It doesn’t get you high, but it’s causing quite a buzz among medical scientists and patients. The past year has seen a surge of interest in cannabidiol (CBD), a non-intoxicating cannabis compound with significant therapeutic properties. Numerous commercial start-ups and internet retailers have jumped on the CBD bandwagon, touting CBD derived from industrial hemp as the next big thing, a miracle oil that can shrink tumors, quell seizures, and ease chronic pain—without making people feel “stoned.” But along with a growing awareness of cannabidiol as a potential health aid there has been a proliferation of misconceptions about CBD.Read More
So far the most studied cannabinoids from the cannabis plant are CBD(cannabidiol) and THC(delta-9-tetrahydrocannabinol) What are phytocannabinoids? They are the group of chemical compounds that are specifically found in the cannabis plant. There are over 400 chemical compounds in this special plant and when you are using cannabis you are getting a mixture of all of these natural compounds that work together to balance each other. I wanted to list the benefits of both CBD and THC to give you an idea of the main effects they have on the body. The following lists are from Dr. Bonni Goldstein's new book, Cannabis Revealed, a book I would highly recommend reading as it has science, how to use cannabis, dosing and patient stories...a well rounded book!
- NOT psychoactive - no "high" effects
- Alerting in low doses
- Reduces pain
- Relaxes muscle spasms
- Potent anti-inflammatory
- Stops nausea/vomiting
- Reduces anxiety & depression
- Counters psychotic thoughts
- Anti-tumor effects
- Reduces pain
- Reduces/stops nausea/vomiting
- Stimulates appetite
- Induces sleep
- Reduces anxiety & depression
- Reduces intraocular eye pressure
- Anti-tumor effects
When CBD and THC are used independent of each other, many people of have found relief from a variety of ailments, but when they are used together, it is called "The Entourage Effect", meaning that the cannabinoids work better together than isolated from one another...an example that Dr. Goldstein gives in her book is both THC and CBD when taken separately, have pain relieving properties but there are studies that show CBD enhances pain relief when used together with THC, compared to using THC by itself.
I have had a few members that have been a bit frustrated when they didn't get the relief they wanted from chronic pain issues, but after they added a small amount of THC, the results were much better! If you keep the CBD dose higher than the THC many people do not get the "high" or psychoactive effects but still get the medicinal effects. Finding the right dose and the right combination for you does take a little time, so have fun and experiment with it!
The following article is from the online website called Leafly.com, it did not list the author but I think it is a very important topic as so many military personnel have had these issues. We must not forget other jobs that entail stress such as first responders, law enforcement, firefighters to name a few. They are in stressful and sometimes traumatic situations on a daily basis and not only take physical assaults, but also mental ones. Although the underlying trauma needs to be addressed, cannabis has showed great promise that these individuals affected can at least cope and carry on their daily living and have better control over their lives.
For those Veteran's that live in the SF Bay Area and want to learn more about cannabis for PTSD, please visit the Veterans Cannabis Group for more information.
Here is the article:
CANNABIS & POST TRAUMATIC STRESS DISORDER (PTSD)
Throughout its prohibition, cannabis has been considered a self-medicated “coping” drug, especially in individuals with anxiety disorders like post-traumatic stress disorder, or PTSD. Government funded studies examining the link between cannabis and PTSD frequently use the term “marijuana abuse disorder,” a co-occurring problem in need of rehabilitation.
There is overwhelming evidence that PTSD and cannabis go hand-in-hand. But while most studies point out the prevalence of marijuana abuse among PTSD patients, a minority of emerging research is looking at the question in reverse: could cannabis be effectively treating PTSD?
Living with PTSD
PTSD, or post-traumatic stress disorder, is an anxiety condition caused by disturbing episodes, such as military combat or sexual assault. Three classes of symptoms characterize PTSD: re-experiencing, avoidance, and hyper arousal (e.g., flashbacks, social isolation, insomnia). The persistence of PTSD over time is attributed to changes in brain chemistry that occur at the time of the trauma, when adrenaline and stress hormones are hyper-responsive.
Since age nine, Ben Nichols has experienced debilitating PTSD symptoms, and with it came a tangle of other issues like insomnia and ADD. Ben takes Adderall to help with concentration difficulties caused by PTSD, but turns to cannabis to treat the anxiety.
“It helps with daily tasks like school, work, and relationships,” Ben said. “My mind races and cannabis helps me slow down and think through the trauma rather than hide from it. I can tell it's helping me because my sleeping patterns are normal and I don't have anxiety attacks.”
Ben is fortunate to live in a state with legal medical cannabis, but not all PTSD sufferers have access to its unprecedented relief. Combat veterans have an especially high propensity for PTSD, and statistics show that about 1 in 5 military personnel deployed in Iraq and Afghanistan experience it. Given cannabis’ federally prohibited status, veterans are instead steered toward antidepressants and antipsychotics, medications that have had very little success in treating severe PTSD symptoms.
“The drugs that they were giving them … they couldn’t get up in the mornings,” said Army first sergeant Gregory Westbrook. “Most of the guys weren’t the type of soldiers who had issues before Iraq or even in Iraq, but they bring them back and put them on these drugs, and they’re falling asleep in the chair. There was no way they could function, especially in a civilian job. So maybe marijuana is an alternative.”
How Cannabis Can Help Treat PTSD
Currently there are no specialized, effective medications available for PTSD patients, but with new discoveries in our body’s therapeutic hotspot -- the endocannabinoid system -- research is beginning to pave new avenues of understanding and treating PTSD.
One investigator of PTSD and cannabis is the Multidisciplinary Association for Psychedelic Studies (MAPS). Martin Lee is a MAPS affiliate and director of Project CBD, and has studied PTSD and cannabinoids in depth.
“Researchers found that people with PTSD had lower levels of anandamide, an endogenous cannabinoid compound, compared to those who did not show signs of PTSD,” Lee wrote, “Innate to all mammals, anandamide (our inner cannabis, so to speak) triggers the same receptors that are activated by THC and other components of the marijuana plant.”
In other words, one pillar of PTSD is an endocannabinoid deficiency: the body stops producing enough endocannabinoids to fill receptor sites, and this is where the cannabinoids found in marijuana play a therapeutic role. By replenishing these missing endocannabinoids with those found in cannabis, researchers think marijuana pharmaceuticals might bring PTSD patients relief from their memories.
“Scientists have determined that normal CB-1 receptor signaling deactivates traumatic memories and endows it with the gift of forgetting,” Lee said, “But skewed CB-1 signaling, due to endocannabinoid deficits (low serum levels of anandamide), results in impaired fear extinction, aversive memory consolidation, and chronic anxiety, the hallmarks of PTSD.”
Accessing Medical Marijuana for PTSD
PTSD patients are advised to first consult a medical professional before treating symptoms with cannabis. Consumers unaccustomed to marijuana may find that THC aggravates anxiety symptoms. Cannabidiol, better known as CBD, is a marijuana cannabinoid that counteracts some of THC’s effects, including paranoia and anxiety. Further research examining the relationship between THC and CBD could lead to more tolerable variants of cannabis pharmaceuticals for high anxiety individuals.
The damage caused by PTSD cannot be fully unraveled by any medication, but for some, cannabis provides respite when nothing else can. Despite a strong need for development of more effective medication without adverse side effects, the promising pharmaceutical possibilities in cannabis are continually dismissed by government-backed research organizations. However, forward momentum builds as education about cannabis’ healing properties spreads.
I am reposting this transcript because it is an important one. Many people have a goal to get off of their opioids and cannabis is certainly a great alternative. This article also talks about dosing and this is one of the biggest questions people have about cannabis...how much should I take? Since I am not a doctor, I am grateful for Dr. Sulak's expertise in this area...please visit his website www.healer.com for more info.....
The following is a transcript of Dr. Sulak’s Opioid Event:
Now that you understand the science behind my claims that cannabis can be used to reduce and replace opioids, treat the withdrawal, and prevent dosage escalation, I’m going to show you how to do it.
We’re going to start with some general dosing terminology around cannabis. And I’m going to show you a few caveats that are unique to medical cannabis compared to other medications. And we’ll go straight into what I recommend for people who are new to cannabis and for people that are experienced with cannabis, and then we’ll go to specific guidelines for cannabinoid opioid combination treatment. Finally, we’ll wrap it up with case studies and patient narratives.
