Final Dont Get High PDF

Don't Get High...
Get WeII
Allan I Frankel, MD GreenBridgeMed.com
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Contents
To All Patients Introduction . . . . . . . . . . . . . . . . . . . 1
Cannabis, the law and you . . . . . . . . . . . . . . . . . . . . 3
Terminally ill patient refused transplant due to Medical
Cannabis Use . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
What do you mean by different ¨STRAINS' of Marijuana? . . . 3
One more good reason to allow concentrates and edibles at Los
Angeles Collectives . . . . . . . . . . . . . . . . . . . . . . . . 7
When is ¨too much¨ Cannabis really too much? . . . . . . . . . 8
Is feeling good a ¨side effect¨ of Cannabis? . . . . . . . . . . . 9
Letter to Governor Schwarzenegger . . . . . . . . . . . . . . . 9
Last Eight Years of Cannabis Research... . . . . . . . . . . . 12
From The Floor To The Ceiling . . . . . . . . . . . . . . . . . . 13
Wagging the dog.. . . . . . . . . . . . . . . . . . . . . . . . . 14
Back to the Past and Beyond . . . . . . . . . . . . . . . . . . . 13
Question: Would You Patent Something That Has No Value? . . 16
Open Source Cannabis . . . . . . . . . . . . . . . . . . . . . . 17
What Do I Think About Pot Cafes . . . . . . . . . . . . . . . . 18
So, how did we get into this mess? . . . . . . . . . . . . . . . . 19
Tar and THC . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
When Do We Use Our Cannabis? . . . . . . . . . . . . . . . . . 21
An amazing new patient I recently saw.. . . . . . . . . . . . . 22
The Plant, the Whole Plant and nothing but the Plant . . . . . . 23
Please read and smile :) . . . . . . . . . . . . . . . . . . . . . . 24
So, how could °Open Source¨ Cannabis work? . . . . . . . . . 24
Nuts to them! . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
How To Eat Edibles . . . . . . . . . . . . . . . . . . . . . . . . 26
Be Careful What We Ask For . . . . . . . . . . . . . . . . . . . 27
Cannabis and Anxiety . . . . . . . . . . . . . . . . . . . . . . . 28
What About The ¨Card¨ and the ¨List¨ . . . . . . . . . . . . . . 29
Letter to City and County of Los Angeles . . . . . . . . . . . . 30
i
Feds Backing Off... Keeping Fingers Crossed . . . . . . . . 32
Federal Raids Are Over! Let research grow. . . . . . . . . . . . 33
Los Angeles Financial Problems Yes We Cannabis! . . . . . . 34
¨Side Effects¨ by Steve Martin for your enjoyment . . . . . . 34
Solving The Health Care Crisis . . . . . . . . . . . . . . . . . . 37
Desire To Clean? . . . . . . . . . . . . . . . . . . . . . . . . . 38
Would I Recommend Cannabis for a Patient With Drug Problems? 39
Cannabis fights MRSA . . . . . . . . . . . . . . . . . . . . . . 39
The Miracle of Cannabinoid Activation . . . . . . . . . . . . . 40
MPP Director of Government Relations Aaron Houston breaks
down his testimony to Congress. . . . . . . . . . . . . . . . . . 41
Cannabis and Insomnia . . . . . . . . . . . . . . . . . . . . . . 42
How Pharmacy Shelves Were Stocked In The Past . . . . . . . . 43
Health Issues and Gay Marriage . . . . . . . . . . . . . . . . . 43
Cannabis and Our Lungs . . . . . . . . . . . . . . . . . . . . . 44
Don't Get ¨High¨.. Get ¨Well¨ . . . . . . . . . . . . . . . . 43
What My Patients Have Learned . . . . . . . . . . . . . . . . . 46
An Email From a Patient . . . . . . . . . . . . . . . . . . . . . 47
Treating Multiple Sclerosis With Sativa . . . . . . . . . . . . . 48
Psychopharmacology and Cannabis . . . . . . . . . . . . . . . 49
Reminder Concerning the ¨Card¨ . . . . . . . . . . . . . . . . . 30
Medical Cannabis and Arthritis . . . . . . . . . . . . . . . . . . 30
More On Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . 31
A Patient With Fibromyalgia Improved With Cannabis . . . . . 32
Marijuana Tincture Recipe, How to Make Cannabis Tincture . . 33
Are Cannabis Docs Seeing Too Many Patients? . . . . . . . . . 38
What Does This Talk Regarding Pot Potency Really Mean? . . . 39
Chinese Rice Noodles and Cannabis . . . . . . . . . . . . . . . 60
Cannabis Tinctures for Anxiety, Insomnia and Depression . . . . 60
Taxation and Regulation of Cannabis . . . . . . . . . . . . . . . 61
Prevention of Alzheimer's Disease Pathology by Cannabinoids . 62
63 Year Old Therapist Treated as Drug Addict In ER . . . . . . 63
Dr. Frankel Made a Tincture . . . . . . . . . . . . . . . . . . . 64
Legally Grown Cannabis Destroying Mexican Drug Cartel's
Profits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Got pot? Fly from Oakland . . . . . . . . . . . . . . . . . . . . 67
Historic California Assembly Getting Real on Medical Cannabis 69
Please Help The Cannabis Ballot Initiative. . . . . . . . . . . . 69
ii
Dr. Frankel Interviewed By CBS. COM . . . . . . . . . . . . . 71
Quick Cannabis Fact . . . . . . . . . . . . . . . . . . . . . . . 71
Multiple Sclerosis and Cannabis . . . . . . . . . . . . . . . . . 72
The Time Has Come For Endorsed Cannabis Testing . . . . . . 72
Tardive Dyskinesia Helped By Cannabis . . . . . . . . . . . . . 73
What Happens to Dr. Frankel if Cannabis Becomes ¨Legal¨ . . . 74
Let's Talk About Cannabis and Drug Schedules . . . . . . . . . 73
Police Want Legalization and Growers Insist Upon Remaining
Illegal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
All Medicine Is Always Titrated For Each Patient . . . . . . . . 76
Why Doesn't TSA Bother Passengers With Cannabis? . . . . . . 77
Why a Puff is Not a Puff . . . . . . . . . . . . . . . . . . . . . 77
Follow-up Post on Cannabis and Anxiety . . . . . . . . . . . . 78
Open Cannabis Dispensaries in Los Angeles June 7, 2010 . . . . 78
Dr. Craig Cohen at GreenBridge Medical . . . . . . . . . . . . 79
Surprise With New Cannabis Tincture . . . . . . . . . . . . . . 80
GreeenBridge Medical and Physician Education . . . . . . . . . 81
¨Animal Farm¨ and Cannabis . . . . . . . . . . . . . . . . . . . 81
SJR 14 May Be a Big Deal . . . . . . . . . . . . . . . . . . . . 82
Michael Jackson and Intravenous THC . . . . . . . . . . . . . . 83
From Dr's. Frankel and Cohen on Seattle's 1068 and The New
England Journal of Medicine . . . . . . . . . . . . . . . . . . . 83
How To Use The New Cannabis Tinctures . . . . . . . . . . . . 83
Oregon To Reclassify Cannabis As A Therapeutic Substance . . 86
Sativa and Sugar Cravings . . . . . . . . . . . . . . . . . . . . 86
Why Do We Worry So Much? . . . . . . . . . . . . . . . . . . 87
Young Physicians and Cannabis . . . . . . . . . . . . . . . . . 89
Raids Used To Fund More Raids . . . . . . . . . . . . . . . . . 89
Patient Given Option of Meetings or Renewal . . . . . . . . . . 90
Chronic Pain and CBD (Cannabidiol) . . . . . . . . . . . . . . 90
Great Quick Update on the Endocannabinoid System . . . . . . 91
It Can be Legal And Still Be a Great Medicine . . . . . . . . . . 92
PLEASE HELP DOCTOR FRANKEL . . . . . . . . . . . . . . 93
Free Drugs at Fast Food Restaurants??!!?? . . . . . . . . . . . . 94
What About Alcoholics Anonymous and Cannabis . . . . . . . 93
GreenBridge Medical Laboratories To Open Soon . . . . . . . . 96
The Time Has Indeed Come For a Constitutional Convention . . 96
Last Night I Had The Strangest Dream . . . . . . . . . . . . . . 98
iii
Save Healthcare Dollars Die Early . . . . . . . . . . . . . . . 99
Dr. Frankel Visited Cannabis Farm With GreenBridge Medical
Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Cannabis Is Now Just like parking in the red zone! . . . . . . . . 101
Dr. Frankel in Playboy . . . . . . . . . . . . . . . . . . . . . . 102
The Kind Doctor? Anyone Out There? . . . . . . . . . . . . . . 104
The Kind Doctor Oath . . . . . . . . . . . . . . . . . . . . . . 103
Never Kiss And Tell . . . . . . . . . . . . . . . . . . . . . . . . 106
Medical Cannabis Research Articles . . . . . . . . . . . . . . . 107
What Happens if Prop 19 Passes? . . . . . . . . . . . . . . . . . 109
Who Wants Their Medicine Tested? . . . . . . . . . . . . . . . 110
Our Drug Czar is Very Misleading . . . . . . . . . . . . . . . . 110
Dr. Frankel's Medicine For Thanksgiving. . . . . . . . . . . . . 112
Dr. Frankel To Be on Internet Radio Show . . . . . . . . . . . . 112
The Thin Line: Both Virtual and Very Real . . . . . . . . . . . 113
Afterthought: Let's call it Social Rather than Recreational Pot Use 113
What Happens to Medical Cannabis If Prop 19 Passes?...
Nothing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Is The Cannabis Use Social or Medical? . . . . . . . . . . . . . 116
Medical VS. Social Cannabis . . . . . . . . . . . . . . . . . . . 117
GreenBridge Medical Offers: ¨Pay What You Can, Just Promise
That You Will Vote¨ Week . . . . . . . . . . . . . . . . . . . . 119
Blog Comment Regarding Making a TIncture . . . . . . . . . . 119
Dr. Frankel To Be On Discovery Channel . . . . . . . . . . . . 120
What is Happening at GreenBridge The Week After The Election 121
Cannabis Allergy . . . . . . . . . . . . . . . . . . . . . . . . . 122
Barry Goldwater Would Roll Over in Grave . . . . . . . . . . . 123
How To Smoke Cannabis and Avoid Dead Space . . . . . . . . 123
Why Have Cannabis Strains Changed So Much Over The Years? 124
Web MD: Chemicals In Marijuana May Fight MRSA . . . . . . 123
Follow Up on Cannabis Allergy . . . . . . . . . . . . . . . . . 123
Yes, Doctors Used To Prescribe Alcohol . . . . . . . . . . . . . 126
Email From A Grateful Patient . . . . . . . . . . . . . . . . . . 127
Dr. Frankel On Internet Radio From October 27, 2010 . . . . . . 128
THC and CBD Both Compete For The CB1 Receptor . . . . . . 129
Have You Been Factcinated? . . . . . . . . . . . . . . . . . . . 130
Patient ¨Grow Letter¨ Most Troublesome and Dishonest
Doctor Behavior Yet . . . . . . . . . . . . . . . . . . . . . . . 130
iv
Could High CBD Products Interfere With Other Drug
Metabolism?? . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
My Trial Day Approaches . . . . . . . . . . . . . . . . . . . . . 132
Eat Cannabis Leaves and Get Healthy . . . . . . . . . . . . . . 133
GOING AFTER DOCTOR FRANKEL . . . . . . . . . . . . . 133
Insomnia Is A Serious Medical Problem Helped By Cannabis . . 137
Dr. Frankel's Trial . . . . . . . . . . . . . . . . . . . . . . . . . 140
Med Board v. Dr. Frankel . . . . . . . . . . . . . . . . . . . . . 140
Interesting Patient Response to Trial . . . . . . . . . . . . . . . 146
Grow Cards Really Suck They Are Worthless, Totally Illegal
and Dangerous . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Doctor or Activist . . . . . . . . . . . . . . . . . . . . . . . . . 148
OMG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
CBD (Cannabidiol) Rich Cannabis Tincture Finally . . . . . . 130
Cannabis Decarboxylation Video by Dr. Frankel . . . . . . . . . 131
Time For Medical Cannabis To Grow Up . . . . . . . . . . . . 131
Trains, Planes and Automobiles, OR Tinctures, Concentrates
and Edibles . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Dr. Frankel Video on CBD . . . . . . . . . . . . . . . . . . . . 134
GreenBridge Medical Steps It Up . . . . . . . . . . . . . . . . . 133
GreenBridge Medical Moves To Brentwood . . . . . . . . . . . 136
To All My Friends . . . . . . . . . . . . . . . . . . . . . . . . . 136
Cannabis Being Rescheduled Right Now . . . . . . . . . . . . . 138
How Early in a Plant's Life Can You Measure CBD . . . . . . . 139
How Do Professionals Extract The Cannabis Plant . . . . . . . . 160
First Two Weeks After Move To Brentwood . . . . . . . . . . . 161
Sativa Tincture Helps a Patient Control Their Diabetes . . . . . 162
Update on Tinctures . . . . . . . . . . . . . . . . . . . . . . . . 163
Patient Letter Regarding Treatment of Anxiety With Cannabis . 164
New Cannabis Tinctures in The Works . . . . . . . . . . . . . . 163
GreenBridge Expands Into Santa Monica/UCLA . . . . . . . . . 163
How CBD Might Decrease Chronic Pain . . . . . . . . . . . . . 166
I Just Heard About CBD!! What Is This About CBC?? . . . . . 167
TINCTURE TESTING BEST METHOD TO GATHER
CLINICAL-MOLECULAR DATA . . . . . . . . . . . . . . . . 168
A Puff Is Not A Puff And Cannabis Tinctures Are Not
Concentrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
CBD And Asthma . . . . . . . . . . . . . . . . . . . . . . . . . 174
v
Patient With Fibromyalgia Helped By Cannabis . . . . . . . . . 176
Terpenes Anyone? . . . . . . . . . . . . . . . . . . . . . . . . . 177
CBD Excitement At GreenBridge Medical . . . . . . . . . . . . 178
GreenBridge Medical Goes On Medication Watch . . . . . . . . 179
CBD Blocks The Appetite Increase From THC . . . . . . . . . 181
Dr. Frankel Used CBD Tincture This Morning . . . . . . . . . . 182
Patient Demanded Parking Ticket For His Cannabis But Was
Denied! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Alcohol, Cannabis and AA . . . . . . . . . . . . . . . . . . . . 183
What's In The Name Cannabis or Marijuana . . . . . . . . . . . 183
CANNABIS: So Many Legal Federal Patents and Still A
Useless Medication . . . . . . . . . . . . . . . . . . . . . . . . 186
Decision-Making Processes Blunted In Chronic Marijuana
Smokers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Pharma Changed It's Mind Again! . . . . . . . . . . . . . . . . 193
Great Medical Cannabis Online Package Insert . . . . . . . . . 193
Patient Asks Great CBD Related Question . . . . . . . . . . . . 198
Let's Start All Over Again . . . . . . . . . . . . . . . . . . . . 199
Keeping The Feds Out Bill HR 2306 . . . . . . . . . . . . . . 202
Federal Policy Headlines On ¨Hypocrisy Today¨ . . . . . . . . 203
One Patient, One Plant . . . . . . . . . . . . . . . . . . . . . . 203
Dear Mr. President . . . . . . . . . . . . . . . . . . . . . . . . 207
Terpenoid Molecules, The Next Cannabis Generation . . . . . . 209
Cannabis Does Not Impair Long Term Cognition . . . . . . . . 210
Medical Board of California Rules on My Case . . . . . . . . . 211
Bridge For Troubled Waters **Need Your Feedback** . . . . . 211
Terpenes And Your Cannabis . . . . . . . . . . . . . . . . . . . 212
Troubled Waters Are Calming Down . . . . . . . . . . . . . . . 213
CBD Drug Interactions . . . . . . . . . . . . . . . . . . . . . . 214
New Weight Loss Medication . . . . . . . . . . . . . . . . . . . 213
Save Cannabis, Save Our Democracy . . . . . . . . . . . . . . 216
Health Insurance and More for Cannabis Patients . . . . . . . . 217
New Cannabis Tinctures . . . . . . . . . . . . . . . . . . . . . 219
THC Toxicity and Edibles . . . . . . . . . . . . . . . . . . . . 220
New Thoughts on Cannabis and Insomnia . . . . . . . . . . . . 221
Update On CBD Rich Cannabis Tinctures . . . . . . . . . . . . 222
CBD And Cancer Just The Beginning . . . . . . . . . . . . . 223
How Should We Classify Tinctures . . . . . . . . . . . . . . . . 224
vi
How to Administer New CBD/THC Tinctures . . . . . . . . . . 223
CBD(Cannabidiol) and Drug Interactions . . . . . . . . . . . . 226
Tamoxifen Joint Pains Helped By CBD(Cannabidiol) . . . . . . 227
Certified Cannabis Tinctures . . . . . . . . . . . . . . . . . . . 227
Medical Cannabis Registration Means No Guns or Ammo!! . . . 229
CMA, The California Medical Association Advocates Cannabis
Legalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Two Patients Facing Court Hearings For Possession of Tinctures
As Being ¨Concentrates¨ . . . . . . . . . . . . . . . . . . . . . 231
My Court Appearances For My Patients And a Problematic Lawyer 233
Feds Say CBD Is Wonder Drug! They patented it. . . . . . . . . 234
More on CBD/THC Tinctures With Terpenes . . . . . . . . . . 236
American Idol To Run Next Election . . . . . . . . . . . . . . . 239
Scotty, Beam In The Cannabis Or What is a ¨Designation Letter¨ 240
Smash and Grab a Collective For ¨Claimed¨ Illegal Activity But
NO ARRESTS. . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Cannabis and Multiple Sclerosis . . . . . . . . . . . . . . . . . 243
Follow-Up On Cannabis and AA . . . . . . . . . . . . . . . . . 244
¨LEGAL¨ Cannabis-Based Medicines . . . . . . . . . . . . . . 246
vii
To AII Patients - Introduction
Wednesday, April 23, 2008
Thank you for checking out my °blog¨ book. You are always welcome to
read updates to my blog and my life in the world of cannabis medicine,
by going to http.77WWW.g¡eehb¡1dgened.con. Recently, I have
devoted time and energy to the certification of cannabis medications. There
are no certification groups, so I started this one in early 2011 which you can
find at http.77ce¡t1f1edcahhab1sned1c1he.con.
As a Physician licensed to practice in the State of California, I believe Med-
ical Marijuana is a powerful and yet extremely safe medication. Anything
that interferes with my patients getting the best possible medication com-
promises the Doctor Patient Privilege. After thirty years of practice and
serving two decades as a Clinical Instructor of Medicine at a prestigious
University Hospital I believe I am qualified to decide whether a given pa-
tient might benefit from Medical Marijuana.
Whether someone suffers from depression, anxiety, nausea, pain, . all pa-
1
tients should have the option of discussing their symptoms and Treatment
Plan with a Physician. If this plan includes Medical Marijuana as deter-
mined by the Patient/Physician partnership AND is legal, as it is has been
since 1996 in California any °Care Giver¨ should be permitted to dispense
the medication.
Marijuana is far safer than Aspirin and Tylenol. It has highly predictable ef-
fects and has no known lethal dose. The °Therapeutic Ratio¨ i.e. the °Ben-
efits to side effect¨ ratio, is the highest of any known medication. There
are also predictable side effects as no medication is entirely without side
effects. Various strains of Marijuana have very different psychoactive ef-
fects. If a patient medicates with an activating form, they might become
over stimulated. If a patient medicates with a sedating strain, they might
become overly sleepy. Knowing how to take a medication is always crit-
ical and the same applies to Medical Marijuana. It is in fact a Medicine
and should not be used without adequate professional advise. Remember,
Marijuana is a °restricted¨ drug for political reasons not medical safety or
efficacy.
The current California Medical Marijuana System is a major advance over
where we were just a few years ago. This system is emerging as a signif-
icant force in alternative care for patients who have not been well served
by traditional methods. Many have dedicated their lives to this end and we
should all be very grateful. Without these pioneers risking incarceration,
we would still be groping in the dark.
Although Marijuana has been used medicinally for thousands of years, it
was not until recently that physicians and patients have learned that myr-
iad strains of the plant have entirely different actions and therefore, diverse
applications. Various Marijuana strains are mind activating and are used
for conditions such as depression and ADD/ADHD. Other strains can be as
sedating as sleep medications. These strains, as all strains of Marijuana are
effective, safe and non-addicting.
With the assistance of a medical doctor the various strains can be used for
specific patient needs. For example:
1 On the °street¨, most Marijuana strains are NEVERIDENTIFIED. I know
of chemotherapy patients who were forced to the streets to purchase their
Marijuana! They have little or no idea whether they are purchasing a stimu-
lant or relaxant. I recently saw a woman with Breast Cancer on chemother-
apy who was told by her Chemotherapy nurse to go °find some Marijuana
2
on the streets..¨!! This is a pretty big issue when it comes to patients prop-
erly treating their symptoms. Is all Marijuana just °pot¨? Do all strains
make the patient sleepy or °stoned¨? Is it possible to recommend different
°medications¨ to a patient?
1 SATIVA STRAINS: These are strains of Marijuana whose THC molecule
has been genetically altered over many years that have stimulant, activat-
ing, focusing and anti-depressant activity. An individual can be medicated
with a Sativa strain achieving an increased level of focus, alertness, mood
elevation and increased creativity. I have many patients who have unsuc-
cessfully tried various medications for mood disorders who are currently
using Sativa Marijuana strains to alleviate their depression. These patients
do not look or act stoned. They are functioning at or above where they usu-
ally function.
1 INDICA STRAINS: These strains have very different biological effects
than the Sativas. Indicas are sedating, calming and muscle relaxing. These
are the strains used best for pain, anxiety and insomnia. The patient, how-
ever, does look and feel °stoned¨. These can be used at bedtime or during
an acute Migraine Headache or acute back spasm.
Who would deprive a dying patient Medical Marijuana? Who would pros-
ecute a CANCER CENTER for giving their patients a Medical Marijuana
Recommendation? Yet, most people with cancer have NOIDEAhowto get
Medical Marijuana. This needs to be remedied. Suggestions anyone?
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Cannabis, the Iaw and you
Wednesday, April 23, 2008
In the practice of Cannabis Medicine, I am often asked by patients if they
will be placed on a °list¨.
The only °list¨ that I am aware of, is the list compiled by the State of Cal-
ifornia. This list is generated when patients purchase a °State ID Card¨.
1
http.77WWW.addtoahy.con7sha¡e¸save
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This card is NOT MANDATORY and in Southern California, is seldom
recognized at the °Dispensaries¨. The Physician letter, which all patients
receive at the end of an approved and legitimate visit, is the only required
ID.
Allan Frankel, MD
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TerminaIIy iII patient refused transpIant due
to MedicaI Cannabis Use
Monday, April 28, 2008
http.77WWW.cbsheWs.con7sto¡1es72uuB7u472ô7heaJth7
na1h4u4B1u7.shtnJ
So, we have here a terminally ill patient. He is dying of liver failure caused
by Hepatitis C. Apparently he was initially infected with Hepatitis C inject-
ing himself with infected needles. He will die without a liver transplant. He
is a candidate for a transplant despite his prior serious IV drug habit having
caused his liver failure. So, his behavior and habits caused his liver to fail,
yet the hospitals and insurance companies are OK with this fact.
This is a reasonable and caring position on the part of the hospital and in-
surance company. What is not remotely reasonable is the insurance com-
pany and hospital now saying he is not °covered¨ due to his use of Medical
Cannabis! Prior IV drug injections causing Hepatitis C and now liver fail-
ure are °OK¨, but the Cannabis use leads them to be concerned about drug
addiction.
Most likely, if the Cannabis had caused some long term medical problem,
they would have covered it, but there are NO long term problems caused by
Cannabis.
3
4
4
Insurance companies always cover injuries fromactivities requiring the °pa-
tient¨ to wear a helmet for protection. I contend that any activity requir-
ing a helmet is much more dangerous than using Cannabis. From Timothy
Garin's story, it is clear that the prejudice regarding medical cannabis causes
much more harm than does cannabis.
Allan I Frankel, MD
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What do you mean by different "STRAINS'
of Marijuana?
Tuesday, April 29, 2008
I educate my patients on the differences in the strains of cannabis they are
using because there are two major different strains of Cannabis: Sativa
strains and Indica Strains. What most people have been exposed to in the
United States, other than during the Vietnam war, is the Indica strains.
These Indica strains produce the typical sedating/munchies inducing/stony
type °high¨ people nowassociate with, Marijuana ¬ POT ¬ stoner. Because
of the media and Cheech and Chong, we have all come to expect that all
Cannabis products produce this °stoned¨ and °unfocused¨ state. With the
Indica strain this is true, but let's not forget, that these strains do help people
with insomnia, severe pain and of course comfort in so many ways for the
seriously ill cancer and HIV patients.
Then there are the Sativa strains. These were around for a while during the
Vietnam war, but until marketed as a part of the California Medical Mari-
juana system, it was nearly impossible for anyone to find Sativa strains be-
cause they were commercially unviable due to their being difficult to grow,
low production rate and long flowering cycle. Now that they are available
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medically, patients are discovering that the Sativa strain can help to address
their symptoms, yet keep them alert, focused and content.
When you look at the list below comparing the effects of the Indica and
Sativa strains, it will probably surprise you.
SATIVA STRAINS
Activating
Anti-Anxiety
INCREASED FOCUS!
Anti-Depressant
Increased Creativity
Treats Chronic Pain
Increased Levels of Serotonin
INDICA STRAINS
Sedating
Relaxing
DECREASED FOCUS!
Muscle Relaxant
Treats Acute Pain
Increased Appetite
Decreased Nausea
Increased Levels of Dopamine
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One more good reason to aIIow
concentrates and edibIes at Los AngeIes
CoIIectives
Saturday, May 3, 2008
There is talk at the level of the City Planning Commission to advise the
Los Angeles City Council to prevent the sale of Cannabis °Concentrates¨
at local Caregivers. This makes little sense.
°Concentrates¨, are a preparation of either Cannabis Sativa or Cannabis
Indica, that can be taken orally as a lozenge, capsule, extract, etc. In my
opinion, the patients using Concentrates are very °legitimate¨ patients be-
cause if they were recreational users, they would not take cannabis in such
an expensive and inefficient manner. That is one reason the City of LA
should consider leaving things alone.
Another reason is medical. In my recent blog, °Liver Failure Patient¨, I
discussed the death of Timothy Garin as a result of being denied a liver
transplant due to him being a medical marijuana user. Mulling over his
case has me thinking that perhaps one medical issue ties the °Transplant¨
and °Concentrates¨ issues together.
I always encourage my patients to use Concentrates as they are able. Yet for
those patients who cannot, such as my Cancer/HIVpatients, I always advise
them to microwave their Cannabis prior to smoking when their immune
function is severely compromised.
This is very important because several Fungi, primarily Aspergillosis, do
tend to grow in many plants. When inhaled by an immunocompromised
patient, this can be potentially harmful, and hence the suggestions to either
stick with Concentrates or °nuke¨ the medication.
Perhaps as the City of Los Angeles becomes more aware of these and other
issues, they will open their thinking to respect Concentrates? Perhaps if
the transplant teams knew a patient were using a concentrate and so not
exposing their immune system, would they be more comfortable treating
medical marijuana patients?
Allan I Frankel, MD
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When is "too much" Cannabis reaIIy too
much?
Saturday, May l0, 2008
Over my thirty years practicing Internal Medicine, I have greatly changed
my opinion regarding what I consider °excessive¨ use of medications. I
now include Cannabis in my assessment as well. So, when patients ask me,
when is °too much¨ Cannabis really too much? I respond that as with all
drugs, too much is when the drug is controlling the patient.
It might not be apparent to the patient they are controlled by cannabis, but
it becomes obvious to most people who know them. Those who know the
patient can see the affects on the patient's life they can tell if the Cannabis
is interfering with work, or an issue at home with kids or family or is causing
responsibilities to be neglected.
If so, it is a problem that simply needs to be addressed. However, (and
you might be surprised by this), the problem is NOT directly related to the
amount of Cannabis being used. Consider this: just as with pharmaceuti-
cals, everyone is very different in their response and sensitivity to drugs.
The various strains of Cannabis have a similar effect: a lot for one person
can be trivial to another.
If the patient is using Cannabis and is acting responsibly, then what better
result could anyone hope for? If friends and family continue to believe
cannabis is adversely affecting the patient when there is no evidence, I think
a good look at personal biases against Cannabis are in order.
Allan I Frankel, MD
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Is feeIing good a "side effect" of Cannabis?
Monday, June 30, 2008
As I have discussed in prior blogs, Cannabis can be a potent anti-depressant.
It has this °happy¨ factor, regardless of whether the patient is medicating
for pain, low appetite or nausea.
As a doctor, I amjustifiably concerned about the side affects of medications.
So, you'd think I'd be concerned when a patient calls me explaining that
their nausea is much improved °but¨ they notice that they feel happier and
just °better¨. In fact, this doesn't worry me at all.
When I hear about their concern over °feeling better¨, truthfully, it puts a
smile on my face. I wish more of the medications I have prescribed over
the many years I have practiced had the same side effect profile: °Warning!
May include increased feelings of well being¨.
All of this begs the question, under what circumstances is happiness or feel-
ing at ease a problem? It is a problemwhen the good feelings lead to poor or
no focus and interferes with one's life. The mood elevating °side-effects¨,
(particularly from Sativa Strains), are packed with increased focus and
this is what is so very different and so very wonderful.
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Letter to Governor Schwarzenegger
Monday, September 8, 2008
September 8, 2008
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The Honorable Arnold Schwarzenegger
Governor
State of California
State Capitol
Sacramento, CA 93814
Re: AB2279 (Leno) Medical Cannabis Employment Non-
Discrimination
Dear Governor Schwarzenegger,
Assembly Bill 2279 sponsored by Assemblyman Mark Leno will soon be
on your desk for a signature. AB 2279 is in response to the California State
Supreme Court decision that allows employers to fire medical marijuana
patients who test positive for medical cannabis. As a California Board cer-
tified physician since 1979 and a graduate of the UC medical system, I felt
compelled to write you. I urge you to support AB2279 and help my patients
receive their medication and keep their jobs. Patients are being unfairly
discriminated against simply as a result of the medications their physicians
chose to recommend for them as the best treatment for their symptoms. AB
2279 will erase unjustified discrimination in the workplace while benefiting
employers, medical marijuana patients and society as a whole.
In my office, I have the forms to order traditional and non-traditional thera-
pies, including medical marijuana tragically one of these can result in the
loss of jobs for my patients. The result of allowing employers to fire medi-
cal marijuana patients for their physician recommended course of treatment
interferes with my ability to prescribe the best course of medical relief for
my patients in essence forcing me to violate the Hippocratic Oath. Of
course, whatever medication I choose to prescribe should not interfere with
my patient's ability to execute their responsibilities. Yet, it is my personal
experience with thousands of patients that medical cannabis allows patients
to function at their best and I have to ask, what employer wouldn't want
that from his employees?
In my practice the average age of my patients is 30. I have examined the
demographics and find most of my patients' function well in society and
hold respectable jobs. I find that by the time patients have come to me
they have tried many standard pharmaceuticals as well as other alternative
health options to deal with their disease. They tell me stories about how
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these therapies have caused them to function at a sub-standard level. They
come to me looking for relief and a better quality of life. For those whom
I have recommended cannabis, I know they have benefited, because nearly
all return for renewals on an annual basis with the same comment, °I've
never had a better year.¨
As I collect more clinical evidence, I am finding that medical cannabis pa-
tients' function at least as well at work than the thousands of patients for
whom I have prescribed standard pharmaceuticals over 23 years.
I understand that the California Supreme Court is trying to interpret the law
as currently written, however, testing for cannabis doesn't prove patients
are less effective at work.
· Testing only proves that the patient used cannabis sometime in the past
several months.
· Effects of cannabis only last about 90 minutes compared to four hours or
more for pharmaceuticals.
· Testing doesn't gauge the °hang over¨ effects such as those that can seen in
patients who use alcohol the night before or come to work groggy because
of their prescription medications.
It is difficult to justify the discrimination of firing a medical marijuana pa-
tient who uses cannabis during their off hours and then has no impairment
at work versus patients who are truly disabled at work, (i.e., hung over or
pharmaceutically medicated patients), being allowed to continue employ-
ment while cannabis patients are fired. There is no justification for allowing
impairment at work for some doctor recommended medications and pro-
hibiting any use, even at home, of another.
Once a medication is legal under state law, it should be legal in the eyes of all
state governmental functions. The state should not allowmedical marijuana
use on one hand and then endorse discrimination against a patient on the
other. Limiting the options of job seekers because of unfair and unjustified
discrimination makes no sense. Upon completion of an exam, I explain to
my patients the details of any medications I might prescribe or recommend.
I believe that my patients use their medications responsibly. So whether I
pick up a prescription pad and write a traditional prescription for the patient
or write a medical marijuana recommendation is a decision between the
patient and me as their doctor. Without AB 2279, some of my patients will
be discriminated against in their workplace, will lose their jobs, and may
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find themselves on public assistance and state supported Medi-Cal. This
serves no public good and hurts us all.
Please sign AB 2279 into law.
Sincerely,
Allan I. Frankel, M. D.
3007 Washington Blvd. Suite 110
Marina Del Rey, CA 90292
310-821-9600
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Last Eight Years of Cannabis Research...
Wednesday, October 29, 2008
I don't often just give out °links¨, but the link on NORMAL is just too
fantastic not to share. Do yourself or your friends a favor and check out:
Diseases treated with Cannabis.
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http.77ho¡nJ.o¡g71hdex.cfn?u¡oup¸Tu=7uu2
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From The FIoor To The CeiIing
Monday, November 3, 2008
In many of my appointments, I tell patients, °Imagine the room you are
currently in, represents 'howyou are feeling'. The floor represents the most
depressed moments of your life and the ceiling represents the highest and
most out of control state you can imagine. Would you agree we are all
somewhere approximately 1/3 of the way up the wall?¨
When they see my point of view, ALL want to increase where they are on
the wall by 23% or so. So often, everything patients do in their lives is to
get this bump in how they feel. When they are feeling a bit better, they
are aware of the change and often do not know even why they are doing
better.
I go on to explain to my patients that many Sativa strains of Cannabis are
very helpful with anxiety and depression. I caution, however, that there are
many instances where Cannabis alone is inadequate to control psychosis,
but this is to be decided between the patient and physician. Regardless,
Sativa strains make most people feel more awake, alert and happy while
remaining focused all characteristics that patients report 'moves them up
the wall that extra amount'.
Once I have educated patients that their symptoms will be addressed using
cannabis, I explain that it is the THC and Sativa Cannabinoids working on
our Cannabinoid receptors in addition to increasing the production and de-
creasing the destruction of Serotonin that makes us feel so much better. So,
are we all a little depressed? Does the Endo Cannabinoids Deficiency Syn-
drome really exist and we are medicating to normalize our internally low
levels of Cannabinoids? Perhaps the mood changing effects of Cannabi-
noids to varying degrees function in a combined state as both direct and
indirect neurotransmitters? This is what I believe is the most likely scene-
rio.
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Wagging the dog..
Monday, November l0, 2008
There is a new drug indicated for °weight loss¨ Rimonabant. It made it
through trials but ultimately was not released.
The purpose of this drug is to block the effects of certain cannabinoids upon
specific cannabinoid brain receptors. Our bodies create natural or °endoge-
nous¨ cannabinoids which stimulate hunger. Rimonabant was developed
to do the opposite by inhibiting the °appetite stimulation¨ of cannabinoids.
Many of us are familiar with getting the °munchies¨ I guess you could say,
Rimonabant is the °anti-munchy¨. We all also know that that cannabinoids
improve our mood.
As the makers of Rimonabant discovered, while the drug blocks appetite
as an inhibitor of certain neurotransmitter functions, the blocking of these
neurotransmitter functions also affects one's mood. In fact, two of the hall-
mark clinical signs of Depression are the loss of appetite and severe drops
in mood. Administering Rimonabant to patients resulted in numerous sui-
cides and nervous breakdowns. You'll be happy to learn that the trials on
this drug have been suspended and it will not make it to market.
However, the failure of Rimonabant has resulted in a sort of °Dog Wag-
ging the Tail¨ Clinical Trial scenario which has ended up confirming that
Cannabis and Cannabis receptors play a major role in mood and appetite
regulation. The Cannabinoids clearly increase both our appetite and mood.
So, if a pill blocks these receptors both our appetite and mood are influ-
enced.
This is more evidence that the internal Cannabinoid system plays a major
role in how we all feel. Cannabis clearly effects mood and in my opinion is
a very sophisticated and powerful mood enhancer.
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Back to the Past and Beyond
Monday, November l7, 2008
I always encourage my patients to find Sativa/Indica tinctures or other con-
centrates. These generally come in some sort of spray mechanism or sub-
lingual preparation.
The advantage of using concentrates should be obvious, but let me list some
reasons to be clear: concentrates allowfor a more steady release of the med-
ication which results in sustained benefits, no smoking is required, and your
privacy is maintained. If we are to medicate ourselves during the day we
generally do this quietly and personally as we should. With a tincture or
capsule, privacy is possible to have while medicating with cannabis. Now
cannabis patients can be like patients using anti-anxiety medications by dis-
cretely taking a pill/tincture/concentrate during the day.
You might be surprised to find out that concentrates are not new. In fact, in
1837 there were six hundred various cannabis tinctures available in phar-
macies. U. S. Pharmaceutical companies produced them all. I suppose it
would be fair to say, °Pharma met Karma¨.
Anyway, the physicians of the time, (from the early 1800's to 1942 when
it became criminal), were certainly recommending lots and lots of medi-
cations which contained Cannabis in many forms from pills to tinctures.
these were all °Over-the-Counter¨. Reviewing much of these doctors notes,
it is clear they were using Cannabis as we are beginning to, as well, it was
used for the same ailments we use it for now.
We can all take lessons from the doctors and patients from nearly 200 years
ago. If you are a patient, encourage your dispensary to carry new and
innovative Cannabis concentrates. At the very least, let's get back to the
past. One never knows, perhaps we will move beyond the 1800's?
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Question: WouId You Patent Something
That Has No VaIue?
Monday, November 24, 2008
So, would you patent something that currently has no value but is consid-
ered more dangerous than cocaine and heroin? Oh, and on top of that, it's
illegal.
Now, if you can believe this, it appears the US government has gone ahead
and patented cannabis. Read on dear Blogger to see howfar down the rabbit
hole we go.
US Patent 6630307 is titled: Cannabinoids as Antioxidants and Neuropro-
tectants. The owner of the rights to this patent is the United States Gov-
ernment. When I first heard about this, I had to read if this were true. It
is. Check out the link: http.77WWW.patehtsto¡n.us7patehts
7ôô3u5u7.htnJ
Patent 6630307 °claims¨ ownership to the °neuroprotectant¨ effect of
Cannabis specifically the CBD group of molecules.
So, what does °neuroprotectant¨ mean? It defines a substance, which serves
to protect nerves from oxidation, lack of blood, stress or trauma. The
Cannabis chemical CBD seems to have the most °neuroprotectant¨ effect
of all the chemicals in cannabis. Research shows that CBD molecules °pro-
tect¨ the brain and nerve cells in general.
CBD is in all strains of Cannabis, however, the levels of CBD fluctuate
according to the strain. This would mean that a strain high in CBD would
have little cognitive effect, (as opposed to a strain high in THC), but have
great neuroprotective and anti-oxident benefit.
What is most interesting is that the Government believes this quality in
cannabis is in fact something patentable while at the same time asserting
that cannabis has no medical benefit!
I certainly don't understand this hypocrisy/greed, but I am not surprised.
The government is looking into licensing this patent to companies who can
then develop °real¨ medications and pay fees to the Feds. I think this is re-
ally pretty funny. However, I will only laugh when the Feds de-criminalize
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Cannabis so they can license/sell their patent. I will also laugh a lot easier
if they leave some of the THC in the medication.
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Open Source Cannabis
Tuesday, December 2, 2008
Open Source, the concept of sharing information, not for one individual's
benefit, but for the benefit of all should be applied to Medical Cannabis.
There is one critical piece of information patients and physicians are entirely
missing with the current state of Medical Cannabis, we don't knowwhat we
are medicating with. Cannabis doesn't come with a chemical breakdown
°a list of ingredients¨.
When we purchase cannabis from a knowledgeable source such as a rep-
utable dispensary, we are able to feel comfortable that we know if we are
using a Sativa or Indica strain (my prior blogs explain why).
We know, however, that all Sativa strains are not the same. The same is true
for Indica strains. What are the differences? There are differences in THC
content, CBD content as well as dozens of other Cannabinoids. We are all
unique as human beings, and so our needs are unique. It stands to reason
that certain strains will work better than others for different people. This
is common in medicating with all treatment modalities in medicine from
the current Western model of medicine to the Alternative and Eastern type
models of medicine.
How about if we had a listing of the most important Cannabinoids on the
bottle of Cannabis? That would alloweach of us to evaluate over time which
of the various Cannabinoids work best for us. At that point, we could be
much more certain to obtain the correct strain as well as potentially the °per-
fect¨ tincture or °concentrate¨. The Cannabis plants are extremely complex
botanicals with over 400 ingredients including over 30 Cannabinoids.
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I envision a genetic research center that would breed cannabis to genetically
alter the strains IN THE GARDEN. The goal would be to obtain varied but
known and reproducible strains of Cannabis. We could all then share this
strain information in centralized databases, much as we have learned how
to share information in the world of Open Source Code, hence Open Source
Cannabis.
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What Do I Think About Pot Cafes
Monday, December 8, 2008
There has been some international uproar of late regarding the closure of
some °coffee shops¨ in Amsterdam as well as the closure by local authori-
ties of dispensaries allowing communal °medicating¨.
Don't get me wrong. I like the idea and freedom of being able to smoke
in private clubs with a group of like-minded individuals. Perhaps in the
future this will be the direction to head, however, it would have to be at
a time when the political climate accepts the use of Cannabis for purely
recreational reasons. Under today's laws, using Cannabis for recreational
reasons is clearly illegal, if only a misdemeanor in some states.
My problemwith cafes, at least in the US, is that we are struggling to simply
get Medical Cannabis accepted legally at regional levels as well as hope-
fully ultimately nationally. As a physician, I just can't see the medical ben-
efit of medicating as a group in a public setting. Until a lot more education
and enlightenment occurs, It is just too hard to justify in the current setting
and as far as I can see, for some time to come.
Alcohol is very different, and as far as I know, it is the only drug we use
socially in public groups that are legal. At the same time, I just don't know
many if any physicians, including myself, who would be drawn into
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°prescribing¨ alcohol for a patient. Even in the waning years of alcohol
prohibition nobody was pushing for Medical Alcohol!
So, I would prefer to keep Cannabis in the medical arena and out of the café
world. Many of us need this medication for help with serious issues. Let's
all please be careful not to become insensitive to the big picture.
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So, how did we get into this mess?
Monday, December l5, 2008
My Director of Education, Michele Nelson, answers this question:
Prior to 1937, cannabis and hemp in America was used as medicine and
material for various industrial needs. One of the plant's greatest industrial
benefits to early American's was that it did not rot in seawater, therefore
enabling sails and rigging. This made hemp essential to the new American
country without it, America could not have a navy. John Adams felt
hemp was so vital to the creation of the new country that it was one of the
first items on his to do list when riding to the Continental Congress. He
wrote, °Encourage the cultivation of hemp.¨ Every farmer was required to
dedicate a portion of his or her farm to hemp production. As a medicine,
cannabis was used from children's pain remedies to relieving adult's de-
pression, anxiety, and pain. During the mid-1800's, there were over 600
tinctures of cannabis available on the market from pharmaceutical compa-
nies well known today Pfizer and Merck for example.
However, in the 1930's two things happened that made hemp/cannabis ille-
gal. One, a machine was invented that processed the hemp/cannabis with-
out using the heavy manual labor needed in the past. Some called it a
°hemp gin¨ like the cotton gin. Suddenly, hemp was not such an expen-
sive fiber. At the time, Popular Mechanics magazine ran an article calling
hemp °America's billion dollar crop¨. Industrialists began experimenting
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with hemp and discovered that it could be used to create plastics, was an
excellent bio-fuel and was a strong fiber for paper.
At the same time hemp was being touted as a new raw material, the petrol
chemical industry was emerging. The Dupont's were at the center of this
industry, discovering other uses for petroleum such as plastics and nylon.
Also during this time, William Randolph Hearst the newspaper tycoon,
needed to secure paper for his news empire, so he invested in forests for pa-
per. Because hemp could replace both petrol chemicals and trees to make
products cheaper, easier, (and it's a renewable resource that many could
profit from producing) these two families joined forces with former Alco-
hol Prohibitionist, Harry Anslinger to create and pass the Marijuana Tax
Stamp Act in Congress.
