Tag: Health

Maximizing CBD’s Effects and Benefits: 5 Experts Weigh In

This article is sponsored by Firefly, a San Francisco-based technology company that specializes in the research, design, and manufacturing of vaporizer hardware.


Is CBD the magic cannabis molecule, or a misleading fad? There’s certainly a major trend toward CBD-only products on the cannabis market, and a push in some states leery of medical marijuana to legalize only one or two cannabinoids. Yet many are fighting back against this approach.  That’s because there’s an interactive synergy between cannabis compounds, known as the entourage effect, and many benefits attributed broadly to cannabis can only be unlocked through “whole plant medicine” – that is, with THC, CBD, terpenes, and other cannabinoids working together in sync.

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Whole plant medicine has been widely debated as many states consider limited legalization of cannabinoids like CBD, and the idea that the entourage effect is integral to using cannabis as medicine is increasingly accepted. In fact, some products are being designed specifically to maximize the value of whole plant medicine for the consumer. Take Firefly’s vaporizer technology, which sets out to capture all the myriad benefits of the entourage effect through dynamic convection technology. “[Firefly 2 was] truly designed around the plant…in order to deliver all the cannabinoids and terpenes in the most efficient way,” says Rachel Dugas of Firefly. Yet given the complexities of these chemical interactions, it’s still hard to pin down how exactly this maximizes the benefits of cannabis.

What the Experts Say About CBD’s Effects and Benefits

Neuron cell network

To shed some light on the subject, we assembled a panel of five experts in different areas of the cannabis space to weigh in:

Here’s what they had to say.

What effects does CBD have on its own?

Mary Lynn Mathre: “Many – anxiolytic, anti-inflammatory, anti-seizure, neuroprotective, bone stimulant, anti-spasmodic, and more.”

Jessica Peters: “Anti-inflammatory, anti-spasmodic, anti-proliferative, analgesic, anxiolytic (anti-anxiety), neuroprotective, anti-psychotic, anti-emetic (anti-nausea) … I can technically answer what are the properties of CBD, but these properties might not pop out if THC is not present. A potential new research category that I’ve seen evidence of anecdotally are addiction-fighting properties … CBD seems to reroute those neural pathways.”

Constance Finley: “Studies have shown CBD to have a positive effect on inflammation, pain, anxiety, psychosis and spasms, but it should be noted that most of these applications are not treated with just CBD alone and in fact do require some level of THC, whose role as a phytotherapeutic compound has already been established vis-à-vis many of the same conditions. CBD acts on different receptors than THC in the body.”

Perry Solomon: “It’s been found that CBD alone can cause a feeling of calm, relaxation. CBD’s other medicinal effects stem from completely separate pathways, such as the cannabinoid receptor 2 (CB2), mu and delta opioid receptors. Taken on its own, CBD has sedative, antioxidant, anti-anxiety, and antidepressant effects on the brain, but does not create any overtly psychoactive high like THC. It’s also been shown to have change gene expression and remove beta amyloid plaque, the hallmark of Alzheimer’s, from brain cells.”

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How are these effects augmented or altered by other compounds?

Peters: “Pretty significantly. CBD being cannabis-based is what’s most crucial for these properties to exist. The range of the volume of THC in relation to CBD will feature different properties. An equal amount of THC to CBD [for example] is often the best pain reliever. Many terpenes have relationships [and] the fact that those relationships exist is becoming clearer and clearer.”

Eloise Theisen: “CBD and THC seem to work better together. They lessen each other’s side effects.”

Solomon: “THC seems to potentiate all the effects of CBD and conversely, CBD affects THC. Dr. Ethan Russo further supports this theory by demonstrating that non-cannabinoid plant components such as terpenes serve as inhibitors to THC’s intoxicating effects, thereby increasing THC’s therapeutic index. This ‘phytocannabinoid-terpenoid synergy,’ as Russo calls it, increases the potential of cannabis-based medicinal extracts to treat pain, inflammation, fungal and bacterial infections, depression, anxiety, addiction, epilepsy, and even cancer … Terpenes act on receptors and neurotransmitters; they are prone to combine with or dissolve in lipids or fats; they act as serotonin uptake inhibitors (similar to antidepressants like Prozac); they enhance norepinephrine activity (similar to tricyclic antidepressants like Elavil); they increase dopamine activity; and they augment GABA (the “downer” neurotransmitter that counters glutamate, the “upper”). However, more specific research is needed.”

Mathre: “CBD has value, but its value can be enhanced with the whole plant and we can develop more individualized medicine (specific ratios depending upon the person and the need).”

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How much more effective would you say whole-plant medicine is than CBD-only?

Peters: “Radically. Not even close. It’s as though you’re working with different substances.”

Solomon: “I think that any whole plant medicine is more effective then any CBD-only product.”

Theisen: “Whole plant medicine is the only way to go.”

Mathre: “Safer and more effective, and tolerance will develop more slowly (if at all).”

Finley: “In almost all cases…I would say whole-plant therapeutics are 100% more effective than CBD-only.”

Thoughts on those who exclude THC or other cannabis components from the realm of medicinal cannabis?

Finley: “I believe everyone should have access to all types of treatment options that could potentially benefit them, and people need to be aware that not all cannabis is created equal. CBD from hemp does not have the medicinal properties that CBD from cannabis possesses, and is frankly an inferior product.”

Mathre: “We have lawyers and politicians practicing medicine without a license – they don’t know what they are talking about. Clearly there may be some patients who need little to no THC, but the vast majority will benefit from it. Patients should have all of the options open to them and research needs to continue to help determine how to best individualize cannabis medicine.”

Peters: “It’s so extraordinarily problematic that it feels criminal to me… The wall of bureaucracy is pushing up against the wall of science.”

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What is the best way to consume cannabis to access its complete entourage of effects?

Finley: “Delivery methods vary greatly in terms of their efficiency and their effects. I heard a colleague say that smoking a joint for therapeutic effect is akin to opening your mouth in the rain to get a drink of water … Our preferred methods [are] buccal ingestion or sublingual ingestion, vaping from a vaporizer or vape pen whose hardware is safe to use with cannabis extracts, and topical for additional localized impact.”

Peters: “Certainly vaporizing flowers is one of the easiest options. I would [also] say tinctures … especially full plant and alcohol-extracted (with organic ethanol).”

Theisen: “Vaporization or tinctures of whole plants. Any sort of extraction method that isn’t going to deplete it.”

How Vaporizer Technology Can Maximize the Entourage Effect

firefly30 copy-web

In the vaporizer world, dynamic convection is the process by which vapes can capture a complete range of active ingredients and flavors in cannabis flowers and full-plant concentrates. This maximizes efficiency and optimizes the benefits of the entourage effect for the consumer. As vaporizer technology continues to advance in this direction, it will become easier and easier for patients to explore the benefits of whole plant medicine for themselves, and hone in on the cannabis strains best suited to their needs.

To learn more about dynamic convection technology in the Firefly 2, please visit the sponsor’s website.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Cannabis Drug Could Extend Lives of Brain Cancer Patients, Study Finds

UK drugmaker GW Pharmaceuticals announced Tuesday it has achieved positive results in the second phase of a clinical study on Glioma, a cannabinoid-based therapy aimed at treating an aggressive form of brain cancer.

