Tag: Health

Is Smoking Cannabis Before or After Surgery Safe?

Most would agree that preparing for surgery is an anxiety-laden task, and with fair reason—whether elective or not, surgery is a serious matter. For the cannabis lover, it may seem obvious to turn to a toke to soothe the nerves in preparation for the big event, but is it wise to do so? Are there any contraindications to smoking before surgery? How about smoking after surgery, and does cannabis make a good post-op medicine?

To find out, Leafly reached out to Dr. David Bearman, a leader in cannabinoid medicine with a long career in drug abuse treatment and prevention, as well as author of the book Drugs Are Not The Devil’s Tools. Dr. Bearman’s credentials are extensive, ranging from his time serving the U.S. Public Health Service, to co-founding the American Academy of Cannabinoid Medicine, and much more.

The top question on the list: Is it safe to consume cannabis before a surgery? The answer, as one may expect, is not a simple yes or no, but instead relies on a few variables.

Note: Although Dr. Bearman is providing his expert opinion, as with all medical concerns, please consult with your doctor or surgeon about consuming cannabis before or after a surgical procedure. For more information, please refer to Leafly’s Terms of Service

How long before surgery should one stop smoking cannabis, if necessary?

Hospital operating room clock
Bearman
: The therapeutic and recreational effects of smoking cannabis usually last from 1.5 to 2.5 hours. For most surgeries, patients arrive at the hospital more than three hours prior to the surgery.

However, smoking can cause increased sputum production; for that reason, I would recommend not smoking cannabis for several hours prior to the surgery.

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In terms of people who are using oral administration, the effects are going to last 3-6 hours. The night before surgery you are instructed not to eat anything after 10:00 p.m., so if you follow pre-op instructions, any effect from oral use would be gone well before the surgery.

There is some speculation that cannabis may affect the heart adversely. Are there any contraindications that heart patients should be aware of?

Bearman: I don’t want to glorify it by calling it a study, but a “study” was done on the East Coast a few years ago suggesting that people who smoke cannabis have an increased chance of having a heart attack. This was a retrospective study, never reproduced, and highly criticized, so I don’t think that I have seen any strong evidence that would suggest that cannabis has adverse cardiac effects.

The effects of cannabis on the heart are, how can I say, not very large and are variable. According to the 1999 Institute of Medicine report, the effects on blood pressure is that it may make it go up or down by five milligrams. That’s not an enormous amount; it’s basically the same as saying it doesn’t have much effect.

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Now what I’ve noticed in a very small number of patients who have severe hypertension, is that cannabis can be amazingly successful in lowering their blood pressure to the normal range. I think that for people who have severe hypertension, I would suggest avoiding cannabis use before surgery, just because we don’t know what the effects of it are going to be. It’s possible that they might actually end up with hypotension—the combination of the cannabis and the anti-hypertension medication might be confusing to the anesthesiologist, who needs to know all the medications they’re on.

It’s very important that if a person is regularly using cannabis that they make sure they let the anesthesiologist know, so the anesthesiologist is aware of all of the medications they’re taking, including cannabis.

Now, in addition, there is supposed to be a fleeting effect [by cannabis] on pulse; it may cause it to increase. Frankly, I don’t know how fleeting it is, but I’ve seen thousands of patients and I don’t think the pulse rate of my patients is any more abnormal or higher than the average patient. So, I don’t think it’s a big deal, because it’s unlikely [your doctors] are going to let you smoke marijuana a half hour before your surgery.

What’s the best method of consumption before surgery?

Sea Salted Chocolate Chip Cookies, Hot Out of the Oven

Bearman: As mentioned, when cannabis is smoked it does cause an increase in cough and an increase in sputum production, so it’s probably not a great idea to smoke it prior to a surgery. If a patient is going to use it before surgery they’re going to want to choose a method other than smoking. Since vaporizing has 70% [fewer] irritants than smoking, if a patient wants to use the respiratory method, they should vaporize.

Alternatively, a patient may want to use an oral administration such as a tincture or edibles.

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Is cannabis a beneficial choice as a post-op medicine?

Prescription Medication Medicine Pill Tablets

Bearman: Yes, I think using it post-op is fine. Again, I wouldn’t smoke it. Particularly after abdominal surgery—that would be a contraindication. With abdominal surgery, doctors don’t want to see you coughing or vomiting. When a surgeon cuts into a person’s abdominal, sutures everything up, and then they start coughing or they start vomiting, the sutures start to come undone because of an increase in the inner abdominal pressure.

So, I would certainly think that cannabis is very useful for treating pain post-operatively, but in particular with abdominal surgery I wouldn’t smoke because of the possibility of coughing. If a patient wants to use the respiratory route they may want to try vaporizing, or it may be more prudent to use an under-the-tongue spray or other routes of oral administration.

Interestingly enough, historically if you go back to the 19th century, and certainly before that, cannabis was used as a childbirth anesthetic. One of the things we know about the cannabinoids is that many of them have analgesic properties, and THC has the most. It may decrease the dosage of pain medication that the person requires post-operatively.


