Cannabis Education

Should Oncologists Recommend Cannabis?

Oncologists Should Recommend Cannabis-Based Medicine for Palliative Care

In Summary:

Earlier this June a review was published that encourages oncologists to recommend cannabis products to their patients as a safe and effective method of palliative care. The opinion piece highlights how cannabis is a useful treatment for a variety of illnesses (nausea, vomiting, sleep, mood, anxiety), and encourages practitioners to prescribe cannabis for their patients so that they can appreciate the safety and effectiveness of the product.  

Dr. Caplan and the #MDTake:

As Dr Abrams makes abundantly and eloquently clear, the reasons for oncologists to RETURN to recommending cannabis (as clinicians were accustomed to doing in generations past) are many. Weighing the safety profile of cannabinoid medicines and the long list of potential benefits for those battling cancers, against temporary adverse side effects (some of which, like appetite stimulation and sedation, can also be advantages for oncology patients), it is almost unethical for modern clinicians to NOT recommend that patients consider cannabis supplementation. The historical sociopolitical war on drugs was never founded in scientific rationale, nor supported by rigorous inquiry that has borne out half a million scientific reviews on the topic. It is high time that physicians return to a practice style that prioritizes patient well-being first, and emphasizes self-education about areas of medicine about which the providers may be less informed.

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Benjamin Caplan, MDShould Oncologists Recommend Cannabis?
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Medical Cannabis for Adults Over 50

In Summary:

As with all elements of the aging process, the human endocannabinoid system loses tone over time. Whether it is a reduction in the numbers of cannabinoid receptors or a slow waning of the machinery used to create the signaling molecules that bind to the receptors or the natural senescence of the system that supports all of these normal signaling processes, the fact remains that adults over 50 are best-suited for external support for the endocannabinoid system.

Indeed, the average age at dispensaries is surprising to most who are not familiar with the modern medical cannabis arena. Baby Boomers, perhaps more than any other age group, tend to dominate the medical cannabis dispensaries. This is no new phenomenon, however. Through the ages, across cultures and around the globe, cannabis has been consumed primarily by older adults. Whether by tribe elders, wise councilmen, spiritual leaders, or the educated elite, cannabis has been an integral part of human aging for as long as we have recorded history.

Here, a review out of Israel followed at 184 patients over 65 (average age was 81.2) beginning cannabis treatment. 63.6% were female. “After six months of treatment, 58.1% were still using cannabis. Of these patients, 33.6% reported adverse events, the most common of which were dizziness (12.1%) and sleepiness and fatigue (11.2%). Of the respondents, 84.8% reported some degree of improvement in their general condition.”

Appropriately, the authors advise caution for older adults related to those adults who may be consuming multiple pharmaceuticals, for potential medication interaction effects, as well as nervous system impairment, and increased cardiovascular risk for those who may quire the concern. Wisely, they recommend that “Medical cannabis should still be considered carefully and individually for each patient after a risk-benefit analysis and followed by frequent monitoring for efficacy and adverse events.”

Dr. Caplan and the #MDTake:

At CED Clinic, we have long seen that the average age of medical patients is over 50. Whether for concerns related to sleep, pain, mental or physical health, it seems as though Baby Boomers have either weathered enough politics to have developed a healthy cynicism for the misinformation campaigns of the 1930s and 1970s, or they have direct or indirect experience with cannabis to have learned of its safety and efficacy. Either way, it is quickly reclaiming its historical place in the care of older adults, although oddly… it seems to be a demographic skipped over by the marketing systems of most establishments in the cannabis arena, at least for now.


suggested dose for elderly and cannabis
direction of action for cannabis treatments
bar of significant improvement with cannabis

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Benjamin Caplan, MDMedical Cannabis for Adults Over 50
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An Analysis of Sudden Cardiac Death Exposes the Danger of Tobacco and Cocaine

Sudden cardiac death associated to substances of abuse and psychotropic drugs consumed by young people- A population study based on forensic autopsies

In Summary:

A recent study out of Spain has revealed alarming trends among cases of sudden cardiac death associated with substances of abuse consumed by young people. Half of the 15-36-year-olds who suffered sudden cardiac death were found with illicit substances in their bodies, primarily cannabis, tobacco, and cocaine. Researchers found that although cannabis was the most common substance found in the deceased systems, cocaine and tobacco are known to have a stronger impact on the cardiovascular system and lead to ischemic heart disease, which is often the more acute causes of sudden death. It was also mentioned here that the duration of cannabis is far longer in the body than that of either tobacco or cocaine, and this duration may easily confuse people to associate it as a trigger for sudden death.

