Medical cannabis

Dr. Jake speaks at the Hemp and Health Expo in Pasco, WA

Dr. Jake speaks at the Hemp and Health Expo in Pasco, WA

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PDF Cannabis talk at the Hemp and Health Expo in Pasco WA – pdf

Click the link above to access PDF slides pertaining to my cannabis talk for the Hemp and Health Expo at the Trac Center in Pasco, WA. on Saturday, November 14th. Topics discussed include how the toxicity of conventional pain drugs compares with cannabis, the endocannabinoid system, how to use synergy in plant medicine to maximize the use of medical cannabis, as well as sections on cannabis and pain and neurological disorders. A YouTube video will be recorded and posted later as well.

Thank you sincerely! -Dr. Jake Felice

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CBD – an interesting question…

CBD – an interesting question…

I recently received this question via email and thought I would post my reply here.  I wish that I had more time to devote to this and to the quality of my answer, but thought that a quick post might helpful to some of the readers of this blog.

I have a quick question for you regarding CBDs and the adrenals.  As a novice to this MMJ world, are we robbing Peter to pay Paul with giving people more energy with CBDs, but not fixing the underlying issues?  I just think of coffee bringing people up, but really draining them in the long haul.  Thoughts?

Cannabidiol_3DThis is a good question.  I think there may be some concern with THC strains but not CBD.  The endocannabiniod system is a harm reduction system in our bodies, and it’s activation leads to protection across multiple body systems.  In general, CBD enhances the body’s innate protective response via the endocannabinoid system (eCB).  I therefore think of CBD as adaptogenic in the best sense of the word. I do not see it causing “depletion”.  In fact, there is a current hypothesis in vogue describing cannabinoid acids including CBD acids as “dietary essentials”, especially during times of stress.  A part of the way CBD works biochemically is similar to how omega-3’s protect – via PPAR signalling, similar to DHA and EPA.

CBD has no known adverse effects and it has been studied very extensively.  It does have a biphasic effect with an optimal dose below and above which it is not as effective.  This effect deals with efficacy though, and not potential harm.

Running, biking and hiking increase our bodies own eCB molecules, which are now largely believed to be responsible for runner’s high to a much larger degree than endorphins.  Wheel running in mice increases cannabinoid receptors as well as sensitivity to cannabinoids.  A part of the way CBD works biochemically is similar to how omega-3’s protect – via PPAR signalling similar to DHA and EPA.

Ethan Russo has proposed that fibromyalgia, migraine, and IBS could represent a clinnical endocannabinoid deficiency syndrome.  Ester Fride has speculated that infant “failure to thrive” syndrome in newborns may be due to eCB insufficiency.  Paolo Sarchielli has described eCB system failure as a basis of chronic migraine.  Mathew Hill posits that deficient eCB signalling contributes to depressive illnesses.  Enhancing eCB with medical cannabis may help with these conditions, as well as the reason cannabis has been found to be effective for those with MS, epilepsy, and chronic pain.

Thank you for your question.  Best,  –Jake Felice, ND, LMP

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Dr. Jake Felice speaks to NPR listeners about cannabis on 90.7 FM KSER

Dr. Jake Felice speaks to NPR listeners about cannabis on 90.7 FM KSER

Click on the player below to play the show! This radio show is a great learning opportunity for those interested in more detail regarding medical cannabis.  Check out Dr. Jake Felice discussing cannabis during the evening commute on NPR 90.7 FM KSER.  Topics include cannabis for PTSD, the use of topical cannabis, cannabis edibles, cannabis for arthritis, MS, Parkinson’s disease, as well as an in depth discussion of terpenes, CBD, cannabis delivery methods, and how to find pure, properly labeled cannabis.  Thanks to the shows host, Dr. Rebecca Dirks, as well as to Dr. Kasra Pournadaeli and KSER 90.7 FM Marysville.

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Dr. Felice announces expanded services at two new locations including Seattle, and Woodinville, WA

Dr. Felice announces expanded services at two new locations including Seattle, and Woodinville, WA

Dear friends and patients, I am proud to announce that I have expanded my clinic services to both Seattle and Woodinville, WA. Please feel free to stop by and see me at my new office locations. Many thanks!file-page1 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CBD

I have teamed up with the Woodinville Women’s Clinic and Ballard Fremont Neighborhood Acupuncture and am looking forward to serving you at these great locations.

