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“Seed to Shelf” – It Matters With more companies emerging into the CBD industry, “Seed to Shelf” is becoming a common phrase used among them. But, do these companies really understand what this entails and are they able to elaborate on the importance?


EDITORIAL & ADVISORY BOARD

ANNE BOLDUC Group Publisher & President EDITOR IN CHIEF Guy J. Jonkman

ROBERT M. GOLDMAN, MD, PhD, DO, FAASP World Chairman-International Medical Commission Co-Founder & Chairman of the Board-A4M Founder & Chairman-International Sports Hall of Fame Co-Founder & Chairman-World Academy of Anti-Aging Medicine President Emeritus-National Academy of Sports Medicine (NASM) DR. RONALD KLATZ, MD, DO, is the physician founder and President of the American Academy of Anti-Aging Medicine. In 1984, Dr. Klatz was a pioneer in the clinical specialty of preventative medicine: as a principal founder of the National Academy of Sports Medicine and researcher into cannabis medicine elite human performance and physiology. Dr. Klatz is a best-selling author, and is columnist or Senior Medical Editor to several international medical journals. He is the inventor, developer, or administrator of 100-plus scientific patents, including those for technologies for brain resuscitation, trauma and emergency medicine, organ transplant and blood preservation. DR. ADAM ABODEELY MD, MBA, FACS, FASCRS is the founder/CEO of ReserveMD™ and is a Board Certified Surgeon specializing in gastrointestinal diseases and cancer. Realizing the benefits of cannabis for patients with such ailments, Dr. Abodeely expanded his medical cannabis practice to include patients with a variety of medical ailments. He is an active member in numerous international cannabinoid societies and he serves as Chairman of the Dispensary Review Committee for the Association of Cannabis Specialists. Dedicated to advancing the science and education of cannabinoid-based therapies, he has a special interest in formulating products which capture the unique benefits of cannabinoids.

DAVID B. MANDELL, JD, MBA, is a former attorney and author of ten books for clients, including For Doctors Only: A Guide to Working Less & Building More, as well a number of state books. He is a principal of the financial consulting firm OJM Group. He has co-authored the Category I CME Monograph Risk Management for the Practicing Physician which has gone through 5 editions since 1998 & is certified for 5-hour business of medicine CME.

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“Seed to Shelf” – It Matters Randy Fink, MD, FACOG, Sahar Swidan, PharmD, BCPS, Cohin Kakar, PharmD, MBA The Seed As more companies nd their way into the CBD industry, a common phrase being shared among many is “Seed to Shelf.” Do companies really understand what this entails and are they able to elaborate on the importance? It is important to verify the source of every CBD product, as more and more reports are released regarding contaminated and mislabeled CBD products. Ultimately, most CBD products are being ingested and/or applied topically and although largely unregulated, no company should be o ering a less than perfect product that is safe for consumers to use. This is why “Seed to Shelf ” is important. Having control of every step of the production process is the only way to be absolutely sure that a product is safe and of high purity & quality. Many companies that claim this capability may not be aware of the true de nition, and therefore are putting consumers at risk. Seed to Shelf – A capability that a company has by FULLY controlling their agriculture, extraction, processing, bottling, and distribution to assure that it is of the highest quality standards, abiding by all applicable regulations. In CBD speci cally, this capability is of utmost importance because every step can alter the quality of the nal product. The soil that a seed goes into matters immensely, as it can determine what cannabinoids will eventually be extracted from the Hemp owers. As more data builds around more cannabinoids, apart from CBD, this initial analysis will become even more important.

The Anthos Group offers a transparent “Seed to Shelf” program, by offering tours of their facilities in Eugene, OR to potential customers. The Anthos Group performs novel soil analysis and rigorous seed germination to assure of nutritious soil and a durable plant prior to planting. This allows for the growth of a Hemp Plant that is rich in cannabinoids and fully enhanced with rich nutrient soil. Furthermore, The Anthos Group has developed a hemp cloning program that guarantees consistency across all lots, offering healthy plants, strong CBD and cannabinoid yields, and a high overall output. Along with a gentle, yet high tech extraction process, The Anthos Group is able to control every step towards quality and produce a top notch final CBD product. By walking a customer through these steps, they are assured of a high quality product that has been cared for through every step. The Anthos Group works closely with Physicians, Pharmacists, and Agricultural Scientists to create safe, high quality brands that can deliver potential benefits to customers; all due to the early care of the seed. For more information, please visit: www.theanthos.com Additionally, a smart plant protection program is just as important. Many farms make the mistake of planting seeds directly into the natural elements, and without a strong root system in place, lots can lose large amounts of yield to the weather.


A Dive into the Science Over 560 components have been identi ed in Cannabis and over 120 unique phytocannabinoids found to date. While, Δ9-THC and CBD are the most abundant and most recognized constituents, the amounts of all these phytocannabinoids vary by strain, cultivation techniques, preparation, and route of administration. More data is accumulating to support that it maybe favorable to use the full spectrum of cannabinoids vs. the isolate such as THC and CBD. The Entourage e ect maybe helpful in various clinical syndromes as we continue to gather more clinical data in this eld. All phytocannabinoids a ect this system by either acting directly on CB receptors or modulating the endogenous Endocannabinoid System (ECS). Studies from the 70s show that THC and CBD work together for synergy but actually it maybe also safer to use the full specrum of phytocannabinoids. One study gave subjects Δ9-THC alone, CBD alone, and both t Δ9-THC caused increased pulse rate and psychological reactions t CBD alone cause no e ects t When given together, CBD blocked the e ects of Δ9-THC t Most notably decreased anxiety and increased euphoria Another study found no PK interaction between the two t THC clearance was 17.4 mL/min/kg without CBD t THC clearance was 20.9 mL/min/kg with 1,500 mg CBD More and more data is showing the anti-in ammatory and pain processing modulation that occurs via the ECS. The ECS modulates peripheral nerve terminals and extend up to the supraspinal centers, which constitute the pain (nociceptive) pathway (3). Endocannabinoids have been noted to have anti-nociception as a prominent feature in various models of pain. The analgesic e ects of cannabinoids are primarily mediated by the cannabinoid receptor 1 (CB1) via inhibition of presynaptic gamma-aminobutyric

