Medical Marijuana 101 with Dr. Corey Anden, MD

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Dr. Corey Anden, MD discusses the history of Medical Cannabis in the United States and how the term Marijuana came into favor, dispelling many myths about its efficacy and role in treating a variety of medical ailments. Specifically, Dr. Anden discusses how Cannabis and CBD work as medicine to reduce pain and provide a viable safe alternative to opiates for many who are suffering from chronic pain, PTSD, Multiple Sclerosis, Cancer and other medical conditions.  Episode Highlights

  • Why cannabis was renamed marijuana 
  • How cannabis and CBD work in the body to produce their effects
  • Myths dispelled around use of marijuana as medicine
  • Research discussed that supports the use of cannabis as medicine

Video or Audio:–Corey-Anden–MD-eohjsh


Dr. Spiker:                  Welcome, everyone. This is Dr. Tim Spiker, and welcome to The In. We discuss topics that improve your health and performance. And we are so fortunate today to have Dr. Corey Anden. She is a board-certified physician that has been practicing medicine in Northern Utah for the past 32 years using a whole person approach and nonsurgical treatment options. She has been a trailblazer for female physicians here in Utah and [inaudible] [00:00:25].

                                    Dr. Anden grew up outside of Pittsburgh, PA. She graduated from Pittsburgh School of Medicine in 1984 with her medical degree as well as honors in orthopedic surgery, neurology, and psychiatry. She moved to Utah in 1988 for the greatest snow on Earth and started her own private practice.

In March 2019, Dr. Anden was the first physician in Utah to open her doors to new and hopeful medical cannabis patients in Utah. She’s been a medical cannabis advocate throughout her career and was anxiously awaiting the day when medical cannabis would come to Utah.

In fact, she’s such an advocate and eager to learn more that she has started a two-year program with the University of Maryland in a Master of Science in Medical Cannabis and Therapeutics, the first graduate program in the US dedicated to the study of medical cannabis. Dr. Anden is knowledgeable in dosing parameters and the entourage system and is comfortable working with medical cannabis for patients of all ages, demographics, and level of experience.

We are very fortunate to have Dr. Anden and really consider her an expert in medical marijuana to really discuss with us today how really medical marijuana may be really helpful to us, particularly in this time as we are going through several crises in medicine, in research, and also economically here in the US with the latest pandemic.

So, Dr. Anden, again, thank you for being here today on The In. I guess, really, the first question for most folks out there really to set the stage is really – what is cannabis? What is marijuana, I guess, in nature? And, really, how can it work for us to help us with our ailments and performance and many other things?

Dr. Anden:                  Well, thank you, Dr. Spiker, for inviting me to this podcast. I love talking about this topic, and there is a lot of misunderstanding. But, first, we just want to think of cannabis as a plant. So, when we talk about cannabis as medicine, we’re really talking about plant-based medicine as opposed to pharmaceutical-type medicine. So, by contrast, cannabis as a plant is obviously an organic substance. And cannabis, the plant, as it grows has more than 500 chemicals that can have medicinal benefits.

                                    Now due to laws and regulations and policies, there’s been quite a bit of propaganda starting in the United States and then around the world surrounding the plant. But there still has been quite a bit of research done in other countries, some in the United States. We’ve been limited here, but there’s quite a bit of research, thousands and thousands of scientific articles, PubMed articles, about use cannabis as medicine, particularly from Israel, Spain, Italy, etcetera.

                                    So, we tend to associate cannabis with THC, which is only one of the 500 chemicals in the plant. Now we have CBD, which is another chemical in the plant, that’s trending. But those fall into the category of chemicals in the plant that are called cannabinoids. And scientists now have determined that there are more than 140 different cannabinoids that are being studied. So, people may hear about other ones – CBN, CBC, CBG, etcetera.

And then there are other chemicals in the plant called terpenes. And I bet many people are familiar with terpenes and terpenoids. Those are what give the plant its flavor and smell. So, all of the essential oils like the brand doTERRA, those are technically terpenes. So, I think people can wrap their minds around the concept that those types of plant oils have medicinal benefits. There’s many of those – more than 200 in cannabis.

So, the cannabis plant then encompasses everything from what we call hemp, which is either used for fiber and industrial purposes to the amount of hemp that contains CBD that is extracted for our ubiquitous CBD products that we see everywhere to a range of having equal amounts of CBD and THC than to plants that have a lot of THC and minimal CBD.

So, there are more than the CBD and THC, but that’s what there is the most of. And that’s what has currently been most studied. So, that’s the two chemicals or two compounds from the plant that we tend to talk about the most.

Dr. Spiker:                  Now my understanding, Dr. Anden – and correct me if I’m wrong – we actually have these cannabinoids. They’re naturally inside of our body? I guess we discovered this around 1992, people kind of trying to figure out why do runners always say, “I get this runner’s high.” I think one of them is called anandamide? Is that correct? We actually produce these ourselves?