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Low-toxic cannabis helps folks using more dangerous opiate pain killers

Low-toxic cannabis helps folks using more dangerous opiate pain killers

Opioid prescription deathsMedical cannabis not only helps patients using opiate painkillers to get better pain relief, it also helps them reduce their use of this very dangerous type of medication. Cannabis is low toxic, and does not have to cause a head high for patients to experience relief. Also medical cannabis does not have to be smoked and there are plenty of good non-smoking options available for folks who prefer alternative methods to smoking. Low-toxic cannabis is an intelligent low cost option for folks in chronic pain, as it helps patients get off of their far more toxic opiate pain killers.  These facts are supported by sound science.  I have compiled a list of science from peer reviewed journals supporting below the video.  Because of its safety and effectiveness for pain, our legislators have a moral, ethical obligation to make sure that cannabis is legally available to patients who suffer from chronic pain.

More science below to help combat the lack of quality information about medical cannabis in today’s media

One of the big criticisms of proposed cannabis legalization is the idea that legal cannabis might increase teen use.  These claims are not based in science.  The most up to date science from the great states of Washington and Colorado show that teen use rates for cannabis have not increased with cannabis legalization.  Basically, the prohibitionists’ non-scientific argument is that young folks are so dumb that they’ll be tempted to use cannabis unless we spend millions of dollars locking them up and destroying their lives.  Young people have been very effectively messaged that tobacco use is a bad choice without making tobacco illegal and there’s no reason to believe that cannabis would be different in this regard.  Prohibition is not the best tool for informing people about how to make intelligent choices.

120926092633Below are several peer reviewed studies showing that medical cannabis helps opiate pain medications work better

Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010. JAMA Intern Med. 2014 Aug 25. doi: 10.1001/jamainternmed.2014.4005. [Epub ahead of print] PubMed PMID: 25154332.  “…States allowing the medical use of cannabis have lower rates of deaths resulting from opioid analgesic overdoses than states without such laws”.   

—Did you know that there are 25% fewer overdose deaths from opiate pain killers in states with legal medical cannabis? That’s right folks, the science has been clear for a long time.  And now there’s even more evidence that low-toxic medical cannabis saves lives for folks in chronic pain.  This time it’s the heavy hitting Journal of the American Medical Association stating “states allowing the medical use of cannabis have lower rates of deaths resulting from opioid analgesic overdoses than states without such laws”.  Below are a few more of the many, many, many studies on cannabis and chronic pain:

Cannabis as an Adjunct to or Substitute for Opiates in the Treatment of Chronic Pain, Lucas, P., Journal of Psychoactive Drugs, 44 (2), 125–133, 2012  “When used in conjunction with opiates, cannabinoids lead to a greater cumulative relief of pain, resulting in a reduction in the use of opiates (and associated side-effects)”….

Cannabis in Palliative Medicine: Improving Care and Reducing Opioid-Related Morbidity, Gregory T. Carter, MD, MS1, Aaron M. Flanagan, MD2, Mitchell Earleywine, PhD3, Donald I. Abrams, MD4, Sunil K. Aggarwal, MD, PhD5, and Lester Grinspoon, MD, American Journal of Hospice & Palliative Medicine 000(00) 1-7, 2011  “…long-term drug safety is an important issue in palliative medicine. Opioids may produce significant morbidity. Cannabis is a safer alternative with broad applicability….”

Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain, Johnson, JR, Burnell-Nugent, M, Lossignol, D, Ganae-Motan, ED, Potts, R and Fallon, MT,MB Journal of Pain and Symptom Management Vol. 39 No. 2 February 2010 167-179  “This study shows that THC:CBD extract is efficacious for relief of pain in patients with advanced cancer pain not fully relieved by strong opioids.”