Many consider the Marijuana Tax Stamp Act as °industrial espionage¨. At
the time, marijuana was not a recognized name for hemp or cannabis and
so the act was passed without the medical or farm community's awareness.
The tax stamp act gave the US government control over what farmers could
plant and destroyed the cannabis pharmaceutical business. If farmers didn't
apply and receive a tax stamp, they were subject to fines and possible im-
prisonment for growing the plant. Cannabis/hemp production plummeted.
Doctors begged Congress to allow cannabis to be used as a medicine, but
they failed to overturn or even modify the Marijuana Tax Stamp Act.
Marijuana prohibition started because two families needed to have a
monopoly on business. However, in today's economic and environmental
climate the prohibition that resulted from that decision might not be viable
any longer. Cannabis and hemp might be needed soon.
Michele Nelson, GreenBridge Director of Education
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Tar and THC
Saturday, December 27, 2008
A recent interest of mine has been to research ingestion methods of
cannabis. In reviewing a few articles regarding the various means we all
use at times to medicate, the following list results: to smoke in one form or
another, vaporize, eat edibles or tinctures.
Since edibles and tinctures are generally not inhaled and have no tar issues,
I will place them aside for this blog's discussion.
What I found most interesting, however, is that BONGS actually absorb
substantial amounts of THC up to 30%, (!), while allowing tar products
through. In other words, water is NOT a good filtration systemfor smoking
Cannabis.
Joints, surprisingly, were better than any other smoking methods other
than vaporizing. Even placing a true °filter¨ on a joint, has similar effects
to water. So, other than vaporizing, a loose joint without any filter, is next
best.
Perhaps it is time to °sell short¨ on bongs??
More to come on Tinctures next week.
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When Do We Use Our Cannabis?
Monday, January 5, 2009
Most patients are reluctant to be open regarding how much and how of-
ten they use Cannabis. I always encourage my patients to be as honest as
possible, as this is the best starting point in any doctor-patient visit.
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Further more, if we are discussing treatment for anxiety, depression or
ADD....we are talking about Sativa strains during the daytime hours. In
my opinion, the most significant issue with daytime medicating is related
to the smoking. If patients are using sativa tinctures, which are ideal for
daytime mood disorders, they are no different than any other patient using
xanax, valium or vicodan out of a pill bottle during the day.
The smoking and smell during the daytime are generally just not acceptable.
I encourage everyone to learn more about the daytime use of sativa tinc-
tures/concentrates. They just seem so much more like °real medicines¨.
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An amazing new patient I recentIy saw..
Monday, January l2, 2009
I recently saw a 70 y/o male as a new patient. He appeared in all ways
to be a street person and seemed a bit out of place. However there was
something in his eyes that got my attention. His body seemed much older
than his stated age, but his eyes reflected something still very much alive
and I escorted him to my exam room.
He was arrested 33 years ago in the State of Georgia for possession of 1
gram of marijuana. He showed me his prison admission form as well as
discharge papers. He spent 32 years in prison and was beatup on so many
occasions that he had become crippled. We discussed his options with med-
ical cannabis and he left.
He returned last week just to say thanks and show me how much better he
was feeling. He didn't say that this new freedom made up for his lost 32
years, but he did say it took a bit of the sting out of it.
I am pleased to hear that, at least in California, non-violent criminals are
going to be released in larger number for financial incentives. Whatever
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the reason, I am grateful. Often very good things happen for the wrong
reasons, but this is an acceptable compromise.
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The PIant, the WhoIe PIant and nothing but
the PIant
Friday, January l6, 2009
Although not the first such study, researchers in Milano, Italy, recently pre-
sented a study on whole plant extracts of Cannabis formulations to treat
neuropathic pain. If you'd like to read the study, please see the reference at
the end of this blog.
After reading the results, researchers learned that extracting a single active
ingredient from cannabis does not produce the ends desired. This is one
more well designed, although °rat-based¨, study encouraging us to realize
that including all genetic variations of the whole plant in medications will
probably produce better and safer drugs than extracting one cannabinoid at
a time.
Researchers might not be achieving the effects they desire, but this might
be the result of ignorance in the knowledge of manipulating cannabinoids,
or it might be that the whole plant is in fact °the medicine¨. Certainly
the ratio of the various cannabinoids in different strains will greatly vary,
but at the very least we can say that overall, cannabis is an extremely safe
medication.
http.77WWW.hcb1.hJn.h1h.gov7pubned71Bô1B522
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PIease read and smiIe :)
Monday, January l9, 2009
I don't know how I missed this letter from Congress to the DEA. I generally
don't cross the °political¨ boundaries as a physician, but I really thought
this would put a smile on your face. As you will find in the article below,
Congress has sent a very tough letter to the DEA. Congress is waiting for a
response from the DEA, but will be holding hearings regardless. It seems
that our Congress is not very pleased with how the DEA has been handling
itself in California.
I am very hopeful.
http:77WWW.greenbr1dgemed.com7Wp-content7upJoads7
20097017Conyers¸0LA¸Letter-1.pdf
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So, how couId "Open Source" Cannabis
work?
Monday, January 26, 2009
Please refer back to my recent post on °Open Source Cannabis¨ for back-
ground on this concept.
One of the most challenging issues facing cannabis research is where to be-
gin to understand how or even which chemicals in cannabis cause an effect
on symptoms. Unfortunately, at least at this point in time, medical cannabis
for clinical trials is just not available. I can only hope this will change, but
in the meantime, I believe we can get started with an intermediate survey
type study Open Source Cannabis.
The idea is to create a database of information that crosses patient testimoni-
als on howstrains treat their symptoms with the chemical breakdown of that
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strain from a Gas Chromatography machine. Regrettably, it takes weeks to
get the results from a Gas Chromatography machine. During this time, the
strain usually is distributed from the dispensary resulting in patients being
unable to use the GC analysis information. Perhaps in the future, the mar-
ket will require all growers to perform their own analysis on their strains or
send them in for analysis, but as with research into this subject, that will not
soon happen.
So, as to a solution for the time delay, what if when any strain is delivered
to the dispensary, it is assigned a random ID by a database program. With
this database, the dispensaries can logon to the system and get the ID for
the strain and send it off for GC analysis.
When patients find a particular strain that really works very well for them,
they logon to the database and enter basic symptom questions as well as the
strain ID that would be stamped on the label.
Over time, as the GC results come back, they are tied back to the strain
IDs.
This will enable two things:
1. As individuals have entered data on strains that work very well for them,
they can see what combination of Cannabinoids and Terpenoids work best
for them. Over time, they would select their medications based upon this
information and not just a name such as °bubble gum kush¨ which can
mean anything.
2. The patient community data should yield interesting results as well. As
patients give feedback on strains analyzed by a GC, I suspect we will begin
to see some trends of cannabinoid and terpenoid benefits that we cannot
even currently imagine.
I would really appreciate feedback on this one.
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Nuts to them!
Thursday, February 5, 2009
Peanut Butter 9 and counting
Marijuana 0
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How To Eat EdibIes
Thursday, February l2, 2009
For more than 2 years I have been cautioning patients regarding edibles.
The time of onset is delayed as compared with tinctures or smoking/inhaling
and the Cannabinoid dosage is often °higher¨ than expected.
So, frequently a very intense and sedating °indica¨ type feeling overcomes
the patient for many, many hours i.e. way too stoned. A91 year old patient
of mine manages her pain strictly with edibles. She came in recently for a
renewal and during the visit, I asked her how she was using her edibles so
successfully. She told me she nibbles on her edible often over a two day
period. After speaking with her further and then discussing the same issue
with a number of patients I have come up with an °Edibles for Dummies¨
suggestion list:
1. Regardless of how you are told how strong the edible is, it is generally
best to ignore what is said.
2. Take a very small morsel or nibble dime size or a bit less at a time when
you have the entire day available.just in case.
3. Wait 90 minutes and see how you are feeling.
4. If you are feeling medicated or probably medicated, do nothing more and
wait another hour and re-evaluate.
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3. If you feel nothing, take 2 nibbles and wait a couple of more hours.
6. Continue a similar version of the above until you begin to learn what
works best for you.
I would appreciate feedback on this one??
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Be CarefuI What We Ask For
As the Obama team begins deciding how to handle the Cannabis situation,
we all need to review what we really want to happen. Naturally, many of us
would want total °legalization¨. This will just not happen as there would be
way too many people upset that it is being handled even looser than alcohol.
People will not tolerate seeing weed in every grocery store.
So, perhaps °decriminalization¨? This would be similar to alcohol. Age
and access restrictions would apply.
What about the re-scheduling of Cannabis into Schedule II? Then it could
be written on a typical MD °triplicate¨ form and every MD could prescribe
it.
The final option is for the Feds to just stay out of the states and allow the
states to decide about distribution and related details. Also, this would also
allow scientists to study Cannabis a major issue for all of us.
Complete legalization is not going to happen. What happens if it is
re-scheduled but all Cannabis products would probably be produced by
Pharma and controlled by the Feds since they control the triplicate Rx's
of physicians.
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Personally I would be most content with a Federal hands-off approach and
de-schedule Cannabis and classify it as a Herb. In this manner, both Pharma
and °organic¨ solutions can be pursued.
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Cannabis and Anxiety
I was initially going to post some thoughts I have concerning Cannabis caus-
ing psychosis, but decided not to because in summary, I believe the data for
this is at best weak.
Of much more general interest is the relationship between Cannabis and
anxiety. There are hundreds of articles/blogs claiming that either Cannabis
causes anxiety or that it helps anxiety. I believe this is primarily strain re-
lated and will address this further, but wanted to first comment that many,
many medications I have prescribed in the past have been for anxiety. How-
ever, in a certain percentage of patients, these pharmaceuticals would at
times increase anxiety. So, this is certainly not rare and should not be a rea-
son to dismiss the patients for whom Cannabis works well for anxiety.
So, back to the strains. In general those patients, who become agitated,
paranoid or even perhaps borderline psychotic, have been using sedating
strains of Indica. These strains tend to worsen our ability to focus and this
results in calmness and sleep for most of us. However, for some patients
with anxiety, this loss of focus triggers a loss of connection to their envi-
ronment and paranoia may creep in. On the other hand, low doses of more
activating strains of Cannabis very rarely, if ever, cause these symptoms.
In my personal clinical experience, the patients who seem to become in-
creasingly anxious from Indicas, do very well on Sativa strains.
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What About The "Card" and the "List"
Monday, February l6, 2009
I often hear that patients are worried about being on a °list¨. This can and
does create a lot of fear over losing privacy as it should. So, here are a
few key points to help clarify what is really going on:
1. There is a °State/County¨ Card. This is always issued by the local county
where the patient resides. It is NOT MANDATORY. This is a voluntary
card.
2. When you see a Cannabis Physician, you receive the °Doctor Letter¨.
This letter enables the patient to visit any Dispensary in the State of Cali-
fornia. It also allows you to purchase the VOLUNTARY Card.
3. In my experience, both the police and dispensaries in Southern Cali-
fornia better recognize the Physician Letter. Additionally, often even if a
dispensary °accepts¨ the card, they still want to see the letter.
4. The °List¨ is generated only when a patient purchases the card.
3. So, save $130, save a trip to the county and remain private just don't
purchase the state card after seeing the Physician.
I realize that many people believe that the basic ID for Medical Cannabis
is the °card¨, in fact it is the letter that physicians create. I hope all of this
helps.
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Letter to City and County of Los AngeIes
Wednesday, February l8, 2009
Re: LA County Proposed Ordinance to Severely Control Edibles and Con-
centrates in Dispensaries
To the Honorable Councilmember Ed P. Reyes
I am a Board Certified Internist having practiced in Santa Monica and
Venice for 30 years. My sub-specialty is in psychopharmacology, so my
transition to becoming a practicing Cannabinologist was very comfort-
able.
I am not a politician or °activist¨. I am a Physician. My responsibility is
solely to my patients and my positions in this letter are entirely on their be-
half. During my patient visits, I determine whether some form of Cannabis
might be of benefit to them. Then together, through an education process,
the patient and I determine whether this might be the case for them.
My patients use various methods to medicate themselves with cannabis
products. Most of them are very motivated to look for non-combustible
means of medication administration. Vaporizing is certainly an answer and
is commonly used, but this is not always practical. It is for this and other
reasons that many of my patients, not wanting to smoke, turn to tinctures,
concentrates, hash, (which is just cannabis) and edibles. It would be a great
loss to my patients if these alternative means of ingestion disappeared. I
love the idea of everyone growing their own cannabis, but that will not
happen easily or quickly and my patients need help now. In addition, in
certain jurisdictions, growing at home would guarantee a visit from child
protective services. The current system may not be perfect and perhaps is
not entirely legal, but it gives tremendous relief to my patients.
I have found Cannabis, in many forms, to help most of my patients. They
are usually on other medications and I frequently speak with their Physician
as to how to best move forward. There is no doubt in my mind, that nearly
100% of the Physicians I have personally met and/or spoken with, are pri-
marily concerned about their patients smoking their Cannabis. Not a single
MD I have spoken with is comfortable having their patients use Cannabis
in a smoked form, but nearly all of them are very much behind tinctures,
concentrates and edibles.
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Attached to this letter is a photo of a wall in my exam room. It shows,
as if on an old pharmacy shelf from the 1800's 1900's, many Cannabis
tinctures in both Sativa and Indica forms all were manufactured by ma-
jor pharmaceutical companies still in business today. °Active ingredients¨
were not listed, the physicians of the day tested the °strength¨ of these
tinctures physiologically, meaning they had patients try it and see what hap-
pens. This process is similar to what I have done for the last 30 years with
current pharmaceuticals. As I like to say, back to the past.
Many of my patients use tinctures and edibles exclusively. Many have ei-
ther never smoked and haven't since college or have no intention of ever
smoking. I know for certain that if my patients were left only the smoke-
able formof cannabis, they would be extremely unhappy. More to the point,
I would not be able, as their physician to advise themwhat to do. We should
all be careful to monitor and regulate the concentrates and edibles, however,
on behalf of my many patients who rely upon these products.
There is another significant group of patients who are being forgotten and
these are the patients that everyone agrees the Compassionate Use Act was
meant to address. I am referring to the most ill patients with cancer or HIV
that have a depressed immune system. Many oncology doctors and HIV
specialists are reluctant to have these patients smoke cannabis as there are
various types of mold that once inhaled can at times lead to a fatal infection
in these immune compromised patients. They need tinctures, edibles and
even hash suppositories.
There may be additional regulations and controls required in the dispensary
systems, however, the wholesale destruction of the current system would
leave many thousands of patients without their medicine. If the above ar-
guments and those made by others to protect the product selection, lead to
a reasonable and rational °dispensing solution¨, we have all done our job.
However, if all sides cannot reach accord, I would propose another solu-
tion that might be inflammatory to some, but IF required, could be a tenable
solution: raise the minimumage to 21, unless accompanied by a parent. As
well, institute some strict but patient-friendly regulations and move forward
with the city of Los Angeles working together to allow the safe growth of
LA based cannabis medicine.
On behalf of my many patients, I would ask that we seriously consider hold-
ing off on major dispensary changes until this issue is given adequate con-
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sideration by all involved.
Kind Regards,
Allan I Frankel, MD
Below are listed the important people involved. Calls and/or emails from
all of us would be helpful to all..thanks, allan
Councilmember Ed P. Reyes
200 North Spring Street, Room 410
Los Angeles, CA 90012
Phone: 213-473-7001
Fax: 213-483-8907
E-mail: councilmemeber.reyes¸lacity.org
Councilmember Rosendahl
councilman.rosendahl¸lacity.org
Councilmember Hahn
councilmember.hahn¸lacity.org
Councilmember Zine
councilmember.zine¸lacity.org, councilmember.zine¸lacity.org
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Feds Backing Off... Keeping Fingers
Crossed
Monday, February 23, 2009
As a physician practicing both internal medicine and cannabis medicine, I
was particularly pleased to hear recent statements from the White House as
well as our State Legislators widening the Cannabis playing field.
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However, before we all begin to applaud too loudly, I would like to see
this in some formal written statement. That statement must include two key
points:
1. The States can run their own Medical Cannabis programs without any
Federal interference.
2. Physicians should be able to run their own clinical trials on cannabis and
begin answering many of the pro and con issues with the medication.
I suspect and feel comfortable that allowing physicians and scientists to
finally legally study this amazing group of medications will lead to various
therapies we only currently dream about.
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FederaI Raids Are Over! Let research grow.
Friday, February 27, 2009
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Los AngeIes FinanciaI ProbIems - Yes We
Cannabis!
Tuesday, March 3, 2009
Consider two facts:
1. The city of LA is broke
2. The city of LAis not always on the best terms with the Medical Cannabis
Community regarding °standards¨
So, how about if we setup a committee to consider the following:
Standards for the dispensing of Medical Cannabis are jointly (pun intended)
determined in a non °partisan¨ manner. To help ensure this, a city cannabis
tax might be introduced within the dispensary system. A portion of this
money would be to create standards which might become national stan-
dards. The balance and the lion's share would go directly to the city of
LA.
Thoughts?
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"Side Effects" - by Steve Martin for your
enjoyment
Wednesday, March 4, 2009
DOSAGE: take two tablets every six hours for joint pain.
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SIDE EFFECTS: This drug may cause joint pain, nausea, head-ache, or
shortness of breath. You may also experience muscle aches, rapid heart-
beat, and ringing in the ears. If you feel faint, call your doctor. Do not
consume alcohol while taking this pill, likewise, avoid red meat, shell-
fish, and vegetables. O. K. foods: flounder. Under no circumstances eat
yak. Men can expect painful urination while sitting, especially if the pe-
nis is caught between the toilet seat and the bowl. Projectile vomiting is
common in thirty per cent of users-sorry, fifty per cent. If you undergo
disorienting nausea accompanied by migraine and raspy breathing, double
the dosage. Leg cramps are to be expected, one knee-buckler per day is
normal. Bowel movements may become frequent-in fact, every ten min-
utes. If bowel movements become greater than twelve per hour, consult
your doctor, or any doctor, or just anyone who will speak to you. You may
find yourself becoming lost or vague, this would be a good time to write a
screenplay. Do not pilot a plane, unless you are among the ten per cent of
users who experience °spontaneous test-pilot knowledge.¨ If your hair be-
gins to smell like burning tires, move away from any buildings or populated
areas, and apply tincture of iodine to the head until you no longer hear what
could be taken for a °countdown.¨ May cause stigmata in Mexicans. If a
fungus starts to grow between your eyebrows, call the Guinness Book of
World Records. May induce a tendency to compulsively repeat the phrase
°no can do.¨ This drug may cause visions of the Virgin Mary to appear in
treetops. If this happens, open a souvenir shop. There may be an over-
whelming impulse to shout out during a Catholic Mass, °I'm gonna w*p
you wid da ugly stick!¨ You may feel a powerful sense of impending doom,
this is because you are about to die. Men may experience impotence, but
only during intercourse. Otherwise, a powerful erection will accompany
your daily °walking-around time.¨ Do not take this product if you are un-
easy with lockjaw. Do not be near a ringing telephone that works at 900
MHz or you will be very dead, very fast. We are assuming you have had
chicken pox. You also may experience a growing dissatisfaction with life
along with a deep sense of melancholy-join the club! Do not be concerned
if you arouse a few ticks from a Geiger counter. You might want to get a
one-month trial subscription to Extreme Fighting. The hook shape of the
pill will often cause it to become caught in the larynx. To remove, jam a
finger down your throat while a friend holds your nose to prevent the pill
from lodging in a nasal passage. Then throw yourself stomach first on the
back portion of a chair. The expulsion of air should eject the pill out of the
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mouth, unless it goes into a sinus cavity, or the brain. WARNING: This drug
may shorten your intestines by twenty-one feet. Has been known to cause
birth defects in the user retroactively. Passing in front of TV may cause the
screen to moiré. Women often feel a loss of libido, including a whole octave
lowering of the voice, an increase in ankle hair, and perhaps the lowering
of a testicle. If this happens, women should write a detailed description of
their last three sexual encounters and mail it to me, Bob, Trailer Six, Fancy-
land Trailer Park, Encino, CA. Or E-mail me at hot-guy.com. Discontinue
use immediately if you feel that your teeth are receiving radio broadcasts.
You may experience °lumpy back¨ syndrome, but we are actively seeking
a cure. Bloated fingertips on the heart-side hand are common. When fin-
ished with the dosage, be sure to allow plenty of °quiet time¨ in order to
retrain the eye to move off stationary objects. Flotation devices at sea will
become pointless, as the user of this drug will develop a stone-like body
density, therefore, if thrown overboard, contact your doctor. (This product
may contain one or more of the following: bungee cord, plankton, rubber,
crack cocaine, pork bladders, aromatic oils, gunpowder, corn husk, glue,
bee pollen, dung, English muffin, poached eggs, ham, Hollandaise sauce,
crushed saxophone reeds.) Sensations of levitation are illusory, as is the
sensation of having a °phantom¨ third arm. Users may experience certain
inversions of language. Acceptable: °Hi, are how you?¨ Unacceptable:
°The rain in Sprain slays blainly on the phsssst.¨ Twenty minutes after tak-
ing the pills, you will feel an insatiable craving to take another dose. AVOID
THIS WITH ALL YOUR POWER. It is advisable to have a friend hand-
cuff you to a large kitchen appliance, ESPECIALLY ONE THAT WILL
NOT FIT THROUGH THE DOORWAY TO WHERE THE PILLS ARE.
You should also be out of reach of any weapon-like utensil with which you
could threaten friends or family, who should also be briefed to not give you
the pills, no matter how much you sweet-talk them.
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SoIving The HeaIth Care Crisis
Thursday, March 5, 2009
I anxiously await hearing what solutions Washington comes up with regard-
ing our Health Care nightmare. I realize this is a bit of a different blog, but I
did practice Internal Medicine in Santa Monica for 23 years. I also admitted
hundreds of patients to the hospital. I have witnessed for many years the
extreme waste within the medical system.
Two of my children are in Health Care. One is a third year resident in
Anesthesia at UC San Francisco and one is completing her first year of
medical school at USC. I was talking with them the other day about their
feelings regarding waste in the system. After speaking with them, I decided
to bring up a very, very delicate issue. My daughter has become fully aware
of this problem in less than one year of her training. I have now seen this
for 30 years.
The issue is all about °rationing¨ care. Rationing simply means giving more
care to some and less care to others. Rationing is nothing new to anyone.
Nearly everything in our lives is rationed in one way or another. With regard
to healthcare, we have elected as a coutry to ration care based upon social
and economic status. So, we have over 40 million un-insured and tens of
millions more receiving less than standard care.
Medicine needs a bailout just like the rest of the country. It has been over-
spending resources and very poorly allocating valuable resources. We have
to begin to choose as a country how we spread our resources. Medicine
is like everything else. So, the question is, are we happy with what we
have? If not, we have to begin changing how we spend our assets of
money, equipment, personel, hospitals, vaccines, bypass surgery, joint re-
placements, etc.
When there were inadequate number of kidneys for transplant, committees
decided who got the kidneys. The same happened with bone marrow trans-
plants. Now there are inadequate resources available in nearly every area.
We must change our rationing position. I believe we need to look at end
of life spending on truly hopeless cases. We spend 93% of the Medicare
dollars in the last several years of life. Perhaps this should be looked at?
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We all realize what I am referring to and it is so painful. On the other
hand, do we really want to keep our ICU hospital beds full and neglect
basic vaccines and preventive care for young and productive individuals?
No other country in the world gives out unlimited care to everyone, we
certainly don't either.
Where should the resources go?
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Desire To CIean?
Tuesday, March l0, 2009
Quick question:
How many of you have noticed a desire to °clean up stuff¨ after medicating
with Sativa strains? I know there is noone out there who cleans up a lot
after some monster kush.
This is also a peculiar °side effect¨ of moderate to high dose steroids. In-
teresting.
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WouId I Recommend Cannabis for a Patient
With Drug ProbIems?
Wednesday, March ll, 2009
Can I/Would I recommend cannabis for someone with a history of drug
abuse or alcoholism?
The short answer is Yes.
1. Based upon 30 years of clinical experience, I believe that nearly 1/2 of
patients in AA use cannabis and I am certain it helps many of them.
2. Although lacking in evidence, it has been my experience for many years
that cannabis, particularly if correct strains are used, helps substance abuse
patients find the feelings they crave.
I recently have been following a few meth patients. I figured that ANY
minute using cannabis is better than smoking meth. So far, they are doing
better.
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Cannabis fights MRSA
Thursday, March l2, 2009
So, what is MRSA? It is an increasingly common and at times life threaten-
ing staph infection that is resistant to most if not all antibiotics. The most
common presentation of MRSA infections are with dermatological infec-
tions.
For many, many patients this infection ruins their lives. For others it is an
expensive and uncomfortable skin infection that just never goes away.
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These guys
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, studied using various cannabinoids, including THC, CBD
and CBN, for their anti-bacterial function. It turns out they have terrific
staphylococcus killing power. The cannabinoids work in an unknown man-
ner, but I am certain many more studies will be done.
Another Reference
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I recently had a patient who started using a cannabis topical solution for her
severe MRSA infection. She has had nearly complete remission.
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The MiracIe of Cannabinoid Activation
Tuesday, March 24, 2009
Think about the following facts:
1. The first species that crawled out of the muck and mire with cannabinoid
receptors and production was hundreds of millions of years ago probably.
2. Cannabis the plant appeared approximately 100,000 years ago proba-
bly.
3. For certain, the plant came a very, very long time after the presence of
cannabinoids and cannabinoid receptors
4. Only humans can prepare the medication, or ACTIVATE it, although
every species will be effected after activation
So, just to make the point, I feel that the cannabis plant and man have a
special connection as man is only direct benefactor. In the natural green
plant, THC, CBD and the other cannabinoids we love so much, are in their
°acid¨ form. In other words, THC is actually THC-A in the plant and has
no currently known effect on brains. It is not active, until the COOH or acid
group is removed allowing the THC to now °fit¨ into our receptors.
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http.77WWW.Webnd.con7heWs72uuBu9u47na¡1¸uaha-chen1caJs-nay-
f1ght-n¡sa
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http.77pubs.acs.o¡g7do17abs71u.1u217hpBuu2ô73
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Pretty interesting stuff.
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MPP Director of Government ReIations
Aaron Houston breaks down his testimony
to Congress.
Monday, April l3, 2009
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Cannabis and Insomnia
Monday, April l3, 2009
Insomnia is an extremely common condition. There is not one of us who has
escaped this entirely. When insomnia is mild and intermittent, it is just part
of life. However, insomnia can become a very serious problem for many
patients.
There are various kinds of insomnia and various ways in which insomnia
presents itself. For some patients, the insomnia is just associated with diffi-
culty turning off their brains when falling asleep. Otherwise these patients
feel fine if not tired. For them, the use of cannabis, generally of Indica ilk,
works extremely well. They dose themselves in one of many ways: smok-
ing, vaporizing, edibles, tinctures, etc. The success rate for these patients
is very high.
The second type of insomnia, is where the patient falls asleep very easily,
but keeps waking up. The typical awakening hours are 1 AM or 3 AM and
then again around 3 AM. These long nights of clock watching are torture
for most patients. Additionally, most find that just taking some cannabis
at night is not enough. Even with nightly Indica, they still keep awaken-
ing. These patients do feel better than without any cannabis, but far from
ideal. These patients almost always have daily and severe anxiety. On their
days off, they often will medicate with Sativa strains, but during the week,
it is tricky to medicate with Sativa strains. This is where I encourage my
patients to use Sativa Tinctures. These are solutions made with alcohol/g-
lycerin. They can easily be sprayed under the tongue, work very well and
are very private. A proper tincture, properly used, will help with daily anx-
iety without causing any sedation or °high¨. The patients soon find that the
daytime Sativa treatment, solves their frequent awakening. Magic!!
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How Pharmacy SheIves Were Stocked In
The Past
Tuesday, April l4, 2009
Read carefully. These are sample bottles of Cannabis Tincture from the
1800's thru 1940.
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HeaIth Issues and Gay Marriage
Friday, April l7, 2009
As a physician, my only °agenda¨ must be my patients health and comfort.
This involves preventive issues as well as °disease¨ issues. None of us
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would minimize preventive health care.
I do not know how much gay marriage restricts extra-marital affairs, but
it does a reasonable job among heterosexuals. I would imagine, that gay
marriage must decrease multiple partner exposure therefore leading to de-
creased exposure to HIV.
How many lives might be saved? How much money would be saved? I
don't know. At this point in time we can't lose lives and money to politics.
Does anyone know about studies regarding this issue? Perhaps this is an-
other way to help pursuade powers that be?
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Cannabis and Our Lungs
Sunday, April l9, 2009
If you could travel to the early 1900's and walk into any pharmacy or Home-
opathy Shoppe, you would find dozens of Cannabis tinctures on the shelves.
These tinctures(made by Pharma), both Sativa and Indica, had 100 spe-
cific AMA approved medical indications. It was easy to medicate and few
smoked cannabis.
After prohibition and the Stamp Act in 1937, these tincture bottles became
old but beautiful and dry antique bottles. I have photos of these on the wall
in my office.
So, as these tinctures went away, everyone smoked more and more, until
smoking was felt to be the only way to medicate. Yes, there is vaporization
and I always do encourage it as one of many options.
Tinctures are returning and on the shelves, at least in Venice, Ca, of most
dispensaries. They work great, are available in both Sativa and Indica for-
mulations, are subtle and particularly great during the daytime.
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If you read Dr. Tashkin's latest review of cannabis and lung cancer or
COPD, he believes that cancer fromcannabis alone probably does not cause
lung disease. However, in large part he relates this to the amount of smok-
ing one does. If a person is smoking 20 joints every day, I would advise
them they ARE at increased risk. There is plenty of tar in cannabis. So,
what to do? This is what I tell my patients:
1. Use all forms of the medication so that smoking can be more limited.
2. Whether or not smoking cannabis causes lung disease, smoking less and
using tinctures gives the cannabis patient more freedom.
3. Try keep smoking to less than 3 joints daily. If more medication is
needed, try, as possible to use edibles, tinctures, sub-lingual preps, vapor-
izing, etc. The reason I choose 3 joints is based upon Dr. Tashkin's com-
ments. He believes that on average 1 joint ¬ 2 cigs. This is a guess. Any-
way, that would be 1/2 pack of tobacco/day, which is below the toxic level
for MOST patients.
4. If the patient develops a cough, they should cut back on smoking and try
harder to switch to alternate forms.
3. Finally, as we study cannabis strains in the community, let's add °tar¨ to
the list. Perhaps we can begin to grow strains with less and less tar?
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Don't Get "High".. Get "WeII"
Wednesday, June l7, 2009
I'd like to talk about the use of cannabis in a dose and manner consistent
with feeling well but not °high¨. In this blog, I'll explore tincture usage and
in my next blog I'll talk about strains that don't make you feel °high¨. These
strains are intended for patients who are in need of treating pain, anxiety,
depression or other symptoms that make them feel ill during the day and
therefore must be treated during the day. So, howdo we use cannabis during
the day at therapeutic doses but without getting high? Today I will speak
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about using daytime sativa tinctures. By the way, how many of us have
used prescriptions for pain/anxiety/ADD that clearly make us quite °high¨
but are socially and legally permissive?
During follow up visits, I have been collaborating with patients on how to
assess their tincture dosage. Then we work together to improve the results
by modifying how they take the tincture. I tell them to slowly increase the
number of °spritzs¨ under their tongue until they feel a little buzz. Then
I ask them to decrease their dose to 30% from that amount and use that
dosage as their daytime Sativa dose. The results have been that they do not
feel high, in fact they really don't °feel¨ anything. They just feel well with
the ability to handle their pain or anxiety much better.
Additionally, with this method, many patients sleep through the night with
much less cannabis or other medication.
Thoughts?
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What My Patients Have Learned
Sunday, June 2l, 2009
I routinely discuss with patients the different effects of Sativas and Indicas.
I counsel them to try different strains and see which is most effective in
treating their symptoms. In a recent e-mail survey I asked 447 patients
to correlate the effects they achieved with the strains that they used. The
results:
EFFECT STRAIN
Focus Sativa (81%)
Motivation Sativa (94%)
Relaxation Indica (92%)
Increase Appetite Indica (72%)
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Reduce Anxiety Sativa (63%)
Daytime Anxiety Sativa (89%)
Reduce Nausea Indica (82%)
Feel Happier Sativa (90%)
Severe Pain Indica (90%)
Tranquility Indica (88%)
It has always been a challenge with cannabis to predict the results after
medicating, especially with edibles. Tinctures have really made a difference
for people who need to use cannabis at therapeutic doses during the day
without getting high. Many of our patients now have access to a tincture
that has very consistent effects and a predictable time of activation. This
tincture doesn't work for every single patient (only 83%) who have tried it,
but what medicine does?
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An EmaiI From a Patient
Wednesday, June 24, 2009
Dear Dr. Frankel:
I gave up smoke last January because I got tired of the constant coughing
and pernicious effects. The edibles I have obtained from some of the dis-
pensaries around Venice are overpriced and generally weak potency. So
far I have not gotten any result from them. Would you recommend using a
vaporizer? If so, do you have a brand name that is affordable? That °Vol-
cano¨ is pretty pricey. Please let me know whether you think they are a safe
alternative to smoke and if they are harmful in any way to the respiratory
tract.
Thanks.
Your Patient
D
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Dr. Frankel Responds:
Hi there,
Here are some thoughts.
1. Consider making your own edibles
2. Try using Indica or Sativa tinctures. They are now in better supply in
the Venice Dispensaries. You can google °make cannabis tinctures home¨
and find lots of cool recipes for making tinctures. They can be made VERY
strong at home just using nearly pure alcohol (the drinking kind) and the
strain of your choice. It will probably be very bitter, but experiment with
flavorings and if you develop a good recipe, email it to me. I might then
post a tincture page.
Again, the most significant difference between a tincture and an edible, is
that with the tinctures you can control the °effect¨ as the cannabinoids are
absorbed directly into your blood stream. With edibles, all the cannabinoids
are absorbed through the liver making the cannabis experience very sedating
and very long acting.
3. There are vaporizers under $100.
Hope this helps,
Allan
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Treating MuItipIe ScIerosis With Sativa
Friday, July 3l, 2009
Many of us know someone with Multiple Sclerosis. The combination of
changing neurological problems and severe pain makes MS a challenge to
treat.
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GW Pharmaceuticals makes a Sativa based medicine, named Sativex. It
is indicated for the pain of MS and does help. Sadly, it is illegal in this
country.
Recently, as more great Sativa tinctures have hit the market, I have noted
that I have been receiving notes and calls frompatients telling me howgreat
they are doing on daily Sativa tinctures available at most local dispensaries.
I can't say it works as well or perhaps even better than Sativex. On the other
hand, the success rate is very high and I would encourage any MS patient
of mine to try daytime Sativa tinctures.
As the pain with MS is often a burning and hypersensitive type of discom-
fort, I would also encourage patients with a neuritic component to their pain
to try the same tincture.
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PsychopharmacoIogy and Cannabis
Saturday, August l, 2009
I practiced °straight¨ Internal Medicine for 24 years. Over those years, I
would estimate that 1/3 of my patients were seeing me for various mood
disorders. I became very active working with these patients with low dose
medications. I didn't have cannabis available to use in those days.
Currently, many of my patients come in on various psychopharmmeds and I
frequently work with their prescribing physician thereby co-managing both
the cannabis and psychopharm/meds side.
Now in my third year of working with these patients, I am very comfortable
managing both sides when appropriate. Very frequently, this has enabled
the patient to use less medications along with the cannabis tinctures.
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Reminder Concerning the "Card"
I know I already blogged once on this topic. However, so many patients
call and ask about the level of their privacy and the so-called °list¨. Here
are the facts:
1. The state/county card is OPTIONAL. If a patient chooses for whatever
reason to get the card, their name is then on state and probably federal lists.
I don't know that these hurt anything, but I certainly cannot be ok with
them
2. The physician letter a patient leaves my office with is all that is required
legally or to enter dispensaries.
No °card¨ means all is private.
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MedicaI Cannabis and Arthritis
Over 31 million Americans suffer from arthritis. There are two common
types, rheumatoid arthritis and osteoarthritis. Both affect the joints causing
stiffness, pain and swelling.
The use of cannabis for musclo-skeletal pain in western medicine dates to
the 1700s. Recent research suggests that cannabis-based therapies are ef-
fective in the treatment of arthritis and other hip, joint and connective tissue
disorders.
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The well-documented analgesic properties of cannabis make it useful in
treating the pain associated with arthritis, on its own or in conjunction with
other medications. Cannabis has demonstrated an ability to improve mo-
bility and reduce morning stiffness and inflammation.
Human studies have shown cannabis to be an effective treatment for
rheumatoid arthritis. Research has also shown that patients are able to re-
duce their usage of potentially harmful Non-Steroidal Anti-Inflammatory
drugs (NSAIDs) when using cannabis as an adjunct therapy.
Cannabis has been shown to have powerful immune-modulation and anti-
inflammatory properties. It could, in turn, play a role in actually treating
arthritis and not just in symptom management. One of the earliest records
of medical use of cannabis, a Chinese text from around 2000 BC, notes that
cannabis °undoes rheumatism,¨ suggesting these effects were known even
then.
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More On MuItipIe ScIerosis
Saturday, August 8, 2009
Yesterday, I saw another MS patient. This one was different than the prior
one who had severe MS neuropathy. BTW, she remains pain free using the
Sativa Tincture AM and PM! Very exciting.
The MS patient I saw yesterday did not have very much pain. She had a lot
of spasticity of her upper and lower extremities making it nearly impossible
to walk without her husband's assistance as well as a walker. After the
visit she went and purchased a Sativa Tincture and took her first dose. She
had a very dramatic improvement and drove back with her husband just to
showme howshe could walk into my office without her walker or husbands
assistance.
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I am extremely excited by these two patients and will keep reporting results
over time.
Yup, clearly no medical benefit here.
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A Patient With FibromyaIgia Improved With
Cannabis
Thursday, August 27, 2009
Dear Dr. Frankel,
I cannot thank you enough for the consultation and education you gave me
last week. After flailing around for many years, I am so grateful to have
found you and to have my world open up to additional tools for treating
fibromyalgia.
When we met I was feeling desperate and at the end of my rope, having just
been told by the rheumatologist how dangerously close I was to a severe
episode of increased chronic pain. Your recommendations prevented that,
and I am feeling incredible relief.
I am still figuring out what is correct for me each day and I thank you so
much for leading me toward a regimen that will work with efficacy. I have
spoken to others who paid less for consultations but they were in no way
thorough or enlightening. The consultation with you was a seminar.
Thank you sincerely,
JTS
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Marijuana Tincture Recipe, How to Make
Cannabis Tincture
Saturday, August 29, 2009
I qenerally never edit older posts, but have jound that is is important to
add some comments with reqard to siqnijicant chanqes in the Cannabis
Medicine Tincture's available, at least in the Los Anqeles area. The cost
oj projessionally made CBD Rich tinctures jor anxiety, manijestations oj
anxiety, pain, particularly neuritic and many other conditions, CBDbased
or ªCannabidiol" based tinctures and capsules are the juture and have in
jact become the present. As usinq CO2 extraction is not jor patients at
home ~ yet ~ I suqqest you check out some oj these tinctures at some local
collectives.
As the CO2 extraction process is nearly 100% efficient, the cost ends
up being not much different than making it yourself. Also, unless you
find some rich CBDor flowers, it will just be a THCextraction, which is
good, but just not great. It is well worth checking into if you are dealing
with anxiety or pain. For Multiple Sclerosis and many degenerative
neurological disorders, CBD is truly a miracle.
For the cost of a movie, popcorn and a drink you can now give it a go.
I really think it is well worth few bucks and trip.
By Jay R. Cavanaugh, Ph. D.
Many patients who utilize and benefit frommedical cannabis do not wish to
smoke due to the perceived health hazards of smoking or for other personal
reasons. These patients are in something of a bind. Smoking cannabis de-
livers the active cannabinoids within seconds. Medicine is absorbed in the
lungs and goes directly to the brain and general circulation. The same ef-
fect can be achieved with a vaporizer, which is safer than smoking burning
vegetable matter. Since the effects of inhaled cannabis are so quick, it is
easy for patients to titrate their dose by simply waiting a minute or two in
between puffs.
Oral cannabis, such as our Better Bud Butter, is absorbed in a very dif-
ferent fashion from smoking or inhalation. The GI tract gradually absorbs
Cannabinoids over the course of one to two hours. Medicine is processed
first by the liver, which converts some cannabinoids such as delta nine to
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delta 11 version of THC. Orally delivered cannabis requires four to ten times
the amount of the smoked version in order to achieve the same effect. Orally
delivered cannabis can present a problem in achieving the required or de-
sired dose level in any consistent fashion.
Tincture is designed to address the problems of rapid medicine delivery and
consistent dosing. Most tinctures are made to be used under the tongue or
sublingually. English pharmaceutical companies are presently working on
a cannabis extract °spray¨ that can be used under the tongue in a similar
fashion. These sprays are not expected to be approved for use in the United
States for years and will be very expensive. Absorption by the arterial blood
supply under the tongue is completed in seconds. One trick is to not swallow
the dose as, if swallowed, absorption will be in the GI tract. Many patients,
though, add their tincture to a cup of tea or cranberry juice for easy deliv-
ery. When tincture is used in a beverage, absorption will be slower than
if absorbed under the tongue. While tincture absorbed in an empty stom-
ach is accomplished in minutes, conversion in the liver remains, as does the
difficulty in titrating dose. Usually, a tincture dose is delivered by means
of a medicine dropper or a teaspoon. A rule of thumb on dose is that pa-
tients receive benefit from 3-4 drops to a couple of full droppers depending
upon the potency of the tincture and the patient's own unique requirements
among other factors.
The methods listed below will detail two major methods of preparing tinc-
ture. While the methods are optimized for purity and potency, ultimately
these will largely be determined by the purity and potency of the cannabis
from which the tincture is made. Another item of note in regard to starting
material for tincture is the patient or caregiver selection of strain. A rough
rule of thumb is to select Indica dominant strains for cramping and muscle
spasticity and Sativa dominant strains for pain relief. The reality, though, is
often that the strain is unknown or not well characterized. Trial and error is
usually required to acquire the appropriate strain and the proper dose level.
General Rules:
Tincture is an extraction of active cannabinoids from plant material.
Cannabis contains many chemicals that can either upset the stomach or taste
nasty. One of the goals of extraction is to secure the cannabinoids while
leaving out as many of the terpenes and chlorophylls as possible. Both
heat and light adversely effect cannabinoids and should be avoided or min-
imized. Tincture should be stored in airtight dark glass containers kept at
room temperature or below. Avoid plastic containers. The ethanol in the
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tincture may solubilize some of the free vinyls in the plastic.
Cold Method with Ethanol
Making tincture cold preserves the integrity of cannabinoids. To be potent,
this method requires starting material high in cannabinoid content such as
flowers or kief made fromtrimand leaf. The material must be mold free and
dry. Drying can be accomplished in the freezer (-4-10 degrees Celsius) or
better yet by placing in a liquid proof bag into a dry ice/ethanol ice bath (-70
degrees Celsius). Once water has been removed then the surface area of the
starting material requires expansion. This can be accomplished a number
of ways but two ways stand out:
Using flowers (bud)- Place dried buds in a coffee grinder and pulse until
thoroughly ground but not powdered.
Making kief- Rub dry trimand leaves over a silk screen. Collect the powder
the comes through the screen. It should be a very pale green. °Kiefing¨ is
an age old way of extracting trichomes from plant material.
Whether kief or ground bud is used both should kept ice cold for this prepa-
ration. Similarly, the ethanol to be used should also be ice cold throughout
the process.
Selection of alcohol- ethanol or ethyl alcohol is the form of alcohol that can
be used by humans. The proof listed on commercial alcohol refers to the
percentage of ethanol that the beverage contains. The proof is twice the per-
centage, so 80 °proof¨ means that the mixture contains 40% ethanol. The
higher the alcohol content used, the better the extraction will work. Ide-
ally, 200 proof ethanol would be best except that ethanol cannot be distilled
to this proof so benzene is used to remove the last vestiges of water. This
makes °pure¨ ethanol poisonous.
Many folks use °Everclear¨ which stands at 190 proof or 93% ethanol. Ev-
erclear has no taste. Apparently, Everclear is not available in all States. A
close second choice is 131 proof rum. This is a light amber liquid that is
73% ethanol that has a sweet taste. One of our caregiver writers will use
nothing but Korbel brandy because she likes the taste. Others use iced Rus-
sian vodka. These °normal¨ distilled spirits are 40% to 30% ethanol. Some
patients find that the higher proofs ethanols like Everclear and 131 rumburn
too much under the tongue. If burning is a concern consider a high quality
90-100 proof Vodka.