Dr. Anden:                  Yes. So, the one you’re referring to is anandamide. And it’s often referred to as the bliss molecule. So, THC was originally discovered by Dr. Mechoulam in Israel in the 1960s and then he soon after discovered CBD and has been studying that. So, then scientists were curious as to why these chemicals work in the body. And it’s actually amazing – not until the 1990s did we as a scientific community discover that we have an internal cannabinoid system.

So, that’s called the endocannabinoid system. We use that term “endo” to refer to things in the body. And it’s a very vast system. It is the largest regulatory system in the human body, and I should say mammalian bodies in general – so, mammals, living organisms. So, dogs and cats have endocannabinoid systems.

                                    So, these are receptors, different cells throughout the body in many different organ systems, and two of them being endocannabinoids that link to our endocannabinoid system are anandamide and AG2. I believe the current number for scientists is they’ve discovered about 20. But we really only know a little bit about a handful and, again, mostly anandamide and AG2.

So, the receptors – I don’t know if the community’s familiar with that concept. But the way our body works is we have cellular mechanisms and transmitters and enzymes, and they bind to receptors on individual cells in the body. That could be your GI tract cells or neurons in the brain, etcetera, and cause processes to occur that regulate how our body is functioning.

The endocannabinoid system is particularly responsible for balance or the term we use – homeostasis. So, if something’s too high, a chain reaction goes into place to bring it lower. Something too low, it brings it higher. So, we have an internal functioning endocannabinoid system.

There are now concepts of thinking that certain disease processes are actually a malfunction of that endocannabinoid system. So, it may be that we might discover along that tract that conditions like autism, Alzheimer’s, seizures, autoimmune disorders like rheumatoid arthritis, lupus, etcetera, are disruptions in the endocannabinoid system because patients who have those disorders find in many cases excellent benefits. Sometimes, there are often superior benefits to pharmaceuticals and other conventional treatment to manage those disorders.

Dr. Spiker:                  Well, that’s really interesting because it sounds to me like we’re dealing with kind of a lock/key mechanism. I put my key into the door lock, and I open it. And then it kind of opens up this system. So, is it that the THC or the marijuana is able to be a key, I guess, in a sense and kind of unlock that system? Am I right with that kind of analogy?

Dr. Anden:                  Yes, that would be correct. And it’s very complex from a pharmacology/pharmacokinetics analysis because when we talk about the cannabis plant and these chemicals, the THC and CBC, we talk about the entourage effect, which is – if we’re talking about the whole plant medicine and all of those 500 chemicals, it’s the synergy of those chemicals working together in the body that has effects.

                                    So, we can talk about THC, studying that individually, and CBD individually as they bind with the two most common or most ubiquitous receptors, the CB1 and CB2 receptors. CB1 is mostly in the central nervous system and brain, and CB2 receptors are more in the immune system. As those individual chemicals bind, it is a lock and a key initiating responses.

So, in this case, THC is mostly associated with the psychoactive or mildly intoxicating effects. That’s because of the receptors that are in the central nervous system. But THC has other interactions in the GI tract that can help alleviate nausea and vomiting. There are ways that these chemicals interact with cells that can decrease cancer cell growth by initiating what’s called apoptosis or cellular death. So, it’s very complex.

And what scientists have determined is that when you have the whole plant and all of the chemicals working together, not just THC and CBD alone, it works better. And it’s required much lower quantities, much lower potency, much lower doses of say THC as a chemical or CBD as a chemical than when you have them as kind of an isolate because there are a couple of pharmaceutical drugs that mimic the effects of cannabis – so, a THC isolate and a CBD isolate. But they don’t work as well really as the whole plant chemicals working together. So, that makes it complex with those subtle interactions that we’re talking about.

Dr. Spiker:                  I was thinking about that because I’ve had some of my patients here at the Positional Release Therapy Institute say to me, “Well, my physician said I can just take this Marinol pill, the synthetic form. And, therefore, I’m not gonna have all the other side effects of say smoking a joint or eating an edible or something of that nature. And it makes sense to me now that you’re saying that this is a synergistic sort of process. I kind of think of it like composing a soup or creating a soup.

Dr. Anden:                  Right.

Dr. Spiker:                  I wouldn’t necessarily just put salt in the soup only.

Dr. Anden:                  Exactly, exactly.

Dr. Spiker:                  To make it taste good, to make it work, I’d have to get all the ingredients kind of working together.

Dr. Anden:                  Exactly.

Dr. Spiker:                  So, with that mindset then because I’ve seen, I guess now, and I’ve heard of three or four different synthetic forms of THC or some of these compounds. Why do you think they’re still being promoted and not necessarily like the whole plant? I’m just curious.

Dr. Anden:                  Well, because the whole plant’s been illegal. So, there’s two parts here. So, big pharma would like to get in on it. So, they created a synthetic THC, which is Marinol. And if that’s all you could get, okay. But it doesn’t work as well because it’s just an isolate. So, you need a lot it. And, also, we found that people do have more adverse side effects when they’re just using that alone.

                                    Now the other side of that is the other synthetic cannabinoids, not pharmaceutical per se, although it started with investigation, the study of these synthetic chemicals at Clemson University, actually in the 60s through the 90s once THC was discovered.