The study looked at 21 patients with recurrent glioblastoma multiform, or GBM, and found that participants who were given the drug—a combination of THC and CBD—lived significantly longer than those who took a placebo.

“These promising results are of particular interest as the pharmacology of the THC:CBD product appears to be distinct from existing oncology medications and may offer a unique and possibly synergistic option for future glioma treatment,” the study’s principal investigator Susan Short, an oncology professor at the Leeds Institute of Cancer and Pathology at St. James University Hospital, said in a statement.

Study participants who received Glioma showed an 83 percent one-year survival rate, GW reported, compared to a 52 percent rate among those who took a placebo. The median survival rate was 550 days among those who took the drug and 369 days among those who did not.

While the company says the treatment was “generally well tolerated”  by patients, there were some observed side effects.  Most common were vomiting, dizziness, nausea, headache, and constipation.

GBM, one of the most common types of brain tumor, is an aggressive cancer that arises in the brain or spinal cord. It carries a poor prognosis, with only 28.4 percent of patients surviving longer than a year after diagnosis. Only 3.4 percent of patients survive to year five.

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CEO Justin Gover said in a statement that the latest results continue to validate the importance of researching cannabis as a treatment for cancer and other diseases.

“These data are a catalyst for the acceleration of GW’s oncology research interests,” he said, “and over the coming months, we expect to consult with external experts and regulatory agencies on a pivotal clinical development program for THC:CBD in GBM and to expand our research interests in other forms of cancer.”

GW Pharma is already known widely for its seizure drug Epidiolex, a cannabis-derived treatment that has shown promising results in reducing symptoms in children with a rare form of epilepsy. Beginning in 2007, the company has conducted research into cannabis as a treatment for various forms of cancer, including brain, lung, breast, pancreatic, melanoma, ovarian, gastric, renal, prostate, and bladder. It has also investigated the possible use of cannabis to treat diseases such as diabetes, schizophrenia, Alzheimer’s and Parkinson’s diseases, and multiple sclerosis.

The company’s research has resulted in a number of registered patents that could become increasingly important as medical cannabis expands both in the United States and globally.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Where Are the Medical Marijuana Doctors in Florida? We Mapped Them.

Medical marijuana in Florida is in a state of flux. The state’s voters overwhelmingly approved–by more than 70 percent–Amendment 2, the medical marijuana measure, in November 2016. But it will be many months before the full system of patient registration, growing licenses, and dispensaries is in place.

Here’s what’s legal as of early 2017.

The Compassionate Medical Cannabis Act of 2014 is still the law of the land. That measure allowed a severely limited number of patients to obtain and use high-CBD, low-THC cannabis. In 2015, Florida added a few conditions (very few–you basically have to be dying in the next 12 months) under which patients can receive higher-THC cannabis. Originally the Department of Health set up a system in which five growers would be licensed to grow, process, and sell to registered Florida patients. But the Department screwed up its judging of the grow-and-dispense license applications, and to fix the error the agency decided to issue two more licenses. So there are now seven licensed medical cannabis companies in Florida.

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What’s the Deal with Florida’s ‘Dispensaries’?

Amendment 2 became effective on Jan. 3, 2017, but it currently offers vague and limited protections under the law. Right now, there’s no way to legally purchase higher-THC medical cannabis in Florida. Patients aren’t legally “qualified” until they receive a written recommendation from a physician, and possesses a valid patient ID card issued by the state. The state hasn’t started issuing those cards yet, so even if you have a physician’s recommendation, you are still operating in a legal gray area.

What is available right now? MMJ-qualified physicians and seven low-THC dispensary companies.

The Florida Department of Health requires physicians who recommend medical marijuana to complete an eight-hour training course before writing those recommendations. The DoH keeps a weekly-updated list of those physicians here, and we’ve turned that data into a handy map, below. The qualified physicians are the orange, smaller dots, the low-THC dispensaries are noted in teal, at a bigger size.

Click on the links below for more information about the 7 dispensaries listed:
Surterra Wellness
Trulieve – Clearwater
Modern Health Concepts
Knox Medical
CHT Medical
Trulieve – Tallahassee
Trulieve – Tampa 


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Cannabis and Epilepsy Treatment

Since medicinal cannabis has become a more commonplace alternative for a well-established list of ailments, patients are finding a place for it next to their Advil and Tums. But unlike many other chronic illnesses that can be managed with over-the-counter supplements, epilepsy requires a specific cocktail of chemicals not readily available at the local corner store.

This is why cannabis – specifically its chemical constituent CBD (cannabidiol) – has become so important for families struggling to treat their epileptic loved ones. Cannabis has demonstrated so much promise in the treatment of epilepsy that FDA-approved clinical trials are underway. But why is it that cannabis in particular is so effective at treating seizures, and why is it critical that clinical investigations continue?

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What is Epilepsy and What Causes It?

EEG tests can help learn more about epilepsy causes

Epilepsy is characterized by recurring seizures of variable intensity and effect. These seizures are usually caused by disturbances in specific regions of the brain’s circuitry that create storms of extra electrical activity. Approximately 1 in every 26 Americans will develop epilepsy in their lifetime, and two-thirds of those diagnosed will have no specific origin for the disorder. But perhaps the most harrowing fact is that 34% of childhood deaths are due to epilepsy or accidents that occur during seizures. These figures illustrate the “hiding in plain sight” commonality of epilepsy and the incredible unmet need for the development of novel drugs to treat seizures.

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While a seizure disorder can be a massive disruption to someone’s way of life and can even be deadly, most patients manage to acquire treatment and medicine while others simply grow out of it – though this is not always the case. Seizures and seizure disorders are as unique as the person afflicted by them, which can make seizures difficult to treat. Recently, epilepsy and cannabis have been highlighted in the news, especially success stories focusing on children with epilepsy who are trying medicinal cannabis. A few notable examples include Charlotte Figi and the high CBD Charlotte’s Web cannabis strain named after her, as well as Renee and Brandon Petro.

These cases and others have shone a spotlight on the medicinal uses of cannabis, regardless of its classification as a Schedule I narcotic (having no medicinal use in the eyes of the Federal government) and the generally accepted legal age of consumption for mind-altering substances (save caffeine and sugar).

The Current State of Cannabis and Epilepsy Research

cannabis and epilepsy clinical trial stages

These inspiring stories help illuminate the efficacy of medical cannabis while defining its range of treatment from the elderly to the young. While the capabilities of CBD and medical cannabis use seems to be self-evident, the DEA has only recently allowed academic institutions to explore the effects, side effects, and usefulness of cannabis as a medicinal plant. This seemingly innocuous change of face is an enormous leap forward for researchers, pharmaceutical companies, breeders, and the cannabis community at large as more scientific capital is put toward understanding this populous plant.

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“Based on these preclinical studies, one would be excited about the potential therapeutic potential of the cannabinoids,” wrote Dr. Francis M. Filloux in the journal Translational Pediatrics. “However, it is undeniable that the complex regulation that surrounds these Schedule I substances has impeded scientific investigation of their therapeutic potential.”

