On this month’s episode, we are joined by Miyabe Shields, PhD, Chief Scientific Officer and Riley Kirk, PhD, Cannabis Research Scientist at Real Isolates, LLC. 

Ep 10: From TikTok Connections to Cannabis Education—Two Cannabis Scientists Design Their Own Path

Check out our July/August issue focused on autoimmune diseases

Cannabis Patient Care July/August

Check out our March/April issue focused on chronic pain

Cannabis Patience Care March/April

Cannabis Research for Chronic Pain

Check out our December issue focused on veterans and PTSD

Cannabis Patient Care December

Here, Dr. Dustin Sulak discusses how his patients, who have sometimes failed to respond to traditional treatments, see symptom improvement and other positive results after being treated with cannabis and psychedelics such as ketamine.

View the video for more of the discussion.

Articles

In this video interview, Dr. Dustin Sulak of Healer.com and Integr8 Health shares the most surprising results and quality of treatment response he sees when treating his patients with medical cannabis and psychedelics.

Cannabis Science Conference East 2022: Dr. Dustin Sulak Shares Surprising Results when Treating Patients with Cannabis and Psychedelics

In early September, the Cannabis Center of Excellence (CCOE), Undoo, LLC, and Patriots Helping Vets launched a new national research project for US military veterans. According to the press release (1), “the Undoo® Veterans Study will be conducted in tandem with the CCOE iCount for Veterans - Veterans Cannabis Access Program (VCAP).” The CCOE’s iCount for Veterans program connects veterans to cannabis products to participate in research and educational programs (1). The study will include 500 qualifying veterans and will study the effects of three Undoo® products (1).

Undoo, LLC develops products that address some of the after-effects of cannabis consumption (1). Patriots Helping Vets is providing support for the research study. Their mission is to provide US service veterans the materials, support, and education to start their own gardens (2). The goal of the CCOE, a 501c(3) non-profit, is to bring together citizens, medical patients, academics, researchers, community members, healthcare professionals, and policy makers to drive change in access, best practices, and social justice in cannabis industry (3).

According to the CCOE press release (1), “veterans will receive Undoo® products as a part of their participation in ongoing CCOE studies and report on their effectiveness for the intended outcomes.” The three products are Undoo® Rescue softgels intended to lessen the effects of tetrahydrocannabinol (THC) consumption, Undoo® Refresh softgels for lingering haziness and mental fog from cannabis consumption, and Undoo® Reset for restoring THC tolerance (1). “Veterans can share their experiences, voice, and opinions to drive changes in the cannabis industry,” the CCOE further stated (1).

This study is approved by the University of Massachusetts Dartmouth Institutional Review Board (1).

For more information on the research project or to register, please visit: 

https://www.cannacenterofexcellence.org/offers/b82wt2hw/checkout

https://www.cannacenterofexcellence.org/undoo

On September 7th, 2022, the Cannabis Center of Excellence (CCOE), Undoo, LLC, and Patriots Helping Vets launched a new national research project for US military veterans to study the efficacy of three products that address the after-effects of cannabis usage.

New Research Project for Veterans Launched to Study the Efficacy of Products Addressing After-Effects of Cannabis Consumption

Here, Dr. Dustin Sulak explains how the attitudes of healthcare professionals have changed over the years and how he has responded. He also notes a positive outcome he has seen recently when training clinicians on medical cannabis.

In this video interview, Dr. Dustin Sulak of Healer.com and Integr8 Health shares the biggest challenge he encounters when educating other healthcare professionals on medical cannabis, both in the past and today.

Cannabis Science Conference East 2022: Dr. Dustin Sulak Discusses Healthcare Professionals and Medical Cannabis Education

Meg is the Group Editorial Director for Cannabis Patient Care and Cannabis Science and Technology magazines at MJH Life Sciences.

Can you tell us more about your background areas of study and how you got involved in cannabis studies?

 I have a broad academic background, my training ranges from evolutionary biology to very applied community research. Some of my research is very theoretical, using evolutionary biology to understand human psychology and behavior. At the other end of the spectrum, it's very applied: I’m trying to understand health patterns in communities and ways to improve them. As part of the latter research, I attend and present in public health conferences, and other venues where people are working in health and healthcare.

Public health conferences would feature presentations on cannabis, but all the presentations were from the framework of the Prohibition Era. It was all about abstinence-based programs, getting people to quit if they're using cannabis, all the possible harmful effects, which is a valid area of study, but also the so-called gateway drug fallacy: basically, if people are using cannabis, that's going to lead them into harder drug use. So, after seeing presentation after presentation repeating these themes, I would talk to the presenters and I would say, “Okay, now California and other states have legalized access to cannabis for people who want to use it for medical purposes. So, what's the public health framework for that?” And there really weren't any answers. I mean, people were stunned. It was sort of like deer in the headlights. If they said anything, they would say, “well, we don't think that's a good idea,” or “that's too risky.” After a while, it occurred to me that public health is really not prepared for this change.

A lot of the changes in the cannabis landscape were driven by ballot initiatives and grassroots legislation. But, transitioning from a world where cannabis is an illicit substance, and you're just thinking about it in a criminal model, to the medicalization of cannabis, there's so many things that you want to know. Just imagine all the things that it takes to bring a pharmaceutical drug to market. All these different phases of clinical trials. You have to test for dosage, safety, risks, and so forth. Unfortunately, because it was just prohibited for so long this research hadn't been done.

So, it's sort of like public health is standing on the train tracks and there's this freight train of legalized cannabis coming down the tracks and it's just going to get run over because millions and millions, in fact, now the majority of people in the United States, have legal access to cannabis, both for medical and even recreational use. They don't even need a medical card.

