A Brief History
Cannabis has been used for thousands of years, dating back to Chinese Emperor Shen Nung in 2727 B.C.1 Before Nixon’s war on drugs, cannabis was grown for the use of rope, clothing
In 1992, Raphael Mechoulam discovered the Endocannabinoid System (ECS—a complex receptor system found in humans and animals designed to respond to the active compounds found in the cannabis plant. The ECS has been recently recognized as possibly the most important modulatory system in the body that regulates the functioning of the brain, endocrine, and immune tissues, as well as creating and supporting homeostasis of the body’s cells. Because the ECS is designed to regulate the body’s functions, it comes as no surprise cannabis helps with so many conditions. Since its discovery, research continues to enlighten us on how and why cannabis has played such a pivotal role in the health and well-being of humans for such a long period of time.
Cannabinoids, the Entourage Effect, and Full Spectrum medicine
Though hemp and marijuana have very different properties, both come from the cannabis plant. The terms hemp and marijuana are typically used to describe the difference in THC content. THC (tetrahydrocannabinol) is one of hundreds of known cannabinoids found in the cannabis plant. It is most commonly recognized as the psychoactive compound in cannabis that causes the “high” affect.
Hemp contains less than 0.3 percent THC. Marijuana, on the other hand, is any plant that contains more than 0.3 percent THC. But despite THC’s popularity and prevalence, it is not the only beneficial cannabinoid present in cannabis.
CBD (cannabidiol) is another cannabinoid found within the plant and does not produce a psychoactive effect. CBD can be extracted from both hemp and marijuana, and it exists in some products in its isolated form. Other cannabinoids, including CBN, CBG, THCa, and others are being researched and found to contain their own unique therapeutic properties. In Florida, however, the most commonly-used cannabinoids in retail products are THC and CBD.
When isolated, CBD and THC can have wonderful healing properties, they work even better used together in their whole-plant forms. Products that utilize all of the naturally-occurring cannabinoids and other properties of the plant are called Full Spectrum products. In the same way that eating an orange is healthier for you than drinking only the juice, full spectrum products offer a broader range of healing benefits by way of a natural phenomenon called the Entourage Effect. This means that CBD and THC are excellent on their own—but when combined, they work even better.
Full spectrum products also include other compounds in the cannabis plant: all cannabinoids, essential vitamins and minerals, fiber, chlorophyll, flavonoids, and terpenes, for example. Just like with nutrition, the less processed and more natural the plant medicine is, the more effectively it can provide benefits.
While dispensaries in other legal states offer hundreds of different strains, concentrates, edibles, topicals, tinctures, patches, sublingual products and more, Florida residents are still limited in their offerings due to restrictive laws and controversial politics.
After integrating the Compassionate Medical Cannabis Act of 2014, Florida allowed qualified patients in the state to obtain “low-THC cannabis.” In order to qualify as low-THC, the flowers, seeds, resin and any other product derived from the cannabis plant had to contain 0.8 percent or less of THC and more than 10 percent CBD by weight.
The statute was amended in 2016 to include all levels of THC marijuana, termed “medical cannabis.”
With the increasing growth of knowledge and education, the beneficial impact patients could see when allowed to utilize the important cannabinoid THC without restrictions is crucial. Growth is constant and progression is visible, which gives hope to those affected by the limitation of the laws.
Common Consumption Methods
One of the most commonly-asked questions about cannabis is how and where to begin comfortably. Fear of feeling “too high” or experiencing no relief are common amongst patients. Knowing how different products affect the body is important to understand where to begin. Remember: each individual endocannabinoid system is unique. Different cannabis products will affect each individual differently based on absorption, bioavailability, and countless other variables.
Take edibles, for instance. Edibles often have a stronger perceived effect because the body converts the cannabinoid THC into 11-hydroxy-THC when metabolized by the liver—in simpler terms, this means your body absorbs orally-ingested medicine differently than it absorbs inhaled medicine, and the effects of each delivery method will therefore be different. Edibles may take up to an hour or more to absorb and the effects to be felt, and it may last longer than inhaled cannabis.