So clinical dosing terminology – it’s important to have a language to talk about this stuff, especially if you’re new to cannabis. So here is a pipe with herbal cannabis in it. That’s for smoking. A lot of you probably recognize it. When we talk about dosing with smoking we’re usually referring to how many puffs a person is taking a certain number of times per day. And you’ll find people that are smoking a whole joint which might be 20 or 30 puffs, and you find people that are taking just one puff off of a pipe. So there’s quite a range in how people use it. And also quite a range in how big those puffs are or how much of the actual medicine is absorbed versus is exhaled.
Here we have a liquid extract of cannabis, often called a tincture, which by definition is an alcohol extract, but also people call other liquid cannabis medicines tincture as well, even though that name isn’t exactly right on for it. Often these are being made with oils. And these can be dosed by the drop. So someone might know with this particular potency of the liquid medicine I’m going to take five drops or eight drops.
Dosing by the Milligram
Over here we have a tube of cannabis concentrate, actually in a syringe, you’ll notice there’s no needle (which is a good thing) because that syringe can be squeezed to express just a small amount of this very potent concentrate. These concentrates can be up to 50 percent cannabinoids by weight. So even something the size of a pinhead can be a really substantial dose when you’re dealing with this stuff. And for people that aren’t prepared this can cause some overdose reactions, which are safe, but quite uncomfortable. And here we have a close up of the cannabis flower.
So as a physician, when I talk about dosing medications, I usually like to talk about milligram dosing. And right now, in cannabinoid medicine we’re talking about milligrams of THC and milligrams of CBD, primarily. There’s other trace cannabinoids and acidic cannabinoids that we refer to in certain cases, but in general we’re talking about how many milligrams of THC and CBD.
So, when I look at the dosing range, the effective dosing range in my practice, it’s unlike any other medication. We’ve seen when dosing by body weight – just to orient you – we’ve seen responses as low as .015 mg per kg of body weight per day, all the way up to 30mg per kg of body weight per day. Now it doesn’t make a lot of sense to dose and adult by their body weight, but I wanted to put it into this perspective for you. This means someone about my size might do well at the very low end taking 1mg of cannabinoids per day versus somebody taking over 2,000mgs. That’s the safe, effective dosing range. It’s an incredibly broad range but it’s still well below the lethal dose – if there even is one. Now, some of you know that researchers have really tried to kill animals with incredibly high acute doses of THC; they haven’t been able to do it. So here we have 300 times the maximum dose I see in my practice, and monkeys are still surviving. But I don’t think they’re having a pleasant experience.
Now within that broad dosing range, we have non-linear dose response curve. So this is unlike the dose response I showed you of morphine and pain earlier. This is, on the bottom here, we have a low dose to high dose and on the side, low benefit up to high benefit. What we often see (not always, but often) in cannabinoid medicine is that if someone starts at a low dose and gradually increases, they get more and more benefit up until a certain point. Beyond that point, as they increase their dose, they actually start getting diminished benefits and when they use high doses, sometimes they’re barely feeling anything at all. Often, when they use ultra-high doses, this curve will come back up again, way at the other end of that extreme.
Now, this has been shown in animal studies, not just my clinical observation. So here’s loco-motor activity in rats. This is how much the rats are running around basically. And here’s there’s baseline level. Given a very low dose of THC, so this is .2mg per kg, the activity is going down quite a bit. This activity level could be analogous in treating a human to something like spasticity or anxiety. Then, as the dose of THC increases the activity level actually goes up. Then as the dose increases even more, the activity level goes back down again. But you’ll notice up here, at 5mg per kg, they didn’t get as strong of a result as they got at 0.2mg. What they did get was the emergence of a side effect, in this case catalepsy, which means remaining still in an unusual position.
So what this shows is that at the very low doses – doses that are so low that some rats or some humans might not even start that low, they might overshoot it, and start up here and think they’re getting an efficacy at an optimal level by the time they get up to the high doses. We’ve been finding in our practices, that ultra-low doses can work very well for some people. And this has been shown in humans. So here was a study on 263 people that were already receiving opioids for the treatment of chronic pain, and they were given that standardized cannabis preparation I mentioned … which is about a 1:1 ratio of CBD: THC. Here’s their baseline pain level at the top. Here’s how much pain relief they got from a placebo, which I’d like to mention is really powerful. So, our bodies have an internal pharmacy. If we use the power of our mind and the power of our belief to make ourselves better, we actually get better. It’s not just that we think we’re better – we don’t just think we’re better – we actually do get better. We can change our physiology, we can change the structure and function of our bodies, or our brains, just using our mind-power. And it’s been shown that endocannabinoids, the molecules that we make that are very similar to the substances in the cannabis plant that are therapeutics, cannabinoids have an important role in the placebo effect.
But anyway, back to the study, the 20mg group had this much reduction in pain. The 52mg group had just a little bit better than placebo. And the 83mg group really didn’t do much better than placebo. So this clearly shows that with cannabis, less can be more; lower dose is often more effective, a higher dose can be less effective.
So now you know some of the basics. I just want to walk you through how we approach our patients, both patients that are new to cannabis and patients that have experience with cannabis.
New to Cannabis
So starting off with new to cannabis: I have a picture here of my grandmother, Elaine Sulak. She just passed away a couple of months ago at age 91. But for the last six or so years of her life, she was using a cannabis tincture quite effectively. And during that time, her mind became clearer; she had reduced pain, improved function, and better mood, her entire quality of life changed. It was really incredible. And she didn’t know what she was getting the whole time. She didn’t have any side effects from it because we were very careful with our dosing strategy. We were able to achieve this incredible improvement in quality of life without any side effects. So what do we do if someone comes that’s brand new to cannabis? The trick is to start sub-therapeutic, and this requires a little bit of patience on the part of the patient because some of them want instant results. We say, we want you to intentionally start at a dose that’s below your optimal dose, obviously. And then we increase very gradually to the minimum noticeable effect. So you start sub-therapeutic, you gradually work up until you can just feel a little bit of something, a little pain relief, a little anxiety relief, and then you hang out at that dose for three days. During those three days something really interesting is happening. And I’m not going to bore you with the science behind it, but the body is actually getting more sensitive to cannabis. And patients will find that staying at the same dose, on day three, they’re actually getting more relief then they got on day one. But then on day four, go ahead and increase to the dose that you find most effective. And we give instructions on how to do that, especially something that I call the “inner inventory,” which is a very quick self-awareness technique for checking in and figuring out how am I feeling right now, how have I responded to that dosage of cannabis that I just took. You can find all of this on healer.com, free patient education with videos that will literally walk you through step-by-step or walk someone through who’s brand new to cannabis. We have a shopping guide that helps them figure out how to get the right cannabis when they go to the dispensary or when they talk to a caregiver. We really want to make it easy for people to have great results – like my grandmother – without the side effects.
With experienced users we have a few other strategies. So the first is what I call the “sensitization protocol.” And the purpose of that six-day protocol is to take people from here and get them back to here. And the thing is, everyone has a different optimal dose. I can’t pick you out and say “here’s your optimal dose,” I’m going to tell you what it is, you can dose cannabis in that way and you’re going to do just fine. But what I can tell you is a methodology for how to find that optimal dose. And almost – not almost all – but quite a few of the patients that are experienced cannabis users coming into our practice, they want to use cannabis for symptom relief or real medical treatment figure out that they’re actually here, and by reducing their dose they’re able to get more benefits, they’re able to spend less money on the cannabis, they’re having less side-effects from the cannabis. If they’re inhaling, they’re saving their lungs from that exposure. It’s just better for everyone when they do the sensitization protocol.
And on the next slide I’ll show you some of the results. But before I go there, a lot of patients that are experienced users have only inhaled cannabis via smoking or via a vaporizer. In switching to a liquid extract, and oral mucosa absorption, so the medicine is actually getting absorbed through the blood vessels in the mouth and tongue, and then some of it’s getting swallowed and being absorbed through the digestive tract, that’s a really wonderful delivery method that can often be used to prevent symptom instead of chasing symptoms around. And when patients figure out how to best use the oral mucosa delivery, they’re often having improved quality of life, less symptoms, better function. And finally, a lot of experienced cannabis users haven’t explored CBD yet. CBD, as I mentioned earlier, is that sister molecule to THC. It’s non-psychoactive but it tends to enhance the benefits and reduce the side effects of THC. They work really well together. So for people that haven’t tried it, we recommend that they do try different ratios of CBD and THC, perhaps to find something that works well during the day so that they can get symptom relief without having any impairment. And then they can use something else at night or weekend that might create a little bit of a psychoactive affect, which I’ll cover later in this talk because there are some real benefits to the psychoactivity of cannabis as well.
