Check out my recent interview with Winnipeg Free Press on cannabinoid medicine as an exit drug for patients on opiates. I go on further by advocating for our Canadian governments to avoid increasing taxes on medical cannabis, thus making it harder for patients to afford their medicine.
Cannabidiol (CBD) is a phytocannabinoid found in moderate to high concentration in a variety of cannabis strains (note it is also found in the hemp plant on it’s own). Over the past few years it has become a very popular option for the treatment of a variety of medical conditions. The best part about CBD is that it does not cause impairment. It does not lead to a high or euphoria like THC (tetrahydrocannabinol) can cause and thus has reduced side effects. CBD came to fame mostly by helping children with treatment resistant epilepsy. None more famous than Charlotte’s Web, a specific strain designed for a child with Dravet Syndrome, a very serious seizure disorder that often leaves children debilitated and cognitively impaired. You can learn more about Charlotte’s web and Charlotte’s miracle with CBD here:
To date I have been fortunate enough to help close to twenty children with debilitating seizure disorders like Charlotte. We have had mixed results with CBD on various seizure disorders but on average we are seeing 50%-75% of seizure patients having significant improvement with seizure reductions. Among these children are ones who have had near 100% improvement in their seizures and general well being. It is by far the most rewarding experiences I have had as a physician.
In addition to acting as an anti-epileptic medication, CBD has also been found to have numerous other benefits such as:
In my clinic I am using CBD as much as possible to alleviate chronic pain, anxiety, MS related spasticity and arthritis to name a few conditions. To date the success has been excellent with many patients reporting reductions in chronic symptoms and improvement in quality of life. The best part about CBD is that the side effects are minimal or non-existent. Very few patients have reported side effects and most are manageable. There are side benefits as well with CBD, such as many patient reporting “mental clarity” and “enhanced energy” when consuming the product.
If you are new to cannabinoids or looking to alleviate symptoms without getting potential cognitive side effects, CBD is the your best option. If you want to learn more about this amazing phytocannabinoid, I recommend heading over to https://www.projectcbd.org/. We still have so much to learn about the potential of CBD on diseases and hopefully more research will be produced in the coming years to understand if indeed this has the potential to a blockbuster wonder drug.
I had a chance to catch up with Stefanie Masotti of CTV news Windsor to discuss my work and life’s passion: cannabinoid medicine. Check out my interview below:
A Tecumseh area physician is dedicating his career to awareness about cannabinoid therapy. Stefanie Masotti has details.
Article first appeared on Lift news – https://news.lift.co/canadas-not-universal-health-care
After 16 years of medical marijuana programs, still no pharmacare for cannabis-based medicine
“In July of 2001, Health Canada established the country’s first regulatory system for legal medical cannabis, formally acknowledging the plant’s efficacy as a medicine. More than a decade and a half later, Canada’s national health care infrastructure has yet to list cannabis and its derivative medicines for the same insurance coverage granted to other medicines and treatments. While insurance administrators drag their heels, Canadian families are struggling to pay medical bills out of pocket.
This lack of coverage is causing one family in North York, ON, to rely on a crowdfunding campaign to pay for their 2-year-old daughter’s anti-seizure CBD treatments. Delilah Krupka was born with cerebral palsy (CP), caused by a single vein having developed too small in her brain before birth, leading to a stroke in utero. For the first year of her life she suffered from repeated seizures and spasms—as often as 50 spasms per hour, every day.
Delilah’s parents and doctors attempted traditionally prescribed treatments, but all of the anti-seizure medications they tried that were covered by Ontario’s pharmacare came with side effects including loss of appetite, which is crucial to any infant, and especially so for an infant in recovery from a prenatal stroke and developmental disorder. As a result of one of her previous prescriptions (a bitter medicine administered by sprinkling on food) she also developed an aversion to food itself, and now has to be fed by feeding tube to ensure she receives enough energy and fibre to survive.