acid (GABA) and glutamatergic transmission which suppresses neuronal excitation. Cannabinoid analgesia occurs via the suppression of nociceptive neurons. Endocannabinoids, the endogenous cannabinoid or eCB, have been shown to modulate pain by behaving as analgesics in both acute nociception and in clinical pain such as in ammation and painful neuropathy. Endocannabinoids do this because the analgesic e ects exist in the CB receptors mentioned above. When a patient has in ammatory hyperalgesia eCBs are able to mediate the pain because their receptors are found in areas of the nervous system important for pain processing and in immune cells that regulate the neuro-immune interactions. Cannabinoids have been found to have action in many parts of the body; over 65 cannabinoid sensitive receptors have been identi ed. THC binds with relative a nity to CB1 and CB2 receptors. CB1 is primarily located in the central nervous system (but not the medulla) and inhibits the release of neurotransmitters. CB2 is largely found in the periphery on immune and nerve cells however, CB1 and CB2 receptors have been found all over the body. Endocannabinoids have e ects on: short term memory, neurogenesis, appetite stimulation, analgesia, inhibition of immune function and reduction of the HPA axis during stress, which is why they can have various physiological e ects due to the availability of these receptors all over the body.

THC/CBD Dosing THC dosing can be reported in two types of units: % THC and absolute mass of THC (mg).1 The former provides only a relative measure of mass THC that cannot be used for comparison between studies that usually employ di erent sizes/weights of cannabis cigarettes. The latter provides an absolute measure of total amount of THC contained in a cigarette and is much preferred over relative units, because it does allow comparison of THC dose across studies.


To nurture a healthy Hemp plant, other measures need to be taken. Organic growth practices are important to keep this eventually ingestible product free of pesticides and contaminants. Some of the more advanced farms have developed cloning programs where they may model their entire lot after the healthiest of Hemp plants. This provides a consistent yield of cannabinoids as well as assures a high quality product, almost every time. These steps are the type of transparency good “Seed to Shelf ” companies should be able to talk through and introduce, yet many cannot. Lastly, the extraction process can be complex and also can alter the quality if not performed correctly. The more processing a plant goes through, the more natural elements are lost. This is very important in Hemp plant extraction as essential cannabinoids can be lost, and therefore make the product ine ective and/or dangerous. Extraction methods should be gentle in nature, taking away a diverse cannabinoid pro le from the plant in a clean fashion that leads to an excellent nal product. Di erent heating methods and temperatures can a ect this process and the nal product greatly.

Why does it matter? Let’s take a step back and look at why CBD is gaining so much attention. Customers are reporting relief in di erent symptoms, including stress, anxiety, pain, and in ammation. All of these characteristics are attributed to balancing the Endocannabinoid System, which is done by CBD and other cannabinoids. So, if the plant is not rich in cannabinoids to begin with, how will the nal product be able to potentially o er any of these bene ts? High quality CBD products should have a rich cannabinoid pro le, because that is what can bring customers the answers that they are looking for.

“Organic growth practices are important to keep this eventually ingestible product free of pesticides and contaminants.”


Routes of administration:

THC: For THC rich cannabis; start with a single inhalation and wait 15 minutes before inhaling again since effects can usually be felt within a few minutes. If taken orally, it may take 60-90 min before effects of a single dose are felt. TITRATING THC: On days 1 and 2, start with one dose of the equivalent of 2.5 mg THC; on days 3 and 4, increase to 2.5 mg THC twice a day; and, if well tolerated, up the dose incrementally to a total of 15 mg THC. THC’s total daily dose-equivalent should generally be limited to 30 mg/day or less.4 THC-mediated side effects such as fatigue, tachycardia and dizziness are avoidable when starting dose is low and titration is slow.

THC/CBD Combo: As little as 2.5 mg of CBD combined with a small amount of THC can have a therapeutic effect. For patients that have not tried/used cannabis before, start with lower doses of a higher CBD concentration and increasing the dose over time.2 The key to combination therapies is to try different concentrations and observe the effects until the patient finds their “sweet spot”. Titration of any cannabis preparation should be undertaken slowly over a period of as much as two weeks.4

According to the European Journal of Internal Medicine the regimen for THC is as followed:

CBD:

• Days 1–2: 2.5 mg THC-equivalent at bedtime. (may start at 1.25 mg if young, elderly, or other concerns).

There are no established dosing guidelines or maximum doses established except in psychosis (800 mg)5 and seizure disorders (2500 mg or 25–50 mg/kg).6

• Days 3–4: if previous dose tolerated, increase by 1.25–2.5 mg THC at bedtime. • Days 5–6: continue to increase by 1.25–2.5 mg THC at bedtime every 2 days until desired effect is obtained. In event of side effects, reduce to previous, best tolerated dose.

ANXIETY: Evidence showing CBD’s e cacy in reducing anxiety behaviors relevant to many disorders, including PTSD, GAD, PD, OCD, and SAD, with a notable lack of anxiogenic e ects. This study shows that “at oral doses ranging from 300 to 600 mg, CBD reduces experimentally induced anxiety in healthy controls, without a ecting baseline anxiety levels, and reduces anxiety in patients.”7 PSYCHOSIS: Currently, the rst and only clinical trial (n=42) compared CBD to amisulpride and clearly showed that CBD is capable of reducing psychotic symptoms equally e ective to amisulpride but with

For other indications, patients can obtain benefits with drastically lower doses, starting with around 5-20 mg per day.

signi cantly less side e ects. This trial suggests that 800mg of CBD or amisulpride provide equally signi cant clinical improvement, with cannabidiol displaying “a markedly superior side e ect.”

Cannabigerol – CBG Cannabigerolic acid (CBGA) is the precursor to CBG, THC, and CBD in the cannabis plant and it is a major pathway that converts CBGA to THC and CBD. CBG is a highly potent α2-adenoreceptor agonist and blocks CB1 and 5-HT1a receptors and is a strong TRPM8 antagonist.


