What I learned from this video:
Transcript, starting at 1:19
E: Your experience as a cannabis treating physican, what advice would you give to doctors and patients when using cannabis medicine?
S: So... education is the key to getting good results with cannabis.
“Education is the key to getting good results with cannabis.”
My advice is that there's no "one size fits all" method for using cannabis,but there's some basics that patients can learn and that doctors can learn that can help them get good success. And these are basics I've been using in my practice for a decade now, and that we put online on my website, Healer.com, so I'm not gonna teach the whole curriculum here, but it's all free, and it's very empowering.
One of the main concepts of integrative medicine is to have a partnership between the doctor and the patient. A partnership to work together towards health, and cannabis really brings that out in the relationship, because there's so many different types of Cannabis, so many different ways that one can use it, like taking it by mouth, or inhaling it.
Ah.. different components within the plant that have different properties. And cannabis, unlike most other medications, isn't just for one condition, or two conditions. It can treat almost every condition in the human body, which sounds a little bit crazy to most people, but there's a strong scientific basis for that, and that basis is that we're already using molecules that we make ourselves that's a lot like the compounds we find in cannabis...
E: Anandamide..
S: Anandamide and 2-AG, right, so our endocannabinoids, these are the cannabinoids made by our inner pharmacy,
“...made by our inner pharmacy...” I like the sound of that.
are constantly working to keep us healthy, and to respond to any type of illness and injury. So this is why when we take the cannabis plant in its various forms we can use it to treat almost an condition that a person may have. The key is figuring out what to use and to use that correctly, but it's not really as hard as it sounds.
E: No, No, it’s interesting, because in a way we know this. Even recreational users, after repeatedly using it for years, but there’s a gap between that use and the medical trial that could certify that amount of cannabis would be suitable for that treatment.
How do you look at this gap between medical trials and the actual use we’re giving cannabis?
S: Well, the biggest difference is the goal. The goal of most people that are using it recreationally, well one would assume the goal is to become intoxicated, or high, or euphoric. That’s true a lot of the time, but not always.
For example, in Colorado, where cannabis is legal recreationally, there’s a survey that showed the number one reason people are buying it recreationally is for sleep. So..., and of course, if someone’s sleeping better, the entire rest of their health will improve.
First off, find and catalogue that study. When the number one reason is sleep, it might be time to face the truth that we’re all patients.
So there’s a gradient. There’s not a distinction between recreational and medical use, but with medical use the goal is to reduce symptoms.
Relief
And when you look at cannabis dosing, there’s usually a dose that’ll, say, relieve pain, relieve nausea, relieve spasticity, and a somewhat higher dose that will cause an intoxication, or a euphoria, and there’s a window in between. And so medical user don’t need to be high. This is an assumption a lot of people make, “Oh if I’m gonna use this to treat my disease I’m gonna have to be stoned all the time, and not be able to function, or I’m gonna lose control.” That’s a fear that a lot of people have, and it doesn’t have to be like that at all.
E: Are there any patients that are looking to get high also, and it’s beneficial for them because it’s produces relaxation...?
S: Yes. Let’s break this down. What is getting high, and why is it so bad? Because for someone that’s really sick, right?
E: This is “Getting High” section with Dr. Dustin Sulak. Awesome! What is getting high?
S: (laughs) What
is getting high? When people are really sick, is it bad for them to laugh? Right? To have an intensified experience of a pleasurable activity like eating, having sex, watching a movie, uh..listening to music, um..more pleasure out of these activities? These are good things for someone. Feeling more social, more outgoing.
Like, these are some of the early aspects of getting high, but what my patients report to me is when they use more cannabis they feel connected to the universe, or connected to God. They feel like they have a different perspective on their challenges. They can see their life from a new angle and find creative solutions. People feel more flexible, more willing to change.
“...but what my patients report to me is when they use more cannabis they feel connected to the universe, or connected to God. They feel like they have a different perspective on their challenges. They can see their life from a new angle and find creative solutions. People feel more flexible, more willing to change.”
The conspiracy theorist is me lit up like a Christmas tree.
And so I have a lot of people who come to me now, and especially the elderly, and I love treating elders. I think that cannabis an excellent medicine for them.
E: They’re one of the biggest increasing communities using cannabis nowadays.
Seniors are the fastest-growing market segment of the cannabis space. Think “topicals” as a pathway in.
S: Yes. Rightfully so, because it has so much to offer them, and they come to me very concerned, “I don’t want to get high at all.” And I say, “OK, you don’t have to get high.”
But then after they use it for a few months and they see how it’s working, I invite them to take their bedtime dose of THC a little bit earlier, and so they’ll take it around dinner time. And now they’ve got a few hours, you know, between dinner and bed, where they’re starting to feel just a little loose, and maybe slightly euphoric. And then we can adjust that dose. But..but these benefits...they come back to me and say, “Oh, I had no idea that’s what people were talking about - getting high.”