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 Detox Symptoms and Withdrawal Remedies

Cannabis Detoxing Symptoms and Withdrawal Remedies

Sad girl lying in bed

For whatever reason–be it a drug test, tolerance break, nutrition, or something else–you’ve decided to detox from cannabis. Although detoxing is sometimes synonymous with withdrawal, a THC detox won’t leave you shaking, sweating, or tweaking out. That said, depending on the frequency and quantity of your consumption, it’s still possible to experience unpleasant symptoms.

Possible negative side effects of detoxing include:

  • Irritability
  • Headaches
  • Depression
  • Anxiety
  • Decreased appetite
  • Insomnia

These side effects are temporary and may not affect everyone. Those with trouble sleeping, for example, may find that their sleep quality was increased when consuming cannabis, and difficulty may return with a THC detox.

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Individuals who use cannabis regularly should consider that their body has become accustomed to an outside source of cannabinoids, so it can take several days of adjustment for the body to its own naturally produced endocannabinoid levels. Since excess THC is stored in fat cells, it may take a few months to work through the reserves. However, most people do not experience withdrawal symptoms lasting more than a few days, unless cannabis was being used medicinally for conditions such as depression, anxiety, low appetite, or insomnia.

So are there any positive side effects?

If you’re one to enjoy dreaming, you will be happy to hear that most people experience an increase in vivid and lucid dreams while abstaining from cannabis. Why is this? Cannabis decreases time spent in REM sleep in favor of deeper, more restful sleep known as “deep sleep.” Deep sleep is when the immune system is strengthened and the body repaired. However, REM sleep is when the brain is most active and dreaming is more intense. The increased REM sleep following cannabis abstinence should lend to more interesting, complex dreams, which will likely be considered a positive side effect for those who enjoy dreaming.

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Medical Cannabis Alternatives

Sliced Fresh Ginger

If you use cannabis medicinally, there may be some natural alternatives that can act as a stand-in during the detox process.

Insomnia: Valerian Root, Chamomile, Magnesium Oil

There are a few options for those who struggle to slip into restful sleep. You may consider some or even all of these as a possible alternative while cannabis is not an option.

For example, valerian root has been used for thousands of years as a sedative, and some may find it to be an effective, temporary aid to fall asleep faster and increase quality of sleep. It may be enjoyed in capsule or tea form. Some side effects and pharmaceutical interactions are possible, so consult your doctor before use.

Another option for a restful night is chamomile. An herb that has been utilized as a sedative since ancient times, chamomile flower makes for a delightful sleep-inducing tea. Alternatively, chamomile is also often smoked to achieve the same results, making it a particularly alluring choice for those who are used to smoking or vaping cannabis before bed.

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Last but not least is magnesium oil, which relaxes muscles and calms nerves. Magnesium also happens to be a common deficiency among United States citizens, and low magnesium levels can increase stress and nervousness, which hinders sleep. As such, adding magnesium to a daily regiment can help improve quality of sleep. Topical magnesium oils are a good choice, as magnesium is well absorbed through the skin. Apply the oil as directed before bed. As always, consult a physician before use.

Inflammation: Turmeric

Cannabis is a powerful anti-inflammatory, and many patients use it to soothe inflammation in various parts of the body. With cannabis out of the picture, consider adding turmeric to your regimen. Turmeric is a well-known, effective anti-inflammatory for conditions both in and outside the body. For those who aren’t sure how to incorporate it into a diet, turmeric is available in pill form and can be added to a daily vitamin spread. Consult with a physician before increasing turmeric consumption to avoid complications.

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Low Appetite: Ginger Root

For those who rely on cannabis to nurture a healthy appetite, it will be wise to aid digestion during a time of detox. Ginger oil improves digestion and decreases intestinal gas. A cup of ginger tea in the morning, sweetened perhaps with a little honey, will be an effective way to kick start digestion and prep your stomach for food. Alternatively, some sources suggest certain herbs may stimulate and increase appetite.

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Depression: St. John’s Wort, Ashwagandha

For mild depression, St. John’s Wort may provide relief by supporting elevated mood and a calm mind. The herb can be taken via capsule or tea. Some side effects and contraindications are possible, so consult a doctor before use.

Similarly, Ashwagandha has been shown to be effective in improving mood and mental health.

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Anxiety: Ashwagandha Root, Kava Root

Originating from India, Ashwagandha, or “Winter Cherry,” is an Ayurvedic herb often used as an effective aid against anxiety and other mental health conditions such as depression. It is available in powder or tablet form. Consult a doctor before use.

An alternative and perhaps more controversial option for treating anxiety is kava root. Native to South Pacific islands, this unique plant has a complicated history. While most tend to agree that kava is effective at sedating, calming, and soothing anxiety, some evidence suggests possible negative side effects on liver health. Speculation remains open, so caution is advised. Kava can be taken via capsule or tea.

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The detoxification process may not be the most enjoyable experience, but it can be very rewarding in the end. For more information on how long THC sticks around in the body and how to detox properly, check out Parts 1 and 2 of this series.


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.

