients are reluctant to be open regarding how much and how often they use Cannabis. I always encourage my patients to be as honest as possible, as this is the best starting point in any doctor-patient visit.

Further more, if we are discussing treatment for anxiety, depression or ADD……..we are talking about Sativa strains during the daytime hours. In my opinion, the most significant issue with daytime medicating is related to the smoking. If patients are using sativa tinctures, which are ideal for daytime mood disorders, they are no different than any other patient using xanax, valium or vicodan out of a pill bottle during the day.

The smoking and smell during the daytime are generally just not acceptable. I encourage everyone to learn more about the daytime use of sativa tinctures/concentrates. They just seem so much more like “real medicines”.

A recent interest of mine has been to research ingestion methods of cannabis.  In reviewing a few articles regarding the various means we all use at times to medicate, the following list results: to smoke in one form or another, vaporize, eat edibles or tinctures.

Since edibles and tinctures are generally not inhaled and have no tar issues, I will place them aside for this blog’s discussion.

What I found most interesting, however, is that BONGS actually absorb substantial amounts of THC – up to 30%, (!), while allowing tar products through.  In other words, water is NOT a good filtration system for smoking Cannabis.

Joints, surprisingly, were better than any other smoking methods – other than vaporizing. Even placing a true “filter” on a joint, has similar effects to water. So, other than vaporizing, a loose joint without any filter, is next best.

Perhaps it is time to “sell short” on bongs??

More to come on Tinctures next week.

My Director of Education, Michele Nelson, answers this question:

Prior to 1937, cannabis and hemp in America was used as medicine and material for various industrial needs. One of the plant’s greatest industrial benefits to early American’s was that it did not rot in seawater, therefore enabling sails and rigging. This made hemp essential to the new American country – without it; America could not have a navy.  John Adams felt hemp was so vital to the creation of the new country that it was one of the first items on his to do list when riding to the Continental Congress.  He wrote, “Encourage the cultivation of hemp.” Every farmer was required to dedicate a portion of his or her farm to hemp production. As a medicine, cannabis was used from children’s pain remedies to relieving adult’s depression, anxiety, and pain. During the mid-1800’s, there were over 600 tinctures of cannabis available on the market from pharmaceutical companies well known today – Pfizer and Merck for example.

However, in the 1930’s two things happened that made hemp/cannabis illegal. One, a machine was invented that processed the hemp/cannabis without using the heavy manual labor needed in the past. Some called it a “hemp gin” like the cotton gin. Suddenly, hemp was not such an expensive fiber. At the time, Popular Mechanics magazine ran an article calling hemp “America’s billion dollar crop”. Industrialists began experimenting with hemp and discovered that it could be used to create plastics, was an excellent bio-fuel and was a strong fiber for paper.

At the same time hemp was being touted as a new raw material, the petrol chemical industry was emerging. The Dupont’s were at the center of this industry, discovering other uses for petroleum such as plastics and nylon. Also during this time, William Randolph Hearst the newspaper tycoon, needed to secure paper for his news empire, so he invested in forests for paper. Because hemp could replace both petrol chemicals and trees to make products cheaper, easier, (and it’s a renewable resource that many could profit from producing) these two families joined forces with former Alcohol Prohibitionist, Harry Anslinger to create and pass the Marijuana Tax Stamp Act in Congress.

Many consider the Marijuana Tax Stamp Act as “industrial espionage”.   At the time, marijuana was not a recognized name for hemp or cannabis and so the act was passed without the medical or farm community’s awareness. The tax stamp act gave the US government control over what farmers could plant and destroyed the cannabis pharmaceutical business. If farmers didn’t apply and receive a tax stamp, they were subject to fines and possible imprisonment for growing the plant. Cannabis/hemp production plummeted. Doctors begged Congress to allow cannabis to be used as a medicine, but they failed to overturn or even modify the Marijuana Tax Stamp Act.

Marijuana prohibition started because two families needed to have a monopoly on business. However, in today’s economic and environmental climate the prohibition that resulted from that decision might not be viable any longer.  Cannabis and hemp might be needed soon.

Michele Nelson, GreenBridge Director of Education

There has been some international uproar of late regarding the closure of some “coffee shops” in Amsterdam as well as the closure by local authorities of dispensaries allowing communal “medicating”.

Don’t get me wrong. I like the idea and freedom of being able to smoke in private clubs with a group of like-minded individuals. Perhaps in the future this will be the direction to head; however, it would have to be at a time when the political climate accepts the use of Cannabis for purely recreational reasons. Under today’s laws, using Cannabis for recreational reasons is clearly illegal, if only a misdemeanor in some states.

My problem with cafes, at least in the US, is that we are struggling to simply get Medical Cannabis accepted legally at regional levels as well as hopefully ultimately nationally. As a physician, I just can’t see the medical benefit of medicating as a group in a public setting. Until a lot more education and enlightenment occurs, It is just too hard to justify in the current setting and as far as I can see, for some time to come.

Alcohol is very different, and as far as I know, it is the only drug we use socially in public groups that are legal. At the same time, I just don’t know many – if any – physicians, including myself, who would be drawn into “prescribing” alcohol for a patient. Even in the waning years of alcohol prohibition nobody was pushing for Medical Alcohol!