There has been no other drug in history that has been as widely consumed and applied for medicinal use without the institutional blessing symbolized by clinical human trials. But patients around the country currently have access to the “generic” versions of life-saving, CBD-rich cannabis products that are thriving beyond the regulatory reach of the FDA. So by conducting clinical trials with pure CBD, as GW Pharmaceuticals is with Epidiolex, concrete, tested scientific evidence can lay the first bricks in the road toward a variety of CBD/THC ratio products as well as synergistic cannabis cocktails targeted at other specific maladies.

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Clinical trials become more rigorous and far reaching as they progress through each stage. Currently GW Pharmaceuticals is undergoing Stage 3 clinical trials on Epidiolex, a nearly pure CBD preparation (98%+), to confirm the therapeutic value of this cannabinoid. This is also an astounding leap forward for cannabis and medicine, because, as noted by Dr. Filloux:

“Until the last few years, the published data was minimal and included [fewer] than 70 subjects. Very few of these were children. Furthermore, none of these studies would meet criteria as Class I-III clinical trials (50-53). However, this state of affairs is rapidly changing given the current climate.”

While this scientific success story isn’t a tear-jerker like Brandon’s or Charlotte’s, it does explain a necessary step toward proving the efficacy of cannabis-based therapies and its more egalitarian medicinal prescription.

Why Does Cannabis Work for Epilepsy and Seizures?

medical cannabis for epilepsy and seizures
The endogenous cannabinoid system is ubiquitous in our bodies, and is heavily regulated by cannabinoids found in cannabis.  With such potent biological usefulness throughout the human body, it’s obvious that the more scientific study that goes into the cannabis industry and the plurality of products it has created, the more the consumer will benefit. Time will be a better judge, but the future of medicinal cannabis as a treatment for disorders like epilepsy is here. Catherine Jacobson, Director of Clinical Research at Canadian licensed producer Tilray (note: Tilray is owned by Privateer Holdings, Leafly’s parent company), weighs in on the future of medicinal cannabis and the scientific progress that needs to be made:

“A pure CBD formula was the safest way to begin trials on epilepsy patients because of its lack of psychoactivity. The trouble with developing a single pure CBD formula is that epilepsy has never been a one-size fits all disorder. Of the 200,000 children living with treatment-resistant epilepsy, only a fraction has access to clinical trials investigating CBD. This leaves most parents and patients to acquire their own CBD-rich cannabis, which always contains some percentage of THC. It’s important to learn from these cases to understand which types of epilepsies might respond to a combination product, and to inform future clinical trials. Early results from clinical studies on GW’s Epidiolex clearly show a beneficial effect of CBD on some types of seizures, but more research is needed to fully understand whether a combination THC/CBD product can reduce the seizure burden in those patients who don’t respond to CBD alone.”

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This statement aligns well with conclusions drawn by Dr. Edward Maa, Chief of the Comprehensive Epilepsy Program at Denver Health and Hospitals. “It is possible that CBD and [THC] work synergistically to suppress seizures,” Dr. Maa write in Epilepsia. “In fact Ethan Russo, senior medical advisor to GW Pharma, recently reviewed the evidence for the ‘entourage effect’ of the phytocannabinoids and terpenoids, and he makes a strong case for their synergistic effects in a variety of disease states.”

Epilepsy is surprisingly common, exceptionally disruptive, and potentially deadly. But the uncertainty behind the effectiveness of cannabis and CBD in regards to epilepsy treatment is fading. This “controlled substance” is finally receiving its due diligence from the scientific community, and Dr. Jacobson is at the forefront of much of the forthcoming research.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Can Cannabis Chewing Gum Treat Irritable Bowel Syndrome?

A biotech firm has launched clinical trials in the Netherlands to test whether its CBD chewing gum could help treat irritable bowel syndrome.

Researchers will give a group of 40 adult patients CanChew Plus chewing gum, which contains 50 mg of hemp-derived cannabidiol per serving. Subjects will be able to take up to six servings per day under the study, which will record general relief of irritable bowel syndrome (IBS) symptoms—most often stomach cramps, bloating, and lower abdominal pain—along with any “change in stool frequency,” according to a press release.

The mint-flavored chewing gum was developed by Axim Biotechnologies, which has offices in New York and the Netherlands.

“IBS is the most common gastrointestinal disorder and affects up to 15 percent of the worldwide population,” Axim CEO Dr. George E. Anastassov said in a statement, “and It has no sustainable cure.”

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The forthcoming IBS trials were developed by Axim and clinical investigators at the Wageningen University, a leading Dutch research institution and where the trials will be held.

“IBS is a very common and often painful disorder which is still difficult to manage,” Renger Witkamp, a nutrition and pharmacology professor at the school, said in a statement that accompanied the announcement. “People often experience sudden flare-ups and for many it has a negative impact on their quality of life. CBD has shown to have promising effects, but there has been a clear need for practical and effective formulations.”

While CBD is currently available in various forms, Witkamp claims that “providing it via a chewing gum results in sustained release of the compound and better bioavailability.”

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Axim also makes CanChew, a controlled-release CBD chewing gum, and a combination CBD/THC gum called MedChew Rx, which is currently undergoing clinical trials for the treatment of multiple sclerosis-related pain and spasticity. Standard CanChew gum is already available in all 50 US states, the company says, as it contains only hemp-based CBD.

If the IBS trial is successful, said Axim CEO Anastassov, “we will be ready to proceed immediately with further trials on our pharmaceutical grade CanChew Rx products to treat inflammatory bowel disease (IBD), ulcerative colitis, and Crohn’s disease.”

In a legal disclosure, the company says it “does not sell or distribute any products that are in violation of the United States Controlled Substances Act”—although the DEA might disagree.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Here’s What the National Academy’s Medical Cannabis Report Actually Says

The release of “The Health Effects of Cannabis and Cannabinoids,” a comprehensive report by the National Academy of Sciences, has sparked a flurry of reaction around the nation. Cannabis advocates have focused on the report’s conclusion that cannabis possesses therapeutic value for chronic pain patients, while others emphasized the report’s warnings about car crashes and memory problems. USA Today’s headline captured the report’s overall sense of caution: “Marijuana can help some patients, but doctors say more research needed.”

What is the report, what does it actually say, and why is it important? We’ve got you covered.

What is “The Health Effects of Cannabis and Cannabinoids” Report?

The National Academies of Science, Engineering, and Medicine is a private, nonprofit NGO established more than 150 years ago to advise the nation on scientific matters. It’s considered one of the gold standard institutions of science. In 1999, largely in reaction to California’s legalization of medical cannabis, the Institute of Medicine (the medical research arm of the National Academies) was tasked by the White House Office of National Drug Control Policy (ONDCP) to conduct a systematic review of the scientific evidence pertinent to the health risks and benefits of cannabis and cannabinoids. To the White House’s surprise, the institute came back with a report that cautiously supported the idea that cannabis could have beneficial medicinal effects.

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Almost two decades later, the National Academies put together this follow-up report to see what the science of the past 18 years has further revealed about cannabis and medicine.

What Kinds of Cannabis Research Did It Consider?

