SHOW NOTES

Dr. Jessica McCain of Southern Comfort Wellness in Port Saint Lucie gives us a peek into the world of medical marijuana. If you think you might benefit, this podcast is a great introduction to the considerations for determining if you qualify. Dr. McCain also discusses some of the requirements established by the state of Florida to qualify as a medical marijuana patient.

She will cover:

• What is Medical Marijuana how does it work?
• What about the high? Does medical marijuana have altering effects?
• What condition(s) is medical marijuana well-suited for?
• What condition is cannibas most frequently requested for?
• Is a medical marijuana recommendation one-size-fits-all? How do I know what is best?
• How to choose a delivery method and what options are available?
• What is the first step for a patient if they think they could benefit from cannabis?

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Transcription:

Kris Urquhart  0:36  

So today, we're gonna pick your brain a little bit about medical marijuana. And so right off the bat, can you share with us, what is medical marijuana and how can it help the body

 

Dr. Jessica McCain  0:50  

So medical marijuana is actually being used to help supplement what we ended up having as natural deficiencies and our endo cannabinoids. So that's a big fancy word for saying that we have a body system with neurotransmitters. Those are chemicals that speak to the different cells of the body, and they do downstream functions. So, to know that this has been around for quite a while but just now becoming more mainstream. It's important to recognize that the CBD and THC that you get from cannabis, your body makes those very similar chemicals, but we just call them two different things. We call them an atomized and to arachidonic glycerol acid, but for the sake of this conversation, we'll just say your man made and THC. So, THC was actually first isolated from the marijuana plant because they knew it had medical benefits by Dr. Raphael Mechoulam, in the 1970s. And then they turned it into pharmaceutical Marinol dronabinol, which I have actually very rarely prescribed that medicine with patients agreeing with it, it seems it caused more side effects. So, fast forward in the early 1990s. In 1992, they actually discovered that we make these chemicals ourselves just like the plant the Phyto cannabinoids in our bodies, we make endocannabinoids and these are the CBD and THC versions I'm referring to. Fast forward again to 2003, they actually now have a clinical diagnosis. Clinical Endocannabinoid Deficiency Syndrome refers to when you are actually depleted in your natural production of those two chemicals, you have downstream disease, because this body system actually regulates chemicals like dopamine, which can lead to Parkinson's acetylcholine, which can lead to Alzheimer’s, it also is in your immune system causing inflammation. It helps with you know, nervous system as far as regulating your serotonin and your adrenaline levels, appetite and mood. So, your natural cannabinoid system is so involved in your entire body system that when you become naturally deficient, you start getting symptoms of disease processes. So basically, think about it is like a vitamin or a supplement that you're using in order to treat a naturally occurring or disease occurring deficiency. 

 

Kris Urquhart  3:03  

So, when most people think of medical marijuana, they know that marijuana can give you a high, so that could be a concern. Can you explain how that plays into how this all works?

 

Dr. Jessica McCain  3:15  

We keep talking about CBD and THC, that's because those are the two most prevalent in the marijuana plant. And again, those are kind of the chemicals that mimic our natural body. But there's actually 113 different cannabinoids and the marijuana plant is pretty complex. It actually has 400 total chemicals which includes like essential oils or terpenes, which has Mind Body effects. So what people are familiar with is kind of the recreational cannabis, which is you know, from the streets we'd say and is high in THC. So, THC can cause a high, we call that the psychoactive effects. Now, when you're getting it from a medicinal perspective, it can also include a greater amount of CBD. And CBD is an antidote to the high, it actually negates those psychoactive effects. Now sometimes we have to kind of appreciate that maybe a high is actually a medicinal thing. If someone is very depressed, and they use a little cannabis, and they get some euphoria out of it, is that really a bad thing, if it's used in the right time and place. Also, for some people their version of a high that they get from THC, may be sedation. So if someone has insomnia, that is certainly something very appealing for people to use THC in order to get a good night's sleep. So, there's a combination of both CBD and THC and I will simplify it, probably more so than it should be, to say that CBD is more so for those chemical deficiencies. You know, in the THC is more for perception and for where the damage is done. And so, when you complement both of those, you can absolutely find balances that are non-intoxicating that you can use in the daytime. And then maybe you have different products that are for those moments when you're in a crisis state.

