The Cannabis Enigma Podcast is wrapping up its first season. After 39 interviews with frontline doctors, researchers, patients, caregivers, practitioners, and expert storytellers, we are taking a summer break as we prepare for season two.
For the season finale, hosts Michael Schaeffer Omer-Man and Elana Goldberg each choose three of their favorite interviews from the first season, discuss why those conversations were important to them, and play a short clip from each one.
Listen to each of the full episodes here:
- No Time for Clinical Trials, with Catherine Jacobson
- Dr. Ethan Russo Says Cannabis Can Be Better Yet
- CBD Nation: Cannabis Science for the Masses, With David Jakubovic
- A Rural Canadian Doctor Prescribes Cannabis for the First Time, With Dr. Tiffany Keenan
- Using Cannabis to Treat Autism, With Dr. Orit Stolar
- So You Think You Know About Cannabis, With Dr. Codi Peterson, PharmD
We hope you enjoyed the first season and we can’t wait to start popping back into your feed in a few months!
The Cannabis Enigma podcast is a co-production of The Cannigma and Americans for Safe Access. Michael Schaeffer Omer-Man is the executive producer, editor, and co-host. Elana Goldberg is co-producer and co-host. Music by Desca.
Michael Schaeffer Omer-Man: Hi, I’m Michael Schaeffer Omer-Man.
Elana Goldberg: And I’m Elana Goldberg. So it’s happening.
MO: It is. This is the season finale of season one of The Cannabis Enigma podcast.
MO: This is our 40th episode, and we’ll be back in a couple of months with a slightly different format. We believe it’s gonna be way more awesome, so if you’re a fan, please stay subscribed and look out for the new stuff, but more exciting than that for the moment is that we’ve prepared an awesome season finale.
EG: Yeah, so we’re gonna get into that in a second. I think what’s great about these awesome season finale that we’ve prepared, if we don’t say so ourselves, is that it’s kind of a bit of an encouragement to go back and catch up on any episodes that you missed during the first season while you’re missing us over the break. And yeah, also a chance for us to kind of relive some of the highlights so far.
MO: So before we get started, just a reminder that The Cannabis Enigma podcast is a co-production of Americans for Safe Access and the Cannigma, please check both of us out on the web, you can Google if you want.
EG: That’s what you can do during the break. Just Google us all the time.
MO: Anyway, so the format of this episode is that Elana and I each chose three of our favorite segments from all of the past 39 episodes of the podcast, and we’re gonna talk about each one, why it stood out to us, and then play you a few minutes of that episode.
EG: Right. Can I start?
MO: Let’s do it. What do you have first?
EG: Okay, so the first episode that I’d like for us to listen to is, it was episode number 13, No Time For Clinical Trials, and it was an interview with Catherine Jacobson, a VP from Tilray, and basically, amongst other things, this is a story of a mother developing a medication to help make her child’s life better. Her son was suffering from an extreme form of epilepsy which was treatment-resistant, and she basically didn’t have another choice but to develop this medication, which then went on to become Epidiolex by GW.
MO: Which is the only FDA-approved cannabis based medication ever approved.
EG: Right, exactly. And as well as just being really moving and interesting story, I think it really shines a light on the importance of product consistency in development, especially for children, but not only for children, and also, you know, and the important work that parents are doing in terms of cannabis regulation reform.
MO: Absolutely. When we think of medical cannabis, oftentimes, it’s just go to the dispensary, get some weed, but that doesn’t work when you’re dealing with a small child, you need something more consistent, you need something more focused, and she played a big role in giving a lot of other parents and children, that option.
EG: Yeah, absolutely. So should we listen to a clip?
MO: Let’s listen, here’s Catherine.
EG: So you made this decision about what dosage you were gonna try and what formulation… What happened after that?
