Dr. Rachna Patel is an emergency medicine physician who has a medical marijuana telemedicine practice, a book, and her own CBD oil. Medical marijuana and CBD, specifically, seem to have become a panacea or snake oil with magical properties that can cure everything. Like what we tell our patients about good nutrition and exercise. She helps to clear up fact from fiction during our wide ranging and comprehensive discussion, from the current state of dispensing, its legal status, biochemistry, risks, FDA approved and internationally approved derivatives, methods of ingestion and for what conditions she recommends it.
She has been interviewed on over 200 podcasts (but this has been her favorite), has taken the stage internationally to spread awareness, has been featured in articles for Lifehacker and MindBodyGreen and has appeared on major news networks such as NBC. She recently published, The CBD Oil Solution: Treat Chronic Pain, Anxiety, Insomnia, and More- without the High, available on Amazon, and her own line of CBD oil.
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Dr. Richard Patel is an emergency medicine physician who has a medical marijuana telemedicine practice a book and her own CBD oil. Now medical marijuana and CBD specifically seem to become as panacea or snake oil with magical properties that can cure everything. Kind of like what we tell our patients about good nutrition and exercise. She helps to clear up fact from fiction during our wide ranging and comprehensive discussion from the current state of dispensing its legal status, biochemistry risks, FDA approved and internationally approved derivatives, methods of ingestion and for what conditions she recommends CBD and medical marijuana.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians, Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers. On this podcast accept no liability for the outcomes of medical decisions based on this information. As the radiologists like to say, clinical correlation is required. This is not medical advice. And this does not constitute a physician patient relationship. If you have a medical problem, seek medical attention. And now here’s Dr. Bradley Block.
Welcome back to the physicians guide to doctoring. On today’s episode, we have Dr. Rashmi Patel, who specializes in medical marijuana. So that’s going to be the topic today. So Dr. Patel, thank you so much for being on the show today.
Thank you for having me. So first,
let’s talk about your origin stories. Which is pretty interesting story. First, start off with your training and then how you got into medical marijuana.
Yes, so during training my backgrounds actually in emergency medicine. I found myself basically what do you do as an ER doctor? you rule out emergent cause right? And if emergent cause has been rolled out, typically you send the patient on their way With a script for prescription medications, typically opioids because most patients come into the emergency room complaining of pain, and a recommendation to follow up with their primary care doctor. Now, given the way that our our healthcare system is set up, a lot of these patients would end up coming back to the emergency room, I see the same patient. And they’re complaining that the medications didn’t work, or that they were getting side effects of medication. Or I was in the unfortunate position of having to resuscitate patients that had overdosed on these medications. And then things really hit home for me on my toxicology rotation, where the only thing I saw were overdosing on prescription and over the counter medication. So, you know, there I was, as a physician, I became a doctor bright eyed thinking that I will actually help people I will actually help them to solve problems in their life. And I instead what I felt like I was I was creating problems. And, you know, during residency isn’t working gosh was over 100 hours, sometimes a week. And so you experienced a ton of insomnia, there comes a point where you’ve been awake for so long, you just can’t sleep. And, and that’s what I was experiencing. So during those times where I was too wired to fall asleep, but too tired to really do anything else productive, I would surf the internet. And I happened on an ad on Craigslist, that said, medical marijuana doctor needed me to reply to the ad right away. I spent a good year digging into the research. I just hung out on pubmed.gov looked at research, study upon research study, what you know what little information there was available on medical marijuana at the time. And about a year later, is when I found another ad, because they were as a bound on Craigslist. And I responded to that ad and so I have now been a medical major Wanna doctor since 2012, essentially a veteran in the field?
So you didn’t find your job after residency by looking on LinkedIn? I mean, I don’t know if any doctor does go into hospital websites. Talking to previous graduates, you found your job on Craigslist.
Yeah. by responding to an ad on Craigslist. I mean, I’m going inside. I made a whole career just because I responded to an ad on Craigslist.
Alright, well, what was the second coolest thing that you’ve ever found on Craigslist?
roommates that have turned into lifelong friends you know, back when Craigslist wasn’t shady Okay, this is
a time when Craigslist wasn’t shady.
Yeah, like early millennial. You know, when I when Craigslist first came out when I was back in like college, that’s where everybody went. To find places to live, and to find roommates, and it wasn’t shady recently, I tried to like buy furniture on Craigslist. And like, there’s people asking me for a cashier’s check, before even seeing the piece of furniture and it’s like, Okay, this is what happens. This is not the Craigslist that I remember.
