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As both a regulated medicine and something people use for wellness and even recreation, the information gaps that exist for cannabis users are unprecedented.
“Any other medication and you’re lawfully entitled to speak to a pharmacist,” explains Dr. Codi Peterson, a clinical pharmacist and medical cannabis professional. “The law states, you must be ensured the opportunity to speak with someone like me.”
With cannabis, Dr. Peterson, continues, your best source of education is often a budtender with nothing more than a high school education.
“I’m here to tell you that there is more going on and there is more to the story of consuming cannabis than just going to someone and saying, ‘I want an indica’ and ‘Here, smoke it.’”
In this episode with Dr. Peterson, we discuss common mistakes people make when they use cannabis, and why new cannabis technologies and products can get a little too far ahead of the science sometimes.
Dr. Peterson also explains why labeling something isolated in a lab as “plant-based” doesn’t necessarily mean it’s always a good thing.
“We’re creating our own issues — nature in my experience has done it better than we have, and so that’s why I think cannabis botanical needs to be preserved as well,” Dr. Peterson says.
“When you start messing around with isolating molecules from a plant, it seems to be when we see more side effects.”
Produced by Michael Schaeffer Omer-Man. The Cannabis Enigma is a co-production of The Cannigma and Americans for Safe Access. Music by Desca.
Full transcript:
Michael Schaeffer Omer-Man: Dr. Codi Peterson, thank you so much for being with us.
Dr. Codi Peterson, PharmD: Michael, thanks so much for having me on. As I’ve kind of mentioned, I’m a big fan of the podcast, so it’s really fun to get a chance to be on the other side of the microphone.
MSO: We’ve communicated in various ways over the past several months you’ve been working with The Cannigma in various projects, and things and I’m glad to get a chance to pick your brain.
CP: I mean, pick away. But yeah, I totally agree. We passed each other in Zoom meetings, reviewed some of my articles that I’ve written with The Cannigma. Somehow, we’ve never had this conversation, so here we are recording.
MSO: You’re a pharmacist, you’re a clinical pharmacist. That means you work in a hospital?
CP: Yeah, I work in the Emergency Department actually. So yeah, I spend my time helping physicians and nurses more than I do counting bills and talking to patients.
MSO: You’re also a specialist in cannabis. We’ve actually had one or maybe even two cannabis pharmacists on this program before. But what is a cannabis pharmacist? Why should a pharmacist be involved in cannabis at all?
CP: Well, cannabis is a bioactive substance. Another word we use for that is called a drug. The cool part is, cannabis has many drugs so to speak, because it has many active ingredients. But nonetheless, these are substances that were consuming in order to influence physiology in the body and create an effect from consuming that substance. In this case, the cannabis plant. Now, replace cannabis with anything else, any other medication known in the United States at least, and you’re lawfully entitled to speak to a pharmacist. The law states, you must be ensured the opportunity to speak with someone like me. When it comes to cannabis, you can’t even ask your doctor about it, right? They can only refer you, and then you get sent to someone with potentially just a high school education.
I’m here to tell you that there is more going on and there is more to the story of consuming cannabis than just going to someone and saying, “I want an indica” and “Here, smoke it.”
MSO: Okay. Let’s say I want to see a doctor and I got a referral for medical cannabis, and I got a piece of paper that says I can walk into a dispensary. For whatever reason, let’s call it a stroke of luck, I bump into you before I walk into the dispensary. What are you going to tell me?
CP: What I’m going to tell you is, is the individual you’re speaking to may not have all the right answers for you, and that it’s important that you figure out what your goal of consuming cannabis is, what you’re aiming to achieve before you decide what chemotype or what variety of cannabis you’re going to pick up. Then, I’m going to tell you how to titrate up slowly to avoid side effects. I’m going to talk to you about any potential drug interactions that you may have with your current medical regimen. Then I’m going to tell you what to watch out for as far as improvements effects, et cetera. But then also, side effects, dry mouth. If somebody’s on a diet and they started consuming cannabis and get munchies, that’s not necessarily desirable.
I want to treat cannabis like every other medicine. The same thing I would talk to someone if they were coming into a pharmacy and picking up the prescription medication. I think that people are entitled particularly those who are seeking cannabis for medical use are entitled to a professional help them navigate this sort of confusing, complex field filled with three-letter acronyms, I can help you.