Cannabis as an Adjunct to or Substitute for Opiates in the Treatment of Chronic Pain, Lucas, P., Journal of Psychoactive Drugs, 44 (2), 125–133, 2012  “Novel research suggests that cannabis may be useful in the treatment of problematic substance use. These findings suggest that increasing safe access to medical cannabis may reduce the personal and social harms associated with addiction, particularly in relation to the growing problematic use of pharmaceutical opiates. “

Cannabinoids against pain. Efficacy and strategies to reduce psychoactivity: a clinical perspective.  Karst, M and Wippermann, S (2009).  Expert Opin Investig Drugs, Feb. 18, No. 2,125-133

“There is a growing body of evidence to support the use of medical cannabis as an adjunct to or substitute for prescription opiates in the treatment of chronic pain. When used in conjunction with opiates, cannabinoids lead to a greater cumulative relief of pain, resulting in a reduction in the use of opiates (and associated side-effects) by patients in a clinical setting. Additionally, cannabinoids can prevent the development of tolerance to and withdrawal from opiates, and can even rekindle opiate analgesia after a prior dosage has become ineffective. Novel research suggests that cannabis may be useful in the treatment of problematic substance use. These findings suggest that increasing safe access to medical cannabis may reduce the personal and social harms associated with addiction, particularly in relation to the growing problematic use of pharmaceutical opiates.”

Cannabinoid–Opioid Interaction in Chronic Pain, Abrams, DI, Couey, P, Shade, SB, Kelly, ME and Benowitz, NL, Clinical Pharmacology & Therapeutics, 90 (6) 2011, 844-851  “We therefore concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.”

Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain, Johnson, JR, Burnell-Nugent, M, Lossignol, D, Ganae-Motan, ED, Potts, R and Fallon, MT,MB Journal of Pain and Symptom Management Vol. 39 No. 2 February 2010 167-179  “This study shows that THC:CBD extract is efficacious for relief of pain in patients with advanced cancer pain not fully relieved by strong opioids.”

Patients and Caregivers Report Using Medical Marijuana to Decrease Prescription Narcotics Use, Peters, D.C., Humboldt Journal of Social Relations, 35, 2013, 25-40  “All patients and producers who were taking opiate pain killers claimed they reduced overall drug use, especially opiates, by using medical marijuana. Patients and caregivers also claimed medical marijuana was preferred over opiates, eased withdrawal from opiates, and in some cases was perceived as more effective at relieving pain.”

Cannabinergic Pain Medicine A Concise Clinical Primer and Survey of Randomized-controlled Trial Results, Aggarwal, SK, Clin J Pain  Volume 29, Number 2, February 2013, 162-171  “Cannabis and other cannabinergic medicines’ efficacies for relieving pain have been studied in RCTs, most of which have demonstrated a beneficial effect for this indication, although most trials are short-term. Adverse effects are generally nonserious and well tolerated. Incorporating cannabinergic medicine topics into pain medicine education seems warranted and continuing clinical research and empiric treatment trials are appropriate.”

Cannabinoid-opioid interactions during neuropathic pain and analgesia, Bushlin, I, Rozenfeld, R and Devi, LA, Curr Opin Pharmacol. 2010, 10(1): 80.

Impact of Cannabis Use during Stabilization on Methadone Maintenance Treatment. Scavone JL, Sterling RC, Weinstein SP, Van Bockstaele EJ.  Am J Addict 2013;22(4):344-51.

Cancer PatientBelow are more peer reviewed references demonstrating that medical cannabis helps patients use less of their prescription opiate pain killers

Cannabis not only helps opiate medications work better, it also helps patients use less of this highly toxic class of drugs. There is positive synergy between opiate medications and cannabis.

Cannabinoid–Opioid Interaction in Chronic Pain, Abrams, DI, Couey, P, Shade, SB, Kelly, ME and Benowitz, NL, Clinical Pharmacology & Therapeutics, 90 (6) 2011, 844-851 “We therefore concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.”

Synergistic interactions between cannabinoid and opioid analgesics

Life Sci. 2004 Jan 30;74(11):1317-24. Review. PubMed PMID: 14706563. http://www.ncbi.nlm.nih.gov/pubmed/14706563

Synergy between THC and morphine in the arthritic rat

Eur J Pharmacol. 2007 Jul 12;567(1-2):125-30. Epub
2007 Apr 20. PubMed PMID: 17498686. http://www.ncbi.nlm.nih.gov/pubmed/17498686

Cannabis reduces opiate use in the treatment of non-cancer pain

J Pain Symptom Manage. 2003 Jun;25(6):496-8. PubMed PMID:
12782429.  http://www.ncbi.nlm.nih.gov/pubmed/12782429

Synergistic and additive interactions of the cannabinoid agonist CP55,940 with mu opioid receptor and alpha2-adrenoceptor agonists in acute pain models in mice.

