William Courtney, a Mendicino County-based physician, recommends eating — or juicing and then drinking — raw cannabis leaf and bud as a way to achieve megadose therapeutic impact from marijuana without psychoactive effect. The green plant contains tetrahydrocannabinol (THC) in its acid form, THCA, which is not psychoactive.
Leading proponents of ingesting raw cannabis — not just in response to illness but for general health maintenance — include Dr. Courtney’s wife Kristen.
For many years, an ailing Kristen Courtney had struggled with systemic lupus. Her prognosis was dismal. But her condition improved dramatically after several weeks of ingesting raw cannabis and drinking the juice of THCA-dominant plants. The plant also contains small amounts of several dozen other cannabinoids (compounds that are unique to marijuana) in their acid form.
Convinced that they had discovered a cure for chronic illness, the Courtneys became passionate advocates of juicing. They have inspired a following of true believers in Northern California and beyond. Juicing, the Courtneys argue, is the best way to consume cannabis therapeutically. But many of their claims about the advantages of juicing cannabis are unsubstantiated and misleading.
A dietary supplement
Courtney recommends “expanding our use of cannabis from the 10-milligram psychoactive THC dose to the 600-to-1000 milligram dietary dose.”
He explains in an online Q&A: “The main psychoactive compound in dried, aged cannabis is delta-9 THC, which is absent in the raw, fresh leaf. In general, patients do not experience a ‘high’ from consuming the raw product. However, other compounds in the plant, such as the terpenes [which give cannabis its unique smell], may have an effect on mood or energy levels.
“Raw bud has a higher concentration of cannabinoids than leaves and is an excellent method of consumption if you have the resources to make this possible. Both are extremely beneficial but they are best combined . . . Bud should be at the state where the trichomes are fully present but not yet amber (i.e., cloudy). Leaves for eating or juicing should be picked from plants well into flowering stage.”
For palatability, the Courtneys recommend blending raw cannabis with “a minimal amount of organic fruit or vegetable juice, just enough to cut the bitter taste of the raw cannabis.”
A wheat-grass juicer is recommended for those using large quantities of leaf. A blender is the preferred method for juicing buds —“quicker, easier to clean, and you recover closer to 100% of what you put in,” according to Courtney.
Raw cannabis, not rinsed, should be stored in the refrigerator or freezer in bags that extend the freshness of vegetables. The Courtneys recommend soaking cannabis leaves in water for five minutes before juicing.
THCA is cleared rapidly from the blood. Courtney suggests splitting the juice into small portions to be consumed during the day.
Not for Everybody
Raw cannabis does not provide acute symptom relief, Courtney acknowledges, although “some effects can be immediate.” One patient at the Humboldt Patient Resource Center in Northern California reported immediate relief from severe nausea after drinking juiced cannabis.
Some effects, according to Courtney, “take three days to be appreciated. Others build for weeks. Full clinical benefit may take four to eight weeks to take effect. It takes that long for plant (phyto) cannabinoids to fully saturate the body’s adipose (fat) tissue. Phytocannabinoids are stored in the adipose tissue, as are the fat-soluble vitamins A, D, E & K.”
Courtney cautions people with kidney or gallbladder problems that raw cannabis might pose a risk. He would not recommend it for a patient with Hypercalciuria, type II, Enteric Hyperoxaluria, or Primary hyperoxaluria.
Also, Courtney notes, anyone on prescribed medications that can be blocked by grapefruit or pomegranate juice should advise their doctor if they are considering a raw cannabis regimen. Ditto those who are taking blood-thinning drugs such as Coumadin. Most leafy greens contain high amounts of Vitamin K, which can prevent the liver from metabolizing such drugs. and raw cannabis might, too.
Those who wish to pursue a juicing regimen face a major obstacle: how to obtain sufficient amounts of cannabis? Purchasing large quantities of cannabis is beyond the budget of most patients. And growing your own marijuana — the ideal in terms of freshness — is an option for all too few in our society and throughout the world.
The Courtneys advise: “If you know a local organic grower, ask if you can use their excess leaves. . . Only use organic cannabis that does not have any pesticides applied at any point in its life cycle. Make sure there are no toxic miticides.”
Ambiguous information re dosing
Dr. Courtney recommends using 25 large fan leaves per day in juice, salsa, pesto, salad, etc. If you have access to fresh bud, he recommends one bud a day for general health maintenance. “If you are suffering from a serious condition,” he adds, “that can go up to several buds/day.”
To determine the cannabinoid content of fan leaves, a prospective juicer sent 30 large leaves from a flowering Omrita Rx plant to the Werc Shop, an analytical lab in Los Angeles, for testing. They were found to contain a combined total of 11.5 milligrams of cannabinoid acids. To ingest 600 mgs of cannabinoids, by this measure, one would need to juice more than 1,500 leaves every day and/or a significant amount of bud.
70 Trillion Interactions?
Courtney credits Ruth Ross, a scientist at the University of Aberdeen in Scotland, with the discovery that CBDA (cannabidiolic acid) and CBGA (cannabigerolic acid) have marked antagonistic activity at the GPR55 receptor, a protein implicated in tumor formation, cancer cell proliferation, and pain perception. At the August 2012 meeting of the International Cannabinoid Research Society in Freiburg, Germany, Mary Abood of Temple University discussed the extent to which GPR55 is expressed in the body. From these two sources, Courtney deduced that “if you smoke, bake, vaporize, sautee . . . CBDA, CBGA and quite probably THCA, you decarboxylate all the cannabinoid acids, sacrificing an interaction with 70 trillion cells.”
Decarboxylating, (i.e., heating) the plant converts the cannabinoid acids – by smoking, vaporizing or cooking – into their neutral, non-acid form: nonpsychoactive THCA becomes psychoactive THC and CBDA becomes cannabidiol (CBD), a potent nonpsychoactive cannabinoid with unique therapeutic attributes. But the notion that ingesting heated cannabis sacrifices “an interaction with 70 trillion cells” is dubious.
“The basic research on GPR55 is still in its infancy,” says Jahan Marcu, Ph.D, a scientist who has worked in Abood’s laboratory. “Experts in the field have published conflicting reports on the activity of various cannabinoids at this receptor. Dr. Abood and Dr. Ross would most certainly caution against extrapolating these findings into effects on humans.”
A 2012 article coauthored by Ross in the Journal of Biological Chemistry noted that several neutral cannabinoids, including CBD, interact with the GPR55 receptor. THCA is a weak activator of GPR55, according to Ross and her colleagues, whereas CBD and CBDA both block the GPR55 receptor.
To apply Courtney’s image in reverse, a person ingesting raw cannabis is “sacrificing an interaction” with the cannabinoid receptors in the human brain and body. Unlike THCA, neutral THC activates the cannabinoid receptor known as “CB2,” which regulates immune and peripheral nerve function. This is one of the reasons marijuana is an effective remedy for peripheral neuropathy, a painful nerve disorder that afflicts millions – diabetics, people with AIDS and cancer, MS and rheumatoid arthritis patients.
When THC binds with the CB2 receptor, it doesn’t have a psychoactive effect because CB2 receptors are localized predominantly outside the brain and central nervous system. THC also binds to CB1, the cannabinoid receptor concentrated in the brain and the central nervous system. This is what makes a person feel high.
CBDA and CBD
There have been numerous studies demonstrating the potential efficacy of cannabidiol in treating heart disease, diabetes, cancer, and neurological illness — but very few studies involving CBDA. During a talk at the April 2012 Patients Out of Time conference in Tucson, Courtney frequently referred to CBD research as if the findings also applied to CBDA.
CBD and CBDA both have therapeutic attributes, but they are not the same. And it is by no means evident that CBDA is innately superior to CBD, as Courtney implies. Or that THC is inherently “psychotoxic,” as he has characterized it.
Pioneering research conducted by Dr. Sean McAllister at the California Pacific Medical Center in San Francisco, has established that CBD and THC are potent inhibitors of breast cancer cell proliferation, metastasis, and tumor formation. But he found that “Compared to CBD, CBDA had negligible effects in cell viability assay against multiple cancers. We therefore never took a great interest in the molecule.”
McAllister noted the findings of a 2006 report, “Antitumor Activity of Plant Cannabinoids with Emphasis on the Effect of Cannabidiol on Human Breast Carcinoma,” by Alessia Ligresti and a team of Italian scientists: “For in vitro studies, the cannabinoids under investigation were screened for their ability to reduce cell proliferation on a collection of tumoral cell lines. Cannabidiol always exhibited the highest potency . . . Cannabidiol acid was the least potent compound. Among the other plant cannabinoids, cannabigerol [CBG] was almost always the second most potent compound, followed by cannabichromene [CBC].”
Kristen Courtney treated herself by juicing THCA-dominant cannabis at a time when there were no analytical labs serving the medical marijuana community in California. In recent years, as CBD-rich plants have been identified and found to be medically beneficial, the Courtneys began to advocate juicing for CBDA content.
Cannabidiol is nonpsychoactive in its acid as well as neutral form; thus “psychotoxicity” is not a factor at any dose of CBD. So why should one go through the trouble of procuring and juicing large quantities of CBDA-rich verdure when measured doses of CBD-rich concentrates are available for patients in California and other states where medical marijuana is legal?
Courtney has suggested that neutral cannabinoids are inferior because they are “synthetic,” by which he means not produced by the living plant. But as the plant dries, decarboxylation occurs naturally. In some tropical cannabis strains, significant decarboxylation happens before the plant is harvested.
A Patient’s Lament
A middle-aged man with prostate cancer, a patient of Dr. Courtney’s, contacted Project CBD, a medical science education service, seeking information about where to obtain large quantities of CBD-rich marijuana in order to juice it. He didn’t want to smoke it or vaporize it, he explained, because “Dr. Courtney says it doesn’t work if it’s heated.”
Perhaps this desperate patient misunderstood Dr. Courtney. Or perhaps he was misled by Courtney’s contention that ingesting cannabinoid acids is the best way to utilize the plant for therapeutic purposes.
There’s not a lot of science about cannabinoid acids in general and CBD acid in particular. From what we know, these compounds have medicinal value and juicing cannabis may help people with cancer and other diseases. But how these benefits are conferred is not entirely clear.
One advantage of ingesting fresh raw cannabis is that you’re getting most if not all of the volatile terpenes, and plenty of chlorophyll. (Odiferous terpenes also have therapeutic properties.) Juicing organic fruits and vegetables, especially leafy greens, is a health-positive practice, even when cannabis is not part of the mix.