MSO: Aside from all the other things that are different and there are a lot, one of the major differences between a normal medication or a western medication dispensed by a pharmacist and cannabis is that, most of the time, your doctor will write down a specific product, with a specific dosage even if you’re titrating up on it. Whereas with cannabis, never mind that you don’t have any medical guidance to this usually, but you have to pick a product and not just the consumption method. Like whether you’re going to smoke it or get a tincture and oil, but also, we have all these thousands of strains that will get into why that doesn’t mean anything in a minute. But how are you supposed to navigate that as a pharmacist? Are you trained to help people make those decisions?
CP: Well, to be clear, there are thousands of medicines on the legal market as well. Typically, it’s not the pharmacist who’s navigating for the right medicine based on the disease state. In the Western sense, that tends to be the doctor. The doctor diagnoses the condition and chooses a specific medicine. I can tell you that Western pharmacists have been being trained and are being trained to be able to think critically about this, think about why the doctor chose that medicine, and to be able to think about other therapeutic modalities that may be of benefit, for any number of reasons. Perhaps the patient turns out to be allergic to that medicine or whatnot. The pharmacist is already acutely attuned to traversing a complex therapeutic landscape is what I’m trying to say. The current state is complicated as well and have the skillset.
The other thing that pharmacists are good at is like a reductionist approach, using the reductionist approach. Yeah, there are thousands of strains, but those thousands of strains, but those thousands of strains only make let’s say one or two of 60 cannabinoids in abundance. Okay. Half of those cannabinoids of plant doesn’t make or three quarters because they’re byproducts. Now, you’re talking about just 12 potential active therapeutic cannabinoids, then you can talk about, do the same thing through terpenes. By doing and approaching cannabis through that pharmacologist reductionist view, you’re able to better narrow your options and come up with a therapeutic plan. Importantly, there’s a lot of different ways to skin a cat, so it’s not that the pharmacist is going to come up with the only plan, but they’re the people with the best skill to come up with a therapeutically approachable one.
MSO: What’s the biggest mistake that you see people making with cannabis?
CP: Right now, over consumption. Not addiction, not misuse. Just like, people are consuming more THC than they need to achieve their desired effects and that leads to more side effects. This is by nature of the way we consume cannabinoids. Like in a joint or in a bowl, particularly someone who’s been using for a while, there’s some ritual, there’s some habit. Then we tend to be taking doses higher than we need. Our body adjusts to that, down regulates. Then that dose the next time or in three times is the right dose. But now you’ve developed something called tolerance. In my humble opinion, that’s the most common mistake, is that we’re not paying close enough attention our dose, particularly THC.
MSO: We’ve seen a few studies recently. They were looking at I think neuropathic pain, but some very small doses were just as effective, if not more effective in many cases than a joint’s worth.
CP: Yeah. You go back and you look and you talk about what scientists have been saying about cannabinoids for quite some time, and they’ll talk about a biphasic effect. Meaning the response is different at a low-dose than it is about high dose, and the body responds in two different sorts of phases. The takeaway message is this. When you inhale cannabis pharmacokinetically, the THC, let’s just focus on that, goes into the lungs is rapidly distributed throughout the whole body, all of the tissues at one time and it acts on CB1 and CB2 receptors, somewhat indiscriminately. When your body produces the endocannabinoids, because this is the magic of the whole thing, is the endocannabinoid system that makes cannabis work at all.
When your body produces endocannabinoids, it doesn’t do so in a whole body at one time sort of deal. It goes tissue by tissue, cell by cell, deciding whether or not we need an endomide or the opposite endocannabinoid of an endomide, or whether you need to [inaudible 00:10:25] glycerol or you need some other signal sent in some other part of the body. If you zoom in all the way, this is happening on a cell-by-cell level. When you consume cannabis, you’re hitting all the cells in the body at once pretty much. It’s not a targeted therapy, that’s why it’s so good at symptom relief, but it hasn’t fix much of anything.
MSO: That reminds me of something I thought when you were speaking earlier. That in order to challenge you on the idea that every other medicine you get to see a pharmacist for, and we’re able to say that because cannabis and medical cannabis specifically, either because of the way that it was legalized or some other reason has been attached to sort of the Western medical establishment, the regulated physicianship — I don’t know how to describe it, as opposed to Eastern medicine, and acupuncture, and herbs and other plant-based medicines that fall outside of that purview, where you might be taking something that’s pharmacologically active, maybe even as active as cannabis, but you’re not seeing a pharmacist for.