So here is the sensitization protocol, again it’s just six days, and it’s basically two days of cannabis abstinence followed by four days of very specific dose titration. The program is free on healer.com/programs. We surveyed 48 of our patients that did it a couple of years ago: 90 percent of them successfully reduced their dosage, and the ones that did, reduced their dosage on average 56 percent. So they’re using less than half the cannabis they were using previously and getting equal or greater benefit, usually with less side effects.
Specific guidelines for cannabinoid-opioid combination treatment
Those are the basics. Now let’s talk specifically about what to do for people that are using opioids that want to try combination cannabinoid-opioid therapy. So, the first rule is to take a small amount of oral or oral mucosa cannabis with every single dose of opioids. Don’t allow those opioids to pass your lips unless you’re taking some cannabis at the same time. It’s really basic from a scientific perspective. It makes sense. We know these medications synergize with each other. We know that the cannabis can widen their therapeutic index and prevent tolerance building. But so many people approach this in the exact opposite way. They think they’re going to use their cannabis or they’re going to use their opioids, that it has to be one or the other. No. Please use them together, and it can be as little as 1mg of THC. So a dose of THC that’s not high enough to reduce pain, that’s not strong enough to cause any psychoactivity, can still potentiate the opioids. I also mentioned that “inner inventory,” so use the inner inventory in healer.com to find the minimal effective dose. Again, you don’t have to do a lot of cannabis. Figure out what you’re minimal effective dose is and then combine that with every single administration of the opioid. If you’re doing a long-acting opioid like a fentanyl patch, for example, then you’ll probably going to want to do an oral or an oral mucosa dosing every four to eight hours, depending on how long the effects last for you, which can be highly individualized with cannabis.
So that’s the mainstay of the treatment, is this oral dosing. Then you can use inhaled cannabis for breakthrough symptom management and to reduce cravings. So you’re doing the opioids, you’re doing the cannabinoids, if a craving comes up and you get that thought “man I wish I could take that next pill right now instead of waiting four more hours, that’s something I’m considering doing”; don’t do it. Reach for the cannabis. You can inhale cannabis. It has such a rapid onset when it’s absorbed through the lungs, that one minute later you’ll be feeling better. It’s a great solution to problems with craving. It can really change your mindset, reduce your pain, and take you off that track, shift you to something else. Now you’re suddenly looking at where you were two minutes ago, and realizing, wow that’s how I was thinking, that’s how I was feeling just two minutes ago, I was considering taking an extra pill when I knew I’d be out at the end of the month (or whatever). Cannabis patients always tell me, cannabis can change that, shift their perspective and help them see themselves in a new light.
If it is available, I’d recommend selecting some combination of CBD and THC, again, to enhance the benefits and decrease the side effects. A 1:1 ratio, so equal parts of CBD and THC, works very well. It’s broadly effective and well tolerated. It’s still a little bit psychoactive, but it’s not very strong. And I just want to mention, because I know a lot of people with opioid addiction also have Hepatitis C, that’s been contracted through IV drug use, there’s some information that high doses of THC in people that have liver fibrosis or inflammation – when the liver disease is active – high doses of THC can potentially make that process worse. We have evidence that suggest this. So for those people, I recommend more CBD than THC, at least a 2:1 ratio. We also have evidence that CBD will do the exact opposite, it actually protects the liver in some situations where there is inflammation or scarring going on, and it can prevent progression of liver disease. So CBD is a great choice for people that have Hepatitis C and other liver conditions.
A lot of people don’t have the luxury that some of us have where we can just go shopping and figure out, I’m going to get something with a 1:1 ratio and I know how many milligrams per millimeter it has and that’s how many drops I should take to follow my doctor’s advice. It’s not always that easy, but it’s getting easier and easier all the time. I just want to point out for people that are dealing with herbal medicine, you can’t just look at it and smell it and know what it has in there. You can’t just look at the morphology and recognize it as a THC strain or a CBD strain. You actually have to get it analyzed and that’s what we’ve been doing in our lab.
So here’s a few examples: here’s a cannabis flower that’s really just THC dominant and barely has any CBD or any of the other cannabinoids in it. Here is a cannabis flower that looks almost identical. I’m not sure how it smells in comparison but you wouldn’t be able to tell the two apart. But the contents are actually vastly different. So this strain has a little more CBD than THC. This would be an excellent choice for someone that’s working with recovering from addiction. And then here’s another strain that looks very similar. This is almost all CBD with barely any THC at all in it. So these three cannabis flowers are going to have vastly different effects if they were prepared in a liquid form, than those three different oils or tinctures would have different effects. And you need to know what’s in there before you can get optimal results in most cases.
So continuing on, on how to combine these two medicines. So cannabis can be used to enhance other health-promoting activities. I strongly recommend this, our patients come back telling us it really enhances the effects of exercise, meditation, prayer, journaling and reflecting, and psychotherapy. And there’s actually some experimental evidence that suggests both CBD and THC, in two separate studies, can improve the response to fear extinction training, which is basically a model of how to get out of that PTSD reaction mode, and no longer be afraid of something that’s not present in front of us. I put these on the slide because these are really important things, a very effective lifestyle approaches to managing both chronic pain and addiction, or both. So, exercise is huge, even if you’re in pain I’m sure there’s something you can figure out how to do that you can tolerate with the body that you have. On healer.com I have a whole page of wellness activities, very simple breathing exercises that will actually get your heart rate going, simple Qigong and yoga-based practices that I make very accessible. The videos are short, two to five minutes, and I promise that everyone can find something that they can do for exercise. And if you’re going to be healthy, if you’re going to recover from opioids, you need exercise in your life. You need a time to reflect. And I really recommend journaling. It’s amazing. It’s not about what’s going into the journal, it’s about what’s going on up here while you’re holding the pen. And that process of reflecting and thinking about what’s important about my day today and then getting ready to write that down helps us gather information, helps us learn from our experiences, and really can help us literally turn the page on our limitations, and start the next day in a new way.
Finally, use cannabis to promote regular sleep patterns – using sedating strains only in the evening. Those of you who know cannabis, know that there’s different strains that have different effects. Some cannabis is better for pain. Some is better for muscle spasms. Some is better for anxiety. All these different strains have different ratios of the various components. So there’s the cannabinoids, there’s the terpenoids (which are molecules that give cannabis its smell, its aroma), and all of those have physiologic effects. So the unique blend from each of these different varieties gives it a different effect in the body. There’s some strains that will clearly keep people awake. And they might be great for late-night creativity sessions, but don’t do it if you’re trying to recover or if you’re dedicating yourself to a healthier life that’s free from opioids or if you’re working to reduce and stabilize your opioid dosage, trust me getting regular restorative sleep is going to be one of your best assets. So you can use cannabis to promote great sleep.
Now we’ve seen clinically when patients are cannabis-naïve, they have excellent responses to starting this combination treatment. So “cannabis-naïve” means they haven’t used cannabis ever or haven’t used it in a long time. They come in on a bunch of opioids, their pain is not well controlled, we get them started on that approach I showed you for the new user – sub-therapeutic, work up slowly, stay there for three days, and then work up a little bit more – they use that approach and they come back and they say within the first two weeks I reduced my opioid dosage by 50-80 percent. It’s just incredible when they get they right dose of cannabis how much they can reduce the opioids in the first couple of weeks. Progress after that first couple of weeks continues, but it’s a bit slower. Really there’s no rush. This is a long-term change. We’re not trying to rush people off their opioids. But really, take advantage of that therapeutic window in the first couple of weeks. When I first started this, before I even knew what was happening, before I recognized these trends in my patients, people were coming back saying I just started cracking those tablets in half because they felt too strong. They literally, when I was taking them with cannabis, they were too strong for me. I couldn’t tolerate the dose that previously wasn’t enough.
For experienced cannabis users that are currently using opioids, before you start to decrease your opioids dose, I recommend first going through the cannabis sensitization program – that six-day protocol. And what this will do is tonify your cannabinoid system, it will up regulate your cannabinoid receptors, it will get your body to start creating cannabinoids and make you more sensitive to the medicine, so that the cannabis can have the optimal effects in helping you with your opioid taper. Stay at the optimal dose to avoid building tolerance throughout the taper, which means if you get to the point where you notice, well I’m needing more and more cannabis to get me the same results, you might consider doing another sensitization round to reset your sensitivity to cannabis. And for people that are only inhaling cannabis, I really will strongly encourage you to try the oral and oral mucosa delivery routes, figure out what your optimal dosage using those delivery routes, before you start tapering the opioids. So you want to really arm yourself with the best tools to be successful in reducing or discontinuing opioids.