There are many valid ways to administer medicinal cannabis. One size doesn’t fit all with respect to cannabinoid therapeutics.
As Anecdotal Reports of Anti-Cancer Effects from Cannabis 'Oil' Pile Up, Doctors Stress Need to Document Its Effects
No one listening to the radio or watching TV in the ‘50s and ‘60s can ever forget the jingle, “Brylcreem, a little dab’ll do ya...” Brylcreem was a formulation of lanolin and grease that enabled men to comb their hair and have it stay in place. Hippie influence on the culture dramatically curtailed the demand for Brylcreem. Perhaps some entrepreneur in the cannabis industry should now buy the rights to the jingle, because “dabs” have become the latest rage in the administration of cannabis.
The popularity of high-THC “dabs” —also known as “waxes”— is largely a youthful and recreational phenomenon. The user inhales a small amount of vaporized and/or burned cannabis concentrate —a dab— that has been placed on a hot “nail” with a tiny spatula or needle. A single deep inhalation has a stronger and faster psychoactive effect than any other delivery method can provide. In other words, the user gets more stoned and the dabs provide a mild “rush.”
Some regular recreational users say that smoking the herb could no longer get them high —tolerance had built up— but the use of dabs restored their ability.
Pipes are now being designed with appendages for positioning the nail next to the waterpipe bowl so that the pipe is ready for a dab as the user inhales. The nail is heated with a torch. When the dab is placed on the nail it vaporizes immediately in one brief puff.
Recently I was on a panel devoted to dabs at a “Cannabis Cup” organized by High Times Medical Marijuana magazine in Richmond, California, and I learned about the technology from the experts.
Dab concentrates are made from oil extracted from cannabis plants by a solvent. The most widely used solvent is butane —better known, although not entirely accurately, as lighter fluid.
Butane is a petroleum product with a very high vapor pressure —it evaporates very quickly into the air once released from the can. When cannabis plant material is drenched in butane, its oils dissolve and can be captured in a container. Instantaneously, the butane evaporates leaving only the oil behind.
There are real problems with this seemingly simple procedure.
Butane extraction is against the law. People are serving time in prison for using butane as an organic solvent.
Butane is a fire and explosion risk because it is so highly flammable. Many people have been severely injured using butane to make cannabis oil extracts.
And “butane” isn’t just butane, it contains contaminants. Approximately 20% of the volatile fuel in a common “butane” lighter fluid is a combination of other hydrocarbons including benzene, ethyl mercaptan, heptane, hexane, and other toxic impurities.
These other hydrocarbons have a lower vapor pressure than butane. They don’t evaporate as readily and are likely to remain as residue in the extracted cannabis oil. When smoked or vaporized, the contaminants enter the body through the lungs. In general these chemicals are considered neurotoxins. Chronic exposure to low-grade butane extracts should be considered poisonous. If it smells like butane, don’t use it.
Higher grade butane (USP grade or laboratory-grade butane) is commercially available —supposedly— but according to the manufacturers on the High Times dabs panel, it is practically unobtainable.
Another risk in the dabbing procedure involves the “nail.” Any object that is heated with a torch to burn or volatilize the dab will gradually disintegrate. Metals such as steel, stainless steel, or titanium might seem inert, but in fact they flake off a layer of metal with the dab. Glass may be a better choice. Someone should do the research.
If an ultra concentrated extract were necessary, a pure ethanol extract would be a better choice, preferably vaporized with a temperature-controlled device.
One could argue that medical users might benefit from dabs to relieve excruciating pain, muscle spasm, or intractable vomiting for which they want immediate relief. If an ultra-concentrated extract were necessary, a pure ethanol extract would be a better choice, preferably vaporized with a temperature-controlled device.
To date dabs are a recreational phenomenon that has caught on mostly in urban America. At the time of publication only a few of my patients in rural Sonoma County have reported using —let alone benefiting from— this fashionable new delivery system. But my patients are not typical of the cannabis-using population, and it was apparent at the Emerald Cup held in Humboldt County in December, 2012, that the popularity of dabs is spreading rapidly, far and wide. time in prison for using butane as an organic solvent.
Butane is a fire and explosion risk because it is so highly.
Editor’s note: Michelle Aldrich, 66, has been working for marijuana legalization —which she defines as “the right to grow it for free in your backyard”— for most of her life. She and her husband Michael live in a comfortable old apartment near the San Francisco Marina which they moved into 40 years ago. The following is adapted from a talk Michelle gave in July 2012 to the Women’s Visionary Congress.
I had smoked cannabis since 1967 but early in 2011 I kept saying I could not get high. I was smoking a lot. I now believe that THC was going to the tumor and lymph nodes, which is why the cancer did not spread more than it had.
On November 15, 2011, I was supposed to have lunch with Diane Fornbacher from the NORML Women’s Alliance. I was too sick to go. I felt like I had the flu.
That week I got a call from Linda Ward, who is now my therapist. I had been looking for a new therapist since 2009, when I got off all the meds that I had been taking for 20 years for depression —Prozac, Lamictal, and Trazadone. Rick Doblin [director of the Multidisciplinary Association for Psychedelic Studies] found Linda for me just when I really needed to talk to someone. The start of synchronicity.
I felt well enough to go see the doctor on November 22. It was my first visit with a physician’s assistant named Sally Holland. The first thing I told her was that I smoked marijuana. She asked if I vaporized? I told her I didn’t. Then I said my husband and I got the lifetime achievement award from High Times Magazine last June. Her response was that her brother was the general counsel for High Times. I knew at that point that Sally and I would get along and I could trust her and didn’t have to educate her about cannabis. Lovely...
Sally said that I had bronchitis, which I usually get at least once a year. She asked when was the last time I had a chest x-ray. I said a long time. She sent me for a chest x-ray and gave me antibiotics. The next day Sally called to tell me I had pneumonia.
I saw Sally again on November 30 for a follow-up. I was still sick and was given more antibiotics. Sally informed me that the x-ray showed a growth on my right lung, which would need to be checked out. My first response was “cut it out” if it was so small. I wanted to be aggressive. I saw Sally again on December 9. She sent me for lab work and said the doctor wanted to see me.
On December 21, I saw Gary Feldman, MD, my primary care physician, who gave me a thorough workup. I told Gary about the heat I had felt in the middle of my chest for almost a year. The tumor and lymph nodes were right on my heart chakra. He sent me for a CT scan on December 23.
The CT scan showed that the tumor on my lung measured 23 x 28 millimeters. [25.4 millimeters = one inch.] There was also a growth on my left kidney.
On January 4th, 2012, I had another CT scan to evaluate the growth they had found on my kidney.
On January 5th I had an echocardiogram, a procedure using ultrasound to show a two-dimensional picture of the heart.
On January 6th I had a CT fine-needle aspiration biopsy of the lung. Tissue was taken for analysis in a lab.
The results of the biopsy were supposed to be available on the ninth. They weren’t.
I saw the kidney doctor on January 11, and he said he thought the growth was a cyst and was not related to the growth on the right lung. This was seemingly good news.
On January 12th I got a call from Dr. Gary Feldman. He said it was cancer on the right lung. It was “poorly differentiated non-small cell adenocarcinoma.” He referred me to an oncologist, Dr. Ari Baron at California Pacific Medical Center (CPMC).
I was fortunate to get on MediCare when I turned 65.
I decided immediately to seek support from my network of friends in the medical cannabis community. I announced my diagnosis on Facebook.
I called Clint Werner, who had recently released his book Marijuana Gateway to Health: How Cannabis Protects Us from Cancer and Alzheimers Disease. Clint, being a macrobiotic chef, told me to avoid sugar since “sugar feeds cancer. Avoid red meats and processed foods, no dairy and no wheat. Eat lots of fish, especially salmon.”
I needed to change my eating habits. I had already avoided wheat for years —now, more restrictions.
Early that evening Dr. Donald Abrams called. A friend for some 20 years, Abrams is chief of Hematology and Oncology at San Francisco General Hospital. I told him that Ari Baron would be my oncologist. Dr. Abrams recalled that when Dr. Baron was a resident, he had taught him how to tie a bow tie.
Dr. Abrams recommended that I add supplements: 3,000 milligrams of Vitamin D, two Ultimate Omega fish oil capsules, and two 1,000 milligram Stamets 7 mushrooms to increase my immune system He wanted to be kept up to date and offered his help throughout the oncoming struggle.
Dr. Abrams had been working closely with Andrew Weil, MD, the founder and program director of the Arizona Center for Integrative Medicine at the University of Arizona, Tucson. Dr. Weil called me on Sunday. He offered sympathy and support, and also asked to be kept up to date on my condition. I have known him as Andy for 40 years. He was a Trustee of the Fitz Hugh Ludlow Memorial Library; Mike and I had been on the board.
And so I had my Dream Team of doctors.
On the morning of January 17th I emailed Jeannie Herer —Jack’s widow— to tell her about my situation. Then I went to see Dr. Baron for the first time. He wanted me to undergo more tests to determine the stage of the cancer. He referred me to Dr. Peter Anastassiou of CPMC, who would be my surgeon.
I saw Dr. Anastassiou and found out he was the doctor who had operated on Jack Herer, when he first needed heart surgery. He was also a friend of Dr. Tom O’Connell and had taken over his practice. More synchronicity.
When I got home Jeannie Herer phoned to say that I should do the “Rick Simpson oil” —a highly concentrated cannabis extract that, taken at high doses, has reportedly had an anti-cancer effect. I had read about it but didn’t know where to get it or how to take it or —the biggest question of all— if it would work. Jeannie told me to call Valerie Corral from WAMM.
I talked to Valerie the next day and she brought me the first batch of what she calls “Milagro Oil” to a California NORML board meeting on January 21st.
On January 19th I met Dr. Charles McDonald, the head of the Pulmonary Function Lab at CPMC, who would be my pulmonologist. Michael and I supplied him with several research studies on smoking cannabis and lung function, since he would be doing an inservice training on the subject for the hospital staff. He scheduled me for a pulmonary function test and he would be doing the bronchoscopic ultrasound, which would tell us how far advanced the cancer was. He would focus on the lymph nodes.
I had the pulmonary function test on January 23rd. Dr. Anastassiou would not do surgery until he knew that the function test was satisfactory. It was.
