Medical Cannabis: What’s New in 2022? with Dr. Dustin Sulak

 

Tuesday Integrative Health Webinar

Tue, Nov 15, 2022 4:52PM • 1:37:20

SUMMARY KEYWORDS

cannabis, thc, cbd, opioids, adolescents, good, cancer, patients, dose, endocannabinoid, people, study, cannabinoids, pain, treatment, products, milligrams, ptsd, started, cbg

SPEAKERS

Bill Clearfield

 

00:19

Hey Don’t bill goes to prostate wars

 

00:27

going well, actually kind of busy right now preparing for the long COVID Reset Summit. This weekend.

 

00:35

Long What’s that?

 

00:37

The long COVID reset.

 

Bill Clearfield  00:40

Okay, your partner that?

 

00:42

Yeah, it’s a it’s a big symposium. They’re gonna have some great lectures going on Friday through Sunday and yeah, I’ll be speaking. Where’s it at? It’s online.

 

00:52

Okay. Yeah,

 

00:55

I’ll put it in the chat here. On code reset calm. It’s this Friday.

 

01:02

through Sunday Yeah. Got all that? Hey, everybody.

 

Bill Clearfield  01:16

I just it.

 

01:17

Hey, Bill.

 

01:17

Good to see

 

Bill Clearfield  01:19

you too. Thank you for being where this was the young lady behind you. That is is about okay, she’s sneaking away I see. Yeah, I gotta cover there. She’s nice jammies. There.

 

01:32

Let me switch. Yeah, the speakers. Let’s see.

 

01:36

Yeah, just so I’m coming through clearly. You’re fine. Yeah. Okay, great. I’m just gonna try switching this off and see how that

 

Bill Clearfield  01:44

we got some time. So

 

01:54

how’s the sound coming in now?

 

Bill Clearfield  01:56

That’s fine. Yeah, sounds fine. You’re coming in.

 

02:01

All right, again, the home studio setup. Is this sounding Okay. Sounds good. Okay, great. All right. I’m gonna read these kids for five minutes. So we’ll get started with our

 

Bill Clearfield  02:14

Okay. All right. We’re good. I’ll let everybody in. Okay. Okay. All right. So, all right, we’re ready to go. So, Jay, how you doing Fred?

 

02:23

Oh, live in life. Okay, I

 

Bill Clearfield  02:26

don’t know why you’re not getting our emails. Usually I

 

02:28

got it Sunday. And then the day of it. At least I knew what it was. So you know,

 

Bill Clearfield  02:36

we’re, you’re on our list. I checked. So yeah,

 

02:40

I figured after all that time Austin disappeared. So well, we didn’t want it to we

 

Bill Clearfield  02:45

didn’t want to tell you we didn’t want you to know last year round. So we just you know, just cut you out. We get about it. Right. So one. One time a guy gave me I learned. I learned I learned I learned from my from my betters. You know?

 

02:58

Yeah. Sorry. Going back to the grandchildren for

 

Bill Clearfield  03:05

Yeah, well, my son’s coming to visit. Thursday. I haven’t seen him in three years. He’s been in China. So oh, he’s finally finally busted out.

 

03:16

Yeah, my son himself in the UK right now. He’s I in computer guys. So tomorrow, I think he does a seminar or conference he does for the half stack. He’s a tech guy and his partners in Serbia so he went to Serbia like four times last year and I will look at Poland today. They’re getting bombed now to you know, so. You know. Anyway, sorry. My earlier appointment just said they talked we were talking I was talking about tomorrow. So just informing you that tomorrow was good. But so what’s the in Beijing it was taken one see there. Sally

 

Bill Clearfield  03:55

was there for 18 years. They left less in the summer last summer and they said it got to bed. They’re out of their minds, you know, with the COVID Nonsense so so I forget

 

04:11

I saw you want to

 

Bill Clearfield  04:12

value lives. Yeah, he lives in Mongolia now.

 

04:15

Oh, let’s see. The Euro sad thing where they have that tribe that Hans was like hawks or Eagles or like nomads. That looks pretty interesting. They have the Eagles hunt for them, you know to kill things. But my golly and they also have to train I think my goalie that goes straight up. You’re afraid how many distance you have to wear like oxygen when you go on it.

 

Bill Clearfield  04:44

So I’ll find out he doesn’t tell me a whole lot. So yeah, okay. I’ll find out he’s coming on Thursday. I said I was he was here Thanksgiving 2019 And then all the virus nonsense happened and his wife is Chinese native and she didn’t want to leave and so they’ve been there for three years. He’s or three years I haven’t seen him. So oh face Facebook only FaceTime.

 

05:15

So well. My wife worked for the airline. So usually we go down visit my son about every month like day trips and stuff because you know, American Airlines can fly for free. But COVID And my wife, last six months of 2018 fought breast cancer and so we’ve been down I think, twice and three times since COVID. But hopefully balanced this year we can go and just be normal again. So anyway, so almost. So I didn’t realize you went to Iowa for schooling. I was

 

Bill Clearfield  05:51

went to school in Iowa. Yeah. Games in Ames

 

05:58

know the point how to mine okay. Yeah. Is that Is that where all the railroads come together? Probably. I almost went Augustana. And, you know, right Quad Cities

 

Bill Clearfield  06:17

Well, that’s that’s that’s when the river it’s about probably about 100 miles from from Des Moines. So

 

06:23

yeah. Well, my dad was like to go to Dubuque because they had a dog track there. So, yeah,

 

Bill Clearfield  06:29

we would go to Omaha where there was a race horse race track. was called AKSARBEN. Oh, yeah. Braska spelled backwards.

 

06:41

Yeah, so here we go to the corn palace. Yeah, this is a place to build out a tin cans, but I guess because you have nothing to do in South Dakota or Nebraska. You know? So like, slowly building

 

06:57

Hey, guys, if you stay in here, you gotta be quiet.

 

Bill Clearfield  07:03

I must be our speaker. Okay, guys, I’m gonna do we’re talking us.

 

07:07

We all know I was talking to the kids. I didn’t realize we were reminiscing

 

07:13

about Iowa. Yeah, yeah. Well, I tell you I what was better when you drove out I’m sure on at Wyoming was like Wyoming has some beautiful spots, but at through Wyoming was just the worst part of the whole trip. Plan. Nothing out there.

 

Bill Clearfield  07:31

You know, nothing better than downtown Reno, Nevada.

 

07:36

Hey, when we first know it’s pretty after that it’s winter. So we went to open Oak Hills. The other day I like to go there Friday. That’s a clam chowder. And yeah, a lot of fun. But I couldn’t listen to you. Yeah. Especially like, I think we’re almost 50 years I always called wife and training. You know, just like yeah, whatever. Like a cat. This I don’t care.

 

Bill Clearfield  08:13

So it’s right about five o’clock. So you got a small group for now Dustin, but we usually get at least double that Double the crowd by the time 15 minutes or so ago. So. So those who don’t know our speaker, this is Dustin Souillac. He is our one of our cannabis experts. And he’s going to tell us what’s new in 2022. I’m going to let him introduce himself and like a couple of other talks you’ve heard in the last couple of weeks. This is these were the talks that a certain medical association that had a big conference two weeks ago that decided that we weren’t worthy of being there. So this is what they didn’t want to hear. So we’re presenting it here. So who shall be who shall remain nameless from now on? And it’s

 

09:10

good. Okay. So,

 

Bill Clearfield  09:13

so thank you, Dustin, and take it away.

 