Now, I’m describing using cannabis to slowly reduce opioids, and this is what works best for everyone. But I’ve also seen a number of patients that are so fed up with their addiction, they don’t want the slow process, they’re ready for a rapid change. And that’s probably just a personality thing. It could be better for some people to have an abrupt change that. Maybe they’re changing a lot of things in their life all at once, which has been shown scientifically to promote lasting changes. So for those people, they can just get everything ready on the cannabis side, go cold turkey on the opioids, use cannabis at probably than their maintenance dose to treat the opioid withdrawal symptoms, and then after the withdrawal symptoms are gone they can reduce their cannabis dose and use it for maintenance to prevent cravings, to treat pain, to help with whatever reason they have for getting into opioids in the first place.
For some patients, low dose cannabis is not effective. But for most patients, it is. I have had several reports of people that are using extraordinarily high doses of cannabis concentrate to help them reduce and discontinue the opioids. And it seems to me that for the patients that don’t respond well to the low-dose approach this actually works well and it can be safe if you do it carefully. So, as I mentioned earlier, one pinhead of this would probably be a very strong dose for most people in this room. But if you start at a tiny dose of this cannabis concentrate, most people would just put a small amount in between their gum and their cheeks to gradually absorb through the oral mucosa, and do that two or three times a day. Over the course of a month and gradually work up to a bigger and bigger amount, up to even 100-500mg of cannabinoids per dose – this is expensive, but if you access to it, it can be very effective and people can use this to get through those really challenging times with opioid taper and opioid abstinence.
More and more in the clinic, we’ve had people coming in that are brand new to cannabis who not only want to try cannabis cautiously, they don’t want to get high. They want no psychoactive experience with their cannabis use. And as I mentioned, that’s totally achievable. You can do that with CBD, in combination with THC. You can do that using THC alone, in very controlled doses. And we have a whole program on that on healer.com, the non-psychoactive strategies for using cannabis. But I want to just mention that the psychoactivity can be quite beneficial and not to fear it, but to embrace it. It’s one of the gifts of cannabis. And when people experience that psychoactivity, this is what they’re reporting – positive mood, relaxation, laughter, socializing, distortion of time (which can be quite helpful for people that have had trauma, that are always thinking in the past about that trauma or worrying about the future), it brings people into the present moment. Intensification of ordinary experiences, things like eating, listening to music, watching films, having sex – these things can feel better under the influence of cannabis. People have reported this from separation of symptoms and suffering, where prior to using cannabis all of their suffering was like in one big ball and they just saw it as this thing that was nagging them or destroying their life or limiting their function. And then after they used cannabis, they can start to separate it out. Here’s the signaling of pain from this area of my body, but at first it’s a neutral signal, it’s coming from, say, an arthritic knee up to my brain, but then my brain is perceiving it as pain and then it’s actually judging that pain as a bad thing, and then I’m attaching some suffering to it because I’m experiencing a bad thing and having anxiety about having more pain in the future. And then all this behavior that goes into how I deal with the pain and what I want to do to treat the pain. That’s all one big ball, separating it out into these different levels is incredibly helpful for patients and that’s another one of the gifts of the psychoactive aspect of cannabis, which again is mostly dependent on the THC. People report increased self-awareness, a sense of connection to the universe, viewing oneself from a different vantage point, fostering acceptance, helping people find creative solutions to their problems – people have these ideas that they never would have thought of without the help of cannabis, so they report. And promoting mental, emotional, and physical flexibility and capacity to change. I put it like that “mental, emotional, and physical flexibility” because they often go together. And as people start feeling more loose and relaxed in their body, as they start maybe doing a bit of yoga or some of the exercises on healer.com, and getting greater range of motion in their body and literally in their nervous system, their thought starts changing, their emotional flexibility increases. So the other things about these gifts from cannabis consciousness, is that they outlast the acute effects of cannabis. I was speaking with a patient recently who told me that under the influence of cannabis she suddenly had this realization that everything in the universe is connected to everything else, and she saw the underlining fabric of reality. And after the cannabis wore off, she took that lesson with her and was able to relate to people in a new way, to connect with nature in a new way, to accept that everything is connected, and that gave her great peace in her life. So some of these lessons will stay with us.
Case Study and Patient Narratives
So let’s move on to a case study. This is kind of the bread and butter of our practice at Integr8 Health, we see a lot of different conditions, but about 70 percent of our patients have chronic pain. And I chose this case because it’s fairly typical of what we see, and I think a lot of you can relate to it. So, a 43-year-old man with chronic pain, a victim of a hit and run motor vehicle-pedestrian accident at age 25, resulting in spinal disc herniation. When he first came in he had already tried cortisone injections, chiropractic, physical therapy, and prescription medications. (I’ll show you his medication list on the next slide.) He did not have satisfactory improvement. He saw an orthopedic specialist who recommended surgery based on the patient’s physical exam, which included weakness in one of his legs, and that is an indication for surgery. But the patient didn’t want surgery at age 43; he wanted to postpone it as long as possible.
He was a high school graduate and worked at an electronics store and at the time he had a 15-month old, first-born child. He came in with an average pain level, 6-7 out of 10. He had a little cannabis history, tried it at age 16, but hadn’t used it in 20 years. He didn’t have any history of adverse affects with cannabis. He simply wasn’t using it. And here’s his medication list: He was on muscle relaxants, two anti-inflammatories, tramadol (which is an opioid pain reliever), hydrocodone (which is another opioid pain reliever), an anti-nausea drug because the pain relievers cause nausea, blood pressure medication, and cholesterol medication. He had previously tried gabapentin (which is an anti-convulsant medication and often used to treat pain and Lyrica, which is in that same category).
So he came back in six months, after cannabis certification. He started using edible cannabis in the form of cookies – not something I typically recommend, I like standardized dosing better where you know how many drops you’re taking or you know how many milligrams – but he was able to access cookies. And then he was also smoking cannabis, not every day, but two to three times weekly, just taking two to three puffs for breakthrough symptoms. Initially he had an adverse affect from the edible, from the cookie, again because it’s really hard to know what the dosage is, but once he adjusted the dosage he was able to use the cookie without any side effect.
At six months, he had stopped hydrocodone and tramadol, the two opioids, and also stopped one of the anti-inflammatories. The anti-muscle spasm medication that he was using daily, he was now using around once a month, just when he needed it. His average pain was 3-4 out of 10, instead of 6-7 out of 10. He had a significant decrease in muscle spasms. And, his physical exam improved. He was actually walking normally, when the first time he came in he had weakness in his leg that made the surgeon want to schedule him for surgery. Now he had normal strength in his lower extremities. Perhaps that’s because he had improved function, perhaps that’s because the muscle spasms had been under control for so long his spine was able to get back into alignment, perhaps it’s because cannabis has anti-inflammatory properties itself and reduced the inflammation that was pressing on that nerve root – probably all of the above. He reported that he was able to carry his son, was able to enjoy fatherhood. And that’s an incredible result!
When I was in my medical training, if I would have seen that happen, I would have thought I was in some alternate reality. How did this patient get such good results? How did he actually come off of all his opioids and medications? This is normal for us now. We see this all the time.
As part of the survey data that I showed earlier, we also invited patients to submit their narratives. We received over 100 very compelling narrative reports of what patients were doing with combining cannabis and opioids. I chose three to share with you, but there is many more that I wish I could share with you, and sometime maybe we’ll compile all of that and give you an overview.
So here’s one of them. I’m just going to read it. “I was in a car accident about 13 years ago. I had a hip injury that was deemed permanent and a severe head injury. I was immediately placed on 24-hour opiate painkillers. Throughout the 12 years, I’d been prescribed just about every different type. I was also on several other mediations ranging from nerve pain meds to blood pressure meds. I became determined to get off the opiates because they truly never eliminated the pain. I use medical cannabis to help me withdraw. It was quite a substantial process due the length I’d been taking them, 24-hours a day for 12 years. It made the withdrawal much easier. I’ve been in much less pain and was able to eliminate all the other medications I was on at the time. It gave me my life back. It was amazing. I credit cannabis for much of my success.”