After the January 24th PET scan, the tumor measured 30x31mm. Either the PET scan showed a better picture or the tumor was growing. The PET scan shows inflammation in the body. It lights up the parts where the inflammation is. The tumor, the lymph nodes and the colon lit up. So I had to have a colonoscopy.
McDonald did the endobronchioscopic ultrasound fine-needle aspiration biopsy on January 25th to finish determining the stage of the tumor. He said the lymph nodes were “big.”
The final diagnosis was “Stage 3A poorly differentiated non-small cell metastatic adenocarcinoma of the right lung with bulky lymph node involvement.” At least three of the lymph nodes were cancerous.
January 26th, I had an MRI to make sure that it had not spread to my brain.
I saw Dr. Anastassiou and he mentioned bulky lymph nodes. He said he wanted to take out two lobes of my right lung butthat he could not operate until the lymph nodes had been reduced in size or sterilized. I would need chemotherapy to reduce the lymph nodes.
I looked up more information on the 27th and found out that the survival rate for this adenocarcinoma is 25% in five years; but with bulky lymph nodes the five-year survival rate goes down to two-to-five percent.
I had nothing to lose by doing the oil except maybe the cancer. The oil couldn’t harm me. It would protect normal cells from damage while I was undergoing chemo. It was very scary to think that if this did not work, I might be dead by Christmas.
I needed to set a new course. A course correction. I needed to change my destiny. I did not want to die of lung cancer. I would do everything possible to restore my health: diet, chemo, acupuncture, and Cannabis oil. I knew I had a wonderful support group and a dream team of doctors.
On January 30th, I saw Ari Baron. He explained that they could not do radiation since the lymph nodes were so close to the trachea. Chemo was scheduled every three weeks for four sessions.
On February 1st, I had the last test, which was the colonoscopy. Three polyps were removed and it showed diverticulitis. I had now finished all the tests to prove I had cancer and where it was. Now I could start the oil and no one would be able to say “but you didn’t have cancer to begin with so how do we know it was the oil that worked?”
We are very lucky to live in San Francisco where many doctors know about cannabis therapy and accept it as a part of the process of treating people with cancer, AIDS and other illnesses. But —except for Donald Abrams— they had not heard about cannabis oil and its potential for healing cancer. They accepted my use of the oil but were dubious that it would get rid of the cancer. I gave them the protocols from Israel. I would show them that it did work.
The “milagro oil” that WAMM provided me with was made by distilling an extract of cannabis until it contained 63% THC. Because the psychoactive effect can be so strong, Valerie recommends that patients start with a 10:1 mixture of hempseed oil (which is nutritious but not psychoactive)and milagro oil, then go to a 5:1 mix, and finally to pure oil as THC levels in the body build up. It took me 34 days before I worked up to taking the oil undiluted.
My regimen was going to be one gram of oil a day for 60 days. I could not stand the taste of it, so I put it in gel caps.
Another knowledgable friend recommended that I use a CBD tincture if I felt anxious from the oil. I followed that advice and it did help.
With each of the ratios, I started with five drops of milagro oil in the morning and five in the evening. I then increased the pm dose to 10 drops. I then increased the am dose to 10 drops until I finished each ratio. I finished the 10:1 oil on February 17th. I finished the 5:1 oil on March 5th. I started the pure with oil that evening and woke up on the 6th with massive dry mouth. On March 25th, I started using a half of gram twice a day until I did the last oil on May 16th. Seventy-two days of using the pure oil. I did not get high at all.
WAMM’s Full Extract Cannabis Oil was made with from both Sativa and Indica plants (mostly Indica). It is made by taking cannabis —buds, leaves and small stems— and distilling it down in an enclosed container using Everclear as the solvent until it becomes a concentrated oil.February 2nd was the date of the first chemo. Michael stayed with me. I was given Alimta, Carboplatin, Avastin and a shot of Neulasta. I would sit in the chair for three or four hours with the drugs dripping into my veins.
It went well except that I was a little nauseous for a couple of days and constipated. The food had started tasting strange. I showed the nurses the Omicron vapor pen. They liked the no smell, no smoke and discreet delivery system. It could be used in hospitals.
During the second chemo session on February 24th, Diane Fornbacher stayed with me. She had come out from the East Coast to interview me about taking the oil and surviving lung cancer. The adverse effect this time was just constipation plus the strange taste of food.
I started acupuncture on February 28th at Quan Yin. SPARC, a San Francisco dispensary, provides low-cost acupuncture for patients through Quan Yin. It is drop-in on Tuesdays.
The third chemo session was on March 15th. My friend Freddie from the South Bay spent the time with me. The constipation was better but the food taste was getting hard to deal with. I did not feel well and it was hard to eat.
The fourth and last chemo was on April 5th. My friend Andie, who is a nurse, spent the time with me. This time I was nauseous for days and could not keep food down. My mouth started burning when I drank water. I finally used the vaporizer to help with the nausea. It worked.
At every chemo I tried to educate the other patients and the nurses about the oil and cannabis in general. I gave them a copy of Clint’s book for the library.
Not knowing if I was going to live or not, I started collecting Social Security. I made a will, a durable power of attorney and other medical directives.
My appetite was fine until the beginning of April. But the diet I was following on the advice of Donald Abrams was unappealing: no dairy, no sugar, no wheat, no meat, chicken only once a month and only organic. I ate a lot of fish (salmon, mainly). I ate fruit for breakfast, a salad for lunch and salmon and vegetables for dinner. It sounds okay, but when you eat the same thing every day for five months, it gets very unappetizing.
An Adverse Effect
Something happened to my mouth after the last chemo on April 5. I stopped producing enough saliva to help the food go down, plus everything tasted horrible. On the way to the Patients Out of Time conference in Tucson, even drinking water burned my mouth. The doctors at the conference told me to take Biotene. It did not help.
After I got back from Tucson, I needed to eat, so I basically threw out the diet and ate anything that I could get down my throat, which was not much. It was very important that I got all the nutrition I could so I would be ready for surgery.
It was not until the beginning of July when I went to the acupuncturist that I was able to eat again. I had been surviving on anything I could get down to my stomach (milk shakes, soups). I survived the hospital on ginger ale. I was 172 pounds when I started and now weigh 137.
I had known Congresswoman Nancy Pelosi for more than 20 years. I had seen her in early April at a political event at City Hall. I took her hands in mine and told her I had lung cancer. “Please stop the feds from taking my medicine away,” I said. I could tell that she was dismayed by my news and urged me to meet with members of her staff.
On April 16th I met with members of Pelosi’s office and urged that she take a stand against the federal intervention that was threatening my health, my recovery and my life. It may have helped that she could put a name and face on someone who would be helped by using cannabis. A week later she issued a press release calling for an end to the raids. It was the strongest statement she had ever made in support of medical cannabis. The Speaker of the House also got 73% of her fellow Democrats to vote “yes” on the Hinchey-Rohrabacher amendment to the appropriations bill that would defund DEA raids on state medical marijuana providers. One day it will pass.
On April 17th I had a CT scan. At 6 pm Ari Baron’s nurse called to say the tumor had shrunk by 50% and the lymph nodes were significantly reduced. No new disease. The doctor, she said, was “ecstatic.”
Peter Anastassiou said it was a great response to the chemo and I reminded him that I believed it was mainly from the cannabis oil. He said the key thing is the lymph nodes, which had totally regressed. He wanted to do a biopsy. If the lymph nodes were negative, he said, then we can remove the tumor. He was thinking that he might be able to remove a small section instead of removing two lobes of the right lung. I wanted to wait until I finished the oil, plus I was going to the conference in Tucson.
The pathology report from the April 17th CT scan reported “significant interval decrease in size of primary middle-lobe lung cancer with marked regression of mediastinal and right hilar lymphadenopathy suggesting response to therapy.”
The CT scan of April 17th showed a few scattered diverticula were present in the colon but no evidence to suggest divertculitis. It had disappeared. Chemo does not touch diverticulitis… it had to be the oil that healed it.
The trip to Tucson for the Patients Out of Time conference was a disaster. My mouth burned every time I drank water. I had extremely sore inner lips and mouth. I could hardly eat. I was nauseous, starving and had cramps in my intestines. I became very anxious and had several panic attacks.
I came home very depressed and just wanted to die, if I could not even eat. Linda came over when I got back and convinced me to “Not make any decisions right now, you’re in an altered state from not being able to eat.” Her advice saved my life and I was willing to be aggressive again.
On May 8th Ari said he didn’t understand why I was still having mouth problems and did not know if it was from the chemo. We scheduled a PET scan on May 10th, which would tell me if I could have surgery or not. He said the chemo drugs were long gone from my system. Anything that happened between then and surgery on May 18th could be attributed to the oil.
On May 10th I signed on to participate in a clinical trial involving stem cells that might help shrink or kill tumors. The tumorous tissue removed from my lungs would be given to the researchers.
The report on the May 10th PET scan said “Disappearance of previously described subcarinal nodal conglomerate and the right middle lobe mass has nearly completely resolved.” Dr. Anastassiou called and said “Spectacular... Active cells light up and nothing is lighting up... No tumor was visible on the PET scan.”
The lymph nodes had completely shrunk and there was “virtually complete resolution of the tumor,” which was pretty remarkable. In other words the cancer was gone.Peter could not say there was no active disease yet because of the high recurrence rate of lung cancer and a resection was warranted.
In the pre-surgery report Dr. Anastassiou wrote: “homeopathic therapies including hemp oil had putative benefit of directing apoptosis by stimulation of the cannabinoid receptors on the tumor cells.” We had learned a new word in Tucson -- apoptosis -- which means reprogramming the cancer cells to kill themselves. It’s a wonderful word for a miracle.
I finished the oil on May 16th and had the surgery on May 18th. It took three hours. Dr. Anastassiou removed six lymph nodes and the (2.5cm) remains of the tumor from the right middle lobe. The residual tumor was a thin rim surrounding a necrotic core. What was left of the tumor turned out to be dead tissue. He used VAT (video-assisted thoracoscopy), a surgical procedure that allows for a quicker recovery time since it is minimally invasive. But two ribs got broken during the process.
Even though the surgery went well, I was sicker than a dog. Thank goodness that I don’t remember much of it. I was allergic to dilaudid. I threw up for days even after they switched me to morphine. I was released on May 23rd even though I was still nauseous. That was the wrong thing to do. The pills they gave me I could not keep down. I was back in the emergency room on Friday for four bags of fluid.
