1. TRANSCRIPT (Part 3): The Science of Cannabis as Medicine

    Cannabis doesn’t necessarily cause psychotic disease but can bring out a previously hidden condition. A recommendation to not use cannabis may be given if there is family history of psychosis meaning a person who has hallucinations, delusions or very disturbed thought, or lack self-awareness. The same would be said for any patient with poor control or recent relapse in their mental or behavioral health. Extra caution advised for patients under 25 years old still undergoing brain development. All users with psychiatric issues should focus on CBD as their backbone compound to avoid psychoactive effects, as well as microdose.
    Overall, cannabis is non-toxic and non-lethal; scientists have literally been unable to kill animals with mega high doses. But it should be appreciated that any chemical introduced into our bodies will have consequence.
    There is mixed data about cirrhosis and use of marijuana, with current belief that in early stages CBD is antifibrotic and hepatoprotective but THC especially in later stages can advance scarring or cirrhosis.
    There are no cannabinoid receptors in the brainstem that control lung or heart rate so it would be extremely rare to have cardiorespiratory arrest because of cannabis, however, reconsideration of use is advised for patients with unstable cardiac disease or congenital heart defect.
    Patients should avoid driving or operating other machinery or ammunitions while using cannabis; everyone should be confident in interpreting their body’s response especially if they are using THC. This is the same advice for any pharmaceutical. Unlike alcohol, people using cannabis are usually aware of their impairment and are able to use their sound judgment. Even the DEA acknowledges that the deaths associated with cannabis have been a result from accidental fatalities- so be responsible and careful with your use as you would other medications.
    Statistics are that an estimated 9% of illicit [recreational] cannabis users become dependent – similar to addictions of caffeine, compared to 15% of alcohol users or 32% of nicotine users. Dependency means a possibility of withdrawal symptoms of anger, aggression, decreased appetite, anxiety, restlessness, and sleep difficulties or strange dreams. These symptoms emerge 1-2 days after cannabis cessation and resolves about a week or two.
    We’d recommend you seek medical advice for help if your cannabis use impairs your social or occupational obligations. Especially if use is to the point of leading to impairment in thinking/mood, or muscle coordination disrupting functioning.
    Cannabis reduces harm for many as an exit rather than a gateway to other drugs.
    I’d like to finish this series by referring you to several resources for additional information.
    Check out our clinic’s website at http://www.socommjcinic.com for a lot of answers to FAQs, but also for a database to other useful resource links.
    “Like” our Facebook page at http://www.facebook.com/socommjclinic for relevant updates on happenings with MMJ in Florida, activities of our clinic, or educational postings. We have a small private patients-only Support Group through Facebook that if interested you would ask us to register your email.
    Our SoCo YouTube channel has our clinic’s educational videos along with our playlist which has a collection of videos from various sources like Dr Sulak, Green Flower Media, Mara Gordon, Dr Sanja Gupta, and more. Unfortunately, YouTube policies have led to removal of a lot of videos related to marijuana and cannabis.
    If you get excited about learning more on all the facets of cannabis, check out
    Green Flower media, which has very entertaining educational articles and videos, hosting round table discussions with cannabis specialists in various fields.
    Dr. Sulak is an admirable cannabis physician with vast clinical experience, and I highly recommend reviewing his website http://www.healer.com. This website is free (but donation is asked) and provides access to recorded video programs you can use during your experiment to help with titration, avoid side effects, strategize for costs, diet tips, and more. He is research oriented with cited references, the articles simply written, so you can read them and be able to understand well enough to explain the science to someone else.
    Please continue to the next in the video series provided by Southern Comfort Marijuana Clinic, where we discuss Your Treatment Plan.
    Thank you for watching these educational videos, which allows us to spend more time taking your education to the next level when we are in our office visits.
    Our contact information is phone number (772) 218-7262 and email at support@socommjclinic.com. When leaving a message please include details of the question, your phone and email address since we often respond after hours. Please allow at least 48 hours for response.