In that sense, the approach to cannabis as you just mentioned right now is very different. It’s much more holistic, it’s not targeted and I hear that from a lot of doctors also. They talk about cannabis is especially useful in treating the whole person. If you’re suffering from X, then you also are oftentimes are going to have maybe depression or insomnia. If the cannabis can help those things, then you’re improving quality of life is a much more holistic approach. I mean, looking at it the right way because Western medicine has such a — maybe you can explain what I mean here, but like single-target approach and cannabis is so different. Does it fit into that paradigm?
CP: I think in some way, cannabis fits into it perfectly. Cannabis is not again going to cure much of anything, but it’s going to be exceptionally good at managing symptoms. That’s really most of the medicine we have in Western medicine if we get down to the brass tacks. Look, cannabis is a tool for help. There’s no doubt about it, and it doesn’t have to be integrated by pharmacist only. I’m not of the mindset where cannabis should only be available to those individuals who have a true medical need and they must come through a pharmacist. What I see is more of a bifurcated model where you have true medical patients. If you have cancer, Michael, and you’re on chemotherapy, and you’re on 14 medicines that you got from your doctor, you sure as hell want to be talking to somebody who knows what’s going on when you say, “I’m going to start taking CBD, and I’m going to start doing this, that or the other.”
Not because cannabis is going to do this, but it could work against your chemo. It could inhibit the breakdown of some medicine the doctor started you want and lead to serious adverse side effects, not necessarily of the cannabis, but of the medicine you’re taking with it. Because we do know that cannabinoids like CBD in particular are very strenuous for the liver to get rid of, and so it can change the way that we metabolize other medicines. You definitely deserve access to talk to someone like me. That said, if you are otherwise healthy, you don’t need to see a practitioner. I do firmly believe you should be able to go by botanical cannabis and consume it at your leisure. If you want help with it, you should be allowed to go get it, but you don’t have to.
I’m talking about medical patients who are now paying out-of-pocket significant amounts of money, dealing with drug interactions or consuming the wrong way with the other prescription medication they have, not knowing how to tinker with their cannabis regimen to achieve their outcomes and improve their quality of life. Those are the patients I’m talking about, but I’m not opposed to your model either, and then powering people to control their health and minds.
MSO: I’m just playing devil’s advocate. I’m not —
CP: You’re good.
MSO: What are some drug interactions that people need to watch out for?
CP: There’s more and more the more we learn. Importantly, people are leaning on cannabinoids that we have not previously been consuming with regularity. The CBGs of the world and the Delta-8. These cannabinoids that have come into our normal repertoire but haven’t been studied or consumed at the high-level, like for example, marijuana or high THC cannabis have. So not to get too deep into the woods, but pretty much any medication that’s working with thinning your blood or preventing clots, there can be significant drug interactions. People who have had surgery on their heart need to be very mindful of this. People who have blood clots and are taking medicine.
It’s so much bigger than just trying to put your finger on it, because again, there’s multiple cannabinoids. Everyone’s going to be a little bit different. Statins for example for your lipids, your cholesterol levels can interfere and interact with cannabinoids. It’s not as simple as just saying, “Oh, these are your medicines.” There are lots of medicines because they’re all metabolized by the similar CYP 450 enzymes, which is the standard go-to set of enzymes in the human body to take care of toxins as it finds them. Believe it or not, even though you think cannabis is natural, cannabis is all herbal, the body still looks at it. It’s like, “Hey! This is foreign, let’s clear this out of here. It’s making us feel funny. It’s throwing off our homeostasis.” Because that’s what cannabis is doing, it’s acting on your existing homeostatic system, so the body sees it. It says, “Hey! This is external, let’s toss it.” Then it immediately starts working to do that, and then you could talk about all the psychoactive metabolites and all that fun stuff that can happen too.
MSO: What could a purely recreational user get out of a long conversation with you? I mean, I guess I have my first question, which is, what are some things that either foods or other things that affect the way that cannabis affects us?
CP: I’m going to say yes and it’s hard to tie this together, but there’s actually some really good animal, and a little bit of human data to support this. Excess adipose tissue, eating too much of the foods and gaining weight because of it, so that’s Oreos, that chips, and really anything processed. Not vegetables and high-quality plant foods. Having excess body fat, et cetera has been associated with an excess in omega-6 endocannabinoids. That sounds crazy, but that’s called an endomide and 2-AG. Those are omega-6 endocannabinoids.
MSO: Okay.