They readmitted me and the next thing I remember was them asking for permission to install a stent in my heart. They thought I was having a heart attack. I wasn’t. It is called stress cardiomyopathy or Broken Heart Syndrome. They thought it was probably from all the vomiting and loss of fluid. It is reversible but it takes time. I was finally discharged on May 31st. Fourteen days in the hospital. And they sent me home with a bladder infection. So much for hospitals…
Dr. Anastassiou had visited me every day in the hospital. I finally asked him if he had gotten it all. He said yes, that I was now what they call NED (No evidence of disease). They use that terminology for lung cancer. Other cancers they say you are in remission. He had never seen lung cancer totally eradicated by chemo, much less in four months. I assume cannabis oil was the factor that made the difference.
It has been a long road back. The hardest part of the whole process was the restricted diet. For weeks I experienced sweats and the chills that alternated all day long. The whole month of June was spent getting my system back to functioning normally. Finally, after acupuncture treatment on July 2nd, I wanted to eat. At that point I decided to eat anything I could. This gave me enough energy to be able to walk. I started with four blocks in 10 minutes. By mid-July I was up to 12 blocks in 27 minutes. When I told my story of illness and healing at the Women’s Visionary Conference on July 28 I was still weak and lacking stamina, but getting better day by day.
I cannot say that I am cured (at least so the doctors don’t get all their feathers ruffled) until I am disease-free for five years. So I say that I have been “healed by the milagro oil.” I do not need more chemo since there is nothing left for the chemo to work on.
Michael says that this is a magic plant. It counters cancer and if it was the flowers of a petunia plant that killed cancer it would be all over the front pages of newspapers round the world. But this is cannabis, which the government maintains there is no medical use for (no matter what the science says). I believe I have proved them wrong.
My cancer was healed by a combination of milagro oil, chemotherapy, healthy diet, acupuncture, brilliant, empathetic doctors, and loving support from many friends. I am truly blessed.
I want to thank my husband, Michael for being there through all the ups and downs of this journey. He has been my support, my scribe, my driver, my cook and of course the love of my life.
I truly believe that if it wasn’t for Valerie and the oil I would not be alive today.
Every day I read about people dying of cancer and I know I was able to heal my body of cancer. Why is this health-giving plant not available to everyone? People should not have to go through the suffering that cancer brings. We need to get this information out to the world.
Cannabis is a healing plant and can even heal cancer if we let it.
This article first appeared in the Winter/Spring 2013 O’Shaughnessy’s. Aldrich reports that her recent check-ups attest to a continuing recovery.
Paul Stanford, 52, is the author and prime mover behind Oregon’s marijuana legalization initiative, Measure 80, which garnered 47% of the vote.
“We came close,” he said when I called to offer condolences a few days after the election/ He did not sound downhearted. “We won Portland by over 60 percent," he said. “Here’s an amazing thing: the day after the election the Oregonian, which had opposed us and called us all kinds of names, ran an editorial arguing that the legislature should now legalize and regulate marijuana!”
The billionaires Back East who put about $5 million into successful initiatives in Colorado and Washington state did not contribute to the Oregon legalization effort. Stanford had implored them for help, to no avail. “If we’d had a half million dollars of outside support for advertising, we’d have won,” he says matter-of-factly.
He wound up providing almost all the money himself—about $400,000 for the signature drive that put Measure B on the ballot and $300,000 for a skeleton campaign staff, literature and ads. Stanford runs a chain of clinics, the Hemp and Cannabis Foundation (THCF), at which doctors confirm that patients qualify to use cannabis as medicine under state law. The patients are pre-screened by staff and must have documentation of their qualifying diagnoses. THCF operates in Oregon, Washington, Hawaii, Colorado, Michigan, Nevada and Rhode Island. Stanford, who spends a lot of time in airplanes, is setting up an office in Massachusetts, where passed a medical marijuana law on Nov. 6. His detractors imply that he has made much more money than he spent on Measure 80. I suspect they’re wrong but I hope they’re right.
Stanford’s friends and staff are working class, his wife works, their three kids go to public school, they rent a modest house in a not-very-classy section of Portland. His business would have suffered in Oregon had Measure 80 passed —people would no longer have needed a doctor’s authorization and a license from the state to obtain marijuana— but Stanford undoubtedly would have adapted with a new business model. Legalization has been his political goal for more than 30 years. He said the wording of Measure 80 was “draft number 90-something” of the magnum-opus leaflet he has been fine-tuning for years. (He has a role model when it comes to rewriting. The late Jack Herer was staying at Stanford’s Portland apartment in the mid-1980s when he produced the first draft of The Emperor Wears No Clothes.)
“I applaud the success of Colorado’s and Washington’s legalization initiatives,” Stanford said. He thinks the new law in Washington might inspire the Oregon legislature to act. The Nov. 7 Oregonian editorial acknowledged that there would soon be “a dependable supply of legally obtainable pot available within a short drive of downtown Portland,” adding, “We’re going to need a new bridge, pronto.” (Knowing that marijuana is not a dangerous drug and eager to signal their own hipness, journalists frequently make light of the subject.)
The Oregonian went on: “Assuming everything goes as planned, Washington’s liquor control board will adopt rules by the end of 2013 for the licensing of marijuana producers, processors and retailers. Marijuana stores will proliferate and people 21 and older will be able to buy up to an ounce at a time. Because Oregonians will be free to buy Washington pot, many will, and they’ll drive it right back into Oregon… Our neighbor to the north will collect millions of dollars in new ‘sin’ taxes, with much of the money coming from Oregonians who’d be happy to keep their business and taxes in state if given the opportunity.”
The editorialists anticipate another ballot initiative from Paul Stanford and suggest that the legislature beat him to the punch. “Lawmakers could refer a better proposal to the ballot, then wash their hands of it. [sic.] This would allow elected officials to draw up something that safeguards the state and the public to the greatest extent possible and establishes favorable tax rates for marijuana.”
One aspect of Washington’s new law that Stanford does not want to see imported into Oregon is the “per se” definition of impaired driving —a blood level exceeding 5 nanograms per milliliter THC. Starting December 6, 2012, drivers suspected of impairment by a police officer in the state of Washington will be forced to submit to a blood test or else give up their licenses for a year. Driving with a blood level of more than five nanograms THC per milliliter of blood will constitute a DUI drugs offense. Those under 21 will be guilty if found to have any THC in their blood while driving.
The science linking 5 nanograms THC per /milliliter of blood to impaired driving ability is dubious, and the punishment seems very severe. It will create blatant inequality under the law because the amount of time THC remains in the body depends on body fat, which varies from person to person. (Women typically have about 30% more than men.) Defense lawyers will challenge the per se definition of impairment on various grounds, but if the courts uphold it, countless lives will be badly disrupted in the name of “legalization.” Stanford says, “I don’t know why they put the DUI limit it in there. I don’t think they needed it. Look at how close we came without it.”
I-502 had been drafted by professional campaign consultants hired by Ethan Nadelmann of the Drug Policy Alliance and Graham Boyd of the American Civil Liberties Union, who are funded by George Soros and Peter Lewis, “progressive billionaires” based Back East. The leader of the campaign in Seattle was ACLU attorney Allison Holcomb. A prominent supporter was Rick Steves, the well liked travel advocate. Steves made a $50,000 contribution to the I-502 campaign, which helped shield Team Soros from any carpetbagger charge. (George Zimmer of the Fremont-based Men’s Warehouse had made a similar contribution in 1996 when Soros backed Prop 215 in California. I guarantee it.)
A group called Sensible Washington had drafted a more liberal legalization measure, but without money for a signature drive, failed to make the ballot. Many Sensible Washington backers, including Seattle Hempfest organizer Vivian Mc Peak, lawyers Jeffrey Steinborn and Doug Hiatt, and journalist Steve Elliott, called for a “no” vote on I-502. They saw the inclusion of a “per se” DUI based on a blood test as an affront and a threat —especially the zero tolerance for drivers under 21.
The day after the election Sensible Washington’s Anthony Martinelli sent out a warning:
We urge individuals to take extra precaution, because this limit has nothing to do with impairment. Probable cause is at the discretion of the officer, and there’s only so much you can do to avoid getting a DUID under this provision. Consider taking these extra steps before driving:
â–ª Never drive with a cannabis-friendly bumper sticker
â–ª Do a quick inspection of your vehicle, making sure there are no obvious problems, like broken taillights.
â–ª Make sure that you do not smell like cannabis when you leave the home –use deodorant, perfume, etc., even if you haven’t smoked in hours. The slightest scent could give the officer reason to test your blood, and to assume you’ll be above the five —or, if you’re under 21, zero— ng/ml limits.
â–ª Be cautious when driving with any amount of cannabis on your person, even if it’s under an ounce. Possessing even a gram is enough probable cause for an officer to search you, and test your blood.
â–ª Understand that even if you consumed cannabis days ago, you may not be safe, and should take these precautions. Active THC lingers in the body for days, and we have no home test for individuals to determine if they’re below 5ng/ml before they drive.
Sensible Washington will work vigorously on making a change to this policy. The Legislature can’t alter it with a majority vote for two years (though they can with a two-thirds majority vote), but we will lobby our state’s house and senate to try and build support for a repeal of this mandate.
The Washington state legislature has more than a year to work out the mechanics of production and distribution through a network of state-run stores. The right to possess an ounce or less of marijuana takes effect December 6 of this year, as does per se DUI. Prosecutors in several counties dropped misdemeanor possession the day after the election. Alison Holcomb told the media she was “incredibly moved” by the gesture and that it took “incredible courage.” Lawrence O’Donnell quoted her approvingly on MSNBC on Wednesday, Nov. 14.
The next night MSNBC’s Rachel Maddow displayed and read aloud tidbits from a webpage the Seattle Police Department had created to answer questions concerning I-502. The subtext of all this love from MSNBC is that the system works after all, democracy abides. Rachel made no reference to the role that money played in getting a law passed in Washington and a law tripped up in Oregon.
How many people who obtain perfectly manicured buds from a dispensary consider the steps involved in its preparation? They may give some thought to the role of the grower, but who thinks about the trim crew?
People come from all over the world to trim cannabis during the harvest season in California. Between early October and mid-November they swell the population of Mendocino, Humboldt, and other counties. Many others work on indoor grows year round, all over the state.
