Cannabis and Alcoholism

The information in this blogpost comes from Martin Lee, Alcoholism and the Endocannabinoid System.

Cannabis decreases damage to our bodies associated with ingesting alcohol.

1. Cannabis is a neuroprotectant: Cannabis minimizes cell death in the brain associated with overconsumption of alcohol.

In 2009, the journal Neurotoxicology and Teratologypresented clinical data indicating that compounds in marijuana helped to “protect the human brain against alcohol-induced damage.” This study, conducted at the University of California in San Diego, found that adolescents who smoke marijuana may be less susceptible to brain damage from binge drinking.

Five years earlier, researchers at the National Institute of Mental Health demonstrated that cannabidiol (CBD), a significant nonpsychoactive component of marijuana, functioned as an “in vivo neuroprotectant... in preventing binge ethanol-induced brain injury.” CBD reduced alcohol-induced cell death in the hippocampus and the etorhinal cortex of the brain in a dose-dependent manner by 60 percent.

Cannabis and Cancer: Studies Show…

1. Cannabinoid receptors and neurotransmitters are upregulated in tumor tissue.[1], [2]

Studies show that cancer cells contain more cannabinoid receptors and endocannabinoids. In other words, tumors are sensitive to (one might even say our bodies are looking for) cannabinoids.

2. Cannabis addresses both cancer causes as well as its symptoms.

  • Cannabis not only hinders the growth and metastasis of tumors, but it has been shown to actually shrink tumors.[1], [3]

Studies show cannabis prevents cancer cells from multiplying and spreading, it prevents the formation of new blood vessels to nourish cancer cells, and it induces cell death in cancer cells.

  • Cannabis helps decrease nausea, increase appetite, and decrease pain in cancer patients.[4], [5]

“Cannabinoids… may exert palliative effects in cancer patients by preventing nausea, vomiting, and pain and by stimulating appetite.”[5]

Cannabis and Sleep

Miscellaneous Information about Cannabis and Sleep

Low-doses of CBD have a stimulating effect, while high-doses of CBD have a sedating effect.[1] So if you use CBD for sleep, make sure you take a high enough dose.

Sleep problems are often multifaceted. The best solution — THC, CBD, or both — depends on the cause of your problem.

Cannabis and Sleep Cycles

During the course of an eight-hour sleep period, a healthy sleeper should cycle through the different sleep stages every 90 minutes or so:[2]

Cannabis in Nursing Homes

Outstanding podcast on cannabis in nursing homes from The Brave New Weed: https://www.bravenewweed.com/all-episodes/ep54
The relevant discussion starts at about 22:20. Issues discussed include:

  • The pioneering use of cannabis in nursing homes in Israel, with a clinic just now opening in Beverly Hills.
  • The use of THC in micro doses — less than 1 mg (“standard” doses are about 10 mg)
  • The majority of patients do not experience any psychoactive effects
  • Cannabis is effective for about 95% of patients
  • The majority of patients experience positive results in addressing
    • Pain
    • Dementia
    • Poly-pharmacy

Cannabis IRL: Review of The Medical Cannabis Primer

Review: “The Medical Cannabis Primer”- The Guide We All Need to Read.

A Cannabis In Real Life Review by Dan Larkin

Getting clear, concise, and easy to understand information about cannabis is tough. There are lots of resources but which ones can you trust? How can you be sure the information isn’t biased? How are you supposed to even understand all the terminology and science? Is it even legal?

All of this becomes doubly important if you’re researching medical cannabis as an alternative to conventional treatments or pharmaceuticals. You or someone you love may have recently been diagnosed with...

Read More

Cannabis Is Reaching its Me Too Moment

I was just listening to the Brave New Weed podcast discussion (Episode 51) about the wrangling going on in New York regarding cannabis legalization. Two different threads in the discussion peaked my interest. One thread discussed the idea that many people in New York – especially in upstate counties – are against legalization of cannabis; this is the Just Say No To Drugs contingent. Politicians will be reluctant to legalize cannabis, if they think this contingent is large enough, and if politicians will lose their vote by voting for legalization. Another thread discussed how big cannabis companies in New York submitted a proposal containing a clause that outlawed homegrown cannabis. This was a clear power-grab by established cannabis companies.

As I listened to the discussion, and these two threads in particular, it occurred to me that cannabis is reaching its Me Too moment. 