We’re trying to rent apartments in New York City, and then you go to see the apartment, and it clearly looks nothing like the picture. They’ll switch. Right. So there’s actually a lot a lot to unpack in what you said about how you first got into medical marijuana. First, it relates to burnout, which is something that we talk about a lot on the show. And one of the sources of burnout is is that we’re not able to stem the tide of this systemic problems that are leading to the health issues that lead us lead people into the office, right. So you’re dealing with a systemic issue that leads To opioid addiction, the lack of safety nets and the lack of the ability for these patients to get follow up care. So there’s that. And then crisis. So your response to the opioid crisis is, is there something else out there? And so that’s how you ended up in medical marijuana. So I think those are two tremendous issues that you really addressed in your career.
Yeah. And I think it just came from like, a gut feeling where I was like, Okay, I can’t spend my life not actually, you know, just clocking in and clocking out, just to be a slave to my wages, like there has to be meaning and purpose to what I do.
So tell us about your practice now, or how it started, and then how it evolved.
Sure. So I started off to learn the ropes by working at a medical marijuana clinic in California, and I did that for a period of about two years. And then in 2014 I started my own practice. Now the reason being a lot of these clinics that popped up in California specifically, because there’s loopholes in the law, they were essentially mill, where doctors were just handing out medical marijuana cards, like candy. The consultation would be maybe all of like, I don’t know, five minutes in the clinic, that I was that there is definitely a lot of pressure to turn over patients, right? No different than in regular medicine, where there’s a lot of pressure to, you know, to see as many patients in as little time as possible. I remember there were times in that clinic where I saw in a matter of seven hours, probably 60 patients. And if I took more than like five to 10 minutes and probably a lot of this is illegal. But if I took more than five to 10 minutes, you know, the receptionist would wouldn’t even knock on the door. They just come barging into the office saying that your next patient is ready. And I actually remember going to the osteopathic medical board of California about this saying that hey, I’m because I didn’t have any other you know, I work for a, a small clinic. I don’t have anybody else to go to so I went to the osteopathic border of California situation. And their response was, well, you don’t have to work there. And I was like, Okay, well, great. Well, this is definitely helping the cause. Oh, and the other thing that happened was that a lot of these patients were coming to me and medical marijuana is illegal in California since 1996. And this is back in 2012. It would have been illegal for quite a while before I started and so these were patients that had you know, been using medical marijuana for a while but they you know, complained to me that hey, you know, I use medical marijuana but sometimes it works. Sometimes it doesn’t. When I go to the dispensary, I don’t know what to pick, you know and so they wanted answers to questions like that. And you need as a physician, you know, a lot of this you can figure out if you know basic pharmacology and then you study the chemical kinetics. of adenoids, you can put two and two together and figure it out, especially when you’re getting clinical feedback as well. Right? So that’s essentially how I figured out it. Basically, I now have protocol by medical conditions on how to use medical cannabis for these specific conditions. So, and you need time for that you need to really sit down, spend time with the patient, and be like, Okay, give me a story. Tell me what’s going on? What medications are you taking? What have you taken in the past, and then based off that, I can give them you know, best practices for their medical condition. So, at that point, you know, I had earned enough capital to start a very lean medical practice. And I did it differently. You know, I was definitely charging a premium and seeing fewer patients, but I was able to spend more time with them. And, you know, and I gained a lot of trust. In that way of the patients that I received from they weren’t, there were hardly any doctors that were doing it the way that I was doing it.
So Let me just get this straight because it sounds like at least in the state of California, you would give the patient a prescription for medical marijuana, but it really wouldn’t. Well, what would that prescription say on? Would it just say? Not not yours, but the standard medical marijuana prescription? Did it say anything about the dosing or the regimen? Or does it just say you were approved for medical marijuana?
So the basic language is, is that based on my professional medical opinion and evaluation, I believe that this patient benefits from the use of medical marijuana for his or her condition. So it’s not even a prescription. It’s called what’s called a recommendation.
Right? Then they go to a dispensary where someone who was hired at the dispensary, maybe getting after having been fired as a barista from Starbucks, maybe not the works there and then they make their recommendation for what the patient needs. Kind of like Going to a bartender and asking the bartender, what drink do you recommend for my back pain or my anxiety? Or my post chemotherapy? nausea? Right? You’re not getting that sounds like you’re not getting that information from the doctor. You’re getting it from someone with no professional training or expertise.