09:16

It’s great to be a part of this organization. So for those of you that don’t know me, I’m an osteopathic general practice. I have been in practice for a little over 13 years in Maine. And quickly after I started my practice, which I intended to be osteopathic manipulation and integrative medicine. Cannabis kind of swooped in and took everything over. I was here in Maine in 2009, where at a time when we expanded a previously dysfunctional cannabis law. And suddenly there were 1000s of people in the state that were using cannabis illegally. And they just needed a signature from a physician in order to be using it legally. And I turned out to be the only one willing to do that. For the first couple of years here. For the most part. There were a couple others that maybe did a few. And so I had this chance to learn a lot from my patients and then look at the primary literature and kind of validate what I was observing and talk to some colleagues on the West Coast. Who have been doing this for a long time. So that was back in 2009. And leading up to now so I’ve had clinics in Maine at one time, we had three different practice sites. Altogether. We’ve seen over 18,000 patients currently following about 5000 It’s myself and two nurse practitioners. I have a book that I published it’s the the handbook of cannabis for clinicians, which came out last year and I feel really proud of it. I think it’s a great place for for people to start kind of empowers clinicians to implement this in their practice and makes it easy for them to do that. And and then I also have I’m part of a company called healer, we have healer.com and we started off as free patient education and later paid education for it was actually designed for bud tenders and people in the industry. But it turns out we have a couple 1000 clinicians that have taken that course as well. And then and then we have products most recently just in the last couple of years. So hemp products, and then here in Maine and in Maryland, we also have THC containing you know, medical cannabis products and through the MediCal program. And so that’s also my disclosure of potential conflicts of interest. Really, Maine was in a really interesting place to kind of grow up with cannabis so to speak. We have, you know, a small population and a huge number of licensed cannabis producers and dispensers in the state. We have something called a caregiver program where basically anyone can get a license to produce and sell cannabis. So there’s there’s over 3500 of those in the state kind of lets a mind pot, kind of homemade and artisanal Lee made products. And so for a long time my patients were getting exposed to just incredible diversity of products and we put an HPLC lab in our office to start analyzing these products and figuring out what people were taking what was working and wasn’t working that this is kind of one of the parts of the story that turned me on early on to the some of these trace constituents in cannabis that were kind of lesser known but have a lot of therapeutic value. And so we’ll have a chance to talk about some of those tonight. Part of the healer program. I do a free webinar every month and it’s actually tomorrow night it’s on a Wednesday night. And on that webinar, I cover usually five or six different peer reviewed publications that have come out in the last few months things that I find interesting and applicable to, you know, clinical practice or just cool ideas from the research community. And so what I would have done for tonight is just select some of those from over the last year and the ones that I think are probably interesting and relevant to you all who might be exposed to some of this so let me start the presentation here that’s looking good. Oh, yes. I have to allow zoom to share my screen sorry about that winter a little update, but I think I’m getting getting there okay, it’s gonna make me quit and reopen to share my screen. I will be right back alright, let’s try that again All right, ready to go. So what I’ll talk about tonight and and really I you know, we have such a nice small group here. I’m happy to answer questions. Don’t feel like you have to wait till the end to question or comment or if there’s something that I’m not planning on covering that you want to know about. I’m happy to share that with you too. So we’re going to start with CBD a and CBG. A lot of you have heard of or used or taken work with CBD. So these are also in hemp based products products that have below point 3% thc. They’re kind of new to the market. And so I wanted to explain what those are and what they might be good for. opioid substitution. Some, you know, there’s year after year we have more data, and how cannabis can substitute or spare opioids and so I’ll show you some of the recent data on that. There are some new PTSD findings which were a little strange and worth talking about. PTSD has been a condition that we’ve thought cannabis has worked for. For a lot of people you know, it appears that way clinically. But unlike chronic pain, where there’s just a whole bunch of clinical data that supports the use of cannabis for for treating chronic non cancer pain, especially, you know enough for the National Academies of Science, Engineering and medicine to say that there’s substantial evidence supporting that there’s very little evidence clinically for cannabis as a treatment for PTSD, especially not in randomized clinical trials. And so there’s a big one that came out this year with some strange findings. And then just looking in general at like a large clinical population in Israel, they’re collecting really good data in their cannabis program in Israel. Well, when I say really good, as good as observational data can be and of course, there’s a lot of problems with that but a lot to learn from that as well. And then the last topic is cannabis safer adolescents, there was some new studies and review articles that came out. And also it’s just a really relevant topic because we’ve seen a major uptick in parents bringing their adolescent kids in for medical cannabis evaluation and potential treatment. And so in evaluating these, maybe you’re getting similar requests. And so it’s nice to know a little bit about the safety.

 

16:15

So we’ll start with this is the female flower of the cannabis plant, and this one has not been exposed to pollen so it’s not making seeds. It’s just growing more and more of these resinous oil glands here. And if you zoom in on those, you can see this is their structure that kind of potential ated structure and just incredible little Oregon’s this these are the factories of a lot of different medicinal compounds including cannabinoids and terpenoids, and flavonoids and all sorts of things that are mostly lipid soluble. And so what we’ve known about and studied and what we talk about typically when we talk about cannabis, are these two structures, the THC on top and the CBD on the bottom. You can see how similar these structures are right? You just have it’s just a dial the CBD has these two alcohol groups here. And and believe it or not, those are not made by the cannabis plant. You know that a lot of people think cannabis produces THC and CBD but actually what it produces are acids, acid versions of the same molecule. So you can see there’s a carboxylic acid group here in here so this would be th ca tetrahydrocannabinolic acid or CBDa cannabidiolic acid. This is what the cannabis plant produces and then these will transform into THC or CBD over time. At room temperature or very quickly when heated. So for a long time, these compounds were considered inactive precursors, because this really seemed you know, THC especially drew all the attention to heavy psychoactive effects such a wide variety of physiological effects. But now, in recent years, there’s been a lot more attention devoted to the THCA and CBDa. And what they might be doing. So let’s start with CBDa because now we’re seeing products on the marketplace that are selling CBD a kind of dominant there’s always going to be a little CBD in there unless it’s isolated. You know in a chemical process, but were the bulk of the CBD is still in its acid form. So how does it compare to CBD? Well, it’s actually got a lot of the same pharmacological properties, but a lot better bioavailability and it seems to be more potent in a lot of the mechanisms. Now CBD is you know, we consider it a dirty drug. It’s it has very low toxicity, but it has a lot of targets in the body. You know, I think 60 some potential mechanisms of action have been identified from receptors and enzymes and all sorts of things. One of the one of the things about CBD A is that it has not been found to act upon the CB one or CB two receptor. So these receptors are the main receptors of the endocannabinoid system, which is this homeostatic regulatory system and especially controls function of the nervous system. It tends to be a negative feedback system. So stimulation of these receptors will suppress release of other neurotransmitters, stimulation of CB two suppresses release of inflammatory molecules from immune cells and suppresses activity in certain cells like osteo class and so forth. And so, while CBD does act upon CB one and probably CB two, and that’s one of its clinical utilities, if CBD is a partial antagonist of CB one, or what it technically is, is a negative allosteric modulator. And so CBD has this ability to mitigate the psychoactive effects of THC to some extent, and this is a clinical strategy you combine CBD with THC tend to get a little more benefit from the CBD and a little less side effect from the THC. CBD a would not be expected to do that. Now often. That’s thought of as a good thing, but sometimes it’s not some people really want the full power of THC to shine through and they don’t want to dampen that with CBD. CBD A would be a good choice in that situation. And if you look at some preclinical studies, the potency of CBDa is really incredible now these are all intraperitoneal. So we’re not taking into account the bioavailability of the oral route. But for just some examples here if you look at Rodon model of emesis CBD was effective at five milligrams per kilogram CBDa at point 0005 milligrams per kilogram and within the dosing range of CBD, there was a biphasic effect where much higher dose CBD would actually cause emesis and this is common, you know, in some of the seizure studies, but the main side effects of high dose CBD is going to be nausea, vomiting, diarrhea, and CBDa did not seem to have that biphasic effect where high dose, you know, had the paradoxical effect. Here’s a Rodin model of hyperalgesia prevention. This one actually was orally administered, and CBDa was, you know, again, we’re looking at 100 times the potency for reducing hyperalgesia or preventing it. And then here’s a seizure model drove a seizures, and it was 10 times more potent than CBD in that model, even though very, very little of it crosses the blood brain barrier. I mean, probably probably hundreds of it compared to CBD crossing the blood brain barrier. So in a lot of ways, it’s more potent. And here if we look at another mechanism of action, Cox two inhibition. You can see on this line here, we’ve got diclofenac This is in vitro 100 micromolar. And then CBD a and very similar potency, well, same potency. 100. Michael micromolar has almost equivalent Cox two inhibition is diclofenac CBD has just a little bit compared to control not much for Cox two inhibition CBD a lot. So we’re talking about something that’s more bioavailable, more potent, more anti inflammatory, at least at this target. And then looking at the bioavailability this was kind of the first pharmacokinetic study in humans. This is published several years ago 2018 And they were basically given a decoction or an oil decoction would be like a tea but it’s boiled for a while of using this kind of what we call type two cannabis cannabis that has roughly equivalent THC and CBD components. But of course those are really THCA and CBDa because the flour hasn’t been heated. But after it’s been heated, this is this is kind of the formula that they came out with the oil. It had about equal parts THCA and THC and it had a little more CBDa than CBD. That’s because the decarboxylation temperature of CBDa is a little bit higher than THC so less of it changed over to CBD. And then similar similar for the decoction the decoction actually had more of even even less of the CBD a converted into CBD, but you know, let’s just look at the oil. You can see there’s like less than two times the amount of CBD a than CBD. But if you look at the bioavailability CBD A and the red, I mean there’s just really no comparison. There’s so much more such higher levels getting into the bloodstream of CBDa versus CBD when taken in an oil or in a decoction and I think it’s about 10 or 11 fold the area under the curve compared to the amount that was taken. Alright, so that’s CBD a you know, in summary, probably more bang for the buck more, you know, better bioavailability more potency. It doesn’t get into the central nervous system as well at least in people that have intact, intact blood brain barriers. But that might not make a difference because it’s more potent and it’s also not likely to impact the effect of THC. So in my company, we’ve been selling CBD and CBDa products. We actually a little less than a year ago sent out a little sample bottle of CBD a to everyone that had reordered CBD and but two thirds or three quarters somewhere in that range actually switched over to purchasing CBDa so when people try both, they tend to like the CBD a more seems to be more cost effective. And then moving on to CBG and I’m just gonna do a little review of CBG. From these couple sources. This is probably the worst title for a book. I’m not really sure what it means, but it’s actually got some pretty good chapters in it. And then this this was another mini review that came out in 2021. And so just talking about CBD again. So how do they find CBD where does it come from? Because I forgot to put that slide on here. CBG A is actually kind of like the initial precursor cannabinoid, it’s it gets produced by the plant and then it gets turned into THCA and CBDa and all these other cannabinoid compounds. And so basically over over several generations, breeders have been able to produce plants that lack the enzyme that converts the CBD GA into some of these other cannabinoids and then you finally get CBD rich cannabis prior to that the only way to really get any decent amount of this would be harvested early and it still wouldn’t be that much. So just in the last couple of years these these genetic varieties of cannabis have been available.

