#04 How is Cannabis a Medicine? Part One: Ancient History to Modern Medicine
You're listening to the curious about cannabis podcast before we get started here. Let me just share a little disclaimer in this episode. We're going it'd be discussing. The medical uses of cannabis. Now all of the information. I present to you in this. PODCAST in general is for education and entertainment purposes only. It should definitely not be considered medical advice. Please never make decisions about your health based on anything you hear me or any other podcast host talk about about. I'm simply sharing information that I've collected from talking with professionals with relevant experience or from research studies that are available out there that have been published. But I'm not a doctor. You should always get your medical advice from a licensed healthcare professional now with that out of the way. Let's move on think about a Mozart symphony so incredibly beautiful and you have a lead violin and then you have all these other other instruments right and all those other instruments basically support that lead violin. Know what's happened is under the illusion and I will call it an delusion that we can control the dose. We've isolated the lead violin and just use that in our pharmacology The rationalization for this is actually really go back and look at the science. The rationalization for doing this is actually not very strong. Scientifically you're in. The state of Oregon Medical Cannabis has been available since nineteen ninety eight for registered patients. With a doctor's recommendation there are a variety of conditions. They can qualify someone to join Oregon's medical marijuana program such as Cancer Glaucoma. PTSD or HIV. But the most common condition being treated with medical canvas by far is pain at the time of this recording in two thousand nineteen eighty eight percent of the twenty seven thousand qualifying patients patients. Oregon's medical marijuana program reported severe pain as a condition that they intended to treat with cannabis the remaining conditions ranked from most common to at least common were spasms. PTSD nausea cancer neurological disease seizures. Glaucoma Wasting Syndrome and HIV AIDS across other states with medical marijuana chronic pain is consistently the most cited reason for treatment. And it's easy easy to see why the CDC estimates that chronic pain may affect as much as forty percent of the US adult population. Clearly people are trying to treat a wide variety of serious. As conditions with cannabis cannabis is ineffective therapy for just some or even all of these conditions. It could change the health and wellbeing for or a massive amount of people currently suffering every day but some people are pretty skeptical about the medical use of cannabis and think the claims around cannabis. Servewell servewell over hyped. So what do we really know about cannabis campus medicine. Hey everybody I'm Jason Wilson and you're listening to the curious about cannabis podcasts. Thanks so much for tuning in once again in this episode. We're going to be exploring the whole idea of cannabis as is a medicine and to guide our curious quest. I wanted to explore several primary questions. How is cannabis been used as a medicine in the the past? Traditionally to power cannabis and cannabis derived drugs being used as medicine today and three Howard medical claims to rise. How do we actually determine something as medicine? So let's get started in two thousand and fifteen. The Journal of the American Medical Association published a Review Acknowledging List of therapeutic applications of cannabis while also expressing skepticism mm-hmm over others then the National Academy of Sciences released a lengthy four hundred plus page review also identifying clear therapeutic applications of cannabis and its constituents and National Academy of Sciences Engineering and medicine published results. Yesterday panel looked at medical and recreational use and examine more than ten thousand thousand studies. Well in terms of treatment is pretty solid evidence that can be helpful in alleviating chronic pain in adults nausea from chemotherapy. And then specificity acidity or muscle spasm and people with multiple sclerosis. They also looked at a whole bunch of other things where there wasn't quite adequate research. They said we need more research for things like epilepsy the PTSD even anxiety. Were you surprised that there are some clear health benefits from marijuana. Not at all. I have to point out here that when we talk about the medical use as of cannabis. We aren't just talking about smoking cannabis and I know that when a lot of people here. The idea of the medical use of cannabis they think about people smoking. But there are a lot of ways to consume cannabis and each consumption method affects the body differently sure cannabis can be smoked or vaporized but it can also be eaten in the form of cannabis infused foods or taken subliminally by taking drops of a cannabis. tincture under the tongue cannabis can also be administered. Administered on the skin topically or less commonly cannabis can also even be taken as a suppository now anything consumed orally eh by the mouth. We'll take longer to take effect because it