CP: I know you haven’t heard them called that, but that’s what they are and I can show you. That’s my next TikTok video you all. Pay attention. This excess production of an endomide and 2-AG that we see that with the Western diet, and the Western lifestyle, sedentary, excess adipose tissue or fat is associated with excessive production of an endomide and 2-AG. Ready? Which over long periods of time down regulates your CB1 and CB2 receptors from being overstimulated. By doing so, we’re setting ourselves up for reduced response to inhaled THC for example, which would have activity at those receptors, because those receptors are less abundant. That is just one example, but my answer is a firm yes.
MSO: I’m going to call that the Jack in the Box conspiracy, where they’re trying to raise my tolerance so I have to buy more.
CP: The Jack in the Box, I think there could be a lot of things to describe that name. I’m with you in saying that there is certainly a problem that people are dealing with in this country, and in the world with obesity, and diet and it is contributing to our health and wellness crisis. I postulate that that is correlated to our endocannabinoid system, which good data is now suggesting, is dysregulated in metabolic syndrome: obesity, diabetes, heart disease.
MSO: Just for any of our listeners who are not from the West Coast, the United States, Jack in the Box is a fast-food chain. There are actually more and more states that either require or mandate in some sort of way that pharmacists are involved in medical cannabis dispension. Is that a word? Dispensation?
CP: Dispensing.
MSO: Dispensing cannabis. Do you think that that should be the case?
CP: That is a funny question. Again, I do but only under this premise. If adults are able to buy cigarettes and alcohol, both of which are known to kill you and they can buy enough alcohol at any grocery store to kill not only themselves but everybody they know, then certainly, adults should be able to go consume and purchase cannabis at any same place. I firmly believe that. However, if you’re going to be utilizing cannabis medicinally, I see no reason why cannabis should not be another medicine that pharmacists and physicians are aware of, and you can gain access through the same channels, and you can get the same level of service and care because this is the 21st century in a first-world nation and you’re going to say that, “Oh! Cannabis, this thing we know that is highly therapeutic is the exception.” But we all say it’s medicine too. I think it needs to be both.
MSO: Maybe I’m asking that question the wrong way then. Should medical cannabis be dispensed in pharmacies as opposed to dispensaries?
CP: Yes. There should be a pharmacist involved. There’s already a lot of landscape out there. There are dispensaries in Pennsylvania that I see right now that are doing this, but they’re not delivering the level of care that I feel is warranted and necessary. They’re not taking good med histories. They’re not integrating it like I want. In that way, I don’t want to just say, “Oh, yeah. You can put it in a pharmacy and we fix all our problems.” Patients deserve to have a specialist reviewed their medicine; help come up with a plan to best integrate cannabis. Whether they choose to follow the plan or not, that’s autonomy. But they should have that option and they should have access to it, even if they’re poor and can’t afford someone like me out-of-pocket.
MSO: I agree.
CP: Good.
MSO: I think it was in the last episode of this podcast, I asked our guest who’s a former budtender, where on whom he thinks the onus educating consumers needs to be, where that needs to lie. Because the industry has its own, let’s say interest —
CP: Sales forward approach.
MSO: Yeah. The state or states, they don’t really have a role in that in most other areas, aside from mandating that information be provided. It’s going to be interesting to see how this plays out over the year.
CP: I’m certainly interested and I’m going to be here along for the ride, advocating for patients who deserve access to this plant that can help them deal with the crazy stressors and world that we live in. But we would be remiss to pretend like medical cannabis is going to save the world. It’s going to take us harnessing the power of the endocannabinoid system in more ways than just using cannabis to help people. Again, pharmacists and healthcare teams in general are the right avenue to approach this, so we need more nutritionists, we need more physician who are all looking at the master regulatory system of the body as an important therapeutic target, not only with drugs, but with lifestyle. Because lifestyle and exercise are always step number one in every drug algorithm. But somehow, in my experience, they skip right over it and go right to number two.
MSO: It’s a lot easier to get somebody to take a pill, right?
CP: Yeah. It’s also easier to get them to take some cannabis. In that way, I think cannabis needs to be higher up, but I think we really need to educate, and reflect on what we’re putting in our bodies, versus what we’re getting out. Because there’s a real wellness crisis around the world right now, and I would argue that part of it is not just our cellphones, but it’s what we’re eating and how we’re spending our time. We’re losing track of some really important benefits of the endocannabinoid system to our health.
MSO: You mentioned a minute ago that one can walk into a grocery store, and buy enough alcohol to kill themselves or somebody else.
CP: Or both.