I like the man’s gentle approach to introducing euphoria.
They’re imagining it’s some type of really intense psychedelic experience, where it’s actually a mild, pleasant feeling.
E: Exactly. We’re still fighting against the old taboo that’s haunting us. That psychedelic...
S: That's right, and so .... this is a primary healing component of the plant.
“..a primary healing component of the plant.” I believe it’s 60-75% of the disease states treatable by cannabs need THC for the desired relief.
Even though it has so much to offer us in our body, what it does to the consciousness is really important, because when people talk about healing, they usually are referring to a change in their life, right? A change in the way they think. A change in the way they behave. A change in the way their physiology works. For a lot of people healing isn’t just, “Oh, I relieved my pain for 8 hours.” Or “I relieved my nausea for 8 hours.” It’s a change in the pattern. And that change in the pattern often happens when people start accessing those consciousness effects of cannabis.
Integrate this idea of healing being a change of patterns - of feeling, response, and action.
E: That’s very true. What do you think.. is there a pharmacokinetic explanation perspective for ... we’ve all been ... consumers have all experienced the highness, the ability to approach problems with a different perspective. That it’s something very hard to explain to other people who are non-consumers, because they feel that we are talking about something very lightweight, or something unsubstantial, when in truth it’s something totally different, something that actually allows you to engage problems in a way more efficient way, when you think about it.
S: Absolutely. There’s a strong scientific basis for this. So, a lot of us, especially as adults, we think in patterns, right? We have these neural pathways that are very ingrained, and they’re.. it’s like we get into a groove and just keep using these same grooves again and again.
It’s called the Default Mode Network, and it serves us. It helps us look at our environment and recognize things, and make assumptions, and take action, so it’s ..
E: So that we don’t have to learn everything all over again.
S: Exactly. So it promotes survival, but it also gets in the way of having a new approach to problems and solutions. It creates rigidity in our thinking.
And so what cannabis does in the brain and pretty much everywhere else in the body, is it suppresses anything that’s excessive, right? If we have too much glutamate, which is an excitatory neurotransmitter, cannabis says, “Oh, there’s too much. Let’s stop doing that.”
If there’s too much GABA, which is inhibitory, the opposite, cannabis can also say, “OK, there’s too much.” If there’s too much pain signaling, or too much anxiety, too much sympathetic, or too much fight-or-flight nervous system activity, cannabis also says, “That’s enough. Let’s tone that down a little bit.”
So in this Default Mode Network, and our repetitive patterns of thinking, cannabis can also suspend that process, or help us temporarily disengage - not fully, but to some extent we can disengage from our normal patterns of thinking, and that allows us to experience things in a new way, to perceive with different filters, and to take things in differently.
Cannabis helps us look at life from new perspectives, to be open to new possibilities, and to feel connected to all that is.
“Danger Will Robinson!”
There’s also a... every time that we learn something new there’s a structural connection happening in a neuron, right? There’s a physical change. So could be someone who’s had a stroke, can’t speak, can’t walk. Over the next six months they relearn how to speak and walk. First of all, whether that person is using cannabis or not, endocannabinoids are directing this process, and it is a process of literal structural connections between the different nerves in the brain.
Cannabinoids direct structural connections in the neural network.
“Just doing my job mam.”
E: How can we find the correct dosage for each person? What is the best consumption strategy to get the medical benefits from cannabis?
S: So, everyone has an optimal dosage, and if they find that dosage they can remain at that for years or decades. They don’t build tolerance. They don’t lose the benefits of cannabis. And so your question is, “How do you find that?”
It’s a trial-and-error process, but it can be very methodical. So what I recommend to people, whether it’s pain, or spasticity, or diarrhea, or really any condition with cannabis, you start at a dose that’s low, a dose that’s not even gonna cause any benefits, and certainly not cause any side effects.
So, for most people, if they were taking it by mouth, that would be 1 or 2 mg of THC. Perhaps there could be some CBD and other cannabinoids in there, but we’ll talk about THC right now. So 1 or 2 mg of THC taken by mouth three times a day, and then you can start very gradually going up on that dose, until you feel a little something. I call this the “Minimal Noticable Effect.”
The Minimal Noticable Effect = the dose level that causes any response (usually between 1 - 5 mg dose of THC).
E: How long does it take to get to that point?
S: Most people feel it before it’s at 5 mg. So it’s just a few days, Ok? You start at 1 or 2, work up to 5. I mean...there’s exceptions, right? There’s some people that feel nothing, even at 10 mg, and that’s ok. Like, everyone is different. So my optimal dose may be 3, yours may be 30, and there’s no judgement there. The idea is if you.. if yours is 30 then you’ll be able to take 30 for years, and still have benefits, but if I took 30 I would get sick, right? So everyone’s different.
