Vape Pen Illness
CDC and State Health Departments caution those who use vaporized oil products
The promotion and sale of e-cigarettes as an alternative to smoking tobacco (and additives) in rolled paper along with the rising popularity of inhaled vaporized oils derived from the Cannabis plant is new to everyone, even those of us in the scientific community. The Increasing use of these new products is revealing new potential harms. We know that inhaling smoked oils from burning oil reservoirs is harmful and may even be the cause of Gulf War Syndrome. We know that inhaling smoke oils in poorly ventilated restaurant kitchens causes a decrease in forced expiratory volume (FEV) among employees. Data from The Dosing Project™ (www.thecesc.org) reveals a significant increase in self-reported cough among those vaporizing Cannabis flower in comparison to smoking Cannabis flower. Poly-ethylene glycol, vegetable glycerin, or tocopheryl acetate (Vitamin E), common fillers in e-cigarette and Vape pen cartridges, have been implicated as a potential throat and lung irritant.
The CDC along with State Health Departments are investigating an increase in serious lung disease not associated with other causes and associated with recent use of e-cigarettes and/or Cannabis oil Vape pens. At this point they have noted at least 215 cases over the last two months. The disease has similarities to lipoid pneumonia, which is distinguished by macrophages exhibiting large intracellular vacuoles in lung tissue. Exogenous lipoid pneumonia is generally considered a rare and benign condition. Patients report cough, fatigue, and shortness of breath. Chest X-rays are non-specific. Chest CT may demonstrate “ground glass” opacities representing thickened interlobular septa. Two of recently reported cases have resulted in death.
10.8 million U.S. adults are currently using e-cigarettes and more than half of them are 35 years old or younger. 2018 data reveals that the Vape pen market is approaching 20% of the inhaled cannabis products sold. This rise in incidence of serious adverse event was bound to occur with the recent shift in social behavior to inhaling vaporized oils. Whether the damage is do the method of administration, ingredients in the oil itself, or contaminants is uncertain. It is appropriate for the CDC and state health departments to caution those who vaporize oils to seek medical attention if the presenting symptoms occur. Patients with chronic lung conditions (Asthma, COPD, etc.) who use Vape pens may consider use alternative methods to using Cannabis until we have more specific information can be gathered and analyzed.
Dr. Jean Talleyrand, M.D.
Chief Medical Officer
MediCann & The CESC
Smell Your Medicine...!
By Dr. Jean Talleyrand
A pheromone is any chemical an animal produces which changes the behavior or physiology of another animal of the same species (animals include insects). Pheromones are not hormones. The difference is that pheromones act outside the pheromone-producing animal, while hormones act inside the hormone-producing animal. In fact, there is no defined chemical structure to a pheromone. Scientists are not even sure they exist!! Pheromones are supposed to cause behavior changes, like making another animal sexually aroused or warding off others from marked territory. Pheromones don’t necessarily have an odor, but they are often described as having an odor or causing its effect through scent. In review of clinical studies on pheromones, often it is the sweat or oil on the skin of a animal that is believed to contain the pheromone.
There exists a group of chemicals that are known for their scent or external effect. They are called terpenes or terpenoids. Terpenes are mostly produced by plants, and sometimes by insects. They have a strong odor and are believed to prevent infection or parasites, or attract beneficial insects to plants. One might consider them the “pheromone” of the plant and insect world. They are defined chemically in groups of five carbon units called the isoprene unit. Terpenes can have one or some multiple of these five carbon units and are often defined by the number of them; hemiterpene (1 isoprene unit), monoterpene (two isoprene units), sesquiterpene (3 isoprene units), triterpene (6 isoprene units). Steroids are terpenes made from the triterpene squalene. The larger (multiple unit) terpenes are found in animals and are an important part of human metabolism. Terpenes include the adrenal hormones, cholesterol, and Vitamins A, E and K.
Aromatherapy is a form of complementary or alternative treatment that uses essential oils, which mostly contain terpenes. Aromatherapists apply essential oils (terpenes) on the skin or through inhalation. (Sound familiar?) Essential oils have been used as medicine at least since ancient civilizations have documented their use and likely before. Dioscorides, physician, pharmacologist, botanist and surgeon to the Roman Army under Nero, described the use of oils from plant as medicine. His writing collected under the title De Materia Medica described six hundred plants and their medicinal uses. The use of oil persisted throughout multiple centuries. The oils were termed “essential” after going through a steam distillation. Aromatherapy was described in 1937 by French chemist, Rene-Maurice Gattefosse in his book Aromathérapie: Les Huiles Essentielles, Hormones Végétales. Outside of medicine, terpenes have uses from agricultural pesticides to perfume. Terpenes are the building block of many organic molecules.