Before the Me Too Movement had gained momentum, there had always been grassroots movements against sexual harassment. I consider the issue of sexual harassment to be a component of the fight for equality, which has been brewing probably since Adam and Eve left the Garden of Eden. Yet, even with the presence of grassroots movements, companies had always gained more by paying off accusers – even if it meant a bit of bad press – than by firing powerful people in the company for engaging in harassment. The fact was the negative costs to companies of any social condemnation paled in comparison to the benefits of retaining valuable employees. 

Medical Cannabis Primer Reviewed by Research Lead at CannaLytica

Research Team Lead at CannaLytica, Jon Calder, recently reviewed The Medical Cannabis Primer. The reivew is available on both LinkedIn.com and Medium.com. This one is much more sophisticated than previous reviews. Thank you, Mr. Calder, for taking the time to dig in deep.

[This book is] well-referenced and researched, across topics including “the controversy,” basic Cannabis botany, cannabinoid pharmacology, Medical Cannabis indications, and counter-indications, consumer awareness of the often less than ethical CannaBusiness, and, what makes this text worth the price alone, a fantastic chapter dealing with “The Evidence.”

He continues:

Combined with good information on how to check your vendor knows what they are providing, the significance of analytical testing and toxicological screening, and the need for solid, clear regulations over safety, the book also deals at length with the dazzling array of Cannabis products, and methods of consumption. Beautifully designed and laid out by her brother, himself a Medical User — possibly her motivation for putting together this single volume reference text, this text makes a worthy addition to any patient’s self-education, and could well be a useful point of first information for clinicians.

Merging Cannabis Science & Technology for Mainstream Adoption

I was honored to have been interviewed for the Periodic Effects Business & Science Podcast, hosted by Wayne Schwind:

How is science different from technology? And why are these merging around cannabis to usher in the new frontier? Our guest is Ruth Fisher, Ph.D., Author of “The Medical Cannabis Primer” and Co-Founder of Cann Dynamics. We discuss the potential futures of cannabis and what it will take for the adoption and use of cannabis to move into the mainstream.

Wayne indicated his biggest takeaway from the discussion was:

There are multiple consumer and operator segments in the cannabis industry like recreational, medical, legacy, doctors/ family practitioners and pharmaceutical. They are all talking about cannabis from a different perspective. Will they all eventually meet on common ground? Or will these segments continue to diverge? It seems like mainstream adoption will require a common ground. We discuss the hurdles and bottlenecks preventing cannabis from mass adoption.

Poster Offering: CBD:THC Ratio by Condition

Purchase the CBD:THC Ratio by Condition poster

The cannabis community is increasingly recognizing the tremendous benefits gained by combining CBD with THC and other cannabis compounds in cannabis products. What’s less recognized than the entourage effect, but nonetheless gaining traction, is the importance of combining CBD with THC in fixed proportions, or ratios. That is, researchers are finding that specific CBD-to-THC ratios may be more effective for treating specific medical conditions. For example, products with high CBD-to-THC ratios — that is, products with 20 or 25 parts CBD to 1 part THC — benefit patients with anxiety, epilepsy, and depression. Alternatively, products with equal parts CBD and THC, 1-to-1 ratios, may be more effective at treating nausea and certain types of cancer.

We included an information table in our book, The Medical Cannabis Primer, which aggregates information across several sources about which ratios may better address specific conditions. This table, “CBD:THC Ratio by Condition,” has turned out to be the biggest go-to page in the book.

We have been delighted with the reception this table has received, so we decided to turn it into a poster. The publisher hired renowned concert poster artist, Alexandra Fischer, to turn our version of the table into something unique that wasn’t too psychedelic. We wanted it to be attractive, yet not off-putting to people who use cannabis for medical purposes. Our goal was a classic vintage look and avoided anything trippy.

The poster is designed to create awareness about how cannabis might best be used to treat common medical conditions. And of course, it also creates awareness about The Medical Cannabis Primer book.

The poster can be purchased from our store here: CBD:THC Ratio by Condition

In Color has distributed over 500 of the posters to dispensaries in CA. There are still some promotional copies left, and we want to give them good homes in places where numbers of people will see them and thus be able to benefit from them. We are offering complimentary posters to qualified educators, dispensaries, and medical offices. If you are interested, it's free to apply on our reseller page here.

Synthetic vs. Isolate vs. Distillate vs. Extract

There are many different methods used to process cannabis and obtain its active ingredients. As far as cannabis users are concerned, the primary difference between the various processes is: which components from the original plant remain in the final extract? Is it a single cannabinoid, a combination of cannabinoids and terpenes, or a combination of many different compounds found in the original plant? Cannabis cultivators and manufacturers also care about the yield and purity of the final extract: how many milligrams of cannabinoids are generated from the original plant, and is there any residual plant matter left in the extract?