    Thanks for allowing us to be part of your healthcare team.

  2. TRANSCRIPT (Part 2): The Science of Cannabis as Medicine

    Cannabis users have made extensive catalogues for these plants which you can read about their features on websites like Leafly.com.
    Yet, there are virtually no safeguards to let consumers know that the strain they have purchased is, in fact, the strain they believe they are buying. Strains can be named by any grower blending species.
    It may be important to note, however, that there could be a fundamental difference if you are using the whole natural plant or getting extract products, which could obviously change chemical balance intended. CBD and THC are consistent and can be lab reported, but often terpenes are extracted in chemical processing and then possibly reintroduced. The extraction method plays into whether the final product is truly full spectrum or an isolate.
    To transition now to how we use marijuana as medicine, we will teach the terminology you need for your recommendation.
    First in our discussion is the route, or method of intake. The categories are oral (meaning medication you swallow) which includes pills, thick concentrated oil, and edibles; Sublingual (meaning dissolvable under the tongue) and includes tincture drops or sprays, inhalation (of either oils or the flower), Topicals lotions or patches, and suppository for rectal or vaginal use.
    Part of your selection is preference, but each route has specific features including the onset time to start working or duration of effects and the different anticipated mind-body experience.
    INHALATION methods include smoke, vaporizers and nasal sprays. Vaporizing cannabis is healthier than smoking since it turns cannabis into a mist with hot coils rather than using butane flames, is at a lower degree temperature and therefore doesn’t lead to combustion which introduces carcinogenic tars. Vaporizers can either be flower or extracted oils. Herbal Vaporizing of the flower is the best, as the heating element evaporates the plant material leaving behind a medicine that is full spectrum. The oil vapor extracts may be more potent than herbal vaping or smoking due to the concentrating process and lose that full spectrum of beneficial chemicals familiar to strains.
    This method is a great option for breakthrough during a symptom flare-up, as it works the quickest- pretty immediately within minutes and lasts about 2 hours. Chemicals go straight to the blood stream, considerably clean and unchanged – you don’t lose any medication to processes of GI absorption or the liver’s metabolism so some find that they need less total volume or milligrams. There is less risk for drug interactions with such routes but the rapid onset of inhalation may be overwhelming.
    To date, I have read there is no significant association for vaping cannabis leading to the cause of asthma, COPD (doesn’t decrease pulmonary function tests), or lung cancer. Some patients may actually benefit from the bronchodilator effects some cannabis has whereas some people may develop a bronchitis-like cough that will resolve when use stops. Avoid products that exposure plastic to heat and when possible contains no MCTs or fillers that turn toxic when heated.
    SUBLINGUAL is a category that includes drops (often called tinctures), oral spray or lozenges. This is also a preferred method whereby the medication is absorbed into the blood stream via sub-meaning under and -lingual meaning tongue route. It is the healthiest way to take cannabis, especially for people with existing lung or heart conditions. These drops can be used for breakthrough with relatively quick onset of 30-45minutes, but more so for maintenance with treatment effects lasting up to 6 hours.
    Sublingual drops should be thinner, taste pleasant, have specific action times; all these characteristics are noticeably different compared to ingested or oils that need to be swallowed– question the pharmacist if you have doubt about your purchase.
    Liquid cannabis can be cooked with, make lotions, and homemade suppositories or saave; you are not limited by your creativity but be aware of the different mind-body effects that the same extract can have taken in different routes.
    ORAL category includes capsules, oils, and edibles. In general, these have a slower onset of up to 2 hours before noticeable effect and those may last up to 12 hours, so really only for maintenance use.
    This route is not ideal for the THC beginner because the effect may be less predictable as the liver changes the 9 delta THC molecules to 11-delta THC which is a more psychotropic/intoxicating chemical, meaning greater risks of unpleasant effects. Now, if the raw plant extract is ingested, the form of chemical is THC-A and has minimal psychotropic effects because it hasn’t been heated or decarboxylated.