Yeah, no experience, other than the fact that they’re probably heavy users of marijuana themselves. That is their only experience. That’s amazing. Okay, so so that’s essentially Yeah, you got it. That’s essentially what’s happening now. You know, California was the beta, right, based on the mistakes that California made. Other states are doing it differently, right. One of the ways that they’re doing it differently is that number one, you can’t go straight from the doctor’s office with your your recommendation or what’s called a certification to the dispensary there’s an in between, and that in between is that you need to register with the state that you want. That’s right. So you have to show things like proof of residency. You have to provide medical records to backup your diagnosing someone also double check that, okay, based on the medical records based on the physicians evaluation, that this patient would actually benefit from the use of medical marijuana. So this book take the state of Pennsylvania, for instance, in terms of numbers, now, they legalized early 2018 that will be legalized prior to that, but the medical marijuana program went into place in 2018 January. Since then, to this point, they’ve now registered 100,000 patients, but only 70% of those patients have actually received their state ID card to then actually get medical marijuana from the dispensary.
Is that because bureaucracy is slow, or because those patients have been denied?
Probably they’ve been denied.
Cuz it sounds like it sounds like a laborious process to to go through all that right?
Right? Yeah, not in California right now it’s legal for recreational use and just if you’re over the age of 21, you can just walk into the sensory. But prior to 2018 the way it worked was that you could just go to your doctor and then go straight to the dispensary. But all the other states did it differently. I don’t know of any other state that did it the same as California. And the other thing was California was that there wasn’t a restricted list of medical conditions. Somebody’s knocking the phrase after the list of medical conditions and any other illness. But basically, it was up to the discretion of the physician to determine whether or not the patient would benefit from medical marijuana. Right, which is typically how medicine works. But when you’re dealing with marijuana, and you know when there’s financial incentives to just hand out cards at any venue At that point, you know, your your ethics are go out the window and you’re then just approving any medical condition and just handing out the cart. So that’s another thing that I think other states learned from California, they have a restricted list of medical conditions that beyond this list of conditions, met, you know, the use of medical marijuana cannot be approved.
So how do you think that liberalisation of recreational marijuana is going to impact medical marijuana?
Well, there’s data to back this up as well. Right. I believe I forget if it was Oregon or Washington, or meeting with Colorado, one of the states. I think it was Colorado, they have data to show that as soon as marijuana gets legalized for recreational use, the number of medical marijuana patients dropped significantly. And you know, is there an economics behind it? There certainly could be right because you’re now not having to pay a physician for Evaluation which often times can be a hefty fee, right? It can run anywhere from 200 to $250, sometimes even more, and then you’re having to spend money on the medication itself. So a lot of people would just bypass the physician altogether and DIY it at the dispensary. How many successful have? I don’t know,
right? Especially if you’re getting your dosing recommendations from the dispensary to begin with right then if the doctor is just giving you the permission, and now the state has given you permission, well then you don’t need the doctor at all. You just need the dispensary in order to get it which is again where you come in right with your recommendations for frequency and dosing and then you know differentiating between THC and CBD which we’re going to get to later so you know your you are your niche, even in places where there is recreational marijuana available.
right because even if Those areas, there’s going to be people who are going to who are like, Okay, well, I think I’d rather just go to a doctor make sure I do it right. Because I don’t want to get high off of marijuana. I you know, I am taking prescription medications, you know, what if their side effects, I’ve even had patients, you know, who had heart attack? And they’re like, okay, should I take using marijuana? Should I not be using it? So there’s questions like that that definitely come up and are relevant, medically speaking.
It’s a while while we’re on the topic of the legal issues, I just want to mention that it is still classified by the FDA as a class one drug. And what that means is there is no therapeutic value, according to the FDA. So here we are talking about the therapeutic value of medical marijuana, which certainly quite a bit is still up in the air and so we’re going to be getting to that later. But what the FDA is saying is, there is no therapeutic value, which is why it remains a class one drug yet there is states where it’s legal. And so how do you how is it illegal federally, but legal in the state and how does that work? And that means federal funds. And I think this came through under Obama that federal funds can’t be used to prosecute in states where it’s legal. So that’s why, if you can have a dispensary even though at the federal level, you’re doing something illegal,
right. So federal law, Trumps state law, but the federal government also has to enforce the federal law as well. Right. And so way back when Yeah, the federal government was enforcing state law by rating dispensary’s. That’s typically what they went after, are the people who were actually selling marijuana, not physicians, not patients, but the people who were selling and the people who are growing marijuana. But yeah, as it stands, THC specifically is considered a class one substance Per federal law, but you have things that have now 10 states plus the District of Columbia that have now legalized marijuana for recreational use. And we have 33 states that has a medical marijuana program in place. So more than half, a lot more than half. And so essentially, that’s what it comes down to is the federal government making a decision to actually enforce federal laws, which has been less and less, as I’ve seen it, you know, back in 2012.