“I am 38-years-old and I struggled with opiate and alcohol addiction for about 15 years, long hours as a chef and a couple of minor surgeries where I was prescribed opiates, led me to become dependent on them to get through my day. Pretty soon I was fully consumed by addiction. Even after going to two detoxes and a 28-day rehab in 2010, I still struggled to stay clean for the next two years. The 12-step meeting that I was going to several times a week discouraged cannabis use, so I tried to do it their way and didn’t use any. That didn’t work, and it led me to several relapses. In 2012, I decided to start using a little bit of cannabis before bed to help me get a good night sleep and when I was getting stressed, angry, etc. It was very effective in keeping me centered and on the path to recovery, although I didn’t feel comfortable – and still don’t – sharing this with fellow addicts at meetings. I had been a cannabis smoker on-and-off since age 18 and always enjoyed the effects. In the throes of my opiate addiction, however, I got out of the routine of regular cannabis using. I believe that this is because cannabis use tends to magnify my own problems and shortcomings in my mind when I use it, and no drug addict wants to take such an honest look at themselves. As of right now, I have been free of active addiction from January 2012. I’ve also been a patient of Interg8 Health since 2012. Cannabis is the only thing that I am currently prescribed, and the only substance I use for pain, stress, etc. I don’t know if I would be here today, and sober, if it wasn’t for cannabis. I use cannabis throughout the day and before bed, and live a happy, healthy, and productive life with my wife and two daughters.”
I just want to comment on a couple of great issues that he brought up. The acceptance – or non-acceptance of cannabis in recovery circles – Martin touched on this earlier, it’s really important that we start bringing this out in the open because for those of you that are in recovery, and you look around the room at the meetings, there’s probably several other people there that are either using cannabis secretly or have an idea that cannabis could be helping them. It’s time to bring that conversation out into the open. I’ve heard it called the “green recovery treatment” option. It’s something that’s becoming more well-known and more talked about in recovery circles. We have a long ways to go. Meanwhile, people are drinking coffee and smoking cigarettes, let’s replace even some of those things with cannabis – healthier option, cannabis. And then this part where he was looking at himself. Yes, cannabis forces us to do that. And it can look really ugly sometimes. But if we don’t take a solid look at ourselves then we can’t change. That inner awareness, that connection with who we really are – because people that are addicted to opioids lose track of who they are. I’ve seen people go from very strong and capable to very weak and very limited. You know, their whole lives changed. And, some people that used to be able to help others, and get a lot done, and feel like they were in service to their community, suddenly find themselves in the situation where they’re dependent on others, where they feel like they’re sucking the energy and the time from the people around them, and they’ve changed that dynamic. Yes, we need to look at that. And if you use cannabis, even if you use it in the way that I’ve described in this presentation, it might show you something that you don’t want to see. But trust me, you need to see it to make that change.
I’m going to offer one more narrative. “I took opiates for 15 years, along with various forms of benzos [again those are the anti-anxiety and anti-muscle spasm medications like valium]. I had legitimate pain. I fractured my back in three places when I was 19. I healed from the initial injury, but the pain got worse over the next few years, to the point where I was drinking to get by. I had an uncanny knack for being able to walk into a doctor’s office and get almost anything I asked for, due to my injury. Anyway, I took opiates to the tune of two Oxycontin 80s and 12mg Dilaudids for PRM [which means as needed, that’s quite a high dose]. At some point, it wasn’t just about the pain anymore, it had become more about the addiction. In retrospect, the opiates were only working on the emotional pain, not the physical pain. So to make a long story short, I’ve been to detox 27 times since I was 27. I’ve been in three 30-day rehabs from here to Ohio. I tried halfway houses, Suboxone treatment, etc. It’s been 21 months since my first visit to your office, and I literally have not used an opiate since. Thank you. P.S. I truly believe that medical marijuana has saved my life.”
That’s incredible. We’ve got a lot more of those, too. So, because I know that this information is now in your hands but it may not be in the hands of your doctor, and that’s an important next step to take, not just for yourself but for all the other patients that your doctor treats, on healer.com we have a free download that’s a succinct summary of what a healthcare provider needs to know if they’re taking care of a patient that’s using medical cannabis. I also want to promote the Society of Cannabis Clinicians, this is a professional organization for people that are practicing cannabis medicine, and I invite you to check out their website that’s full of great resources.
This article was written by Dr. Jessica Fox , May 31, 2016 and came from Green Flower Media.
Lots of good information!! Please share with others..... Elizabeth, Pianta Tinta
Have you ever wondered how cannabis actually works in the body?
If you’ve read up on the endocannabinoid system, you’ll know that our bodies are full of receptors that interact with cannabinoids. Cannabinoids are chemical compounds that act directly and indirectly on cannabinoid receptors to help the body maintain stability and health.
Our bodies make their own cannabinoids – called endocannabinoids because they are produced internally – to work on cannabinoid receptors. By some happy coincidence of nature, cannabis and other plants also produce cannabinoids that interact with our receptors. These plant cannabinoids are known as phytocannabinoids.
Phytocannabinoids are just one of the cannabis plant’s active ingredients. Other plant compounds known as terpenes and flavonoids also direct how cannabis will work for you.
But the phytocannabinoids are the cornerstone of your medicine’s effect.
What do you need to know about phytocannabinoids?
There are over 85 known phytocannabinoids – some sources put the count well over 100! Here, we will tour the nine phytocannabinoids that have been most thoroughly documented, starting with the two most prominent compounds: THC and CBD.
The ins and outs of THC
Newcomers to cannabis are finding a lot of guidance through knowledgeable physicians.
THC is famous for its psychoactive effects and while those cognitive effects can have a variety of advantages or disadvantages depending on the situation, THC offers additional health properties that should not be overlooked.
THC is particularly valuable for managing pain and reducing inflammation, the compound directly addressing the underlying drivers of chronic pain and inflammatory disorders. THC also has great effect in reducing nausea and vomiting, and on the flip side of that coin, stimulating appetite.
Other common uses for THC include aiding sleep, managing glaucoma, reducing muscle spasms, and protecting the nervous system. The nervous system protection has made THC a useful tool in helping to manage autism, ADHD, and post-stroke symptoms.
THC does have some side effects to be aware of – especially if you take too much.
The most common side effects of THC include rapid heart rate, anxiety and paranoia, sleepiness, increased appetite, dry mouth and dry eyes, forgetfulness, dizziness, reduced blood pressure, and potentially hallucinations if you take a lot. For the most part, side effects resolve when the medicine wears off and are generally considered benign.
Getting your THC dosage just right can help you get the most benefit from your medicine while avoiding unwanted side effects, which typically arise when a patient has dosed over their tolerance. The side effect profile of THC is why cannabis doctors counsel their patients to start with a very low dose – around 2.5 – 5 mg of THC, and to gradually increase the dose according to how well they tolerate it.
Finally, you may have noticed that some of the uses for THC are the same as some of the side effects! This is because cannabis is the ultimate personalized medicine. A negative side effect for one person may be a positive side effect for another. A classic example is a patient with cancer regaining his appetite after medicating – what a blessing for him! Similarly, an insomniac will be deeply grateful for THC’s ability to cause sleepiness after an exhausting day.
CBD – the “new kid” on the block
CBD has changed how a lot of people view cannabis and for good reason.
While it has been around just as long as THC, CBD has only in the past few years become very popular in the medical cannabis world due to its effectiveness against epilepsy and cancer without the head high effects of THC. Though some would argue the claim that CBD is not psychoactive because it promotes relaxation and anxiety relief, it is generally accepted that CBD does not cause the euphoric high that THC does.
In addition to reducing or eliminating seizures and fighting the growth of tumor and cancer cells, CBD is an excellent treatment for anxiety. CBD is also an antipsychotic agent, which is why cannabis can actually be a useful tool in managing mental illness, contrary to mainstream belief.
Other popular uses for CBD include reducing muscle spasms and spasms of the small intestine, and application as a pain reduction and anti-inflammatory agent. Finally, even more so than THC, CBD protects the nervous system, making it a great tool for managing dementia and Parkinson’s disease, and essential for use with THC in autism and post-stroke care.
While typically much better tolerated than THC, CBD can have side effects of its own at very high doses, such as dizziness or lightheadedness, anxiety, decreased appetite, drowsiness, increased heart rate and palpitations, and jitteriness.
A really amazing fact about CBD is that it actually reduces undesirable effects of THC, such as inebriation, sedation, and racing heart. Specifically, in medicines with phytocannabinoid content of 4 parts or more CBD to 1 part THC (a 4:1 CBD:THC ratio or higher), CBD will dampen the head high and side effects caused by THC.
Not only that, but CBD can enhance the pain-relieving, nausea-reducing, and anti-cancer effects of THC (yes – THC is quite active against cancer cells too!).
Bottom line – your medicine is better when it contains both THC and CBD!
You said there were 9 major phytocannabinoids…
Though THC and CBD are the most well known phytocannabinoids, we continue to learn more about the characteristics and applications of the other seven.
