Coverage and Commentary on the Top Cannabis Conferences
Welcome to the first issue of Mary’s Prime Time! This is the first issue of Mary’s Prime Time, an occasional publication that will report on presentations from cannabis conferences around the globe. The goal is as simple as it is complex: to provide the public with the latest research on, and discussion of, cannabis as medicine. In the past decade there has been an explosion of interest in medical cannabis. A constant stream of ballot initiatives and state legislation in the U.S. has opened the door for patients to legally acquire this medicine that is still prohibited by the U.S. federal government. Around the globe there is even more change as entire countries legalize medical access. Concurrent with reform is an extraordinarily dynamic expansion of research with results being presented at dozens of conferences around the globe. At Mary’s Medicinals we realized that this valuable information was being shared with the few hundred individuals lucky enough to be in attendance but little was being done to disseminate it to the thousands who want to know more about the medicinal properties of this wondrous plant. We now know that cannabis has been a companion of mankind for tens of thousands of years. But it was not until the early 1990s that we learned just how cannabis provides the therapeutic action for so many different diseases when the ECS was discovered. The ECS—endocannabinoid system—creates cannabinoid like substances which help us maintain our homeostasis (physiological balance). This discovery ignited a new age of cannabis research. Scientists and pharmaceutical companies were quick to see the promise of a substance that targets the regulation of a major physiological system. While U.S. researchers continue to struggle under the shackles of an outmoded federal prohibition, researchers in Europe, Israel, and South America have been energetically exploring the wonders of cannabis. The results are promising and often remarkable. Without question, discovery of the ECS began this exciting new age of cannabis-focused scientific discoveries and research. Mary’s Prime Time will bring that science to those who need it most -- patients, healthcare providers and caregivers. Alice O’Leary Randall Editor-in-Chief, Mary’s Prime Time
Conference Facts Title: NUNM Medical Cannabis Conference Sponsor: National University of Natural Medicine (NUNM) Dates: July 29-30, 2017 Venue: NUNM Campus, Portland, Oregon Attendees: 50 in person, about 60 online Presenters: Eleven total. This publication reports on six presenters. Meeting Background: This is the third year of the NUNM Medical Cannabis Conference. Recordings of the conferences (2017 and previous years) are available at the NUNM website. Link: nunm.edu/ceonline Miscellaneous: • Currently, 19 states, the District of Columbia, and the US territories of Puerto Rico and the US Virgin Islands all have laws regulating naturopathic doctors (NDs). In these states and provinces, naturopathic doctors are required to graduate from a four-year, residential naturopathic medical school and pass an extensive postdoctoral board examination (NPLEX) in order to receive a license or registration. • There are seven (7) accredited naturopathic programs in North America including two in Canada. • MD vs. ND: “ .. the main difference between MD, DO, and ND medical programs is not the content of the coursework, but rather the underlying philosophy which guides the physician to choose one treatment over another.” Link: http://bit.ly/2BdYz85
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What is Naturopathy? The concept of naturopathy – the use of natural substances to promote healing and well being – is probably as old as mankind but according to Wikipedia, the term “naturopathy” wasn’t coined until 1895 and was first used extensively by Benedict Lust, a German who brought the concept to the U.S. in the early 1900s. The practice became somewhat controversial in the mid-1900s as Western pharmaceuticals reached a zenith in terms of development and promotion, crowding out “the old ways.” By the end of the 20th century, however, consumers (i.e., patients) were revisiting naturopathic medicine and the practice saw a resurgence of interest that continues today.
There are seventeen states that recognize naturopathy and numerous schools that teach naturopathic physicians. This includes the National University of Naturopathic Medicine (NUMN) in Portland, Oregon. In late July, NUNM presented its third “Medical Cannabis Conference” sponsored by the continuing education department at NUNM. What follows are reports on six of the eleven presentations at the conference. All reports on the NUNM conference are written by Mary’s Prime Time editor-in-chief, Alice O’Leary Randall. Those interested in reviewing the proceedings can access the tapes via www. nunm.edu/ce.
According to the American Association of Naturopathic Physicians: “Naturopathic medicine is a distinct primary health care profession, emphasizing prevention, treatment, and optimal health through the use of therapeutic methods and substances that encourage individuals’ inherent self-healing process. The practice of naturopathic medicine includes modern and traditional, scientific, and empirical methods.” The merging of naturopaths and medical cannabis seems, well, a natural fit. Cannabis is often described as an herb and naturopaths use many herbs in their regimens. But the decades of false information and the ongoing U.S. federal prohibition of cannabis had the same chilling effect on many naturopaths as it has on medical professionals. Some naturopaths have embraced cannabis, especially its component cannabidiol (CBD). But other naturopathic doctors (NDs) still shy away from the substance with worries of addiction and, more realistically, concerns that the therapeutic abilities of cannabis may be overblown and lead patients down the wrong pathway, especially in the treatment of major illnesses such as cancer.