When modern literature described terpenes as having a synergistic or “entourage” effect on the Endocannabinoid system it was no surprise. Apparently, terpenes play a significant role in the medicinal effect of cannabis. Most medical cannabis users and some non-users know that cannabis has an odor. The odor varies from “fuel” to “earthy” to “floral” or “fruity” depending on the strain. Some medical cannabis users associate the odor with symptom relief. The fruity and floral smelling flowers will uplift mood while the earthy or fuel smell reduce pain and make you sleepy. Terpenes are the source of that odor. It may be argued in the future that terpenes, the “pheromone” of the plant and insect world, add to the medicinal effect of cannabis. It might also be argued that aroma alone is the cause of the effect. What’s clear is the terpenes and their smell are at least as important as THC and CBD.
Among medical cannabis patients, it’s commonly agreed that their are two major effects from cannabis. One effect is more stimulating and euphoric and the second is more sedating and pain relieving. There are studies that have tried to correlate the chemical makeup of the plant with these two effects noted among cannabis users. Out of southern California, Dr. Pearce et al performed an internet survey and was able to verify the distinct effects. However, the conclusion that the effect came from botanically distinct plants was self evident in that the surveyors decided whether the plant was distinct without prior botanical training or knowledge. Another botanical study tried to identify plants as either C. Sativa (a narrow leafed plant) or C. Indica (a wider leafed plant) and ended up distinguishing six different plant types rather than two. So what causes this distinction between stimulating and euphoric (“sativa effect”) and sedating and pain relieving (“indica effect”)? Dr. John Abrams, founder of the Clinical Endocannabinoid System Consortium (CESC - www.thecesc.org) believes it’s the terpenes. The more floral or fruity odor might create the sativa like alertness and euphoria. The sour, fuel like odor of the plant is more likely to produce the indica-like relaxation and somnolence. “Time will tell. We will have to prove that with appropriate research.” states Dr. Abrams. Meanwhile, start smelling your medicine.
1McPartland, J. et al, PLOS ONE:Care and Feeding of the Endocannabinoid System: A Systematic Review of Potential Clinical Interventions that Upregulate the Endocannabinoid System, March 12 2014
2Pearce, D et al, Discriminating the Effects of Cannabis Sativa and Cannabis Indica: A Web Survey of Medical Cannabis Users, The Journal of Complementary and Alternative Medicine, Vol. 20, No. 10, 2014, pp. 787-789
3Hillig, K. et al, A Chemotaxonomic Analysis of Cannabinoid Variation in Cannabis, American Journal of Botany, 91(6), 2004, pp.966-975
Dosing with Edibles
By Christopher Lindquist & Jean Talleyrand
Edibles are food items made with cannabis or infused with cannabis oils or butter. They come in brownies, cookies, chews, gummies, candies, chocolates, butter, and beverages. Many cannabis patients choose to medicate with edibles. Some prefer ingesting cannabis rather than smoking; others prefer edibles because eating part of a cookie is more discreet than lighting up a joint or bowl. Some like the difference in effects.
Edibles are a great option to administer medicine, but it’s important to know that the body responds differently to each mode of administration. Consider these factors when taking edibles as opposed to smoking cannabis: 1) The effects of ingesting a cannabis infused edible takes longer to begin, 2) The effects can be stronger and more intense, and, 3) The effects can last longer.
The differences derive from how the body responds to cannabis when it is smoked as opposed to when it is ingested as an edible. When smoking, THCA (non-psychoactive cannabinoid present in fresh bud) is immediately converted to THC when it is lit. This process is called decarboxylation: (removing the (A) carboxylic acid from THC). The THC is then absorbed in the smoke by the exposed blood vessels of the lungs. The effects of a puff can happen within minutes, even seconds. Both smoking and taking edibles involve decarboxylation. Edibles often have a manufacturing process when heat is applied with edibles before they are baked. The effects of eating a cannabis infused edible take approximately 30-40 minutes to begin. This is because the medicine takes time to travel through the digestion process before entering the bloodstream.
The edible enters the stomach, is absorbed by the lining of the intestine, and then is shuttled to the liver where it’s metabolized. When metabolizing an ingested edible, the liver converts THC to 11-Hydroxy-THC (11-OH-THC), which has greater affinity for the cannabinoid receptors and produces stronger effects. This conversion by the liver of THC to 11-OH THC creates a stronger effect that can last 6-8 hours, as opposed to 2-3 when smoking.