There's a lot of research and education that needs to come along with that for us to fulfill the proper mission of public health. And that's really to keep people healthy and to maximize the health benefits, and to minimize the costs, risks, and harms of any kind of medication or substance that people are using. And at the time, a decade ago, the kind of research that would support that was few and far between. So, like George Washington getting called into action, somebody has to do this work and I guess it's us. It wasn't really an area that we had trained in, there was no training available at the time. So my partner and I started research collaborations investigating naturalistic cannabis use and how people were using it to treat all sorts of different health or medical conditions: what they knew about it, what they didn't know, what harm reduction techniques they were using. I'm pleased to say that now there's a boom in cannabis research just like there is in the cannabis industry. It’s a very different landscape than it was 10 years ago, but there are still many, many questions to be answered.

So, 10 years ago when you started this research, what kind of challenges did you face? Was it hard to get people to be honest in the kind of questions you were asking them, or even just to get the research approved?

 I don't think that people were as concerned, because we had a little bit of an outside the box thinking in terms of our initial studies. One of the challenges when we're thinking about this is, well, how are we going to survey people who are using cannabis, which at the time was technically illegal. How are you going to advertise for a study or gather people or get them to respond even to an online survey?

Fortunately, being at the University of Michigan in Ann Arbor, the people come to us because there's an annual event called Hash Bash that started originally as a protest when John Sinclair, who's a musician, poet, and activist was arrested for giving away, not selling, but giving away two joints to an undercover agent. This happened in the early 1970s. At the time, cannabis use was really prevalent—I don't think the police were really even arresting people for it so much then. But Sinclair was a troublemaker for the powers that be. He was an activist and they wanted to get rid of him, so this is how they were going to do it. Because at the time, the laws in Michigan were still very strict. So technically, he committed this crime that they could sentence him to 10 years in jail, so they did and then there was a big protest about it.

In fact, John Lennon and Yoko Ono came as well as many other musicians, and they filled up the Crisler Center arena, which is where they play hockey and basketball at the University of Michigan. There was this big protest, but coincidentally, a federal judge also reviewed the case and said, “Now this is ridiculous, you can't sentence someone to 10 years in prison for having two joints.” So, he threw the case out and then technically there were no anti-cannabis laws on the books in the state of Michigan. There was this legal opening and people threw a celebration that became the first Hash Bash when technically it was not illegal because the law of criminalizing it had been thrown out. Of course, the Michigan legislature quickly responded and recriminalized it. But this started a tradition where thousands and thousands of cannabis enthusiasts come to Ann Arbor and have a rally and celebration right in the heart of campus, right on what we call “The Diag,” which is like the quad in front of the big, beautiful library. You have guest speakers and there's thousands of people.

Well, we thought this was the perfect opportunity to do a survey there, having a lot of experience in the survey world. In fact, when I was training, I even interned as a door-to-door survey researcher in Chicago on a National Institute on Drug Abuse (NIDA) drug use study. So that gave me some real practical lessons in the best practices for conducting a survey like this. We actually had a team of students and at the time—we were still really concerned about this. It was the first time that we had done this or anyone had ever thought about doing something like this. It was a team of faculty and graduate students; we thought graduate students would be more mature and better able to handle anything that would happen than undergraduates. It went really smoothly and we went out there and we had colorful displays and people wore costumes to be more relatable to the potential participants.

It was a great success. We were able to collect, I believe, more than 300 surveys and thus document naturalistic cannabis use and how people were using it and what their concerns were. Then after that, I thought, I can't believe that nobody else had thought about this before because it really was a great opportunity. You really had to know how to do it appropriately. Long story short, we couldn't come in there with a typical psychological survey instrument that takes 30 to 45 minutes to complete and such. We knew that we only had a short amount of time to get to get people's input.

We continued to do that every year and then our studies were eventually published. Then when we made it into the news, we were contacted by a local dispensary in Ann Arbor, whose staff at the time had a very idealistic vision for what they wanted their dispensary to be. They really did want to follow best practices and be informed by research and be good for consumers. Not just a profit-making business, but something that really did have the best interests of their clients in mind. So, I partnered with them and then through them met other researchers who had a similar mind set and were surprisingly also at the University of Michigan, but miles away in a different part of campus.

We’ve continued to collaborate since. So, it's nice that there's a growing research community at the University of Michigan, looking at cannabis and taking it seriously. Well, what does it mean to take it seriously? If we were to take the medical use of cannabis seriously, what would that look like and how should we do it?

What made you decide to work as the principal investigator with the Releaf app in your current study related to chronic pain?

 There are a lot of different components to that. One is pain, which is one of the main conditions that people use medical cannabis to treat. We found that in our studies, and other people have found it in their studies as well, pain is consistently one of the most common conditions that that people are treating.

The National Academies of Science, Engineering, and Medicine, basically, the United States’ official scientific body and authority, issued a 

 a few years ago, a literature review on cannabis to really determine the state of the field and the state of evidence, especially regarding risks and benefits (1). They concluded that cannabis was effective at treating chronic pain. It’s very promising and at the same time, very general, because there's a lot of details in there that we'd want to know beyond just that simple fact. So that really encourages more research.

There's also the technical element of the Releaf app as a data collection platform. It can conduct what we call ecological momentary assessments (EMA), which ping people at specific times of the day, or even random times if the study wants that, to fill out a brief survey on their phone. So, it's a mechanism for data collection, or platform for data collection. The larger picture is that this sort of cross-sector collaboration enables the kind of research that needs to be done that would be difficult to do otherwise, because right now, cannabis is still illegal at the federal level. It's still a Schedule I substance. So, if we were to do a study where we wanted to give cannabis products to people and then assess their efficacy for treating chronic pain or anything else, we'd have to get a Schedule I license from the Food and Drug Administration (FDA). Those are incredibly difficult to do. There are some people that do it, but it's a very difficult, cumbersome, and lengthy process of setting up such a study.