    Some will find they need higher amount of milligrams to achieve effect because of metabolic breakdown in the GI tract and liver. Also, if you do not have a well-functioning gallbladder it may limit cannabis absorption. For extra safety, if you take high dosages then have your physician monitor your liver function labs when initiating this method.
    TOPICALs include lotions and patches. CBD penetrates the skin better than THC, good for targeting arthritic areas where the skin is thin like feet, ankles, knees, elbows, hands or neck. It has been used for skin conditions like psoriasis, atopic dermatitis, healing from cancer or burns, and cannabinoids also have antiMRSA and antifungal properties.
    THC can also be helpful in topical preparations for nerve damaged areas such as from shingles or in restless leg syndrome.
    SUPPOSITORIES are used both vaginally and rectally. Both CBD and THC have been deemed beneficial for treatment of colitis, proctitis, post-menopausal changes and dyspareunia, and even conditions like interstitial cystitis with local its absorption. There is variable data if this method can lead to high enough levels in the blood stream for systemic disease, but consensus is that these routes have the benefit of minimized psychotropic affects and useful if no other route is possible. Benefits can be noticed in 10-15min and last up to 8 hours.
    Medscape, which is a very popular database for all medication information, including a drug interaction checker. Clinically significant interactions will be more likely at higher doses of cannabis, with oral routes of intake, inconsistent use, or maybe when using the whole plant versus extracts. Since cannabis hasn’t been studied with all other pharmaceuticals often this is theoretical.
    With this herb having mechanisms of action similar to many other pharmaceuticals, you may find a need to adjust your current prescriptions. Listen to your body and continue with your routine labwork and guidance from your other prescribing providers.
    If your goal is to come off medications, do so under their supervision; but we would suggest initiating with cannabis first and then weaning off after 2 weeks by cutting back 50%. A specific opioid protocol is introduced in the next video series.
    Some medication specific suggestion are as follows:
    Some seizure and cholesterol medications may become stronger, monitor for liver function.
    Avoid use simultaneously with triptan migraine medications.
    Insulin dose might need to be reduced.
    Check INRs more frequently as coumadin dose may need to be decreased.
    Blood pressure and heart rate initially may be labile, but with consistent use, both will lower so monitor your vitals before and after dosing until this level out; pay particular attention if you take b-blockers.
    Also monitor yourself if you take heart rhythm medications which by themselves have a narrow therapeutic window.
    Use alongside stimulants like coffee, amphetamines like ADHD meds, or cocaine is not advised either.
    Avoid taking the same time as any pharmaceuticals that are by themselves sedating or slow cognition; including, benzodiazepines, barbiturates, mood stabilizers, anti-seizure meds.
    There is a good safety profile for opiates combined with cannabis.
    Alcohol should also be avoided as it enhances THC psychoactive effects.
    I can’t emphasize enough how this medication is very individualized and that this will be a personal, safe experiment if taken slowly and as directed.
    Some of the listed side effects happen to be the symptoms that other patients use cannabis to treat- it goes back to finding that balance in the cannabinoids, noting that “more is not better” and strategy to minimize side effects will be explained in the next video.
    Unpleasant events can last up to 4-24 hours depending on method of use. It seems to happen more frequently with ingestible options like infused foods or capsules due to the THC becoming more psychotropic. Overdose will not cause long-term organ damage or death.
    The American Medical Association reports the most common side effects are dizziness, dry mouth, nausea/vomiting/diarrhea, fatigue/ sleepiness, euphoria (excitement and happiness), depression, anxiety, disorientation, confusion, impaired balance, hallucination, and paranoia. Patients also reported impaired short-term memory, but without significant reports of long-term impairment having tested recall is restored after a month of discontinued use.

