Can cannabis be a substitute for prescription drugs?

In order for a prescription drug to reach the market, it must be extensively studied, first in animal and then in human clinical trials. Safety, efficacy, and risks must be determined. But as anyone who has seen a commercial for a prescription drug knows, there are still side effects. There are risks in stopping a prescription. And, of course, there are the risks of addiction.

Prescription opioid painkillers have increased drastically from common-use pill to massive public health crisis. At the same time, the perception of marijuana has shifted away from it as a gateway drug to using it as medicine.

Now, several recent studies show that public opinion is shifting to the point of substituting cannabis for opioids and other prescription drugs that have high risks or low efficacy. In addition to opioids, drug substitution is most common for benzodiazepines, like Valium or Klonopin, and antidepressants.

The benefits of substituting a substance for an addictive drug seem obvious, but there is a serious hidden risk in doing so without talking to a doctor. For example, with CBD, its interactions with prescription drugs have barely been studied. Complications can arise from drug interactions and withdrawal symptoms, resulting in incorrect dosages and potentially unknown side effects.

Patients are substituting prescriptions with cannabis

With unregulated whole-plant and hemp-derived CBD easily available online and in grocery stores across the United States, as well as recreational and medical cannabis in shops in the US and Canada, some people are doing just that.

One specific substitution holds promise, but also danger: benzodiazepines.

Benzos—such as Klonopin (clonazepam) and Valium (diazepam)—are commonly prescribed for anxiety, insomnia, seizures, alcohol withdrawal, and muscle spasms, all of which also have the potential to be treated with medical cannabis, especially CBD. But unlike CBD, benzodiazepines have been around the scientific block, completing the clinical trial process and landing on the market in the 1960s. Also unlike CBD, they are known to be addictive.

“There’s this great opportunity because of the opioid crisis to find alternatives,” said Dr. James Corroon, Medical Director at the Center for Medical Cannabis in California, who published a study on cannabis substitution for pharmaceutical prescriptions last year. Of 2,774 participants, 46% reported substituting cannabis for a pharmaceutical drug. “There’s reason to be hopeful,” he said, “but we need more data.”

There’s also reason to be concerned. Self-identified “medical” consumers were about five times as likely to substitute drugs with cannabis than recreational consumers, according to the study. And almost a quarter of recreational consumers also reported substitution.

Non-prescribed swapping of THC or CBD for a prescription drug often occurs accidentally at first: A chronic pain patient might smoke marijuana recreationally and notices it helps; an insomnia patient might eat a CBD chocolate for anxiety but then is able to sleep; a person might get a medical marijuana card for anxiety and discover it helps with pain and insomnia.

While this might seem like a serendipitous coincidence for patients, the pattern is a warning to doctors. “These people aren’t getting the right care,” said Dr. Corroon. The concern is with drug interactions.

If you add CBD to a drug regimen of an opioid or a benzo, it creates an amplification effect, Dr. Corroon explained. With CBD and Valium, for example, the liver metabolizes CBD first. The Valium is then sent back into the bloodstream, allowing the same dose to last longer. As a result, the patient may be unintentionally overmedicating. This also means a patient could be prescribed a lower dose of Valium to experience the same relief.

This can be great if a healthcare worker is supervising a patient and their drug substitutions, but doses of benzos need to be slowly decreased to be safely stopped, regardless of whether another drug is added.

Rapid decreases of any drug can be dangerous. Benzodiazepines depress the central nervous system and an abrupt change can leave the brain struggling for balance. Benzodiazepine withdrawal can cause a return of symptoms, additional anxiety, insomnia, and flu-like symptoms. More severe symptoms include panic attacks, hand tremors, depression, and seizures.

Without medical advice and supervision, a person could experience withdrawal, unnecessarily low or high doses, or vacillation between the two as anxiety decreases and returns, said Dr. Corroon.

Can cannabis help?

Cannabis treatment is being broadly studied as a partial or full substitution for opioids, but research is just beginning on its possible use in reducing benzodiazepine use.

“There is a role for benzodiazepines in clinical practice,” said Dr. Chad Purcell, a surgical resident at Dalhousie University. But there’s an issue with benzodiazepines that is similar to that of opioids, he said.

In a small study, Dr. Purcell and his associates analyzed information provided by patients new to cannabis treatment who were already taking benzodiazepines. Almost a third stopped their benzodiazepine treatment within two months. And almost 45% ended use by four months.

“There seems to be something at play here,” Dr. Purcell said. But he cautioned against drawing a direct line between the two. Just because two things happened—starting cannabis and stopping benzodiazepines—doesn’t mean one caused the other.

Another recent study, led by Dr. Phillipe Lucas, VP of Patient Research at cannabis producer Tilray, showed high trends of cannabis substitution across all types of prescription drugs.

Dr. Lucas and authors analyzed cannabis use patterns and substitutions of 2032 Canadian medical cannabis patients who responded to a survey.

Many participants reported more than one substitution. About 45% reported substituting cannabis for alcohol, 31% substituted it for tobacco, and 26% substituted it for illicit drugs. A whopping 69% reported substituting cannabis for prescription drugs.

Unsurprisingly, opioids were the most common among pharmaceutical substitutions, at 35%. Antidepressants and anti-anxiety prescriptions came in close behind at 21%.

Detailed questions revealed that chronic pain and mental health issues were the two most common reasons participants took cannabis, both at just under 30%.

Chronic pain is often accompanied by mental health conditions, especially anxiety and insomnia, said Dr. Lucas. It’s a common trifecta of diseases and a troubling one. The conditions can exacerbate each other and the knot of symptoms can be difficult to untangle. It’s not uncommon for endless pain to cause severe anxiety and prevent sleep, Dr. Lucas said. Roughly half of participants reported experiencing all three as primary symptoms, according to the study.

Patients experiencing this medical triad often take more than one daily prescription as treatment, so it’s not surprising that many study participants substituted for more than one drug, Dr. Lucas explained. And it’s possible that, if a cannabis substitution could more effectively treat a root cause of chronic pain, medications for anxiety, insomnia or depression could become unnecessary.

For those people who are making a conscious choice to substitute, and doing so with medical guidance, there seems to be only an upside. It’s the people who accidentally substitute or self-prescribe that worry Dr. Lucas. “It gives me great concern.”

Stay informed and healthy

Always talk to your doctor before starting or stopping a new medication. Ask about potential prescription interactions and options. If you already take a prescription medication, talk to your prescribing physician about your marijuana and/or CBD use.

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8 essential cannabis strains to grow at home

If you’re a regular cannabis user, you’ve probably thought about growing your own. Now is a great time to start. With cannabis prohibition lifting in many places, it’s easier than ever for would-be cultivators to glean knowledge from experienced growers.

Robert Bergman is an industrial cannabis grower and breeder, but he started growing cannabis at home 25 years ago just five little plants. He’s since started I Love Growing Marijuana (ILGM) to help cannabis users turn into successful cannabis growers, with more than 200 grow guides on every stage of cannabis production, grow journals for learning from other growers, andin-depth profiles on the best cannabis strains. When you’re ready to get started, you can buy seeds and everything else you need to start growing in the ILGM shop, which ships across the US and Australia.

With a little planning, you can find a strain perfect for your first crop, whether you’re looking for a little hobby or a new vocation. Not sure where to start? Here are eight iconic strains to get you started, from a centuries-old classic to some of the latest legends.

Know before you grow

Cannabis can be a pretty high-maintenance crop. Before you pick a strain, you should take stock of a few things, like what kind of cannabis you’re after, the amount of grow space you have, lighting constraints you may have, and your budget.