There are variations in potency, up to 15 percent in some products, which is something to keep in mind when consuming. Liquid products, such as tinctures, are measured in milliliters and will have a ml serving size and its cannabinoid equivalent for consumers to correctly dose. Tinctures are best to drop sublingually, or under the tongue to infuse the herb directly into the bloodstream. These can also be used to infuse drinks or smoothies, depending on the consumers’ preferences.
For many, vaporized cannabis flower is the preferred consumption method. Inhalation of cannabis provides a fast-acting effect and is popular amongst patients who need immediate relief. Cannabis flower is available in hundreds of different cultivars, or strains, in other legal states—and Florida is beginning to boast some of its own unique strains from local cultivators as its medical industry grows.
Each strain of cannabis has its own unique cannabinoid and terpene profile, and each profile offers a subtly different medicinal effect. Research on terpenes (the essential oils found in cannabis that house therapeutic benefits) suggests that our natural attraction to certain terpene profiles in the scent of cannabis can provide us with information on what strain may be best for our condition. As the saying goes, “Your nose knows.” Smelling your cannabis in its whole flower form is one of the best ways to choose your medicine. Since our sense of smell is so unique and different and cannabis has a huge array of profile combinations, you’ll know when you smell the terpenes if you’re into the particular flower. If you smell a strain and are drawn to it, chances are that your body will respond positively to its effects. Alternatively, if you are turned off by the scent of a product, steering clear may be the best option.
In most medical and recreational states, as well as some Florida dispensaries, patients are presented will “smell jars,” or small containers of sample products to view and smell to make sure that the product is free of pests, pesticides, and other contaminants. Smelling also provides the body with the knowledge it needs to choose strains effectively. Without this access, it is very difficult for a patient to determine the quality of what is going into their medicine.
Because not all dispensaries offer the opportunity for a patient to view and smell their product before purchase, deciding which strain to consume can be a daunting and overwhelming task for new patients. If your dispensary does not offer this option, ask the manager to consider providing this beneficial service to patients.
Thankfully, Florida is moving towards more reasonable access laws for patients, and it is important that patients lend their voice to protect their right to transparency around the production of their medicine. In the meantime, it is beneficial for patients to educate themselves on the basics of cannabinoid and terpene science to help determine which strains and terpene profiles may be best for them.
Vaporizers are another growing choice for health-conscious consumers due to their discretion in delivery. Small size and lack of odor make them popular amongst those who need fast-acting relief and anonymity. Concentrates, however, come with their own set of challenges.
It is important to remember that concentrates are concentrated forms of cannabis. There are several extraction methods used to create concentrates, each with its own set of health hazards. The use of solvents or CO2 in extraction practices are controversial—many of the products used to create solvents contain thinning agents and additives with proven health risks attached. It is important to remember that the state of Florida has no regulation or testing requirements around the use of many of these hazardous chemicals in the production of cannabis concentrate products.
In addition, concentrates are typically much more potent than flower products. Flower potency usually ranges between 10-25 percent THC. A concentrate, however, may have 50-80 percent THC or more. Knowing your tolerance and desired effects can help you decide which product is best for you.
One of the most common answers everyone wants to know is how much should be consumed for a dose. Unfortunately, dosing with cannabis is a process that requires individual attention, experimentation, and time. However, a good cannabis physician can help you determine where a good starting point is for you.
The best advice for cannabis patients is to follow your marijuana doctor’s recommendation. However, the old adage still applies: “Start low, go slow.” Monitoring the effects and dosage of each product through journaling will also help you find your ideal dose. By slowing self-titrating (or adjusting your dose as necessary) and keeping track in your journal of what products have the desired effect, you’ll be able to effectively dose based on your comfort levels. Remember: each Endocannabinoid system is different, and each individual will respond to different doses and delivery methods in their own unique way. Until research offers us more insight on how to approach dosing in a more streamlined manner, it is up to the patient and their doctor or educator to spend the time getting to know which dosing procedures are best suited to the ailment.