The committee reached nearly 100 research conclusions based on consideration of more than 10,000 research articles. They gave more weight to articles published since 1999 report. From this information, each specific research conclusion was assigned to one of five “levels of evidence”: conclusive, substantial, moderate, limited, and no/insufficient evidence. Importantly, the committee focused exclusively on the human literature, and did not consider basic research conducted using animal models.

You can read the full report, highlights, and public release slides here.

Female scientist in lab with hand detail

What Medical Applications Are Supported by Conclusive Evidence?

The committee found three medical applications for cannabis use supported by conclusive evidence (as opposed to substantial, moderate, limited, or insufficient evidence):

  • Nausea and vomiting associated with cancer chemotherapy
  • Chronic pain in adults
  • Spasticity in multiple sclerosis

There’s a lot more to dive into (see below), but let’s first consider some important caveats to the study’s conclusions.

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Barriers to Cannabis Research

One thing the report emphasizes is how much we don’t know—and why we don’t know it. It provides us with four conclusions about research barriers:

  • Specific regulatory barriers, especially the classification of cannabis as a Schedule I controlled substance, are an impediment to the advancement of research on cannabis and cannabinoids;
  • It is difficult for researchers to obtain access to the types of cannabis products necessary to address questions surrounding the health effects of human cannabis consumption;
  • A diverse network of funders is needed to help support the necessary research efforts;
  • Improvements and standardized set of research methodologies will be needed to develop conclusive evidence for the short- and long-term health effects of cannabis use.

This is a key take away point. If there’s one thing that everyone can agree on when it comes to cannabis, it should be that we need to do the research necessary to inform ourselves about its health effects. But this is very difficult to do in practice because of cannabis’ absurd designation as a Schedule I controlled substance. Because this report identifies multiple medical applications supported by conclusive evidence, it directly contradicts the Schedule I designation the federal government places on cannabis.

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Important Caveats

There are three big caveats I think we should keep in mind when reading this report:

Caveat 1: When reviewing human studies, members of the committee looked for statistical associations between cannabis use and health outcomes, but they did not attempt to evaluate whether significant associations were due to cannabis use causing a specific health outcome or whether cannabis use and that outcome were associated for some other reason, such as a common underlying cause. This is a key weakness when we only consider human studies involving a Schedule I substance: the findings are usually correlational and thus prevent us from drawing conclusions about cause-and-effect.

Caveat 2: Many human studies rely on self-reporting of cannabis usage. This is a huge caveat for many human studies, as any conclusions drawn about the effects of light, moderate, or heavy cannabis use rest on the assumption that subjects are accurately reporting their consumption.

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Caveat 3: The committee explicitly decided to not consider basic research studies. That helped simplify the gargantuan task of evaluating tens of thousands of research abstracts. There are many thousands of basic research studies out there (both test tube and animal studies), and considering these would have been incredibly time- and labor-intensive. While that basic research isn’t conducted in humans, it does allow us to dig deeper into mechanisms of action and establish cause-and-effect relationships. There’s a lot of interesting and compelling basic research out there that should inform the direction of human clinical research. This represents a huge knowledge gap in the report.

Below, I’ll walk us through the chapter highlights of the 11 chapters of the report. The basic conclusions reached by the committee are listed as bullet points, with my own commentary below them, including what we should take away and any important caveats we should keep in mind. Each heading below corresponds to one chapter of the report focused on a specific health concern.

woman's hands holding leafs of medicine marijuana

Therapeutic Effects of Cannabis

  • Oral cannabinoids are effective at treating chemotherapy-induced nausea and vomiting in adults.
  • Adults with chronic pain are more likely to experience clinically significant levels of pain reduction when treated with cannabis or cannabinoids.
  • Oral cannabinoids provide improvement for adults with MS-related spasticity.

Not much new here. These effects have been widely known for some time. Again, these are the areas supported by evidence deemed “conclusive” by the committee. There are many more things for which “substantial,” “moderate,” or less convincing levels of evidence exists.  For me, the second bullet point is arguably the most important, as it could have huge implications for the country’s ongoing opioid epidemic.

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Cannabis and Cardiometabolic Risk

  • The evidence is unclear about the association of cannabis use with heart attack, stroke, and diabetes. 

Not a whole lot to add here. To be safe, people with cardiovascular issues should be extremely careful, as THC’s action through CB1 receptors in the brain can cause an acute (temporary) increase in pulse and blood pressure.

Cannabis and Cancer

  • Evidence suggests that smoking cannabis does not increase the risk of lung, head, or neck cancers in adults.
  • There’s limited evidence for an association between cannabis use and one particular subtype of testicular cancer.
  • There’s minimal evidence that parental cannabis use during pregnancy is associated with greater cancer risk in children.

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Cannabis and Cancer

Not much new here, either. The weight of the evidence to date suggests that smoking cannabis, unlike smoking cigarettes, does not increase lung cancer risk. Apparently there is modest evidence for an association between cannabis use and a specific form of testicular cancer. The important caveat for these conclusions is that they’re based on finding (or failing to find) statistical associations between cannabis use and a specific cancer outcome. Controlling for confounding variables, such as tobacco smoking, is critical for interpreting the results.

The association between cannabis and one subtype of testicular cancer is considered limited because the studies finding a link suffered from one or more of the following: they relied on self-reported data, response rates were sometimes low, or potential confounding variables were not controlled for in all studies.

Cannabis and Respiratory Disease

  • Smoking cannabis regularly is associated with chronic coughing and phlegm production.
  • Quitting smoking is likely to reduce these symptoms.
  • It’s unclear if cannabis use is associated with other respiratory problems (e.g. asthma, general lung function).

Again, not much new here. If you smoke cannabis all the time, there’s a good chance you’ll be coughing up some phlegm. We recommend regular smokers consider vaping instead.

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Cannabis and Immunity

  • There’s a general lack of data on how cannabis-based therapies affect the human immune system.
  • There is insufficient data on the overall effects of cannabis on immune system competence.
  • There is limited evidence suggesting that cannabis smoke exposure has anti-inflammatory effects.
  • There is insufficient evidence to support an association between cannabis use and adverse immune effects in HIV patients.

This is a section where the authors concluded that limited or insufficient evidence exists across the board. But it’s also an area where a lot of basic research has been done that should be used to guide human clinical research. For example, we know that THC is a more potent anti-inflammatory that aspirin and hydrocortisone, and we know the endocannabinoid system has an important role in regulating the immune system’s inflammatory response. This makes it plausible that there are useful anti-inflammatory applications of cannabis-based therapies, and we should be pursuing human studies to investigate what these might be.

Cannabis and Prenatal, Perinatal, and Neonatal Exposure

  • Smoking cannabis during pregnancy is associated with lower birth weights.
  • The relationship between smoking during pregnancy and other outcomes is unclear.

This one is pretty straightforward. Please don’t smoke anything if you’re pregnant. It’s the only safe and reasonable strategy to take. The report contradicts a 2016 review that Leafly covered, which found that cannabis use was not linked to negative birth weight of preterm delivery outcomes (at least when used without tobacco or other illicit substances). However, the current report points out that there’s reason to think that non-cannabinoid byproducts of combustion that are found in smoke (including carbon monoxide), can impair fetal growth. The only reasonable conclusion here is that pregnant woman should avoid all forms of smoke inhalation.

