This is exercise connections.

I'm Rachel Stephen filling in for Evan Dawson.

In this hour we're talking about marijuana.

Studies show that marijuana use is generally increasing, especially with the legalization of marijuana in many states, including New York, and marijuana use among older adults in the U.S. has reached a new high.

No pun intended.

We're not talking about using marijuana recreationally, but using it medically.

We have three guests with us in studio.

I have Doctor Paul Vermillion.

He's an assistant professor of palliative care in the Department of Medicine, pediatrics and neurology at the University of Rochester Medical Center.

Thank you for joining us.

Doctor Vermillion.

On the phone, we have Doctor Leonid.

The Linsky is the medical director of Upstate Pain Clinic in Pittsford.

And Doctor Verbinski joins, joins us remotely.

Doctor Valencia, are you there?

Actually, I'm on camera.

You're.

Yes, you're on camera.

Yes.

We join us by.

By camera.

Remotely.

And we also have Al Bain.

He is a user of marijuana for medical purposes.

Al Bain, are you on the line?

Yeah.

I'm here.

Okay, great.

So we're going to start with our doctors.

Doctors?

Let's break down what we mean by cannabis.

Are we just talking about marijuana?

Pot, CBD, thc, ABCs, element ops, all the letters that we associate with cannabis.

What?

What are in these?

What is in the substance?

What is in cannabis?

Sure.

I'll take that.

So, cannabis generally refers to anything that is a cannabinoid, which is a family of compounds that we know is in the plant cannabis and we actually discover that there are two chemicals that our body makes that are cannabinoids.

So there are two things that our body makes all by itself that are very similar to the components in cannabis, similar to THC and CBD, and THC Tetro hydro.

It don't don't worry about it.

It doesn't matter.

But THC is what you tend to think of as making you high CBD is what we used to think of is more of a body like a chill effect, a calming, but although this plant used to have cannabis sativa and cannabis indica as two pretty clear strains of the plant, there's been so much cross-breeding that those distinctions are pretty much, you know, they don't really exist anymore.

We just have cannabis plants have all sorts of different, concentrations of these two main components.

And then there are so many different things, you know, you have the cannabinoids, but then you have the turbines and all sorts of different components in this plant that gets really messy to talk about what we actually mean when we say cannabis.

But it is usually some variation that includes THC and CBD, and there's a way you can extract these, these, these ingredients or these components, individual like banks and create different products.

Yeah.

So, you know, any dispensary now will sell a variety of products ranging from the plant flower, the flower that you would smoke to extracts that are then put into powders if you want, or gummies, you know, and these are done in fancy labs now, not done in people's garages for the most part.

And so as far as like what they use, right.

You use them for very different conditions.

We have pain, seizures, sometimes cancer symptoms.

What do they do to make people feel better?

I don't know if doctor.

Verbinski for Linsky would like to answer that.

What does cannabis do to make people feel better?

Let me explain you first.

Yeah.

The main difference between therapeutic or medical marijuana and recreational marijuana.

So for obvious reason, people use recreational marijuana just to get high.

And during thousands here of selection of different strains of marijuana.

Recreational marijuana is extremely high on THC, which is psychoactive component and very low on CBD because from the point of getting high CBD, it has no use otherwise.

Recreational medical marijuana can contain way more CBD and may have less THC.

So the usual ratio we start use on a patient to control pain.

For example, it's a ratio of 1 to 1, which refers to 50% of THC and 50% of CBD.

Also, we have a different, delivery around inhalation.

It's not smoking, it's vaping.

Because the vaping ban has nothing to do with smoking, because smoke is a product of burning.

There is no burning in the vaping part.

It's actually very small particles of fluid.

You can think about vaping pen as a very little small nebulizer.

The second delivery, route for medical marijuana.

And I'm mostly talking about medical marijuana because I certify people or patients to use medical marijuana.

So the second delivery route for medical marijuana is sublingual.

Why?

We like to use sublingual?

Because the absorbance from under the tongue, which is a sublingual, it's much faster.

And also whatever you absorb from under the tongue bypassing liver, which eliminates about 60% of whatever you put in liver, it neutralize and eliminate.

That's why when you use sublingual preparation of marijuana, your effectiveness of it is much higher.