So, I would prefer to keep Cannabis in the medical arena and out of the café world. Many of us need this medication for help with serious issues. Let’s all please be careful not to become insensitive to the big picture.

Open Source, the concept of sharing information, not for one individual’s benefit, but for the benefit of all should be applied to Medical Cannabis.  There is one critical piece of information patients and physicians are entirely missing with the current state of Medical Cannabis; we don’t know what we are medicating with.  Cannabis doesn’t come with a chemical breakdown – “a list of ingredients”.

When we purchase cannabis from a knowledgeable source such as a reputable dispensary, we are able to feel comfortable that we know if we are using a Sativa or Indica strain (my prior blogs explain why).

We know, however, that all Sativa strains are not the same. The same is true for Indica strains. What are the differences? There are differences in THC content, CBD content as well as dozens of other Cannabinoids. We are all unique as human beings, and so our needs are unique. It stands to reason that certain strains will work better than others for different people. This is common in medicating with all treatment modalities in medicine – from the current Western model of medicine to the Alternative and Eastern type models of medicine.

How about if we had a listing of the most important Cannabinoids on the bottle of Cannabis? That would allow each of us to evaluate over time which of the various Cannabinoids work best for us. At that point, we could be much more certain to obtain the correct strain as well as potentially the “perfect” tincture or “concentrate”. The Cannabis plants are extremely complex botanicals with over 400 ingredients including over 50 Cannabinoids.

I envision a genetic research center that would breed cannabis to genetically alter the strains IN THE GARDEN. The goal would be to obtain varied but known and reproducible strains of Cannabis.  We could all then share this strain information in centralized databases, much as we have learned how to share information in the world of Open Source Code; hence Open Source Cannabis.

So, would you patent something that currently has no value but is considered more dangerous than cocaine and heroin? Oh, and on top of that, it’s illegal.

I always encourage my patients to find Sativa/Indica tinctures. These generally come in some sort of spray mechanism or sublingual preparation.

There is a new drug indicated for “weight loss” – Rimonabant. It made it through trials but ultimately was not released.

The purpose of this drug is to block the effects of certain cannabinoids upon specific cannabinoid brain receptors, the CB1 receptors. Our bodies create natural or “endogenous” cannabinoids which stimulate hunger. Rimonabant was developed to do the opposite by inhibiting the “appetite stimulation” of cannabinoids. Many of us are familiar with getting the “munchies” – I guess you could say, Rimonabant is the ultimate “anti-munchy”.

We all also know that that cannabinoids improve our mood.

As the makers of Rimonabant discovered, while the drug blocks appetite as an inhibitor of the CB1 receptor, the blocking of these neurotransmitter functions also affects one’s mood. In fact, two of the hallmark clinical signs of Depression are the loss of appetite and severe drops in mood. Administering Rimonabant to patients resulted in numerous suicides and nervous breakdowns. You’ll be happy to learn that the trials on this drug have been suspended and it will not make it to market.

However, the failure of Rimonabant has resulted in a sort of “Tail Wagging The Dog” Clinical Trial scenario. This debacle has ended up confirming that Cannabis and Cannabis receptors play a major role in mood and appetite regulation. The Cannabinoids clearly increase both our appetite and mood. So, if a pill blocks these receptors both our appetite and mood are influenced.

This is more evidence that the Endo Cannabinoid system, or ECS plays a major role in how we all feel. Cannabis clearly effects mood and in my opinion is a very sophisticated and powerful mood enhancer.

In many of my appointments, I tell patients, “Imagine the room you are currently in, represents ‘how you are feeling’. The floor represents the most depressed moments of your life and the ceiling represents the highest and most out of control state you can imagine. Would you agree we are all somewhere approximately 1/3 of the way up the wall?”

When they see my point of view, ALL want to increase where they are on the wall by 25% or so. So often, everything patients do in their lives is to get this bump in how they feel. When they are feeling a bit better, they are aware of the change and often do not know even why they are doing better.

I go on to explain to my patients that many Sativa strains of Cannabis are very helpful with anxiety and depression. I caution, however, that there are many instances where Cannabis alone is inadequate to control psychosis, but this is to be decided between the patient and physician. Regardless, Sativa strains make most people feel more awake, alert and happy while remaining focused – all characteristics that patients report ‘moves them up the wall that extra amount’.

Once I have educated patients that their symptoms will be addressed using cannabis, I explain that it is the THC and Sativa Cannabinoids working on our Cannabinoid receptors in addition to increasing the production and decreasing the destruction of Serotonin that makes us feel so much better. So, are we all a little depressed? Does the Endo Cannabinoids Deficiency Syndrome really exist and we are medicating to normalize our internally low levels of Cannabinoids? Perhaps the mood changing effects of Cannabinoids to varying degrees function in a combined state as both direct and indirect neurotransmitters? This is what I believe is the most likely scenerio.

I don’t often just give out “links”, but the link on NORMAL is just too fantastic not to share. Do yourself or your friends a favor and check out:

Diseases treated with Cannabis.