Catherine Jacobson: So I went to the dispensary in San Francisco and I said, can I have some CBD please? ’cause I thought that’s what they did. Of course, they didn’t. They handed me dried flower and said, “Here’s CBD.” And I looked at him and I said, “What do you mean here’s CBD? You’re handing me a flower, which I know contains a 100 different compounds, right.” And what I think what he was trying to say is, “Here is some dried flower that has a higher CBD content than any other dried flower in the store.” So I set out to make it myself then, and what I had to find first was dried flower that had enough CBD in it to make it worth my while to extract it, but also it had to be low in THC, because the method I used to separate the THC from the CBD depended on that initial ratio. So, I was lucky because I found a chemist at UC Davis who actually had started a cannabis testing lab, and with his help, I learned how to extract the cannabinoids with ethanol.
CJ: And I used a pipette because it was ethanol, right it is alcohol and I didn’t want Ben to get a lot of alcohol, so I used a pipettor to get the right volume that would give me 200 milligrams of CBD or 300 milligrams, and often it was a fraction of a milliliter because it was so highly concentrated.
EG: Wow, I’m listening to you kind of talk through this process and I’m struck by first of all, how lucky Ben is that he happened to get you as a mother, and secondly how inaccessible a course of action like this would be to pursue treatment for the majority of other parents in a similar situation.
CJ: Yeah, and I have to say it was actually awful, I spent… First of all, it was expensive, and I was buying pounds of marijuana from drug dealers all over California, so I had to find them, and then I had to go to their houses and buy it, for thousands of dollars per pound, and it was so anxiety-producing. So once I figured out that it actually benefited Ben, every batch was different because the starting material was different and I didn’t have any consistency in how I did it. Imagine this set up in my garage; no standard procedure defined, and there were days where I would work on this for a week and at the end not get the right outcome and then have nothing to give him, so it was absolutely… It was just an incredible amount of stress to be responsible for making Ben’s medication on top of dealing with the daily management of uncontrolled epilepsy, and it was really, it was too much for me.
EG: If you’d like to listen to the rest of that clip, we’ll put a link in the show note to the full episode. So what are we talking about next, Mike?
MO: So first on my list is episode number 24, Cannabis Can Be Better Yet, with Dr. Ethan Russo. Dr. Russo is one of the most famous cannabis researchers, probably the most famous after Raphael Mechoulam, who discovered THC and the thrust of his work, and I’m probably doing a disservice by saying this, ’cause I’m sure it’s much broader than that, is working on the theory of… And you’ll hear him say in this episode that it’s not just a theory, of the entourage effect, which is this idea that the pieces inside cannabis, the molecules, the chemicals, that they actually have a greater effect when they’re combined, meaning when the whole plant is consumed as opposed to just single elements of it, as Catherine Jacobson isolated in the previous clip. And one of the pieces of that, that we’re gonna play for you, is talking about how CBD, in his experience, in his research is way more effective when combined with THC, which if you consider how abundant and easily available CBD is in the world today is probably a really important point that we should listen to.
EG: Yeah, this was a big interview for us, as you mentioned, something of a cannabis research rockstar, Dr. Russo and I think we’re gonna need a follow-up interview with him pretty soon.
MO: Absolutely, he’ll definitely, hopefully, be making an appearance in season two. And the other thing that really fascinated me about this interview was some of the things he said about tolerance and building tolerance or not building tolerance to cannabis. And I’m not gonna say any more about that. So let’s hear it from Dr. Russo.
Ethan Russo: So if we’re talking about pure CBD, we usually need doses that are much higher for acute anxiety, it’s a few hundred milligrams, for treatment of psychosis it’s somewhere around 800 milligrams a day, for treatment of severe epilepsy syndrome, such as Dravet and Lennox-Gastaut it’s 20 milligrams per kilogram per day of a pure substance. But interestingly, when this has been analyzed, it’s been shown that CBD doses can be effective at about 20% of that level, if there are other components available, and I’m fond of saying that there’s nothing that CBD does that won’t be enhanced by having at least a tiny amount of THC present as well. And additionally, it would apply to terpenoid content, it can certainly add to the adjunctive value. For instance, if we’re treating anxiety, it’s very helpful, they have some of the terpenoid linalool aboard, ’cause it’s a very prominent potent agent in treating anxiety without being overtly sedating and without being addictive at all.