MSO: Or both, depending on what kind of machinery you’re operating. I read an op-ed or a column in the New York Times a few weeks ago that totally blew my mind, where this person was basically arguing that we don’t have enough safety information about cannabis in order to be legalizing it everywhere. That there’s not enough information about, there’s not enough clinical trials, and there’s not enough this and that. I mentioned, I had another pharmacist on this show, Dr. Melani Kane, a few months back who I believe she said that cannabis is by far the safest drug she’s ever dispensed. Why is that gap, that knowledge gap? I want to call them tropes for lack of a better word, just because they come from propaganda in a the time when we knew so little. How is there such a huge gap still, between the science that granted we’re learning so much so quickly, and these dated beliefs that cannabis is this dangerous, dangerous plant?
CP: I totally agree. It’s frustrating. Melani is great. She’s the president of the International Society of Cannabis Pharmacists group of which I am a member. Certainly, I know Dr. Kane. She’s not far off base on her safest drug in the pharmacy. The doses that can be tolerated of basically any cannabinoid in human, which hasn’t been tested, but rats are certainly very, very high. Far higher than most of us could ever come close to consuming, which already makes it much safer than the vast majority of drugs in the pharmacy. Many of which if you took even ten times too much, you could have life-threatening complications.
There’s no doubt that cannabis has an extremely wide safety window, is what we call that in pharmacy, or therapeutic window. Sorry, that’s important, safety window. The therapeutic window is a little bit smaller, so we want to hone in and figure out what the right dose is, that sweet spot of not overly stoned. Not the stoned is bad, but stone is going to build tolerance, and getting the therapeutic effects that we want. That sort of the therapeutic window is much narrower than the safety.
My biggest qualm is this, and I was talking with someone on LinkedIn about this earlier. Psychology Today just put out a big piece about increased risk of cannabis use disorder, and how it was almost as addicting as opioids. They just published this. I definitely agree that using a recreational substance in your adolescent years is going to set you up for failure, not meaning that everyone who uses cannabis is a failure. Not even close. I mean, teen users are very successful and intelligent. But your brain is changing in the endocannabinoid system is a critical part of that. So consuming any substance, whether it’s alcohol, cigarettes, tobacco, opioids regularly between the age of 12 and 17 is going to change the way your brain thinks for most of your life, it not all of it. There’s no doubt that there is an influence.
My whole thing is, the same thing with pregnancy. We advocate no cannabis in pregnancy period, based on studies. All of these studies had point into adolescent risk and have pointed to risking babies in pregnancy, have all been observational retrospective trials. Because you can’t actually get kids or pregnant women to be like, “Sure, I’ll do this. I’ll take this drug,” so we have to look back. What we’re always associating it with is recreational marijuana use, or high THC cannabis. We don’t have any data if someone is using a Type III-high CBD strain in pregnancy. We don’t have that data period. We just know that babies who are born to mothers who admit to using cannabis, particularly the marijuana variety have been associated with some of these different risks later in life.
But we’re not studying this well, so then the studies that do come out often don’t shed a very positive light on cannabis, even though they focused on marijuana, just one small section of cannabis. They get pumped out through the media and everybody’s talking about how dangerous it is. I use a lot of medicine in children that has not been studied, and has certainly not been looked at under the safety lens that cannabis has. I promise you, there are some detrimental effects of all the medicines I’m giving to children. There has to be, because I’m giving them a lot of antipsychotics and things. And to pretend that cannabis is going to have this tremendous effect, but these prescription medicines, oh no. These medicines have not been studied in children in the long-term way that cannabis has. None of them. Same thing in pregnancy.
No drugs are being studied with the rigor that cannabis is being looked at in pregnancy. When you look under the microscope and you start to see a few issues, I really start to wonder, “Okay. But what if we found better data, would these issues still be in this sub category?” Concerns about the validity of results and observational results are real. We accept risk-benefit profiles of all drugs. There are many medicines I’m going to give you in the hospital that do carry a low but real risk of causing a lifelong side effect, one that could bother you for the rest of your life even if I just give you this medicine one time. Risk-benefit. Cannabis never ever carries that. Even in schizophrenics or whatnot, really, it’s chronic continued use of THC.
We’re putting these risks that are real in cannabis. We’re trying to slide them into like, “This happens all the time,” or “This is with all cannabis.” But really, what we’re talking about is, individuals who are chronically using cannabis and we’re not distinguishing.