The third debate around traditional oral oral is, much, much slower beginning of action, but more and more way more prolonged than sublingual and inhalation.

Also, there is a suppository of medical marijuana you can use, and there is a place for this use when you use, marijuana for long term care.

Actually, oral and suppository.

So rectal use is more preferred.

And, we have to realize than in our body we have so-called and the cannabinoid system and the cannabinoid receptors, which is accepting this molecule of THC and CBD.

So when you have both molecules approximately in the equal amount on and the cannabinoid receptor, it's switch in a pain control mode.

That's why the best pain control, when you use equally an equal amount THC and CBD.

That's why people who use recreational marijuana doesn't have much pain control because it's predominantly THC.

So you smoke pot or use, recreational marijuana in any other way and you're getting high.

So you have psychoactive action going on, but not pain control.

That's why people, don't think about marijuana, much of the pain control medication.

But you have to realize again that medical marijuana is very different from recreational.

It's way more or less psychoactive effect and the way more pain control affect.

Doctor Vermillion, I see you here, responding your own way.

Is there do you want to is there any connection to to what you're doing or what Doctor Belinski is doing?

Yeah.

So I want to touch on a couple of things, and I will get back to the question of what do we actually use this for?

As I answer that, because what we have seen over time is that people are using cannabis for all sorts of things, and I would actually draw a distinction from what Doctor Polinsky said is that, yes, there are differences in the way people are typically balancing these ratios and amounts of THC for those who are using it medically, in those who are using it recreationally.

Many of my patients who are using medical cannabis are using something on the order of two and a half, 5 or 10mg at a time, maybe mixed, maybe more THC products.

And folks who are, you know, smoking an ace a day, going through an ounce in less than a week.

They're just using more, and those products often are higher THC content.

The only distinction I would make, though, is that it is the same product.

If you look at many of the dispensaries, their recreational and medical menus overlap.

So there is nothing magical about the fact that it is a medical product other than it has gone through the laboratory testing the checks and balances on safety, that being a regulated product, go through the products that you may get from your friend on the street corner person you know who got it from a different state.

They may not have those same checks.

And so when we think about products that come from a medical dispensary, the primary perk of those products in my mind is safety.

Because I know what they're getting, I know they are tested.

And, that being said, I often refer to the medical use of cannabis rather than the use of medical cannabis because it is not a difference.

Well, so it is not it's not the product that makes it.

This is something I can sanction versus not.

It is how they are using it.

It is the benefits that it is having on their life and the harms it is introducing to their life.

And so we have to think a lot about, you know, is this a net positive in their life or not, in terms of how I think of something as medical?

But getting to what we use this for, there's a whole host of symptoms in my world.

I am caring for many people who have cancer, and I am treating both the symptoms of cancer and the side effects of treatment.

And so that can be pain.

It can be nausea, poor appetite, poor sleep, anxiety, all of those things that people going through cancer and cancer treatment suffer from.

Cannabis has the potential to help.

I say potential because it is absolutely not helpful for everybody.

Some people feel worse with it and that, you know, they may try it once and never again, but some people get benefit from it.

And so it is that broad combination.

And then there are so many different diseases that have specific use cases.

You mentioned, seizures.

Epilepsy is one of those diseases that they have found pretty early on.

CBD specifically is helpful for.

So there's an FDA approved, Epidiolex, just cannabidiol.

Cannabidiol.

And we actually have an FDA approved THC, which is, an abnormal marinol, which is just THC.

Other countries have mixed products that are approved.

So, there's a 1 to 1 product that's approved in many European countries that isn't approved here.

And so there are specific use cases that are happen.

All here is only approved for chemotherapy induced nausea and vomiting, as well as the the the poor weight gain or appetite associated with HIV infection.

It's not approved for pain, so I can't prescribe it for pain.

Or it doesn't get covered for pain.

I could prescribe it.

But yeah.

So there are so many uses in people with specific diseases like multiple sclerosis, using it for muscle spasms that you really have to delve into exactly who the person is in front of me.

What are they hoping that marijuana cannabis does for them?

And do I have evidence for that condition in and that symptom in that condition?

Before I can really think about whether or not it is a useful tool for them.

Okay.

So for me right now, it seems like opposing viewpoints, right?

