Dispense MagazineThere’s a huge gap in people’s understanding of cannabis. Most patients want to know why it’s illegal, while most doctors want to know why they didn’t learn about it in medical school. So says Dr. Paloma Lehfeldt, Director of Medical Science and Patient Liaison for Vireo Health.
Vireo Health is a physician-led company, now in ten states and Puerto Rico, that works very hard to educate patients and physicians. For that very purpose, They have just launched a new cannabis brand called 1937, named for the year that cannabis prohibition started in America. Now available in Penna and Maryland, 1937 features historic cannabis strains and gives an opportunity to learn more about the history of cannabis.
In this episode, we talk about that new brand and the long history of cannabis as medicine, including prohibition and the science that is finally leading us out of these dark ages and into the full acceptance of the healing power of this plant.
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Transcription
DM:
Today we're talking with Dr. Paloma Lehfeldt, MD. She is the Director of Medical Education for Vireo Health, which is one of our multi-state operators and growers here in Pennsylvania and now in 10 states and Puerto Rico. Welcome, Paloma.
PL:
I am so excited to be here. I think I met you at The Innovation in Medical Cannabis Conference about six months ago, and I've just been so excited to speak with you since then. So, thanks.
DM:
Thank you so much. I've been looking forward to speaking with you two. Really enthused and really happy and grateful.
PL:
I'm really grateful to be here
DM:
We're really grateful to have Vireo as a sponsor for our magazine. I met Dr. Dahmer at an event back in March, I think it was and he's just an amazing guy as your chief medical officer.
PL:
He is, and we both, Vireo loves Dispense Magazine. We love bridging that gap between patients and cannabis and just getting information up there. So Stephen and I are both huge supporters. Happy to be here.
DM:
Well, today I really love the topic we came up with, and that is, you know, you're out there doing all this medical education with patients and doctors. So what's the most common question you get asked from patients?
PL:
Why is this illegal? Why is this medicine that is helping me illegal?
DM:
Right? And what's the most common question you get from doctors?
PL:
Why aren't we taught about this in medical school?
DM:
Which I think is an amazing crossover because to answer both of these questions, we're going to go through a little bit about the history of medical cannabis, which I know you love to talk about, and then the era of prohibition. And then we'll get into a little bit of the science of why that prohibition is coming crashing down like a house of cards that should always have been.
PL:
I love that. I love it. I mean, in order to understand, you really do have to go back. One of the questions that I always asked myself in medical school was, why aren't we learning about this system in our bodies that literally interacts with every other system at our body possesses?
DM:
And it seems like magic, you know, for people who don't understand the science that one plant could have so many different positive effects on the physical body and that just that lack of education there kind of leads to people thinking, "Oh, all medical use is just a front for recreational use."
PL:
Absolutely. Name one other you know, drug or plant that has all of these indications. The qualifying conditions in every state - 20 plus. There's no aspirin can do one thing - two things tops, you know. And then you look at Canada's - you have PTSD, chronic pain, ALS, et cetera, et cetera.
DM:
It's amazing. It's really amazing.
PL:
Absolutely.
DM:
Well, let's get into that then. So we're gonna talk about the history of medical cannabis, and when we look back prior to, say, the 1800s in, especially in America, it has always been used as medicine or for religious ceremonies, Is that about right?
PL:
Absolutely. We have co-evolved with this plant for thousands and thousands of years. We heard about it the first time in ancient China from the emperor. Shen Nung, who talks about the yin and the yang of the cannabis plant, calls it ma in just the medicinal purposes of this, the myth is that he used cannabis and other plants as antidotes for taking poisons. And that's actually how he's rumored to have died by not finding the correct antidote for a poison he was using. It wasn't cannabis because, as we know, cannabis can't kill you.
DM:
It cannot kill you. Absolutely. So we have it in ancient China. I know it's been recorded in India and Egypt. Names other places we find it.
PL:
Absolutely. We see it in ancient Rome as well. We see it in 70 a.d. We have a Greek physician, Pedantes, who brought it to the Roman Army. He wrote about it in his book of medical matters, which was the go-to, medicinal book for the next hundreds of years.
DM:
Do we know where he brought that from?
PL:
He brought it from - he was traveling all over Asia at the time, so he brought it from India. He traveled there as well as a physician.
DM:
So really has it's - the first signs of it then are all over Asia.
PL:
Yes, and then we see it in China again. We have Hua T'o in 200 a.d., who was a surgeon, a Chinese surgeon, and he reduced the cannabis plant to a rosin, into a powder, mixed it with wine and used as an anesthetic for opening the chest wall. So it's not necessarily as powerful as some of the anesthetics that we see today, but again better than nothing. So he did see also the healing properties of cannabis as a pain reliever which we see still today.
DM:
So yes, let's bring it up to the modern era, starting in America, you say was brought to Jamestown.
PL:
This trip out to Jamestown by the settlers in 1610 was a major, major export. Hemp was the export. It was used for sails on the ships. It was used for clothing. It was grown by George Washington. It was grown by Thomas Jefferson. So this is it was a tax on all these properties. So it's a huge part of America. It was in our backbone when we came here.
DM:
And when do we see the first signs of it being used as medicine in America?
PL:
So in 1850, which is the third edition of the pharmacopeia, we see it added. It had just like now for the qualifying conditions, had a bevy of uses, including leprosy. But most importantly, for opiate addiction, was one of the indications.
DM:
So, we're still re-learning something they knew in 1850.
PL:
Exactly. Exactly. I mean in 1850 we have this in every pharmacy. Every household has a cannabis tincture in it. They know that it could be used for pain. It could be used for so many different things.
DM:
So it wasn't smoked back then. It was used in the tincture.
PL:
Right. It was mostly used as a tincture for medicinal purposes back in 1850, 100%. But it was in every physician's tool kit for pain. Whereas now, you know, the last time that we've seen a novel pain medication is in 1973 when naproxen, which is aleve, was developed. So still were so if you and then you look back to 1850 and we see that we have this in our tool kits.
