continuing.....
Practical applications of cannabinoids and terpenes for chronic illnesses
Presentation by Mara Gordon at CannaCosta2015
Cannabinoids
The ECS is the reason cannabis functions as it does for as many different disease states.
B-caryophyllene, found in black pepper and other sources, may qualify as a cannabinoid, because it activates the CB2 receptors.
- It's not only cannabis that will stimulate the ECS, it's just that cannabis does so in so many ways as to set it apart from other sources of cannabinoids.
The euphoria caused by THC is a side benefit of all the other wonderful things the cannabinoid is doing for your healing body.
CBD doesn't offer any reported psychoactivity, but it does sometimes cause anxiety and sleepiness, which could be called psychoactivity of a different sort.
Terpenes are what you smell.
- They're involved in the entourage effect, the synergistic interplay of cannabinoids, terpenes, flavonoids, etc, the many components of cannabis sativa.
- Together they're greater than the sum of their parts.
- Full-plant extractions create very different physiological results than isolates.
Choose the terpenes you use carefully when developing medicines for particular disease states. All chemovars are not made alike.
For example, pinene is a good bronchial dialator, an anti-inflammatory, AIDS in memory function and is a good anti-bacterial, but it can also cause anxiety and allergic reaction in sensitive persons. Pine needles have high concentrations of pinene.
Limonene is very, very uplifting, is good for acid reflux, anxiety, and depression.
Linalool anti-convulsants, analgesic, and anti-anxiety. Lavender is high in linalool.
Beta-Caryophyllene has anti-inflammatory effects, is an analgesic, and will protect the cells lining the digestive tract. It's found in black pepper.
Myrcene contributes to the sedative effects of strong indicas, making it a powerful sleep aid, as well as a good muscle relaxer. It's also found in hops.
Eating a mango prior to ingesting cannabis demonstrates the importance of the entourage effect. The myrcene in the mango increases the absorbtion of the cannabinoids, thus improving bioavailibility. Myrcene has a very relaxing effect.
- When choosing your cannabis you're usually looking for something to slow you down or something to energize you. Slowing you down is what myrcene does.
- Myrcene is typically highest in the chemovars we refer to as indicas.
Sativas are used with PTSD, ADHD, Tourette's, some autism.
Indicas are preferred for chronic diseases like cancer, chronic pain, sleep disorder, etc.
Examples:
ACDC is an extremely high indica dominant chemovar bred specifically for high CBD It has little psychoactive effect for most people and is used (in conjunction with THC-rich chemovars) for epilepsy, cancer, and inflammatory disease.
Blue Dream is an extremely high THC sativa dominant chemovar that carried the Myrcene from an indica ?????? It's one of the most popular sativa dominant chemovars in the adult use market yet has ??????????? pain relief properties.
Can't read the graphic and she didn't mention them.
Granddaddy Purple (GDP) is a high THC indica strain that is very relaxing and calming. Many patients choose it as a sleep aid.
The purpose of the ECS is to create homeostasis by balancing the CNS and the immune system. Disease is the lack of homeostasis.
- Cannabinoids and receptors in the ECS will do whatever they can to create a homeostatic environment.
THC has more medical applications in current clinical work
(this was presented in 2015, and things have progressed) Without THC you're leaving the vast majority of diseases in most sick people without treatment.
Why is happiness and euphoria listed as a negative side effect?
Reefer Madness, that's why.
THCa is becoming recognized as an important medicinal component.
- THCa is an anti-inflammatory, anti-prolific, and anti-epileptic. It's an important tool in the medicine box.
- Aunt Zelda's treats a lot of seizure disorder patients, either from epilepsy or some other condition like glioblastomas or metastatic cancers that've settled in the brain or other parts of the body.
Decarboxylation frees the carbon molecules from the acid cannabinoids so they can activate the receptors. With the carbon molecules attached they won't fit the receptors.
In treating epilepsy and CBD becomes less effective or isn't effective THCa is a viable substitute. You always need a small amount of THC.
CBD is being studies as an anti-psychotic, anti-epileptic, as useful in extreme inflammatory response.
- It's good for inflammation and pain.
- CBD will be effective in keeping cancer from returning. After cancer is in remission the maintenance dose can be dropped to low THC, high CBD (can be very high) so they can live more normal lives.