So, Doctor Vermillion, you're saying that it's not what's in it, it's how much is being prescribed.

Right.

And Doctor Belinsky, you're saying it's what it's in the product.

Less THC, more CBD.

The difference is nothing is being prescribed.

Just specifically for using medical marijuana.

I am not prescribing patients any particular products because we call them products.

It's not medications.

And I am generally, I am certifying patient to use medical marijuana.

So the when you come to dispensary, in every dispensary there is a pharmacist which has specifically education in use of medical marijuana.

And we forgot to mention a very broad spectrum problem connected with dependance and medical marijuana, very successfully used for treating such a big problem as opioid dependance.

Yes.

And addiction.

So there is a very good data confirming that medical marijuana make withdrawal problems when you try to minimize use of, addict addicted probable problem like use heroin or opioids, we can use medical marijuana as a substitute to make withdrawal process more, effective.

And, most of my patients use medical marijuana for two big reason.

It's a control of pain and withdrawal syndromes and addiction and dependance on opioids.

That's an area which use of medical marijuana, mostly successful.

So so you you so your patients, you suggest medical marijuana to to remove this opioid addiction.

It makes it easier to overcome addiction.

And most of the patients who are, prescribed opioids when they start using medical marijuana, they are able to minimize amount and dose of opioids.

And in some cases, about 40% of the patients can come off, opioids totally and completely and replace them with medical marijuana.

And doctor, doctor Vermillion, this, this, this battle here between opioids and medical marijuana.

What is your take on that?

Do you believe that medical marijuana can remove all, use of opioids?

So I suppose I am, less enthusiastic about cannabis fully replacing opioids.

And I think the studies that have shown when we, are treating somebody with new pain, I have some patients with cancer related pain who only use cannabis and they don't need opioids.

And that's great.

I have had less benefit.

And actually looking at the studies, it does not bear out as well that people who are already on opioids come off of them with their cannabis.

And I would also really make clear that if there are folks listening struggling with opioid addiction, opioid use disorder, heroin or fentanyl addiction, cannabis is not a replacement for medicated medication assisted therapy with methadone or Suboxone programs.

And those are much better evidence based standard of care for those conditions.

Whether cannabis is additive to that, I don't know if the data is borne out.

What we have seen is that neighborhoods with more dispensaries have fewer opioid overdoses.

There is some data to support that.

States that enacted cannabis, legislation had fewer opioid dispensing things.

So fewer opioids are being dispensed into the community.

And areas that have medical cannabis programs.

But for an individual struggling with addiction, I am not convinced that, they are able to better manage that addiction with just cannabis.

And I don't think that that's what Doctor Pinsky is really implying.

So I think let me give you yeah, go ahead, Doctor Linsky, let me give you some studies, which is done in 2014 and it's published in Jama Internal Medicine.

And it's found that states as medical cannabis, legal has lower rates of opioid overdose deaths.

And in 2018, study published in Addiction Journal showed some patients cut down on opioids when using cannabis.

So this is a scientific data.

So it's, evidence based medicine.

And I think you mentioned, such medications as methadone and Suboxone.

So methadone clinics are closing around the United States and Suboxone you is getting smaller and smaller.

We actually replace Suboxone, which is one of the components of Suboxone.

Buprenorphine.

As you know, Suboxone consists of two ingredients.

It's buprenorphine and naloxone, which is a neutralizing action of up north to to minimize in, psycho affective effect and possible addiction with somebody.

But now we have a data and, actually, CDC's center for Disease Control published, guideline.

So we are gradually replacing Suboxone with pure buprenorphine.

And it's reflected in the decision to, eliminate special license for prescribing Suboxone.

You don't need to have special license anymore.

If you remember, we had even, like, three years ago, it's still needed now.

Every family doctor, any, primary care doctor can prescribe buprenorphine and Suboxone, but preferred treatment for, opioid dependance is today addiction medicine world is buprenorphine.

I want to I want I want to have al, chime in on this conversation.

I want to know what why do you use, cannabis?

Okay.

I suffer from arthritis.

I don't sleep at night.

And I also deal with depression.

And, you know, that's pretty much what I use it for.

And before cannabis, what were you were you taking anything, to treat these condition?

Oh, yes.

Yeah.

There was.