You’re going to want to know about growing an indica plant vs. a sativa plant, and not because of the strain’s effects. Indica varieties have shorter flowering times, so they’re ready for harvest more quickly, and stay relatively short and bushy. Sativa strains can be a little more challenging: They’re tall, lanky, and tend to have smaller harvests per plant, although they grow more quickly at the beginning. Sativa plants handle heat well, while indica plants tolerate cool weather a little better.

Hybrid plants can inherit traits from both their indica and sativa ancestors—whether it’s a high yield, a love for hot weather, or fast growth—so just do a little background research before bringing the seeds home.

You’re also going to want to think about whether to plant feminized or autoflower seeds. Feminized seeds only produce female plants, which is good: Female plants are the ones with the smokable buds you know and love, and having no males around to pollinate means strong, potent crops.

If you’re willing to trade off some potency and yield for an easier growing experience, autoflower cannabis plants don’t need as much light and keep a much lower profile. They’re an especially great choice for dimmer climates and smaller spaces.

6 time-tested cannabis strains—and 2 new icons—to grow at home

Need a well-established strain to get your home grow started? Here are the basics on some decades-long cannabis staples and a couple of instant classics, all available from I Love Growing Marijuana. Some are available both feminized and autoflower, but keep in mind the autos are going to have a smaller yield.

Northern Lights
90/10 indica

Image provided by ILGM

This relaxing, euphoric herb is one of the most famous strains to emerge in the 1970s and 1980s, when cannabis breeders operated in the shadows—but according to legend, Northern Lights was born just outside of Seattle, Washington before it entered the Netherlands seed bank in 1985. It’s an enduring classic, with a strong lineage in Afghani indica combined with a whisper of Thai sativa. Expect to harvest about 22 ounces per outdoor plant or 18 ounces per square meter indoors.

Available from ILGM both feminized and autoflower.

Purple Haze
70/30 sativa

Purple Haze is one of the most recognizable cannabis strain names—and while the Jimi Hendrix song wasn’t named for the strain, they date back to a similar era.

Purple Haze has been a popular strain for half a century for good reason: a cerebral high that’s both calming and uplifting, with a psychedelic vibe that matches the Hendrix jam perfectly. One square meter can yield up to 19 ounces of bud indoors, or 14 ounces per plant outdoors.

Available from ILGM feminized.

Durban Poison
Pure sativa

Image courtesy of ILGM.

There’s no breeding backstory to Durban Poison: It’s a landrace strain, meaning it’s more or less the same strain that came to America in the first place, with no subsequent genetic meddling. This is what gives Durban Poison—hailing from Durban, South Africa—its pure, 100% sativa profile.

This strain offers an intensely energizing, happy high that can promote focus and creativity. An outdoor plant can grow to 8 feet tall, and can yield about 16 ounces. Grown indoors, expect 13 ounces per square meter.

Available from ILGM in feminized.

OG Kush
75/25 indica

The early-90s offspring of an unknown strain and an old-school kush, OG Kush is a staple in West Coast cannabis, with a high THC content that packs a euphoric punch. Its children include high-profile strains like GSC and Headband, but there’s nothing quite like the original.

The plants are low and dense, offering a relatively high yield in a smaller package—about 16 ounces per plant outdoors or 17 ounces per square meter indoors.

Available from ILGM in feminized, autoflower, or high-CBD.

Sour Diesel
40/60 sativa

Sour Diesel will keep you off the couch with euphoric, energizing, and creative effects. This especially dank strain, generally believed to have descended from Chemdawg 91 and Super Skunk, rose to prominence in early 1990s California and has stayed in the spotlight ever since.

These tall, dense plants can yield 18 ounces per square meter indoors, or more than 25 per plant outside.

Available from ILGM in feminized and autoflower.

Jack Herer
40/60 sativa

Image courtesy of ILGM.

Jack Herer, named for the legendary cannabis activist, is a soothing, energetic strain, perfect for coaxing people out of social anxiety and a variety of other physical and mental benefits. Originally bred in the Netherlands for medicinal purposes, it has a reputation for being well-rounded, balancing the best of what cannabis has to offer.

Expect about 18 ounces of yield from each square meter indoors or each plant outdoors.

Available from ILGM in feminized and autoflower.

Bruce Banner
40/60 Sativa

A pungent green monster, Bruce Banner is known for its earthy diesel aroma and lives up to its name with hulking, high potency yields.

Originally bred from OG Kush and Strawberry Diesel, feminized seeds can yield 14 to 19 ounces per square meter indoors or in sunny climates, and even its autoflower variety can get up to 25% THC.

Available from ILGM in feminized and autoflower.

Zkittlez
70/30 indica

Image courtesy of ILGM.

The super-fruity child of Grape Ape and Grapefruit, Zkittlez won multiple Cannabis Cups when it emerged in 2015. While it’s a traditionally-relaxing indica, it’s also uplifting and euphoric, perfect for letting the stress of the day melt away without tucking yourself into bed quite yet.

This plant is pretty easygoing and relatively compact. Expect yields of 13 ounces per square meter indoors, or about 17 ounces per plant outdoors.

Available from ILGM in feminized and autoflower.

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Gut Microbiota & the Endocannabinoid System

Living inside and on each of us is a vast population of bacteria, fungi, protozoa, and viruses. Cumulatively, the microbiome includes as many cells as the human body and encodes 100 times more genetic material than the human genome. Up to 1,000 different species of bacteria live in the gut alone.

With this knowledge has come the realization that the microbiome is a key player in human health, affecting everything from mood to metabolism. Microbiota inside the gut – a hollow tube extending from the esophagus through the intestines to the anus – play a huge role in human disease. Disturbances to this system, also known as the gastrointestinal or digestive tract, have been associated with obesity, cancer, and neurodegenerative disorders such as Parkinson’s and Alzheimer’s disease.

How it all works is a subject of ongoing scientific inquiry, one whose central discoveries have been widely publicized in popular and mass media in recent years. Yet there’s an important aspect of the link between human health and the microbiome that has received almost no attention outside the often obscure world of scientific journals: the role of the endocannabinoid system (ECS).

Current thinking suggests that the ECS serves as a sort of bridge between bacteria and the body itself, including the brain, relaying signals back and forth in a symbiotic, mutually beneficial relationship. At least that’s how it should be – but chronic imbalance or impairment of the gut microbiome, also called dysbiosis, can harm physical and mental health.

In the most basic sense, humans and other animals influence the “bugs” in their gut primarily through their diet, including the intake of so-called probiotic foods that promote a healthy microbiome. These bugs in turn help break down food and make nutrients more available to the body. We provide them sustenance and an amenable place to live, and they help us extract as much nutrition as we can from food in the digestive tract.

This in itself is awe-inspiring. But it also turns out to be incomplete. Groundbreaking research has shown that we also impact our gut microbiome through not only exercise and certain pharmaceuticals but also the consumption of cannabis, all via the common path of the ECS.

Cannabis for Gut Health

Interactions between gut microbiota and the endocannabinoid system were first explored in 2010. A Belgian research team showed that altering the gut microbiome of obese mice through prebiotics, foods that promote the growth of beneficial bacteria, altered ECS expression in fat tissue with implications for lipid metabolism and fat cell formation.1

More evidence came in 2015, when researchers in Canada administered a daily regimen of THC to mice sustained on a high-fat diet. Gut microbiome health in these animals improved after 3 to 4 weeks to more closely resemble that of animals fed a healthy, balanced diet.2

Few studies have investigated the effects of cannabis use on the human gut microbiome, but in 2017, researchers found key differences among 19 lifetime users and 20 non-users. Cannabis users possessed bacteria populations associated with higher caloric intake but lower BMI, though diet was thought to also play a role.

In 2018, researchers used archived anal swabs to assess the microbiomes of HIV-positive individuals. They found that cannabis use was associated with decreased abundance of two strains of bacteria linked to obesity.