How It Works: An Overview
Activation of CB1, CB2, [and GPR55?] receptor sites promotes homeostasis in all other body systems
THC has more mechanisms of action in medical applications of cannabis than other cannabinoids or terpenes. It is the most potent activator of CB1 and CB2 receptor sites. It also has anti-inflammatory properties.
THCa is an anti-inflammatory, antti-proliferative, and anti-epileptic.
THCV reduces the parinoia side effects of THC through the entourage effect. It's being studied for use in diabetes. It can act as an appetite suppressant.
CBD is being studied as an anti-psychotic and anti-epileptic, and is proven to have extreme anti-inflammatory properties more potent than hydrocortisone. It also has antibacterial and anti fungal properties. The US has (Had) a patent on CBD as an anti-inflammatory and neuro protector.
CBG, when combined with THC, is a powerful pain suppressant (Entourage effect)
CBN, when combined with THC, is a sleep agent (Entourage effect)
CBC is a potent anti-bacterial, anti-fungal, and analgesic.
CBDV is another non-psychoactive cannabinoid that shows promise with epilepsy.
There are somewhere between 200 and 500 terpenes found in cannabis and new cannabinoids are being discovered al the time.
CB1 receptors primarily in CNS, CB2 receptors primarily in the immune cells of the lymphatic system.
- With disease states the eCBRs will appear where needed.
How it works: Cancer
THC: Super-activation of CB1 and CB2 receptor sites by THC leading to apoptosis (programmed cell death) of cancer cells.
Dr. Sean McCallaster (sp?) has been researching the ID-1 gene and has discovered that CBD restricts the translation of the ID-1 gene in many cancers, blocking the proliferation and metastasis of many cancers.
- High levels of ID-1 are found in brain, liver, lung, skin, and thyroid gland cancer cells. It is also expressed in fetal cells and in the umbilical vein endothelial cells.
Cannabidiol is indicated as a major component in the cancer protocol for
* Non small cell lung cancer
* Gastric cancer
* Breast cancer
* Prostate cancer
* Melanoma
* Glioblastoma
* Hepatocarcinoma
* Anaplastic thyroid tumor
* Metastasis of certain cancers
The ID-1 gene is responsible for tumor growth and metastasis. CBD doesn't activate the eCBRs, but rather affects other body systems to block proliferation and metastasis.
Try higher CBD and lower THC formulations for cancers involving the ID-1 gene.
** The last patient on the list is a 3-yr old female.
What does success mean? Because of the frustrations and stigmas attached to cannabis many cancer patients wait until it's very advanced or without hope before they seek a cannabinoid therapy. When we can reverse this trend we won't have as many people getting that desperately sick to begin with.
The patient determines the goals of the therapy. Are we treating symptoms or treating disease?
- After reviewing the patient history you work out the dose goal and the most desirable terpene and cannabinoid profile.
Give up the need to find a mg/kg formula for all canna is patients. It won't happen. Look at that picture. It pretty much says it all.
The closer correlation is with age; the younger the patient, the higher the dose. In the chart pictured the 88-yr old woman is only taking 75 mg of THC and 30 mg of CBD. The 3-yr old child is taking substantially more.
While the 75 mg of THC doesn't look like much, Marinol is marketed in doses of 2.5 mg, 5 mg, and 10 mg.
- For some patients, that 2.5 mg dose is too much.
- If you took 75 mg of the isolate a day you wouldn't be able to function. When you take a hit from a joint you're lucky to get 10% of that.
- For some - possibly most people - 75 mg of THC is a large dose.
The takeaway on this: More isn't always better, and age is what's most important when determining dose.
The second patient listed was triple negative, which means she was not hormone receptive, so they were looking at using a higher CBD and lower THC with her, and ended up with a 1:1, dosed at 100:100 (Sour Diesel:ACDC)
- She couldn't tolerate a dose higher than the 100mg each.
Start low, titrate very slowly. You're looking for a particular, very individual sweet spot. It can be easy to overshoot if you're not being slow and thoughtful.
She followed the example of Luis Pauling titrating his patients with Vit C.
The two women represented at the bottom of the list were on maintenance doses.
- The 35-yr old was super sensitive. Anything higher than the listed dose was intolerable for her, making her life unbearable.
You determine the patient's goals when setting a treatment plan.
- Are they interested in using cannabis to treat the cancer, or just to treat symptoms and side effects of conventional treatments?
