Cannabis Science: What to Believe?

Alan was disoriented and his words were not making sense. His wife thought he might be having a stroke, so she took him to the emergency room where he was seen by the on-call neurologist. When asked, Alan admitted to using cannabis on a regular basis for many years. The neurologist then brought him a printout with the title: “Marijuana Use Associated with Increased Risk of Stroke, Heart Failure.” That was when I got the call asking me if this was for real.

I have not seen this dangerous trend in my clinical practice, but many of my patients have used cannabis for many years so I was motivated to track down the referenced article and review it. If this was a valid concern, I wanted to know so I could inform patients about the risk.

BIAS BAKED IN

A valid study can inform, enrich, and save lives. Poor studies can create fear and ignorance. The bias can lean either pro or con. Either way detracts from our understanding of cannabis and our ability to provide patients with the best care. I obtained a copy of the original article and reviewed it carefully.

The first paragraph gave me a clue. “…cannabis is…the most widely cultivated, trafficked, and abused drug…” (emphasis added)

I had read similar statements in other scientific articles:

  • “Cannabis remains one of the world’s most widely used substances of abuse amongst pregnant women.” (emphasis added)
  • “Despite increasing public health concerns, cannabis remains the most commonly used illicit drug…” (emphasis added)

What do all these first paragraphs in published scientific articles have in common? Each one reveals a prejudice that makes the rest of the data that follows less trustworthy. Because cannabis has been illegal and vilified for so many years, many publications assume harm even before they are written.

PATIENTS ARE LOOKING FOR ANSWERS

The scientific literature is teeming with new publications every week reporting on cannabis, cannabinoids, and other medicinal uses for the plant. Some of these studies are well done, but how do you know which are valuable and which are faulty? Scary headlines like “Cannabis Use Predicts Risk of Heart Failure” are dramatic, and often circulate widely in the press and on social media.

Most health care providers know little about the medical use of cannabis; they are not taught the endocannabinoid system in medical schools and many avoid this sensitive topic altogether. Patients are educating themselves the best they can by reading news articles and reviewing scientific studies made available online, but not everything we read is accurate and not every study is well-designed. Here are a few guidelines to help you tell the difference between valid information and that which should be taken with a grain of salt.

imageANIMAL vs. HUMAN STUDIES

A study of value to real people reports on a sample that is representative of most human beings. Humans are not mice, so valid conclusions shaping clinical care cannot be reliably based on how mice respond to cannabis. This does not mean that information derived from mice, rats, pigs or other animals is not useful, but the best we can say about animal studies is that further research may be indicated.

UNRELIABLE SOURCES

“Associations between regular cannabis use and both mental illness and lung cancer have been well established.” [1] This is an untrue statement. Dr. Donald Tashkin at UCLA designed a study intending to prove that smoking cannabis was associated with increased cases of lung cancer.

To his great surprise he found that this was not true, and eventually published an article that indicated just the opposite. [2] False statements based on poorly designed studies are sometimes referenced as fact, leading to further poor conclusions. Supporting a hypothesis with weak science is often an indication of prejudgment.

OPINIONS STATED AS FACTS

“Mortality post [myocardial infarction] may additionally be increased in cannabis users…” [1] This statement was used in a scientific article reporting on the damaging effects of cannabis in the cardiovascular system. The use of the word ‘may’ here makes this an opinion, not a fact.

It is also contradicted by other data. Look out for words like “may” or “could” as they indicate a guess, assumption, or opinion rather than a fact backed by observation. The accuracy of the above statement is questionable. In 2018 Johnson-Sasso [3] published a well-done study concluding: “(Our) results suggest that, contrary to our hypothesis, marijuana use was not associated with increased risk of adverse short-term outcomes following AMI. Furthermore, marijuana use was associated with decreased in-hospital mortality post-acute myocardial infarction.”

SELECTION SKEWING

Science studies humans when possible, but selection of subjects is difficult, especially when studying the effects of cannabis. As long as the plant is federally illegal and socially suspect, most individuals will be apprehensive about disclosing information related to their use.

In many studies, information is gathered by asking patients if they use cannabis, or any illicit substances (self-reporting). The substances are often listed: “Have you used any of the following: amphetamine, marijuana, methadone, heroin, LSD, PCP, cocaine, other?” Not everyone is going to admit to using a substance included in that list. Would you?

This problem was clearly illustrated in a study done in 1995. [4] This research collected data from both self-reports and blood tests. When tested, 585 women tested positive for THC, but only 31% of these women had self-reported use of cannabis. As expected, self-reporting clearly carries the risk of under-reporting. If data is collected only on those who disclose the personal use of an illegal substance, that data will be skewed.

Lab testing to select subjects has limitations as well. Serum drug tests may underestimate the use of cannabis because the THC metabolite they test for is only present for a short period of time. A study subject could have used cannabis last week, or a few days ago, and no longer test positive.

Selection skewing leads to statements like, “Compared with non-cannabis users, cannabis users were older and predominantly men [and]…had an increased prevalence of most risk factors including hypertension, tobacco use, and alcohol use.” [1] This is most likely true for that study’s selection, but not accurate for the general population.

CONTROLLING FOR VARIABLES

Many, but certainly not all, who use cannabis also use other substances that include tobacco and alcohol. Separating out the subjects who are only affected by cannabis is difficult but must be done accurately for good data on the effects of cannabis alone. Because this task is so challenging, many study results are weakened by confusing the effects of more than one substance.

imageWE NEED FACTS–WELL-COLLECTED AND WELL-STATED

It is important to review scientific publications carefully and consider any weaknesses stated or implied. The risks and benefits of cannabis as medicine need to be known so the plant can be used safely to everyone’s best advantage. Fear and social attitudes have no place in well-done scientific studies. Unscientific enthusiasm for a widely used herb has no place in the science either. For cannabis to be trusted and appropriately used as medicine, we need impartial facts-well-collected and well-stated.

Thankfully, Alan had not had a stroke. It appeared he had a ‘TIA,’ which is a transient loss of blood flow to the brain with no long-term damage done. But they kept him overnight for tests and to make sure he was safe to discharge. He went home the next day and continued to use cannabis, knowing that the information shared with him by a well-meaning neurologist was not necessarily valid. For him, the personal benefits were worth the possible risks.


Stacey Kerr, M.D. is a teacher, physician, and author living and working in Northern California. After several years working with the Society of Cannabis Clinicians, and co-developing the first comprehensive online course in cannabinoid medicine, she now serves as Medical Director for Hawaiian Ethos. Dr. Kerr is a Project CBD contributing writer. This article was originally published by Hawaiian Ethos.


SOURCES

1. Kalla et al. Cannabis use predicts risks of heart failure and cerebrovascular accidents. J Cardiovasc Med, 2018, 19:000-000 doi:10.2459/JCM.0000000000000681

2. Tashkin. Effects of Marijuana Smoking on the Lung. Ann Am Thorac Soc Vol 10, No 3, pp 239-247, Jun 2013

3. Johnson-Sasso CP et al. Marijuana use and short-term outcomes in patients hospitalized for acute myocardial infarction. PLoS ONE 13(7): e0199705. 2018.

4. Shiono et al. The Impact of cocaine and marijuana use on low birth weight and preterm birth: A multicenter study. Am J Obstet Gynecol. 1995 Jan;172(1 Pt 1):19-27.