By collaborating, we can investigate naturalistic cannabis use, or basically people who are self-medicating. We can survey them and ask them about their experiences, and if they're doing it systematically, it's fairly equivalent to a clinical trial. If there are standards and procedures that are followed and it’s putting the components together in a way that makes this kind of work feasible, or much more feasible, given the current restrictions. So, it’s pretty ideal.

Another reason why this kind of partnership is ideal is because, you have both industry—people who are working in this field—and academics working together. There’s often very different perspectives that they bring to the table, but one aspect that academics bring is independence. In other words, we can use solid science and follow the data. We’re not so much tied to what the results of a particular study are. Not necessarily the partners we’re working with now, but certainly some people in industry would feel pressure to have positive results. Some might even fudge or fake data to show those positive results even if they’re not there. But if you have academics who are outside and independent and the outcome of this study really isn’t going to affect my career, it’s nice to have that independence where you can objectively assess the data and say these are the results.

I think that builds trust, especially in an area like this that’s sort of sensitive. I think that’s one big component of value that this kind of partnership brings to the table. I actually consulted in other industries where there was some internal evaluation staff and they’re basically cherry-picking evaluation results because they want it to show that their program worked. I said to them, “listen, here are the results, this is the way I wrote it up, and I wrote it up in a way to try to be clear and informative, and don’t change it. Don’t edit it.” They really struggled with that and I think that's one reason why I'm not working with them any longer, because I wouldn't let them bend the data to their interests.

These are results, and honestly, you really do want to be informed by honest, accurate information for someone who has a dispassionate interest. We really want to seek the truth. Ideally, that's what academics do.

Can you tell us more about the chronic pain study and how it was designed? What types of pain you're looking at?

 We're looking at individuals who have different types of chronic pain conditions such as fibromyalgia, rheumatoid arthritis, and osteoarthritis of the knee or hip. To make a long story short, these conditions have somewhat different mechanisms biologically, maybe even psychologically. So, it's interesting to study them together and to see how effective cannabis is at relieving pain because they might operate with somewhat different mechanisms in the body. Also, we are studying how different types of chemical compositions of cannabis could be more or less effective at treating each one of those.

That's important because cannabis is very complex in terms of all the different compounds in it. It's not like alcohol. Alcohol is just one substance, ethyl alcohol and we have a pretty good understanding of its effects. But with cannabis, there's hundreds of different cannabinoids, as well as terpenes and other components that people are now investigating, things like the entourage effect. Is there any truth to this notion that there's a synergistic effect between all these different compounds? That's a good question.

Many people know about tetrahydrocannabinol (THC), and cannabidiol (CBD). These are probably the two most well-known cannabinoids, but there are hundreds more that we know very little about. Imagine if you went to a pharmacy and they gave you a bunch of different looking pills in unlabeled bottles and said, “just take these pills until you feel better.” It's not very systematic. That's the picture with cannabis right now.

There's a lot of research going on, but we really do need to answer these questions. What are all the different effects of all these cannabinoids separately and how do they work together? What are the appropriate dosages? Is there individual variation in what the appropriate dosage is?

There are all these questions that you really want to answer to maximize the effectiveness beyond just the statement that cannabis is effective for treating chronic pain. That's just the start. That’s really our call to action to see how we really can maximize the benefits and minimize the cost, risks, and harms for people who are using cannabis to treat chronic pain conditions.

How do people enroll? Is it still ongoing or has the study ended?

Enrollment is currently open. Interested individuals can learn more about this study and enroll by visiting 

What do you hope to learn from the chronic pain study, and when do you plan on having results published?

 There are two major components to this: 1. The different cannabinoid compositions and how effective those are; and 2. The different types of pain. We might even see an interaction where there are certain types of pain that certain compositions are more effective for. Then other compositions are more effective for other types of pain. Those are some of the basic questions that we're looking to answer. The data collection was launched in August 2022. We're hoping to complete data collection in late fall 2022. Then we'll be working on our data analysis and writing up reports, and then we will submit at least one manuscript to a peer-reviewed journal. That again puts our research through another process of scientific scrutiny, where independent researchers and scholars will look at our study to see if there are limitations? Can we justify the conclusions that we're presenting? We think we have a solid study and given the National Academies’ determination and other evidence that we've seen from the field, we're expecting to see interesting results. We're looking forward to writing up that manuscript and submitting it, and then it will go through a peer review process to see how trustworthy this information is.

Sometimes that does take months because you will likely have to revise your manuscript sometimes more than once. But hopefully we'll have an article out by the middle of next year. Then certainly anyone, anyone who participated in the study, can contact us and we'll share the results with them.

You also conducted a study in 2019 to find out how knowledgeable a sample of cannabis consumers were in regard to the effective levels of THC and CBD and dosing. Why was it important to gather and study this kind of information and what were the outcomes?

This really gets at some of the major issues regarding the gap between the medicinal use of cannabis and what you would expect best practices to be. As well as the gap with mainstream medicine. We found that most of our participants use cannabis every day and the vast majority, 85%, use cannabis to treat a health or medical condition. That's significant. People might consider recreational use something different. Maybe they wouldn't take it as seriously. But if people are using it medically, using it to treat a health or medical condition, you really want to know what the best practices are, especially regarding something like dosage.

However, people's knowledge about cannabis was mostly from their own experiences. Maybe about a fifth of them got information from a medical cannabis caregiver or dispensary, the place where they were getting their cannabis from. That would be expected, but fewer get any from their primary healthcare provider. That’s less than one-fifth. That's really striking and remarkable. In fact, many of them said that their primary health care provider didn't even know that they were using cannabis to treat their health or medical condition. For us, that raises serious issues, if there's a disconnect between their medicinal cannabis use and the healthcare system.