Keeping Love + Faith Alive
After losing 36 to Covid-19
What started as a “Shelter in Place” check-in with friends Barbara and Daniel Melvin, grew into this article about a family with extreme losses to COVID-19. Barb first told me they had lost 12 family members and friends from COVID-19 in mid-April. By the end of April, the number had grown to 33. The current count is 40 family and friends lost to COVID-19 as of May 18, 2020.
Daniel and Barbara lived in Detroit before relocating to Naples, Florida, in 2001. Barbara has worked in banking for 30 years and is currently a Vice President at First Florida Integrity Bank. Dan is a multi-talented singer, radio personality, and entrepreneur. They are two of the happiest, kindest, giving, and loving people you could be lucky enough to know.
Together, they have worked to give back to their community through philanthropic endeavors, as well as volunteering on numerous nonprofit boards. They celebrate their mutual birthdays, Sept 6 & 10 by holding an annual event called “Party Hearty for Charity,” formerly known as “Party with a Purpose,” their nonprofit organization., They have raised over $90K in the past six years to help support several nonprofit organizations in SouthWest FL.
Barb says, “The coronavirus is real. I first heard about it in March, but like everyone else, we didn’t understand it, and at that time, we didn’t personally know anyone that was sick from it. Then, as time went on, we started to hear about people that we knew who were dying. My husband and I hated to wake up and look at Facebook because it seemed every time we checked someone close to us or someone we knew had died.”
Barbara tells us, some of the churches in Detroit continued to hold services, after the recommendation not to gather in large numbers. The members met to seek comfort in the face of the pandemic. Barbara believes that was crucial for most of the people she knows who were infected and died.
How could one couple know so many people who have passed from COVID-19? They are an extensive close-knit family, descendants of Tom and Etta Rhoades, born slaves. Tom and Etta’s dreams were to keep their descendants together spiritually, in harmony, and in brotherly love. They have honored their ancestors by gathering each year, for 46 years, for a three-day family reunion. Friday is meet and greet (you would need it with over 200 attending). Saturday is picnic time, complete with a softball game between the North and the South. Sunday, everyone goes to a local church, followed by a family dinner. With all those family members together, not an argument or fight ever. Until 2020, when the pandemic hit the family, and they canceled the family reunion.
Barbara shares with us information on a few of those they have lost. “My aunt, Mary Rhoades, died on April 22, 2020, she was 97 years old. She was in good health, and we were praying she made it to 100.” Several of her siblings had achieved that milestone, and she was reasonably healthy for 97 years of age so that expectation was a real one. “Aunt Mary became infected in early April; two weeks later, she was gone. She went to the hospital in Philadelphia for minor surgery, and we believe she was infected there. What hurts the most is she died alone; no family or friends could visit her.”
“Jason Hargrove was a close friend of ours. He was the bus driver who went on Facebook Live to talk about a woman coughing on his bus without covering her mouth. Two weeks later, he was diagnosed with the coronavirus, and he died shortly thereafter. His death was not in vain as the Detroit Department of Transportation made many changes to enhance the safety of their drivers. Jason was a Deacon at my church.”
Barbara continues, “Another close friend of ours was Larry Griffin. He died on April 16. He sang in my husband’s band called “In Full Effect” when they were performing in Detroit. He continued to sing in a new band called “Serieux,” who performed mostly in Detroit but also in Las Vegas. He had a beautiful voice and some great dance moves. He was so healthy until he caught the virus, and, in weeks, he was gone.”
“It spread so much faster in the churches. Many Pastors we knew caught the virus and were gone. They were older and many had health issues, when the virus attacked them they could not fight it off. These 4 Pastors were all a part of the Church of God In Christ (COGIC). Many had large congregations and were still holding services after the call for social distancing. These great men are a true loss for the COGIC community.”
“On April 23, we lost a very dear friend of mine, Lynn Raimey. I called her my sister as her father was the Pastor of my church in Detroit. Her family took me in and treated me like family when I first moved to Detroit and didn’t know anyone. She had many health issues, so when she was infected by the virus, it killed her very quickly.”