After celebrating Delilah’s first birthday during a month-long stay at the SickKids Hospital in Toronto, her mother Bella met the parent of another child who suffered from CP, and who had found success in treating the condition with CBD oil. Bella consulted with Delilah’s physician, and reached out to Dr. Michael Verbora, medical director at the Cannabinoid Medical Clinic.
A short time after beginning CBD treatments the frequency of Delilah’s seizures and spasms both saw significant reductions, from 50 spasms per hour to just 20 spasms per day on average, as well as secondary benefits as a result of the reduction in seizures.
“Delilah has developed better in the 7 months since starting CBD treatments,” said Mrs. Krupka, “than she had in the rest of her two years.”
The universe is waiting
CBD coverage is just one aspect of a larger universal pharmacare discussion that has long been called for by provincial and federal constituents. Canada is often lauded by US lawmakers for its comprehensive health care system, highlighting its contrast from the American status quo of families going bankrupt when loved ones injure themselves or are diagnosed with medical conditions. But there’s one area of health care coverage in which Canada remains as stagnant as its southern neighbour.
Among the 62 countries worldwide that have instituted universal health care, Canada stands out as the only developed nation that has not yet instituted universal pharmacare as part of its health care umbrella. So when the Krupkas saw the results the new CBD treatments had for their daughter, they were dismayed to find the medicine was not covered by either their provincial health care or Delilah’s father’s employee benefits.
Faced with the choice of returning to the previous treatments that are covered by pharmacare, knowing it would likely mean a return to nearly one spasm per minute for Delilah, or somehow finding an extra $700 per month to cover her medicine, the Krupkas decided to follow the lead of countless Americans similarly neglected by their country’s lack of coverage: they started a GoFundMe campaign.
So far the campaign has raised enough money to cover a little over a year’s worth of CBD treatments, but Delilah will require more frequent, higher dosage treatments as she grows in size and as she transitions off other medications.
Currently Delilah requires five anti-seizure medications and one hormone treatment for a separate thyroid condition. All but the CBD treatment are covered by Ontario’s pharmacare and Irek’s—Delilah’s father’s—employee benefits. After seeing the improvements in Delilah’s condition as a result of replacing previous treatments with CBD oil, the Krupkas are eager to further reduce the remaining prescriptions (and their respective side effects). But that may require increasing the dosage of CBD, which is thus far financially out of reach for the family.
One recent case that came before a human rights board in Nova Scotia may have made a significant leap forward for cannabis coverage in Canada. An inquiry in February of 2017 resulted in the ruling that the Canadian Elevator Industry Welfare Trust Plan, which provided insurance to Nova Scotia resident Gordon Skinner, violated the province’s Human Rights Act when it denied Skinner’s claim for coverage of his legally issued medical cannabis.
“Denial of his request for coverage of medical marijuana,” declared the ruling, “amounts to a prima facie case of discrimination.”
The insurer was ordered to cover Skinner’s cannabis expenses in full.
While most Canadian underwriters are leaving their customers out in the cold for cannabis coverage, two insurers are leading the charge on progressive coverage policy. In 2016, Sun Life and BMO Insurance became the first insurance companies in Canada to grant coverage for medical cannabisexpenses, and have already started paying out claims.
University of Waterloo student Jonathan Zaid was one of the first to receive cannabis coverage through his student union health plan, with Sun Life having reimbursed roughly $2,000 for cannabis and a vaporizer he had purchased the previous year.
Although some Canadians are starting to be covered, that’s a far cry from the average Canadian having the comfort and security of knowing their health care will be assured should they fall ill, be injured, or otherwise find themselves in need of costly medical treatments.”
Written by: Scott Johnstone
I meet patients daily who claim cannabis helps them with their anxiety. However, many physicians will claim that cannabis actually worsens anxiety. So which group is correct, patients or doctors?
Well it appears to be that both are correct.