So I got bags and bags of medicines for just about everything that ails me.

And those were the three things that actually concern me and my doctor the most was the no sleeping.

So, you know, they they, suggested it.

I tried it, it works, it works.

And so now that this bag of medicine that you have, where where is that located?

Do you still use as medicine or is it this cannabis is you, you got rid of it and now you're just strictly using cannabis.

No no no no no no.

Oh oh, I take, if I might, you if I may ask what kind of, marijuana you use, you use medical or recreational?

Well, actually, I've tried them both, and they come out in the same store.

I've tried them both, and I don't really see a difference in them.

I mean, technically, from a regulatory standpoint, the main difference between medical and recreational, if you go to a dispensary is the 13% tax that you're going to pay on the recreational.

And so actually there is a more difference.

You don't need any certification for use of recreational marijuana.

Marijuana.

But for use of medical marijuana, you need to be certified.

So so you initially you did receive, a script for your for your marijuana, correct?

Oh yeah.

Yeah, yeah, yeah I can I did that.

Can you take us to that process and how what was what were you prescribed and how much and can you take us through that there, there was never, how much?

I just told them what I was using.

Okay.

After I got started and, you know, they just showed me that, you know, just watch what I'm doing.

Be careful.

Yeah, yeah.

Doctor.

Ski, when I know you on your website, you have a list of conditions that you you, Yeah.

There is this medical conditions which make you eligible for certification for medical marijuana use.

It's a long list.

Yeah.

In the beginning, like, five years ago, when marijuana was first legalized, medical marijuana and recreational marijuana was legalized way later, it was a very limited list of medical, medical conditions.

But now this list getting more and more extensive.

For example, it's in the beginning it was only two conditions is a chronic pain and spinal cord damage.

Now, it's rare that, Parkinson's disease say that multiple multiple sclerosis, they are, has multiple conditions, including opioid dependance and addiction.

So when you're when you're prescribing this, how do you know what to give your patients, what what type what dosage.

As I said, there is no prescription for marijuana.

You getting product in dispensary according to recommendation of a pharmacist I am giving patients the guideline.

Like I explained, the difference between THC and CBD and different ratios like 1 to 1 ratio.

It's even, consistent evenly from THC and CBD.

And there is a preparation like 1 to 6.

Predominantly CBD has 6 to 1, predominantly THC.

They have a different effect on a patients.

And I explain all this to the patients.

It takes like 45 minutes to an hour to explain patients what, ratio you have to use and what delivery allowed, which makes a big difference.

And it's a complicated process, but there is no prescription.

I give patients certificate to use.

And he is going by my guidelines.

And, advice is from pharmacist in dispensary.

Because if the pharmacist in dispensary has any doubts, they call me and I answer all the questions.

It's the process of treatment for medical marijuana have to be tailored to particular problems and particular patient.

For example, I have a big population of older people older than 65, and they are asking me the most often question they ask, doctor, I am not going to get high on this because they don't like to get high and they, making statements off.

I am using medical marijuana just to control my pain or my other problems, but not to get high.

Yeah, I was going to add, if I, the certification process sounds complicated, but it's mostly because marijuana is not considered a medication.

Yes, legal.

So, for liability reasons, we are not specifically saying you should take this amount this often.

And, I think most many practitioners vary in how in-depth this, sort of counseling that Doctor Wolinsky talks about giving is anywhere from giving specific ratios, specific dose recommendations, all of that to simply saying, I am happy to certify that you have chronic pain and that that is a condition that is appropriate for medical cannabis, and that is all they need to do.

And as a starter, Belinski said, there is a pharmacist at all of the medical dispensaries who can talk with you and help make product recommendations around that ratio of THC to CBD, around an appropriate starting dose.

And, for anybody out there, just sort of curious, wanting to learn a little bit more about that.

The New York State website cannabis.ny.gov does have some recommendations around specific dosing for people who are new to this, who, don't have prior cannabis exposure or don't know what a milligram of cannabis would be like.

And so you can go there as well if you don't have a physician in your life or, clinician in your life who can give you recommendations.

And I want to touch on the, the age.

Right.

There is an increase in individuals over 65 or 50 to 65 that are, that are using medical marijuana, right?

I think an increase of about 6%.

I want to talk to al.