There are young adults —high school drop-outs and college graduates— looking for work. There are local moms clipping to help pay the bills. There are Mexican families who come every year from down south. Trimmers come from all walks of life. You find yourself taking part in interesting conversations —a good fringe benefit.
Cultivators generally want workers they are acquainted with, who have trimmed before, and are trustworthy. Training someone new takes time, and the novices tend to work slowly at first.
The amenities of a trim job for an outdoor harvest are varied. Sometimes the trimming is done deep in the woods. A person will be sleeping in a tent with an outdoor toilet. Other times there are more plush accommodations, with guest houses, electricity and plumbing. Growers generally pay for the trimmers’ food and caffeine. They want a productive workforce.
A trimmer will usually be tight-lipped about the details of their employment. In October, my friends simply know that I am “up north.”
During the last month or so of a plant’s development, growers remove the big “fan leaves” as they begin turning yellow. This exposes the lower buds to the sunlight.
When the grower decides plants are ready to harvest —usually when the white hairs on the buds are turning red— they are cut down and either branches are lopped off to be trimmed immediately, or the whole plant is hung upside-down to dry in a cool, dark space for a week or so of curing.
As the plant dries, the remaining leaves wrap themselves around the buds and cling to the resinous trichomes. It is the trimmer’s job to cut these small leaves away with a small, sharp scissors —exposing the flowering top, which is covered with the beautiful crystals we know and love.
Strains are trimmed in different ways, depending on the structure of the colas and the intentions of the grower. For example, the Afgooey strain is very leafy, but the leaves are generally covered in crystals. If the product is intended for the medical market, the trimming technique needs to be altered to keep some of the larger, crystallized leaves.
The idea is to retain as much of the flower as possible. “Mowing” the weed makes trimming faster but is wasteful because it cuts off trichome-rich parts of the flower. Mowing also makes the buds look too uniform.
Wet and Dry Trimming
There are two methods of trimming: wet and dry. When you trim dried flowers, you are generally paid by the weight of finished product. The going rate in the fall of 2010 was $200 per pound.
A few years ago, when growers could sell a pound of manicured, high-grade sinsemilla for $4,000, trimmers were typically paid $250/lb. or more. Our labor was in such high demand that growers hired caterers and massage therapists to enhance the working conditions.
Increased cannabis cultivation in recent years has cut the wholesale price of pounds sold in California by about 50 percent, and most growers cite this as grounds for cutting the wages of trimmers.
When you do a dry trim, workers are given either a small branch with buds or individual buds to snip. Usually the first step is to “buck” the plant. This means cutting off the buds from the larger stalk and separating the small fluffy buds from the larger, denser ones.
Next the larger buds get what some call a “haircut.” The leaves are trimmed off to shape the bud and reveal the flower. The portion of the leaf that connects to the stem, the petiole, also needs to be clipped off. Some people call these “crow’s feet” or “crow’s toes,” because of their W-shape. The last step is to cut the stem of the finished nug as small as possible. If you cut it too close, a budlet may break off and you have to reshape the bud.
The finished product is placed in an unsealed turkey-roasting bag to be cured.
A wet trim will pay you by the hour. The going rate in 2010 was $20/hour. The process starts as soon as the grower cuts down their plants. The cannabis is brought to the trimmers still on the main branches. Workers trim the buds right while it is still on the branch. You need not cut the leaves as close as you would in a dry trim because they will shrink when they dry. The finished flowers are then dried, hung up (still on the branch), or on screens that allow air to circulate around them. When dry, leaves that were missed in the first go-around are clipped off.
Cannabis grown outdoors usually get dry-trimmed and indoor plants wet-trimmed. It’s up to the growers. If they want to move their product as soon as possible, then they will do a wet trim.
One advantage of dry trimming is that the work can be rationed out over time. Growers can decide to trim part of their crop and save the rest to trim later (after they’ve generated some cash flow). Another advantage: dry-trimmed cannabis is ready to be used immediately.
Some say that a wet trim, because it involves less handling of the flowers, results in a better final product.
Wet trimming happens year round, and is generally done in an extremely busy couple of days. You sit for hours in a chair, scissors in hand, using the same repetitive motion. You are fed and provided caffeine to keep you going.
The last trim gig I had took two intense days. The grower who oversaw it had a room in the house, but never stayed there. The two residents (who had done most of the work during the growing cycle) left each morning for professional jobs in the city, while 13 temps in their basement finished off 50 plants.
A wet trim is advantageous for a worker who doesn’t go very fast because you are paid by the hour, not the amount you finish. Also, it appears that wet-trimming is less likely to trigger allergic reactions.
Last season, a friend and I were both coughing and wheezing during a dry trim, and we assumed we had caught the same “bug.” My friend, who was sleeping where the cannabis was drying, was more symptomatic. As soon as we left the job site, our symptoms disappeared.
Reactions like ours are not uncommon, and a serious, scientific study of “cannabis allergies” might yield some interesting results. According to activist/author Ed Rosenthal, “I have received hundreds of letters over the years from people who were experienced users and then developed an allergy. These include wheezing and choked throat, extreme eye dryness or tearing, panic attacks, headaches and sweating.”
The cult of the nug
In medical cannabis dispensaries, well-trimmed, seedless buds are the norm. But back in the mid-1960s, the herb smuggled into the United States from Mexico, Colombia, and Southeast Asia, was leafy and full of seeds. California sinsemilla, marketed in the late 1970s, was manicured, but not very meticulously. An old-timer of my acquaintance says, “Growers used to want to show off the size of their colas. The current emphasis on perfectly manicured ‘nugs’ is coming from the dispensaries. They call it ‘bag appeal.’”
Undoubtedly, trimming is now considered an essential part of the cannabis production process, and the snipped leaves and budlets are being put to good use making tinctures and edibles.
It is the growers (and the consumers) who bear the expense. Some profit-minded growers invest in $15,000 mechanical trimmers so that they won’t have to pay a crew. These entrepreneurs may refer to cannabis as “the sacred herb,” but they really see it as just another commodity to be sold for maximum profit.
The website for a machine called “The Twister,” claims that it “will slash the number of workers you’ll need to harvest your crops while also dramatically reducing the overall time you spend harvesting. Fewer workers to manage over a shorter harvest time makes your job easier and less stressful, and saves you time and money —all without sacrificing quality.”
An East Bay chef compares the mechanical trimmers to Cuisinarts. “You can Cuisinart an onion,” she observes, “but it’ll never taste the same as an onion chopped with a knife. The machine heats the onion and releases some of the volatile flavor elements. If you want a really good gespacho, you do it with a knife, not a blender.”
As you would expect in any workforce, there is a wide spectrum of competence and commitment. Some people prefer to show up, do their work, get paid, and go home. They’re likely to be ripping through their second pound while others are shooting the breeze and going out to have another smoke break. Their focus is on making good money in a short amount of time, and growers tend to notice, appreciate, and re-hire them.
To others, cannabis means “party.” Trimming can be fun. You are essentially hanging out, chatting with people, listening to music, looking at beautiful buds, and sampling their effects. The free-lance nature of the work enables people to pursue other interests.
Working a trim job will send you to some odd locations. “The strangest trimming experience I had,” says Mamiya, 24, was going to a house in Oakland to wet trim for two days. I walked into the house and took a deep breath in anticipation of smelling that lovely skunky smell... Strangely, it wasn’t present.”
She was led “to this little hole in the floor no bigger than the size of a bed pillow. A whoosh of odor crept up from the floor boards. He ushered me down into the pit I thought I would never return from. I found unstable footing on some lopsided sand bags and managed to find my footing on the ground. I stood up only to find my head touching the ceiling.
“As I looked around, I saw about 15 people crouched down trimming stalks of herb perched on sand bags. I later found out that the many sand bags which were being used as seats, stairs, backrests, and tables had been filled with hand-dug dirt from that very basement to create three large grow rooms.
In that environment she trimmed for 21 hours in two days.
Unless one has a longstanding relationship with established growers, trimming work may be inconsistent. One might be employed for many days consecutively, then there might be nothing going on for weeks. Ideally, you get paid for the work you do at the end of each day. However, I have experienced lags in payment, and once I was paid with counterfeit bills.
Trimming for an entire outdoor season or even a lengthy indoor job can leave you burnt out. I sometimes think, “I don’t want to look at trimming scissors or plastic trash bags ever again.” You get very zoned out, looking at the bud for hours. Your eyes close and you can still see the green, crystalline leaves. You sit working for as long as you can tolerate it. If you get distracted and get up, you are losing precious time that you could be working. Trimmers sometimes won’t get up to eat because they are “in the zone.”
Another downside is the air of paranoia, which varies depending on where you are working and how much “weight” is on the premises. Even if you are employed by a grower associated with a medical dispensary, even if there is paperwork confirming that the cannabis is intended for bona fide patients, there is always the chance of getting busted.
It is said that trimmers often get off easily when an operation is discovered by law enforcement. However, being raided at gunpoint and detained —even if you are then released— is not something one wants to go through. What database would your name show up on in the future?
Trimming is now an essential component of the cannabis industry. The work we do may be taken for granted, but it shouldn’t be. Next time you find yourself in possession of some beautiful, glistening cannabis flowers, thank the provider, thank the cultivator... and thank the trimmer.
Copyright 2012 by O’Shaughnessy’s. All rights reserved. Address reprint requests to firstname.lastname@example.org.
Like other oil seeds, the hemp nut consists mainly of oil (typically 44%), protein (33%) and dietary fiber and other carbohydrates (12%, predominantly from residues of the hull). In addition, the nut contains vitamins (particularly the tocopherols and tocotrienols of the Vitamin E complex), phytosterols and trace minerals.
Overall, hemp’s main nutritional advantage over other seeds lies in the composition of its oil, i.e. its fatty acid profile, and in its protein which contains all of the essential amino acids in nutritionally significant amounts and in a desirable ratio.
Most oil seeds contain plenty of linoleic acid (LA), an essential fatty acid (EFA) from the “omega-6” family, yet they offer little alpha-linolenic acid (ALA), the other EFA from the “omega- 3” family.
Health agencies around the world agree that humans should ingest these EFAs in an omega-6/omega-3 ratio of about 4:1. Since common seed oil and animal fat, both low in omega-3, account for most of our fat intake, Western diets typically have omega-6/omega-3 ratios of 10:1 or more, which is far too rich in omega-6 and correspondingly too deficient in omega-3.