 

25:40

So what do we know about it readily crosses the blood brain barrier and again Now this time I’m talking about CBG not CBGa this would be the heated or decarboxylated version of it at CB one CB two receptor it actually acts a lot like THC but with a much lower affinity so it’s a lot less potent and then it ion channels which are common target of cannabinoids things like the trip v one channel this is the target of capsaicin, and some of these other trip channels can control pain and thermo regulation, thermal sensing things like that. So CBG is more similar to CBD at those targets. So it’s got something in common with THC but a lot less potent. It’s got some things in common with CBD and then it’s got some novel mechanisms that you don’t see in either of the other two. And this This is one agonist at the alpha two adrenoceptor centrally. So this would be a similar mechanism of action to I guess what’s considered the main mechanism of quantity and quantity and has other targets. as well but stimulating this adrenoceptor centrally will actually have a simple catalytic effect. And so CBG has a higher affinity than clonidine based on in silico models and and we don’t really know which subtype it’s it’s addressing does it work just like clonidine or is it a little bit different? But there’s implications for blood pressure, pain, AD D and ADHD if you know guanfacine, which has the same target use for that condition, opiate withdrawal, tic disorders, PTSD, dementia and more. And then CBG also has kind of interesting activity at the serotonin five HT one a active receptor, it’s considered a neutral antagonist some of blocks both agonists and inverse agonist just kind of blocks things at that receptor. CBD and CBDa are both considered indirect agonists and this is their mechanism of action for antidepressant anti nausea and other effects. So a little different than than its brother and sister. They’re at the five HC one a receptor. And you know, receptors are so weird. We like to think about them black and white, like, you know, does it turn it on or does it turn it off? Or does it block it in what’s interesting is that some synthetic five HT one a blockers have actually been shown to in crease the like have a pharmacodynamic increase in SSRIs and other serotonergic agents. So why if you just block it a little bit, do you end up getting a stronger effect? And I don’t know maybe if we think about something like low dose naltrexone, we can start to understand that a little bit. So does this decrease serotonergic activity or increase it or is it dose dependent? It’s really hard to know but I think you know, one caution is mixing it with serotonergic drugs could have unexpected effects. We haven’t seen that clinically, I’ve been watching for it, but I suspect that at some dose CBG could have some interactions with serotonergic drugs. And then it’s a strong anti inflammatory so we were talking about CBD a at the Cox two inhibitor before we’ll take a look at CBG now and and the other one that was kind of the lower bar was showing cuts to activity. This is showing Cox one and Cox two inhibition so the longer the bar is the more of an inhibitory effect it has on that enzyme. And you can see that CBGa is quite a quite an inhibitor of Cox one and Cox two, you know, so CBGa and it actually seems to be quite superior to CBDa in this model. And then one of the things that we’ve known about for a long time with CVG is it’s anti bacterial effects seems to be the most potent cannabinoid in terms of its antimicrobial effects

 

29:37

including in antibiotic resistant strains. So just a little summary of its therapeutic potential. Lots of things here has some anti neoplastic effects, similar to THC can lower intraocular pressure, worked well in animal models of inflammatory bowel disease. I mentioned antibacterial, some of those ion channel targets are relevant in the treatment of psoriasis. It has some bone healing stimulation properties, decreases neuro inflammation even has some modulation of the testosterone system. And I would call that a therapeutic potential based on early animal studies. And that’s suggesting if you use that way right now, and then mood disorders and feeding disorders, and of course analgesia and inflammation. All right, so that’s enough for our CBD a and CBG. Now, you know, it’s out there in the marketplace. Let’s take a little look at opioid substitution. We’re going to start with a study that I published with data from my practice, this was just survey data and online convenience sample. And you know, I’m certainly proud of this, but it really didn’t give us anything new. There’s been quite a few of these observational studies that all show similar results. So this was from back when I had three practice sites. We had two clinics in Maine and a sister practice in Massachusetts. Now. That all stopped in what I think 2018 We sold the Massachusetts practice and then beginning of COVID, downsize to one practice in Maine. I like it much better that way. I actually had an opportunity to get exposure to this paper, you know, many patients, and so we had 525 respondents that had been using opioids consistently for at least three months and then they added cannabis to their regimen. And this is how they answered some questions. How has your opioid drug use changed since you started using cannabis? And if you look at this line here stopped opioids 40% stopped their opioids completely. And then you can see another about 40% right here, were able to decrease their opioid use 13% had no change and 1% and an increase in their opioid use since starting cannabis. And then despite really stopping and reducing opioids for a lot of people, if you ask them, what happened to their pain level, you know, almost everybody had had like 90% of people had some decrease in their pain, and quite a few had more than a 40% decrease was which is considered clinically relevant. That was about 40%. So less opioids and better pain control. What about function? I think that’s the most important thing. 80% said that it improved their function since they started cannabis and 87% said their quality of life improved. Now, this is just you know, a lot of potential selection bias in the survey respondents and you know, no control group so far from perfect data, but this is this is what this is what we see you know, I mean, it’s still 13 years later, you know, with with the people I practice with, at the end of the day, my colleagues, we’re still talking about how many people got off opioids and how many people got off benzos and it’s, you know, it’s it’s really impressive. This is this is what it feels like to be in a cannabis practice. And then, here was a review article that came out with nine studies, systematic review, over 7000 patients, and what they found was that 32 to 60% of patients with non cancer are unable to produce the I think we’re echoing your computer. Thank you. So yeah, so three among these, the set nine studies somewhere between 32 and 60% of people reduce their opioids. And in the amount of reduction ranged from 64 to 75%, on average, so this is big, you know, not everybody reduces. And when some people reduce a they don’t stop all the way but if there’s just a lot of opioid sparing going on in these in this clinical data. And then, in 2020, I was a part of a paper that provided consensus based recommendations for how to titrate cannabinoids and taper opioids. So this is kind of like a consensus of experts in the field. Of how to do it. We use the Delphi process and so I just showed that as a reference if anybody wants to really easy how to, they can just, you know, Google Scholar or PubMed search me and you’ll find this paper and then also we have a patient guide on healer.com That’s free how to substitute opioids with cannabis. All right, let’s talk about PTSD. As I mentioned, clinically, we think it works really well our patients tell us it works really well. What does it work well, for? I’d say the the best thing that it does is reduce or completely eliminate the nightmares and people with PTSD. It helps them get sleep and of course if you can do that, they wake up feeling better, it just changes their whole day changes their capacity for learning their memory, their emotion, cognition, their hormones, I mean, get get these people sleeping is kind of a first line strategy in and then it also helps reduce anxiety and it can be used in ways that help with processing the trauma as well. And and that actually has been shown, you know, through fMRI studies that THC can alter the connectivity between the prefrontal cortex and in the limbic system and it really helped people’s brains work differently when thinking about trauma. And then also it’s been shown in a couple of studies that it can enhance extinction learning in humans. So this would these would be models of like you know, having a conditioned fear response to something.

 

Bill Clearfield  36:12

appears we’ve lost our speaker again Dustin if you’re there bail out, bail back in. So in the interim, if you’re interested, there’s a long COVID

 

36:37

conference this weekend. And

 

Bill Clearfield  36:42

here’s a link for it online. Steven Hartman is going to be part of that and so anybody who’s interested in that can get some information here. So

 

37:05

is that in the chat?

 

Bill Clearfield  37:07

It’s right in the chat. Yeah. And Stefan, can you explain what that is? Sure. I don’t see it yet. In the chat, but it’s in the chats and the only Johnny message Yeah.

 

37:21

Yeah, it’s it’s me a couple good speakers Dr. Hater. Doctor, I think Peter Cory couple other big ones, doctors side and Dr. Bean, who’s a big famous on YouTube, they’re only speaking about lung COVID treatments. I’m going to be there as well describing my cases that I’ve been using. I’ve been using a lot of stuff that we’ve been talking about, you know, oxytocin, and so forth. So putting it into practice. And presenting it and it’ll be fun

 

37:54

All right, sorry about that. You guys. My computer totally froze. It is backup now. So I’m just logging in on the computer. But I think this is probably a nice break. I’ve been talking for a half hour. So yeah, wondering if anybody’s got any questions or comments about the content that we covered or about anything else? Maybe we can have a little chat while I’m getting the slides back up.

