It’s January and you want to garden. Well, it’s time to start thinking about this year’s Cannabis Garden.  Yes, I mean growing your own Cannabis plants.  Even if you don’t plan to grow your own Cannabis, if you benefit from a plant, you should know a little something about how it is made.  The act of tending to live things is nourishing, productive, and addictive as you realize the sum benefits of gardening are greater than its parts.  Once you get started, you may want to add tomatoes, herbs, and maybe other medicinal plants to your garden.  Let’s get going!
 
The Benevolent Female
You must grow a female plant to produce the Cannabis flower.  Flowers in the Cannabis world contain the highest content of active ingredients.  Botany 101: Male plants create pollen that encounters flowers to produce seeds.  If you wish to produce seeds, this is an easy task.  However, most consumers are interested in the resinous oil found in the waxy crystal like trichomes of the Cannabis flowers.  Cannabis flowers that grow without pollination are called Sinsemilla
 
Seeds or Plant Cuttings?
Your choice.  Seeds generally produce stronger, more disease resistant plants.  However, it’s difficult to predict whether a seed will become a female or male plant. Feminized cannabis seeds are created through a process of genetic manipulation. Essentially, the idea is to induce female plants to make pollen. Normally, only male plants produce pollen, but if you can somehow make a female plant produce pollen, then what you have is pollen containing only female chromosomes. On the other hand, cloning Cannabis or the Cannabis clone is a branch from a Cannabis plant that is cut in a such a way that it will grow into a plant itself.  A cutting from a female Cannabis plant will most likely be female.
 
Indoor or Outdoor?
Another choice to make.  Your living situation dictates this journey.  It’s difficult to plant an outdoor garden in an urban environment.  The impediment is most likely your neighbor.  A greenhouse or closet grow allows you to establish secure barriers to your neighbors’ prying. But indoor growing produces other problems.  Plants prefer fresh air and sunshine and tend to get sick indoor.  You must be careful to keep the indoor space clean.  Either that or learn to make a biosphere.  Indoor lighting is costly and critical.  The sun produces a broad spectrum of wavelengths and sun grown plants produce a broad spectrum of active plant constituents.  However, if you can’t grow outdoor, do what you must.
 
Soil
If you just started thinking about soil, then it’s too late to make your own.  It’s January.  You’ll have to buy it.  Hydroponic is a self-contained option that does not require soil.   Make sure there are no leaks in your system.  Soil is best when it’s full of life.  Some might say that growing plants is really growing soil.  If you are buying your soil, you will need to consider Nitrogen, Potassium, and Phosphorus supplementation.  There are many who have opinions on the bests soil for growing Cannabis.  Do your homework, but don’t get too caught up in it.  Composting is best in my opinion. 
 
Water
Water is for plants like air is for humans.  Rainwater and spring water are great at helping plants grow.  Tap water and distilled water may not hurt plants, but you will notice that they don’t grow as tall and sturdy as the plants that were given rainwater and spring water.  Too much sugar or salt in water can kill plants.  Chemicals like iodine or chlorine (often found in tap water) can stunt growth.  A common mistake first-time growers make is to overwater plants. A cycle of wet and dry is healthy and necessary for the roots of a plant to grow out and reach deeper into the soil.  Roots pull in oxygen as soil dries and when soil is too wet, the plant can't pull in oxygen efficiently and essentially can't breathe.
 
 

During the holidays, we are often inundated with scenes, signs, and messages of alcohol drinking.  What is it about this time of year that permits, or insists on drinking?  Instead of the usual message, I thought it might be a good idea to discuss alcohol and Cannabis
 
According to data published in the journal, Health Policy, medical Cannabis in Canada was associated with a reduction in alcohol sales over an 8-year period.  The results have important public health implications. 
 
From a public health perspective, the potential reduction in alcohol related harm might partly offset any increases in cannabis-related harm that Cannabis brings.
 
The study found significant negative association between legal Medical Cannabis sales and liquor store alcohol sales, which means when Medical Cannabis sales increase alcohol sales go down.  Each Cannabis sales dollar was associated with an average alcohol sales reduction of between $0.74 and $0.84. 
 