Recent clinical research continues to identify this imbalance as a co-factor in a wide range of common illnesses, including cardiovascular diseases, arthritis, diabetes, skin and mood disorders. A 1999 workshop by the U.S. National Institute of Health demonstrated the impressive benefits of a balanced omega-6/omega-3 ratio in our diet: reduced risk of atherosclerosis, sudden cardiac death and certain types of cancers, decrease in the symptoms of rheumatoid arthritis, mood improvement in bipolar disorders and optimized development in infants.1
In clinical studies, these benefits are often achieved using omega 3-rich fish and flax oil supplements. A more “holistic” approach consists of shifting our general dietary fat intake towards nuts and oils offering a better omega-6/omega-3 ratio. Hemp nut and oil offer an omega- 6/omega-3 ratio of 3:1 or less, depending on plant variety. This exceeds the target ratio of 4:1 and compensates in part for omega-3 deficiencies in the rest of our diet. No other vegetable oil offers EFAs at such high concentrations and, more importantly, in such a desirable omega-6/omega-3 ratio.
Hemp oil also provides significant amounts of the more rare ‘super’ polyunsaturated fatty acids, notably gamma-linolenic acid (GLA) and stearidonic acid (SDA). These are not essential themselves, but our body only naturally produces them from the LA and ALA essential fatty acids, respectively.
Supplementation with GLA and SDA appears to alleviate the symptoms of atopic dermatitis and other skin diseases in some patients. Clinical trials of the putative benefits from ingested hemp oil are currently under way at the University of Kuopio in Finland to assess the extent of these potential benefits. GLA and SDA content in hemp seed vary considerably with variety and this needs to be considered when using hemp oil to treat such symptoms.
Hemp oil typically contains less than 10% saturated fatty acids, and no trans-fatty acids, which are particularly detrimental to our blood cholesterol balance. To avoid conversion of polyunsaturated fatty acids to unhealthy peroxides at higher temperatures, hemp oil and nut are best used for cold and warm dishes where temperature is kept below the boiling point (212° F). Hemp oil should not be used for frying. When using it for light sautÃ©ing, keeping the pan at low heat and with sufficient moisture in the bottom limits both temperature and the formation of peroxides and off-flavors. Hemp nut can be lightly toasted and baked in bread and pastry dough keeping in mind these temperature and moisture caveats.
Hemp protein is also of exceptionally high quality in terms of amino acid composition and protein structure, the latter affecting digestibility and utilization by the human body. Hemp protein contains all of the essential amino acids in more nutritionally significant amounts and at a ratio closer to “complete” sources of protein (like meat, milk and eggs) than all other oil seeds except soy.
Hemp protein consists of two globular proteins, albumin (33%) and edestine (67%), with a structure very similar to proteins manufactured in our blood, and is thus readily digestible. Hemp protein appears to be free of antinutrients that are found in soy to interfere with protein uptake. So, eating hemp seed or nuts delivers protein with a favorable amino-acid composition and in a structure readily utilized.
Hemp’s nutritional advantage over other sources of fats and protein thus lies in its highly desirable balance of basic nutrients. Simply put, when eating hemp seed, nut and/or oil, our body obtains much of what it needs without the caloric ballast of non-essential nutrients. Yet, unlike fish and flax oil supplements and assorted protein powders, properly processed hemp seed offers these benefits with the additional bonus of a nice flavor profile —hemp tastes good. Fresh, cold-pressed hemp oil and hemp nut, particularly when toasted, add a nice nutty flavor to many dishes and packaged food products.
Unfortunately...The U.S Drug Enforcement Administration continues to cite drug-test-interference problems from the mid-1990s as grounds to curtail the legitimate hemp industry. The DEA has not attacked poppy-seed bagel makers for promoting opium use, despite the fact that poppy seeds come from the same plant species as does opium, and contain trace opiates which could interfere with narcotics drug testing. The U.S. government has also not harassed fruit juice companies regarding trace alcohol in juice present through natural fermentation.
The DEA should concern itself with dangerous drugs. It would make much more sense for the Department of Agriculture to develop and implement reasonable hemp regulations.
Cannabis use by children and teens raises a specter which has long been exploited by opponents of the herb: the nation’s youth seduced into drug dependence, depravity, and slackerdom by a dangerous substance whose use leads inevitably to addiction and harder drugs.
Could it be that many teen cannabis users are simply self-medicating to alleviate undiagnosed anxiety and depression? The prevalence of depression, anxiety and other forms of stress in teens may be considerably greater than is commonly understood. A National Youth Violence Prevention Center survey revealed that 20% of teens had thought about suicide within the past year.
As Tom O’Connell, MD, has pointed out, self-medicating with cannabis for anxiety and depression can be a safer alternative to use of nicotine, alcohol, cocaine, heroin, and other drugs. There are a number of conditions with significant incidence in children and teens—notably asthma, ADD/ADHD, and auto-immune disease—that are amenable to treatment by cannabis. Unfortunately, given the intensity of the political and emotional charge surrounding this issue, the necessary research cannot be carried out.
Joanie: A Teen with Pain
Joanie was 19 when I met her in a clinic. She had been using cannabis for four years. Her mother accompanied her to the clinic, and was obviously very supportive of her use, and positive about what she agreed were dramatic benefits Joanie had experienced. As her story unfolded, I felt a widening disconnect between Joanie’s obvious poise and intelligence, and the severe problems she had overcome. She was an achiever and a survivor, and far from holding her back in any way, cannabis use had apparently been critically important in facilitating her reemergence from years of physical, mental, and emotional debility.
Joanie: I broke my leg in a skiing accident when I was 13. They put in a rod, and they had to take out my kneecap to do it.
Dr. M: What kind of pain meds did you use?
Joanie: I was in constant pain, and they put me on Vicodin. It made me sick to my stomach. I was vomiting every day, every time I took it. Celebrex also hurt my stomach.
Dr. M: How did all this affect you mentally?
Joanie: I got depressed, and they put me on antidepressants; Pamelor first, when I was 14. It didn’t work, and every time I saw a doctor they were trying a new antidepressant medication, or changing the dose. I can’t tell how many antidepressants I tried. None of them worked, they all made me worse. They didn’t know what to label me; bipolar, or whatever. They had me on antipsychotic drugs, which also made me worse.
When I was 15 I had another surgery, because the rod in my leg had got stuck as I grew, and caused nerve damage. The pain was constant, and the next drug I tried was Darvocet. I took that for a year, and it gave me terrible rebound headaches. I had had migraines since I was 13, and the Darvocet made them way worse.
Then, when I was 16, I got rear-ended by a big truck while I was waiting to make a left turn. The whole back of my car was crunched right up, practically to the back of my head. I had a whiplash injury. When they did the MRI of my spine, they discovered I had scoliosis.
Dr. M: How and when did you discover cannabis?
Joanie: I tried it at school with friends, when I was 15.
Dr. M: Recreationally, or did you think it might help with the pain?
Joanie: I knew it was legal medically in California, but I was just trying it with friends. But I could tell instantly that it made me feel a lot better: it took my mind off the pain, and made me less depressed.
Dr. M: And did you start using regularly right away?
Joanie: No, only occasionally, for the next few years. I would get it from friends a couple times every week.
Dr. M: What happened with school during those years?
Joanie: Well, l could have done better if I hadn’t been so depressed and in so much pain. The fluorescent lights gave me a headache every day, so I had really poor attendance. For a two-year period I never made it to a full week of school because of the headaches and medication side effects. Finally, I sort of gave up on the kind of academic pre-college program I had been working on, and went to culinary school at the Skills Center. I couldn’t do school work or study, but I figured it was okay to be in the kitchen.
Dr. M: How did that work out?
Joanie: Not too well. The teachers were sending me to the office all the time because of the way the antidepressants and antipsychotics were making me act. They thought I was on drugs, which I was.
Dr. M: So, when did you start using cannabis regularly?
Joanie: When I was 18.
Dr. M: And how has that helped?
Joanie: Well, you could call it a complete turnaround, I guess. First, I figured out that what I had been getting from my friends was not good quality, so when it became legal and I got my card I started growing my own much, much better stuff. I smoke it every day—my vaporizer broke—and I’m back in school. I have a double major now, in French and Linguistics. I have a 3.88 GPA in my junior year, and am doing very well, thanks to the cannabis. I also make an arthritis balm with olive oil and beeswax, and put it on my knees and my back.
Dr. M: Do you still take any prescription medications?
Joanie: I take Fiorcet, because the lights at school still give me headaches. Fiorcet takes the pain down to where I can function, and when I get home in the evening, the cannabis takes it away completely. I’m off the antidepressants and psych drugs completely.
Dr. M: What is your parents’ attitude towards your use of cannabis?
Joanie: Oh, totally supportive. My father is a builder, and he has back pain. We smoke together. My mother gets too spaced out from it, so she just uses the topical butter for her back pain. They are both just very happy to know that I am doing better, and functioning again, after seeing me on so many pills for years, and not wanting to get out of bed. Even my grandma is so happy to see me back in school. But she doesn’t know about the pot!
Dr. M: Do you have many friends who medicate too?
Joanie: Not too many. There have been so many raids around here lately that I keep pretty quiet. But I keep in touch with a few people about their grows, and different strains we try out.
Jack: Pediatric Diabetes and ADHD
Jack is a seven-year-old boy with type-I diabetes and ADHD who was brought to the clinic one recent afternoon by his mother. Michigan requires two physician certification signatures for children under 18. The family had already gotten one from another doctor —not one of Jack’s personal physicians—so it was my call about his card.
I had previously certified one kid this young (see next case). But I had encountered dozens of older patients who had been helped by cannabis with their attention deficit problems. ADD is not a qualifying condition in Michigan, so my learning about this benefit was often accidental, especially if a patient had been able to drop his Ritalin or other stimulant once on cannabis. I felt that I had a solid base of clinical experience to support that many people with ADD and ADHD did indeed get a real benefit from cannabis.
My mental trump card was the YouTube video that I had gone back to view repeatedly of the late Claudia Jensen, MD, being interviewed by Keith Olberman. Jensen’s patients included teenagers who had used cannabis for ADD with dramatic success. She said the reason she had become an enthusiast for cannabis therapy was that she listened to what her patients had to tell her.
Jack was a blond kid, small for his age, and on his best behavior for the visit. His mother, Laura, provided clear documentation of his problems: ADHD as well as type I diabetes, with nausea (which is a qualifying condition). She said he was having significant behavior issues in school as well as at home.
