by Dr. Heather Sandison , August 31, 2018

Unveiling the Truth About Cannabis and Your Well-Being

Dr. Jamie Corroon, ND, MPH, founder and Medical Director of the Center for Medical Cannabis, joins us in this episode of Collective Insights to discuss the massive misinformation regarding cannabis consumption. We take a look at how it affects our society and its future in medical health-care.

Could THC and CBD be considered good medical drugs? Although THC provides a myriad of positive effects, including reduced pain, anxiety and improved sleep, its window for therapeutic value is very narrow. Join us as we explore the differences between addiction, dependence and tolerance, and dive deep into the various types of cannabinoids and the products and methods for administering them.

In This Episode We Discussed:

The differences between the various types of cannabinoids
The misinformation in society and on the internet
The Controlled Substances Act
The benefits of THC and CBD
The adverse effects of THC and CBD
Synthetic THC and whole plant extracts
FDA drug approval
Addiction, tolerance and dependence
What do the products we buy contain?
The various methods of consuming cannabis
Terpenes and terpenoids
The potential risks in flavoring cannabis
Combining alcohol and marijuana
The opioid epidemic
The effects on younger populations

People Mentioned:

Books, Tech & Products Discussed in the Show:

Center for medical cannabis
Controlled substances act
Dronabinol
Epidiolex
Proposition 65

Show Notes:

00:00 Intro
01:33 There is a variety of names for marijuana – what do they really mean?
11:00 The differences between THC, CBD and the various types of cannabinoids
20:07 How Dr. Jamie Corroon got into the area of medical cannabis
24:18 The benefits and adverse effects of THC and CBD
32:10 Scheduling and approving drugs based on potential for abuse and addiction
35:30 The distinction between dependence, tolerance and addiction
37:32 The rescheduling of CBD
41:25 How do we know what’s in the products we purchase?
43:12 Exploring the various methods of cannabis consumption
56:44 The potential risks in adding flavours to cannabis
01:00:20 The role of cannabis as a solution to the opioid epidemic
01:06:34 “There has never been a reported overdose death from marijuana”
01:07:25 Statistics among the younger populations
01:11:53 How long does it take to achieve the desired benefits of cannabis?
01:17:36 How to get in touch with Dr. Jamie Corroon and where to find out more information

Complete Episode Transcript:

Dr. H. Sandison:00:00:38Welcome to Collective Insights. I'm your host, Dr. Heather Sandison. I'm a naturopathic doctor and the Medical Director of North County Natural Medicine. I also serve here at Qualia on the Medical Advisory Board. Today, I am really honored to have both a friend and colleague, Dr. Jamie Corroon joining us. Dr. Corroon has a naturopathic Doctorate as well as a Master's in Public Health from San Diego State University. He's the founder and Medical Director of the Center for Medical Cannabis Education. Dr. Corroon is a licensed naturopathic doctor, peer-reviewed clinical researcher and industry consultant with a focus on medical cannabis.

He's committed to investigating the important clinical and public health questions resulting from the broadening acceptance of cannabis in society. Welcome, Dr. Corroon. It's nice to have you today.

Jamie Corroon:00:01:29Thank you. Thanks for the invitation to be here.

Dr. H. Sandison:00:01:33I thought we would start with what are we calling this these days? In high school, we called it weed. Today, we talk about CBD and THC ratios, cannabinoids. What is it that you are studying? When we say cannabis, what does that mean?

Jamie Corroon:00:01:52Yeah. This plant has so many names. More names than any other plant and all of them are really fun and funny to say. In the scientific literature, we stick to the botanical name, which is cannabis sativa. Cannabis is the genus and sativa is the species. It does get more complicated because we talk about common names with regard to plants. It's not what the common name is because hemp could be considered a common name. Perhaps, marijuana could be considered a common name but even hemp and marijuana are two different things. Even though they're the same plant by virtue of the genus and the species. We can tease that out a little bit more.

The term marijuana has this pejorative historical use in that it was, I think used early in the 19th century to refer to Mexican immigrants who had come over into the US and seem to pose a threat to the establishment at the time. There's a pretty long sordid history of using that word to demonize this group of people. There's a lot of people, myself included who would prefer not to use the term. At the same time, it does seem to serve a role in terms of clarifying the difference between hemp and marijuana. There's all of the other fun and funky names that people use to describe what they're going to do in the parking lot before the concert or whatever. Maybe I should talk a little bit about the difference between hemp and marijuana.

Dr. H. Sandison:00:03:49Yeah. Please do because you just educated me right now. I didn't realize that cannabis sativa referred to both hemp and marijuana. I would have thought that that was a different species and that maybe they share the genus. I would love for you to expand on what are the differences. How would we know? Clearly, at a regulatory level, there's a difference. Please.

Jamie Corroon:00:04:11Yeah. My understanding is that the first time that marijuana was defined, at least from a regulatory standpoint was in 1937 with the Marijuana Tax Act, which was an attempt to basically levy taxes against the purchase and the sale of marijuana such that it would make it more difficult for people to access. That definition was adopted in 1970 when Richard Nixon was the president for the definition of marijuana in the Controlled Substances Act. That was passed as I said in 1970. The definition of marijuana there is rather extensive but it's basically the cannabis sativa plant, every compound or constituent in the plant, the flowering, tops, etc. except for the mature stalks and the sterilized seeds and then compounds that would come from the mature stalks and the sterilized seeds.

That's really the definition from a regulatory standpoint that we have right now from marijuana. It comes from the Controlled Substances Act. The Controlled Substances Act does not define hemp. It defines marijuana and not marijuana. The DEA in public statements has come to basically associate what is defined as not marijuana in the Controlled Substances Act as hemp and has a very significant historical use in our culture. Also, going back to the 1800s where it was grown by virtually everybody to be used in textiles, clothing, rope, things of that nature. It was mostly using the fiber from the stalk. Hemp plants from a physical appearance or a phenotypic standpoint tend to be really tall with very long stalks and not a lot of flowers.

Whereas marijuana plants tend to be short and fat with big, fat flowers that concentrate the resin. As far as the definition is concerned, that was the definition of marijuana and by exclusion, hemp until the Farm Bill or the Farm Act was passed in 2014. In which case, hemp was actually defined as the cannabis sativa plant with a concentration of THC, the principal psychoactive cannabinoid of less than 0.3% by dry weight. I realize this might be getting a little bit confusing. If you had two plants sitting on a table in front of you and they were both of the genus cannabis and the specie, sativa.

You've plucked off a flower or a bud from each of these plants and you dry them and then you sent them to a lab, if one of them by dry weight had less than 0.3% THC, we would call that one hemp. If the other one had 0.3% or greater, we would call that one marijuana.

Dr. H. Sandison:00:07:31That is fascinating. Correct me if I'm wrong here. I'm trying to parallel with tropical flowers. Say you have a hibiscus. You have all these hibiscus and one is yellow and one is red. Is that a degree of difference that we're talking about? It's just a phenotypic difference? It's a genetic expression that shows up differently but the genetic potential is in the hemp to express the THC?

Jamie Corroon:00:07:54Definitely, genes play a huge role. THC is synthesized as THCA. When we say THC, typically we're referring to Delta 9 THC. HCA is the acid form of it, which is the form that is naturally occurring in a plant. That form is not psychoactive. When the acid is removed through decarboxylation, which is what happens when light or heat is exposed to THCA. The carboxylic acid comes off and it becomes psychoactive. There's an enzyme THC synthase, which synthesizes THCA. That enzyme as you know is a protein. Proteins are coded by genes. One way to discriminate at the genotypic level, hemp from marijuana would be the genes for THCA synthase whether they exist or not.

