“We’re here for a short time on earth. Why wouldn’t we try to help each other? And it just, you know, it’s kind of a different approach when you take medicine away from people.”
— Bonni Goldstein, M.D.
It’s now medically legal in 36 states, yet many people don’t understand the medicinal power of cannabis. So Bonni Goldstein, M.D. wrote a second book: “Cannabis is Medicine: How Medical Cannabis and CBD Are Healing Everything from Anxiety to Chronic Pain.” Trained as a pediatrician, Dr. Goldstein saw how cannabis could help young patients with epilepsy, and has since become an advocate for cannabis use for a variety of conditions.
There’s lots of practical information in this interview. Listen, and learn how:
- Cannabis has been held to a different standard compared to other medicines.
- Your endocannabinoid system can get out of balance, and cannabis can help you reestablish that balance.
- Research into the therapeutic use of cannabis is finally starting to progress.
- Dr. Goldstein helped her mother find the right dose of CBD to bring longstanding nerve pain under control.
- Steps you can take to find the right dose and form of cannabis or CBD for you.
- Speak with your doctor about whether cannabis might have a role in your health care.
- Or find a doctor through the Society of Cannabis Clinicians at CannabisClinicians.org.
Transcript of Podcast with Bonni Goldstein, M.D.
Copyright © Kannaboom 2020
Kannaboom (00:00): Cannabis is medicine. This is not just my opinion. It's the title of Dr. Bonnie Goldstein's second book, and the subtitle is: How Medical Cannabis and CBD are Healing Everything From Anxiety to Chronic Pain. This is a book you should pick up, because it breaks down the latest science and serves as a practical guide, not just for patients, but for medical practitioners too. A lot of us have questions about how and why to integrate CBD or cannabis into our care. This episode is for you. And if you've been meaning to have the cannabis conversation with your doctor, Dr. Goldstein's book is a good thing to have under your arm when you go into the office. Whether you're a subscriber or a first-time listener, please stop by and see us at Kannaboom, with a k dot com. We're focused on how cannabinoids and CBD can help you achieve better wellness, and importantly, how to find CBD that's trusted and reliable. If you like the podcast, please subscribe and please do leave a review so other people can find the show. Thanks to our producer, Danny in Milwaukee. Here's my interview with Dr. Bonnie Goldstein.
Kannaboom (01:12): Hey Bonnie, how are you?
Dr. Bonni Goldstein (01:13): I'm doing great. Thanks.
Kannaboom (01:14): You are medical director of Canna Centers, based in California, a practice devoted to educating patients about the use of cannabis for serious and chronic medical conditions. You've also recently published your second book called Cannabis Is Medicine. Can you tell us more about how you came to be the doctor who writes cannabis books?
Dr. Bonni Goldstein (01:33): Sure. Well, so after a number of years working in pediatric emergency medicine in downtown LA, I was a bit burned out and I took a little time off. And during that time, a friend who was going through a pretty serious medical condition asked me about cannabis. And this is about 2007, 2008 ish. And I really didn't know anything. I mean, I had been a doctor already for about my goodness 18 years or so 17, 18 years. And I just wasn't on my radar. I knew California had cannabis, medical, cannabis laws, but just hadn't really come across in terms of what I was doing at the time. And then she asked me about it. So I said, well, let me look into it. You know? So I did some research and I couldn't believe what I was reading, that there was this endocannabinoid system that no one ever talked about, or I never learned about in school and major physiologic regulator of human health, basically. So I started reading, I was intrigued and I've always been a bit of a science geek. So I helped her. And I was also at the time, you know, in my, in my personal life, looking to figure out a way not to be working such crazy and in such a crazy place, especially as a mom and a wife. So I started working in a medical cannabis office and I just fell in love with the practice. And again, since I'm kind of a science geek, I delve in a fully, and I just read everything I could read. One of the things I noticed when I first started out was the patients knew more than me and they were educating me. So I decided I better catch up. So I, again, I started reading, going to conferences and, you know, just decided to write a book after, you know, a number of years later, a patient said to me, 'Every time I come see you, I learn all this stuff. Where can I get this information?' And it just kind of dawned on me. Maybe I should start sharing the information that I'm finding, not just the research, because anybody can find it online, but really how to apply that research to a clinical practice to really make a difference in somebody's quality of life.