Scientists are still trying to understand the details. But evidence is accumulating that the endocannabinoid system interacts directly and bidirectionally with bacteria in the gut, influencing the activity and makeup of the microbiome while simultaneously helping to transmit its messages to the body and brain. What’s more, microbiome health may be modified and even improved through plant cannabinoids, including both THC and CBD, as well as through the body’s own endocannabinoids, anandamide and 2-AG, whose production is stimulated through exercise and the consumption of certain foods.34567.8

A Pioneering Study

Just as the makeup of our microbiome depends on more than diet, the bacteria living in our gut do more than simply break down food. They also help regulate the epithelial barrier, a critical protective layer lining the interior of the long, narrow “tube” we call the gut or gastrointestinal tract. How do they do it? At least in part through interactions with the ECS, especially CB1 receptors, according to a pioneering 2012 study whose implications are still being sorted out.9

The epithelial barrier plays a hugely important role in maintaining overall health and warding off disease, says University of Calgary professor and researcher Keith Sharkey, who has studied the gut for decades and, more recently, both the microbiome and the ECS. He also served as senior author of the aforementioned 2015 study in which THC was administered to mice.

“The epithelial barrier is very crucial to maintaining what we call homeostasis, or the normal body’s functions,” Sharkey says. “The control of that fine lining is extremely carefully managed by the body. We have developed as mammals this very intricate control system, which prevents damage or quickly repairs damage, to prevent further erosion of our bodies. The bacteria we have in our gut contributes to that system. And it seems that the ECS is a very important control element.”

Sharkey is currently leading research to confirm whether CB1 receptors play a role in the acute regulation of epithelial barrier function. Preliminary evidence supports this hypothesis, he says.

Though he isn’t investigating concurrent changes to the microbiome, a link would make sense given that gut bacteria interact extensively with the epithelial barrier. “We live in a mutualistic symbiotic relationship,” Sharkey says.

Targeting the Microbiome

This all points in a predictable direction. If the ECS communicates with both the gut barrier and the microbiome, whose health is essential to human well-being, and we know we can manipulate the ECS through diet, exercise, and cannabis-derived compounds, might there be other ways to target the microbiome through the ECS in order to achieve specific health outcomes?

It’s a question the pharmaceutical industry has been actively investigating, says Cris Silvestri, a professor at Laval University in Quebec and Canadian Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health. Though no drugs have yet been developed for this purpose, Silvestri says the fast-growing field could start producing answers within the next five years that will point directly to pro- or post-biotics that can be used to tweak the gut microbiome via the ECS.

In fact, Silvestri and colleague Vincenzo DiMarzo say they’re already working with a pharmaceutical company on related research – though they can’t provide any details. Silvestri was, however, able to discuss another research project under development with the Quebec government, which is hoping to learn more about interactions between cannabis and the gut microbiome following Canada’s legalization of cannabis edibles earlier this year, Silvestri says.

“We’re in discussions for a project with the government to understand how edibles are going to affect your gut microbiome, and how is that potentially going to affect your response to edibles,” he says. “Is the gut microbiome going to change those cannabinoids, make them more or less active?”

Silvestri is also involved in two additional studies that will shed more light on this complex relationship. One is investigating effects on the gut microbiome of genetic modulation of the ECS, which increases 2-AG levels and suppresses CB1 activity in treated mice. This builds on research published in January 2020 by the same team showing that experimentally controlled alteration of the gut microbiome resulted in significant changes to gene expression and signaling within the endocannabinoidome, a broader system of receptors, enzymes, and lipid mediators related to the ECS.10

The other current study looks at ECS levels in the brains of so-called germ-free mice, which have no microbiome, and associated impacts on behavior and anxiety. It also evaluates effects on both after the introduction of a microbiome through a fecal microbiota transplant.

“The hope is that there will be therapeutic applications in the end,” Silvestri says. “The drive comes from being able in the future to harvest the functionality of these bugs to improve human health.”

THC & COVID-19

A cannabinoid science lab led by Prakash Nagarkatti at the University of South Carolina is also pioneering investigations into the ECS, the gut microbiome, and disease. It may even have found a clue for treating one of the most harmful complications of COVID-19 in some patients.

In a June 2020 study published in Frontiers in Pharmacology, Nagarkatti and colleagues demonstrated that administering THC to mice affected with a form of acute respiratory distress syndrome (ARDS) could stop the condition in its tracks.11 A severe consequence of the runaway immune response known as a cytokine storm, ARDS occurs in a small percentage of COVID-19 patients but is often fatal.

“We have a mouse model of ARDS, where we inject Staphylococcal enterotoxin B [a bacterial toxin], and the mice die within four or five days because of cytokine storm and ARDS in the lungs,” Nagarkatti says. “And we found that if you give THC, it cures the mice. They are just running around healthy. That was amazing.”

Nagarkatti doesn’t know exactly how it happens, but he does know it involves the microbiome. “What we found was that THC was changing the gut microbiome, as well as the microbiome in the lungs, and there were similar changes in the gut as well as in the lungs, and then on top of that, when we transplanted the fecal material from the cannabinoid-injected mice into the normal mice, even they became resistant to the ARDS or cytokine storm.”

Though this was demonstrated in mice and is therefore not directly transferable to humans – or COVID-19, for that matter – this is perhaps the first evidence that cannabinoids’ alteration of the gut microbiome can play a role in suppressing the systemic inflammation seen in a cytokine storm, Nagarkatti says.

Interestingly, in one of its first papers on the ECS and the microbiome back in 2017, Nagarkatti’s lab also demonstrated that treatment with a combination of THC and CBD altered the gut microbiome in mice in a way that reduced inflammation, in this case with beneficial implications for autoimmune disease.12

“Suppressing inflammation in the colon as well as systemically is very critical for preventing any type of disease, because right now inflammation is considered to be the underlying cause of everything, not only autoimmune disease but cardiovascular and neurodegenerative diseases, PTSD, Alzheimer’s, obesity, cancers, COVID-19,” Nagarkatti says. “You name it and there is inflammation.”

While the molecular mechanisms still need to be worked out, the ECS plays an important role in modulating inflammation through gut microbiota.13 Nagarkatti reports: “THC alters the microbiome in the gut in a way that seems to be beneficial in suppressing inflammation because bacteria that are favored by THC or cannabinoids seem to produce short-chain fatty acids that suppress inflammation.”

Unanswered Questions

Nagarkatti’s lab has also shown that THC treatment in mice leads to increased levels of bacteria in the beneficial genus Lactobacillus, often found in fermented foods and dietary supplements.14

Otherwise researchers know little about which specific “bugs” from among the roughly 1,000 species of bacteria in the gut are modulated by the ECS, or which species are themselves able to modulate the ECS, says Silvestri.

Indeed, there remains much more to learn about interactions between the ECS and the microbiome. Sharkey has his own list of unanswered questions that could become research priorities as the field progresses.

“We don’t quite know if it’s happening throughout the gut or if it’s restricted to certain regions of the gut,” he says. “We don’t know the interactions between various dietary constituents and the way that they change the microbial components of the gut as well as the ECS. We don’t know how many constituents of the cannabis plant are able to regulate the gut microbiome. We’ve yet to understand how the body’s own endocannabinoids really regulate epithelial barrier function.

“There are very, very many unanswered questions, but they are exciting because the consequences have the potential to be important for health,” he continues. “Almost daily when I look in the literature now, a new thing pops up that links the gut to bodily health: gut-heart connections, gut-lung connections, gut-kidney connections. So it would not surprise me to see a role for the ECS in many of those links. And we’re just scratching the surface of that right now.”