So, the Spice and K2 that are synthetic cannabinoids. They were kind of street drugs. Smoke shops were selling them as a natural incense or fake weed. Those drugs are very, very, very toxic. So, they’re analogs to THC. But from a pharmacology standpoint, they’re even more potent than THC. They’re called full agonists. They bind to the receptors completely whereas actually THC is a partial agonist.

So, these synthetic chemicals are very dangerous. They can even cause death by nature of causing a couple of degrees of hypothermia. They can cause seizures, just really hyperactivity in the central nervous system – so, opposite what one might think. These are drugs that are hard to regulate because chemists just – I don’t know; it sounds very, very smart. But they keep modifying these molecules slightly to avoid detection. So, the forces that be, the law enforcement, etcetera, it’s hard to control those. But those are very dangerous.

So, just to everybody who’s listening, don’t ever use K2 or Spice or any of those other drugs because they’re dangerous. They were originally created though in order to do research, and it facilitated the elucidation of the endocannabinoid system. And they need to stay in that area.

Dr. Spiker:                  Right.

Dr. Anden:                  The drug companies also did come out with one that was going to be promoted for weight loss, but it caused such adverse side effects. It actually was legalized in Europe for a couple of years before it was pulled off the market because it was causing many adverse side effects, including suicidal ideation, etcetera. So, pharmacologists are still working on that, but it’s more complex than we might think.  

Dr. Spiker:                  Well, I’m curious then. Since we have these research studies with the synthetic form and now we have an emerging sort of robust research base coming about with the whole plant being very effective as you mentioned, I’m just curious because you had said this has been around a while as far as all this research. So, I’m just trying to wrap my head around – why is it now that it’s just becoming so popular? Why has it taken so long for us to get here to this point? I’m fascinated by that.

Dr. Anden:                  It is. It’s a very complex history. It’s very interesting. So, cannabis has been used as medicine for 5000-6000 years. Now how do we know that? So, there have been grave and archeological discoveries of cannabis seeds, etcetera, from 5000-6000 years ago. There’s some literature in the Chinese documents referring to cannabis. Some people even believe that the holy anointing oil referred to in the Bible was actually cannabis. And this is from Israeli scholars reporting that.

So, cannabis has been used for a long time. So, it was a major part of the United States Pharmacopeia through the 1800s. But people weren’t using it like they’re getting high and getting drunk, like alcohol or things. It was just part of whole plant medicine, like other herbs and such.

So, about in the 1930s, some things happened in the United States. We had a little bit of a war with Mexico. Some of the cannabis, which was called marijuana, referring to the Mexican association – the propaganda associated marijuana with Mexicans. There was actually an anti-Mexican sentiment just culturally speaking because we had had a war.

There were also associations with the Black community with marijuana. And also at the same time, big industrialists were producing lumbar and cotton and initiating the production of pharmaceuticals like aspirin, and it served a purpose for big business and profit to eliminate hemp and marijuana so that these other products would become more profitable.

Then that led into more and more propaganda and the war on drugs where we had President Nixon really cracking down on any drug, particularly cannabis. But during this time, there were quite a few experts and even experts from the American Medical Association and physicians of the time – so, we’re back in the 1930s – and then through time saying that, really, cannabis isn’t that bad and should not be in the same category as heroin and cocaine or even alcohol for that matter, which we went through prohibition and then was legalized.

So, it was illegal. But as we know, people still continued to use cannabis because it’s fairly easy in a way to grow, and it just is such powerful medicine that people have used it over time, easy to get through the black market, etcetera.

But the whole tragedy of all of this is that it was our people of color, our communities of color, that suffered the most because Blacks are four times more likely to be arrested, prosecuted, and spend long times in jail than members of the white community.

So, there is talk these days, now understanding that cannabis is medicine, it’s for the most part very safe. States that are now legalizing it are working on expungement of criminal records and reparations for those communities that have suffered the most because of this false propaganda about the plant and the medicine.

Dr. Spiker:                  Well, it must drive you a little crazy then because you go on to some of the governmental sites even today, and they say and they have been for quite some time saying, “Well, medical marijuana doesn’t have any medical value. It’s lacking research to show that it’s helpful.” Why do you think they’re taking this stance still? And I guess, maybe, how does that make you feel as both an expert in this area and a practitioner and researcher about medical marijuana?

Dr. Anden:                  Well, it’s disturbing that there are organizations and people in power that can perpetuate falsehoods. So, it’s kind of a grand picture of the world, I suppose.

And I say to myself now being really a quiet advocate but now more vocal about it that – wow, these people who have been promoting cannabis since the war on drugs dating back to the 60s and 70s and have stuck with it and have put efforts through the Supreme Court, etcetera, and the FDA to try to change these things and they just get shut down even when they’re promoting the facts of the research, it’s very, very, very, very frustrating. But I understand that’s how our government works.

                                    So, cannabis is still Schedule I in the list of medications, Schedule I through V, the Controlled Substances Act, which means it has no medicinal benefit. It has potential for abuse and harm, even under the direction of a medical provider. So, that is just outright false. And proponents have been fighting this for a long, long time.