Whether there's mutations or not and then there's these epigenetic factors if they do exist that could contribute to the expression of that gene.

Dr. H. Sandison:00:09:14The divergents from marijuana to hemp, was that basically a human controlled thing? There were pressures? I guess in plants, you can select for like our Mendelian peas where you can select for pink or white or whatever flower color. Is that what happened between hemp and marijuana? That there were people who were cultivating it who select it for a certain phenotypic expression?

Jamie Corroon:00:09:42I would guess. I'm definitely not an expert in this particular area but yes. Mostly in the US in the 1800s, it was all about hemp. This idea of smoking marijuana really came from as far as I understand it, the early 1900s when these Mexican immigrants came over and introduced this behavior, this substance that could be smoked, that had higher levels of THC. As far as breeding is concerned, that is certainly what has been happening with regard to recreational marijuana. In that we had been constantly trying to breed plants that are high in THC. As a result of doing that, we have lost biodiversity within the cannabis plant in terms of all of the compounds. We've also lost cannabinoids including CBD.

I think for a long time, CBD was basically bred out of cannabis because the purpose for breeding cannabis was to get really high THC containing [inaudible 00:10:52]. Because the primary use was recreational use. Now, that's starting-

Dr. H. Sandison:00:09:42To get high.

Jamie Corroon:00:10:58Yeah, exactly. To get high. Now that's starting to change.

Dr. H. Sandison:00:11:00Yes. Can you talk a little bit about the differences between CBD and THC? This area I really rely on you actually. When patients come into my office, which happens more and more and more frequently, I think as the regulatory specie's expanding and people are feeling more comfortable asking the doctors about it. People ask me and I say, "Hey. Talk to Dr. Corroon. Talk to Jamie. He is really the expert on how to dose this and what way to administer it." I'm so grateful that you're here to share because I'm learning a ton as well. What I remember from probably med school and somebody talked about it was that there's a bunch of cannabinoids that aren't CBD or THC that might also be helpful.

Are we oversimplifying when we start talking about just CBD and THC? Are there other cannabinoids we need to consider? What's the difference between even just those two if we start there?

Jamie Corroon:00:11:55Yeah. That's a lot. We're definitely oversimplifying as we do in medicine and in science when we're trying to explain complex things. When we're trying to understand them ourselves, let alone explain them to patients or consumers. There are over 100 cannabinoids that have been identified to date. We don't know very much about most of them. We know the most about THC and CBD. There are others like CBN and CBG and THCV that we are starting to learn more and more about. As most people know, the regulatory status of cannabis or marijuana as a Schedule 1 controlled substance has really hindered our ability to study it. Schedule 1 controlled substance, which many people know is one that has value and has a high potential for abuse.

Maybe down the road in this conversation, we can tease out whether that's true or not with regard to cannabis. When you talk about these cannabinoids and THC and CBD, we tend to fall into this trap that is the pharmacological model where we're focusing on one molecule. What is the active ingredient? As you said, these compounds exist in a matrix of other compounds inside of a plant. Even when they're extracted and concentrated, you still have a variety of other phytochemicals that are in the matrix that may be modulating the effects of what we believe to be the pharmaceutically active ingredients. THC and CBD are very, very different. They're both lipids. They have activity at the cannabinoid receptors. THC much more so than CBD.

CBD is really a fascinating because it seems to do so many different things. It's very promiscuous in that it has associations or affinities with other types of receptors other than cannabinoid receptors. CBD has been shown to have an affinity for GABA receptors and for serotonin receptors and adenosine receptors, etc. Whereas, that's not quite the case for THC. THC-

Dr. H. Sandison:00:14:24If you're talking about in the body, in the human body and particularly maybe in the human brain. Because you talked about GABA, which is a neurotransmitter but also in the gut I'm assuming. Maybe that's why we get both psychoactive and GI effects with I was going to say marijuana but I guess it's CBD and THC. A wider breath than I've even considered before but we're getting those effects because we have inherent in all of us. In every human, there are these receptors. In addition-

Jamie Corroon:00:14:51Yeah.

Dr. H. Sandison:00:14:51There are specific cannabinoid receptors?

Jamie Corroon:00:14:55Right, exactly. Depending on what level you want to approach this. Yes. There are many systems in the body use this ligand receptor model. The ligand is a molecule. The receptor is a target basically. The metaphor that we use a lot in medicine and in science is a key and a lock. The key in this example might be THC or might be dopamine. The receptor is the lock. There are different ways that these ligands or these molecules can interact with the receptor. The key can be into the lock and nothing can happen. The key could be put into the lock and it can block other keys from getting put into the lock. The key can get put into the lock and it can get turned and something can happen inside the cell.

THC when it comes to cannabinoid receptors and cannabinoid receptors like other receptors sit on the cell surface of a variety of different cells. We talk mostly about nerve cells and neurons but cannabinoid receptors are found in all tissues. As you said, in the gut, on white blood cells, immune cells. It's a very distributed system throughout the body. A lot of times, when we are talking about it, we're talking about the central nervous system. The T-

Dr. H. Sandison:00:16:17Wow. There is so much complexity here. I'm glad I'd just refer fumes to you because this is a lot. I'm feeling a little overwhelmed already.

Jamie Corroon:00:16:25Yeah.

Dr. H. Sandison:00:16:25By how much there is to bite off here. As you were talking about that complexity, there's this paradox or maybe just different paradigms between an herbalist's perspective. Where you might have a lot of leverance for the plants, for the synergies that are within those plants the way they are. As opposed to the pharmaceutical paradigm where, okay. What we want is that single active molecule separate from everything else. We're going to see what that does at this receptor site. We're hanging in this balance between do we use the whole plant? Do we take out that one molecule and just study that? You do end up with this really, really complex system if you're talking about the whole plant in the whole body.

Versus just trying to get one effect on a neurotransmitter when you take out a single active ingredient or single active ligands. Did you say they're ligands or ligands?

Jamie Corroon:00:17:26Yeah.

Dr. H. Sandison:00:17:28Yeah. There's a lot of meat on this to explore. Tell me more.

Jamie Corroon:00:17:37I don't know. It is extremely confusing and complex. It's overwhelming for me, too. I don't know how much the audience knows. A few things to touch on based on what you just said. With regard to THC and CBD, in our reductionist view of things, we talked about when we're trying to simplify complex systems, there's a phenomenon that's occurring now where people are saying that CBD is medical cannabis. THC is recreational cannabis. I think Sanjay Gupta in his special on CNN a few months ago called Weed 4. He was really doing this. I don't think it's fair because that's a gross over simplification. THC and CBD are both cannabinoids. They have a variety of different effects in the body. There's some overlap in terms of what they do. Both are anticonvulsants.

Both are analgesics. Both are anti-inflammatories. There's a lot of effects that THC has that CBD does not have that are very important clinically. It's just that THC happens to have this side effect that can occur even at a very low dose, which may be adverse effect for some people, which maybe a desired effect for other people. With regard to these two cannabinoids and cannabinoid receptors, I don't want to get too complex. THC binds to a site on the cannabinoid one receptor so as to initiate and intracellular cascade. If the key goes in the lock, the lock turns, something happens. This is the orthosteric site. CBD binds to the cannabinoid receptor one pill. It binds to a different site. It binds to the allosteric site.