Nate Seltenrich, an independent science journalist based in the San Francisco Bay Area, covers a wide range of subjects including environmental health, neuroscience, and pharmacology.

Copyright, Project CBD. May not be reprinted without permission.


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9 Black athletes trailblazing the cannabis industry

For decades, the relationship between cannabis and sports was non-existent. Every major league except Major League Baseball has a ban on cannabis use. And the “character” issues associated with Black athletes and drug use has always been volatile.

Luckily, the ‘20s are shaping up to be a new era for cannabis and the Black athlete. From investments to deals with TV networks, Black athletes are quickly becoming champions of both sports and cannabis. Check out these athletes making history in the cannabis industry.

Being a gold medal Olympian makes you one of the best athletes in the world. And putting your face behind CBD might take you back to the #1 spot. 

GABBY DOUGLAS

Gabby Douglas swinging from gymnastic bar.
(AP Photo/Bullit Marquez)

When she’s not winning gold medals at the Summer Olympics, Gabby Douglas is making golden investments. Teaming up with other professional athletes, Gabby invested in Motive CBD. Motive’s product line is geared towards athletes, but with CBD popping up in every gentrified neighborhood, Gabby’s investment might win her a medal.

As one of the most respected and decorated athletes in America, Gabby could be a catalyst for future endorsements for the woman athlete. With topical creams and capsules focused on muscle and joint support, it wouldn’t be surprising if other individual women athletes like Serena Williams, Allyson Felix, or fellow gymnasts Simone Biles follow in her footsteps. Keep raising the bar higher and higher, Gabby.

Basketball players are some of the most influential athletes in the world. It’s no surprise that current and former NBA players are finding more than one way to get into cannabis.

KEVIN DURANT

Kevin Durant dunks during the World Basketball Championship.
(AP Photo/Mark J. Terrill)

After joining his former rival, winning back-to-back championships and heckling fans on Twitter with his burner account, Kevin Durant could definitely use a smoke. The NBA still has an active ban on cannabis use, thought they won’t test during the COVID bubble tournament. But KD hasn’t let the ban stop him from making investments. His venture capitalist firm, Thirty Five Ventures, has invested in both cannabis ordering technology and cannabis venture capital.

Durant has spoken out about marijuana, saying “there shouldn’t even be a huge topic around it.” And as one of the best and most visible players in the game, Durant’s views on cannabis are pivotal if the NBA is going to stop testing players for weed.

If the best player can get high and put up high scores, shouldn’t we all be able to?

MATT BARNES & STEPHEN JACKSON

Matt Barnes reacts after being fouled.
(AP Photo/David Zalubowski)

Former NBA champions Matt Barnes and Stephen Jackson were some of the most competitive and intimidating players in the league. Unless you knew them personally, you would’ve never known that for a lot of their games…they were high.

Since retirement, the two ballers have been very vocal about recreational and therapeutic cannabis use in sports. Apparently, some of our favorite hoopers are firing up more than jump shots before the game.

Stephen Jackson warms up.
(AP Photo/Bahram Mark Sobhani)

Barnes and Jackson have turned their advocacy into a multimedia endeavor with a video podcast called “All the Smoke.” Partnering with Showtime, the stoned duo talks to current and former NBA players, entertainers, and celebrities. And since the NBA season has been on a COVID-19 pause, “All the Smoke” has become a top basketball podcast.

NBA fans have never complained about players appearing to be high on the court, so maybe Barnes and Jackson are the ambassadors the league needs to reverse the ban on cannabis.

AL HARRINGTON

Al Harrington drives to the basket.
(AP Photo/Nam Y. Huh)

In the early 2000s, a NBA player being suspended for smoking weed was basically a PR death sentence. The perception of the ‘hip-hop’ generation and marijuana was not a healthy one. Hell, players couldn’t even wear basketball jerseys to the game because it lacked ‘professionalism.’ Well, that stigma has changed, at least off the court, and former NBA player Al Harrington is a big part of the movement.

A non-smoker until 2008, Harrington immediately realized the positive effects of cannabis. The mental health improvements and CBD creams post-surgery helped Harrington transition from being known as an ex-player to a true stoner. His cannabis company, Viola, produces in California, Oregon, Michigan, and Colorado.

Along with selling products, Viola is focused on increasing minority ownership, reinvesting in the community and creating opportunities for equity in the industry. Harrington never won the MVP award, but the advocacy work he’s done definitely deserves recognition.

GARY PAYTON

Gary Payton catches a high pass.
(AP Photo/John Raoux)

Gary Payton was never the tallest player while he played in the NBA, but he was known for being the biggest mouth in the league. The hall of famer, Olympian, and NBA champion is a cultural icon because of his game and his trash talk, but recently he’s done something no other NBA player has ever done. The Oakland native inked a licensing deal with cannabis lifestyle brand, Cookies.

The Gary Payton strain is a cross between The Y and Snowman, two of Cookies’ most sought after strains. Known for its “loud” smell, Gary Payton could run you about $70 for 3.5 grams.  But the dope packaging designs and the connection to this sports star probably make that price point manageable for superfans. Will Gary open the door for more athletes to use their likeness for cannabis? The pothead sports fan inside of me is excited to see.

Week after week, the gladiators of the NFL put their bodies and their futures on the line for the love of the game. But what people don’t see are the measures that players go through in order to perform.

EUGENE MONROE

Eugene Monroe runs a drill.
(AP Photo/Darron Cummings)

Eugene Monroe was one of the best football players in the world. The high school All-American became one of the best offensive tackles in college football. And as a top 10 pick in the NFL draft, Eugene made his presence felt on the professional level too.

The other thing that Eugene felt was the physical effects of the game. Chronic Trauma Encephalopathy, better known as CTE, is a brain injury detected in 90% of former NFL players examined.

The use of opioids to help with the physicality of the game has been commonplace in the league for years. But In 2016, Monroe became the first active player to advocate for cannabis use in the NFL – disregarding the opioid trend.

Now, as a member of the NFLPA Pain Management Committee and the Athletic Ambassador for Doctors for Cannabis Regulation, Monroe is taking a stand against the mistreatment of all players. Hopefully, Monroe can help push the NFL to a place of progress and equity for all players in the league.

CALVIN JOHNSON & ROB SIMS

Calvin Johnson warms up before an NFL football game.
(AP Photo/Rick Osentoski)

Yet again, two former Black players are stepping up to the plate, doing things with their earnings from the billion-dollar behemoth football industry. Calvin Johnson Jr. and Rob Sims aren’t the first NFL players to advocate for cannabis use, but they are the first to work with Harvard University. The two former players created Primitiv Group, a cannabis research company fighting the opioid crisis and finding the benefits of the flower.

Rob Sims enters an NFL football game.
(AP Photo/Rick Osentoski)

Based in Michigan, Primitiv is going to work with Harvard on how medical marijuna effects CTE. Since can’t be confirmed until death, science needs to get ahead of it by learning more. The behavior of players can be seen and felt in their everyday life, and it’s easy for serious symptoms to become commonplace. Disturbing behaviors like memory loss are normal for players who have been banging their brains inside of a helmet for 10+ years and are beginning to develop CTE.

With the trend towards federal legalization, there’s only a matter of time before the NFL finally realizes what must be done. Cannabis isn’t worse than the pills. If we can’t see eye to eye about that, then there will be unnecessary pain for future players.


The future is bright for Black athletes in cannabis. With more endorsements, investments and licensing deals bound to happen, when will all the pro leagues in America stop banning cannabis? Will we line up for new strains like we do new sneakers? Only time will tell, but I hope so.