And there were rulings that said that the FDA needed to address this, and they have postponed it year after year after year after year. I don’t really understand how our government doesn’t abide by laws and orders. I don’t understand why there are now 33-plus states and territories that have made cannabis legal medically and 11 or so where it’s for adult use, what we would call recreational, but yet our federal government is still just dragging their feet on this.

I can only assume that there are lobby efforts to still keep it illegal. My understanding is that Big Pharma is a big contributor to the anti-cannabis movement. These things can all be researched. This is the world we live in. We have access to so much information that people can investigate, and they can learn on their own instead of listening to propaganda.

Dr. Spiker:                  Well, I think we’ve been in that propaganda mill for quite some time. I think one of the more popular, I guess, propaganda that was put out – I believe it was the late 40, early 50s. Correct me if I’m wrong – but Reefer Madness? It was a movie produced about the dangers of marijuana and how it would hurt you. And I’ve seen tidbits of that from the pharmaceutical industry. And I’m wondering if they themselves are worried about it taking away a slice of the pie, particularly related to opiate sales, other pain-relieving kind of prescriptions?

Dr. Anden:                  I believe that there is a concern about that. I was just reading an article that Sanjay Gupta, Dr. Gupta, who did a documentary about cannabis – I don’t know if you’ve heard about this – a few years back. So, he did a Part 1 and a Part 2. And he was initially just anti-cannabis. But as he did the documentary, he came more and more to understand the potential benefits and at one point said, “I was wrong. I admit it. I was wrong about cannabis. It’s very important. It can be good medicine.”

                                    So, he is involved in a CBD product company, and he’s being sued by pharmaceutical companies, some breach of contract of some sort. I’m not sure what he was involved with with them because he promoting CBD is hurtful to their bottom line. So, it just shows to me that Big Pharma is not really about helping people. We do have good medicine. They’re about profits and such.

                                    Well, I don’t know what to say about the opioids because they’ve been slammed down here. Pfizer and such have had billion dollar fines that they need to pay. Just in general, physicians are not supportive of more and more opioids like we did through the 90s and 2000s.

And in reality, I’m seeing quite a few people who are getting off of opioids. There is research on this as well. People can decrease their opioid dose considerably. They can get off of it if they’re very highly motivated in a couple of weeks. Other people may take a longer period of time. But cannabis actually decreases cravings and withdrawal symptoms.

It can be a substitute as an analgesic. And it also because of this – and we’re talking about the endocannabinoid system – actually helps the opioid receptors to be more receptive. So, people can cut their opioid dose by quite a bit but still have the same amount of pain relief. And over time, people are finding they forget to take their opioid dose, and they’re just doing fine with cannabis.

                                    And we mentioned about the dangers of cannabis. So, cannabis is not lethal. There’s no lethal dose of cannabis. It does not kill you because there are no cannabinoid receptors in the brain stem, which is what controls our breathing. And that’s why people die from opioids is because of taking too much or combined with other sedative medications. They stop breathing and die. So, cannabis doesn’t do that. The worst thing is if a person took too much, they might either be sleepy, or they might be anxious, but it’s very short-lived.

Dr. Spiker:                  Or maybe hungry?

Dr. Anden:                  Yeah, people talk about that, but that’s not all that common. I have a couple people. It’s kind of a fallacy that it gives people the munchies. It’s possible because of the way it works in the endocannabinoid system. And in some ways that’s actually helpful for people who have anorexia related to chemotherapy or other disorders or diseases. We wanna stimulate appetite. But that’s not really that common.

Dr. Spiker:                  Well, I bring that up because that’s been a concern. Some of my patients are like – well, I don’t wanna gain a lot of weight. I heard that marijuana makes you eat a lot. And I’m like – well, actually, some studies have shown that it reduces your BMI.

Dr. Anden:                  Right.

Dr. Spiker:                  I agree with you. It’s a bit of a fallacy out there, but you do hear that a fair amount.

Dr. Anden:                  Yeah, that’s not one to be too concerned about. The study show that regular cannabis users are typically of a more normal BMI than the general population. And there are some of the cannabinoids in there, THCV and others, to be investigated that actually decrease appetite.

So, as scientists learn more about different chemicals – I’m not a big fan of morphing something that’s great just the way it is. But perhaps studying some of the chemicals and maybe perhaps the people that study cannabis genomics targeting some of the chemical structures as the plant is growing to try to increase the number of certain cannabinoids as opposed to other cannabinoids so that there are particular cultivars we say or strains that are better for certain disorders.

You want to encourage weight loss or we wanna stabilize diabetics with their blood sugars or we want to help autism, then there would be particular cultivars – that’s the new term we want to promote instead of strains – that would be better for certain disorders. So, that’s what I see as a positive movement for the future.

