Marijuana has been legalized in a number of US states; 20 states have legalized cannabis for medical purposes; two states—Colorado and Washington state—also permit recreational use. Certain forms of cannabis are actually very potent medicine, with few or no psychoactive effects.
In California, medical marijuana has been legal for 18 years. Dr. Allan Frankel, a board-certified internist in California, has treated patients with medical cannabis for the past seven years.
By and large, cannabis is highly favored by people across the US. According to Dr. Frankel, 85-95 percent of Americans are in favor of medical cannabis, and 58-59 percent are in favor of legalizing marijuana.
The federal government, meanwhile, wants to get rid of all medical use of marijuana, which of course begs the question: Why? According to Dr. Frankel, the answer is simple. "They want it. This is a huge market," he says.
And yes, medical cannabis is clearly competition to the pharmaceutical industry, as the cannabis plant can take the place of a wide variety of synthetic drugs, especially for mood and anxiety disorders. The last thing they want is a therapy that's going to take away from their bottom line.
Cannabis as Medicine
Dr. Frankel initially learned about medical cannabis through glaucoma trials and cancer work performed at UCLA in the 70s and early 80s.
"I've always seen it as a medicine," he says. "Eventually, I got interested in it. I thought my tool box was getting too small for typical issues with patients related to anxiety, pain, or the common issues where we just had inadequate medications.
I saw the cannabinoid future was something that was bright. Seven years ago, I kind of picked up my formal white coat and sprayed a little green on it..."
Green Bridge Medical is his professional corporation where he sees patients, performs research, and provides physician and patient education and outreach. For all its benefits, using cannabis in lieu of other medicines has many challenges.
"It's a complicated process, as a physician in particular, working inside the medical system, to work outside the medical system to make these dose-consistent extracts available."
Many may find the idea of medical cannabis abhorrent or somehow "wrong," as we've been indoctrinated to view marijuana as a dangerous gateway drug that will lead you down a path of illicit drug use.
Many fail to realize that prescription drugs actually have FAR greater potential to turn you into "a junkie." Legal drug addiction is also taking lives in record numbers. In the UK, one million people are addicted to over-the-counter (OTC) and prescription painkillers and tranquilizers.
That's significantly more than the number addicted to illegal drugs.1 In the US, there were four times more deaths among women from prescription painkiller overdose than for cocaine and heroin deaths combined in 2010.2
Pharmaceuticals in general are among the leading causes of death in the US, and some medicines have killed tens of thousands of individuals. The painkillerVioxx is one classic example, which killed over 60,000 before being pulled off the market.
The diabetes drug Avandia is another, and most recently, a study estimated that in a five-year span, some 800,000 people in Europe were killed from inappropriate use of beta-blockers in non-cardiac surgery patients. Deaths attributed to cannabis barely registers in comparison.
"I think that any intervention, regardless of how benign (I would say in my 35 years of medical experience, cannabis should be considered a benign substance overall), there are potential uses and abuses," Dr. Frankel says.
"For me, we're just talking about the real solid indications. The issue of abuse and neglect is there, but I think it's relatively small. I think the claim that it is a gateway drug has been pretty soundly proven not to be correct.
Even if cannabis to some extent is a gateway drug (which I do not believe it is), even if it is, it should be legalized to protect the gateway [drug] issue, because legalization opens up communication."
What's the Difference Between Medical and Non-Medical Marijuana?
According to Dr. Frankel, cannabis has been cultivated in Northern Europe since before the last Ice Age. Even back then, there were two very distinct groups of strains. One is cannabis; the other is hemp. There's plenty of confusion about the similarities and differences between these two plants. While they are subspecies of the same plant species, they look very different, and are extremely different in ways that really matter when it comes to medicinal use.
The thing they have in common is that they both contain cannabidiol (CBD), which has medicinal properties. The amount of CBD however, differs greatly between the two. Dosing, therefore, is dramatically different where you to try to use hemp in lieu of cannabis, as the latter, cannabis, is up to 100-fold more potent. Another difference that appears to matter in terms of its usefulness as medicine relates to differing terpene profiles. Hemp contains very little of these valuable medicinal compounds.