Leave judgement out of it.
But once you get to that dose where you just feel a little something - this is the trick that I discovered - stay there for three days. So this is for someone’s who’s new to cannabis, and this is all on my website, so I won’t..I wont overdo it in the interview here, but if you stay at that dose for a few days and then start going up again, what happens is, one can build tolerance to the side effects. So we talked about this therapeutic window, these are the benefits, these are the side effects. Side effects you can start building tolerance to, and the benefits, you can actually become more sensitive to.
Resetting tolerance levels
* When you get to the Minimal Noticable Effect stay there for at least 3 days before increasing the dose.
* If you stay at the new dose level until it feels normal you can again increase the dose until you feel effect shift, then stay there again, until it feels “normal.”
All of these cautions are to control the euphoric effects of THC. It’s important to remember that not everyone has a problem with euphoria. There are also ways to control THC’s euphoric effect by balancing with CBD.
So you get this widening of the therapeutic window, which is really useful, because then you can go on to increase your dose again, until you find some really good relief.
And so for most people THC somewhere in the 3 - 10 mg dose is right for, I’d say 75% of people.
In Dr. Sulak’s experience, 75% of patient’s find the relief they’re seeking with THC doses between 3 - 10 mg. That doesn’t mean a singular dose, since many conditions would benefit from multiple doses, spread across the day. I like 3-5 doses a day, to keep that steady, reliable flow of phytocannabinoids coming along.
E: You’ve also addressed the fact that in terms of dosage, one of the difference between cannabis and other pharmaceuticals is like, it’s very safe, right? So overdoing, overdosing is not actually a problem, like if you were doing it with opiates or something.
S: That’s right. So if one of my patients accidentally took 1000 times their dose I recommended to them they would have no brain damage, no organ damage, no long-term disability from that experience. It would...it’s safe. They might have a very bad time for 12 hours or 24 hours. They might be vomiting. They might be be confused....
E: Like ?? ...the movie.
S: Exactly... it’s unpleasant, but it’s safe, and that makes cannabis extremely comfortable for me to work with in the clinic. Um.. because as a cannabis clinician, and most doctors that work with cannabis in Chile are having the same experience, we become magnets for people with rare conditions that have failed to respond to all the conventional treatments.
So now we’ve got someone we already know conventional medicine doesn’t have any left for them, we have to do something experimental. Isn’t it better to experiment with something we know isn’t going to kill this person? We know isn’t even gonna hurt this person? And has such a high likelihood of being effective? It’s wonderful.
The relative safety of cannabis medicines is why I’m so comfortable with what we do. I’m not afraid of hurting someone with what I share.
E: What advice can you give heavy users, like now we’re talking about recreational use, so uhh.. many of them, many of us have generated a tolerance that actually avoids us to get the real benefits of cannabis maybe. So what advice do you give us heavy users to regain those benefits?
S: Yeah..it’s a great question. I saw hundreds of people that were using more cannabis than was good for them when I first started my practice, and I asked them what worked, and eventually I came up with this protocol. It takes 6 days, but it’s really very simple.
So, the advice is to take two days off. Two days, no cannabis, and then when you start using cannabis again you start at a very low dose that makes you feel nothing, and repeat what I told you for the new user. You slowly go up until you feel something. And so for recreational users this is what that means: tonight is Friday night. I’ll take my last...you know...smoke my last joint, or whatever it is that someone is doing, and then they’ve started their fast.
So number one is to be intentional about it. Uh..”I love this herb. I want this herb to work better for me. I want to have a healthier relationship with it, so I’m gonna take a break.”
Intentionality.... the man always leaves me feeling like maybe I could survive the protocol.
So you fast. Friday night there’s none. Saturday there’s none. Sunday there’s none.
Now Sunday night start up again. Don’t pick up a joint, take a pipe. The reason is, the joint is burning, and most people will keep smoking it while it’s still burning. So you take a pipe. You take one puff, and you put it down, and you look at the clock and you wait at least 5 minutes, preferably 10 minutes.
If you feel
nothing you pick up the pipe again and have another puff. If you feel a little something you’re done. Monday morning comes around. Do the same thing. Just feel a little something, ok? Uh.. we’ve tested this. I’ve done a survey. On average, people cut their dose in half when they use this protocol, and they receive more benefits.
So this means people can save money. If you’re a smoker, reduce the amount of smoke to your lungs. Get stronger benefits from cannabis, avoid building tolerance, and then there’s more for everyone else to share, ‘cause you’re not wasting it.
E: Exactly! Thank you. Thank you. This is like the Sulak Method, we can call it that.
S: You can call it that, I call it the Sensitization Protocol. It’s also free on Healer.com. The Sulak Method is fine.
Laughs