Al, yes, you are.

You are in your 60s, correct?

Yes.

And that's correct.

And you for your cannabis use, are you seeing any any side effects or any complications?

Actually, no.

You're just enjoying this.

No, no.

Well, see, if you maybe, a year and a half ago, if you if someone would have suggested me using, marijuana to, I mean, for anything.

Yes.

That would have been a hard no.

Yes.

Okay.

But I've, I went and I went, like, 13, 13 years, maybe like 4 or 5 hours of sleep a day, if that, if that up all night.

But now, you know, are you when I use it now what what happens is I get to sleep and I get to sleep for, you know, for quite a while.

Yeah.

And is there any such thing as being addicted to cannabis?

That those that do have to tell you that, you know, I mean, some some of what they're saying, you know, I agree with.

But then there's some, you know, if I, if I heard right, I kind of don't agree with it, but, you know, I'll leave it there.

Okay.

So you don't want to address what you don't agree with.

No.

Because, you know, I'm not really knowledgeable of a whole lot.

I understand that that, medical marijuana is not really, you know, something that a doctor would prescribe, you know, as, you know, as, as a, prescription, but, You got to excuse me on.

I got lost, you know, you you said you understand that is not something that a doctor would prescribed.

Like, it's not a prescription, but.

But, you know, actually is needed.

You know, for me, I don't know about anybody else.

For me is neat because it.

If you only knew what it's like waking up, you know, after you slept for like between 3 and 5 hours, you know, I mean, there comes, there comes a time when you, you want to do something different.

You want to, you know, you want to feel right in the daytime and basically, that was the best thing that that could have.

Yeah.

Then suggested for me and I fell into it.

And it works.

It works, doctor.

Yeah.

It works.

Yeah, I appreciate it.

That.

And I'm so glad that you got some relief from it.

I can tell you that the terminology around prescription is just semantics.

And it's just like I don't legally prescribe it, but I do have enough people who say that this is really helpful to them, that almost every single patient I see, I will ask them about it.

And patient.

I'll tell you, people are nervous to bring it up.

They don't know if this is a thing you can talk to your doctor about.

Really?

I've had referrals to me where the oncologist already knows that the patient is interested in medical marijuana, and yet I will do like a 40 minute visit, and they haven't brought it up yet.

And so I need to, like, pull it out of them.

And, you know, there are some people who, I would say the average person would rather try FDA approved medications, first.

So try to manage their nausea, their trouble sleeping in their pain with things that have more rigorous science behind them.

And then when those don't work, have cannabis as a second or third option.

And some people really just want to try cannabis first and that's okay.

But yes, it is a thing that some of us bring up proactively and for a long time, physicians have sort of had their head in the sand, hoping that they wouldn't have to learn about this, because it's just like I think people do.

But now that about a third of young adults are using marijuana with some regularity, and an increasing number of older adults are using it, we just don't get to pretend that it's not a thing that affects our patients anymore.

Yeah, I would think because of the increase and because of it being legal now that it would, the stigma or the taboo would put drop.

But you're saying that people still have a hard time bringing it up.

We still don't know what is okay to talk to your doctor about.

Yes, I know I have a few callers here.

I have, Linda Naples, and she wants to know about magic mushrooms.

You can.

Linda, you are on the.

You are on connections and you want to know about magic mushrooms.

You're taking it way, way, way that you're going way in advance here.

The.

Linda, thank you for taking my thank you for taking my class.

Thank you.

I wanted to share a recent story.

About the magic of psilocybin mushrooms.

My partner had, a traumatic brain infection a year and a half ago.

She was in the hospital for, 81 days in the ICU.

ICU for 60 of those days.

And before she left the hospital, we had a rehab, neurologist say that she probably.

My right arm and right leg.

And that we needed to prove ourselves that that paralysis might be permanent.

And I took it upon myself to start bringing her, what I called the magic milkshake that had a lot of supplements, including a microdose of psilocybin mushrooms.

Many doctors might say this was a coincidence, but after the third dose of those mushrooms was the first time she wiggled her thumb.

And I'm happy to report today she is walking.

She's a concert pianist.

She is back playing the piano.

And, I always, you know, ask the nurses or doctors who I shared this information with.