Anxiety is an extremely common medical issue. About 25% of Canadians at some point will suffer from an anxiety disorder (Stats Can). Anxiety is a state where one feels constant worry that is greater than what an average person would experience. Anxiety can be protective at times. Think about when you’ve had anxiety before an exam or big game. In these moments, anxiety can help motivate us to better prepare. Chronic anxiety or high levels of anxiety over a long period of time however, cause impairment in our day-to-day functioning. It can lead to isolation and avoidance. It causes many people to call in sick to work or to avoid activities and social events. There are many types of anxiety disorders. The most common ones include: Generalized Anxiety Disorder (GAD), Obsessive Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), Social Anxiety Disorder or Phobias (fear of specific things such as spiders or heights). Risk factors for anxiety include: family history (genetics), environmental factors, chronic stress and chronic disease.
During anxious moments, or a chronic state of anxiety, the brain is undergoing neurotransmitter changes that involve dopamine, serotonin, GABA and noradrenaline. This leads to a state of arousal physically and can lead to panic symptoms which include chest pain, chills/hot flushes, fear of losing control, light-headedness, a racing heart, numbness/tingling, trembling or sweating. What is interesting to the field of cannabinoid medicine is that recent research has demonstrated that the endocannabinoid system is also directly involved in stress and anxiety (Tulane University).
Based on the research done at Tulane University, and published in the Journal of Neuroscience, when our bodies feel stress they produce cannabinoids (see here to learn the basics on cannabinoids) which acts on the emotional centers of our brain, the amygdala. This type of cannabinoid may actually lead to worsening stress based on the mechanism of action.
On the other hand, when we consume phytocannabinoids (plant based cannabinoids), particularly THC, the amygdala (the fear center of the brain) experiences a relaxation and calming of neurotransmitter release, or which we experience as reduced stress or anxiety. This is how THC can help anxiety. Interestingly, the phytocannabinoid ingredient CBD can also help anxiety given it works on serotonin pathways just like many of the antidepressants we used today (called SSRIs). So when patients state that using cannabis helps relieve their anxiety, there is a biochemical model that supports this subjective experience.
But why are doctors so worried about worsening anxiety with cannabis? How can they also be correct in stating that cannabis causes worsening anxiety? Well the answer lies in dosage. There is a saying that goes “a small tincture is medicine, too much is poison”. Researchers at the University of Illinois and Chicago, discovered that low dosages of THC leads to a reduction of stress in a public speaking task (see study here). When a higher dose was given and there was a reported “high” there was worsening anxiety. Today many experts in the field believe that the key to helping medical ailments with cannabis relies on microdosing. Using small amounts of THC has been very effective in alleviating symptoms for patients.
Based on my experience there is still a lot more to learn about cannabis and anxiety. Through my observations I have learned that sativa dominant strains likely worsen anxiety given they have specific terpene profiles that lead to increased energy. Anyone knows that given energy to an anxious person worsens their anxiety. In my experience, indica dominant strains with high myrecene levels, can lead to a reduction of anxiety. Putting all of this together the best medical advice I can give anxious patients is to use very low dosages of THC and stick to indica strains. Also always try to use CBD strains as this is likely going to be proven in the future to be better at controlling anxiety than THC. Too much THC will lead to worsening anxiety and a higher reliance on cannabis.
Future research will lead to better insight into specific strains, terpene profiles and dosages. Boosting your natural endocannabinoid system through running, yoga and meditation can also reduce anxiety and should always be used first prior to any medication.
Interested in learning more about medical cannabis? Check out my presentation to the government of Estonia on medical cannabis.
Access to regulated cannabis that has controls in place is important if it is being used as a medicine and being prescribed properly by a physician. While North America has been experiencing a green rush, many other patients across the globe still do not have access to regulated medical cannabis. Dr. Michael Verbora (medical director of Canabo Medical Corp and physician lead of the Toronto Cannabinoid Medical Clinic) was invited to the Estonian parliament (Riigikogu) earlier this month to present on Canada’s world leading medical cannabis system after an online petition in Estonia garnered more than 1000 signatures to address cannabis.