MSO: Yeah. I mean, when you look at one of the most common uses for medical cannabis is chronic pain, compared to the other famous drug that the American medical system relied on a little bit too much over the past few decades to treat pain. Any cannabis side effect is nothing basically.
CP: Yeah, for sure. I mean, especially from like a neurocognitive addiction perspective. Even if you do become addicted to cannabis, which certainly can happen. It’s dopaminergic in the same part of the brain that the opioids are, and that cocaine is. It stimulates and tickles the same receptors. It’s far less damaging. The withdrawal is far less severe, and people tend to just not be bothered by it as much. But opioids were always in medicine, right? The wisemen, the shamans, they were all using the poppy flower for hundreds, if not thousands of years and they were acutely aware of its effect. But the poppy flower and sort of where the opium is produced in the poppy is not a mono molecular production of opioids. It is produced alongside between four and ten other opioid-alkaloid like molecules, some of which act kind of like CBD does with THC. Counterbalancing some of the side effects and really smoothing out this pharmacologic soup.
What happened is, obviously we went to mono molecular. But once we discovered the way the opioids were working in the 1960s, 1970s, we were like, “Oh! We got it now. We’re going to formulate these special drugs that are really targeted and they’re going to be really clean drugs, because they don’t any other aims or targets that they hit. Whereas, cannabis is dirty. It hits all these receptors, the TRPs, the CB1, CB2, CB3. That’s dirty, right? Opioids are specifically selective for the mu opioid receptor. You have more than one kind of opioid receptor in your body, and fentanyl, and morphine, and some of the other drugs are specifically formulated to just go after one.
We’re creating our own issues. Nature in my experience has done it better than we have, and so that’s why I think cannabis botanical needs to be preserved as well. When you start messing around with isolating molecules from a plant, it seems to be when we see more side effects. I’ll give an example, Marinol. 2.5 mg edible, people don’t mind at all. You give them 2.5 mg of Marinol, and they have hallucinogenic experiences. It matters whether something is isolated. Yeah, Marinol is dronabinol and it was the first FDA approved THC drug. It is THC, delta-9 trans THC, but it’s made synthetically rather than by the plant. Why we’ve seen those side effect profiles? We don’t even fully get it yet, we don’t. But people report similar experiences using THC isolate compared to whole plant or even with one terpene mixed in. There’s no doubt that there’s some degree of interplay when you start mixing more than one plant molecule.
MSO: I want to give you a few more fun questions. And by more fun, I mean, ones that I want to ask you from my own personal interest. We talked about other foods that you can eat, and what junk food can do to your tolerance. Those are really interesting, and I’ll be having a salad for dinner tonight.
CP: Good. Make sure you get some omega-3s in your dressing.
MSO: What are some other things that people might not know can affect the way that cannabis affects them. The way you smoke, the way you inhale vaporizers hit differently than smoke. I don’t mean that in this puny sort of way. They’re quite literally are different. The temperatures achieved during smoking are high enough to convert the cannabinoids into byproducts. Some which look like cigarette byproducts, little tiny hydrocarbons that go deep into the lungs and cause cellular damage. That’s happening when you burn cannabis. Most people don’t burn 20 cannabis cigarettes a day though, I’ll point out, or 40 for that matter.
The other thing that’s going on is not the little molecules, but the terpenes and the cannabinoids are being converted so THC is partially converting to CBN right behind the ember of that joint. When you inhale that, it’s going to go into the body, and compete is the word we use in pharmacy. Competitive agonism with THC. It’s going to modulate it out, and there’s many other products that can happen during that smoking process. It could be influencing the effects of cannabis. Definitely, your consumption method makes a big difference. Vape is not the same stuff.
CP: Well, hold on. What is a vape do differently?
CP: Good question. The ember of your flame or your torch lighter is around 2,000 degrees Fahrenheit, a thousand degrees Celsius at least. So then, you have your vaporizer which gets to the might vaporizer that go to Israeli medical patient vaporizer only goes to 200 Celsius. During that heating, it is not combusting, it is not mixing flame, flower and air and causing smoke. It is decarboxylating and creating vapor, which is sort water carrying the cannabinoids in. You’re going to get far less production of those harmful chemical, and of those byproducts that are biologically active, which could be derivatives of terpenes or cannabinoids, including CBN. That’s one way.
Then the oral, we talked about this all the time. My big shtick is sublingual. We don’t have data to save sublingual works really fast, but everyone says it does.
MSO: That was my next question that I wanted to ask you. Do other things work sublingually? Is it that we don’t know that cannabis does or is it that the entire idea of sublingual absorption is a crock?