“Although we have lost many family, friends, and associates, we know God is good, and he continues to show us favor even through the midst of this storm. Even though we know of many deaths, we also know of many survivors and to that we are grateful. These people are given a second chance so their test can become their testimony. I know of an entire household, The Washington family of Detroit, who are survivors. Pastor Jamonty, his wife Tamela and their daughter Ariel Washington all recovered and are doing well.”
Barb specifically finds strength in the Beatitudes; “Jesus said in Matthew 5:4, Blessed are they that mourn, for they shall be comforted. It is during these tough times of losing loveda ones that I can refer to scripture to give me the comfort I and my family needs. The question is have you ever suffered? Please know that we all have. But I have come to know through leaning on God and his word, he meets me at my very point of need. As believers, the Bible speaks about plagues and famine and death, and its teachings prepare us for what life has to offer. Oftentimes we don’t understand the current situations, but when we look back, we realize this had to happen.”
As of May 5, 2020, there have been over 72,000 deaths in the United States, and over 257,000 deaths Worldwide. It is critical to find strength either within or in a higher power, focus on the positive, and stay connected.
It is GRAM’s honor to recognize this incredible family.
Blessed are they that mourn, for they shall be comforted.
Family & Friends Lost to Covid-19 (35 as of 5/5/20)
Mary R. – PA
Jason H. – MI
Rachelle Lynn R. – MI
Rev. O’Neil S. – MI
Gerald H. – MI
Curtis H. – MI
Larry G. – MI
Rosalind C. – MI
Rev. Gerald G. – VA
Skylar H. – MI
Rev. David F. – MI
Laneeka B. – MI
Ejuan W. – MI
Darnielita B. – MI
Bishop Phillip B. – MI
Bishop Robert S. – MI
Bishop Robert H. – MI
Tatia W. – MI
Rev. Lonie J. – MI
Carrie W. – MI
Helena J. – VA
James J. – VA
Robert J. – VA
Annette W. – NY
Helen L. – MD
Walter H. – DC
Carol T. – DE
Benjamin T. – DC
William B. – KY
Daniel R. – TX
Karen S. – NC
Denise B. – NC
Doris M. – OH
Trina D. – MI
Earl T. – VA
Nathaniel S. – MI
Lonnie L. – MI
Nathaniel S. Sr. – MI
Nathaniel S. Jr. – MI
Angel R. – IL
Americans for Safe Access + Covid
Americans for Safe Access (ASA) is a 501(c)(3) nonprofit with the mission of ensuring safe and legal access to cannabis for therapeutic use and research. The organization began in 2002 and has been helping educate people, change laws, and get more research out there about the therapeutic benefits of medical cannabis. “We also care about safety, and we want to make sure patients are using cannabis safely and legally throughout the United States,” explains Debbie Churgai, Interim Director for ASA.
GRAM sat down with Churgai to discuss how they are handling COVID-19 for patients throughout the U.S. She tells us, “When it first started, patients were really concerned about there being a lack of access to their medicine. So, one of the first things we did was host a stakeholders call. We contacted a bunch of people: patients, industry professionals, medical professionals, legal professionals, and within two hours, 15-20 people were on the phone strategizing. From that phone call, we then created a letter that we sent to Governors, medical cannabis commissions, and health departments urging them to keep medical cannabis businesses as essential, not just the dispensary but also cultivation and manufacturers so that there was no stop in production or supply chain.”
“It also meant, we needed to make sure patients were receiving safe products, that employees were also being kept safe. Then we started thinking about delivery for states that did not have that yet, and the states that did not yet offer telehealth – we wanted to encourage the changing of regulations at least temporarily to help accommodate the patients. As well as things like tax relief and adding additional caregivers, it wasn’t just about keeping businesses open, it was about making sure that patients were being protected and that products and employees were safe.”