The study is like a 2017 US study where alcohol sales fell by 15% in several states following the introduction of medical Cannabis laws.  The states experienced a significant decrease in the aggregate sale of alcohol, beer, and wine.  The study authors concluded, “We feel that Cannabis and alcohol are strong substitutes.”  Moreover, the effects of Medical Cannabis law are not short lived with significant reductions in sales for up to 24 months after passage.
 
In another study published in 2021, data from the Youth Risk Behavioral Survey suggested that adolescents had a lower risk of initiating alcohol use in states with Medical Cannabis laws.  Although, some demographics used more alcohol, tending to combine it with Cannabis.
 
We know that Cannabis has a better safety profile than alcohol.  For those who enjoy alcohol, it’s not the enemy.  History indicates that prohibition is not the best way to reduce harm.  I propose autonomy, acceptance, and education.  As my mother likes to say, “Everything in moderation.” 
 
Alcohol when used in appropriate doses can be safe and beneficial.  As well, some alcohol might pair nicely with Cannabis for an improved experience.  So, as you plan your holiday parties, remember Cannabis and Alcohol dosage matters.  You can keep track of your dosage with the CESC’s Dosing Project  Be safe and don’t drive intoxicated.
 

​Does Cannabis actually relieve pain – or is something else going on?
 
Treating pain is by far the most common reason many millions of Americans use Cannabis.  Often, the Cannabis is used instead of opiates or other prescription medicine.  The therapeutic benefit is implicit.   Most patients seeking medical Cannabis have pain.  This is real world evidence. 
 
Is it belief or faith in Cannabis?  The placebo effect is the suggestion or belief in a substance resulting in therapeutic benefit.  Research suggests Cannabis and placebos provide similar pain relief, but that may not be the whole story.  Many drugs have similar effects to placebo.  These drugs are sold in the marketplace because they improve lives.  In the end, does it matter how they work if they are safe and effective?
 
Traditional studies are meant to be models of the real world.  They are controlled studies, and, therefore, not ideal for studying variable, multi-agent botanicals.  A recent study published in the Journal of the American Medical Association proposes that Cannabis is no better at relieving pain than placebos.  The authors suggest that “positive expectations may contribute to the improvements” of pain.  The conclusion was based on a literature review with selection bias in searching only published studies where single agent drugs are used. And in the real world, It’s clear that the plant’s broad spectrum of active ingredients is more desirable for pain. Cannabis products used by community consumers are not single agents.
 
Harvard neuroscientists believe that the placebo effect is triggered through specific nerve pathways involving neurotransmitters, including endocannabinoids.  According to Dr. Ted Kaptchuk, director of the Program in Placebo Studies, the effects of a placebo rival or mimic the physiological effects of certain active medications.  An additional consideration is that some people are predisposed to having a placebo effect.  That may explain why some Cannabis users respond to lower doses of Cannabis and others require higher doses. 
 
The FDA requires the “gold standard” trial to regulate the pharmaceutical industry. The studies are developed to identify safe and effective pharmaceutical drugs. Health care professionals are accustomed to assessing the effectiveness of a single agent pharmaceutical with the gold standard in research, a double blind, randomized, controlled trial.  In that regard, they are not accustomed to assessing the benefits of botanicals
 
Real world evidence is the best scientific path to understanding Cannabis.  Cannabis is a plant that has been used for thousands of years.  Its components are influenced by cultivator, season, and location.  Despite the variability, real world evidence demonstrates a safety profile that rivals or beats pharmaceuticals.   Many pharmaceuticals approved by traditional studies have side effects and adverse events despite blinded controlled trials. 

For too long, societies worldwide have prohibited Cannabis, a historically useful and valuable commodity.  The predominant concern has been Cannabis delta-9-tetrahydrocannabinol (THC) content and its psychoactive effects.  How does THC affect mental states? Is it beneficial?  What are its liability concerns?   CESC’s Cannabis Mind Initiative focuses on the psychoactive or intoxicating effects of Type I (THC dominant) Cannabis and its subtypes of varying potencies.
 