Chronic Pain Is Now a Qualifying Condition in New York State. Here’s What That Means for Patients

After months of regulatory review and public comment, New York last week officially added chronic pain as a qualifying condition for its medical cannabis program.

The change was long overdue in the eyes of many patients, coming more than a year after New York’s medical cannabis program began in January 2016. The rollout has happened slowly: While initial estimates pegged the number of potential patients at somewhere between 200,000 and 400,000, so far only 15,000 patients and 911 registered practitioners are part of the program. Many hope the inclusion of chronic pain as a qualifying condition will open the doors to patients who so far have felt shut out.

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Chronic Pain: How to Qualify

The first step to getting a medical cannabis card in New York is establishing a doctor-patient relationship with a state-certified practitioner.

“We have over a hundred patients who’ve been contacting us since at least December,” said Manhattan-based Dr. Ken Weinberg, who had a full slate of appointments starting at 9:30 a.m. on the day the program launched. New patients to Weinberg’s practice, Cannabis Doctors of New York, are required to provide extensive medical paperwork, but unlike many other clinics, the practice doesn’t require a referral from a primary doctor.

What qualifies as chronic pain? According to the state Department of Health, it’s “any severe debilitating pain that the practitioner determines degrades health and functional capability.” To qualify for medical cannabis treatment, the department requires that a patient “has experienced intolerable side effects, or has experienced failure of one or more previously tried therapeutic options” and that pain has lasted longer (or is likely to last longer) than three months.

Chronic pain is a symptom of a variety of illnesses, from endometriosis to arthritis to traumatic injuries. Many who suffer from it rely heavily on opioids.

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Rachel Schepart is a pharmacist who oversees PharmaCann’s four dispensaries. Part of her job involves working directly with doctors to integrate cannabis into existing treatment regimens and help wean patients off other drugs.

“We all know opiates are overprescribed, but what a lot of people don’t realize is that there are a certain percentage of patients that are taking opiates but are still not under pain control” she said. “They’re living in a chronic pain scenario even on traditional medication. This is where the opportunity for medical marijuana is … so that they can get off their opiates or maybe even get off of pain.”

A majority of New York’s medical marijuana-certified doctors still don’t advertise their services.

Some patients who begin taking opioids looking for pain relief end up abusing the drug, developing addictions and fueling the country’s deadly overdose epidemic. Medical cannabis helps mitigate that. It’s not chemically addictive, nor has it caused a single recorded overdose death. Moreover, states that have implemented medical marijuana programs have seen opioid overdose deaths decrease by 25%.

But patients interested in trying medical cannabis needn’t be recovering opioid addicts. While New York mandates that a patient has to have tried other therapeutic options before seeking cannabis, those treatments include a range of holistic and low-intervention treatments, such as occupational therapy, massage therapy, acupuncture … acetaminophen, [and] topical creams or ointments,” among others.

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“There’s an incredible amount of discretion tacitly imbued in the physician, saying we trust the physician to find the best way to treat this,” said David C. Holland, the legal director for Empire State NORML. “Doctors who are in compliance with the New York state statute can feel comfortable believing that they will not be the target of a federal investigation because of the well-regulated state-level framework.”

‘The Biggest Issue Is Acceptance’

Despite the reassurance from advocates, some doctors still are hesitant to embrace cannabis due of its federal status as a Schedule I  controlled substance. A majority of New York’s medical marijuana-certified doctors still don’t advertise their services.

At Compassionate Care NY, a patient advocacy group that fought to pass the state’s medical marijuana law,more than 50% of outside inquiries are from patients with chronic pain looking to qualify for medical cannabis. “As a patient advocacy group, we try to give patients the tools they need to navigate the system on their own,” said Kate Hintz, an advocate for the group. “This may mean helping them start a conversation with a doctor they feel might not be open to cannabis therapy, or steps they can take to communicate issues or problems to the Department of Health.”

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Dent Neurologic Institute in Buffalo requires a doctor’s referral in order to be seen. As a comprehensive neurological research center, the Dent Cannabis Clinic is one of the rare cannabis clinics that accepts insurance for consultations. Amanda McFayden, the clinic manager, estimates that it has a waiting list of more than 600 patients referred for chronic pain.

“The opioid medications, they make you drowsy and nauseous. So I decided to go in another direction.”

Chris Reid, medical cannabis patient

The clinic’s 16 certified practitioners now serve 527 patients—or roughly 3.5% of the state’s entire medical cannabis population. The demand has led Dent to open the clinic on Saturdays, and on a recent Saturday morning it had more than 40 consultations scheduled. Patients who are approved for medical cannabis are asked to return to the clinic for an initial follow-up visit after starting treatment, returning every two to three months afterward.

Patients without a referral are often forced to scour the internet looking for doctors willing to publicize their cannabis certification. New York has an online database that doctors may use to refer patients, but the information isn’t accessible to the general public. “The biggest issue is acceptance within the the physician community and enrollment,” said Hillary Peckham, the spokesperson and chief operations officer for Etain, a chain of woman-owned medical cannabis dispensaries. “We need to focus on getting the physician community—including nurse practitioners and PAs—on board, taking the course and getting enrolled.”