“Cannabinoids have been found to have action in many parts of the body; over 65 cannabinoid sensitive receptors have been identi ed.”

We have limited human studies right now and mainly mice studies but more and more will continue to accumulate about these new phytocannabinoids.

Cannabichromene – CBC CBC is also abundant in the cannabis plant and has low a nity for CB1 and CB2. Further more it is a potent agonist at TRPA1 and activates TRPV3 and TRPV4 which may modulate in ammation and many mice studies have looked at the anti-in ammatory e ect of this of phytocannabinoid.

Cannabinol – CBN CBN is the oxidation product of Δ9-THC and is a weak CB1 and CB2 agonist. Its activity is about 10% as compared to Δ9-THC and therefore exhibits weak psychoactive e ects. The drug Nabilone is a CBN derivative. All phytocannabinoids exhibit anti-microbial e ects but CBN was the most potent against MRSA and showed MIC of 1ug/mL for all strains.

Δ9- Tetrahydrocannabivarin – THCV The main di erence between THCV and THC is the side chain. THCV exhibits weak activity at the CB1 and CB2 receptor and have further activity on the 5HT1A receptor, the TRPA1 and TRPV2 and is an antagonist at the TRPM8 receptor. A 2016 study examined the e ects of THCV and CBD on patients with type 2 diabetes (non-insulin dependent) Gave subjects: 200 mg CBD daily, 10 mg THCV, 10/10 mg CBD/THCV, 200/10 mg CBD/THCV, or placebo for 13 weeks

t THCV signi cantly decreased fasting glucose

“The Entourage E ect is de ned as the synergy among various cannabinoids that are derived from the hemp plant that can lead to signi cant therapeutic bene ts.”

t Estimated treatment di erence from placebo = 22 mg/dL

t THCV signi cantly improved pancreatic function t THCV could represent a new treatment for diabetes

Minor phytocannabinoids in cannabis may contribute the therapeutic e ect via the entourage e ect and potentially be used in the treatment of various disease states such as pain, in ammatory disorders, schizophrenia, diabetes, oncology, infectious disease and many more. More clinical trials are needed to


learn the individual e cacy of these isolates but also the combined entourage e ect. This is a major reason for seed agricultural research and expertise to better understand how the Hemp Plant can be supported to nurture this phytocannabinoid pro le.

CBD in Clinical Practice As CBD has come more into the clinical lexicon, so too its uses have expanded. To be clear, in Florida, as in certain other states, medical marijuana is legal and indeed the use of THC-rich products has become more mainstream. The confusion between state laws allowing and Federal laws restricting THC muddies the waters, just as the Farm Bill of 2018 allows federally for the use of hemp-derived CBD while state legislation is often slow to catch up. Nevertheless, the indications for medical marijuana are well de ned by the Florida legislature, and despite hoops through which a patient must jump, receiving certi cation for medical marijuana is relatively easy with criteria that is uid and open to broad interpretation. Interestingly, the marijuana dispensaries o er a low-THC CBD oil at 0.8% THC; while it is hard to know if a clinical di erence exists in the one-half of one percent di erential between the dispensaries’ product and the 0.3% THC in over-the-counter fullspectrum hemp oil, the price in a dispensary is often multi-fold higher.

make them sleepy. As sleep hygiene in the industrialized world is often poor, patients are thus recommended to start their product at bedtime. In relatively short order, our pilot study demonstrates that tolerance develops to the somnolence e ect, though the overall quality of sleep continues to improve. Often the ruminations and anxieties that delay onset of sleep are easier to quiet, so that sleep comes faster and with less distraction. Consumers may nd that they still wake up at night if they were prone to doing so, but they tend to fall back to sleep quickly and get out of bed more rested. It is not uncommon that they still want to stay in bed come morning, but they usually have no residual fatigue once they are up. Dreams may become more lucid, because it appears that REM sleep in increased. Those with sleep tracking apps will see an immediate di erence in the graphs generated by the sleep tracking technology, so the bene ts can be easily documented.

The e ects of even once-daily dosing on anxiety and mood disorders are similarly remarkable. Some consumers bene t from dosing more frequently, such as two or three times daily to maintain a steady-state, and even PRN at times of increased need. The advantage of using tincture is that consumers may titrate the dose to their own e ect, though this very bene t is often confounding to clinicians who are accustomed to It has also become more common for patients to inquire the regimented and xed dosing of pharmaceuticals. about CBD and hemp oil, though by far more are being Though there is less ability to objectively quantify the led to trying it at the recommendation of a well-informed bene ts on anxiety, our pilot study demonstrates most clinician. Obstacles to its use are most commonly from patients report a decrease in repetitive thoughts and misinformation, such as the incorrect impression that ruminations, psychomotor agitation, and symptoms of hemp oil is intoxicating or in some way “fringe”, like the both panic and agoraphobia. While we have yet to make use of marijuana is often perceived to be. a head-to-head comparison of full-spectrum versus broad-spectrum products, empirically it seems that fullThe three most common clinical uses of hemp oil are for spectrum has increased e cacy in both sleep and anxiety. sleep, anxiety, and pain. This suggests that even a nearly unmeasurable amount of THC, less than 0.3%, improves the entourage e ect Initially, a patient with an endocannabinoid dysfunction of the cannabinoids in a measurable way. in sleep will nd that use of full-spectrum hemp oil will