Cold Extraction and purification- Use at least one ounce of starting material
to each pint of ethanol. Place cold powdered kief or ground cannabis flow-
ers together with ethanol in a glass quart-mixing jar. Close the jar tightly
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and vigorously shake for five minutes then return to the freezer. Continue
to agitate the mixture every few hours with refreezing. Continue for a pe-
riod of two to three days.
Pour the cold mixture through a double thickness of sterile cheesecloth.
Save the cheesecloth °ball¨ for topical uses or use the material to make bud
butter once dried. The liquid collected through the cheesecloth should then
be filtered twice through a paper coffee filter. Use gloves throughout the
process, as it is necessary to squeeze the cheesecloth and coffee filters to
facilitate the extraction. Without gloves some of the material will be ab-
sorbed on the skin.
If Everclear is used the tincture will be pale green to golden. If 131 rum is
used an amber tincture results. Dark green tinctures mean that excess plant
material is present. This does not mean that the tincture will not be potent,
just taste nasty. When Everclear is used, various flavor extracts may be
added (vanilla, raspberry, etc.). Be careful to use only a few drop of flavor
extract.
Traditional or Warm Method
The old fashioned (and effective) way to make tincture from trim, leaf or
°shake¨ is to grind the plant material to expose surface area. A fine grind
is not needed and will just make the tincture cloudy. A rough chop will
do. Most folks can't afford to use kief or bud for tincture but may have leaf
handy. If so, this is the way to go. Use ethanol as described above in the
same proportions. The key difference is that in this preparation the materi-
als are kept warm (not hot). Light must be avoided.
Place the ethanol and chopped cannabis in a large glass Mason jar. Shake at
least once a day. Place the jar in a brown paper bag or otherwise shield the
jar from light. Leave in a warm spot (near a window) for 30-60 days. The
mixture will turn a very dark green. Strain as previously described through
cheesecloth. Save the °shake ball¨ for topical applications.
While this method produces a nasty tasting tincture, it is powerful. It may
upset some fragile stomachs. It is recommended that Warm Tincture be
used orally in cranberry juice or coffee with sugar. Keep the filtered tinc-
ture in light blocking glass jars or bottles in a cool dry place (refrigerator or
freezer is fine). The shake ball should also be kept in the freezer. For topi-
cal applications, just take out the cold shake ball and apply a few drops of
fresh tincture to the cloth then hold it on the affected area for a few minutes
with gentle rubbing.
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Glycerine-based Tincture
by Leanne Barron
.
You need to use food grade U. S. P glycerine, this can be relatively hard
to find inexpensively but a gallon lasts a LONG time. Glycerines have a
shorter shelf life than alcohol based tinctures and while they can sit on the
shelf I refrigerate mine. Vegetable glycerine has nearly no impact on blood
sugar or insulin and is very low in calories (4.3 per gram). It's sweet taste
makes the tincture more palatable than the alcohol based tincture and is a
suitable substitute for those concerned with alcohol consumption. Add the
amount of cannabis that you desire for potency. I added 6 oz of roughly
trimmed (finger trimmed the leaves off) cannabis to 1 gallon of glycerine.
For your personal preference add more cannabis or less depending on de-
sired potency. I blend mine, using a coffee grinder, blender or if you are
lucky enough to have a Vita Mix. Make sure there is no other product mat-
ter in whatever you use. I use a clean basting brush to clean out my Vita
Mix when I am done powdering my cannabis.
Place in a crockpot on low. Some crockpot's low settings are too high so
you may not be able to use yours. A °Keep Warm¨ setting if you have it is
the best choice. Too hot, and you are killing the properties you are trying
to extract, you want the mixture to be as warm as possible without boiling,
I left my tincture like this for 24 hours. I have heard people leaving the
tincture from anywhere from 4-6 hours to 3 days. You can try the tincture at
intervals to decide when you are done. REMEMBERthat glycerine tincture
retains heat VERY WELL, do not burn yourself!!
If you do not have a crockpot you can place the herbs in a clear, sealed jar
in a warm, sunny spot and accomplish the same thing over 4 weeks. Some
people make their °sunshine tinctures¨ over 2 weeks. I do not feel that is
long enough, especially in colder weather. Some leave them in the sun for
up to 12 weeks. I have never seen a need to go that long myself. Shake
each day to mix the herbs in.
When ready to strain use cheesecloth and a strainer to extract the cannabis
debris, the THChas been extracted and the tincture is ready to use. The best
way to store is in a glass amber bottle. A good place to obtain a large bottle
for the bulk of your tincture is a brewery store that has supplies to make
wine or beer. I also obtained a few small amber bottles with eye droppers
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for convenience. It takes a lot longer to strain glycerine than it does alcohol,
the tincture will drip when strained instead of flow.
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Are Cannabis Docs Seeing Too Many
Patients?
Monday, August 3l, 2009
Check out this article: http.77WWW.huff1hgtohpost.con72uu
97uB73u7coJo¡ado-atto¡hey-gehe¡aJ¸h¸272227.htnJ
Apparently in Colorado, there are 10,000 Medical Cannabis patients. The
latest issue is that there are claims that these patients for the most part are
being seen by a small number of Cannabis Physicians. In other words, they
are concerned that docs are °raking it in¨ by seeing tons of patients every
day.
For example, it is claimed in this article that a number of the docs see 10%
of the state's cannabis patients. This would represent approximately 1000
patients per year.
So, let's assume that there are only 10 Cannabis Docs in Colorado (many
more in reality). If each of these docs saw 10% of the state's patients, that
would be 1000 patients per doctor. As there are approximately 230 work
days in a year, this would mean that each doctor is seeing 4 patients per
day. This is certainly NOT very rushed. Assume it is double, and a solo
doctor in Colorado sees 8 patients daily. This would mean that he/she is
seeing 20% of the state's patients. This would allow each patient nearly
one hour.
So, is an investigation warranted? I doubt it considering that most primary
care docs see 30 or more patients per day!!
So, where should the investigation begin?
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What Does This TaIk Regarding Pot
Potency ReaIIy Mean?
Wednesday, September 9, 2009
I am sure most of us have heard that Cannabis is much °stronger¨ than it
used to be. There are some cannabis strains with over 20% THC. There are
also plenty of strains with 6 or 7% similar to 20¹ years ago. So, the most
we can say is that some strains have been bred to produce more THC.
This elevated level of THC, in both Sativa strains and Indica strains, does
not necessarily mean that the THC always has some increased °high¨ as-
sociated with it. It certainly does not mean that it is better, more potent or
anything else, other than there is more THC in the strain. In some studies,
high levels of THC has been found to be much less °potent¨ if the Terpenes
in the cannabis are removed.
So, we are very far from understanding what the various levels of THC,
CBD and CBN mean clinically.
I hope that in this era where we are beginning to study strains and their
clinical effects, we must do this in at least a single blinded manner, else
assumptions of higher levels of THC or other assumptions will contaminate
our attempt to obtain clean and meaningful data.
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Chinese Rice NoodIes and Cannabis
Thursday, October l, 2009
I was just reading that the FDA and the Chinese in Chinatown are fight-
ing over whether the manner in which Rice Noodles are packaged is safe.
These noodles have been packed and cooked in the manner now debated
for hundreds of years.
Sound familiar? If we still can't figure out a rational way in which to deal
with Chinese Rice Noodles, how are we expected to come up with easy
solutions for cannabis.
At least Rice Noodles are not illegal yet!
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Cannabis Tinctures for Anxiety, Insomnia
and Depression
Every day in my office I see and speak with patients who have tried the
sativa tinctures I have spoken about in prior blogs.
With some of the new and improved tinctures, patients are reporting that
their daytime anxiety/depression is well managed with just a few °sprays¨
of tincture under their tongue. They never get buzzed, high or stoned. It is
NOT that they could not use a few more sprays and get very stoned, it is
just that they are using the tincture as their medicine.
These same patients tell me that in general, if they are smoking it is to kick
back and relax ?? recreational?? At the same time, they view the tincture
administration as their medicine.
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So, is it possible that perhaps cannabis for recreation might be smoked or
vaped or eaten, but for controlled medicinal use °tincting¨ is the way to
go.
We can get into an endless debate whether relaxing and °chilling¨ with
smoked cannabis is a crime, recreational use or actually treating anxiety
and depression the hallmarks of our society??
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Taxation and ReguIation of Cannabis
I wish to go on record as stating that I am strongly in favor of taxation and
regulation of cannabis. IF this means, that medical cannabis is no longer a
specialty for me to practice, so be it. I am in favor of liberal legalization
and regulation.
I hear everyone speak about taxation of cannabis as the reason to do this. I
would remind folks, that most dispensaries are already paying sales tax and
the most seem ok with paying additional city tax. I think the real benefits
for the California economy lay in two other areas:
1. Like it or not, if we de-criminalize cannabis in California, tourism will
dwarf Amsterdam and LA and California will flourish.
2. I would imagine Pharmaceuticals would be very interested in setting up
some labs in California to see what products make sense in the °Rx¨ world.
Why can't the state °own¨ a piece of the action.
Just consider the Gold Coast of California hosting cannabis to the world of
tourism, capitalism and Pharma???
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Prevention of AIzheimer's Disease
PathoIogy by Cannabinoids
Monday, October 5, 2009
Alzheimer's disease (AD) is characterized by enhanced -amyloid peptide
deposition along with glial activation in senile plaques,
selective neuronal loss, and cognitive deficits. Cannabinoids are neuropro-
tective agents against excitotoxicity in vitro and acute brain
damage in vivo. This background prompted us to study the localization,
expression, and function of cannabinoid receptors in AD and the
possible protective role of cannabinoids after A treatment, both in vivo and
in vitro. Here, we show that senile plaques in AD patients
express cannabinoid receptors CB1 and CB2, together with markers of mi-
croglial activation, and that CB1-positive neurons, present in
high numbers in control cases, are greatly reduced in areas of microglial
activation. In pharmacological experiments, we found that
G-protein coupling and CB1 receptor protein expression are markedly de-
creased in AD brains. Additionally, in AD brains, protein
nitration is increased, and, more specifically, CB1 and CB2 proteins show
enhanced nitration. Intracerebroventricular administration of
the synthetic cannabinoid WIN33,212-2 to rats prevent A-induced mi-
croglial activation, cognitive impairment, and loss of neuronal
markers. Cannabinoids (HU-210, WIN33,212-2, and JWH-133) block A-
induced activation of cultured microglial cells, as judged by
mitochondrial activity, cell morphology, and tumor necrosis factor-release,
these effects are independent of the antioxidant action of
cannabinoid compounds and are also exerted by a CB2-selective agonist.
Moreover, cannabinoids abrogate microglia-mediated neuro-
toxicity afterA addition to rat cortical cocultures. Our results indicate that
cannabinoid receptors are important in the pathology of AD
and that cannabinoids succeed in preventing the neurodegenerative process
occurring in the disease.
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Key words: Alzheimer's disease, -amyloid, cannabinoids, microglia, neu-
rotoxicity, neuroprotection
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65 Year OId Therapist Treated as Drug
Addict In ER
Tuesday, October 6, 2009
I just got off the phone with a patient of mine. She is a 63 year old profes-
sional therapist who very rarely, if ever had used cannabis in the past. She
came in as an obviously legitimate patient with severe degenerative pain.
During our visit, I °warned¨ her about edibles, because many of us know
someone who has taken a little too much of an edible and had a paranoid
reaction. Unfortunately, she did not heed my advice and took too much of
an edible. As a result of over medicating, the paramedics were called due to
her age and she was brought to a local ER. Over a few hours she felt much
better and was discharged.
So far, the story is a common one. The very sad end of the story is that on
her discharge papers from the ER, she was diagnosed as a drug addict and
cannabis abuser!
I would have suggested something along the lines of °drug reaction¨ in-
stead. I am certain the ER has never seen any other drug reactions.LOL
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Dr. FrankeI Made a Tincture
Wednesday, October 7, 2009
I qenerally never edit older posts, but have jound that is is important to
add some comments with reqard to siqnijicant chanqes in the Cannabis
Medicine Tincture's available, at least in the Los Anqeles area. The cost
oj projessionally made CBD Rich tinctures jor anxiety, manijestations oj
anxiety, pain, particularly neuritic and many other conditions, CBDbased
or ªCannabidiol" based tinctures and capsules are the juture and have in
jact become the present. As usinq CO2 extraction is not jor patients at
home ~ yet ~ I suqqest you check out some oj these tinctures at some local
collectives.
As the CO2 extraction process is nearly 100% efficient, the cost ends
up being not much different than making it yourself. Also, unless you
find some rich CBDor flowers, it will just be a THCextraction, which is
good, but just not great. It is well worth checking into if you are dealing
with anxiety or pain. For Multiple Sclerosis and many degenerative
neurological disorders, CBD is truly a miracle.
For the cost of a movie, popcorn and a drink you can now give it a go.
I really think it is well worth few bucks and trip.
At the same time, I do want to make available to as many patients possible
methods to create their own very high quality tincture, as independence
from any legal restrictions may at some times, interfere with availability.
To that end, have fun and don't burn the stuff. Also, consider dropping by a
couple of cc's for testing. I can help get your sample tested for THC/CBD
and the efficiency of decarboxylation for $30. I wish it were free, but this
is a very fair price and we will all learn much.
Ingredients:
1 oz shake select either sativa or indica
8 oz vegetable glycerin
Steps
1. Grind shake in coffee grinder
2. Mix ground shake into the glycerin. If overly thick, add water as neces-
sary. They will easily mix.
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3. Place into oven at 200 degress for 43 min DON'T GO ANY HIGHER
TEMP THAN THIS
4. Take out of oven and let sit and cool for one hour
3. Place into crock pot and set on °keep warm¨. MAKE SURE YOUR
CROCK HAS A KEEP WARM SETTING.
6. °Keep warm¨ for 12 hours
7. Remove and strain thru cheese cloth as many times as needed (usually
around 3 strainings)
8. DON'T BURN YOUR MOUTH. MAKE SURE IT IS COOL BEFORE
BOTTLING into spray or dropper bottles
9. Generally 1/2 dropper bottle or 3 spritzes are adequate.
10. If too strong, dilute with water.
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LegaIIy Grown Cannabis Destroying
Mexican Drug CarteI's Profits
Thursday, October 8, 2009
http.77WWW.Wash1hgtohpost.con7Wp-dyh7cohteht7a¡t1
cJe72uu971u7uô7AR2uu91uuôu3B47.htnJ
... ARCATA, Calif. Stiff competition from thousands of mom-and-
pop marijuana farmers in the United States threatens the bottom line for
powerful Mexican drug organizations in a way that decades of arrests and
seizures have not, according to law enforcement officials and pot growers
in the United States and Mexico. ....
Almost all of the marijuana consumed in the multibillion-dollar U. S. mar-
ket once came from Mexico or Colombia. Now as much as half is produced
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domestically, often by small-scale operators who painstakingly tend green-
houses and indoor gardens to produce the more potent, and expensive, prod-
uct that consumers now demand, according to authorities and marijuana
dealers on both sides of the border.
The shifting economics of the marijuana trade have broad implications for
Mexico's war against the drug cartels, suggesting that market forces, as
much as law enforcement, can extract a heavy price from criminal organi-
zations that have used the spectacular profits generated by pot sales to fuel
the violence and corruption that plague the Mexican state.
While the trafficking of cocaine, heroin and methamphetamine is the main
focus of U. S. law enforcement, it is marijuana that has long provided most
of the revenue for Mexican drug cartels. More than 60 percent of the car-
tels' revenue $8.6 billion out of $13.8 billion in 2006 came from U.
S. marijuana sales, according to the White House Office of National Drug
Control Policy.
Now, to stay competitive, Mexican traffickers are changing their business
model to improve their product and streamline delivery. Well-organized
Mexican cartels have also moved to increasingly cultivate marijuana on
public lands in the United States, according to the National Drug Intelli-
gence Center and local authorities. This strategy gives the Mexicans direct
access to U. S. markets, avoids the risk of seizure at the border and reduces
transportation costs.
Unlike cocaine, which the traffickers must buy and transport from South
America, driving up costs, marijuana has been especially lucrative for the
cartels because they control the business all the way from clandestine fields
in the Mexican mountains to the wholesale dealers in U. S. cities such as
Washington.
ad_icon
°It's pure profit,¨ said Jorge Chabat, an expert on the drug trade at the Center
for Research and Teaching in Economics in Mexico City.
The exact dimensions of the U. S. marijuana market are unknown. The
2007 National Survey on Drug Use and Health estimated that 14.4 million
Americans age 12 and over had used marijuana in the past month. More
than 10 percent of the U. S. population reported smoking pot once in the
past year.
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Mexico produced 33 million pounds of marijuana last year, according to
government estimates. On a hidden hilltop field in Mexico's Sinaloa state,
reachable by donkey, a pound of pot might earn a farmer $23. The wholesale
price for the same pound in Phoenix is $330, and so the Mexican cartels
could be selling $20 billion worth of marijuana in the U. S. market each
year.
°Marijuana created the drug trafficking organizations you see today. The
founding families of the cartels got their start with pot. And marijuana re-
mains a highly profitable business they will fight to protect,¨ said Luis As-
torga, a leading authority on the drug cartels at the National Autonomous
University of Mexico, who grew up in Sinaloa in 1960s and recalls seeing
major growers at social functions in the state capital, Culiacan.
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Got pot? FIy from OakIand
Tuesday, October 20, 2009
By Josh Richman
Oakland Tribune
Posted: 10/17/2009 02:30:48 PM PDT
Updated: 10/17/2009 02:30:33 PM PDT
Oakland International Airport may be the nation's only airport with a spe-
cific policy letting users of medical marijuana travel with the drug.
The policy is spelled out in a three-page document quietly enacted last year
by the Alameda County Sheriff's Office. It states that if deputies determine
someone is a qualified patient or primary caregiver as defined by California
law and has eight ounces or less of the drug, he or she can keep it and board
the plane.
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Deputies warn the pot-carrying passengers that they may be committing
a felony upon arrival when they set foot in a jurisdiction where medical
marijuana is not recognized. But they say they don't call ahead to alert
authorities on the other end.
°We never have. We're certainly within our right to, but we never have,¨
said Sgt. J. D. Nelson, a spokesman for the sheriff's office. °Our notifica-
tion of the passengers is for their own safety and well-being.¨
California voters approved medical marijuana use in 1996, while federal
law still bans all possession and use.
But Oakland attorney Robert Raich notes the Code of Federal Regulations
says a prohibition on operating a civil aircraft with knowledge that there is
marijuana aboard doesn't apply to carrying marijuana that's °authorized by
or under any Federal or State statute.¨
The federal Transportation Security Administration does the screening and
when marijuana or any suspected contraband is found, the
Advertisement
sheriff's deputies are summoned.
Low profile
Oakland's airport policy was enacted in February 2008, but Raich said he
didn't want to publicize it until recently lest the Bush administration change
federal regulations, or lest it become an issue in Obama administration drug
officials' confirmation hearings.
°All other airports in medical cannabis states should have similar policies
but they don't,¨ he said, adding that he hears San Francisco International
and Los Angeles International airports are relatively kind to medical mari-
juana users while airports in Burbank, Ontario and San Diego are not..
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Historic CaIifornia AssembIy Getting ReaI
on MedicaI Cannabis
Friday, October 30, 2009
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PIease HeIp The Cannabis BaIIot Initiative.
Tuesday, December 8, 2009
I have written to you before about the continuing debate by the Los Angeles
City Counsel over cannabis dispensaries in Los Angeles. Just before the
Thanksgiving holiday, the council had a meeting and debated regulations
that
would have essentially shut down all dispensaries within the city. I
personally doubt that the steps taken by the city counsel will be draconian,
but I really don11,t know. None of us know. Therefore I believe the more
certain we can be, the better.
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As things are now, you have the ability to grow cannabis if you are a
medical patient under the Compassionate Use Act as well as possessing up
to
8 oz. We are all aware though that this is still not clear to the legal
system and patients are being hassled all the time.
Until cannabis is legal, your ability to obtain or grow medicine remains
threatened. In addition, research to create better medicines, such as
tinctures, is impossible because samples of cannabis cannot be possessed.
Fortunately, there is now an opportunity to fix this problem. A group of
cannabis entrepreneurs joined together to hire focus groups and conduct
field polls, discovering that 39% of Californians are ready to make change
and legitimize cannabis by taxing and regulating it. The result of their
investment is the Tax Cannabis 2010 initiative. It does NOT legalize
cannabis, however, it guarantees immunity for all adults over the age of 21
to possess up to 1 oz. This initiative will offer cities the opportunity to
allow the sale and distribution of cannabis in their local jurisdictions
according to what they are willing to accept in their communities.
Passage of this initiative will not affect your medical marijuana rights, it
will simply clarify once and for all to the authorities that you are able to
legally possess and grow cannabis.
The campaign is gaining momentum and I endorse their efforts. Already
almost 600,000 signatures have been gathered to put the Tax Cannabis 2010
initiative on the ballot. There has been a flurry of media attention from
the New York Times, to CNN and the Los Angeles Times. Now the cam-
paign
needs your help to get this initiative passed.
Please visit the tax cannabis website and show your support at:
https.77secu¡e.taxcahhab1s.o¡g7page7coht¡1bute
7hRN194u
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Dr. FrankeI Interviewed By CBS. COM
Wednesday, December 9, 2009
Watch CBS News Videos Online
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Dr. Frankel Discusses Tinctures
Watch CBS News Videos Online
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Quick Cannabis Fact
Sunday, December 20, 2009
Marijuana was first federally prohibited in 1937. Today, more than 83 mil-
lion Americans admit to having tried it.
Sources: Morinuono Tox Acr o[ 19S7, Subsronce Abuse onJ Menrol
Heolrn Services AJminisrrorion, Summory o[ FinJinqs [rom rne 2001
Norionol HousenolJ Survey on Druq Abuse (Roc|ville, MD: Deporr-
menr o[ Heolrn onJ Humon Services, 2002), Toble H.1, [rom rne web or
nrrp:://www.somnso.qov/oos/NHSDA/2|1NHSDA/vol2/oppenJixn_1.nrm,
losr occesseJ Sepr. 16, 2002.
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MuItipIe ScIerosis and Cannabis
Wednesday, January l3, 20l0
I have had the good fortune this past year to see a number of Multiple Scle-
rosis patients. The two primary symptoms of MS that Cannabis helps are
°neuritic pain¨ and spasticity. In particular, these patients do extremely well
with a Sativa Tincture. Several of my patients only need to use the tincture
a couple of times/day. The tinctures they use do not get them stoned in any
way. Their functional level and comfort level greatly improve.
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The Time Has Come For Endorsed
Cannabis Testing
Monday, February 8, 20l0
Last week a dispensary was closed in Los Angeles. The stated reason being
that the cannabis was contaminated with various pesticides. Is there reason
to be concerned sure there is. Although almost all foods we ingest do
contain similar contaminants, Cannabis as a medicine should be held to
higher standards.
Here is the rub. I have visited the several °underground¨ cannabis dispen-
saries in California. They all operate very inefficiently as they are not cer-
tain if they have the legal right to exist. Whether it is city/state/federally
based, if we are to held to reasonable standards, we must be able to openly
and fully legally test the product.
Any individual dispensary will find it clumsy and very expensive to test
the Cannabis delivered to them, although this could be affordable if each
strain is purchased in minimum 1 pound increments, the cost is affordable.
Clearly it would make much more sense for all sellers to test their Cannabis
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and receive certificates with test results. Of course there are lots of details
to work out, but it must be done.
Again, if we are nowbeing held to these newstandards, we must be allowed
to legally perform these tests.
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Tardive Dyskinesia HeIped By Cannabis
Friday, March 5, 20l0
Tardive Dyskinesia 8 Reglan
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Tardive dyskinesia is a condition that may develop in patients who use meto-
clopramide, a drug sold under brand names such as Reglan in the United
States. When a patient has been taking certain prescription drugs over a
long period of time, often in high dosages, involuntary, repetitive tic-like
movements can result, primarily in the facial muscles or (less commonly)
the limbs, fingers and toes. The hips and torso may also be affected.
Research indicates that tardive dyskinesia results from damage to the sys-
tems that use and process dopamine. Dopamine is a biochemical substance
produced in numerous areas of the brain. It functions as a neurotransmit-
ter, working with the brain to regulate movement and emotion within the
body.
The best treatment for tardive dyskinesia appears to be prevention, either
by lowering the dosage of a medication known to cause this condition or
switching the patient to a different drug. Tetrabenzine, a medication that
reduces levels of dopamine, has been of some use in treating tardive dyski-
nesia symptoms. Many kinds of °anti-Parkinsonian¨ drugs such as Aricept
and Miraplex appear to offer some benefit as well. For more information
please visit: http.77WWW.ta¡d1vedysk1hes1a.con
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http.77WWW.ta¡d1vedysk1hes1a.con7
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What Happens to Dr. FrankeI if Cannabis
Becomes "LegaI"
Monday, March l5, 20l0
I favor legalization/taxation/regulation. There can be no question that ul-
timately this will be the outcome. It might come as soon as November by
ballot initiative or by the legislature where new legislation was just intro-
duced.
Just because it becomes legal, doesn't mean that it isn't great medicine. Will
dispensaries function as they currently do? Will docs like myself have any
°Recommendations¨ to write? Will the Feds °allow¨ legalization?
In a future blog I will be speaking about the issue of scheduling Cannabis.
It is Schedule I now and if changed to Schedule III, any physician can write
a regular prescription for it, although it would strictly be pharmaceutical.
So, what will I do? I am doing it very actively now. I believe that I will
be involved in research and physician education. However, the areas I am
putting the most time into are tinctures and Cannabis laboratories. These
will always be needed and are desperately needed now. The structure of
my practice may change but my involvement and commitment to Cannabis
will only increase.
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Let's TaIk About Cannabis and Drug
ScheduIes
Monday, March l5, 20l0
As many of you know, Cannabis is scheduled on a federal level as a Sched-
ule I Drug. This places it with cocaine and heroin. One of my biggest fear
with cannabis is what happens with a change in schedule. We all naturally
feel that re-scheduling to Schedule II or Schedule III would at least take it
off the °illegal¨ list. No doubt, this is correct. This would allow any physi-
cian to write a normal °prescription¨ for Cannabis. The caveat being that
the physician will have to write the prescription for a pharma based medica-
tion. There will be no °Trainwreck, 2 puffs every 4 hours. . So, does this
kill medical cannabis? It might. °Weed¨ will always be available, but I am
concerned that if we are forced to use pharmaceutical cannabis products,
we will just not be as happy.
So, what is the solution? I personally believe it should be de-scheduled. It
is a herb, has always been and will always be. Let pharma and non-pharma
sources create prescription and non-prescription medications.
Can't we all get along?
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148
PoIice Want LegaIization and Growers
Insist Upon Remaining IIIegaI
Saturday, March 27, 20l0
I would have never believed I would live to the day where the Police of
California want legalization of pot and the growers in the Emerald Triangle
desperately want to keep it illegal.
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The cops in large part want it to be legal because even they are getting sick
of the stupid arrests. The growers want the status-quo because legalization
may very well hurt their bottom line. Pretty funny. Can you picture picket
lines where cops in uniformare holding legalize pot signs and hippie grower
types are fighting with them!?!
Of course the bottom line for all of us is that cannabis is an herb not a
drug. We don't want anything else but for people to recognize this and take
it off all schedules. Oh yeah, let's let the people out of jail.
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AII Medicine Is AIways Titrated For Each
Patient
Friday, May 7, 20l0
It seems to me that some people make disparaging remarks regarding
cannabis due to the fact that all patients need to adjust their doses. This
is true and also true of most other medications. In 1990 when Prozac was
first released it was only in one dose of 20 mg. Lily insisted upon calls from
myself and many others as to this perhaps being way too high of a starting
dose for many patients. Anyway, it was years before another dose was re-
leased and many of my patients would mix their capsule in apple juice and
take some percent daily. I.e. They had to adjust their dose.
That said, it is very difficult to adjust a dose if you don't know what dose
you are taking every time. A °hit¨ or a °bong rip¨ is never the same dose
for anyone. Way too many variables. Edibles and even vaporizing do not
allow typical medical titration. It is by using tinctures that we at least have
a form of the medicine where titration can begin.
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Why Doesn't TSA Bother Passengers With
Cannabis?
Friday, May 7, 20l0
This past year there have been announcements from both Oakland and LA
airports that they will not be bothering patients with cannabis.
Many of us travel with minor amounts of our medication and are never both-
ered or °caught¨. This past year or so, I have heard from many patients
that they in fact were caught, but when they displayed their Medical Letter,
they were just let through the gate. So, Why??
Can you imagine some patient with modest medication being caught and
TSA causes a tumult about it? There would be such an uproar as some
attention had to be taken away from watching for terrorists and bombs. If a
terrorist were enabled by such a marijuana distraction, I believe the terrorists
would use this knowledge.
They are really looking for bombs not our medicine.
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Why a Puff is Not a Puff
Friday, May 7, 20l0
We often speak about taking one puff, or several puffs, as if we think we
are truly measuring our medicine. Sure, there is some amount of measuring
counting puffs, but here are some reasons, there are others, why puffs are
not very accurate measures:
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Depth of breath, type of cough, medicine strength in each nuggie, breath
holding, combustion efficiency of the medication, temperature of the burn,
etc etc
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FoIIow-up Post on Cannabis and Anxiety
Friday, May 28, 20l0
I thought I would post an update to my prior blog on anxiety. I have been
seeing a lot of success with patients using sativa or non psychoactive tinc-
tures. The patients generally take a few drops in the AM and repeat after
lunch. There has been no stony effects and patients find that they sleep
much better at night.
Any similar experiences??
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Open Cannabis Dispensaries in Los
AngeIes June 7, 20l0
Monday, June 7, 20l0
Here is a link for you guys to the open dispensaries
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http.77naps.googJe.con7naps7ns?1e=UTFB8hJ=eh8nsa=u8ns1d=11
7ô312929ô1u5ô724u14.uuu4B7ub21bua941b35338JJ=34.u4174B,-
11B.3971428sph=u.53u3uô,u.4252738sou¡ce=enbed
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Dr. Craig Cohen at GreenBridge MedicaI
Monday, June l4, 20l0
GreenBridge Medical is growing. Dr. Craig Cohen recently began see-
ing patients. His impressive resume follows and Craig is a very welcome
addition to GBM.
EMERGENCY DEPARTMENT EXPERIENCE
Assistant Clinical Instructor, UCSF Medical Center, San Francisco CA
1999-2003
· ACLS Instructor
Attending Physician, California Pacific Medical Center, San Francisco,
2003
Attending Physician, Hurley Medical Center, Flint Michigan, 1999
CERTIFICATION/LICENSE
Diplomat American Board of Emergency Medicine, to be renewed Septem-
ber 2010
California Physician 8 Surgeon'sLicense, to be renewed October, 31 2010
Certified by Society of Addiction Medicine for Office-Based Treatment of
Opiate
Dependency, 2007
EXPERIENCE
Private practice recommending cannabis as alternative medicine, 2006-
present
English Teacher, Sechuan University, China 1991
Research Assistant, Smithsonian Environmental Research Center, 1990
Paralegal, Howrey 8 Simon, Washington, D. C., 1989-90
EDUCATION
University of Pittsburgh School of Medicine 1992-96
Emergency Medicine Residency, University of Michigan 1996-99
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BA, Amherst College, cum laude 1989
Indiana Area High School, Indiana, PA 1983
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Surprise With New Cannabis Tincture
It has come to my attention that it is currently difficult to predict what prop-
erties a tincture will have based upon the effects from smoking the same
strain. I clearly do not understand why this happens, but recently, a very
activating Sativa strain turned out a very, very sedating or °Indica Like¨
tincture. During the formation of this tincture, a lot of waxy terpenes were
seen floating in the tincture. Sadly we can't find a lab to test for these ter-
penes, but hopefully that will be rectified in the near future.
We don't even understand what the chemical differences are between Sativa
and Indica. It does not seem to be in the cannabinoids but perhaps more in
the terpenes. As newtinctures are made, I encourage everyone to save some
of the really useful tinctures for lab testing when it becomes available in the
future.
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GreeenBridge MedicaI and Physician
Education
I have been working with the LAMedical Association and the Young Physi-
cians organization. I did my first Physician lecture last month. It was re-
ceived very well by the physicians and there are now 3 more lectures and
panels scheduled. I am extremely excited by this as it is being driven by the
medical community who is now beginning to accept cannabis medicine as
something to consider as a part of a patient's treatment plan.
This has been my dream and hence the name GreenBridge Medical. I fi-
nally feel like I have crossed the bridge and the climate is becoming more
comfortable.
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"AnimaI Farm" and Cannabis
Friday, June l8, 20l0
As most of you remember from high school, George Orwell wrote °Animal
Farm¨ in 1943. It was a spoof on the Russian Revolution, where the pigs
and other farm animals tried to destroy any animals that walk upright.
As is often the case in a revolution, the baby is thrown out with the bath
water. In this case, the pigs did not properly investigate howtheir newfound
anxiety, fear and anger might have been best treated with Cannabis.
So, in °Animal Farm II¨, we see that Napolean, the head pig, discovers that
Cannabis can help the farm animals cope with these stresses and they watch
in horror as they see surviving humans smoking Cannabis and making tinc-
tures none of which the pigs can do without human thumbs and fingers.
So, over time, the pigs begin to befriend their human slaves and over time
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the pigs, other animals and upright beings of all kinds live together in peace
and harmony.
Morale of the story: don't get your pigs stoned too soon.
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SJR l4 May Be a Big DeaI
Tuesday, June 22, 20l0
SJR-14 is an assembly bill that has passed through a senate committee and
is to be presented to the State Legislature in the near future. I have posted
a link to a PDF containing the text of the bill. Essentially, the state of Cal-
ifornia is telling the Federal Government to leave California alone. This
is a very strong statement with the state telling the feds to not only leave
patients alone, but also will allow clinical trials to begin in California.
Once the bill passes the assembly, it does NOT to go to the governor. This
is terrific as our governor has just not been a cannabis supporter. The bill
will go directly to Washington and will land on President Obama's desk. I
am proud to be a member of Americans For Safe Access and a resident of
California as our legislature most certainly passes this bill and tells the Feds
we are starting research and plan on having a rational cannabis system in
California.
Here is the Bill
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http.77WWW.g¡eehb¡1dgened.con7Wp-cohteht7upJoads72u1u7uô7
5JR¸14.pdf
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MichaeI Jackson and Intravenous THC
In several countries, intravenous or IV THC is being experimentally used
for anesthesia. It shows a lot of potential for a totally safe anesthetic that
has no lethal dose.
Michael Jackson would have been way better off with Intravenous THC. I
am sure it will be a number of years before this is possible in this country,
but hopefully as costs in medical care continue to mount, more options will
be available in the Land of The Free. Some months ago I received from
somewhere an order form for IV THC and IV CBD as well as THC eye
drops. I never placed the order to Austria, but I admit I was tempted.
By the way, did you ever wonder why there is no lethal dose for cannabis?
The reason is that although the brain has very large number of cannabinoid
receptors, there are virtually no receptors in the brain stem. The brain stem,
as you might remember, is what controls the heart and lungs. No receptors
no problems.
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From Dr's. FrankeI and Cohen on SeattIe's
l068 and The New EngIand JournaI of
Medicine
Wednesday, June 23, 20l0
As medical cannabis doctors in California we are adding our support to
1068! Seattle is looking to legalize cannabis!
The New England Journal of Medicine April 22, 2010, says:
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°Although state laws represent a political response to patients seeking re-
lief from debilitating symptoms, they are inadequate to advance effective
treatment. Medical experts emphasize the need to reclassify marijuana as a
Schedule II drug to facilitate rigorous scientific evaluation of the potential
therapeutic benefits of cannabinoids and to determine the optimal dose and
delivery route for conditions in which efficacy is established. This research
could provide the basis for regulation by the Food and Drug Administration.
Current roadblocks to conducting clinical trials, however, make this more
rational route of approval unlikely and perpetuate the development of state
laws that lack consistency or consensus on basic features of an evidence-
based therapeutic program.
Reliance on state laws as the basis for access to medical marijuana also
leaves patients and physicians in a precarious legal position. Although the
current Justice Department may not prosecute patients if they use marijuana
in a manner consistent with their states' laws, the federal law remains un-
changed, and future administrations could return to previous enforcement
practices.¨
Legalization in states like Washington, and California (also with a ballot ini-
tiative this November to legalize cannabis) will benefit this national cause.
I believe this is a small issue but important to people everywhere. I made
someone cry recently when I told her she could legally use cannabis, the less
pejorative term. For some people it is medicine, and it's affordable. With
cannabis there is no lethal overdose or lethal complication of withdrawal.
Not true for FDA approved drugs like benzodiazepines, or opiates. There
are plenty of medical reasons a beneficial plant should be freely grown by
citizens I'm glad to answer any questions.
*p.s. you too may post a comment to show support for 1068 at the link:
http.77WWW.pubJ1coJa.het72u1u7uô7217ext¡a-f1zz-
pot-pet1t1oh-1h-Buuuu-cop1es-of-the-st¡ahge¡7#co
nnehts
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How To Use The New Cannabis Tinctures
Monday, June 28, 20l0
As I have discussed in numerous blogs, tinctures are primarily absorbed
through the sub-lingual veins. This makes them different than edibles,
which are absorbed through the stomach and must go through hepatic
metabolism which turns the cannabis molecules into much longer lasting
and very, very stony medicine.
In addition, when a patient uses a tincture in their mouth, they can enable
some lung absorption by taking deep breaths in through their mouth and out
through their nose. I can't currently prove that this cannabinoid pulmonary
absorption in fact takes place, but clinically the tinctures work much better
when the breathing is done. So, below is my best advice when it comes to
medicating with tinctures.
1. Place the dose of tincture under your tongue.
2. Use your tongue to gently °paint¨ the tincture around your inner
cheeks
3. Take ten very slow and very deep breaths: in through your mouth and
out through your nose and then swallow the tincture
Try very hard not to swallow until the ten breaths are done
The first time you use a new tincture, be sure to be around a safe place and
not plan on driving.
Happy tincturing!!
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Oregon To RecIassify Cannabis As A
Therapeutic Substance
I thought this article from Americans For Safe Access was worth posting.
This state level reclassification as cannabis as a therapeutic substance. Al-
though I would prefer it ultimately be reclassified as an °Herb¨, this is a
great start. As more states do this, the Federal Government will ultimately
be forced to make the change.
Check it out: Oregon Reclassifies Cannabis
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Sativa and Sugar Cravings
Sunday, July 4, 20l0
As discussed in prior blogs, the strains of cannabis have very different ef-
fects. One of the classic Indica effects is to increase appetite. Cannabis
physicians use this effect with many very ill patients to increase their caloric
intake.
However, it is rarely mentioned that many patients have a very different
effect from some Sativa strains. I have been hearing this from patients for
four years and it is something that needs a lot more study. It has been my
experience, that many patients notice decreased sugar cravings from some
Sativa strains. Why? I have no idea.
I would love to hear from any of you that have noticed this interesting and
quite beneficial effect of Sativa.
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Why Do We Worry So Much?
Wednesday, July l4, 20l0
One problem all of us humans have in common is excessive and irrational
worrying.
If we just worried about issues we really need to focus on, it would be fine.
However, we all worry about issues we have no control of much of the
time. We are often told we are worrying for nothing and making ourselves
ill. We all know this. We are quite aware that our worrying is giving us
many physical symptoms. The most extreme result of uncontrolled worry-
ing is can be suicide. I have seen this in my Internal Medicine Practice, but
not in my cannabis practice.
There is no doubt that I am speaking in generalizations, but I bet everyone
reading this blog will identify with it. We lay awake for hours just obsessing
about stuff we have no control of. We want to °let go¨, but we can't.
Is this excessive worrying simply a manifestation of anxiety? Perhaps. For
sure, neurochemistry is involved.
We have all commented that our pets really have the life. They have noth-
ing to worry about, no jobs, plenty of food and shelter. No doubt, this is
enviable, but I don't think it is their lack of responsibility. Look at pets that
are service pets, they have a huge responsibility and work hard. What about
special animals trained to work with police and firemen? They work hard
and have emotional experiences that are very upsetting. However, I have
never heard of one not being able to sleep and eat unless they themselves
become depressed. On the other hand, we all know wealthy and healthy
people who really by most standards should have nothing to worry about,
but they certainly do worry as much as any of us. I.e. Security and safety
don't seem to help much.
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So, Why did evolution leave us humans with such a destructive and useless
issue with worrying?
Endo-cannabinoid deficiency states have been well documented in the lit-
erature. Please see my page on educational material. The science is pretty
clear. I have now seen hundreds of patients who have used certain cannabis
tinctures, who tell me that their worrying goes away and their mind left
100% clear, with low dose and controlled dose of sativa tincture.
Here goes my personal beliefs...I believe that we are now able to treat
this mild cannabinoid deficiency. With virtually the same dose of tincture,
nearly all patients become calm, totally clear and focused and are able to
control their worrying and make better and clearer decisions.
Here goes the real leap of faith. It is my hypothesis and I offer no proof, only
perhaps some limited understanding. During the past 100,000 years or so
of our own evolution, our brain cortex has grown tremendously in size and
function. For this solar system, we would win every spelling bee. However,
perhaps the natural selection advantage for a better thinking brain just didn't
consider the comfort of that brain. I believe that our proven hungry cannabis
receptors, until medicated keep us from this level of comfort.
The primary reason I feel this way, is why else would virtually the same
tincture dose work so well for so many different patients of different size,
gender and prior cannabis use? In my opinion, it is a replacement dose. In
my years of practicing Internal Medicine, I saw this primarily in the hor-
mone replacement field, as although our doses are different, it is in a very
narrow range.
So, yes, I believe small doses of the correct cannabinoids help with many
of our problems, including our pathological worrying.
Thoughts?
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Young Physicians and Cannabis
Thursday, July l5, 20l0
Last night I attended a Young Physicians meeting in Santa Monica. By def-
inition, you must be under 40 to join, but they seemed fine with my visiting.
In fact, speaking with approximately 13 young docs was invigorating. They
totally get it and are very anxious to work it into their practices. Their spe-
cialties included internal medicine, rheumatology, orthopedics and more.
It seems that physicians are becoming more and more open to considering
use of cannabis tinctures.
We can't expect physicians to take a positive support role on smoking and
they also have a bit of a difficult time with edible dosing. In other words,
they really get it and are looking to help all of us. Please spread the word
regarding Young Physicians, they are rapidly becoming the future and so
will cannabis medicine.
Once physicians fully accept cannabis as a legitimate drug, all issues will
rapidly evaporate. Yeah!
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Raids Used To Fund More Raids
Friday, July l6, 20l0
I rarely get very political, and this is probably obvious to many. I had lit-
tle idea that the money seized at raids, at least the federal ones, is used to
finance more raids.
This is really bothersome, as the task force survival depends upon raiding
and stealing money. I know this is time old stuff, but I am just a simple
country doctor.
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Patient Given Option of Meetings or
RenewaI
I heard a great story from a patient yesterday. He was pulled over for DWB
(driving while black) and had 2 grams in his car. His Recommendation had
expired and he was cited. In court, he was given the choice of going to 12
AA meetings or getting his Rec renewed with me within 3 days.
Have things changed or what? Impressive.
Four years ago when I started GreenBridge, any patient on probation was at
risk when/if I gave them a Rec. Now every probation officer I speak with
promotes their clients getting and using medical cannabis. They know it is
safer. It is simply a matter of harm reduction.
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Chronic Pain and CBD (CannabidioI)
I am sure many of you are beginning to hear about CBD (Cannabidiol).
It is one of approximately 70 Cannabinoids, the most famous being THC.
CBD is an amazing compound and I will have many future blogs about the
non-psychoactive properties of CBD, but also how it can and will be used
to treat chronic pain, anxiety and other mood disorders, as well as being
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a neuro-protectant and a very help anti-cancer drug. For today, let's talk
about CBD's value in treating chronic pain.
CBD works against pain primarily in the peripheral nervous system. It does
not work like typical pain meds by effecting the central nervous system, it
works at the neuro-synapse. When we sustain injuries, often the pain is
acute and disappears completely. Other times we have persistent or in-
termittent pain, but it is still not that big of a deal. However, with many
disorders the pain is either part of the underlying problem itself (Multiple
Sclerosis, Rheumatoid Disease, etc ) or the pain becomes a syndrome of it's
own. In other words, the pain takes on a life of it's own and is nowcrippling
the patient. A certain level of pain is of course protective, but we all know
the difference.