#1) THCA is the acidic parent of THC found in the raw cannabis plant. When exposed to heat, sunlight, or time, the THCA in the harvested plant will convert to THC. THCA is non-psychoactive and is particularly useful for reducing nausea, reducing seizures, reducing muscle spasms, and fighting tumor and cancer cells.
#2) CBDA is the acidic parent of CBD found in raw plant. CBDA converts to CBD when it is exposed to heat, sunlight, or time. Like THCA, CBDA is non-psychoactive. CBDA is also great for reducing nausea, reducing inflammation, and fighting tumor and cancer cells.
#3) CBN is a breakdown product of THC. As harvested cannabis ages, THC will gradually be converted to CBN. CBN is known to be particularly useful for aiding sleep, and also good for reducing pain and muscle spasms.
#4) CBGA is actually the precursor molecule that is turned into THCA and CBDA as the cannabis plant develops, so it is found only in tiny amounts in the mature plant. In the harvested plant, remaining CBGA converts to CBG with exposure to air and light.
#5) CBG is useful as an antidepressant, a muscle relaxant, an antibiotic and antifungal agent, and as a blood pressure reducer.
#6) CBC is also found only in tiny amounts in the cannabis plant. CBC has pain reducing, anti-inflammatory, antibiotic, antifungal, and anti-cancer effects.
#7) THCV does have psychoactive properties, but much less than THC. THCV has been found to suppress appetite and can aid weight loss, and also has antiseizure effect.
Which phytocannabinoids are right for you?
An experienced physician can guide patients to getting the most out of cannabis.
Your goal should be to tailor the phytocannabinoid content of your medicine to the conditions and symptoms you want to treat. As noted before, cannabis is a very personal medication, with every person requiring a different medicine composition for even the same condition. As such, there is often much trial and error that goes into finding your ideal phytocannabinoid content.
You can use the details outlined above to help get you started in finding the best composition for your medicine, and here are some examples of the phytocannabinoids that may be useful for the most common conditions seen in many cannabis clinics:
Chronic pain: There are several different forms of chronic pain. Nerve pain may be best managed with CBD and THCA. Muscular pain often responds well to THC. A combination of THC and CBD can be useful for bone pain. Inflammatory pain can be managed with THCA or THC. Skeletal and internal muscle spasms can be relieved with CBD.
Insomnia: THC and its breakdown product, CBN, are particularly useful for aiding sleep. And spoiler alert for the follow-up article on terpenes and flavonoids: the terpene called Myrcene is a great tool for improving sleep!
Anxiety: CBD is the best remedy for anxiety, but at high doses can actually increase anxiety. THC can also be useful for anxiety, but only at low doses. Again, whether you’re using high CBD or high THC medicine, you should always start at a low dose and increase only gradually as needed to achieve the relief you’re seeking.
I recently received this article from Green Flower Media regarding Insomnia and using cannabis as a natural sleep aid. There are many many reasons why people can't sleep, stress, pain, anxiety and many more. Please pass this on to anyone you know that is having issues with sleeping OR want to get off medications like Ambien. This article was written by Seshata, a journalist and researcher specializing in medical, cultural, and geopolitical aspects of cannabis. Elizabeth...PiantaTinta
How insomniacs find sleep with cannabis – not pharmaceuticals.
Estimates suggest there’s up to more than a billion insomniacs the world over, and for severe cases, the effect on health can be catastrophic.
Lack of sleep has been associated with conditions such as cardiovascular disease, diabetes, obesity – not to mention an inability to keep up with daily tasks and an increase in motor vehicle incidents.
In the United States alone, approximately one-third of all adults will experience insomnia at some point in their lives. Women are afflicted at twice the rate of men, and about half of all seniors over 65 suffer from the condition.
So that means that in the U.S., there are between fifty and seventy million adults afflicted with sleep disorders. At least nine million of them regularly take prescription sleep aids in the effort to keep heads on pillows.
But the massive irony is – most of these prescription medicines have dangerous, debilitating side-effects, and the vast majority don’t really do very much anyway!
For example, Ambien (the biggest selling sleep aid in the U.S.) has never been proven to be effective at maintaining sleep, except when delivered in a controlled-release form (so the drug stays in the system for longer).
But this controlled-release form is associated with dangerous levels of morning drowsiness, which has led to motor vehicle accidents on numerous occasions. On top of that, users are also taking on a scarily high risk of addiction, violent psychosis, blackouts and suicidal thoughts!
Your alternative to this prescription medicine madness
No need for dangerous pharmaceuticals like Ambien when cannabis is proving to be so much more effective.
For centuries, if not millennia, people have been using cannabis as an all-natural sleep aid, reporting that they are able to get to sleep more quickly and ultimately feel more rested.
To understand more about cannabis and healthy sleep cycles, we spoke with the esteemed physician and medical journalist Uwe Blesching. Uwe is the author of The Cannabis Health Index as well as a new online course on cannabis and insomnia.
“Insomnia is a disease that affects millions, and is the number one reason that women turn to cannabis" he says.
It’s also clear that when used properly, cannabis can certainly help an insomniac get a much better night’s rest, and with practically zero risk or side-effects compared to current drugs.
The mechanism via which cannabis influences sleep in humans is extremely complex and far from being fully understood. However, it’s clear that several cannabinoids have an important role to play in sleep cycles.
So which cannabinoids can help, and how?
As we expand our understanding of cannabinoid science, we learn how to better use this plant for many illnesses or ailments – including insomnia.
Uwe explains that THC causes an increase in “deep” sleep and a decrease in REM sleep (the “dream” stage of sleep).
In fact, during withdrawal from THC, REM sleep goes back up and deep sleep goes down. This ties in with the common belief that tolerance breaks lead to an increase in dreams.
THC also appears to increase initial sleepiness and make the user fall asleep faster. However, it has also been repeatedly associated with feelings of lethargy the next day (an effect also commonly found in prescription meds!).
CBD appears to have a twofold effect. When attempting to fall asleep, CBD can mitigate against the possible anxiety-inducing effects of THC, allowing the user to feel relaxed, calm and peaceful.
On the other hand, CBD can also increase feelings of alertness and wakefulness, so when combined with THC in the correct ratio, it can decrease the likelihood of feeling that next-day “hangover”.
Finding the right combination of THC and CBD could potentially get you to sleep quicker and leave you much more refreshed in the morning!
THC and CBD are just the beginning!
We also now know that several lesser-studied cannabinoids such as cannabinol (CBN), cannabichromene (CBC) and cannabigerol (CBG) can have a sedative effect. In fact, Steep Hill Labs says: “Of all the cannabinoids, CBN appears to be the most sedative.”
There are over a hundred unique cannabinoids in cannabis, and even more important organic compounds such as terpenes and flavonoids, which can act together in countless different ways, to produce a range of unique effects.
Several terpenes commonly found in cannabis, such as myrcene, linalool and citral, have been shown to have sedative or relaxant effects. For more information, check out Green Flower’s fantastic resource on cannabis terpenes!
How Stress is Fundamental to Insomnia
Cannabis, when properly administered, can also help you tackle underlying issues that cause insomnia, particularly stress.
According to Uwe, “The most common cause for primary insomnia is so universal that it is almost synonymous with the condition itself: STRESS – especially chronic stress. More specifically the kind of stress that builds up in the form of worries, fears, emotional distress, heartaches, longings, or simply bad news.”
Targeting the symptoms of stress, as well as directly manipulating sleep cycles, should therefore prove to be a far more effective approach than the current standard in healthcare.
Currently, doctors may look at your medical history and run a few diagnostic tests, but it is unlikely that they will explore the causes of your stress in-depth. What’s far more likely is that they’ll throw a prescription sleep aid at you and move on to the next patient.
Instead, many of us now have the information and the high-quality, legally-accessible cannabis medicine with which we can begin to tailor our cannabinoids to suit us best.
Finding the Right Blend For You
This THC-free terpene oil is a great example of how we are expanding access to different formats of cannabis medicine.
More research into cannabinoid and terpene ratios could lead to the development of seriously effective, individually-targeted insomnia medications – which will reduce stress, keep the user asleep for longer, and wake up more refreshed and less “hungover” than any existing pharmaceutical! As well as – perhaps most importantly – cutting out practically all of the potential health risks.
The key to the puzzle is finding your “subjective therapeutic window,” as Uwe puts it. Your optimal dosage, in other words.
Individual genetics, state of health – these crucial factors determine what your body needs at any given time. Meeting those requirements with the correct cannabinoid profile is, in essence, finding that subjective therapeutic window.
Why is this so crucial? Uwe says: “Because taking too little is sub-optimal, while too much can actually increase the very symptoms you are attempting to treat.”