But the basic scientists, botanists, biochemists – we call it cannabis genomics – are really quite baffled by the plant. This is a very, very complex plant if you consider when they study corn or quinoa or beets. We know in our agriculture these days, farmers can grow thousands of acres of corn. And every piece of corn will look the same. Cannabis doesn’t do that, whether you’re growing it inside or outside, it’s subject to environmental pressures. And every plant has slight variations in the chemicals that it produces in the buds, which are the flowers and the resin.

So, in order to know what every cannabis plant or product that you might buy at the pharmacy or find – in order to know exactly what cannabinoids and terpenes are in it, it needs to be tested. You can test sort of a small batch, but you can’t say that if you test one plant for a field of crops that they’re all going to be exactly the same. So, there’s a lot of trial and error with people finding the right medicine with cannabis. But, again, it’s fine. It’s not going to kill you.

Dr. Spiker:                  Sure, unlike our opioids, which, obviously, we still have this kind of raging problem here. I think the last estimate we were losing about 128 every day, and I think one woman here in Utah she overdoses every day as well.

Dr. Anden:                  And I read that they’re predicting the numbers to go up because of this whole pandemic. People are depressed and just looking for escape.

Dr. Spiker:                  Sure. So, with that, let me ask you this. So, what I’m hearing is that medical marijuana may be a great alternative for those seeking to get off opioids or to avoid opioid addiction. But, also, we have a fair amount of population here at our clinic but also elsewhere who are just a little apprehensive about going the full route of medical marijuana like – oh, I’ll just try the CBD. And I’ve had some patients say to me, “Oh, that CBD is amazing. I can’t believe how much it’s helped my back pain.” And then I have others. It’s like 50/50 – ah, it does nothing for me.

Dr. Anden:                  Right.

Dr. Spiker:                  So, what’s going on there?

Dr. Anden:                  So, CBD is one of the main cannabinoids in the cannabis plant. So, CBD has lots of medicinal benefits. So, it works a little bit different in the endocannabinoid system than the THC. It actually stimulates more anandamide because it decreases the breakdown of the cannabinoids. It works a little different.

So, it has analgesia, antiinflammatory, antiseizure, anti-muscle spasm, promotes bone growth, promotes decreased cancer cell growth – so, lots of good things. So, I think of CBD as a good supplement like people take their multivitamin or vitamin D or fish oil every day. So, 20 to 30 mg of CBD every day is good.

Now, remember I talked about all of those chemicals working together works better than an isolate. So, full-spectrum CBD, which is whole plants, so we have all of those other cannabinoids and terpenes with it, works better than a CBD isolate.

And that’s important because CBD can be very expensive. It can be 10 to 12 cents a milligram. So, you need to take 5 to 10 times more as an isolate than you would as a full spectrum meaning a person might need to take 200 to 300 mg of CBD. So, that’s like $30 a dose. So, that’s not gonna happen.  

However, that does contain a small amount, less than 0.3%, THC. So, the concern is that depending on where a person works and if they’re drug tested, even though they’re just using CBD, a very sensitive drug test could show the presence of THC. So, that’s another area that employers and human resource departments and such we need to get around.

So, CBD can be very effective for those reasons. And CBD is not psychoactive. However, if it’s not enough, then my approach would be to add small amounts of other products that contain a small amount of THC. So, I said CBD 20 to 30 mg. So, a good starting dose of THC would be 2.5 mg or less. And I say 2.5 because it’s easier to calculate 2.5, 5, 10, 20, that sort of thing.

But if you were really sensitive, it could even be microdosing 1 mg of THC or less with the CBD. So, then we talk about that as a ratio, a CBD to THC ratio. So, if you had 20 mg of CBD and 2 mg of THC, that’s a 10:1 ratio. Or if you had 30 mg to 1 mg, that’s a 30:1 ratio. So, those are some products like Charlotte’s Web that people might have heard of that Charlotte Figi who was a young girl who had an uncontrolled seizure disorder. She was taking a product like that, and it completely eliminated her seizures.

So, there are people who will respond to just tiny, tiny amounts of THC with the CBD. So, there’s ways of using cannabis. If people are using CBD, they are using medical cannabis. I hardly ever use the word marijuana other than to discern the difference between hemp, which is a lot of CBD and minimal amounts of THC and everything beyond that.

So, hemp is defined by us humans as less than 0.3% THC. So, if it has 0.4% THC, now we’ve crossed the line from a product that is available over-the-counter through the hemp bill to something that is federally and state regulated. So, you still have a lot of CBD, but you have 0.4% THC. So, we can call that marijuana. But it’s all cannabis. It’s all medical cannabis. If people are using CBD, they’re using medical cannabis.

So, what I would do with people then is there are ways that you can use it. You don’t even have to inhale. There’s tinctures or oils. There are lozenges, gummies, edibles, topical salves that could have any ratio. You can make any ratio of CBD to THC.

And then there are people who really respond better to higher amounts of THC than CBD. So, in particular people with PTSD seem to respond well to the higher THC products or a combination, equal amounts CBD to THC. It just helps with decreasing the occurrence of bad memories and nightmares and fear repetition, of bad thoughts, etcetera. 