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Cannabidiol and Epilepsy Meta-Analysis

How often have we heard, “More research is needed,” from those who would prefer to see no change in policies that should be informed by science? From climate denial to cannabis prohibition, the demand for absolute scientific certainty is a call for inaction.

It begs the question: When is there “enough” research?

How about not enough to eliminate all uncertainties, but enough to recommend medical treatment or change policy?

Published in September 2018, a meta-analysis of CBD treatment for epilepsy provides “enough” research – both to say that CBD is effective in certain kinds of epilepsy, and that CBD-rich extracts are generally better medicine than CBD isolates1.

Three Brazilian scientists – Fabricio Pamplona, Lorenzo Rolim da Silva and Ana Carolina Coan – examined data from 11 different studies comprising 670 patients who were treated for an average of 6 months. The meta-analysis focused specifically on three kinds of childhood seizures (Dravet, Lennox-Gastaut, and those caused by CDKL5 deficiency), and sought to describe the effectiveness, required doses, and side effects associated with cannabidiol.

The authors further analyzed the differences between CBD-rich extracts and CBD isolates. Epidiolex (FDA-approved pharmaceutical CBD) and some unregulated, hemp-derived CBD products are considered isolates, as they lack the full spectrum of other cannabinoids and terpenes that are present in whole-plant extracts.

It works!

Seventy-one percent of people using CBD-rich extracts had reduced seizure frequency, compared with 46% of those using CBD isolates.1 Both of these numbers are incredible. What’s more, the population was treatment-resistant, having tried between 4-12 medications for three years before using CBD.

The authors also examine whether the improvements met specific thresholds: How many people had greater than 50% reduction of seizures (a typical threshold used in medicine)? How many had greater than 70%? Complete cessation of seizures?

Both the whole-plant extracts and CBD isolates helped cut the number of seizures in half for roughly 40% of patients, once again suggesting that both formulations – single-molecule and whole-plant – can be highly effective medicines.

Both formulations reduced seizures by 70% in about one quarter of the patients, but fewer studies recorded this. And roughly one in 10 patients using CBD became seizure-free, although not enough studies reported this metric to compare different formulations.

Less is more

Perhaps the most striking conclusion of this study is the dramatic difference in doses for isolates compared to full spectrum CBD-rich oil extracts. The mean dosage for people using pure CBD was 25.3 mg/kg/day, but for CBD-rich extracts it was 6.0 mg/kg/day.

In other words, CBD in a whole plant extract was over 4 times more potent than isolated CBD. This result is a reflection of what’s known as the “entourage effect,” whereby the therapeutic impact of the whole plant is greater than a single compound or even the sum of the plant’s individual medicinal components.

We can say that “more research is needed” to fully understand the biochemical basis of the entourage effect in epilepsy, but we are well past the point of questioning its existence and importance.

Adverse events

Whole-plant cannabidiol also distinguished itself from isolate CBD with a lower rate of side effects. Isolate CBD was associated mild adverse events2 in 73% of patients, whereas whole-plant CBD was associated with mild adverse events in only 33% of cases. The authors suggest that this difference is due primarily to the lower dose of CBD used when formulated as a whole-plant extract.

It’s worth noting that many of these “side effects” are present in the absence of CBD, and that adding CBD to treatment tends to reduce these side effects, so the numbers may be overestimates.

What’s a meta-analysis?

A meta-analysis is a specific kind of study meant to draw firmer conclusions once many papers have been published on a single topic. It is used to determine quantitative information, and can also help determine the basis for different results that the initial studies did not have the power to prove.

Meta-analyses, however, are prone to bias when the studies used very different designs, and there was one notable difference between the whole-plant extract and CBD-isolate research. All the isolate studies were prospective, meaning that participants were treated according to a protocol written by the researchers. The whole-plant extract studies, on the other hand, were retrospective analyses or surveys.

The lack of prospective studies with whole-plant extracts is due to the schedule 1 status of marijuana, which seriously hinders research into the medical uses of cannabis. Retrospective studies are slightly more prone to bias, such as underreporting of side effects. Despite the potential for bias, this meta-analysis demonstrates that whole-plant cannabidiol extracts are as effective as CBD isolates, if not more so, and can treat refractory epilepsy at much lower doses.


Adrian Devitt-Lee, a Project CBD contributing writer, is a graduate from Tufts University with a degree in mathematics and chemistry.


FOOTNOTES

1. The numbers reported here are not exactly the same as those reported in the meta-analysis. There were a few minor mathematical errors due to complications when consolidating the various data. The mistakes do not change the conclusions of the original study, and the authors have issued a correction. The correct numbers are reported here.
2. “Adverse events” were defined by the authors of each individual study, which could lead to some bias. Mild events included weight loss, fatigue or sedation, gastrointestinal problems, and nausea. Severe events included alterations in liver function.

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Canadian Researchers Studying Hemp Protein to Treat Hypertension

Researchers at the University of Manitoba are investigating the use of hemp protein to prevent and treat high blood pressure, also called hypertension. The study of 35 hypertensive adult volunteers will also assess the effects of hemp protein on other physical attributes, including weight, cholesterol, body mass, hormones, and insulin production.

“Hypertension is a multifactor disease,” says Dr. Rotimi Aluko, the lead scientist for the clinical trial. “To get a full picture of the treatment, we need to know how the participants respond,” says Dr. Aluko, a professor in the Department of Human Nutritional Sciences at the University of Manitoba. “The why is sometimes more important than the results,” he says. The clinical trial follows previous studies at the University where hemp protein was found to be beneficial to hypertensive rats.

The World Health Organization calls hypertension a global health crisis, responsible for 45-51% of global deaths, annually. Worldwide, over 1.3 billion people are hypertensive. Untreated, hypertension can lead to heart attack, stroke, kidney disease, vision loss, and sexual dysfunction, among other conditions.

“Drugs can have side effects, if we can demonstrate that this protein works to reduce hypertension, then people could take a natural protein instead.”

Dr. Rotimi Aluko

Recently, studies have shown that high blood pressure between the ages of 45 and 65 could lead to a higher risk of dementia later in life. In 2011, the United States spent US$46 billion on medicines, services, and missed days of work due to high blood pressure. Blood pressure is considered normal when the systolic (top number) is 120 and the diastolic (bottom number) is 80.

In the 22-week hemp protein study, the 35 adult volunteers with high blood pressure will be divided into three groups. All groups will have three 42-day periods during which the only food they consume is a fruit smoothie with protein powder taken twice a day. Each group, however, will have a different form of protein powder in their shakes: hemp, hemp plus peptides, or casein, which comes from milk. Participants will not know what form of protein they are consuming.

Dr. Aluko says that a smoothie was chosen for two reasons: it’s not hard to drink, and people can’t tell what kind of protein is in it. “A smoothie is easier for volunteers to consume, and you need to make sure participants are blind to the study,” says Dr. Aluko.

If the clinical trial shows that hemp protein can be used to lower blood pressure, Dr. Aluko says that one day hypertensive patients could take hemp protein instead of the commonly prescribed medicines. “Drugs can have side effects,” he says, “if we can demonstrate that this protein works to reduce hypertension, then people could take a natural protein instead.” Common side effects of high blood pressure medicines include diarrhea or constipation, cough, headache, skin rash and erectile dysfunction, among others.

The hemp protein powder for the clinical trial is being supplied by Manitoba Harvest, a cosponsor of the study. The protein powder is commercially available in the USA and Canada as Hemp Yeah! Max Protein. Manitoba Harvest has provided materials for three studies at the University of Manitoba. A 2017 experiment compared the effects of hemp consumption in the form of hemp protein or hemp snacks vs non-hemp controls. The goal of the experiment was to see how hemp products vs non-hemp controls impacted blood glucose, insulin, appetite, and food intake in adults.