has to pass through the digestive system and it undergoes a process called first pass metabolism before the canal passed into the bloodstream during this metabolic process can avenues are chemically altered for instance win. THC Is ingested orally nearly half of that THC is metabolize Tua compound called eleven htc which is considered nearly nearly four times the strongest thc. This is why the experience of eating cannabis products can sometimes be really unique and sometimes a lot. More powerful than consuming cannabis by other means however when cannabis is smoked or vape or when someone someone uses a sub lingual product or suppositories collaborates. Actually bypass the liver and passed straight into the blood and this leads to a much faster onset eh in avoids the chemical alteration that can happen during metabolism so it seems among the scientific and medical communities. There's no doubt that in some contexts cannabis can be a medicine but to what extent and for what conditions and what dosages uh-huh and in what form that's where much of the debate currently resides according to the United States government at the time of this recording in in two thousand nine hundred cannabis and it's cabinet constituents or classified as schedule one drugs classification reserved for drugs that are presumed to have no medical value And a high propensity for abuse other drugs that are classified as schedule. One drugs include things like heroin and vassals into put this into even better perspective dude drugs like cocaine and methamphetamine which are scheduled to drugs are less controlled than cannabis. Despite the US government's determination determination that cannabis should be a schedule. One Drug and as such has no medical value the government actually held a patent on the antioxidant and neuro protective properties of can have adenoids up until this year and too many this patent represents some deep hypocrisy regardless of the legal status of cannabis. There are many people across the US that have jumped on the canvas bandwagon touting benefits so profound and diverse that can't help but sound like a pitch for the next snake-oil browsing through instagram or facebook. It's so easy to get barraged by me. M- after me about the different promises of cannabis and the ills of Big Pharma. So what's the truth here while the start. Let's explore the ways cannabis has been used as a medicine throughout route history. Then we can look at some of the more modern cannabis research and see how some of these traditional uses hold up against modern science cannabis has been used by humans for a long long long time. We're talking thousands of years. I mean really. We're talking like five thousand thousand years half of Deca Millennium if Deca Millennium is even a phrase if not it is now canvases Mrs of course shrouded in all this prohibition and a lot of politicals struggle in different energies throughout it's gotten into a darker occur place even like just sort of information we have about it. That's Dr Jason Miller. A medicinal plant in Chinese medicine expert. That's been noticing that more and more of his patients are starting to talk about cannabis. You know I'd like to start always when I'm looking at. What is the benefit of plant? Or what are the weaknesses of it or the potential dangers of it. I WanNa see what did the what is the record of that. Plant look like yeah across traditional cultures. Again it's not like you know people talk about all its warts. What's folk medicine whether you call it that or not? Those people were carrying oral traditions and written traditions about medicines to help their people that they cared a lot about. They didn't have time to sit around and go to the movies. No were living and it was. Life was a struggle for a lot of people and medicine was really important. And so there's a lot of heart in it. There's a lot of attention and there's a lot of empiricism so I was go there first. And what I've done with cannabis you know. When my kind of digging into what his cannabis as a medicine I've had to cut through that same kind of shrouding and sort of darkness like hot? What what really is it when looking back at? What are the records from Chinese medicine? And the use of cannabis cannabis and I've looked at deeply into it and try to find. What are the threads? Because most of the time in you know in school in medical school with Chinese medicine in the doctors from China's this we don't talk about. Yeah you of course the hempseed. Everybody knows that that's nutritional. Yeah and it's it's generally. There's a couple of great formulas that use MODs Iran and mine is the word in Chinese for China for Ham or cannabis right for marijuana And so mad thirds seed. And so you got Macho. Ma is the seat of the candidates right so that seed has been used really successfully for moistening up the bowels and helping with constipation and you combine it with other herbs herbs that have parasol took actions or pull some fluids into the large intestine. Miracle Letham things like that and then those will all work to kind of create this bowel but but beyond that you start digging into what was actually cannabis use for as a medicine and was it was it cannabis in the sense of THC rich or was it cannabis