Maybe people aren't revealing it because they're concerned about the legality in their state or maybe they have employment concerns like, “what if my job finds out that I'm using cannabis?” It's a very real issue as to why people might not be disclosing to their primary healthcare provider. At the same time, that does create additional issues or concerns. One of these concerns is that to what extent do people really know what they're doing. So, we asked, “What do you think an effective dose of THC is? What do you think an effective dose of CBD is?”

There are also some questions to be answered. For example, are there different dosages for different conditions? That's something that hopefully, we'll find out in our research and future research. But as of now, there are a number of different bodies that have defined dosages for THC and CBD. For THC, that's typically, 5 milligrams or 10 milligrams. For research purposes, 5 milligrams has been defined as the standard unit. California, other states, and other areas have defined 10 milligrams of THC as a standard dose. So, if you're buying an edible, they'll say, okay, here's a chocolate bar, and it has 10 pieces. Each of them has 10 milligrams, so it's 10 doses. It's really good to inform people about how much you need to take. But the majority of our participants had no idea what an effective dose of THC was. Even those who did gave estimates that averaged 91 milligrams. That's about nine times what the guidelines would recommend. Honestly, this is one of the legitimate concerns you have with cannabis. People might overconsume an edible because they don't know how much to take. They might see one cookie or one brownie and just eat the whole thing and then literally might end up in the hospital because they're having a panic attack.

That's something that people really need to be educated on—and the same with CBD. There's less research into dosages of CBD, but still the majority in our 2019 study had no idea what the dosages were and said that the appropriate amount would be 177 milligrams. So again, that's several times what you would typically find, say, in a gummy or a capsule that has maybe 25 milligrams of CBD.

There were also estimates for how much THC and CBD would be in strains of cannabis flower, basically, the raw bud that people might smoke or vape. Their estimates were way higher than in reality. They thought that the average THC content in cannabis flower was 52% and that's far beyond what even the highest THC strains have right now. This is the same for CBD. Long story short, they grossly overestimate how much THC is necessary, how much CBD is necessary. That's a concern and something that we really should address with education and more research.

What has surprised you most from your research with cannabis?

: I think those findings show how far we are from where we need to be. Imagine an ideal system where cannabis is treated seriously as a medicine and is fully integrated with people's medical treatment. All those different aspects we would need to have, including patient education.

It’s apparent to us from our research that we're still pretty far away. Honestly, I think the Schedule I status is probably still a major barrier for this to be fully realized for legal concerns, constraints on research, and other aspects. So hopefully, that will shift in the future, especially now that a majority of the American population, as I said, have legal access to not just medical, but recreational cannabis.

Where do you recommend people go to find information on similar studies, current or past studies, and research on cannabis usage?

Google Scholar is a great tool. You can search Google Scholar and you can now find thousands of articles on cannabis. They may be difficult to digest, but that could be a good start. The National Academies Report is also available online. You can download a PDF, especially the summary of findings, which is free to download. Go to the National Academies of Science, Engineering, and Medicine and look for their most recent report on cannabis. Hopefully more and more trusted sources will get into cannabis education.

We actually did have a previous study on internet content on cannabis because that was actually the second most prevalent source of information that people had beyond their own individual experiences. Where do you get information? From the internet, everyone searches the internet. And we found that the information on the internet was very mixed in terms of the quality and value of its content. It’s concerning. So, we do really want to have more trusted information sources and ways that we could digest the primary literature for non-researchers.

People really have a good understanding of what these studies mean. Academic fields take years, sometimes decades, to master. It might be too high of an expectation to say, go to Google Scholar and just read a bunch of articles there, because there's going to be a lot of technical language. I think that would be a worthy effort for someone to really try to summarize that and translate it translate it for people who are non-researchers.

Psychedelics have been coming up a lot for us in our two publications as the next big area of research. Do you have any plans to conduct studies similar to what you've done with cannabis on psilocybin or psychedelics in general?

our first manuscript has been published on naturalistic psychedelic use

 (2). A very similar paradigm to see just how people are using it, and sure enough, they are using it to treat health and medical conditions, although it's different from cannabis in the sense that cannabis is something that people take on an ongoing basis to treat anxiety, pain, or sleep issues.

Psychedelics are something that people could have a lot of change with in just one or a few sessions. Those are also predominantly for things that are related to mental health, but also for all sorts of existential issues, for cancer patients or other people who are facing the prospect of mortality, a fear of death. For existential issues like that as well as post-traumatic stress disorder or depression. There's a lot of people who have treatment-resistant depression. All the medications on the market today just aren't working for like a third of people who are clinically depressed.

That's one of the reasons why there's so much interest in psychedelics being the next big thing. We're just getting into this in the sense that we now have a few studies going on. Hopefully, in the future, we'll be able to conduct a similar study to this one with psychedelics.

The medicalization of psychedelics is happening 10 times as fast as the medicalization of cannabis, especially interest from industry and investors. I think that a lot of that rapid change has been driven more so from the top-down rather than the bottom-up grassroots efforts of cannabis advocates.

It’s going to be an interesting research future and it is really nice that we can conduct this kind of research now, studying naturalistic use with surveys, but also the fact that more and more people are paying attention to it and that we can conduct the study with the approval of the Institutional Review Board at the university. Those are those are very promising signs.

 Well, there's so much more that needs to be done to answer questions with cannabis. There's all sorts of other cannabinoids. We've also looked into Delta-8 THC, so we have some studies on that. That is a product that really surged in popularity in areas where Delta-9 THC was prohibited or restricted.