The hemp protein for hypertension clinical trial is a recipient of Grant-in-Aid from the Heart and Stroke Foundation of Canada. According to a Foundation spokesperson, the grant was awarded to the study because “experts in the field judged it meritorious amongst the hundreds of applications against our rigorous standards of scientific excellence and relevance.”

If the clinical trial shows that hemp can help reduce blood pressure, then other treatment areas will be examined. “Following this trial, if we see a positive effect, then kidney disease will be next,” says Dr. Aluko. A 2011 experiment, also conducted at the University of Manitoba, showed that hemp protein had positive effects on rats with kidney disease, including normalizing heart size.

Although the hemp protein for hypertension clinical trial has generated a good response, Dr. Aluko says getting 35 people to sign up might take 6 months. Volunteers must live within a 45-minute drive from the research center in Winnipeg.

Dr. Aluko anticipates completing the study in 2019. The results should be published by the end of 2020.

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Hemp Wick 101: Is It a Better Way to Burn?

While it might look like the stuff you made hippie necklaces out of in high school, hemp wick is definitely for smoking.

Marketed as a natural alternative to lighters and matches, this weed accessory has been popping up in head shops and cannabis stores all over Canada. But is it a better way to burn?

What is Hemp Wick?

Hemp wick is essentially a length of hemp twine that’s been coated in beeswax. Think of it as a slow-burning candlewick, especially for use with pipes and bongs.

hemp wick
Photos by Jesse Milns for Leafly

Simply light it up with a match or lighter, use it to spark your bowl as needed, then blow or shake it out when done. Be careful, of course, not to burn yourself. Because it’s a little bit sticky, you can even keep it wrapped and ready around your lighter or bowl.

Explore More Smoking Accessories

Why Use It?

The theory is inhaling hot butane from a lighter or the admixture of combustible chemicals, glue and wood from a match is worse for your body than a flame atop all-natural, wax-coated hemp twine. Hemp is cannabis, after all–it’s the same plant you’re already smoking (although, as you know, there’s really nothing in it that’s going to get you high).

Hemp wick also burns at a lower temperature than a lighter, meaning that hits are smoother and there’s more potential to appreciate terpenes. Added bonus: with hemp wick, very little ends up having to go to landfill.

How Is Hemp Wick Sold?

hemp wick
Photos by Jesse Milns for Leafly

You can buy a tiny bundle for just a dollar or two to rolls of up to 420 feet (no joke) or more. It can come in different diameters too-the thicker the twine, the slower and larger the flame-though it’s mostly sold at 1.0 millimetres. If your local head shop or cannabis store doesn’t have it, it’s very easy to find online–even the Ontario Cannabis Store carries it. Various hemp wick dispensers are also available.

The Verdict?

Hemp wick is not for the clumsy. If hand-eye coordination is an issue, you might redefine ‘burning one down,’ right? But if you’re kicking back to savour a bowl, its steady flame and mild beeswax aroma make it a very pleasant alternative to fumbling with matches or lighters. Some purists, though, might still prefer the ash-less and comparatively tasteless experience that comes with burning butane.

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Why CBD Works Better With a Little THC (Even If You Don’t Want to Get High)

Way back in 2014, I wrote an article called Desperately Seeking CBD that profiled several families who either broke the law or moved clear across the country to access cannabidiol (CBD)–a non-intoxicating compound found in the cannabis plant that’s proven effective in treating pediatric seizure disorders that don’t respond to more conventional therapies. At the time, the father of a two-year old epilepsy patient explained that they’d uprooted their entire existence and moved to Colorado just to try the treatment.

The best available science makes clear that whole-plant cannabis preparations are quantifiably superior to single compounds.

Five years later, you can buy CBD ice cream in Texas. Cannabidiol is officially “trendy.” Capsules, tinctures, ointments and oils containing the compound can be readily purchased online (as well as at gas stations and hair salons nationwide), and the legalization of hemp farming this December via the most recent US Farm Bill means that this rapidly growing market segment will likely expand exponentially over the next five years.

All good news, even if the recent media focus on shiny objects like CBD-infused cocktails has threatened to crowd out significant research showing cannabidiol has tremendous promise in treating cancer, diabetes, head trauma, chronic pain, neurodegenerative disease, depression, anxiety, and addiction.

But unfortunately, along the way, there’s been a lot of shady operators selling CBD in a largely unregulated grey market, and as a result a ton of misinformation has attached itself to this potentially life-saving cannabinoid.

In fact, Project CBD–a non-profit dedicated to boosting science-based understanding of cannabidiol–has compiled an extensive list of pervasive misconceptions. One of which is “CBD is medical, THC is recreational.”

On the contrary, even small doses of THC combined with CBD can improve the efficacy of your cannabis medicine.

THC Is TLC for Your CBD

Originally, cannabis contained far less THC than it typically does now, and a lot more CBD. But over time, breeders have created ever more potent strains, as that’s what fetches the best price in the underground market. These breeders certainly understood that selecting for greater potency meant maximizing THC output, but just ten years ago few had even heard of CBD, never mind realized it was steadily getting bred out of existence.

Project CBD was founded in 2009, a time when CBD had almost entirely vanished from the cannabis gene pool. The organization’s founders recognized that while there’s long been evidence of CBD’s medical efficacy, unlike THC, it wasn’t reaching actual medical cannabis patients in appreciable amounts. So they worked directly with cannabis labs in California (then a new phenomenon) to identify the few remaining CBD-rich strains in circulation and make them available to growers, researchers and patients.

Which means you can put them down as big fans of CBD. Just don’t put down THC while you’re doing it.

Project CBD receives many inquiries from around the world and oftentimes people say they are seeking “CBD, the medical part” of the plant, “not THC, the recreational part” that gets you high. Actually, THC, “The High Causer,” has awesome therapeutic properties… [but] diehard marijuana prohibitionists are exploiting the good news about CBD to further stigmatize high-THC cannabis, casting tetrahydrocannabinol as the bad cannabinoid, whereas CBD is framed as the good cannabinoid. Why? Because CBD doesn’t make you feel high like THC does.

Project CBD categorically rejects this moralistic, reefer madness dichotomy in favor of whole plant cannabis therapeutics.

The best available science makes clear that whole-plant cannabis preparations are quantifiably superior to single compounds because the plant’s complex mix of cannabinoids, terpenes and flavonoids interact synergistically to create an “entourage effect” that enhances each other’s therapeutic effects.

  • A study conducted at the California Pacific Medical Center in San Francisco found that combining THC and CBD produces more potent anti-tumor effects when tested on brain cancer and breast cancer cell lines than either compound alone.
  • A 2010 study found that patients with intractable cancer-related pain tolerated medicines that combined THC and CBD notably better than a pure THC extract.
  • A 2012 study in the Journal of Psychopharmacology found that CBD “inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment”

Finding the Sweet Spot

Products with a balance of THC and CBD are becoming more commonplace in cannabis shops as consumers realize the value of cannabinoid synergy. (Elise McDonough for Leafly)

Lots of people (like yours truly) enjoy the psychoactivity of cannabis and find it mood elevating and healing in and of itself, but rest assured that you don’t need to get high AF to reap the benefits of THC.

However, finding your optimal dose will involve some trial and error.