 

Kris Urquhart  4:56  

Gotcha. So, you mentioned insomnia and you mentioned depression, what are some of the health conditions that you find that this is well suited for?

 

Dr. Jessica McCain  5:07  

So worldwide, the three most common reasons to use cannabis would be number one, pain, number two, anxiety and depression. And then number three insomnia. And I will tell you that a lot of our patients actually have that trifecta because mind body experience is very interconnected. And of course, if you're not getting a good night's sleep, then pain and mental health is also suffering. So those are kind of the three most common reasons. Now the state of Florida has a set of approved medical conditions where you're considered kind of automatically qualified for cannabis. So, for example, that is if you have a seizure disorder, if you have glaucoma, Crohn's disease, ALS, which is Lou Gehrig's, cancer, multiple sclerosis, I think I mentioned Parkinson's, PTSD, HIV. But the state of Florida also gives specific cannabis physicians the opportunity to certify a patient if they have a similar condition. So maybe they don't have Crohn's, but they have ulcerative colitis. Maybe they don't have muscle spasms from Parkinson's, but they have spinal cord damage, where they have chronic pain and muscle spasms. So as long as that condition is considered debilitating again, and that is where it affects the quality of your life and reduces strength, whether that's physical or mental fortitude, then you're probably a good candidate for cannabis. As long as you've been counseled about those traditional therapies, or if you've at least tried something in the past and you're not getting the adequate control.

 

Kris Urquhart  6:33  

Are there certain conditions you find that it's most successful for or more frequently asked about from patients?

 

Dr. Jessica McCain  6:42  

I would say cancer patients, we get really good feedback, I would encourage most patients who are undergoing cancer treatment to use cannabis. One, for the palliative benefits because it can allow them to succeed and do the max tolerable doses of chemo therapies for example, and, you know, maintain dignity and quality of life. So that's one plus, cannabis does have anti-cancer properties. It's well known, it was studied in the 70s. These studies are being repeated. And today they're finding some great results that you can actually use cannabis to help control the spread of the cancer and actually increase or decrease its growth basis. Of course, for pain. Again, using CBD, you can reduce inflammation, you can combat some of those rheumatoid conditions, autoimmune conditions, it just down regulate, so it doesn't over actively affect your own system. And then where the damage is done. The THC is helpful for reducing those spasms, it's actually neuro protective. So, some people are using it in think about sports teams. They're legalizing cannabis use, because it's actually helpful to prevent the CWLA from concussions, for example. And then, in a state of anxiety that I would say this is one of the biggest, we use the CBD to help elevate serotonin. That's kind of why people are put on SSRI medications, for example. CBD works very similar to a lot of pharmacological medications. It reduces your noradrenaline, so you're not always in a state of fight or flight. But what about the people who have triggers, you know, from PTSD events? While the THC, again is helpful for just changing your perception, lowering your barriers, allowing you to participate in therapies, but also, you know, making those triggers a little bit more tolerable. So, they don't set you off. So, I have tons of good success stories where people everyday people, very professionals, very, you know, people coming out of jail systems. I mean, this is an excellent therapy modality. And I loved seeing our waiting rooms full of such a variety of different people.

 

Kris Urquhart  8:47  

You mentioned that there were different formulations. So, it's not a one size fit all, how would this be individualized?

 

Dr. Jessica McCain  8:57  

This is super, super individualized to the point where we really give you a lot of education when you come to our clinic, to understand that treating this like a medication, there is a method of how you take it in, there's a dosing protocol. And there's a selection of the formulations that are just exponential options. So really kind of you can fine tune how you're using it to get your full needs. Because people who have complex issues think about multiple sclerosis, for example, some days, it's a more weakness or it's more pain. Some days, it's more of mental health or their vocal cords aren't working the right or the appetite. So you can get different products for different specific symptom needs. But again, with the different formulations, there's some people who can tolerate THC, there's some that need a little bit more CBD. And certainly, it's very individualized and that's why it's important to have a physician that can tell you the basic rules of the game, but then give you some suggestions about the dispensaries and there's new technologies coming out there that change the absorption of these medicines. It's a pretty amazing time right now to be in the cannabis world.

 

Kris Urquhart  10:05  

You mentioned absorption. So, I assume you also would provide some guidance on the delivery method, since it comes in different forms. Can you speak to how that might impact the patient?