- If wanting to kill cancer cells, then proceed. If not, just get the patient to comfortable.
Questions for the patient:
- What's the diagnosis?
- What's the current cannabis use and history of use?
- What pharmaceuticals and nutraceuticals are being used? Be aware of CP450 pathway pharma drugs. CBD may interfere with their metabolism allowing them to build to intolerable and dangerous levels in the system.
- Patient's age?
- What is your objective? What are you hoping to get from the cannabinoid therapy? What are you trying to accomplish?
In a gram of high THC CCO you can realistically expect to get between 500 and 750 mg of THC.
The actions in epilepsy of THC
How it works: Epilepsy
THC: Activation of CB1 receptors shorts out calcium ion pump on pre-synaptic neuron. This potentially stops grand mail seizures, with hydrocortisone 1like anti-inflammatory mechanism.
CBD: Has 30-50 times the anti-inflammatory properties of hydrocortisone, and appears to dramatically reduce seizure activity. It's also a major neuro-protective agent.
THCa:Similar to CBD m charisma. More studies needed. Typical use is after acclimation of patient to CBD resulting in increased seizure activity. THCa will often replace CBD when it stops working and vice-versa.
Example:
* 7-yr old female (35kg) -10.3:250 (ACDC)
Epilepsy is difficult because the diagnoses is a catch-all for seizure disorders.
- Seizures have many triggers, and you have to first determine what's triggering and treat that.
- If it's gut issues THCa is invaluable for healing the gut.
All healing is mind/body/spirit. Treat the whole patient.
- What are you doing to improve nutrition?
- What exercise and movement practice is being followed?
- What are you doing to align your spirit?
- What are you doing to calm and quiet the mind?
The last patient listed was taking 10.3 mg of THC to her 250 mg of CBD.
- In a CBD-only state her therapy would be illegal.
- The restrictive levels of THC being written into the laws are ineffective therapeutically for many, if not most disease states.
Mara believes hemp is wonderful. Let's save the world with it. Make medicine with whole-plant cannabis extracts.
How it works: Intractable Nerve Pain
THC:
5 Mechanisims involved in pain reduction with CB1 and CB2activation by THC
1. Retards electrochemical reactions at peripheral pain r captors.
2. Interrupts pain signal at dorsal root ganglia.
3. Interrupts pain signal at neuron.
4. Activation of CB2 at leukocyte provides major anti-inflammatory response.
5.
Psychoactive euphoric effects and short p-term memory reduction reduces stress response to pain.
CBD:
Anti-inflammatory mechanism provides 39-50 times hydrocortisone relief without shutting down adrenal gland
Patient: 78-yr old female - 15 mg THCa, 5 mg THC, 15 mg CBD (OG2xSour, Swiss Gold)
As pertains to psychoactivity; when a person's in severe pain, a little freedom from that is not a bad thing.
- With the right dose you're still fully functional, not incapacitated by intoxication.
Medical doses vs recreational doses
- A medical dose is to relieve the pain.
- A recreational dose is for the pure fun of euphoria.
Working out the regimen: Patient was a 78-yr old woman
The first medication they chose for the patient was made with Swiss Gold with 6.9 mg CBD and 0.7 mg THC per ml.
- Target dose was 15 mg if CBD, split into 3 doses.
- The total tincture used was 2.174 gr per day, administered in three doses of 0.725 gr each.
The second medication chosen was made from OG2xSour, with 37 mg of THCa and 9.3 mg THC per ml.
- The target dose was 15 mg of THCa per day in a single dose of 0.405 g of tincture that also supplies 3.8 mg of THC.
Her total THC dose is only 5.3 mg daily, and she reports she's sleeping like a baby for the first time in over 20 years of sleeping fitfully, and only after total exhaustion.
How it works: Insomnia
THC: Many indica dominant strains of cannabis contain terpenes such as beta myrcene and other cannabinoids like CBN that will cause somnolence at the correct dose. (importance i
Of Entourage Effect)
* Activation of CB1 receptor sites by THC at pre synaptic neuron slows neural activity at the synaptic cleft (Homeostasis)
* Activation of CB1 and CB2 sites by THC causes vasodilation of blood vessels by causing relaxation (Homeostasis)
* Anti-anxiety action of THC at correct dose aids sleep.
