Medical cannabis

Listen to Dr. Jake on The Cannabis Consult podcast

Dr. Jake discusses medical cannabis with Dr. Jamie Corroon, N.D., M.P.H.  of The Cannabis Consult podcast.

Topics included in this podcast at the following times:

04:15  How the FDA’s regulation on botanical drugs differs from single molecule drugs

06:30  Clinical trials of cannabis

07:50  Terpenes

08:09  Why cannabis makes THC/(THCA)

09:09  Flavonoids

12:52  Terpene variability in cannabis strains

13:35  Standardized cannabis products

14:30  The entourage effect and cannabis (cannabis synergy)

15:58  Risk-benefit ratio in prescribing cannabis

17:11  Why the endocannabinoid system (ECS) is the internet of our body and how this necessitates individual dosing in cannabis prescribing

18:33  Dosing with cannabis: the patient centered dosing paridigm

19:11  Cannabis and anxiety:  Dose titration with patients to reduce anxiety

20:54  Why naturopathic doctors are great for cannabis patients

21:40  Dosing with THC

23:35  RSO dosing   (Rick Simpson Oil)

26:00  Risk-benefit ratio and cannabis revisited

27:18  Standardized cannabis products

29:18  Standards for doctors recommending cannabis – AACM American Academy of Cannabinoid Medicine

28:40  Naturopathic doctors and cannabis – educating patients

32:10  What cannabis patients are looking for

33:45  Differences between Washington state and California cannabis laws

35:20  Budtender education and medical advice

39:33  Cannabis culture:  Washington state vs. California

41:50  What kind of cannabinoid medicine Dr. Felice wants for his patients

43:00  Topical cannabis products and pain

43:28  Enteurage effect with cannabis

44:38  What Dr. Felice wants in a good topical product

47:12  Why CBD from hemp is better than single-molecule CBD

-Dr. Jake F. Felice ND, LMP

 

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CBD reduces blood pressure

CBD reduces resting blood pressure, as well as blood pressure increases caused by stress.  That’s right, and it helps to remember that CBD is particularly good for anxiety too.

Check out this study by researchers of the University of Nottingham and Oxford, United Kingdom, Royal Derby Hospital Centre, in the Journal of Clinical Investigation Insight.

-Dr. Jake F. Felice

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2,700 year old cannabis shaman reveals links to modern day strains

2,700 year old cannabis shaman reveals links to modern day strains

In a remote part of Central Asia, researchers have discovered 789 grams of uniquely preserved cannabis buried 2700 years ago along with a light skinned, light haired, blue eyed cannabis shaman.  This sample gives us the oldest proof that cannabis was used for the purposes of “getting high”, as the sample contained high levels of THC, and relatively low levels of CBD.  

According to the Journal of Experimental Botany, the vegetative material was lightly pounded and was “cultivated for psychoactive purposes”, rather than as fiber, clothing, or as food.  It was likely used for purposes of divination or spirituality.  

The ancient cannabis stash came from plants that were THC dominant.  Wild-type or hemp based cannabis strains would have yielded lower levels of THC and more of a 1:1 ratio of THC to CBD.  About 100 seeds were also found, though unfortunately the genetic material in them was lost as researchers were unable to germinate the seeds.  

Dr. Jake Felice is an accomplished naturopathic physician with extensive experience with cannabinoid therapeutics and medical cannabis consultations.  As a national cannabis brand ambassador he has provided scientific, medical, public relations, product development, and compliance based advice for companies in emerging and existing cannabis markets.  He has consulted for major cannabis companies including Willie Nelson’s brand, Cannabis Basics, Medical Marijuana 411, Seattle Central College, and The Academy of Cannabis Science.  Additionally, he provides ongoing industry training for cannabis professionals in Washington State which are required by law for professionals to obtain medical marijuana consultant certification through the Washington State Department of Health.

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The endocannabinoid system (ECS) is the Internet of our Body

The endocannabinoid system (ECS) is the Internet of our Body

Researchers only recently discovered the endocannabinoid system (ECS), which in many ways resembles the internet of our body. Cells can use it as a kind of email since the ECS allows individual cells to send specific information to other cells in our body. This system helps cells coordinate our immune response for example, and enables the different systems of our body work together.

The endocannabinoid system helps our body organize itself, enabling cells to communicate better, creating and maintaining physiologic balance. It homeostatically regulates all body systems: (nervous, digestive, immune, cardiovascular, endocrine, musculoskeletal, reproductive).

The foundations of the modern endocannabinoid system developed 600 million years ago to help single cell organisms manage the increased demand for information processing required to help single cells evolve into more complex multi-cellular organisms. Cells needed a way to talk to each other to share information and organize themselves into more complex bodies in this early chaotic environment. Multicellular organisms developed the ECS to help manage the flow of information between and within different cells so that individual cells in newly evolving bodies could share resources, protect themselves from harm, and make to prevent damage to their molecular machinery.

