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Cannabis in Modern Medicine

Dr. Allan Frankel, a board-certified internist at GreenBridge Medical in Santa Monica, California, has treated patients with medical cannabis for the past 13 years. 

The first time I interviewed him back in 2014, cannabis laws in the U.S. were quite different, so in this interview, he provides us with a much-needed update. Not only is recreational use of cannabis now legal in California and several other states, but hemp is also legal nationwide, thanks to a change in the farm bill passed at the end of 2018.1 As noted by Frankel:

“Cannabis is becoming more and more a viable option that people can count on; you can have reliable dosing. There are certainly a lot of bad products out there … In general, we’re looking for whole-plant [products]. 

Hemp is going through a big change now because with the farm bill, the Version 2 hemp is going to be cannabis plants that started with 0.4% tetrahydrocannabinol (THC). I actually developed some of those. Now we just went to 0.3%. With the new farm bill, that’s defined as hemp. It’s basically whole-plant cannabis … So, it’s confusing out there.”

Exciting Developments in Cannabis Medicine

Frankel is particularly excited by the discovery of a new cannabinoid molecule, tetrahydrocannabivarin or THCV. While very similar to THC, which is the psychoactive part of marijuana, THCV is not psychoactive, but can still induce a sense of “focused euphoria.” 

“It’s a wonderful feeling, I think, for [those with] depression and anxiety,” Frankel says. It’s also helpful for pain, which is a really important medical need. Opioids are now killing an estimated 47,600 Americans annually,2 and we desperately need safer alternatives. Medical cannabis is one such alternative. 

THCV has also been shown to improve symptoms of Parkinson’s disease and prevent progression of the disease. As of right now the majority of plant strains contain about 50/50 THCV and THC. Breeding will eventually lower the THC content to within legal limits though, Frankel says, who estimates breeders may be able to lower the THC content to within legal limits in three to five years.

“I would say the most exciting thing that we’ve found with THCV is for treating existing neuropathy. There are 20 million people in this country who have neuropathic pain. It’s been called suicide pain. It’s horrible, horrible pain. There’s not very good medication for it … But it turns out THCV works unbelievably well for neuropathic pain.”

A couple of animal studies have also looked at THCV for multiple sclerosis(MS). Two of Frankel’s MS patients used transdermal THCV, resulting in the resolution of neuropathic discomfort, weakness and pain from their feet to their thighs.

“That’s definitely one thing we’re going to be pursuing a lot,” Frankel says. “It’s for mood, for seizures. You’ve got to get a little bit less THC in it. But for seizures, I see where it’s going to be cannabidiol (CBD), tetrahydrocannabinolic acid (THCA), THCV or cannabidivarin (CBDV) — similar to treating cancer.

If we can have five or eight different major cannabinoids and maybe 100 terpenes that all kill cancer, why not mix them together? I mean, why wouldn’t we want them together since they balance each other’s side effects (and there’s not much in the way of side effects).”

Autoflowers 101

While most have only heard of sativa and indica, there’s a third cannabis strain called ruderalis, which is an autoflower. Frankel explains:

“What happened a few thousand years ago is sativas that were trying to grow in the steppes of Russia, the summers were so short with so little light that it was impossible for them to go through growth and then a flowering period. One plant, one day, had a little genetic change. 

It started flowering at the same time that it’s growing. It’s amazing when you see these plants, because you can put them in any light and they grow up. Everybody will be hearing more and more about autoflowers.” 

From seed to mature plant, it takes but 55 days. And, while it’s a smaller plant, it’s very easy to grow. “I see this as something for the home patient market,” Frankel says.