Kannaboom (03:58): There's so much ignorance based on the hundred years of prohibition, but there is some research going on, probably not as many clinical studies as people in medicine like you would like, but it is happening. So it's sort of a moving target at this point, I guess.
Dr. Bonni Goldstein (04:12): Yeah, no question. One of the things I always share with people is I'm a pretty conservative physician, look, I took care of children. I trained at Children's Hospital, Los Angeles. I was chief resident there. I went on to do critical care transport. I took my oath of do no harm quite seriously, try to do the best I can to give patients the best possible care. I've always practiced medicine that way. And I kind of felt like this was no different, but one of the things that, you know, we say, 'Oh, we don't have evidence of this. And we don't have evidence of that.' And there's, it's true. We're missing a lot of information. But the one thing that we know that people who take cannabis, people who work in the field of cannabis and certainly doctors who are recommending cannabis to their patients. And if you listen to your patients and you follow up with them closely, and you, you bother to kind of learn about it, like you learn about any medicine you learn that really is extraordinarily safe. And especially when someone's between a rock and a hard place, u,r instance, you know, children that come see me, who've been on 10 different seizure medicines and they're still having 50 seizures a day know CBD is going to be safe for that child, whether it's going to work or not as the question, right, or any cannabis compound going to work for that child. Um,t when we, any time we're recommending treatments or prescribing a medicine, we always as physicians, good physicians always look at benefit versus risk and certainly, u,e benefits be quite great. And I will share with you, even giving cannabis to children under medical supervision, the risk is very low. And I think that is why kind of the industry is, and laws are kind of outpacing the science at this point. It's time for the science to catch up though.
Kannaboom (06:16): And that's a good place to begin is you hear a lot of cannabis advocates mentioned that, you know, no one has ever died. There was no record of anyone having died from an overdose of this and you in the book, you bring up lethal dose, the LD 50 calculation, almost anything could be lethal in a large enough dose, right?
Dr. Bonni Goldstein (06:34): That's correct. And with cannabis, we know well again, so you have to look at the mechanism of action of how death is caused by drugs. Okay. So for instance, we all know that people across our country are dropping dead from opioid overdoses. So how does that work? Well, you have opioid receptors in the area of your brain that control breathing your, your respiratory rate. And if you take now, by the way, those opioid receptors are not, do not exist in our brains for synthetic opioids, or even for the opium plant. That's not why we have them. We have them because we make endorphins. Okay. And, and it, we make the compound that binds to the receptor, just like we make serotonin for our serotonin receptors and dopamine for our dopamine receptors. So there are no cannabinoid receptors, which is where THC binds in our brains in order to cause the well known effects like intoxication and decreased pain and sleepiness and less anxiety. And so on those receptors do not exist in the part of your brain that controls your breathing. So you will not go into respiratory arrest and stop breathing from cannabis.
Kannaboom (08:00): I've heard it said that you could drink enough water to kill yourself, but with cannabis, you'd have to intake an incredible dose.
Dr. Bonni Goldstein (08:08): Exactly. And you know my friend, Dr. Dustin Sulak who's in who practices in Maine ha I've heard him speak numerous times. And he says, you know, scientists have been trying to kill primates with cannabis with THC for years. And we're just not able to do it because unless you were really, I guess, force fed, but still even then the mechanism of action is not there. Meaning the target in the brain does not result in fatality, but you would fall asleep before you could take so much cannabis. I mean, you, you, you've some literature that's a little bit older, says you'd have to smoke 1,500 pounds of THC in 15 minutes. I mean, this is just not, it's just ridiculous. The stopped counting deaths from marijuana, just because there aren't any, so you know, and again, safe, it's not just, 'Oh, I won't die from this,' but what else won't happen? And when we look at medications, you know, we know people that, again, take all different kinds of medications can have liver issues. You can have kidney issues, you know, early in my career, as a cannabis physician, a gentleman came in who was 51 years old who had pretty bad arthritis from when he was younger. And you know, maybe it was auto-immune. I can't recall the exact details, but he started taking nonsteroidal anti-inflammatories like ibuprofen, and Naprosyn over the counter. And we assume over the counter must be safe. And at 51, he had come into my office and said, 'I was told that I can no longer take nonsteroidal anti-inflammatories for my joint pain, because my kidneys are shutting down.' Now it wasn't with the first dose. It was over 20 years, but he took them daily and he actually started to cry because he said, 'I can't believe that I went to the doctor to follow up on my blood work. And they made an appointment for me at the dialysis clinic.' He goes, 'And nobody ever said anything about stopping.' He goes, 'And I went and did my own research. It's clearly from this cause I'm otherwise a pretty healthy guy.' So you see, we have to be very careful about benefit, benefit versus risk for all things. But again, with cannabis, especially under medical supervision, you know, all these compounds are, are, are very safe. I think the biggest concern is if you are taking medications for other conditions, you have to be careful about CBD, potentially causing a drug interaction
Kannaboom (10:46): And people do need to be aware of that.