CBD is well documented in treating pain, both from the systemic and topical approach. We have found that using CBD in topical products combined with, for example, non-steroidal anti-in ammatories (NSAIDs), decreases the amount of the NSAID necessary. We have found that systemic use improves pain in general in ammatory states such as those in some arthritic conditions, and even improves pain in both de ned and ill-de ned connective tissue diseases. Fibromyalgia, chronic tendonitis, rheumatoid arthritis, and plantar fasciitis are but a few examples, along with more acute problems such as low back strain. Like mood disorders, pain is often multi-factorial, and every patient’s endocannabinoid dysfunction is unique. Thus, self-titration with tincture is useful. Empirical human evidence suggests bene ts in numerous other areas, often substantiated by animal data. The rst phytocannabinoid drug to be approved in the United States is the anti-epileptic Epidiolex (GW Pharmaceuticals), approved for the narrow cohort of patients with Lennox-Gastaut or Dravet syndromes. It will certainly not be the last cannabinoid drug. Meanwhile, epilepsy meets criteria for THC-laden medical marijuana. It stands to reason that hemp oil phytocannabinoids will be shown to bene t across the spectrum of seizure and other neurologic disorders, as they are being used empirically now. It takes only a modicum of experience with hemp oil derived phytocannabinoids for a clinician to begin to understand the bene ts of use, but there remains several obstacles to its broadest acceptance. Only Big Pharma has the nancial resources to produce massive clinical trials resulting in the type of scienti c data to which clinicians are accustomed; for now, we will need to accept case reports and sample sizes signi cantly smaller than those paid for in multimillion dollar drug studies. Secondly, the lack of rigorous quality control criteria for the growth, production, labeling and overall quality control of consumer-facing, or even clinician sold brands leaves the marketplace ripe for confusion. From the clinician’s perspective, this lack of uniformity makes the recommendation of speci c CBD-related products and brands a free-for-all. Hence, the need arises for criteria to establish a “medical grade” of hemp oil. And nally, the variation in dose requirements for given individuals with given ailments may make clinicians more comfortable with personalized medicine and the individualization of dosing more likely to recommend CBD as an option. Classic medical education still approaches use

of cannabinoids as less than rigorously scienti c, and clinicians accustomed to regimented prescribing of regulated pharmaceuticals may be slower to adopt. Nevertheless, the future of phytocannabinoids in clinical practice is ripe with excitement, possibility, and promise.

The Shelf Achieving shelf space is a major goal for most CBD companies, but are they making sure that their product is not causing any harm to the very people that may purchase it o of that shelf ? Do they look at the clinical science behind each cannabinoid to understand why the farming must be designed to support healthy growth of a plant to o er these cannabinoids? If not, the time to start is now. A true “Seed to Shelf ” experience can bene t customers, patients, retailers, and manufacturers alike as the campaign to educate around CBD continues throughout the country. High quality products and compliant practice will demonstrate the commitment and value in CBD, supporting the overall industry. Next time you evaluate a potential supplier, ask them to walk you through their true “Seed to Shelf ” capability. References: 1. Ramaekers, Johannes, and Gerold Kauert. “Up in Smoke: Comparability of THC Dosing across Performance Studies.” Spring Nature Publishing, 16 Nov. 2006, www-naturecom.proxy.lib.umich.edu/articles/1301211. 2. Johnson JR, et al. “Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC: CBD extract and THCextract in patients with intractable cancer-related pain.” Journal of Pain and Symptom Management. 2010;39(2): 167-179. 3. Barnes MP. Sativex: clinical efficacy and tolerability in the treatment of symptoms of multiple sclerosis and neuropathic pain. Expert Opin Pharmacother. 2006 Apr;7(5):607-15. Review. PubMed PMID: 16553576. 4. MacCallum C, Russo E. Practical considerations in medical cannabis administration and dosing. European Journal of Internal Medicine. 2018;49:12-19. 5. F.M. Leweke, D. Piomelli, F. Pahlisch, D. Muhl, C.W. Gerth, C. Hoyer, et al.Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Transl Psychiatry, 2 (2012), Article e94. 6. O. Devinsky, J.H. Cross, L. Laux, E. Marsh, I. Miller, R. Nabbout, et al.Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. New England Joural of Medicine, 376 (2017), pp. 2011-2020. 7. https://link.springer.com/article/10.1007/s13311-015-0387-1 8. https://www.sciencedirect.com/science/article/pii/S0924977X13003325 9. Cannabidiol interferes with the effects of delta 9 - tetrahydrocannabinol in man. (https://www-ncbi-nlm-nih-gov.proxy.lib.umich.edu/pubmed/4609777) 10.Evidence that cannabidiol does not significantly alter the pharmacokinetics of tetrahydrocannabinol in man. (https://www-ncbi-nlm-nih-gov.proxy.lib.umich.edu/ pubmed/6270295)




CANNABIS Journal of Medicine

SHE TURNED TO MASSAGES USING CREAM INFUSED WITH CBD

Wellness & CBD

SPAS TAKING TREATMENTS TO NEW LEVEL BY ADDING CBD TO MASSAGES CBD is a big trend in wellness this year. CBD, or cannabidiol, is a compound in cannabis. Some tout it as a wonder drug able to stop pain, promote relaxation and ease various body issues. And as Kenneth Craig discovered, some spas around the country are taking their treatments to a new level by adding CBD to massages.

"CBD is great for relieving inflammation and pain, and it's also good for relaxation and reduction of anxiety and stress," said massage therapist Demetri Travlos.

Breanna Arrington spends her life being active. She's an actor and a personal trainer, so when she recently injured a muscle in her hip, it was a major setback.

CBD is popping up in drinks, snacks - even cosmetics. But experts say it's happening faster than the science can catch up.

"An injury will not only not allow me to do my job, but also it takes a little way - some of me dies," Arrington said.

"We are are still at the beginning of trying to understand what CBD does in the body," said Dr. Margaret Haney at Columbia University Medical Center.

Physical therapy didn't help, so a few months ago she turned to massages using cream infused with CBD. And she quickly saw results. "I'm here twice a month and I'm back doing the things that I love to do," she said. "I'm back at taekwondo, back lifting, back sprinting, using my body in dynamic ways." The compound is derived from cannabis but doesn't contain THC, the chemical that gets you high. And advocates believe it may be the answer for all kinds of health problems. www.cannabisjournalofmedicine.com

Dr. Haney is internationally recognized for her research on cannabis. She says while she's excited by CBD's "potential," right now there is little evidence to support its medical claims. "We don't know as scientists if it gets absorbed, how it's acting, what dose one needs, so there are so many unanswered questions. I need placebo-controlled evidence to be convinced," Dr. Haney said.