Mary’s Prime Time Published peridiocally by Mary’s Medicinals Editor-in-Chief: Alice O’Leary Randall alice@marysmedicinals.com Special Assistant: Jesica Clark
Cannabis in the Therapeutic Order Presenter: Paul Bergner, ND Director, North American Institute of Medical Herbalism MarysMedicinals.com
Design: Luminary Digital Published by Mary’s Medicinals, Denver, CO Copyright (c) 2017 - All rights reserved This publication is solely for educational purposes and is not intended to substitute for the medical advice of a treating physician. Medicine and cannabis research is an ever-changing science. Therefore, the editor, contributors and publisher do not accept responsibility in the event of negative consequences incurred as a result of the information presented in Mary’s Prime Time. We do not claim this information is necessarily accurate by rigid scientific and regulatory standards applied for medical treatment. No warranty, expressed or implied, is furnished with respect to the material contained in this publication. Readers are encouraged to consult with personal physicians with respect to treatment of any medical condition.
The goal in attending the NUNM Conference was to learn how (or if ) naturopathic doctors are integrating medical cannabis into their practice. With eleven speakers on the agenda (six are featured in this issue of Mary’s Prime Time) it seemed a relatively wide range of viewpoints would be presented but the first speaker made this writer’s heart sink. Paul Bergner is director of the North American Institute of Medical Herbalism and editor of the Medical Herbalism Journal. A search of the web after the conference revealed that Dr. Bergner has frequently spoken on the adverse effects of cannabis and even though he issued an opening disclaimer that he was speaking neither “for nor against” medical cannabis his presentation had a distinct lean towards the latter. He began by explaining the Therapeutic Order, a concept that is not necessarily new but has been re-packaged for the modern era by Drs. Jared Zeff and Pamela Snider. The Therapeutic Order emphasizes the classical regimen of the ancients with focus on diet, exercise, rest, and emotions. Under this scenario, herbal treatments are rather high on the chart. As Dr. 2
how Dr, Bergner treats cannabis dependent patients at his clinic. He stated it was important to understand heavy cannabis users, which he loosely described as using “multiple times a day,” as they become “dependent” on the drug. He also stated that he believes “medical cannabis users become heavy users.”
Bergner noted, the ancient Chinese felt that “once you resort to needles and herbs you have already failed.” But, as Dr. Bergner acknowledged, most naturopathic practitioners are likely to use herbal remedies more readily than the Therapeutic Order would dictate. So the question in this writer’s mind was, “Why not cannabis?” According to Dr. Bergner the reason lies in the concentrated forms and high doses of cannabis that are needed. Besides, noted the herbalist, it is not curative for any condition. Micro-dosing cannabis apparently has not yet reached the proponents of Therapeutic Order nor did the effective treatment of symptoms get much respect from the opening speaker. Dr. Bergner’s “long term strategies” for medical cannabis use are as follows: • Cannabis used for harm reduction. • Cannabis used in place of, or to wean the patient off a more dangerous drug, or to reduce its dose. • Cannabis used to palliate while more substantial cure is put in place. My heart sank a little lower. While Bergner acknowledged that: 1) cannabis is far safer than most pharmaceutical medications, 2) may be good for those with terminal illness, 3) may help reduce the dose of opioids, and 4) has no lethal dose (“Let’s have a parade,” he rather cynically exclaimed), the speaker did nothing to elaborate on these possibilities. Instead the presentation took a strong right turn towards “Cannabis Adverse Effects” and for the next forty minutes we learned
His final ten slides did deal directly with therapeutic cannabis use but even here the bias was obvious as he featured studies that, for the most part, used the synthetic dronabinol (Marinol), not cannabis. Dr. Bergner’s full presentation was two hours long and at the conclusion this writer made a notation, “Focus of talk really treatment of withdrawal.” While I had no idea what I would find at the naturopathic conference I expected more tolerance and curiosity. Only two hours into a two-day conference and I was feeling as if I had wasted my time and was about to hear the naturopathic version of “Just Say No.”