An allosteric modulator is a compound that binds to that site and it change the confirmation of the receptor so that other ligands like THC have a different affinity for the receptor. There is this idea that I'm sure you have heard that when you administer THC on its own as an isolate, there are some certain set of effects. When you administer with CBD, those effects are different. That potentially could be explained by the fact that CBD changes the shape of the receptor so that the effects of THC are different.

Dr. H. Sandison:00:20:07That is fascinating. Just so everyone will stay with us as we go further into the weeds here. Tell me a little bit more about the benefits. Also, how you got into this. You're clearly very passionate about this area of medicine. You went through the whole naturopathic doctorate program and then a Master's in Public Health. Really, your niche has become cannabis and medical cannabis specifically. How did you end up there?

Jamie Corroon:00:20:40I think mostly, it just came from my own personal experience. I always loved smoking weed just to be very direct. I never really care too much about alcohol. I enjoyed the effects. I liked how I felt when I use cannabis. When I was 32, I suffered a life-changing neck injury, which you know, very serious. I had about three or four years where I was in very severe chronic pain. I was experiencing a lot of disability. I was in neck braces. I was preparing for surgeries or having surgeries or doing physical therapy. I was on a lot of drugs to help with the pain and the depression and muscle spasms and everything. One of the interventions that really helped me a lot was cannabis. There's obviously a lot more complexity to that story.

That was the experience that led me to get into medicine. I used to work in the technology industry and in finance. I started to study things and biochemistry and the physiology. To make a long story short, when I got out of naturopathic medical school, I knew that I needed to understand statistics. Because I have to understand things. It's just how I am. A lot of the interventions that we use in the world of complementary and alternative medicine are subject to a lot of personal beliefs. I wanted to be able to break down the research and be able to understand what was fact and what was opinion. With regard to cannabis, I just felt like this was an area that I can be very helpful. Because what was happening in 2015, 2016 was that this was getting a lot of attention in the popular press.

It was on MPR. It was on CNN. It was in USA Today. They're-

Dr. H. Sandison:00:22:53There's Netflix documentaries all over about it. Yeah.

Jamie Corroon:00:22:58A lot of people who had lived for decades hearing that this was a substance that wasn't a threat to society, that was something that was deleterious to our personal health. They were hearing a completely different story. These people were sick. They were wondering. "Wait a minute. Is this something that could help me?" They were going to their doctors. Their doctors didn't know anything about it. As a result, they were ending up in dispensaries talking to bud tenders and to sales reps for cannabis products or product manufacturers. Many of these people are very smart and very committed and well-intentioned but they're not trained in medicine. I just felt like there was a real need to help patients.

That given our background as naturopathic doctors, with our training in botanical medicines and the fact that this is a botanical medicine, that this was a good place for me to focus. What I did basically was I took advantage of a data set that Laurie Mishley and Michelle Sexton, two other naturopathic doctors had collected over time with regard to cannabis use, medical cannabis use. I took the data set and analyzed data and wrote a paper and got it published. I was on my way in this field.

Dr. H. Sandison:00:24:18Great. Talk about some of the benefits. I certainly have these sweet little old ladies coming in asking me about cannabis as they heard about it on all of the media that you were talking about. Yeah. I didn't know what to tell them really. I come to you. They were coming in with anxiety certainly around cancer. Sleep issues, lots and lots of different complaints would attract the attention of someone, would draw people to consider cannabis. Can you tell me about some of the things that maybe there is published literature that would be beneficial to maybe consider that as a treatment?

Jamie Corroon:00:24:59Yeah. There's different ways of approaching this. If you look at surveys of individuals who are using cannabis for medical purposes, they will report to you that the top reasons that they are using cannabis is for pain and anxiety, depression, sleep and then cancer, probably. In most studies, those are the top five right there.

Dr. H. Sandison:00:25:23Is it in that order? Is that arbitrary?

Jamie Corroon:00:25:26It's usually in that order. Yeah. It's usually in that order. We also have drugs that have made their way through the FDA drug approval process that have been developed for certain clinical indications. In 1986 I think it was, the FDA approved a drug named Dronabinol. That's the generic name, Dronabinol, which is synthetic THC. There's the same chemical formula and the same chemical structure as THC that is synthesized in nature by the cannabis sativa plant.

Dr. H. Sandison:00:26:02This was an FDA approved drug for what indication?

Jamie Corroon:00:26:05It was first approved for nausea and vomiting associated with cancer chemotherapy, in patients that had failed traditional antiemetics, which are anti-nausea meds. I think the indication was extended in 1992 to include patients with HIV and AIDS who were suffering from anorexia, loss of appetite and cachexia, which is the loss of muscle mass that comes from wasting basically when you're not eating. This drug at least according to the FDA was safe and effective for reducing nausea and vomiting and stimulating appetite. Just to draw back to a few moments ago, the DEA still says it has no medical value. Yet the FDA has approved it for at least two indications.

You could be thinking about using THC for both of those reasons. Either to stimulate appetite or to reduce nausea and vomiting. Those are pretty common uses as well. There is a drug-

Dr. H. Sandison:00:27:09Excuse me. With that drug, Dronabinol, with a D? Is that what you said?

Jamie Corroon:00:27:09Yeah. Yeah.

Dr. H. Sandison:00:27:13Does that have psychoactive effects? Because you mentioned that THC has more psychoactive effects than CBD. Somebody getting that drug administered in a hospital for either the cachexia or nausea and vomiting, would they feel high?

Jamie Corroon:00:27:25Yeah. Depending on the dose and depending upon the person's sensitivity. Dronabinol is one of the pillars in the isolate versus whole plant extract argument. A lot of people will say that even if you took the same dose of THC, let's just say it's five milligrams. If you take it as isolated THC in the form of Dronabinol, a synthetic THC or if you take it as isolated THC in the form of Delta 9 THC synthesized in a plant, your risk for adverse effects is higher. If you took that same five milligrams in a whole plant extract with all of the other cannabinoids, all of the terpenes and terpenoids and the other compounds in there. Many people like to say-

Dr. H. Sandison:00:28:14What is the risk?

Jamie Corroon:00:28:14The risk-

Dr. H. Sandison:00:28:15Can you just describe them?

Jamie Corroon:00:28:16Yeah. The risk would be the risk of adverse effects. The most common adverse effect is individual. The most common adverse effects that you hear with regard to THC are sedation, lethargy, so feeling tired and fatigued. Memory loss, difficulty concentrating. Dizziness, paranoia, hunger is an adverse effect for a lot of people. Increased heart rate, tachycardia. Many people like to say that if you look at the Dronabinol studies, you see that the risk for adverse effects is higher than people who use THC dominant cannabis. We don't actually have a study that compares those two things.

Dr. H. Sandison:00:29:00Okay. There hasn't been a head to head.

Jamie Corroon:00:29:00No.

Dr. H. Sandison:00:29:04Even in the published literature on both of those, that holds true.

Jamie Corroon:00:29:11In terms of those adverse effects?

Dr. H. Sandison:00:29:12Yeah. What you see in the general literature around cannabis as a whole plant versus what you see in the literature that is on Dronabinol or the isolated THC.

Jamie Corroon:00:29:22Yeah.

Dr. H. Sandison:00:29:22Generally, what you're seeing is this difference. In a pseudo meta analysis, there's not a head to head study but overall in the analyses, if you compare those two groups, there's more adverse events reported in one than the other.