So, it’s complex in that way, but there’s ways of using cannabis where you don’t get intoxicated. The stereotypical thing that was promoted is very high THC products. Yes, they can be intoxicating, but the effect doesn’t last. The effects of an inhalation last like a couple hours. So, if you don’t like it and you don’t feel good, just lay down and watch a move and it’ll be over.

Dr. Spiker:                  Right.

Dr. Anden:                  In my experience, that little bit of anxiety generally lasts less than half an hour. So, don’t panic.

Dr. Spiker:                  Well, with our patients here, we deal with a lot of chronic pain patients, particularly back pain patients. And we know that one of the primary reasons that chronic back pain patients receive opioids is because, 1.) That’s what’s been offered to them. And, 2.) Many may be apprehensive like what you said about – oh, well, what if I take too much THC or cannabis and something happens?

                                    Well, I’ve heard multiple stories here. I’ve heard one individual who went across the border, decided to eat a whole bunch of gummies, and had a bad experience. So, therefore, they said, “Well, no, that stuff is not gonna help me and my pain.”

                                    So, the roundabout here, what I’m hearing, is the dosing and having the right product or the right prescription is really super, super important to make sure that what you’re doing is effective because I’ve had patients say to me, “Well, I don’t wanna go get a medical marijuana card. I don’t want people to know that I’m taking marijuana. I’m gonna just drive across the border and get some.” And I’m like – well, we should talk about that.

Dr. Anden:                  Right.

Dr. Spiker:                  Because, obviously, there’s legal implications. But what I’m hearing, there’s a bigger therapeutic implication, right?

Dr. Anden:                  Exactly. Well, I guess the first thing we want people not to do is to completely eliminate the likelihood of using it because it can be very helpful used properly and correctly with good education on how to use it. No. 2, we don’t want people to have a bad experience where they listen to a friend. And, frankly, that’s where most people are getting their information from a friend or a friend of a friend of a friend, which may not be accurate.

                                    So, the extreme is to take too much or the wrong product and have a bad experience and then say, “I’m never going to do that again.” But that’s just like anything else. I might eat too much pumpkin pie and say, “I’m never gonna have pumpkin pie again.” That’s not the pumpkin pie. It’s that I ate too much of the pumpkin pie.

Dr. Spiker:                  Right, right.

Dr. Anden:                  So, again, the starting dose for someone that is totally cannabis naïve could be 1 to 2 mg of THC. So, those edibles that you can buy, a common dose is 10 mg. So, it’s a little gummy. You look at it, and people just say, “Oh, I’ll just eat this gummy.”

And the other thing notorious with edibles is that it can take an hour or even two to have an effect because it has to get digested and metabolized by the liver. So, people take it, and they wait a half an hour. And nothing happens. So, then there’s this little bag of edibles, and they just have another one. And then it all sort of hits at once. And then they have too much.

                                    So, even though an edible in the package, something that I don’t like to see is – it says, “One dose is one edible.” Well, a dose is whatever the patient and I decide is the dose. It’s one whole edible. But a dose of a 10 mg edible for a new person is no more than a quarter of that edible. So, just because it is an item, you have to cut it in different pieces. Or even it was 2.5 mg, if someone was very sensitive, I might even say cut that in half and take it with some CBD. So, there are products that are available that are already a combination of CBD and THC in different ratios.

So, the pharmacies we have in Utah here have – I’ve seen the tincture that’s a 10:1 ratio or a 5:1 or a 1:1 ratio. And our other states that have mature cannabis markets and they’ve been doing this for decades have even a wider variety of products. So, when you go out of state, they want to be helpful, but they can’t spend hours explaining this all.

You go into the dispensary in Wendover, and you say, “I have pain.” And they say, “Here, buy this.” And they don’t give you a lot of instruction necessarily. They try. But as we just have been talking for almost an hour about it, it’s very complex, and people don’t really know. Even when I meet people and I go through this and I do the education and I write things down and I say, “Get this,” I can’t tell you how many times they go to the pharmacy or dispensary, and they get something completely different.

You have to calculate. There’s a little bit of math there. If you use the tincture, all these little brown bottles have different potencies. And there’s a little bit of math involved to know how much to take. So, it is complicated. So, I like to communicate regularly with my patients. If they buy something and they don’t know how to take it, call me. Send me a picture of the product. Let’s try to figure out how much of it that you should take to have a good experience.

Sometimes, we’re gonna start at a really low dose, and people aren’t necessarily gonna feel anything at first. That’s fine. We’re trying to find the right dose. And one thing about it is with our endocannabinoid system and these compounds, once a person finds the dose that works for them, it generally stays that way forever.

So, unlike opioids, you don’t feel the tolerance such that you need more and more and more and more. It’s just a beautiful thing with our endocannabinoid system. Once we find our dose – and for most people, like I said, a starting dose is 2.5 mg of THC often combined with CBD – most people are kind of in the 5 to 15 mg, maybe up to 20 mg range. There are people that use more than that, but they’re probably overusing it because the science says that that’s really all that we need to help with these disorders we’re treating.