Practical Uses of Cannabinoids in Clinical Practice Presenters: Chris D. Meletis, ND and Brian Martin, BSc, ND, EmerChanges Health and Happiness Clinic After such a dismal opening the next speaker, Chris Meletis, proved to be a bracing gust of fresh air. He immediately distanced himself from the first speaker saying, “Whereas Paul Bergner was speaking about the marijuana side of cannabis sativa I am speaking about the hemp side” and then proceeded to give a robust discussion of the cannabis component cannabidiol (CBD). He quickly ran through some informative slides providing information on the hemp industry and the “self-medicating” population of the U.S.A. His point was clear: Americans are self-medicating already with hemp and all manner of other medications. Should naturopaths be helping them do so effectively?
Dr. Meleits did not come to coddle or hold hands. He expected a certain level of knowledge from the audience relative to CBD and the endogenous cannabinoid system (ECS) as well as a proper perception of the culture today which is, in Dr. Meletis’ view, suffering from a wide array of inflammatory diseases including depression which he feels is inflammation of the brain. CBD, he notes, is an excellent anti-inflammatory agent and there is “plenty of research” to back up this statement. Meletis feels that CBD is safe and should be used as a preventative. “Do you wait until a patient has it?” he asked the audience about an dementia patient, “Or do you start preventatively?” For Dr. Meletis the answer was obvious. He acknowledged that cannabinoid science 3
is in its infancy but feels that it has a bright future. The former Dean of Naturopathic Medicine and Chief Medical Officer at the NUNM, Meletis feels that hemp derived CBD is a good option for starting patients on cannabinoid medicine because it lacks the psychoactive effect (the “high”) of regular cannabis. Can people get “high” on CBD? Meletis acknowledges that some patients claim to get high from CBD so he asks them to explain why they feel they are “high.” Meletis will tell them, “that’s not high, that’s alive.” The patients, he says, “didn’t know how broken they were” until after the CBD starts to work and their resulting sense of well-being is sometimes euphoric.
Martin is clearly fascinated by CBD and stated “there is a huge amount of interplay” between the body and CBD. An area of particular interest for him is the role of CBD in controlling cortisol, a naturally produced steroid hormone. As the body faces stress it will produce increased amounts of cortisol which, in turn, can increase blood sugar, suppress the immune system as well as numerous other effects on the metabolism of humans. Using CBD to control cortisol results in a win-win situation for the patient.
Meletis was keen on distinguishing between cannabis and hemp, or as his final slide noted “hemp is not marijuana.” This proved to be a common theme as the conference moved on through the weekend. The next speaker was Brian Martin, a naturopathic doctor from Canada. He continued the cannabidiol enthusiasm of Dr. Meletis but noted that CBD is not as readily available in Canada as it is in the U.S. This seemed a particularly odd statement given Canada’s liberal national stance with respect to medical cannabis. Unfortunately Martin was too rushed by time constraints to cover all of the topics that are contained in his slides. His presentation, and all the presenters, were taped by NUNM and those presentations are available online. Dr. Martin feels that CBD has a special place in the treatment of alcoholism. In a fascinating 2013 study published in Elsevier’s Pharmacology Biochemistry and Behavior (http://bit.ly/2AvoGvb) it was discovered that transdermal delivery of CBD lessened alcoholinduced neurodegeneration in rodents by almost 50%. It is obviously preliminary research but it demonstrates the potential value of CBD in medical treatment. Hand-in-hand with neurodegeneration in alcoholism is the damage that alcohol causes to the liver. Martin presented excerpts from a 2016 article that appeared in Clinical Liver Disease: A Multimedia Review Journal entitled “Cannabinoids in liver diseases” (http:// bit.ly/2i9AKKO) that contained some conflicting but nevertheless promising conclusions. And a study from 2017 demonstrated that CBD is almost as effective as interferon in treating hepatitis C. Dr. Martin concluded that “CBD is almost to good to be true.” He paused for a moment before adding, “if it was a drug I wouldn’t believe it.”
The CBD Evidence Base & Understanding Terpenes Presenter: Kevin Spelman, PhD, CEO at Health Education and Research University of Exeter/University of North Carolina Kevin Spelman is a very entertaining speaker and that is probably why he was asked to give two presentations at the NUNM conference. On the first day Dr. Spelman spoke on “The CBD Evidence Base” and on the second he discussed “Cannabis Chemistry: Understanding Terpenes.” Not surprisingly there was some repetition but the purpose of these conferences is to educate and repetition is a remarkably effective educational tool. Additionally the two topics do blend nicely and so both talks will be covered in this report.