However, on the other hand, there are several tragic cases of young, otherwise heart-healthy individuals who have died with cannabis as the only substance discovered. Fortunately, these cases are extraordinarily rare, but unfortunately, no reproducible association has been established, so the mysterious concerns are not easily relieved or forgotten.

Dr. Caplan and the #MDTake:

While the return of medical cannabis to modern medical care seems to bring with it a return of appreciation for more naturalistic care, it is critical for us all to recognize that we still have much to learn. The tools and high standards of scientific evaluation have only recently been applied to cannabis, and there are reasonable arguments that the usual tools may not actually apply (for example, some are suggesting that the placebo effect, a cornerstone of randomized control trials may be a facet of effects related to the endocannabinoid system.)

For these, and a great many other unknowns, it is important for the discerning consumer to consult with trusted resources, including friends, family, scientists, and where possible, doctors, to ensure the appropriateness of use on an individual basis.




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This paper is also stored here:   http://bit.ly/2SmffX3      inside the CED Foundation Archive

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Benjamin Caplan, MDAn Analysis of Sudden Cardiac Death Exposes the Danger of Tobacco and Cocaine
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Flavonoids Proven to be Safe and Effective Treatment for Chronic Venous Disease

Recommendations for the medical management of chronic venous disease- The role of Micronized Purified Flavonoid Fraction (MPFF)

In Summary:

A recent review has affirmed that treating chronic venous disease with Micronized Purified Flavonoid Fraction (MPFF) therapy is safe and effective. After reviewing 250 papers, the authors have found a large body of supportive evidence that the MPFF treatment, known as Diosmiplex, is effective for healing venous ulcers on its own or in combination with compression therapy. Diosmiplex, the only MPFF prescribed in the United States, as of 2017, is derived from orange rinds and favorable among patients due to its high safety rating. 

Dr. Caplan and the #MDTake:

Flavonoids are one of the categories of natural compounds produced in nature, including within the innate production system of the cannabis plant. Several patients have reported using strong cannabis topical agents to help venous insufficiency and disease, including conditions such as varicose veins, phlebitis, and post-surgical venous incompetence.

varicose veins picture

Process of leukocyte trapping to tissue degradation
contributing factors to  skin pathology and edema
Genetic and environmental risk factors for CVD
US and European Guideline Recommendations that include flavonoids  and MPFF
Cellular Molecular pathology of venous hypertension
CVI Symptom Assessment
WBC adhesion  with venous hypertension
Recommendations for the use of MPFF in the management of chronic venous disease

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Benjamin Caplan, MDFlavonoids Proven to be Safe and Effective Treatment for Chronic Venous Disease
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Recent Study Reveals Natural Method for Improved Crop Growth (Microbiome!)

Plant-derived coumarins shape the composition of an Arabidopsis synthetic root microbiome

In Summary:

While investigating plant molecules that inhibit parasitic growth, researchers have uncovered a new method for improving crop growth and overall yield. Small molecules, such as flavonoids and coumarins, improve the microbiome of plant roots in order to help them grow and maintain their health. While investigating how the absence of coumarins and flavonoids affect the growth of a common weed the authors stumbled upon a molecular mechanism that will facilitate efforts to grow crops in iron-deficient soils.

Dr. Caplan and the #MDTake:

The natural machinery of Cannabis supports the production of tremendous numbers of flavonoids, coumarins, and microbiome-supporting compounds. Over millennia, cannabis has evolved fastidious attention to detail, and an integral role in the animal ecosystem. Although this natural role has historically been disagreeable to many oppressive movements (religious and cultural), it is nonetheless, self-evident as modern society returns to embrace the science of cannabis. The scientific, medical, textile, farming, nutrition, recreational, and materials construction industries are all wishing only that they had come back to cannabis sooner.

plant microbiome image

the gnotobiotic platform used to investigate the effect of plant metabolism on root microbiome composition
root coumarins shiting the microbial community of plants
root-excluded purified coumarins shiting the microbial community of plants
purified coumarins shiting the microbial community of plants

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Benjamin Caplan, MDRecent Study Reveals Natural Method for Improved Crop Growth (Microbiome!)
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SENIORS, CBD, AND THE LAWS OF ATTRACTION

Kudos @abbierosner for this moving piece in CBD Today, “SENIORS, CBD, AND THE LAWS OF ATTRACTION” The article reviews an evolving #CBD playing field, the fears, the market, and a few sprinkled quotes by Dr Laurie Vollen, @JamiePaz, and me!