I made sure that we had doctor patient confidentiality, because, of course, we don't want that on our records as it's illegal.

But I, I don't think it was a coincidence, and I we've been microdosing for the last year, and she is improving every single day.

Wow.

Doctors magic mushrooms.

Let's get where we're heading.

Yes, doctor Belinsky.

I mean, talking now about general group, which called psychoactive medications and marijuana is one of them, but only one of them.

But there is a group of psilocybin and another medication from legal from medical legal point.

Psilocybin preparation legal only into states.

It's Washington and Oregon and there is no commercial of commercially available psilocybin preparation anywhere else.

But in these two states, there is also another psychoactive medication.

It's like ketamine and ketamine, gaining more and more popularity around all United States for treatment chronic pain, depression, and post-traumatic syndrome disorder.

So?

So, doctor, this is not a coincidence.

No, it's not, it's not.

For instance, it's very popular.

Also, people have not enough knowledge about all this medication.

For example, some people going as far as to Mexico to use, specific Mexican products as they call Alaska.

And it's consists of different kinds of psilocybin and other psychoactive, substances.

Not not really.

Well, it's, designed or studied.

So if you don't know much about these substances, but people using them.

Yeah.

So the ketamine treatment is absolutely legal.

Very well, learned and, very well known, especially in Europe.

We use ketamine in our practice to use chronic pain and depression every day in my clinic.

Doctor Vermillion, do you agree that people need more education on these these substances?

I think we in medicine need to learn more before we're able to educate, too.

Well, I think that there is a lot of wonderful preliminary data here.

I'll say, by way of financial disclosure, that I own some stock in some of these, companies that have early products in the pipeline because they're there's so much interest and I think legitimately a lot of promise in some of these psychedelic, medications for treatment of post-traumatic stress disorder, depression, anxiety, one of our faculty members at the university is really interested in, ketamine assisted psychotherapy.

And one of the really important factors in this is not so much using the psychoactive substance self, but that taking that opportunity to process to, you know, we think of ketamine as a dissociative, anesthetic.

And so maybe folks are able to, while using ketamine, see their situation from a different perspective.

And having somebody sherpa them through that experience, has been more impactful than just giving them the drug and walking away.

So we don't fully understand, you know, where these medications are going to be most helpful, most safe.

And what we need to do to help support people through these experiences.

Because if you know, you went to college, you may know people who had really bad, traumatic trips that left them with PTSD.

And so I am certainly not at the point where I'm recommending everybody go out and try their vision trip.

But I do think that there is a lot of promise, things like ketamine for depression, as ketamine is now an FDA approved nasal spray for depression.

And although you have to do a, I think every two weeks, you know, the effects just aren't lasting.

But I do think there's a lot of promise there.

We're going to take a quick break.

All right.

Stay with me.

We're talking about cannabis use for people with chronic health conditions right here on connections.

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Okay.

We're back on connections, talking about the use of cannabis for people with chronic health conditions.

My guest, al, being a patient who uses cannabis, he's on the phone line.

I have Doctor Paul Vermillion in studio with me.

He's assistant professor of palliative care in the Department of medicine, pediatrics and neurology at the University of Rochester Medical Center, and Doctor Leonid Belinsky.

He's a medical.

He's the medical director of Upstate Pain Clinic.

Now we have a caller on the line who wants to talk about his experience, as a cannabis medical marijuana user.

He's right here.

Line.

Hello, caller.

You're on the air.

Yep.

Oh, yes.

Hello, this is Sean.

I'm a patient of Doctor Belinsky since about a year into the medical marijuana program.

Oh, Sean.

Doctor Valencia, when I, when I first came into you, I was, had just recently, left my job to be a stay at home dad.

And I had some pretty bad nerve issues with my arm.

I ended up going with the sublingual route for a long time for for my medicine.

But a lot of the options really, all of the options that were out there, they had a lot of, like, alcohol and, and they would burn underneath your tongue.

So I just wanted to let people know, I still don't think that there's a lot of good options out there on the market that you can go and buy, but I learned how to make my own, sublingual medication at home using, water hash.

And, since then, that's been a game changer.

Instead of needing to take a full medicine dropper, .75 milliliters, I believe it was.

Now I'm able to just take one drop under my tongue and it doesn't burn.