in the sense of Ham. Was It ragweed. What's really hard to determine that from the records that we do have but there are some consistency across the writings? I've examined in using cannabis for conditions dishes that involve something in Chinese medicine called wind. Which I've talked with you before? which is like the idea that there's an instability in the body? So there's a Homeo- static stabilising stabilising effect from cannabis. Were it's instability in the mood. There's things like tics and twitches. And tremors and disconnect disconnect and things of that nature that cannabis was really good for that. It's been recorded. That people would use it for that and again it's hard understand whether using CBD at that time or is that a strain that was blended blended. We don't really know the records are hard to follow but clearly. It was used for problems of the mind. You know people having anxiety schizophrenia. People that had mental mental instabilities. It would really help to bring back some balance to them and one of the things that I I saw that people used was. They made a A cannabis wine wine and it was made you know so they would take it was. It was more like a cannabis wine extraction. I guess but they would take their rice or sorghum. Wine that they would make ferment. Those bring the the grain and create an ethanol rich solution. And of course we know that you know. Ethanol is a great way to extract tabloids right and so they would they would take the seeds with the coating on the seed you know. What what do you call that? The it's not the case but it's actually. There's a coding around the seat as it sits on the plant and that coating putting is covered in little hairs right little. Try Combs so it's got a lot of Kanada in on it. But so they would put the seeds with those little tricalm's into their solution extracted. And they'd give it as this cannabis wine and they give it to patients for different conditions. So it's clearly been used that way and it has you know it's very safe medicine but I think that part of the problem is just that we have a hard time understanding understanding with this. Plant the differences in its phenotype in the different types cultivars of cannabis which are so which is one of the things that makes the plant. Really unique you can get a very different physiological fact from one strain right than another and that's you know and they're to some degree of some plants. Let's have that but very few into that degree. And I think it's one thing that makes cannabis unique and fascinating Is that it's just that you know. God there's so much we talk about. What is cannabis do? I'm like well. Yeah which what what. What part canvas which cannabis are you talking about? Are you using it in chapter two of the book. The handbook of cannabis Doctor Ethan Russo neurologist and can avoid researcher that's been studying cannabis for well over twenty five years summarizes. Some of the ways in which cannabis was used therapeutically throughout the last several millennia. Here's an extremely condensed version of what he presented. Oral traditions of cannabis use for things like appetite stimulation and fighting the effects of old old age date back to nearly three thousand years. BC That's five thousand years ago in fifteen hundred BC. The Authority Beta data indicates that Indians were using cannabis for anxiety. Relief Cannabis is suspected to even be a component of the holy anointing oil of the Hebrews as far back a seven hundred and fifty BC. The juice of the leaves was noted to be a remedy for earaches and the first century and in the second century Chinese records indicate that cannabis was. I used wine as an anesthetic. In the early Tenth Century Persian records indicate it was even used to stimulate hair growth in fifteen forty. Two it was. It's not that cannabis roots could be boiled use to treat gout in Burns. And throughout the sixteenth century records. Indicate that cannabis was used for things like sore muscles. MM stiff joints burns. Wounds even Jaundice Colic and tumors in eighteen thirty nine. A researcher named o'shaughnessy studied Indian use of Canvas Davis performed experiments in dogs and then later people to determine if cannabis was a suitable treatment for things like tetanus rabies epilepsy and even rheumatoid toyed disease. Now Shaughnessy is particularly interesting. Figure in the history of medical cannabis and we're going to be learning a lot more about his work in future assists. Shortly after Shaughnessy published. His findings cannabis began. Showing up in the European and United States Pharmacopoeia as records become more easily obtainable. We can find records throughout the eighteenth and nineteenth centuries of cannabis being used tree. Things like migraines pain specificity. This ity anxiety depression and insomnia cannabis was even featured in the US Pharmacopoeia as medicine until the twelfth edition was released in one thousand nine hundred eighty two. Well after the marijuana prohibition had begun in Nineteen thirty seven you can still look up old issues of the US. P. and and look for entries for extract cannabis or Tink tour cannabis may also be listed as extract of him or Tincture of him and upon the initial publication Asian of cannabis in