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Johns Hopkins Wants To Hear About Your Psychedelic Journeys For New ‘Real-World’ Study

Among women who enjoy marijuana, there’s no shortage of anecdotal evidence that adding a bit of cannabis can bring a thrill to the bedroom, and in states where the drug is legal, marketers have capitalized on that claim. THC-infused lubricants promise increased arousal and better orgasms, and some sexual health advocates have built entire careers on cannabis-enhanced intimacy. But is there anything behind the hype?

While researchers are still trying to tease out the precise relationship between cannabis and sex, a growing body of evidence indicates the connection itself is very real. The latest study, which asked women who use marijuana about their sexual experiences, found that more frequent cannabis use was associated with heightened arousal, stronger orgasms and greater sexual satisfaction in general.

“Our results demonstrate that increasing frequency of cannabis use is associated with improved sexual function and is associated with increased satisfaction, orgasm, and sexual desire,” says the new study, published last week in the journal Sexual Medicine.

“Increased cannabis use was associated with improved sexual desire, arousal, orgasm, and overall satisfaction.”

To reach their conclusions, the team analyzed online survey results from 452 women who responded to an invitation distributed at a chain of cannabis retail stores. Researchers asked respondents about their cannabis use and had each fill out a Female Sexual Function Index (FSFI) survey, a questionnaire designed to assess sexual function over the past four weeks. The survey scores six specific domains, including desire, arousal, lubrication, orgasm, satisfaction and pain.

“To our knowledge,” the authors wrote, “this study is the first to use a validated questionnaire to assess the association between female sexual function and aspects of cannabis use including frequency, chemovar, and indication.”

Generally speaking, a higher FSFI score is understood to indicate better sexual function, while a lower score indicates sexual dysfunction. Comparing frequency of cannabis use to each participant’s FSFI score, the researchers determined that more frequent consumption was associated with lower rates of sexual dysfunction.

“For each additional step of cannabis use intensity (ie, times per week),” the report says, “the odds of reporting female sexual dysfunction declined by 21%.”

“We found a dose response relationship between increased frequency of cannabis use and reduced odds of female sexual dysfunction.”

Women who used cannabis more frequently had higher FSFI scores in general, indicating better sexual experiences overall. More frequent consumers also had higher specific FSFI subdomain scores—indicating things like greater arousal and better orgasms—although not all of those differences reached the threshold of statistical significance.

Another weak relationship showed that women who used cannabis frequently reported lower levels of pain related to sex.

“When stratified by frequency of use (?3 times per week vs <3 times per week), those who used more frequently had overall higher FSFI scores and had higher FSFI subdomain scores except for pain,” the study says.

The research doesn’t shed much light on what marijuana products might work best for sexual stimulation, however.

“Our study did not find an association between cannabis chemovar (eg, THC vs CBD dominant), reason for cannabis use, and female sexual function,” the researchers, who included members of the Stanford Medical Center’s urology department and the medical director of the Victory Rejuvenation Center, wrote. “Neither, the method of consumption nor the type of cannabis consumed impacted sexual function.”

Researchers said a number of mechanisms could explain the overall results, noting that prior studies have postulated that the body’s endocannabinoid system is directly involved in female sexual function. It’s also possible, authors wrote, that cannabis could be improving sex by reducing anxiety.

“As many patients use cannabis to reduce anxiety,” the report says, “it is possible that a reduction in anxiety associated with a sexual encounter could improve experiences and lead to improved satisfaction, orgasm, and desire. Similarly, THC can alter the perception of time which may prolong the feelings of sexual pleasure. Finally, CB1, a cannabinoid receptor, has been found in serotonergic neurons that secretes the neurotransmitter serotonin, which plays a role in female sexual function thus activation of CB1 may lead to increased sexual function.”

As the study notes, cannabis’s potentially positive effect on women’s sexual function was first noted in research from the 1970s and ’80s, when women in research interviews who used cannabis reported better sexual experiences, including more intimacy and better orgasms. But subsequent research has yielded mixed results. Some studies have found that women’s orgasms were actually inhibited by cannabis use. Authors of the new report said that past studies used interviews rather than a validated questionnaire to conduct research.

“The mechanism underlying these findings requires clarification,” the authors said of their report, “as does whether acute or chronic use of cannabis has an impact on sexual function. Whether the endocannabinoid system represents a viable target of therapy through cannabis for female sexual dysfunction requires future prospective studies though any therapy has to be balanced with the potential negative consequences of cannabis use.”

Regardless of the mechanics at work between marijuana and sex, emerging evidence is overwhelming that there’s some sort of relationship at play. A nationwide survey conducted by an East Carolina University graduate student last year found that “participants perceived that cannabis use increased their sexual functioning and satisfaction.” Marijuana consumers reported “increased desire, orgasm intensity, and masturbation pleasure.” Numerous online surveys have also reported positive associations between marijuana and sex, and one study even found a connection between the passage of marijuana laws and increased sexual activity.

Yet another study, however, cautions that more marijuana doesn’t necessarily mean better sex. A literature review published last year found that cannabis’s impact on libido may depend on dosage, with lower amounts of THC correlating with the highest levels of arousal and satisfaction. Most studies showed that marijuana has a positive effect on women’s sexual function, the study found, but too much THC can actually backfire.

“Several studies have evaluated the effects of marijuana on libido, and it seems that changes in desire may be dose dependent,” the review’s authors wrote. “Studies support that lower doses improve desire but higher doses either lower desire or do not affect desire at all.”

CBD Is A ‘Promising’ Therapy In Treating Cocaine Misuse, Meta-Study Finds

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How to maximize your harvest by growing light deprivation cannabisJohanna Silver

Light deprivation—or light dep—is a technique in outdoor cannabis cultivation in which growers reduce the daily amount of light plants receive, tricking the plants into thinking fall has come early. This is done with light-blocking tarps that are draped over hoop houses for 12 hours a day, triggering the flowering phase early and letting farmers harvest their buds and bring them to market several months before the big fall harvest.

In Humboldt—ground zero for craft cannabis—the technique showed up in the late 1980s and took off in the 1990s and early 2000s. The reason? Farmers realized they could squeeze out not one harvest, but two, increasing productivity and profit.

Farmers typically grow seedlings or clones under supplemental light to get a strong start, and then put them under light dep conditions to finish within two months. So long as they’ve got another batch of clones or seedlings ready to go into the ground, they can do it all again in time for fall.

The benefits of growing light deprivation cannabis

Example of a light dep greenhouse from Advancing Alternatives.

It can be a game changer for a number of reasons. “It’s a great way to get some money before the typical fall harvest, so you’re not waiting so long for income,” said Rachel Turiel of Herbanology in Mendocino. About a quarter of her farmland is devoted to light dep. Her setup is nothing fancy: two hoop houses made out of PVC. The cannabis goes straight into the ground, she said.

Not only is it some early money for farmers, the price for light dep cannabis is often higher. “People will always want the freshest stuff,” said Turiel, “So if someone is still selling last fall’s harvest and you come along with light dep, you’re definitely going to get a higher price.”

A less-crowded market might not be the only reason light dep commands a better price. Jason Gellman of Ridgeline Farms in Southern Humboldt believes light dep blends the benefits of outdoor cannabis—“better terpenes and a lower carbon footprint,” he said—with what the market demands.

“People just love that indoor look,” said Gellman. “You can grow someone a big outdoor bud, and its potent, but it’s not purple or covered with powdered sugar.” Light dep cannabis gets closer to that frosty, indoor look, while still harnessing most of those sun grown qualities.

If he had his druthers, he’d farm completely outdoors, sans light dep. “I’m convinced a completely outdoor run makes for a better high.”

Is the quality of light dep cannabis better?