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Chris Reid, 44, found a cannabis-certified doctor online. He was at the doctor’s office first thing on a recent Wednesday morning, and later that afternoon he registered at the Etain dispensary in Yonkers. He expects to get his card in the mail within a few days. A former corrections officer, Reid retired early due to constant pain from injuries sustained on the job.

“I’ve had three spinal cord surgeries and am on a pain management system I really don’t care for,” he said, adding that “the opioid medications, they make you drowsy and nauseous.”

“So I decided to go in another direction,” Reid said. “I think if more people knew it was attainable, they would try.”


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.

Is THCV Psychoactive?

It’s “the sports car of cannabinoids,” according to one California cannabis testing lab. That’s certainly a sexier way of referring to the THCV molecule than by its full name, tetrahydrocannabivarin. But the zippy tagline might be misleading. While some claim the little-known cannabinoid packs a punch—“a powerful high without the munchies,” one website promises—the science tells a different, much more complicated story.

THC is, of course, famous for its psychoactive properties. CBD, by contrast, is known for having next to none. As science dives deeper into the physiological effects of lesser-known compounds in cannabis, there’s always that voice calling from the sideline: “Yeah, but does it get you high?”

When it comes to THCV, the answer is… probably. We’re not 100% sure yet.

This is science, after all. It’s complicated.

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Researchers haven’t been talking about THCV for long. In the 1960s, scientists were isolating and identifying all sorts of new cannabinoids: CBD, CBG, CBC, CBDV, and—in a seminal 1970 paper—THCV. The vast majority of study, understandably, focused on that intriguingly psychoactive molecule, THC.

Figure 1: (Amy Phung/Leafly)Figure 1: Enzymes in the cannabis plant convert cannabinoid precursors CBGA and CBGVA into a variety of cannabinoids. (Amy Phung/Leafly)

Like you might guess from those letters, THCV is a not-too-distant cousin of THC. A side-by-side diagram makes clear THCV is basically the THC molecule with the end snipped off, just a few carbon atoms shy of what emerged as the family favorite. Science calls this an analogue—it’s similar, but different in an important way.

THCV-vs-THC 3Figure 2: Molecularly speaking, the THC and THCV differ only by a few carbon atoms. (Amy Phung/Leafly)

THC is what’s called a CB1 receptor agonist—it activates CB1 receptors in the brain, and that activation is what allows for psychoactive effects.

Early studies suggested THCV was about a quarter as potent as THC in this regard—meaning it did seem to exhibit psychoactive effects. But later research suggested something interesting: The behavior of the molecule seems to change depending on the dose.

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At lower doses, THCV acted as a CB1 antagonist—in very, very simple terms: does not get you high. At higher doses, however, it can switch, behaving as a CB1 agonist, much like THC. In other words, take a lot of THCV, and zoom—it’ll tickle that CB1 receptor and produce a psychoactive buzz.

(For a quick catch-up on how these receptors work, see Bruce Barcott’s explanation of why THC is psychoactive and CBD isn’t.)

The buzz associated with THCV, from what little science has studied it, appears to be clear-headed and stimulating. It’s said to intensify the euphoria of THC—although it doesn’t last as long. A THCV-induced high seems to set in quickly yet fade faster, demonstrating about half the duration of THC.

THCV seems to act a bit like CBD in that it modulates and dampens some traditional effects of THC.

There are good reasons beyond the buzz to study THCV. If you’ve read about the cannabinoid before, for example, you’ve probably read of lab tests that show the cannabinoid can suppress food consumption and even encourage weight loss. (Queue a parade of articles on “skinny pot.”)

Keep in mind, first, that THCV is a minor cannabinoid, found at trace levels in most strains. It’s found at slightly higher concentrations in certain strains of African descent, and in some cases plants “highly predominant in this agent have been produced,” leading cannabinoid researcher Dr. Ethan Russo wrote in 2011.

Most consumers will probably (for now) only encounter THCV in small amounts, for example in African landrace strains like Durban Poison. Even if you’re able to track down a higher-THCV strain, such as Doug’s Varin or Pineapple Purps, you’ll be consuming THCV alongside other cannabinoids—most notably THC.

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THCV seems to act a bit like CBD in that it modulates and dampens some traditional effects of THC, which normally bind easily to CB1 receptors in the brain. Take THCV’s effect’s on the munchies: In mice, the ingestion of THCV has led to decreases in both food consumption and body weight. (Decreased food consumption is a general effect of compounds that block CB1 receptors.)

The effect doesn’t seem to turn off hunger completely. Mice deprived of food—the ones that were truly hungry, in the nutritional sense of the word—ate roughly the same amount whether they’d received THCV or not. Nor did it decrease food intake or body weight of obese mice, though THCV did seem to improve insulin resistance in those animals. That’s likely one reason scientists have begun looking into the possible effects of THCV on diabetes.

Dosing may also play a role here. If THCV is blocking CB1 receptors at lower doses and reducing food intake, we might expect higher doses to activate those receptors and instead increase food intake. But that’s just speculation—such an experiment hasn’t been tried yet.