According to Project CBD:

The successful use of cannabis as a medicine depends to a great extent on managing its psychoactive properties. The goal is to administer consistent, measurable doses of a CBD-rich cannabis remedy with as much THC as a person is comfortable with… Preclinical science lends credence to the notion that a small amount of THC can confer health benefits. Oral administration of a low dose of THC (1 mg/day) resulted in “significant inhibition of disease progression” in an animal model of atherosclerosis (hardening of the arteries), according to a 2005 report in Nature, which noted: “This effective dose is lower than the dose usually associated with psychotropic effects of THC.

In a feature called We Asked a Scientist: What’s the Right Dose of CBD?, Nick Jikomes, Leafly’s in-house neuroscientist, explored the complicated process involved in optimizing the benefits of cannabis without going one toke over the line, including managing the complex interplay between THC and CBD.

CBD is essentially getting in the way of THC’s ability to bind the CB1 receptor, which is why the presence of CBD has a significant impact on the psychoactivity of THC-containing products, [and] why the ratio of the two compounds is important for anticipating the effects of cannabis products… While THC and CBD have different pharmacological properties, they can both have similar physiological effects, probably acting through different mechanisms. For instance, both compounds can have analgesic and anti-inflammatory effects; they may act through different mechanisms, so having THC and CBD could potentially enhance an outcome surrounding pain relief.

If you’re fortunate enough to have access to a legally operating cannabis dispensary, you should have no problem finding flowers, concentrates, topicals, and edibles with a wide range of THC-to-CBD ratios. But patients and consumers still sourcing their cannabis from the underground market will encounter more difficulty.

Browse Menus Near You For CBD/THC Products

One suggestion is to try combining whatever form of CBD you can access locally with the best whole-plant cannabis you can lay your hands on. Perhaps this means swallowing a CBD capsule and then taking a few puffs off a joint an hour later.

As always with cannabis, start with small doses and work you way up until you find the sweet spot.

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Cannabis Consumers Have Higher Sperm Counts, Harvard Study Finds

New research conducted at Harvard could disprove another major myth about cannabis fans.

A study published on Wednesday in the Human Reproduction medical journal found that male cannabis smokers might actually carry higher sperm counts and concentrations when compared to men who have never used the botanical drug.

“Those who had never used marijuana had 28 percent less potent semen.”

“Our findings were contrary to what we hypothesized at the start of the study,” study lead author Feiby Nassan, a postdoctoral research fellow at the Harvard T.H. Chan School of Public Health, said in a statement.

Researchers analyzed health surveys and semen samples from more than 650 men who were part of couples seeking treatment at the Massachusetts General Hospital Fertility Center between 2000 and 2017. The majority of the men participating had normal sperm counts, suggesting that other conception issues may have been the issue.

A survey found that 55 percent of men reported ever smoking marijuana in their lifetimes, and 11 percent said that they currently smoked marijuana.

Experts found that men who reported to have smoked marijuana had an average sperm concentration of 63 million sperm per milliliter of semen. Those who had never used marijuana were 28 percent less potent (48 million sperm/milliliter).

However, researchers also observed that people who stopped smoking tended to have slightly higher sperm counts than current pot smokers.

“We spent a good two months redoing everything, making sure that there wasn’t any error in the data,” said co-author Dr. Jorge Chavarro, an associate professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health. “We were very, very surprised about this.”

Testosterone Might Be The Link

One possible explanation could be that men who generally produce higher testosterone levels are more likely to use marijuana, rather than the implication that cannabis use itself affects sperm potency.

“It is well-documented that within normal ranges, high testosterone levels are associated with greater engagement in risk-seeking behaviors, including drug use,” Chavarro said. “Higher testosterone levels are also related to slightly higher semen quality and sperm counts.”

Despite the surprising results, experts say that much more research must be conducted before reaching a definitive conclusion.

“We could have found what we thought we were going to find, and maybe wouldn’t have been as surprised and would have ended up writing a very different paper,” said Chavarro. “But the fact that we showed the exact opposite forced us to look very, very deeply into the marijuana health effects literature. There is not that much. We are operating mostly on assumptions and good intentions and hunches.”

In 2017, Stanford University researchers found a similar surprise — cannabis users had significantly more sexual intercourse than non-users. Male daily cannabis consumers had 1.3 times more sex per month (6.9 sex instances) than never-users (5.6 instances) as well as very infrequent users of cannabis (5.5 instances). Female daily cannabis consumers had sex about one more time per month (7.1 occurrences) than never-users (6.0 occurrences) as well as very infrequent users of cannabis (6.0 times).

Do you think cannabis has hurt or helped your ability to conceive? Let the Leafly community know in the comments below!

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Science Backs Most Medical Cannabis Treatment, Study Finds

Chronic pain is the most common reason people give when they enroll in state-approved medical marijuana programs.

That’s followed by stiffness from multiple sclerosis and chemotherapy-related nausea, according to an analysis of 15 states published Monday in the journal Health Affairs.

“The majority of patients for whom we have data are using cannabis for reasons where the science is the strongest.”

lead author Kevin Boehnke, University of Michigan

The study didn’t measure whether marijuana actually helped anyone with their problems, but the patients’ reasons match up with what’s known about the science of marijuana and its chemical components.

“The majority of patients for whom we have data are using cannabis for reasons where the science is the strongest,” said lead author Kevin Boehnke of University of Michigan in Ann Arbor.

California became the first state to allow medical use of marijuana in 1996. More than 30 states now allow marijuana for dozens of health problems. Lists of allowable conditions vary by state, but in general, a doctor must certify a patient has an approved diagnosis.

While the U.S. government has approved medicines based on compounds found in the plant, it considers marijuana illegal and imposes limits on research. That’s led to states allowing some diseases and symptoms where rigorous science is lacking. Most of the evidence comes from studying pharmaceuticals based on marijuana ingredients, not from studies of smoked marijuana or edible forms.

About 85 percent of patients’ reasons were supported by substantial or conclusive evidence in the National Academies report.

Dementia and glaucoma, for example, are conditions where marijuana hasn’t proved valuable, but some states include them. Many states allow Parkinson’s disease or post-traumatic stress disorder where evidence is limited.

The analysis is based on 2016 data from the 15 states that reported the reasons given for using marijuana. Researchers compared the symptoms and conditions with a comprehensive review of the scientific evidence: a 2017 report from the National Academies of Sciences, Engineering and Medicine.

About 85 percent of patients’ reasons were supported by substantial or conclusive evidence in the National Academies report.

The study shows people are learning about the evidence for cannabis and its chemical components, said Ziva Cooper of University of California Los Angeles’ Cannabis Research Initiative. Cooper served on the National Academies report committee, but wasn’t involved in the new study.

About two-thirds of the about 730,000 reasons were related to chronic pain, the study found. Patients could report more than one pain condition, so the figure may overestimate patient numbers.

Patients include 37-year-old Brandian Smith of Pana, Illinois, who qualifies because she has fibromyalgia. On bad days, her muscles feel like they’re being squeezed in a vise. She said she has stopped taking opioid painkillers because marijuana works better for her. She spends about $300 a month at her marijuana dispensary.

“Cannabis is the first thing I’ve found that actually makes the pain go away and not leave me so high that I can’t enjoy my day,” Smith said.

The study also found:

–Alaska, Colorado, Nevada, and Oregon saw a decline in medical marijuana patients after legalization of recreational marijuana in those states.

