continuing.....
Notes:
CBD 101 with Martin Lee of Project CBD
A Green Flower Media class
Cannabis has been a friend to man since before the written word.
Cannabis has a rich history as a medicine, going back thousands of years, including the U.S.
- In the latter part of the 19th century cannabis tinctures were and important, essential part of the medicine cabinet.
- Prohibition forced cannabis underground where it turned into a recreational drug.
- We're relearning ancient methods for using cannabis therapeutically.
Today it's not as simple as lighting up a joint.
- We have potent cannabis oils of every conceivable formulation.
- Many people are confused about what to do with all this choice.
How can we best use cannabis oils with varied ratios for maximum therapeutic benefit?
About CBD
Cannabidiol (CBD) is a plant cannabinoid.
This is not technically true. In the growing plant you have CBDa. CBD is a decarbed molecule, either by natural or man-made forces of time and temperature.
CBD is not psychoactive in the way THC is. You'll get a sense of well-being, but no euphoria commonly associated with THC.
Discovered in 1940 by Roger Adams, an American scientist.
- The molecular structure wasn't known until Raphael Meschoulem elucidated it in 1963.
- The following year he did the same for THC.
Interest in CBD didn't take off for years, because the focus was on THC.
- All the research money in the 1960s spent on cannabis research was with the intent to prove it was a dangerous drug, and it was that evil THC that got people stoned.
In 1980 there was a study in Brazil that demonstrated the dramatic therapeutic results available using CBD to treat seizures.
- The study was about a dozen patients, and was wildly successful.
- Nothing came of it for decades.
In 1988 NIH funded a study identified THC and CBD as potent neuroprotectors and anti-oxidants.
- The Federal government holds a patent on plant cannabinoids as neural protectors, filed in 2003.
Both THC and CBD are known to induce neurogenesis, the creation of new brain cells, in adult mammals.
- As close as 30 years ago the idea of neurogenesis in adult mammals was heresy. We knew better.
CBD has been studied as a molecule fairly extensively around the world.
Properties of single-molecule CBD
- Anti-tumor
- Anti-spasmodic
- Anti-convulsant
- Antidepressant
- Antipsychotic
- Anti-addictive
- Anxiolytic (anxiety-reducing)
- Antibiotic
- Analgesic (pain reliever)
Whole plant CBD is different in many ways from single-molecule CBD.
CBD and THC work best together.
- To gain the greatest therapeutic benefit of both molecules, use them in combination.
Benefits of whole-plant cannabinoid medicines
- CBD potentiates THC's pain modulation abilities.
- CBD enhances cannabis's efficacy for neuropathic pain, auto-immune diseases, cancer, and other conditions. These conditions respond better with CBD in the formulation.
Once CBD gained recognition and appreciation (starting in 2009 in N. Cali) it became obvious that CBD broadened the range of conditions treatable with cannabis.
- Conditions that didn't necessarily respond positively to high-THC formulations.
- Liver, cardiovascular, and metabolic disorders now currently treated with CBD wouldn't be possible without THC.
In a study published in 2010 by the California Pacific Medical Center it was shown that CBD will magnify THC's inhibitory effect on brain cancer.
- The study showed that THC and CBD alone have individual anti-cancer properties, but combined they had a synergistic effect on glioblastomas.
CBD doesn't get you high the way THC does.
- Though many enjoy euphoria, many others don't.
A greater ratio of CBD to THC will lessen and eliminate the euphoric effects of THC.
- You can now customize to your level of comfort with THC.
-There's no single ratio, dose, or product that'll work for everyone. Cannabis insists on being an individualized medication.
- Cannabis patients have the option of using cannabis without the euphoria.
-
However, THC is a necessary component for a complete and effective canna med.
- A low-THC medicine won't get you high, but it also might not be effective medically.
- A medicine with both major Cannabinoids will be the most effective.
Determining the ratio that suits you.
- How sensitive are you to both compounds, in particular THC.
- How experienced are you with cannabis?
You control euphoria with ratio and dose.
- Always start with low dose THC when starting new patients with little or no experience.
The starting goal of a new cannabinoid therapy with a cannabis naive patient is to administer consistent, measurable doses of a CBD-rich medicine with as much THC in the formulation as the patient can comfortably handle.
"Dosage is everything." - Paracelsus
A personalized medicine focuses on the person, not the condition, because you're treating a person, not a condition.
- It's not so much finding the perfect ratio or dose for the disease state being treated, but rather finding what's appropriate and comfortable for this patient.
- Some will do well with a balanced ratio, others will find it too euphoric.
- Instead of gearing the medicine for the disease, make it reflect the patient.
What's the patient history with cannabis? How comfortable is the patient with cannabis, and in particular, THC?
The emerging patterns
At Project CBD they've begun to see patterns arising with cannabis therapeutics.
- Anxiety is treated best with higher CBD with low THC.