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Problem Cannabis Use

  • Using cannabis more frequently and starting at a younger age are associated with developing problem cannabis use.

“Problem cannabis use” here means cannabis use disorder. While cannabis does not have nearly as much habit-forming potential as substances like alcohol, nicotine, or opioids, it is possible to develop a habit. What’s a habit? If you have trouble voluntarily taking a break, and especially if doing so gives you withdrawal symptoms, then you’ve got a habit. Using cannabis very frequently, especially if you start at a young age, increases the chances of habit formation. This is important but also nothing new.

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Cannabis Use and Abuse of Other Substances

  • Cannabis use is likely to increase the risk of developing dependence for a substance other than cannabis.

This one jumped out at me. If you look at this chapter of the report in detail, things get confusing. The authors reach these three conclusions in the chapter of the full report:

  1. There is limited evidence for an association between cannabis use and the initiation of tobacco use.
  2. There’s limited evidence for cannabis use affecting the rates and patterns of use of other illicit substances.
  3. There is moderate evidence for a statistical association between cannabis use and the development of dependence for other substances, including alcohol, tobacco, and other illicit drugs.

I found this trio of conclusions confusing. The first two conclusions are that there’s limited evidence for an association between cannabis and both initiation of tobacco use and changes in the rate or pattern of use of other illicit substances. But then we’re told that there’s moderate evidence for an association between cannabis use and the development of dependence for other substances. Wouldn’t the development of dependence be considered a change in the pattern of use? And if the chapter summary (the bullet point above) is based on these three conclusions, what justifies the definitive-sounding statement, “Cannabis use is likely to…”?

It isn’t clear me why they separated the studies that were considered for points (2) and (3) above. Point (2) is about changes in patterns of usage, and point (3) is about the development of dependence, which is itself a change in the pattern of usage.

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While some of the studies considered had large sample sizes and controlled a variety of confounds, most or all seem to have relied on self-reported data around consumption of cannabis and other substances. These types of studies also don’t include any biological data that might tell us whether someone is generally predisposed to developing a substance use disorder of some kind.

If lifetime use of one substance is associated with increased use of another, how do we know that using the first substance was what increased the risk of using the second? How do we rule out the existence of a biological predisposition that makes one more likely to develop a dependence on any intoxicating substance? We can’t, at least not from these types of studies. Thus, I find the conclusion given in the chapter highlights, that cannabis “is likely to increase the risk for developing substance dependence,” to be specious and inappropriately phrased given the content of this chapter.

Cannabis Effects on Injury and Death

  • Using cannabis before driving increases the risk of being in a motor vehicle accident.
  • In states with legal cannabis, there’s an increase in unintentional cannabis overdose injuries in children.
  • There is no clear relationship between cannabis use and mortality or occupational injury. 

Without diving into the report in detail I think we can come up with some common-sense conclusions about the first two points: You shouldn’t operate a motor vehicle while under the influence of any psychoactive substance, and you need to be extremely careful about storing your cannabis products if there are children around. That latter point is especially important for cannabis edibles, which can allow unsuspecting individuals to mistakenly consume uncomfortably large amounts of THC.

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The last point should come as no surprise, since we know why you can’t die from cannabis consumption. People in states with legal medical cannabis also don’t appear to be getting stoned before heading into work. In fact, we’re seeing lower rates of workplace absenteeism in states with legal medical cannabis.

Psychosocial Effects of Cannabis

  • Recent cannabis use (within the last 24 hours) impairs cognition (memory, attention).
  • A limited number of studies suggest there are such cognitive impairments in people who have stopped cannabis use.
  • Adolescent use is associated with impairments in subsequent academic achievement and other social outcomes.

The first two points are straightforward. The acute effects of THC intoxication involve impairments in cognition (e.g. short-term memory, attention), and there is limited evidence that such impairments can persist after people stop consuming cannabis. The last point about academic impairments associated with adolescent use is true based on the studies considered in this report, but we also highlighted a 2016 study too recent to be considered in this report that didn’t find this type of association (but only after controlling for confounding variables, namely tobacco use). Because childhood and adolescence are critical periods of nervous system development, the use of cannabis or any psychoactive substance should be avoided before adulthood.

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Cannabis and Mental Health

  • Cannabis use can increase the risk of developing schizophrenia.
  • Individuals with schizophrenia and a history of cannabis use may show better performance on learning and memory tasks.
  • Cannabis use does not appear to increase the likelihood of depression, anxiety, or PTSD.
  • In individuals with bipolar disorder, near daily cannabis use may worsen symptoms.
  • Heavy cannabis users are more likely to report thoughts of suicide.
  • Regular cannabis use increases risk for social anxiety disorder.

OK, the first two points beg for a double-take. Cannabis use can increase the risk of schizophrenia, but those with both schizophrenia and a history of cannabis use show better performance on learning and memory tasks? What? Box 12-1, titled “Co-Morbidity in Substance Abuse and Mental Illness,” helps us start to digest this. Here are its three main points:

  1. Substance use may be a potential risk factor for developing mental health disorders.
  2. Mental illness may be a potential risk factor for developing a substance abuse disorder.
  3. An overlap in predisposing risk factors (e.g., genetic vulnerability, environment) may contribute to the development of both substance abuse and a mental health disorder.

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Cannabis and Depression

The report follows with a statement about why the relationship between mental health and substance abuse is so difficult. Substance abuse can affect mental health, mental health can affect substance abuse, and other variables can affect both. In their words:

Although the precise explanation is still unclear, it is reasonable to assume that co-morbidity between substance abuse and mental health disorders may occur due to a mixture of proposed scenarios. With this context in mind, however, it is important to note that the issue of co-morbidity directly affects the ability to determine causality and/or directionality in associations between substance use and mental health outcomes. This is a complex issue, one that certainly warrants further investigation.

Again we see the emphasis on more research. The nature of the link between cannabis use and schizophrenia was debated by scientists in the journal Nature in 2015 (look here and here for opposing views from scientists).

Summary

It will take some time to dissect this 400-page report in more detail. This report looks at a lot of human health issues and how they  may potentially be affected by cannabis use. While I don’t envy anyone tasked with such an enormous undertaking, I was somewhat disappointed to see that the report didn’t consider any basic research findings and instead relied on only human studies. While this allowed the committee to focus on studies directly related to human health, a large proportion of those studies are based on self-reported data that are correlational in nature. Occasionally, some of the language used to summarize their conclusions doesn’t adequately capture these important caveats.

A major emphasis of the report is that we need much more research. Unfortunately, doing the types of well controlled, large-scale clinical studies that we need to be doing is very difficult in the United States today. Given that this report, conducted by a cautious set of researchers, finds conclusive evidence that cannabis has legitimate medical applications, the federal government’s classification of cannabis as a Schedule I Controlled Substance, with “no currently accepted medical use,” must be considered untenable and inappropriate.