Traditional healthcare providers view purity as the gold standard for any medication. A purified compound contains no impurities that may generate undesired and/or unexpected outcomes. Whole plant advocates, on the other hand, believe that medications taken in whole plant form, that is, with all the compounds naturally found in the plant, are best, because all the compounds work together in our bodies to generate optimal outcomes. 

mj forms large4

Click for larger version

Synthetic Cannabis

Synthetic cannabinoids are made in a lab. Scientists use cannabis plants to understand the molecular structures of cannabinoids (phytocannabinoids) found in plants. They then reproduce those plant compounds in a lab using chemicals. When cannabinoids are synthesized, the output is a single compound (an isolate) that is pure (uncontaminated by another compounds). In short, synthetics are purified, isolated, man-made compounds.

Pros: Synthetic cannabinoids are relatively inexpensive to make, they’re pure, and their yield is predictable and consistent from batch to batch.

Cons: Synthetic cannabinoids may not be exactly the same as phytocannabinoids, in which case they might not generate identical user outcomes. When used in synthetic form, isolates also don’t generate entourage effects like whole plant extracts do.

The Medical Cannabis Primer Reviewed by Cansoom

Renowned cannabis educator, Lolita Korneagay of Cansoom, recently reviewed The Medical Cannabis Primer and said some nice things about our book:

"The book is only 10 chapters and about 144 pages, but it was chocked full of interesting information.

"I thought that this book would be filled with the same information that I already know...I do feel that Ruth touched all of the major points and she even brought up a couple of points that I had not considered before.

"I think that this book is great for people who are curious about using cannabis medically and it’s also a great refresher for the medical cannabis professional."

Thank you, Lolita!

Unresolved Cannabis Supply Chain Issues

The cannabis industry is new, but quickly evolving. The rapid pace of change is aggravated by the complexity of the plant itself, the complexity of its supply chain, the complexity of products offered, the complexity of rules and regulations for legal cannabis, and the complexity of legal market suppliers having to compete with a thriving black market.

Many of the problems the industry is currently facing will be resolved over time as the market matures. Yet, these problems are still quite relevant to current cannabis users, especially those seeking medical relief. This post enumerates some of the more significant problems that users should be aware of regarding cannabis product testing, labeling, dosing, and variety.

Testing

The purpose of cannabis testing is two-fold: to establish (i) product safety and (ii) product potency (total cannabinoid content).

When states first started legalizing cannabis use, most required some sort of testing before products could be sold. Over time, more states have adopted testing requirements, and the requirements implemented have become more comprehensive. Basic testing requirements include:

  • Reporting product potency, that is, a product’s total cannabinoid contents
  • Establishing the product is uncontaminated by
    • Pesticides used to cultivate plants
    • Residual solvents used to extract cannabinoids and terpenes
    • Bacteria, such as fungi or mold, that might have infected plants during cultivation or processing
    • Heavy metals, which plants might have absorbed during cultivation

Increasingly, states are requiring more detail in the reporting of plant profiles:

  • Reporting profiles of plant compounds, including cannabinoids and terpenes

While consumers are generally better off with more comprehensive product testing – information is power – tests are both costly and time consuming to perform. So, more comprehensive testing requirements increase both:

(i) The time it takes to get products onto shelves and

(ii) The prices of products to consumers.

Protocols

While it may seem like a test is a test is a test, that’s not the case when it comes to cannabis. Test results – especially those for product potency – can vary, depending on the particular equipment and procedures used to test cannabis samples.[1] Reported test results may also vary due to fraudulent reporting practices.

Cannabis testing is still in the early stages. Eventually, regulations will specify testing equipment and protocols to be used, which will then generate more uniform results across testing labs.

Comprehensiveness

Cannabis testing requirements vary across states: some states require more comprehensive testing than others.[2] As previously noted, while more comprehensive requirements provide more information to consumers, they also increase processing costs and time requirements.

I think eventually, there will be a certain minimum battery of tests that are required for all cannabis products. But in addition to those minimum standards, some suppliers will offer more comprehensive information to those customers who are willing to pay the higher associated costs.

Labeling

The purpose of product labeling is to inform customers about product contents. All states require suppliers to include certain information on product labels. However, there is tremendous variation across states, across product forms, and across brands in the information provided on the labels.[3] Furthermore, the information required, as well as that provided, have been evolving over time. And if all this weren’t confusing enough, the fact that most product packages are only a couple of inches in size means a lot of information has to be crammed into tiny spaces using nano-sized type fonts. The good news is that cannabis labeling currently leaves huge room for future improvement.