Delta-9 THC is the primary component of cannabis that gives people the high feeling. The regulation in terms of the legality of hemp or cannabis is defined based on Delta-9 THC. Delta-8 is an isomer, so it's chemically similar to Delta-9 THC, but it doesn't bind as strongly to the endogenous cannabinoid CB1 receptor in your brain. So, people will say maybe it's about half as strong or so. It has a slightly weaker effect, but it was being widely sold and utilized. At the same time, local and state governments were cracking down on it because we don't know anything about this. What is this? Following the experiences people had with the so called spice, which is any kind of substance sprayed onto some plant matter that people are buying from a gas station and smoking. And, there's a lot of issues with that. I mean, that's one of the challenges.

Well, if you criminalize cannabis, then people are going to try to find a substitute for it, sometimes with really, really awful results. So, people are maybe being very cautious, maybe overly cautious thinking, “we don’t know enough about this Delta-8 THC, so let’s just stop it.” Ironically, that's happening in states that are medicalizing and legalizing Delta-9 THC cannabis—they’re suppressing Delta-8 cannabis. So, we did a study of Delta-8 cannabis use. Based on people's self-reports, it seems to have maybe an even more desirable profile of effects than Delta-9 cannabis. It’s the inverse of what you'd expect of the legal trends. Again, that's self-report, so it's based on people's experiences and what they said to us and we have no reason to doubt that they're being honest. It would be great to do a nice double-blind trial with Delta-8 and Delta-9 cannabis so we can really confirm that.

That's one possibility. There are many others. Eventually we hope to do similar types of studies with various psychedelics. We're seeing very rapid change and hopefully very rapid progress in these areas that have really been suppressed and repressed for decades.

If you’re interested in learning more about Dr. Kruger’s current study with Releaf or participating, please visit 

https://nap.nationalacademies.org/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the-current-state

https://www.tandfonline.com/doi/abs/10.1080/02791072.2022.2108356?journalCode=ujpd20

One of the recurring challenges in the medical cannabis space is the difficulty in conducting research because of the plant’s Schedule I status. Although there are some researchers diving in with special licenses to conduct clinical studies, there are others that are looking at real-world users to supply data. For instance, Dr. Daniel J. Kruger is a Research Investigator with the Population Study Center at the University of Michigan and Principal Investigator on a study being conducted with the Releaf app. Here, Dr. Kruger shares his interest and background in these types of surveys and his plans for the current study with Releaf on chronic pain.

Chronic Pain Research Endeavors: How an App and University Are Presenting Real-World Patient Data

Here, Dr. Dustin Sulak shares some of the key talking points from both of his talks at Cannabis Science Conference East 2022. His first talk in the Medical track was titled "Cannabinoid Acids: Inactive Precursors or Powerful Therapeutics?" and his second talk in the Psychedelics track was titled “Ketamine at Home: An Effective Adjunct to Cannabis?"

Dr. Dustin Sulak of Healer.com and Integr8 Health shares some insights from two talks he gave at Cannabis Science Conference East 2022.

Dr. Dustin Sulak Discusses Acidic Cannabinoids, Ketamine, and Their Therapeutic Benefits at Cannabis Science Conference East 2022

Recently in France, 31 senators from the Socialist, Ecologist, and Republican group published a co-signed letter in a forum in the French newspaper, 

 calling for the launch of a consultation process to introduce new laws to legalize cannabis in France (1). The letter examines several options for the legalization of cannabis, ultimately rejecting the notion of decriminalization because it only “buys social peace with a certain cynicism.”

“Almost 18 million of our fellow citizens have used cannabis recreationally, according to a recent report by the National Assembly. Although it is banned, 1.5 million consume it regularly,” the letter states, using this to explain why the legalization of cannabis is a social issue that the public authorities must respond to (1). The letter compares this legalization to existing public policies for tobacco and alcohol, adding that it will provide the means to better protect citizens, especially younger ones, from uncontrolled consumption.

The Senate is the upper house of the French Parliament and sits alongside the lower chamber, the National Assembly. It is made up of 348 senators elected by part of the country’s local councilors and French citizens living abroad (1).

Currently in Europe, several countries have decriminalized cannabis or have medical cannabis programs, and as of this summer, Germany is preparing “to establish Europe’s first national recreational cannabis market” (2). Currently, no country allows the import or export of recreational cannabis.

https://businesscann.com/french-senators-petition-macrons-government-for-urgent-cannabis-reform/

https://mjbizdaily.com/big-questions-about-germany-cannabis-legalization-still-unanswered/

Recently in France, 31 senators published a co-signed letter in the French newspaper “Le Monde,” calling for the launch of a consultation process to introduce new laws to legalize cannabis in France.

French Senators Publish Letter Urging Cannabis Legalization in France

Madeline Colli is the Associate Editor for Cannabis Patient Care and Cannabis Science and Technology magazines at MJH Life Sciences.

How did using a cannabis app help you on your medical cannabis journey?

 What was cool about this particular app is that it was out of Canada and they had all the backend certificates of analysis for the products. You could literally type in the product you are using, for example, Blue Dream from producer A or you could type in Blue Dream from Producer B. Different chemical profiles may exist from the exact same strain name. What this app allowed me to do was log both of those experiences because I had assumed that Blue Dream from dispensary A and Blue Dream from dispensary B were going to have the same effect, but that isn’t always the case. That's why using the app was so powerful and having that data behind the scenes of what's in the plant and why it's working, it's ingenious. I mean, that's how you figure this out, my friends. If we can get that data and if these license producers—or in New York it's registered organizations—all manufacturers should have a responsibility of sharing what's in their products. I don't understand why cannabis is different from any other food or medication. Cannabis products are being tested, so why can't we have access to that information? It should just be readily available as part of every single state's law.

Hemp growers have to go through more testing requirements than our medical cannabis providers right now; I mean, that's just messed up, in my opinion.

Has the cannabis market in the United States become more affordable for medical cannabis users? What differences have you seen in various states?