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

The Benefits of Cannabis on Your Self-Esteem

If I told you that your body is worthy of love, care, and compassion exactly the way it is right this second, would you believe me? If you’re suddenly squirming uncomfortably or rolling your eyes, the odds are you probably aren’t completely comfortable with your body. You’re not alone. A 2012 UK study conducted by the All Party Parliamentary Group found that “roughly two-thirds of adults suffer from negative body image.” Yes, all adults. This is not just a “women’s issue.” People of all genders struggle with body image.

I’ve previously talked about using cannabis to help reframe limiting beliefs. After exploring more deeply, I’ve found cannabis can help cultivate body love as well. Since poor body image can negatively impact mental and physical health, you’re doing yourself a huge favor by taking active steps to improve your relationship with your body. Cannabis is the perfect conduit for such a transformation because it can help muffle some of the negative self-talk in your brain which, at least for me, often feels like it’s communicating exclusively in SHOUTY CAPS.

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For me, cannabis helps me feel more present in my body and more open to pleasurable sensations. In 2010, I spent 100 hours getting certified as a hypnotist and I learned how useful hypnotic trance can be for unlearning negative beliefs and redirecting your attention and intentions. I find cannabis can produce similar effects to being in a trance (relaxation, bringing the unconscious mind into the forefront as the conscious mind recedes slightly, being more open to positive change, etc.)

If you’re interested in utilizing cannabis to re-shape your self-esteem, make sure to avoid a strain or product that might increase anxiety or paranoia (which would be antithetical to your goals). I suggest looking for a 1:1 CBD to THC ratio, and depending on how much time you can commit to the process, choose a shorter-acting method like smoking or vaping. The idea here is not to get so stoned that you “forget” the things you dislike about your body. This is about mindfully choosing cannabinoids and terpene profiles that will augment the positive changes that you’re setting in motion.

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Beta-caryophyllene, a peppery terpene found in many plants from cannabis to cinnamon, has been shown to reduce anxiety and depression. Ask your budtender about strains like OG Kush and Skywalker OG, which tend to be high in caryophyllene, and ask about the lab results (does your dispensary have lab testing results on hand?) to verify the terpene profiles. Part of loving your body means being aware of what goes into it, so be a savvy consumer!

Kayla Arielle, cannabis guru and social media specialist, shared this powerful experience:

“In the movie ‘What The Bleep,’ there’s a scene in which a habitually self-loathing woman realizes the effect that she is having on both her body and reality with her negative thought patterns. She ends up sitting in front of a mirror with a marker and writing letters of love all over her body, in effect deprogramming her hateful thinking and replacing it–in a very tangible way–with positive, loving thoughts. I was going through a really hard time with my marriage then and my condition [juvenile rheumatoid arthritis] as well. I was flared up 24/7 and in so much pain.

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“After I saw that scene, I felt extremely moved to do the same thing. I locked myself in my bathroom and alternated between the tub and mirror, marking all over my body, laughing and crying in the process. I definitely used cannabis as a tool and companion during the process…I had bowls and a blunt. It helped my mind to elevate to my intended frequency of soul vibration, as they say, unlocking obstacles and guiding the way back to the light after many years of moving towards despairing darkness. I had started to feel so trapped in this crippling vessel. The hour or so alone in my bathroom brought about so much healing and truly was a milestone of great change in my life.”

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The exercise she’s describing is deeply transformative, and I would recommend it if you feel inspired and ready for a big change. However, you don’t have to jump right to writing on yourself in marker. It’s all about making small, sustainable changes.

Here’s a bit of homework for you: carve out time for yourself where you’ll be alone and uninterrupted. An hour would be best, but you can do this in as little as 10-15 minutes. Enjoy the cannabis product of your choice–just enough that you feel it in your body, but not so much that it feels distracting. The goal is focused enhancement.

Stand in front of a mirror and look at yourself. Look into your eyes and take a few deep breaths into your belly. Notice the things about some part of your body that you like. For instance, looking at your face, perhaps you like the way your eyes light up when you smile, or a freckle on your cheek, or the way your lips purse when you’re concentrating. Maybe it’s the softness of your skin or the curve of your jaw. Revel in it. You might notice things you don’t like, too. That’s okay, just don’t dwell on them. When a negative thought comes up, just let it pass by. Express gratitude to your body for all the ways it makes you unique and awesome.

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When you’re done looking and appreciating (do this for as long as you can), write down what you remember in a journal. Have one page for positive things you noticed, and on another page spend a few minutes writing about how you felt doing that. What was it like to just focus on the good stuff? How can you make that a habit?

Has cannabis impacted your relationship with your body? If so, share your stories in the comments below!

Got a sex, relationships, or intimacy dating question for Ashley Manta? Send it to tips@leafly.com and we may address your request in a future article! (Don’t worry, we’ll keep your queries anonymous.)


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Can Cannabis Help with Inflammation for Athletes?

Athletes today are bigger, stronger, and faster than they were just a decade or so ago. Men and women are becoming more competitive thanks in part to technological advancements designed to improve workouts and recovery time, as well as a better understanding of athlete physiology and the advent of new training exercises designed to maximize an athlete’s potential.

With these innovations, however, come drawbacks. Playing a contact sport like football has become more dangerous as athletes pile on the muscles, speed, and agility. The rise of brain injuries like CTE, as well as knee, shoulder, or back strains, have resulted in increased usage of painkillers that have become alarmingly dangerous and addictive.

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The United States is currently in the middle of a national opioid addiction and overdose epidemic. In 2015, there were 20,101 overdose deaths related to prescription pain relievers. The same year, heroin contributed to 12,990 overdose deaths. In 2015, opioid overdose deaths surpassed gun homicides in the United States.

This epidemic is only growing stronger, in part because companies like Insys, who makes the widely used and abused pain killer Fentanyl, are getting involved in local politics. They’re donating to politicians and other initiatives that could possibly contribute to the rise of painkiller use/abuse. These companies only seem to care about one thing, and it’s not the health and well-being of Americans, it’s money.

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Unfortunately, the cavalier attitude towards prescription painkillers has trickled into sports. Doctors in professional sports are handing out painkillers like Fentanyl to the players like candy. As a result, a growing number of former athletes, mainly in the NFL, suffer from opioid addiction problems, creating the need for the NFL and other professional leagues to find alternatives to how to treat these persistent pain problems athletes face.

One possible alternative to prescription painkillers may come from certain components of the cannabis plant. Recent studies have found that cannabis could possibly reduce inflammation, acting almost like Tylenol. In fact, when comparing the anti-inflammatory potency of THC and other drugs that are on the market, THC has 20 times the anti-inflammatory potency of aspirin, and twice as much as hydrocortisone (Evans 1991).

How Cannabis Can Contribute to Pain and Inflammation Recovery

How Cannabis Can Contribute to Pain and Inflammation Recovery
Intense sports competition or physical activity can act as a stressor on the body, resulting in the release of molecules called cytokines that have pro-inflammatory actions. Despite the long-term benefits of exercise, there is no doubt that in the short-term, high-intensity exercise leads to inflammation. Over time, this can cause damage to muscle tissue, leading to pain and soreness.

There has been emerging evidence that cannabis reduces pain, muscle spasms, stiffness, and inflammation in humans. In particular, cannabis has been associated with the reduction in levels of specific pro-inflammatory cytokines.