–More than 800,000 patients were enrolled in medical marijuana programs in 2017 in 19 states. That doesn’t count California and Maine, which don’t require patients to register. Other estimates have put the number at more than 2 million .

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What Is Caryophyllene and What Does This Cannabis Terpene Do?

Terpenes provide a wide variety of aromatic properties ranging from floral and earthy notes to musky and citrusy ones. When it come to the spicier side of the spectrum, caryophyllene holds the trophy for the most flair.

The terpene caryophyllene is present in many herbs and spices, including black pepper, basil, and oregano, and cannabis strains with high levels of it deliver a spicy, funky warmth to the nose, similar to cinnamon and cloves.

What makes caryophyllene an intriguing terpene is its relationship with our endocannabinoid system, particularly, its ability to bind to CB2 receptors. Because of this, it comes with a host of potential medical benefits.

Caryophyllene’s Unique Profile

Also called beta-caryophyllene or BCP, this terpene can be found in aromatic oils like rosemary and clove oil, and in nature it’s most commonly found in hops, cloves, black pepper, oregano, cinnamon, and basil. It’s responsible for the slight bite of pungency associated with smelling cracked pepper.

Caryophyllene is a bigger molecule than terpenes like myrcene and limonene. Caryophyllene’s molecular structure also contains a cyclobutane ring, something rare in nature and not found in any other known cannabis terpene.

The human body’s endocannabinoid system contains a vast network of receptors located throughout the body. Two major types exist: CB1 and CB2 receptors. CB1 receptors are primarily located in the brain and central nervous system, while CB2 receptors are found mainly in our peripheral organs.

When a cannabinoid such as THC is ingested, it primarily binds to CB1 receptors located in the brain and central nervous system, producing a euphoric effect.

The unique molecular structure of caryophyllene allows it to easily bind to CB2 receptors primarily located within our peripheral endocannabinoid system. This means that is doesn’t cause any of the euphoric feelings of cannabis while providing many of the benefits associated with activating those receptors, like reducing inflammation.

It’s unlike any other terpene because it is the only one that has the ability to directly activate a cannabinoid receptor, especially CB2 receptors.

Strains Containing Caryophyllene

Cannabis strains with high levels of caryophyllene tend to be spicy and musky, and some are also known to have a funky profile. Many carry prominent notes of diesel and fuel that are known to cause the same nose-tingling bite associated with taking a whiff of pepper.

Some strains with a higher-than-average amount of caryophyllene include:

(Elysse Feigenblatt/Leafly)

The graph above shows how much caryophyllene a strain produces on average, relative to its total terpene content. For example, about a third of Lavender’s terpene profile is caryophyllene (33.27%). The length of the bars represents the range of samples obtained from growers, which were verified by Confidence Analytics.

According to the graph, caryophyllene is found in high levels in many strains of the Cookies family–Platinum GSC, GSC, Cookies and Cream, and Candyland (Platinum Cookies x Grandaddy Purple).

This stress-relieving terpene is also present in many hybrids known to cause relaxation and reduce anxiety. Given its unique aromatic notes, it’s fairly easy to detect in a strain.

Many cannabis topicals and salves utilize strains with high levels of caryophyllene, showcasing its natural aromatic profile while also providing therapeutic benefits.

The Medical Benefits of Caryophyllene

Studies on caryophyllene indicate a wide variety of therapeutic potential. A 2014 study shows pain-relieving properties of the terpene in mice, and another rodent study shows caryophyllene’s potential to reduce alcohol intake, making this terpene a possible treatment for addiction.

Caryophyllene has also been shown to have antioxidant and anti-inflammatory properties, and to be a possible therapy for treating inflammatory bowel disease. Research has even found that caryophyllene may be able to treat anxiety and depression.

Current studies are hoping to unveil even more of the therapeutic potential behind caryophyllene, including research indicating that it may help with lifespan longevity by reducing gene stress.

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The Most Efficient Way to Smoke Cannabis? Study Says Dabs

There are so many different ways to use cannabis. But have you ever wondered what method is most efficient? A new study points to dabbing–suggesting that inhaling heated extract vapor maximizes delivery of cannabis’ active ingredients.

Dabbing Outperforms Alternatives

According to the 2019 study from Forensic Science International, dabbing is significantly more efficient at delivering cannabis’ main active ingredient–THC–compared to other inhaled methods like burning a joint or a pipe bowl.

Over 75% of the THC in a dab makes it into the users’ lungs. By contrast, smoking cannabis destroys about 75% of the THC before it can get into the user, the study found.

The experiment utilized a machine built in-house which replicated smoking and dabbing, while collecting the smoke and vapor for analysis. The smoke or vapor that would have made its way into the lungs was analyzed for cannabinoid content. Comparing this result with the cannabinoids in the original sample, scientists were able to estimate how much THC and CBD from the original cannabis product would make its way into the consumer’s system. They called that the “recovery rate”.

Previous Studies on Vaping, Smoking and Joints

While this study points to vast differences between smoking and dabbing, earlier studies found less pronounced results. A 2015 study by Dr. Jeffrey Raber found decent recovery rates for smoking, with a range of 27.5% to 46.3%. While this represents a more optimistic picture for cannabis smokers, it is still significantly lower than the reported 75.5% recovery rate for dabbing.

Dabbing is also different than “vaping”. Dabbers inhale extract that’s boiling off a heated piece of quartz, ceramic, or titanium.

Vapers might be toasting flower in a Pax, or a Volcano, or sipping vapor from the equivalent of an e-cigarette.

Research on vaporizers shows a wide range of recovery rates that vary greatly based on the vaporizer used. Most vaporizers averaged recovery rates in the mid-to-high 50’s. One study showed rates from 51.4% – 82.7%, depending on the vaporizer. Only one vaporizer studied came close to the recovery rates for dabbing.

Keep Those Temps Low

While dabbing seems to outperform the other methods at first glance, Dr. Raber argues that dabbing doesn’t always have such high recovery rates. His team performed experiments on dabbing and pipe smoking, along with his research on joints. They found much lower rates of recovery for dabbing–around 40%. His research suggests that dabbing is on par with smoking when it comes to recovery.

Still, he says, “It is certainly possible that you could see high efficiency in terms of recovery via a dab.”

So why would we see such large variation in these studies?

“It seems to primarily be based on temperature,” explains Dr. Raber.

Higher temperatures lead to more combustion, which may destroy or convert active cannabinoids into something else.

In Raber’s experiments, he analyzed not only the smoke and vapor that goes to the lungs, but also the ash, side stream, and the exhaled smoke. Still, they only recovered about 50% of the cannabinoids from the original sample. The other 50% of the cannabinoids seemed to be destroyed or converted into something else. So, the new study may have used a lower temperature to dab, reducing combustion.

While combustion seems to be the culprit for smoking’s low numbers, we simply can’t assume that these cannabinoids just ‘go up in smoke’. After all, smoking joints has a strong effect that feels quite different from vaping or dabbing.

“It is quite possible other molecules that form during combustion, which are absent in vaporization, are leading to some of those experienced physiological effects,” explains Dr. Raber. Unfortunately, it would be very difficult to determine specifically what that molecule might be.

Is It Dab-O-Clock Yet? Leafly Locates Your Local Dab Menus

Is Dabbing THCA More Efficient?

Another important factor in the varying rates is the composition of the extracts used.

“We did observe differences depending on concentrate composition,” recounts Dr. Raber about his own study.