 For the first part of your question, that all depends on what state you're in. Every single state has a different set of circumstances, laws, with different availability of products for medical patients in that state versus other states. It is hard to find states that offer reciprocity, such as Nevada, which recognizes all out-of-state medical cards and also allows out-of-state patients to obtain a medical cannabis card.

In most states, one must be a resident of that state and have a state-certified provider make the recommendation to give you a “medical card,” and most states do not offer reciprocity. In other words, me being a medical patient from New York, I can’t go to a dispensary in Pennsylvania, because they don’t offer reciprocity. That's not cool because I'm still a medical patient no matter what state I am in.

In contrast to the US, Canada has a universal program. Cannabis is federally legal in Canada for all provinces. We need to do better for patients in the US. I shouldn't be penalized, for example, if I'm in California, but I live in New York and I run out of my prescription of cannabis or Xanax or any other medication. I should be able to get any of my medications in California without much trouble. Can it happen? Yes, but it would take some effort.

Once we go from medical to recreational or adult-use, there is a difference in the market. Meaning, it becomes more about the money – selling the product – than doing what’s best for the patient.

I'm currently working with Americans for Safe Access (ASA). We have a New York State Patient Advisory Committee, and I'm working to bring awareness about the patient experience. We are tackling questions such as: which conditions are bringing patients to cannabis, and how do we not lose our access when we transition to adult-use? How can we include the pharmacists that have been there for the medical patients, who are knowledgeable about helping patients handling multiple pharmaceuticals and especially contraindications?

I'm very concerned about states just lumping their medical programs into their adult-use programs without some types of safeguards to allow patients to retain all their benefits. For example, medical patients are allowed higher purchase limits than those for adult-use customers. Being able to purchase more product during a visit usually saves money. It also means that I don't have to run to the dispensary every other day when I consume medicine all day. Another important benefit is product availability. Adult-use consumers generally buy different products than medical patients, and it’s important for medical patients to continue having access to the same variety of products after adult use is legalized. There are also tax breaks. Medical patients should continue to get tax breaks on their purchases after adult use is legalized.

Are you still having to travel to Canada to obtain your medical cannabis?

: I still travel to Canada, go to events, and things like that over there. I love Canada because I can try so many different products and I can learn what works for me, and in many cases this app still has that back-end information of various strains in Canada.

Different experiences and different retail outlets have been great. It's crazy how many stores there are now in Canada since the pandemic. I mean, before there was like one every 30 miles or so. Now it's like there's one every 2 miles. They're everywhere. It's amazing because there are so many options for patients, and I actually do feel it's gotten more affordable in Canada.

What are your opinions on the medical cannabis industry in New York? Are there things that you are seeing that aren’t working and would like to change (3)?

 We just recently changed management of our medical cannabis program. The Department of Health used to manage the program, but now the Cannabis Control Board, the CCB, of New York is in charge. There's been some growing pains in every way. There have also been improvements.

We've eliminated the limited number of qualifying conditions. Now, if a doctor sees fit for you to have medical cannabis, they don't have to jump through hoops anymore. This has made it much more accessible, which is a good thing. We’ve also legalized adult-use, but adults can't purchase cannabis in any of the current dispensaries.

We only have 38 in the entire state of New York. Think about that for one second. We have about 125,000 medical patients in New York state right now. But we have 38 dispensaries, the majority of which are upstate. I'm in upstate, and we have roughly nine dispensaries, I believe, in our region, but our region covers a large geographic area.

There are three dispensaries in the Buffalo area, the smaller region in which I live. However, people in more remote areas have like a three-hour drive to reach a dispensary. Access is still really limited for a lot of people. Another problem is that New York state has been talking about eliminating pharmacists. As I already mentioned, if we eliminate pharmacists for our medical program, how is that really going to work?

Currently, our 10 medical producers can open up an additional number of recreational stores as proposed under the law. How are we going to differentiate the medical stores from the recreational stores? If the recreational stores of the same name as the medical stores don’t have pharmacists, then patients could easily think they're getting the same helpful information from a pharmacist when they’re not.

Having reciprocity in New York state, for other state patients is another huge issue for me. And having access to certificates of analysis (CoAs), that's probably my biggest issue for New York state. There should be testing with public access to CoAs on each product that they're putting into our medical program. Period. End of story. It's not proprietary. List the ingredients. We're patients, we’re not just stoners. There needs to be better care of medical patients.

What would you like to see change in the cannabis industry over the next 5 years?

 One of the things I'd love to see is interstate commerce. When I find a product in California that works really well for me, why should I have to be in New York state and not have access to it? We can do a much better job.

I don't know how that looks or how that works, but I know we get drugs to different states with no problem. Why can't we have a similar system for cannabis? I totally believe products need to be grown in our state. Like I'm not suggesting we should be getting all our products from California. But what I'm suggesting is we should have access to products grown in California.

Also, all products with the same cultivar name should have a very similar chemical profile. If a product called Super Lemon Haze is in California and it's also in New York state, those two products should have very similar chemical profiles, not something completely different.

That's one of the things that I've found a lot in my travels. For instance, an edible brand that I used in Boston was the first edible that's ever worked for me. I was ecstatic. And I then saw the same brand in Canada and it absolutely had no effect. That was a very disappointing experience.

There are also still a lot of problems with the stigma of smoking cannabis. One of the things New York state did right was allowing cannabis consumption anywhere tobacco is consumed, such as outside or in consumption lounges. That was a huge win for medical patients.

Personally, I became so much more comfortable residing in New York state now that cannabis use is legal in certain public spaces. I use cannabis all day in small amounts, and now I can be outside downtown Buffalo and know that I don't have to be ashamed that I'm consuming cannabis in the same area as someone smoking a cigarette. I also love consumption lounges, where I can be with like-minded humans that just want to get to know each other or have events that are cannabis friendly.