 

38:22

This is great. I had a question. Have you done the protocols like for cancer and stuff like the Simpson protocol and other ones like that or had any results with that?

 

38:34

Yeah, I’ve had some patients do some really high doses of cannabis. I actually just last month published a case of one of my patients who had a new and say somewhat interesting response to combination. High Dose cannabis and conventional therapy for metastatic breast cancer thing was the highest dose human ever recorded in the literature she was taking about seven grams a day total lots of acidic cannabinoids. And she Yeah, she had a pretty impressive response that wasn’t expected. You know, but it’s hard to put a finger on exactly what it was. My experience with with that is that sometimes it works. You know, I’ve had you know, thinking of some cases right now I’ve had somebody with hepatocellular cancer that really just stopped growing and hasn’t grown at all. I had someone a few years ago with malignant melanoma that was doing two grams of cannabis oil a day and he he had his disease just completely stopped. It had been stopped for about a year and a half when he reduced his dose of cannabis without talking to me, and then started growing again very quickly, and then he passed away a few, you know, maybe two weeks later. So I’ve, you know, I’ve seen some just like a handful of good results with that there’s a lot of anecdotes is very, is just very uncertain. Right. So what if you’re going to implement a high dose protocol like that, then you need some way of having surveillance to know if it’s working or not, because if it’s not working, it could also be having an immunosuppressive effect. That’s, you know, not good for the cancer. Cannabis can suppress th one activity. And so we we don’t really want that unless it’s having anti cancer effects and other ways. I also see some cases of cannabis, helping with cancer pretty obviously low and moderate doses. And there is some human data to support that. And I guess, you know, just what Fred was talking about this Rick Simpson protocol, is you know, for a lot of people that means take as much cannabis as you can possibly tolerate or afford. You know, I think the goal is usually like one to two grams of oil a day, which would be you know, that’s anywhere from 50 to 80% THC or perhaps CBD. by weight. It’s usually a mix of both. So you know, hundreds or maybe even more than 1000 milligrams of THC and CBD a day. And what’s interesting is people really build tolerance to the negative effects. There’ll be you know, not getting high in the walking around 1000 milligrams of THC A day or 10 milligrams maybe used to get them high. And so the

 

41:22

Alright, there we go back and I’ve got my slides, but we’ll just chat for another minute here. So that’s, that’s my experience. You know, I have a chapter in my book on cancer that I think spells it out. Usually my strategy is like, if they’re going through conventional treatment, what I really want to do is just support them and having a good quality of life. Give them a neuroprotective effect if they’re using neurotoxic chemotherapy. And we see really good results with that. Cannabis has some evidence that it can sensitize cells to radiation and to various chemo therapies. And so we’re using it in a way that kind of like, fine tunes their lifestyle, maybe we’re a little liberal with it, but we’re, they’re getting good sleep, they’re feeling good. They’re feeling happy. You know, that’s our first goal. And we do that with low and moderate doses. And then if they’re not having clinical response and looking for then we talk about Plan B, which is, let’s do as much as you can tolerate or afford and we usually slowly roll up on the THC at night to you know, give them a chance to build tolerance to it and we can more aggressively increase the other things like CBD CBDa CBG THCA. There’s some evidence out of Israel that some of that anti cancer compounds are not the ones that we can test for they’re actually minor constituents, you know, relative molecules that are present in very low quantities. Some of them haven’t even been named, they’re just going by their structural name, and that and they’re actually big movers in that anti cancer effect. So you know, what we what we see is just the tip of the iceberg and there’s all this you know, kind of unknown beneath the surface, but yeah, we know enough to give it to people and sometimes it works. I wanted to tell also, one story about a young man who I’ve been following for about five years, who had testicular cancer, and he did nothing but cannabis and melatonin, and it completely vanished and it was measurable by beta hCG. You know, it’s a really easy to track the dose response on that haven’t published this case yet. And again, maybe it was the melatonin you know, he’s think he’s doing about 40 milligrams of melatonin, and 60 or 70 milligrams of both THC and CBD a day. These are not big doses and something really cool happened with that too. So I’m very interested in low dosing range of cannabis. I think we see some interesting and unexpected things there and sometimes less is more quite often it is actually so that was a super long answer. Sorry, but I think good information All right, so jump back into slides or anybody have anything else they want to bring up?

 

43:57

Another one of the first question, my wife cases Dr. Solomon stuff for her pain, which is the blend of THC and CBD is a reason why they blended Is there any advantage or is it would be better to just do the THC when the pain is bad? For Yeah, so

 

44:17

it really depends on somebody’s you know how how sensitive they are to the adverse effects of THC. No, THC always has a therapeutic window. And so if you’re able to really dose it with precision, even in people that are sensitive, you can usually get inside that window and get some benefits without side effects. And that’s where the oral doses are much harder with inhaled you know, there’s some people that are just so sensitive, like they take one token they’re one toke over the line already. And in people that are really sensitive to THC like that, buffering it with some CBD is nice, you know just kind of decreases the intensity of the psychoactive effects and reduces the likelihood of angiogenic effects so, you know, I think there’s some rationale to that. It does make the product more expensive, you know, more milligrams per dose, and then some people that some people don’t like CBD, it makes them feel a little mentally racy. Sometimes it keeps people up at night, even though other times it helps people sleep Yeah, so really, when it comes to analgesia, though THC is the main mover. CBD is an analgesic. It’s got some human clinical data that shows that it can help with pain. And, and sometimes a dose is lower than I would expect based on what I’ve seen clinically, but but usually it’s like you got to take a lot of it, you know we’re talking for someone with with considerable pain 50, maybe 100 milligrams of CBD per dose. And then when you look at the label, you realize, oh, at that 50 milligrams of CBD, you’re getting like one and a half milligrams of THC, which one’s really doing the work here? You know? So yeah, great. questions. Thank you. And please keep them coming. I’m happy to answer those. And, and yeah, I guess Fred, how how’s it working? Like, give us give us the punch line here. Is it helpful?

 

46:04

Well, to me, it’s better than pyramidal. Oh, for sure. The Tramadol just is an opioid and just kills her stomach. Things like that. But at least the THC when she first got on it first few times, take the full dose they should definitely she was high immediately, you know, but also, it’s always paying pain management to me for a lot of illnesses, you know, because the inflammation and other things in the body. So for pain management, it’s it’s fairly expensive. It’s been good Farber and like I said, the Tramadol or some of the other medicines because a lot of those are not normal. At least the THC is normal. So the pain is handled differently to me in the body. I’m not a doctor, so got it.

 