MO: You mentioned in one of your previous answers, tolerance and whether somebody has it, specifically toward THC. How does that work? And when you develop a tolerance to what people refer to as the euphoric effects or high of THC, does it lose its other… Do you develop a tolerance to most of the therapeutic effects as well?
ER: Yeah, that’s a great question, I’m glad you asked. Yeah, one of the beauties of cannabis as a therapeutic agent is, yes, you can become accustomed to the psychoactive effects and work through them, and with careful dose escalation over time, maybe two weeks or so, people can get quite accustomed to even higher doses of THC. What we want them to do is use the lowest dose that treat symptoms without producing intoxication. But the beauty of cannabis is, even though one gets accustomed to the psychoactive effects, benefits on whatever you’re treating remain, in other words, if we have a chronic pain patient, they get benefit from using cannabis. As long as that condition is stable, it’s not getting worse, we don’t see dose escalation over time, and in fact, there are many people who’ve taken cannabis therapeutically for decades that are using the same dose. So it’s quite different to what we see with opioids where often there is dose escalation, increase in side effects, dependency, craving and all those problems.
EG: Alright, so the third episode that we wanna focus on today is, was number 23 in the season, and it was an interview that I did with the director of CBD Nation, David Jakubovic. I’m pretty sure I mixed up his accent in the original interview as well.
MO: You’re Australian, you get a pass.
EG: Yeah, yeah, exactly. I’m playing my Australian card. So, you know, this was a really fun interview for me, first of all, because watching movies for work is always fun. So I enjoyed that, and also because this is a fantastic film, it’s a documentary on cannabis research basically over the past few decades. And what I really loved about it was the kind of correlation between this film and what we’re doing at the Cannigma, which is taking complex scientific concepts and translating them into a language that pretty much everyone can understand. I also think, you know, it’s not just about the correlation between what he did in this film and what we’re doing, but rather the importance as well of pulling apart these important topics for a mass audience, and we really got stuck into that in the interview, so let’s go straight into it.
MO: I enjoyed it. Let’s hear it.
EG: Another section that stood out to me was the explanation of the endocannabinoid system, we made actually a few months back, a very short… Not comparing it to your film, we did like a one-minute animation explaining the endocannabinoid system and pulling apart a complex topic like this and presenting it in a clear and yet accurate way is very, very complex. And a technique that I really like that you used in that particular section was how you kind of zoomed out and gave the big picture and then finished that up, and then dove in for a much deeper explanation. Who helped you put that all together and kind of find the best way to explain these concepts.
David Jakubovic: The Israeli Air Force.
DJ: Because… Well, that’s a partially, that’s a joke sort of, but also not really, because I started my film life, making training films for the Israeli Air Force when I was in there for my service, and when making training films back then you’d make these… You’d make these movies about subjects that you don’t know anything about, I don’t know how to fly planes, but we’re making these videos about how to fly planes, and we’re trying to make them really entertaining and understandable and clear, and I think that was training for me, and that really instilled in my brain how to approach complicated scientific subjects and make them interesting and easy to understand. So a very basic teaching technique is you just explain the subject, explain it broadly and then start going in details, which is just kind of like basic, basic teaching 101, almost. And so that’s what I did there. I just tried to keep it really simple and clear. Part of explaining science to a layperson has to do with looking at this whole giant scientific picture, which me as a filmmaker, I don’t understand it, right? I’m not a scientist, but I ask the questions a million times until I grasp enough of it and then I go and distill all of that millions of bits of information into just the most important bits that the layperson can understand.
DJ: And when you do that, you can watch this movie and grasp the science without actually being a scientist; you grasp enough to understand, “Oh, there’s real science here and I understand what it’s about.”