In a recent Scientific American article, chronic pain and CBD are discussed
in a very creative way that fits with my clinical experience. When an injury
takes place, increased Glial cell production forms around the neuro junc-
tions. These Glial cells produce Cytokines which are chemical transmitters
spreading inflammation and signaling pain. When a molecule of CBDbinds
to the Glial cell, the cytokine production decreases and the patient feels a
marked decrease in pain. This would also explain why some patients have
pain relief that lasts way beyond the theoretical effect of the CBD.
I suppose we are all just a bit low on CBD, but there is a cure.
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Great Quick Update on the
Endocannabinoid System
Tuesday, July 27, 20l0
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It Can be LegaI And StiII Be a Great
Medicine
Saturday, July 3l, 20l0
Proposition 19 or °Tax and Regulate¨, is not really true legalization of
cannabis. To me, °real¨ legalization means that it is treated the same as
alcohol. It would mean that it was readily available. It would mean that as
a physician, I could openly do clinical trials at GreenBridge. It would mean
that I could open a lab and run as many tests as I wanted on as many strains
as needed. I would be able to legally do genetic testing, analytic testing and
correlating this data with the associated clinical conditions.
With Prop 19, none of these will be the case. So, this ballot initiative is just
a step. Nonetheless it means a lot. It means that nobody is ever arrested.
It means, our jails will begin to empty and it means anybody can grow at
home in a 23 sq ft area. That will take care of most people's needs.
With regard to Medical Cannabis, if the physician visit offers nothing more
than a signed Recommendation Letter, they will in fact go away. We never
needed, and will never need physicians to supervise recreational use of
cannabis. We all know it is silly and to me, Prop 19's other significant con-
tribution is formally setting a boundary, even if vague and gray, between
medical and recreational use of cannabis.
As I have said before, if my blood pressure medication made me feel better
and more social, I very well might take it at breakfast with friends and share
the good feelings. Would that make my blood pressure pill a recreational
medication? Of course not.
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PLEASE HELP DOCTOR FRANKEL
Wednesday, August ll, 20l0
Dr. Allan Frankel needs your help.
For years, Dr. Allan Frankel and GreenBridge Medical in Marina del Rey
have been there to provide qualified patients with the Letter of Recommen-
dation needed under Prop 213 to allow safe access to the cannabis products
needed to treat ailments and medical conditions.
Now, in an outrageous affront to the voters of California, the Califor-
nia Medical Board is seeking to revoke Dr. Frankel's license to practice
medicine based upon the absurd allegation that Dr. Frankel is not qualified
to safely practice medicine because he, also, is a patient who uses cannabis
for his own medical condition.
We are fighting the Medical Board's attempt to revoke Dr. Frankel's license
to practice medicine and, thus, to prevent him from providing the needed
recommendations for his patient's medical cannabis but this battle is costing
more in legal expenses than any doctor can afford.
Your donation will help assure that the many patients who use cannabis to
treat their serious medical conditions can continue to obtain safe and legal
access to their needed medication from a leader in the medical cannabis
world.
Dr. Frankel is only one of a number of well-respected physicians who have
been persecuted by the California Medical Board so contributing to his legal
defense fund will help not only Dr. Frankel but the many other doctors
and patients who are being victimized by the improper war on medicinal
cannabis now being waged by the California Medical Board.
Please help us win this battle so that the Medical Board will have to think
twice about its persecution of other doctors who are willing to risk their
medical licenses in order to provide safe access to cannabis for their pa-
tients.
Thank you in advance for your generous contribution at http.77WWW.
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Free Drugs at Fast Food Restaurants??!!??
Friday, August l3, 20l0
You must check out this link: Cheeseburger, Fries and Lipitor Please
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.
I was listening to the news, couldn't believe what I was hearing and then
looked up this article. I realize this is not my usual blog style, but this story
is much bigger than it seems at first glance.
So, the idea that these researchers have in England is to hand out a choles-
terol lowering drug, Lipitor, with every fatty meal. They claimthat the risks
of liver disease and muscle problems will not outweigh the risks of eating
fat. So, we are being told that rational people are allowing fast food workers
the right to dispense medication.
1. This is the most sickening form of advertising I have ever seen as this
must be the intention. Go ahead and eat all the burgers which are bad for
you and we admit it, but also take this drug which may not be as bad.
2. Just take the drug, as your fast food guy knows best. He/she is the new
primary care doctors we have been looking for.
3. No follow-up? Can't we setup a little lab next to the bathrooms at Mc-
Donalds? Free liver profile with every Over-sized meal?
4. Think of a sign at McD, °Take drugs with our food and you will live
another day to buy more food and drugs¨
3. I could go on and on, but I am not yet to the point where I want to trash
pharmaceuticals, but please, as a board certified physician, I am not safe to
recommend cannabis, but these kids can distribute °free¨ drugs? Next the
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drugs will be INSIDE the food and we won't even know how well we are
being taken care of.
How about some healthier food and a free joint?
YUCK!!
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What About AIcohoIics Anonymous and
Cannabis
Wednesday, August l8, 20l0
When I see a patient who abuses Methamphetamine's, I feel good about
giving them a recommendation in an effort to practice °Harm Reduction¨.
This form of treatment is growing in favor and is even now accepted by
many substance abuse specialists.
So, why would AA be so against allowing medical cannabis? I would per-
sonally insist upon it being °Medical¨ Cannabis at the start to try keep the
lid on the entire concept blowing up. However, allowing °recreational¨
users at the meetings would just be too much a political challenge.
Anyway, why not try having some more medical cannabis friendly AA
meetings? What do you guys think?
Would there be any interest in having GreenBridge Medical host such a
meeting? Perhaps one or more substance abuse specialists might join us?
I volunteer my office and my time. Anyone interested?
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GreenBridge MedicaI Laboratories To Open
Soon
Friday, August 20, 20l0
As I have spoken about many times, testing of our medications is critical.
We have been stymied in the past due to laboratories being afraid to touch
the °stuff¨. Well, that is changing, although it is not all °changed¨.
For certain, it is safe and legal for GreenBridge Medical Laboratories to
receive specimens and run basic pesticide and herbicide testing. This testing
is now a requirement by the Los Angeles Medical Cannabis Ordinance.
Ultimately we plan on adding equipment that will allow full testing of
cannabinoids, terpenes, etc, but there are some potential legal issues with
that one. This is a baby step in some ways, but to have a Medical Cannabis
Lab as part of GreenBridge Medical fulfills one of several dreams.
Stay tuned as we begin to open in coming weeks.
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The Time Has Indeed Come For a
ConstitutionaI Convention
Wednesday, September l, 20l0
By Bill Leahy
Governors of 33 states have already filed suit against the Fed-
eral Government for imposing unlawful burdens upon them. It
only takes 38 (of the 30) States to convene a Constitutional
Convention.
This will take less than thirty seconds to read. If you agree,
please pass it on.
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An idea whose time has come!
For too long we have been too complacent about the work-
ings of Congress. Many citizens had no idea that members of
Congress could retire with the same pay after only one term,
that they specifically exempted themselves from many of the
laws they have passed (such as being exempt from any fear
of prosecution for sexual harassment) while ordinary citizens
must live under those laws. The latest was to exempt them-
selves fromthe Healthcare Reform.in all of its forms. Some-
how, that doesn't seem logical. We do not have an elite that is
above the law.
I truly don't care if they are Democrat, Republican, Indepen-
dent or whatever. The self-serving must stop.
A Constitutional Convention this is a good way to do that.
It is an idea whose time has come. And, with the advent of
modern communication, the process can be moved along with
incredible speed. There is talk out there that the °government¨
doesn't care what the people think. That is irrelevant. It is in-
cumbent on the population to address elected officials to the
wrongs afflicted against the populace.you and me. Think
about this.
The 26th amendment (granting the right to vote for 18 year-
olds) took only 3 months 8 8 days to be ratified! Why? Sim-
ple! The people demanded it. That was in 1971.before
computers, before e-mail, before cell phones, etc.
Of the 27 amendments to the Constitution, seven (7) took 1
year or less to become the law of the land.all because of pub-
lic pressure.
I'm asking each addressee to forward this Email to a minimum
of twenty people on their Address list, in turn ask each of those
to do likewise.
In three days, most people in The United States of America will
have the message. This is one proposal that really should be
passed around.
Proposed 28th Amendment to the United States Constitution:
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"Conqress snoll mo|e no low rnor opplies ro rne cirizens o[
rne UnireJ Srores rnor Joes nor opply equolly ro rne Senorors
onJ/or Represenrorives, onJ, Conqress snoll mo|e no low rnor
opplies ro rne Senorors onJ/or Represenrorives rnor Joes nor
opply equolly ro rne cirizens o[ rne UnireJ Srores "
You are one of my 20¹.
Keep it going.
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Last Night I Had The Strangest Dream
Friday, September 3, 20l0
No, I was not dreaming about Simon and Garfunkel. In fact I was not dream-
ing, I had a °vision¨. All the religious leaders throughout history are in
a sort of corporate version of Hell. There is the usual fire and brimstone,
but in addition, there are corridors with many offices.
In the offices, all the heads of major corporations are working away and
frequently conversing with the religious heads. The religions are making
up new rules regarding sinning and sinners, their primary purpose being to
scare human beings who fell from the Garden of Eden. This of course is
everyone.
So, the religious side of corporate Hell comes up with the rules and regu-
lations regarding suppressing all human desires. This causes sublimation
of these drives which in turn leads to the purchase of merchandise no one
really needs. This makes the business side of Hell very happy as profits
are up. So, they are more than happy to give free land and other financial
incentives to their religious brothers and sisters.
And so it goes on and on and on. As silly as this story is, it does make you
wonder??
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Save HeaIthcare DoIIars - Die EarIy
Thursday, September l6, 20l0
In a recent article, Cost of Obesity
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, the authors make a very interesting
point. We all assume that by taking better care of ourselves and achiev-
ing lower weights that we will be healthier and be less of a burden on the
health care system. This article points out an obvious problem with this
logic, if these obese patients lose weight, they LIVE LONGERANDCOST
MORE.
So, perhaps there is another way to be a loyal and patriotic citizen? Perhaps
patients should be paid to do dangerous and unhealthy, but fun activities.
We should cancel all helmet laws sure more head injuries, but most will
die younger and save money.
Perhaps the government should subsidize McDonald's rather than the oil
companies? Also, if the patients begin dying much younger, they will use
less petroleum products in their lifetime.
So, it seems that preventive and healthy care will kill the system. I say tax
incentives for any really bad habits we have. In fact, why not encourage
murder? Each murder would save tons of money?
I am only partially joking. Few people are aware that in 1988 the °right
to die¨ legislation was passed. It was tied to other Medicare legislation
no longer giving incentives to hospitals for long term care. The hospitals
would be paid by DRG or °Diagnosis Related Group¨. This is essentially
a fixed fee for a certain patient. In other words no financial incentive to
keep the patients alive longer, so letting them choose death was to be °en-
couraged¨. I know this is dark and seems nuts, but I was there practicing
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Internal Medicine in Santa Monica at the time, and trust me, this is what
happened.
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Dr. FrankeI Visited Cannabis Farm With
GreenBridge MedicaI Laboratories
Monday, September 27, 20l0
On Sunday, I visited a grower colleague in Malibu. He is an organic grower
who is all about the medicine, testing product and safety. I wish I could tell
you his name and location.
Anyway, I brought with me an organic chemistry professor who I am work-
ing with to help launch GreenBridge Medical Laboratories. This was one
of the most exciting meetings I have ever attended. If you are a regular
blog reader, you know how important I believe plant safety and knowl-
edge means to me and to the Medical Cannabis world. We discussed our
new-found ability in working together to begin answering known and un-
known questions about Cannabis Medicine. A few of the questions dis-
cussed were:
1. How does the THC, CBD and other cannabinoids change as the plant
is finally getting ready to harvest, i.e. when should we really harvest for
which benefit?
2. Howdo the various leaf types, (bud, water or sun leaves) vary in chemical
composition?
3. Testing for pesticides and fungal elements
4. Begin genetic testing of strains and looking at the above variables and
many more.
QUESTION:
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How many of you out there would want your medication tested for basic
cannabinoids and purity from contaminants if it could be done for $40?
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Cannabis Is Now Just Iike parking in the
red zone!
Sunday, October 3, 20l0
California Gov. Arnold Schwarzenegger (R) just signed into law a bill that
decriminalizes cannabis. Starting January 1, 2011, any person carrying less
than 1 oz of cannabis can no longer be accused of a misdemeanor. It will
be a very minor infraction, such as parking in the red zone and carries a
maximal fine of $100. This is great news. I can't be sure how this will
effect Proposition 19, but I am afraid it will hurt it's chances as many will
feel, with good reason, that this new legislation will hold up perhaps better
to Federal Invasion. I truly have no idea.
Regardless, on behalf of my patients and myself, I am very grateful, as we
all should be. We have all seen way, way too many patients, particularly
minorities being arrested, even without jail, and are thrown into the court
system. This should save the state approximately $2 or $3 billion in prose-
cution costs.
A step forward!!
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Dr. FrankeI in PIayboy
Monday, October 4, 20l0
Sorry folks, no centerfold photos. They paid me $1 million to NOT do the
photo shoot, but here is the full text from the article:
THE KIND DOCTOR (see it online)
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On the bottom floor of a leafy courtyard in Marina del Rey, California sits
Green Bridge Medical, one of the dozens of newcannabis-physician offices
cropping up around Los Angeles. Sandwiched between a yoga studio and
real estate offices, Green Bridge looks like an acupuncture clinic. Enter
Dr. Allan Frankel. Wearing jeans, an Izod polo and tennis shoes, the 60-
something Frankel looks every bit an M. D. He has been a board-certified
internist for more than 27 years, with big chunks of that time at UCLA
Medical Center.
°Five years ago, when I first told my colleagues and friends I was leaving
to open a cannabis practice, not one supported it,¨ he says with a smirk.
°Now my colleagues refer patients to me weekly and I'm a leading lecturer
on this subject.¨
To buy medical marijuana legally a patient needs a doctor such as Frankel
to provide a °recommendation¨not a prescription, as cannabis is not an
FDA-approved medicine. Frankel didn't try pot until his mid-40s, and it
was not until eight years ago, when a vicious virus in his chest attacked his
heart, that he began to smoke regularly. But as a doctor he has believed in
marijuana's medicinal value for a long time.
°For years at UCLA I worked with chemo and oncology patients,¨ he re-
calls. °They were in so much agony that I would wheel them out into the
garden and give them a joint. And every single one of them would feel
better. I never saw it as a moral issue but a human issue.¨
So after suffering a fate similar to his former patients' and being told he had
less than a year to live, Frankel began to smoke heavily, and, well, here he is.
According to Frankel, the lion's share of cannabis doctors are not smokers,
they're in it for business reasons and will, for a fee, offer a cannabis card
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after a 10--minute consultation for anything from insomnia to back pain.
The majority of patients in Los Angeles, for example, are in their 20s and
30s, hardly a demographic of ill people.
A large portion of voters who will weigh in on legalization next month be-
lieve the -doctor-patient system is a scam, an excuse for smokers to get high
and doctors to earn money. A Wosninqron Posr blogger recently called the
medical marijuana movement °an insult to our intelligence.¨ Justin Hart-
field, who started the company weedmaps.com to help people find dispen-
saries, has a doctor's recommendation for pot to ease anxiety. °I'm fine. I
don't really have anxiety,¨ he recently told Tne Woll Srreer Journol. °The
medical system is a total farce. It just needs to be legal.¨
But not all doctors are in it for the cash. Even the American Medical As-
sociation has reversed its 72-year antipot policy and urged the federal gov-
ernment to do the same, suggesting that °marijuana's status as a federal
Schedule I controlled substance be reviewed.¨
No matter if doctors themselves smoke or not, they all face the same issue of
dosage. How can you give a proper dose of a medicine when no definitive
studies have been done and the medicine itself is a plant, not a pill created
to exact specifications in a lab?
°This is a gray area for sure,¨ Frankel admits. °A lot of doctors use
edibles, but since those are absorbed through the stomach and must go
through hepatic metabolism, which turns the cannabis molecules into a
much longer-lasting and very stoney medicine, it is almost impossible to
quantify dosage, and too much can cause psychotic reactions.¨ He contin-
ues, °Smoking has some of the same issues, plus the possible harmful ef-
fects on the lungs. Vaporizers definitely have less tar, but again, it's very
hard to define dosage.¨
The solution? Tinctures, liquid THC doses that are dispensed under the
tongue through a dropper. The medicine is absorbed through the sublingual
veins, a reliable delivery conduit. The method is not yet widely usedmost
doctors recommend -vaporizersbut Frankel is a tincture pioneer.
°I was told by colleagues and my lawyer not to be involved with tinctures,¨
he says. °But I believe in the Hippocratic oath, in serving your patients first
and making them well.¨
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By placing three drops under the tongue twice a day, Frankel claims, no
matter howold you are, howmuch you've smoked or howmuch you weigh,
your pain or anxiety will be alleviated for up to six hours. Says the good
doctor, °I treat lawyers, doctors, executives, and it almost always has the
same results for every patient.¨
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The Kind Doctor? Anyone Out There?
Saturday, October 9, 20l0
Well, I am going to try write this blog without sounding a bit arrogant, so
please forgive me in advance. To begin with, I am not claiming that I said
I am a kind doctor, but in my prior blog from Playboy, I was identified
as °The Kind Doctor¨. Truthfully, I liked it and I still do. It got me
thinking, however, about general kindness in medicine. So, I started with a
google search for °the kind doctor¨. I found nothing. AMAZING!! You
could search for any adjective in place of °kind¨ and find tons of references.
Compassionate is used so much, as we all already know, but kindness is just
not out there. Very Strange.
Then I went to the next obvious sites, the web and trademark. Well, all were
available. (so I took them by the way) Why has this happened?
Clearly the expectation of °kindness¨ or even the assumption of kindness
intertwined within medicine or now our °health care delivery system¨ is
simply not even an afterthought. The more you reflect upon this the odder
it seems.
So, now, one of the projects I am working on is defining what °The Kind
Doctor¨ is and try see if there is any merit to reviewing the lack of kindness
in medicine. For example:
What would °The Kind Doctor¨ do ?? Wouldn't that be lovely?
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Kindly yours,
Allan I Frankel, MD
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The Kind Doctor Oath
Sunday, October l0, 20l0
Ok, this is version 2. Any suggestions as to what we can add or expect from
a kind doctor would be greatly appreciated.
THE KIND DOCTOR OATH
* The Kind Doctor listen to his patient to the exclusion of all distractions.
* The Kind Doctor welcomes the patient to the exam room with a smiling
countenance
* The Kind Doctor maintains eye contact with the patient and their support
system
* The Kind Doctor builds an empathetic connection during the patient en-
counter
* The Kind Doctor understands the patients' expectations, the expectations
dictated by their
illness and blends them into the patient informative but kind presentation
summary
* The Kind Doctor remains open to alll models of medicine and is comfort-
able bridging
the patient's model with the MD's model.
* The Kind Doctor is the °Coach Wooden¨ of the health care team
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Never Kiss And TeII
Tuesday, October l2, 20l0
Ok, this is way off my usual topics, but I just have to state for the record that
the °kissing and telling¨ we are seeing with our sports heroes and politicians
is truly shameful. It is naive to think that famous men or women are often
entirely irresistible and one's common sense perhaps is diminished a bit or
entirely absent. We have all been in situations where our common sense
was left behind. We might regret them, we might be ashamed, but we all
have those moments or years.
I think this is all part of a societal issue where we don't want to take respon-
sibility for our actions. We all knowthese °tell alls¨ are about money and/or
damaged relationships. The money portion is ridiculous as it has become
accepted °Gossip Blackmail¨. Currently, with the famous quarterback and
sexting from two years ago. Who really cares? If the person receiving
the °improper¨ text had given out her/his phone number, then expect texts.
Perhaps certain ones are really awful. Some are really pornographic. Some
might be very hurtful. This has always been the case, but now we are doc-
umenting our lives to be saved and played back when it suits us. I believe
it is still not worth all of us losing more levels of our privacy as a result of
our own beloved technology.
Before cell phones and texts and the internet, the same human behaviors
were taking place. I don't accept nor reject these human activities. They
just have always been and will always be. I suppose both sexes or in LA
all 12 genders will always be hurting one another. I would just ask two
things:
1. If the relationship is a romantic one, both sides need to do their best to
contain their own privacy. With love and jealousy being what they are, this
type of public display is sad but perhaps unavoidable.
2. If the relationship is a °professional¨ one, i.e. pay for play, I believe that
s a part of the verbal contract automatically includes lifelong silence. We
are seeing more paid sexual professionals blackmailing ex-clients and that
is just
a bad example for everyone else in business and should be discouraged as
much as possible.
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The Kind Doctor would never do this nor any other kind person. (see two
prior blogs)
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MedicaI Cannabis Research ArticIes
Wednesday, October l3, 20l0
Medical cannabis articles. Sources at bottom
Glossary of Important Terms
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Definitions and important concepts about medical cannabis (marijuana)
Medical Cannabis Research: What Does the Evidence Say?
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Health and Human Services claims that °marijuana has no currently ac-
cepted medical use in treatment in the United States.¨ However, more than
6,300 reports and journal articles fromaround the world support the medical
value of cannabis (marijuana). Here is an overview of the latest research.
A History of Medical Marijuana
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August 16th, 2003
A thorough history of medical marijuana prepared by medical marijuana
expert, Dr. Lester Grinspoon.
National Institute of Health Workshop on Medical Marijuana
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In 1997 the National Institutes of Health held a 2-day scientific meeting
about medical marijuana. According to the panel, research is justified into
symptoms of certain conditions including pain, neurological and movement
disorders, nausea, loss of appetite and severe weight loss, and glaucoma.
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http.77WWW.cahhab1s-ned.o¡g7sc1ehce7sc1ehce-def1h1t1ohs.htn
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http.77WWW.safeaccesshoW.o¡g7a¡t1cJe.php?1d=4177
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http.77WWW.naps.o¡g7nn¸7g¡1hspooh¸h1sto¡y¸cahhab1s¸ned1c1he
.pdf
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°Marijuana and Medicine: Assessing the Science Base¨
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In 1999, the Institute of Medicine released their report, on the potential
health benefits and risks of marijuana. They stress the need for more scien-
tific research.
Cannabis in painful HIV-associated sensory neuropathy Abstract and Full
Study
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Based on the effects of cannabinoids in pre-clinical models of neuropathic
pain and anecdotal case reports, a controlled trial of smoked cannabis was
conducted.
Missoula Chronic Clinical Cannabis Use Study
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In this study designed to examine the long term effects of smoked cannabis,
researchers reviewed the overall health of patients who have used medical
marijuana legally under federal law for 11-27 years. Results demonstrate
clinical effectiveness in treating glaucoma, chronic musculoskeletal pain,
spasm and nausea, and spasticity of multiple sclerosis.
Cannabinoid Receptor as Therapeutic Targets
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by Ken Mackie, Annual Review of Pharmacology and Toxicology
March 14th, 2006
The Emerging Role of the Endocannabinoid System in Endocrine Regula-
tion and Energy Balance
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by Uberto Pagotto, Giovanni Marsicano, Daniela Cota, Beat Lutz, and Re-
nato Pasquali, Endocrine Reviews
February 1st, 2006
The Classification of Cannabis under the Misuse of Drugs Act 1971
(2002)
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http.77WWW.hap.edu7¡ead1hg¡oon7books7na¡1ned7
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Z2uofZ2utheZ2uEhdocahhab1ho1dZ2u5ystenZ2u1hZ2uEhdoc¡1heZ2u
ReguJat1ohZ2uahdZ2uEhe¡gyZ2uBaJahce.pdf
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The United Kingdom's Advisory Council on the Misuse of Drugs recom-
mends the reclassification of all Cannabis preparations from Class B to
Class C.
The Advisory Council's Report Further consideration of the classification
of cannabis under the Misuse of Drugs Act 1971 (2003)
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In light of new research, the United Kingdom's Advisory Council reviewed
its position on the classification of cannabis products in light of new re-
search. This new report confirms the Council's 2002 decision.
Database of Clinical Research and Case Reports
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A database of clinical research and case reports, from the last 30 years,
maintained by the International Association for Cannabis.
From ASA October 13, 2010
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What Happens if Prop l9 Passes?
Saturday, October l6, 20l0
check this out
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aJ¡eady-khoW7
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Who Wants Their Medicine Tested?
Saturday, October l6, 20l0
I believe I have been able to arrange 100 free tests for GreenBridge Medical
Patients only. Finalization can occur once I get your responses. I will post
further details in the next two weeks, but basically below is how I see this
first step going. I believe we, as a group, will be the first physician, patients
and laboratory working together to try improve the safety of our medication.
When you drop off the medication, it needs to be at least 2 grams of bud
in the original dispensary bottle. The bottle needs to be sealed BY YOU
with tape upon which you have signed your name. Then the sealed plastic
container should be placed into a small plastic zip-lok bag. At the time of
dropping off the package, you will be asked to login to our newdata system,
°Strain Genius¨. I have blogged on this in the past.
We are really after those strains where you had a really great or perhaps
really bad experience. After you enter your strain thoughts online, you will
then be able to obtain these results within a number of days. By this I mean
several days, but don't want to pin down an exact timing. You will be able
to know if the sample was fungal and pesticide free, i.e. really organic, as
well as knowing the THC-A, THC, CBD and CBN levels. Over time we
will be adding a fairly complete cannabinoid profile as well as terpenes.
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Our Drug Czar is Very MisIeading
Tuesday, October l9, 20l0
I find it so irritating that our Drug Czar is to be speaking out against Propo-
sition 19 from a drug rehab center in Orange County. The point he will
certainly make is that more marijuana use leads to more rehab stays. Well,
he is not entirely wrong, but he is partially correct for the worst reason pos-
sible.
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As a parent, if my kid gets caught with a joint, the family is given two
choices:
1. Go through the juvenile criminal system for their °crime¨ which of
course should not be a crime at all.
2. Go to rehab for a few weeks and be °cured¨ of your addiction to the evil
weed
So, of course lots and lots and lots of kids are in rehab, it is much better
than a ride through the criminal justice system. Really, what parent would
want anything else for their kids other than just being left alone and letting
the family decide what is to be done.
So, listen carefully today. You are to be shown how many kids are being
saved by rehab. Please at least know why.
In fact, picture all of this as a Saturday Night Live skit. Rehab for
marijuana?? Please stop. I am laughing too hard and can't consume
my medicine.
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Dr. FrankeI's Medicine For Thanksgiving.
Wednesday, October 20, 20l0
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Dr. FrankeI To Be on Internet Radio Show
Thursday, October 2l, 20l0
I have long wanted to broadcast a °medical cannabis talk¨ hour with Dr.
Frankel. So, I have been lucky and will be on the °Medical Marijuana
Show¨ on WSRADIO. COM next Wednesday, October 27 at 3 PM. The
details are listed below. This is a great start to help me get my message
out to millions of listeners. This show has 3 million monthly listeners. If
some of you could call into the show it would show great support and help
move towards °our own¨ Medical Marijuana Hour¨ on the web and perhaps
satellite.
The Date: WEDNESDAY October 27 2010
The Show Airs: 3pm-6pm PACIFIC TIME
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Please call into: 888-327-0061 at 4:SS and their Technical Director will
route your call. Calls on landlines are required for proper quality. If you
cannot call in from a landline please alert our Producer.
Site for show: http.77WWW.Ws¡ad1o.con71hte¡het-taJk-
¡ad1o.cfn7shoWs7The-hed1caJ-ha¡1¸uaha-Rad1o-
5hoW.htnJ
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The Thin Line: Both VirtuaI and Very ReaI
I am referring to Proposition 19 coming up now just days away. Many
wonder whether The Governor signing the °Parking Ticket¨ bill #1440, i.e.
post January 1, 2011, anyone over 21 with less than one ounce is just given
a $100 parking ticket. So, possession is going to be a non-issue whether
Proposition 19 passes or not. We will however lose the 23 sq ft growing and
as well as any ability to tax and regulate. Even if 19 passes, each city/county
will need to pass local laws allowing the sale of this °recreational¨ cannabis.
Will cities allow liquor stores? Some will. Will some city's block all sale?
Yes!! In fact, I think it is very unlikely that LA will allow recreational
cannabis sales in the current climate.
So, howamI voting? I already voted and I voted in favor of the proposition.
I am a guy from the 60's, regardless how this may or may not effect my
business is irrelevant. If GreenBridge Medical cannot provide a special
and desired service in a °legal market¨, then I need to change my business
model. In fact, I am changing it and will speak about the changes in a future
blog.
However, I have a strong feeling it will not pass. Again, I voted for it. IF
it does pass, it will be extremely interesting to see what happens from the
federal and local authorities.
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Regardless of whether or not it passes, the underling true and complex issue
is that of differentiating between medical and recreation cannabis. This
is why the tile begs the question of this very thin line. Is it the Real line
between °legal and illegal¨ or the virtual and softer line between medicinal
and recreational.
Well, I have two angels sitting on my shoulder telling me what to say re-
garding this difficult question of °drawing the line¨. Perhaps one is really a
devil and I just don't know which one right now. Anyway, One says °Who
cares, let this all be totally legal and let the patient the human being seek
out their medication in their own way¨. The other angel is saying °NO.
ABSOLUTELY NOT. We must preserve the purity of °Medical Cannabis¨
and keep recreational use under raps or at least separated.
In the end, none of this will matter. No matter what happens on any level,
there will be some doctors and companies making tinctures and running lab
studies to be able to produce better medications and SOME patients will go
seek this out. There will be a market for this. There will also be °weed¨
dealers¨ everywhere forever. There will be roadside °boutique¨ pot. The
consumer is just being given more options as time goes by. There will be
city grows in Oakland either way I think.
If the proposition fails we are left to walk a more °virtual thin line¨ sepa-
rating recreational pot from medical cannabis. It will be the responsibility
of the leaders of Medical Cannabis to stand up and help separate the recre-
ational users from Medical Cannabis. The best way to begin to achieve this
to to enforce age 21 for every doctor and every dispensary. I believe that
when voters come back to re-visit this issue, a cleaned up and more profes-
sional Medical Cannabis will help legalization slide through easily the next
time.
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Afterthought: Let's caII it SociaI Rather
than RecreationaI Pot Use
It occurred to me today that it is odd that with alcohol we use the term
°social¨. Social is, after all well..being social. That is a good thing?
Right? Plays well with others? Now, when we use the term °Recreational¨
for cannabis, it all of a sudden is a bad thing. I can't think of a single
reason we should not consider using the term °Social Smoking¨ and give
up Recreational Use. It sounds better and it is just the social use of cannabis
as compared with the medical use of cannabis.
So, this again begs the question..what is the difference between the two.
I THINK I have the beginning of a good way for us to begin distinguishing
the two and this will be the subject of my next blog or two.
Again, I believe that this distinction, this very fine line is important to begin
serious discussions on.
Stay tuned...
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What Happens to MedicaI Cannabis If Prop
l9 Passes?... Nothing
Ok, I can see the look on your faces. This guy is dreaming that he can have it
legal and medical. What a strange notion, legal and medical. I don't know,
but for me it really does work.
For the truly °legitimate¨ patient, and this is still a blurred area for certain,
cannabis can be true legitimate °Medical Cannabis¨. Regardless of what
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else is going on and is going to happen, there is a certain percent of the
medical cannabis community of patients that is truly legitimate. Is it 23%,
30%? I don't know, but I would venture that this is decent estimate.
So, for the doctors and patients where legitimate medical cannabis evalua-
tions are being done, they will remain in the medical cannabis system. If on
the other hand the Doctor/Patient °relationship¨ is defined by the signing of
a card, then it is just not medical and these patients are and should be legal
social cannabis users. I see no problem at all with this. More resources
available to support the research cause and a system that looks and feels
like we all know it SHOULD feel. It should feel, at least in my opinion,
like I feel every day working at GreenBridge Medical.
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Is The Cannabis Use SociaI or MedicaI?
So, to begin with, I am trying on for size the term °social¨. For now I like
it. What do you think?
This is my first attempt, right out of the gate, to throw the first draft of dif-
ferentiating medical from social cannabis use. Mind you, I am not saying
that one is right and one is wrong. It is just that with 34 years of medi-
cal experience, I know of no other medication that such powerful yet safe
medicinal value while also having °social¨ qualities. We all know about the
social experience with alcohol, it is just that none of us, with rare exception,
can think of any true °medicinal¨ value of alcohol. Yes, I know there are a
few exceptions, but they are very rare and hardly practiced any longer.
Here is the first attempt. I will begin with a list of what I believe goes
into making a professional and kind decision, between doctor and patient
to enter the Medical Cannabis World. The second is what goes into what is
involved in the social smoking arena. Please feel free to add:
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THE MEDICAL CANNABIS DOCTOR PATIENT INTERACTION DIS-
CUSSES:
1. The nature of the symptoms being treated
2. The time of day the symptoms occur
3. Discussion of the work and home environment
4. Discussion of the family and relationship issues as related to cannabis
use,
i.e. is a significant other opposed?
3. Types of strains that might best be suited for the patient
6. A discussion on all non-smoking alternatives with a focus on tinctures
7. Any and all safety issues and concerns
THE SOCIAL CANNABIS INTERACTION:
1. Roll a joint
2. Light the joint
3. Smoke alone or with a friend
4. Go back to #1
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MedicaI VS. SociaI Cannabis
Tuesday, October 26, 20l0
We have all decided at times that we need some help with some form of
medication. There are times for most of us, when we have gone to some
pharmacy and selected among many assorted Over-The-Counter medica-
tions. We purchase the medication and go home and take it. Generally all
works out just fine.
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However, there are times when we decide it might be best to see a physi-
cian. Why do we do this? We do this generally because we need informa-
tion about our own medical problem and we want to know the Physician's
thoughts as to what might be best.
I believe we can all identify with these basic differences? Right? Okay, then
how is cannabis any different. For many people under most circumstances
they might find that °social cannabis¨ is just fine. It should be cheaper and
very available and we all knowthat we have not always required a physician
to help us get °stoned¨.
However, what if you have a medical condition, where just smoking pot is
inadequate. You can't smoke. Edibles make you nuts. You want and need
information on tinctures. What is a tincture? Where do I get them? How
different are they? Should I get a tincture with high CBD? What is CBD?
Should I care? Can I safely medicate during the daytime? If so, how? On
and on and on.
So, ask yourself, were these above questions and others answered during
your cannabis visit with your doctor? If yes, that is great. If not, in my
opinion you received a permission slip to use social cannabis. Again, I have
NOPROBLEMWITHSOCIAL CANNABIS USE! I amonly saying that if
we are practicing medical cannabis, we must be educating our patients in a
kind, thorough and caring manner. It should look and feel like a doctor visit.
We all know what this is and we all know when it is being done properly.
I am not even picking on cannabis docs, I feel we have the same problem
with our entire health care system, but more on that later.
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GreenBridge MedicaI Offers: "Pay What
You Can, Just Promise That You WiII Vote"
Week
Friday, October 29, 20l0
For the coming week, beginning November 1, 2010, GreenBridge Medical
is offering this special service:
Pay What You Can, 3ust Promise That You Will Vote
So, for the coming exciting election week you decide what you feel is the
right payment for your services at GreenBridge Medical. Regardless of
your feelings about California Prop 19, it is critical to VOTE AGAINST
COOLEY. This in many ways is as important or more important than the
proposition itself.
Look forward to seeing you at the polls and in the office. PLEASE
VOTE!!
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BIog Comment Regarding Making a
TIncture
I don't often do this, but I am just going to paste into this blog a comment I
received regarding tincture manufacturing efforts. One of the most critical
issues in making a tincture is to be able to measure how thorough the decar-
boxylation of THC is. In other words, with the heating how much THC-A
is converted to THC. In a tincture, this is one of the most critical points. So,
here it is:
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°I have found if I use a Carnival strain (80%) Sativa and cure properly, then
freeze to get extra dry, then preheat oven to 323F and break into small pieces
and put into oven on foil sheet (not cookie sheet) for ex actually 3 minutes.
This causes decarbox. Then I soak for 20 minutes in EtOh (everclear) and
put bud/ethanol mixture in jar and boil (actually keeping it below the boil)
for 20 minutes in hot water bath while mixture is separate from water. Then
strain through a non-bleached coffee filter- I get a tincture that I store in
brown lightproof dropper bottles that works well. I can get 13 six hour
doses with only 3.3 grams of bud. Its the most efficient way I have found.
I make chocolates the same way- but MUST decarbox in oven or vaporizer
first or it doesn't work well at all.¨
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Dr. FrankeI To Be On Discovery ChanneI
Saturday, November 6, 20l0
I just had my second interview with Discovery Channel. I am being in-
terviewed and filmed for a show and potentially series that will come out
the first half of 2011. Of more interest, I think, is that they have agreed to
and very much want to film my trial. Of course, that is great news for me.
Really good news? I don't want any favors, I just want the Medical Board
to follow the law. That is it. By having Discovery Channel filming, it will
certainly increase the chances of an honest trial. If I lose, and the board
was obviously dishonest I will then have their support in going on to the
next level of the justice system, which would almost certainly clear me. It
is getting there that is tough. So, I still do need your help. Really I do.
With this media coverage, perhaps even the Medical Board of California
will have to be fair. If not, it will certainly open up a bag of worms for
them. I have already lost much, but they have not yet begin to lose.
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What is Happening at GreenBridge The
Week After The EIection
Sunday, November 7, 20l0
The election itself was not likely to have much effect on GreenBridge either
way it went. We are morphing into a full care clinic and with Dr. Adrienne
Grant, a doctor of Osteopathy now working here (GBM), we are adding
holistic and homeopathic care for our patients.
However, the big story from my perspective is the incredible and positive
feedback we have had from the community after offering:
If money is tight pay what you can. If you have the money -pay what is
fair
Patients are in fact being fair. Most see me as well, but that is optional. One
very ill woman offered her last $10 dollars which we obviously declined.
Another patient paid way over our usual fee. The spirit at the office has been
wonderful. The patients and the dispensaries are feeling that why not have
all valid patients over 21 go to GBM? Well, I believe that is happening.
This will allow a truly higher (pun intended, sort of) level of medical
cannabis to take place. Please understand, I am not a saint, I realize this
is good for GreenBridge Medical (GBM), but if it helps everyone, I can
live with it and hope all of you can. What I am hoping is that if we can help
elevate the quality of care in our area, the patients, with our input, can help
guide the collectives in quality of medicine, types of medicine required and
of course, MORE TINCTURES.
We can have weekly evening educational seminars at GBM or at various
collectives in the area. Let's add full testing to EVERY STRAIN SOLD
IN EVERY COLLECTIVE IN OUR AREA!! This would empower the
physicians and patients to get what they need. It would present to the public
the way it should be done.
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Best of all, GBM only has to educate patients for free and have patients
carry the message and make the changes by voting with their pocketbook
with a strong likelihood of making changes in the market.
Empowering the medical cannabis patient can only be a good thing.
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Cannabis AIIergy
Tuesday, November l6, 20l0
I was speaking with a patient yesterday who has a true allergy to cannabis.
In reading more about cannabis allergy, it seems it is simply the same as
any plant allergy. It seems that it is not as rare as I had thought.
I will be following up on this one patient and post a follow-up blog, but in
the meantime I have two initial thoughts:
1. Consider using one of the new °E-cigarettes¨ that work like the nicotine
e-cigs, but use small inserts of sativa or indica tincture. I would think that
the plant material from vaporized tincture should be very low.
2. See an allergist. I would think that a desensitization program SHOULD
work??
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Barry GoIdwater WouId RoII Over in Grave
Tuesday, November l6, 20l0
Well, it happened. Arizona is now the 13th state to adopt Medical Cannabis
legislation. YEAH!!
As we are all very aware of, Arizona is a very °red¨ state, but perhaps the
elderly helped in Arizona. It was a close ballot vote, but it is done and it is
a pretty reasonable initiative.
What will it take for the Feds to finally give up? I am not sure, but recent
polls also show that legalization of cannabis nationally is at about 46%. It
will happen. There is no doubt this will happen.
This is a good week.
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How To Smoke Cannabis and Avoid Dead
Space
Friday, November l9, 20l0
Well, what is this °dead space¨ I am referring to? Well, when you take a
breath, the average volume of each breath is around 800 cc, or around a
quart. For each breath of 800 cc, approximately 1/3 is dead space. This
dead space is taken up by your mouth, trachea and all major airways. These
volumes are °dead¨ in that there is no airway to blood exchange. We only
°absorb¨ the medication once the cannabinoids (thc, cbd, etc) are in the tiny
alveoli or lung sacs.
So, if when you take a hit from your device and take as deep a breath as
possible, the °top 1/2ª of the airway space is useless and all that cannabis
smoke or vape is totally wasted.
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It is best to take a modest °hit¨ and then breath in air to complete your
breath.
This should decrease the amount of smoke you use by 1/3. Let me know
what you think and if this makes sense.
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Why Have Cannabis Strains Changed So
Much Over The Years?
Saturday, November 20, 20l0
The average age of my patients is 33. In other words, I have a lot of baby
boomers as patients. Many of them report that they used cannabis socially
during the 60's and 70's but stopped around 1980. This is how is often
goes,
°I smoked in high school a bit and in college, but after that I had kids and
just sort of gave it up. I tried it a few times at various points in the late 80's
and 90's but found it to be very much a downer and I really didn't enjoy it
like I had. I just chalked it up to being older and the pot being stronger.¨
The fact is there were significant events that happened in 1980 and in the
few years preceding it. The War's in Vietnam and Korea were over, cutting
off the huge supply of Sativa's being smuggled via the armed forces supply
line. The famed AIR AMERICA being the most infamous operation of the
Vietnam War. This, combined with the beginning of Regan's war on Drugs,
which slowed the flowof Mexican and South American Sativa's, and forced
domestic cultivators to switch to growing more low lying Indica strains that
were better suited for indoor growing and had shorter grow times. The
popular °Kush¨ varietals are predominantly Indica.
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So from 1980 to today the majority of the cannabis, outside of medical
cannabis, are predominantly Indica strains. This has led to the common ex-
pectation that weed causes users to feel stoned. While true of Indica strains,
the same does not hold for Sativa strains. Sativa strains are in fact lighter
and more upbeat, most appropriate for daytime medicating.
Remember, the plant is NOT JUST a single medication.
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Web MD: ChemicaIs In Marijuana May Fight
MRSA
Tuesday, November 30, 20l0
Web MD: Chemicals In Marijuana May Fight MRSAj NORML Blog, Mar-
ijuana Law Reform
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FoIIow Up on Cannabis AIIergy
Wednesday, December l, 20l0
I have been working with one patient recently who has a severe cannabis al-
lergy. As I mentioned in a prior blog, cannabis allergies are not uncommon
and in general appear to be allergic reactions to the actual plant material.
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In working with this patient, it seemed that using the least plant material
possible would be ideal. She had done a bit better with vaping and a little
better with tinctures. So, we thought how can we vape a tincture?? The
answer is using the new Pen size device that vaporizes a tincture matrix
(can't endorse any product). I am not in the habit of advising product use,
but this is something really worth mentioning, so it is mentioned.
If any of you out there have had similar experiences, I would love to hear
from you.
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Yes, Doctors Used To Prescribe AIcohoI
Wednesday, December l, 20l0
This form was used by physicians during alcohol prohibition to °pre-
scribe¨ alcohol for medical conditions. Kind of looks similar to our current
cannabis forms???
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EmaiI From A GratefuI Patient
Thursday, December 2, 20l0
°I am, and always have been a supporter of the good Doctor.
I live quite frugally, on Social Security Disability, with no other income.
I only tell you this to explain my inability to contribute. I used to bring
cookies, cupcakes, and flowers, to show my appreciation. I hope my words
will be as appreciated.
The Dr. is a mensch, who should not be subjected to a witch hunt.
When I first came for my recommendation he was compassionate, caring,
and a professional physician in every way. We discussed my depression is-
sues, my osteoarthritis pain, and how each disease, and pharmaceutic treat-
ment, has negatively impacted my life.
He advised me that there were many different strains, and encouraged me to
educate myself, and cautiously, and judiciously use cannabis as needed.
I have found cannabis to be so much more effective than antidepressant
medication to treat my depression. There are no side effects to the cannabis.
As far as the osteoarthritis, I refuse to take the opiate pain killers which
are so highly addictive. The cannabis brings relief without me being in a
narcotic fog. The medication made me nauseous, marijuana does not.
The Dr. through his practice has alleviated my suffering. I see no reason for
a human being to be allowed to suffer pain, caused by a medical condition,
whether physical, or emotional, when there is a substance available which
can relieve that suffering.
I am grateful to Dr. Frankel, and I know many people are. I am a law
abiding citizen of the state of California, and I vote.
I wish to have my physician be allowed to practice what he has devoted his
life to, the care of his patients. I wish him to be allowed to do so unfettered
by unjust persecution.