In Colorado, we have seen dispensaries adapt to this crisis by adding hand sanitizer at checkout counters, wearing gloves and masks and only allowing one person in the purchasing area at a time. 33 states now have some sort of medical cannabis program.
According to news around the U.S., cannabis is now considered essential. But it wasn’t that way at first. According to Churgai, “Some states seemed to hold back on making any temporary changes in regulations. Within two weeks though, all the other states began implementing the suggestions we recommended.”
We needed to make sure patients were receiving safe products, that employees were also being kept safe.
“California has reached out more than any other state, I believe that is due to the fact that every single county there is different, from its tax structure to its implementation of the laws. Massachusetts was high with the questions as well because of them deciding to close down their recreational dispensaries for adult use. Now there is an influx of new patients. Now there are new concerns.”
Each state has a different set of rules and regulations surrounding their medical cannabis programs. “We wanted businesses to all have the same information so we offered a live training on health and safety during COVID-19, that can now be purchased as part of our Patient Focused Certification.1 In the training we provide information such as how to properly put on and take off gloves, how to properly touch things, how to properly sanitize surfaces, and more to make sure that businesses are being as safe as possible during this time.”
“When we realized that we helped assist in making these services essential, we wanted to learn how they actually worked for patients throughout the U.S. We wanted to understand, what do they still need during this time? Are their needs being met as patients? Would they like to see services like telehealth and delivery continue after COVID-19? We realize that we really need to streamline our advocacy efforts at this time, and we felt the survey would be a great way to learn what we can do for patients out there,” Churgai explains.
Help ASA discover what patients need around the United States.
Take the survey here: https://www.safeaccessnow.org/covid-19_survey
COVID-19 Patient Experience Survey asks questions like:
• How do you obtain cannabis?
• Do you feel you are at risk for covid and why?
• Rate your state’s response to the covid crisis.
• How should your state be assisting you more?
Patients are at greater risk for a variety of reasons so ASA is working to ensure that the needs of patients are taken into account. So, in addition to creating this survey, Americans for Safe Access has also created a page on their website dedicated to resources for patients seeking information surrounding COVID-19.2
Churgai says, “Cannabis is real medicine. I have been in this industry for so long, and I am a realist, and I know things will not change overnight. But I do feel the pandemic has highlighted the need for this medicine to be seen as real medicine. At ASA, patients are our priority, we are unbiased, we are not paid to play, and patients will always be our top priority.” You can learn all about Americans for Safe Access by visiting their website: https://www.safeaccessnow.org/
Trends in Endocrinology + Metabolism
The quest for a healthy
Endo-Cannabinoid System (ECS)
Emphasis on immunoregulation
The ECS is a disperse system, extending throughout the body; it is in constant interplay with all other organ systems promoting homeostasis in almost every aspect. Despite that, the ECS is still neglected and not included in the curricula of medical schools. For this reason a few introductory notes are in order (Battista et al, 2012). The ECS is the regulator of cognition, mood, nociception, energy metabolism, oxidation, inflammatory processes and a disease modifier as well (Tantimonaco et al, 2014).
The ECS consists of receptors, ligands to these receptors and enzymes that synthesize and degrade these ligands. The number of known endocannabinoid receptors is still growing to more that 55; the two most outstanding receptors are CB1R, mainly distributed throughout the nervous system and responsible for the psychoactivity of cannabis, and CB2R, mainly distributed on immune cells, even those “disguised” as specialized cells within other organs. Other receptors include TRPVx, GPR55, PPaRs etc; all these receptors form dimers between them as well as heterodimers with other types of receptors, like opioid, dopamine, serotonin, adenosine, catecholamine receptors and many others, thereby promoting a universal regulatory interplay throughout the body. The ligands to these receptors are the endocannabinoids (ECs): lipids of the eicosanoid family, derivatives of arachidonic acid (AA); the latter abounds in cell membranes; five of these are well characterized to date, but two are well studied: Anandamide (AEA) and 2-Arachidonoyl-Glycerole (2AG). ECs in the nervous system act in negative feedback loops, more or less like neurotransmitters, but, unlike them, they are synthesized and degraded on demand, and not stored in micro-vesicles. Several formerly unrelated morbid conditions are now recognized as ECS deficiencies, including, among many, migraine, autism, fibromyalgia, irritable bowel syndrome, etc (Russo, 2016).