Spelman unabashedly loves CBD but also feels that the current climate is a bit “over zealous” with respect to CBD in general because “people want to cash in.” He insists, however, that does not negate “the remarkable science” that is emerging with respect cannabis and CBD in particular. He began by dispelling some popular misinformation about CBD in particular the notion that CBD is non-psychotropic. CBD, says Spelman, is not “euphoric” but it is “psychotropic.”
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then re-infused, although there is some controversy about this process and whether it destroys the desired chemical activity. Terpenes give cannabis its distinctive odor. They do the same for pine trees, oranges, lemons and on and on. But the emerging science is showing that terpenes may influence the properties of cannabis in far more ways than the aroma. Those who embrace the concept of the entourage effect nod knowingly at this thought and say, “of course.” The terpene talk was highly technical and made the audience keenly aware of the complexities in the emerging field of medical cannabinoids. Dr. Spelman noted that research is showing terpenes and cannabinoids can effect even the tiniest of metabolic factors, SNPs (pronounced “Snips” — Single Nucleotide Polymorphisms) which are found in your DNA. One questioner at the end of the session pleaded with Dr. Spelman, “I need you to write a book!,” she said to laughter, “Because I can know some of these things but this is a lot! This is a whole specialization and I’m looking at general patients.” He also addressed the notion that CBD, when ingested, becomes THC due to the interaction with stomach acid. While it may be possible to do this in a test tube, Spelman says, in vivo the idea just makes “no sense” and cited an article by Grotenhemen and Russo that “lays to rest” this notion of molecular changes (see page 8). Dr. Spelman did provide an excellent overview of using CBD in about a half dozen conditions including inflammation, traumatic brain injury (TBI), epilepsy, memory, and chronic pain, noting that nearly all these conditions involve some form of inflammation and hence the value of CBD. The current problem, one noted by several speakers and questions from the audience, is dosing Spelman encouraged using CBD in “nudges.” “It’s all about dose,” he said and noted that effective doses can be as low as 0.01mg to 20 mg.
Terpenes
Spelman’s second presentation at the conference focused on terpenes which have taken on a nearly mystical fascination in recent years. Terpenes are any of a large group of volatile unsaturated hydrocarbons found in the essential oils of plants, especially conifers, citrus trees and cannabis. Cannabis has many different terpenes and the science is so sophisticated at this point that plants can be bred to possess certain terpenes. They can be removed from plants prior to processing and
Spelman’s light hearted demeanor became very serious. And rightly so. This is a question that burdens naturopaths, physicians and nurses throughout the world. Spelman noted that cannabis is, after all, only a plant and that naturopaths already use other plants on which there there is far less data adding that at present “we are over-focused on cannabis.” He counseled the audience member to begin learning the cannabis plant just as she has learned about others and recognize that this is simply a part of being a naturopath--it is a lifetime of learning about plants. Spelman took one the mantras of cannabis opponents — “cannabis is a gateway drug” — and put a new twist on it. “Cannabis,” he said, “is a gateway plant for physicians to start taking medicinal plants seriously.” Cannabis, Spelman believes, has made medical doctors sit up and take notice of medicinal plants and, in Spelman’s estimation, this is a tremendous opportunity for naturopathy and Western medicine to come closer together.
Cannabinoids for Inflammation and the Immune System Presenter: Sunil Pai, MD, House of Sanjevani Integrative Medicine Clinic
Unlike the other presenters, Sunil Pai is an M.D., not an N.D. but his philosophy of treatment seems very in tune with the naturopaths. He is the author of An Inflammation Nation which examines the prevention and treatment of disease through diet, lifestyle and the use of natural anti-inflammatories. For Dr. Pai, cannabis, and in particular CBD, is a tailor-made agent for treatment of many inflammatory disorders. The operative statement is “tailor-made.” Numerous speakers at the NUNM Conference addressed the idea of tailoring cannabis to the patient but Dr. Pai is practicing what he preaches at his clinic in New Mexico. Not surprisingly given the title of his book, he also emphasized the need to treat inflammation which in medical parlance is an “-itis” as in arthritis, gastritis, rhinitis, etc. There are over 200 different forms of “itis” in medical books and conventional Western philosophy is to treat the symptoms as opposed to the cause. Dr. Pai feels that careful treatment of the ECS is one way to actually resolve inflammation problems and believes “ECS regulation is strongly influenced by the individual’s microbiome.”