He’s not alone in that thinking. “The jury is still out on if I’m all-in on light dep,” said Johnny Casali of Southern Humboldt’s Huckleberry Hill Farms. Some of his estate cultivars, originally bred by his mother, don’t do well under light dep. “A full run takes six to eight months as compared to the two or three of light dep,” he explained. “Farmers often get smaller buds, lower THC, fewer cannabinoids, and fewer terpenes.” He theorizes that cannabis has its fullest expression of qualities when grown under the full UV spectrum the sun provides for as long as possible.

Light dep can also be hugely expensive for farmers. Unless they do their own cloning, it’s a whole lot of clones to purchase to put in the ground. Casali does all his own cloning, but if he didn’t, he estimates that each round of plants in his setup would cost $14,000. And farmers differ as to whether light dep yields more or less than a full-term run.

The process may or may not be super labor intensive. Gellman’s garden is small enough that the covering and uncovering of tarps doesn’t bother him. For Casali, the task is so big, he built a pulley system that lifts a 500-pound tarp up and over the plants. As for Turiel, it’s a lot easier when her husband—measuring 6’2” versus her 5’2”—pitches in. Otherwise, “it’s one person running back and forth to tie down sides before it flies off like a sail,” she said.

Heavy or not, it’s constant. “Every day, someone has to be home to pull tarps,” said Turiel. She considers that to be the technique’s biggest drawback. “It absolutely ties you to the land.”

Casali agrees. “You can’t miss a day,” he said. “Every morning, I’m up at 5:30am to make my coffee. By six, I’m pulling tarps. And then again, I have to be home in the evening to do it all again.”

While some farmers, like Casali, are wondering whether the extra labor is worth it, others are all in. Light dep allows Gellman to try out many more cultivars than he otherwise would without having to fully commit. And the experimentation doesn’t end there: This year he’s going for a third run, getting plants in by early September and seeing what he can eek out in a few months.

Turiel is also all-in: “Light dep keeps it exciting for us.”

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CBDA–The Raw Story

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Raphael Mechoulam isolated CBDA in 1965.

In the last five years, the world has fallen in love with cannabidiol (CBD). Perhaps the biggest uptake has been in countries like the UK and United States where almost 10% of the population admit to having tried CBD oil. Most people probably assume that the cannabis or hemp plants used to make their CBD products can be found dripping in the magic molecule. But, actually, that’s not the case.

Cannabidiolic acid (CBDA) – the botanical precursor of CBD – is what’s found in fresh raw cannabis and hemp. CBD only comes into being when its acidic counterpart is exposed to heat.

Outside the inner sanctum of cannabinoid science, CBDA hasn’t gotten the column inches enjoyed by its botanical sibling. Indeed, for many years CBDA was mistakenly assumed to be an inactive compound. This notion – combined with CBDA’s instability whereby over time it begins to degrade – meant that scientific research into CBD’s acidic form has been fairly limited.

But CBDA is now undergoing a renaissance of sorts with increased media interest thanks to the launch of a patented CBDA “ester” (an intriguing molecular variant of CBD) and a host of positive anecdotal accounts of CBDA’s efficacy from medical cannabis patients and doctors.

What is CBDA?

Cannabidiolic acid was first isolated by Israeli scientist Raphael Mechoulam in 1965.1 Through exposure to sufficient heat or sunlight, CBDA changes into CBD by going through a chemical process called decarboxylation in which the carboxyl group is lost.

While many of us associate decarboxylation with cannabis, the same chemical reaction occurs in cellular respiration. It’s the reason we all exhale CO2 as a byproduct of metabolism.

For many years, decarboxylated cannabinoids were considered the ‘activated’ compounds, producing more potent therapeutic effects in our bodies. However, this assumption has recently been turned upside down with studies showing CBDA’s activation of 5-HT1A serotonin receptors to be significantly more potent than CBD. And CBDA was also shown to have a stronger binding affinity than CBD as an antagonist at another important receptor known as GPR55.

These discoveries suggested that CBDA could indeed have an important place at the therapeutic table for conditions as varied as cancer, anxiety, epilepsy, and treatment-resistant nausea and vomiting.

CBDA for Nausea & Vomiting

Serotonin is perhaps the most widely known class of neurotransmitter due to its role in mood regulation. However, serotonin’s biological reach extends far beyond just keeping us happy. It is involved in such diverse physiological functions as nausea, vomiting, and intestinal movements.

Much of what we know about CBDA’s activation of 5-HT1A serotonin receptors is thanks to research by Erin Rock and her team at Guelph University in Ontario, led by neuroscientist Linda Parker. Rock examined the therapeutic application of both CBD and CBDA for different types of nausea and vomiting.2 She showed that by binding with 5-HT1A receptors in a more potent fashion than CBD, CBDA suppressed nausea and vomiting caused by toxins and motion sickness.

Perhaps the most exciting breakthrough relates to CBDA’s remarkable success in reducing anticipatory nausea – the type of intense nausea one experiences prior to chemotherapy when patients feel horrible before treatment has even begun. Anticipatory nausea, it should be noted, has no effective pharmaceutical treatment.

In a different study examining the efficacy of combining CBDA with ondansetron, a standard antiemetic drug, Rock’s team found that even at very low doses CBDA enhanced the pharmaceutical drug’s anti-nausea effect.3 In fact, Rock goes on to assert that the amount of CBDA needed to reduce nausea was a staggering 1000 times less than required by CBD to have the same effect.

Furthermore, the Canadian scientists confirmed that CBDA is not intoxicating or impairing as it does not interact with CB1 cannabinoid receptors. This makes CBDA potentially a better option for patients who struggle with the mood-altering effects of THC-rich cannabis or dronabinol (FDA-approved synthetic THC).

CBDA & Epilepsy

CBD burst into the mainstream largely because of its celebrated anti-seizure effects. To date, the only approved CBD pharmaceutical in the United States is the purified CBD tincture, Epidiolex, for three types of drug-resistant epilepsy.

It’s not surprising that GW Pharma, the company behind Epidiolex, is looking closely at CBDA’s therapeutic potential. In pharmacokinetic studies comparing CBDA with CBD, GW scientists found CBDA to have superior bioavailability and faster onset than CBD – properties that make CBDA a very attractive option for drug development.

Not only did it require lower doses (thus reducing the chance of side effects), but CBDA was more effective in seizure reduction in certain parameters. Some of this data appears in GW’s patent application4 for the ‘Use of cannabinoids in the treatment of epilepsy,’ rather than in a peer reviewed study. But it certainly backs up Rock’s findings, as well as anecdotal reports coming from U.S. cannabis clinicians such as Bonni Goldstein and Dustin Sulak, who’ve had great success when treating patients with CBDA.

A Case History

Peruvian physician Max Almazora shared a compelling case study involving CBDA in a recent Society of Cannabis Clinicians webinar.

14-year-old Glendy came into his office having 10 seizures a day due to autoimmune encephalitis. Prior to seeing Dr. Almazora, she had at one point been in a medical coma for 45 days. She also contracted drug-induced hepatitis, which was caused by medication she’d been prescribed.

Glendy’s parents acquired CBD oil from the United States, which brought about some seizure reduction. However, buying imported CBD oil wasn’t financially viable for the family, so Dr. Almazora found a local source of CBD oil. Or so he thought.

It turns out, the CBD oil hadn’t been decarboxylated, and Glendy was in fact taking CBDA. This was later confirmed when the oil was sent off for analysis in a Californian lab. And guess what – her seizures reduced even further. In fact, at latest count, Glendy, now 16, only has ten seizures a year and no longer takes any pharmaceutical anti-epileptic drugs. Her cognitive development, anxiety, autistic-like behaviour, and overall quality of life have all markedly improved since switching to the CBDA oil.