The endocannabinoid system is involved in immunoregulation through the CB2 receptor and through receptor independent biochemical pathways. The mechanisms of immunoregulation by ECs include modulation of immune response in different cell types, effect on cytokine network and induction of immunoapoptosis; in brief, ECs down-regulate the innate and adaptive immune response in most, but not all, instances. Manipulation of endocannabinoids in vivo may constitute a novel treatment modality against inflammatory disorders.
It is obvious that the health of the ECS is of great importance in many ways, including the facing of a viral infection like COVID-19. A healthy ECS depends on many factors, most importantly from proper nutrition (McPartland et al, 2014).
Dietary ω3 fatty acids seem to act as homeostatic regulators of the ECS, acting in opposite directions if consumed by obese or non-obese individuals. Little change in EC levels are seen in individuals with normal weight, not fed a high ω6 diet.
Dietary ω6 fatty acids are also essential, but should be in a balance to ω3s; suggested balance is ω3:ω6=1:1 to 1:3 for proper ECS signaling and prevention of peroxidation in general. Arachidonic acid is an essential component of the ω6 fatty acids.
Probiotics and prebiotics play a significant part in ECS health, but, for a bizarre reason, they are generally not mentioned: They up-regulate CB2Rs residing on immune cells of the gut; they also modulate CB1Rs, depending on conditions, for instance, they down-regulate CB1Rs in obese individuals and help them gain less or no fat.
Some flavonoids, like kaempferol, genistein, epigallocatechine gallate, and curcumin enhance the ECS; same happens with some anthocyanidins, like cyanidin and delphinidin, although with a different mechanism.
Phthalates, pesticides, additives to pesticides like piperonyl butoxide act as ECS disruptors, meaning that consuming organic food may be a sound protective measure, along with intake of detoxifiers, in case of health problems consistent with ECS deficiency not otherwise explained.
Chronic stress impairs the ECS by decreasing levels of AEA and 2AG, and possibly through changes in CB1R expression too. Stress management may reverse the effects of chronic stress on ECS signaling. Anecdotal reports and common experience suggest that techniques such as meditation, yoga, deep breathing exercises and practicing of sex as well, exhibit mild cannabimimetic effects, thereby balancing the system.
Exercise is also an ECS regulator: Long-term exercise leads to sustained elevations of ECs, and predictable CB1R down-regulation.
Chronic alcohol consumption and binge drinking likely desensitize or down-regulate CB1R and impair EC signaling. Alcohol is not compatible with a healthy ECS.
Nicotine is an ECS deregulator: It induces EC production in some areas of the brain, while decreasing them in others. It should be avoided too.
Caffeine, acutely administered, potentiates CB1R-mediated effects through antagonizing adenosine at the A1 receptor (AA1R). At the undisturbed state, AA1Rs tonically inhibit CB1R activity; Caffeine antagonism on AA1Rs sets CB1Rs free of inhibition, thereby enhancing ECS function, for example by letting 2AG activate CB1Rs. During chronic administration of caffeine, the effects are blurred by individual differences in adaptation. In general, CB1Rs are down-regulated.
Chocolate: Cocoa contains sm-all amounts of at least three N-acyl-ethanolamines with cannabimimetic activity, expressed either directly by activating cannabinoid receptors, or indirectly, by increasing AEA levels (di Tomaso et al, 1996).
Battista et al, 2012: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303140/
Tantimonacco et al, 2014: https://pubmed.ncbi.nlm.nih.gov/24526057/
(Russo, 2016): https://pubmed.ncbi.nlm.nih.gov/28861491/
(McPartland et al, 2014): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951193/
(di Tomaso et al, 1996): https://pubmed.ncbi.nlm.nih.gov/8751435/
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