DM:
Part of the confusion, I think with some people, is that there's a difference between hemp and cannabis, and it seems like in the early part of this country, the emphasis was on the hemp plant, which has a very low THC content. Is that about right?
PL:
Hemp was used for cloth, but when we talk about the medicinal purpose of cannabis, it was the full plant extract, yes.
DM:
So they had that knowledge back then. Although most of them were interested in making clothes and sails.
PL:
Yes, as well. So it was used for everything. They used the whole plant. It's really an amazing plant. I mean, we know of 138 phytocannabinoids within the plant now. All of them working together. We knew that back then, too.
DM:
That really is amazing. So let's bring it up to then, uh, the 1900s. And all of a sudden things start to change around this here...
PL:
Right? This is the dark times of cannabis. This is when we see the 1910 Mexican Revolution, which really introduced the recreational use of cannabis to the United States, followed quickly by the Great Depression and the development of the Federal Bureau of Narcotics. The first Commissioner, the infamous Henry J. Anslinger. His name should have a big boo from the audience. I hope that everyone's booing. Followed by, so he purported that cannabis made you a criminal. It made good men do bad things. He had this very racist and xenophobic undertone because the people that were using cannabis were in the black and brown communities. This is also during the Great Depression, when their jobs are unavailable, that people are scared that the immigrants are taking their jobs so really horrible on undertone. Well, and this was quickly followed by the Marijuana Tax Act of 1937 would successfully criminalized cannabis.
DM:
And that whole era, though, is just It's just so awful with the things that he said about,
PL:
Right. It had a very that's why marijuana is such a has a racist undertone to it, which is why we try to stay cannabis as much as possible. But you're absolutely right.
DM:
That's what we do too. The state requires that when we talk about their program you call it the medical marijuana program. It's medicalmarijuana.pa.gov.
PL:
Yes.
DM:
But I think as we throw off the last vestiges of this reefer madness, we're going to start calling it what it really is, which is cannabis.
PL:
I hope so, 100%. Whenever I hear that the word marijuana, it's very antiquated and awful to say.
DM:
It is. It is. So here we are - 1937 you all at Vireo there have just announced and released a new product. Tell us about that.
PL:
I am so excited for 1937. it is standing on the right side of wrong of Prohibition 1937 Cannabis is our Instagram handle. Were really bringing history back, really educating people about, again - Why is this illegal? Why is this a schedule one? Why are the people in these communities getting prosecuted harsher? So we really have all of that information and we're bringing it to stand on that side. We have really classic strains. Really classic. Look for it. I'm so excited about it. We're in Pennsylvania and Maryland, right now. I just love the message.
DM:
Yeah. What can tell us about the strains? What kind of terpenes? What kind of effects do we see?
PL:
So the terpene profiles are different for everything. We grow them. We have Indica and Sativa as well as hybrids, and they're just amazing. In Maryland, we also have hash and rosin, so we're really trying to bring these classic tastes back. We're really excited.
DM:
We'll get back to this. We're talking about the history of how everything got so screwed up when it comes to cannabis. So we suffered through. And so the other thing about Anslinger, I think is fascinating is he was in charge of the prohibition of alcohol. Tell me if I'm my timing and my history is right on this. And then once alcohol was made legal again, he started scrambling around looking for something else to prohibit. Basically, he needed another boogieman.
PL:
A scapegoat. I think he did a great job because we still have cannabis is a schedule one drug, which was followed in 1970.
DM:
That was like 70 right?
PL:
Yeah, 1970 when we have our buddy Nixon, who classifies cannabis as a schedule one drug.
DM:
And he forced the DEA to do this. I mean, they were not. The scientists were not in favor of doing this, right?
PL:
No, I mean, so it was removed from the pharmacopeia in 1942. The American Medical Association was completely against this. They knew the effects of it at the time, and they released a statement. But then we have, we still have the prosecution of the black and brown communities with cannabis. It's still federally illegal. It's schedule one. And as we know, this followed with Reagan with the war on drugs.
DM:
I think there's actually recording, I know Haldeman. I think it was admitted that they deliberately used cannabis and put it on a schedule one as a way to target both the hippies, the antiwar people who were given him a lot of pain. And the black community, which they apparently just didn't like.
PL:
Absolutely. And unfortunately, we still see that today.
DM:
It still is that way. I know, yeah.
PL:
It's so important for everybody to do their own research here. You have to become a medical cannabis historian. You have to understand the social justice aspect of it, and it's once you get into it, just Google 1937 and everything will come up. You'll see some of the awful, deplorable things that Henry J. Anslinger was saying about these communities. So you'll be able to answer the question. Why is this illegal? Why is there such a sick? Why is this a schedule one drug?
DM:
He literally in congressional testimony, as I understand it said that marijuana, what he called marijuana, would make white women want to have sex with black men. That was literally kind of the mindset that he put in everybody's head and it still seems to be.
PL:
There's still - that undertone hasn't gone away from that long ago. No.
DM:
You cannot separate the issue of prohibition from what it's done to the African American community - people of color.
PL:
Yes, 100%.
DM:
So yes, well, now we have the 1980s, Nancy Reagan, Just Say No, This Is Your Brain on Drugs.
PL:
Crazy refer that makes you do horrible things, Of course, of course. But yet we have schedule two - we have oral opioids that can kill you as we know that remains on a schedule two drug. Where we have marijuana has a schedule one that's listed there, which cannot kill you. Schedule one, by the way, means that it has no medical value whatsoever and a high potential for addiction. So we have that as a schedule one lesser with heroin, where a scheduled two is our codeine and are opioids that, you know, every day we have 113 to 130 people dying a day. How many people do we have dying of cannabis every day?
DM:
I know.
PL:
The only thing that, the only way cannabis can kill you it was if you smoke the amount needed to kill you and it lands on your head.