And, I also wanted to mention that, flower smoking the actual flower.

There's other compounds in there that actually help, too.

And you don't have to burn the flower.

There are plenty of ways to vaporize the flower.

I don't care if they vape pens.

And there's other stuff in there that I don't care to put into my lungs.

As far as addiction, I take a holiday from my medication every once in a while.

I only need it when I'm really using my arm.

That ties the, the nerve damage.

And also, there are true indications that is out there that you can get.

Everything is not been hybridized out of existence.

Also, when I first came in, I had lost a brother to opioid addiction recently, so that wasn't an option for me.

I was never going to use that for my pain.

The with the, medical license there, you mentioned the no tax, but there's also some stronger options out there for gummies and things like that.

If you have the medical license that you wouldn't otherwise have access to through the recreational market.

And, thank you to Doctor Lenski, and I'll take any comments off the air.

Thank you.

Thank you, thank you, Sean.

Doctor, for Lynskey.

We're talking about side effects, right?

Of.

Yeah, the medications.

And how do we how do you work around that with your patients?

I actually remember this particular patient.

I have to say thank you.

And I'm very glad I did help you.

The good news about medical marijuana, there is not many side effects, and it's in general, there is not many possible complications.

Like, it's practically impossible to overdose on medical marijuana.

You can get, high, you can get nausea, you can get vomiting, but nothing more serious.

Totally.

Unlike opioids, you cannot stop breathing.

You cannot die from a dose of medical marijuana because it's practically unknown.

And you death from using medical marijuana.

And side effects are easily controlled by minimizing the dose.

As soon as you have unwanted side effects, you just lower your dose, and in most cases, your side effects go away.

And Doctor Vermillion, for older people that are using marijuana, my my 50 to 65 year old and 65 age group, how does that play with their their aging process and the side effects for them?

Yeah.

It's an interesting question because, you know, the side effects, the most common ones that you would sort of comment as a side effects are, often desired effects.

This idea of the distortions of time and space, people do sometimes report some paranoia that comes with that.

If you had a friend in school who would smoke and then would, like, be terrified, the cops were outside.

But I do have some patients who use medical cannabis particularly higher in THC, who get very paranoid.

And, yeah, but to Doctor Lansky's point, you can just stop using it.

The ones that you would worry about most, you know, there's whole lists of medicines that are more dangerous as you get older.

And marijuana would certainly be on that list.

It can certainly cause some dizziness, lower blood pressure.

There's some concern that it increases your heart rate.

There has been fairly well borne out increase in the rate of heart attack in individuals who are currently, using cannabis.

The absolute risk there is very small.

And so that is not enough of a risk that I tell the average person, don't use cannabis because you might get a heart attack.

But for folks who have active coronary disease, active heart disease, or recent heart attack, definitely a reason to try to avoid it.

Because it does have make your heart pump a little bit faster, asks more of your heart, and, but you know, the biggest things that I would worry about is increased falls.

So if you have individuals who are at a high risk of fall and you have any mind altering substance, and that could be an opioid, a benzodiazepine, like out of an, any of those substances that alter some of your perception may lower your blood pressure, may make him dizzy, or they all put you at higher risk for falls.

So you need to be careful with that.

Eye is also on the line.

Oh.

No.

Okay.

We're going to ask our about the risk.

So I just wanted to continue with, certain medical situations that you would absolutely not recommend cannabis use.

Yeah.

So, certainly active coronary artery disease.

Active heart disease like that.

People who are on dialysis, it would be a hard discussion, but I would, there are some specific medications that you need to be careful on.

And this is not an exhaustive list.

So please, no one in the audience take this is the end all be all.

But people with organ transplants who are on tacrolimus, there are certain immunotherapies that you want to make sure that, your oncologist is aware that you are using cannabis.

There are less commonly used drugs like theophylline.

So the most important message here is, to be honest with your clinicians, be honest with them about what you are using so that they can monitor and advise appropriately.

Along the lines of the microdosing of the, patient who called in, like, we just need to know that that is happening, because what happens?

I know that there are people who are in our hospital who use substances without us knowing it.

And, it is unsafe for us to then sort of manage their symptoms in the hospital if we don't know everything that they are taking.

So everything above board guess.