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There are also indications THCV could reduce anxiety attacks in PTSD patients, improve tremors and motor control problems associated with Alzheimer’s disease, and stimulate the growth of bone cells. Research suggests it may also have anti-inflammatory effects.

For now, we still don’t know a ton about THCV. In cosmic terms, it’s a tiny satellite in a system that science has only recently pulled into view. We’ve long been dazzled by the sparkle of THC. We’re starting to understand the sway of CBD. But as we pull them into focus, THCV and other less obvious cannabinoids are proving to be captivating worlds of their own. What a universe a single plant can unlock.

References:
Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011;163(7):1344-64. PDF
Mcpartland JM, Duncan M, Di marzo V, Pertwee RG. Are cannabidiol and Δ(9) -tetrahydrocannabivarin negative modulators of the endocannabinoid system? A systematic review. Br J Pharmacol. 2015;172(3):737-53. PDF
Gill EW, Paton WD, Pertwee RG. Preliminary experiments on the chemistry and pharmacology of cannabis. Nature. 1970;228:134–136. PDF

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.

How Does Cannabis Interact With Other Drugs?

Virtually all chemical compounds, from over-the-counter drugs and prescription pharmaceuticals to illicit substances, interact with other compounds. There are, for example, 82 identified drug interactions with caffeine (of which 25 are classified as moderately severe to severe). Even seemingly benign substances, like grapefruit, are known to interact with many prescription drugs. When it comes to cannabis, most potential interactions that have been identified are relatively mild. And, in fact, some drugs seem to work together with cannabis favorably.

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But, before we dive deep on some of the most common drugs people combine with cannabis, it’s important to understand the difference between an “additive” and “synergistic” effect. Additive simply means the interaction between two chemicals equals the sum of their parts (e.g. 1+1 = 2). Synergistic means that when two chemicals interact, the effect is greater than the sum of their parts (e.g. 1+1 = 3. Sounds like “alternative math!”). Likewise, keep in mind that THC/CBD ratios and different strain profiles (with variable cannabinoid and terpene profiles) can influence effects.

Note: in some cases, cannabis may actually increase the effectiveness or potency of other drugs. But, even if the interaction is potentially beneficial, close monitoring by a medical professional, along with regular blood work, is important as a patient may need adjust their dosing accordingly.

Drugs That Affect Blood Sugar Levels

close up of hands making injection by insulin pen

Interestingly, there is evidence to suggest cannabis may decrease insulin resistance, improve the metabolic process, and improve blood sugar control. However, most evidence comes from large epidemiological studies that analyze general patterns, including the causes and effects of various health conditions within specific populations. (Several studies found that cannabis users had lower rates of obesity and diabetes when compared to non-users.) However, far fewer studies look specifically at how THC, CBD, or other cannabinoids interact with other drugs that have known effects on blood sugar (like insulin).

Although we don’t have conclusive evidence, it’s possible cannabis may work together with other drugs favorably. But, by the same token, there could be a risk that cannabis combined with other drugs could lower glucose levels too much. Clearly, patients should continually monitor the effects (under medical supervision) to mitigate potential risks and adjust medication appropriately.

Drugs That Lower Blood Pressure

Measuring blood pressure

One of the major features of THC is that it simultaneously activates the CB1 and CB2 cannabinoid receptors. Activating both receptors induces a cardiovascular stress response that can elevate cardiac oxygen consumption while reducing blood flow in coronary arteries. While reports of adverse events are relatively rare, patients who are taking blood pressure medication should be aware that cannabis may compound effects.

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Drugs That Increase Risk of Bleeding

Medication - Over the Counter, otc

Both THC and CBD may increase the effect of drugs used for blood thinning (e.g. warfarin or heparin), or drugs known to carry their own risk of blood thinning (e.g. ibuprofen, naproxen, etc.). How? By possibly slowing down the metabolism of these drugs. To a lesser extent, THC may displace warfarin from protein binding sites.

Opioids

Several Prescription Pill Bottles in a Pile

Most studies suggest there is a bidirectional modulatory relationship between the body’s natural opioid system and the body’s natural cannabinoid system (the endocannabinoid system). However, characterizing the specific mechanisms by which they interact proves challenging. Nonetheless, the pain-relieving properties of cannabis are well-established. And, many medical professionals have come forward to suggest cannabis (as an alternative pain medication) could play a role in stemming the overuse of prescription (and illicit) opioids.

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There’s no question. From an abuse potential and toxicity perspective, cannabis as a substitute to narcotic pain medications would be a far better first-line drug for management of chronic pain.

However, what about as an adjunct to opioid therapy? How does cannabis measure up? Could cannabis reduce a patient’s reliance on opioids, or would combining the two elevate risk of concurrent dependency or abuse?

Examining the subjective effects of vaporized cannabis in conjunction with opioids, Dr. Donald Abrams, an oncologist from UC, San Francisco, and his team published a small study in 2011. They found no significant change in opioid blood level concentrations after exposure to cannabis. Moreover, patients reported a 27% decrease in pain following cannabis administration.