In the end of July, 2016, two petitions regarding medical cannabis garnered enough signatures to trigger government evaluation. One of the petitions, initiated by Aleksander Laane of the Estonian Green Party, focused on the medical side of cannabis regulation only, and demanded five things: 1) that the government develop guidelines for medical cannabis growing, preparing/processing, and sale in pharmacies based on the best examples from abroad; 2) that herbal cannabis be removed from Schedule I of narcotic drugs to Schedule III of the same, and that additional regulations be developed to allow for use of medicinal cannabis that do not mimic similar regulations set in place for medical use of opium and opioids; 3) that the process of prescribing both herbal cannabis as well as cannabinoid preparations be simplified in a manner similar to how Canada, Germany, the US, Israel and other countries have done it or are planning to do; 4) that herbal cannabis as well as cannabinoid preparations be made instantly available to patients with relevant prescriptions; and 5) that the state stop penalizing people for simple possession and use of cannabis.
The second petition, by private citizen Elver Loho, consisted of three standalone proposals. The petition, titled “Suggestions to the Parliament for better regulation of the cannabis market,” proposed that: 1) Estonian enterprises be allowed to produce cannabinoid medicines for export, in the same way they are allowed to produce mainstream psychoactive medicines and precursors, to be sold on the international market; 2) that the Minister of Health should decree that THC be moved from Schedule I of Narcotic Drugs to Schedule II to make it easier for doctors to prescribe THC-based medicines; 3) that the government initiate a pilot study into a heavily controlled and regulated recreational cannabis market model, whereby doctor-approved adult citizens would be allowed to buy and consume strictly tracked limited amounts of recreational cannabis on the premises of heavily regulated and screened cannabis consumption facilities.
While the petitions were gathering signatures, the Estonian Medical Cannabis Association (MTÜ Ravikanep) compiled a concise compendium of evidence-based information on cannabinoid medicine and medical cannabis regulation, containing a piece of original research—results of an anonymous survey into the unlicensed medical use of cannabis in Estonia—which was published in the fall of 2016, at the same time as both petitions reached the necessary minimum amount of signatures, but before the dates for the first session of the parliamentary commission were set. The evidence of effectiveness of medical use of cannabinoids cited in the compendium is mostly based on the Health Canada medical cannabis monograph of 2011.
The Parliamentary Commission on Social Affairs first gathered to discuss the medical cannabis related proposals of both petitions in February of 2016. The petitioners met with stern resistance to any liberalization of the procedures for prescribing medical cannabis and cannabinoids, especially on the part of the Estonian Doctors’ Association. The main objections by Estonian doctors to easing regulation, or even to simply starting to prescribe cannabinoid medicines in the legal framework that’s currently in place, are that: they don’t know enough about cannabinoid medicines and their nonconventional routes of administration, especially with regards to cannabis flos (Bedrocan’s herbal preparations), to confidently prescribe them; that the medications available on the market, especially Sativex, are prohibitively expensive; and that doctors don’t want to be “keepers of the key to the narcotics vault.”
In order to assuage these fears, and to demonstrate that safe, efficient, evidence-based cannabinoid treatments are actually feasible and in many cases preferable to other treatments, the petitioners, in tandem with the Medical Cannabis Association, started looking for a foreign expert. I was contacted and agreed to travel to Estonia to present to the Parliamentary Commission. The Medical Cannabis Association was able to crowdfund over 3000 euros in less than one week to support this visit.
While in Estonia, I met with patients to answer questions about my practice and cannabinoid medicine in general. One of the national commercial TV broadcasters, Kanal 2, made an hour-long in-depth feature for a current issues program Radar, which will be aired in the beginning of May 2017, featuring interviews with myself, the petitioners, some patients and commission members. Patients with brain cancers (or other cancers), patients on chemotherapy, and people living with chronic pain attended a meet and greet and shared their stories and how Cannabis helped ease their pain and suffering.
I attended the Estonian Parliamentary Commission on April 11, 2017 to present on the Canadian Cannabis system and the expertise of Cannabinoid Medical clinic physician, and demonstrated patient outcomes and medical evidence supporting the use of cannabis.