The ECS for example became a central mediator for how the earliest complex organisms reduced harm from things such as a lack of oxygen to their biological systems. Also, the ECS developed biological coordination to help individual cells share nutrition and energy with and between other cells in these newly evolving bodies. In complex biological systems such as humans, this ECS coordination of information prevents disease, and maintains the flow of information between cells.

Chronic disease both causes and results from biological dysfunction in the body. Appropriate cannabis use reduces harm caused by stress, by physiologic imbalances in chronic disease, and particularly in conditions and symptoms that increase as we age. The broad therapeutic potential of using cannabis to help the body balance its own ECS is just beginning to be realized, and major universities and pharmaceutical companies around the world are aggressively engaging in cannabinoid research.

The ECS maintains health and balance not only between different cells, but also within each single cell. Inside single cells, the ECS helps control basic metabolic functions such as sugar metabolism. Between individual cells, the ECS also regulates communication between our immune systems and our nervous systems. For example, when an immune cell needs to alert brain or nerve cells, it can send a biochemical email that functions through the endocannabinoid system. However during disease, a breakdown in ECS communication can disrupt this information flow, resulting in disease or death of the organism.

-Dr. Jake

Dr. Jake Felice is an accomplished naturopathic physician with extensive experience with cannabinoid therapeutics and medical cannabis consultations.  As a national cannabis brand ambassador he has provided scientific, medical, public relations, product development, and compliance based advice for companies in emerging and existing cannabis markets.  He has consulted for major cannabis companies including Willie Nelson’s brand, Cannabis Basics, Medical Marijuana 411, Seattle Central College, and The Academy of Cannabis Science.  Additionally, he provides ongoing industry training for cannabis professionals in Washington State which are required by law for professionals to obtain medical marijuana consultant certification through the Washington State Department of Health.

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RIP medical marijuana

RIP medical marijuana

Washington states medical marijuana collectives are officially closed, leaving many patient’s only option to be state licensed recreational stores for their medical needs. My patients report that the price of their medicine has tripled, and that selection is scant to nonexistent, especially for medical strains.
It is the sickest and poorest of patients that are harmed most of by this new change. One of my biggest fears for patients is that they are now being forced onto the black market to obtain affordable medicine illegally.

“I need clean medicine, and I’m going to do whatever I have to do to save my child’s life,” says the mother of Madalin Holt age 3, whose life was saved by cannabis. “That’s really what this is about. I’m saving my child when the medical community gave up on her. They were out of options. I found an option, and I’m not going to let my child die because a few people in the legislature decided to strip us of our rights. I know what I’m doing is right.” From The Stranger

I also have serious concerns that new pesticide testing regulations are inadequate, and that pesticide laden cannabis is now being smoked by patients all over Washington state. More about pesticides in another post.

This post was inspired by an article Here’s more from The Stranger:

On July 1, Washington State’s medical marijuana dispensaries and collectives officially closed, leaving only state-licensed recreational stores to serve patients. This is a result of the Cannabis Patient Protection Act (SB 5052), which is perhaps the most egregious bit of doublespeak ever. The law does not protect patients. In fact, evidence suggests that it will put the state’s most vulnerable patients at risk.

Both the Washington State Liquor and Cannabis Board and the Washington State Department of Health—the state’s two regulatory agencies that govern the new medical cannabis system—have stated that they believe the only difference between medical and recreational use is the intent of the user. Essentially, that the needs of the medical market can be just as easily served by the recreational market. If only that were true.

Under the new system, the state’s 1,500-plus dispensaries and collective gardens will disappear. To make up for the loss, the state issued just 222 new retail licenses.

That will directly impact patients such as Madeline Holt. She’s three and a half years old and has a terminal genetic disorder that gives her frequent seizures. According to her mother, Meagan Holt, doctors didn’t believe she would live this long.

“I was told on April 10, 2015, to take my child home for one more night before she died,” said Holt. “Then I tried cannabis, and she’s still alive.” Not only is she alive, but her seizures have become less frequent since she started taking cannabis on a daily basis. While Holt says she still gives her daughter conventional drugs to counteract the seizures, cannabis is an essential part of her medical regimen.

“The importance of this medicine is life or death for Maddy,” said Holt. Madeline takes a minimum dose of 90 mg of CBD oil and 40 mg of THC oil to treat neuropathic pain, muscle spasms, and other issues. The oil she takes is a very specific formulation referred to as full extract cannabis oil or FECO. It is prepared by Deep Green Extracts, a medical oil extractor, and donated to Maddy completely free of charge. (The medical cannabis community, despite being portrayed as “99.2 percent a criminal enterprise” by certain lawmakers, was often extremely compassionate.)

The situation is a precarious one, however, and Holt fears that the changes brought about by SB 5052 will threaten it. For one, she’s worried that she won’t be able to find the same products on the recreational market. “When you go into a rec store, you cannot find the oil that Maddy uses,” said Holt. “Patients like her who rely on the medication that is in the dispensaries, it’s not even available. We don’t even have the option to go to recreational.” While medical patients benefit from both THC and CBD in different ways, they’re in particular need of high-CBD products, which can often be in short supply in the recreational market.