THC has been shown to stimulate production of some of the body’s natural painkillers, such as beta-endorphin (Manzanares et al 1998). For this reason, cannabis may help prevent the development of tolerance to and withdrawal from opiates (Cichewicz and Welch 2003).

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Think of it this way: an athlete may need to take a prescription opioid painkiller due to an injury that causes intense pain. But for injuries that cause long-term, chronic pain, the pain-reliving properties of opioids may be outweighed by their addictive potential.

Cannabis isn’t as potent a painkiller as opioids are, but it can help with pain and inflammation, and help athletes wean themselves from opioids. Plus, compounds like CBD might actually be useful for decreasing the anxiety and withdrawal symptoms that can make it so difficult to stop taking opioids.

More recently, other compounds in the cannabis plant have been found to possibly help pain treatment. Some of the terpenoids and terpenes, the fragrant oils that give cannabis its aromatic diversity, also display numerous attributes that may be germane to pain treatment (McPartland and Russo 2001).

Leafly cannabis strain terpene wheelLike cannabinoids, terpenes bind to receptors in the brain and give rise to various effects. The above infographic outlines properties of six common cannabis terpenes along with a few strains that tend to express notable levels of each.

Though different parts of the cannabis plant are showing promise when it comes to treating pain management as well as other medical conditions, more research is needed. Research may be hard to come by though, as cannabis is still federally illegal in the United States, making it very challenging to get permission to do studies on cannabis.

Former All-Pro NFL QB Jake Plummer Shares His Experiences with Cannabis

Jake Plummer opinion on cannabisDenver Broncos quarterback Jake Plummer looks for a receiver as he roles out of the pocket during the second quarter in an exhibition football game against the Houston Texans in Denver in this Aug. 27, 2006 file photo. (AP Photo/David Zalubowski)

Even though there is still room to be made with researching the possible medical benefits of consuming cannabis medicinally, there are already people out there in the pro sports world rehabbing their beaten body with medicinal cannabis.

One of those former pro athletes is former All-Pro quarterback for the Denver Broncos and Arizona Cardinals, Jake Plummer. After playing 10 seasons in the NFL, Plummer retired from the game in 2007 and would soon try to find something to help him deal with his lingering post-football injuries.

The answer for Plummer was to consume cannabis and CBD to help fight the daily pain he was feeling after his playing career. Plummer told Leafly that he now regularly uses the CBD strain Charlotte’s Web in oil form. He takes the strain in liquid, oil form out of a dropper at the beginning and end to his day.

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“I wake up with a feeling of being refreshed, no matter how much sleep I got, even sometimes if I go see friends and have a few beers and then don’t get the sleep I need – even with a two-month old baby in the house right now, I am still functioning at a high level,” Plummer told Leafly. “I don’t have those achy days with a headache, or as often as I were.”

Plummer added that having a general overall feeling of health and well-being can be “liberating,” especially after taking the punishment he did playing professional football for a decade. For this former professional athlete, Charlotte’s Web oil, and cannabis in general, have helped speed up his recovery process – though, as Plummer said, cannabis and CBD will not fix everything.

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“It is not going to fix my L5 spondylolisthesis or some other injuries that happened to me, leaving parts of my body compromised, but I can tell you this: The pain and feelings of pain and stiffness and occasional debilitating pain that I used to have, when I would be active in any way—is gone now,” he said.

“Now if I go kick some ass and go play some handball and do a bunch of crazy stuff, I am going to be sore. But I’ve also kind of found out how to recover much quicker, and that is taking a little extra helping of the oils.”


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

‘Marijuana Drains Brain Blood Flow, Boosts Alzheimer’s Risk’: Fake News or Flawed Study?

The Internet was abuzz last week over Dr. Daniel Amen’s new study suggesting cannabis use increases Alzheimer’s risk. The media quickly took the bait. Raw Story wrote, “Smoking weed may accelerate Alzheimer’s disease.” The New York Daily News, who’ve never been shy about posting sensational clickbait headlines, wrote, “Marijuana drains brain blood flow, boosts Alzheimer’s risk: study.”

The study’s findings seem to contradict a large body of emerging evidence suggesting cannabinoids may lower risk for Alzheimer’s and may even be useful in treating the disease. Consistent with the research, Juan Sanchez-Ramos, MD, PhD, a professor of molecular pharmacology and physiology at the University of South Florida and a recognized expert on neurological disorders, believes cannabinoids — by virtue of their neuroprotective and anti-oxidative actions — have the potential to “slow the onset and progression of neurodegenerative conditions.”

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The research thus far begs the question: how could cannabis — with its demonstrated neuroprotective properties — increase the risk of Alzheimer’s? Was this a situation where the media misrepresented a study, or did the study’s authors exaggerate their findings?

Comparing media reports with Amen’s study and press release, remarkably, Amen appears more culpable than the media. Amen’s study fails to disclose serious limitations. Worse, in his own press release, he grossly misrepresents what his team’s research proved.

Let’s examine further…

Problem 1: Define “Marijuana User”

Analysis of marijuana

Is a “marijuana user” a clinical cannabis patient? An occasional recreational user? According to Amen’s study, he studied individuals “with a diagnosis of cannabis use disorder by DSM-IV and DSM-V.” In other words, participants were people who are addicted to cannabis. See the problem? We’re dealing with a very small subset of the population.

Leafly reached out to Dr. Dave Schubert to get his take on the study. Schubert is a professor and head of the cellular neurobiology laboratory at the Salk Institute, and in June 2016, he published an important study that found cannabinoids remove plaque forming Alzheimer’s proteins from brain cells. Schubert notes that few people who use cannabis become physically addicted, yet this was the population Amen and his team studied (clearly not a representative sample of the cannabis using population). To put things in perspective: 91% of those who try cannabis do not get addicted.

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While causality and longevity continue to be debated, most well-designed, properly controlled studies have only demonstrated persistent adverse cognitive effects (which are generally mild) in heavy cannabis users. These effects appear to be reversible after periods of abstinence (ranging from one to six months). An 8-year cohort study, for example, of more than 2,000 subjects (including abstainers, light users, former light users, heavy users, and former heavy users) found no difference in cognitive performance among groups except current heavy users. Findings suggest quitting heavy use is associated with a reversal in adverse cognitive effects. (Notably, an increasing number of studies suggest cognitive declines persist in chronic users who start during adolescence.)

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Problem 2: Poorly Controlled for Comorbid Conditions

Hand with Rolled Cigarette or Joint

The small subset of the cannabis consuming population that Amen’s team looked at also have a high rate of comorbid psychiatric conditions (approximately 95%) and often misuse other substances — a fact Dr. Amen acknowledges on the addiction treatment section of his website. Yet, the use of other substances (like alcohol, nicotine, and other drugs) and other conditions may also contribute to decreased cerebral blood flow issues.

In Amen’s study, he notes that of the nearly 1,000 cannabis-dependent subjects he studied, 67% had ADHD, 35% had major depressive disorder, and 47% had traumatic brain injury (TBI). He failed to mention nicotine or alcohol use.