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CANNABIS Journal of Medicine

Wellness & CBD

CBD – YOU CAN SMOKE IT, INGEST IT, USE OIL FORM Arrington, however, believes it's only a matter of time. "It works great for me; it might not work great for everybody," Arrington said. "So if I feel better, I'm going to take that as a win." And she says that's all the evidence she needs.

Experts report business continues to grow. One study anticipates CBD consumer sales to hit $1.8 billion by 2022 compared to the half a billion dollars in sales they saw in 2018.

Products made with CBD are not currently regulated by the FDA.

But is it safe?

CBD PRODUCTS POP UP IN STORES THROUGHOUT HAMPTON ROADS, BUT ARE THEY SAFE? CBD products are popping up in stores throughout Hampton Roads. Its official name is cannabidiol. You can smoke it, ingest it or use the oil form. Users who spoke to News 3 say CBD helps with all different types of aliments. “My knee gives me trouble time to time and if I take it for a few days - some CBD - it certainly gets better,” said JD Hakes. Stores throughout Hampton Roads are selling it. It can look like marijuana, but users say it gives you a very different feeling. “Know that you’re not going to get high. You’re not going to get silly and giggly or that kind of thing because the psychotropic affect isn’t there. It’s entirely the medicinal part of cannabis,” said Hakes.

“We’re kind of in the infancy of research at this point,” said Dr. Ryan Light with the Tidewater Physicians Multispecialty Group. People said they use it to treat anxiety, arthritis, sleep problems and other medical issues. Experts say there has been little research on the long-term effects. “When we look at it from a patient care standpoint we do see some benefits from it, but that could be the placebo effect it,” said Dr. Light. “We don’t have any research that says it’s harmful, but we don’t have any research that says it’s going to benefit you greatly.” The FDA issued a statement in early April saying they recognize that stakeholders are looking to them for clarity. They’re holding a public hearing at the end of May to get more information about CBD. They said the FDA issued warning letters to three companies after they made unfounded claims about the products ability to cure and treat cancer, opioid abuse and other promises without sufficient evidence. “When we look at it, we don’t know if it’s beneficial or not. We don’t know the risks, either. When we look at it, we've got to take it with a grain of salt and say it may be beneficial, it may not be,” said Dr. Light. CBD products pop up in stores throughout Hampton Roads, but are they safe? But, supporters of CBD says they’ll continue to use it. “I think it has a lot of good properties in it to help a lot of people in a lot of different ways,” said Hakes. The FDA calls this a complicated topic and expect it to take some time to resolve it fully.

CANNABIS JOURNAL OF MEDICINE •

www.cannabisjournalofmedicine.com


CANNABIS Journal of Medicine

VIRGINIA DISPENSARIES WILL OFFER WELCOME RELIEF TO PATIENT CBD AND THC-A OIL DISPENSARIES SET TO OPEN ACROSS VIRGINIA Virginians with a doctor’s recommendation soon will have access to CBD and THC-A oil dispensaries throughout the state. The Virginia Board of Pharmacy has approved five companies to open the dispensaries — one in each of the commonwealth’s five health service areas. The dispensaries will provide CBD and THC-A oils to approved patients only. The Board of Pharmacy met in private to review 51 applicants before selecting five: PharmaCann, Dalitso, Dharma Pharmaceuticals, Green Leaf Medical and Columbia Care. Background checks will be conducted before each company receives a license. There are no scheduled opening dates for the dispensaries, but it’s possible they could be operational by winter. “Under the terms of their conditional approval, they all have to be open by the end of 2019,” said Diane Powers, director of communications for the Virginia Department of Health Professions. The companies do not have to operate on any other specific timeline. The dispensaries will offer welcome relief to patients suffering from a range of health problems, according to medical cannabis advocates. Legislation passed in 2018 allows medical practitioners to issue a certification for CBD or TCH-A oils for patients who would benefit from such substances. Dispensaries are only able to provide up to a 90day supply at a time. Stephanie Anderson of Richmond is considering CBD oil as an alternative treatment for her son’s ADHD. She wanted her son to have safe and legal access to CBD products. “I’ve been hesitant to try CBD from online sources, so the idea of having in-state pharmaceutical processors puts my mind at ease,” she said. PharmaCann, founded in 2014, currently operates medical marijuana facilities in five other states and is licensed to operate in three more. Its dispensary will be in Staunton in Health Service Area I, which stretches from Fredericksburg to the Shenandoah Valley.

www.cannabisjournalofmedicine.com

Dalitso is a Virginia-based company that will specialize in the production of CBD and THC-A oils. It is in the process of obtaining approval to open a processing facility in Prince William County. Dalitso will open a dispensary in Manassas, which will serve Health Service Area II, including Fairfax and Alexandria. Dharma Pharmaceuticals will open its dispensary in Bristol, covering Health Service Area III, which encompasses southwest Virginia. Dharma is an international producer of medications for hepatitis, cancer and other diseases. Green Leaf Medical will set up its dispensary in the Swansboro neighborhood in city of Richmond, serving the surrounding area south to Emporia in Health Service Area IV. Green Leaf is a producer of CBD and THC-A oils, along with other medical marijuana products available in almost 30 locations in Maryland. Columbia Care will be based in Portsmouth and provide CBD and THC-A oils in Health Service Area V to residents in the Tidewater area to the Eastern Shore. Columbia Care is an international cannabis-focused health-care company with locations in 13 states, Puerto Rico and the Mediterranean nation of Malta. Each dispensary submitted an initial $10,000 application fee. The permit fee is $60,000 and a dispensary must pay an additional $10,000 per year to renew its license. n

• CANNABIS JOURNAL OF MEDICINE

Wellness & CBD


CANNABIS Journal of Medicine

Canna Stocks

“VALUATIONS ARE LITTLE BIT AHEAD OF OUR SKIS”