To date, the Social Affairs Commission has yet to make any definitive decisions regarding medical cannabis in Estonia, but the head of the Commission, Mrs. Helmen Kütt, said to a reporter that they have asked the State Medical Board to explain the reasons for the current double classification of THC/dronabinol into Schedules of Narcotic Drugs I and III, and will look into simplifying the process of prescribing and acquiring not just cannabinoid-based medications, but all medicines that aren’t licensed to be sold in Estonia.
Unfortunately, patients using medical cannabis in Estonia are not getting proper medical advice, expertise or supervision on the use of cannabinoid medicines. Their government often views them as criminals rather than patients trying to heal their suffering. Hopefully, countries like Estonia will develop evidence-based approaches to prescribing cannabinoids and consider changing regulations so patients can palliate their symptoms with peace of mind.
This Article was first posted on Lift News
Canabo Medical Inc. observational study finds nearly fifty per cent drop in benzodiazepine use within months of cannabis treatment
TORONTO, ON – (April 7, 2017) – Today, Canabo Medical Inc. (TSX-V:CMM) (OTCQB:CAMDF) (“Canabo” or the “Company”) released the results of a new, landmark observational study that connects doctor-supervised medical cannabis treatments to a sharp drop in benzodiazepine reliance among Canadian patients.
Research conducted over the past year revealed that 40 per cent of patients who were prescribed medical cannabis to treat pain and anxiety eliminated the use of benzodiazepines within 90 days. That percentage increased to 45 per cent within a year of cannabis treatment. The findings were announced by Dr. Neil Smith during a presentation at the Canadian Consortium for the Investigation of Cannabinoids (CCIC) event in Toronto.
Canabo, which operates 15 cannabinoid clinics across Canada under the brand CMClinics, partnered with a consortium of medical research experts to analyze data from more than 1,500 patients with the aim of understanding how cannabis interacts with or lessens the need for pharmaceutical treatments. Preliminary findings in late 2016 indicated a downward trend in benzodiazepine use – a trend that was confirmed after additional investigation and included in the Reduction of Benzodiazepine Use in Patients Prescribed Medical Marijuana report. The team responsible for the peer-reviewed report has shared their findings with several Canadian medical journals and details are expected to soon appear in the Dalhousie Medical Journal.
In Canada, 10 per cent of the general population use benzodiazepines daily, with common side-effects such as sedation, dizziness, drowsiness, unsteadiness, headache and memory impairment. Long-term benzodiazepine use is also associated with complications including problems with concentration, tolerance, addiction and overdose.
“We wanted to take a close look at the likelihood of continued benzodiazepine usage after commencing medical cannabis treatments and to be perfectly honest, the results are extremely promising,” said Dr. Neil Smith, Executive Chairman of Canabo. “When conducting this type of research, experts are typically encouraged by an efficacy rate in the neighbourhood of 10 per cent. To see 45 per cent effectiveness demonstrates that the medical cannabis industry is at a real watershed moment.”
Augmenting pharmaceutical regimes with cannabinoid treatments
The study isolated a group of 146 patients from a database of individuals being treated for a wide variety of pain and other disorders for approximately one-year. Each patient was referred by a primary physician or specialist and thoroughly assessed by CMClinic’s own doctors before being prescribed cannabis as supplemental treatment. Additional patient details include:
- The average age of the sample of patients using benzodiazepines on initial contact with the company is 48 years-old
- Nearly 43 per cent (42.9%) of that group report a work status of either temporarily or permanently disabled
- Nearly 60 per cent (59.9%) of the patients are female
- Those individuals taking benzodiazepines have primary conditions that are representative of all CMClinic patients
- Well more than half (61.3%) are primarily interested in treatment for a pain condition, 27.4 per cent for a psychiatric condition and 11.3 per cent for a neurological condition
In all cases, patients remained under the care of the referring doctor and all were examined in detail to understand the effect of cannabinoid treatments on benzodiazepine use.
Canabo is also collecting data as to what extent cannabis serves as a substitute or effective complement to traditional opioid therapies and today’s report is expected to be the first in a series that examines the role of cannabis in modern therapies.