Br J Pharmacol. 2005 Mar;144(6):875-84. PubMed PMID: 15778704; PubMed Central PMCID: PMC1576059. http://www.ncbi.nlm.nih.gov/pubmed/15778704

Cannabinoid-opioid interactions during neuropathic pain and analgesia, Bushlin, I, Rozenfeld, R and Devi, LA, Curr Opin Pharmacol. 2010, 10(1): 80.

Additionally, there is a lot of good science showing synergistic effects between the molecule CBD and THC.

Feel free to comment at CannabisMatrix.com or email me at DrJake@DrJakeFelice if you have any questions regarding these synergistic effects.

Jake w Hatch surf photoBelow is essential data for citizens to consider which puts into perspective the magnitude of the scope of drug toxicities for our citizens, and why low toxic cannabis can be such an excellent option for patients suffering from even mild to moderate chronic pain.  

 No other pain relieving medication is less toxic than cannabis, not even aspirin or Tylenol. If deaths from toxic effects from NSAIDs such as ibuprofen and Aleve were tabulated separately in the National Vital Statistics reports, these drug toxicities would constitute the 15th most common cause of death in the United States. This is why cannabis as medicine can be an excellent choice as a substitute for more toxic pain-killers such as opiates and NSAIDs.

The July 1998 issue of The American Journal of Medicine stated the following: “Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.”

And again in June 1999 the prestigious New England Journal of Medicine issued a similar statement:  ”It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States. This figure is similar to the number of deaths from the acquired immunodeficiency syndrome and considerably greater than the number of deaths from multiple myeloma, asthma, cervical cancer, or Hodgkin’s disease.

If deaths from gastrointestinal toxic effects from NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain mainly a “silent epidemic,” with many physicians and most patients unaware of the magnitude of the problem. Furthermore the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDS.”

A recent study in Therapeutics and Clinical Risk Management notes that the number of deaths and hospitalizations from GI bleeding due to NSAIDs has remained unchanged since the 1999 study.  Again, medical cannabis has never killed a single patient.

Yours truly,

-Dr. Jake Felice

Seattle, WA

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Dr. Jake answers your cannabis questions

Dr. Jake answers your cannabis questions

Thanks for watching CannabisMatrix.com  I’ve decided to do a series of short videos answering patient questions about cannabis.  If you find this interesting, please share with a friend.  Also, feel free to email me your questions at DrJake@DrJakeFelice.com.  As a post script, I’d like to say that I wish I would have added more information regarding the synergy between opiate medications and cannabis. Cannabis not only helps opiate medications work better, it also helps patients use less of this highly toxic class of drugs.

Below are a few more peer reviewed references supporting the facts discussed in this video:

From JAMA:  25% fewer overdose deaths from opiate pain killers in states with legal medical cannabis

Synergistic interactions between cannabinoid and opioid analgesics http://www.ncbi.nlm.nih.gov/pubmed/14706563

Synergy between THC and morphine in the arthritic rat http://www.ncbi.nlm.nih.gov/pubmed/17498686

Cannabis reduces opiate use in the treatment of non-cancer pain http://www.ncbi.nlm.nih.gov/pubmed/12782429

Synergistic and additive interactions of the cannabinoid agonist CP55,940 with mu opioid receptor and alpha2-adrenoceptor agonists in acute pain models in mice. http://www.ncbi.nlm.nih.gov/pubmed/15778704

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Photo by Derek Sparks dereksparks.com

Additionally, there is a lot of good science showing synergistic effects between the molecule CBD and THC that I did not have time to explore. Feel free to comment or email me if you have any questions regarding these synergistic effects.

Yours truly in health,

-Dr. Jake Felice, ND

CannabisMatrix.com

Seattle, WA  USA

Special thanks to Derek Sparks for the images on this post!

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