Infused Beauty Cover Image
Seniors, CBD, and the laws of attraction article substance

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Benjamin Caplan, MDSENIORS, CBD, AND THE LAWS OF ATTRACTION
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Participants in Cannabis for Chronic Pain Study Describe Life-Changing Results

Restored Self: A Phenomenological Study of Pain Relief by Cannabis

In Summary:

In an Israeli qualitative study investigating the impact of cannabis use on chronic pain patients, all but one of the nineteen study participants experienced pain relief after cannabis use. Participants explained how cannabis allowed them to not just discontinue medications treating their pain, but also medications treating secondary outcomes of their pain, such as poor sleep and anxiety. Patients described feeling “a sigh of relief,” being “reborn” or being saved by cannabis use after years of debilitating pain and medication side effects.

Dr. Caplan and the #MDTake:

The pathway through which cannabis works to combat pain is different from the usual pathways doctors have used for the last 90 years. Prior to the 1930s, cannabis was used routinely, just about everywhere, but political and social agendas kidnapped the medicine and hid it away from most of the mainstream and from routine medical education.

Patients often describe typical pain relievers as adjusting the impact of the pain. Reducing or quieting the pain, softening discomfort, allowing the sufferer to perform previously typical tasks without debilitation or dysfunction. Cannabis, on the other hand, is sometimes described as “taking the sufferer away from the pain,” rather than the other way around. The effects that cannabis can have on the reduction of inflammation, attention, memory, and relaxation, provide a new type of opportunity for relief.

Still, other patients describe the effects of cannabis through a lens of mental focus. Whereas in daily use we typically open a standard set of drawers, some have said, the use of cannabis allows the consumer to open up a different set of draws, and through this adjusted lens, to see discomfort from a different perspective.

For those suffering with chronic pain, years upon years of discomfort, suffering that, when paired with modern medicines, has only met frustration and further discomfort, cannabis is frequently seen as a welcome “sigh of relief.”

different types of  pain
Discussion  from text of research  doc
Sample of text discussing lack of adverse  side effects of cannabis

This paper is also stored here:     http://bit.ly/32FZkUU    inside the CED Foundation Archive

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Benjamin Caplan, MDParticipants in Cannabis for Chronic Pain Study Describe Life-Changing Results
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Veterans Using Cannabis Medicinally More Likely to have PTSD than Recreational Users

Title: Medicinal versus Recreational Cannabis Use among Returning Veterans

In Summary:

A recent study found significant mental and physical health differences between veterans who use cannabis that they label as “medicinal” use versus those who prefer to label their use as “recreational.” Veterans who feel that they are self-medicating with cannabis, in what they believe fits more closely with a “medical” label are five times more likely to suffer from post-traumatic stress disorder (PTSD), nearly four times more likely to suffer from Major Depressive Disorder, and are more likely to experience Insomnia, or trouble sleeping. Furthermore, a majority of veterans medicating with cannabis suffer from conditions that qualify them to receive a medical marijuana registration card. Even so, they tend to refrain from discussing their interest in access with their doctors, out of fear of losing their valuable VA benefits.

Dr. Caplan and the #MDTake:

Over the years, countless veterans have valiantly and courageously dedicated themselves to missions of support for their fellow men, women, and country. In preparation, training, service, battle, leadership, education, and so many other ways, veterans have given back to their culture in a way few others can. The understanding that they may be shunned by their culture for seeking help, related to the suffering they may have experienced while serving their country, is unconscionable. It is shameful that the government and military have not appreciated and supported the easy opportunity to give back to our veterans, and it is long overdue that the culture gives back to those who have given a piece of themselves so that others may share the liberties they have served to uphold.

group differences between medicinal and recreational cannabis users in diagnoses, cannabis-related problems, reasons for using marijuana, and other health-related and substance use outcomes

characteristics of medicinal cannabis users

characteristics of medicinal cannabis users

characteristics of medicinal cannabis users

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Benjamin Caplan, MDVeterans Using Cannabis Medicinally More Likely to have PTSD than Recreational Users
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Could Inhaled Cannabis Be More Effective to Relieve Pain than Oral Cannabinoids?