Jamie Corroon:00:29:22I don't-

Dr. H. Sandison:00:29:22Is that what I'm understanding?

Jamie Corroon:00:29:36I actually have not done that. I'm just saying that that's what people will say.

Dr. H. Sandison:00:29:41Interesting.

Jamie Corroon:00:29:43THC is not a good drug. The reason why THC is not a good drug is because it has a very narrow therapeutic window. It's a great drug in the sense that it has a lot of different effects. It's very versatile. It can do many things. Typically, if you recommend it for one thing like pain, the patient will come back to you and say, "Well, I also experienced improved sleep. I also experienced reduced anxiety." It's great that it has multiple different effects. You can't go high in the dosing range on it because people tend to get high. For a lot of people, that's an adverse effect. On the other hand, CBD is a good drug in the sense that you could go really high in terms of a dosing without people experiencing adverse effects. The most common adverse-

Dr. H. Sandison:00:30:33Is that what CBD-

Jamie Corroon:00:30:33Sorry. Go ahead.

Dr. H. Sandison:00:30:35No, no, no. Go ahead. The common adverse effect with CBD?

Jamie Corroon:00:30:37The most common adverse effects with CBD is also sedation, feeling fatigued. It's much less common to feel an adverse effect if you're using a CBD dominant product as opposed to a THC dominant product.

Dr. H. Sandison:00:30:52Is there a CBD comparable to Dronabinol that is a FDA approved, regulated synthetic CBD?

Jamie Corroon:00:31:03Yes. I don't know if you're setting me up for this or what but yeah.

Dr. H. Sandison:00:31:07No.

Jamie Corroon:00:31:07Yeah. There was one that was just approved on January 25th, I think. It's called Epidiolex. It is manufactured by GW Pharmaceuticals. The US subsidiary is Greenwich Biosciences. They're here in Carlsbad. It is the first FDA approved drug that is derived from marijuana. It's derived not from hemp but from marijuana. It's an isolated CBD in sesame oil. It's 99% CBD. It was approved to treat two intractable seizure disorders in pediatric patients, Lennox-Gastaut syndrome and Dravet syndrome. I think it was three Phase 3 clinical trials. It should be pretty effective in reducing the frequency and even the severity of seizures in these patients. It was designated as an orphan drug, which allowed it to be accelerated through the drug approval process.

We don't actually have a lot of participants in those three Phase 3 clinical trials. The interesting thing in addition to what I said that the fact that the FDA has approved a marijuana-derive drug is that it's actually going to force rescheduling of CBD. This actually could lead into another very complex part of this conversation. The DEA has until September 24th. They have 90 days basically to reschedule CBD. Because obviously now, CBD has to be able to be prescribed. You can't prescribe a Schedule 1 controlled substance because it has no medical value. CBD will be rescheduled, which will be very exciting. There's a lot of speculation as to where it will end up. Maybe Schedule 4, maybe Schedule 3.

Dr. H. Sandison:00:33:06You alluded to this whole is it addictive? Is it not? That's part of how they determine how to schedule certain medications or drugs like opiates and benzodiazepines are scheduled the way that they are because there's a high risk of-

Jamie Corroon:00:33:19Abuse.

Dr. H. Sandison:00:33:21Of abuse, thank you. They're scheduled, too. Because they have some medical benefit but high risk of abuse. When we talk about cannabis and this potential for rescheduling, what is the literature around abuse potential?

Jamie Corroon:00:33:38As far as cannabis itself?

Dr. H. Sandison:00:33:44Or THC and CBD, are they different? Are they showing differences when they do the research?

Jamie Corroon:00:33:47That's really complicated because if we talk about cannabis as a medicine or as a drug, it's obviously a combination drug. It has a variety of different compounds. There are other combination drugs out there that have been approved. To answer this question, we break it down into individual components and then we fall into the trap of the isolate versus the whole plant extract. That's really difficult to talk about, all of this. In most evaluations of a particular drug's potential for abuse, it's measured and again, I'm not an expert in this particular area but it's measured in animal models where they give rats usually access to a substance and then they offer them food. They look to see whether the rats self-administer the substance over the food.

Rats for example and I haven't read these studies. I'm just usually basically going up on other people that have told me this and things that I've read that aren't the actual studies. They will hit the bottle to take cocaine until they starve to death. With regard to THC, there does seem to be some abuse potential there but not so with CBD. In 2017, the World Health Organization put out this very comprehensive preliminary report on CBD in an effort to try to I think set the groundwork for de-scheduling CBD worldwide in terms of the World Health Organization. They concluded after reviewing the research that there's no abuse potential for CBD. There is a difference between dependence, tolerance and addiction.

We should probably just tease those things out. Because tolerance is the physiological adaptation. When we are exposed to a given substance-

Dr. H. Sandison:00:35:48This would be coffee or sugar.

Jamie Corroon:00:35:50Yeah, nicotine, caffeine, whatever the case may be. At some point over time, you need a higher dose in order to maintain the same effect. Because the body is adapting to it. Dependence, which is oftentimes confused with addiction is basically the appearance of withdrawal symptoms when we abstain from using the substance or performing the behavior.

Dr. H. Sandison:00:36:16An example would be somebody who gets the shakes after not having alcohol.

Jamie Corroon:00:36:21Yeah, exactly.

Dr. H. Sandison:00:36:22A headache after not having coffee.

Jamie Corroon:00:36:25Yes. Yeah. Addiction is really a behavioral disorder. It's this inability to stop using the substance or performing the behavior despite the fact that there are negative consequences, despite the acknowledgment of those consequences. This compulsive impulsive use of the substance or performing the behavior. THC, you can develop tolerance to THC. You can develop dependence to THC. You can become addicted to THC. The withdrawal symptoms from THC are much more similar to say caffeine withdrawal, than even nicotine withdrawal or alcohol withdrawal. I don't know if you've ever experienced someone who was giving up nicotine. They can be a monster. That's typically not the case with THC.

With CBD, I don't honestly know. I don't really know how much we know about that. I don't think that there's much of a dependence with CBD.

Dr. H. Sandison:00:37:32Okay. Interesting. That may influence how it becomes scheduled in the next 90 days. Now, do you have any idea? You can say no. If they don't hit that deadline, if the federal government doesn't hit that deadline for whatever reason, then will this drug not be released? What will happen?

Jamie Corroon:00:37:47They'll hit it. The head of the DEA said flatly they're going to do it.

Dr. H. Sandison:00:37:47Okay.

Jamie Corroon:00:37:51It's going to happen. Even then, the drug is going to be very expensive. These anti-epileptic drugs are very expensive generally. Insurance coverage will certainly be important. It's not clear even with insurance coverage how affordable it will be. It's not clear how physicians, how comfortable they will feel using it off label for other things. It's a very exciting development. It creates a lot of uncertainty in the hemp derived CBD world, which is a world that you know a bit about. Certainly, more people are using CBD that's derived from hemp than they are using CBD that's derived from marijuana or CBD that's about to be available through physicians via-

Dr. H. Sandison:00:38:42Wait. There's a whole spectrum. This is another part of it. It totally confuses me. How do you know what you're getting? I guess if you get a pharmaceutical, there's a tracking system. There's a lot number. There's a pharmacy that it came from. There's a lot of regulation around what happens to that substance. Now, if you go into a dispensary like here in California or Oregon or Washington or Colorado, how do you know what you're getting? When I start to think about plants, even when we're talking about a zucchini. How many pesticides or herbicides did this get sprayed with? When you talk about consuming something like cannabis, how many pesticides or herbicides did that get sprayed with? Are you going to expose yourself to toxins?