Cannabis typically contains one of two dominant phytocannabinoids, THCA or cannabidiolic acid (CBDA), and several combinations of other active ingredients.   Consumers might inhale, apply, or ingest a product without apparent psychoactivity. However, it is the use of THC (derived from its THCA precursor) in products that most often leads to intoxicating states. THC’s psychoactive effects are mostly attributed to its activity on CNR1 (CB1), a prevalent G-coupled protein receptor in the brain.  THC consumption may cause adverse effects; however, it also leads to meaningful subjective experiences.  Despite a diverse and rich potential for Cannabis in the marketplace, THC is the elephant in the room.  CESC’s study of THC dominant Cannabis addresses its psychoactive and intoxicating effects
 
In the past decade, we have seen unprecedented shifts in the availability of Cannabis.  Increased access to Cannabis has been associated with an increase in high potency THC products.  From 1995 to 2014, THC potency tripled (4%-12%) in confiscated Cannabis flowers.  Today, markets sell Cannabis flowers with 20% or more THC content.  Extracted and concentrated oil products have potencies of 50-80% THC. Jurisdictions that have tried to prohibit D-9 THC see legal hemp products converted to other isomers of THC as companies work around regulations to offer a product with more psychoactivity.
 
Americans have a love-hate relationship with Cannabis. Harry J Anslinger, head of the US Treasury Department's Narcotics Bureau, wrote his opinion in a 1937 article titled Marijuana, Assassin of Youth.  “How many murders, suicides, robberies, criminal assaults, holdups, burglaries and deeds of maniacal insanity it causes each year can only be conjectured.”  The ludicrous notion that a plant could initiate such behavior had been popularized in a movie called Reefer Madness. Relative to the history of worldwide use, Anslinger’s perspective didn’t last long.  By the 1960s, Anslinger had already conceded that the criminal penalties in force for Cannabis use were too severe. In 1967, mainstream voices of Life, Newsweek, and Look magazines questioned why the plant was illegal at all.  By 1996, California had legalized Cannabis use for medicinal purposes through a proposition titled The Compassionate Use Act.
 
Contrasting perceptions and opposing effects are a hallmark of Type I Cannabis. The relaxing and euphoric effects are contradicted by concerns of anxiety and psychosis.  It’s well understood that acute psychosis from THC can be debilitating, especially when unexpected.  Dr. Nora Volkow, Director of the National Institute of Drug Abuse, notes that high potency Cannabis products are associated with acute psychosis.  However, intentional Cannabis experiences with appropriate doses of THC can also be used as therapy. The hypothesis is that THC may help expand the walls of perception and engender psychological flexibility, which leads to improved mental health conditions.
 
In a Natural Language Processing analysis of open-sourced reviews by respondents that used Type I Cannabis flowers, CESC identified commonly used words.  These descriptors group into three categories; states of altered consciousness (high, stoned, buzzed), a relaxed-energetic dichotomy, and a broad range of psychosomatic states.  We anticipate that this categorization scheme will facilitate correlation with underlying pharmacologic mechanisms.
 
With access to a Northern California community of 2,000 active users, CESC investigates the risk factors and therapeutic benefits of Type I Cannabis use.  Data is gathered on the acute and chronic effects of Cannabis use.  Longitudinal observations track health and wellness endpoints of Cannabis users.  Quantitative EEG analysis provides an objective biomarker in comparisons of subjective mood and consciousness scales.  Our community serves as a model in our investigations of the “Cannabis Mind.”

See more in the Cannabinoid Monthly Playbook by 8th Revolution

Psychoactives, a peer-reviewed scientific publication, recently published a study proposing that a pleasant Cannabis aroma (not THC content) predicts pleasant effects from smoking or vaporizing Cannabis.  The story struck me for several reasons; 1) There are very few Cannabis studies that report positive outcomes after smoking, 2) This study is an indication that Cannabis science is maturing beyond the novelty of THC to finer qualities of Cannabis. 
 