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Schubert notes, “There was a minimal attempt to control for comorbid conditions that could influence cerebral blood flow in this study.” But he adds, “The bottom line is that the excessive use of any of these items leads to big medical concerns. It is quite clear that cardiovascular problems are caused by all of them, but we simply do not know if this occurs with marijuana — much more work is needed both from the toxicology and medical use ends of the issue.”

Dr. Gary Wenk, director of neuroscience programs at Ohio State University and a leading authority on Alzheimer’s disease research (with a focus on drugs that can slow the progression of Alzheimer’s disease) shares his perspectives with Leafly: “All of the study’s participants had been previously diagnosed, using a DSM label, with ‘marijuana use disorder.’ That means that these people were true addicts, not your normal weekend smoker.”

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The consensus seems to be that the population Amen studied — with its high use patterns and comorbids —  can tell us very little about the risks of cannabis in the vast majority of users.

Problem 3: Exaggerated Population

doctor chatting to a patient on the hospital corridor.

In Amen’s own press release and media reports, he studied nearly 1,000 “marijuana users” (more accurately, users with clinically diagnosed cannabis use disorder — conveniently omitted). He excluded approximately half of the 1,000 subjects because of TBI, leaving 436 subjects that use cannabis heavily. Clearly, had he left those subjects in the study, even a naive reader would find that peculiar. But, one wonders, why did he exclude them after the fact? These were patients in his clinic’s database — not prospective participants he was screening. Why did he even consider them for the study in the first place?

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“The researchers included 982 individuals who used marijuana. That sounds like a lot —  actually, it’s not for a study that is asking this type of question. Does a change in blood flow correlate directly with getting AD? Certainly not,” claims Wenk. “Many things correlate with getting AD, such as small head circumference, being short, head injury, etc. Also, they did not control for gender or ethnicity or duration of use or addiction vulnerability, etc.”

Problem 4: Amen Chose the Healthiest of the Healthiest

Grandma taking pills

While restricting his cannabis use population to a subset of cannabis users who are not a representative sample of the cannabis consuming population, by contrast, Amen choose the polar opposite population for his group of “healthy subjects.”

Here is some of the criteria he used to exclude patients:

  • Past (or present) psychiatric disorders? Excluded.
  • Current medical illness? Excluded.
  • On medication? Excluded.
  • Past drug or alcohol misuse? Excluded.
  • Close relative with a psychiatric illness? Excluded.

Given the opportunity to study Olympians for his research, he probably would have. (Maybe not Michael Phelps…)

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Problem 5: Low Cerebral Blood Flow Has Not Been Proven to Predict Alzheimer’s Risk

vein, human vein

This is the biggest issue with Amen’s study (and publicity campaign). It’s built on the unproven assumption that low cerebral blood flow predicts Alzheimer’s risk. Not only is it an unproven assumption, CBF is all over the place in Alzheimer’s risk studies.

Schubert notes, “The major problem from the AD perspective is that blood flow is not predictive of AD risk. Brain blood flow and associated glucose uptake — determined by PET scans — is all over the place with respect to age, areas of amyloid deposition and risk factors (see study). So while I agree with the paper, in that we need more studies, both on addiction and medical use, they cannot conclude that MJ [marijuana] use, even at very high levels as in this paper, is a bona fide risk factor for AD.”

“My research suggests that low dose marijuana is protective. If you’re smoking so much to be diagnosed with a disorder, then you’ve got other issues that are likely predisposing someone to mental health problems,” Wenk adds. “High doses of any drug or nutrient are probably bad for the brain.”

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At the end of the day, clearly we need to research the potential benefits of cannabis as well as the risks. But researchers should not allow their personal beliefs to cloud their ability to produce unbiased research. When they do that, we all lose!

Schubert sums it up well: “The problem with this issue is that it has always been a political one. Since there is no absolute relationship between blood flow and AD, the only take home lesson from this study is that more unbiased work is required on the long-term health consequences of cannabis use.”


Thank you for visiting MDMMCC.com, the premier Medical Marijuana Certification Center in Maryland. Our Mission at the Maryland Medical Marijuana Certification Clinics (MDMMCC) is to provide the certification necessary for qualified patients to obtain Medical Marijuana in compliance with the Maryland Medical Marijuana Laws in the State of Maryland.  MDMMCC will have offices open throughout Maryland.

Could Virtual Reality Help Fight Cannabis Use Disorder?

Cannabis isn’t the most addictive substance on earth—some argue whether it’s technically addictive at all—but it’s nevertheless true that people sometimes have difficulty reducing or stopping their consumption. Some studies suggest that a small portion of people are prone to what researchers call “cannabis use disorder,” which can interfere with daily life. Now, psychologists seeking to treat the disorder are exploring a new weapon in the fight: virtual reality.

A team led by Melissa Norberg, a psychology professor at Sydney’s Macquarie University, this month published a systematic review of cannabis cue-reactivity studies in the journal Addiction. Cues are the objects or actions that can trigger strong cravings in dependent drug users. Cue-reactivity is the combination of our responses to cues, related attentional biases, and craving.

“Our systematic review showed that individuals who regularly smoke cannabis pay a lot of attention to cues associated with use,” Norberg said. And virtual reality could be an important tool in helping reduce the impact of those triggers. “There may be potential for the use of VR for people who want to stop using cannabis.”

Replicating cues in virtual reality environments could be used in so-called non-use training. The idea is that subjects are shown the cues they associate with cannabis but then aren’t given an opportunity to consume. In theory, the training weakens the learned associations between a trigger and the desire to consume. Virtual reality could allow for realistic exposure to cues in controlled research and clinical environments.

“Therapists are not able to attend parties with their clients,” Norberg pointed out. “Thus, they are unable to directly help someone resist smoking weed at a party, but they could indirectly help someone with VR. Party paradigms can be created, and individuals can practice seeing cues in the VR environment and then not smoke.”

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One of the studies that was canvassed but ultimately excluded from Norberg’s review was a 2009 paper from a team of scientists led by Patrick S. Bordnick of the University of Houston. In that study, Bordnick played cannabis consumers five minutes of classical jazz (for reasons not explained in the paper), and then used virtual reality to expose them to cues—such as cannabis accessories or someone rolling a joint—associated with consumption.

The study found that exposure to such cues had a significant effect on self-reported cravings for cannabis compared to subjects shown “neutral” imagery.

Another study, published in Frontiers in Human Neuroscience in 2014, looked at how virtual reality might be used to meet “the unmet clinical need” of suppressing cravings among people struggling with substance disorders. The study found that across a range of substances, exposure to cues in virtual reality environments was successful in inducing cravings. As technology improves and virtual reality environments become more realistic, subjects will be able to interact with those in more complex and sophisticated ways, potentially opening the door to new treatment options.

In Australia, however, Norberg cautioned that virtual reality “as a standalone” may have some limitations. Among them is the difficulty of incorporating surprise, an important learning tool in exposure therapy. In other words, people expecting to be exposed to cues may not benefit from that exposure in the same way. It’s a phenomenon that hasn’t yet been tested with respect to cannabis, Norberg said, although “we definitely need research in this area to inform how and under what circumstances VR might be helpful to individuals who no longer wish to use cannabis.”


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