Abrams concluded that cannabis can, in fact, safely augment the pain-relieving effects of opioids. His team also found that combining opioids and cannabis may allow for treating patients with lower opioid doses while reducing risk of dependency and fewer side effects. Several other studies, which we’ll explore further in an upcoming series, support the findings from Abrams’ study.

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Alcohol

Red wine

Mixing alcohol with virtually any drug is generally not a good idea. In fact, mixing it with some drugs (particularly opioids and central nervous system depressants like benzodiazepines, barbiturates, and sleep meds) can prove fatal. But, what about alcohol and cannabis? There’s no doubt: cannabis and alcohol is a popular combination. But what does the research say? Is mixing these two substances okay?

Overall, drawing a conclusion based on available research is subject to interpretation and personal biases. The same studies can be interpreted positively or negatively, depending on your perspective. On the one hand, studies have provided compelling evidence that alcohol increases blood THC levels (although no evidence suggests the converse–that THC increases blood alcohol levels). On the other hand, some research suggests people consume less alcohol when they use cannabis.

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These two findings aren’t mutually exclusive. In fact, they make sense. If THC reacts to alcohol by potentiating the desired effects on mood, then one would need less alcohol.

After digging back to 1985, I did find one study published by the National Institute on Drug Abuse (NIDA), Alcohol and Marijuana: Concordance of Use by Men and Women, that examined consumption pattern differences in three different environments (only alcohol is available, only cannabis is available, both are available).

Here’s what they found:

  • 14 out 16 subjects drank significantly less alcohol when both alcohol and cannabis were available (compared to when only alcohol was available)
  • 12 of the 16 subjects consumed slightly more cannabis when both were available (compared to when only cannabis was available)

Basically, when people have access to both substances, their consumption patterns change: they smoke a little bit more, but they drink a lot less! It was a small study, so we can’t necessarily generalize the findings; however, they do seem consistent with most people’s experiences.

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That being said, one still needs to be cautious. For one, alcohol and cannabis together pose even greater dangers driving than when using either one independently. Second, if someone has had too much to drink–to the point they need to vomit to expel the toxins–know that cannabis inhibits nausea and vomiting. By preventing yourself from vomiting, you’re putting yourself at greater risk of suffering from alcohol toxicity.

Sedatives

Pills

Many sedatives–such as alcohol, benzodiazepines (Ativan, Valium, etc.), some antidepressants, barbiturates such as phenobarbital, and narcotics such as codeine–influence GABA neurotransmitters in the central nervous system, producing a calming effect. Likewise, cannabinoids like CBD and THC as well as terpenes like myrcene and linalool, can produce sedative effects. (Although, each of these compounds produce effects differently, and sometimes paradoxically. For example, higher doses of THC can actually be stimulating and increase anxiety, while CBD can be both calming or wake-inducing.)

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When combined with sedatives, cannabis produces an additive effect. Cannabis doesn’t seem to elevate blood levels or potentiate the sedative actions of other sedatives (as would be the case if it were synergistic effect). Therefore, while it’s not as risky as mixing alcohol with sedatives (which can prove deadly), the combination is still risky. Users should exercise extreme caution, or better yet, avoid the combination altogether.

CBD and Cytochrome P450

Neuron cell network

Cytochrome P450 isn’t a drug. It’s a class of essential enzymes known to play a significant role in drug interactions–not just with cannabis, but many drugs. Although evidence suggests CBD is largely safe, well-tolerated, and non-addictive (even anti-addictive), in some patients it can interact synergistically (beneficially or adversely) with other medications. How so?

Most notably, the interplay between CBD and cytochrome P450 seems be most prominent when it comes to epilepsy and anti-seizure medications. One small study published in 2015 found that CBD elevated blood concentrations of clobazam (an anticonvulsant) in children while elevating norclobazam (an active metabolite of clobazam).

The good news is the remedy seems fairly straightforward: reduce the dose of clobazam, which reduces side effects. Moreover, the study found that all but four of the subjects (out of 13) had a 50%+ reduction in seizures. The researchers concluded CBD (in combination with clobazam) is a “safe and effective treatment of refractory epilepsy.”

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There are a few other potential interactions that we’ll go into more depth in an upcoming series. But in short, CBD inhibits breakdown of warfarin (a blood thinner), thereby increasing its duration of action and effect. Patients taking CBD-rich products should pay close attention to changes in blood levels and adjust dosage accordingly as instructed by their doctor. Also, patients who are undergoing chemotherapy and taking CBD should be aware that the same dose of chemotherapy may produce higher blood concentrations.

In Summary

For most patients, cannabis is relatively safe, well-tolerated, and carries fewer risks of adverse drug interactions than many other commonly prescribed drugs. Nonetheless, cannabis is not a single drug; it’s a complex plant comprised of numerous compounds from cannabinoids to terpenes. Influenced by these cannabinoid and terpene profiles, potential interactions, both good and bad, can vary from strain to strain. Drawing broad conclusions on how this “pharmacological treasure chest” interacts with other drugs is inevitably imprecise.