  3. TRANSCRIPT (Part 1): The Science of Cannabis as Medicine

    Hello, I’m Dr. Jessica McCain with Southern Comfort Marijuana Clinic. I am board certified in Family Medicine and have been involved in medical cannabis since the passing of Florida’s Amendment 2 in 2016. My disclaimer is that my knowledge is based on independent study via attending seminars, reading research papers, speaking with other cannabis experts and patients – so my understanding will continue to evolve as will my teachings. I apologize for missing citations
    These educational videos are designed to help guide patients in the process of legally accessing and using cannabis specifically for disease treatment and health promotion. In this part of the video series titled “Marijuana as Medicine” I will showcase cannabis as a valuable herb for a number of medical conditions. In the other videos in the series we go over the legal setup in Florida and cannabis use recommendations.
    The Endocannabinoid system functions to maintain balance from stress placed on organ systems, controls processes like innervation of organs, memory, appetite, energy balance and metabolism, social behavior and psychiatric patterns, immune defense and inflammation, reproduction, pain sensation, motor/coordination, thermoregulation, sleep, etc.
    The field of medicine that studies the ECS is relatively still new – only discovered in 1993, and barely even mentioned in medical schools. Over the past decade, there has been significant advances in public policy and perspectives of healthcare providers due to growing worldwide appreciation for antidotal life-changing experiences, the increasing volume of published scientific studies (of which there are about 25,000 mentioning cannabis), and the advances in technology that prove the importance of the cannabinoid system for our health.
    When you see lists like this it’s reasonable to be skeptical of how one plant can benefit so many diseases and symptoms.
    The ECS is a very important system has been maintained though millions of years of evolution in all species, except insects, and the theory is that disease happens when the balance cannot be maintained, in part because of a deficient endocannabinoid system.
    Supplementing with cannabis may also be good for health promotion, with chronic users being 1/3rd less likely to be obese, have issues of HTN, HLD, or diabetes. It may lower occurrence of cancer, help with osteoporosis, and prevent dementias. Sports teams are interested in the vasodilatory effects for muscle healing and concussion support, relating to preclinical studies of smaller infarct size in studies of induced stroke and heart attack.
    Even the US Government can appreciate the neuroprotective and antioxidant potential of cannabinoids.
    Unfortunately, the near century-long ban and still limiting policies, curb full understanding of Cannabis pharmacology and clinicians have variable levels of understanding and strategy. It’s generally understood that every person will have different dosage needs for their cannabinoid deficiency so there’s no standard protocol or prescription.
    The THC and CBD we identify in cannabis plants are the human equivalents of Anandamide (abbreviated AEA) and 2-Arachidonoylglycerol (2-AG); so, when these chemicals become low in our bodies we can replenish with plant versions, and marijuana happens to be a plant of high concentration of cannabinoids.
    Since 2003, scientists have built upon the understanding that a Clinical endocannabinoid deficiency syndrome (CECD) is likely related to the pathology of many diseases since AEA and 2AG regulate many other hormones and neurotransmitters. Some example include;
    Dopamine and Parkinson’s,
    Acetylcholine and Alzheimer's disease with additional affects to the amyloid plaque buildup,
    serotonin, norepinephrine and glutamate implicated in behavioral health,
    GABA for seizures,
    cortisol associated with glucose intolerance and Cushing’s,
    The plant cannabinoids have also been shown to have similar pharmacology to multiple pharmaceuticals classes like COX-2 inhibitors as is the NSAID Celebrex and anti-TNFa action like biologic medications such as Humira- neither prescription is truly a “safe” medication.
    We really need to accept that our Western lifestyle contributed to the deficiency, with low intake of fruits and vegetable but high sugar and processed foods diet being both pro-inflammatory), and lack of exercise which limits positive reinforcement to make new receptors. So healthy lifestyle changes need to be taken along with cannabis medication.
    There are hundreds of beneficial chemicals in cannabis, and the two most common cannabinoids we place focus on are Cannabidiol CBD (which is non-intoxicating and in many organ systems throughout your body) and Tetrahydrocannabinol THC (a psychoactive chemical that can get you “high” but also so entwinned in the nervous system it has significant medicinal benefit).