When making an edible, cannabis flower is usually heated to about 220º F. This decarboxylates the THCA to THC. The decarboxylation produces the psychoactive “high”. The process of heating cannabis is not necessary. THCA reduces pain and doesn't create a “high”. As patients report the desire to not get “high” when using cannabis, more and more products are being created that skip the decarboxylation process. As well, CBD, an important molecule in the cannabis plant, is sometimes used instead of THC in order to reduce the high and still produce medicinal effects.
Baked goods are a popular conduit for cannabis because most of them use an oil or butter, and THC and CBD are soluble in fat. The molecules dissolve well in fat and are evenly distributed throughout the product. Some edibles are mostly sugar based. Unless careful attention is put into dissolving the THC and CBD, the molecules clump and produce unpredictable effects. One product or portion can be much stronger than another. This is often seen in candy, lollipops, and sodas.
We highly recommend patience when dosing with an edible. The longer wait can make a person anxious to feel the effects. And when testing the waters, we strongly recommend microdosing: the act of taking a small amount of medicine at first - gauge the effects - and next time, slightly increasing or decreasing the dosage amount to arrive at the best, most effective dose. Microdosing is also important with an edible because - once eaten, it’s difficult to “go back”. It is usually a good idea to wait 4-6 hours to re-dose. With smoking, you can microdose as you go. Some people prefer to smoke because it‘s inherently easier to gauge within minutes from puff to puff.
We suggest finding a quality edible that is as consistent as possible. Read reviews and ask questions of your dispensary. MediCann will soon be testing, reviewing, and providing information that helps point patients in the right direction for finding medicine that works best for them. Please be responsible and store cannabis infused edibles out of reach of children. Also, store in cool, dark places; heat and sunlight can compromise cannabinoids and terpenes.
The Emerald Conference, the largest collection of scientists and experts from the Cannabis Industry, is having its 3rd Annual Conference in San Diego this week, February 2nd and 3rd. You may have seen ads for Hemp Con, or various regional Cannabis Cups. This is NOT that. This is science. Science, yeah!! - REAL SCIENCE!
Participating in the 3rd Annual Emerald Conference is our very own Dr. John Abrams, Ph.D. Dr. Abrams is the founder and chairperson of the CESC (the Clinical Endocannabinoid System Consortium). The Consortium was set up to provide cannabis business with the science it needs to bring cannabis from plant to medicine. The CESC is unique in that it was set up as a nonprofit, for the public good. Recognizing that good medicine needs good science and that only the pharmaceutical industry has the resources to afford the research, founders of the CESC decided to establish the Consortium and collectively raise funds for research, the results of which would be publicly shared. “It's never been done before”, states co-founder and CMO of MediCann. “Not only are we developing medicine directly from a plant rather than as a synthetic, we are doing it as a collective effort.”
Dr. Abrams, raised in California, received his Bachelor’s degree with a major in Biochemistry from liberal UC Berkeley in the early 1970’s. He then travelled to Montreal, Canada and completed a PhD in Biochemistry at McGill University. He’s had a longstanding interest in linguistics; and since he was fluent in French, he wanted to experience firsthand life in a bilingual city. From 1980 onward, Dr. Abrams was part of the ground breaking application of therapeutic monoclonal antibodies to major diseases like Cancer and Autoimmunity. These are the class of blockbuster drugs now produced by the likes of Roche / Genentech, Pfizer, and Abbott. “I see the work of understanding cannabis as medicine as very similar to the work we were doing in the field of Immunology in the 1980’s”, remarks Dr. Abrams. The big difference is that with the CESC, Dr. Abrams is poised to give beneficial information to the small grower and processor.
Dr. Abrams and cannabis testing laboratories throughout California have been data collecting and analyzing the various cannabinoids and terpenoids in cannabis. After several years of data gathering, patterns have emerged that define cannabis into distinct chemotypes. The process is not easy. Getting different labs to agree and standardize a method of analysis that is verifiable is the first step.
