Show NotesEpisode Overview

In this episode, Dr. Jim provides a deep dive into the world of CBD, its molecular structure, and its unique activity across multiple biological systems. The conversation explores the behavior of CBD, often referred to as a "promiscuous" molecule due to its diverse interactions, and its place within the medical landscape.

• The discussion begins with a detailed examination of CBD, highlighting its unconventional nature within Western medical models. CBD acts on a wide range of different receptors, enzymes, and neurotransmitters, with over 65 different mechanisms of action currently identified in lab-based analyses.

• CBD's unique activity across so many pathways typically would label it a "dirty drug" within conventional medical practice. However, unlike conventional "dirty drugs," CBD is well-tolerated and often has more side benefits than side effects due to its low binding affinity.

• An interesting perspective is shared on the "lock and key" analogy often used to explain the action of drugs. Dr. Jim argues that this analogy oversimplifies the complex processes that are at play, particularly when it comes to CBD.

• A notable point is the potential synergy of CBD and THC when used together. CBD reduces the activity of THC at the CB1 receptor, making THC more tolerable and less likely to provoke anxiety. This can allow for personalized treatments depending on an individual's sensitivity to THC.

• Even though CBD is often not prescribed in isolation, the discussion on the activity of CBD at 65 different receptors, enzymes, and neurotransmitters refers to CBD as an isolated molecule. The structure of CBD, having one solid ring and a long tail, makes it a "floppy" molecule, which means it can fit into many different "locks" (i.e., receptors), albeit imperfectly.

Show NotesEpisode Overview

In this episode, our guest, Dr. Jim, who prescribes medical cannabis, shares his journey learning about the nuances of cannabis-based therapies, focusing on cannabinoids like CBD and THC, and how the field is evolving with new ones like CBG and THCV.

• Dr. Jim initially dipped his toes into the medical cannabis world by prescribing mainly oral formulations or oils, integrating these treatments into the conventional treatment paradigms his patients were already on.
• He initially leaned more towards CBD due to its increased safety profile and lower chances of intoxication or side effects.
• Dr. Jim educated himself primarily through the companies that provide these therapies, which offered educational platforms and product information sheets with dosing and titration protocols.
• Over time, however, he realized the challenges of standardizing cannabis treatments, as most patients didn't fit the typical mold, leading to underdosing or overdosing.
• This realization prompted Dr. Jim to embark on self-education, learning more about the nuances of prescribing and dosing medical cannabis.

Dr. Jim highlights the healer training modules by Dr. Dustin Ulla as a pivotal resource that deepened his knowledge in the field.

• The more he learned, the more he understood the vast complexities of the field. However, this knowledge helped him regain the confidence he initially had when starting out.
• With time, Dr. Jim developed an internal "machine learning algorithm" for prescribing and dosing based on patterns he noticed in patients.
• Today, he empowers his patients with the tools they need to understand their own symptoms and the impacts of the medication, fostering a level of self-awareness and active participation in their own treatment.
• Dr. Jim found that CBD, lacking a psychotropic element, often required deeper reflection and monitoring for patients to understand its impact.
• He shares an example of patients who thought CBD was doing little for them until they stopped it and noticed a significant difference, underscoring its subtle but important effects.

This episode offers a fascinating look into the evolving world of medical cannabis, shedding light on the complexities and nuances of prescribing and dosing different cannabinoids. Dr. Jim's journey and insights offer valuable lessons for anyone interested in this dynamic and rapidly developing field.

Show Notes

1. Absorption & Effectiveness of Inhalation vs. Ingestion: The form of administration is determined by factors like the patient's metabolism, symptom pattern, goals for treatment, and time of day. For ultra-metabolizers, bypassing the first-pass metabolism via inhaled methods may be effective but it's a short-term relief. Sublingual or oral mucosal methods could be beneficial for them too.

2. Dealing with Chronic Conditions: For patients with chronic conditions, the focus is on their symptoms pattern throughout the day and the functional goals they have in relation to time of day. A long-acting formulation covering background symptoms is generally provided orally or sublingually, dosed 2-3 times a day.

3. Use of CBD & THC: The use of CBD and THC depends on the time of day and the user's goals. More CBD is used during the day due to its functionality with less risk of cognitive impairment. At night, more THC is used because of its relaxing effects and its potential as a sleep aid.

4. Considering Occupations: The severity of the symptoms that need treatment and the occupation of the patient are both taken into account when prescribing cannabis. For those with severe symptoms, a combination of CBD and THC can provide relief and improve their ability to concentrate. Tolerance to THC side effects can also be built over time without losing medical benefits.

5. Switch from Traditional Anti-anxiety Medications: Switching to a THC or CBD product from traditional medication depends on the patient. Some may feel a lack of emotional range on traditional antidepressants and can benefit from a more natural approach. CBD can help manage distressing feelings without dulling positive emotions.

6. Holistic Approach: The importance of a holistic approach in managing the treatment is stressed. Conventional pharmaceuticals are not disregarded but can be integrated with the use of CBD and THC for a more comprehensive treatment plan.

7. CBD for Well-being: CBD can be effective in managing anxiety, aiding cognition, and focusing. It provides a less intense emotional experience without reducing the capability to experience positive emotions, thus creating a smoother emotional curve.

8. Crisis Management: In severe crisis situations, conventional pharmaceuticals are still considered an appropriate choice.