Accuracy

One of the dirty little secrets in cannabis is the prevalence of inaccurately labeled packages. Studies continue to show that for large portions of cannabis products on the market, labeled information on products packages regarding potency does not match information generated by independent 3rd-party testing.[4] There are several reasons why labeled information may not match independently generated information, some innocent, but others malicious.

The industry is still very new; as it matures, solutions will appear to address the accuracy problem. In fact, different technologies are being developed to validate the integrity of supply chains.[5]

Transparency

The vaping crisis has brought to the forefront the issue of transparency of cannabis product ingredients.[6] Ingredients are added to cannabis products to aid suppliers in, for example, extraction (extracts), flavoring (vapes), dilution (tinctures, topicals), absorption (tablets), and viscosity (vapes). While we’ve been using cannabis for tens of thousands of years, many of the processing (cultivation, processing) and consumption techiques (vaping) we’re now using are relatively new.

I believe users should have access to lists of all ingredients used to process and generate cannabis products. Currently, however, many suppliers do not provide complete disclosure of product contents, claiming certain ingredients are either proprietary or used in miniscule amounts. Consumers should insist on full disclosure of information by product suppliers. If there’s enough demand, suppliers should be forced to comply.

Standardization

Perhaps the starkest evidence to me of the newness of the legal cannabis market is the complete and utter lack of standardization across product labels. Every form of cannabis (flower, cartridge, tincture, capsule, edible, topical) seems to bear different labeling information. Even after I became familiar with the different cannabinoids and forms of cannabis use, I still struggled to figure out how to extract the information I needed from the different product labels.

Labeling requirements have been evolving quickly. Yet, standards boards must do a better job in making cannabis labels more consistent across forms and more meaningful to consumers.

Dosing

Dosing has two aspects: accuracy and consistency. When you buy different packages of the same product, are you confident that the total amount of, say, THC, is the same across different packages of the same product, as well as across doses within a single package? In terms I find easier to understand: if the label says, “1,000 chocolate chips per package and 10 chips per cookie,” how sure are you that each cookie in every package you buy will have exactly 10 chocolate chips?

Cannabis dosing can be problematic because the different compounds in a plant are not evenly distributed throughout the plant. The potential for inconsistency is a larger problem for flower and edibles than it is for tinctures or tablets. In particular, what portion of the total cannabinoids contained in a joint or a vape is inhaled in a single puff? The market is still new, and these problems are being studied. New devices are being released that provide consistently measured doses for vaping.[7] I think most of the problems associated with ensuring consistent dosing will eventually be worked out.

Variety

Cannabis is personalized medicine.[8] Each person has different needs, which are best addressed by particular cannabis products. The industry is evolving. No one knows which suppliers will survive (large multi-state providers vs. small artisan growers). No one knows what type of variety will eventually be provided (mass-market vs. specialty). Currently, hundreds of new brands and products are appearing on the market, yet dispensaries don’t have the shelf-space to house them all. Two important questions will be:

(i) To what extent will consumers be able to find the particular profile and form of cannabis they need to best treat their conditions?

(ii) To what extent will consumers be assured that the product they want will consistently be available for purchase?

 As I said, I think most of these problems will resolve with time. However, cannabis users should nonetheless be aware of the problems so they can take measures to minimize their effects.

 

References

[1] See, for example, https://ministryofhemp.com/blog/cannabis-testing-labs/

[2] https://www.leafly.com/news/industry/leaflys-state-by-state-guide-to-cannabis-testing-regulations

[3] http://www.weberpackaging.com/pdfs/Cannabis%20Laws%20by%20State.pdf

[4] https://www.leafly.com/news/strains-products/cbd-oil-test-results

[5] See, for example, https://cannverify.com/

[6] See, for example, https://news.yahoo.com/is-vaping-a-health-crisis-161209095.html

[7] See, for example, https://www.cannabisdispensarymag.com/product/indose-metered-dosage-vaporizer/

[8] https://www.newcannabisventures.com/the-future-of-cannabis-health-lies-in-personalization/

 

What Can Nevada Extract from Cannabis?

Dr. Fisher will be participating in a panel discussion in September 2019, being held in Las Vegas, Nevada. Cannabis became legalized for recreational use in Nevada on January 1, 2017, after having been legalized for medical use since 2000. The discussion is titled, “What Can Nevada Extract from Cannabis?” The panel brings together a collection of political, business, health, and other experts to discuss what Nevada might expect in terms of entrepreneurship, tax revenues, pain relief, and recreational use. In addition to Dr. Fisher, the panel includes the following experts:

John Ralston, journalist, political commentator, and talk show host.