Dr. Abrams will be one of many speaking at the Emerald Conference. He is scheduled to speak at 1:30pm on Friday, February 3rd at the Regatta Pavilion Exhibit Hall at the Hyatt Regency Mission Bay San Diego. At Friday’s presentation, Dr. Abrams will discuss some recent data from a 4-strain test plot and the variability of its sample analysis. The conference also offers Brian Berger, Associate Professor at Lehigh University, discussing microbial contamination, and Rick Crum discussing his experience with pests and pathogens in a high volume nursery. Dr. Jahan Marcu, Chief Science Officer at Americans for Safe Access, will be speaking on Thursday afternoon on international standards on the quality testing of cannabis. As well, Dr. Justin Fischedick, who will present his analysis of terpenoids in cannabis.
The information presented at this conference is the real science that will likely affect policy in this new and burgeoning industry. This conference is highly recommended for growers, processors, or manufacturers in the cannabis industry.
The Dosing Project: MediCann & the CESC
When it was discovered that the human body contains endocannabinoid receptors, and that cannabinoids found in marijuana - like THC, CBD, and THCA - organically attach to these receptors, much like aspirin, it opened up a whole new world for medical cannabis.
Now, in collaboration with the CESC (Clinical Endocannabinoid System Consortium), a nonprofit research group, MediCann is in a unique position to better understand the efficacy of cannabis. We know it has proven health benefits, but what types of strains best treat which conditions? What is the most effective dosage? Mode of administration? When is it best to take it? These are all common questions a physician asks when prescribing medicine for a patient's condition.
The Dosing Project is CESC’s flagship clinical study that establishes, in milligrams per kilograms, important dosage information from patient data. It establishes what cannabis plants and products are best for sleep, pain, inflammation, and any other medical condition for which cannabis is used. We’re finding out how different strains treat different conditions in patients. In addition, the CESC is developing strain nomenclature and analyzing plot sampling methods that will move cannabis cultivation for medicine rapidly into the future. This clinical study will improve the efficacy of cannabis for all patients, present and future.
Participation as a patient in The Dosing Project study is FREE and is protected under HIPAA privacy laws. Click Here to Join The Dosing Project Study
If you or your organization would like to sponsor or become a member of the Dosing Project, click here.
Better Medicine...Less Myth
MediCann physicians have the unique opportunity to hear about a person’s experience using cannabis. We can document pain, evaluate anxiety, and review sleep patterns and assess how well cannabis works to improve these symptoms. Gone are the days of sharing myths with someone you don’t know or don’t want to tell that you use cannabis. Cannabis today is accessible, varied, and abundant. As medicine, it’s not just a plant. It’s a capsule, a tincture, an oil, a salve, or ointment. Although the use of cannabis is old, the medical cannabis industry is young. We are just learning about different strains and which to use. Which cannabis helps you sleep? Which is best for pain? Rather than rely on a here today, gone tomorrow individual who is illegally selling cannabis, patients now depend on a knowledgeable physician and knowledgeable dispensary service. That state of California enacted the California’s Medical Cannabis Regulation and Safety Act (MCRSA), on January 1, 2016, to be implemented in January 1, 2018. The act calls for factions of the cannabis industry to apply for specific licenses and follow stated regulations. It brings the young medical cannabis industry one step away from a sneaky purchase in a dark corner of the downtown park and one step closer to safe, clean and natural medicine.
What does this mean from the patient perspective? For one thing, if you have your own garden, you can continue to grow your own medicinal plants. The new California law allows patients to grow up to 100 square feet of plants. If you grow for patients as their “caregiver”, you have to limit your garden to 500 square feet and serve 5 or fewer patients. For the many of us who don’t have our own garden, dispensaries will continue to be available. Dispensaries will receive their cannabis products from state licensed commercial cultivators and manufacturers. All cannabis will go through mandatory testing and placed in tamper proof packaging. In contrast to the upcoming vote for “adult use”, California’s MCRSA law is already in place with specific regulations being developed. Whether Prop. 64 passes or not, medical cannabis will become available in California in better form and as better medicine.
Sativa vs Indica...
After attending one of MediCann’s Affiliate Physician offices, a patient receives a recommendation letter (similar to prescription) that allows you to purchase your cannabis medicine at a dispensary (similar to pharmacy). The noticeable difference is that the recommendation letter doesn’t tell you what to use or how much to use. Medical studies have yet to verify appropriate strains and appropriate doses for specific indication. When you arrive at a medical cannabis dispensary, your letter will be verified at the entrance and then you’ll be directed to a counter displaying multiple dried cannabis flowers with different names. Outside of the name, a standard distinction between cannabis products is “Sativa”, “Indica” or a hybrid of both. The reality is that all cannabis plants have been hybridized. Some display a thin leafed “Sativa” trait and others have the broader leafed “Indica” trait. Pearce et al published a survey among medical cannabis users in the Journal of Alternative and Complementary Medicine, finding that “Indica” is best for pain and sleep while “Sativa” increased energy and improved mood. The study concluded that there was a difference in effect, but could not identify whether the shape of leaf or THC/CBD ratio was the source of that difference.