Nonetheless, given its therapeutic versatility, one of the most compelling arguments for cannabis is that it can actually reduce the need to combine multiple medications that have a high risk potential of producing adverse interactions. Dr. Donald Abrams, chief of hematology-oncology at San Francisco General Hospital and a professor of clinical medicine at the University of California, San Francisco, echoes this important but often overlooked point: “Why would I write six different prescriptions, all of which may interact with each other, when I could just recommend one medicine?”


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.

Does Cannabis Use Lower Your IQ?

The manner in which cannabis affects IQ has long been a hotly debated topic. Policymakers, parents, researchers, and, of course, the media, passionately (and empathically) weigh in on the debate. The debate often plays out in the press.

How many times have you seen headlines like this?

Fox News writes: Pot Does Lower IQ, Study Finds

On, the other side of the spectrum, the Washington Post opines: No, Marijuana Use Doesn’t Lower Your IQ

So, who’s right?

“Yes, Cannabis Lowers IQ.”

library

Most of the reports that cannabis lowers IQ rely on one study: the seminal Dunedin Study led by Madeline Meier. In all fairness, it’s one of the best studies we have to date. Most research of this kind is retrospective (or captures a small period of time); the Dunedin Study, on the other hand, is a prospective cohort study.

In retrospective studies, individual outcomes of the participants are known from the outset, and the investigators look back in time to determine how various factors influenced the outcome. Prospective studies, on the other hand, don’t know the individual outcomes from the outset; they follow a group of people over time, identifying predicted outcomes and determining how various factors influence the outcomes.

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In the Dunedin Study, researchers followed 1,037 people born between 1972 and 1973 in Dunedin, New Zealand, from birth to age 38. In fact, their study pool represented 91% of all eligible births. The study—like all studies—had limitations. But, unlike far too many studies, the authors were candid in what their limitations were, and tried to minimize their influence by excluding many of the most common confounding factors that could provide alternative explanations for an IQ decline, including:

  • Acute or residual cannabis intoxication
  • Tobacco dependence
  • Hard-drug dependence (e.g., heroin, cocaine, amphetamines)
  • Alcohol dependence
  • Schizophrenia

There are other potentially unaccounted factors that could influence outcomes. For example, could it be people with unknown (or undefined) shared characteristics are more likely to misuse cannabis at a young age, and these shared characteristics are associated with a decline in IQ? We know nutrition, industrial toxins, stress, and exposure to trauma are a just few factors that can influence IQ (and possibly the risk of addiction).

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However, it’s impractical to control for every possible confounding factor. What we expect is that the authors are forthcoming in their study’s limitations, and that they make their best effort to control what they can. The Dunedin team clearly did that. It was well designed, and the authors were nuanced in their conclusions.

The authors examined six hypotheses:

  • Cognitive decline: Persistent cannabis consumers demonstrate greater decline in test performance from childhood to adulthood than nonusers.
  • Specificity: Are impairments confined to specific neuropsychological domains or are they present across each of the five specific domains? The authors hypothesized that impairments aren’t limited to specific cognitive domains.
  • Education: Some evidence suggests staying in school can boost one’s intelligence. Could persistent cannabis consumers experience neuropsychological decline simply because they abandoned academics in favor of other opportunities?
  • Everyday Cognition: Does cannabis-induced neuropsychological impairment translate into functional problems in daily life? The authors posit that it would.
  • Developmental Vulnerability: Cannabis has heightened toxic effects on the developing brain, thus adolescents are particularly vulnerable to the effects of persistent cannabis use.
  • Recovery Hypothesis: Former persistent users who quit or reduce their cannabis use may be able to restore their neuropsychological health.

What were their conclusions?

  • Early initiation to cannabis correlates to a decline in IQ as adults, with more persistent use associated with a greater decline in IQ.
  • Predictably to some, surprisingly to others, they found no decline in IQ among individuals who waited until they were adults before using cannabis. This finding was consistent not only among casual users, but also among those with a use disorder.

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How did abstainers compare to users?

This is where it gets interesting.

Abstainers: Of the 1,037 study participants, 242 reported never having used cannabis. Those participants experienced a modest uptick in their IQ—from 99.84 to 100.64.

Casual Users: 479 participants reported prior cannabis use, but were never diagnosed with a use disorder. This group experienced a modest decline in IQ—from 102.32 to 101.25. Roughly one point.

Problematic Users: Among the 38 participants who met the criteria for cannabis use disorder at three out of five follow-up assessments (ages 18, 21, 26, 32, and 38), the IQ decline was far more profound. They experienced a decline nearly six points—from 99.68 to 93.93.

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What was particularly interesting is the IQ difference between those reporting being lifelong abstainers versus those who reported prior cannabis (but had never met the criteria for a use disorder). The average IQ for the latter was nearly 2.5 points higher than the abstinent group prior to induction into cannabis. At age 38, due to modest upticks in the “never used” group and the modest decline in the “used, never diagnosed” group, the IQ gap narrowed. But the “used, never diagnosed” group managed to maintain a 0.61 point IQ advantage. Perhaps that finding warrants a headline: “Study: Cannabis Abstainers Are Less Intelligent Than Casual Users.”