EG: Right. Well, that’s it, isn’t it? Because the viewer only needs to understand these concepts to the extent that you understand them, not to the extent that the scientists understand them.
DJ: Exactly, that’s exactly it. And I understand them to the extent that the viewer understands them.
EG: Right, right.
DJ: What you see in the film is my understanding of the science based on asking dozens of scientists the same questions a thousand times till I really understood it.
MO: Fourth on our list today is episode number two.
EG: Yeah. So this really takes us back, Mike, to when we were still trying to work out how to use this fancy recorder we had bought ourselves, and we were like looking for quiet corners in a big exhibition hall in Tel Aviv.
MO: Yeah, and Dr. Tiffany Keenan was quite patient with us, it’s a total trip down memory lane, but it’s also… It’s fitting that it’s from the beginning of the show because it’s telling the story of the beginning of somebody’s journey with cannabis, with a doctor’s journey of cannabis. So the episode was titled, A Rural Canadian Doctor Prescribes Cannabis For The First Time.
EG: And what’s it about?
MO: Well, it’s one of my better headlines that I’ve ever written as it’s quite descriptive, but you’ll hear it from her. She came across medical cannabis in a way that any normal person would and she took it upon herself to educate herself about this medicine as it became legal in Canada, and she did her patients a service by really making it available to them in a way that fit into a holistic medical treatment plan, and she talks about that, and it…
EG: I think really… What stands out for me about this interview, and we’ve had ongoing conversations and attended other conferences with Tiffany since, is that it really helped us to understand the role of the doctor in this whole medical cannabis story.
MO: Absolutely. So here’s Dr. Tiffany Keenan.
MO: What was your journey as a doctor coming to a place where you began prescribing cannabis to patients and sort of… Yeah, what was your journey coming to that.
Tiffany Keenan: Well, a few years ago, I wouldn’t be having this conversation with you because I thought that if people wanted to smoke cannabis, they could go and buy it, but about a year and a half ago, I was watching a documentary series on television. And during that documentary, there were many people telling their stories of how medical cannabis had changed their lives. And I’m very much holistically based in my practice, I focus on nutrition, mind, body, spirit, trying to really use a lot of plant-based medicines when I can, and I said, “Well, this is quite interesting that this medical cannabis now is out there, it’s being used.” It has been… Physicians have been prescribing it in Canada for over 12 years, and then I said, “Well, it’s gonna be legalized in our country in October, so maybe I need to learn a little bit more about it.” So I contacted some of our local, our licensed producers of medical cannabis and I had one of them sit down with me and discuss the basic indications of how physicians are using medical cannabis, and because patients were starting to ask me if they could get prescriptions. So, basically I’d watched the documentary, started to do some of my own basic research and then because of patient demand, I began prescribing medical cannabis.
MO: For what types of conditions, and you know.
TK: So initially it was for chronic pain. And even now that’s the majority of my patients; they’re generally older, like 50 age and up, they’re coming for… Oils is what they want to use. Patients generally don’t want to smoke it. They want something that’s not gonna make them high, so the majority of what I use with my patients even now, is still CBD-based preparations. And then things have just kind of started to grow. I think in areas, especially in smaller towns, the word kind of gets out that people are getting relief from this, and then they tell their friends and so on and so on, and so my practice has started to grow, which is the reason I’m gonna be expanding my practice now.
MO: And how do you see it as a treatment, compared to other options that are available to you, that you’re able to prescribe, that you were able to prescribe in the past, what are the benefits that you’re seeing that are making you embrace this.
TK: Low side effect profile. So that’s really important. So many times with opioid medications in particular, people have a lot of side effects, the sleepiness, the dizziness, constipation, just not feeling well, and what I’ve been so encouraged by is that the patients when they start even just using CBD-based preparations, they’re able to come off of many times, of opioids. And so sometimes I wonder, other physicians, everyone’s not on the same page in Canada yet about the use of medical cannabis, but when you see a patient that’s been taking long-term opioids come off of that prescription, then I definitely know that there’s a benefit to that patient and then to our healthcare system overall, in terms of cost, people are not on a lot of higher dose more expensive preparations.