CBD: Mechanisims of action not completely understood as sleep agent. Studies have been done for sleep and for wake-inducing properties.
Patient: 60-yr old male (82kg) 25:0 (Granddaddy Purple)
Go with indica chemovars, higher in myrcene. Avoid the chemovars high in sativa terpenes of pinene and limonene. Use them for daytime.
- Sativas are appropriate for night meds with some PTSD patients, but not really for anyone else.
THC slows down the neural responses, creating a sense of ease so you can let go and sleep.
CBD will wake some people up and others to sleep. The patient discussed above had no CBD in his meds for insomnia because it made him hyperactive
Go with purples for night meds. Be careful with them during the day. Use only if you have experience and know how to dose it without putting the patient to sleep all day.
How it works: Hypertension
THC:
* Activation of CB1 and CB302 receptor sites by THC
- Causes vasodilation of blood vessels, lowering blood pressure
- Causes relief of stress by blocking production of acetylcholine
- Slows down neural activity in the neural cleft
Treatment of hypertension with cannabis is controversial, because it works for some patients and not for others.
Patient: 57-yr old male 30 mg THC/day 13 mg CBD/day in infused olive oil.
Aunt Zelda's tests at every stage of processing. They weigh their medicines down to 0.000. In this way they're building a data base that can more easily predict outcomes for individual patients.
This graphic shows how they compounded a medicine to replace the Cotton Candy Diesel that was doing a marvelous job, but was unavailable for purchase.
- You look for chemovars that come closest in cannabinoid and terpene profiles.
- This process is simplified if you already have lab results for what you're mixing.
- Consistency in dosing is the goal, so the patient knows that a dose of medicine will create an expected outcome.
How it works: Chron's Disease, Irritable Bowel Syndrome
THC: Activation of CB1 and CB2 r crept or sites in the gut relieves mobility and inhibits se creations causing inflammation.
CBD: Reduction of inflammation leads to relief of many IBS symptoms. Anti-bacterial properties relieves opportunistic abscesses often seen in Chron's.
Patient: 54-yr old female 30:15 (Pepe la Pu:ACDC) Note: also vaporizes for breakthrough.
Include THCa in any treatment plan for Chron's or IBS.
Aunt Zelda's tries to standardize their infused oils to 10 mg/ml. Infused oils allow for micro dosing with control.
- With CCO your cannabinoid counts are so high that it's easy to overshoot.
- When treating cancer or bowel disorders you want to avoid the extracts with alcohol. Nutrition is a very important part of the treatment.
THC blessedly interrupts your short-term memory. This is a godsend to someone with PTSD, caught in fight-or-flight.
Citocholine is available for OTC sale. It will calm the brain, relieving some of the distress patients may get with THC's euphoria.
- Start at 250 mg. you can go as high as 200mg.
- If the patient is on high doses of THC, introducing citocholine into the treat,net plan can mak the difference between success and failure of the regimen.
The patient is treating PTSD, not what she originally went to Aunt Zelda's tear the initial interview it was obvious that she was really dealing with PTSD.
- She's also super-sensitive to her body.
- That hyper-sensitivity allowed them to dial in a more pr case low dose that successfully keeps her on a healing path.
* With a super-sensitive patient the tendency is they'll stop when they get uncomfortable, so you need to be particularly focused on getting to the OTD.
CONCLUSIONS
* Cannabis is more than the sum of its parts.
* Endo and exocannabiniods play a significant role in treating
ALL DISEASES
* It's important to select the right chemovars.
* It's possible to dose correctly and consistently.
* Individualized treatment plans are necessary.
* Separating the THC and CBD doses does influence results in a positive way.
* All cannabis medicines should be lab tested to guarantee consistent patient outcomes.
Without THC, most diseases wouldn't be treatable with cannabis.
If you chose the wrong chemovar nothing bad will happen, but you won't get the results you were working for.
- Get the chemovar matched to the patient and you'll get success with lower doses.
The entourage effect favors full-plant medicines.
If your medicines are lab tested by a reputable fascilitate with proper equipment and training you can compound medicines for individual patient regimens.
When you're using a THC dominant medicine and a CBD dominant medicine together in the treatment plan it will help to keep doses lower if they're seperated by at least 2 hours.
All the notes are taken. Now it's just a matter of formatting. Time to take a break woman.