DM:
If a bale falls on your head is basically the only way it can kill you. So I actually talked to the researcher who did the actual study to determine what is the low, what they call the LD50, the lethal dose for 50% of the people that consume it. And they had to, of course, make it into a concentrate and they used rats and so forth. But they determined that the lethal dose - to consume the lethal dose of cannabis, you would have to smoke 1,500 pounds in 15 minutes. That is literally the amount that it would take.
PL:
I heard that as well.
DM:
That's just wild to think about.
PL:
I mean, good luck trying.
DM:
Comeback liners. Well, so many of us have tried to get there, haha.
PL:
Right, Right? Don't actually try that.
DM:
Do not try this at home. So, what was the eighties acted that really helped keep the coffin shut?
PL:
The anti-drug abuse act.
DM:
Okay. So I don't want to get into what Bush wanted Bush two did. So we finally see science rearing its head, I guess. A very interesting individual over in Israel is actually doing some research. We're back in the Middle East where, you know, 2,000 years ago it was used as a medicine, and this Israeli scientist discovers what?
PL:
So Raphael Mechoulam, the Godfather, grandfather, cannabis. We all love him. In 1964 discovered Delta nine tetrahydrocannabinol, also known as THC. Everyone knows about THC. So this was discovered in 1964. So just think of the juxtaposition of what's going on the United States in 1964 and what's going on in Israel. They're discovering beautiful plants, our internal endocannabinoid system in the early nineties. Raphael Mechoulam, his lab going strong, he discovered anandamide, which is an endocannabinoid, my favorite one that I like to talk about all the time. I get excited about it. I'm smiling from ear to ear. Ananda is the Sanskrit word for bliss, and this is the chemical responsible for producing the runner's high. So anyone that has run either begrudgingly or for fun knows that when you do it for a long time, you get that feeling of euphoria, and that's anandamide. That's our body producing that runner's high. I just love it.
DM:
It's also found in Mother's breast milk, is it not?
PL:
Yes, yes, it is. It stands for bliss. Bliss. We do this on our own, our body's able to do this in their ways that we learn to stimulate our endocannabinoid system there, the director of medical education over in Minnesota, she's an RN, Sarah Overby. She produced this sheaf of ways to stimulate your endocannabinoid system, one of which is taking a 30-second cold shower in the morning. If you wanted to - the last 30 seconds of your shower. She imagines her endocannabinoid system being stimulated, which I just love. Don't do it in the winter, but it really does work. It gives you a little jump start. Smelling lemon, black pepper - I mean, there are so many different ways to do it. So I just love those ways that you could do it internally.
DM:
I have a little experience with that formula. I was taken down by mold about four years ago, and I spent a month in a naturopathic clinic and if I'd have stayed with American medicine I would be dead because they were not gonna treat me for mold. That's a long other story. There's other podcasts about that out there, but one of the treatments was to go from a hot 105-degree tub into a 55-degree tub.
PL:
Wow.
DM:
Do that like six times, if you can within about 40 minutes. Now, you can only spend about a minute or two in the cold tub, it feels like you're getting frostbite. Yeah, I'm interested to hear your take on this as a physician. Literally what happens is when you're in the hot water, you're capillaries expand. Then you jump into the cold water, they contract and when they contract, the toxins go out of your capillaries into your lymph system where they could be processed out through the lymph system. So I'm interested to hear how the endocannabinoid system figures into this because that was one of the things that were most impactful on clearing toxins and especially that mold out of my system through my hands. And it was amazing. The first few days I was there, I was doing this every day, sometimes twice a day. And when I got into the cold water, my hands would swell up like Popeye hands, and I could barely close my fists. It was very strange but very, very powerful. So, yes, I'm anxious to hear how you think about how the endocannabinoid system factors into all of that.
PL:
No, that's a great question. There are a huge amount of CB1 receptors in your hypothalamus, which is the part of your brain that's responsible for the regulatory processes such as temperature. No, that is exactly where that occurs. It's just, for instance, Hyperemesis Syndrome, which occurs when you overdose on THC, sometimes it's when you have intractable vomiting. They say the way to resolve that is to take a very hot shower because it takes down your endocannabinoid system, it slows it down. So it's really important for people that are using it to know how their body temperature is affecting the endocannabinoid system, and that's because of where the different receptors are located.
DM:
Well, that's a good place to jump in there, back to our history of the science. After the Israelis have discovered THC then, was it in the nineties that they discovered the first receptors and the whole endocannabinoid system?
PL:
Yes, so in 1991 they discovered anandamide, followed by one of Dr. Mechoulam's Ph.D. students discovered 2AG, which is our other main endocannabinoid in our system. So the ECS, the endocannabinoid system, which I love, consists of those endocannabinoids. So anandamide and 2AG, which are the things that bind to our receptors to activate them.
DM:
And those are the natural that occurs in the body?
PL:
Yes, yes, it's all us. It's all human beings that are doing it. So this goes to one of our questions. Why weren't we taught about this internal system in our bodies in medical school? That interaction plays a part in roles with our two main neurotransmitters, glutamate, and gabba of excitatory and inhibitory neurotransmitters in our brain. It would literally be like taking out - this is what I always say. It would literally be like taking out our module that we learned on the cardiovascular system and never learning about it, graduating from medical school, treating patients and not knowing about this robust system in our body that interacts with literally everything else. It was taken out of medical school textbooks. I heard a statistic that 13% of medical schools teach about the endocannabinoid system. But I think it's lower than that to be honest.
DM:
Yeah, and even if they do teach it's probably not much.
PL:
Right. 100%. But the endocannabinoid system, our endocannabinoid receptors, and enzymes break these particles down and recycle them. And what's so amazing about the endocannabinoid system is that it works it backward. So instead of going from Point A to point B, the endocannabinoid system works by going from point B and turning off with A. It's literally life, if you like to go to bed early, as I do, and my neighbors are being really loud and having a house party, it would be like me going next door and telling them to turn the music down. That's what that endocannabinoid system does. It's our thermostat. They have these jokes that dads don't like to turn the thermostat down. That's what the endocannabinoid system does when it's too cold.
DM:
Well, that's really fascinating.