 

Dr. Jessica McCain  10:16  

So again, when you're thinking about different forms, you might want to think about how you're using it. Again, is it just for crisis control? Then you need something very quick acting, or you just need a little something to get you over a speed bump? Or is your issue really 24-7, and you need to control that process, and you need something maybe lingering in your bloodstream a little bit longer to actually take those chemical effects. So the different modalities, part of it is preference. I have some patients who come and they say, Oh, I have lung disease. I don't want to do any inhalation. Well, first of all, that's not a true contraindication. In the early 1900s. They were using cannabis THC specifically, in a prescriber database to treat asthma, there's no increased risk of COPD. In fact, maybe even less likely because people are actually training their lungs how to fully expand. But if that is a preference, again, that's a very reasonable thing. But there's, there's even like, like inhalers like an albuterol style inhaler, so you don't have to use the heat of a lighter or a vape pen. But installations probably most popular because it's most predictable, you get the onset within minutes. So if we're talking about a panic attack, you can stop it or a seizure of about half and you can stop it right before it gets really bad. Now, if you want more lasting effects, like for example, people who have sleep issues, they may smoke or do something quickly to get asleep. But it doesn't last in your bloodstream very long, maybe like four hours. So they're waking up at 3am, we would just suggest patients to use longer lasting preparations like drops under the tongue, or oral options. They've got capsules, they've got edibles, chocolates, they've got lozenges that can go under the tongue. And then for maybe even other considerations. There's topical preparations, there's patches, creams and lotions, way more popular and effective than I would have originally thought but very, very reasonable option, even up into suppository. So I have both men and women both using suppository options for both gynecological issues and rectal or prostate issues too. So again, this goes into where it's not a one size fits all but really customized to a patient's personal preference and medical needs.

 

Kris Urquhart  12:20  

Yeah, yeah, it really is. So if a patient thinks that they maybe could benefit from medical marijuana, what would be their first steps?

 

Dr. Jessica McCain  12:31  

First, it would be probably gathering up your medical records, because the state of Florida is very specific that this is not supposed to be a first line option. So, how do you prove that? Well, you get a note your last office note perhaps from a doctor that says what it is that you're considering using cannabis for. So if it's anxiety, you just need a document that said, You've spoken to someone and they've maybe offered pharmaceutical medicines, or you've done therapy in the past. So one is just getting medical records. The second is finding a cannabis physician. And this is hard because the state of Florida makes it so complicated. there's not very many of us that are doing this. And so my clinic is actually just a specialty cannabis clinic where we really get to know the dispensaries, the products that are out there, and the strategies, the new science that is coming out. And we do advocacy as well. So we're kind of a specialty clinic. And that's really all we do at our Port St. Lucie location. The tricky thing too, is there are some bad players in this whole system, unfortunately. So the laws are that you actually have to see a physician every seven months, like you can't go beyond that, that's actually required that every 210 days, you get a follow up, and we use that follow up to really talk about how to fine tune it. Even to the point of saying how do you make it more financially, health wise for you, there's a lot of you make it yourself things that we can talk about to keep cost down so you can keep your other medications as well. But we find that some physicians, have requirements that they are every three months are six, you know, it is up to the office, obviously, it's up to the office and individual providers. But we have it every seven months because that's illegal max, we want to make this affordable and accessible. But in between time we actually offer our patients access to us at no charge. They can email us any questions they have. And one of our doctors or one of our, dispensary specialists or product specialists will kind of go back and forth with them too because we want to see patients successful. So the first is finding a physician. The second part is when you meet with that physician, they'll register you with the Department of Health and you get put into a registry system. That is what the dispensaries look at to see that you're approved and that you have a recommendation which the common people would say that's like a prescription but we have to use the word recommendation. And then from there they can access purchasing cannabis from the dispensary. But the ID card process is something separate. We walk you through all those legalities. But the Department of Health has an ID card requirement every 12 months And there is a $75 fee for that.

 

Kris Urquhart  15:03  

Lots and lots involved in this, for sure. Thank you so much Dr. McCain for taking us through it and giving us an overview of this whole medical marijuana world. We really appreciate it.

Dr. Jessica McCain  15:15  

I enjoyed it. I love educating about this and I'm truly a patient advocate trying to get this destigmatized.

 

Kris Urquhart  15:21  

Absolutely. And for everyone listening be well stay connected. Thank you.