EG: So that was Dr. Tiffany Keenan, and the next episode that we’re gonna listen to a little excerpt from is with Dr. Orit Stolar, who is an Israeli-based pediatric neurologist. And this was episode number 14. It was titled, Using Cannabis To Treat Autism. And as you can guess from that title, the majority of the interview was about Dr. Stolar’s work in treating children with autism, but what I think really stood out from this interview and from various conversations that we had before and afterwards with Dr. Stolar was the importance of breaking down stigmas within the medical community. And one thing that Orit pointed out in this interview was that a few years before or a few years earlier, she would have thought it was crazy, absolutely unheard of to give cannabis to children, and now, not only is she working with cannabis in her practice, but she’s also leading really some ground-breaking research on the topic.
MO: Yeah, I found this one to be really interesting. She is an amazing speaker, an amazing researcher, and again, somebody that I hope to have back on the podcast again in season two.
EG: Yeah, absolutely. Something else I wanna just point out before we keep going, that really stuck with me from this interview and has kept coming back, I think to our work at the Cannigma over and over again, is how this sort of research can show us the work of the endocannabinoid system in action. So the example that Dr. Stolar gave here that really stuck with me is common side effects that we all think about colloquially, when we think of cannabis, like short-term memory loss, can actually be really important when it comes to treating certain conditions like autism. So where generally speaking, we think of memory as a good thing, and we wanna remember more, actually with patients with autism, sometimes remembering too much can be a real barrier to their functioning, and this is somewhere where cannabis can help.
MO: I think actually, another person that we interviewed in a different episode brought up that same thing; how short-term memory loss can be a positive effect for people treating chronic pain.
EG: Right. And actually, now that you mention it, PTSD.
EG: Yeah, so we’re gonna stop listing conditions, let’s move on to the interview.
MO: And just a reminder, we will put all of the links to these episodes in the show notes of this episode.
Orit Stolar: Okay, A, first of all we have to talk about what it is, in the whole… In everybody, basically it’s an old system that we had in our body, but we just discovered it in the past 20 years ago or so, or a bit longer. It’s an amazing system, I must say, because that system has the ability to basically cause homeostasis; to balance everything in our body. It balance our sleep, our eat, our pain reaction, our moods, and it also has an important role in brain development, which it is called pruning, it’s the ability to… There’s a lot of synapses that happening while the brain is developing, and it’s part of the process of deciding what is going to be chopped off and what is going to be left in, and it has a very important role, because otherwise the brain is over-wired which is a problem.
It also helps us forget things, which is kind of cool because when you go to a place where there is thousands of faces, for example, in a subway, you don’t need to remember all this data, this is a data that is irrelevant and is not important. So it’s like a control-alt-delete that you do on your computer and you download that information, because it doesn’t help you for anything. It’s the same thing as remembering the number of the room you’re staying in in a hotel; it doesn’t help you for anything. And you would see children with autism, that suddenly when you talk to them, they remember all those very useless data, like they would say to me, “Oh, I went to this and this hotel and I stayed in room 531,” and you say to yourself, “Why do you have to tell me this, and why do you remember this?” And then you ask, “When was this trip?” And they say like 10 years ago, and you say to yourself, why they need to remember that information. Nobody ever showed any relationship between those two things, and that’s one of the things that I really want to show that maybe there is a relationship between this system and the memories of all those details.
MO: Before we get to next one, I just wanna say that it was really difficult to choose these six episodes because each one of them has… Well, almost all of them have a… They taught me, and I think you too Elana.
MO: If you’re new to the podcast, I would encourage you to start from the beginning. There’s 40 episodes, you don’t have to listen to all of them, but you should. Anyway.
EG: However, if you only listen to one, we’re suggesting this next one.