Raber’s study used extract rich in THC, while the new study used the natural “acid” form of THC — called “THCA” — that you’ll find on the fresh plant. The difference is important.

It may be that dabbing with THCA extracts offers a particularly efficient way to consume THC.

(We’re getting into organic chemistry here, but when you heat THCA it becomes THC — which is great for your recovery rate. But if you heat THC, it becomes CBN — bad for your recovery rate. This is why old weed is so weak. The THCA has mostly become THC and or worse, CBN.)

High-THCA extracts have become increasingly available in recent years, but they aren’t the standard when it comes to dabbing.

Is dabbing really more efficient overall? Or is it about low-temp dabbing with THCA to max out recovery rates? More research is needed to fully understand this picture.

Face-Off: Dabs and vapes might beat joints for efficiency. Note: rates can vary by device, method and chemistry Sources: 'A preliminary investigation of lung availability of cannabinoids by smoking marijuana or dabbing BHO and decarboxylation rate of THC- and CBD-acids.' Marianne Hadener, Sina Vieten, Wolfgang Weinmann, Hellmut Mahler. Forensic Science International, Vol. 295. February 2019, Pages 207-212. 'The Conversion and Transfer of Cannabinoids from Cannabis to Smoke Stream in Cigarettes' Sytze Elzinga, Oscar Ortiz, Jeffrey C Raber, Natural Products Chemistry & Research, Jan. 2015
OG Face-Off: Dabs and vapes might beat joints for efficiency. Note: rates can vary by device, method and chemistry
Sources: ‘A preliminary investigation of lung availability of cannabinoids by smoking marijuana or dabbing BHO and decarboxylation rate of THC- and CBD-acids’, Forensic Science International, Feb. 2019; ‘The Conversion and Transfer of Cannabinoids from Cannabis to Smoke Stream in Cigarettes’, Natural Products Chemistry & Research, Jan. 2015; ‘Medicinal Cannabis: In Vitro Validation of Vaporizers for the Smoke-Free Inhalation of Cannabis’ PLoS One. 2016 (Graphic by Leafly)

Sounds like low-temp, THCA dabs might be the way to go! Comment below!

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UC Berkeley Launches a Cannabis Research Center

BERKELEY, CA — One of the nation’s premier learning institutions is bear-hugging the once-feared cannabis plant like never before.

A newly formed Cannabis Research Center at UC Berkeley launched Tuesday night. The center could be the beginning of something huge in academia, said co-director Van Butsic, who has a Ph.D in forestry, and is studying cannabis farming and water use in 2019.

Butsic said researchers all across the university are performing or proposing cannabis-related studies. The Cannabis Center hopes to catalyze those elements to boost grant funding and publish major findings in leading journals–the dual fuels of academic success.

“This really opens things up. We really should be so much further ahead in our ability to gather data, analyze it, and get it out there.”

Dominic Corva, Ph.D, founder, executive director, Center for the Study of Cannabis and Social Policy

Cal’s number one rank among among public universities bestows unprecedented credibility on the burgeoning field of cannabis studies. Tuesday night’s private reception took place on the top floor of the Barrows science building overlooking the school’s famed campanile. A wine and cheese reception followed a panel talk.

The panel discussion included: Richard Parrott of farming regulator CalCannabis; Joanna Cedar from major producer CannaCraft; Patricia Brooks, cannabis advisor to Alameda County Supervisor Nate Miley; longtime advocate Kristin Nevedal of the Nevedal Group; and Stephen DeAngelo, founder of Oakland’s biggest retailer Harborside.

In the audience were more than 50 guests including cannabis research all-stars Amanda Reiman, who has a doctorate in social welfare; Dominic Corva from the Center for the Study of Cannabis and Social Policy in Washington state; and Cal post-doctoral fellow Michael Polson.

This first year, the Cal Cannabis Center maps the barriers to entry for cannabis farmers and determines farm water use. Many more grant applications should follow.

“It’s great the UC system is coming along with this stuff,” Corva said. “This really opens things up. We really should be so much further ahead in our ability to gather data, analyze it, and get it out there. This will get us over the hump.”

A New Epoch In Academia

A small grant from the UC Berkeley Social Science Matrix pays for this year’s Cannabis Center. Butsic said that’s a world of difference from even a few years ago, when he asked about applying for cannabis research grant money.

“They said, ‘Don’t even bother to apply.’ And now, how things have changed,” he said.

One in five Americans lives in an adult-use legalization state. The US cannabis economy might total $40 billion in illicit and licit annual sales.

Until recently, institutional bias against cannabis plagued academia, which mostly relies on federal funding. The vast majority of cannabis research funding comes from the National Institutes of Health (NIH), signed off by the National Institute on Drug Abuse (NIDA). NIDA has a congressional mandate to seek evidence only of cannabis’ harms, not its benefits.

Reiman gave the example of the National Survey on Drug Use and Health (NSDUH), which prevented respondents from supporting legalization. The NSDUH survey asked a cannabis legalization question where the answers were either, “strongly oppose,” “oppose,” or “neutral.”

This type of obvious bias “pushed away so many brilliant people,” said Reiman, who got her Ph.D. from Cal in 2006. “You lose really smart people or you jade them. We all knew the way the game was being played.”

Today, legal cannabis taxes fund unbiased research grants in multiple states — including UC San Diego‘s work on medical marijuana, as well as traffic safety. Plant biology and ecology researchers can also tap new grants from more traditional sources, such as the National Science Foundation. Northern Michigan University now offers a “Medical Plant Chemistry” degree for cannabis.

Alameda County’s Patricia Brooks said solid data on cannabis’ environmental or economic impact will buttress future policy discussions. “We need to have clean data so we have a baseline of credibility moving forward.”

Nevedal represents small outdoor farmers and said she was amazed to see Cal level up its cannabis research game. “This is kind of a dream,” she said.

Cannabis Research Starts At The Farm

Butsic’s focus on cannabis farmers’ barriers to entering the legal market is especially timely.

Parrott, the lead state regulator at CalCannabis, which oversees growers, noted cannabis is the only agricultural crop subject to state licensing. “You don’t need a license to farm tomatoes, you just plant them.”

As a result of state licensing, cannabis farms are subject to tough environmental standards under the state’s environmental quality act (CEQA) that no other farms face.

NIMBYs have long abused CEQA as a cudgel to kill local development in California. That reality has now come to cannabis.

Both cities and the state of California will face NIMBY lawsuits over cannabis that invoke CEQA this year, it seems. CEQA reviews are the number one thing slowing down annual farm licensing in California, Parrott said.

These kinds of regulatory hurdles are “devastating to this community,” said DeAngelo, who has seen his 3,000-grower supplier roster shrink to 25 distributors in 2018.

The launch of Cal’s Cannabis Research Center follows a very popular Science of Cannabis public symposium in 2018 produced by the school’s Botanical Garden.

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Which Is More Potent, Vaping Cannabis or Smoking a Joint?

Cannabis vaporizers and pre-packaged cartridges continue to grow in popularity, with sales estimated to grow nearly 50% from 2017 to 2018. Vaping delivers a different experience than smoking a joint, but it’s not easy to quantify that difference. Recently, though, scientists have looked into the question and found that vaping actually packs a more powerful punch than the traditional joint.

Vaping ‘can produce drastically different’ experiences than smoking joints.