“In for a dime, in for a dollar,” I was thinking as I signed the cert paper.
I called Laura about six weeks later for a progress report.
Laura: Well, he’s not having any more trouble in school, and he has a much better attitude at home. The teachers have all noticed the difference, and say he is paying much better attention now. Before the medicine change, we were getting calls every day, and he was being kicked out of school all the time. They said he was talking back, and always arguing with everybody. I’m still calling someone at school almost every day, and they are very positive. It had been iffy about Jack passing this grade, but now it looks like he will advance for sure.
Dr. M: How about his written work?
Laura: Well, now I now can read his writing, whereas before it was mostly scribbles. And his spelling, which was not even remotely close to correct, is better. His work is actually better than his older sister’s now, which has never been the case.
Dr. M: Tell me about his medicine.
Laura: We are making “medibles” for him, in the morning before school, and in the evening. He gets a little drop of the Simpson oil, that I scoop up with a toothpick. It’s about the size of one of those large pinheads. He takes it with peanut butter, and generally doesn’t notice the taste.
Dr. M: Where did you get the idea for Simpson oil?
Laura: From the Run from the Cure videos on the internet.
Dr. M: Did somebody treat for ADD in that video?
Laura: No, for diabetes. Several people had improvements.
Dr. M: So your original idea was to treat Jack’s nausea from the diabetes, not so much the ADHD?
Laura: That’s right.
Dr. M: Has there been any change in his sugars?
Laura: Yes, a big change. He is testing now even lower than his target, which is 200. He has been in the low hundreds, and sometimes lower. Before the cannabis, he was in the two- and three-hundreds.
[Cannabis has been shown to reduce inflammation in the pancreas, and improve control of blood sugar. Sugars in the low one-hundreds in a type-one diabetic would indicate very good control.]
Dr. M: Wow! That’s remarkable.When does he see the endocrinologist again, and what are you going to tell him?.
Laura: Next month. The sugar readings are all there in his meter. We’ll cross that bridge when we come to it.
Dr. M: What strain of pot is he getting?
Laura: White Widow.
Dr. M: How about the pediatrician who prescribed the Ritalin?
Laura: I think I can level with him. We don’t have a scheduled appointment, we just go in when there is a problem.
Dr. M: Wasn’t he getting some benefit from Ritalin?
Laura: No, he was not controlled at all. That medicine did nothing for him and even made him worse, in every possible way. He was always complaining that it made his stomach hurt, but he took it anyway because he knew it was supposed to help him. But it didn’t. Plus, he had zero appetite. He could never gain weight. We had to try to force foods into him. Now he is gaining weight and asking for seconds. The new clothing I bought for him just after Christmas, three months ago, is all too small now.
Dr. M: What about at home? How is Jack feeling about himself and this new medicine?
Laura: He is happier, and very much aware that this medicine is helping him. He goes to bed with no hassle. He’s even reading to me from a book, where it used to be a battle to get him to just lie down. And getting up in the morning is no longer the struggle it was. Oh, and his headaches are gone now. He was having them two or three times per week, coming home from school and having to sleep for hours.
Dr. M: I want to keep in touch, and see you in the office in a month or so. Is there anything else you want to add?
Laura: Yes. After one week on the cannabis, Jack said to me, “Mom, I want to flush those old pills down the toilet.”
So that’s just what we did.
Nikki: Brain Cancer
Nikki was the first child patient I certified. I saw her in April of 2009, soon after she finished more than a year of chemotherapy for a brain tumor.
“A polycystic astrocytoma,” her mother Jane told me. Her father Joe was there, too.
Nikki was bony, blond, with thin, fly-away hair. She was a little distracted, but smiling appropriately. Her left eye didn’t track properly. Her mother did most of the talking about her history.
Jane: The problem started in January of 2008. I went to wake her up one morning when she was three years old, and she looked like somebody who’d had a stroke; wasn’t using her left side, and her face was drooping. We called the ambulance, and at the hospital they did a CT scan, and sent her straight to the university in Ann Arbor. They did more scans there, and found the tumor. It was too big to remove completely, so four days later they did a debulking surgery, and she started the chemo in February. She went four weeks on and two weeks off all year, and just finished recently. It was carboplatin and vincristine originally, but she went totally blind for three weeks, so they stopped the vincristine. She’s still blind on the left.
Dr. M: How did she tolerate the chemo?
Jane: It made her sick some days, but not deathly ill. She was always tired, and passed out once at a session. After that they let her quit early.
Dr. M: And what about the behavior problems?
Jane: Well I think the root of it all was that she couldn’t sleep. She would go days without sleeping, and then just crash wherever she was, always for four hours. Then she’d wake up, and the whole thing would start all over again. We had her grandparents staying over some nights so her father and I could get some sleep. “I can’t sleep, Mom,” she’d tell me. I think that was 90 percent of the problem. She was just miserable and mad at the world, because she was so tired all the time.
Dr. M: What kind of behavior problems were there?
Jane: She became really angry, and wouldn’t share anything with other kids. She didn’t want to play with them, or even be around the dogs and cats. She would scream at her sister, “Leave me alone,” and “Get out of my room.” She lost her appetite, and would tell us she wasn’t hungry when we tried to get her to eat. She also had a hypersensitivity to noise, and couldn’t stand the radio in the car when we went out.
Dr. M: What about school?
Jane: We tried kindergarten, but she puked on the third day, and with the way she was acting, the principal said she wasn’t ready for school, so we pulled her out.
Dr. M: How has her use of cannabis changed things?
Jane: Well, basically she’s a happy little girl again. She’s back in school and has lots of friends. She’s big into hugs, hugs everybody now.
Dr. M: Tell us about the way you use the medicine
Jane: She uses the Simpson oil, at bedtime every night. We mix up a quarter teaspoon of the oil into a half cup of peanut butter. I microwave it to soften it up. She gets a half teaspoon of that mix every night, a little before bed. She sleeps from 8:30 at night to 6:30 in the morning, and gets up to go to school, and does fine all day.
Dr. M: Does anybody know she’s using cannabis?
Jane: We haven’t said anything to the teachers. The oncologist knows. His staff told us “Just keep doing what you are doing.” The brain scans have been stable now for a year, with some suggestion on the last one that the tumor may even be shrinking. She got scans every four months for a year, but now she’s going to a six-month schedule. All of her blood work has also been good.
Dr. M: And are there other doctors she sees?
Jane: We don’t see the pediatrician much, because she hasn’t been sick. I don’t know if it’s the oil, but she never gets colds, or sore throats, or earaches. We did not tell the psychologist. We have a home counselor, and she knows, but hasn’t said anything to the psychologist or anybody else. After we started the oil treatment she noticed the improvement immediately. She said, “What have you done with this child? She is so much better!” I was afraid of having complications, and I said “Nothing,” but then I came clean about it the next time she asked. She has been really helpful in keeping it quiet. I am nervous about having problems. My little girl doesn’t need that.
Dr. M: How is Nikki doing in school?
Jane: She is doing really well. She’s in kindergarten, a year behind for her age, but doing well with numbers and letters, and she can write her name. She’s legally blind, but she can read the large print books they have for her. Her behavior is so much better, but if I hold the Simpson oil for even one day, Nikki can’t sleep, and goes back to her same problems. I have tried not giving it several times on weekends, and the sleeplessness and irritability come back right away.
Copyright 2012 by O'Shaughnessy's. All rights reserved. Direct reprint requests to email@example.com
Those Pungent Smells Oozing Out of Marijuana Buds Are Actually Giving You Clues About What Their Effects Will Be Like
Scientists are now formally acknowledging something that Cannabis consumers have long taken for granted: aroma is associated with effect.
Plant cannabinoids —21-carbon molecules found only in Cannabis— are odorless. It’s the terpenoids —components of the plant’s “essential oils”— that create the fragrance. Terpenoids contain repeating units of a 5-carbon molecule called isoprene and are prevalent in smelly herbs such as mints and sage, citrus peel, some flowers, aromatic barks and woods.
The aroma of a given plant depends on which terpenoids predominate. They tend to be volatile molecules that readily evaporate, and they’re very potent —all it takes is a few reaching the nose to announce their presence.
Evidence that “phytocannabinoid-terpenoid interactions” enhance the therapeutic effects of cannabis was presented by Ethan Russo, MD, at a conference in Israel in 2010 and published in the August 2011 British Journal of Pharmacology. Russo, a neurologist and ethnobotanist, is senior medical adviser at GW Pharmaceuticals.
Both terpenoids and cannabinoids are secreted inside the Cannabis plant’s glandular trichomes, and they have a parent compound in common (geranyl pyrophosphate). More than 200 terpenoids have been identified in Cannabis. The most common and most studied include limonene, myrcene, alpha-pinene, linalool, beta-caryophyllene, caryophyllene oxide, nerolidol and phytol. Anecdotal evidence suggests that pinene is alerting, limonene “sunshine-y,” and myrcene sedating.
The fact that most terpenoid compounds are common components of the human diet and “generally recognized as safe” by the Food and Drug Administration has made research possible, and scientists employed by flavor and fragrances manufacturers have investigated their properties over the years. But the terpenoids “remain understudied” in terms of therapeutic potential, according to Russo.
His paper mustered all the evidence —proof in some cases, hints in others— that cannabinoids and terpenoids can work in concert to abate symptoms of pain, inflammation, depression, anxiety, addiction, epilepsy, cancer, fungal and bacterial infections, including methicillin-resistant Staphylococcus aureus (MRSA, which kills more Americans nowadays than AIDS) and other illnesses.
Jeffrey Hergenrather, MD, president of the Society of Cannabis Clinicians, who heard Russo’s presentation in Israel, expects its publication to “generate great interest in terpenes among medical cannabis users as well as physicians.” The SCC recently began collecting data on patients’ responses to CBD-rich Cannabis. Future surveys will seek to document which other cannabinoids and which terpenoids are associated with which effects.
The “Entourage Effect”
The conference at which Russo presented his paper was held at Hebrew University, Jerusalem, where Raphael Mechoulam directs a lab, in honor of Mechoulam’s 80th birthday.
In 1999 Mechoulam co-authored a paper with Shimon Ben-Shabat suggesting that cannabinoids made in the body work by means of an “entourage effect.” They had found that the endocannabinoid 2-AG (2-arachidonoylglycerol), when administered with two related compounds, would bind more readily at the cannabinoid receptors and exert more pronounced behavioral effect on mice.