I'm going in a lot of directions here. There's so many different pieces to consider with what you're getting. How do you know what you're getting? There's also this financial piece. You just mentioned this drug, this CBD analog is going to be super, super expensive. Maybe not even accessible to a child that has epilepsy. Then are they going to go to a dispensary and get that and will it be a good product? How do we know?

Jamie Corroon:00:39:51Yeah. Will it be available over the counter if it's a hemp derived product or online or at a dispensary? Because once it's approved as a drug, presumably, it cannot be sold as a dietary supplement or even in a cannabis product. You can't go somewhere and buy Lovastatin or Hydrochlorothiazide in something that is not approved by the FDA. That is what's going to happen. September 24th when we all wake up, you can go to your doctor and if you qualify, get a prescription for CBD, you could go to the health food store and buy CBD. You could go to a licensed dispensary in a state that has a medical or recreational cannabis law and buy CBD there, too. Those are three different sources and they're regulated three totally different ways.

If you had a patent on CBD like Greenwich Biosciences or GW Pharmaceuticals, you might not want people to be able to go to the store and get CBD. If I go to my doctor and I have health insurance and they say, "Okay. It's $175 a month for you to use this drug." You might go to the health food store and say, "Well, I can get it over the counter for $80 a month." I'm just speculating. There's a lot of concern and confusion about what's going to happen with regard to CBD outside of the prescribing or the prescriptive right of the physician. Anyway, to answer your question, how do we know what's in the products that we buy? I think it really depends on the state that you live in and the regulations.

In California where we live, if you are buying a cannabis-based product at a licensed dispensary, that product has to be tested by a third party. Those test results which are a batch, it's testing a batch have to be made available to you. A lot of companies are really trying to make this as transparent as possible. They're putting the lot number or the batch number on the box of their products. They're offering websites where you can go in and you could put in the batch number. You could look at the chemical analysis. It not only breaks down the cannabinoid content, the absolute concentration and the absolute amount but also, you can look at pesticides. You can look at heavy metals. Not look at it. This is required and microbial testing as well. There are other companies that are putting scanner codes on their label so you can scan it with your phone and automatically, you can pull up a certificate of analysis. California really has very strong regulations with regard to lab testing, which is awesome. If you want, as a consumer, you can have access to that information. Now, you can walk at a Whole Foods tomorrow and you can see nine bottles of CoQ10 on the shelf with other things in them. Can you get a certificate of analysis for those? No. You can't. I think in a lot of ways, the cannabis products are going to have greater scrutiny and more resources available for purchasers than other dietary supplements and in some cases, the drugs.

Dr. H. Sandison:00:43:12That's really interesting. Probably very beneficial for the consumer to know. I have questions around dosing and administration. Now we're getting into this area of walking into a dispensary. You can walk into Whole Foods or even Walmart and there are CBD products. How do you know which would be the right one for you or even where to start? You can vape it. You can drink it. It can be raw. The list goes on and on. It can be edibles. It could be heated. These ratios of CBD to THC and then you get into all of these funky names of different things. Where do you start?

Jamie Corroon:00:44:01Where do I start in terms of answering that question?

Dr. H. Sandison:00:44:05Okay. Let's take my little old lady. I have an 80-year old patient who walks in and she's in pain. She's got arthritis. She has some nausea from another medication that she's taking. It's a side effect from another medication. She doesn't really have an appetite anymore. She has been losing some weight but not too much. She's not cachectic. She has some difficulty sleeping at night. She's like, "Well, I read something or my nephew told me something about cannabis and how it's helped him." What should she do? Where should she go? Where should she get more information?

Jamie Corroon:00:44:39Okay. If our clinical objective would be to reduce nausea and stimulate appetite, at least this is just how I would approach this. We were thinking about cannabis as the intervention here. I would be thinking about THC, not so much CBD. Because THC really is more effective in those two areas than CBD is. I don't think that CBD stimulates appetite. That has not been shown in the Epidiolex studies. It really hasn't been shown in terms of reducing nausea as well. I'd be first thinking about THC. That means we're now buying a product in a licensed dispensary. Okay?

Dr. H. Sandison:00:45:24What about her arthritis?

Jamie Corroon:00:45:27Sorry. I didn't hear that part.

Dr. H. Sandison:00:45:28Yeah.

Jamie Corroon:00:45:30If that's the case as well, I still think we're probably going to use THC. If she didn't have those other two symptoms and she just had arthritis, then I'd probably would be thinking about CBD and probably from hemp because it's accessible. It's affordable. It's not going to lead to any kind of impairment. I'm already worried that this little old lady is going to fall down. I'm worried she's going to get dizzy and fall down. I'm worried about using THC. Already, the first objective is to be able to give her a dose of THC that is not going to lead to impairment. There is this dichotomy now as I said before where people think, if you take CBD, you don't get high. If you take THC, you get high. That's not the case.

Everything depends on the dose. The effects of THC are dose-dependent. You could take a dose of THC and not feel high. Just the same way you could take a sip of a glass of wine and not get drunk. It depends on how much you're taking. The analgesic properties of THC will also help with her arthritis. CBD will not help with her anorexia and her nausea. We're going to go with a product that she's going to buy at a dispensary. It gets really complex in terms of access. I would start with trying to determine a dose of THC that is not going to make her feel anything. Because that's my first goal in a situation like this. Do no harm. Demonstrate that she could take THC without feeling impaired. From there, I would very slowly inch it up.

That's why this is a very difficult therapy or modality to use in clinical practice because it requires a lot of hand holding. That is basically how I would approach that. You talked about all of these different products. The method of administration is really important. The method of administration is important for a lot of different reasons. One is that it determines the difference between the dose that is administered and the dose that is actually received. Just because you ingest 10 milligrams of THC or five milligrams of Valium doesn't meant that amount is received in the body. It's only some portion of it is going to be absorbed. Some other portion is going to be metabolized in the liver.

Your method of administration really determines this difference between what you take and what you actually receive. Because if you're inhaling it, the diffusion through the vascular system in the lungs will allow you to absorb a lot more of it as compared to let's say the gut where you're going to absorb less of it. As compared to the dermis where you're going to absorb even less of that.

Dr. H. Sandison:00:48:22A topical administration to a source.

Jamie Corroon:00:48:26Yeah. Basically, I break it down. Inhalation as a method of administration which includes smoking and vaping. Oral administration which includes oral absorption like sublingual absorption and buccal mucosal absorption. Enteral absorption, which is basically ingesting it. Dermal, which is topical and transdermal and topical is like you said, it's applied to something that's cutaneous like a rash or a scratch or perhaps an inflamed joint. Whereas a transdermal would be seeking a systemic effect like a nicotine patch or hormone patch. You would put it in a highly vascular area not the place where the problem is. The pharmacokinetics are different for all of these methods of administration. Bioavailability is one component of pharmacokinetics.

As we said, you're going to absorb a different amount is going to be bioavailable depending upon the method of administration. Also, whether it goes to the liver or not is going to also have a huge impact. Because another part of pharmacokinetics is metabolism. We have all of these enzymes in our liver that receive whatever is absorbed through the small intestine. Basically, the objective of these enzymes is to modify these compounds so the body can eliminate them. The body mostly tries to turn these compounds into water soluble compounds so that we can eliminate them via urine or sweat or via expiration. These cannabinoids or lipids however so it's difficult for the body to get rid of them.