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He emphasizes the need to treat “the moment” as well as the fact that it is “not as simple as on/off” when it comes to CB1 and CB2 receptors. Indeed, several speakers at the conference emphasized this latter point: that treating disease via the ECS system is not simply a matter of prescribing CBD and seeing the patient six months later. One of Dr. Pai’s slides put it well although not succinctly: This system is not a simple on/off receptor effect. [It is a] complex response mechanism … between the endogenous and exogenous [molecules], in cross-reactions with non-cannabinoid receptors, and in the plasticity of response, which is dependent on local tissue characteristics (state of health) or the presence of other molecules. “The most important thing of my lecture,” Dr. Pai said, “is that CB2 receptors act differently based on the state of pathology.” In fact, according to Dr. Pai, CB2 receptors are more active in diseased organs. Thus, again, the need for tailoring the treatment on a regular basis when treating the diseased state as well as microdosing. Too many clinicians err in thinking that a patient who responds well initially to CBD just needs more CBD. In fact, the opposite may be true because a constant dose of CBD may dull the receptors by interfering with upregulating. Once again, tailoring the treatment for the patient. Dr. Pai’s presentation is highly recommended and available for viewing at: https://cemoodle.nunm.edu/course/category.php?id=221
Cannabis in Cancer Care Presenter: Neil McKinney, BSc, ND Vital Victoria Naturopathic Clinic
Neil McKinney is a practicing naturopath from Canada who specializes in treating cancer patients. He has been a clinician for nearly forty years and his presentation was a delightful mix of pertinent information along with some homespun common sense. His comments in the first two minutes of the presentation set the stage for what was to come when he expressed his fascination with the ECS and declared how delighted he was to have natural cannabinoid products available for his patients because “it is part of our biological heritage, it’s part of our legal right to have this plant.” He quickly ran through the main cannabinoids — THC, CBD, CBC, CBN and CBG — making it clear that he is a great fan of aggressive research into the many cannabinoids but rather confidently predicted that CBG (cannabigerol) will “be the next big bomb.” He has used CBG together with CBD and THC to treat cancers with some success. One of the most informative sections of his talk had to do with concerns about using cannabis to treat children and he listed the
reasons why. Dr. McKinney provided a comprehensive look at his philosophy relative to treating cancer patients with cannabis. He basically addressed two separate areas. First, he dispelled the concerns relative to using a natural medicine like cannabis with today’s sophisticated oncology medications. Acknowledging the number of clinicians in the audience he stated categorically, “There are very, very few interactions between natural medicines and oncology drugs. Period. End of story. Forty years of experience in the field and I tell you you really don’t have to sweat it that much.” Secondly, he addressed the use of cannabis, in particular pure THC oil, for treatment of cancer, cautioning the clinicians that the high doses required to make the THC effective can really create adverse effects in patients. He advocates administering citicoline or CBD prior to dosing with THC oil saying it will help mitigate the effects of THC. (Note: some practitioners feel citicoline can be harmful for cancer patients, especially those with brain tumors.) Dr. McKinney provided several case studies from his practice as well as those found in the literature. Space will not allow recounting these several cases. For those seeking specific information on this topic the complete talk with powerpoint slides is available at: http://www.nunm.edu/ceonline
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Cannabinoids and Opiates: Crosstalk and Connections with Regard to Reward, Addiction, Dependence and Recovery Presenter: Kevin Wilson, ND, DAAPM
Kevin Wilson, ND had the unenviable position of final speaker at a two-day conference. The good doctor never acknowledged it but it seemed to this writer that he was exhibiting some of the same feelings as those in the audience. He seemed weary and a bit dazed by the wealth of information that had come before him. At one point he said that what he had learned that week-end was a little “overwhelming.” The room seemed to issue a collective thought of, “Amen!”
Nevertheless Dr. Wilson had come to present on Cannabinoids and Opioids so he pressed on with his slides in an almost apologetic fashion. Claiming to be “pro cannabis” he noted that he was beginning to have “reservations because [cannabis] does lead to dependency” and later noting that perhaps “we need to put it back in perspective after this sort of post prohibition time.” Dr. Wilson spoke with the air of someone wanting to stop the hands of time. It was a peculiar presentation in that regard. As the talk proceeded it seemed apparent that what puzzled Dr. Wilson was what Dr. Pai had addressed in his talk: the complexity of the cannabis plant and the realization that cannabinoid receptors are far more complex than “on or off.” For Dr. Wilson, like Dr. Bergner on the first day, there was almost and annoyance that cannabis was proving so difficult to fathom.