And al, how did you did you know about the risk and did that at all influence whether or not you would, did you hesitate at all knowing these risk?

Well when it comes down to risk okay.

No, I was I was a cannabis user when I was in high school.

Okay.

And I quit when I was in high school because of, like, the, the young man said a little earlier paranoia.

And, you know, all sorts of different other crazy things.

And like I said, if you'd asked me a year and a half ago, I called you crazy if, if you said that that, cannabis would make me feel better.

Yeah.

But, It it's good.

It's good for me.

Yeah.

So there is this.

There is this.

When you're younger, you use it for recreational purposes.

But as you're older, it does.

Yes.

It does feel better.

It works.

I, I had more problems when, actually, when I was in high school, you know, now.

Wow.

There's only three.

There's only three side effects that I see, and that's, you know, hungry, happy.

And, you know, sleepy.

So why is that?

Doctor works for me.

Thank you.

Oh, why is that?

Why?

Why is it working now?

Wireless side effects now without or older?

Yes.

Because, as soon as you start using marijuana, medical or recreational, in some time, you develop so-called tolerance.

So the same dose caused much less effect as the time goes.

So, developing a tolerance, you eliminate most of side effects, unwanted.

So if you start using medical marijuana and if you feel nausea or vomiting, and you continue to use it in smaller doses, and as the time goes, all this side effects goes away.

And for older population older than 65, my standard recommendation for use of medical marijuana you have to start not with the ratio 1 to 1, but we use predominantly CBD.

So let's say 60% of kids CBD and 40% of THC, or even lower because older people, they are more prone to developing hallucinations and confusion.

So I recommend them very carefully to increase THC dose.

So standard recommendation again, low THC and high CBD dose.

Okay.

So we have a caller here.

We have Steve from Canada and Steve is he says he's been using for it's been decades since he has had good sleep.

And he wants to ask about getting advice.

Steve, are you on the line?

I am hello, Steve.

Yes.

Let's talk about your insomnia.

What is what's going on?

It's been decades.

Okay.

It's something that al said is what made me prompted me to call for decades.

I don't have a problem going to sleep at night.

I can go to sleep, but typically at 11:00 to midnight, somewhere in there, and I wake up at six, 630 ish.

I cannot go back to sleep, but I, I have never in decades felt when I got up, I was rested.

That I would I feel like I'm still just as tired and sleepy as when I went to bed.

No, I've had the insomnia tests.

The sleep apnea test.

All of those have no bearing on it.

So I thought, well, maybe this would be of help to know.

What is it, a THC, CBD?

What?

What might be a value to me and the doctors opinions to where when I wake up in the morning, I feel rested and ready to go rather than just wanting to go back to sleep.

But I can.

Doctor Vermillion, any advice for for Steve?

Yes.

First off, I feel for you.

It, waking up and feeling not well-rested and never feeling well rested is just an awful way to feel, unfortunately for folks who are falling asleep and staying asleep, I don't have any reason to think that marijuana is going to improve the actual sleep architecture.

The quality of the sleep you're getting.

Almost every one of our sleep aids that are on the market just help you not be awake.

Very.

There is very little there apart from, you know, a CPAp machine for your sleep apnea that actually improves the quality of your sleep.

But I'm not a sleep doctor, and I don't want to speak, on behalf of all of their expertise.

So you wouldn't know not to interrupt, but I've already done that.

And there was no, I don't have that condition, so.

Yeah.

No, I hear you on that one.

Okay, so this is not a case where you would.

Doctor Verbinski, you would not suggest medical marijuana for Steve.

I will probably recommend anybody who has a sleep problems start with using pure CBD.

Not any THC, because, basically THC increased excitability.

And so people getting more problems sleeping on a high THC products.

So I recommend you to start with pure CBD, not EEG whatsoever, and see if it's going to help you to sleep.

Most people improve improve sleeping with pure CBD.

And Steve, we're going to send you an invoice for that for that consultation.

Absolutely.

And I was going to tell you, doctor, that we would I haven't because we, we were well, we have the wrap up this hour of connections.

Thank you, gentlemen, for your expertise.

I'll been on the line.

Thank you, Doctor Paul Vermillion and Doctor Leonid Belinsky.

All right.

Our experts on medical marijuana.

Stay with us here on Sky news.

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