46:53

Well, I mean, like, neuropathic pain is notoriously hard to treat and opioids tend not to do a great job with that and cannabis tends to do a much better job and like I mentioned earlier, sometimes combination, the THC in particular potentiate the opioids and sometimes combination is best for people. All right, cannabis for PTSD. Let’s jump into this study. This study made a lot of headlines over the years because they’ve been trying to get it approved since like 2015 or something like that. And then sue Cicely one of the primary investigators she was fired from University of Arizona, right before she started the study after she finally got through like the, you know, all these different federal departments that you need to go through for cannabis studies, but anyways, they picked it back up again and they finally published it. It was a study in veterans where they were given three different types of smoked cannabis preparations. These were okay, let’s go to the next one. So oh, well, I guess the next one jumps to the punch line. So what they first of all, they had to get the cannabis from NIDA, National Institute of Drug Abuse and right now there’s only one supplier it’s the University of Mississippi. They have notoriously terrible quality cannabis. There’s been several peer reviewed publications about how bad this cannabis is. And you know, Sue and her team showed, you know, pictures of it, it was moldy, it had stems and seeds in it and it was just nasty, but they still had, you know, roll it up in a cigarette machine and use it for the study and so that’s what they did. They had THC dominant cannabis they had THC slash CBD, kind of one to one cannabis. They had CBD dominant cannabis. And they had placebo cannabis, which is basically cannabis that’s been washed with ethanol, the cannabinoids are removed and it’s dried. It still kind of looks like cannabis but it doesn’t really smell like it and they use that as well rolled up into cigarettes, which is probably how most veterans are using cannabis to treat their PTSD anyway, so kind of a decent real life model. And what they found was that there was actually no difference. They they all treatments provided benefit equal or superior to standard treatments. So in one point, it was kind of disappointing that the act of cannabis was no better than the placebo cannabis. But that was because the placebo cannabis work better than SSRIs and how how do you make sense out of that, you know, kind of mixed feelings in the in the cannabis community on this one? You know, I think there’s a lot of a lot of good questions that arise like he’s just smoking something that they think might be helpful for them better than other types of placebo, maybe, or maybe just standard treatments are just so bad that they’re no better than placebo. And this this placebo was better than that one. But really interesting to me that the act of cannabis didn’t shine as being most effective. Now in my practice, you know, if somebody comes in with PTSD, they’re not just getting treated with inhaled cannabis that might be a part of their regimen. And that would be for breakthrough symptoms or maybe as an adjunct to something therapeutic like counseling or therapy or exercise or intimacy or you know, something like that in there like wouldn’t be there kind of mainstay treatment because typically, PTSD symptoms are there around the clock and the better treatment with a longer duration. delivery method, which would be oral inhalation is rapid onset, but short duration. So kind of strange. And then there was another study the short and long term effects of cannabis on symptoms of PTSD. Now this was not a controlled study. It was data collected through an app, people that were logging their cannabis sessions, so just observational data, but 404 people reported on over 11,000 cannabis using events over 31 months, and they limited the data to people that were inhaling it. So we have that randomized control using terrible quality cannabis even though it didn’t have something in it. It was it was really bad stuff. And now this is asking people who are using real medical cannabis, you know, that’s available on the market, what their experience is like, and you can see what they rate it you know, before and after the sessions, symptom severity in terms of intrusive thoughts, flashbacks, irritability and anxiety. You see a really statistically significant difference there. So I think this is a good snapshot of what’s really happening out there what I’m seeing in the clinic now what’s occurring in these randomized controlled trials. While sometimes we we work so hard, we petition so hard we spend all this money on these placebo controlled trials and then they end up not really reflecting what’s happening out there. And I think this is so some impressive observational data. And then I already talked about those. These were just some Oh, yeah. So now we’re on to the next one. So this is the data from Israel, you know, big population, looking at their data from 2015 to 2018. How many people will that they had kind of different cohort numbers for different aspects of the data analysis. For adherence to treatment, they had almost 10,000 People primary endpoint, which included pain control and quality of life and function so over 5000 people using using cannabis here and the average age 54 30% had prior cannabis experience. So these were the most common symptoms for which people were using cannabis. There were sleep disturbances was number one on the list and pain was a close number two, weakness and fatigue. A lot of people don’t think about cannabis for fatigue because that can be one of the side effects from using too. Much of it. But for people that have fatigued using just a little bit can really help help them with energy, digestive digestion, anxiety, restlessness, you can see you know, you look at a list like this and you have to think like how does one you know medicine, treat so many different things from different fields of medicine, different organ systems, and, you know, like, how does it do that? And the answer is, you know, often via the endocannabinoid system, which is a master controller of all these other systems. So the the most significant improvements out of all of these based on the endpoints were rage attacks. There was a decrease in 91.5% of rage attacks. Now that wasn’t very big. You know, that was 14.2% Well, that is actually big. This over 1000 people you know, had rage attacks. Restlessness was another high responder, sleep disturbance, very high responder and nausea. So these are, this is where it worked the best and the rage attacks we use that then, you know, children and adults with autism that’s going to be the most common patient population, other genetic and neurologic disorders okay and then as far as effectiveness, you can see here as far as treatment success was defined it defined as like a clinically significant improvement. People with cancer had improvement and this will be in their symptoms, not in the actual cancer, a lot of improvement in pain. Here’s another signal for PTSD. 430 people with PTSD had a successful treatment. 90% of them had successful treatment. And you can see autism in Israel, they really lean on CBD for treating autism. So I think that number could be higher if they were a little more generous with the THC and you can see just across the board, high response rates in a wide variety of conditions, people were more likely to have success if they were previous users. Maybe they knew how to use it better. Maybe they had built tolerance to the adverse effects and so they could tolerate more of the dosage to get better. therapeutic effects. Younger people responded better driving. People that were driving versus not driving people that smoke cigarettes and people that were employed tend to do better with cannabis. If you look at pain intensity, this is a before and six months after that, so the orange bars before just look at how many people raised their pain intensity way up here before treatment like you know, the eight nine and 10 is really high before treatment. And then all that just shifts down to the left at the you know, after six months of treatment. I think that’s that’s pretty impressive. There. That’s that’s what we see in the clinic is really good. treatment for pain, especially when it’s done right. There’s a lot of people living up here and I think we can get them down here.

 

55:37

And then quality of life. I mean, like you know, so many people are really rating their quality of life bad or very bad at the beginning of the study, and almost nobody reports it very bad at the end of the study, you know, 50 people down from 130 to 1500 down to 281. I mean that’s that’s pretty cool. And there’s been other studies that have shown that quality of life tends to improve in cannabis users even more drastically than say like visual analog scale of pain, or some of these inventories of function. people rate their quality of life as being better. They tend to say that they feel more like themselves and that they in that they feel more normal when they’re using cannabis especially people with pain and then just across the board drugs substitution like what one medicine can substitute opioids, antidepressants, anti epileptics, Gerd it drugs and they throw like, I don’t know Exalytics lipid modifying agents like just across the board drugs substitution is people’s physiology gets tuned up. You know ACE inhibitors people are stopping their drugs and cannabis and blood pressures are normalizing their metabolism is improving their inflammation is going down less corticosteroids you know and so and I forgot to show that the columns like in parentheses here is the percentage of people that stopped like, you know, 26% of those using corticosteroids stopped and then another 7% decrease their dose. That’s not all of them. But what an interesting signal that one herb substitutes like every class of drug and then as far as side effects, about 34% said they had experienced some side effects most common would be dizziness, dry mouth, and increased appetite, sleepiness. And then you know, coming down here nausea, weakness, drop and sugar, headaches, these are all things from probably using too much. And then if you look at the cognitive effects, feeling high, only 4.3% That’s pretty low. That’s because a lot of these people are taking it as an oil instead of inhaling it but they’re using THC, very low percentage of confusion and disorientation and restlessness and hallucinations and all that stuff. And in six months 77% were still on it so it must have been doing something for them. All right. So that’s what it looks like you know, give five five to 10,000 people cannabis in the country and you know, monitor what happens to them and basically they have better quality of life. They have less pain and they stop taking a lot of their drugs. Sounds like a good thing to me. And then finally, so what’s happening with adolescents in cannabis medicine, it’s a hard time in the world right now. I think it’s especially a hard time for adolescents. You know the combination of the technology and the level of communication, the style of social interaction, the stressors at school and just in the world. I mean, it’s it’s a lot. And so I’ve been seeing a lot more adolescents you know, one common pattern is, you know, kid gets caught at school vaping or something in the bathroom and parents say, you know, stop, stop vaping THC or whatever it is, and, and then they start having worse grades, and their social life starts falling apart or they start getting real angry at their family members and those relationships are rupturing and, and then the parents say, Okay, well you know that I believe you it was helping you and the kids starts using it again and they get so much better and parents tell the pediatrician that and pediatrician says go see Dr. Sue leg so that you can do this legally. And it’s really beautiful. I love having these young people in my practice and kind of partnering with them in what I envision is a learning experience about how to best relate to this substance that is a double edged sword and can you know help them and can harm them. And it’s not so much just about me telling them what to do. It’s about me kind of guiding them along along the path. It’s a really rewarding and younger people are getting referrals from pediatricians and primary care providers to make it so it’s legal for the patient and, and also, you know, some of the alternatives. I mean, I just see so many adolescents that are on SSRIs right now, even suicidal ones even though we know that that can increase their risk for taking action on that suicide and honestly, the SSRIs helped some of them like I don’t know, less than half I would say and then among those sometimes it stops working after a while so it’s far from perfect, and I think cannabis can be really helpful. So what do we know about adolescent cannabis use almost nothing when it comes to medically supervised cannabis. But if you look at illicit cannabis use, then there’s there’s a lot to learn there about how safe it is. So this was a review article published this year that looked at IQ intelligence quotient decline following frequent or dependent cannabis use in youth. And this was a systematic review and meta analysis, seven studies, 800 cases and 5000 controls. And most of these studies controlled for alcohol use not all of them which is major confounder because a lot of teenagers that are using cannabis or using other substances. And so the results first of all, there was no baseline difference in full scale or verbal IQ. Before and after cannabis. There was a significant association between frequent or dependent cannabis use and a change in their full scale IQ. So measuring IQ before and after cannabis use, there was a change there was a decrease, and that decrease was a little under two points overall, and among the verbal IQ it declined. Even a little bit more 2.9 points. So can cannabis. I mean, this is an association. This isn’t causal, but say it was causal. Can an adolescent that smoking too much cannabis have a negative impact on their IQ? Probably yes. But if you look at a big population of them that did that this is only a two point change, which is really not considered clinically significant, at least according to these authors and to others. And they said alone, it’s unlikely to completely explain the range of psychosocial problems linked to cannabis use in this cohort. If you look at a similar study from 94, that looked at alcohol, and there is a surprisingly little bit of data and alcohol use in adolescents and its impact on IQ. But this was this one showed about a 10 point decrease. So that’s compared to a two point so I think cannabis is a lot safer for adolescents and alcohol, at least in terms of IQ and certainly in other ways as well. It was a study from 2021, a multicenter study conducted in four European countries 804 Adolescents average age 14 at baseline and almost 19 at follow up so this is really good longitudinal data. And they looked at neurocognitive functioning IQ, self reported substance use, and socioeconomic status. And none had been ever used cannabis at baseline. So pretty good data here. What they found was that there was no evidence of effects of cannabis and attention working memory, short term memory or risk taking. And authors commented This could be due to various reasons. First, we examined subclinical cannabis use now mostly studies on adolescents are looking at people that are in cannabis use disorder treatment. So this was considered subclinical, this is kind of a normal adolescent use of cannabis. And and it really didn’t show that there was any Detrick longitudinal detriment and the measures that they looked at. In summary, we find no evidence to support the presumption that cannabis consumption leads to a decline in neurocognitive ability. If anything, our findings suggest that like cannabis use, and late onset thereof, do not disrupt normal brain development with regards to decision making. So they’re saying it’s not disrupting their decision making, which is such an interesting thing to say and it’s just that kind of a relic of cannabis literature. Because so often you get these authors with their funding from National Institute of Drug Abuse and studies that are designed to show harm and then when they show benefit, they just kind of like mentioned that very quietly, you know, and in the headlines and in the abstract, they say, well, there was really no harm here. But actually, if you look at decision making, the higher the score is the better decision making and you can see that in the control group just over time, you know, as people age, their decision making score gets a little bit better. But in the people that were cannabis users, both early onset and late onset, you can see a much bigger jump in their decision making it it looks here, like adolescent cannabis use is associated with improvement in their decision making scores. Now what could that be? You know, I’ve got some theories, but I think besides the effects of the medicine, there’s often some qualities, some shared values in cannabis endorsing social groups. There’s probably very different than, say, alcohol endorsing social groups or other drugs. And I think one of those qualities is kind of a value and emphasis on individuality. And so maybe, maybe the cannabis users are more than you know, kind of less conformist and more likely to make independent decisions and score better on these tests. That’s one of my theories. And then this one had a clever title evidence lacking and we’re just about done here. I’ve been slacking for cannabis users slacking a longitudinal and analysis of escalating cannabis use and motivation among adolescents.