Dr. John Abrams, Chairman and Chief Science Officer of the Clinical Endocannabinoid System Consortium (CESC) proposes a chemical difference between strains. After sampling 686 plants, he noted three distinct chemical types based on THC/CBD ratio. Does this identify the “Sativa”, “Indica” and hybrid effect? Dr. Abrams plans to find out as he launches the CESC’s first clinical study, The Dosing Project (http://www.thecesc.org/the-dosing-project). The study aims to discover the chemical types of cannabis that improve sleep and reduce pain.
The myth among cannabis users suggests a “Sativa” effect and “Indica” effect. The person behind the counter at your local medical cannabis dispensary will launch into an explanation of “Sativa” flower and how it gives a mood uplifting, non-drowsy effect. In contrast, the description of “Indica” flower includes a sedating and pain reduction effect. Can you rely on this information? Probably, yes. Since there is not a scientific way to distinguish “Sativa” vs “Indica” other than the shape of the leaf, my guess is that the dispensary staff is sampling their products and concluding the distinction through experience. Errors in distinction are covered up by adding categories. Some dispensaries describe an “Indica” dominant - “Sativa” hybrid or a “Sativa” dominant - “Indica” hybrid. Research is slow and methodical for a reason. We want to come to the right conclusion. As Dr. Abrams pursues the truth, we wait and do the best we can. Buy small amounts. Experiment and observe. “Sativa” or “Indica”? Your call. If it works, it works.
 Pearce, et al. Discriminating the Effects of Cannabis Sativa and Cannabis Indica: A Web Survey of Medical Cannabis Users. The Journal of Alternative and Complementary Medicine. Volume 20, Number 10, 2014, pp. 787-791
Welcome to a new MediCann!!
Times are changing...
Since MediCann first opened its offices to the community, our providers have always been convinced of the medical efficacy of cannabis. Over the last 12 years, MediCann has seen the number of states joining the movement grow from 5 to 25 plus Washington D.C. The list of organizations that support medical cannabis include, the American Academy of Family Physicians, the American Nurses Association, the American Osteopathic Association, the American Preventive Medical Association, the American Public Health Association, the American Society of Addiction Medicine, the Lymphoma Foundation of America, The Montel Williams MS Foundation, Kaiser Permanente, the New England Journal of Medicine, and many more. High profile physicians, such as Dr. Sanjay Gupta, Dr. Dean Edell, and Dr. Andrew Weil also support cannabis for certain conditions. Those who continue to scoff at the potential of cannabis to help are simply without access to appropriate information or resource. Our discussion has changed from “Does cannabis help?” to “What does cannabis help?” The new MediCann would like to present itself as an intermediary to information and resources on the use of cannabis as medicine.
With greater acceptance comes greater responsibility…
Now, more than ever, there are so many questions. “Does it really cure cancer?” Can I use it and not get “high”? The many years of prohibition left vital questions unanswered. Science has eighty years of inactivity to overcome. MediCann takes on the responsibility of investigating some of the answers through its association with the Clinical Endocannabinoid System Consortium (The CESC), a non profit research organization and the launch of its flagship program, The Dosing Project. Additionally, MediCann educates patients on where to find the best cannabis preparations for their symptoms diagnosis through our new Medicine Locator. Our News and Events page will keep you up to date on the latest on the growing cannabis knowledge and industry. We still refer potential patients to top rated physicians who provide evaluations for optimal and legal medical cannabis use. Our Doctor Locator page provides you with contact information to assist in scheduling an appointment by phone or email.
Not everything changes….
Science has identified potential for anti-cancer, anti-inflammatory, anti-seizure, anesthetic, anti-diabetic, anti-anxiety, anti-depressant and sleep agents all from the chemical components of the cannabis plant. Pharmaceutical companies are preparing cannabis based medicines for sale and financial investors are placing their bets on the best cannabis product. Our grassroots movement has blossomed into a burgeoning industry. Yet, you can still grow it easily and inexpensively in your backyard. We have a lot more to know. Throughout its existence, MediCann has always supported patients. As MediCann brings you more information and resources, our fundamental mission will not change. We look forward to many years as your partner in cannabis and health.
Jean Talleyrand, M.D.,