Dr. Spiker:                  Well, as complex as this is and it’s hard for even the common person to get their head wrapped around this as well as healthcare professionals, I’m wondering in the physician community – are they being educated on this? And where do they get their education? Are we now educating medical school students on medical cannabis? I don’t know that. Do you happen to know that yourself?

Dr. Anden:                  So, in Utah now, in order for a patient to get a card, they need to be evaluated by a physician who is a qualified medical provider. In order to be a cannabis-qualified medical provider, the state requires that people take a course of a minimum of four hours. So, I can say that I think some physicians balk at that, the four hours. But I probably have 400 hours of education, and I’m still learning more and more.

                                    So, four hours is quite inadequate. You think about your specialty and what you do. Four hours is touching the surface. And a lot of the education is targeted for some reason research on Marinol and Epidiolex, which as we just sort of talked about have very little correlation to what is actually going on in the real world.

So, I would venture to say that many physicians in Utah are very unfamiliar with cannabis, where even the chemicals that we’re talking about come from. What is the plant? What does it look like? What are these buds? What are the actual products that are available in a pharmacy? It’s very, very complicated.

So, my view – because I’ve talked to legislators, and they say, “Well, we just want more doctors to be involved in it.” If you have a specialty and you’re already learning more about high blood pressure and diabetes and this and that and the new drugs that come out for rheumatological disorders, how much mental energy or time do you actually have to study cannabis?

It’s not like – oh, here’s cannabis, and here’s a pill. And it comes in three different doses. And you start with this one. And then if that doesn’t work, you prescribe this. No, that’s not how it works because you’re gonna trial and error in what you recommend, and they’re gonna trial and error in what they’re taking. And it’s very, very time intensive.

So, I think there’s the apprehension on the part of physicians. And unless they’re gonna do a deep dive to really understand it, I don’t think they’re going to embrace the topic. I’m happy to educate. I’m happy to bring that around.

Dr. Spiker:                  Sure.

Dr. Anden:                  But it’s sort of trying to explain to doctors why positional release or chiropractic care or acupuncture or something might be helpful. If they’re not into it, then they’re just gonna do what they do.

Dr. Spiker:                  The reason I brought that up is because I had a recent experience, a couple of them actually, one with an MS patient who was undergoing medication therapy, traditional, and another who is stage V cancer. She only has a short period of time to live. But they both had asked their physician groups – well, what about taking marijuana? And the response they got back was one they didn’t expect.

It was promoted to be fearful, that taking that would essentially thwart their recovery, or it would complicate their symptoms. And the physicians were not on board even entertaining the idea of even using CBD as a supplement or cannabis as an adjunct. So, I’m wondering when we might get there?

Dr. Anden:                  Well, I think that’s sad. I’m kind of an out-of-the-box thinker I would say. So, I’m just concerned that as a community, physicians, we have a lot of training, and it’s stressful. And we know what we know, and sometimes we get a little bit of a superiority complex. We think we know what we know, and we don’t know what we don’t know. And we feel very powerful in making a statement like that, which is unfortunately completely false.

                                    But we all have our own personal securities and ways that we think that make us feel like we’re competent as physicians. But I’m not going to talk about what would be the best chemotherapy for a person with cancer. So, I would say that it would be more logical for a physician who doesn’t really know about cannabis to maybe reach out and talk to someone who does or as an expert and have a professional conversation and kind of come to some terms with what is possible.

                                    So, the cancer patient, they’re stage IV or V and they’re terminal and they’re hospice, what? Are you kidding me? What harm could cannabis do?

Dr. Spiker:                  Right.

Dr. Anden:                  It’s going to help them. It’s going to help them to feel better. It has spiritual repercussions. It could ease their days, help their pain, help nausea and vomiting. So, it’s a tragedy.

Dr. Spiker:                  And who knows? Maybe it might lengthen their life because I’ve seen some recent studies that show it has antitumor effects.

Dr. Anden:                  Right. It encourages apoptosis meaning the cancer cells just stop growing or they die. So, I’ve read articles with people – these are anecdotal. But, hey, we believe our patients. And the tumors just stop growing. They don’t necessarily go away, but they’re just there. They kinda turn from malignant to benign, pancreatic cancer, lung cancer.

                                    So, there’s research in Israel. There’s a wonderful article. I’ll send it to you of studying different strains or cultivars of cannabis against different cancer cell lines. And there are certain strains that work better for this type of breast cancer or this pancreatic cancer or this colon cancer and that sort of thing. There could be – you have this cancer; so, you should use this cannabis strain or this cultivar. So, that would be great.

                                    But then, what would need to happen is that cultivators and processors would need to grow those strains. So, we have that whole other end of the industry where right now we have medical cannabis in Utah, but the cultivators are growing whatever they want to grow and because a lot of the people in the population don’t understand and on your end, patients we see, they’re afraid of THC.

But we have this other population that thinks it’s all about the THC, and they want higher and higher THC potency products. So, cannabis flower is up to 28% THC. Back in the day, 25 years ago, it was less than 5%. So, people seem to focus on the intoxicating effects of the THC. And I have to say it’s not all about the THC. It’s all about these other chemicals that are working together that we need to focus on.