One thing that happens in that metabolism in the liver to THC is that it's converted to a metabolite 11 hydroxy THC, which is much more potent at the CB1 receptor. It's three to seven times more potent. That's why you hear a lot of people report a very different experience when they ingest a cannabis product as opposed to inhaling it or applying it topically because-

Dr. H. Sandison:00:50:45Okay. Just have to ask because I'm curious and giggling to myself. Is this a full on dazed and confused moment? This is why people get so high after having a brownie or whatever it is?

Jamie Corroon:00:50:55Yeah.

Dr. H. Sandison:00:50:56The classic '70s hippie movie where it's all disastrous and there's munchies and they can't talk to anybody? It's because of that secondary metabolite after the liver? Is that right? Am I drawing the right connections?

Jamie Corroon:00:51:11For the most part, yes. There's dabbing. There's such high concentrated extracts that can be inhaled. That you could get a really high dose of Delta 9 THC that would lead to that level of impairment. For the most part, yes. We're talking about someone who ingests something, sitting around, waiting. Doesn't think anything is really happening and then within a few moments, they're completely floored and they can't do anything. That is I think to a large degree an effect that's mediated by this metabolite of THC 11 hydroxy.

Dr. H. Sandison:00:51:47That sounds like an adverse event. We'd want to avoid that.

Jamie Corroon:00:51:50Depends on the person and situation.

Dr. H. Sandison:00:51:50Got you.

Jamie Corroon:00:51:54Yeah. I think the duration of that effect is also longer. Most older people, most patients don't want to inhale. The real benefit of inhaling is that you feel the effects right away. You're going to absorb more of the active ingredients in whatever you're using. The downside is that it doesn't last as long. The benefit to ingesting it is that you're going to have a greater duration of effect and you're probably going to have to use a lower dose. It takes a while to feel the effects. A lot of patients will use a variety of different methods of administration. If you're in chronic pain and you're taking opioids throughout the day and you go to sleep at night.

You wake up in the morning and you haven't medicated in eight hours or whatever it may be and you're in a lot of pain, you might not want to sit around for an hour or an hour and a half for your orally administered product to kick in. In that situation, you might use an inhaled product and then use an oral product as well. The promise of these sublingually absorbed products and these buccal mucosally absorbed products is that it's some hybrid in terms of the onset of effect between inhalation and ingestion. Even then, we actually don't have really good data on that. A lot of people don't actually feel the onset of any kind of effects in the timeframe that is often advertised. They typically, "Oh, 12, 10, 15 minutes, you should feel something." A lot of people don't feel any difference.

Dr. H. Sandison:00:53:38When I talk to patients about this, I do have concerns around the inhalation and the risk that could be associated with that. Whether you're smoking a cigarette or taking up, I feel like there are these particulates. These burnt particulate that is going into your lungs and has a potential to be really harmful. Even though you're getting this potential benefit. Can you speak to that? Would it be better to vape? Do we know? Vaping's relatively new. If you're talking about inhalation administration, is there one that's safer than the other?

Jamie Corroon:00:54:09Yes. I don't really know that we have the data to compare inhalation to smoking in terms of safety yet. I think from a theoretical standpoint, I think we can draw the conclusion that it's probably a better idea to vape than to smoke. In California, according to Prop 65, smoked cannabis is a carcinogen. It contains itself the substances of carcinogen. It contains a variety of carcinogens that are also on that Prop 65 list. The risk of vaping really is what else is in that cartridge? What other excipients are used to dilute the oil so that it can be less viscous and so that it can work better with regard to the heating element and it can be vaporized?

A lot of times, we look to the e-cigarette industry in terms of safety because mostly, these excipients are propylene, glycol or polyethylene glycol or vegetable glycerine. Sometimes, MCT oil is used. Really, as far as I understand it, I've looked at some of these literature. It has to do more with the temperature in the heating element as opposed to the compound itself. There was an article that was published in the Journal of the American Medical Association I think it was a couple of years ago that was indicating that propylene glycol was being converted to formaldehyde. That formaldehyde was being inhaled and it was causing negative or at least had the potential to do so. The temperatures were seven or 800 degrees fahrenheit.

The boiling point for THC is around 300. I've seen 315. I've seen 280. If the objective is to get THC, cannabinoids and terpenes, you certainly don't need to be vaporizing at a temperature up in 700 where the propylene glycol might get converted to formaldehyde or some other toxic substance. I advice-

Dr. H. Sandison:00:56:26Somebody with a brain to put the vape together to make sure that you're getting to the right temperature.

Jamie Corroon:00:56:31Yeah.

Dr. H. Sandison:00:56:32As a consumer, have the knowledge of what you just explained to make sure that you're getting a vape that gets to the right temperature, to get those terpenes and to an aerosolized into something that you can inhale.

Jamie Corroon:00:56:43Yeah.

Dr. H. Sandison:00:56:44Not get the other. Sorry to interrupt. I also have a question around flavoring them. Do we need to worry about the flavorings like they're doing with the e-cigarettes? Is that an issue?

Jamie Corroon:00:56:56Yes, potentially. A lot of times, what they're doing is through the extraction process, all of these different phytochemicals have a different point at which they are able to be extracted. The individuals who are operating these extraction systems are using variables like pressure and temperature and time to determine what fractions of these chemicals they want to extract. With terpenes or an eclectic compounds, they're the compounds that give cannabis the flavor and the taste and the smell, the aromas. These compounds are highly volatile. They have boiling points. The boiling point is the temperature at which it goes from a liquid to a gas that are very low. Some of them are at room temperature.

They are much more likely to be lost during the extraction process as gas at lower temperatures. What happens a lot of times is they will run extractions in order to basically get THC. They'll use the temperature pressure and time that's going to optimize that fraction for extraction. Then they'll get the THC and then they will add back terpenes in order to try to enhance the flavor or perhaps even replicate the terpene profile of the original starting material. A lot of times, those terpenes come from cannabis. Maybe even at same cannabis flower or from other cannabis flower. Sometimes, they come from other foods. We don't really know how safe it is to be inhaling the concentrations of terpenes that we're seeing in those cartridges.

Because we know people have been inhaling smoked cannabis for a long time. There are terpenes that they're inhaling as a part of that process. In a concentrate, you have a much greater dose of those terpenes as you do THC and other cannabinoids. If you were to pull out a gram of cannabis flower that was 25% THC, you would say, "Wow. That's really potent." If you look at a gram of an extract, it's probably 80 or 90% THC. Everything gets concentrated in an extract including terpenes. We really don't have people who have over long periods of time inhaled the dose of terpenes and terpenoids that they're getting in a cartridge.

Dr. H. Sandison:00:59:29Got it. There's a lot of gray area here basically. There's a lot we don't know about vaping, about these cartridges, about these new routes of administration that are coming out. We're left with a big question mark. We'll have to see.

Jamie Corroon:00:59:43Yeah. The other thing, too is some of these fertilizers and pesticides that have been approved, that are used in cultivation, they were approved for tomatoes. Where you might ingest residues of these chemicals. They weren't approved to be inhaled. There's that as well. That's part of the reason why in many of these states or most of these states, there are requirements for testing for a large amount and a wide variety of different synthetic chemicals of that.