- Depression, spasms, pediatric seizure disorders respond best, at least initially, to low THC, high CBD products.
- Cancer, neurological disease, and gut issues do best with a 1:1 ratio.
- Chronic pain, neuropathic pain is best managed by a 1:1 ratio.
GW Pharmaceuticals proved that a balanced ratio manages chronic pain best.
- Chronic pain, neuropathic pain... the type of pain opioids don't treat well at all.
- Extensive clinical trials in Europe have proven that a balanced ratio can help someone struggling with chronic pain to live a better life, if they're comfortable with the euphoria that may occur with a 1:1
- Any chemovar will potentially help with auto-immune diseases (when your immune system attacks your cells inappropriately)
- THC activation or eCB2 receptors can regulate (dial down) an overactive immune response.
There are now CBD-rich products available in all the ways you can find THC-rich products.
What to look for in a CBD product
- clear labeling of quantity, ratio of major cannabinoids, and dose
- evidence and documentation of lab testing to be free of pollutants (molds, solvent residues, other contaminants)
- purity (no artificial additives) *be alert to thinning agents*
- look for sustainably-grown, high-resin content plants instead of industrial hemp
- avoid products extracted with solvents (butane, hexane, hydrocarbons)
- look for super-critical CO2 extractions or high-grade ethanol extractions
In the wild cannabis expresses close to an even ratio of the major cannabinoids.
- When prohibition percerted the market breeders went for high THC, overlooking CBD.
- Most plants available have high THC, and minimal CBD. That's quickly changing.
Low-resin industrial hemp has about 3.2% CBD by dry weight. By contrast, you can now find cannabis with levels up to 20%.
You can get CBD from industrial hemp
but
- You need huge amounts of hemp to extract a little bit of CBD.
- Cannabis is a bioaccumulator, a florid way of saying that it'll suck toxins and heavy metals out of the soil it grows in.
- Although this makes hemp a valuable plant to clean polluted lands, it's not so cool when you're extracting oils for medicine. You end up with concentrations that can become problematic.
Hemp is defined as a cannabis sativa having 0.3% or less THC value.
- Martin believes, and I agree, that this definition exists solely to perpetuate prohibition.
- Grow a CBD-rich plant with a higher than 0.3% THC value and you're now breaking the law and dealing in a federally-controlled substance.
***When this class was originally broadcast CBD was federally illegal and not permitted to be shipped across state lines. Has this changed? I don't believe it has. ***
There are still problems with quality control, a consequence of prohibition.
- Since this class originally aired there's been an increase in quality control on the producer level as more states become legal, but there's still much to be done.
Of concern is the use of polypropylene glycol being used in vape pens.
- It's been approved for ingestion, but not for inhallation, yet everyone acts like this isn't an issue.
- When overheated - as would be done in a vaporizer - polypropylene glycol breaks down into a carcinogen.
- People reaching for a CBD pen are sick, and don't need carcinogens added to the formula.
- Many come flavored as well. No one tested those flavors as inhaled meds.
- The few things that have been tested turned out to be nasty.
Avoid flavored vape pens unless there's evidence that the flavoring agents were tested for inhalation.
It's not likely that they were tested. What was tested wasn't pretty. Be safe and avoid them.
Pick up at 28:55.
Pharmaceutical CBD products will be legal
(I believe they are already???)
- Epidialex has been clinically tested.
- CBD isolate will be legal, but the effectiveness of isolates lacks the synergy of whole-plant CBD products.
An isolate has a very limited therapeutic window.
- You need precise doses, and high doses to be effective.
- Get the dose a little too high or low with an isolate and you get no effect.
- Whole plant meds are more effective for longer times with smaller doses. No exact dose is necessary for effectiveness.
CBD will interact with over 60% of prescribed pharma drugs.
- The interactions problems aren't a concern with whole plant extractions.
- Isolates are another matter. High doses of an isolate will cause some drugs to build up in the body, sometimes to dangerous levels.
- CBD interfere with the metabolism of these drugs.
- If your drugs say "avoid grapefruit juice" you want to have this levels checked more frequently if you're using a CBD isolate.
The take home message:
Cannabis is personalized medicine. At least initially it's about the person, not the condition. You're treating a person.
There's no single ratio, dosage, strength, or product that's right for everyone.
THC and CBD are the "Power Couple" of cannabinoid medicine, working best together.
Whole plant CBD is superior medicine, safer and more effective than single-molecule CBD.
Q & A Session
1. When would you suggest someone start with a CBD-dominant medication?
Without generalizing too much - cannabis is individualized medicine - what they're seeing in California is that the determining factor is experience with cannabis.
- A good starting point is a low-dose THC, high-CBD medicine. This will be tolerated by just about anyone.
- This works well for those with bad experiences in their history or patients with no experience
What kind of health challenge are you dealing with?