    When used together, the medical benefits are mutually enhancing compared to using either pure CBD or THC, and you’d also use less total dosage when used in a combined blend verses independent. This is because of a very important phenomenon called Entourage effect, and this is a cornerstone concept that you do need both, medically and financially.
    Although it is too much a simplification, we could consider CBD as a main chemical to target the chemical imbalances and THC could be used to enhance perception of symptoms- though both really can treat diseases as well.

    This chart can be used as an example of how some might tailor the ratios, or the recipe-like balance of CBD and THC for specific conditions, noting however this is not a set rule for any person. The mechanism of action of is analogous to many pharmaceuticals and can be used to treat near 71 different symptoms and conditions, the most common reasons for use being pain, anxiety/depression, and sleep.
    CBD is a key component for pain relief, minimizing inflammatory markers targeting arthritis and autoimmune conditions, i.e. lessening the joint destruction and swelling. It is studied for promoting bone health as supporting osteoblast function, which is lost after menopause with the lack of estrogen. Most pain conditions are a combination of inflammatory and neuropathic causes, such as fibromyalgia, and benefit from the combined use of THC which is helpful in the sensation of such nerve pains.
    For mental health and neurologic conditions, CBD can elevate serotonin to assist depression, lower adrenaline for anxieties, elevate GABA to quiet nerves, adenosine for associated IBS-symptoms, and lower glutamate to minimize aggression. It has also been shown to balance acetylcholine levels which can be helpful in dementias as well as organic insomnia due to chemical imbalances. Given that THC receptors are in the nerves, using cannabis can be neuroprotective to toxins to prevent inflammatory or infectious dementias and painful neuropathy, cleanse plaques in Alzheimer's, control spasms in musculature including in the GI tract and blood vessels. It also helps mentally to assist in tolerance of triggers and relaxation, but in excess may cause paranoia. THC is helpful for insomnias due to PTSD flashbacks or nerve pain that prohibits peaceful rest.
    The balance of CBD and THC are further emphasized with this chart.
    Pay attention the medical benefits and presence or lack of side effects at the different ratios. Generally, for medical purposes, there should not be much reason to go beyond a 1:1 for maintenance dosing, and higher THC would likely be appropriate for breakthrough or for sleep.
    I hope I am clear though, that having a solid amount of CBD and THC is needed for symptom and disease control for most people.
    The understanding of terpenes is a growing interest in the cannabis community and are credited not only for the aroma of the specific plant givens but also additional mind-body effects. They act similar to common Essential oils which are popular in homeopathic treatments. Even baby lotions, often lavender scented, use terpenes like linalool for the relaxing effects.
    Myrcene provides a musky, lemongrass smell to cannabis plants and is known to be a muscle relaxant and a sedative. Cannabis strains that contain higher levels of myrcene are more likely to cause that couch-locking drowsy effect. In contrast, plants high in terpenes like Pinene, a crisp aroma, may be more energizing and alerting, and this terpene is known for its ability to expand airways and be anti-inflammatory.
    There are thousands of varieties of marijuana profiles, based on the balance of the 400+ chemicals including cannabinoid and terpenes. This is what makes up a specific marijuana strain or also called a cultivar. And here is where pop culture and science clash in terminology making it difficult for consumers. These cultivars are given trendy strain names like Blue Dream, Girl Scout Cookies, Pineapple Express, 9lb Hammer.
    Unfortunately, the terminology conflict is further complicated as Strains are in pop-culture classified as Sativa, Indica, or Hybrid. Scientifically, these terms were designed for naming of species based on botanist interests like leaf pattern or growing environment. It’s like knowing a cat is a feline and dog is canine though not all animals are lap pets and definitely have different internal nature.
    Pop-culture has inadvertently used the terpene profile to say that those plants that have a majority of relaxing terpenes would be an Indica or if energizing then a Sativa.
    Cannabis users have made extensive catalogues for these plants which you can read about their features on websites like Leafly.com.

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