So yeah, I think this has developed a momentum and it’s only going to spread spread further and further, but one of the things that that’s confusing to me is that you can now buy substances that contain CBD. So we’re going to talk in a little bit about the difference between THC and CBD. But since we’re talking about the legal issues, right, how is it that you can just buy CBD in a skin cream?
Right. So you CBD is classified a little differently. So it’s interesting because the hemp plant itself was on a national level deemed legal to grow. Before you go any further, what’s the difference between hemp and marijuana? Okay, the basic difference. They’re like cousins, okay marijuana and hemp are like cousins are from the same family main difference is a legal distinction in terms of the amount of THC, that’s me, okay. So by law, hemp should not have hemp or any hemp derived products should not have more than point 3% THC. And then by default, marijuana products have more than point 3% THC. That’s essentially what it comes down to. And point 3% is arbitrary. If there’s nothing scientific about it. There was a guy named Ernest small way back when, who decided it’s going to be point 3% and so in Stuck since then. And so that’s that you know, here we are today. And then Okay, so back to what was the question that I was originally answering?
I think it dovetails into the CBD. So how can we have CBD in all these other substances?
product? Yeah, so you had Farm Bill 2014 which allowed certain institutions to grow hemp for for research purposes. And then fast forward to 2018 where the cultivation of hemp has now been legalized. Okay, now, CBD is tricky isn’t a great area. Even when you read the law, different departments say different things. So the DEA is saying one thing the FDA is saying one thing, there’s no united front when it comes to CBD, so it’s really murky. So let me tell you what each of them are saying her and a lot of this change because of it. prescription medication called epic deal. Okay, this is basically an FDA approved version of CBD. It’s just like the CBD that comes from hemp and the CBD that comes from marijuana, the molecule is the same. It’s just that it’s the formulation that has been has been approved by the FDA. Okay, so this all happened in the summer of 2018. What happened was this company called GW Pharma, I believe they partnered up with bear came up with this medication. They did clinical trials. It was approved for specific subsets of epilepsy, pediatric epilepsy. And basically the FDA went Hey, look, we’ve approved this drug, it’s gone through you know, phase three clinical trials. And then they went to the DEA and they said you need to request by CBD. It was pretty much that that easy, and they said you have 90 days to do it. But what the DEA decided was okay CBD in that’s an FDA approved drug is going to be considered class five CBD that’s in any other form is going to be considered class one which as a physician It makes no sense because it’s the same damn chemical doing the same damn thing right? where it comes from doesn’t really matter I mean yeah, you know the end product will be more standardized when it comes from pharmaceutical company health as opposed to it being extracted by grower or manufacturer out in Colorado. So that’s essentially where we stand. The FDA also says that a lot of what was going on with that CBD was being sold as a supplement a dietary supplement. So they’ve made the statement that CBD cannot be sold as a dietary supplement. But it still is right and CBD is being sold rampantly and the FDA doesn’t have any enforcement jurisdiction as far as I know. And the DEA, I believe it is There was something somewhere that said that they’re not going to spend funding on enforcing the THC and the CBD products, not the THC products, sorry, but the CBD products being sold. So that’s kind of where we stand. And it’s basically an unregulated industry. 70% of CBD products are mislabeled. So people are out there, buying, you know, a one ounce bottle of pretty much olive oil, and paying like, a lot of money for it, in hopes that it will help things like their pain or their anxiety or their insomnia, but 70% of the time, it doesn’t help them because the products are labeled.
Well, that’s the supplement industry to begin with, right? It’s because it’s not regulated by the FDA. They’re not subject to any type of screening to make sure that they’re selling what they actually say that they’re selling. And actually, that happens in restaurants too. That happens restaurants where they tell you that you’re getting one fish and you’re really eating another buy there was an article in The New York Times a couple of years ago about the frequency of Miss labeling food, particularly fish on the menu, but you think you’re eating one type of fish and really you’re you’re eating type of another so so as much as people like to trash the FDA, at least by and large, we are getting what we think we’re getting. So, but yeah, it sounds like CBD is in the wild west of the of the supplement industry.
So you you mentioned what was that product? That’s you that’s a CBD is it? Is it CBD is just CBD derivative that’s used to treat epilepsy. pediatric epilepsy.
Yeah, so is CBD derived from cannabis? Not hemp. And it’s called epi, epi di o le. And quite pricey.
Why wouldn’t it be?