Are you involved in any advocacy measures for cannabis?

 I am! I'm the Chair for Americans for Safe Access, New York State Patient Advisory Committee. It's quite the long title. That's a federal organization that I fully support. They're a nonprofit based out of Washington, D.C., that's been around for more than 20 years and they care about patients, which is what I'm all about. One of the things I've noticed through traveling is cannabis is not always safe, due to the stigma. The thought of having run-ins with law enforcement in less-cannabis-friendly states is frightening.

I'm also on the advisory board for Cannabis BPO [Business Process Outsourcing].They're an organization that puts the personal touch into cannabis call center work. So instead of getting that 1-800 annoying number with Press 1 for this and Press 2 for that, you actually get a live person, and they do all types of work in the cannabis space. They really care about the patient voice. They wanted me to be able to advise them on any kind of things that they might be able to improve, if they're helping patients directly.

Do you have any advice or guidance for beginner interested in using cannabis or getting involved in advocacy measures to encourage legal change?

 Research, research, research, learn, and ask questions. Don't be afraid of the plant. Come out of the cannabis closet and try to become educated instead of opinionated. I personally have changed so many people’s minds about the plant who would have never considered cannabis as medicine. I, myself, never considered cannabis as medicine before my injury.

So, when you find people that are passionate about the plant, learn from them. Educate yourself and don't judge a book by its cover. Just because some of them might have long hair and look a little hippie-ish doesn't mean that they're not true advocates and don't understand what the plant's about.

I encourage people to join other organizations. It's about working together and collaborating and working for the greater good as a group, rather than fighting over small pieces of funding that one group could make a much bigger difference than many little ones.

In the beginning of this interview, you mentioned you had experienced a lot of feedback or pushback from doctors. Are you still seeing medical professionals with these mindsets? Are their attitudes on cannabis changing and becoming more accepting, or are you still seeing the stigma towards cannabis?

 I am definitely still seeing the stigma, no question and it's frustrating. I'm not seeing all the doctors I was before because I'm no longer under Worker's Compensation care, but I'm seeing a small shift. Like my primary care doctor asked me, “hey, who can I send patients to, to learn about cannabis?” And so, I gave him a number. But the point is, he never would have thought of cannabis years ago as medicine. He's seen the transformation in me, but he also cares. Having a doctor that cares makes all the difference in the world from a standpoint of being able to change someone’s mind.

I've had some negative experiences at the Canadian-US border, but I've had way more positive experiences. One time, there was a joint that had slipped in the ‘fatal hole of death’ between the two seats in my car, and a dog found it when I was crossing into Canada. Basically, that landed me with a seven-year penance, meaning that I need to get pulled over and searched every time I cross into Canada. What's funny is cannabis is legal in Canada. The last time I crossed, my experience with the border patrol man was really classic. He said, “Why would you bring cannabis into Canada? It's like bringing your own sandwich into a buffet. How stupid is that?” I mean, it's really true. Why would you? After that experience, though, I would get post -traumatic stress disorder (PTSD) whenever I was crossing into Canada, because that one time I had been caught with this less than a gram of cannabis going into their country.

It's really PTSD-provoking every time I cross the border. Because what if something else slipped? But in 90% of the cases that I've crossed in, I've actually educated people while I get pulled over.

My point is, everything happens for a reason, and I truly believe I was injured for a reason to help educate, to help remove the stigma, and to be a true voice of cannabis as medicine.

For more with Nikki Lawley, please see part I of this interview series: 

https://www.cannapatientcare.com/view/cannabis-saved-my-life-an-interview-with-traumatic-brain-injury-survivor-nikki-lawley-part-i-journey-to-health

https://www.nikkiandtheplant.org/about-nikki-and-the-plant.html

https://www.youtube.com/watch?v=OKppk-gnIxc

https://www.syracuse.com/marijuana/2022/06/nys-medical-marijuana-program-suffering-as-state-focuses-on-a-recreational-market.html

When a patient isn’t able to access the care or medication that they need in their home country, they aren’t left with much of a choice but to travel to a country that will give them the treatment they need. In part II of this interview series, Nikki Lawley, founder of Nikki and the Plant, LLC, and retired licensed practical nurse (LPN), continues discussing her journey to health, the broken healthcare system hurting medical cannabis patients in the US, and what needs to change to make access better for patients.

“Cannabis Saved My Life:” An Interview with Traumatic Brain Injury Survivor, Nikki Lawley, Part II: Crossing Borders for Cannabis

Recently, Healer.com, a cannabis education and training resource and provider of cannabis products, joined nonprofit Leaf411 as its newest member (1). Both organizations aim to provide education and guidance on the use of cannabis and hemp products (1). Founded in 2019, Leaf411 is the US’s first cannabis nurse guidance call service. According to their website, their mission is “to provide education and directional support to the general public about the safe use of legal cannabis” (2).

“Now more than ever, we need as many voices and resources as possible educating patients and consumers on cannabis with evidence-based information and honest guidance,” said Katherine Golden, a registered nurse and CEO of Leaf411 (1). “Dr. Sulak and Healer.com are among the strongest voices helping people make well-informed decisions about cannabis consumption. We are thrilled to have them on board as a member and look forward to collaborating our efforts.”

Dr. Dustin Sulak, an osteopathic physician, began incorporating cannabis as medicine for his patients in 2009 and later founded Healer.com when he realized that a lack of cannabis knowledge was preventing people from getting the best results possible from products (1). Healer.com provides online medical cannabis training for patients, healthcare providers, and dispensaries. As a part of their member relationship, all Leaf411 nurses will become Healer Certified in Healer.com’s cannabis education programs (1).