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He noted that in states that have legalized cannabis for medical purposes there is a drop in prescription pain medications and tipped his hat to the work of Ashley and W. David Bradford which has shown significant economic savings in those states. Dr. Wilson’s confusion is fueled, in part, by his compassion. He wants to help opioid addicts and those in pain. He views cannabis as a possible tool in that quest. His admitted a fascination with neural plasticity (“the love of my [academic] life”) and the vast complexity of the human brain. As a practitioner he seems frustrated, almost conflicted, with the unexpected complexity of cannabis, particularly with respect to dosing. This is a common problem, not just for naturopaths but also MDs who are recommending cannabis. Naturopaths, however, seem almost guilty about this internal conflict, perhaps because cannabis is a natural product. As Dr. Wilson made his way through his presentation he provided leads to some excellent research articles. Several of them are listed on page 8. He made his case for cannabis addiction (which should have been called THC addiction) by citing several studies (all animal based) and concluded that approximately 7% of cannabis users are estimated to become addicted. But then he added, “I’m beginning to realize that people can be addicted to all kinds of things.” The final third of his presentation gave attendees some ideas relative to treating withdrawal with a variety of available pharmaceuticals including clonidine, Immodium and even ketamine. It is ironic that the naturopathic conference on medical cannabis would begin and end with presentations so heavily weighted in the issue of alcohol and opioid addiction and treatment. Perhaps this investiture in the recovery community has made it particularly difficult for NDs to embrace medical cannabis. Certainly this conference revealed hints of that.
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Bibliographies The The following following references references are are from from the the presentations presentations of of several several speakers speakers at at the the National National University University of of Naturopathic Naturopathic Medicine Medicine (NUNM) (NUNM) Medical Medical Cannabis Cannabis Conference. Conference. The The citations citations are, are, for for the the most most part, part, available available online, online, particularly particularly using using Google Google Scholar. Scholar.
Dr. Kevin Spelman: CBD and Terpenes Even Even High High Doses Doses of of Oral Oral Cannabidol Cannabidol Do Do Not Not Cause Cause THC-Like THC-Like Effects Effects in in Humans: Humans: Comment Comment on on Merrick Merrick et et al. al. F. F. Grotenhermen Grotenhermen Franjo, Franjo, Russo Russo Ethan, Ethan, and and Zuardi Zuardi Antonio Antonio Waldo. Waldo. Cannabis Cannabis and and Cannabinoid Cannabinoid Research. Research. January January 2017, 2017, 2(1): 2(1): 1-4. 1-4. https://doi.org/10.1089/can.2016.0036 https://doi.org/10.1089/can.2016.0036 Cannabidiol Cannabidiol in in Inflammatory Inflammatory Bowel Bowel Diseases: Diseases: A A Brief Brief Overview. Overview. G. G. Esposito, Esposito, et. et. al. al. Phytotherapy Phytotherapy Research, Research, May May 2013, 2013, 27(5): 27(5): 633-636. 633-636. https://www.ncbi. https://www.ncbi. nlm.nih.gov/pubmed/22815234 nlm.nih.gov/pubmed/22815234 Neuroprotective Neuroprotective Antioxidants Antioxidants from from Marijuana. Marijuana. A.J. A.J. Hampson, Hampson, et. et. al., al., Annals Annals of of the the New New York York Academy Academy of of Sciences, Sciences, January January 2000, 2000, Vol Vol 899. 899. https://www.ncbi. https://www.ncbi. nlm.nih.gov/pubmed/10863546 nlm.nih.gov/pubmed/10863546 Perceived Perceived efficacy efficacy of of cannabidiol-enriched cannabidiol-enriched cannabis cannabis extracts extracts for for treatment treatment of of pediatric pediatric epilepsy: epilepsy: A A potential potential role role for for infantile infantile spasms spasms and and Lennox–Gastaut Lennox–Gastaut syndrome. syndrome. S.A. S.A. Hussain, Hussain, et.al., et.al., Epilepsy Epilepsy & & Behavior, Behavior, June June 2015. 2015. Vol Vol 47, 47, pos. pos. 138-141. 138-141. https://www.ncbi.nlm.nih.gov/pubmed/25935511 https://www.ncbi.nlm.nih.gov/pubmed/25935511 Handbook Handbook of of Cannabis Cannabis Therapeutics: Therapeutics: From From Bench Bench to to Bedside, Bedside, E. E. Russo Russo and and F. F. Grotenhermen, Grotenhermen, Routledge, Routledge, 2006. 2006.