Lastly, there's the tetrahydrocannabinol (THC) content. THC is the psychoactive component of marijuana; it's the molecule that makes you feel "stoned." (While cannabidiol (CBD) also has certain psychoactive properties, it does NOT produce a high.) By legal definition, hemp cannot have more than 0.3 percent tetrahydrocannabinol (THC) in it. So to summarize:
Hemp has less value for medicinal uses, as it only contains about four percent CBD and lacks many of the medicinal terpenes and flavonoids. It also contains less than 0.3 percent THC, which means it cannot produce a high or get you stoned. However, for many disease processes, THC is very much indicated and required. So, for many disease processes, CBD alone has much less value.
Cannabis is potent medicine courtesy of high amounts (about 10-20 percent) of CBD, critical levels of medicinal terpenes, and flavanoids, as well as THC in varying ratios for various diseases. The higher the THC, the more pronounced its psychoactive effects
How Marijuana Got a Bad Rap
"What happened in the '60s and '70s was that due to desires for psychedelia, the changes in the war in Vietnam, and the war on drugs with Nixon, the types of strains that were available and the demand for psychedelia changed. Before we knew it, CBD—due to a lack of 'stoniness'—was bred out of the plant," Dr. Frankel explains.
As a result of growers breeding out the all-important CBD, marijuana became known primarily as a plant that gets you high. Its original medicinal properties and uses largely fell by the wayside. Things are changing however.
"Five years ago, California Physicians, and other groups around the world, didn't really know if we would find CBD-rich strains anymore, but we have. Now there's many different varieties of it. We keep bringing back new CBD rich strains every month or two. These plants genes' haven't seen the light of day for God knows how long."
CBD is currently a Schedule 1 controlled substance, which means:
The drug or other substance has a high potential for abuse
The drug or other substance has no currently accepted medical use in treatment in the US
There is a lack of accepted safety for use of the drug or other substance under medical supervision
There's no doubt that CBD needs to be rescheduled, as each of these three points are blatantly wrong. Dr. Frankel actually thinks cannabis should be de-scheduled altogether, as a plant really does not belong on any schedule of a controlled substance.
"How could we have a plant on a schedule? What if it's an all-THC plant? What if it's an all-CBD? What if we find some other psychoactivity? If you take the Physicians' Desk Reference (PDR) and look at every product, none of them looks like a plant to me. This is the only plant, and it's not just one medicine. One entry with one data ID or MDI cannot be applied for cannabis. For example, we're actually right now making different medicines with cannabis plants based upon harvest time.
As the plants mature, the flowers get darker and darker. There's a traditional time when you're just supposed to pick them. Of course, what we've done is we picked them at different times in large amounts, ground them all together so we can get very representative samples, and see what happens in the last few weeks of flowering. The medicine changes a lot in the last three weeks. You can make more sedating medicine by letting it just stay on the vine three weeks longer. Even how long you let it grow makes it a very different medicine, a noticeably different medicine," he says.
Who's a Good Candidate for Medical Cannabis?
In his medical practice, Dr. Frankel treats a wide variety of patients with medical cannabis, which has become his specialty. Despite the many claims of cannabis performing miracles, he's reluctant to think of it as a cure for anything. Occasionally, however, patients will experience very dramatic results. For example, he has seen tumors virtually disappear in some patients using no other therapy except taking 40 to 60 milligrams of cannabinoids a day. The most common thing he sees in cancer patients, however, are tumors shrinking, or a metastasis disappearing. Sometimes tumors will shrink or vanish, only to reemerge in other areas, months later, and then shrink or vanish again... Other common ailments being treated with cannabis include:
Degenerative neurological disorders such as dystonia
He recounts how two dystonia patients with severe myofascial spasms were able to return to normal life after taking two milligrams of whole-plant CBD three times a day for a little more than one week. This is quite astounding, considering each of them had spent more than a decade undergoing neurosurgeries and taking multiple medications.