CP: No, other drugs work. Cannabis is a kind of a big molecule, 21 carbons or don’t judge me, whoever is listening. I think it’s 21. It’s 21 or 22, shoot. It has trouble getting through the membranes that are there. There are some thought that terpenes can help get it through the membrane in the mucous of the mouth. However, there are certain drugs that do get absorbed that way. There’s also something to be said about how drugs that can go into our throat and be absorbed through mucous membranes are also swallowed. A great example, an elicit one is cocaine. We’re like, “You put cocaine in your nose, and it gets absorbed through your nose.” That’s partially true.
A lot of cocaine actually drips down your throat, goes through your stomach, and goes into your liver and it creates byproducts and difference bioactive cocaine metabolites that can be affecting how people are feeling the next day, clenching their jaw, stimulated. Because even though we apply it to our mucous membranes, much of that will eventually just sort of drip down the throat into the stomach and will go through the liver in the way that most drugs would.
MSO: Should every drug dealer have a pharmacist alongside them? I’m kidding.
CP: I know. I mean, as a pharmacist who has an interest in all of these sort of niche areas, like I’m certainly interested in psychedelics. I don’t have much interest in cocaine. Cocaine is an approved medicine. I have this in the pharmacy, legit. I have 4% cocaine solution. Ear, nose and throat doctor still apply it to the mucous membranes of patients while they do surgery, so I know about this drug. Cocaine was also the base molecule what they form all the topical anesthetics on, so Lidocaine when you get stitches, Novocaine when you get your tooth pulled. All the caines came from cocaine. Plants have always been the source of our medicine, Michael. Like it’s no surprise. I talked about the poppy plant. That’s contributed over 50 to 100 prescription medicines, all based on molecules found originally in a flower. Go figure.
MSO: Well, the caines. Now, I’m just — that blew my mind right now.
CP: Yep. All based on that same mother molecule or just little appendages added. That’s what med chemists do. They find a molecule, it does something and then they manipulate it in ways to try to get it to behave in more desirable ways. It backfires sometimes. I’d point you to Fentanyl.
MSO: Tim Kaine did not work out for Hillary.
CP: Tim Kaine, I don’t know that one.
MSO: Hillary’s running mate in 2016.
CP: Oh! Now, I do. Didn’t work out, I get it. Terrible choice, but let’s not talk about Hillary.
MSO: Terrible joke. Speaking of sublinguals working and not working. I was in California a few months ago, and I had the pleasure of trying a nanoemulsion beverage. Tell me about that? Does that do something different? Because it felt different. Does it do something different than ingesting in different ways? Is that something that could alter sublingual absorption, granted this was a beverage, I drank it. But I imagine if the nano means small and cannabis molecules are big, that that could be a solution there also. What do you think of nanoemulsion?
CP: I think there’s a lot of tech coming out as far as enhanced absorption. I’ve also had a nanoemulsified drink in California and shared it with the non-cannabis consuming friend and he loved it. He thought it was just the bee’s knees. Look, I think there could be something to it. I think it makes sense that if you get the molecule size down small enough, it could even work locally, it could more rapidly enter the bloodstream, but it’s not going to fully bypass the traditional system of the liver. I think you’re going to get a bit of a mixed effect. I still don’t think you’ll get all rapid absorption. But there’s a lot tech in the space, whether it means water soluble, water miscible, nano, how nano? When you say nano particle, how many nanometers is each particle? Because there’s nanoemulsion and a microemulsion.
A microemulsion means that every particle is around a micron, so that’s 100,000 decimeters. Then you take it to nano, hypothetically you’d think, “Oh! Each particle should be a nano particle, but that’s not. That’s not entirely true a nanometer.” But we’re seeing mixed effects, and one of the biggest problems I see is, the only time we’ve ever done nanoemulsions is with some drugs and those are limited too. Those were looked at by the FDA. When you start changing the way the body sees these cannabinoids, you’re starting to again mess with nature a little bit, because nature would have these cannabinoids nano particlized. There are questions and concerns as it relates to that.
Again, probably mostly unfounded, but we got to study it and that’s the whole thing, is like prohibition has just kept us from knowing anything. Again, we don’t even have good data on whether any cannabis oil under my tongue is more rapidly absorbed into the body. In fact, I hate to break it to all the die harders, the limited data we have based on sativex, the approved European medication for multiple sclerosis one the one, THC, CBD sativex is that one to one in some alcohol and some peppermint oil. And even that doesn’t appear to absorb much quicker or any better than orals with a meal. Orals without a meal take much slower time to kick in, so you just take a gummy on an empty stomach, you’re looking it can be over two hours, even three hours before you fully feel it. As opposed to if you take it with a meal, it could be 60 minutes or less when you start to have the onset of effects.