So are there any other either any other marijuana derived medical patients that have been approved by the FDA. So what I want to get to is I want to start off talking about really the, the stuff that’s backed by as much evidence as possible. And then we’ll kind of loosen it up a bit.
Yeah. So there is another marijuana or a derived medication not approved in the United States, but approved in other countries called Sativex that is also a cannabis, derivative of both THC and CBD. And then finally, we have molecules that mimic THC, right. So you have drew national, which goes by the trade name, marijuana oil, and then you have mamelodi and forgot the trade name for that. But those are basically synthetically derived or synthetic synthetically produced, twin of tsp.
And what are those do?
They have been approved They were approved back in the around the 1980s for the use of nausea, vomiting and lack of appetite in patients who are undergoing chemotherapy and in HIV AIDS patients.
Okay, so so far we have some specific types of pediatric epilepsy that are treated with marijuana derivatives. We have nausea, vomiting, wasting syndromes that are treated with marijuana derivatives, are there or synthetic versions thereof? Are there any other currently FDA approved medications either derived or that mimic any other aspect of marijuana?
Those are the main ones. There’s bad effects. Like I said side effect was not approved in the United States. But it’s been approved in other countries like the United Kingdom or Israel and one of them Australia. or multiple sclerosis facticity associated with multiple sclerosis.
Do you know if they’re used for spasticity in any other condition? Or is it that specific that it’s just in multiple sclerosis?
Just multiple sclerosis, okay? Because that’s what they, they they ran the set the clinical trials one.
So let’s take a step back and just talk about some of the biochemistry, just some basic biochemistry, right? Because the tagline for the podcast is everything that we should have been learning while we were memorizing Krebs cycle. So we don’t want to get into the minutiae of human race. And I can’t remember any of the steps of the citric acid cycle, but you get what I’m saying. So just some basics of the biochemistry of THC and CBD. How do they work? What do they bind to? Where Where are those receptors?
Sure. So you have in terms of receptors, the most prevalent receptors, that the cannabinoids interact with our CB, one cannabinoid, one receptor. CBG cannabinoid two receptor, okay, maybe one is very prevalent in the central nervous system, whereas CB two is more prevalent in the immune system. In terms of like in right the ligature, chemicals that interact with these receptors we have endo cannabinoid, right so cannabinoids that our body produces, the two of which have been most studied include a Nanda mind, which is similar in structure to THC, and to ag. Okay, so those are endocannabinoids. Then you have Phyto cannabinoids. So you have a cannabinoids that are derived from either marijuana or from hemp. And they those that are made and most prevalent by these plants are CBD and THC. And then you have the synthetic cannabinoids, which I talked about, such as Marinol and now below as well.
So what about side effects? What are the types of side effects that you see with? Let’s start with THC?
Sure. So with THC if any of your listeners have ever gotten high back in high school or college, what you experienced were the side effects of THC, right? So the side effects occur at based on dose if you overdo it, you’re going to experience side effects, which is typical of basically any medication. And so with THC. The most common side effects include palpitations, right so your heart’s gonna feel like it’s racing, anxiety or in worst case scenario, paranoia, dry mouth, and dizziness. Those are the most common side effects of THC. Now, that’s if you somewhat overdo it, if you really overdo it. In all likelihood, you’ll you know, you’ll probably be like curled up in a fetal position somewhere and you’ll feel really nauseous. You’ll you may start vomiting and you may hold and with CBD, the worst case scenario if you take too much most common side effects that have been reported include tiredness and diarrhea, and changes in appetite and weight.
The side effects of THC somehow remind me of, you know, how does a hair dry as a bone? marrow doesn’t matter? Whatever that medical pneumonic, what about the potential for overdose,
overdose so we don’t have cannabinoid receptors in our brain stuff, right? And that’s the area that controls the breathing. And so though you may feel really crappy by overdosing on these chemicals, it’s not there. It’s not lethal dose. It’s not a Wiesel substance.
And you mentioned that if you’ve ever gotten high then you’ve experienced the side effect of THC. You know, keep in mind that that’s, I mean, our listeners Keep in mind, I know you keep that in mind that that’s all a matter of perspective, right? Like Benadryl, Benadryl, when used as an ad histamine for its or diphenhydramine when used to anti histamine. One of the side effects is drowsiness now Yep. If you’re taking NyQuil or taking Tylenol PM, well the active drowsiness inducing medication is diphenhydramine. So you’re using the side effect as the desired effect and so potent is are effective is NyQuil that they branded z coil, which is just diphenhydramine. Some brilliant marketing, I think, in some ways that maybe went to the wrong profession should have gone into more. So, okay, so no overdose potential for those because there’s no binding in the brainstem, so there’s no potential for respiratory depression. What about any drug interactions that you see?