Dr. Spiker:                  And I think that’s been a bright light brought today with our conversation is that we really need to maybe look at the utilization of the whole plant with much more vigor as well as its research other than just trying to isolate out a particular chemical or cannabinoid. And I’ve never heard of anyone overdosing, dying from taking too much pot or cannabis.

And, finally, that we have the potential to utilize this medicinal plant for a variety of conditions. We didn’t even touch on that. I guess in a way we’re scratching the surface today because we didn’t talk about how it’s interacting with chronic pain or Alzheimer’s disease or PTSD or even MS and cancer very much, but it has such broad implications for helping individuals not only become addicted to opioids but also to improve their quality of life in multiple, multiple areas.

So, I really appreciate you bringing this to the forefront, Dr. Anden, and being a huge advocate for your patients and others out there. So, with that, where can people find you? How can they get connected to you, Dr. Anden?

Dr. Anden:                  So, I have an office in South Ogden. I’m located in the Northern Utah Rehabilitation Hospital. We have a website that explains a lot about the medical cannabis and how they can be seen. They can sign up online on our website, and then we contact them to make an appointment.

And I do offer those other types of treatments as well combining the conventional and the alternative or unconventional, we would say, treatments for musculoskeletal disorders. So, I am pain management physician. And I’m trying to get away from the opioids and more towards lifestyle management and healthy lifestyles and improving their health.

So, I’m happy to see people. The easiest thing like I said is to go on our website or call our office 801-732-5914 and just reach out to us. We have a Facebook presence as well. And I’m really happy to help.

So, different from other – we call them cannabis card clinics where people can just go and they can meet with someone and they’ll just check the box that, yes, they have a qualifying condition, which could be just pain longer than two weeks. And then here’s your card, and good luck with the medicine. I don’t find that that approach works very well.

There’s people who have been long-time cannabis users and are just smoking cannabis. And I can still educate them on different ways to use it and use it better. It’s expensive. It’s not covered by insurance. So, I hate when people are sort of wasting their money or wasting product because they’re not using it most effectively.

And we want to encourage people to use high quality products that are from a pharmacy and have been third party tested and that sort of thing. There’s a lot going on. So, my passion is to evaluate and educate people, much like you, understand the person who has the disorder and treat the person, not just the disease – a whole person approach. We’re trying to improve the quality of life.

Dr. Spiker:                  Tell me if I’m crazy about this, but it almost sounds like that’s the way medicine should be.

Dr. Anden:                  Well, we could go on and on about that. I agree. I sent you that article about the Flexner Report when they changed it to a wholly scientific model and evidence-based and such. And it moves to an algorithm approach, but it’s not a suitable approach to conventional medicine to people that these days have multiple disorders that are combined and interacting and multiple organ systems. And on top of that, they’re in psychological distress. We need to look at the whole person –

Dr. Spiker:                  I agree.

Dr. Anden:                  – and sort of peel away the layers like an onion. And I really feel like cannabis can kind of take a high level of disease and anxiety and such and just like turn down the dimmer switch on whether it’s the immune system or anxiety or all of those things. Let’s just like calm it all down, and then let’s start peeling away the layers of the onion.

Dr. Spiker:                  That’s beautiful. So, with that, I guess, I’m curious, Dr. Anden, with your work going forward, what impact do you wanna have on humanity with your work?

Dr. Anden:                  I would really like to educate people about how they can learn to manage their disorders, how they can understand their body and manage things. And I guess my goal is to sort of be less dependent on just following the directions of physicians and medical training. I’m not putting down physicians. But our medical training when you go to a physician is really focused on pharmaceuticals and devices, drugs and surgeries.

And I’m not seeing people necessarily always getting better. It’s sort of like one drug has side effects, and then you have more drugs. Or you have side effects from surgery. Lots of people are having infections. I think that maybe there’s an alternative where we can learn to manage things and accept our disorders and really just look at putting chemicals in our body or having major surgeries as a last resort, not a first report. 

So, I guess as a physician and a healer, I’d like to just get back to a more organic and self-management strategy, I think, and then you and I as helpers along that course.

Dr. Spiker:                  Guides.

Dr. Anden:                  Guides – it empowers people to really take ownership rather than just taking direction.

Dr. Spiker:                  That’s wonderful. And we hope here at The In that we’re helping guide individuals in making those smart choices to choose products, topics, interventions, guides in healthcare to really help improve their heath and performance and improve their overall quality of health.

                                    So, thank you for your contribution, Dr. Anden. And we look forward to future ones. And maybe in the future if our listeners out there would like us to talk about certain topics, such an anxiety or Crohn’s disease or how medical marijuana might be helpful with that, please let us know. And thank you again. And we hope to speak with you soon. And keep doing the good work that you’re doing.

Dr. Anden:                  Yes. Thank you, Dr. Spiker. I hope that we can have more conversations.

Dr. Spiker:                  That sounds great. Well, thank you, everyone. And we’ll see you next time on The In.