Respectfully,
(Joseph) Alan Corrao¨
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Dr. FrankeI On Internet Radio From
October 27, 20l0
Saturday, December 4, 20l0
Better late than never? These are the four segments of that original radio
show. Also, beginning next Wednesday, December 8, 2010, I will be on the
air two hours every month.
ENJOY!
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THC and CBD Both Compete For The CBl
Receptor
Sunday, December 5, 20l0
So, it turns out that THC and CBD (cannabidiol), the two most common
cannabinoids, both compete for the CB1 receptor in the nervous system.
As mentioned in prior blogs, the two primary cannabinoid receptors in the
body are CB1 and CB2. CB1 is primarily in the nervous system and CB2
in the lymphatic system.
There is a single chemical bond change that differentiates THC from CBD.
With this minor of a change, it would make sense that much of the two
molecules are identical, which in fact is the case. The common end of the
two molecules, can each fit into the CB1 receptor. There is some new work
showing that if you give a patient pure CBD first and then give the patient
THC, the °high¨ is greatly diminished.
It seems clear to many, that some balance in the plant between THC and
CBD is critical. Over the past 80 years, we have pretty much bred out the
CBDcontaining strains. What is worse, is that it seems that everyone is after
very high (pun intended) THC levels and that testing is affording patients
the ability to actually select high THC plants.
This is a real problem for two primary reasons.
1. Very elevated levels of THC cause increase anxiety and paranoid reac-
tions.
2. We need to study various combinations of THC/CBD and if we label
everything, it is like doing a labeled wine testing I.e. nothing is blinded
So, let's get all our strains tested but not labeled at the dispensaries until
we have some clue as to what we are doing. At the very least, let's have a
number of the strains unmarked so we can finally begin studying this.
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Have You Been Factcinated?
Monday, December l3, 20l0
No, not a typo. When we get vaccinated, we are preventing some infec-
tion from inuring us. With Factcination, you are being made immune to
FACTS. I was thinking about this yesterday after listening to someone rant
on regarding Medical Marijuana. There was an initial exchange of ideas,
but he was so reluctant to even consider any science, that I was forced to
come up with some explanation for this person's very serious resistance to
facts, he had been factinated, never to listed to a fact again.
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Patient "Grow Letter" - Most TroubIesome
and Dishonest Doctor Behavior Yet
Thursday, December l6, 20l0
I have been noticing more and more °Doctors¨ selling these °GrowLetters¨
to patients for up to $200.
THERE ARE NO °GROW LETTERS¨ OR PERMITS OR ANYTHING!
These are 100% bogus.
1. They in fact offer no help under any circumstance
2. They make the patient feel safer when they are really at increased risk
by adding an illegal °card¨ to their illegal grow.
Of course, you can grow legally, but this is only as a patient or as a co-op.
There is no other legal way. Period.
If anyone disagrees, I have °Meth Lab¨ permits for $1000. ha, ha
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CouId High CBD Products Interfere With
Other Drug MetaboIism??
Sunday, December l9, 20l0
I hope all of you find this as interesting as I did.
Yesterday, with a high CBD strain and high THC strain available, a friend
and I did some °serious¨ science. We alternated smoking the two different
strains.
So, what both Patrick and I noticed is that we remained °stoned¨ for a lot,
lot longer than usual.
So, in looking up what sort of metabolism issues might be involved, I have
come across the following issues, the last of which is the true reason for this
post.
1. CBD inhibits the metabolism of THC and delays it's excretion. So, in
fact, what my friend and I noted was most likely real and has implications
both medically and °socially¨. Less weed..saves $$
2. The metabolic issue is delayed metabolism in the liver.
3. Here it is folks, CBD competes for the hepatic cytochrome P430 excre-
tion pathway, SO...
4. We must assume that CBD might compete with the metabolism of all
medications that use the same P430 pathway. This means we will need to
begin being very careful as we start using very high cbd tinctures, ANDWE
WILL NEED TO CONSIDER PLACING A WARNING NOTE ON ALL
HIGH CBD PRODUCTS.
Until/unless we can find out this is NOT an issue, we really must be careful.
Being careful is not just to assure patient safety, but IF this is a really sig-
nificant effect, which it very well may be, we now have the ability to really
mess with some patients medications.
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We should discuss this on Project CBD and the SCC should make a deci-
sion as to whether or not we should advise warning notes on all high CBD
products.
Can you imagine what will happen to medical cannabis if patients begin
getting tons of CBD who are on Coumadin and some die? We base ev-
erything we do and how we do it on the assumption cannabis is extremely
safe. I don't want to be overly concerned, but we need to decide as a group
whether this is significant enough to really worry about.
Thoughts?
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My TriaI Day Approaches
Tuesday, December 2l, 20l0
Many of you have asked for the details of my trial date and location. So, I
have it below. As an interesting aside, these guys are getting so desperate
that the DA's office requested that I not be able to use any experts!! Incred-
ible. Anyway, it appears that the Judge already took care of that. Pretty
scary and sad commentary.
So, here it is:
Monday, December 27 at 9 AM
6th Floor
320 W 4th Street
LA Ca 90013
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Eat Cannabis Leaves and Get HeaIthy
Thursday, December 23, 20l0
I have blogged on this in the past and will be doing a lot more blogging in the
future. THC and CBD(the other white cannabinoid) are great to eat! In the
plant, both of these cannabinoids are in their acid form, or THC-Aand CBD-
A. These acid forms have very powerful anti-inflammation properties.
So, if you can, eat 6 fresh leaves every day in salads or sandwiches or
shakes. More to follow. A LOT more to follow.
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GOING AFTER DOCTOR FRANKEL
Monday, December 27, 20l0
By FRED GARDNER
The Medical Board of California is trying to revoke the license of a pro-
cannabis doctor for using cannabis. Today in Los Angeles Allan Frankel,
MD, will appear at a hearing before an administrative law judge to defend
his right to practice.
Frankel is 39, barrel-chested, curly-haired, and jolly amazingly so, given
that his parents were Holocaust survivors. His looks and something about
his manner remind me of the comedian Albert Brooks. He is divorced with
three grown children two who are practicing MDs and one with a business
degree. (The businessman, Josh Frankel, was the place-kicker for the Uni-
versity of Oregon Ducks. In 1999 he booted the winning field goal against
USC in triple-overtime.)
Most of Frankel's career was spent practicing internal medicine. °I had a
hotsy-totsy office on Wilshire Boulevard in Santa Monica,¨ he says, and an
affiliation with UCLA. In 34 years of practice Frankel never had a problem
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with the medical board. He used marijuana on rare social occasions, and
knew nothing about its medical aspect. In 2001 Frankel underwent disk
surgery for intractable back pain. The following year a viral infection of
the heart almost killed him and left him °in general, permanent discom-
fort.¨ Relief came when some of the cancer and AIDS patients for whom
he had written recommendations urged him to try cannabis. °My patients
did a reverse intervention on me,¨ Frankel recalls. °Cannabis helped me
get better so fast I couldn't collect all the insurance I was due.¨
After resuming practice in late 2002, Frankel designed software that is still
used by the Bowyer Cancer Center at UCLA Hospital. He describes it as
°a specialized medical language that enables them to build very complex
what-if scenarios involving drug interactions, allergies, insurance, all the
factors that have to be taken into account in a treatment plan.¨
In March, 2006, Frankel opened a new office in Marina Del Rey dedicated
to cannabis consultations. °I really didn't know anything about cannabis
except what I learned from my patients,¨ he reflects. He joined the Society
of Cannabis Clinicians, read the relevant medical and scientific literature,
attended conferences, and did everything he could to educate himself about
the body's cannabinoid signaling system. He began tracking strain differ-
ences and encouraged patients to find the type of cannabis and the delivery
system best suited to alleviating their symptoms. In other words, Allan
Frankel was serious about mastering his new specialty.
Early on, Frankel says, °I realized that my patients were lying about how
much they used as if they feared my disapproval. Finally I would tell
them, 'I use an ounce a month. How much do you really use?' And then
they would level with me about dosage, about everything.¨
In June 2007 two agents from the medical board's enforcement division
°walked into the office and announced that I was under investigation,¨ says
Frankel. °They showed their badges in front of all the patients it was
terrible.¨ A vindictive ex had filed a complaint against him. In addition
to several false charges, he says, was a true one. As he would eventually
acknowledge when he agreed to accept probation from the medical board,
he had prescribed Vicodin for himself, °less than one pill a day on average,¨
while recovering from back surgery.
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Although the self-prescribing had occurred years before Frankel become a
cannabis specialist, the terms of his probation included a punishment never
before imposed on a California MD: for one year °Respondent shall not
issue an oral or written recommendation or approval to a patient or a pa-
tient's primary caregiver for the possession or cultivation of marijuana for
the personal medical purposes of the patient.¨
Friends and colleagues urged Frankel not to accept this punishment, which
the med board had recently added to its arsenal. He says he didn't have
money to fight it (having just put two kids through med school) and he
felt truly foolish and embarrassed about his self-prescribing. Cannabis had
politicized him and he had become self-critical. When he accepted proba-
tion it was partly by way of penance.
As of April 22, 2010, Allan Frankel, MD, stopped issuing approvals for
patients to use cannabis. Other terms of his probation, which have been
met, included taking courses in °prescribing practices,¨ °medical record
keeping,¨ °ethics,¨ and °professional boundaries,¨ undergoing a psychiatric
evaluation by a psychiatrist chosen by the board, seeing a psychotherapist
on a regular basis, abstaining totally from alcohol (which had never been a
problem for him), and submitting to random °biological fluid testing.¨
The probation requirement that Frankel has allegedly violated reads, °Re-
spondent shall abstain completely from the personal use or possession of
controlled substances. and any drugs requiring a prescription. This prohi-
bition does not apply to medications lawfully prescribed to Respondent by
another practitioner for a bona fide illness or condition.¨
Frankel was and is using cannabis with the approval of Christine Paoletti,
MD, and Cymbalta and Dalmane prescribed by Robert Gerner, MD, for
anxiety and insomnia. He was first prescribed Dalmane when he was in his
twenties to quell °recurrent nightmares I'd been having since I was a kid in
which the Nazis were coming to get me.¨
The case developed by med board investigators against Frankel will be pros-
ecuted by lawyers from the state attorney general's office. (His name is
Jerry Brown and he approved this prosecution.) The key witness against
Frankel will be Daniel Fast, a psychiatrist chosen by the board for this pur-
pose. Fast is a member of numerous establishment and gay psychiatric as-
sociations. On his resume he lists participation in °National Depression
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Screen Day,¨ an Eli Lilly scam intended to boost the number of Americans
getting Prozac prescriptions.
°I actually knew him slightly when I was at UCLA,¨ says Frankel of Fast.
°Like I'd nod to him in the cafeteria.¨ On April 28 Frankel went to Fast's
Beverly Hills office for °a 70-minute talk session.¨ Fast subsequently re-
ported to the board that Allan Frankel was unable to practice medicine
safely because of impaired cognitive function and °chronic marijuana us-
age.¨
Frankel's lawyer, John Fleer, has been handling cases before the med board
for more than 20 years and says he has rarely seen an accusation as °des-
perately flawed¨ as the one the med board is pressing against Frankel. °The
board is ignoring its own prior Decision and Order,¨ says Fleer, °by over-
ruling Dr. Frankel's personal physicians¨ in regard to appropriate treatment
for his condition.
The hearing before ALJ Susan Formaker begins today with opening state-
ments, followed by Daniel Fast's testimony. Frankel himself might testify
on Tuesday. His expert witnesses are set for Wednesday: Robert Gerner,
MD, a psychiatrist who sees Frankel regularly and does not discern cogni-
tive impairment, and Christine Paoletti, MD, who approved his cannabis use
and will testify that it does not render him unsafe to practice medicine.
°The irony is,¨ says Frankel, °that all my work is directed towards safety.
Finding the right strain, the right delivery method, the right dosage .
Working with an analytic chemist so that potencies can be known and con-
sistent. Promoting cannabidiol in hopes of developing less psychoactive
strains. Always issuing warnings and reminders to patients. It's just
ironic.¨
HUMAN SMOKE: Some might call it coincidence but in fact it's a polit-
ically consistent pattern: Frankel is the second member of the Society of
Cannabis Clinicians (1) whose parents were Holocaust survivors, (2) who
practiced medicine for decades without running afoul of the medical board,
(3) who got investigated and charged soon after becoming a Cannabis spe-
cialist, and (4) against whomthe board deployed a veteran of Eli Lilly's Na-
tional Depression Screening Day. The other was Hanya Barth, MD, whose
cruel ordeal was reported in O'Shaughnessy's, Spring 2007.
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Fred Gardner is a co-founder of ProjectCBD.org. He can be reached at
fred¸plebesite.com.
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Insomnia Is A Serious MedicaI ProbIem
HeIped By Cannabis
Friday, December 3l, 20l0
Source Healthy Living, °Dying to Sleep¨ written by Lanny Swerdlow,
RN
Lanny Swerdlow, RNhosts Marijuana Compassion 8Common Sense the
Radio Show every Monday at 6 p.m. on Inland Empire radio station KCAA
1030AM and simulcast at www.kcaaradio.com .
When anti-medical marijuana nay-sayers rant against laws allowing for
medicinal use of cannabis, they always trot out insomnia as an example
of a trivial ailment for which medical marijuana recommendations can be
written.
Far from being trivial, the impact of insomnia on your health is enormous.
Complications from insomnia include daytime fatigue, difficulty paying
attention or focusing on tasks, tension headaches, gastrointestinal upset,
lower performance on the job or at school, slowed reaction time while driv-
ing and higher risk of accidents, weight gain or obesity, poor immune sys-
temfunction, increased risk and severity of long-termdiseases, such as high
blood pressure, heart disease and diabetes and psychiatric problems, such
as irritability, depression and anxiety.
Robert Goldberg, Ph. D. of The Center for Medicine in the Public Interest
has stated that °we should treat insomnia as it should be treated: a serious
medical condition that has significant health and economic implications.¨
A survey conducted by the Washington-based National Sleep Foundation
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estimated the annual medical and reduced productivity costs associated with
insomnia among U. S. workers to be $92.3 to $107.3 billion.
The Institutes of Medicine, which advises Congress on health policy,
reports that Americans spend nearly $3 billion a year trying to get to
sleep. Consumer Reports warns readers that all these medications can
cause dependency, and even worsen sleeping problems along with signif-
icant side effects such as daytime sleepiness, cognitive impairment, dizzi-
ness, unsteadiness, rebound insomnia, sleep-walking, sleep-driving, mem-
ory lapses, and hallucinations. Ambien is one of the most popular insomnia
medications with physicians writing 26 million prescriptions a year, was
reported by the New York Times to make the top 10 list of drugs found in
impaired drivers.
Desperate for sleep, turning to extremes is all too commonplace. Michael
Jackson died trying to get to sleep. The night of his death, his doctor had pre-
scribed a host of medications including Valium, Ativan, Versed and Propo-
fol. Obviously this is an unconscionable use of prescription pharmaceu-
ticals, but Michael Jackson is not the first celebrity who died from using
medications to treat insomnia. Heath Ledger, Anna Nicole Smith, Elvis
Presley, Judy Garland and Marilyn Monroe all died from prescription phar-
maceuticals used to get a good night's sleep.
Instead of drowning them in prescription pharmaceuticals, if their doctors
had instructed all these famous folks to ingest some marijuana, they would
have all lived another day as well as gotten that longed for good night's
sleep.
Cannabis as an aid for sleep has been used safely and effectively for thou-
sands of years. Seventy years ago before cannabis was declared an illegal
substance, cannabis was found in almost every American medicine cabinet
and one of its principal uses was as a sedative. When grandma was tossing
and turning not able to fall asleep, she would get up, go to the medicine cab-
inet for a bottle of tincture of cannabis, place a few drops under her tongue,
get back into bed, snuggle up next to grandpa and drift off to sleep.
By reducing some of problems associated with insomnia such as pain, de-
pression, anxiety, stressand nausea, cannabis can help induce sleep. Even
without any underlying problems, cannabis can help you get a good night's
sleep.
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Although popular anti-insomnia medications like Ambien and Lunestra will
get you to sleep, you quite often do not feel like you had a good night's
sleep when you wake up because these medications induce an artificial
sleep. With cannabis you wake up feeling refreshed and rejuvenated be-
cause cannabis induces a natural night's sleep.
How much cannabis to take for insomnia is a very individual matter. Due to
the government's opposition to allowing research to go forth that can would
show positive benefits for cannabis, there is no research out there for deter-
mining how much to use other than anecdotal evidence. You will have to
determine how much you need to use to obtain the therapeutic dose neces-
sary to fall asleep. Unlike commercial drugs for insomnia that regularly kill
celebrities and non-celebrities alike every year, no one has ever died from
using cannabis, so determining the proper dose poses no significant health
risks.
One thing you need to consider is how to ingest cannabis for insomnia. Al-
though inhaling cannabis remains the most common method of ingestion,
many patients find that ingesting cannabis as an edible to be the most ef-
fective delivery route for insomnia. Although it takes longer to achieve its
effect when taken through the digestive system, the effects last longer.
The other thing to keep in mind when using cannabis for insomnia is which
strain to use. Most people find Indica strains to be more relaxing with a
pronounced sedative quality. Sativas tend to be more of an energizer. For
many people, it doesn't seem to make much of a difference and the bottom
line is generally any pot is better than no pot. If you are not getting at least 6
to 8 hours sleep a night because you can't fall asleep, stay asleep or you're
waking up too early, then cannabis may very well give you the good night's
rest that has been eluding you for far too long. You shouldn't have to die
trying to get to sleep.
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Dr. FrankeI's TriaI
Friday, December 3l, 20l0
Well, it is finally over. We don't get the formal results for up to several
months, but there was truly no contest. The case of the Medical Board was
just shredded, as they really had no case.
It was pretty gruesome and scary to see what happens in our justice system,
at least at this level. I am very optimistic and will write more after checking
with my lawyer, John Fleer.
I would like to publicly mention a special Thank You to Mr. Fleer. As
I told him, he was just as good as a TV lawyer. He was incredible and I
would °highly¨ recommend him to any physician having problems with the
Medical Board. Thank you John.
Please check out: http.77couhte¡puhch.con7ga¡dhe¡u1u32u
11.htnJ for a good summary of this travesty and waste.
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Med Board v. Dr. FrankeI
Monday, January 3, 20ll
Beverly Hills Shrink
By FRED GARDNER
Imagine having to attend a public hearing at which a psychiatrist to whom
you told the unguarded truth discourses on your °anti-social personality dis-
order.¨
That was Allan Frankel's plight as his fitness to practice medicine was
debated before an administrative law judge in Los Angeles Dec. 27-
30. (CounterPunch recounted the background of the medical board's case
against Frankel as the proceedings began.) Lucky for Frankel he was sur-
rounded by anti-social friends, including Tyler Strause, who kept Frankel's
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whole anti-social community up-to-date by Twitter.
The board's expert witness, a Beverly Hills shrink named Daniel Fast, was
supposed to reiterate and explain the diagnoses he had conferred on Frankel
after a 63-minute °psych eval¨ last spring. Here are some informative gems
from Fast's written report:
· Dr. Frankel was born in New York City and moved to Redwood City,
CA at age 7. He was captain of the football team and valedictorian in high
school but never had sex. His father, who had lost a son in the concentra-
tions camps, was never happy.
· Of these relationships, Dr. Frankel said °I'm attracted to borderline
women¨ and that it was °sloppy and wrong¨ [to prescribe for her and her
daughter| but he was °in love¨ and °will never do it again.¨
· He has a good relationship with his sister, several old friends, his three
adult children and a 16-month old grandson.
· He loves his work as CEO of Green Bridge Medical Services. 23% of his
referrals are from doctors in the community. He loves to help patients, es-
pecially those with MS, HIV and cancer. He is active and excited about his
new ventures -testing, developing tinctures [solutions of active cannabis|
and medical education about cannabis. He currently acts as a °greeter¨ in
his business and has hired another physician to see patients.
· He reports that °life is good, even now.¨ The worst is the °humiliation¨
by the Medical Board which he believes is °political.¨ He has no issue with
the Medical Board restrictions, i.e. to prescribe no scheduled medication
or to give marijuana recommendations. He accepts being unable to enjoy
wine and won't go back to doing what he was doing.
· Affective status: Mood is cheerful, optimistic and confident, inappropri-
ate in this context. [Emphasis added.|
· There is no evidence of alterations of reality testing -no hallucinations, il-
lusions or delusions. There is flight of ideas. There is preoccupation with
the medical uses of marijuana.
Fast's bottom line: °I believe that Dr. Frankel suffers from a variety of psy-
chiatric conditions which significantly interfere with his ability to process
information, form judgments or relate a coherent history.¨
Diagnosis based upon DSM-V Criteria:
· Axis I
· 304.30 Cannabis Dependence
· 303.20 Cannabis Abuse
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· 292.89 Cannabis Intoxication
· Rule out underlying 296.89 Bipolar II Disorder or 301.13 Cyclothymic
Disorder, Hypomanic.
· Rule out 314.9 Attention-Deficit/Hyperactivity Disorder Not Otherwise
Spcified.
Axis II
· 301.9 Personality Disorder Not Otherwise Specified with Antisocial,
Histrionic and Narcissistic features.
On direct examination by Deputy Attorney General Edward Kim, Fast tes-
tified that he had done eight previous psych evals for the med board. He
always asks doctors to come 13 minutes early to fill out some paperwork,
and most arrive 13 minutes earlier than requested. Allan Frankel, however,
arrived at Dr. Fast's office seven minutes late. And he was not wearing a
coat and tie, he was wearing slacks and a sports shirt. [Rosie asks, ¨Who
wears a coat and tie in LA?¨ And, ¨Those doctors who came a half hour
early how guilty were their consciences?¨|
Frankel, according to Fast, was dismissive of the medical board's charges
against him. He believed the prosecution to be °a witch hunt¨ that was °po-
litically motivated.¨ Yes, Frankel was contrite about the self-prescribing
episode and some bad choices he'd made involving women, but not suffi-
ciently contrite. In other words, Frankel, even facing loss of his license,
remained his brash and breezy self.
The expert Fast testified that he himself had never approved mari-
juana use for depression, anxiety, or insomnia, preferring to prescribe
pharmaceutical-industry synthetics. The psychoactive effects of marijuana,
he mentioned, last for 14 days. An anti-social friend of Frankel's whispered,
°Where can we get some of that stuff?¨
On cross-examination Fast would retract all the cannabis-related diagnoses.
Fleer began by calling Fast's attention to the fact that the Diagnostic and
Statistical Manual itself requires the doctor to select two of the three condi-
tions that he had pinned on Frankel. Fast said, °Oh, you're right. Well, I'll
choose Dependence and Abuse.¨
Fleer then had Fast read aloud from the DSM the so-called °Bible of
the American Psychiatric Association¨ all the symptoms and traits that
characterize Cannabis Dependence and Abuse, and got him to admit that
Frankel did not manifest them! According to Tyler Strause, °Fast was kind
of puny to begin with and he seemed to be withering away on the stand. He
wound up saying, 'I was incorrect. I'm sorry.'¨
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Fleer matter-of-factly termed Fast's inaccurate diagnoses °irresponsible¨
and moved on to the °Not Otherwise Specified¨ personality disorder. Fast
testified that he had based his assessment on traits he observed in Frankel
such as °impaired judgment,¨ °flight of ideas,¨ °poor impulse control,¨ and
°lack of concentration.¨
Fast had been consulting some notes while testifying. Fleer asked about
them. Fast said they were notes he had made during his 63 minutes with
Frankel. Fleer asked for and got copies. (No notes had been provided to the
defense on °discovery,¨ the legally required pre-trial sharing of potential
evidence). He then led Fast through a review of the notes, which revealed
that Frankel had proceeded from topic to topic in a logical order.
Howoften, Fleer asked, did people in the general population exhibit aspects
of an unspeficied personality disorder? This brought the stunning conces-
sion that Allan Frankel did not exhibit more signs of a disorder than most
people Daniel Fast has met! °I couldn't believe what I was hearing,¨ says
Fleer, who has handled med board cases for more than 20 years.
And there went the last of the prosecution case, if Med Board v. Frankel
was being tried in the Court of Common Sense. But an administrative law
hearing is more like the Court of Alice in Wonderland, and the hearing went
on.
In Defense of Frankel
The doctor who approved Allan Frankel's cannabis use, Christine Paoletti,
MD, is a Santa Monica obstetrician whose practice has expanded to include
cannabis consultations. Her testimony was °considered and deliberate,¨
according to our source in the gallery. She had recommended that Frankel
seek out and use CBD-rich cannabis, which is reported to be more effective
against anxiety than high-THC strains. The judge picked up on this and
Dr. Paoletti got to explain how Cannabidiol had been bred out of Cannabis
grown for maximum psychoactivity, but that CBD-rich strains were now
becoming available for medical users.
According to Paoletti, the judge took over her cross-examination from
Deputy AG Kim because °he wasn't cutting to the chase and she got frus-
trated. She knew very little but asked good questions. She asked why I
hadn't asked for a note from his psychiatrist [confirming his diagnosis|. I
had asked, but he hadn't brought it. But he did have his primary care records
documenting Insomnia and Anxiety. And that was substantial enough to
justify the recommendation.¨
Paoletti also noted that she had attended meetings of the Society of Cannabis
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Clinicians at which Frankel took an active part °and was always very co-
gent.¨
Paoletti was asked by ALJ Formaker whether she had questioned Frankel
about his past drug dependence. She said, °'No, he volunteered his history.
I asked him to elaborate on certain aspects of it. When he was recovering
from his cardiomyopathy he became concerned about addiction to Vicodan
and went through a program.¨
Paoletti considers Frankel's use of cannabis as an alternative to Vicodan °a
classic example of harm reduction. I have several patients who have been
able to get off their pain medications thanks to cannabis.¨
Formaker asked Paoletti if she had drug-tested Frankel. She said no, but
she knew that he was being drug-tested as a condition of his probation.
°My job,¨ she informed the judge, °was to determine 'Did he have a medi-
cal condition that merits the use of cannabis?' And 'Is he stable?' Yes and
yes.¨
Two other MDs testified that Frankel is fit to practice: Robert Gerner, a
psychiatrist who is seeing Frankel on a weekly basis (in according with the
terms of his probation), and Glenn Gorletski, an internal medicine specialist
who praised Frankel's character and skills as a physician. Gerner said that
Frankel was coping very well while on probation. °His treatment regimen
is working,¨ he said. °My advice is: 'don't change anything.'¨
Frankel himself took the stand to state that he was aware of his prior trans-
gressions and appropriately remorseful. His goal was simply to show the
judge that he could think and speak coherently. By design, he did not ex-
pound on medical cannabis. Fleer was concerned that his expertise could
be mistaken for a preoccupation.
Kim's cross-examination was °lame,¨ according to Tyler Strause. °I was
amazed how much of his time Kim devoted to flipping through his notes
and papers trying to find some point with which he could contradict Dr.
Frankel. He would flip through his papers for 30 seconds, then ask a three-
second question. Over and over.¨
Kim's closing argument, says Fleer, revealed an assumption that Frankel
had been °high¨ when he went for his appointment with Fast and will be
°high¨ when treating patients, if allowed to practice again. Kim repeatedly
reprised Fast's complaint that Frankel had been seven minutes late and ca-
sually dressed. °Kim got very worked up,¨ says Fleer, °trying to say that
if you don't wear a coat and tie, it means you're high.¨ (Move over, John-
nie Cochran.) °He really couldn't accept the idea that Dr. Frankel could
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use marijuana and see patients. He had to be 'high' and therefore dysfunc-
tional.¨
At the very end of the hearing, the judge told the lawyers there was an is-
sue on which she needed clarification, either via briefs or right then and
there. Fleer said best to deal with it now if we can, what is it? The judge
asked whether Depression and Anxiety were conditions to which Prop 213
applied. The relevant sentence was read to her the first sentence of the ini-
tiativeand she acknowledged that the conditions were covered. Frankel's
friends were shocked by her level of. let's call it naivete at that stage of
the proceedings.
In both his written report to the medical board and his direct testimony be-
fore ALJ Formaker, Daniel Fast lingered on the transgressions involving
women and prescription drugs that got Allan Frankel in trouble initially.
But Frankel hasn't skirted any med board guidelines since he started Green
Bridge Medical Clinic in 2006, and he isn't accused of having done so.
The present accusation boils down to an insufficient show of remorse over
things that happened before Frankel became a medical cannabis user and
proponent.
The judge has 30 days to write a °proposed decision,¨ and the med board
has another 30 days to decide whether to accept, reject, or modify it. The
whole board then has to vote on the decision at a quarterly meeting. If the
decision isn't favorable, Frankel will seek a writ in Superior Court to over-
turn it.
Fleer doubts that Attorney General Jerry Brown was aware that his office
was prosecuting the med board's case against Frankel. In fact, says Fleer,
the doctors who make up a majority of voting board members may not be
aware that Frankel's license was and is at risk. Board members come
and go, while the staff, which is dominated by investigators from the En-
forcement Division, stay unto retirement (and beyond, thanks to double-
dipping). Fleer says he is °almost certain it was the head of the Enforcement
Division who chose to go after Dr. Frankel¨ for taking the same medicine
he recommends to patients.
Fred Gardner edits O'Shaughnessy's, the journal of cannabis in clinical
practice. He can be reached at fred¸plebesite.com.
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Interesting Patient Response to TriaI
Thursday, January 6, 20ll
Among the many things that stood out to me as crazy about this trial was
Mr. Kim's closing argument, where he argued (rather ridiculously) that Dr.
Frankel should lose his license to practice medicine because throughout the
entire ordeal Dr. Frankel had masterminded and controlled all the processes
involved. He controlled who his witnesses were, he controlled the informa-
tion his physicians saw in making their evaluations and recommendations
for him, and he controlled how much cannabis medicine he could take on
a given day. This idea that somehow Dr. Frankel was in control seemed to
make Mr. Kim particularly hystericalhis voice cracked several times as he
said it.
It seemed a very strange way for Mr. Kim to close his argument given that
the entire trial was based on the Med Board's absurd accusation that Dr.
Frankel had lost control over himself and his senses because of his use of
cannabis. Essentially, the argument was this: Dr. Frankel was out of
control. And Dr. Frankel controlled everything.
I have tried to understand how those two seemingly mutually exclusive
ideas could exist in the prosecutor' head without causing it to explode. Per-
haps it's that same old reefer madness paranoid religious fanaticism that
we've always struggled againstthe belief that cannabis is a tool of the devil.
From this point of view, it was not the doctor who was in control, but the
marijuana. It was the marijuana that masterminded the trial, that deter-
mined the witnesses, that convinced a physician to recommend cannabis
to Dr. Frankel, that determined how much medicine he could use. All
along it was the marijuana pulling all the strings and manipulating every-
one and everything in the process. The devil himself in the form of the
demon weed is insinuating itself into every aspect of our society, trying to
take over America and snuff out the light of godly civilization, and by God
it must be stopped. That would at least explain the hysteria.
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Alternatively, it was simply about control. Who controls your body and
your fate? Perhaps nothing is so terrifying to a government bureaucrat than
that ordinary citizens, in consultation with knowledgeable people that they
trust, would assert their right to determine the terms of their health and their
healing without interference from an ignorant, overbearing, and dishonest
state.
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Grow Cards ReaIIy Suck - They Are
WorthIess, TotaIIy IIIegaI and Dangerous
Sorry about the language and sorry about repeating this subject, but I find
that this one creepy thing being done in LA and ?? elsewhere just irritates
me so much, I can't keep quiet.
Again, many doctors, at least in LA, are SELLING GROW CARDS. These
are worthless, illegal and dangerous. There is no such legal form or per-
mission as a °grow card¨. It is made up and for a couple of hundred bucks,
patients are getting these documents they BELIEVE and TRUST will keep
them safe. The patients are not really to blame, although if one is seriously
growing, one SHOULD know this is nonsense. (I wanted to use stronger
language, but.).
Regardless, the doctors for sure know they are selling something that is
worthless and illegal. Worse yet, patients will/are relying upon these as
being real and will get themselves into serious trouble.
I am requesting (without much hope) that all doctors signing these grow
letters, just stop. Please stop. You all have a right to make a living, but not
in this manner.
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Doctor or Activist
Up until this year, I always felt comfortable answering every question as a
physician. It was what I have done most of my life and I love medicine.
The recent charges, as they are playing out, have changed who I am to an
extent. It was and still is not a very pleasant experience, to say the least. It
changed three major aspects of my life:
1. Cash is gone. Oh well.
2. I can't say that I have no fears, but it appears that for the most part,
win or lose at this point, my level of fear in life has virtually vanished. I
am not saying there are not things that scare and worry me. Of course that
is the case. However, facing one's worst fears (or what we thought were
the worst fears) and just making it through them is an amazing experience.
Fear is truly a killer and our society in general is fear-based. I have been
shocked to find out how many cannabis physicians, even those over 40 y/0,
are hiding what they do from their parents!! Tragic. Very tragic. Frankly,
I think it is pathetic for the doctors and their parents, but mostly for the
doctors. If a doctor is that scared of doing what they are doing, they just
cannot be very effective. Patients see it and feel it. We are supposed to
make our patients feel better and better educated. How do we do this in the
midst of terror??
3. Finally, the main point of this blog. I never truly saw myself until now
as an activist. I tried so very hard to keep on the °straight and narrow¨
although some would say that my entering cannabis medicine five years ago
ended that portion of my life. In either case, I am now a physician activist.
I can't help myself at least for now. I truly did not want this as I didn't
want any distractions from the work I have been doing. So, now that I was
pretty much forced to become an activist, I will be balancing my role as
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physician and as activist. This is entirely new to me, so you will probably
see some changes in my blogs.
Love to hear your feedback.
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OMG
Tuesday, January ll, 20ll
You have got to check this out:
http.77WWW.f¡unfo¡un.con7d1d-pot-t¡1gge¡-g1ffo¡
ds-shoot1hg
So, the Gifford shooting was done by a °pot head¨. If this were not so
horribly scary, it could make a pretty good Saturday Night Skit.
The article refers to old work, that has been pretty much debunked, that
cannabis leads to an increase in Schizophrenia. I doubt this is the case and I
have written about this previously. Regardless, to state that this killer acted
out because of the °Pot¨ is simply ridiculous. What about other drugs and
alcohol let alone political motives in a hateful human being.
I hope that people don't buy this crap. I suppose this is an example of one
of the last buggy whips. They die hard and don't want to go away.
By the way, I believe I can use the same logic and statistics and prove that
drinking water causes all disease.
Give me a break.
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CBD (CannabidioI) Rich Cannabis Tincture
- FinaIIy
Monday, January l7, 20ll
As many of you know, who follow my post, CBD is a cannabinoid neuro-
transmitter in the same group as THCand dozens other more minor cannabi-
noids at least at this point in time. There is little doubt in my mind that
many other cannabinoids will find extremely useful places in the anti-tumor
and anti-biotic worlds. Stay tune for CBG and others.
In the meantime, let's expound a bit on CBD. Research sponsored by the
NIHand run at UCSF, has shown some very impressive anti-tumor effects of
CBDat fairly °low¨ doses. I quote °low¨, because we are still learning what
low means and of course how does the dosing translate to humans. Much
of the data is still unpublished but suffice it to say, I was stunned. Truly
stunned, particularly by the Human Breast Cancer treatment with CBD and
how it works. (more in another blog).
Cancer aside, CBD, is a non-psychoactive neurotransmitter that has pur-
ported wondrous effects on pain and anxiety. So, a tincture richer in CBD
and balanced to varying extents with differing concentrations of THC will
lead us to blends of many tinctures more and more specific to different pa-
tient problems, also, with or without psycho activity!
So, imagine, a tincture counter where patients could test single doses of
varying tinctures under the care of their care-giver and reporting the various
effects of the various tinctures. This would not be a true °trial¨, but we will
gather information. Once a supply of this tincture is available, it will in part
be made available through http.77p¡o¸ectcbd.con. Let me be very
clear. Project CBD can only let you know where these products become
available.
As this and other products become available, even for just testing, http.
77p¡o¸ectcbd.con will be a great resource for all of you.
Thoughts?
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Cannabis DecarboxyIation Video by Dr.
FrankeI
Friday, January 28, 20ll
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Time For MedicaI Cannabis To Grow Up
Monday, February 7, 20ll
Next November, medical cannabis will be 16 years old in California. Per-
haps these teenage years just represent °adolescent¨ growth phase. I cer-
tainly hope so.
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I have become more and more excited about what real medical cannabis rep-
resents and so disenchanted with the process. The fact that we have to even
call it °medical¨ sort of bespeaks the trouble we are all having separating
the real from the silliness.
So, is the silliness the many really horrible dispensaries, the doctors who
are corporate in mindset, the growers who were against legalization or ?? I
believe the silliness is the form in which the entire system is run. The paper
°recommendation¨ of which I have created thousands, is truly silly. The
system has become a manner in which to distribute/sell these silly pieces of
paper and nearly nobody spends a minute speaking about the true benefits.
In California, doctors are discouraged to even speak with growers or tincture
makers. It can be construed as °aiding and abetting¨ which in the rest of the
medical world is called °patient information¨.
I have come to the conclusion that the only way for medical cannabis to
become a minimally graceful 16 year old with wheels, we desperately need
to change the model. In my opinion, growing up will occur when the general
medical community not only accepts cannabis as a medicine, but is anxious
to help their patients with it.
Any physician or osteopath in California can create the °silly¨ paper. How-
ever, if it comes from the primary care physician, pain specialist, neurolo-
gist, etc, it is more than just silliness. The physicians who are true specialists
in cannabis can be cannabis consultants, but the °recommendations¨ should
come from the patients' doctor.
This will be a long process, but I am becoming very involved in physician
education. I believe the time is right and many doctors are open to the pos-
sibility, particularly after they learn how safe it is for them to do so. A
°recommendation¨ from the primary doctor is not only more °real¨ but it
will aid in advancing the true science of cannabis. This also begs the °le-
gality¨ issue. I still strongly believe that cannabis should be fully legalized.
It is only then that the true medicinal value of cannabis will be sorted out
from °social¨ smoking.
I can't wait.
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Trains, PIanes and AutomobiIes, OR
Tinctures, Concentrates and EdibIes
For patients and law enforcement, let's all keep these straight:
1. Cannabis Flowers This is what most people are familiar with. It is
the bud of the plant and is most often smoked. The average per cent THC,
the most abundant psychoactive component of cannabis, in buds or flowers,
ranges from as low as 4% to as high as 23%. The average THC% in most
strains of cannabis is in the 10-13% range. This is a critical number to
compare with the options below.
2. Cannabis Edibles This product, such as the famous °brownies¨ is meant
to be a product that is swallowed and absorbed through the stomach. Once
it leaves the stomach in passage to the blood stream and to the brain, it must
travel through the liver and be metabolized there. It is the metabolism of
THC in the liver that differentiates °Edibles¨ from all other delivery meth-
ods, a chemical change takes place that makes the cannabis much more
sedating, longer acting and much less predictable. In my experience, as
many as 23% of patients have a toxic reaction to edibles at one time or an-
other and I only recommend using edibles in a carefully monitored setting.
Trying to estimate a THC% in an edible is very difficult due to baking pro-
cesses being so poorly regulated. However, most experts agree that a 3
10 mg is an average dose.
3. Cannabis Concentrates or °Hash¨ Hash is nothing more than the °hairs¨
or trichromes of the cannabis flower pressed into a concentrated resin mate-
rial. It is highly concentrated cannabis and THC % often approach 60% or
even more. So, this is 3x more concentrated than the flower, and therefore
requires a lower dose. There are issues, such as the use of butane in the
creation of Hash, but it's use is entirely safe for patients, although very psy-
choactive and often very sedating. Again, the THC%can approach 70%!!
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4. Cannabis Tinctures Atincture is a very dilute extract of cannabis. They
are often made with alcohol or glycerin. Often the cannabis is extracted into
liquid carbon dioxide. Regardless of how the THC and other chemicals in
cannabis are extracted into liquid, the resulting product is a liquid that is
extremely dilute. The average tincture that I have had tested runs around
1-2% THC. So, this is much, much lower than the flower and just 2-3% of
that in concentrates or hash. The only reason tinctures work so well is that
they are absorbed directly under the tongue over a two minute period.
Tinctures are NOT concentrates. They have little to no relationship to Hash
and they are not used as edibles. As such, they represent the only predictable
manner in which patients can use cannabis.
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Dr. FrankeI Video on CBD
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GreenBridge MedicaI Steps It Up
Wednesday, February l6, 20ll
I have been discussing how important bringing the legitimacy of cannabis
medicine to the cannabis medicine system. The medicine is the best, but
the current system is very poor. The only longterm solution I see is to bring
cannabis medicine to the general medical community.
GreenBridge is doing this by moving it's offices in Marina Del Rey to a
medical building in Brentwood, 11633 San Vicente Blvd, 107 LA 90049
(in the Jon Douglas Medical Building). We will be on the first floor and
will have access either through the main medical building or directly thru a
beautiful sidewalk entrance.
There are no dispensaries in the area but there are thousands of physicians.
I believe some of these physicians, as they learn about tinctures and CBD
Rich medicines, will be more encouraged to either refer patients to Green-
Bridge. I also hope that many of the doctors will begin writing recom-
mendations for their own patients. This would make the recommendation
actually mean something. Doctors such as myself who are very experienced
can serve as consultants for those doctors and patients.
Of course, GreenBridge will continue the patients without recommenda-
tions, but will be encouraging patients to help their own doctors become
more comfortable with medical cannabis. When that happens, we will have
taken a big step forward.
Again, our new address is:
11633 San Vicente Blvd Suite # 107
LA CA 90049
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GreenBridge MedicaI Moves To Brentwood
Thursday, February l7, 20ll
GreenBridge is moving to the Jon Douglas Medical building on San Vicente
this Monday, February 21, 2011.
The entrance is at street level into Suite #107 at:
11633 San Vicente Blvd
Suite #107
Los Angeles, CA 90049, USA
In the Jon Douglas Medical building big red brick building on the north
side of San Vicente just around from where it curves, next to Toscana's
restaurant.
NEW GREENBRIDGE MEDICAL OFFICE:
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To AII My Friends
Thursday, February l7, 20ll
My Dear Friends,
As you all know, I dearly love the medicine from the cannabis plant but
pretty disgusted by the system both on the physician and dispensing side.
We have become more of a joke, despite our great work and incredible ad-
vances. The clinics doing this purely for the dollar have deteriorated to the
level that they sell °GrowCertificates¨ for $200!! It is a joke and dangerous
as it gives patients a false sense of security.
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http.77naps.googJe.co.1h7naps?f=q8sou¡ce=s¸q8hJ=eh8geocode=
8q=11ô33+5ah+v1cehte+BJvd.+5u1te+Z231u7,+Los+AhgeJes,+CA.+9
uu498sJJ=24.ôBô952,92.9BB2B18ssph=1u1.3353B4,227.ô3ô71981e
=UTFB8hq=8hhea¡=11ô33+5ah+v1cehte+BJvd+Z231u7,+Los+AhgeJes,
+CaJ1fo¡h1a+9uu49,+Uh1ted+5tates8v1eW=nap
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The only way to solve this, at least in my opinion, is to finally bring the
medicine of cannabis to mainstream medicine. I think I have figured out a
way to °Encourage¨ physicians to write recommendations. As one major
step to place me in a position to actually begin doing this seriously, I have
decided to move to the Jon Douglas Medical building in Brentwood and am
moving this weekend.
This is the location and information . Patients can park on the street and
walk right in to #107 or go through the building with valet, etc.
So, I will working together with Dr. Tahzib
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Her practice focusses on
anti-aging, integrative medicine and family medicine.
The really exciting part of this, is that it places GreenBridge smack in the
middle of West LA medicine and between Santa Monica and Beverly Hills.
I am working hard on more CME and physician education projects and
would love to involve all SCC Physicians. For those of you who do not
knowwhat the SCCis, please check out their web site. Any serious cannabis
physician is involved in this TINY but critical organization. In my opinion
it is perhaps the only serious medical cannabis organization in the state.
I apologize for making this long, but the idea is this:
When I visit these doctors I am happy to have them either send me their
patients but I really prefer for them to get signed up with online verification
and Rec creation and allow them to profit from this process, many of their
patients will be thrilled. Many docs are overloaded with low fee patients.
Many are fearful and will never write a Rec, but SOME will be able to
overcome their fear when they see that they can make $30 to $200 having
their nurse print up a Rec for a patient. They just have to sign and the nurse
makes a note in the chart. All the records are there. They will NEVER be
bothered as the primary doc. In one minute, the docs can create the most
valid Recs ever. Perfect!