Um, yeah, there can be drug interactions with CBD specifically, what they found when they were studying at the DLS was that when taken in conjunction with valproic acid, which is a commonly prescribed anti seizure medication, they saw the participants, liver enzymes, and liver enzyme levels go up. Okay. So In general, they just said in that in that study that any medication that has the capacity to cause hepatocellular injury should be used with caution when use with PPG. Right. So you really want to have your liver enzyme, enzyme levels monitor, we’re taking something that could potentially cause injury to liver and you’re taking CBD along with it. Okay. With THC, it’s a little bit more gray because there isn’t as much definitive data on it. There was a case study where a patient who was on THC took warfarin and impacted their INR levels. But clinically, I’ve treated patient upon patient with who were on warfarin. And you know, from year to year, we track their INR levels, and it stayed the same, you know, they didn’t have to adjust the warfarin level, the INR levels were not impacted. So, you know, I don’t know One case report that you know, who knows what could have happened there. So and I haven’t really seen any other major drug interaction, but THC off the top of my head. If you go to
a few episodes ago with Dr. A fib, where he was talking about the use of warfarin for a fib, it looks like it was when I was a resident that was the anticoagulant of choice. But now with eliquis, and some other medications, looks like most of those patients that were previous on warfarin are getting off of it. So that other potential interaction that the case report is not gonna be as relevant as maybe it once was.
Yeah. And I’m actually going to have Dr. molars on my YouTube channel to discuss this very thing he said, and medications that are used, and potential for interaction. DMT is free. So tune into that YouTube channel. Yeah, I look forward to seeing that.
Yeah. So we’ve talked about side effects. We talked about overdose. We’ve talked about interactions, what about addiction
addiction. Okay, so this is really interesting. There’s there’s this whole sort of notion that marijuana is the gateway drug. Right. And I looked into the research on this as well, around back in 2010, there was an international study done to me, where, you know, they actually studied whether or not marijuana is a gateway drug. And so the hypothesis was, was that when you have a population that has access to marijuana, in all likelihood, there’s going to be greater use of other illicit drugs. And when and if there’s a we see a lot of use of illicit drugs and in all likelihood, these these, this population is probably also using a lot of marijuana. Okay, so they looked at Japan, Japan, the data showed that by the age of 29 89.2% of the population had to use some form of an illicit drug other than marijuana. However, Only one point like 6% of the population had used marijuana. So it blew one of the theories out of the water. Now, the other thing that they did was they compared this was back in 2010. Number This is when in the United States, marijuana was only available for medical use, not for recreational use. Okay, so they compared the United States to Amsterdam, right, which is known as the marijuana capital of the world, or was at least, and so that population had a lot of access to marijuana, the US at the time, did not. And so they assumed that there’s been a lot of illicit drug use in Amsterdam compared to United States, not the case. There was more illicit drug use in the United States, then in Amsterdam. So this entire study, International Studies sort of, you know, blew the whole theory that marijuana is the gateway drug out of the water. And that is the data speaks for itself. In that case, there is potential prediction, I’m not going to say there is is a potential for addiction. Okay, it all depends on how you use it. When you do moderation, there’s little to no potential for addiction. But if you abuse it like a drug, yeah, there is potential for addiction. Again, like a lot of other medication.
What would you experience any type of withdrawal symptom after stopping chronic use? Are there any reports of that?
Nothing, nothing like with alcohol or opioids. The reason is, is that that the cannabinoids are fat soluble, okay? So even if somebody stops that cold turkey, you have stories of it in your body that can help you essentially wean off of it. Worst case scenario, you have withdrawal symptoms for a period of maybe four to six weeks, where you have changes in mood, appetite, sleep patterns, that’s probably about it.
Well, you just mentioned the fat solubility. So let’s use that to dovetail into the different methods of of ingestion, right? The difference between smoking and eating and topical application. So what is it? What is important to know about the different methods of ingestion?