Tory Spindle, postdoctoral fellow, John Hopkins University

According to a recent JAMA study that examined cannabis consumption in infrequent consumers, people who vaporized cannabis flower experienced more pronounced effects than those who smoked the same dose. What’s more, effects increased along with the dose administered, suggesting that vaporized flower should be approached with more conservative dosing than any other consumption method, especially for infrequent consumers.

While the lead author acknowledged that the study has some limitations, he echoed its conclusions in an interview with Leafly: “It was surprising, the magnitude of difference between equal doses of smoking versus vaping,” said Tory Spindle, a postdoctoral fellow with John Hopkins University’s Bayview Medical Center. Vaping “can produce drastically different impairment” for all consumers, he said.

More Efficient THC Delivery

Previous studies have shown that vaping is a more efficient THC delivery method than smoking, so researchers sought to examine its impacts on several outcomes at two doses and to compare these results with both smoking the same doses and consuming placebo doses of a THC-free substance. Researchers conducted the study between June 2016-January 2017 at Hopkins’ Behavioral Pharmacology Research Unit.

The population studied was made up of nine men and eight women with a mean age of 27.3 who were prescreened for cannabis and other drug use beforehand to confirm they all had gone an average of 13 months without consuming cannabis before the study.

Additionally, researchers assessed the participants before they consumed cannabis and then at 10 points afterwards up to 8 hours after they had consumed each of the six study doses (three vaping and three smoking) and each dose was measured to ensure consistency and with participants blinded to the amount they were using.

“We were able to control dosing better across the two conditions,” Spindle said, noting that this was likely why the study yielded different results. This research method allowing for titrated doses, or more carefully-calculated individual doses, which has been difficult to achieve in much of the past research on this subject.

Measuring Vaporized Flower’s Effects

When it came to measuring the cannabis affects, researchers applied the Drug Effect Questionnaire and three computerized tasks, The Digit Symbol Substitution Task, Divided Attention Task and Paced Auditory Serial Addition Task. These tasks were chosen because they “previously demonstrated to be acutely influenced by cannabis self-administration and representative of workplace performance and/or operation of a motor vehicle.”

Researchers tested subjects vaping flower, not cannabis oil. So there’s more work to be done.

Comparing 17 participants’ outcomes across vaping and smoking, researchers found statistically significant differences at a 25-mg THC dose. With vaping, consumers experienced more adverse effects, or “pronounced impairment of cognitive and psychomotor ability,” determined by their performances on the computer tests. Consumers that vaped also experienced more paranoia and anxiety than their smoking peers.

The results were similar at a lower dose as well. At 10 mg THC, vaporized cannabis flower “modestly” harmed cognitive functioning and yielded significant differences with smoking, as measured by mean drug effect scores.

“For both inhalation methods, mean peak changes for ratings of drug effect at the 10-mg and 25-mg doses were significantly greater than placebo,” the researchers also found. “Significant, sometimes adverse, drug effects can occur at relatively low THC doses in infrequent cannabis users,” they wrote, “and accordingly, these data should be considered with regard to regulation of retail cannabis products and education for individuals initiating cannabis use.”

What This Means for Consumers

The cannabis administered in the study contained 13% THC (as well as 0.03% CBD and 0.8% cannabinol), according to Spindle, which says a lot about how infrequent users and especially new medical cannabis patients should dose themselves if they choose to vape. Keeping in mind too that cannabis products available at dispensaries are usually more THC-rich than these research doses.

As for regular cannabis consumers with a high tolerance to THC, the results cannot be extrapolated, one of a few limitations in the study. Other limitations included using a range of only three doses and one strain of cannabis (which was low in CBD, Spindle noted), and using only flower and a single vaporizer type (the Volcano Medic) for the vaping portion, and a small pipe for the smoking research. Researchers did not examine the effects of vaping liquid cannabis or using other vaping instruments.

“This is one vaporizer and we need to do more research,” Spindle said. “Definitely more studies are needed to see if these effects are applicable across other types of variables.”

Need to Test More Variables

That idea was echoed in the research, which stated that more controlled studies of a variety of vaporizing and smoking methods are “vital” and “may inform dosing guidelines, cannabis policy and regulation, and procedures for detecting acute cannabis intoxication.”

In addition, the corresponding author for this study, Ryan Vandrey, said, “We still don’t have a full look at the long-term effects of vaping, such as whether there is a risk for chronic bronchitis, and more work needs to be done on that front,” according to a news release issued by the Hopkins School of Medicine (where Vandrey is an associate professor of psychiatry and behavioral sciences).

On the other hand, some results from previous studies were echoed in this John Hopkins study, like, for instance, researchers did not find strong correlations between results and THC blood concentration.

“THC doesn’t stay in the blood that long,” Spindle said, cautioning: Blood concentration levels “can go back to baseline before you’re done feeling the effects.”

Collectively, the findings from this study and others indicate yet again that blood THC concentrations are not a valid indicator of a cannabis consumer’s intoxication and/or impairment, and that it’s a much more complex issue than once assumed.

As the study concluded: “It highlights the need to explore other biological and behavioral means of detecting acute cannabis impairment.”

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Pain Relief, Cannabinoids, and Neuroplasticity With Dr. Michael Moskowitz

The most amazing thing about the progress in cannabis medicine is that most of it is being made by individuals. People are experimenting on themselves to find relief, create products, and discover remedies for a variety of illnesses and diseases. It’s 2019, we can go to the moon, we can create artificial intelligence, but we are still in the dark about the many miracles of medical cannabis.

Until the American federal government, through the Drug Enforcement Administration, reclassifies cannabis from its very political Schedule I status, patients, nurses, caregivers, and doctors are very much on their own for information, research, and resources that can help guide their use of medical cannabis treatment. Without consistent regulation and efficient laboratory testing, it can be hard to use medical cannabis right now, though it is finally easier to get in states that have legalized medicinal use.

Dr. Michael H. Moskowitz, MD, MPH has been working in public health and medicine for almost forty years, specializing in researching and writing about neuroplasticity and chronic pain. After experimenting on himself first and then going rogue within his own practice, he compassionately gives his experience and research of medicinal cannabis in the exceptional book, Medical Cannabis: A Guide for Patients, Practitioners, and Caregivers.

Diving into questions and issues everyone has about using cannabis medicinally right now, this book is the best thing available on the market. Dr. Moskowitz delivers the science and the practicality necessary to understand how cannabis works in the brain and the body, and how you can approach using it–whether you’re the doctor or the patient.

Breaking the Stigma Between Doctors and Cannabis Medicine

“I was treating patients for probably thirty years when I came upon this [cannabis] in chronic pain treatment, and what I was impressed with was how muddy all of the medicines we were using were. Even though we got people better, we never got anybody well or rarely got anybody well. The rubric in chronic pain treatment is to tell the patient ‘we can help you reduce your pain but we can’t make it go away.’ I thought, that’s just crap, why are we telling people that? We’re only telling them that because we don’t have the tools that we know how to use to make it go away, but it doesn’t mean they don’t exist,” Dr. Moskowitz explained.

“With cannabis, it was the opposite. People decided this was a medicine that was helpful to some of their issues, doctors kind of thought it was just wink, wink, nudge, nudge, and they were just getting high … They just looked at it as a reasonable thing for people to do who felt so awful.”

Dr. Michael Moskowitz

While researching chronic pain treatment, Moskowitz experimented with neuroplastic hypnotherapy treatment. Unfortunately, it didn’t work so well for that particular patient, but it absolutely helped his own chronic neck pain. So he dived deeper into working with visualizations and developed a graphic workbook with animations that proved successful in treating chronic pain. He added, “We’ve developed lotions out of that that treat part of the brain where pain’s really harbored. We brought in salves and vibrations and all kinds of things to counter stimulate the pain signal with other sensory input.”