PL:
I love it.
DM:
And we're still discovering new receptors. The parts of the body that actually take in these cannabinoids, whether it's the endocannabinoids or the phytocannabinoids that come from plants, they work in very similar fashions, right? What do they think is happening there?
PL:
So in Israel and other places in Europe, in Canada, they're looking into our CB3 receptor. There isn't as much research out about it now, but stay tuned. I'm excited. What we know the most about CB1 and CB2 right now, CB1 is in our central nervous system, which is why we have intoxicating feelings. And CB2 is mostly in our immune system. But they all play a role in everything, and CBD and THC bind to the same receptors that are endocannabinoids bind to as well, just in a different way.
DM:
Now the CBD binds more with the CB1 receptor, am I right about that?
PL:
CBD binds with both receptors, THC, they both bind with the CB1 receptors.
DM:
Okay, they both do. Well, we're finding the CB1 and CB2 in new locations around the body as well, yes?
PL:
Yes, it's so exciting. They're literally if you just Google location on the Google machine, put in endocannabinoid receptor locations. Literally, every part of the body lights up.
DM:
Wow. But so we really are just on the very beginning of this of the science around this plan?
PL:
Oh, my gosh, yes. And what's gonna happen? I mean, once we know, the opportunities are boundless for the treatment of different ailments. Once we know, Hey, this strain works for this. Hey, this ratio works for this. That's the future. That's how we practice evidence-based medicine through algorithms. That's what we do, especially when we're talking about our opioid epidemic. We're trying to reduce that. One of our physicians, Dr. J. Westwater, come up with a dosing algorithm for opioid reduction. It's called the Freedom Protocol, and it stands for flexible reduction and eradicates an expedited disco continuation of opioid medications. This to give to physicians because physicians are just as frustrated as you think they are with the opioid epidemic, it shows them ways to decrease that opioid dosage with the aid of cannabis because of the synergy that happens when you use cannabis and opioids is amazing. They work on the same receptor. They're called G protein-coupled receptors. The sum of the parts is greater than the whole, so not necessarily getting everyone completely off opioid medications. As much as I'd like to say that that's gonna happen, it's not a miracle drug, but what it can do is it can greatly, greatly reduced that dosage, that risk that you're taking when you're taking opioids on a daily basis.
DM:
And I know it's very helpful for nausea that you get coming off of opioids as well.
PL:
Yes, 100%. Which is why the FDA came up with Marinol initially, which is a synthetic THC, and it has just, it binds very tightly to the receptor. So that was the initial indication for nausea and cancer patients because it has these anti medic properties, However, because it didn't have that whole-plant extract the side effect profile was unbearable for some of the patients with paranoia. So it didn't have that entourage effect that we love so much. But Marinol is now a schedule three drug. So tell me how that makes sense.
DM:
Well, I'm still trying to figure out how the DEA is one branch of the government, one branch of the executive part of the government has it as schedule one, and yet the Department of Health and Human Service has the patent on cannabis as medicine. It just makes your head spin.
PL:
I know, it does! Another thing to put into the Google machine - a patent on cannabis, right? Everybody, do your research because it's like drinking water out of a fire hose when you start to learn about it, because, I still say this every day when I learn something new every day, 1,000,000,000 things every day. And I always, you know, I've gone to graduate school and medical school. Both focused on the sciences in neuroscience, clinical medicine, and I never learned about any of this.
DM:
And I think part of the resistance to is people don't like to think that their government has lied to them as totally and completely and for as long as they had been lying to us about cannabis.
PL:
No, it's it's frustrating. It feels dirty. So I'm so happy that we have people like you out there as I like to say it's spreading the cannabis gospel.
DM:
There you go. There you go. Well, anything that you think we should emphasize or anything we missed talking about when we covered the whole history of medical cannabis and the prohibition and then the scientific discoveries today?
PL:
I would just love to talk about how to reduce the stigma and that is through education and research, which is what we are about at Vireo Health. We're physician-led, physician-run. And what that means is that we want to bring the best research technology, innovation to cannabis. I have to talk about our NIH $3.8 million grant that we run with Montfiore at our dispensary in White Plains focusing completely on chronic pain patients and opioid reduction with the use of cannabis-based medicine. That study is gonna come out in the next couple of years and I'm just so excited about the implications for that. I know that there were paired with many other research institutions across the country, and that is the way to end stigma, that is the way to get this in front of people, back into medical text, back into the U.S. Pharmacopoeia and back into everyone's home because it's not gonna kill you. And people need it.
DM:
So get out there and get your third edition of the Pharmacopoeia. Get right up to speed here on everything that's happening. Well, I really do think that make Vireo stand out as a grower. You're growing here Pennsylvania and you have your first dispensary opening soon?
PL:
We do have our first dispensary opening soon. It's gonna be called Green Goods in Scranton. We don't have a date yet but stay tuned. So excited. I know everyone else is excited as well. We have a lot of great things coming on the research on the research and 1937. Again, 1937 Cannabis check it out on Instagram. Just a really great brand. And for what it stands for. Look, do your own research. Look at the 1937 Marijuana tax Act. And, we love Pennsylvania.
DM:
Well, thanks, we love you here in Pennsylvania too! We'll just sign off with noting that in the most recent edition of our magazine in the Releaf page, where the Releaf app lists the top reasons of the people in Pennsylvania take medical cannabis. The number one reason being anxiety. Now that's got to be, you gotta be in favor of that, right? Adding anxiety to this?
PL:
Absolutely! Absolutely! I mean, it just got approved in Pennsylvania as a qualifying condition. I mean, yes.
DM:
Then the number one rated product for anxiety is OGKush from Vireo Health.
PL:
Whooooo!
DM:
Yeah. So tell us what exactly that is. The OGKush.
PL:
Our OGKush is our green formulation. So our products are on a spectrum of the rainbow - red being our highest THC formulation in 19 to 1 all the way down to indigo, which is our CBD, the THC in 19 to 1. And in the smack dab in the middle of that rainbow with a 1 to 1 ratio is our Green OGKush. I'm so happy to hear that. And I'm really happy to hear that it's helping anxiety specifically, and that that just got approved is a qualifying condition of Pennsylvania. Kudos!