This article was originally published in O'Shaughnessy's Reader and reposted on the ProjectCBD website. Although some of it went over my head....I did get some interesting info from it. So give it a read and take what you can!!
Elizabeth - Pianta Tinta
Cannbidiol (CBD), a non-psychoactive component of the marijuana plant, has generated significant interest among scientists and physicians in recent years—but how CBD exerts its therapeutic impact on a molecular level is still being sorted out. Cannabidiol is a pleiotropic drug in that it produces many effects through multiple molecular pathways. CBD acts through various receptor-independent channels and by binding with a number of non-cannabinoid receptors and ion channels.
Here are some of the ways that CBD confers its therapeutic effects.
CBD and FAAH
Unlike psychoactive THC, CBD has little binding affinity to either the CB1 or CB2 cannabinoid receptors. Instead, CBD indirectly stimulates endogenous cannabinoid signaling by suppressing the enzyme fatty acid amide hydroxylase (FAAH)—the enzyme that breaks down anandamide, the first endocannabinoid discovered in the mammalian brain in 1992.
Whereas the cannabinoid molecules found in cannabis are considered “exogenous ligands” to the cannabinoid (CB) receptor family, anandamide is an “endogenous” cannabinoid ligand—meaning it binds to one or more cannabinoid receptors and is found naturally inside the mammalian brain and body. Anandamide favors the CB1 receptor, which is concentrated in the brain and central nervous system. Because FAAH is involved in the metabolic breakdown of anandamide, less FAAH means more anandamide remains present in the body for a longer duration. More anandamide means greater CB1 activation.
CBD enhances endocannabinoid tone by supressing FAAH.
By inhibiting the enzyme that metabolizes and degrades anandamide, CBD enhances the body’s innate protective endocannabinoid response. At the same time, CBD opposes the action of THC at the CB1 receptor, thereby muting the psychoactive effects of THC.
CBD also stimulates the release of 2-AG, another endocannabinoid that activates both CB1 and CB2 receptor. CB2 receptors are predominant in the peripheral nervous system and the immune system.
The Vanilloid Receptor
While CBD has little binding affinity for either of the two cannabinoid receptors, it has been shown to directly interact with other “G-protein-coupled” receptors and ion channels to confer a therapeutic effect. CBD, for example, binds to the TRPV-1 receptor, which is known to mediate pain perception, inflammation and body temperature.
TRPV is the technical abbreviation for “transient receptor potential cation channel subfamily V.” There are several dozen TRP receptor variants or subfamilies that mediate the effects of a wide range of medicinal herbs.
Scientists also refer to TRPV-1 as the “vanilloid receptor,” named after the flavorful vanilla bean. Vanilla contains eugenol, an essential oil that has antiseptic and analgesic properties; it also helps to unclog blood vessels. Historically, the vanilla bean has been used as a folk cure for headaches.
CBD is a TRPV-1 “agonist” or stimulant. This is likely one of the reasons why CBD-rich cannabis is an effective treatment for neuropathic pain.
Capsaicin—the pungent compound in hot chili peppers—activates the TRVP-1 receptor. Anandamide, the endogenous cannabinoid, is also a TRPV-1 agonist.
The Serotonin Receptor
Jose Alexandre Crippa and his colleagues at the University of San Paulo in Brazil and at the King’s College in London have conducted pioneering research into CBD and the neural correlates of anxiety.
At high concentrations, CBD directly activates the 5-HT1A (hydroxytryptamine) serotonin receptor, thereby conferring an anti-depressant effect. This receptor is implicated in a range of biological and neurological processes, including (but not limited to) anxiety, addiction, appetite, sleep, pain perception, nausea and vomiting.
5-HT1A is a member of the family of 5-HT receptors, which are activated by the neurotransmitter serotonin. Found in both the central and peripheral nervous systems, 5-HT receptors trigger various intracellular cascades of chemical messages to produce either an excitatory or inhibitory response, depending on the chemical context of the message.
CBD triggers an inhibitory response that slows down 5-HT1A signaling. In comparison, LSD, mescaline, magic mushrooms, and several other hallucinogenic drugs activate a different type of 5-HT receptor that produces an excitatory response.
The Adenosine Receptor
CBD’s anxiolytic (anti-anxiety) properties may in part be attributable to its activation of the adenosine receptor. Adenosine receptors play significant roles in cardiovascular function, regulating myocardial oxygen consumption and coronary blood flow. The adenosine (A2A) receptor has broad anti-inflammatory effects throughout the body.
Adenosine receptors also play a significant role in the brain. They down-regulate the release of other neurotransmitters such as dopamine and glutamate.
Whereas cannabidiol activates the TRPV-1 vanilloid receptor, the A2A adenosine receptor, and the 5-HT1A serotonin receptor, some studies indicate that CBD functions as an antagonist that blocks, or deactivates, another G protein-coupled receptor known as GPR55.
GPR55 has been dubbed an “orphan receptor” because scientists are still not sure if it belongs to a larger family of receptors.
GPR55 is widely expressed in the brain, especially in the cerebellum. It is involved in modulating blood pressure and bone density, among other physiological processes.
GPR55 promotes osteoclast cell function, which facilitates bone reabsorption. Overactive GPR55 receptor signaling is associated with osteoporosis.
GPR55, when activated, also promotes cancer cell proliferation, according to 2010 study by researchers at the Chinese Academy of Sciences in Shanghai. This receptor is expressed in various types of cancer.
CBD is a GPR55 antagonist, as University of Aberdeen scientist Ruth Ross disclosed at the 2010 conference of the International Cannabinoid Research Society in Lund, Sweden.
By blocking GPR55 signaling, CBD may act to decrease both bone reabsorption and cancer cell proliferation.
CBD also exerts an anti-cancer effect by activating PPARs [peroxisome proliferator activated receptors] that are situated on the surface of the cell's nucleus. Activation of the receptor known as PPAR-gamma has an anti-proliferative effect as well as an ability to induce tumor regression in human lung cancer cell lines.
PPAR-gamma activation degrades amyloid-beta plaque, a key molecule linked to the development of Alzheimer’s disease. This is one of the reasons why cannabidiol, a PPAR-gamma agonist, may be a useful remedy for Alzheimer’s patients.
PPAR receptors also regulate genes that are involved in energy homeostasis, lipid uptake, insulin sensitivity, and other metabolic functions. Diabetics, accordingly, may benefit from a CBD-rich treatment regimen.
CBD’s enzyme-mediated activation of the PPAR-alpha receptor may have antipsychotic effects. Polymorphisms or mutations in the gene encoding PPAR-alpha can result in deficient PPAR-alpha signaling, which has been linked to schizophrenia. PPAR-alpha activation is both anti-inflammatory and can decrease dopamine release, thereby minimizing schizophrenic symptoms.
The natural occurring compounds found in plants are called phytochemicals and have been extracted using ethyl alcohol for use as medicinal remedies for a long, long time. The ingredients in plants are highly soluble in alcohol and easily extracted, however cannabinoids are only significantly soluble in more concentrated ethanol solutions greater than 75% (150 proof) but ideally 190 proof should be used. With the 190 proof ethanol the cannabinoids, terpenoids, flavonoids and other essential oils will be easily extracted.
Tinctures made with alcohol are generally better preserved than other types of tinctures due to the antibacterial nature of alcohol. They tend to be more stable and reliable over a long period of time with or without refrigeration. This lends itself to a very long shelf life. Another plus with using ethanol in our tinctures is that the alcohol when taken orally permeates the mucus membranes of the mouth and is delivered into the bloodstream. This is a much quicker delivery system than taking an edible and waiting for the digestive system and liver to break it down.
Our first interview!!
Cannabis as a Sleep Aid for Insomnia: An Interview with Pianta Tinta
October 30, 2015, By Pamela Hadfield, Co-Founder & Director of UX
Topics: Insomnia, Pain, Cancer, Fibromyalgia, Muscle Spasms, Epilepsy
Tinctures are an easy-to-ingest way to administer marijuana.
Due its lack of psychoactivity and for its ability to effectively treat a variety of medical conditions, CBD (Cannabidiol) is the rising star among the cannabis plant’s cannabinoids. Pianta Tinta Collective, a new manufacturer within the cannabis marketplace, focuses on high CBD tinctures, oils and rubs ‘to enable others to live a higher quality of life.’ Their tinctures target insomnia and chronic pain as well as other common conditions people often face. Co-founders Elizabeth Knight and Dr. Kathy Acquistapace feel they have found their niche with a more medically oriented customer base and pride themselves on ongoing customer consultations with Dr. Acquistapace, the in-house Naturopath.