“To say that we’re encouraged is an understatement but there’s a lot of work still to be done,” added Dr. Smith. “We hope to conduct formal trials both in-house and in collaboration with others pending further analysis of what we believe to be one of the most promising advancements in many years.”
Today I’d like to pass on some knowledge that I have gained from both researching the medical evidence and from my own personal experience prescribing medical cannabis. The topic, helping patients with chronic pain.
Let’s start by defining the problem; chronic pain is any pain that has been present for at least three months. This term can represent one or more different types of pain which can be divided in three main categories: nociceptive pain, neuropathic pain and sensory hypersensitivity (see image below for our visual learners). Most chronic pain tends to be neuropathic in nature, meaning the peripheral and central nervous system is involved in producing pain. Common chronic pain disorders include: prolonged muscle/skeletal pain, chronic low back pain (mechanical), nerve entrapment syndromes (ie: carpel tunnel, sciatica, neck impingement), diabetic neuropathy, HIV neuropathy, post-operative pain, complex regional pain syndrome, osteoarthritis, inflammatory arthritis (ie: rheumatoid arthritis, lupus, ankylosing spondylitis), chronic headaches (ie: migraine, tension, cluster), and fibromyalgia just to name only a few. It has been declared a human right, according to the World Health Organization, to have access to pain treatment (http://apps.who.int/medicinedocs/en/d/Js18774en/). Despite our knowledge and access to therapy and medications, it is well known that pain is poorly managed in Canada (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084407/). Many are calling for a national pain strategy to solve this problem.
Ok, so now that we have an idea of what the condition is, why is this such a hot topic right now? Chronic pain is a health epidemic and economic burden for society. In Canada, it is estimated that almost 19% of people over the age of eighteen suffer from chronic pain (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298051/). Over half of these patients report suffering lasting more than ten years. In America, more people report suffering from chronic pain than diabetes, heart disease and cancer combined (https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=57). Patients with chronic pain also have three times the average risk of developing psychiatric symptoms such as mood and anxiety disorders. Furthermore, patients who suffer from depression also have three times the average risk of developing chronic pain (http://www.health.harvard.edu/mind-and-mood/depression_and_pain).The combination of these conditions can lead to significant disability in patients. Given that mood disorders and chronic pain conditions commonly go hand in hand, we often see physicians using psychiatric therapies (medications, psychotherapy, etc) to help patients with chronic pain.
Physicians treat patients with pain on a daily basis. Chronic pain can be frustrating for all parties involved given that there is often not a complete, permanent or quick fix for the pain. Physicians often think of treatment in terms of medical, surgical, psychological/psychiatric (ie. cognitive-behavioural therapy), lifestyle (ie. exercise, Yoga, meditation) and rehabilitation. It is important to note that when looking at certain medical therapies, a “success” is often defined by only 30% reduction of symptoms, and the goal is often to make the pain tolerable enough so the patient can take care of themselves independently as opposed to complete pain resolution. Surgery, despite all of the advances we are making, alleviates only very few chronic pain conditions. Rehabilitation may help but often pain relief is temporary, expensive and there is very limited coverage. Getting back to medical therapy, physicians tend to rely on prescription medications to help decrease pain and improve functioning. There are a variety of classes of medications physicians will utilize and combine: anti-inflammatories (ie: Advil/Ibuprofen, Naproxen, Celebrex), neuropathic agents (ie: Lyrica, Gabapentin, Cymbalta, Amitriptyline), opiates (ie: Codeine, Oxycodone, Percocet, Morphine, Hydromorphone, Fentanyl), and recently a more common form of treatment, cannabinoids (ie: herbal cannabis, Nabilone, Sativex)..
Many pharmaceuticals are supported by physicians given they have more research at this point in time compared to that of cannabis. It is important to note, that whenever medications are being used, particularly in combination, there is the potential for side effects. In my personal experience, patients are reporting that cannabis has been far more effective than traditional pharmaceuticals for their pain. They often report this being the “very best” medication they used with the “least” amount of side effects. Note: I said least, not devoid of, side effects. Outcomes have been quite tremendous with many of them getting off numerous prescription medications and have improved functioning. I suspect in the years to come the research will begin to better match what I am witnessing on the front lines.