Dr. Neil McKinney: Cannabis In Cancer Care Integrating Integrating cannabis cannabis into into clinical clinical cancer cancer care, care, Curr. Curr. Oncology. Oncology. Abrams, Abrams, D., D., 2016 2016 ;; 23 23 (2): (2): S8-S14. S8-S14. https://www.ncbi.nlm.nih.gov/pubmed/27022315 https://www.ncbi.nlm.nih.gov/pubmed/27022315 Cannabis Cannabis Use Use and and Risk Risk of of Lung Lung Cancer: Cancer: A A Case Case Control Control Study, Study, European European Respir. Respir. J., J., Aldington, Aldington, Harwood, Harwood, Cox, Cox, et et al., al., 2008; 2008; 31 31 (2): (2): 280-286. 280-286. https:// https:// www.ncbi.nlm.nih.gov/pubmed/18238947 www.ncbi.nlm.nih.gov/pubmed/18238947 Delta-9-tetrahydrocannabinol Delta-9-tetrahydrocannabinol may may palliate palliate altered altered chemosensory chemosensory perception perception in in cancer cancer patients: patients: results results of of aa randomized, randomized, double-blind, double-blind, placebo-controlled placebo-controlled pilot pilot trial, trial, Annals Annals of of Oncology, Oncology, Brisbois, Brisbois, de de Kock, Kock, Watanabe, Watanabe, et et al., al., 2011; 2011; 22 22 (9): (9): 2086-2093. 2086-2093. https://www.ncbi.nlm.nih.gov/pubmed/21343383. https://www.ncbi.nlm.nih.gov/pubmed/21343383. Cannabinoids: Cannabinoids: A A new new hope hope for for breast breast cancer cancer therapy?, therapy?, Cancer Cancer Treatment. Treatment. Caffarel, Caffarel, Andradas, Andradas, Pérez-Gómez, Pérez-Gómez, et et al.,Rev. al.,Rev. 2012; 2012; 38 38 (7): (7): 911–918. 911–918. https:// https:// www.ncbi.nlm.nih.gov/pubmed/22776349 www.ncbi.nlm.nih.gov/pubmed/22776349
Cannabidiol Enhances the Inhibitory Effects of delta-9-Tetrahydrocannabinol Cannabidiol Enhances theCell Inhibitory Effectsand of delta-9-Tetrahydrocannabinol on Human Glioblastoma Proliferation Survival, Marcu, et al., on HumanCancer Glioblastoma Proliferation and Survival, Marcu, et al., Molecular Therapy.Cell 2010; 180-189. https://www.ncbi.nlm.nih.gov/ Molecular Cancer Therapy. 2010; 180-189. https://www.ncbi.nlm.nih.gov/ pubmed/20053780 pubmed/20053780 The Path Ahead - What Should We Tell Our Patients about Marijuana The Path Ahead What Should We Tell Our Patients about Marijuana (Cannabis indica- and Cannabis sativa)? Pizzorno, Integrative Medicine. 2016; (Cannabis indica and Cannabis sativa)? Pizzorno, Integrative Medicine. 2016; 15 (6): 8-12. https://www.ncbi.nlm.nih.gov/pubmed/28223891 15 (6): 8-12. https://www.ncbi.nlm.nih.gov/pubmed/28223891 Cannabis Extract Treatment for Terminal Acute Lymphoblastic Leukemia with Cannabis Extract Treatment for TerminalSingh Acute&Lymphoblastic Leukemia with a Philadelphia Chromosome Mutation, Bali, Case Reports in Oncology a2013; Philadelphia Chromosome Mutation, Singh & Bali, Case Reports in Oncology 6: 585-592. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901602/ 2013; 6: 585-592. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901602/
Dr. Kevin Wilson: Cannabis and Dr. Kevin Wilson: Cannabis and Opioid Withdrawal Opioid Withdrawal Medical Cannabis Use Is Associated With Decreased Opiate Medication Use Medical Cannabis Cross-Sectional Use Is AssociatedSurvey With of Decreased OpiateChronic Medication in a Retrospective Patients With Pain.Use K. F. in a Retrospective Cross-Sectional Survey Patients WithVolume Chronic17, Pain. K.6,F. Boehnke, E. Litinas, and D.J. Clauw, The of Journal of Pain, Issue Boehnke, Litinas, and D.J. Clauw, The Journal of Pain, Volume 17, Issue 6, June 2016,E.pages 739-744. https://www.ncbi.nlm.nih.gov/pubmed/27001005 June 2016, pages 739-744. https://www.ncbi.nlm.nih.gov/pubmed/27001005 Substitution of medical cannabis for pharmaceutical agents for pain, Substitution of medical cannabis forDeKeuster, pharmaceutical