Okay, so let’s back up a little bit talk about what are the different methods of administration or delivery methods, right for marijuana products and for CBD oil products. So, common methods include topicals. Okay, we do have receptors for cannabinoids in our skin. And that’s one formulation. Then you have edible right most commonly with found are things like gummies and chocolate. Then you have what are called tinctures which is basically a sublingual formulation of either CBD oil or marijuana product. Then you have inhalation right now. Yeah, there’s smoking but typically I don’t recommend that to my patients, but rather, what I recommend is vaporisation. And essentially that’s, that’s eating These products up to the point where you know, they’re not combusting. So you’re not creating hydrocarbons. And then Believe it or not, there’s also rectal and vaginal formulation of these cannabinoids as well. And best delivery methods depend on the patient’s current medical history, and also what other medical conditions they have. So as an example, I’ve had patients who’ve undergone gastric bypass surgery, and what I know from treating patients is that these patients do not have edible Wow, and instead need to use inhalation or sublingual formulation to be you know, to get a better effect from the cannabinoids directly. Yeah, that’s another way to use it as well.
I’m always gonna recommend that not just because it’s available. Right and not being serious.
Okay, I thought you were I was like it was a possibility.
This is the time that having a podcast interview people that don’t know me so well anyone who’s listening to the podcast knows that. They would just assume that I’m going to say that anyway. But my recommendation, anytime you’re administering a THC or CBD is going to be rectally. It doesn’t matter what your condition is. In the touch.
Well, also a doctor talking to doctor it’s like, okay, yeah, sure, you know, as opposed to somebody else. Okay, sorry to interrupt. Yeah. So basically, those are the various different delivery methods. And you know, it varies by condition like anxiety, for instance, obviously, topicals are not going to be effective. migraine topicals typically not effective, you have to take it internally. So it’s really going to depend on the patient’s history, the patient’s medical condition that they’re looking to treat. So
what do we have to know about like, say, the bioavailability for those different methods of ingestion? So if you’re, if you’re making a recommendation to a patient, right, because certainly the bioavailability is going to be different for oral sublingually transcutaneous Li, or inhaled or directly?
Yeah, so we don’t have a lot of information about availability, we do have information on in terms of pharmacodynamics. Our peak effects and average duration of effect, right? Not what percentage is available for your body to consume, like with inhalation may have an idea like inhalation versus vaporization, what amount is actually getting into your body. But we don’t we don’t have it down to exact numbers yet when it comes to comparing with different methods, but what I can tell you is that with inhalation, the peak of fact is anywhere from two to four hours. With ingestion, it’s six to eight. With sublinguals. It’s about four to six hours. Now duration is a little bit different because again, it’s a fat soluble substance. So for some patients, you know, the effect can last for a while. I mean, it just depends on on, on, you know, your metabolism of your fat cell.
And I would imagine, in patients that have obesity, they’re the half life is going to be a whole lot longer, right? Because it’s like salt in the fat. And then then it’s going to say more slowly, just like a patient with obesity when they’re getting an inhaled anesthetic, right, that’s going to be fat soluble, and it’s going to take a lot longer for them to breathe it off then for someone with less adipose tissue,
right, so there’s the half life in the adipose tissue, but then there’s also the plasma half life as well, right? The plasma halfway from what we know is anywhere from a can range anywhere from nine to up to 30 hours.
That’s quite a range. Yeah, it is. Alright, so we’ve we’ve spoken about the marijuana derivatives and what they’re FDA approved for or approved for and in other countries. What is the most ridiculous thing that someone has hoped that they could use? Use it for but actually can’t use it for like, will it help me to regrow my hair or help me break a nine minute mile or something? Have you heard any say preposterous use for medical marijuana or derivative thereof that you think is not true?
Well, okay, so this is this is a tough situation to be in. But I’ve had patients come in wanting to cure their cancer with marijuana or CBD oil. And you know, they may they most Usually what happens is that they read something on the internet, that BAM Dr. Google, and you know, people are telling stories that Yeah, you know, a cured my cancer, and then I have to sit down with them and explain to them that I cannot say with certainty that it will cure your cancer. First of all, the concept of curing a cancer is not even used by physicians, right will say that they can Cancer is in remission, we won’t say it’s cured or treated. And yes, there’s research in animal models, and in petri dishes to show that these companies compound could have could have anti cancer properties. But we barely have any research in humans. And so you know, it can’t be fast. But then I’ve had, like, family members of people who’ve had patients and call my receptionist up and you know, very adamant and say, What is Dr. Patel mean that it doesn’t cure cancer? I need to talk to her. She’s a doctor in this field, how could she not know this? And so you know, I’m in the position that a lot of other positions are where you’re fighting medical misinformation on the internet. And it’s unfortunate because these patients, especially the patients with cancer, they’re doing it at the width of their life. Right, they could potentially what they might be doing before going conventional treatment, which for certain cancers is Nowadays very successful, have they found ways to do it, you know, have very targeted their treatments that minimize side effects. And yet, they’re like, No, I don’t want to do that, you know, the chemo is going to kill me. I just want to treat, you know, cure my cancer with marijuana or with CBD oil. And so I’ve had to send patients back out, I wouldn’t issue them the recommendation, because it felt like okay, this is they’re endangering themselves. They’re endangering their life by doing this.