So how is Cannabis different? Cannabis just works differently from the other medications for pain. First, in terms of herbal cannabis, it is plant-based which contains multiple ingredients that work synergistically to produce an effect (see my previous post for more on cannabis ingredients) compared to pharmaceuticals which is often a single standardized ingredient. This makes cannabis much more complex to study and also means there is a bit of an art combined with trial and error to find the best mix of ingredients to improve symptoms. I often describe to patients that “THC can help with the pain coming from the brain”and “CBD can help with the pain coming from the body”. This is an oversimplification of what these ingredients do but does the job of explaining the differences between them. The components of cannabis lead to a reduction (though, like the other medications, often not complete elimination) in reported pain via multiple ways such as muscle relaxation, inflammation reduction, blocking nervous system pain signals (neurotransmitters) and regulating the immune system. Patients often tell me, “I feel relaxed, and at ease. My mind is also distracted from the pain. My body feels less tight and my thoughts are less intrusive or produce less of an emotional response. I can look at my pain from almost a different perspective. When I use cannabis I can function better”.
Based on thousands of patient conversations with chronic pain patients, I do believe cannabis is working than many other pain medications. I also consider it to be safer than many other medications, especially CBD-derived cannabinoid products that do not cause cognitive impairment. Anti-inflammatories can lead to ulcers, heart disease, hypertension and kidney disease. Neuropathic agents can lead to weight gain, “brain fog”, sedation, drowsiness and mood changes. Opiates, well don’t even get me started. We have created an opiate epidemic that causes close to 20,000 deaths in the United States a year. Once started on opiates many patients become dependent and require escalating, sometimes unsafe, dosages. In my practice I do not prescribe opiates for chronic pain given these risks and lack of evidence on their efficacy for chronic non-cancer pain. Don’t get me wrong: all of these medications do have a time and place with research to back them up for specific conditions. But, I continue to see a high percentage of patients failing these options or not tolerating the side effects. Cannabis on the other hand has zero deaths and is typically well tolerated. It is by no means benign but generally safe for most people. It can also be easily combined other pain-control therapies to help treat the patient’s condition so it is definitely not a be-all end-all approach. Some other pros: addiction and dependence are far lower compared to opiates, and withdrawal from cannabis is typically mild. On the flip side: psychosis and paranoia is a real risk, but this only happens in an extremely small subset of people and can be avoided with proper education and counselling by an experienced physician. Patients often report side benefits, not side effects. In addition to reduced pain patients often feel less anxious, report improved sleep, improved intimacy, feel happier and have improved quality of life. There still remains much to be discovered about cannabis and funded research will help to paint a more accurate picture of the medical uses of cannabis.
I expect in the future we will be more aggressive in using cannabis earlier to help patients, rather than a last line therapy as is is often suggested as in medical guidelines. There is a gap, mind you a closing one, between observational front line data and medical evidence. Companies like Canabo Medical Corp will publish studies to help people draw more accurate conclusions around cannabis as a medicine. As we begin to isolate ingredients in the plant, and bring over pharmaceutical technology to cannabinoids, patients will have a portfolio of cannabis derived medications available to them to help alleviate their pain. The future looks GREEN for pain management and I am excited to be part of this change.
1 – http://www.kirbyknoxmd.com/wp-content/uploads/2016/02/You-Are-Leaving-Pain-Sign.jpg
2 – http://www.rethinkopiods.com
3 – http://www.statcan.gc.ca/pub/82-229-x/2009001/c-g/c-g-4/ch4_graph6.2-eng.jpg
4 – http://www.integrativeoncology-essentials.com
5 – http://www.businessinsider.com
There is a lot of confusion and misconception regarding how cannabis works on the body and mind. I thought I would take a second to explain and clarify some of the misinformation.