pain, anxiety, and sleep. B.J. Piper, R.M. M.L.agents Beals,for et.al. Journal of anxiety, and sleep. B.J. Piper,31, R.M. DeKeuster, Beals, et.al. Journal of Psychopharmacology, Volume Issue 5, April 4,M.L. 2017. http://bit.ly/2n3BPWb Psychopharmacology, Volume 31, Issue 5, April 4, 2017. http://bit.ly/2n3BPWb Cannabis and intractable chronic pain: an explorative retrospective analysis of Cannabis and of intractable chronic anet. explorative retrospective analysis of Italian cohort 614 patients. G. pain: Fanelli, al., Journal of Pain Research, 2017; Italian cohort of 614 patients. G. Fanelli, et. al., Journal of Pain Research, 2017; 10: pages 1217-1224. https://www.ncbi.nlm.nih.gov/pubmed/28579820 10: pages 1217-1224. https://www.ncbi.nlm.nih.gov/pubmed/28579820 Opioid withdrawal suppression efficacy of oral dronabinol in opioid Opioid withdrawal efficacy oral dronabinol opioid dependent humans.suppression M.R. Lofwall et. al.,ofDrug and Alcohol in Dependence, dependent humans. M.R.pages Lofwall et. al., https://www.ncbi.nlm.nih.gov/ Drug and Alcohol Dependence, Volume 164, July 2016, 143-150. Volume 164, July 2016, pages 143-150. https://www.ncbi.nlm.nih.gov/ pubmed/27234658 pubmed/27234658 Cannabinoid and opioid interactions: Implications for opiate dependence and Cannabinoid andScavone, opioid interactions: Implications for opiate Neuroscience, dependence and withdrawal, J.L. R.C. Sterling, E.J. Van Bockstaele. withdrawal, Scavone,2013, R.C. Sterling, E.J. Van Bockstaele. Neuroscience, Volume 248,J.L. September pages 637-65. https://www.ncbi.nlm.nih.gov/ Volume 248, September 2013, pages 637-65. https://www.ncbi.nlm.nih.gov/ pubmed/23624062 pubmed/23624062
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Cannabinoids Cannabinoids induce induce apoptosis apoptosis of of pancreatic pancreatic tumor tumor cells cells via via endoplasmic endoplasmic reticulum reticulum stress-related stress-related genes. genes. Carracedo, Carracedo, Gironella, Gironella, Lorente, Lorente, et et al. al. Cancer Cancer Research. Research. 2006; 2006; 66: 66: 6748–55. 6748–55. https://www.ncbi.nlm.nih.gov/ https://www.ncbi.nlm.nih.gov/ pubmed/16818650. pubmed/16818650. Medical Medical marijuana: marijuana: the the conflict conflict between between scientific scientific evidence evidence and and political political ideology. ideology. Part Part two two of of two. two. Cohen, Cohen, P.J. P.J. JJ Pain Pain Palliat Palliat Care Care Pharmacotherapy. Pharmacotherapy. 2009;23:120-140. 2009;23:120-140. https://www.ncbi.nlm.nih.gov/pubmed/19296351 https://www.ncbi.nlm.nih.gov/pubmed/19296351 Comparison Comparison of of the the analgesic analgesic effects effects of of dronabinol dronabinol and and smoked smoked marijuana marijuana in in daily daily marijuana marijuana smokers. smokers. Cooper, Cooper, Comer Comer & & Haney. Haney. Neuropsychopharmacology. Neuropsychopharmacology. 2013 2013 Apr Apr 22. 22. https://www.ncbi.nlm.nih.gov/pubmed/23609132 https://www.ncbi.nlm.nih.gov/pubmed/23609132 Marijuana Marijuana Smoking Smoking in in Patients Patients With With Leukemia, Leukemia, Khwaja; Khwaja; Yacoub, Yacoub, Cheema, Cheema, et et al., al., Cancer Cancer Control Control 2016; 2016; 23 23 (3):278-283. (3):278-283. https://www.ncbi.nlm.nih.gov/ https://www.ncbi.nlm.nih.gov/ pubmed/27556668 pubmed/27556668 Adverse Adverse Structural Structural and and Functional Functional Effects Effects of of Marijuana Marijuana on on the the Brain: Brain: Evidence Evidence Reviewed. Reviewed. Mandelbaum Mandelbaum & & de de la la Monte, Monte, Pediatric Pediatric Neurology. Neurology. 2017; 2017; 66: 66: 12-20. 12-20. https://www.ncbi.nlm.nih.gov/pubmed/27789118 https://www.ncbi.nlm.nih.gov/pubmed/27789118
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