MSO: What other problems with cannabis do you hope can be solved by technology?
CP: I’d like to learn more about this crazy — we’re going to need supercomputers to look at the entourage effect and start studying which cannabinoids or which terpenes are acting on which receptors in the body. But because it is such a complex mix, it’s not going to be as simple as what we’ve been doing. The science so far has been very simplistic. Pharmacology in general is a reductionist approach to medicine and trying to figure out what each molecule might do each receptor, but it turns out the body is amazing. Every major cell type in your whole body has cannabinoid receptors, and your body makes at least — ready for this? Thirty different endocannabinoids. When you expand to the greater endocannabinoid om, you’re talking about probably 15 to 30 targets in the body for these medicines. This is not something humans are going to be able to tease out with, “Oh! Well, we tried myrcene with THC and it did nothing at the CB1.” It’s like, “Okay. In a test tube. That doesn’t help.”
We need real patient studies right freaking now, and people are using these substances. Many would be willing to commit to using just one or commit to sticking to one and being followed. But because of the illegality, there’s no good way to study this. In fact, it’s so challenging that even in a state like Colorado, who has legal cannabis, adult use cannabis, you still can’t study this very well. What they’re doing is they have a mobile lab, where they drive around a big ass van, and they go in front of people’s houses. The people come out, they’re like, “Hey! Good morning. Go smoke your shit, and then go do that,” and then they come back out to the van and they take assessments, and tests, and blood levels and all this, because it’s that hard to study. The only way they could figure out how to test real weed was by going and sitting in front of people’s homes in a van.
MSO: Not shady at all.
CP: They’re not dealing the drugs. It’s quite the opposite. They’re studying the drug consumer, but I hear you. It’s a little weird. It’s a weird situation we are in, and I am glad to see the wall of prohibition, even globally just start to crumble because the war on drugs failed. Not just the US, it failed the US miserable. It failed the world when we just started writing that wrong.
MSO: That would be a great point to end this interview on. But unfortunately, I didn’t ask the first question I should have asked, which is, how did you get into the field of cannabis at all?
CP: Well, I’m a pharmacist so drugs are sort of my thing. I learned along time ago —
MSO: You have that written on a t-shirt; drugs are kind of my thing.
CP: No, but I could. Now you know what to get me for Christmas, Michael. I saw cannabis use medicinally in a dying cancer patient. I personally made them a batch of brownies. It was a loved one of someone I loved, and it changed the way that person left this world, and the mark that they left on other people. I’ve seen cannabis do this multiple times. Help provide pain relief and mood lifting effects to somebody who’s on their last few days of life. That is what has touched me most about this plant. I’ve personally seen it and have helped some individuals facilitate the same thing.
That is what really drove me here, but kind of a circumstantial thing. I work in pediatrics. We’re using Epidiolex regularly, we use Marinol, dronabinol in cancer patients. I’ve seen the lack of outcomes that Western medicine has provided for chronic patients in particular. We’re really good at surgery and fixing something that is fixable. But when we have to try to provide quality of life and maintain, we’re not really that good at it. Knowing what cannabis has done for people that I’ve seen, and knowing what I think it can do, I felt it was wrong to not put myself out in the space. It also helps that my profession has been handcuffed, and not talking about this, and not engaging in this sphere for fear of losing our license.
I moved to California, I felt a little emboldened by the legality here, and I see this wave coming, and I want to be on the leading edge of it and I want to drive forward patient-focused cannabinoid-based therapy from the pharmacist’s side. We’ve got some really good doctors in this space, but they’re going to need support in my area. We got to teach physicians and pharmacists about the importance of the endocannabinoid system, and that’s one of my missions.
MSO: If they’re looking for that information, they can go to cannigma.com.
CP: That’s a great place to check it out. I write at Cannigma and then Michael writes at Cannigma. There’s a lot of really just useful content I think that helps people just frame what’s going on in this space.
MSO: Codi, thank you so much for taking the time. This has been great. I hope to have you back on the podcast sooner than later. Thank you.
CP: Yeah, absolutely. I’m looking forward to all of our future conversations and good to meet you.
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