CANNABIS STOCKS ARE FLYING SO HIGH THAT EVEN SOME IN THE INDUSTRY ARE GETTING NERVOUS Canopy Growth's US$11 billion-plus market value is on par with Barrick Gold's, even though the mining firm is expected to post 20 times the sales this year

Cannabis companies are experiencing a rush of investment that’s making even some participants paranoid. “You might argue our valuations are a little bit ahead of our skis,” said Paul Rosen, chief executive officer of Tidal Royalty Corp., which finances weed companies. Tilray Inc., a marijuana company valued at nearly US$9 billion, currently trades at a price-to-sales ratio of about 124. That’s more than 25 times higher than Amazon Inc. and Apple Inc., the two most valuable companies in the S&P 500. And Canopy Growth Corp.’s US$11 billion-plus market value is on par with Barrick Gold Corp.’s, even though the mining firm, with 18,000 workers, is expected to post 20 times the sales this year as the 1,000-employee cannabis company.

CANNABIS JOURNAL OF MEDICINE •

“It’s still not a grown-up sector by a lot of portfolio managers’ standards,” said Bruce Campbell, founder of StoneCastle Investment Management Inc., which is launching a cannabis-focused mutual fund. “The valuations are off the charts if you use any type of typical metrics, so that scares a lot of institutions.” As Canada legalized marijuana last Oct. 17, the cannabis industry has soared from virtually nothing five years ago to one with global sweep today. Canadian companies, such as Canopy, Tilray, Aurora Cannabis Inc. and Aphria Inc., are leading the way. Global consumer spending on cannabis is expected to reach US$32 billion by 2022, according to U.S. firms Arcview Market Research and BDS Analytics. www.cannabisjournalofmedicine.com


CANNABIS Journal of Medicine

RECREATIONAL MARIJUANA REMAINS ILLEGAL FEDERALLY

Canna Stocks

CONGRESS APROVAL? Recreational use is now legal in nine U.S. states and the District of Columbia, and countries from the U.K. to Mexico are in the process of approving use of medical marijuana. But a lot of cannabis investing depends on the continued march toward legalization in the U.S., which is difficult to handicap given gridlock in Congress. Marijuana remains illegal federally in the U.S. The latest investment frenzy really got rolling last month when Constellation Brands Inc., the maker of Corona beer, announced a US$3.8 billion stake in Canopy. Since then, the BI Canada Cannabis Competitive Peers index has gained 45 per cent. Large public companies and institutional investors had largely avoided the marijuana industry, fearful of running afoul of U.S. law. Constellation’s investment was seen as a validation. The growth potential in marijuana has yet to translate into big sales or profits. Tilray reported second-quarter revenue of US$9.7 million. Aurora, valued at about US$6.4 billion, had sales of US$12.2 million in its most recent quarter. In just the first two days of this week, Aurora stock has risen 12 per cent and Tilray is up 23 per cent. The market is expected to grow after legalization, but that still might not be enough to justify valuations.

CANADA BASE “The investment narrative centres on their ability to use Canada as a home base from which they can expand internationally as the opportunity grows,” Andrew Kessner, analyst at U.S. brokerage William O’Neil & Co., wrote in a recent note. In a situation reminiscent of the turn-of-the-century dot-com boom, cannabis companies that would be considered reasonably valued under normal circumstances, such as Hexo Corp., are being pressured by investors who want to see them achieve the same sky-high numbers as their competitors. Riposte Capital LLC last week urged Hexo to pursue “strategic alternatives,”

www.cannabisjournalofmedicine.com

pointing to the fact that its enterprise value is 8.1 times 2020 consensus Ebitda versus Tilray’s at 93.8 times or Canopy’s at 89.2 times. Ebitda is earnings before interest, taxes, depreciation and amortization. The high valuations drew the attention of short-seller Andrew Left. Shares of the company Cronos Group Inc. sank recently after Left’s firm, Citron Research, said the stock should be trading at about a quarter of the price.

REASONABLE MULTIPLES Once the industry reaches maturity, it’s likely the stocks will trade at multiples between those of a consumer products company and a pharmaceutical company — somewhere between 12 times and 20 times forward Ebitda, said Matt Bottomley, an analyst at Canaccord Genuity Group Inc. “Trying to pick what a reasonable multiple is on a oneor two- or three-year basis is not a very fruitful exercise because of how steep the growth profile is,” he said.

BLOOMBERG NEWS Kristine Owram and Craig Giammona

Until then, even the companies themselves acknowledge that it’s tough to know how valuable they are.

With assistance from Anne Riley Moffat.

“Honestly, I don’t even know,” said Cam Battley, Aurora’s chief corporate officer. “Our CFO and I, we talk about this all the time. But nobody’s done this before.” n

• CANNABIS JOURNAL OF MEDICINE


CANNABIS Journal of Medicine

Canna Market

LAB EQUIPMENT GIANT THERMO FISHER MAKES A QUIET BET ON THE CANNABIS INDUSTRY THE FORTUNE 500 COMPANY WANTS TO SELL TESTING EQUIPMENT TO CANADIAN CANNABIS COMPANIES TO ENSURE THE REGULATION AND RELIABILITY OF THE MARIJUANA BEING SOLD The Canadian cannabis industry has managed to attract another Fortune 500 company, although not in the way some might have been expecting.

AUTHOR Geoff Zochodne Reporter Financial Post

THERMO FISHER

is a Massachusetts-based company

On Friday, Thermo Fisher Scientific Inc., a leading provider of lab equipment, announced it is offering scientists in Canada a wide variety of products that could be used for cannabis testing.

Thermo Fisher’s decision comes just weeks away from Canada’s legalizing of recreational cannabis. It also follows the announcement in August that U.S.-based alcohol giant Constellation Brands Inc. would invest billions more into Canadian pot producer Canopy Growth Corp. According to Thermo Fisher, the range of its “workflows” — made up of its “consumables, instruments and software” — could allow scientists to test for THC content and microbial contaminants, among other things.