DM:
That's great.
PL:
Thanks to you Sven for doing what you're doing.
DM:
Thank you so much, Dr. Paloma, with Vireo health, it's great to talk to you today.
DM:
Today we're talking with Dr. Paloma Lehfeldt, MD. She is the Director of Medical Education for Vireo Health, which is one of our multi-state operators and growers here in Pennsylvania and now in 10 states and Puerto Rico. Welcome, Paloma.
PL:
I am so excited to be here. I think I met you at The Innovation in Medical Cannabis Conference about six months ago, and I've just been so excited to speak with you since then. So, thanks.
DM:
Thank you so much. I've been looking forward to speaking with you two. Really enthused and really happy and grateful.
PL:
I'm really grateful to be here
DM:
We're really grateful to have Vireo as a sponsor for our magazine. I met Dr. Dahmer at an event back in March, I think it was and he's just an amazing guy as your chief medical officer.
PL:
He is, and we both, Vireo loves Dispense Magazine. We love bridging that gap between patients and cannabis and just getting information up there. So Stephen and I are both huge supporters. Happy to be here.
DM:
Well, today I really love the topic we came up with, and that is, you know, you're out there doing all this medical education with patients and doctors. So what's the most common question you get asked from patients?
PL:
Why is this illegal? Why is this medicine that is helping me illegal?
DM:
Right? And what's the most common question you get from doctors?
PL:
Why aren't we taught about this in medical school?
DM:
Which I think is an amazing crossover because to answer both of these questions, we're going to go through a little bit about the history of medical cannabis, which I know you love to talk about, and then the era of prohibition. And then we'll get into a little bit of the science of why that prohibition is coming crashing down like a house of cards that should always have been.
PL:
I love that. I love it. I mean, in order to understand, you really do have to go back. One of the questions that I always asked myself in medical school was, why aren't we learning about this system in our bodies that literally interacts with every other system at our body possesses?
DM:
And it seems like magic, you know, for people who don't understand the science that one plant could have so many different positive effects on the physical body and that just that lack of education there kind of leads to people thinking, "Oh, all medical use is just a front for recreational use."
PL:
Absolutely. Name one other you know, drug or plant that has all of these indications. The qualifying conditions in every state - 20 plus. There's no aspirin can do one thing - two things tops, you know. And then you look at Canada's - you have PTSD, chronic pain, ALS, et cetera, et cetera.
DM:
It's amazing. It's really amazing.
PL:
Absolutely.
DM:
Well, let's get into that then. So we're gonna talk about the history of medical cannabis, and when we look back prior to, say, the 1800s in, especially in America, it has always been used as medicine or for religious ceremonies, Is that about right?
PL:
Absolutely. We have co-evolved with this plant for thousands and thousands of years. We heard about it the first time in ancient China from the emperor. Shen Nung, who talks about the yin and the yang of the cannabis plant, calls it ma in just the medicinal purposes of this, the myth is that he used cannabis and other plants as antidotes for taking poisons. And that's actually how he's rumored to have died by not finding the correct antidote for a poison he was using. It wasn't cannabis because, as we know, cannabis can't kill you.
DM:
It cannot kill you. Absolutely. So we have it in ancient China. I know it's been recorded in India and Egypt. Names other places we find it.
PL:
Absolutely. We see it in ancient Rome as well. We see it in 70 a.d. We have a Greek physician, Pedantes, who brought it to the Roman Army. He wrote about it in his book of medical matters, which was the go-to, medicinal book for the next hundreds of years.
DM:
Do we know where he brought that from?
PL:
He brought it from - he was traveling all over Asia at the time, so he brought it from India. He traveled there as well as a physician.
DM:
So really has it's - the first signs of it then are all over Asia.
PL:
Yes, and then we see it in China again. We have Hua T'o in 200 a.d., who was a surgeon, a Chinese surgeon, and he reduced the cannabis plant to a rosin, into a powder, mixed it with wine and used as an anesthetic for opening the chest wall. So it's not necessarily as powerful as some of the anesthetics that we see today, but again better than nothing. So he did see also the healing properties of cannabis as a pain reliever which we see still today.
DM:
So yes, let's bring it up to the modern era, starting in America, you say was brought to Jamestown.
PL:
This trip out to Jamestown by the settlers in 1610 was a major, major export. Hemp was the export. It was used for sails on the ships. It was used for clothing. It was grown by George Washington. It was grown by Thomas Jefferson. So this is it was a tax on all these properties. So it's a huge part of America. It was in our backbone when we came here.
DM:
And when do we see the first signs of it being used as medicine in America?
PL:
So in 1850, which is the third edition of the pharmacopeia, we see it added. It had just like now for the qualifying conditions, had a bevy of uses, including leprosy. But most importantly, for opiate addiction, was one of the indications.
DM:
So, we're still re-learning something they knew in 1850.
PL:
Exactly. Exactly. I mean in 1850 we have this in every pharmacy. Every household has a cannabis tincture in it. They know that it could be used for pain. It could be used for so many different things.
DM:
So it wasn't smoked back then. It was used in the tincture.
PL:
Right. It was mostly used as a tincture for medicinal purposes back in 1850, 100%. But it was in every physician's tool kit for pain. Whereas now, you know, the last time that we've seen a novel pain medication is in 1973 when naproxen, which is aleve, was developed. So still were so if you and then you look back to 1850 and we see that we have this in our tool kits.
DM:
Part of the confusion, I think with some people, is that there's a difference between hemp and cannabis, and it seems like in the early part of this country, the emphasis was on the hemp plant, which has a very low THC content. Is that about right?
PL:
Hemp was used for cloth, but when we talk about the medicinal purpose of cannabis, it was the full plant extract, yes.
DM:
So they had that knowledge back then. Although most of them were interested in making clothes and sails.