Dr. H. Sandison:01:00:20That makes a lot of sense. I'm curious. You have a Master's in Public Health. I would like to get your take. I think some of the literature that you've published and published research is in this public health space. What is the role of cannabis in the opioid epidemic in that context? What do you think the role of cannabis is as the regulatory space changes so much? How do you see that playing into public health? Are there issues maybe that would come up or some benefits?

Jamie Corroon:01:00:51That's a really good question. Probably a bit of both. It will take time for us to really answer those questions. As far as the opioid epidemic is concerned, I think that cannabis certainly will play a role in helping to curb this systemic problem. It's great that over the last year or so, so many important people, politicians, clinicians, researchers and journalists frankly have brought this issue to light. Cannabis, I think from a variety of different perspectives, has already proven to be a reliable solution. It's not the solution by any means whatsoever. We have a lot of disparate types of data and different research methodologies that indicate that individuals are using cannabis as a substitute for prescription opioids.

As a result, they're able to use lower doses of those opioids. They're able to experience fewer side effects of the opioids. In many cases, they're able to stop using them. There are epidemiological studies that show that individuals who live in states with medical marijuana laws that have access to medical marijuana or medical cannabis through dispensaries are as a result not getting written as many prescriptions for opioids by their doctors. There's Medicare party data that supports that there's Medicaid data that says the same thing that generally speaking, in these states, there's fewer opioid prescriptions being written. There's data that shows that there are fewer hospitalizations for opioid overdoses. There's fewer admissions to opioid treatment programs, for opioid use disorders.

There's lower mortality in states that have access to legal medical cannabis for the residents of those states. We have some clinical trials which are the gold standard in medicine and research that show that actual research participants who are using opioids are able to use a lower dose. They're able to delay tolerance that might build up overtime with exposure to an opioid. I think it's definitely helping how much it's going to help-

Dr. H. Sandison:01:03:09My mind's a little bit blown right now. I don't think I realize that there was that much literature spanning that much breadth that was so supportive of this. Am I clear? That pretty much every single thing you listed said that if you compared states with legal access to medical cannabis to states without like Colorado versus West Virginia. This might be part of the explanation for why the opioid epidemic is hitting some states worse than others is because medical cannabis can potentially play a role in people. Maybe not even potentially. Are you saying that the literature is saying that unequivocally, there is a difference in how often people have overdose events and how often people get prescribed opiates and how often people go to the hospital. Is that really what you just said? Is it that clear?

Jamie Corroon:01:04:01I'm smiling because you've probably know me well enough. I would never use the word unequivocal because I'm so cynical. Well, no. I'm saying that there is a-

Dr. H. Sandison:01:04:13Because I know your degree of skepticism and how much it hates for you to express to overcome some threshold to make you be convinced of the benefit of something. That's part of why I'm shocked right now that you just listed so many amazing benefits, potential benefits at an epidemiological level. Where this might have the potential to help solve the opioid epidemic and potentially, the benzo epidemic. I don't know if there's literature there. I think that's the next wave of this opioid crisis is the benzos. What you just said was powerful.

Jamie Corroon:01:04:49Yeah. Just to summarize, my personal opinion after looking at published data on this particular question is I definitely think, my own personal opinion that cannabis is a part of the solution. How big a part of the solution remains to be seen. This is a very, very complex problem. It's a very widespread problem. I think that cannabis can be a part of the solution. I think we have enough data from enough different sources to conclude that. On the flip side and this goes to the other part of your question, cannabis is not all good. We said you can become addicted to THC. You can develop dependence to THC. THC and alcohol are not a good match because alcohol tends to dilate your blood vessels and oftentimes, that leads to greater absorption to THC.

THC and alcohol can have this potentiation when you use them together. There's a lot of people using alcohol. Alcohol is really a problem from an individual and a public health perspective. There's this whole issue of teenagers and children who have developing central nervous systems and whether having legalized access recreational and/or medical to cannabis in the states where they live is going to lead to increased usage and perhaps affect their cognitive development. Driving an influence-

Dr. H. Sandison:01:06:21Yeah. Go ahead.

Jamie Corroon:01:06:22There's a lot of potential issues on the downside to cannabis. I don't want to make it just sound like it's a miracle. I do think with regard to the opioid epidemic, I think it can be very helpful.

Dr. H. Sandison:01:06:34Thank you for the balance there. Has anyone ever died from cannabis overdose? I don't even know the answer-

Jamie Corroon:01:06:39This is awesome. I love it. I love being able to site the DEA as the source for this. You could go to the DEA. They have drug monographs for illicit substances. If you download the marijuana drug monograph from the DEA, it says there has never been a reported overdose death of or from marijuana.

Dr. H. Sandison:01:07:03Wow.

Jamie Corroon:01:07:03So far, the answer is no.

Dr. H. Sandison:01:07:05Okay. Wow. From the public health perspective, there's a lot of potential here.

Jamie Corroon:01:07:13Yeah. There's a lot of potential for good. There's some potential from harm. My personal opinion is that the benefits are going to outweigh the harm. The really interesting thing I find this so fascinating. You would think that if you were to allow recreational use, legal access for non-medical use in states that it would be easier for teenagers to get access to cannabis. As a result, teenagers would be using cannabis more regularly. That just makes sense to me. We know so far looking at data from Oregon, Washington and Colorado that that's not actually happening. What they do is they survey 12 to 17-year olds and then different age groups. They survey them and they ask them, "Have you used cannabis in the past month?"

Usually, they're looking at the percentage of those survey respondents that report past month use. They're comparing before it was legalized in Colorado, before 2014. They're looking at 2015 versus 2016, 2017. They're not really showing an increase in that particular statistic.

Dr. H. Sandison:01:08:31That's surprising.

Jamie Corroon:01:08:32Yeah. It's definitely surprising and a little bit confounding. A lot of this stuff it takes time to sort it out. Part of the hope is that in legalizing this, the state of California will collect tax revenue that will fund research that will answer some of these important public health questions.

Dr. H. Sandison:01:08:52As a clinician, I see a lot of brain stuff, neurocognitive. Certainly, everything from autism and ADD affecting young kids. Oppositional defiance all the way to anxiety, depression and middle age and then Alzheimer's at the end of life. One of my big concerns is the effect of the medications that are commonly prescribed to young children. The Adderall at five or six years old as they're starting school. What effect does that have on a developing brain? THC or CBD, these products, I wouldn't exclude from that. I have a real fear around what happens to a developing brain if you start adding all these substances and these super physiologic doses of neurotransmitters or things that bind neurotransmitter receptor sites.

Can you have a permanent effect on that human's potential for the rest of their life by altering that? Do you have any thoughts?

Jamie Corroon:01:09:52Yeah. I have the same concern.

Dr. H. Sandison:01:10:01Do we know? Is there any literature that suggests that?

Jamie Corroon:01:10:02I think we have literature that suggests that that could be dangerous or detrimental with regard to THC. The great thing about THC if you want to look at it this way is that it doesn't take a lot to have an adverse effect. It's really hard to give a very high dose of THC to a kid. I can't say no one is really doing that. The doses of THC that are being used and I'm not doing that I'll say that but are very small.

Dr. H. Sandison:01:10:35Yeah.

Jamie Corroon:01:10:35Yeah.

Dr. H. Sandison:01:10:35Can you tell us where you start with the dosing? I know you're not giving medical advice.