Dr. Mowgli Holmes, co-founder and CEO of Phylos Bioscience. He was a founding board member of the Open Cannabis Project, and is Chair of the Oregon State Cannabis Research Task Force.

Chris Giunchigliani,former state Assemblywoman and past president of the Clark County and Nevada state education associations. Sheis a member of the Nevada Marijuana Advisory Panel.

Brandon Weigand, Chief Compliance Officer for The Source Dispensaries. He is responsible for improving the efficiency of operations, and for regulatory compliance.

Dr. Jon Norman,Chief Scientific Officer for Vivera Pharmaceuticals. He leads the design and implementation of clinical trials for Vivera'a proprietary CBD sublingual products.

What's the Vaping Scare About and Why Is It Happening?

What are e-cigarettes?

Electronic cigarettes, or e-cigarettes, are all the rage. Since their introduction in 2003, e-cigarette use (vaping) has mushroomed: as of 2018, more than 10 million people globally vape.

Wikipedia describes an e-cigarette as follows:

An electronic cigarette or e-cigarette is a handheld battery-powered vaporizer that simulates smoking … but without burning tobacco. Using an e-cigarette is known as "vaping" and the user is referred to as a "vaper." Instead of cigarette smoke, the user inhales an aerosol, commonly called vapor.

E-cigarettes, also called vaporizersor vape pens, are used to vape either tobacco or cannabis. Some vaporizers are disposable, while others have reusable pens that take replaceable cartridges containing e-liquid (see Figure 1).

Figure 1: Electronic Cigarette with Cartridges

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Whole Plant Cannabis Doesn’t Fit the Healthcare Industry Mold

Moreover, this [Epidiolex] is a purified form of CBD. It’s being delivered to patients in a reliable dosage form and through a reproducible route of delivery to ensure that patients derive the anticipated benefits. This is how sound medical science is advanced.

-- FDA Commissioner Scott Gottlieb, M.D. (June 25, 2018)[1]

This statement by FDA Commissioner Scott Gottlieb helps illuminate why government – as well as many in the healthcare industry – are so averse to cannabis in flower or other whole plant form: Whole plant cannabis is simply not a form of medication that reflects “sound medical science,” that is, it is not a purified form that can be reliably dosed.

Origins of Medication Standardization

The idea that active ingredients in medication should be isolated and purified is not a new concept. The idea dates back to ancient times, to the Greek physician Galen (c. 130–c. 200 AD). Yet, it wasn’t until the 1800s that active compounds were actually first isolated. The ability to isolate and purify individual compounds radically changed how plants were used in medicine. Henceforth the healthcare industry insisted on the exclusive use of isolated and purified compounds in healthcare – rather than whole plant medicines – for three reasons:[2]

  1. Accurate dosing of medications,
  2. Elimination of toxic effects due to impurities in plant product, and
  3. Synthesis of related compounds for use in other valuable drugs.

Why Most Doctors Are Reluctant to Recommend Medical Cannabis

My brother has multiple sclerosis (MS). MS is a degenerative disease affecting the brain and spinal cord; it generally causes problems with vision, balance, and muscle control. My brother’s body was deteriorating, but none of the medications his doctors recommended seemed to help. While researching the disease on his own, however, he discovered that stem cell transplants have been successfully used to halt the progression of the disease. He was unable to undergo the procedure in the US; he eventually had it performed in Mexico. It’s been 1,193 days since my brother’s stem cell transplant, and so far, the disease has not progressed (my brother has documented his journey here).

My brother, along with many of the people (from all over the world) who underwent the transplant procedure with him in Mexico, was extremely frustrated that none of his doctors had even mentioned — let alone recommended — having a stem cell transplant. Just recently, one of his doctors, Dr. Timothy West, formerly of UCSF Multiple Sclerosis Center and Sansum Clinic, Santa Barbara, gave a talk that provided some much-needed clarity on the issue.

Dr. West explained that when doctors get their licenses to practice medicine, they take a vow to “first, do no harm.” Doctors take this vow very seriously. In particular, doctors strongly resist recommending any treatment that may cause patients harm. Even if there’s evidence a treatment might work, if there is a risk that the treatment may cause harm to the patient, then doctors will generally refuse to take that risk, regardless of whether or not the patient himself is willing to take the risk. In the case of stem cell transplants, there is a chance that patients may die from the procedure. Consequently, doctors are not willing to recommend stem cell transplants, especially when alternative treatments are available to address the condition. My brother's blogpost describing Dr. West's comments is eye-opening:

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