MO: Yes, for my third episode that I chose, I chose episode number 36, which is one of the more recent ones. It’s titled, So You Think You Know About Cannabis, and it’s with Dr. Cody Peterson, who is a pharmacologist and clinical pharmacist. I think actually, one of the things that we learned through these first 40 episodes, and through a lot of our work actually, is the super important role that pharmacists play that we don’t really think about as patients and consumers, as the people who are really responsible for just making sure that our bodies are getting the right chemicals and the right doses at the right times, and that they’re not interacting with other medications or chemicals or foods that we’re taking even.
So Cody is somebody who you will definitely hear more of in season two. And I had a lot of fun on this one, as Elana said, if you’re gonna listen to any of them, start with this one; he’s also just fun to talk to. One of the things that really interested me about this, and you’ll be seeing more of this on the website is, as I mentioned, the role that food can have in the way that cannabis affects our bodies, and also I asked him what he thinks the most common mistake that people make using cannabis is, and I was a little surprised, although maybe I shouldn’t have been, ’cause his answer was overconsumption, not in an abuse kind of way, but just like, you don’t need that much.
EG: Yeah, I mean, I feel like I’ve experienced this in my own cannabis consumption for sure, it’s something that I’ve learned. And yeah, I don’t think we need to introduce this much more, Cody I should add, by the way, as well, is also our scientific adviser at the Cannigma, so he’s involved in a lot of the educational content that we produce.
Cody Peterson: So even if you do become addicted to cannabis, which certainly can happen, it’s dopaminergic in the same part of the brain that the opioids are, and that cocaine is; it stimulates and tickles the same receptors, it’s far less damaging. The withdrawal is far less severe, and people tend to just not be bothered by it as much, but opioids were always in medicine, right? The wise men, the shamans, they were all using the poppy flowers for hundreds, if not thousands of years, and they were acutely aware of its effects. But the poppy flower and sort of where the opium is produced in the poppy is not a monomolecular production of opioids. It is produced alongside between four and 10 other opioid-alkaloid-like molecules, some of which act like CBD does with THC counterbalancing some of the side effects and really smoothing out this pharmacologic soup. And what happened is, obviously, we went to monomoleculars, but once we discovered the way the opioids were working in the 1960s, 1970s, we were like, “Oh, we got it now. We’re gonna formulate these special drugs that are really targeted and they’re gonna be really clean drugs, ’cause they don’t have any other aims or targets that they hit, whereas cannabis is dirty, it hits all these receptors, the TRPs and the CB1, CB2, CB3.”
That’s dirty, right? Opioids are specifically selective for the mu opioid receptor. You have more than one kind of opioid receptor in your body, and fentanyl and morphine and some of the other drugs are specifically formulated to just go after one; we’re creating our own issues. Nature, in my experience, has done it better than we have, and so that’s why I think cannabis botanical needs to be preserved as well. So when you start messing around with isolating molecules from a plant, it seems to be when we see more side effects. I’ll give an example, Marinol, right? So 2.5 milligram edible, people don’t mind at all. You give them 2.5 milligrams of Marinol and they have hallucinogenic experiences, so it matters whether something is isolated. Yeah, Marinol is dronabinol, and it was the first FDA approved THC drug. It is THC, Delta-9 trans THC, but it’s made synthetically rather than by the plant. And why we’ve seen those side effect profiles, we don’t even fully get it yet, we don’t, but people report similar experiences using THC isolate compared to whole plant or even with one terpene mixed in, right? And so there’s no doubt that there’s some degree of interplay when you start mixing more than one plant molecule.
EG: Alright, so that’s our six excerpts. Highly recommend that you go back and listen to the full episodes, like Mike said, we’re gonna have the links in the show notes for you, and we’ve almost got our cocktails ready, our cannabis cocktails for our summer vacation.
MO: I hear you’re going somewhere cold.
EG: Yeah, I’m going to Australia, actually, no cannabis cocktails there.
MO: Which way do the toilets flush?
EG: I don’t know, this is such an American question. Just the normal way.