In doing so, the Waltham, Mass.-based company appears to be trying to tap into a different sort of marijuana-related market, one that is connected to analyzing and ensuring the quality of cannabis, not just the sale of it.

“Thermo Fisher Scientific is supporting regulatory laboratories, contract research organizations and licensed dealers, producers and suppliers across this emerging sector with a diverse and comprehensive product portfolio that offers complete workflows, from sample preparation to analytical methods, for the analysis of cannabis matrices to the testing standards set by Health Canada,” a release said.

“Thermo Fisher Scientific is supporting solutions for compliance with cannabis testing regulations in Canada by providing complete workflows and technologies to equip and supply licensed Canadian analytical labs with everything they need to start or scale laboratory operations and produce reliable results,” said Dan Shine, president of analytical instruments at Thermo Fisher, in a release.

It is not the first sign of interest shown by Thermo Fisher in the Canadian marijuana industry. In 2017, it was announced that one of the company’s subsidiaries was partnering on a “Centre of Excellence in Plant Based Medicine Analytics” with the testing lab owned by British Columbia-based cannabis company Valens GroWorks Corp.

“The workflows will enable the end-user to collect data, proof statements and application notes leveraged from key private, fully-licensed laboratories in Canada that are focused on development, validation, accreditation and sample preparation.”

Thermo Fisher had been lobbying the Canadian government as well, according to the federal registry, “with regards to cannabis safety testing, and providing the government, regulators and provinces technical support to establish a safe marijuana market nationwide.”

Thermo Fisher’s move looks to be a quiet bet on the Canadian cannabis industry, albeit by a company that has around 70,000 employees worldwide, reported revenue of more than US$20 billion for 2017, and a market cap of more than $100 billion as of Friday.

The company was just one of many exhibitors at the Grow Up Cannabis Conference and Expo in Niagara Falls, Ont. on Friday, where a Thermo Fisher booth was sandwiched in among the many licensed producers and other cannabis-related companies at the city’s Scotiabank Convention Centre.

The firm was formed in 2006 after a merger between Thermo Electron Corp. and Fisher Scientific International Inc. In 2013, the combined company agreed to buy Life Technologies Corp. for approximately US$13.6 billion, a deal Thermo Fisher claimed would create “an unrivaled leader in serving research, specialty diagnostics and applied markets.”

CANNABIS JOURNAL OF MEDICINE •

In smaller print at the bottom of a flyer the company circulated touting its products and upcoming free educational seminars, was a caveat: “Thermo Fisher Scientific does not support, encourage or promote the use of its products or services in connection with any illegal use, cultivation or trade of cannabis or cannabis products.” n www.cannabisjournalofmedicine.com


CANNABIS Journal of Medicine

ETF AIMS TO OUTPERFORM THE BROADER CANNABIS SPACE

Cannabis Investing

CANNABIS INVESTING’S LATEST BET: A NEW MARIJUANA ETF WITH THE TICKER YOLO By LIZZY GURDUS

You only live once, but when it comes to cannabis, your investing options are seemingly endless. Case in point: Recently saw the debut of a new marijuana-themed exchange-traded fund called the AdvisorShares Pure Cannabis ETF, an actively managed fund with nearly $2.5 million assets under management. Trading under the ticker YOLO, the ETF is backed by BNY Mellon and holds shares of Canadian growers like Aurora Cannabis and Canopy Growth.

A

few things about this particular fund set it apart from its 3-year-old counterpart, the ETFMG Alternative Harvest ETF, ticker MJ. First, it’s actively managed, which means that it aims to outperform the broader cannabis space with the help of a professional money manager. Second, it’s bank-backed, which lends credibility. “The previous fund here, MJ, had to kind of do a bit of an end-around” with its backers, ETF.com Managing Director Dave Nadig told CNBC’s “ETF Edge” on Monday. “They sort of turned a Latin American real estate fund into a marijuana fund. ... They had to go get Wedbush, a brokerdealer, to hold the assets. And that’s fine, but the difference is it’s not a bank. It’s not regulated like a bank, and a lot of institutional investors really care about these things.”

AdvisorShares got around those hurdles by putting together a preapproved list of holdings with BNY Mellon, Nadig said.

“The new fund, YOLO, is really a pure play,” he said. “This is a case where active management may make sense. This is a fast-moving space. ... Being able to move around the edges of the industry, I think, is going to be really important for success.” Reggie Brown, senior managing director of Cantor Fitzgerald’s ETF Group, said the real success of these investments will come down to the politics of pot. “With cannabis, it really comes down to regulatory outcomes,” Brown said in the same “ETF Edge” interview. “It depends on how the regulatory bodies look at it, and then how the banks can adopt to be custodians broadly. So, it seems like there’s a lot of demand in cannabis. It’s an emerging new area of commerce, and so I can only see the ETFs be covered by that.” n

“Because it’s actively managed, obviously they need to know what’s OK and what’s not OK” to trade, he said. “So they’re working through their ‘OK’ list, and they’ve put together a portfolio which, when you look at it, looks like a pretty darn good pure-play cannabis ETF.” Another important distinction is YOLO’s list of holdings, which includes 20 stocks involved either directly or tangentially in the marijuana trade. Nadig pointed out just how “pure” that looks in comparison to MJ, which invests in companies like gardening product maker Scotts MiracleGro and tobacco giant Philip Morris in the hopes they’ll get into the space.

www.cannabisjournalofmedicine.com

• CANNABIS JOURNAL OF MEDICINE

Lizzy Gurdus is a multimedia producer for CNBC's "Fast Money," with a focus on its "Trading Nation," "Futures Now," "Options Action" and "ETF Edge" franchises. She was formerly a digital producer for "Mad Money" with Jim Cramer. Prior to joining CNBC as a News Associate in September 2016, she held internships at WABC, CNN.com, the Observer, and Vice News, covering a range of fields including local news, politics, and commentary. Gurdus graduated from NYU in May 2016 with a dual Bachelor's degree in journalism and dramatic literature.