 

1:05:35

And this is just a little background information. There was a systematic review that looked at this and adults motivation and concluded that the evidence was equivocal meaning like does cannabis improve motivation or decreased motivation didn’t really show any signals in this systematic review from 2018? And then there were two adult longitudinal studies that supported the hypothesis that heavy cannabis use leads to reductions in motivation and reward sensitivity mean that so they’re less sensitive to natural reward, so the less less likely to be motivated to achieve those rewards. And so this study had 401 adolescents in the Miami area, aged 14 to 17. at baseline. They, they they included them only if they had alcohol, cigarettes, or cannabis. They were like kind of getting this. At least 90% of the sample had to be kind of like your typical cross section of someone in High School in Miami. Not some weird group of people that had never tried cannabis before. But they excluded heavy use or substance use disorder. They evaluated apathy, motivation and engagement, depression, anxiety and stress. And they did five assessments at six month intervals over two years. So pretty cool study. And in what did they find after controlling for covariates greater cannabis use was significantly associated only with lower valuing of school was the only significant association. They valued school less. It’s hilarious. Females who reported higher levels of self efficacy at baseline also reported greater escalation in cannabis use over time. That’s interesting that the young women who seem to be able to take care of themselves best. Were using more cannabis over time. And cannabis use frequency increased over time. So people started off using it infrequently and then they started using it frequently after that, disengagement and planning facets of motivation. These are like kind of beneficial aspects of motivation also increased significantly over time, other aspects of motivation remained stable, and after controlling for covariates there was no link between cannabis use and reduced motivation in adolescents using cannabis in the way that they typically use it. So that is the end of the slideshow, some some interesting information, I hope kind of thought provoking for you all. And I appreciate your time and attention and just your invitation to speak to the group tonight. Some happy to

 

Bill Clearfield  1:08:07

be here. We’re always happy. We’re always happy to hear from you Dustin you always have interesting take on you know, some of his old start oldsters you know, we’re still in the Reefer Madness generation. So, right Fred?

 

1:08:23

Yeah. Can I ask the question? You’re like here when it first came out, you had to get a doctor to write some scripts. So they write a script and basically allows you to go to the dispensaries and buy something. So how do you prescribe one of the items because normally go into the dispensary? You deal with some header? It’s 725 year old and up on the screen. They put okay, my hip hurts, okay, boom, here’s the five items we have to sell. So how do you prescribe?

 

1:08:53

It’s really hard. So, you know, my patients leave the office with a printed plan. It says here’s step one, here’s how I want you to start. Here’s how I want you to titrate here’s what I want you to look for. Once you finish that, here’s step two, you know and they come back for follow up visits in the you know, for for about 11 years. That plan would say here’s the type of cannabis product I want you to acquire. You know, here’s some criteria for it. And then they go shopping in this marketplace. It’s probably I’m guessing you’re in California, is that right? Nevada? In Nevada, okay, so similar, like, you know, it’s like a needle in a haystack trying to find the right product at some of these stores. And if you just listen to the bud tender, they’re gonna send you out with way more than you need. You know, so we put a shopping guide on healer.com You know, for people to help them with that. But now my life and my patients life is just so much easier because I’ve got this formulary of these products that this company makes and I supervise the quality control. I designed each formula, you know I help select the starting material. We’ve got organic farmer

 

1:09:58

sorry. Do you have international

 

1:10:01

International? No, we’re not. We don’t have any intranasal and I think that’s an interesting delivery method. I haven’t haven’t utilized it very much because for rapid onset we’re pretty good with inhaled and for slow onset long duration. We’re pretty good with oral so, you know, but I do think engineers might be interesting for some conditions. I’m curious, do you have experience with that?

 

1:10:23

No, I just find it’s the best delivery to get into the brain and get the function maybe less dose you need and more economically better for even for you don’t need much of doses.

 

1:10:36

Yeah, it could be cost effective. They were going to do some experimentation and that I liked that because you know so often I think clinically when we got something that we think is working well enough, we kind of ignore possibilities that might work even better. Well, thanks for bringing that up. What do you think about it? That’s my situation and main memory now it’s really easy. I see a new patient I tell them what product to get, how many how many capsules to start with, you know, it’s really straightforward.

 

1:11:05

I’m also here in Nevada, and we have recreational and medicinal. The only difference is I believe it’s an 18.9% tax for the recreational as compared to Minnesota so you don’t pay the tax. But I was wondering I’m someone who definitely I smoked at 17 before I went in the Marine Corps, and continued it, and I I can tribute it to save my life when I was definitely ill, and 2015 and Dr. Clearfield saved my life. And as I started to volunteer and work with him, I just couldn’t keep up no more while smoking so I finally switched to the Rick Simpson oil and it did increase my appetite because I was diagnosed with discoid lupus and lipid dystrophy and plus Gulf War illness and crap like that PTSD add did it ended up well it all stabilized when he balanced out my hormones. It was insane. And it balanced out the cravings and everything I needed for the THC. And so I did some of the tea to CBD THC ended up on the Rick Simpson oil increase. My appetite did pretty good. But I just didn’t really want to spend the money no more and I was able to quit. Now when I go back and smoke with my nephew just a little bit. Holy cow the anxiety is off the charts is really hard. So for someone like us or even high level professionals like doctors and so forth, what do you recommend for like a Rick Simpson type oil or a dose to prevent the cancer

 

1:12:44

so yeah, I mean the Rick’s when I think of Rick Simpson oil and this is probably what you were using. This is this is a very thick, very potent oil and people are often dosing it like by the rice green eyeballs like a little bit and you get a gray screen versus a whole racecar and you can be talking about a difference of like 30 or 40 milligrams of THC, which for some people that’s enough to produce toxic psychosis for like 12 hours you know, it’s and this is you know, so often somebody gets a diagnosis with cancer and their nephew hands on this syringe of this dark stuff and says start with a half rice screen. And that night they’re freaking out thinking they’re dying because they listen to their nephew. And it really feels like you’re dying but it’s not you know, it’s actually no organ damage or anything like that. And so, you know, for people that have access to that what I’ll have them do is dilute it right we want oral delivery preparations that are dosed herbal so whether you know like my products, one drop equals one milligram it’s really make it real simple for people put it put a you know five drops on the spoon, take it like that. They’re not trying to get it just right, squeezing something thick out of a syringe. And then we’ve got capsules. So you know, I think if you’re looking at how to use cannabis to promote health and prevent disease, because I think it is a great, you know, at low doses, it really works as an adaptogen. It does have anti inflammatory, anti cancer neuro protective properties. And so usually that’s the oral route of consumption. And actually one of the best ways of using cannabis for that purpose is cannabis tea and a lot of people don’t think about that. So you can take a little button and you brew it in as a cup of tea, you could add it to some other hot beverage and in an eight ounce cup, you’re going to have no more than two and a half milligrams of THC that’s below the level of impairment for for most people except for the very, you know, sensitive people and then you’ll you’ll also have about 10 milligrams of THC AAA, which is this non psychoactive anti inflammatory, anti nausea, anti cancer. So tea is a really nice way of using cannabis as a tonic without having to worry about much for side effects,

 

1:14:54

and a follow up. Do you believe we hear the rumors that you have to have some of the THC which we believe is the delivery system via cholesterol for the CBD and the cvgs and the CBD A?