the U. S. P. in eighteen fifty one the ninth edition of the US. dispensatory had this to say about the medical use of cannabis quo doc. It's been found to cause sleep to allies spasm to compose nervous disquietude into relieve pain. The complaints in which which it has been specially recommended are Neuralgia gout rheumatism tetanus hydrophobia epidemic cholera convulsions. Korea mental depression delirium trimmings insanity and Uterine Hemorrhage after cannabis prohibition began and cannabis became unavailable as medicine and research into the plant progressively slowed down into the late nineteen fifties. Modern medical research into cannabis cannabis really started to take off again in the nineteen sixties when teach was isolated and synthesized little known fact but CBD was actually actually isolated and characterized approximately twenty years prior to when thc was isolated but because he doesn't elicit an intoxicating effect. It went largely ignored it. I more recently. The FDA is also approved a CBD based drug called dialects for the treatment of drug resistant. Epilepsy the and children as THC research progress throughout the nineteen sixties in the nineteen seventies. Research confirmed I'M NOT H. C could reduce nausea vomiting associated with cancer. Chemotherapy that he had the same analgesic effect as Codeine and that. THC performed formed as well as the anti asthma drug. Use Them All A. K. L. Meteorology or Venelin as a Bronco dilated now. The nineteen eighties ushered in renewed interest in CBD as well as continued research thc in one thousand nine hundred eighty one CD was identified as an anti convulsant a year later found CBD could help relieve the anxiety brought on by THC in one thousand nine hundred five. The you need flavonoids. Ken Flavin a was discovered. In this really broke cannabis research away from the cannabinoid chemical class to encompass other types of plant compounds was also in nineteen eighteen eighty five that the pharmaceutical drug marinol was approved by the FDA for chemotherapy related nausea in one thousand nine hundred eighty five synthetic thc. The as Marinol was approved by the FDA. That's Ethan Rousseau and he's had a little bit of experience with cannabinoid pharmaceuticals. The thought among certain people. People at the time was this would obviate. The need for cannabis treat night For medical conditions instead. What we got was has a drug that is very poorly tolerated and doug gain no traction in the marketplace cheat let's see by itself is a very disorienting? Drug people tend to be dysphoric unhappy. RATHER THAN EUPHORIC I. Even people were accustomed cannabis find THC in pure form a very difficult drug to tolerate and very few people remain on it for any length of time and when people have had the opportunity compare almost invariably they prefer herbal forms of cannabis us in one thousand nine hundred eighty eight. Scientists finally discovered a chemical receptor in the body that seemed to be responsible for most of. THC's affects the cannabinoid type. One receptor or as we call it now. CB One receptor this marks the beginning of piecing together graph fascinating puzzle about a physiological system that had since been ignored the Indo Canadian system which wouldn't really be formerly named talk for another ten years. We'll get into that story in another episode in Nineteen Ninety three CDs anti anxiety effects effect. That have been previously noted in the nineteen eighties were again confirmed. In one thousand nine hundred seven it was found that teach C- could help reduce agitation in patients with dementia in two thousand three clinical trials of the cannabis based pharmaceutical sat affects began investigating whether it could be an effective treatment for multiple sclerosis symptoms. In two thousand five side effects will go on to be approved in Canada for the treatment of MS related pain over the years sat affects will later be approved for other types of pain such as neuropathic pain and cancer pain eventually sat of X.. Would be approved in the UK and Spain for specificity in MS patients. In two thousand ten it would be discovered that settavex can also treat nausea related to chemotherapy treatments. One problem with our current approach to medicine at least in the United States might be that it tends to favour isolated or limited ingredient formulations over things like botanical title extracts that would contain a high diversity of compounds. People Wanna know what herbal cannabis cannabis extracts may or may not treat not what not see or cbd alone maitree in fact time and time again research is indicating that canvas extracts with the broader diversity of chemicals from from the canvas plant actually tend to perform better than isolated avenue. It's like thc or see a lot more research is needed to understand. Understand the nuance differences in the therapeutic activity of isolated cabinets versus herbal cannabis or cannabis extract. But they're certainly seemed to be major. Differences is one of the big issues right now is trying to sort out whether people should have single compounds like single tabloids versus versus whole plan extracts and I'm clearly in the latter camp. Yeah for the synergy that boosting fact that these provide and over