“No, Cannabis Doesn’t Lower IQ.”

Development Team Cooperating In Their Office.

Contrary to many assertions, the Dunedin Study was well designed and the authors attempted to control many of the most common confounding factors that could have tainted the results. Interestingly, many of those who initially criticized this study as biased later praised the authors’ follow-up study (analyzing the same populations) that found the only negative physical health effect associated with long-term cannabis use was an increased risk of gum disease.

Nonetheless, several notable critiques emerged:

Declines could be explained by socioeconomic factors. Norwegian research economist Ole Røgeberg suggested socioeconomic factors could account for the decline. The basis of his argument is that cannabis use is more common among those of lower socioeconomic status, and that education temporarily boosts the IQ of these children, creating a false impression that IQ declines later in life. However, even applying these potential factors, Meier’s findings (which are consistent with other studies) have found that socioeconomic background is a poor predictor of cannabis use. Cannabis is popular across all backgrounds. Likewise, Meier didn’t find any differences in adolescent IQ versus adult IQ among those who came from lower socioeconomic backgrounds.

Personality traits explain the decline. British behavioral scientist Dr. Michael Daly suggested personality traits could explain positive non-causal associations between cannabis use and cognitive functioning. High levels of openness to experience could lead people to seek out activities—including cannabis experimentation—that promote cognitive functioning. Daly analyzed data from 6,401 individuals who participated in the British study. His post hoc analysis found openness positively predicted cannabis use and an increase in neuropsychological functioning.

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Likewise, he challenged Meier’s findings, suggesting conscientiousness (one of the five defined personality traits) may explain the cannabis decline. However, Daly didn’t assess personality—his primary predictor—until well after cannabis initiation, at age 50. Early initiation to cannabis was a central feature of Meier’s study. Moreover, Meier applied the hypothesis to her data, and found that it didn’t alter the outcomes to a statistical significance.

Sample size is too small. Others have also weighed in. Columbia University’s Dr. Carl Hart noted that Meier’s study had a very small sample of heavy users—only 38 people. The small sample size, he claims, limits how generalizable the results could be. He’s right: 38 people is a small sample size. But it should be noted that Meier’s study included three other subsets of early onset users, all of which experienced declines proportional to how persistent their use was. However, there are still likely limits to how generalizable the studies are. Why, for example, do those with one use disorder diagnosis start with the lowest IQ (lower than even those diagnosed three times), while those diagnosed twice have the second highest starting IQ (102.14)—second only to the “tried, never diagnosed” group—of all groups?

Twin Studies on Cannabis and IQ

Marijuana bud close up

As I mentioned previously, it’s virtually impossible to eliminate every potential confounding variable. However, one way to eliminate most of them is by conducting a study on twins. And, at least one such study did just that. A multi-institutional study, “Impact of adolescent marijuana use on intelligence: Results from two longitudinal twin studies,” compared IQ changes in twin siblings who either used or abstained from cannabis during a 10 year period. After accounting for potentially confounding familial factors, the scientists found no link between cannabis use and a decline in IQ. In twin sets where one twin used cannabis and the other didn’t, they found comparable declines in IQ, potentially validating their hypothesis—there were other familial confounds (such as genetics or home environment) that could account for a decline in IQ scores.

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This particular study provided the most convincing evidence to counter the Dunedin Study. However, it’s not without notable limitations. For one, the study contained little detail on frequency of use. Moreover, the study looked at two populations (Minnesota and Los Angeles), but used different surveys for each. The survey for Los Angeles posed questions with far less specificity than Minnesota. For example, if a youngster pulled a Bill Clinton and tried it but “didn’t inhale,” he or she would still be categorized as a “user.”

The Final Verdict

Life in Amsterdam

For adults, cannabis use doesn’t seem to impact IQ. However, chronic use is associated with adverse cognitive effects that seem to be reversible. For teens, the jury may be still out on how much of an impact cannabis use has. But we do know that the brain is particularly vulnerable while it still developing.

I suspect there’s truth to both sides of the debate. One, that early (and frequent) cannabis use can have persistent (and possibly irreversible) consequences. Two, it’s also likely that cannabis use is not the only factor contributing to a decline in IQ. If a kid is engaging in frequent cannabis use, chances are there are other things going on at home or in their life that may influence their addiction risk and potentially affect their IQ. However, in reviewing most of the research out there, Meier’s study thus far puts forth the most persuasive evidence that early onset cannabis use likely has a negative impact on IQ.

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The effect of cannabis exclusive of other factors may not be as profound as presented in the Dunedin Study. But the findings shouldn’t be discounted. How much does it really matter if cannabis causes a two point or six point decline? Both suggest adverse outcomes. Perception of risk—not the legality or illegality of cannabis—influences a teen’s decision to use or not. And, as the stigma around cannabis diminishes, it’s important that teens understand cannabis is not completely harmless. And that the use of it, particularly frequent use, carries risks.


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.

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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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.


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