Yeah. And that’s some of the danger of complementary and alternative medicine is, I mean, people make the argument that some of them well, it doesn’t have any negative effects. So if we’re taking advantage of the placebo effect, what harm Could it be doing? Well, some of the harm is situations like this where people then take that and run with it and use it, not in addition to allopathic medicine, but instead of allopathic medicine,
right. And the thing is, is that it’s being touted As a journal, but as a doctor, I always have to remind people look, it works great for certain medical conditions better than pharmaceutical meds, but not for all conditions. Right? So even for instance, like blood pressure, I’ve had patients come in wanting to treat their blood pressure with with medical marijuana with CBD oil. And clinically I, I’ve never seen anything that you know, these medic medications haven’t made blood pressure worse but they haven’t made it better. You know, a lot of my patients who started off on antihypertensive a year later after being treated with medical marijuana CBD oil had to continue to stay on antihypertensive. So there you know, I think that’s the other thing so one of the other things that I do on my YouTube channel is not do I not only do I talk about what these substances, you know, CBD oil and marijuana help, but also what did they not help as well? Because I think that’s that’s important and you know, Thing is, is that a lot of these claims are driven by money, right people making claims on the internet to sell their products or their services. But they don’t realize the harm that can be done in, you know, nonchalantly saying. Yeah, marijuana cures cancer, you know, it could be at,
I think CBD has gone the way of Frank’s Red Hot, right, the commercial for Frank’s Red Hot. I put that on everything. I think that’s what CBD has has become. So let’s actually go into what else what you do use it for. So what are the conditions you use to treat that you use medical marijuana to treat if you use medical marijuana, or you use specifically CBD, please, you know, differentiate between the two.
Yeah, so let’s start with CBD. What if I found CBT effective for most common conditions, migraines and headaches. nerve pain and we’re talking about mild to moderate nerve pain, not severe nerve pain, muscular pain, anxiety and mild to moderate insomnia, with THC. In some cases, it’s just high amounts of THC that are effective in some cases. In addition to the THC, you do need some amount of CBD for to be effective. But overall within this category, you have autoimmune conditions, right such as psoriasis, Crohn’s disease, rheumatoid arthritis, you have nausea, vomiting, lack of appetite, severe nerve pain, and severe insomnia. So those are that covers, I would say, the most common like 80% of conditions that medical marijuana and CBD oil are affected for. And then you also have conditions such as autism, and other conditions that fall within the other 20% of categories.
Well, is there anything else that you want? To discuss today because I think this was pretty, pretty comprehensive.
Um, no, I hope that, you know, whoever your audience’s walks away, well informed with the information that I had to share.
They definitely will be. So you mentioned that you’re going to have Dr. Morales, Dr. A save on your YouTube channel. So where can people find this YouTube channel?
Yeah, so just do a Google search for the medical marijuana expert plus YouTube or the CBD oil expert plus YouTube, either one of those two, the channel will show up on the first page of Google search results at the very top. I also have a book that’s coming out tomorrow, which releasing tomorrow, March 5, and it’s on CBD oil. It’s titled the CBD oil solution. You can find that on Amazon or wherever books are sold, including Barnes and Noble. And then finally, I have a Facebook group that’s dedicated to just answering questions about CBD and CBD oil. We can get to that by going to facebook.com backslash groups backslash ask the CBD expert in there one other product. Yes. So I do I have CBD oil. And I also do consultations online as well. So, so that’s that’s the full range. You got it all.
Fantastic, fantastic. And one more question and if you don’t want to answer this, I completely understand where do you were in the house? Do you keep your stash? Is it in the medicine cabinet? Is it with the grains? Is it with the next to the oregano? Where do you keep it?
Okay, so I’m very scientific about this. I keep it in the refrigerator. And that is because the chemical breakdown when exposed to heat and light. So to prevent the chemical breakdown, I stick it in the fridge. Excellent. Yeah.
If you come to my house, open up my frigerator that’s my sash. That’s okay.
All right. Well, it has been extremely informative, and comprehensive. And I really appreciate you taking the time, especially the day before a book launch. So, best of luck with the book launch. And we’ll definitely have links to all of that in the show notes. And, again, appreciate you taking the time.
Yeah, yeah. Thank you so much.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for previous guests, or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
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