To pharmacologists who customarily designed experiments aimed at finding the active ingredient, this had heavy implications. Mechoulam spelled them out: “Biochemically active natural products, from either plant or animal origin, are in many instances accompanied by chemically related though biologically inactive constituents. Very seldom is the biological activity of the active constituent assayed together with inactive ‘entourage’ compounds. Investigations of the effect of the active component in the presence of its ‘entourage’ compounds may lead to results that differ from those observed with the active component only.”
In 2001 John McPartland and Russo published a paper in the Journal of Cannabis Therapeutics applying the “entourage” concept to the plant itself. “Good evidence shows that secondary compounds in cannabis may enhance the beneficial effects of THC... and reduce THC-induced anxiety, cholinergic deficits, and immunosuppresion,” they wrote. “Cannabis terpenoids and flavonoids may also increase cerebral blood flow, enhance cortical activity, kill respiratory pathogens, and provide anti-inflammatory activity.”
A decade later, Russo is substantiating the molecular-teamwork hypothesis and expanding on it. His BJP paper, “Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects,” contains 304 citations.
Although the paper takes the form of a review of the literature, Russo’s perspective is forward-looking and practical. The paper can be read as a strategic guide for breeding and/or blending Cannabis so as to maximize specific medical effects. Its structure is straightforward:
1. Russo cites studies documenting the beneficial effects of THC, CBD, CBC, THCV, CBDV, CBG and CBN (noting the adverse effects attributed to THC).
2. He cites studies documenting the beneficial effects of Limonene, Î±-Pinene, Myrcene, Linalool, Î²-Caryophyllene, Caryophyllene Oxide, Nerolidol, and Phytol.
3. He notes which cannabinoid effects would be augmented by which terpenoids, and which terpenoid effects would be augmented by which cannabinoids.
There is a huge body of information to convey, and Russo’s style is compressed —documented fact after documented fact after documented fact, with insights positioned fittingly. The slides he showed in Israel have been integrated into two full-page tables for the BJP paper, listing the relevant studies and the cannabinoid-terpenoid combinations likely to produce a desired effect. The paper is well worth reading. My summary and the disjointed highlights that follow cannot do justice to Russo’s carefully constructed thesis.
The Cannabinoids Formerly Known as Minor (CFKMs)
The extensive breeding program directed by GW Pharmaceuticals’ Etienne de Meijer has yielded plants rich in CBD, CBC, CBG, and THCV.
Cannabichromene (CBC) is produced early in the plant’s life cycle according to a paper published by de Meijer in 2009. Citing de Meijer’s co-worker David Potter, Russo notes that “An innovative technique employing cold water extraction of immature leaf matter from selectively bred cannabis chemotypes yields a high-CBC ‘enriched trichrome preparation.’”
Cannabigerolic acid (CBGA), the precursor of THC, CBD, and CBC in their acid forms, is usually found at low concentrations. “But recent breeding work has yielded cannabis chemotypes lacking in downstream enzymes that express 100% of their phytocannabinoid content as CBG,” according to Russo. (More details are provided on GW Pharmaceuticals’ very informative website.)
Tetrahydrocannabivarin (THCV) blocks the CB1 receptor at low doses, and activates it at high doses. GW Pharmaceuticals hopes that a THCV-rich extract will be an effective appetite suppressant and will counter the symptoms of metabolic syndrome.
THCV is present in cannabis chemotypes from southern Africa —from which plants that are “highly predominant” in THCV have been bred.
Whereas plant cannabinoids are found nowhere else in nature, terpenoids are produced by countless plant species. Some 20,000 terpenoids have been identified by chemists; they constitute the largest group of plant chemicals. More than 200 have been found in cannabis.
“Essential oil composition is much more genetically than environmentally determined,” Russo states. Every compound the plant produces has or had an evolutionary purpose. The bitter 15-carbon terpenoids in the fan leaves repel grazing animals, while the predominantly monoterpene mix in the flowers is unappealing to insects —and, thanks to its stickiness, can also entrap them.
Alpha-pinene is the most common terpenoid in the plant world; limonene is second. Named for their strong presence in pine needles and lemons, respectively, they are monoterpenes, also prevalent in cannabis.
Terpenoids may account for only 1% of the weight when cannabis is tested but 10% of the weight within the trichome.
Monoterpenes evaporate more readily than the di- and sesquiterpenes during drying, storage, and production of extracts, which results in a relatively higher proportion of caryophyllene.
How do terpenoids exert effects within the body? Citing the relevant studies, Russo explains that they are “lipophilic, interact with cell membranes, neuronal and muscle ion channels, neurotransmitter receptors, G-protein coupled (odorant) receptors, second messenger systems and enzymes.”
The beneficial effects are wide-ranging and, in many cases, well established. Limonene, for example, has been shown to decrease anxiety in mice via the serotonin receptors. “Compelling confirmatory evidence in humans,” Russo writes, was provided by a Japanese study of severely depressed hospital patients whose moods improved when exposed to citrus fragrance. (Nine of 12 were able to get off antidepressants.)
Limonene, inhaled, is an immunostimulant. In lab experiments it has killed breast cancer cells and acne bacteria. It is a potential treatment for gastro-esophageal reflux.
Alpha-pinene —as anyone who has walked into piney woods and breathed deeply can sense— is a bronchodilator. It also has anti-bacterial and antibiotic properties. Î±-Pinene inhibits the enzyme that breaks down acetylcholine, a neurotransmitter involved in memory. “This feature could counteract short-term memory deficits induced by THC intoxication,” Russo notes.
Myrcene, another monoterpene common in cannabis, is also abundant in the flowers of humulus lupulus —hops— the only other member of the Cannabinacae family. In addition to its anti-inflammatory effect, Russo writes, “Myrcene is a recognized sedative as part of hops preparations, employed to aid sleep in Germany... Myrcene acted as a muscle relaxant in mice, and potentiated barbiturate sleep time at high doses.
“Together, these data would support the hypothesis that myrcene is a prominent sedative terpenoid in cannabis, and combined with THC, may produce the ‘couch-lock’ phenomenon of certain chemotypes that is alternatively decried or appreciated by recreational cannabis consumers.”
Linalool, which is abundant in lavender, affects serotonin neurotransmission and counters anxiety, according to a study cited by Russo. Linalool has sedative and anti-convulant properties, and is also “the likely suspect in the remarkable therapeutic capabilities of lavender essential oil to alleviate skin burns without scarring.”
Beta-caryophyllene, which is found in black pepper, Echinacea, and marigolds, “is frequently the predominant terpenoid in cannabis extracts, particularly if they have been processed under heat.” Î²-caryophyllene is anti-inflammatory and, unlike other anti-inflammatories, protective of the stomach lining.
In 2008 Swiss investigators led by Jurg Gertsch showed that Î²-caryophyllene activates the CB2 receptor —making it “the first proven phytocannabinoid beyond the cannabis genus,” Russo proclaims. “Given the lack of psychoactivity attributed to CB2 agonists, caryophyllene offers great promise as a therapeutic compound, whether systemically or in dermatological applications.”
Other terpenoids with therapeutic potential mentioned by Russo in his BJP paper are nerolidol (found in citrus, it may have sedative and anti-fungal effects); caryophyllene oxide (found in the herb lemon balm, it repels insects); and phytol (a breakdown product of chlorophyll with relaxant properties that may be the reason that green tea, despite its caffeine content, doesn’t jangle the nerves).
In their landmark 2001 paper in the Journal of Cannabinoid Therapeutics, Russo and lead author John McPartland touched on the beneficial effects of eucalypytol, pulegone, alpha-terpineol and other possibly efficacious terpenoids. These compounds were not discussed in Russo’s 2011 BJP paper.
Russo describes several mechanisms by which terpenoids and/or cannabinoids can act synergistically.
• They can work on separate targets. For example, if CBD were combined with limonene as an acne treatment, the cannabinoid could penetrate the skin and induce the cells that produce sebum to self-destruct, while the terpenoid could inhibit production of the key pathogen, Propionbacterium acnes. (Linalool and alpha-pinene also suppress P. acnes.)
• They can interact to overcome bacterial resistance. For example, CBD and CBG “powerfully inhibit MRSA,” according to one study cited by Russo, while in another study, an essential oil rich in pinene proved “as effective against MRSA and other antibiotic resistant bacterial strains as vancomycin.”
• They can have an antagonistic effect, as in the case of CBD countering THC’s ability to promote an accelerated heartbeat, the munchies, drowsiness, and anxiety.
Key role for CBD
CBD will play a key role in extracts designed for medical use. Although deemed “non-psychoactive,” CBD reduces anxiety by affecting the serotonin receptors. It also reduces cravings —for heroin, cocaine, food, nicotine and other addictive substances.
Russo describes a recent study that “demonstrated the fascinating result” that stroke patients who had suffered damage to a part of the brain called the insula “were able to quit tobacco smoking without relapse or urges.”
“In a provocative parallel,” he adds, functional MRIs of patients given CBD (600 mg p.o.) dramatically reduced activity observed within the left insula “suggesting the possibility that CBD could act as a pharmaceutical surrogate for insular damage in exerting an anti-addiction therapeutic benefit.”
Which terpenoid(s) would be complementary? Citing a study in which inhaledvapor from an essential oil of black pepper reduced craving for cigarettes, Russo writes: “the terpene profile of black pepper suggests possible candidates: myrcene via sedation, pinene via increased alertness, or especially caryophyllene via CB2 agonism.”
The Research Agenda
Cannabis designer extracts are likely to yield safe, effective new treatments for a wide range of conditions, and —in due course, it is hoped— to regulatory approval and sales. GW Pharmaceuticals has already bred cannabis chemotypes with very high fractions of myrcene and limonene, and we assume they’re working on plants high in pinene, linalool and other terpenoids with therapeutic potential. As Russo puts it in his BJP paper, “Selective cross-breeding of high-terpenoid- and high-phytocannabinoid-specific chemotypes has... become a rational target.”
Meanwhile back in California, research-minded doctors, cannabis cultivators, dispensary and lab owners, have been thinking along similar lines. (The idea that cannabis can be bred to maximize production of more than one compound is as obvious as the association between aroma and effect.) We don’t have the resources to do high throughput pharmacological screening or animal studies involving radioactive labeling, but we do have access to labs that can identify the compounds in a cannabis bud, and we have our own senses to evaluate effects.