- Many disease states benefit from THC in the mix. You start low and slowly increase.
- As a patient becomes more relaxed with euphoria they may discover that they prefer a little THC for the experience.
- Some patients will always be more comfortable without any euphoric experience, and for them, low THC, high CBD will be the preferred formulation.
2. Are there conditions you're seeing that respond better to high CBD medications?
That's a tricky one. Take epilepsy, for instance.
- There's been dramatic footage of children responding well to CBD and having their seizures stop or lessen in frequency and power.
- That doesn't mean all children with seizure disorder can use a CBD-only medication and get these results. Some need THC.
- It's not the seizure that's the focus, but what's the underlying cause? With epilepsy you treat the cause, and some causes require THC.
- Genetic testing by Medicinal Genomics shows that there's a coding problem with the sodium channels in the bodies of children with certain types of seizure disorders. These conditions respond to CBD.
- The genetic mechanism is key to the treatment of seizure disorders with cannabis.
- Genetic testing can tell if a child will respond to CBD medications.
- Some children can have an adverse effect from CBD.
Start low, go slow.
3. Are there other ailments where CBD-dominant medicines are working as well as other options?
There's a wide tableau of conditions that can be treated with CBD.
- CBD interacts with the EVS, which regulates all other body systems.
It comes down to what the patient is comfortable with.
- During the day many are most comfortable with a high CBD medicine that doesn't interfer with social functionality.
- At night many switch to a higher THC value
A person might be using differently formulated medications at different parts of the day.
Glioblastoma seems to respond best to high THC medicine.
Neuroblastoma - more common in children - seems to respond best to a high CBD medicine.
4. What's the best way to find the right ratios and profiles to make cannabis a personalized medicine?
First off, it depends on where you are. Is it even available to you, and if so, in what forms and products?
- You have to make due with what you can access.
- Flower is accessible in most of the country.
- You can smoke it or make cannabis flowers into edibles with little effort.
- The medical cannabis movement started with high THC meds.
Where are you psychologically?
- How experienced and comfortable with cannabis are you?
- What kind of guidance do you have?
- What's your support group look like?
- How open is your community?
You can start with a CBD-dominant product at low doses, slowly increasing.
- Begin to add in other products to get a more varied cannabinoid profile, as more options present themselves.
The industrial hemp archetype is high CBD, very low THC.
- There's nothing inherently wrong with that, it's simply limited.
- it's a good starting point for people, but it's a sliver of the available spectrum of cannabinoid therapeutics.
- Patients deserve more options.
THCa, in very small doses, has demonstrated remarkable synergy with other cannabinoids, and with CBD in particular.
- For some children with seizure disorder there's not the dramatic results they were expecting with CBD only.
- Parents began experimenting in their kitchens with new oils and discovered that THC and THCa made the oils more effective for their children.
5. How do you determine a quality CBD medicine?
- Learn to read the labels and then do that.
There was no regulation in the underground market, and corporate regulation leans further towards making a profit than ease of use.
-There aren't necessarily the best examples of how to do it in the current marketplace.
- You take the best of the situation by being informed.
You should be able to tell from the label what's in there.
When someone gets a product that isn't what the label says and gets too high, resulting in a bad experience, it can scare them away from something that could potentially improve their lives in a way nothing else can.
You don't want things like trans-fats or corn syrup in your cannabis medicines. You want clean, safe medicine.
6. How do you determine the quality of a cannabis product in the current market?
There are generally two kinds of products being sold:
1. Single-molecule CBD
2. Whole plant extracts
The single-molecule is being marketed as "pure CBD", the implication being that it's better. It's not.
- When given a choice, go for the whole-plant extractions, whether hemp or regular cannabis oils
When this class aired quality determination was a bit of a crap shoot.
- Things have gotten a little better, but it's still buyer beware.
And this is why we encourage people to grow and process their own.
If you're in a state with a robust medical cannabis program you stand a better chance of getting quality control.
- You can visit a dispensary and ask around for advice.
- Get some cannabis and experiment.
- If you don't get the results advertised on the label you can return it to a dispensary. Good luck with that over the Internet.
Project CBD does a lot of training of dispensary staff.
- Most people come in saying something like "I have this disease I want to treat. What do you recommend?"
Turn the focus of the questions from what product to take to treat a condition to the patient being treated
- Have you ever used cannabis?
- Tell me about your experience?
You're dealing with a person, not a condition.
The person behind the counter at a dispensary likely isn't schooled in medical sciences, doesn't hold a medical degree, and is pushing a product line to increase the bottom line.
- They're not professionally qualified to tell you how to treat your disease with cannabis.
Let's give a shout out to those bud tenders who take their jobs seriously enough to get educated in cannabis therapeutics. Let's not get too caught up in the medical professionals being so much more qualified. It's medical professionals who got us into this mess.
pick up at 52:29