It is both scary and exciting leaving, but please call us at 310-821-9600,
email us at (yourname)¸greenbridgemed.com (BTW, yes, even your-
name¸greenbridgemed.com will work. )
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Again, beginning this Monday, come visit us at:
11633 San Vicente Blvd
Suite #107
Los Angeles, CA 90049, USA
In the Jon Douglas Medical building big red brick building on the north
side of San Vicente just around from where it curves, next to Toscana's
restaurant.
GreenBridge Med New Office
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Allan
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Cannabis Being RescheduIed Right Now
Friday, February 25, 20ll
I doubt that anyone ever believed that THC would remain Schedule I, i.e.
useless and very dangerous. You would think that changing this schedule
would come from the huge Medical Cannabis machine and the people's
demand for better and safer medications. Well, most of you already guessed
it is Pharma. The really ugly part of it is that it is Pharma working with the
DEA!
Check this out: Cannabis Rescheduled
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So, to summarize, the DEA and Pharma have sort of worked out what will
happen as new Pharma based Cannabis tinctures come out to the market in
a few years. Sativex
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Sativex has already passed early clinical trials in
the USA and will be starting Stage II trials very soon.
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As most readers are aware, cannabis tinctures in collectives are showing up
more and more and are getting better and better. For my blog readers who
are familiar with my thoughts, I believe that cannabis tinctures are pretty
much the only predictable, safe and dosable method by which to adminis-
ter cannabis. Pharma feels the same way and we will have a collision in
a few years between Pharma based cannabis tinctures and Med Cannabis
°organically¨ made tinctures.
I doubt the efficacy will be much different, but the °organically¨ or °Med-
ical Cannabis¨ tinctures, at least in my opinion, will be far advanced by
that time. The big difference will be price. I believe that organically cre-
ated tinctures using Super Critical CO2 Extraction, will cost $1 or $2 daily.
The Pharma based tinctures are already over $23/day. This price may come
down, but there will always remain a huge price differential since Pharma
must make up for billions in debt, product development and lawsuits.
This is clearly why the °law¨ is attempted to define tinctures as a concentrate
or HASH. Very silly.
Can't wait to see how it all turns out!
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How EarIy in a PIant's Life Can You
Measure CBD
Saturday, February 26, 20ll
Traditionally, as we try to find Rich CBD strains, we thought we needed to
wait until the plant flowered, dried and then tested. This was/is very helpful,
but what if we COULD find out way earlier in the plant life cycle what that
plant was going to produce.
We have recently heard that at 13 weeks Rich CBD plants can be identified.
I amreporting today that after 4 weeks, a Harlequin Strain showed 1%THC
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and 2.1% CBD. So, it is clear that at no longer than 4 weeks, it becomes
clear. As others of these clones are grown out, we will keep repeating the
testing.
So, what can we do with this information. The most exciting is that we can
go obtain a number of very different strains and begin testing them as 3-4
week old seedlings. If we obtain 3 clones at a time, we can use one for
testing and have the other two to begin creating mothers IF/WHEN they
show promise of being something interesting.
Up until now, we would get the results of the °flowers¨ and then not have
another plant to grow out. We are certainly moving along.
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How Do ProfessionaIs Extract The
Cannabis PIant
Friday, March 4, 20ll
Below is a photo of an LA based Super Critical CO2 extraction setup. Most
folks are familiar with extraction of cannabis into butter/oils for edibles, or
alcohol/glycerin for tinctures. Well, with regard to tinctures, in the State
of California, the only truly legal way to make tinctures is utilizing Super
Critical CO2 extraction. This is basically a process where the plant material
is extracted using liquid CO2. The extra plant material is removed and a
pretty think white/yellow °goo¨ is what is left. From a pound of trim, one
is left with approximately 1 oz of this very concentrated goo with which to
make tinctures.
We recently sawa °goo¨ where there was just over 26%CBD. These people
should come up with a pretty good rich CBDtincture. Although much more
complex, using CO2, there is a much better cannabinoid extration.
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So, here it is:
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First Two Weeks After Move To Brentwood
Tuesday, March 8, 20ll
Well, we have now been at 11633 San Vicente Blvd, #107 in Brentwood for
two weeks. It certainly has a different feel to it. It is beginning to feel a bit
more serious and less °beach types¨ (so sorry, but..) wanting Recs for
fun.
I am meeting with physicians in the area and encouraging them to either
start doing recommendations themselves, in which case I would help them,
or sending patients to GreenBridge.
So, why would I want to create °competition¨ with myself, you might ask??
Well, I will tell you:
1. I think the physicians doing the recommendations SHOULD be the pa-
tients' primary or specialist physician. These RECS would be truly legiti-
mate and would lend so much credibility to the Medical Cannabis Commu-
nity.
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2. Some physicians WILL send me patients and these are patients with
whom I can work with together with the primary doctor.
3. If a significant number of physicians begin to RECS for their own pa-
tients, there should be a trickle down to consultants, perhaps such as myself.
If it is not needed, I will go do something else, knowing I helped bringing
Medical Cannabis to the Medical World
Anybody know any primary care docs who want to begin writing RECS? I
would be happy to help them, no charge at all.
Allan
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Sativa Tincture HeIps a Patient ControI
Their Diabetes
Thursday, March l0, 20ll
PATIENT LETTER:
Allan,
Wanted to follow up with you. I saw you last week and you recommended
I try the Sativa Tincture. I've been using it the last three days and it does
seem to be helping to keep my blood sugar levels more stable. I've notice a
definite difference at night. It's been very helpful. I'm experimenting with
dose/time of day, etc., but I think it's going to be helpful in giving me better
control of my diabetes.
Thank you for your help. I enjoyed talking to you, and appreciate your help.
And thank you for the work and support you give the MM community.
MS
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Update on Tinctures
Monday, March l4, 20ll
Any of you who follow my blog know I am a supporter of Cannabis Tinc-
tures. Again, a °tincture¨ is an extraction of the cannabis plant into so-
lutions such as glycerin, alcohol, acetic acid and others. The majority of
the tinctures currently on the market are pretty simple alcohol or glycerin
extractions with the plant material being trim.
The advantage of using trim is price by far. However, °trim¨ can mean
so many different parts of the plant. Also, as I have spent time reviewing
the lab testing of trim, it is just not consistant. Also, particularly if outdoor,
much of the trim has been stepped on and worse. Indoor trim will be more
predictable and less messy, but indoor growth tends to produce less trim to
begin with, so it is still an issue.
Using just the flower of the plant is expensive, but some tincture manufac-
turers do this. The other issue with just using flowers, is that the rest of the
plant's cannabinoids PROBABLY do in fact represent a better
cross of all the cannabinoids of the °whole plant¨.
So, from my perspective, perhaps other than the larger branches, the entire
plant, including the water leaves should be used in the tincture. I feel that
both from a legal perspective as well as being the most efficient extraction
method, Super Critical CO2 extraction is the best method to use. It seems
to extra the vast majority of the plant cannabinoids. This extract is then
diluted using glycerin and often some alcohol to make the final tincture.
In my next blog, I will discuss some thoughts as to why most tinctures are
not that °stony¨.
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Patient Letter Regarding Treatment of
Anxiety With Cannabis
Monday, March 28, 20ll
I have constant generalized, very debilitating anxiety (caused mostly by
THC!), scoliosis, chronic neck and back pain, I am recovering from kidney
surgery, and experience some psychotic symptoms from my cannabis use
(THC use). I know that CBD is a strong anti inflammatory, anxiolytic, and
anti-psychotic. If CBD was made in a pure, (NO THC!) tincture form I
would be able to naturally live my life! -not having to worry about my pain
and anxiety and only using a plant with very little or no side effects. Best
of all I wouldn't have to get high! I'm literally waiting for the day CBD in
a pure, tincture form hits the market. My prayers will be answered.
Dear Patient:
The anxiety you are feeling is not entirely just from the THC. There are
strains of cannabis which cause anxiety and some that decrease anxiety with
the exact same level of THC. In general, for whatever reason, Indica strains
are in general more the culprit than Sativa strains. That said, the simplest
way to avoid the anxiety caused by the cannabis is to avoid smoking and
even vaporizing. I would strongly suggest, of course, to entirely avoid any
and all edibles. Tinctures will be, in my opinion, the best way to medicate.
There are some CBD containing tinctures hitting the market. They WILL
have some THC in them, and that is fine. CBD and THC compete for the
cannabinoid CB-1 receptor and generally the CBDwins. Check out http.
77p¡o¸ectcbd.o¡g for locations and strains that contain CBD.
If you live in Los Angeles. Come by or give me a call and we can speak
further. REMEMBER, you do NOT have to get rid of all the THC.
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New Cannabis Tinctures in The Works
Saturday, April l6, 20ll
Any reader of this blog or patient of mine is well aware that I strongly be-
lieve that the best way to predictably medicate with cannabis is by the sub-
lingual route using tinctures or extracts of cannabis.
For those familiar with CBD, there are some new rich CBD tinctures about
to become available. If you are not familiar with CBDcheck out: http.77
WWW.g¡eehb¡1dgened.con7d¡-f¡ahkeJ-v1deo-oh-cbd7
Small doses of CBD along with very minimal amounts of THC is a big part
of what the new tinctures are all about. They will be certified (followed
from plant to bottle), organic and clearly state how much THC, CBD and
other cannabinoids and terpenes are present.
This will allow many more patients to safely medicate during the day with-
out turning to smoking. I am very excited by the upcoming releases. Stay
tuned.
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GreenBridge Expands Into Santa
Monica/UCLA
Wednesday, April 27, 20ll
Dr. Christine Paoletti is joining GreenBridge Medical making GreenBridge
Medical the first pro-cannabis office to form such a professional partner-
ship. We are all very excited!!
So, why are we moving?
1. Location in UCLA Medical Building and proximity to hospitals will
allow easier education of physicians
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2. I will be working with Dr. Christine Paoletti, an excellent Cannabis
specialist, herbal physician and gynecologist. We will be doing combined
patient research and education
3. Working with Dr. Paoletti will allow our patients access from 10-6, Mon
Sat
4. This expansion will create the first physician owned °group¨ medical
cannabis office i.e Not corporate or °venice beach¨ level
Here is the map to 1304 1Sth St, Suite 40S, Santa Monica CA 90404:
View Larger Map
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How CBD Might Decrease Chronic Pain
Friday, May 6, 20ll
There have been a number of publications, including Scientific American,
November 2009, talking about new concepts in control of chronic pain. As
every one of my friends and patients know, we are often in way too much
pain.
Pain serves a useful purpose both acutely and chronically to make and keep
us aware of our possible limitations, makes us more careful. However,
the body is not perfect and sometimes the response to an event, such as
an injury, is to setup a chronic pain situation where the amount of pain is
far, far greater than necessary to make and keep us aware, it can confine us
to our beds and chairs. So, what are the possible reasons our bodies betray
is? Well, I certainly dont' know, but a number of studies are suggesting the
following:
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When we have an injury, our nerve synapses (where nerves join) release a
number of cells called °Glial¨ cells. These cells produce cytokines which
are immune stimulants. That can be helpful in some conditions, but with
pain with associated inflammation, it can be debilitating. The cytokine pro-
duction is somewhat unchecked and the pain is just °over the top¨. We
generally use typical NSAIDS or narcotics.
The glial cells have a binding site for CBD(Cannabidiol) and it appears that
when CBD attaches to the glial cells, the cytokine production decreases.
With decreasing cytokines in the local tissue...less pain.
This may explain why I have been hearing from some patients that with
chronic use (longer than one week) of daily CBD tincture usage, their pain
and swelling of their knees and other joints are improved.
Again, this is NOT STUDIED AND WE DON'T KNOW ANY AN-
SWERS, but this is something to just put out there.
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I Just Heard About CBD!! What Is This
About CBC??
Sunday, May 8, 20ll
Well, folks, as in prior blogs, there are probably nearly one hundred some-
what unique cannabinoids and we are just learning about them. A local
growing group shared with me the results from The Werc Shop
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, a great
LA based cannabis laboratory. The owner and lead chemist, Dr. Jeffrey
Raber is an excellent organic chemist and he has taught me much of what I
currently knowabout the molecular biology of the cannabinoids. So, please
check out their site.
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Anyway, I was consulting on the strain reports and it became clear that
there was CBC in some moderate amount in the plant. We can't quantify it
at the current time, but that will come. So, why is this important? CBC is
one of the cannabinoids possessing natural anti-bacterial properties. CBD
and CBG also have these properties. Of particular note, these cannabinoids
have a bactericidal effect on MRSA. (Methicillin Resistant Staph Aureus)
a highly resistant and deadly nosocomial infection.
I am excited for a number of reasons, but only one is the possibility that
a °tincture¨ or °wash¨ rich in CBC MIGHT be useful around hospitals.
To me, another very important opportunity lies in our potential ability to
demonstrate to the medical mainstream that CBC and other cannabinoids
can help with patients, without any added toxicity. It will be topical at first
and before this, we will need to demonstrate in those old °petri¨ dishes that
a disc embedded with CBC has a good kill zone for various pathogens who
are resistant on the same agar plate to other standard antibiotics.
This should buy us a few more votes?? Don't you think?
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TINCTURE TESTING BEST METHOD TO
GATHER CLINICAL-MOLECULAR DATA
Thursday, May l2, 20ll
Since the mid 1990's when the endocannabinoid system was discovered,
scientists and physicians from around the world have been working on sort-
ing out which molecules in cannabis are responsible for which effects.
We have a very, very long way to go, but we certainly know much more
than just 10 or 13 years ago.
We knowthat THCis one of the primary psychoactive cannabinoids and en-
joyed by millions, but that there is an °edge¨ with THC. Many patients are
sensitive to the agitating effects of THC and some of the newer and richer
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THC are being sought after with mixed clinical results.
We know that CBD, cannabidol, is an amazing cannabinoid. It has minimal
psychoactive effects other than helping treat anxiety and depression. So,
does that mean that °feeling better¨ is psychoactive? I suppose if it does,
then perhaps CBD does in fact have some psycho activity, but it certainly
has no significant sedative or hallucinogenic properties so far. CBD also
is very promising as an anti-bacterial, along with CBC and CBG as well as
having some new, and very promising anti-tumor effects.
We know that as above, CBC and CBG have anti-bacterial effects and
specifically seem to have bactericidal properties against MRSA and per-
haps other antibiotic resistant bacteria.
We know that smoking cannabis is only approximately 20% efficient, with
80% of the cannabinoids/terpenes being lost. We also know that a °puff is
not a puff¨. Every puff is different
WE know that using cannabis orally has issues with dosing as well as with
hepatic 11-hydroy addition that increases the THC receptor's affinity for
THC by five-fold.
We know that we cannot differentiate Sativa vs. Indica strains based on
their cannabinoid content.
We certainly know much more, but how are we going to truly find the as-
sociation between the clinical effects and the chemistry of the medicine.
There are several databases around that are trying to accomplish this with
smoked cannabis. However, frequently, a strain is tested once and the la-
bels used over and over again. Anyone who has grown and tested cannabis
plants knows that this is folly.
The genetics of the plant is only one of the critical pieces of information.
Regardless, it is nearly impossible currently to detect genetic differences
amongst various strains. The reason for this is that the body and the brain
respond to the chemistry of the plant and not the genetics. Even with the
exactly same apparent genetics, many genes are turned on and off every
generation and this leads to the expression of different proteins.
This environment effect on the expressed genetics is generally passed on to
the next generation, so genetic testing, such a great idea, is not adequate.
As many tinctures of varied cannabinoid and terpene content can be fully
tested PRIOR to use, and the absolute values and ratios of cannabinoids/ter-
penes can be tested and reproduced (mostly), we can begin to use a database
that has tables for the clinical input and tables for the chemical component
input.
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We are encouraging all collectives who create tinctures to both label them
as well have a online °package insert¨. This online form will give the pa-
tient much information about the strain as well as offer a series of questions
regarding the reason they took the tincture. If the patients provide the data,
perhaps they could share the database and see what other chemical profiles
work best for them.
So, I am very excited. Stay tuned.
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A Puff Is Not A Puff And Cannabis
Tinctures Are Not Concentrates
Friday, May l3, 20ll
The general medical community in the United States, as well as the inter-
national cannabinoid medicine community of scientists believes cannabis
to be effective both in its natural plant state as well as with certain safe ex-
tractions. At times, safe extraction is confused with °concentrates¨ or hash
and there remains a lot of confusion concerning tinctures and edibles.
The plant Cannabis Sativa has 430 or more unique molecules. Approxi-
mately 90 of these are cannabinoids. Terpenes and flavanoids are present
in large numbers, which give the individual strain of Cannabis its unique
medical and psychotropic effects.
The plant itself does have more tar than many tobacco products and it is
difficult as a physician to advice using the plant as a medicine by the °burn
and smoke¨ technique. Although smoking the plant is effective, it is very
difficult to control dosing and proper dosing is somewhat challenging.
So, smoking the plant has the tar and dosing issue, , the general issues asso-
ciated with smoking, access to the medication in public during the day and
others. Howcan a patient possibly rely upon a medication that they can only
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use under certain limited situations? What other Rx could a physician pre-
scribe that MUST be smoked and only used in certain private situations?
Any acceptable medication, endorsed by a physician must be both easily
available to the patient and dosable. One cannot dose with smoking.
One final point on smoking, there is much discussion regarding the risks as-
sociated with altering the cannabis plant and °manufacturing medication¨.
At the very least, if one takes the plant and uses it °naturally¨, the following
must still be done:
1. After the plant is grown, it must be harvested dried and cured. These last
Two processes are associated with risk of mold and other contaminants.
2. Even if the herb is °pure¨ when it is dried and cured, it must be delivered
To the patient, and many things can go wrong in this area.
3. Once the patient has the herb it needs to be BURNED to be activated. A
Patient cannot simply eat the plant and obtain most effects. This burning is
dangerous, uncontrolled and injures patients as well as causing fires.
4. To consider leaving the patient options restricted to burning cannabis is
Irresponsible
So, in conclusion, I can't see any argument how/why burning cannabis
should be the preferred method to leave to our patients. It seems very un-
professional and without any rational scientific basis.
Let's now turn to cannabis vaporization. Vaporization is a process where
cannabis is heated to around 330 degrees F and is generally not burned. At
this temperature, much of the cannabis is °activated¨, as it is by burning,
but the amount of tar delivered to the patient is far less. This is clearly an
advantage, but it is the only advantage of using a vaporizer. The main prob-
lem remaining is that it is not dosable. I.e. the patient does not know what
they are truly receiving. Finally, in most situations, it is just not convenient
as most machines require 110-volt plug-in.
So, vaporization is a much cleaner burning of the plant, but still a very
unpredictable process. In addition, for many patients with sensitive lungs,
the vaporized particles are actually much larger than the smoked ones, and
can be more irritating. Again, not a great solution in any way.
Next, let's turn to the issues of °concentrates¨, tinctures and edibles. By
definition, a °concentrate¨ should actually be some °concentrated¨ form of
cannabis. According
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to the medical definition of concentration, it is defined as °starting at a cer-
tain concentration of a chemical, performing a process that results in mak-
ing the chemical more °dense¨ or more molecules/volume. It is no different
than concentrated orange juice. We understand that, and cannabis concen-
trates are no different.
Very standard °flowers¨ of cannabis, test out in the 10-20% THC level.
Some are a bit lower and some a bit higher. A typical °concentrate¨ or
°hash¨ is generally around 60% THC, clearly MORE concentrated. In my
opinion and in the opinion of all experts I know, a concentrate MUST have
more THC/gm than the flower it came from. No exceptions.
Edibles, are taken in the mouth, swallowed, absorbed by the stomach and
metabolized by the liver. In the liver, a chemical change takes place that
makes the cannabinoids 3X more °sticky¨ to the CB1 brain receptors. So,
edibles can be intense, but when they are made professionally with known
stated doses, patients can use them very safely. The only issues I have with
edibles are the ones made in unclean kitchens and those made without any
cannabinoid testing.
This testing of edibles is absolutely mandatory.
Finally, with regard to tinctures, a tincture can only be truly professionally
made if it is done with CO2 extraction. To the best of my knowledge, using
alcohol or any chemical for the cannabinoid extraction is not legal in Cal-
ifornia, but as CO2 is just a gas that makes up 3% of the air we breathe, it
cannot be considered a chemical more than air is a chemical.
These extracted cannabinoids are not in usable form and must be greatly
diluted with glycerin and water to be used.
The final product of a tincture is the ideal method by which to administer
medical cannabis:
1. It is entirely dosable by drops under the tongue
2. It can be taken anywhere privately and safely
3. The dose duration is predictable
4. The effect of the particular tincture is predictable
3. The tinctures are readily testable and verifiable
6. It is easy to set standards and enforce them
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7. The various cannabinoid and Terpene medicine delivery can be con-
trolled allowing not just treatment with THC, but also many other safe and
effective medicines.
The Medical Cannabis field is a new one and considered to be a wild one.
Standard international pharma and the FDA are clearly still considered the
medical standard and this will not quickly change.
If one accepts this premise, one should not be surprised by the current
cannabis medicine currently being produced by pharma around the world
and here in the United States.
Marinol, or Dronabinal, has been available in this country for approximately
20 years. It is THC in a caplet and has a very long testing history. It has
limited value as it is oral and only contains THC, while cannabis tinctures
are °whole plant¨.
So, one would think that Pharma would be into making tinctures if all the
above is true? Well, there are many international products being made by
many different pharma houses. The most notable is GW Pharmaceuticals.
Bayer has in fact purchased the North American license for selling their
primary product, Sativex.
Sativex is a CO2 extracted cannabis product produced in the precise
same way professional tincture manufactures make tinctures in California.
Sativex is nearly completing their Stage II clinical trials in the US and will
certainly be approved by the FDA in the next several years.
The only serious difference between medications such as Sativex and other
Pharma Cannabis Tinctures, and the non-pharma based tinctures is the
cost.
Using tinctures is the most cost effective and safest way of administering
cannabis. Smoking cannabis is both the least efficient manner in which to
medicate, as well as an impossible method to regulate.
I often hear about the term °manufacturing¨ medicine and that this is not
legal in the cannabis world as cannabis is illegal. I can understand why
controls regarding making medicine are essential, but there still should be
some rational discussion of what represents °altering¨ or manufacturing the
basic plant.
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I would strongly argue that the most unsophisticated and crude way to use
the cannabis plant is by smoking it. It has tars similar to cigarettes and
burning and inhaling a °puff¨ is not any recognized dosing that I have ever
heard of. It is true that one °puff¨ is one puff, but every single puff is
different. There are different burn rates and burning temperatures. Every
puff comes from a different part of the flower. Every puff is different with
regard to depth of inhalation. I could go on and on.
So, with smoking, we are in reality, asking the patient to alter/burn/man-
ufacture smoke. It is generally done with butane lighter. Is this really the
best way to deliver the cannabinoid medicines? Hardly.
With edibles, it depends upon how they are being made. If the oil/-
cannabis/butter is using a chemical extraction, then there is in theory an
issue, but the medicine in it's oral form is acceptable IF the patient can be
given a specified dose. There is no way to have any medicine of any form
be useful if it is not dosable.
There are in fact internationally established safe methods for making
cannabis tinctures and certain forms of edibles. Denying patients these
forms of cannabis medicine while forcing them to burn tar seems irrational
and unsafe.
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CBD And Asthma
Friday, May l3, 20ll
It has been known for many years that smoked Cannabis is a bronchodilator
and can be useful in treating asthma. Usually, asthma is a problem with
bronchospasm (wheezes) and increased mucous production in the smaller
airways of our lungs. There is a large component of anxiety associated with
asthma, as who would not be scared when it is difficult to breathe. More
anxiety causes worsening bronchospasm, which causes more anxiety.
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Typical inhalers contain adrenergic (adrenaline-like) stimulants, which
work well but tend to heighten anxiety. It would be nice to have more
alternatives to treat bronchospasm.
Since richer levels of THC can cause increased anxiety, using CBD seems
like a reasonable thing to try. Last week a patient came into our office who
had obtained some CBD-rich tincture at a local collective and said he felt
it was helping his asthma. He was off of his Advair inhaler for a week and
wanted to be °checked.¨
We administered a baseline spirometry test and then repeated the test 13
minutes after the patient had taken three drops of his CBD-rich tincture.
The graphic shows the result:
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FEV1 is forced expiratory volume at one second (when the patient breathes
out as hard as s/he can).
FVCis forced vital capacity (the amount of air you can blowout after taking
a deep breath).
PEF is the peak expiratory flow rate at any point during the exhalation.
You can see that after a three-drop dose of the tincture taken sublingually,
the patient's FEV1 and PEF nearly doubled. This would generally be con-
sidered a great response to a typical bronchodilator!
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Patient With FibromyaIgia HeIped By
Cannabis
Monday, May 23, 20ll
Here is a brief, but lovely note from a patient with fibromyalgia:
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Thank you, so much! I am a newbie and this is the first relief I have had in
months. I was doubtful that cannabis would help me, but amnowa believer!
I am pretty much pain-free. It feels like a dream! Thank you, again!
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Terpenes Anyone?
Monday, May 23, 20ll
This past year I have taken some time to study plant medicine to better
understand Terpenes, which are in fact a very important group of molecules
in cannabis and many plants. They are responsible for taste, scent and they
have been shown to bind to the CB2 receptor, which are not so much in
the nervous system, but mostly in lymphatic tissue. Regardless, a number
of Terpenes have been shown to have various psychoactive properties. I
personally had one experience with some Terpenes, where we heated it in a
vaporizer and inhaled, effect very stony for 90 minutes. It is becoming
clear that it is the more than 100 terpenes in cannabis that affords the strains
their taste, scent and nervous system effects.
The Terpenes seemto have potent anti-bacterial actions and offer protection
for most plants from bacteria, mold and other predators. With some plants,
it is believed that the scent from the Terpenes attracts animals that protect
the plant when it is being damaged by a herbivore. Amazing!! Terpenes are
calls for help and they exist is nearly all species.
When tinctures of cannabis are made, the very volatile Terpenes escape
and are lost. There are groups now who are collecting the Terpenes in gas
form, allowing them to cool and infusing them back into the tincture being
created.
Stay tuned for more.
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CBD Excitement At GreenBridge MedicaI
Wednesday, May 25, 20ll
Over the past several weeks, a local °grow collective¨ has accomplished
something pretty amazing.
They are using Super Critical CO2 extraction on whole plants and are en-
tirely focusing on cannabis tincture creation. They are Clean Green certified
as well as certified by The Werc Shop as to cannabinoid levels.
Their current tincture measures around 4 mg/cc CBD and 2 mg/cc THC.
Although these are not huge numbers, this is something I have never seen
before.
More important are the patients' clinical responses.
I saw a 48 y/o male with a horrible chest sarcoma eating through his chest
wall, obtain nearly 100% pain relief.
I saw a 33 y/o woman's pelvic pain decrease 73% in 40 minutes.
I saw a Turret's patient's spasms slowly disappear 93% over one hour. An
interesting note on this patient, which I have seen many times before, is that
the tincture administration causes the pain/spasm/etc symptoms to decrease
beginning at their heads, going down their neck, shoulders arms and hands.
Then, it moves BACK UP to their upper chest and works its magic down
the body. So, if you have pain in your foot, it will take the longest to feel
better. I have no idea why I keep seeing this phenomenon.
I have seen another 10 patients with panic attacks and severe anxiety be-
come virtually perfect within 30 minutes. This is the toughest area with
regard to placebo effect, but time will tell more.
So, why am I so lucky to see all this? I certainly cannot administer tincture
to patients in the office. What has occurred is that one collective who does
the tincture creation, refers me the patients to learn more and be instructed
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in it's use. They request that the patient not use the medicine until they
are symptomatic and meet with me, i.e. they often just pop in with their
medication.
Many of these patients have prior recs, so I am just helping them learn how
to use the tincture WHEN THEY ARE HAVING SYMPTOMS!!. Excuse
the caps, but this point is very important. If a patient is feeling fine, the
tincture has very minimal effects. You must medicate specific symptoms
and monitor their changes. It is a new world of non-psycho activity.
Speaking of psycho activity., I am seeing patients becoming °happier¨ after
they medicate themselves. I don't know if this is mild °euphoria¨ from
the THC in the tincture, or whether they are just much happier with their
discomfort gone. J
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GreenBridge MedicaI Goes On Medication
Watch
Friday, May 27, 20ll
As you all well know, I have been extolling the virtues of tinctures for over
3 years. I have consulted with nearly every tincture °maker¨ and have done
some consultations with three different collectives over the years and have
learned a lot.
I must say, that I have learned that standard or °usual¨ methods for making
tinctures in the cannabis industry are just not very effective. Extracting into
alcohol or Glycerine or Acetic Acid is extremely inefficient. Most makers
use mixed shake without any effort to know what their product tests at or
whether it is organic. It is one thing smoking some bud that is not organic,
but is quite another when making °real¨ medicine in tincture form. By the
way, what I mean by °real¨ medicine will be in another blog very soon.
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So, let me share some of my experiences of the past several years regarding
tinctures and their effectiveness as well as some possible solutions.
To begin with, the vast majority of tinctures or medication capsules, are not
tested. I was in San Francisco yesterday looking at different collectives and
gathering samples.
1. There was a capsule where I was informed contained 1300 mg of THC!!
The entire capsule weighed in at 1 gram! So, who knows how much THC
is in it. Well, I purchased a few and we will find out.
2. Tinctures that claim to have exactly 10 mg/cc of THC. Another that was
10 mg/cc of CBD. Amazing that they can claim such a °round number¨.
Anyway, I tried the tincture and I seriously doubt the claims. Again, we
will test it and see what is the real deal.
3. It was bothersome that the collectives didn't know that 1.3 GRAMS
OF THC would be beyond coma..but again, never lethal, but certainly
way over any limits of typical over-medication. For example, people are
LUCKY if the strongest and biggest edible had more than 10 mg per dose
and most are much less. These guys are claiming 130 times this dose.
Please!! Well, again we will send these samples to multiple labs and report
back.
The list goes on and upon awakening, and taking my new CBD tincture for
my back that JUST went out after yesterdays travels, I am hoping it has
what it says.
So, I am beginning GreenBridge Medical °Medication Watch¨. We will
legally obtain medicines and have themtested at at least 2 state laboratories.
This itself is a very important thing to do, whether we are talking CBD or
THC or any medication. As far as I know, this has not yet been done and
needs to be.
Ignoring the chemical makeup of our smoked medicine can be tolerated,
as various realities right now make it difficult for every collective to have
every flower tested. However, with tinctures it is so much easier to do this,
as it is always make in large batches and testing is feasible.
CBD is making a big splash and I am splashing more than most. So, when
I see CBD levels on a bottle that seem suspect, we are going to test them
and publish what we find good or bad.
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I believe that a number of collectives believe that Indica ¬ CBD and Sativa
¬ THC, they base the labeling on howmuch Indica or Sativa they are mixing
in a cap or tincture. Of course, this is nonsense.
Going forward, with input from many respected experts in the field, I will
be posting what I believe might be considered as a good starting point for
standards as well as education and the °ethics¨ of making real cannabis
medication.
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CBD BIocks The Appetite Increase From
THC
I have already heard that some of the early CBD tincture patients claim that
their appetite is NOT increased through the use of CBD.
Well, this is great news for many of us and perhaps not as good news for
the patients who require appetite stimulation.
Still too early to tell, but check this out from our friends at ProjectCBD:
http.77WWW.p¡o¸ectcbd.o¡g7CBu. Attenuation. Ap-
petite.html#Appetite
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Dr. FrankeI Used CBD Tincture This
Morning
I was sitting on the floor with my legs crossed writing the prior blog when
my lower back went into an awful spasm. You know what I am referring
to. I have had these in the past and was really upset as it is generally a 4-3
day process.
So, I had some Rich CBD tincture from a local collective and took 1/8 cc
at 9 AM and a repeat dose at around 1 PM. There was in fact no immediate
relief, but as the hours passed my entire lower back softened up and the pain
is already 60% gone, or down from a 9/10 to a 4/10 and now the discomfort
seems to be decreasing every few hours.
I have used different medications in the past, including hot-boxing my room
and this is by far the best experience I have ever had with cannabis with
respect to pain relief or any symptom relief for that matter.
Thank you CBD
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Patient Demanded Parking Ticket For His
Cannabis But Was Denied!
Friday, June 3, 20ll
I just heard a great story from a patient of mine. He was pulled over for
a minor registration tag issue and the officer noticed a small contained of
cannabis on the passenger seat. There was no odor and no °open cannabis¨.
The officer asked if the driver had a cannabis recommendation, to which the
patient said °Yes, but I insist you issue me a parking ticket!¨. The patient
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reminded the officer that as of January 1, 2011, having less than one oz is a
parking ticket and the patient tried to push the issue.
The officer became frustrated, refused to issue a parking ticket and finally
just left the patient/driver.
Funny story, but also important for all of us to remember. Our recommenda-
tions and patient rights DO protect us, but so do the new laws in California
making it a minor parking level offense.
I love this guy for insisting upon a parking ticket.
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AIcohoI, Cannabis and AA
Sunday, June 5, 20ll
Here is a comment from a blog reader that I felt I should share and
comment on regarding Medical Cannabis use and Alcoholics Anony-
mous.
"Tnis is o very inreresrinq ropic. I wos sober in AA [or 1S yeors onJ very
ocrive in rne proqrom. I moveJ ro NorCol onJ srorreJ wor|inq wirn meJicol
Morijuono. I wos qoinq ro AA onJ noJ o sponsor onJ srill very leory obour
crossinq rne MJ JiviJe. I wos mo|inq MJ coo|ies onJ jusr noJ ro rosre rnem.
Wnor noppeneJ wos ir srorreJ o wnole experimenrorion perioJ. I now use
coo|ies obour once o wee| onJ smo|e o lirrle o [ewrimes o wee|. I no lonqer
qo ro AA becouse I [eel con[licreJ. I Jo nor consiJer mysel[ sober os I nove
qorren nello sroneJ or rimes onJ I DO rnin| ir o[[ecrs me [rom rne nec| up
biq rime. I nove been usinq MJ [or obour 7 monrns now onJ nove nor noJ
o Jrin|. I [eel os i[ my rime in AA nos been [onrosric onJ I nove o cleor
picrure o[ wnor on olconolic is onJ rnor I om one. I |now rnor ro Jrin| [or
me is suiciJe. I rnon| AA [or beinq rnere wnen I wos in serious rrouble onJ
cnonqinq my li[e, nowever, o[rer 1S yeors o[ beinq Jeeply enrrencneJ in AA
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recovery, I [eel I`ve qor ir now. I om nor noppier or livinq o more proJucrive
li[e now rnon I wos in AA, onJ om consiJerinq qerrinq boc| ro bosics. Bur
one o[ rne rninqs I Jo li|e is rnor I om no lonqer sreepeJ in juJqemenrs, I
[eel os i[ I om [inJinq my own woy onJ nor livinq in [eor.
I have written a few times regarding medical cannabis and AA. I person-
ally believe that if °Bill and Bob¨ the AA founders were alive and aware
of the harsh judgements being made against physician and medication in-
volvement in AA, they would feel sad. Addiction is currently defined as the
ongoing use of a substance or behavior whose SIDE EFFECTS are ruining
ones life. It does not matter how frequently someone uses a medication, it
matters how it effects them and those around them. If all is good and the
person is productive the behavior is not be considered an °addiction¨. To
the best of my understanding, this is the new/current definition of addic-
tion and using medical cannabis under the direction of a physician, can be
positively done in AA.
We now know that patients with substance use, nearly always have an area
of their pre-frontal cortex that °lights up¨ differently that others. Substance
°USE¨, has many facts, but much is biological and this must always be
remembered. Judging these patients just pushes them away from support
and care. Placing patients in jail who have a medical condition they are
struggling with, of course will be seen in the future as being a very, very
dark time.
It is not a simple issue, I am not saying it is. We just don't know all the
answers and ANY group that believes they know it, I believe is fooling
themselves. I amalso not saying that AAhas not helped millions of patients,
such as the one above, but perhaps it is again time to review?
How about us at least TRYING to get a small group of AA members who
wish to have a meeting that includes discussion of how cannabis has helped
them stay sober? Why not check it out?
To this end, if I ever receive a small handfull of cannabis patients in the LA
area that would like to have a meeting that does not judge medical treat-
ments, but just openly discusses them, write me and I will set one up and
provide juice and cookies.
Just to be very clear, this will not be a smoking meeting.
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What's In The Name Cannabis or Marijuana
Monday, June 6, 20ll
We all keep hearing these words, as well as pot, ganja, weed, pot, etc etc
but I believe we should try stick to °Cannabis¨ when speaking in any pro-
fessional setting. I am well aware that many in the cannabis world believe
it is our right to use the term Marijuana and that it °should¨ be just fine, but
I disagree.
The term Marijuana, as many of you know, was a hispanic slang term for
cannabis. Congress in the late 1920's and early 1930's was very familiar
with cannabis and it's benefits. They were aware that help was critical for
the war they were considering entering. The Navy itself produced a film
named °Hemp For Victory¨. When the vote occurred in Washington to
criminalize cannabis, they were instead voting on Marijuana and didn't re-
alize they were getting rid of cannabis and hemp. I am not saying they had
NOidea, but I do believe that this was certainly a part of the reason cannabis
became °illegal marijuana¨.
So, the term cannabis, the name of the medicine we are studying, was taken
from °us¨ and replaced with marijuana. Currently, the pharmaceutical in-
dustry is actively pursuing creation of CANNABIS medicines. Personally
and professionally, I don't want to be calling the medicine Marijuana while
the Pharma companies are calling it cannabis. They took it away and are
now taking it back. I believe we will look foolish with °Marijuana Tinc-
tures¨ while Pharma makes Cannabis Tinctures.
Something to think about.
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CANNABIS: So Many LegaI FederaI Patents
and StiII A UseIess Medication
Sunday, June l9, 20ll
We have known about the patent for neuroprotection and anti-oxidants re-
lated to CBD for years now. The Federal Government patented CBD for
this and other potential health benefits. The US Patent # ¬ 6630307
There are also many OTHER patents on cannabis thatI recently found
on
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:
2304669 1942 Isolation of cannabidiol 20110217.003017
2334492 1944 Marihuana active compound 20110217.003419
2419934 1947 Optically active tetrahydrodibenzopyrans having marihuana
activity and process for .. 20110217.010128
2419933 1947 Marihuana active compounds 20110217.010934
2419936 1947 Preparation of compounds with marihuana activity
20110217.011317
2309386 1930 Dibenzopyran marihuana-like compounds
20110217.012129
2309387 1930 Dibenzopyran marihuana-like compounds
20110217.012313
3668224 1972 Process of producing 6a, 10a-trans-6a,7,8,10a-
tetrahydrodibenzo (b, d)-pyrans 20110217.013244
3728360 1973 Ester derivatives of tetrahydrocannabinol
20110217.013646
3734930 1973 Direct synthesis of (-)-trans-delta-9-tetrahydrocannabinol
from olivetol and (¹)-tr.. 20110217.003434
4023316 1977 Process for the preparation of (-)-6a,10a-trans-6a,7,8,10a-
tetrahydrodibenzo[b, d|-p.. 20110217.022419
4116979 1978 Process for the preparation of (-)-6a,10a-trans-6a,7,8,10a-
tetrahydrodibenzo[b, d|-p.. 20110217.030800
4126694 1978 Composition and method for treating glaucoma
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http.77goo.gJ7sbYhg
186
20110217.031302
4126693 1978 Anti-glaucoma composition and method 20110217.031624
4179317 1979 Novel tetrahydrocannabinol type compounds
20110217.032121
4189491 1980 Tetrahydrocannabinol in a method of treating glaucoma
20110217.032331
4193078 1980 Nabilone granulation 20110219.131638
4279824 1981 Method and apparatus for processing herbaceous plant
materials including the plant .. 20110221.003824
4313862 1982 Process for preparing cannabichromene 20110219.132328
4327028 1982 Composition of matter 20110219.132834
4464378 1984 Method of administering narcotic antagonists and analgesics
20110219.134318
4476140 1984 Composition and method for treatment of glaucoma
20110219.133923
4738397 1988 Carenadiol and derivatives 20110220.233422
4837228 1989 Antiinflammatory and antimicrobial compounds and
compositions 20110219.133422
4847290 1989 Delta 1-thc-7-oic acid and analgesic and anti-inflammatory
agents 20110219.140914
4876276 1989 (3s-4s)-7-hydroxy-delta-6-tetrahydrocannabinols
20110219.141600
4933363 1990 Method for effecting systemic delivery of delta-9-
tetrahydrocannabinol 20110219.144031
3227337 1993 Method for the production of 6,12-dihydro-6-hydroxy-
cannabidiol and the use thereof.. 20110221.003133
3237037 1993 Tetrahydrocannabinol derivatives and protein and polypep-
tide tetrahydrocannabinol d.. 20110219.144338
3292899 1994 Synthesis of 11-nor-delta-9-tetrahydrocannabinol-9-
carboxylic acid glucuronide 20110219.143249
3302703 1994 Tetrahydrocannabinol derivatives and protein and polypep-
tide tetrahydrocannabinol d.. 20110219.143809
3338733 1994 (3r,4r)-delta-6-tetrahydrocannabinol-7-oic acids useful as
antiinflammatory agents .. 20110219.130617
3342971 1994 Process for the preparation of dibenzo[b, d|pyrans
20110219.130633
3389373 1993 Stable suppository formulations effecting bioavailability of
delta-9-thc 20110219.131013
187
3440032 1993 Compositions useful as a cannabinoid receptor probe
20110219.131433
3308037 1996 Stable suppository formulations effecting bioavailability of
delta-9-thc 20110219.131931
3332237 1996 Indole derivatives with affinity for the cannabinoid receptor
20110219.132606
3338993 1996 Certain tetrahydrocannabinol-7-oic acid derivatives
20110219.132901
3396106 1997 Cannabinoid receptor antagonists 20110219.133207
3603906 1997 Cannabinoid receptor agonists 20110219.133323
3603928 1997 Antiemetic compositions 20110219.133323
3631297 1997 Anandamides useful for the treatment of intraocular hyper-
tension. 20110219.160906
3633330 1997 (3s,4s)-delta-6-tetrahydrocannabinol-7-oic acids and
derivatives thereof, processor.. 20110219.134139
3688823 1997 Anandamide amidase inhibitors as analgesic agents
20110219.161202
3716638 1998 Composition for applying active substances to or through
the skin 20110219.161348
3747324 1998 Cannabinoid receptor antagonists 20110219.161846
3804392 1998 Method for improving disturbed behavior and elevating
mood in humans 20110219.162419
3847128 1998 Water soluble derivatives of cannabinoids
20110219.162839
3872148 1999 Compositions useful as a cannabinoid receptor probe
20110219.163222
20110219.163803
3923768 1999 pyrazolecarboxamide derivatives having cannabinoid
receptor affinity 20110219.164326
3932610 1999 Tumor necrosis factor alpha (tnf-alpha) inhibiting pharma-
ceuticals 20110219.164744
3939429 1999 Cardiovascular uses of cannabinoid compounds
20110219.164938
3977180 1999 Anandamide analog compositions and method of treating
intraocular hypertension usin.. 20110219.163307
3990170 1999 Therapeutic use of mono and bicarboxylic acid amides
188
active at the peripheral canna.. 20110219.163901
6008383 1999 Method of preparing delta-9-tetrahydrocannabinol esters
20110219.170127
6013648 2000 Cb2 receptor agonist compounds 20110219.170339
6017919 2000 Compounds and pharmaceutical use thereof
20110219.232239
6096740 2000 Dexanabinol derivatives and their use as neuroprotective
pharmaceutical compositions 20110219.232844
6100239 2000 Cannabinoid receptor modulators 20110219.233213
6113940 2000 Cannabinoid patch and method for cannabis transdermal
delivery 20110219.233830
6132762 2000 Transcutaneous application of marijuana
20110219.234036
antiinflammatory agents.. 20110219.234311
6166066 2000 Cannabinoids selective for the cb2 receptor
20110219.234631
6274633 2001 Alkylated resorcinol derivatives for the treatment of immune
diseases 20110219.233334
6284788 2001 Use of known agonists of the central cannabinoid receptor
cb1 20110219.233634
6328992 2001 Cannabinoid patch and method for cannabis transdermal
delivery 20110220.000814
ceuticals 20110220.002303
6344474 2002 Use of central cannabinoid receptor antagonists for regulat-
ing appetence 20110220.002717
antiinflammatory agents.. 20110220.002933
6380173 2002 Method for enhancement of delivery of thc by the adminis-
tration of its prodrugs via.. 20110220.003309
6383313 2002 Compositions comprising cannabinoids 20110220.003336
6391909 2002 Anandamide inhibitors as analgesic agents
20110220.003732
6448288 2002 Cannabinoid drugs 20110220.004111
6309003 2003 delta-9 tetrahydrocannabinol (delta-9 thc) solution metered
dose inhaler 20110220.010440
6309367 2003 Pyrazole cannabinoid agonist and antagonists
189
20110220.010824
ceuticals 20110220.011139
6363009 2003 Vasodilator cannabinoid analogs 20110220.011723
6366360 2003 Resorcinolic compounds 20110220.012340
20110220.013014
6610737 2003 Non psychotropic cannabinoids 20110220.013607
6630307 2003 Cannabinoids as antioxidants and neuroprotectants
20110217.040403
6642238 2003 Use of central cannabinoid receptor antagonist for preparing
medicines-20110220.141047
6633304 2003 Cannabinoid receptor modulators, their processes of prepa-
ration, and use of cannabi.. 20110220.141700
6703418 2004 Appetite stimulation and induction of weight gain in patients
suffering from sympto.. 20110220.141926
6713048 2004 Delta-9 tetrahydrocannabinol (delta-9 thc) solution metered
dose inhalers and metho.. 20110220.142132
6747038 2004 Stable composition for inhalation therapy comprising
delta-9-tetrahydrocannabinol a.. 20110220.142330
6823209 2004 Compounds having unique cb1 receptor binding selectivity
and methods for their prod.. 20110220.142627
6864291 2003 Agonists specific for the peripheral cannabinoid receptor
20110220.142827
6900236 2003 Cannabimimetic indole derivatives 20110220.143112
6903137 2003 Agonists specific for the peripheral cannabinoid receptor
20110220.144738
6930122 2003 Use of central cannabinoid receptor antagonist for preparing
medicines designed to .. 20110220.223931
6939977 2003 Analgesic and immunomodulatory cannabinoids
20110220.230137
6943266 2003 Bicyclic cannabinoid agonists for the cannabinoid receptor
20110220.230333
6949382 2003 Method of relieving analgesia and reducing inflamation
using a cannabinoid delivery.. 20110220.230331
6974368 2003 Treatment for cough 20110220.231124
6993187 2006 Peripheral cannabinoid receptor (cb2) selective ligands
20110220.231316
190
7049329 2006 Amines that inhibit a mammalian anandamide transporter,
and methods of use thereof 20110220.231649
7037076 2006 Bicyclic and tricyclic cannabinoids 20110220.231942
7067339 2006 Cannabinoid receptor ligands 20110220.232124
7071213 2006 Cannabinoid receptor ligands 20110220.232329
7088914 2006 Device, method and resistive element for vaporizing a
medicament 20110220.232627
7103683 2006 Cannabinol derivatives 20110220.232801
7109243 2006 Vasoconstrictor cannabinoid analogs 20110220.233007
7119108 2006 Pyrazole derivatives as cannabinoid receptor antagonists
20110220.233234
7129239 2006 Purine compounds and uses thereof 20110220.233310
7141669 2006 Cannabiniod receptor ligands and uses thereof
20110220.233811
7143012 2006 Cannabinoid receptor ligands and uses thereof
20110220.234023
7161016 2007 Cannabimimetic lipid amides as useful medications
20110220.234200
7169942 2007 Cannabinoid derivatives, methods of making, and use
thereof 20110220.234343
7173027 2007 Receptor selective cannabimimetic aminoalkylindoles
20110220.234621
20110220.234841
7179800 2007 Cannabinoids 20110220.233606
7183313 2007 Keto cannabinoids with therapeutic indications
20110220.233821
7220743 2007 Heterocyclic cb1 receptor antagonists 20110221.000208
7229999 2007 Pyridine-3-carboxamide derivatives as cb1 inverse agonists
20110221.000408
20110221.000602
7233384 2007 Non psychotropic cannabinoids 20110221.000739
7241799 2007 Cannabimimetic indole derivatives 20110221.000920
20110221.001038
191
20110221.001308
7276316 2007 Cb1 antagonist compounds 20110221.002739
7276613 2007 Retro-anandamides, high affinity and stability cannabinoid
receptor ligands 20110221.002933
7283683 2007 Bicyclic and tricyclic cannabinoids 20110221.003404
7283687 2007 Cannabinoids 20110221.003830
7294644 2007 Cb 1 receptor inverse agonists 20110221.004028
7321047 2008 Separation of tetrahydrocannabinols 20110221.004243
7323376 2008 Synthetic route to dronabinol 20110221.004441
7329631 2008 Cannabimimetic ligands 20110221.004633
20110221.004823
7333688 2008 Bicyclic cannabinoid agonists for the cannabinoid receptor
20110221.003006
7344736 2008 Extraction of pharmaceutically active components from
plant materials 20110221.003433
20110221.010029
7338243 2008 Treatment of gastroesophageal reflux disease
20110221.010322
7393842 2008 Pyrazole analogs acting on cannabinoid receptors
20110221.010732
7399872 2008 Conversion of cbd to delta-8-thc and delta-9-thc
20110221.011142
7402686 2008 Cannabinoid crystalline derivatives and process of cannabi-
noid purification 20110221.011644
7392328 2009 Natural cyclodextrin complexes 20110221.011900
7392468 2009 Production of delta-9 tetrahydrocannabinol
20110221.012444
7648696 2010 Composition for inhalation comprising delta-9-
tetrahydrocannabinol in a semiaqueous.. 20110221.012933
Read more: http.77xcahhab1s.con72u117u57JoW-ahd-
behoJd-they-Waht-to-¡escheduJe-cahhab1s7#1xzz1Pk
uquuZn
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Decision-Making Processes BIunted In
Chronic Marijuana Smokers
Wednesday, June 22, 20ll
This blog title was the lead question in a North Carolina medical news wire.