“Cannabis possesses amazing healing properties for a wide variety of symptoms,” said Dr. Sulak (1). “But without knowledge of how it might work and which type of products might be best for any particular individual, its potential for consumers and the industry will never be realized. We applaud the work that Leaf411 is doing across the country and look forward to working together to ensure evidence-based cannabis education is available for all.”

Leaf411 and Dr. Sulak will also be regular contributors to 

 digital issues, covering both the nurse and doctor focus areas for a given issue, respectively. These contributions will begin with our July/August issue on auto-immune diseases.

For more information on Leaf411, please visit 

. For more information on healer.com, please visit 

https://www.globenewswire.com/news-release/2022/07/13/2479267/0/en/Healer-com-Joins-Leaf411-to-Amplify-Cannabis-Education-Efforts.html

Recently, Leaf411, the United States’ first cannabis nurse guidance call service, welcomed as its newest member Healer.com, a cannabis education and training resource founded by osteopathic physician, Dr. Dustin Sulak.

Two Major Cannabis Educational Organizations—Leaf411 and Healer.com—Form Collaborative Effort

In early July 2022, several cannabis organizations and retailers in Massachusetts joined forces and launched a research project to study veteran access to medical cannabis. Directing the project is the Cannabis Center of Excellence (CCOE), a “non-profit organization that conducts citizen-science-focused population studies and programs in the areas of community engagement, medical cannabis, adult-use cannabis, and social justice in the cannabis industry” (1).

“The results from the 2019 veterans medical cannabis study highlighted that regular access to cannabis was a barrier for many veterans,” said Dr. Marion McNabb, DrPH, MPH, president of CCOE. “Gibby's Garden has a strong passion to give back to veterans, and so we teamed up to launch a study that would increase access and help gather opinions and ideas from veterans for future programs. I am most excited to learn if this type of program is feasible at a pilot scale, and how veterans respond to cannabis use.”

According to the project description on the CCOE website, 450 qualifying veterans will complete a baseline survey and will then be able to purchase a cannabis product bundle consisting of Gibby’s Garden products at one of the four participating retail outlets in Massachusetts (1). Additionally, “as part of the research study, participating veterans will be asked to report on access to cannabis issues, products, and its impact on their health and wellness via paper-based forms or a mobile medical cannabis app called Tetragram (1).”

According to CCOE, the four participating cannabis retail outlets are:

This research study is reviewed and approved by the University of Massachusetts Dartmouth Institutional Review Board for human subjects research (1).

For more information on the study or to register, please visit: 

https://www.cannacenterofexcellence.org/veterans

For more information on Tetragram, please see our podcast: 

https://www.cannabissciencetech.com/view/ep-6-tetragram-how-patient-data-is-powering-research

To learn more about the 2019 Veterans study conducted by Dr. McNabb, please visit: 

https://www.cannapatientcare.com/view/the-2019-veterans-health-and-medical-cannabis-study

https://www.cannacenterofexcellence.org/our-history-1

On July 11, 2022, the Cannabis Center of Excellence (CCOE), Gibby’s Garden, Patriots Helping Vets, Tetragram, and several retailers united to study veteran access to medical cannabis. The research study will reportedly request feedback from 450 veterans to gather their firsthand experiences with access, products, and the impact on health. 

First-of-its-Kind Research Project Launched in Massachusetts to Study Veteran Access to Medical Cannabis

In early June 2022, the New York State Senate approved a bill which mandated public health insurance programs to cover medical cannabis expenses and defined how private insurers are allowed to handle these expenses as well (1).

New York State Senator, Diane Savino (D), sponsored the legislation that had to travel through two committees before passing in the Senate by a vote of 53-10. The bill titled, SB S8837, has been transmitted to the Assembly and is currently awaiting action in the Ways & Means Committee.

The new legislation reportedly amends state public health and social services to address the out-of-pocket costs medical cannabis patients have been left to figure out on their own. It is one of the most difficult barriers for patient access and will help provide relief for those who seek it for treatment.

Medical cannabis would be defined as a “prescription drug,” “covered drug,” or “health care service” under the relevant codes so that public health insurance providers, including workers compensation and Medicaid, would be mandated to provide coverage. Although this is a step in the right direction, private and commercial insurers would not be subjected to mandating cannabis coverage and instead have the choice to make coverage optional.

“For thousands of patients, medical marijuana is a safer and more effective medication than other drugs, especially opioids,” a justification memo attached to the bill stated (1). “While it can be prohibitively expensive for many patients, especially in the absence of insurance coverage, it may often be less expensive than what their insurance coverage pays for other medications.”

Savino addressed concerns from fellow lawmakers on the floor ahead of the vote about the potential costs of the legislation and stating that it was time for New York state to lead the way on this issue. “Some state is going to have to force this issue,” Savino said. “I believe that our state is the one that should lead the way on this.”

If the legislation is enacted, public health insurance programs such as, Medicaid, Child Health Plus, Elderly Pharmaceutical Insurance Coverage (EPIC), Essential Plan programs, and workers compensation, would be applicable to the proposed policy change.

“Cost is the primary barrier to patient access in New York’s medical marijuana program. Medicaid, other public health plans, and commercial health insurance plans do not cover medical marijuana, forcing patients to pay out of pocket,” the justification memo also stated (1). “Some patients begin treatment only to stop due to inability to pay, while others turn to the black market. Efforts by registered organizations to offer discounts have helped, but are inadequate for many low-income patients.”

While there “would presumably not be federal matching funds until the federal government changes its policies” for programs like Medicaid and Child Health Plus, the memo stated that “New York’s Medicaid and Child Health Plus programs have always covered people and services for which we do not receive federal match.”

https://www.marijuanamoment.net/new-york-senate-approves-bill-to-mandate-medical-marijuana-health-insurance-coverage/

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