PL:
Yes, as well. So it was used for everything. They used the whole plant. It's really an amazing plant. I mean, we know of 138 phytocannabinoids within the plant now. All of them working together. We knew that back then, too.
DM:
That really is amazing. So let's bring it up to then, uh, the 1900s. And all of a sudden things start to change around this here...
PL:
Right? This is the dark times of cannabis. This is when we see the 1910 Mexican Revolution, which really introduced the recreational use of cannabis to the United States, followed quickly by the Great Depression and the development of the Federal Bureau of Narcotics. The first Commissioner, the infamous Henry J. Anslinger. His name should have a big boo from the audience. I hope that everyone's booing. Followed by, so he purported that cannabis made you a criminal. It made good men do bad things. He had this very racist and xenophobic undertone because the people that were using cannabis were in the black and brown communities. This is also during the Great Depression, when their jobs are unavailable, that people are scared that the immigrants are taking their jobs so really horrible on undertone. Well, and this was quickly followed by the Marijuana Tax Act of 1937 would successfully criminalized cannabis.
DM:
And that whole era, though, is just It's just so awful with the things that he said about,
PL:
Right. It had a very that's why marijuana is such a has a racist undertone to it, which is why we try to stay cannabis as much as possible. But you're absolutely right.
DM:
That's what we do too. The state requires that when we talk about their program you call it the medical marijuana program. It's medicalmarijuana.pa.gov.
PL:
Yes.
DM:
But I think as we throw off the last vestiges of this reefer madness, we're going to start calling it what it really is, which is cannabis.
PL:
I hope so, 100%. Whenever I hear that the word marijuana, it's very antiquated and awful to say.
DM:
It is. It is. So here we are - 1937 you all at Vireo there have just announced and released a new product. Tell us about that.
PL:
I am so excited for 1937. it is standing on the right side of wrong of Prohibition 1937 Cannabis is our Instagram handle. Were really bringing history back, really educating people about, again - Why is this illegal? Why is this a schedule one? Why are the people in these communities getting prosecuted harsher? So we really have all of that information and we're bringing it to stand on that side. We have really classic strains. Really classic. Look for it. I'm so excited about it. We're in Pennsylvania and Maryland, right now. I just love the message.
DM:
Yeah. What can tell us about the strains? What kind of terpenes? What kind of effects do we see?
PL:
So the terpene profiles are different for everything. We grow them. We have Indica and Sativa as well as hybrids, and they're just amazing. In Maryland, we also have hash and rosin, so we're really trying to bring these classic tastes back. We're really excited.
DM:
We'll get back to this. We're talking about the history of how everything got so screwed up when it comes to cannabis. So we suffered through. And so the other thing about Anslinger, I think is fascinating is he was in charge of the prohibition of alcohol. Tell me if I'm my timing and my history is right on this. And then once alcohol was made legal again, he started scrambling around looking for something else to prohibit. Basically, he needed another boogieman.
PL:
A scapegoat. I think he did a great job because we still have cannabis is a schedule one drug, which was followed in 1970.
DM:
That was like 70 right?
PL:
Yeah, 1970 when we have our buddy Nixon, who classifies cannabis as a schedule one drug.
DM:
And he forced the DEA to do this. I mean, they were not. The scientists were not in favor of doing this, right?
PL:
No, I mean, so it was removed from the pharmacopeia in 1942. The American Medical Association was completely against this. They knew the effects of it at the time, and they released a statement. But then we have, we still have the prosecution of the black and brown communities with cannabis. It's still federally illegal. It's schedule one. And as we know, this followed with Reagan with the war on drugs.
DM:
I think there's actually recording, I know Haldeman. I think it was admitted that they deliberately used cannabis and put it on a schedule one as a way to target both the hippies, the antiwar people who were given him a lot of pain. And the black community, which they apparently just didn't like.
PL:
Absolutely. And unfortunately, we still see that today.
DM:
It still is that way. I know, yeah.
PL:
It's so important for everybody to do their own research here. You have to become a medical cannabis historian. You have to understand the social justice aspect of it, and it's once you get into it, just Google 1937 and everything will come up. You'll see some of the awful, deplorable things that Henry J. Anslinger was saying about these communities. So you'll be able to answer the question. Why is this illegal? Why is there such a sick? Why is this a schedule one drug?
DM:
He literally in congressional testimony, as I understand it said that marijuana, what he called marijuana, would make white women want to have sex with black men. That was literally kind of the mindset that he put in everybody's head and it still seems to be.
PL:
There's still - that undertone hasn't gone away from that long ago. No.
DM:
You cannot separate the issue of prohibition from what it's done to the African American community - people of color.
PL:
Yes, 100%.
DM:
So yes, well, now we have the 1980s, Nancy Reagan, Just Say No, This Is Your Brain on Drugs.
PL:
Crazy refer that makes you do horrible things, Of course, of course. But yet we have schedule two - we have oral opioids that can kill you as we know that remains on a schedule two drug. Where we have marijuana has a schedule one that's listed there, which cannot kill you. Schedule one, by the way, means that it has no medical value whatsoever and a high potential for addiction. So we have that as a schedule one lesser with heroin, where a scheduled two is our codeine and are opioids that, you know, every day we have 113 to 130 people dying a day. How many people do we have dying of cannabis every day?
DM:
I know.
PL:
The only thing that, the only way cannabis can kill you it was if you smoke the amount needed to kill you and it lands on your head.
DM:
If a bale falls on your head is basically the only way it can kill you. So I actually talked to the researcher who did the actual study to determine what is the low, what they call the LD50, the lethal dose for 50% of the people that consume it. And they had to, of course, make it into a concentrate and they used rats and so forth. But they determined that the lethal dose - to consume the lethal dose of cannabis, you would have to smoke 1,500 pounds in 15 minutes. That is literally the amount that it would take.
PL:
I heard that as well.
DM:
That's just wild to think about.
PL:
I mean, good luck trying.
DM:
Comeback liners. Well, so many of us have tried to get there, haha.