Cannabis for Chronic Pain: Challenges and Considerations

In Summary:

Comparisons between the use of inhaled cannabis plant versus pharmaceutical-grade oral cannabinoids demonstrate an advantage of inhalation over oral delivery. Conditions for which inhalation has provided superior over oral consumption include:

HIV, diabetic neuropathy, post-herpetic neuralgia, complex regional pain syndrome, spinal cord injury, traumatic neuropathic pain, multiple sclerosis, and cervical disk disease.

An important note: patients consuming cannabinoids orally are more likely to withdraw from studies due to negative side effects and lack of efficacy. Also, edible cannabis may compete, amplify, or have effects delayed, when interacting with other ingested foods and drinks, A major advantage of inhalation is the opportunity for patients to titrate, or easily test varying dosages at home, with reasonably rapid feedback. On the other hand, dosage adjustments for oral food-borne cannabinoids are much more complex, and cannabis in the form of oral pharmaceutical-products may require a doctor visit and a new prescription.

Dr. Caplan and the #MDTake:

In the clinic, there seems to be a great divide in the population, a group of patients who simply adore the edibles (often in low-dose candies, low-dose chocolate, or titrated tinctures), and a group who use inhalation, almost exclusively. There are also some who are discovering topicals (salves, patches, lotions). There is a growing number of patients who use each of these methods with intention, related to their timing of onset and their duration of action, but this requires education, practice, and a degree of sophistication in use that is relatively new to the industry.

As with most consumption, medicinal or not, it seems common for individuals to find a method that they enjoy and stick to it. Interestingly, in recent years, the US cannabis industry has evolved in a wild growth phase. As it has embraced a dynamic landscape, with increasing competition from all sides, including new stores and product offerings popping up all the time, there seems to be a growing openness, in consumers, to trying new products and exploring new offerings. Coincidentally, this openness to change and the unfamiliar happens to mirror one of the core neurobiological functions of cannabis in the brain, as seen across the neuropsychiatric and neuroimaging cannabis literature.

How exciting to imagine a future medicine that may help consumers to be more open to change?

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Benjamin Caplan, MDCould Inhaled Cannabis Be More Effective to Relieve Pain than Oral Cannabinoids?
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Study Finds “Insufficient Evidence” to Support the Use of Medical Cannabis for Pain Management

In Summary:

In a recent review of systematic reviews and controlled studies, researchers were unable to find sufficient evidence to support the clinical use of medical cannabis or the pharmaceutical formulations for gastrointestinal, cancer, or rheumatic pain, or weight loss in cancer of AIDS. Many data from previous studies were either statistically insignificant or were of low quality. However, the authors did find that existing literature sufficiently supported the treatment of neuropathic pain with cannabis. Additional controlled studies may shed more light on the use of cannabis for general pain management. Interestingly, while the authors do raise two important limitations of the studies that they highlight in the article (inadequate size of some studies and generally limited supply of traditional scientific studies from which to draw conclusions) they do not address some of the more fundamental concerns with the reporting.

Dr. Caplan and the #MDTake:

The limitations of studies in cannabis are numerous and an important consideration for researchers as they study cannabis, and equally essentially to consider for those of us reading the study product. To my personal count, there are at least 40 different types of biases that can skew data in a way that delivers information other than a precise description of actual events. This study, as many like it, presumptuously assumes that, if data doesn’t show a trend that so-mocked “anecdotal” data shows, then surely the anecdote must be incorrect. What if the reviews are simply not yet accurately recording what human iteration has discovered repeatedly for millennia?

The conclusion the review draws follows:

Conclusion: The public perception of the efficacy, tolerability, and safety of cannabis-based medicines in pain management and palliative medicine con- flicts with the findings of systematic reviews and prospective observational studies conducted according to the standards of evidence-based medicine.

BUT…

Is the right question for science to question the validity of the stories that individuals are telling, against an imperfect science of information collection, as well as the limited scope of statistical validity for understanding data? Or is the right task for science to question its own methods of assumptions in discovery and understanding?

On the one hand, we have millions of people calling the color of the ocean “blue.” On the other hand, we have data that tells us that water, in fact, has no color. Similarly, the anecdotes from cannabis consumers are telling a story that is starkly different from the currently available data.

For those interested in combing through a close inspection of the many ways that data can be misrepresented and misunderstood, check out https://first10em.com/bias/

and/or watch the video below:

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This paper is also stored here:   http://bit.ly/34NXhQV      inside the CED Foundation Archive

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Benjamin Caplan, MDStudy Finds “Insufficient Evidence” to Support the Use of Medical Cannabis for Pain Management
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