CANNABIS Journal of Medicine

Canna Tourism

CANNABIS-FRIENDLY HOTELS WANT DISCRET BOOKINGS

SO FAR, ONLY A HANDFUL OF MOTELS IN CALIFORNIA OPENLY ADVERTISE THEMSELVES AS ACCEPTING CANNABIS SMOKERS. BUT MARIJUANA ADVOCATES SAY MANY HOTELS AND INNS ARE QUIETLY LETTING IT BE KNOWN IN POT-SMOKING CIRCLES THAT THEY TOLERATE SMOKING ON THEIR PROPERTIES.

“They don’t want to be recognized openly,” said Mike Eymer, chief executive and founder of Colorado Cannabis Tours, which lists cannabis-friendly hotels in Denver, California and Las Vegas. “They want discreet bookings.” Among Eymer’s list of cannabis-friendly hotels in Los Angeles is a property that is described only as a “420 Friendly Boutique Hotel in West Hollywood.” (The “420” reference is a widely accepted code for marijuana.) The photos on the page seem to identify the property as the Moment Hotel on Sunset Boulevard. Dan Brannan, the general manager of the 39-room Moment Hotel, said his property allows smoking — of cigarettes, cigars, pipes and cannabis — on the 2,000square-foot rooftop lounge but not in any of the rooms or indoor common areas where non-smokers and children might be exposed.

“What sometimes happens is people are saying I’m pot friendly, but I’m not really pot friendly,” he said, adding that a better description is “pot tolerant.” Brannan said marijuana smokers tend to be pretty mellow customers. “Pot smokers are not out there being screamers,” he said. “I’d rather have pot smokers than alcoholics and drunks.” At the Desert Hot Springs Inn, Thatcher has visions of expanding his tiny nine-room hotel to become a mini pot resort. The hotel already offers a pool filled with mineral water — set at 85 degrees — and hot tub — set at 105 degrees. Plus he has a massage room, where guests can get a rubdown with a cannabis extract oil. The guests typically smoke around a fire pit and a shaded patio that looks out onto the San Jacinto Mountains, but they are also allowed to heat up a vaporizer in their rooms. The hotel sits on nine acres of land, with a large section that remains undeveloped. Thatcher has notions of one day adding an upscale restaurant or a “bud bar” where guests can buy cannabis. For now, he directs his guests, who hail from as far away as Chicago and Miami, to a pot dispensary down the road. “It’s a big thing for them to come here and have the stigma of smoking be gone,” Thatcher said. “I haven’t had a problem renting out rooms.”

CANNABIS JOURNAL OF MEDICINE •

www.cannabisjournalofmedicine.com



INTRODUCING A NEW, NON-OPIOID PAIN SOLUTION:

RAPIDCBDTM By Larry Banegas, Kumeyaay.com

The report “World Analgesics Market - Opportunities and Forecasts, 2015-2022” projects that the world analgesics market would reach $26.4 billion by 20221. Pain sufferers have long regarded plant botanicals as a source of healing; there are more than 100 plants known to have pain relieving properties2. Consumers have sought retail brands of topical pain relief with menthol as an active ingredient3. There is a “new” botanical that consumers need to be aware of for pain relief: cannabidiol. In a study published by the National Institutes of Health4, it is stated that, “The nonpsychoactive cannabinoid, cannabidiol (CBD), has great potential for the treatment of chronic and 'breakthrough’ pain.” The study also states, “Chronic pain relief can be best achieved through the transdermal route.” Today, the United States faces a health epidemic: prescription opioid addiction. To address this problem, manufacturers are producing a new topical combination of CBD with menthol. These non-habit forming ingredients are a welcome solution for consumers who do not wish to pursue prescription opioid pain medications or are looking for an alternative to prescription pain medicine. The irony is that CBD is anything but “new”. CBD is a naturally occurring component of the hemp plant. Hemp is from the cannabis genus and cannabis for medicinal use dates back to the ancient Chinese emperor, Shen-Nung (c.2700 B.C.). Having compiled the medical encyclopedia called, Pen Ts'ao,5 Shen-Nung is regarded as the Father of Chinese Medicine. Cannabis or “Ma”was used by the Chinese to treat weaknesses (menstruation), gout, rheumatism, malaria, beri-beri, constipation, and absentmindedness. During the second century A.D., the Chinese surgeon, Hua T'o, began to use cannabis as an anesthesia. CBD is activated in the body through CB2 receptors located in the skin. CB2 receptors play a role in antinociception, or the relief of pain.6 Menthol is a known active ingredient with cooling properties. Working similar to ice, menthol binds with temperature-sensitive receptors in the skin and is thought to modulate pain signals within the body’s natural pain relieving systems. CBD, known to be hydrophobic and lipophilic, does not dissolve or emulsify readily in water, but will dissolve in fat. Bioavailability of CBD depends on the way that the cannabinoid is delivered into the human body. Today, science has enabled CBD to be water soluble as well as time-release. The new topical pain cream, RapidCBD™, delivers a powerful combination of micro-encapsulated time-released CBD called Cebidiol™. In Cebidiol™, consumers will benefit from menthol plus eight additional homeopathic ingredients including lavender and rosemary essential oils to relieve pain. The RapidCBD™ Cooling Pain Cream is ideal after strenuous activity and has been proven to be as effective and work as fast as an FDA approved OTC topical pain relief solution. The immediate availability of RapidCBD™ is welcome news for consumers who are seeking a non-opioid solution for muscle aches, strains and joint pain. 1 -http://www.prnewswire.com/news-releases/analgesics-market-is-expected-to-reach-264-billion-globally-by-2022-575688921.html 2 -http://www.motherearthliving.com/health-and-wellness/the-best-herbs-for-pain-relief.aspx 3 -http://health.usnews.com/health-products/top-rec-topical-analgesics-arthritis-joint-pain-135 4 -http://www.ncbi.nlm.nih.gov/pubmed/20545522 5 -https://www.psychologytoday.com/blog/the-teenage-mind/201105/history-cannabis-in-ancient-china 6 -https://en.wikipedia.org/wiki/Cannabinoid_receptor

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