PL:
Right, Right? Don't actually try that.
DM:
Do not try this at home. So, what was the eighties acted that really helped keep the coffin shut?
PL:
The anti-drug abuse act.
DM:
Okay. So I don't want to get into what Bush wanted Bush two did. So we finally see science rearing its head, I guess. A very interesting individual over in Israel is actually doing some research. We're back in the Middle East where, you know, 2,000 years ago it was used as a medicine, and this Israeli scientist discovers what?
PL:
So Raphael Mechoulam, the Godfather, grandfather, cannabis. We all love him. In 1964 discovered Delta nine tetrahydrocannabinol, also known as THC. Everyone knows about THC. So this was discovered in 1964. So just think of the juxtaposition of what's going on the United States in 1964 and what's going on in Israel. They're discovering beautiful plants, our internal endocannabinoid system in the early nineties. Raphael Mechoulam, his lab going strong, he discovered anandamide, which is an endocannabinoid, my favorite one that I like to talk about all the time. I get excited about it. I'm smiling from ear to ear. Ananda is the Sanskrit word for bliss, and this is the chemical responsible for producing the runner's high. So anyone that has run either begrudgingly or for fun knows that when you do it for a long time, you get that feeling of euphoria, and that's anandamide. That's our body producing that runner's high. I just love it.
DM:
It's also found in Mother's breast milk, is it not?
PL:
Yes, yes, it is. It stands for bliss. Bliss. We do this on our own, our body's able to do this in their ways that we learn to stimulate our endocannabinoid system there, the director of medical education over in Minnesota, she's an RN, Sarah Overby. She produced this sheaf of ways to stimulate your endocannabinoid system, one of which is taking a 30-second cold shower in the morning. If you wanted to - the last 30 seconds of your shower. She imagines her endocannabinoid system being stimulated, which I just love. Don't do it in the winter, but it really does work. It gives you a little jump start. Smelling lemon, black pepper - I mean, there are so many different ways to do it. So I just love those ways that you could do it internally.
DM:
I have a little experience with that formula. I was taken down by mold about four years ago, and I spent a month in a naturopathic clinic and if I'd have stayed with American medicine I would be dead because they were not gonna treat me for mold. That's a long other story. There's other podcasts about that out there, but one of the treatments was to go from a hot 105-degree tub into a 55-degree tub.
PL:
Wow.
DM:
Do that like six times, if you can within about 40 minutes. Now, you can only spend about a minute or two in the cold tub, it feels like you're getting frostbite. Yeah, I'm interested to hear your take on this as a physician. Literally what happens is when you're in the hot water, you're capillaries expand. Then you jump into the cold water, they contract and when they contract, the toxins go out of your capillaries into your lymph system where they could be processed out through the lymph system. So I'm interested to hear how the endocannabinoid system figures into this because that was one of the things that were most impactful on clearing toxins and especially that mold out of my system through my hands. And it was amazing. The first few days I was there, I was doing this every day, sometimes twice a day. And when I got into the cold water, my hands would swell up like Popeye hands, and I could barely close my fists. It was very strange but very, very powerful. So, yes, I'm anxious to hear how you think about how the endocannabinoid system factors into all of that.
PL:
No, that's a great question. There are a huge amount of CB1 receptors in your hypothalamus, which is the part of your brain that's responsible for the regulatory processes such as temperature. No, that is exactly where that occurs. It's just, for instance, Hyperemesis Syndrome, which occurs when you overdose on THC, sometimes it's when you have intractable vomiting. They say the way to resolve that is to take a very hot shower because it takes down your endocannabinoid system, it slows it down. So it's really important for people that are using it to know how their body temperature is affecting the endocannabinoid system, and that's because of where the different receptors are located.
DM:
Well, that's a good place to jump in there, back to our history of the science. After the Israelis have discovered THC then, was it in the nineties that they discovered the first receptors and the whole endocannabinoid system?
PL:
Yes, so in 1991 they discovered anandamide, followed by one of Dr. Mechoulam's Ph.D. students discovered 2AG, which is our other main endocannabinoid in our system. So the ECS, the endocannabinoid system, which I love, consists of those endocannabinoids. So anandamide and 2AG, which are the things that bind to our receptors to activate them.
DM:
And those are the natural that occurs in the body?
PL:
Yes, yes, it's all us. It's all human beings that are doing it. So this goes to one of our questions. Why weren't we taught about this internal system in our bodies in medical school? That interaction plays a part in roles with our two main neurotransmitters, glutamate, and gabba of excitatory and inhibitory neurotransmitters in our brain. It would literally be like taking out - this is what I always say. It would literally be like taking out our module that we learned on the cardiovascular system and never learning about it, graduating from medical school, treating patients and not knowing about this robust system in our body that interacts with literally everything else. It was taken out of medical school textbooks. I heard a statistic that 13% of medical schools teach about the endocannabinoid system. But I think it's lower than that to be honest.
DM:
Yeah, and even if they do teach it's probably not much.
PL:
Right. 100%. But the endocannabinoid system, our endocannabinoid receptors, and enzymes break these particles down and recycle them. And what's so amazing about the endocannabinoid system is that it works it backward. So instead of going from Point A to point B, the endocannabinoid system works by going from point B and turning off with A. It's literally life, if you like to go to bed early, as I do, and my neighbors are being really loud and having a house party, it would be like me going next door and telling them to turn the music down. That's what that endocannabinoid system does. It's our thermostat. They have these jokes that dads don't like to turn the thermostat down. That's what the endocannabinoid system does when it's too cold.
DM:
Well, that's really fascinating.
PL:
I love it.
DM:
And we're still discovering new receptors. The parts of the body that actually take in these cannabinoids, whether it's the endocannabinoids or the phytocannabinoids that come from plants, they work in very similar fashions, right? What do they think is happening there?