 

1:15:12

No and I don’t think so. Okay, these are all lipid soluble, soluble molecules. You know, they’re all available through the GI tract, not not a lot of bioavailability but enough certainly to use it clinically. And I think that there’s a lot of synergistic effects amongst these different compounds, you know, additive and synergistic effects and so they often work better together than alone. But there’s been other studies on on like, isolated or chemically synthesized cannabinoids and they work very well to you know, get some patients to take drug Avenal which is a schedule three THC capsule. And that’s that’s that’s working for them that you know, their insurance covers it and it’s stable. Every dose is the same and they like that. Before we jump off for anybody else jumps off, I just want to mention, you know, just some of the opportunities to learn more about cannabis and some of the other things we’re doing. If you’re if any of you are interested in a nice winter vacation to Maine or maybe next summer I host these small group clinical training courses. Usually eight clinicians at a time come we see some patients together, we do some didactics we do some kind of therapeutic maneuvers on each other you know, cannabis assisted therapy, ketamine assisted therapy, it’s, you know, we’re doing some some fun stuff out here. And, you know, over time I started these courses as a way to teach clinicians and just help them feel confident implementing these things in their practice, right when they get home. And then, you know, what we’ve learned is that it’s it ends up being a lot more than that and it becomes a very healing experience for the group and a lot of bonding and learning together and sharing goes on. So if anybody’s interested, feel free to reach out my, the website is healer.com There’s a lot of resources there and I’m on the emails you know, I’m happy to hear from many of you directly.

 

1:17:03

Well, I just want to add something. The reason why the mainstream medicine is behind the use of integrating or adding endocannabinoid system or endocannabinoid drugs into the mainstream it just because the endocannabinoid system it’s still vague most of the world it’s not yet in the medical education way that we supposed to be. So that’s one there is another system recently they came up with, which is the oxygen Azure nergic system or oxy synergic, which is oxytocin system. And just recently they have, we find that all our body has a receptor of oxytocin and it has many dramatic effects. And there’s two system endocannabinoid and oxygen nergic. They are interacting with each other. So in the way that some of actions have endocannabinoid mediated by oxytocin, and then some of the actions of oxytocin mediated by endocannabinoid system. I think this system needs to be explored more and possibly creating protocols where we can work on those two sets system which is oxygen, oxytocin, and endocannabinoid. Where we can see a lot of benefit. Yes, across all chronic diseases across all medical specialties, cancer, the genotype autoimmune and name it. But when it comes into cancer, it’s a different animal. And the reason because cancer is adapting and changing, it’s like fighting a war. And what we used to do and up to now we’re using is we’re using the nuclear bomb, which is the chemotherapy and radiotherapy and destroy both sides. Right now we’re trying to do it more targeted and trying to hit the target without the cancer without affecting the immune system. And using endocannabinoid as you said it just helps to possibly modify the immune system in a way it moves or resume the th one activities and kill the cancer and passive by inhibiting interleukin six that’s most of the mechanism if it oxytocin does the same thing. But again, you cannot just say, I’m going to cure the cancer just by giving endocannabinoid system because cancer can adapt and change. And you don’t want to give false promise. But it may help it may nip in some patients and medicate. But we just need to be very aware about cancer, that it’s unpredictable. And all we’re doing is heading it and sometimes we were able to get read from it. And that’s very low percentage. But most of the cases really you need to have a combination of therapies for cancer that include chemo LOTOS photodynamic endocannabinoid metabolic in order to really immuno therapy as well, which is antibodies, PDL one and CTLA four, and all this. That’s the middle of college right now. And do it all together to really have some impact on cancer but I don’t want to be doctors being confident say oh, just do it then to kind of avoid and hey, you know, your cancer will go away. There is some percentage of chances that happen, but it’s not for everybody because really we need to work on multi therapeutic approach to manage cancer in order to to have some really serious impact and really something promising for the patients to pay that big money for cancer but other diseases Yes, I can. We can tackle them with the things that we are doing naturally, some of the big pharma and you can be very successful and you know, your promises not going to be failed most of the time. Thank you.

 

1:21:13

Thank you. Yeah, and just just to clarify you know, you I think using the term endocannabinoid, which would be our endogenous ones, which, you know, in the plant based ones would be phyto cannabinoids. There is an endogenous cannabinoid that’s available as a supplement. It’s called P e a palmitoylethanolamide. That has a really surprising amount of controlled clinical data showing it’s beneficial for a variety of conditions including pain, inflammation, neuropathy, anxiety. You know, this is an endocannabinoid like compound that’s found in lecithin. And it’s so interesting to plants and the animal biosynthetic pathway is almost identical or it is identical. So plants make it we make it and that’s another therapeutic agent. That’s the only endocannabinoid that’s available right now. Sorry, I had to switch over to my wife’s computer who’s watching from a different part of the house. My mind keeps messing up. And I did post the link to look at some of those retreats. And, and the website. I believe all the dates are up there. Hey, Dustin, good to see. John Burgess here. You too, John. It’s great to see you too.

 

1:22:27

I want to give you an update and I want to thank you for everything you’re doing. You’re still the leader in this game in every way. And research ethics and clinical work. You’re really something and you’re appreciated. I wanted to give you an update that our relic tan thing is still going on. And we’re hoping to do in Honduras so we’re hoping to do a rotation research there and involve with cannabinoids, so we’re hoping that you will help us with that and give us some guidance. Yeah, and the other thing is you were helpful before in the past and willing to help us with our ethical guidance. So the two subjects of ethics and research are still high on our list and we’re hoping you will help us with that.

 

1:23:12

I love this group.

 

1:23:13

I love that you got me involved John and I’d be happy to stay involved with course.

 

1:23:17

Thank you other follow up.

 

1:23:19

I don’t remember if it was you I spoke to about the dial pure or if it was another cannabis specialists

 

1:23:26

and Misha Cogan. I know he was on a couple months ago.

 

1:23:31

And on your dial Pierre is supposedly made from plants, not him. And it’s part of the tour pine family and they get their CBD from plants. I think oranges are and the fruits themselves. I’m not too sure. Oh,

 

1:23:50

yeah, I think I can clarify. I don’t know the product but I think I understand what what’s going on. So cannabis is like one of the stinkiest plants on Earth. Right? And, and when you look at what’s what are the chemical compounds that are causing that strong aroma? These are the terpenes and terpenoids which are found really all over the plant kingdom. And cannabis can synthesize so many of these so when you smell a cannabis variety that kind of smells like pine it has alpha and beta pinene in it just like pine essential oil. And those those are compounds that have been studied they Bronco dilatory effects, they can have some cognitive effects and and so forth cannabis that smells like lavender has Alpha linalool in it. And so, you know, there are like we don’t need cannabis to tell us that essential oils are powerful medicines, but it has told a lot of people that and so now there’s products out there that are combining essential oils or components of essential oils in ways that might mimic what might be found in cannabis. And sometimes those are kind of added to CBD isolate. So, uh, you know, something that else that I think is probably we’re talking about right, right now real quick is that, you know, there were a couple of years and maybe John can help us understand this a little bit. There were some years and over the last three years a lot of farmers grew a lot of CBD not so much this past summer, but the one before it and especially the one before that just huge, huge fields grown no market for buying it and so they extracted it into CBD isolate and it’s been sitting around for a while and more recently people have figured out that you know, if you throw it in some strong acid, you can get it to turn into delta eight THC, which is not naturally occurring in the plant. When it turns into that it’s probably turning into a whole bunch of other compounds that are stereoisomers that have never been studied and you know, thinking back on things like the lid amide you know, stereoisomers can make a big difference sometimes. And so, you know, I think there’s a lot of like hemp based Delta eight vape pens out there, you know, and these are toxic, in my opinion are very potentially toxic and so, do not assume that they’re the same thing is is, you know, the good old Delta nine from the plant. There’s also some other ones like, you know, just strange derivatives of the THC molecule that are kind of in a legal gray area, so I would steer far away from moles. Thank you. Great presentation. Thank you. All right, you guys will have me back anytime you want to hear more about cannabis as a private keep your cannabis buckets full for a while.

 

1:26:32

So you’ve doc and give me domain.

 

1:26:34

Where’s Dr. William?

 

Bill Clearfield  1:26:36

He’s right here.

 

1:26:37

He’s here.

 

1:26:38

Where are you? We didn’t hear your voice, man.

 

Bill Clearfield  1:26:40

I’m here I’m here. I’m just you know mesmerized by by all of the you know, okay, cannabis talk here.