“While I was already getting good results in my patients with cannabinoid treatments containing THC and CBD,” says Dr. Almazora, “CBDA has been especially effective in treating epilepsy, Parkinson’s, and inflammatory conditions. For me, the acidic cannabinoids open a whole spectrum of therapeutic possibilities.”

But medical scientists still have much to learn about CBDA’s multiple mechanisms of action with respect to epilepsy and other conditions. “I personally will be gathering more evidence that I hope will benefit patients,” Almazora asserts.

Anti-Inflammatory CBDA

With Glendy’s epilepsy caused by an autoimmune condition, it’s possible her positive response to CBDA in part could be attributable to the acid cannabinoid’s anti-inflammatory action, which may occur because of its role as a selective Cox-2 inhibitor.5

There are two types of Cyclooxygenase (Cox) enzymes: Cox-1 maintains the normal lining of the stomach and intestines, and Cox-2 has a pro-inflammatory effect. Non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen, inhibit both Cox-1 and Cox-2 enzymes. By inhibiting Cox-1, long-term use of these over-the-counter drugs can cause major gastrointestinal complications.

It’s therefore of therapeutic interest to develop selective Cox-2 inhibitors that bypass Cox-1 and relieve patients’ inflammation-related symptoms, while sparing them of any dangerous long term consequences. As a Cox-2 inhibitor, CBDA shows potential as a safer non-steroidal anti-inflammatory drug, although studies have yet to be carried out on humans.

One preclinical study6 also found that CBDA’s downregulation of Cox-2 enzymes may help prevent the spread of a certain type of invasive breast cancer typified by higher than normal levels of Cox-2. When the breast cancer cells were treated with CBDA over 48 hours, both Cox-2 and Id-1, a protein associated with the aggressive spread of breast cancer cells, were down-regulated, while Sharp-1 expression, a suppressor of breast cancer metastasis, increased. Although this is very much preliminary data, it suggests that for certain types of breast cancer, CBDA may halt the spread of malignant cells to other parts of the body.

A Synthetic CBDA Compound

In the last few months, Professor Mechoulam has generated headlines once again with the launch of a patented synthetic CBDA methyl ester. With its chemical structure subtly altered to make the methyl ester compound more stable than CBDA, Mechoulam and his team have begun to investigate the compound’s therapeutic use in conditions such as anxiety, depression,7 inflammatory bowel disease, nausea and vomiting, and as an alternative to steroids.

While this stabilised version of CBDA may be easier to work with in the lab, particularly for the development of pharmaceutical drugs, it’s not at all clear that it represents a significant improvement as a therapeutic modality compared to artisanal cannabis or hemp products containing CBDA.

When stored appropriately in a cool, dark cupboard away from sunlight (or even the refrigerator in hot climates), CBDA does not tend to degrade if it is consumed within a few months. However, if you’ve got an opened CBDA bottle that’s been hanging around for a couple of years in direct sunlight, it probably won’t have the same cannabinoid profile it once had – and your carrier oil may have gone rancid.

Get Some CBDA in Your Life

For the conscious consumer trying to navigate today’s largely unregulated market, the presence of CBDA in a cannabis oil extract suggests that it’s likely a true full-spectrum product, rather than a formulation made from CBD isolate or distillate, both of which require heat to decarboxylate.

If you happen to have access to a few fresh cannabis leaves or flower tops, you may want to add some to a salad or smoothie. It’s an easy way to get acidic cannabinoids into your system. Or as Dr. Dustin Sulak recommended at the 2019 CannMed conference in Pasadena, try putting a small amount of raw CBDA-rich bud into a cup of steeping tea – the heat won’t be sufficient for decarbing and you’ll get the benefits of this hitherto neglected cannabis compound.

Indeed, it seems that after all these years of living in CBD’s shadow, CBDA is finally gaining recognition as a safe, and in some ways more potent, alternative to its famous cannabinoid relative. For those who are already taking CBD oil, or for those who are thinking about it, small doses of a CBDA-rich product may be worth considering. And let Project CBD know if and how CBDA works for you.


Mary Biles, a Project CBD contributing writer, is a journalist, blogger and educator with a background in holistic health and TV production. She is author of The CBD Book: The Essential Guide to CBD Oil and hosts the podcast Cannabis Voices. Her website is here.

Copyright, Project CBD. May not be reprinted without permission.


Footnotes

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Cannabinoids & Cancer in the Clinic

Adapted from Healing with Cannabis: The Evolution of the Endocannabinoid System and How Cannabinoids Help Relieve PTSD, Pain, MS, Anxiety, and More by Cheryl Pellerin (Skyhorse Publishing, 2020).

Dr. Donald I. Abrams is an oncologist at San Francisco General Hospital, an integrative oncologist at the University of California-San Francisco (UCSF) Osher Center for Integrative Medicine, and a professor of clinical medicine at UCSF. He was also a member of the sixteen-person professionally diverse committee that produced the 486-page volume The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence, a 2017 update on the topic from the National Academies of Sciences, Engineering and Medicine.

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“I’ve been an oncologist in San Francisco for thirty-six years now, and I venture to say that most of the cancer patients I’ve taken care of have used cannabis,” Abrams said in a May 3, 2019, interview. “But there isn’t a day that goes by where I don’t see a cancer patient with loss of appetite, nausea, vomiting, insomnia, pain, depression, or anxiety, and if I have one medicine that can decrease nausea and vomiting, enhance appetite, decrease pain, and improve sleep and mood, I consider that to be a valuable intervention. Instead of writing prescriptions for five or six pharmaceuticals that all could interact with each other or the chemotherapy I prescribe, I can recommend one very safe botanical.”

When Abrams was a medical intern and resident in 1970s San Francisco, many people used cannabis, including young people with cancer. He started an oncology fellowship at UCSF in 1980, a time when cannabis was popular and there weren’t many effective anti-emetics (drugs that help nausea and vomiting).

“We had prochlorperazine, or Compazine, and Tigan [trimethobenzamine hydrochloride] … but they weren’t very good,” Abrams said, “and young people getting young-people cancers, such as Hodgkin’s disease or testicular cancer, told us, ‘You know what? Cannabis is an effective anti-nausea therapy, better than your prescription meds.'” Abrams thinks that’s what led the National Institutes of Health National Cancer Institute and several pharmaceutical companies to investigate synthetic delta-9 THC as a potential anti-nausea medication.

“A number of studies were conducted in the ’70s and ’80s that allowed both dronabinol [synthetic THC in a capsule] and nabilone [oral THC analogue] to be approved in 1985 for treatment of chemotherapy-induced nausea and vomiting. I’m not sure how much of that I used for patients in those days,” he added, “but in 1992 the FDA expanded the indication for use of dronabinol to treat anorexia associated with weight loss in patients with HIV.”

That’s when he first really started with dronabinol, Abrams explained, “because I became an AIDS doctor after my training to be a cancer specialist, and that’s when I started to really prescribe a lot of dronabinol. And patients said, ‘You can keep it. I prefer to smoke cannabis because [dronabinol] takes too long to kick in and when it does I get too zonked.'” Delta-9 THC in sesame oil [dronabinol marketed as Marinol] is a very different medicine from whole-plant cannabis, Abrams said. “That’s what I learned in my first clinical trial.”

Whole Plant Cannabis Versus THC

In the mid-1990s and still today, the National Institute on Drug Abuse is the only official source of cannabis for clinical trials. And NIDA has a congressional mandate to fund only studies investigating substances of abuse as substances of abuse and not as therapeutic agents, Abrams said.

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Dr Donald Abrams

“So they could never fund a study that I was trying to do — to show that cannabis benefitted patients with AIDS wasting — but they could fund a study to see if it was safe for HIV patients on protease inhibitors to inhale cannabis. So that study ultimately got funded.” It was his first NIH-funded cannabis study. A third of the patients took dronabinol, 2.5 mg three times a day, a third smoked a whole-plant NIDA cigarette, and a third took a dronabinol placebo.