Pianta Tinta is also representative of the booming artisanal marketplace within California. Smaller product manufacturers often focus on sourcing the highest quality outdoor grown cannabis for unique offerings, such as CBD tinctures, that may or may not be found in your local dispensary. Elizabeth Knight took time to speak to us about Pianta Tinta and the growth of their business over the past year.
What was the inspiration for starting Pianta Tinta?
Pianta Tinta means ‘plant tincture’ in Italian. We chose that name because we focus on the cannabis plant as well as more natural modalities of healing. We founded our business based on Dr. Kathy Acquistapace’s research on CBD and the newly found applications for it as a medicine.
As a naturopath, Dr. Acquistapace was looking for more alternative natural medicines for her patient base. As she learned more and more about CBD, we became excited about the possibilities but also became aware of the lack of CBD alternatives in the market, especially within dispensaries.
As a business, we were most interested in entering the cannabis marketplace with products that were high CBD and very low THC. When you visit a dispensary as a first time medicinal marijuana patient, it is not that easy to find high CBD products. When a senior citizen enters a dispensary today they will most likely be presented with products that are very high in THC. Even a 1:1 ratio of CBD to THC may be too much THC for a first time cannabis patient. Ultimately, we decided to make tinctures as this is a very easy way to ingest cannabis.
What high CBD cannabis strain do you favor for your product lines?
We work with ACDC as our favored strain. It is a hybrid strain that is bred to have very high CBD content and very low THC content. It is not the easiest strain to grow but we think it works very well for the high CBD products that we produce. Our grower grows the ACDC strain outdoors, in organic soil; he uses grow pots without the use of pesticides/fungicides which we feel is very important.
We also test our products at Steep Hill Halent and CW Analytical labs. We first test the ACDC flower to know the cannabinoid ratios, the terpene profiles and to make sure it is free of any microbes, fungus or molds. After we go through making the tinctures we test again to get the final cannabinoid content, which is what we print on our labels. We strive to represent our product as accurately as possible.
Other than the ACDC flower, what other ingredients do you put within your cannabis tinctures?
Our tinctures are very straightforward. All of our labels list the ingredients, which include the ACDC flower/leaves and ethyl alcohol. We do not flavor or put any additional chemicals in our products. We pride ourselves on providing our customers with very ‘clean’ products.
Are you targeting a particular segment of the population with your product line?
The people we want to reach represent a wide range of ages and demographics. We believe that we are able to reach these people because our products positively address a wide variety of symptoms that affect almost all age groups. We often find that senior citizens are looking for alternatives from a regime that is far too heavy with opioids, so they are open to trying cannabis as an alternative. We see that younger people are far too stressed out and can use some anxiety relief, which CBD is also good for. Our products are for anyone who is seeking to use marijuana medicinally, and to receive the benefit from CBD.
Do your products target specific medical conditions?
We are not able to make claims as we do not have any clinical studies to back these up. However, anecdotally we have seen great success across a variety of conditions including adults with seizure disorders. For instance, we had a patient, a man in his fifties, who was having 4-6 seizures a month, and since taking our Super High CBD tincture he has had a total of 5 seizures since January. That is a huge reduction of seizures and in addition he was able to drop many of his pharmaceutical medications.
We have also seen a lot of people who have chronic pain, whether that be arthritis, pain from previous injuries, general inflammation, etc. This topic of pain covers a wide swath of medical conditions and can encompass so much, but we have found that many people have found relief with our Super High CBD product. We also have members of our collective with cancer who have added our Super High CBD as well as our High THC tincture and oil to their treatment regime.
Since virtually all pharmaceutical products carry unwanted side effects, CBD offers the alternative of providing the positive benefits without the negative side effects.
On your website, I see that you are promoting a new high THC tincture for sleep. Is this tincture good for treating insomnia?
We recently produced a high THC tincture that we feel is particularly good at relieving insomnia. As we all know, insomnia can be difficult to overcome. Not everyone has insomnia for the same reasons. For instance, one person may not be sleeping because they have pain related to inflammation. If you bring the inflammation down with a high CBD product, they may be able to get a good night’s sleep every night. In other instances, a high THC tincture will help relax a person who struggles to get to sleep and also help them to stay asleep longer.
Our newest tincture contains a high percentage of THC and almost no CBD. THC tends to relax people, however everyone is different. Some people find that CBD may relax them and others may find that a combination of THC and CBD may be best for them. As we are all unique, we recommend that people try our new high THC tincture for their sleep issues and see if their sleep improves. Some people may find that it works well and others may find that adding CBD to the THC may work best for them. We suggest that a person starts with a small amount before bedtime and keep a sleep log. This way, they can find what works best for them based on their own body.
You offer members of your collective consultations with your in-house Naturopath. What should a patient expect to gain from a consultation?
Dr. Acquistapace is our Naturopath. She has over 25 years of healthcare experience and her focus is on alternative and natural healing. She works with people who are wanting to reach their highest level of heath and explains to them how Pianta Tinta tinctures can be a part of their health plan. At Pianta Tinta, she often works with people, many first timers to marijuana, to better understand cannabis and how to integrate it into their lives. She is also available to answer more general health questions as well.
People are often overwhelmed by the amount of information they are given, especially those new to cannabis, so Dr. Acquistapace is there to help guide and consult with people along the way. Our customer base is often looking for answers and wondering how medical marijuana interacts with their body and possibly with their existing medications. Dr. Acquistapace consults in 15-minute increments over the phone, over Skype and in-person. We want to be flexible based on the patients needs.
What general advice would you give to people that are new to cannabis?
Read your labels! A lot of products are mislabeled or misrepresent the medicine. This is especially true for many of the high CBD hemp-based products that are sold over the internet. Hemp is different from cannabis and the products made from it is sourced differently as well. Make sure that the products are lab tested and make sure you know how much of the medicinal cannabinoids CBD and THC is in the products. Ratios are popular but it does not tell you specifically how much cannabinoids are actually in the product. It is important to educate yourself or consult with someone who can give quality advice before ingesting your medicine. Also read the label for any additional harmful or unnecessary ingredients such as residual solvents like, butane, naphtha, isopropyl alcohol, propylene glycol, dyes, artificial flavoring and fragrances.
How do you people find Pianta Tinta Tinctures?
We do not currently sell through storefront dispensaries. We have chosen to be a collective and produce and manufacture our own cannabis tinctures for our members. We are located in Vallejo and people pick up their products from us directly by appointment only. Before seeing us you will need to obtain your medical marijuana recommendation, which you can do through HelloMD. To obtain our products you must first go online to the Pianta Tinta website and fill out our short membership form, which requires a valid medical marijuana recommendation and photo ID. You can contact us to schedule an appointment or we are also able to deliver for a small additional fee.
By Pamela Hadfield, Co-Founder & Director of UX
Indica, Sativa & Hybrids...What's the difference?
Alot of you are new to cannabis medicine and the information out there is extensive and sometimes confusing! I wanted to say a bit about the types of cannabis so that you know the differences between them.
Cannabis indica plants are short and stout, about 2-4 feet tall. They have broad leaves and tend to be a darker green. The plants are believed to have originated in the middle east, they tend to like cooler climates and do better with harsher conditions. The effects of Indica is a very relaxed feeling, many people use Indica after a long day of work to relieve stress, relieve pain and help them fall asleep since it mainly affects the body.
Sativa strains are taller and thinner than Indicas. They have more narrow leaves and brighter green. They originated in the equatorial countries of Columbia, Mexico, Thailand, and South East Asia and thrive in warmer and more temperate weather. Sativa strains are known to produce a cerebral high and is very uplifting and stimulating....great for people with depression. Sativias are great for during the day when you want to be more alert.
Hybrids are strains that are in between sativa and indica. They encompass all the great qualities of both Indica and Sativa, but they tend to be either more sativa dominant or indica dominant. Many strains out there today are hybrids with varying amounts of CBD and THC. Hybrids allow breeders to manipulate the genetics to have either a higher THC level or higher CBD level. The strain that we use in our high CBD tinctures is a hybrid called AC/DC which is a phenotype of the parent plant "Cannatonic" and is considered a sativa dominant plant. Its extremely high concentration of CBD (cannabidiol) and low THC makes the AC/DC strain ideal for anxiety and pain management among many other conditions.....
A group of researchers commissioned by the United States government has unwittingly found that cannabis can actually kill cancer cells. The research was done by a team at St. George’s University of London and found that tetrahydrocannabinol (THC) and cannabidiol (CBD) weakened cancer cells and made them more susceptible to radiation treatment...to read more please see this article in the Washington Post.