 

1:26:47

Yeah, we’re just walking quiet. That’s scary.

 

Bill Clearfield  1:26:51

Yeah. Well, you know, you know what, so you know what’s coming next. So next week. We have Dr. Hall Lawson is going to be talking to talking to us about all his studies on oxytocin. He’s going to summarize it all

 

1:27:04

for us. I really look forward.

 

Bill Clearfield  1:27:07

We get we get bits and pieces all the time when you’re gonna put it all into one succinct package for us. Right, right. Dr. Lawson.

 

1:27:14

Yes, yes. And I find out that endocannabinoid and oxytocin is our cousins or friends. They work together as a team.

 

1:27:22

He’s got me one that I’ll put it that way.

 

Bill Clearfield  1:27:26

So a couple of weeks coming up, a for EMS Week, you know, big weekend. Anybody going?

 

1:27:33

Are you going there are you going? At the moment? I’m

 

Bill Clearfield  1:27:36

not going

 

1:27:39

to go we’re gonna have dinner together at lunch, and maybe we go well, if

 

Bill Clearfield  1:27:42

we’re gonna have dinner together, then I’ll have to I’ll have to show up.

 

1:27:47

Yes, please. We have lots of things we can do.

 

Bill Clearfield  1:27:51

All right. So okay, um, and we’re still we’re still on with Nevada Osteopathic Medical Association. The third week in January in South Lake Tahoe. It’s a little bit of a pain to get to from the East Coast. I know but we do have two days we they’ve reserved for us and if we can put a get get a program together, we can get deal credits through them. We are still certified by the MDS though so we can we can we can take care of that also. So John, you got anything for us.

 

1:28:29

Everything is extremely good and very happy Dustin could help us tonight.

 

Bill Clearfield  1:28:35

Okay, I know it’s holiday season. So maybe our census will be down a little bit but we’ll continue on. Same time. Same station next week. Doc like I said, we have Dr. hawaiiusa. will be with us. And he’s going to be telling us all about everything that he’s learned about oxytocin. So that’s been as, you know, his, you know, he gets he gets something under his skin and he doesn’t let it go for months at a time so, but notice we haven’t heard a whole lot about methylene blue lately. So I was

 

1:29:06

just thinking about methylene blue when you said that that is so strange, Bill. I’m serious. Who’s gonna give us a presentation on that?

 

Bill Clearfield  1:29:15

Maybe I get Mike Beamer, maybe he’s done one for Dr. Losses group.

 

1:29:21

I think we have like eight recordings. Yeah.

 

1:29:24

Yeah. Okay. Library.

 

Bill Clearfield  1:29:28

We need something. So we’ll just just a little political thing. So I have a couple of long long haul COVID patients and they’ve actually done quite well with with methylene blue. We started out five milligrams twice a day and we’ve gotten them up to most of them one up to 10 Twice a day and one up to 20 Twice a day and you actually done quite well with that. That low dose Naltrexone you know, get their vitamin D levels adequate in the 60s, some zinc and then I use a combination of course it’s in luteolin and somewhat in our routine. Routine, right? Yeah. It’s a we actually get it off with just in case you’re interested we get it off of Amazon as it comes as a as a single pill called neuro protect your content, when we will use it originally with autistic kids and and you know, it’s pretty potent any you know, it’s an NA oxidant anti inflammatory. So,

 

1:30:33

I know we’ve done pretty well so stabiliser right and I mentioned that the P e is also a potent mast cell stabilizer that that endocannabinoids supplement. So another one to consider in these kinds of hyperreactive COVID cases. But Bill Where do you get the methylene blue?

 

Bill Clearfield  1:30:54

I got it off of with me here. I’ll get it for you next time. Okay, I’ll send it to you and I’ll send it send it in the chat. Right. Joe? It’s that from that book that you had in the back there? That’s where it that’s where we got it from?

 

1:31:12

Mark Mark Sloan. He came out with a book and he’s got the organization that he trusts with the I don’t have it with me right now. I’m in the middle of moving. I can’t remember the organization but it does come off of Amazon or you can get it from the manufacturer and of course

 

Bill Clearfield  1:31:30

AIMEX font you know, might might be beamers a mix pharmacy, we’ll make it into capsules, so So we’ve got two Yeah, so we’ve gotten it from there too. Okay, and your patients are going to pee blue though so don’t

 

1:31:42

get Yeah, I haven’t used it myself or with my patients but I’m getting ready to

 

Bill Clearfield  1:31:47

a though Yeah, so we’ve used it a little bit. So. Okay, Dr. Lawson, so we got the methylene blue in there for you. So. Okay,

 

1:31:55

great. Yeah, yeah, sure. I mean, methylene blue was first we thought about it to do it for digibytes and for the dynamic. And then when COVID had me and Dr. Mike beamer said well this could be something we can do for COVID. And we develop a lot of kids with photodynamic along with methylene blue, and I think they have almost 10,000 scripts per month in certain time. But none of our patient descent into you know, all those severe clinical problems of COVID. But yeah, let’s see you next week. Tuesday, hopefully there’s a lot of material better than the one I present in my on Monday. It better be better. Visuals a lot

 

Bill Clearfield  1:32:41

better be better. No, it’s gonna be way, way right.

 

1:32:46

Next year, Dr. C, like you convinced me to purchase the CME to get licensed to do this here in Florida.

 

1:32:54

Oh, good. Yeah, there’s no there’s no the PMP is not a particle.

 

1:32:58

But no, I have to in Florida you have to get additional yet to buy a certificate to prescribe marijuana. Marijuana. You mean okay. Yeah, marijuana.

 

1:33:09

Yeah, I think I think you’ll see that it’s a very versatile tool, you know, after you use it for a year so you probably feel like hey, why would I do you know? It’s like, instead of instead of all these different classes of drugs, and you know, like this will give you a good start, like, you know, there’s kind of a back section with kind of a cliff notes on each condition and easy way to get started there.

 

1:33:32

Okay, it’s called medical marijuana applications.

 

1:33:35

It is called the handbook of cannabis for clinicians. But if you just search my name, it’s my only book, so, okay. All right, guys. Well, it’s been great hanging out with you tonight, and I look forward to seeing you next week.

 

Bill Clearfield  1:33:50

Thank you all and thank everybody and it doctor or Stephanie, any update on the prostate program from the dark Mr. Gonzalez in Spain?

 

1:34:03

Not yet. I’ve been just so busy preparing for the long COVID reset. My lecture is coming up this weekend. But I’ll get back on that trial and focus on that next week.

 

Bill Clearfield  1:34:14

Okay. Okay. Any one doc?

 

1:34:16

Just a quick one. Yeah, there was a big huge propaganda exposed unleash Ty and Charlene Bollinger. And I think the fifth show or fourth show, there was two doctors who put a full page ad in the USA Today that they did a full blown research project with proline, glycine, and vitamin C. Those three combined actually were proven to kill cancer on contact. And then Big Pharma made them come back and retracted from a full page ad. And then they started getting sued and the whole thing kind of like some of the stuff going through it. Dr. Clearfield I don’t know if you’ve heard of that. I’ll try to get the information and forwarded to you it might help.

 

Bill Clearfield  1:35:03

Well, since we’re you know, since we’re the bad guys out here, and maybe we can have you do a presentation for us on

 

1:35:12

it sounds like something was right up our alley. Right.

 

1:35:15

I mean, like there’s a lot of good things that have been suppressed out there that probably none of us have ever heard of. Unfortunate I

 

Bill Clearfield  1:35:21

specialize that’s why that’s why we’re here. Right, John?

 

1:35:24

Does that.

 

Bill Clearfield  1:35:27

Okay, all right. Anybody else? Anything, David, good to see you again. It’s been a while and shell Good to see you too. Thank you for being here. And of course our our doc Dr. Smith. Thank you and Sylvia cruise. Thank you and Dr. Gerber and Marie Fogarty and Dr. Word tell thank you all for being with us. And if Dave what’s going on behind you.

 

1:35:58

I’m just hanging out in the hospital.

 

Bill Clearfield  1:36:00

Okay, I was gonna say hey,

 

1:36:03

just rural, rural Nevada bomber

 

Bill Clearfield  1:36:08

looks pretty ominous back there.

 

1:36:11

And make you wear a mask still. Yep, most hospitals do VA does still too.

 

1:36:17

Yeah, I was in Kuwait for the summer and we were supposed to be wearing masks but of course nobody did. But yeah. are very few did probably should have just because of how horrible the error was. All right.

 

Bill Clearfield  1:36:32

Okay, anybody else? going once going twice. We will see you guys next week. Same time, same station. Dr. Lawson, be ready. This will be up on our website. As always aos, er d.org/webinars or website that doesn’t exist. It will be there. Okay. And usually we get a transcript too. And thank you. Thank you all so much for being with this. And Dr. Souillac. As of course always thanks a lot. Okay, everybody. We’ll see you again next time. Tonight raw