What is quite fascinating is that our own bodies produce “cannabis-like” molecules which we call endogenous cannabinoids. These cannabis-like molecules then enter the brain and immune system (primarily) and go to work regulating: appetite, mood, inflammation, cardiovascular functioning, metabolic homeostasis, sleep and pain perception. This system is necessary for our survival. What’s fascinating is that even small nematodes have these endogenous cannabinoids in their body.
Our cannabis molecules act on a system in our body known as the endocannabinoid system. The system has receptors in the brain, immune system and is also found throughout the body lining our organs and skin. When endogenous cannabinoids bind to these receptor areas one begins to experience the benefits of cannabinoid therapy. As you read this article your body is at work making these cannabis-like molecules. We also know that the “runners high” many people report is part of your body releasing larger amounts of endocannabinoids. Yoga and meditation can also boost endocannabinoids. It is no wonder I often prescribe exercise, meditation and yoga to all my patients as part of healthy living. It is part of developing and promoting a healthy endocannabinoid system.
Nature seems to have created the cannabis plant which is far more complex in cannabinoid options than our own bodies can produce. The cannabis plant has closer to 100 cannabinoids compared to our own bodies which make closer to 10 (known to date). The most popular plant cannabinoids are THC (tetrahydrocannabinol) and CBD (cannabidiol). These two are also likely the most medicinal ingredients in cannabis strains given their higher concentrations compared to other ingredients. I like to call cannabinoids level one ingredients in the plant. There are other ingredients known as terpenes and flavonoids, which I call level 2 and level 3 ingredients, respectively. They are also important in producing varied medicinal effects but I will save that for a different discussion. More commonly we appreciate the aromas and colors they produce in the cannabis flower. See below for some terpenes commonly found in the cannabis plant and appreciate the overlap we fine throughout nature.
When a patient chooses to boost their endocannabinoid system through medical cannabis they are enhancing the effects of their bodies own system with plant cannabinoids. This leads to both mind and body symptoms.
In the brain THC will bind to receptors and lead to deep relaxation, reducing of nerve pain, muscle spasms, reduce pain/inflammation and boost our appetite. THC is also what is responsible for the “high” or euphoria people experience. THC is the ingredient that produces some side effects including: sedation, dizziness, dry mouth, short-term memory loss and a racing heart. Sometimes THC combined with specific terpenes (level 2 ingredients) can cause a racing heart and energy which can make someone feel anxious, paranoid or in rare circumstances hallucinate. This side effect can be eliminated or minimized if a patient is educated well by a knowledgeable physician on which strains to avoid if they are at risk for this side effect (not everyone is at risk for this side effect). Side benefits often reported are happiness, creativity and mental clarity.
CBD on the other hand works more on our body and allows our body to make more serotonin and boost our own endogenous cannabinoids. Interestingly, CBD can block some of the THC from working. CBD is responsible for muscle relaxation, reducing inflammation, stimulating bone production and can improve seizures. CBD does not have the side effect of producing a “high” or euphoria. In fact there are very few reported side effects from patients taking pure CBD (sometimes a bit of fatigue/drowsiness but even this is rarely reported). CBD is being used more commonly today as an anti-anxiety, anti-depressant and being researched as an anti-psychotic. It may have great utility in mental health disease. It can help patients with chronic pain as well, but in my experience it does not always work for these patients. A combination of THC and CBD seems to work best for the majority of pain conditions.
When I meet patients and prescribe cannabis I try to selectively determine which ingredients or combination of ingredients will be best for them given their condition, medical history and medications. I combine all of this information to produce a very personalized and custom treatment plan designed to improve their health and well-being. There is still experimentation that is often required and no two patients require the same mix of cannabinoids. In Canada, we have a licensed producer system which regulates cannabis production and distribution. The benefits to me as a physician is I can control the THC and CBD amounts patients receive given the regulatory framework in place. This is important when using cannabis as a medicine. As a medical doctor I do not ignore that sometimes pharmaceuticals can be better than cannabis for various conditions and I still recommend these when appropriate.
I hope you feel more knowledgeable on how cannabis work on your mind and body. Drop a comment below if interested in discussing further. Don’t forget your run or yoga session today to boost your endocannabinoid system!
- Cannabinoid MD