Jamie Corroon:01:10:41Yeah, definitely. Here's what I'll say. There's obviously a therapeutic objective. I want to reduce pain. I want to improve sleep, whatever the case may be. Most people have multiple therapeutic objectives. We don't even know. If we're talking about THC, if we can achieve those objectives without hitting their tolerance threshold, some people feel the intoxicating effects of THC and they like the way they feel. Some people feel them and they hate the way they feel. Some people are in between. Really, the governing factor is how sensitive a person is to THC and how they feel about its effects. The way I think about dosing for THC is first and foremost, I'm thinking about safety and tolerability. There are situations where patients cannot achieve the therapeutic objectives because they can't tolerate the adverse effects.

Dr. H. Sandison:01:11:46It's not a good medication for them then. It's not really a good intervention.

Jamie Corroon:01:11:50No.

Dr. H. Sandison:01:11:50You have to try something else.

Jamie Corroon:01:11:52Yeah.

Dr. H. Sandison:01:11:53Say someone who suffers from insomnia and I live in Nebraska. There's no access. Is there access in Nebraska? I'm totally making that up. I'm assuming it doesn't have access.

Jamie Corroon:01:12:05In West Virginia, I'm thinking about that. Hoping there's listing from those states.

Dr. H. Sandison:01:12:12Hopefully, someone is. That would be part of my goal here and the why I'm asking this question. Say someone lives in a state where there's absolutely no access. They are vacationing in Colorado. They do get access for a week. Is it something that they might be able to try and see if, "Okay. Is this worth the benefit?" Is it going to take six months or a month to get any benefit?

Jamie Corroon:01:12:40No. A little bit depends on the context, what the objective is and which-

Dr. H. Sandison:01:12:49I can't sleep. I've got a terrible insomnia.

Jamie Corroon:01:12:52Yes. If we're talking about THC and/or CBD dominant products and you want to understand if they may help your sleep, within a couple of nights, I think you could be on your way to answering that question.

Dr. H. Sandison:01:13:07Okay.

Jamie Corroon:01:13:07If we're talking about cancer, then how would we know after a couple of nights?

Dr. H. Sandison:01:13:11Yeah, fair enough. Arthritis? Would we know pretty quickly with arthritis?

Jamie Corroon:01:13:16Yeah.

Dr. H. Sandison:01:13:16Certainly, anxiety? Depression, would we know?

Jamie Corroon:01:13:19Anxiety and depression are a little bit more difficult because as you know, these symptoms are so variable anyway. Some days, you wake up and you feel more anxious than the day before. It's difficult to know why. Even if you did feel an effect on the first day after using CBD or THC, whatever the case may be, we won't actually know that it's because of the CBD. You would need a longer period of time I think to be able to draw a causal relationship. You may feel an effect right away. Yeah.

Dr. H. Sandison:01:13:49Okay. Pain was the number one thing that you listed when you talked about potential indications. What about with pain?

Jamie Corroon:01:13:55Yes. Assuming we can handle the tolerant issue, I think within a couple of doses, you should be able to feel some pain. Honestly, I think pain relief is very easily achieved with cannabis. I don't mean total resolution but I mean, improvements in pain. There's this whole other element in terms of the mechanisms. There's a difference between pain and suffering. In pain management, we talk about how pain is simply a sensation. It's a noxious stimulus. Suffering is the psycho emotional response to this stimulus. I think from a mechanistic standpoint, we have data to rely on to say that we have a general understanding how THC and CBD, but more so THC might help reduce pain. On the flip side, I think THC also is a very important compound for reducing suffering.

The euphoria, the distraction, the forgetfulness that can occur. I think those can be therapeutic in that perspective.

Dr. H. Sandison:01:15:17Making people's lives better through amnesia?

Jamie Corroon:01:15:20Yeah, absolutely. Think about if we remembered all of the horrible things that occurred in our lives. We would probably be catatonic.

Dr. H. Sandison:01:15:27Fair enough.

Jamie Corroon:01:15:28Exactly.

Dr. H. Sandison:01:15:31Okay. What else do you want to add? There's so much complexity here. I feel like we could go in lots of directions for hours. What else do you think would be most important for someone who's just learning about cannabis to know?

Jamie Corroon:01:15:44We can't go for hours because my battery's telling me I only have 5% left. This ended here. I don't know. There's so much misinformation on the internet. I would say, be careful what you read. I would say, listen to testimonials and anecdotes with a skeptical lens. I would say, talk to your medical provider. Tell them what you're doing. Don't be afraid to have that conversation with them. If you talk to your doctor or whatever type of clinician you see about cannabis and you're interested in it or your use of it and they are discouraging or they don't have any answers for you. They make you feel like you shouldn't be using it without a solid educated rationale, my advice would be to keep shopping for a different provider.

Because as we discovered in this conversation, this is a very complex field. A lot of medical providers may be intimidated to get into it. They may just have some resistance at the onset. This is something that is very safe. To a large degree, especially if we're talking about hemp-derived CBD, it's pretty inexpensive. For me, if you're trying to answer the question, should I try this? The thing that you're considering is generally safe and inexpensive, then the answer is like, "Yeah. You should try it." Also, just be careful. When we're talking about THC, use low doses. Start there and slowly build your way up. Be patient.

Dr. H. Sandison:01:17:36If somebody wanted to know specifically for them, we talked about a couple of hypothetical patients today. Somebody has some questions or they want to read your publications, where can they find out more?

Jamie Corroon:01:17:47Yeah. You could go to my website, centerformedicalcannabis.com. I've got a blog there with lots of articles. My research is there. You can schedule an appointment with me there if you want to see me in person or over the phone. I've got a podcast that you can get to from there. Yeah. Pretty much, my website centerformedicalcannabis.com.

Dr. H. Sandison:01:18:13With the battery you have left, would you just describe what a visit with you would look like?

Jamie Corroon:01:18:18It's a standard healthcare visit with your average medical provider. I want to understand your health history. I want to understand what your clinical objectives are. I want to know what medications you're taking. I want to know about your lifestyle. I want to know what you're eating. I want to know how you're sleeping. I want to know how much stress is in your life.

Dr. H. Sandison:01:18:42It doesn't sound like an average visit with a naturopathic doctor. Maybe not all medical-

Jamie Corroon:01:18:46I'm very quick.

Dr. H. Sandison:01:18:51Okay.

Jamie Corroon:01:18:51Yeah. If you come to me, we're going to rip through it. Even though I'm comprehensive, I don't do the 90-minute deal or even the 60-minute deal. Sometimes, I do the 60-minute deal but I need all of this information so that I can understand who you are and basically, mitigate risks. Drug interaction is an issue for sure especially with CBD. Psychiatric disorders, especially bipolar disorder, schizophrenia. Your history, your family history of psychiatric disorders is important. That's something that I need to know about. Obviously, I want to know what your values are and what your goals are. That way, I am better able to recommend a specific protocol hopefully that will achieve those objectives.

Dr. H. Sandison:01:19:37That sounds great. Jamie, thank you so much for your time and for educating me. I've learned a ton today. I am grateful I can pass it on to patients and also pass on your information to patients to get them the help that they deserve. Thank you. Thank you. Thank you for the work that you're doing, for the publishing that you're doing, for the contribution to the community and also for your time today.

Jamie Corroon:01:19:59Yeah. Thank you so much. It was my pleasure. I was happy to be here. It's always good to talk to you.

Dr. H. Sandison:01:19:59Talk to you later.

Jamie Corroon:01:19:59All right. Bye.

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