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.

Episode notes:

1. Introduction: Discussion on the unique variability in how individuals respond to medical cannabis, and the complexities of dosage determination.

2. Dispelling conventional wisdom: Discussing the ineffectiveness of basing cannabis dosage on factors such as age, gender, and kidney or liver function.

3. Case study: Highlighting interpersonal differences in THC dosage requirements between individuals like older women and young men.

4. Unpacking THC: Delving into how THC is processed by the liver into 11-hydroxy THC, its more potent form, and how it impacts individuals differently.

5. Comparative Analysis: Comparing effects of inhaled cannabis and oral THC, highlighting the stronger body effect observed with the latter.

6. Ultra Metabolizers: Discussing the phenomenon of ultra metabolizers who quickly convert THC into inactive metabolites, rendering it less effective.

7. Absorption issues: Discussing the possibility of poor THC absorption due to difficulties in absorbing fats, leading to decreased effectiveness.

8. The endocannabinoid system: Discussing how individual variations in the endocannabinoid system, due to genetics, age, or chronic health issues, can impact a person's response to THC.

9. Influence of food: Discussing how food intake, specifically fat-containing meals, can influence the absorption and effectiveness of oral THC.

10. Alcohol and THC: Discussing the interplay between alcohol and THC, cautioning listeners about the increased effects and potential risks.

11. Practical Advice: Providing practical advice for new cannabis users on how to optimize absorption, such as taking THC with fat-containing food.

12. Conclusion: Emphasizing the need for continued research into the factors influencing individual responses to THC, to improve personalized dosing and patient outcomes.

Dr. Jim Connell, a General Practitioner and pioneer in cannabis medicine. Dr Jim shares with us his journey into this relatively new medical field, how he's using it to help patients with complex and chronic diseases, and his initial reactions to the transformative power of cannabis medicine.

- Dr Jim, a GP by training, wrote his first cannabis prescription in early 2018. He was always interested in treating complex and chronic diseases, but often found conventional treatments inadequate or even harmful. His journey into cannabis medicine started when he was introduced to it by a fellow prescriber who helped him navigate through the red tape. 

- As one of the early doctors prescribing cannabis in Australia, Dr Jim describes his early experiences as challenging. He noted that there was no standard training, with much of the information provided by product companies. The products available at the time were all very similar and had no significant differentiating features. 

- Rather than focusing on specific conditions, Dr Jim’s approach was patient-focused. His first patients were often those with multiple complex issues, such as chronic pain, poor sleep, and mental health issues, who had exhausted other treatment options.

- Interestingly, in the early days, it was Dr Jim who brought up the idea of medicinal cannabis with his patients, as most people were unaware of its availability. He was pleasantly surprised by the positive reception, even from patients who had never tried any drugs. Dr Jim believes that celebrities like Olivia Newton John, a known advocate of medical cannabis, played a significant role in creating awareness and acceptance for medical cannabis.

- Dr Jim shares a compelling case study about a veteran soldier who had been struggling with chronic pain issues and PTSD. The prescription of medicinal cannabis at nighttime resulted in significant improvement in the patient's condition, addressing issues related to pain, sleep, and recurring nightmares. 

- Despite the initial challenges, Dr Jim has witnessed the transformative power of cannabis medicine and continues to explore its potentials in providing solutions for patients who have exhausted all other treatment options.

Stay tuned to learn more about the medical possibilities of cannabis, its application in chronic disease management, and the future of cannabis medicine.

We've reviewed the FAQ section on The Greens website - https://greens.org.au/legalise-it. Dr Jim throws a personal, clinical and industry lens over the plan's major components. We are working on having some pro-legalisation MPs on the show so we deep dive into the areas we think need work. For this episode we cover the following FAQ's:

How much will it cost?

Is this all about money?

Won’t people still keep buying on the black market?

Who will be able to get cannabis?

Can I grow it at home?

Who will be growing and selling?

Where will I be able to buy cannabis?

What forms will cannabis be available in?

Where will I be able to use cannabis?

What about the health impacts?

Will this change medicinal cannabis?

What about drug driving?

What about work drug tests?

Will this wipe out previous cannabis convictions?

Summary with Timestamps for Podcast Show Notes:

• Driving and Cannabis (09:47 - 10:12)

  • Most states prohibit driving with any THC in the system.
  • CBD products may contain trace amounts of THC, potentially detectable in oral swab tests.

• CBD and Driving (10:12 - 12:55)

  • CBD-only products with absolutely no THC are legal to drive on.
  • No evidence of intoxication or impairment with CBD-only use.
  • CBD is not typically tested for in roadside swab tests; THC is the compound they are looking for.

• Tolerance to Cannabis Side Effects (11:15 - 11:41)

  • Regular cannabis use leads to the development of tolerance to side effects faster than to therapeutic benefits.
  • Intoxication is recognized as a side effect, and tolerance may diminish the feeling of intoxication over time.

• Challenges of THC Testing for Impairment (11:41 - 13:47)

  • Regular cannabis users may have a large amount of THC in their system but not be impaired due to tolerance.
  • Cannabis-naive individuals with small amounts of THC may be significantly impaired.
  • Oral swab tests detect recent contact with THC in the mouth, not THC in the bloodstream.
  • The test provides a positive or negative result without quantifying the amount of THC.

• Avoiding Detection with Cannabis Use (13:47 - 14:19)

  • Products that bypass the mouth (e.g., oils or decarboxylated dried flower capsules) may not register on oral swab tests.

• False Positives and Blood/Urine Tests (14:19 - 14:59)

  • Oral swab tests may produce false positives, causing unwarranted concern for recent use.
  • Subsequent blood or urine tests can detect THC metabolites, indicating cannabis use within the past month.

Key Subjects with Timestamps:

1. Checking for Drug-Drug Interactions with Cannabis (32:26.998 - 34:56.588)

- Considerations before shifting a patient from mainstream medications (SSRIs or opioids) to plant-based therapy.

- Checking for drug interactions using online drug interaction checkers like Medscape.

- THC and CBD are metabolized by cytochrome P450 enzymes, leading to potential interactions with certain medications.

- High-risk medications like tacrolimus and clopidogrel may have significant interactions with CBD.

- Considerations for using cannabis in combination with other medications and assessing potential catastrophic consequences.

2. Drug-Drug Interaction Check for Cannabis (37:45.132 - 38:50.432)

- Drug interaction checkers are useful and effective for cannabis as well, especially with the data from Epidiolex and Sativex trials.

- Clinical relevance of interactions with cannabis is generally low, except at very high doses, particularly in the case of CBD.

3. Identifying Patients Who May Benefit from Cannabis (39:11.294)

- For patients not responding well to their current medication paradigm, there might be an indication that cannabis could be a potential treatment option.

Please note that the timestamps are approximate and may vary slightly depending on the audio recording.