Dr. Frankel is very focused on trying to develop accurate dose-consistent medicine. The Patient Access Centers he consults with create a diverse collection of dose-consistent oral-buccal sprays. He also believes it's very important to open up and start talking about dosing—what works, what doesn't. It is his belief that some patients, in large part due to lack of education about the medicine, may be taking 10, or even 100 times higher dosage than is really needed to treat their ailment. Unfortunately, many doctors in this still highly controversial field are afraid to recommend dosages, for fear of the repercussions.
"There's this false notion (I think I can very safely say it's false) that doctors cannot recommend dosage because of this federal [law against] aiding and abetting with cannabis. It's not true. It's just not true," he says. "There are no [cannabis] medications that we dose by body weight. We now have about 120 kids with seizure disorder, and if you look at the surveys, across the board, the average dose is 37 milligrams [of whole-plant CBD] per day, and there's no relationship with body size."
How Can You Obtain Medical Cannabis?
In states where medicinal marijuana is legal, such as California, you can join a collective, which is a legal entity consisting of a group of patients that can grow and share cannabis medicines with each other. By signing up as a member, you gain the right to grow and share your medicine. Dr. Frankel explains:
"A patient or a human being 18 and over or with a parent's consent in California can get a medical cannabis card recommendation letter if they or any physician or doctor of osteopathic medicine (D.O.) agree. It doesn't have to be for any specific condition. In other states, it's very, specified. In California, there are 12 conditions listed, but then it says 'or any condition agreed upon by the doctor and patient,' which kind of opens it up quite a bit."
[With your medical cannabis card], you have the authority to go to whatever collective you want and pretty much select what medicine you want. Now, that is exactly what the good, the bad, and the ugly is. I love free choice, but we need free choice with education. There's virtually zero education going on in the collectives. I mean, there are random places here and there that make an effort but it's really minimal."
When cannabis is inhaled, smoked, or vaporized, its effects are rapid and short-lasting. Orally, it's the most unpredictable and delayed. When ingesting it, it can take up to two hours to take effect, but if dosed appropriately, you can achieve once-a-day dosing with an edible medicine.
When smoked, as little as 10 mg of CBD acts as a major appetite suppressor. CBD is also an excellent painkiller, particularly for tooth pain when the cannabis oil is applied sublingually or directly onto the tooth. Cannabis oil can also help heal sunburn overnight. CBD is also very effective for anxiety disorders. Just a couple of milligrams of whole-plant CBD can effectively subdue anxiety without causing any kind of mental deficiency or high.
In fact, to determine how much THC in an oral dose would be required to get high, they made liquid edibles with 5mg, 10mg, and 20mg of THC. The lowest dose, 5mg, did not produce a high. The upper two—10 and 20 mg—did. Taking 50-100 mg of oral THC could get you into serious trouble. Paranoia is the most common side effect. Overdosing can also produce nausea and vomiting.
The Power of Raw Cannabis
The video below features some of the top researchers on the healing effects of Cannabis in its raw form. The leaves can be eaten in a salad or juiced.
A British pharmaceutical company called GW Pharmaceuticals has a cannabis product that is distributed in Canada and five other countries. It's a 1:1 CBD-THC whole plant extract. "It's a very good medicine," Dr. Frankel says. "But it's expensive. That's the problem with pharmaceutical [companies]." Dr. Frankel also consults with various states that are interested in growing medicinal CBD, i.e. cannabis with a high CBD content and hemp-level (extremely low) THC. He even gives the CBD seeds away. "I make the offer: if any governor in the 50 states wants, absolutely free – as long as I can do it legally – any of these high-ratio CBD strains, I can make it happen. No cost," he says.
"This is one of the important points I'd to emphasize: I think we're going to find ultimately that CBD is a nutritional supplement for everybody. I think we were all using [cannabis] 100 years ago... I think then, if they had hemp for food, there was CBD in it. Again, I wasn't there, but my guess is that everybody had CBD in their diet up until 100 years ago or so. CBD appears in some of the newest data to help protect your DNA epigenetic layer. That's important stuff for all of the toxins that we have in our environment. I think we have more toxins now, and we're missing one of the major protectants that we used to use for this. That's a double whammy."