and above the kinds of facts that we can get with single compounds. We have now a lot of evidence both laboratory and clinical that a much better results accrue. When were dealing with complex mixtures from cannabis extracts as opposed to pure compounds pounds a recent illustration was a an article from Spain? BLASCO Benitez at all In which they were looking at facts at effects on cancer both in cell culture and in animals Comparing pure thc. With which work to some Tom. Extent on treating the cancers But in comparison to a cannabis extract there was much much greater activity with very salient. Salient statistically significant differences. Another good example was there was a paper by Plan Pamplona in twenty eighteen gene That compered heure. CB on as would be happy dialects to the results that people got got with CBD predominant cannabis extracts. What they found was equal efficacy but with the cannabis extracts the doses were about on average twenty two percent of what was required with pure? CBD So instead of fifteen hundred milligrams a day perhaps three hundred milligrams saw would be enough of the corresponding extract This can represent a substantial savings and cost Additionally with the high doses the pure. CBD There is the possibility of drug Dr Dana ration particularly sedation. With some of the drugs that are used in epilepsy. TRINA AETNA over and over healthcare professionals I spoke with commented on the superior efficacy of broader spectrum cannabis products over isolated cannabinoid. We've seen that and it was interesting when we started out We thought half of our patients didn't want thc in their product so we gave him a co two extracted Just CBD in the others did one a little thc. This is Dr James Taylor a pain physician working in North Carolina ever since hemp became federally legal in the United on states. He's been working with his patients to understand how him extracts and CBD particularly might be a tool to help treat chronic pain in what we found and is are once again in the waiting room. The people who were trying to see beauty products the ones that had a little bit of THC and had a full spectrum for having profound profound results. Those that were on. The Ice Elit weren't having such profound results so it was in the waiting room that the patients were talking so when they came back to the office visit did they said. Hey I don't want to take the CBC damn taking. I WanNA think Dagan so. It was the patients that were coming back telling us that the full spectrum superior over an isolate so I'm assuming these large doses the folks need with the the locks in the CBD isolates is because it just inferior product. It can take much less through Daniel full spectrum product. This difference in therapeutic outcome between isolated compounds from cannabis and the use of herbal cannabis or broad broad-spectrum or full spectrum cannabis extracts is attributed to something often called the entourage effect. I think the best Depiction Shen of this idea of the entourage effect or what we have called for probably longer synergy. An emotional plants is a symphonic affect. That's Kevin Spelman a molecular biologist. And FIDO chemist this dedicated his entire professional career to try and understand why plants affect the body. The way they do and lately. He's had his eyes on cannabis so think about think about Think about a Mozart Symphony did so incredibly hardly beautiful and you have a lead violin and then you have all these other instruments right or not. All those other instruments basically support that lead violin now. So what's happened in pharmacology is under the illusion and I will call it an illusion that we can control the dose. We've isolated the lead by a land and just use that in our pharmacology in the rationalization for this is actually really go back and look at the science. The ED rationalizations for doing this is actually not very strong. Scientifically in the thirties. In the early twentieth a century twenty s you have eclectic physicians during studies on Whole plant extracts? And then in some cases says they actually used Nice late constituent. And this is the Loyd brothers. The ECLECTIC physicians were supported by some brilliant pharmacists. Called the Loyd brothers Lloyd. Brothers were really good extra. At extracting fact some of their instrumentation their chemical instruments are still used. Today they invented them to do extractions and we still use them today and and chemical and chemistry labs so they had this opportunity to look at whole plant extracts versus Isolated constituents and they found in many cases not always but they found in many cases that the whole plant extracts were Had A better outcome Now I think that's really what we have to look at. Because in an isolated model for example Apple Cell Culture and animal model actually might get a better outcome with an isolated CONSTITU right because you're right hounding e e essentially its pharmacological dosing versus physiological pricing. All right so on physiological dosing being out idea of using just enough to get the effect. You're looking for minimum effective dose. Exactly exactly and what we end up seeing with this in in healthcare is that everybody's too busy to do that. The patients too busy to