“The patients were each in our General Clinical Research Center for twenty-five days, during twenty-one of which they took the dronabinol or smoked the cannabis. And it was very clear to me which patients were on dronabinol because they were in bed pretty much all day long, totally wiped out. Whereas the cannabis patients were up and dancing, cleaning their rooms, and very much more activated. So yeah,” Abrams said, “I think it’s definitely a different medicine.”

One thing that’s fairly dramatic in his experience with cancer patients, Abrams added, is that “a lot of cancer patients at the end of their lives are put on opiates by well-meaning oncologists who are trying to ease their pain and suffering, both physical and emotional. And the patients say, ‘This doesn’t allow me to communicate with my family because I’m way too stoned.’ So they wean off of opiates and just use cannabis, and they like that a lot better.”

Abrams said medical cannabis has been legal in California for twenty-three years and recreational for two years, but in the days when a medical recommendation was needed, Abrams would write a letter that patients would take to the dispensary, and that would allow them to obtain cannabis for a year.

“But I didn’t say take this strain, this much, this many times a day,” he said. “I don’t think cannabis is a medication that needs a package insert. Most people can probably figure out how to use it. Every patient is different, every strain is different — I think the best recommendation is ‘start low, go slow.’ That’s become quite a mantra.” And Abrams thinks the pharmaceuticalization of cannabis is wrong.

“I think we should regard it as a botanical therapy that’s been around for 5,000 years and has significant benefits,” the oncologist said. “But to try to say that it’s a medicine using a pharmaceutically dominated paradigm might not be correct. I think it should be treated like saw palmetto and echinacea but regulated like tobacco and alcohol, and let responsible adults use it as they see fit.”

Cannabis for Cancer Symptoms & Chemotherapy Side Effects

Dr. Dustin Sulak is an integrative osteopathic physician and medical cannabis expert whose clinical practice has focused on treating refractory conditions in adults and children since 2009. He is the founder of Integr8 Health, with offices in Maine and Massachusetts, that follows more than 8,000 patients using medical cannabis and other integrative healing modalities. Sulak has published in the peer-reviewed literature, and lectures to health-care providers internationally on the clinical applications of cannabis. The following information is adapted, with permission, from Sulak’s educational website, Healer.com, which offers a range of programs about medical cannabis, as well as medical cannabis training and a certification program for physicians, other health professionals, and consumers.

When working with cancer patients, cannabis treatment efforts often take two distinct paths — using cannabis to reduce symptoms and improve treatment tolerability, or using cannabis, typically in high doses, to help kill the cancer. The goals aren’t mutually exclusive, according to Sulak, but each requires a different approach to dosing.

When used properly, cannabis can be a safe, effective treatment for cancer patients with chronic pain, insomnia, and chemotherapy-induced nausea and vomiting. Animal studies have shown that cannabinoids can prevent the development of neuropathic pain, a common chemotherapy side effect that can limit a patient’s chemo dose or course. Even after achieving cancer remission, many patients are left with debilitating neuropathic pain that can be permanent.

“Patients can often achieve significant improvements in quality of life with minimal side effects, using very low doses of cannabinoids in the range of 10 mg to 60 mg per day,” Sulak writes in his course materials: “A combination of THC, CBD, and other cannabinoids in various ratios can be used to fine-tune the benefits and minimize the side effects of cannabinoid treatment.”

Medical cannabis can help patients tolerate conventional cancer treatments like chemo and radiation, and can be used along with these treatments with a low likelihood of drug interaction. This means there is seldom a reason to avoid combining cannabis with conventional cancer treatments (with a few exceptions noted in the educational materials).

For patients with terminal cancer, cannabis offers many benefits in palliative care at the end of life. “It’s an incredibly useful addition to conventional treatments in hospice medicine,” says Sulak.

Cannabis to Fight Cancer and Promote Healing

Along with symptom relief and improved quality of life in cancer patients, cannabinoids also have shown anticancer effects in many cell and animal experimental models. And a large body of anecdotal evidence suggests that human cancers also respond to cannabinoid treatment, Sulak observes. Several patients have reported slowing or arresting tumor growth, and others have experienced full remission of aggressive cancers while using cannabis extracts.

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Dr Dustin Sulak

To achieve these powerful anticancer effects, most patients need a higher dose than is needed for symptom relief — often 200 mg to 2,000 mg of cannabinoids a day, or the equivalent of one to two ounces of herbal cannabis a week. This treatment level may be cost effective if the cannabis is grown by a patient or caregiver outdoors, but purchasing this amount of medicine from a medical cannabis retailer could be expensive.

At these high doses, Sulak says, “a knowledgeable medical provider must monitor the treatment to prevent side effects and interactions with conventional cancer treatment. Patients must carefully titrate up to reach these high doses without significant adverse effects. Surprisingly, doses in the range of 2,000 mg/day can be well tolerated.”

Any medical treatment carries certain risks, he adds, but high-dose cannabis is nonlethal and much safer than conventional chemotherapy, though the effectiveness of high-dose cannabis for cancer hasn’t been studied in people. Some patients reaching very high doses report global improvement in symptoms and better quality of life. Others find that at ultrahigh doses the cannabis stops helping with symptoms like pain, anxiety, and sleep disturbance — benefits they easily achieved at lower doses. Still others fail to build tolerance to the adverse effects of high cannabis doses and find themselves stoned, groggy, and uncomfortable.

No Cookie-Cutter Solutions

Sulak says patients and students should beware of anyone who claims to have a cookie-cutter solution to cannabis dosing for cancer. The internet is full of ratios, doses, and other treatment plans for specific cancer types, but many of these claims are based on the success of a single patient or on partially relevant findings from the preclinical literature (cell and animal studies).

Cancer is incredibly complex, and “even the same type of cancer in two different individuals can respond very differently to standard or alternative treatments,” Sulak writes. “Because they’re abnormal cells, cancers do unusual things — like overexpress or fail to express cannabinoid receptors,” he adds. “Each individual’s inner physiologic environment, genetics, diet, and other factors produce a unique case. Good results from one case or one study can’t be broadly applied — at best they can be used as guides. A cancer treatment plan also must take into account an individual’s goals and personal preferences.”

Cannabinoids fight cancer through different mechanisms of action, including triggering cell death, preventing cell growth and division, preventing the growth of blood vessels that feed tumors, and preventing cancer cells from migrating to other areas of the body. Sulak notes that most individual accounts of success using cannabis to kill cancer involve high doses, but several patient accounts describe profound reductions in cancer burden while taking low-to-moderate doses.

“Unlike conventional chemotherapy treatments,” he writes, “we know that cannabinoids are nontoxic to normal cells. In conventional chemotherapy, the strategy is usually to use a drug that’s more toxic to cancer cells than it is to healthy cells, and to give the patient as much as he or she can tolerate. Intolerable side effects, like peripheral neuropathy or malnutrition from nausea and vomiting, often are the limiting factors in treatment.

“Cannabis dosing may be limited by side effects,” Sulak asserts, “but not by toxicity that will lead to long-term limitations.”


Cheryl Pellerin, a writer who specializes in science journalism, is the author of Healing With Cannabis: The Evolution of the Endocannabinoid System and How Cannabinoids Help Relieve PTSD, Pain, MS, Anxiety, and More (Skyhorse Publishing), with a foreword by Jeffrey Y. Hergenrather, MD. Her first book, Trips: How Hallucinogens Work in Your Brain, with art by Robert Crumb, was translated into French and German.

Copyright, Project CBD. May not be reprinted without permission.

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