As a Cannabis Scientist, I spend a lot of time following the advances in Cannabis science.  From my perspective, Cannabis research is split into two camps.  The first camp focuses on single agents like THC, CBD, or synthetic cannabinoids and is more aligned with traditional research paradigms.  The second camp studies the whole plant with its broad spectrum of active ingredients.  Although more complex, this camp reflects the real-world usage of Cannabis. Most published studies are of the first camp.
 
Cannabis aromas range from sweet floral to pungent fuel. In the study, 278 healthy Cannabis users selected or were given 8-10 one-gram samples of Cannabis flowers with varying aromas to take home. They were asked to smoke each sample on separate occasions and rate their experience.  One caveat, they had to abstain from using Cannabis for 48 hours before judging each sample, which was difficult for the daily users. 
 
Here are the highlights…
 

• On an appeal scale, older people reported a more pleasant experience than younger people.  Participants aged 40 or older reported more subjective appeal after smoking than those 40 or younger.  And the 60 + demographic reported the most pleasant experience.

 

• There was negative correlation with the frequency of consumption.  In other words, those who smoked less than once per week reported a more pleasant experience than those who smoked multiple times per day.  That probably has something to do with tolerance.

 

• Participants who consumed small doses reported a more pleasant experience.  THC potency, in general, did not correlate with subjective appeal. Neither did terpene content. However, males did report more pleasant experience with higher THC potency when the results were stratified by biological gender.

 

• The strongest correlation with a pleasant experience was the Cannabis flower aroma.  The more pleasant the aroma, the more pleasant the experience.

 
Traditional academic researchers (the first camp) raise concerns about high content THC products and their propensity to be associated with Cannabis Use Disorder, Cannabinoid Hyperemesis Syndrome, and Psychosis.  In response, offering Type II (THC & CBD equivalent) and Type III (CBD dominant) Cannabis flowers institutes product differentiation and attracts the more mature consumer.
 
So, there you have it. It’s not all about THC.  In fact, Cannabis companies have already responded by adding Cannabis with less THC and more CBD, CBG, or THCv to their inventory.  Garden Society and Pure Beauty, brands that provide lower THC alternatives, offer pre-rolls with 10% THC or less.  Science indicates that Cannabis aroma is likely an important quality attribute of the plant.  In response, marketing “floral”, “pungent”, “sweet”,  and “earthy” aromas may soon replace the unsupported designations that frequent the Cannabis marketplace
 

Skilled nursing facilities, assisted living facilities, or nursing homes are institutions where much of us will spend the last decade of our lives.  There are about 1.3 million residents in U.S. nursing homes. There are over 26,000 nursing homes in the U.S. 70% of people who reach the age of 65 will need long-term care at some point in life. By 2050, up to 30 million people in the Americas will require long-term care services. Whether bed bound or just needing help with activities of daily living, the extra help that these facilities provide is crucial.  As we reach this stage in our lives, the question is; “How do I get access to Cannabis at a nursing home?”
 
Shelby Grebbin writes in Skilled Nursing News about a skilled nursing facility in New York called Hebrew Home at Riverdale’s.  In 2014, when New York passed their Compassionate Care Act, Dr. Zachary Palace, the Medical Director of Hebrew Home, was faced with a perplexing question: By permitting residents to exercise their full rights as citizens of the state to access Cannabis, could he put the senior care center at risk for non-compliance?
 
In the 21st century, Cannabis use continues to be decriminalized and de-stigmatized, and baby boomers are the major reason why.  Remember, publicly displayed pro-Cannabis sentiments started back in the 70s.  A couple of decades of “Say No to Drugs” was followed by a movement that permitted legal access Cannabis worldwide.  
 
As a compassionate geriatrician, Dr. Palace recognizes the potential benefits of Cannabis for his patients.  His clients need help with chronic pain, insomnia, poor appetite, and neurological conditions like Parkinson’s, Alzheimer’s, and seizures.   Dr. Palace is also aware that Cannabis is a Schedule I drug and any skilled nursing facility receiving federal aid is in jeopardy of losing their Medicare and Medicaid reimbursements.  In response, Dr. Palace and Hebrew Home CEO Daniel Reingold set out to create a Medical Cannabis program for their residents that legally works with the rules.
 