The point was that smoking cannabis and gambling were two behaviors that
led to °poor decision making¨. WOW!! This is really a news flash. They
are actually going out on a limb and saying that gambling your money away
and getting stoned all day compromises ones decision making ability!!
I must re-think next weekend.
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Pharma Changed It's Mind Again!
Friday, July l, 20ll
In the 1930's, when cannabis was initially ex-communicated, there were a
number of known reasons and probably many still unknown reasons for it's
demise. For certain, The world of Pharmaceuticals had plenty of reasons to
see it go, despite their having many, many tinctures and elixers of cannabis
available on their own formularies. They were big then and were growing
fast as they were learning how to manufacture pills at about this time, there
was much more profit in the new generations of medications to follow and
they easily went along with destruction of cannabis tinctures approximately
80 years ago.
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Opium and cocaine, which were removed from cannabis tinctures in the
early 1900's, were on there way back into the pharmaceutical formularies
and we all know what happened with narcotics from there. Addiction to
pharmaceutical pills now is the countries's number one drug issue! This is
truly pathetic.
So, Medical Cannabis comes on the scene in 1996 but falls into dis-repair
due to the People's great desire to have social or recreational cannabis. If
you keep something people really want away from them, they will get it.
So, Yes, I do think the Medical Cannabis System is sadly broken and to
a large extent a joke. this does not mean, however, that the medicine is
problematic. The newer levels of quality and certified medical cannabis
tinctures are just beginning to get out to patients and the Feds are serious
about shutting down every dispensary, if possible, to allow Pharma to open
the newTrillion $ CBDmarket. Trust me, this will be huge.very huge and
we are in the way.
What are we to do to protect ourselves?
1. Of course we should continue to fight for our rights to medicate and we
should fight for the rights of legitimate collectives.
2. We need to begin clearly separating the medicine from the social aspect
as best we can. This can only be done thru development of medicinal grade
cannabis medications as well as truly focussing on °real¨ patients, patients
who desire dosed and verified medication. Where will these patients come
from? Well, there are millions of them out there seeing their primary care
doctors. Their primary care doctors should and WILL begin writing rec-
ommendations. This is a good new business for these doctors and it fully
legitimizes medical cannabis. Their patients should join this °mega¨ collec-
tive and obtain very reasonably priced medication. While on this subject,
it is anticipated that pharma based/sold cannabis tinctures/sprays/capsules
will cost upwards of $20/day. The current medication grade cannabis tinc-
tures are approximately 30 cents/day. The pharmaceutical based tinctures
will be highly regulated and controlled for very limited diagnoses while the
non-pharma tinctures, at least in California, can be used for any condition
deemed appropriate between the physician and patient.
3. In planning for the worst, the shutting of all dispensaries, we need to
build a state-wide collective where many patients growa plant or two. With
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this, we can internally convert the individual plants into medicinal grade
medicines to distribute to the entire collective. Perhaps the growers would
get their medication for no charge and all the other members would pay a
reasonable fee.
This collective should have thousands and thousands of patients, perhaps
hundreds of thousands of members. It should begin offering not only great
and inexpensive medications, but begin offering health insurance plans to
cannabis cruises. We can do it, but it means a lot of different factions be-
ginning to pull together and that sadly rarely works.
if we fail, we will lose everything. Cannabis medicine will be over-run by
the government and the pharmaceutical companies and controlled in a way
to greatly limit access and allowed conditions. It will be legal, but HIGHLY
restricted.
We really must do something. How can I help?
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Great MedicaI Cannabis OnIine Package
Insert
Saturday, July 2, 20ll
Check this out:
ONLINE PACKAGE INSERT FOR CANNABIS TINCTURE
C3.7T1.9_0001
ALERT!
The CBD and THC concentrations should read:
CBD 3.9mg/cc
THC 1.7mg/cc
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A cannabis tincture is an extract of the medicating molecules. All plant ma-
terial is removed using CO2 under pressure and is extremely efficient. The
extract is combined with glycerin and water to reach the desired dilution.
4% alcohol is added for preservative value at the very end. Product ID C3.9
T 1.7_0001, has 3.9% CBD and 1.7% THC. Terpenes were not measured,
but future products will have terpene values.
TINCTURE OF CANNABIS DIRECTIONS
All tinctures released will have this format. The °C¨ tells you the level of
CBDand the °T¨, THC. The number after the °_¨ is the internal IDnumber.
This product is grown in accordance with California State law and is Clean
Green certified. This product is the property of and produced exclusively
for the members of WFX Collective and it is not for sale or resale. Diver-
sion or distribution of this product for non-medical purposes is forbidden
under California State and Federal laws.
CBD-Rich Tincture of Cannabis
Use as Needed
A. General Statement on Dosage
This tincture of cannabis is made available to qualified patients in the State
of California in accordance with the laws of the State of California. It is
provided as a tincture manufactured in compliance with the guidelines of
the State of California. An oil of cannabis is created without the use of al-
cohol or chemical solvents. It is then diluted and emulsified to a stable state
at which point an approved analytical laboratory tests it. It is then blended
and further diluted with purified water and organic vegetable glycerin to a
consistent concentration. A small amount of alcohol is added as a preser-
vative only after all other processes are complete. Patient is to use a dosage
that is appropriate to their circumstances. It should be taken as needed to
treat the condition for which medical cannabis is recommended.
The details of the formulation are as follows.
THCA ND
THC 1.7 mg/mL
CBDA ND
CBD 3.9 mg/mL
CBNA ND
CBN ND
ND ¬ None detected during analytic testing.
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B. Preparation and Administration.
Remove the bottle containing the tincture of cannabis. Shake the bottle in
an up and down motion for 3 to 10 seconds before each use. Open the bottle,
smell the contents by inhaling deeply through the nose. Using the dropper
withdraw a amount of tincture for administration as directed by your care
provider. Administer the tincture under your tongue. It is important not to
swallow the tincture. ORAL USE OF A TINCTURE AT THIS CONCEN-
TRATION WILL BE UNPREDICTABLY INEFFECTIVE. Spread the liq-
uid around the mouth using the tongue. Replace the dropper assembly and
refill the dropper by pinching the plunger. Shake again after use before
storing in a cool dark location. DO NOT REFRIGERATE.
C. Storage
Store in a cool dark place away from sources of heat or light.
D. Shelf Life
Cannabis Tincture should be used within 12 months of date listed on the
bottle.
E. Caution
The most common side effects with cannabis tincture are dizziness and
tiredness. Some people may also feel depressed or confused, may feel over-
excited or lose touch with reality, may have difficulties with memory or
trouble concentrating and may feel sleepy or giddy. For most people tak-
ing cannabis tincture, these side effects are mild to moderate, last only a
few hours and can be managed by changing the dose, taking a short break
from using the medicine, or using an alternative formulation. Side effects
are most likely to happen when you start treatment and will often decrease
as you become more used to cannabis tincture. Patients should not drive a
car or operate machinery until an initial tolerance has developed. Patients
should also not to take cannabis tincture with other CNS depressants such
as alcohol, opioids and benzodiazepines.
Who should not use this medicine?
patients with a psychotic disorder not under a doctors care
patients with a history of drug addiction or the °potential to become ad-
dicted¨
pre-existing °serious¨ cardiovascular disease
under 18 years of age absent a the approval of a parent or legal guardian
pregnant/nursing women or in women of childbearing years and not on re-
liable contraception
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Patient Asks Great CBD ReIated Question
Porienr:
Hos onyone reoJ more obour rnis on orner sires' I om loo|inq [or more in[o
os ir relores ro CBD onJ rne porenriol rnor ir moy limir orner meJicorions
e[[icocy. I nove smo|eJ por [or yeors onJ pre[er niqn CBD srroins ro niqn
THCbur rnis orricle concerns me. I`ve been on o coc|roil o[ meJicorions [or
yeors onJ om worrieJ rne CBD srroins moy prevenr my meJicorions [rom
beinq properly obsorbeJ.
AJJirionolly I complerely oqree wirn T`s commenr obour rne possible
wniplosn e[[ecr on meJicol morijuono snoulJ rnis ocruolly be rrue onJ come
ro liqnr. All o[ ir concerns me bur I noven`r neorJ onyrninq more on rnis
ropic. I[ onyone |nows o[ orner orricles pleose reply onJ poinr me in rne
riqnr Jirecrion. Tnon|s oll, be so[e.
Dr. Frankel responds:
First of all, how do you know you are smoking rich CBD strains? Are they
labelled as to what percent CBD they contain? Do you know which strains
they are?
A lot of people still hold on to the rumor that indica strains are more cbd
and sativa strains are more thc: THIS IS NOT TRUE AT ALL!! Please tell
your friends this is not true. If CBD were so easy to find, I have wasted an
awful lot of time. In fact, the richest CBD strains I have recently seen have
all been sativa strains!
Now, assuming you really are using a rich CBD strain or tincture, that has
been tested at an independent qualified lab, then the question I believe you
are referring to is what effect can CBD have on the metabolism of other
drugs. CBD interferes with the metabolism of a number of drugs, including
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THC. This means that if you take a °lot¨ of CBD, your THC and other
drugs will hang around longer at higher levels in your serum and brain.
This means that if you are taking any medications metabolized by the P-
430 Cytochrome Oxidase system in the liver, such as Lipitor, you MIGHT
need to LOWER your dose. So, please do monitor your meds with your
physician IF you are taking a medication that is in fact metabolized through
this specific hepatic (liver) pathway.
It should be noted that GW Pharmaceuticals in England and soon to be in
the US studied this issue and in typical CBDdoses did not showany clinical
problems.
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Let's Start AII Over Again
I was just thinking, what if we knew what we currently know and were de-
ciding howto run with Proposition 213, the 1996 Medical Marijuana Propo-
sition, how would we do it? Let's call it a °do-over¨. How would it look?
HowSHOULDit look? This is an academic question to the max, since most
of what we currently know regarding CBD was not even known in 1996,
but still, a °do-over¨. Let's start today. I know I will certainly irritate a lot
of people on both sides of the fence with this next series of blogs, but I sup-
pose that since it is my blog, I get to do whatever I want. I also understand
the reader has the right to make comments and question everything. I truly
hope my next series of blogs does stimulate a lot of discussion. I really do,
because I think medical cannabis is in very serious trouble and we need a
new model pretty quickly.
I am actually more concerned, in some ways, regarding social or recre-
ational users of cannabis than I am regarding °real patients¨. I think I have
a rough model on how we should move forward on the medical front. I
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am concerned, however, that whatever I personally believe, the dispensary
or store model of cannabis °sales¨ is in serious jeopardy by the Federal
Government, but not for reasons we have previously believed. For social
cannabis use, it needs to be done through legalization. It just can't any
longer weigh on the shoulders of the crumbling Medical Cannabis System
in California. If Cannabis were legally and freely available, the overwhelm-
ing number of patients would use it without any doctor's help at all. Get-
ting stoned or just feeling better does not require any physician input at
least in my opinion.
So, my concern must focus on medical cannabis and as time goes by, I will
repeat that I favor legalization at every possible level for cannabis. I have
never been a physician who °dreaded¨ legalization. I have always spoken
out in favor of it. I am just concerned that I need to solely focus on helping
to develop safe and effective medicines as well as helping to reshape the
face and perceived face of Medical Cannabis in California. I understand
that this appears quite grandiose. I know I cannot accomplish this alone,
but in this blog and blogs to follow, I will be outlining a new/old/very old
path we might consider. This path would be a parallel path to the store front
model. I do have some concerns for the long term viability of the stores due
to Federal pressures triggered entirely by Pharmaceutical $$$.
These Federal pressures are no longer morale, legal, ethical or even political
issues, it is all about Pharmaceutical profits and what the government can
make in taxes and re-elections. The reality of medical cannabis tinctures
from the international Pharma market has landed quite well and our own
Pharmaceutical companies are purchasing shares of these other companies
as well as receiving grow licenses from the federal government. Yes, you
are hearing me correctly. I will separately publish all the references regard-
ing my current blog series on °Starting Over Again¨.
So, despite only 20%of US Citizens being against Medical Cannabis, Med-
ical Cannabis is in a lot of trouble due to the Feds, supported by Pharma,
having a huge financial incentive to shut down any stores that might market
competing medications. The competition will be very fierce as the °Medical
Cannabis¨ can be marketed for less than $1/day while the Pharma tinctures
will be in the $20 range and up.
So, in upcoming blogs I will discuss:
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1. Where do the new or existing patients come from for this Statewide Col-
lective?
2. What Medical Cannabis products will be provided by this Collective?
3. How and growing work and who will grow?
4. How medications will be ordered and delivered by patients.
3. What the collective can do with any excess professionally made
medicines.
I am hoping, that with this blog series a starter platform can be generated
from which many of you can help sort this out. Perhaps we can create a
forum? Anyone know how to do that? Should I just leave it as a train of
comments?
Thanks so much,
Allan I Frankel, MD
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Keeping The Feds Out - BiII HR 2306
Sunday, July 3, 20ll
Let's help Bill
House Bill 2306
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appears to be our best hope to avoid Federal closing of
most of California's store front collectives. Please read it carefully and send
an email to your congressman.
If the Federal Government will treat Cannabis as it did alcohol at the end of
prohibition, it is pretty clear that most states will adopt Medical Cannabis
legislation as well as begin legalizing Cannabis in some states. Remember,
Proposition 19 this past November did get 46% of the vote and would likely
easily pass if we all knew the Feds would be staying out.
I ampraying this passes, but I amnot overly optimistic as the financial/phar-
maceutical forces are so great. I believe the religious right has lost it's
stronghold on Cannabis as the evil weed, so IF the Feds stay out, it will
be a major relief.
In the event HR 2306 passes, we can all breathe a sigh of relief. However,
in the meantime, I will return in a day with a further thoughts on how to
protect our medication.
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http.77b1t.Jy7kBBÇe5
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The political leaders and the °People¨ must decide upon legalization and
social cannabis, medical professionals must be responsible for the creation
and preservation of the true medicine of this incredible plant, regardless of
the °policy of the day¨.
So, have a great 4th of July and let's return on Tuesday to continue to work
towards the Independence of Medical Cannabis.
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FederaI PoIicy HeadIines On "Hypocrisy
Today"
The DEA just released it's °updated¨ opinion regarding the scheduling of
cannabis. Not surprising, they are leaving it as Schedule I, useless and dan-
gerous. This is despite a number of incredibly hypocritical actions.
I would LOVE, truly LOVEto hear fromsomeone, anyone, who can explain
the following facts:
1. Dronabinol, or Marinol, is pure THC. THC, as we all know, is the most
psychoactive and side effect ridden molecules in the cannabis plant. By side
effects, I am referring to the ability of THC to cause agitation. So, the most
psychoactive and the most side effect prone molecule in the plant is Sched-
ule III. This means that a physician can phone in a verbal/oral order for
Dronabinol, but that same doctor, according to the Feds (and occasionally
the California Medical Board), cannot smoke weed!
So, please explain to me why cannabis is Schedule I and it's main psychoac-
tive molecule can be phoned in?
2. In 2003, the Feds patented CBD, Cannabidiol. This is a non-
psychoactive cannabinoid as discussed in a number of my prior blogs. Now,
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the Feds would clearly not have patented CBDif it were dangerous and use-
less. Right? Who would patent something that is both illegal and useless?
So, please explain to me why cannabis is Schedule I but CBD is patented
by the Feds?
3. How/why are the feds giving grow licenses to various Pharmaceutical
companies, yet to be named?
Please explain this to me as well?
4. CBD, approximately 10 months ago just dropped off Schedule I. Why?
Is it legal or not? I really don't know. CBD is a truly magical molecule,
certainly while acting as a complete medicine within the plant's molecular
environment. I.e. I believe, as an aside, in whole plant medicine. Ap-
parently so do a number of international pharmaceutical companies, as a
handful are being released around the world.
Please explain what the legal status of CBD is now? Is it different if it is
Pharma based??
Well, with Sativex (GW Pharma/Bayer Pharma), in a few years it will be
passed through clinical trials and be a legal drug in the USA, but only by
controlled prescriptions. I would bet anything on it. It is a whole plant
tincture. It has approximately balanced THC and CBD, it is completing
State II trials int he US AND the DEA and FDA are having meetings.
Pharmaceutical based cannabis medicine will end up in a different schedule
that the identical medicines produced outside of Pharma. The issue is no
longer about morales and evil weed. It is about Pharmaceutical companies
working with our government to get rid of any competition to their own
weed products.
Hypocrisy to the max.
Can someone out there get someone fromthe administration to explain this?
Should I draft this as a letter to the president? Can anyone help me get some-
one's attention. I would love to speak with someone to help me understand
these confusing issues. I need help.
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One Patient, One PIant
Try imagine what a 1960's type cannabis cooperative might have looked like
if Proposition 213, the California initiative legalizing Medical Cannabis in
1996, was passed in the 1960's. You might have seen a huge number of
patients growing one or two plants and sharing them with the community.
The °collective¨ would have no store, but might have meeting places for
patients to exchange their medications.
One patient might bring their Sativa strain and swap it out for some Heavy
Indica. One or two of the members might make tinctures or edibles and
trade them at this °growing commune¨ of sorts. No money would change
hands, there would be no commercialization and it would be the ultimate
compassionate °collective¨. One patient might get °credits¨ for helping
other patients or teaching. Many values related to growing and creating
medications would all be shared and as we know from the °Open Source¨
community, it is the best way to get top products created.
Although plentiful right now, the storefronts are at risk in many people's
opinion. What if the Feds really get what they want? It is not impossible
that all retail stores will be closed to make way for the new $Trillion dollar
CBD and Tincture based Pharmaceutical medicines. These medications are
coming and it will be sooner than you think. This will be a huge market
and the pharmaceutical companies and related interests in Washington, are
clearly quite aware of what is happening. I would not be surprised if some
pharma $$ is used by the Feds for raids.
Last week I spoke about thoughts I wanted to begin sharing with all my
readers and patients. My concern is again outlined above and I would like
to begin suggesting actions we all might take to help protect our real medica-
tion. I am not concerned regarding available of °smokeable¨ cannabis and
I doubt the government is really still that concerned about it, barring some
extremists. However, I amextremely concerned that just as the non-pharma
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°medical cannabis¨ community is beginning to produce very professional
level tinctures and other dose-able medications, Pharma and the Feds will
steal back cannabis.
So, how could °one patient, one plant¨ work and deal with protecting our
newly evolving high-grade medications? There are some that argue that
this is not important. They argue that if Pharma is creating the medicines
and doctors can prescribe it, we are done! Well, this could not be further
from the truth. The pharma based cannabis medications will have several
issues, regardless of how great they are.
1. They will be very expensive, while non-pharma is pretty reasonable.
2. They will be controlled, watched and only available for limited diag-
noses. It will be a LONG time before pharma based cannabis medications
will be used for anxiety and muscle spasms.
3. Pharma cannot get away with a large variety of tinctures or other med-
ications. The way it works is that they make ONE medication, with ONE
fixed dose. This helps people, but is extremely limiting.
Wouldn't you want to have a choice of various capsules and tinctures with
differing THC/CBD/TERPENE ratios and amounts? Having a selection is
always good and why should Pharma decide what the
correct ratios are for everyone?
These are real issues, and IF we lose entire control of cannabis medications
to Pharma, we will sorely regret it. So, let's explore a new and very old
concept as stated at the start of this blog. What if we had a true State-Wide
Collective?
What if many of these patients, including YOU, grow a single plant? What
if the collective can provide a pretty automated manner in which to grow
this one plant?
What if the strains/genetics could be controlled by the Collective?
What if any/all diversion is avoided as this collective would not keep any
patient who diverted one bud for anyone else or for smoking.
What if these genetically controlled plants are processed by the collective
into professional tinctures and capsules/elixers?
What if some of these patients grow and the plants are processed and the
tinctures/other meds are shared at a great discount with any non-growing
patients?
What if this °community¨/collective/co-op begins purchases of group
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health insurance or cannabis friendly cruises, etc etc etc?
What if this became a sacred and protected source of high level cannabis
medications at fair and compassionate prices?
Please tell me why this cannot happen?
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Dear Mr. President
Sunday, July l0, 20ll
I am a board certified internist working in the Santa Monica, CA area for 32
years. For the past 3 years I have become a pro-cannabis physician and have
learned much on how the cannabis plant can be very helpful to millions of
patients.
I amnot talking about °pot clinics¨. I amnot speaking about °brownies¨ and
°hash bars¨. I am talking about dosable cannabis medications which come
in both tincture and capsule form. These organic medications are made to
extremely rigorous standards and are already helping many people.
Further federal intrusion into our ability to create these very exceptional
medications just seems harsh and entirely unwarranted. I have a list of sev-
eral questions that I would like to be addressed publicly. These are going to
appear as pretty straightforward questions, but any honest answers would
be incredibly helpful for me to understand the current federal standing on
medical cannabis.
The DEA just released it's °updated¨ opinion regarding the scheduling of
cannabis. Not surprising, they are leaving it as Schedule I, useless and dan-
gerous. This is despite a number of incredibly hypocritical actions.
Mr President, I would very much appreciate answers to the following que-
sitons:
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1. Dronabinol, or Marinol, is pure THC. THC, as we all know, is the most
psychoactive and side effect ridden molecules in the cannabis plant. By side
effects, I am referring to the ability of THC to cause agitation. So, the most
psychoactive and the most side effect prone molecule in the plant is Sched-
ule III. This means that a physician can phone in a verbal/oral order for
Dronabinol, but that same doctor, according to the Feds (and occasionally
the California Medical Board), cannot smoke weed!
So, please explain to me why cannabis is Schedule I and it's main psychoac-
tive molecule can be phoned in and is not controlled?
2. In 2003, the Feds patented CBD, Cannabidiol. This is a non-
psychoactive cannabinoid as discussed in a number of my prior blogs. Now,
the Feds would clearly not have patented CBDif it were dangerous and use-
less. Right? Who would patent something that is both illegal and useless?
So, please explain to me why cannabis is Schedule I but CBD is patented
by the Feds?
3. How/why are the feds giving grow licenses to various Pharmaceutical
companies, yet to be named?
Please explain this to me as well?
4. CBD, approximately 10 months CBD ago just dropped off Schedule
I. Why? Is it legal or not? I really don't know. CBD is a truly magical
molecule, certainly while acting as a complete medicine within the plant's
molecular environment. I.e. I believe, as an aside, in whole plant medicine.
Apparently so do a number of international pharmaceutical companies, as
a handful are being released around the world.
Please explain what the legal status of CBD is now? Is it different if it is
Pharma based??
Sativex (GW Pharma/Bayer Pharma), will be passed all clinical trials in
a few years and be a legal drug in the USA, but only by controlled pre-
scriptions. Am I correct? It is a whole plant tincture. It has approximately
balanced THC and CBD, it is completing State II trials in the US AND the
DEA and FDA are having meetings concerning this.
Pharmaceutical based cannabis medicine will end up in a different schedule
that the identical medicines produced outside of Pharma. The issue is no
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longer about morales and evil weed. It is about Pharmaceutical companies
working with our government to get rid of any competition to their own
weed products. At least this is how it seems. Please explain how and why
I am incorrect?
Thank you for your time,
Allan I Frankel, MD
310-821-9600
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Terpenoid MoIecuIes; The Next Cannabis
Generation
Sunday, July l7, 20ll
I will be speaking more on this in a future blog, but the attached article on
the critical important and synergy between cannabinoids and terpenoids is
just being uncovered.
Terpenes are ubiquitous in nature. They are present in all plants and give
them their essence, flavor, scent, taste, as well as acting as plant commu-
nicators to other plants and to animals. There are certain terpenes that are
emitted from a plant when it is being eaten by a herbivore which attract
a carnivore to eat the herbivore! Pretty amazing. Just think of what non-
verbal communications must be going on with us humans. It must, just must
be way beyond posture and eye contact.
In the cannabis plant, the terpenes are in abundance and in addition to giv-
ing strains their character, scent, taste, etc, act as active neurotransmitters
within us! I once smoked some Beta Kariophylline, with a couple of lab
guys. There were no cannabinoids present, no THC/CBD. We all were very
°effected¨. :
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Since that experience a couple of years ago, I have been studying more
plant medicine. As I came across this great article by Dr. Ethan Russo, it
reminded me to blog on the subject and of course post the article.
As you all know, I work as a consultant for various groups helping to de-
velop dosable medication. Terpenes have been an exciting and still much
unknown field. I will keep you posted. In the meantime, check this out and
try stay awake.
Dr. Ethan Russo on Cannabinoids and Terpenoids -Terpenoid Entourage
Effects Brit J Pharmacol 2011
413
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Cannabis Does Not Impair Long Term
Cognition
Wednesday, July 20, 20ll
As we all know, °stoners¨ are considered to be dumbed down by cannabis.
Well, as most of us already know, this is not the case. Here is another article
published in a mainstream medical journal that states what I believe to be
closer to The Truth
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.
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http.77WWW.g¡eehb¡1dgened.con7Wp-cohteht7upJoads72u117u77
Russo-Tan1hg-ThC-Poteht1aJ-Cahhab1s-5yhe¡gy-ahd-Phytocah
hab1ho1d-Te¡peho1d-Ehtou¡age-Effects-B¡1t-J-Pha¡nacoJ-
2u111.pdf
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http.77goo.gJ7uB412
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MedicaI Board of CaIifornia RuIes on My
Case
Tuesday, July 26, 20ll
I WON!!
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Bridge For TroubIed Waters **Need Your
Feedback**
Friday, August l2, 20ll
I am always amazed but never surprised about our government's bizzarre
behavior particularly with relationship to Cannabis. Most recently, I have
heard froma number of collective personel that banks and bank cards as well
as merchant accounts are being interfered with by the banks in exchange for
various governmental °perks¨.
For SURE many collective stores are having trouble with merchant ac-
counts and the cards, such as AMEX, VISA and MC. The salvos come
and go, but everyone is testing the waters of attempting to help kill dispen-
sary stores by giving perks to the card companies in exchange for ratting on
°suspicious behavior¨.
I am meeting tomorrow with a gentleman who works as a banker and spe-
cializes in smart cards. I am thinking perhaps we can have patients load up
their card on a little machine at each dispensary. It can even be the same
machine that swipes for standard credit cards.
So, we would be creating a nearly free °dispensary card¨ that any patient
can load up when at any participating location. There are a couple of bugs
to work out, but assuming it can be done, what does everyone think?
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Allan
ps, I expect to hear from each and everyone of you.
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Terpenes And Your Cannabis
Sunday, August l4, 20ll
What are Terpenes and what is their effect in making Cannabis Tinctures?
The Terpenes are multi-carbon chained molecules ubiquitous in the plant
kingdom. They give the plant it's °character¨, similar to the wine industry.
In addition, the Terpenes are responsible for communication in nature, plant
to plant and plant to animal.
There is one Terpene which I recently read about, that is released when it's
leaves are crushed by a herbivore. These terpens attract carnivores who are
then more likely to eat the herbivore before the plant is all eaten. Terpenes
are °balancers and communicators¨.
Clearly we have receptors for Terpenes and some Terpenes interact with the
CB1 receptor. Terpenes are probably the most improtant variable other than
the THC and CBD. There is much to learn, but it is clear that including the
Terpenes in the extraction and re-infusing them into the tincture is a good
if not at least, interesting concept.
So, our team has been looking into adding Terpenes back into various tinc-
tures. It is more a messy than difficult process, assuming you are using C02
extraction. I don't know how else to do it.
Anyway, the Terpenes are large, but volutile molecules and upon any pro-
cessessing tend to just float away.
As far as I know, there are two methods used to capture the Terpenes in
water. Once this is done, you just cook it all up. So, in the first, one just
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allows the Terpenes to circulate and re-circulate with the CO2 itself. A
water bath near the end collects the Terpenes and this °Terpene¨ extract
is tested. I just consulted on my first Terpene extraction and much was
learned.
The other method, which I have read about but not tried YET! Here you
give up on any attempts to re-circulate the C02, and each °run¨/¨batch¨ you
need to replenish the C02. This is only a cost issue. So, the C02 is not kept
under pressure and is just released into the atmosphere. Again, sterile water
is used to flush the Terpenes and all efforts are made to keep the Terpenes
in solution in a closed system.
Either way, the Terpene flush is mixed with the cannabinoids and presto!
With regard to effects, for SURE, it helps with achieving many altered
states.
Allan I Frankel, MD
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TroubIed Waters Are CaIming Down
Sunday, August l4, 20ll
I am thrilled to report the results of two meetings with the CEO of a public
company which, although it is not a bank, does handle merchant accounts,
all major credit cards AND a very cool °Smart Card¨ which I tested. This
is a cool card and already being used by many collectives.
So, this company just delivered a °letter of intent¨ to work with any credit
worthy collective. No discrimination AND I am 90% certain they will offer
a two year contract. Usually this is the WORST thing anyone would want,
but in this situation, it is likely in my opinion, that every collective will want
it.
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On Wednesday evening I am talking at °The Greater Los Angeles Care-
givers Alliance¨(GLACA), on CBD and tinctures, but I will turn this con-
nection over to GLACA to do with as they best see fit.
I would really love to see GLACA grow 10X and become a true force. This
requires money. Perhaps with all the savings in credit card fees, merchant
accounts lost business, etc, a portion of the savings can be donated to a
Cannabis Club °Legal and Survival¨ fund.
I hope this helps.
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CBD Drug Interactions
Monday, August 22, 20ll
As discussed in prior blogs, CBD CAN and does to a ?? extent interfere
with drugs patients take that are metabolized in the liver by the Cytochrome
P430 system.
As promised, here is a list:
CBD DRUG INTERACTIONS:
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http.77ned1c1he.1upu1.edu7cJ1hpha¡n7uuTs7CJ1h1caJTabJe.aspx
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New Weight Loss Medication
Wednesday, August 24, 20ll
How about an old and brand new medication that:
1. controls anxiety
2. helps control pain of many kinds
3. significantly reduces appetite
I suppose nobody should be surprised. Typical THC containing cannabis
causes the munchies. THC decreases focus. CBD decreases appetite and
increases focus.
In years past the cannabis plant had lots of both CBD and THC occurring
naturally. The CBD was slowly and accidentally bred out to make way for
just the real stony plants.
As CBD plants are being brought back, we are learning a lot and cannabis
has become an even more amazing plant. Need to increase your appetite
use mostly THC and no or little CBD. If you are eating too much due to
simple over-eating, CBDvery comfortably and powerfully will reduce your
appetite.
I wonder if instead of creating fixed tinctures, how about giving patients
options to use nearly pure THC OR CBD. The patient can then do their
own internal study. How much T? How much C? What order? Let us know
and these patients will teach us much of what we need to learn. Hmmmm,
a Duo-Pak??? Spray-spray??
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Save Cannabis; Save Our Democracy
Sunday, August 28, 20ll
Anyone reading this is of the ilk to agree and feel strongly about this blog.
Those who don't, may think I am quite crazy.
I think there is a way to accomplish some of the following goals for
$1/month. Here is my version of the list of issues:
1. Cannabis is only on lease to us from the Federal Government, They will
take it back as soon as the pharmaceutical versions of our medical cannabis
tinctures are released through GW Pharma/Gayer. Many others to follow.
In fact, over 30 growing licenses were very recently issues by the Feds to
Pharma. No question. Right? Pharma will destroy anything they can that
we have built. I am certain this is their intent.
2. The same as #1, but apply to our virtual entire loss of our democracy. No
details needed. You all know better than I.
It seems impossible to solve either of these issues. I have felt despair over
what has happened in recent political years. I love the Medicine of our
plant, but fear it is to be taken away again in a very big way.
So, here is a solution:
1. Every Cannabis Patient pays $1/month. There are nearly 1.3 million
patients just in California.
2. As these are horrible financial times, the patients will be reimbursed
twice their monthly $ donation in collective coupons
3. The list and money is used very simply:
a. Fight EVERY case against patient, collective or physician that in any
way takes away our rights. In my we can change their °bad behavior¨ fairly
quickly.
b. Actively change the laws that need to be changed
c. fund research and donate grants
d. Not last and certainly not least:
CREATE A OUR OWN SINGLE PAYOR SYSTEM IN THE STATE OF
CALIFORNIA FOR EVERY CANNABIS PATIENT. THINK ABOUT IT.
MORE TO FOLLOW
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HeaIth Insurance and More for Cannabis
Patients
Monday, August 29, 20ll
I have been asked what I mean by a single payor health care system for
any medical cannabis patient. The most difficult part of the entire plan is
defining who is a medical cannabis patient and that will have to eventually
be worked out.
Regardless, there are many reasons that this particular demographic would
be ideal to insure:
1. As a group I would say there is 90¹ %concordance in thought and feeling
among cannabis patients. For example, if every cannabis patient voted on
same sex marriage, we know the outcome and it would be virtually 100%.
Other significant actuarial issues are:
a. somewhat younger population
b. even with a zero dollar deductible, the vast majority of cannabis patients
would still rather not go to the doctor at all. Then when at the doctor, they
fight every prescription, test, etc. In other words, as a group, they would
automatically be low utilizers.
c. Cannabis can be given away for free in tincture form to every patient
just for signing up for the health plan. This will further decrease trivial and
DANGEROUS visits to clinics who only understand volume and volume
discount.
d. So, although much study would be needed, the insurance companies
probably already have tons of data showing med can patients to be low
risk.
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2. Numbers of patients in the hundreds of thousands is not impossible and
it would be very possible to approach one million with time. Over years on
a national level, it would be tens of milliions of citizens.
3. These citizens could be certain that they would NEVER lose this group
coverage, no matter what.
4. As I have had a fair amount of experience in building an insurance com-
pany, I believe this would be by far the easiest one to insure. There would
be internal coverage up to $30,000/person/year. Above that, for the rare dis-
asters, we would re-insure with Lloyds or any other competitive proposal.
3. I believe that with a few months of actuarial study, we would find that
as long as we can control the quality of the primary care (A HUGE, HUGE
ISSUE IN MY OPINION), patient satisfaction will be through the roof and
costs will be way, way down.
6. we reward doctors by paying them more if they are open to cannabis and
have taken classes on cannabinoid medicine and pass a pretty tough test.
They will study VERY hard, else they lose their practice.
7. The group might also consider a kaiser model where the group screens
every doctor and we hire them, giving themthe PROPERREWARDS AND
PROPER PENALTIES. We all know what all these are and the list could
easily be agreed upon.
I believe the profit from this would partially go back to the patients as a re-
duction in premiumbut much of it would be earmarked for various projects,
free clinics, anything we agree upon. Also, agreeing will be VERY easy
FRED: the reasons to large extent for the few bucks per month are:
1. you then have a list of potential voters, letter writers, big contributors,
insurance buyers
2. this is a huge war chest to build the insurance company, hopefully a
pharma company and a PAC to weight heavily upon local, state and Federal
elections.
If this became national over the next 6 years, the tens of millions of patients
across the nation could probably control a LOT.
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New Cannabis Tinctures
Tuesday, August 30, 20ll
Currently, there are two very different certified (i.e. we KNOW for sure
what is in them/cc) tinctures.
1. the °CBD¨ tincture, which is 3 mg/cc of each cbd and 3 mg of thc.
2. The THCtincture is 11 mg/cc THCand 2 mg/cc CBD. For the time being,
I feel from a lot of
°studies¨ both locally and internationally, that a little CBDseems to prevent
THC
toxicity(paranoia, anxiety, agitation, panic, etc).
Currently I am thinking that for now, all tinctures should have some CBD
to balance it out and prevent the toxicity which is a really important deal.
We are studying how little CBD is needed to accomplish this. In addition,
with the rich CBDtinctures, we are trying to see howlittle THCis needed to
achieve the same results. For example, do we absolutely need ANY THC??
Just don't really know. For many reasons, this is critical information and
here are two:
1. if some patients who need the medicine, but are tested at work, the zero
or nearly zero THC should prevent any positive tests.
2. We are collaborating with some docs in Canada. We are helping them do
exactly what we are doing here, but with female Hemp flowers and whole
plants. If this is effective, it could be in Savon and would be as legal as a
hemp shirt. We shall see.
Having some CBD in every product, at least for now, is turning out to be a
bit confusing up front, as having ANY CBD seems to lead folks to assume
it is the rich CBD. I am thinking that we should go back to just calling them
either T or C and ignoring the fine points until patients begin to get the hang
of looking at the ratios, terpenes, etc and obtain their medication based upon
the actual medicine and begin to ignore all other labels. Any thoughts?
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THC Toxicity and EdibIes
Most of us have tried edibles, food with active cannabis inside. I have
always thought it so silly as the patient has no idea what medicine is inside,
how much medicine, etc etc. We all either have had or know people who
have had toxic reactions. However, many patients just love edibles. If they
are using edibles JUSTto prevent smoking, they should just use tinctures.
These paranoid/agitated reactions are actually pretty common. My guess is
that it is over 20% for all patients. This is almost as bad as °pills¨ and is
just not acceptable. Patients are told to start slow, wait 2 hrs before the next
bite, etc, but in reality it is rarely done.
I have always felt that the actual medicine should be in a simple capsule.
The patient can purchase food if they wish t, o eat with it. The capsules
would always, I think, contain a little CBD and come as 2.3 mg, 3 mg or
10 mg of THC and perhaps around 2 mg of CBD inside each capsule. This
would allow very simple titration. The small amount of CBD should also
nearly eliminate the THC toxicity.
If you do the math, the clinical effect is MUCH less expensive this way.
So, what about the patients who just love edibles and don't want to use
tinctures? How about a °tincture mix¨ that allows any baker to obtain the
PRECISE amount of THC/CBDand ?? even Terpenes, per brownie? In this
situation, an amount of cannabinoid substrate could be provided to make
X number of brownies or any other food units. The baker would know
EXACTLY what medicine is inside each item. A little CBD could be part
of the °magic goo¨ if desired as well.
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Patients in a very short time would learn their precise dose and from then
on always know exactly what they need.
Does this seem impossible or way down the line??? Well, I just tried a few
last week with 10 mg THC and 3 mg CBD per brownie and it felt like the
same tincture, but just lasted a very long and wonderful time.
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New Thoughts on Cannabis and Insomnia
Up until very recently, I always advised patients to use use a °sedating¨
Indica for sleep. I think the current dogma is that Sativa is for the day and
Indica for the night. I truly believed this and wrote much on it. It is still on
the back of my cards.
I am not saying this is entire bunk, but it was what we understood at the
time. My current understanding, which will always remain open to change,
is that whether using allopathic meds (sedatives, tranquilizers, SSRI's) or
cannabis it is just NOT necessary to sedate the patient to help with sleep.
Of course I understand at first blush this seems ridiculous, but I do believe
this to be the case for the vast majority of patients. I have already heard back
from over 100 patients who have very recently stopped using for sleep at
night and are just using 2 mg CBD in the AM and 2 mg at night. They seem
to do great and you avoid the munchies. BTW, CBD really, really decreases
ones appetite. No wonder the Feds patented it in 2003.
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!! YES, THIS
IS CORRECT. CHECK THE LINK. Let me digress, CAN ANYONE EX-
PLAIN TO ME HOW/WHY CANNABIS IS CONSIDERED USELESS
AND DANGEROUS WHILE BEING PATENTED BY THE FEDERAL
GOVERNMENT??? How/why can this be?
