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 certainly don’t understand this hypocrisy/greed, but I am not surprised. The government is looking into licensing this patent to companies who can then develop “real” medications and pay fees to the Feds. I think this is really pretty funny. However, I will only laugh when the Feds de-criminalize Cannabis so they can license/sell their patent. I will also laugh a lot easier if they leave some of the THC in the medication.

I always encourage my patients to find Sativa/Indica tinctures or other concentrates.  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. 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 “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 certain neurotransmitter functions, 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 “Dog Wagging the Tail” Clinical Trial scenario which 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 internal Cannabinoid system 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.