Most states allows residents to access Cannabis via recommendation from a physician.  “They’re able to maintain it in their own space in their room,” says Dr. Palace. “They get a lock box that only they have the key to. It’s truly their property. And it’s not in the facility’s possession, but it’s in their own personal possession.  Another participation condition requires residents to self-administer the Cannabis — unless they have a companion or family member who can administer it for them.”

​The Ohio Medical Marijuana Control Program published an annual report with results of physicians who recommend Medical Cannabis.  648, that’s the number of Ohio physicians actively certified for the program.  The program permits 25 medical conditions that qualify for Cannabis treatment in Ohio.  One of the key questions of from the report asks physicians, “How satisfied are you with the effectiveness of medical marijuana in treating your patients with the qualifying conditions”.  The Physicians were asked to rate each condition with “Satisfied”, “Neutral”, “Dissatisfied”, “Other”, and “Not Applicable”
 
An article by Laura Hancock in Cleveland.com puzzles me.  Although the results of this report are overwhelmingly positive, for some reason the story downplays it.  It identifies that 59.4% of physicians were satisfied with the effect of Cannabis on chronic or intractable pain, 53.5% were satisfied with its effectiveness for cancer patients, 50.8% were satisfied for fibromyalgia and 50.3% for post-traumatic stress disorder patients.  The results were much better. Only 65% of the doctors responded to the survey.  If the percentage of respondents are calculated, 91% of physicians who saw patients with pain were satisfied with the results, 82% for cancer, and 77% for both fibromyalgia and PTSD.  Out of the doctors seeing patients with Sickle Cell, 82% were satisfied with Cannabis.  Prior studies indicate only 65 % of patients are satisfied with traditional treatment for Sickle Cell and 75% seeking alternative treatments.  For every condition in this report, physicians were more satisfied than dissatisfied with Cannabis as treatment. Even for less responsive conditions, like Huntington’s Disease.
 
Dr. Ryan Marino, Case Western University toxicologists and addiction medicine specialist notes, “There is little evidence in the US about the effectiveness of marijuana”. When asked about the report, he backtracks and qualifies his answer by saying, “I think those conditions are anecdotally what people report success with,” and adds, “the low dissatisfaction rates are likely due to marijuana’s relative low risk.
 
Dr. Solomon Zaraa, president of Compassionate Cleveland, a medical Cannabis practice sees the survey results as like his own experience.  He sees many chronic pain patients who prefer not to depend on opiates.  He also sees PTSD patients who are less reluctant to enter therapy after they use Cannabis. 
 
Rather than downplaying, the results of this report, we should shout it from the mountain tops.  It’s promising that doctors of patients who use Cannabis are satisfied with the results. However, the stigma of Cannabis continues to be an adversary to real-world evidence.  As a response, we must keep publishing survey results such as this.   And as a follow up, we should probably find out what the patients themselves think of using Cannabis. 
 
 

I evaluated a couple of patients this week treating cancer with Cannabis and looked at recent news to see what progress is being made in Cannabis cancer research.
 
Early-stage research suggests that Cannabis-derived medicines could be effective in treating various cancers.
 
Although those of us in the Cannabis industry may already be aware of this, the medical community is just coming around to accepting the idea. 
 
Recent experimental treatments and small-scale clinical trials in Europe are showing the efficacy of medicinal Cannabis formulations.
 
THC has primarily been used in cancer treatment for palliative care, to relieve nausea, and stimulate appetite.  However, early-stage research is suggesting that Cannabis, which is more than THC, is also a highly effective treatment for killing cancer cells.
 
So, how does it work?
 
Pre-clinical studies have shown that cannabinoids reduce cancer cell growth and disrupt the blood supply to cancerous cells, including brain tumors, breast cancers and prostate cancer, among others.
 