pay attention. Because they're going to have to pay attention to where they get the effect the doctors too busy to actually put put an inquiry into. Where was that dose that worked for you and everybody wants instant relief so so? It's fallen by the wayside. But how were we to pursue that further. I think we'd have a much more effective model. The other thing that happens here when we look at Islip slits versus Whole plant extracts is the the adverse event profile goes up and this is a huge issue and for example in my I own body in a fight tank if I take Gingko twenty four six the standardized stuff I actually end up With a huge diuretic effect. I'm running to the bathroom every twenty minutes. If I just use gingko leaf that's thrown in a capsule I don't have that effect. Yeah I noticed I noticed the blood flow effects in terms of Cognitive function With both of them. But I'd rather use the holiest ground up so we have that lead violin. That's that's working thing and what we found in reductionist chemistry now is it. Oh there's more than one lead violin. Turns out that the oboe takes a lead in this section as well yeah right and oh it turns out that the cello also Ends up having a lead in. So we've have found multiple active constituents in the case of ECHINACEA. It's been hypothesized. PARTHA CISE said at least three at least four now. Compounds are considered the active when they came across a CB two binding of alkyl. Emma is what happened is everybody throw all we finally done it. We have found the active. ECHINACEA will not not so fast has got the cafe. ACID derivatives with by the way are anti directly antiviral but incredible antioxidants accidents and potentially Block histamine release by the way if you're looking at NFL lactic reactions. And you're you're stuck in a pinch we've also got the The polysaccharides irrational glad tens and ECHINACEA that are also super active in directly stimulate immune function so that becomes very interesting because here in one plant. You've got something that's a bit of a immuno. Dampening effect alkyl Emma's and you've also got something that's direct act immune stimulator. That's a ribbon glac towns. And then you've got something that tends to modulate immune function. That's a cafe guest Ruse Owen by the way it's antiviral so oh we can't simplify plants to one constituent and that's the mistake it's being being made over and over and over. It started in the seventies with Ginseng. wincing people were looking at Jensen and saying. Oh what's the active constituent. They came upon the agency no sides or the saplings of the of the plant. And so what what happened from this ridiculous research in the seventies is there was a time when people would look at plants in if they didn't have alkaloids or they didn't have saplings. They were thrown out. No other not active. Yeah it's all fancy now these tribes using this are not getting any effect we know best right. We've studied it exactly so yeah we could. I could talk about this all day. I've written a couple of chapters on it and in books and Post a couple of papers papers on synergy but the idea that there's only one active compound is really really naive. There is this bias in science against medicinal plants. As if it's not real and we need to stop and realize that about half of all of our drugs dugs have been. Based on medicinal plants in about twenty five percent of all of our PHARMACOPOEIA is still directly isolated from additional plants. If you look at cancer answer drug something like seventy percent of the last. Ten years of come from Natural products in some sort of way so when physicians and healthcare providers. Look at me. As you know with a disapproving look that I'm intimately they don't understand stand their own PHARMACOPOEIA. The writing from daily so far we've looked at the ways in which cannabis has been used as a medicine in the past and some ways sandwich cannabis and cannabinoid. Drugs are being used as medicine today. Join US in part two of the series where we pick up on our quest to understand cannabis as a medicine by examining the ways in which medical claims are derived. How do we determine something's a medicine? And what results are clinician. Seeing in their patients agents that are using cannabis until next time. I'm your host Jason Wilson. Stay curious and take it easy special. Thanks to our guests that were so gracious in spending time with me for interviews that helped construct not just this episode but other episodes throughout the season to check out the citations for this episode. And there are plenty you can check out the show notes by visiting. CAC PODCAST DOT COM. You WanNA learn more about got canvas. You can check out the curious about this book available now on Amazon Dot Com and other online book retailers. You like what we're doing here in one of support the show. Please please consider porting us by liking. Sharing this episode with your friends and family can also choose to support us on Patriot. PATRIOTIC DOT com slash natural learning ready to get access to the full link guest interviews by seems content and a lot more can also connect with curious about cannabis on social social media on Instagram facebook. Twitter and Youtube. I really lives in home. We can face Yeah.