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Back to Insomnia. In my 34 years of experience as an internist, it has always
been clear to me that knocking people out to sleep was ridiculous and more
to the point, just not necessary or helpful. If the patient can simply get some
help slowing down the °spinning¨ in their head, they just go to sleep and
have a way better quality of sleep.
With regard to Cannabis and Insomnia, this appears to translate to using
CBD both during the day and during the night, that is two times/day. This
12 hour dosing seems to work fine and this is what GW Pharma says on it's
package insert.
So, if you have never tried it, for a few days just try using a small amount of
balanced CBD/THC AM and PM and see how you feel and how your sleep
is. Try not to smoke for some days, although I don't think it will matter
UNLESS you smoke a rich THC flower at night and that could certainly
keep you awake. Of course, knowing how much THC you are ingesting
by smoking at night is entirely impossible. Even if the patient knew EX-
ACTLY types and levels of cannabinoids and terpenes in their smoke, what
in the world is °a puff¨?? For sure, no two puffs are ever the same.
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Update On CBD Rich Cannabis Tinctures
Friday, September 9, 20ll
I thought it was overdue to share more of my experiences with CBD rich
cannabis tinctures. I am actually still not certain what in fact CBD Rich
means, but am fine with adapting Project CBD's definition. A CBD rich
tincture is one that has at least 4 mg of CBD/cc. I would love to hear any
ideas regarding to all the new nomenclature of this new world of cannabis
medicine.
Last week there was a period when the production and availability of these
tinctures was in question. When I thought what that would mean for me as
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a cannabis physician, I was both happy and sad. I was happy that this truly
new world has opened up for patients. Truly amazing. However, it became
clear to me that if these wonderful new medications were to cease, I don't
think I could do the recommendations any more. I would not be sure what
to even discuss with patients. I guess I have perhaps painted myself into a
corner, however I think I would in fact do something different. There are
many things to do in this world, but signing °recs¨ without truly believing
the patient was being cheated out of the best medicine would be difficult
and painful.
These balanced THC/CBD tinctures, where the CBD is at least 4 mg/cc,
are truly amazing. Altered mental status is rare and anxiety, pain, neuritis,
irritable colon, PMS, chronic neurological disorders, tumor suppression,
appetite suppression....more and more
This is almost 100% of the time achieve with 2 mg of CBD twice daily.
It feels so good to be able to tell someone an actual dose. I know this is
frowned upon, but there is that old Hippocratic oath. Right? Doesn't that
obligate me to share any/all information I deem helpful to a patient? How
could it be otherwise.
Let's not forget, the Feds patented CBD in 2003 as discussed in several
prior blogs. How can they really say CBD is horrible? How can anyone
say that any caring physician would not want to help his patients find the
best medicine for them? Nothing else makes any sense to me.
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CBD And Cancer - Just The Beginning
Thursday, September l5, 20ll
For those of you interested in learning about the potential future of CBD
and treatment of cancer, read on:
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http.77WWW.hcb1.hJn.h1h.gov7pubned72uu537Bu
http.77WWW.hcb1.hJn.h1h.gov7pubned71ô72B591
http.77WWW.hcb1.hJn.h1h.gov7pubned7215ôôuô4
http.77WWW.hcb1.hJn.h1h.gov7pubned71BB33429
Tumor Studies:
http.77WWW.hcb1.hJn.h1h.gov7pubned71Bu352u5
http.77WWW.hcb1.hJn.h1h.gov7pubned714ô17ôB2
Clinical Trials:
http.77cJ1h1caJt¡1aJs.gov7ct27¡esuJts?te¡n=cahhab
1d1oJ
http.77WWW.cahhab1s-ned.o¡g7stud1es7WW¸eh¸db¸stu
dy¸sea¡ch.php
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How ShouId We CIassify Tinctures
Thursday, September 22, 20ll
The new super critical Co2 extracted tinctures are working very well in the
community. New tinctures are being released by collectives a batch at a
time. They all have different effects that are determined by the THC level,
CBD level, ratio of the two as well as perhaps a hundred different terpenes.
So the clinical effect is determined by all of these factors and perhaps more.
Right now we do believe that CBD in close balance seems to be a very
good way to create a non psycho-active tincture, but with some patients
this appears to either be too much THC or some terpene effect. As new
batches of tincture are made, the terpene extraction is getting better and
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better and we may begin seeing some psycho-active effect even when the
CBDTHC.
This is a complicated issue and will require time and research. In the mean-
time, how should we best classify a tincture?
1. For certain we should measure and label as much cannabinoid and ter-
pene content as possible
2. There must be some initial trials with groups of patients to determine
the effect to get an initial scale for that tincture. This can be adjusted over
time
With this in mind, I am suggesting we perhaps could employ a °psycho-
active¨ scale. It would go from 0 to 10, with 0 being no perceived psycho
activity and
10 being °make no plans¨. I am suggesting that we consider placing this
number of every batch. It should even be the °name¨ of the tincture. At
least it should be clear and simple.
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How to Administer New CBD/THC Tinctures
Friday, September 23, 20ll
As with most medications, they should be titrated. This means start with a
very low dose and add additional drops or sprays one or two at a time every
30 minutes. You will find out what dose is effective this way. With regard
to how frequently, it is difficult to say for certain, but my experience from
what my patients tell me is:
1. If the tincture has only THC and no CBD, the duration will most likely
be 3-4 hours
2. If the tincture has CBD content, patients seem to only need to be dosed
every 8-12 hours.
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The CBDslows down the THCmetabolismin the liver and increases greatly
the duration.
With regard to how long and when to decrease, I think this is something
we just don't know. If treating a chronic condition, it is likely that the tinc-
ture will be helpful long term. If symptoms are more intermittent, I would
suggest using the tincture intermittently as well.
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CBD(CannabidioI) and Drug Interactions
Sunday, September 25, 20ll
CBD is metabolized in the liver by the P430 enzymatic system. So, any
other drug, including THC, is affected to an unknown amount. Generally
these interactions are said to be minimal, but for sure with THC, the THC
effect is prolonged by a number of hours. So, I woud not be surprised that
we see more drug interactions with the many prescription drugs that use the
same P430 system.
A couple of common drugs, Lipitor and Xanax both use the P430 system,
so their dose may have to be adjusted downward.
Here is the best list of drugs using the same pathway. Any patient using
CBD and taking one or more of these drugs should notify their physician.
Generally nothing needs to be done, but I am hearing of cases where doses
should/can be reduced.
Here is the list:
Drugs using P430 Hepatic metabolism
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ugs-us1hg-P45u-hepat1c-netaboJ1sn.pdf
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Tamoxifen Joint Pains HeIped By
CBD(CannabidioI)
Tuesday, September 27, 20ll
I have had two patients recently with breast cancer who were on Tamox-
ifen, an estrogen inhibitor. A fairly common side effect of Tamoxifen is
joint pains. For many of these women, it presents as an arthritic condition
affecting both large and small joints.
When these two women started using as little as 1 mg BID of CBD, their
pains were significantly improved. One of them restarted exercising within
a day.
I will be following these women and am communicating with their oncolo-
gists and will post more on this topic as more experience is gathered.
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Certified Cannabis Tinctures
Tuesday, September 27, 20ll
Certified Cannabis Tinctures assure the patient that:
1. The cannabis plants used in the making of the tincture are organic
2. The entire plant is used in the making of the tincture other than fan/water
leaves
3. The cannabis plant as well as the tincture is chemically tested for cannabi-
noids and 33 Terpenes
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4. Carbon Dioxide in liquid form is pressurized to separate the plant mate-
rial from the lipid soluble medicating molecules
3. No alcohol is used
6. The labels will be Sherman Act compliant and state cannabinoid/terpene
content in mg/cc
7. Each tincture is clinically evaluated for its degree of psychoactivity
altered thinking/mind altering
HOW TO SELECT THE RIGHT TINCTURE FOR YOU?
Strain type is not the best predictor of which tinctures may work the best
for you. Strain type as well, does not predict efficacy. So, a psychoactive
clinical scale is used, as below, to help the patient select a tincture that is
likely to be best for them without causing excessive psycho activity, or how
mind altering the tincture may be for you.
The scale goes from 0 to 10, with 0 being no psycho activity and 10 being
extremely psychoactive.
Not Psychoactive·0 1 2 3 4 3 6 7 8 9 10 Very Psychoactive
In general, the greater the ratio of CBD(cannabidiol / THC the less psy-
choactive a tincture will tend to be. However, for many patients even with
a relatively high level of THC, even a small amount of CBD can virtually
eliminate the psychoactivity. Also, as with everything in medicine, patients
and conditions vary. We will be asking your help in determining what works
best for various conditions in different groups of patients.
If you are using a tincture with CBD, please take the Project CBD survey.
It is one of the main pages of this site.
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MedicaI Cannabis Registration Means No
Guns or Ammo!!
Sunday, October l6, 20ll
I amsorry for not posting this sooner. When I first heard about this, I frankly
thought it was just a rumor, that it just could not possibly be true. Well, it
is true, and I have posted three links below for more details.
It appears that the ATF (Anti Terrorist Force) has recently dictated that any
registered Medical Cannabis Patient, cannot own/register a firearm. This is
outrageous. I am certainly not an NRA supporter, but picking on cannabis
in this fashion is insane and everyone knows this is federal policy at work.
There has already been action, see in one of links below, of a woman in
Oregon arrested for this, she had a medical cannabis state card and owned
a gun. She potentially faces jail time. Incredible!!
There is more and more talk that the State of California will be forced to
release it's list of registered patients and cross check with gun licenses. It
is of course horrible, but it will be interesting to see what the percentage of
registered cannabis patients posses a gun license.
In addition to the obvious, I have one other concern. In my six years in this
field and much experience in the/¨their¨ legal system, it is not too paranoid
to consider that:
1. The patients who posses cards are in large part those who grow or
travel with cannabis. There is no reason in the world, from my perspec-
tive, for anyone to have a state card, unless they travel with large volumes
of cannabis. Even in this circumstance, personally in many visits to court
on behalf of patients, I have NEVER seen the State Card help anyone par-
ticularly if the doctor shows up. So, perhaps my going to all of my patients
trials for free over six years, I may have a biassed view here, but I would
love to have feedback from other people. Also, if going to court keeps pa-
tients out of jail, every cannabis doctor should stand by their patients for
free. It should be our obligation.
2. The state may come to the conclusion, after crossing the database of
medical cannabis card holders with the database of gun licensing and come
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to conclusions concerning what it means regarding cannabis users in gen-
eral, and go arrest these people for breaking the law.
In other words, I am concerned that the Feds will cross the states' PATIENT
list with the GUN PERMIT list and find those patients who carry gun per-
mits. I would imagine there will be quite a few found, as so many of these
patients are the patients who grow and transport and I would think many
of them have guns. So now there will °legal¨ arrests of patients as well
as slandering the medical cannabis industry stating °statistics¨ that x% of
cannabis users have permits for guns. Obviously if they cross the database
of ALL cannabis patients (which does not even exist outside of the state
card) the people with gun permits will most likely be lower than the norm,
at least I believe this would be the case.
This is really awful. I think that everyone should boycott the use of the state
card to the extent possible
LIST OF USEFUL LINKS
http.77huff.to7qvbRJJ
http.77b1t.Jy7pukuTx
http.77b1t.Jy7hF2TpN
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CMA, The CaIifornia MedicaI Association
Advocates Cannabis LegaIization
Friday, October 2l, 20ll
CMA wants cannabis legalized
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!!
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http.77WWW.nouhta1h-heWs.con7heWs7a¡t1cJe¸Bdfc9bbc-fb3u-
11eu-a4B7-uu1cc4cu32Bô.htnJ
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The CMA just released a white paper with strong language advocating the
legalization of cannabis. In large part, this is to enable legal studies of the
medicine without any fear of reprisal from the Feds or Medical Board.
I amthrilled to see this development froma very reputable and conservative
medical organization.
It is a good day.
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Two Patients Facing Court Hearings For
Possession of Tinctures As Being
"Concentrates"
Sunday, October 30, 20ll
I am appearing as an expert witness and physician for two of my patients
over the next two weeks. I have been to 34 hearings or trials and am happy
to say I have never and will never charge for this service. I would love
to be able to charge, but in this field, any received money shows guilt to
something. Anyway, these patients are broke by the time I see them. For
these patients, much of the issue was the numerous tincture bottles they had
in their possession. They were working with legal collectives and had all
proper legal documentation. Much of the issue in the end is that the state
and county seem to believe that a tincture is a concentrate such as hash.
Below is pretty much what I wrote to the courts:
One of the most troubling and silly reasons for jail or potential prison time,
has been the possession of bottles of tincture. Of course it is never one
or two bottles. It is generally someone legally delivering bottles of tinc-
ture to collectives, hey, there are flowers and tinctures in every collective
store..they get there somehow and
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A cannabis tincture is not a concentrate, it is a dilution of the cannabis plant
medicine. It is a dilution of the THC, CBDor any of the other 448 molecules
in the plant.
A concentrate is defined in chemistry as a solution or solid °material¨ that
was altered in some manner to make the amount of the °material¨ per
weight, such as in mg/cc altered from a lower value to a higher value. For
example, if one begins with a lemonade solution that contains 10 mg of
sugar in every cc of water and the water in the lemonade is allowed to evap-
orate, a concentrate of lemonade is produced. If more water is added, it is
diluted. A single lemon can make one glass or several glasses of lemonade
depending upon how concentrated or dilute the lemonade is intended to be.
Asingle lemon can therefore make much more than it's weight in lemonade,
as sugar and water make up the bulk of the weight.
If we apply this same logic to the situation in the cannabis plant, the starting
°material¨ is the actual cannabis plant with an average of 10% THC by
weight. One tenth of a gram of cannabis is 100 mg. (one gram ¬ 1000
mg and 10% or one tenth of this is 100 mg). If this extraction into a liquid
is even 30% efficient, a total of 30 mg of THC can be extracted into the
tincture fromthe single gramof cannabis plant material. Alchemy's tincture
averaged 1 mg of THC for every cc of tincture. Each bottle has 10 cc's. So,
each bottle averaged approximately 10 mg of THC.
This means that one gram of 10% THC plant will make 3 bottles of tincture
at the dilution used by Alchemy Collective.
Another way to view this is that each gram of cannabis makes 3 bottles,
so a pound of cannabis, 434 grams, would make over 4000 bottles. If it
took pounds and pounds to make 100 or 200 bottles of tincture, each bottle
would be prohibitively expensive and useless.
In addition, butane or other toxic chemicals are not used in the creation of
tinctures as they are only used in the making of the true °concentrates¨ or
hash or cannabis oils.
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My Court Appearances For My Patients
And a ProbIematic Lawyer
Wednesday, November 2, 20ll
I have always helped and and all of my patients if they are arrested or has-
sled. Every one of them are legal, belong to the collective they are growing
or delivering for and they all have legal designation letters. More on the des-
ignation letter in a future blog, but this CRITICAL DOCUMENT, is often
neglected. It basically states that the management of the collective is direct-
ing this patients, or °designates¨ this patient to grow or transport. There is
cannabis inside the dispensaries and they are not delivered by chopper.:)
People drive the cannabis. No planes, no trains. The designation letter is
key.
In general I love the work and so far not one patient has ever lost. I never
charge the patient for any of my work. Never. In this manner, I have gained
a lot of legal experience and am able to serve my patients very well since
at hearings or trials, this comes across as it should, I care about my patients
and the cause.
On a few occasions, I have had the displeasure of working with one partic-
ular lawyer who is well known in the Southern California area. I assume
this lawyer is a good attorney, but I can no longer work with the office. As I
am a volunteer doctor, and really a strong patient advocate, I would expect
to be treated civilly. I should be able to speak with my patients' lawyers,
as I have done without issue on dozens of times, but this lawyer never re-
turns my calls. This lawyer does not make it easy for me to know which
days of my work to cancel. This lawyer never notified me when a day was
cancelled and I showed up on several occasions just to go back. The worst
issue with this attorney is that as a Physician who has specialized in this
area, I should be brought in not left out.
So, if any of you are my patients, who need my help with a legal issue,
please speak privately with me before hiring a lawyer. It has taken a lot of
events to get me to this point, but please call before hiring.
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Feds Say CBD Is Wonder Drug! They
patented it.
Tuesday, November 8, 20ll
Ok, I know this was from 2003 and I have blogged several times on this
amazing hypocrisy that is somehow not ever explained to us. I have
written everyone I can think of, including Mr. Obama. To briefly
summarize, for those of you not familiar with this hypocrisy, the Feds
patented CBD in 2003. I have read this site a number of times, but for
some reason, I saw it more clearly today. They are not just saying that
CBD is a great neuro-protectant, they are making reasonable, but bold
statements for a group who says cannabis has no value. We need to
somehow make this public in a big way. I am always amazed that I never
see or hear these issues being challenged and certainly not answered. Let's
not discuss the details now. Perhaps let's all begin asking how this is
possible? The federal patent site is pasted below. If I didn't view it from
time to time, I wouldn't believe it myself, but it is true. The feds are
clearly stating:
ªcannabinoids usejul in the treatment and prophylaxis oj wide variety oj
oxidation associated diseases, such as ischemic, aqe-related,
injlammatory and autoimmune diseases"
Forgive me, but aren't they saying Cannabis is a great medicine?
Isn't this sort of an endorsement for Cannabis as medicine?
They are keeping it for themselves.
They are placing people in jail.
Does anyone know any way for this to be brought to a national television
audience? I am happy, as always, to be involved in any way I can be
helpful. Let's get this on national television and dare the DEA to come on
the show and respond. This is the smart and right thing to do. Read Below
or CLICK HERE
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http.771.usa.gov7tdhJs5
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( 1 of 1 )
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United States Patent · 6,630,S07
Hampson, et al. · October 7, 2003
Cannabinoids as antioxidants and neuroprotectants
Abstract
Cannabinoids have been found to have antioxidant properties, unrelated to
NMDAreceptor antagonism. This newfound property makes cannabinoids
useful in the treatment and prophylaxis of wide variety of oxidation asso-
ciated diseases, such as ischemic, age-related, inflammatory and autoim-
mune diseases. The cannabinoids are found to have particular application
as neuroprotectants, for example in limiting neurological damage following
ischemic insults, such as stroke and trauma, or in the treatment of neurode-
generative diseases, such as Alzheimer's disease, Parkinson's disease and
HIV dementia. Nonpsychoactive cannabinoids, such as cannabidoil, are
particularly advantageous to use because they avoid toxicity that is encoun-
tered with psychoactive cannabinoids at high doses useful in the method of
the present invention. Aparticular disclosed class of cannabinoids useful as
neuroprotective antioxidants is formula (I) wherein the R group is indepen-
dently selected fromthe group consisting of H, CH.sub.3, and COCH.sub.3.
##STR1##¨
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More on CBD/THC Tinctures With Terpenes
Tuesday, November 8, 20ll
I am posting this information, which is in a constant state of updating, to
help all of us begin to understand what our evolving medicines should look
like. There is some consensus that the °best¨ medicine is °equal¨ CBD
and THC per ml of tincture. Our experience certainly indicates that this
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is a great medicine, but we don't believe anyone knows what is °best¨ for
all clinical situations and for all patients. As a practicing physician for 34
years, I have never seen a single anything work for everything and I doubt
this is the case here.
So, the intended plan of the current scientific group (listing and details
to follow soon), is to always have some °balanced¨ cannabinoid tinctures
available for patients, but that we will always be working on many differ-
ent strengths and ratios. For example, at this point in time, every tincture is
re-infused with all the terpenes that were in the original plant. This changes
the medicine in very significant ways most of which we are still learning
about. So, one might have a tincture with near equal amounts of THC and
CBD, whether 3/3, 3/3 or ? others, but due to the makeup of the terpenes,
might be more or less psychoactive.
For example, there could be a tincture that is 3/3(balanced) but some ter-
penes in the tincture alter the psychoactivity effect as well as other effects.
So, we are looking into other manners in which to help the patient select the
correct tincture. Our first venture into this area is a PSYCHOACTIVITY
SCALE. This goes from 0 10. A low number tells the patient that the tinc-
ture is very unlikely to cause any psychoactivity or °altered¨ mental state.
It would help with anxiety and pain, for example, but not alter mentation.
Similarly, a number of 8 or 9 is very likely to be very psychoactive and the
patient should expect a buzz and for sure, as always, be extra careful with
potential side effects
So, think of this number. We will be posting these numbers on all future
releases. For the currently new batch, the T11C2 is rated at a 7. The other
new release contains THC 4.3 and CBD 3.1. It is rated at 1.3 and seems
very similar to the 3/3. We need your help in this ongoing process and will
be asking for feedback.
Here is a way to look at this psychoactive scale.
Low, Medium and High level of psychoactivity
or altered mental state:
j0 1 2 3 4 3 6 7 8 9 10j
Low Med High
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In addition, going forward we will make available the tinctures in both a 3
cc and 13 cc bottles with identical spray caps. This will make trying new
tinctures much easier and less expensive
This product is grown in accordance with California State law and is Clean
Green certified. Diversion or distribution of this product for non-medical
purposes is forbidden under California State and Federal laws.
TINCTURE OF CANNABIS DIRECTIONS
Use as Needed
A. General Statement on Dosage
This tincture of cannabis is made available to qualified patients in the State
of California in accordance with the laws of the State of California. It is
provided as a tincture manufactured in compliance with the guidelines of the
State of California. An oil of cannabis is created without the use of alcohol
or chemical solvents. It is then diluted and emulsified to a stable state at
which point an approved analytical laboratory tests it. It is then blended
and further diluted with purified water and organic vegetable glycerin to
a consistent concentration. Patient is to use a dosage appropriate to their
circumstances. It should be taken as needed to treat the condition for which
medical cannabis is recommended.
The details of the formulation are as follows.
B. Preparation and Administration.
Remove the bottle containing the tincture of cannabis. Shake the bottle in
an up and down motion for 3 to 3 seconds before each use. Use the sprayer
to administer 3-3 sprays of the tincture under your tongue. Use your tongue
to gently spread the liquid around the soft pink tissue inside your mouth.
After a few seconds, swallow any remaining liquid, leaving the vegetable
glycerin coating the inside of your mouth. Do not eat or drink for 13 min-
utes to allow full buccal absorption.
C. Storage
Store in a cool dark place away from sources of heat or light.
D. Shelf Life
Cannabis Tincture should be used within 12 months of date listed on the
bottle.
E. Caution
The most common side effects with cannabis tincture are fatigue and THC
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induced agitation. Some people may also feel depressed or confused, may
feel over-excited or lose touch with reality, may have difficulties with mem-
ory or trouble concentrating and may feel sleepy or giddy. For most people
taking cannabis tincture, these side effects are mild to moderate, last only a
few hours and can be managed by changing the dose, taking a short break
from using the medicine, or using an alternative formulation. Side effects
are most likely to happen when you start treatment and will often decrease
as you become more used to cannabis tincture. Patients should not drive a
car or operate machinery until an initial tolerance has developed. Patients
should also not to take cannabis tincture with other CNS depressants such
as alcohol, opioids and benzodiazepines.
Who should not use this medicine?
Patients with a psychotic disorder not under a doctors care
Pregnant women
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American IdoI To Run Next EIection
Friday, November ll, 20ll
I only wish! Our election process is so intertwined with the special interest
groups that it appears we can't undo any of the knots right now. As always,
fear runs amuck and nobody feels anything can be done to fix the level of
incompetence and corruption. Well, here is a possible solution:
What if we had a system where NO CAMPAIGN DONATIONS WERE
EVER ALLOWED? I know we have all thought about ways to change the
election process as that is the only way to change politicians motivations.
Currently, as huge sums of money are donated to campaigns, the candidates
owe favors and that is where their allegiance lies.
There is another, equally large °election¨ that this country does every year
°American Idol¨. The number of citizens voting, I BELIEVE, is about the
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same as in general elections. So, why not have American Idol run our na-
tional and even local campaigns? The candidates will have to speak directly
to the national audience . No special interests.
As the campaigns locally advance to regional and national levels, the can-
didates would/could do anything from explain their position, debate others
and perhaps a bit of a song and dance, we need happy politicians up there.
The fact that this seems like a decent idea to me right now is horribly sad,
but perhaps, just as books and papers are all going digital, perhaps this will
work better than the current system.
Frankly, I would argue that the °representatives and senators¨ was necessary
230 years ago as there was a need for °representation¨, perhaps now we
should run the place ourselves through a special social networking group.
It could not be any worse.
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Scotty, Beam In The Cannabis Or What is a
"Designation Letter"
When a °store front¨ collective is being built, the shelves are empty. There
are no Cannabis products on the shelves. Then, somehow, upon opening,
the store is filled with all sorts of cannabis products. So, how did that hap-
pen? If transportion is at times or oftentimes considered illegal, but the
stores are not closed, how are the shelves supposed to be stocked in the first
place?
Then, these patients come in, make donations and walk out with bags of
cannabis products. I am certain that after a few days, the shelves are be-
coming empty again and more cannabis products are needed.
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Of course I am being sarcastic, but really, the law treats the delivery of
cannabis differently than it's being on the shelves.
Scotty never beamed in weed. Cars driven by humans come to the store
and walk in with the medicine. So, how do or how SHOULD collectives
receive their products? Howshould or howcan lawenforcement even begin
to know what is °legal¨ or °legal enough¨ for enforcement to leave the
transporter alone? How do the collectives know what is legal and what is
not legal? To the best of my knowledge, the only distinction is the ºLetter
of Designation". I must say that not only does law enforcement not know
about this but most collectives do not know or understand this.
You can be a legal patient and be a legal member of a collective but that does
not give a patient the right to transport cannabis to a collective or to sell it.
The patient certainly do need to be patients and members of the collective,
but they also need a critical document, signed by the management of the
collective. I have pasted below a sample °Designation¨ letter. This is a
legal statement that this legal patient is ºDESIGNATED" TO GROW OR
TRANSPORT.
I, Name of Collective Manager, declare as follows:
The information contained in this declaration is true of my own personal
knowledge or on my information and belief, unless stated otherwise.
1. I am an officer and director of the nonprofit medical mari-
juana patient collective (hereinafter °The Collective¨). I am responsible
for the management of the Collective, hold a position of authority within
the corporation and am authorized to execute this declaration on behalf of
the Collective.
2. The Collective is incorporated as a California nonprofit corporation
under the name COLLECTIVENAMEHERE, and operate as a nonprofit
medical marijuana collective of qualified patients pursuant to Health and
Safety Code §11362.3 (¨The Compassionate Use Act of 1996¨ enacted as
Proposition 213), Health and Safety Code §11362.7 et seq. (°The Medical
Marijuana Program Act¨), and, the California Attorney General's August
2008 Guidelines for the Security and Non-Diversion of Marijuana Grown
for Medical Use.
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3. In order to obtain medicine from the Collective, a person must
(a) be a member of the Collective, (b) be a qualified patient with a valid
recommendation from a physician licensed to practice medicine in Califor-
nia authorizing the patient to use marijuana for the treatment of a serious
medical condition, and (c) possess valid identification establishing that he
or she is at least 18 years of age and a resident of California, as required by
law.
4. The Collective obtains marijuana for its patients exclusively
from members of the Collective, and pays only for the out-of-pocket costs
and labor for the time spent cultivating, processing and transporting the
medicine to the Collective for safekeeping, as required by law.
3. Patient Name is a member of the Collective, and has been
since DATE This member has been duly authorized to transport medicine
on behalf of patients of the Collective.
6. Cultivation and transportation of medical marijuana by this member
of the Collective is authorized under Health and Safety Code §§11362.63
and 11362.77.
I declare under penalty of perjury under the laws of the State of California
that the statements made in this declaration are true and correct, and that this
declaration was executed on November 8, 2011 in Venice, California.
________________________________ ______________________________
Signature of Authorized Collective Manager Printed Name Representa-
tive
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Smash and Grab a CoIIective For "CIaimed"
IIIegaI Activity But NO ARRESTS.
Back in 2008, a lot of these °smash and grabs¨ were going on and only
occasionally were participants arrested. There were a few arrests, but only
the most extreme. The feds did another smash and grab in Medicino a few
weeks ago. The plants were destroyed and money taken. This collective
was, as far as I am aware, not breaking any laws and was operating within
its rights.
In my experience, if agents of the government at any level come and seize
property, it is because the owner was involved in some illegal activity. I
presume the feds felt this collective was doing something illegal, else why
would they smash it? The most serious issue in my opinion, is that they
very, very rarely arrest the collective management.
So, why would the authorities destroy a business and not arrest anyone?
This is generally the case. I do choke when I say this, but shouldn't they
arrest this people so we can then defend ourselves even if our business was
already destroyed? What happened to due process? What happened to trial
before your peers? By not arresting anyone, they just get away with it.
So, with sadness, I am suggesting that IF authorities are going to destroy or
seize property, there should be due process, notification, filed charges and
give the collective or any other business, the right to defend itself.
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Cannabis and MuItipIe ScIerosis
Sunday, November l3, 20ll
Although it has been known for years that cannabis can help with the pain
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and spasms associated with Multiple Sclerosis and related disorders, it has
not been until recent years that the real miracle of how to use cannabis for
MS has been uncovered.
As I have stated in many prior blogs, CBD or Cannabidiol, is the °missing
link¨ in cannabis. It is very similar in chemical structure to THC, but has
no psycho activity or °stony¨ feeling and has wonderful analgesic and other
properties. With regard to MS, this has been very well studied and GW
Pharmaceuticals in England has been producing a very helpful cannabis
whole plant extract including CBD for use with MS patients. Although it
is not legally available in England nor the US, it will be over time.
In the meantime, a number of medical cannabis collectives in Los Angeles
do have tinctures, or drops under the tongue, that are quite similar to Sativex
and at least °empirically¨ seem to work quite well on my MS patients.
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FoIIow-Up On Cannabis and AA
Monday, November l4, 20ll
In a few prior blogs (search °AA¨), I have mentioned that I believe there
should be an °AA¨ type meeting, perhaps it can't be called °AA¨?? I don't
know. However, today another patient responded that I thought represented
the feelings of a number of patients responding to this topic. So, below I
am posting his comments and below that, my response:
Tnis Jiscussion is inreresrinq. I nove smo|eJ por since I wos 12 yeors olJ
onJ srorreJ smo|inq Joily wnen I wos in my miJ 20s. I om now 45. I nove
nor noJ o Jrin| in more rnon 2 yeors nowbur never once rnouqnr obour srop-
pinq por wnen I [irsr wenr ro AA. I Jon`r conJone ir os o woy ro "qer sober"
os I Jon`r rnin| por is [or everyone. I become prerry uncom[orroble or AA
once I reolizeJ rnor everyone else consiJereJ ir rne some os olconol. As I
nove Jone my wnole li[e, I Jon`r rell people rnor I smo|e por, incluJinq AA
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people. I nove rolJ o couple o[ people I rrusr in AA ro qer ir o[[ my cnesr onJ
see wnor rney woulJ nove ro soy obour ir. Tney were supporrive ro voryinq
Jeqrees bur suqqesreJ I |eep ir ro mysel[.
As you poinreJ our I come ro AA becouse I om powerless over olconol onJ
ir obsolurely moJe my li[e unmonoqeoble. Ir nos ro|en 2 yeors owoy [rom
everyJoy Jrin|inq, neovy Jrin|inq, ro reolize oll rne nuonces o[ unmonoqe-
obiliry. I Jo nor believe my li[e is unmonoqeoble becouse o[ por, co[[eine,
nicorine, jer|inq o[[ or onyrninq else. Tne booze wos |illinq me onJ ruin-
inq every relorionsnip I nove/noJ. Por mo|es me less onxious onJ wonr ro
worcn TV. I li|e por. I li|e rne woy ir mo|es me [eel. Moybe I`m in Jeniol
bur I nove rnouqnr o lor obour ir onJ orner rnon ir beinq illeqol I Jon`r see
onyrninq norm[ul [or me.
I con unJersronJ now rroJinq por [or olconol is obsolurely nor rne woy ro
srop Jrin|inq bur I`ve olwoys smo|eJ onJ olwoys Jron|. I |new I noJ ro
srop Jrin|inq or else. I`m nor so convinceJ obour por.
As I rolJ my AA [rienJ on Nov.2, 2009 I woulJ nove qone ro o meerinq [or
por smo|ers wirn o Jesire ro srop Jrin|inq i[ rnere wos one. So, I wonr ro
AA insreoJ.
I[ you ever ore oble ro orronqe o meerinq onJ con mo|e ir ovoiloble online,
I woulJ li|e ro orrenJ.
ReqorJs
Dr. Frankel replies:
I totally understand and agree. People all around the world use all sorts
of medicines, herbs, drinks, sex acts, etc to help them feel better. It is
universal. It is not a matter of right and wrong but that is the labeling
that is generally applied. Harm reduction therapy, i.e. using cannabis
to replace alcohol just makes sense. There is plenty of data to support it
and personally I cannot be the judge of what is ºright and wrong". I am
a physician and am better at deciding what is safer or more effective.
When one applies this logic, there is no question that cannabis is safer.
You don't need any studies to prove this, although there are plenty. The
fact for you and for many others is that your life is now in control and
you are doing well; before, with alcohol, your life was unmanageable as
you state and now it is manageable. Pretty simple. Not broken, don't
fix it.
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"LEGAL" Cannabis-Based Medicines
Monday, November l4, 20ll
Please see my recent blog
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regarding the US patent in 2003
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by the Fed-
eral government for CBD. In addition, the patent boldly also states the many
benefits of CBD and other cannabinoids.
The application was applied for April 21, 1999 and was finalizing in 2003.
The findings were published in Drugs R D. 2003,4(3):306-309 which is al-
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http.77WWW.g¡eehb¡1dgened.con7feds-say-cbd-1s-Wohde¡-d¡ug-
they-patehted-1t7
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http.77patft.uspto.gov7hetacg17hph-Pa¡se¡?5ect1=PTu185ect2=
hTTuFF8d=PALL8p=18u=Z2FhetahtnJZ2FPTuZ2Fs¡chhun.htn8¡=18f
=u8J=5u8s1=ôô3u5u7.PN.8u5=PN7ôô3u5u78R5=PN7ôô3u5u7
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most 10 years ago and I have wondered why this happened at that time.
Well, this article
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, explains very clearly that GW was looking for and ob-
tained support and I presume a lot of cash from Bayer Pharmaceuticals.
Bayer was involved with GW before 2003 and the patent by the Feds in
2003 is no coincidence. Please read here, the abstract of GW Pharmaceuti-
cals actions
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.
Here is the text of the abstract from the study:
Connobis-BoseJ MeJicines GW Pnormoceuricols: Hiqn CBD,
Hiqn THC, MeJicinol Connobis GW Pnormoceuricols, THC: CBD
Drugs R D. 2003,4(3):306-309
ABSTRACT
GW Pharmaceuticals is undertakinq a major research proqramme in the
UK to develop and market distinct cannabis-based prescription medicines
[THC: CBD, Hiqh THC, Hiqh CBDj in a ranqe oj medical conditions.
The cannabis jor this proqramme is qrown in a secret location in the UK.
It is expected that the product will be marketed in the US in late 2003.
GW`s connobis-boseJ proJucrs incluJe selecreJ pnyroconnobinoiJs [rom
connobis plonrs, incluJinq D9 rerronyJroconnobinol (THC) onJ connobiJ-
iol (CBD). Tne compony is invesriqorinq rneir use in rnree Jelivery sys-
rems, incluJinq sublinquol sproy, sublinquol robler onJ innoleJ (bur nor
smo|eJ) Josoqe [orms. Tne recnnoloqy is prorecreJ by porenr opplico-
rions. Four Ji[[erenr [ormulorions ore currenrly beinq invesriqoreJ, incluJ-
inq Hiqn THC, THC: CBD (norrow rorio), THC: CBD (brooJ rorio) onJ
Hiqn CBD. GW is olso Jevelopinq o speciolisr securiry recnnoloqy rnor will
be incorpororeJ in oll irs Jruq Jelivery sysrems. Tnis recnnoloqy ollows [or
rne recorJinq onJ remore monirorinq o[ porienr usoqe ro prevenr ony poren-
riol obuse o[ irs connobis-boseJ meJicines. GW plons ro enrer inro oqree-
menrs wirn orner componies [ollowinq pnose III Jevelopmenr, ro secure rne
besr commerciolisorion rerms [or irs connobis-boseJ meJicines. In June
200S, GW onnounceJ rnor exclusive commerciolisorion riqnrs [or rne Jruq
in rne UK noJ been licenseJ ro Boyer AG. Tne Jruq will be mor|ereJ unJer
rne Sorivex((R)) bronJ nome. Tnis oqreemenr olso proviJes Boyer wirn on
oprion ro exponJ rneir license ro incluJe rne Luropeon Union onJ cerroin
484
http.77WWW.cahhab1s.het7ned1c1he7
483
http.77WWW.cahhab1s.het7ned1c1he7
247
worlJ mor|ers. GWwos qronreJ o clinicol rriol exemprion cerri[icore by rne
MeJicines Conrrol Aqency ro conJucr clinicol sruJies wirn connobis-boseJ
meJicines in rne UK. Tne exemprion incluJes invesriqorions in rne relie[
o[ poin o[ neuroloqicol oriqin onJ Je[ecrs o[ neuroloqicol [uncrion in rne
[ollowinq inJicorions: mulriple sclerosis (MS), spinol corJ injury, peripn-
erol nerve injury, cenrrol nervous sysrem Jomoqe, neuroinvosive concer,
Jysronios, cerebrol vosculor occiJenr onJ spino bi[iJo, os well os [or rne
relie[ o[ poin onJ in[lommorion in rneumoroiJ orrnriris onJ olso poin re-
lie[ in brocniol plexus injury. Tne UK Governmenr sroreJ rnor ir woulJ be
willinq ro omenJ rne Misuse o[ Druqs Acr 1971 ro permir rne inrroJucrion
o[ o connobis-boseJ meJicine. GW sroreJ in irs 2002 Annuol Reporr rnor
ir wos currenrly conJucrinq [ive pnose III rriols o[ irs connobis Jerivorives,
incluJinq o Jouble-blinJ, plocebo-conrrolleJ rriol wirn o sublinquol sproy
conroininq Hiqn THC in more rnon 100 porienrs wirn concer poin in rne
UK. Also incluJeJ is o pnose III rriol o[ THC: CBD (norrow rorio) beinq
conJucreJ in porienrs wirn severe poin Jue ro brocniol plexus injury, os ore
rwo more pnose III rriols o[ THC: CBD (norrow rorio) rorqerinq sposric-
iry onJ bloJJer Jys[uncrion in mulriple sclerosis porienrs. Anorner pnose
III rriol o[ THC: CBD (norrow rorio) in porienrs wirn spinol corJ injury is
olso beinq conJucreJ. Resulrs [rom rne rriols ore expecreJ Jurinq 200S.
Tnree oJJirionol rriols ore olso in rne eorly sroqes o[ plonninq. Tnese rri-
ols incluJe o pnose I rriol o[ THC: CBD (brooJ rorio) in porienrs wirn in-
[lommorory bowel Jiseose, o pnose I rriol o[ Hiqn CBD in porienrs wirn
psycnoric JisorJers sucn os scnizopnrenio, onJ o preclinicol rriol o[ Hiqn
CBD in vorious CNS JisorJers (incluJinq epilepsy, srro|e onJ neoJ injury).
GW Pnormoceuricols submirreJ on opplicorion [or opprovol o[ connobis-
boseJ meJicines ro UK requlorory ournoriries in Morcn 200S. Oriqinolly
GW nopeJ ro mor|er connobis-boseJ prescriprion meJicines by 2004, bur
is now plonninq [or o louncn in rne UK roworJs rne enJ o[ 200S. Severol
rriols [or GW`s connobis Jerivorives nove olso been complereJ, incluJinq
[our ronJomiseJ, Jouble-blinJ, plocebo-conrrolleJ pnose III clinicol rriols
conJucreJ in rne UK. Tne rriols were inirioreJ by GW in April 2002, ro
invesriqore rne use o[ o sublinquol sproy conroininq THC: CBD (norrow
rorio) in rne [ollowinq meJicol conJirions: poin in spinol corJ injury, poin
onJ sleep in MS onJ spinol corJ injury, neurop spinol corJ injury, neuro-
pornic poin in MS onJ qenerol neuropornic poin (presenreJ os olloJynio).
Resulrs [rom rnese rriols snow rnor THC: CBD (norrow rorio) couseJ sro-
risricolly siqni[iconr reJucrions in neuropornic poin in porienrs wirn MS onJ
248
orner conJirions. In oJJirion, improvemenrs in orner MS symproms were
observeJ os well. Pnose II sruJies o[ THC: CBD (norrow rorio) nove olso
been complereJ in porienrs wirn MS, spinol corJ injury, neuropornic poin
onJ o smoll number o[ porienrs wirn peripnerol neuroporny seconJory ro
Jioberes mellirus or AIDS. A pnose II rriol o[ THC: CBD (brooJ rorio) nos
olso been complereJ in o smoll number o[ porienrs wirn rneumoroiJ orrnri-
ris, os nos o rriol o[ Hiqn CBD in porienrs wirn neuroqenic symproms. A
pnose II rriol nos olso been evoluoreJ wirn Hiqn THC in smoll numbers o[
porienrs [or rne rreormenr o[ perioperorive poin. Tne pnose II rriols proviJeJ
posirive resulrs onJ con[irmeJ on excellenr so[ery pro[ile [or connobis-boseJ
meJicines. GW Pnormoceuricols receiveJ on IND opprovol ro commence
pnose II clinicol rriols in ConoJo in porienrs wirn cnronic poin, mulriple
sclerosis onJ spinol corJ injury in 2002. Followinq meerinqs wirn rne US
FDA, Druq Ln[orcemenr Aqency (DLA), rne O[[ice [or Norionol Druq Con-
rrol Policy, onJ Norionol Insrirure [or Druq Abuse, GW wos qronreJ on im-
porr license [rom rne DLA onJ nos imporreJ irs [irsr connobis exrrocrs inro
rne US. Preclinicol reseorcn wirn rnese exrrocrs in rne US is onqoinq.
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486
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487
486
487
249
Index
A
administer, 223
allan frankel, 3, 8, 9, 1219, 21
24, 26, 32, 34, 64, 160,
227, 246
allan i frankel, 7, 19, 2124, 26
allan i frankel MD, 3, 19, 2124,
26, 43
C
CA, 3, 3, 7, 19, 2124, 26, 34, 43,
160
cancer, 223
cancer and cannabis, 9, 1219,
2123
Cannabidiol, 223, 223227, 246
cannabidiol rich, 222
cannabis, 3, 8, 9, 1219, 2124,
26, 34, 43, 227
cannabis and anxiety, 9, 1219,
2123
cannabis and depression, 9, 12
19, 2123
Cannabis Tinctures, 160, 222,
227
cannabis treating pain, 9, 1219,
2123
CBD, 160, 223, 223227, 246
cbd rich, 222, 246
CBD Tinctures, 246
D
drug interactions, 226
E
evaluation, 9, 1219, 2123
F
federal and state laws, 33
Federal cannabis laws, 33
G
gay marriage, 43
Greenbridge, 9, 1219, 2123
GreenBridge Medical, 160
greenbridge medical, 9, 1219,
2123
greenbridge medical santa mon-
ica, 3, 3, 7, 19, 2124,
26, 34, 43, 160
I
insomnia, 221
3
joint pains, 227
K
Kindness in Medicine, 103
L
Legal Marijuana, 9, 1219, 21
23
230
M
Marijuana Edibles, 26
marijuana recommendation, 9,
1219, 2123
marijuana tincture, 223
marijuana tinctures, 227
md, 7, 9, 1219, 2124, 26
Medical Cannabis, 2124, 26,
43, 160, 221, 223, 227,
246
Medical Cannabis Evaluations,
160
medical cannabis tinctures, 223
medical marijuana, 3, 79,
1219, 2124, 2630,
3234, 3733, 3863,
67, 69, 7183, 83
87, 8996, 98102,
104107, 109, 110,
112, 113, 113117,
119133, 137, 140,
146131, 133136,
138168, 170, 174,
176179, 181183,
183, 186, 193, 193,
198, 199, 202, 203,
203, 207, 209217,
219227, 229231,
233, 234, 236, 239,
240, 243, 244, 246
Medical Marijuana Card, 26, 27
Medical Marijuana Doctor, 9,
1219, 2123
medical marijuana education, 9,
1219, 2123
medical marijuana evaluations,
9, 1219, 2124, 26,
43, 160
medical marijuana laws, 32
medical marijuana legal, 32
Medical Marijuana Physician, 9,
1219, 2123, 26
S
strains of cannabis, 24
sublingual, 223
T
tamoxifen joint pains, 227
THC, 160
The Kind Doctor, 104, 103
U
Uncategorized, 1, 4, 9, 1219,
21, 23
under the tongue, 223
V
various strains of marijuana
helping different
conditions, 24
231

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