About five years into this research and treatment, he was asked by the American Academy of Pain Medicine to do a series of talks and lectures around the country on medical cannabis. “As a medical concept, it’s completely backwards from the way we mostly do things where some scientists develop an idea about something and it gets studied, tested on animals, then tested on humans and brought to market, etc. etc. With cannabis, it was the opposite. People decided this was a medicine that was helpful to some of their issues, doctors kind of thought it was just wink, wink, nudge, nudge, and they were just getting high. But these people were in such bad shape it was okay for them, and so doctors really didn’t look at it as a legitimate treatment. They just looked at it as a reasonable thing for people to do who felt so awful.”

Up to this point, doctors would send people to dispensaries and they would talk to people [budtenders] who generally didn’t know anything about medicine. Dr. Moskowitz began gathering his own research and doing lectures on it, despite never trying it as a treatment. This went on for about five more years, the first lecture being in 2011.

“I taught it at a number of places. I’m actually one of the two people I know in the world that’s taught medical cannabis to the federal government. I taught it at Walter Reed Hospital for the 5th Annual Army, Air Force, VA International Chronic Pain meeting,” he said. He still had not used it on himself or any patients.

Healing, Cancer, and Why Whole Plant Medicine Matters

As Moskowitz was teaching and researching, he became impressed with the fact that it looked like cannabis might be a fairly effective treatment for cancer. He experienced problems with his own prostate in the past without it being cancer, but after receiving an MRI that showed he had about a 90% chance of it, along with a high PSA (Prostate-Specific Antigen), his neurologist wanted to biopsy. He asked his doctor if they could wait and watch since it didn’t seem aggressive at that moment, and he wanted to instead treat himself with cannabis for a few years first. His doctor agreed and certified him for medical cannabis use.

“I really researched this out and I did a number of different things on myself. I realized as I was doing this that I was feeling really good, my physical health felt improved after about three months. I ended up continuing to feel really good, my PSA dropped that first year from 9.5, (which is high) to 8.3, which was still high but quite a bit lower. But the next year it jumped up to 13.5, which it’s not absolute that you’ll have prostate cancer, but it’s a pretty good chance you will–they thought 99% sure I had it. I did a biopsy about a year and 8 months into this treatment. I’d been very methodical about this, I treated it very very carefully, and it was negative.”

“Everything we know about CBD as a treatment pretty much came from THC … we gradually learned a lot more about THCA, CBDA, THCV, CBC, CBDV, CBN, and CBG. There’s this tremendous synergy that makes up that ensemble or entourage effect.”

Dr. Moskowitz

The day after these results, Dr. Moskowitz broke his ankle and fibula. He had to have 4 surgeries and still, he had never used cannabis for pain. After his first surgery, he used opioids for three days, and it helped a little, but not particularly well. “I started using more cannabis with higher THC because I was doing nothing but laying around at that point and I got great pain relief. I came up with a treatment where I used a combination of THC and CBD in alcohol tincture in a rollerball, rolled around the area where the surgery was because I couldn’t touch it, it was still an open wound, and it took the pain away 100% within three minutes. It never failed to do that, not once.”

Passionate about using the whole plant in his treatments, he began to tap into the ensemble effect of medicinal cannabis. “CBD doesn’t absorb particularly well under the tongue, it’s actually one of the worst places to absorb it into the body, but THC does. Everything we know about CBD as a treatment pretty much came from THC as a recreational drug because that’s all anybody ever looked at. Now, we gradually learned a lot more about CBD but also THCA, CBDA, THCV, CBC, CBDV, CBN, and CBG. There’s this tremendous synergy that makes up that ensemble or entourage effect,” Dr. Moskowitz explained.

With hardware in his leg for several months, Dr. Moskowitz continued applying the rollerball treatment, which lasted 6–8 hours, sometimes longer. Struck by the remarkable qualities he experienced, he wanted to bring this into his own practice. After looking at the law and acknowledging the potential problems, he decided he could not deny it to his patients. “They’re really suffering, and this looks like a really good treatment. When I treated the pain issues with myself, not the prostate, I noticed it didn’t just suppress the symptoms but it healed the tissue–it’s also healing the tissue in the dermis of the skin which then helps heal the tissue below that.”

Discovering New Methods of Treatment With Cannabis

In his own practice in Marin County, California, Dr. Moskowitz asked his patients if they were interested in trying medicinal cannabis. For those who were, he followed them in a separate database to see what it did for their pain, stress, quality of life, sleep, energy and focus. The last two of which he expected were going to be worse. He also considered if they were on opioid medications, if they lowered them.

His book further explains how he worked with his patients, and ultimately, he discovered that cannabis is an infinite treatment. There were so many combinations and permutations that you can never run out of ideas.

Knowing only the THC and CBD content of a strain is limiting; it takes away the blending of the entourage effect and doesn’t help in recommending something based on its medical values.

“I did it [cannabis treatment] over nineteen and a half months, and I followed 161 people. Every time [a patient] came in, I would talk to them about their pain, stress, sleep, quality of life, energy, focus. And if they were on opioids, did they lower their opioids? At the end, 87% of the patients reported pain reduction, 81% reported improved sleep, 73% improved stress, and 76% improved quality of life. Those are remarkable numbers in a practice like mine. We get tough cases and we work them for years and years and years, so I really know these people. It’s not like a typical study where you’re getting randomized strangers from out in the world. These are my patients, and I know them pretty well. It also brings in a little bias in their results because they want to please me, but I’ve done many of these things with neuroplasty over the years and I never saw such a robust response.”

Other results included 53% reporting improved energy and only 7% worse energy. 43% reported improved focus and only 8% worse focus. They weren’t stopping their other medications, just adding this treatment and then adjusting whatever needed adjusted. 71.3% of patients reduced their opioids and 14% came off of them completely.

The ensemble effect that Dr. Moskowitz has tapped is there for a reason. In the plant, it’s there to help the plant survive in nature, but the doctor is quick to point out that over the last 30,000 years, humans have moved the plant from the three isolated places it existed in the world (Asia, sub-Saharan Africa, and equatorial South America). “We’ve planted this in closets, desert, in rocks, in water, and in the air. We’ve done all kinds of things with it and we’ve totally changed the genetics of the plant. We’ve also used it in mass quantities. We’ve really passed these genes to most of the population, so most people have adapted to this plant even though they’ve never had it,” he said. Another reason why this is important is because it faults animal studies. Humans have a unique interaction with cannabis , no rat or dog or monkey has adapted to cannabis over the last 30,000 years.

As more dispensaries open and have quality medicinal products available, we should request they begin to give more information on their labels. Knowing only the THC and CBD content of a strain is limiting; it takes away the blending of the entourage effect and doesn’t help in recommending something based on its medical values.

When purchasing medicine, not only is strain knowledge important (beyond “sativa” and “indica”) but also the embodiment of the way they’re manufactured, whether it’s tinctures, capsules, vaporizers, etc. New laws in different states are emerging to make testing imperative, but the lack of consistency in testing itself is still an issue. Dr. Moskowitz added that it would be beneficial if at least nine cannabinoids were covered in the testing and available on the labeling. With so much more to discover in this early phase of cannabis research, his book is a fantastic and easily accessible guide into everything you need to know about using medicinal cannabis today.

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