“There is no retail cannabis store that could keep a supply of what we need,” said Holt. “I would be in there weekly getting all of the FECO that they have, I’m sure.” While it’s not yet clear whether Holt’s assertion is true, the current climate around CBD seems to support her view.

Although SB 5052 allowed growers to expand their canopy area in order to help meet the new demand of the medical market, it did not require them to actually grow high-CDB product. Last week, I traveled to farms around the state to see how much CBD product is growing, and it wasn’t promising. At Emerald Twist—a farm in Goldendale whose general manger, Jerry Lapora, is a longtime grower from the Oregon medical market—only about 6 percent of its canopy is dedicated to high-CBD cannabis. Lapora said the farm has discussed selling its CBD plants to Seattle-area processor botanicaSEATTLE for full-plant oil extraction, but those plans are in their nascent stage. Indeed, Chris Abbott, a partner at botanicaSEATTLE, said that sourcing was the biggest hurdle to getting new medical products to market.

“We plan to make these medical products,” he said, “but it’s vital that we can source a sufficient amount of pure and clean CBD plant material to serve the patient base. That has proven to be difficult in this market that has largely focused on high numbers of THC.” Indeed, market pressure has made it very difficult for growers to add CBD to their portfolio.

Alex Cooley, the vice president and cofounder of Solstice, which began as a producer/processor of medical cannabis and has transitioned to recreational, had similarly dismal news: “When Solstice was operating its medical facility, 20 percent of the facility was always CBD rich [or CBD pure]. In adult use we have grown less than 2 percent with our partner farms and are about to harvest our first CBD-rich crop in our separate adult-use facility. This summer we have really bet on people wanting CBD since the two systems have been Frankensteined together.” And that’s a big bet. Lapora, of Emerald Twist, said he’s still sitting on his 2015 harvest of CBD. Cooley and others may grow it, but there’s no guarantee the patients will come. Indeed, they may not be able to afford to.

While pot grown and sold through the legal market comes with certain benefits—legality, safety, ostensible purity, et cetera—it’s also more expensive. The requirements of “medically compliant” cannabis—which all higher-dose medical products will have to meet—will inevitably add to the overall cost of production. Although patients are eligible to buy their cannabis free of sales tax, many likely will not get that discount because they are required to sign up for the new patient registry to receive the benefit, and many aren’t doing so for privacy reasons. Even if they do, the sales tax is a mere 9 percent of the cost. The marijuana excise tax, which they are still required to pay, is 37 percent.

“Even when we started looking into cannabis,” Holt said, “the price that it cost to keep up with her medicine was unattainable. We knew we would need a community to surround us to help us. That community is shrinking really fast, and that’s what’s scaring me.”

Holt’s greatest fear is that, due to an inadequate supply of affordable medicine, she’ll be forced to get hers illegally. “It’s not necessarily the day of July 1, it’s what happens after July 1,” she said. “What happens after August when it starts cooling down and everybody starts running out? I’ve heard of people starting to stockpile medicine. I can’t really do that. I can’t afford to do that, so I’m forced into the black market and forced to just hope that I have people who will help us. Another sad reality of our situation is that my child is living on borrowed time, I’m her only caregiver, and I’m living on a fixed income.”

Holt receives her daughter’s medicine for free, but those types of donations will likely become less frequent in the highly regulated, highly taxed recreational market. Deep Green is getting a recreational license, but in order to continue to give free cannabis to Holt, the business would have to either sell it to a retailer at a 100 percent loss so that the retailer could give it away for free or sell it to the retailer at cost so the retailer could take the loss. Given that most legal cannabis businesses are struggling to stay afloat, it’s hard to imagine that even the most noble-hearted ganjapreneur will give away product. Without donations, low-income cannabis patients like Madeline Holt are basically screwed.

While the market could adapt in a variety of interesting ways—fundraising drives for patients, increased cultivation of CBD plants, a legislative fix on taxes, sensible regulatory action—patients are going to suffer in the meantime. In Megan Holt’s case, that means putting herself at risk of criminal prosecution to get necessary medicine for her daughter.

“I need clean medicine, and I’m going to do whatever I have to do to save my child’s life,” Holt told me. “That’s really what this is about. I’m saving my child when the medical community gave up on her. They were out of options. I found an option, and I’m not going to let my child die because a few people in the legislature decided to strip us of our rights. I know what I’m doing is right.”

Yours truly in health, -Dr. Jake

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Dr. Jake teams up with Seattle Central Community College and The Academy of Cannabis Science

Dr. Jake teams up with Seattle Central Community College and The Academy of Cannabis Science

13244649_575553585949460_3329169813822742267_nI’m proud and excited to announce that I have just signed with Seattle Central Community College and The Academy of Cannabis Science. We will be teaching and developing curricula that offer professionals the opportunity to advance their careers in the marijuana industry while helping companies comply with state law. This is a very exciting and interesting time for cannabis in Washington state.

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