PL:
So in Israel and other places in Europe, in Canada, they're looking into our CB3 receptor. There isn't as much research out about it now, but stay tuned. I'm excited. What we know the most about CB1 and CB2 right now, CB1 is in our central nervous system, which is why we have intoxicating feelings. And CB2 is mostly in our immune system. But they all play a role in everything, and CBD and THC bind to the same receptors that are endocannabinoids bind to as well, just in a different way.
DM:
Now the CBD binds more with the CB1 receptor, am I right about that?
PL:
CBD binds with both receptors, THC, they both bind with the CB1 receptors.
DM:
Okay, they both do. Well, we're finding the CB1 and CB2 in new locations around the body as well, yes?
PL:
Yes, it's so exciting. They're literally if you just Google location on the Google machine, put in endocannabinoid receptor locations. Literally, every part of the body lights up.
DM:
Wow. But so we really are just on the very beginning of this of the science around this plan?
PL:
Oh, my gosh, yes. And what's gonna happen? I mean, once we know, the opportunities are boundless for the treatment of different ailments. Once we know, Hey, this strain works for this. Hey, this ratio works for this. That's the future. That's how we practice evidence-based medicine through algorithms. That's what we do, especially when we're talking about our opioid epidemic. We're trying to reduce that. One of our physicians, Dr. J. Westwater, come up with a dosing algorithm for opioid reduction. It's called the Freedom Protocol, and it stands for flexible reduction and eradicates an expedited disco continuation of opioid medications. This to give to physicians because physicians are just as frustrated as you think they are with the opioid epidemic, it shows them ways to decrease that opioid dosage with the aid of cannabis because of the synergy that happens when you use cannabis and opioids is amazing. They work on the same receptor. They're called G protein-coupled receptors. The sum of the parts is greater than the whole, so not necessarily getting everyone completely off opioid medications. As much as I'd like to say that that's gonna happen, it's not a miracle drug, but what it can do is it can greatly, greatly reduced that dosage, that risk that you're taking when you're taking opioids on a daily basis.
DM:
And I know it's very helpful for nausea that you get coming off of opioids as well.
PL:
Yes, 100%. Which is why the FDA came up with Marinol initially, which is a synthetic THC, and it has just, it binds very tightly to the receptor. So that was the initial indication for nausea and cancer patients because it has these anti medic properties, However, because it didn't have that whole-plant extract the side effect profile was unbearable for some of the patients with paranoia. So it didn't have that entourage effect that we love so much. But Marinol is now a schedule three drug. So tell me how that makes sense.
DM:
Well, I'm still trying to figure out how the DEA is one branch of the government, one branch of the executive part of the government has it as schedule one, and yet the Department of Health and Human Service has the patent on cannabis as medicine. It just makes your head spin.
PL:
I know, it does! Another thing to put into the Google machine - a patent on cannabis, right? Everybody, do your research because it's like drinking water out of a fire hose when you start to learn about it, because, I still say this every day when I learn something new every day, 1,000,000,000 things every day. And I always, you know, I've gone to graduate school and medical school. Both focused on the sciences in neuroscience, clinical medicine, and I never learned about any of this.
DM:
And I think part of the resistance to is people don't like to think that their government has lied to them as totally and completely and for as long as they had been lying to us about cannabis.
PL:
No, it's it's frustrating. It feels dirty. So I'm so happy that we have people like you out there as I like to say it's spreading the cannabis gospel.
DM:
There you go. There you go. Well, anything that you think we should emphasize or anything we missed talking about when we covered the whole history of medical cannabis and the prohibition and then the scientific discoveries today?
PL:
I would just love to talk about how to reduce the stigma and that is through education and research, which is what we are about at Vireo Health. We're physician-led, physician-run. And what that means is that we want to bring the best research technology, innovation to cannabis. I have to talk about our NIH $3.8 million grant that we run with Montfiore at our dispensary in White Plains focusing completely on chronic pain patients and opioid reduction with the use of cannabis-based medicine. That study is gonna come out in the next couple of years and I'm just so excited about the implications for that. I know that there were paired with many other research institutions across the country, and that is the way to end stigma, that is the way to get this in front of people, back into medical text, back into the U.S. Pharmacopoeia and back into everyone's home because it's not gonna kill you. And people need it.
DM:
So get out there and get your third edition of the Pharmacopoeia. Get right up to speed here on everything that's happening. Well, I really do think that make Vireo stand out as a grower. You're growing here Pennsylvania and you have your first dispensary opening soon?
PL:
We do have our first dispensary opening soon. It's gonna be called Green Goods in Scranton. We don't have a date yet but stay tuned. So excited. I know everyone else is excited as well. We have a lot of great things coming on the research on the research and 1937. Again, 1937 Cannabis check it out on Instagram. Just a really great brand. And for what it stands for. Look, do your own research. Look at the 1937 Marijuana tax Act. And, we love Pennsylvania.
DM:
Well, thanks, we love you here in Pennsylvania too! We'll just sign off with noting that in the most recent edition of our magazine in the Releaf page, where the Releaf app lists the top reasons of the people in Pennsylvania take medical cannabis. The number one reason being anxiety. Now that's got to be, you gotta be in favor of that, right? Adding anxiety to this?
PL:
Absolutely! Absolutely! I mean, it just got approved in Pennsylvania as a qualifying condition. I mean, yes.
DM:
Then the number one rated product for anxiety is OGKush from Vireo Health.
PL:
Whooooo!
DM:
Yeah. So tell us what exactly that is. The OGKush.
PL:
Our OGKush is our green formulation. So our products are on a spectrum of the rainbow - red being our highest THC formulation in 19 to 1 all the way down to indigo, which is our CBD, the THC in 19 to 1. And in the smack dab in the middle of that rainbow with a 1 to 1 ratio is our Green OGKush. I'm so happy to hear that. And I'm really happy to hear that it's helping anxiety specifically, and that that just got approved is a qualifying condition of Pennsylvania. Kudos!
DM:
That's great.
PL:
Thanks to you Sven for doing what you're doing.
DM:
Thank you so much, Dr. Paloma, with Vireo health, it's great to talk to you today.
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Dispense Magazine 
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Dispense Magazine