With, potentially, hundreds of naturally occurring constituents, there is no one magic medical Cannabis bullet in cancer treatment. Cutting edge work using artificial intelligence (AI) is being carried out to analyze Cannabis plant genetics and to determine the best combination of cannabinoids, terpenes, flavonoids, and other constituents to target and optimize the treatment of various cancers.  It’s a many-to-many puzzle; many active ingredients to treat many types of cancers.
 
In pre-clinical studies, Cannabis cancer treatments can be tested through either 2D or 3D cell culture testing. 3D cell cultures allow researchers to recreate specific pathological environments The improvement in 3D cell culture technology has led to the generation of models that encompass more physiological and tissue-specific micro-environments, 
 
Despite advancements in pre-clinical testing, the key to gaining full acceptance in the medical community is real human data from clinical trials.  Currently, there is a small-scale clinical trial on glioblastoma (a brain cancer) in the UK and another trial on liver cancer in the Netherlands.
 
Scientists are also assessing the role of ‘personalized medicines.  Personalized medicine recognizes that we are all physiologically unique and uses individualized DNA sequencing to target treatment.  Personalized medicine is already used in the traditional treatment of cancer. 
 
Combined,. the analysis of AI, 3D Cell Cultures and personalized medicine present a huge opportunity for medical Cannabis and the treatment of cancer. 

The lifetime prevalence of post-traumatic stress disorder (PTSD) ranges from 6.1 to 9.2 percent of the general population.  Does past trauma cause trouble sleeping?  Yes.
 
A new Israeli study published in the Journal of Anxiety Disorders assesses the association between PTSD, Medical Cannabis use, and sleep.  After a traumatic experience, 80-90% of people suffer from sleep disturbances. Nightmares and frequent or early awakening are common. People with sleep disturbances caused by PTSD are likely to worsen their PTSD, potentially experiencing suicidal ideations, inflicting self-injury, and becoming disabled.
 
Some pharmaceutical medications are effective for improving sleep in people with PTSD.  However, research on Cannabis use and PTSD is limited. There’s some evidence that THC reduces the occurrence of nightmares and improves sleep quality in patients with PTSD.  As well, some animal studies indicate that CBD improves sleep.  Typically, studies evaluate low dose, single molecule extracts or synthetic cannabinoids.  However, Cannabis is more than THC or CBD.
 
A recent study by Dr. Sue Sisley examined the effects of smoked Cannabis flowers and PTSD.  The study was randomized, double-blinded, and placebo-controlled. However, it didn’t demonstrate any improvement in sleep.  How could this be?  The accounts of thousands of patients Cannabis can’t be wrong.  Dr. Sisley’s study involved participants who are long term Cannabis users.  During the study, they reported Cannabis withdrawal symptoms, indicating that the controlled dosage of the study was likely too low.
 
The Israeli study was conducted differently.  Rather than control the amount used, participants were asked to keep a diary of their daily Medical Cannabis use.  On average the Cannabis used by participants had higher THC levels (18%).  As for the conclusion, Medical Cannabis users demonstrated a shorter time to falling asleep, less nightmares, and less early awakening.  Furthermore, those who used Cannabis with a higher CBD content were less likely to wake up early.
 
Randomized, double-blind, placebo-controlled trials are generally considered the gold standard in single agent pharmaceutical drug discovery.  However, the study of herbal Cannabis needs a paradigm shift.  Real world Cannabis users have never relied on single agent cannabinoids in controlled fashion.  Their herbal Cannabis use ranges widely from a few puffs to consuming a full gram or two.  These contrasting studies highlight an important conclusion about Cannabis research.  Controlled trials are not the best way to initiate studies on Cannabis.  Non-interventional studies where participants are permitted to dose themselves have more external validity, meaning they reflect what is happening in the real world. 
 
Herbal Cannabis has helped patients with PTSD tremendously; particularly those with insomnia and nightmares.  Studies are best used to understand how herbal Cannabis works not if it works.  Real world evidence, like the Israeli study, demonstrates that Cannabis works.