Dr. Bonni Goldstein (10:49): Absolutely. And seizure medicines blood thinners certain new immunotherapies or, or chemotherapies for cancer. It's just a good idea to make sure that anybody taking medications goes over, you know, especially if they're going to take it, it's usually a high-dose CBD interaction. It's not low doses. Like, you know, under 25 milligrams usually won't cause a problem with other drugs. But again, you want to make sure that you're not pausing a drug to become toxic or ineffective by using CBD, high-dose CBD, especially with other medications,
Kannaboom (11:25): Those contraindications that you want to avoid. You mentioned your early career in pediatrics, and this has come up in several interviews that I've done. I did one a couple of weeks ago with a pediatric nurse. Sanjay Gupta was there with his CNN special, I think it was called Weed from 2011 or so where they identified epilepsy, pediatric epilepsy. And I think autism is kind of related to that. And that seemed to be like a tipping point. Have you noticed that in terms of public acknowledgement that this is a legitimate medicine?
Dr. Bonni Goldstein (11:58): Absolutely. Dr. Gupta came out and said, 'This is why I changed my mind. I used to be against cannabis and now I'm pro cannabis.' And he shared that story about little Charlotte Figi and Colorado who had a severe pediatric epilepsy caused by a genetic syndrome. And basically she was sent home to die. And her mother managed to get ahold of some CBD plant cannabis plant material, got it, turned it into oil and gave it to her and it changed everything for her. It slowed her seizures down. It's not magic. It's just that we, it appears that CBD you know, has all these different targets in the brain that help with what we call neuro excitatory conditions. And there's no question that kind of, you know, Dr. Gupta put the mainstream approval there. It was after that special, which I actually believe was August, 2013. After that special that I started getting inundated with phone calls, you know, 'Do you see children?' And remember my background's pediatrics and I did pediatric ER and critical care. So I'm very comfortable with children who are ill and who are on a multitude of other medicines who have complex issues. And so I just started seeing those kids cause they really had no other place to go. And I had already seen a few kids that were having a good result. The big problem at the time was actually getting a hold of good quality CBD medicine, you know, cannabis medicine. And it's interesting. The market responded, didn't it look how quickly now there's, you know, hundreds of cannabis CBD cannabis products on the board.
Kannaboom (13:42): It's sort of opened the door. I mean, who could be against a medicine that can save little kids from seizuring to me, it opened the door. Okay. If it's good for that, maybe people are talking about PTSD. It's good for that. And you know, when I look at your book and I looked at the table of contents, I think there were 26 conditions that you wrote about from anti-anxiety to traumatic brain injury and a lot of things in between. It's obviously a very versatile medicine too.
Dr. Bonni Goldstein (14:09): Yes, it is. And it's funny because there are some people say, 'Oh, how can cannabis do all that?' And look, I'm the first to say, it's not a panacea. Okay. That not everybody responds. And that would be curious to know what is, I love to see a study to understand the people who don't respond to it. Right. Is it an absorption issue? Is it a receptor issue? You know, really what's going on with those people. But the reason that it is a crossover across what we call, you know, the body system. So remember anxiety is a brain issue, right? And arthritis is a joint issue, and Crohn's disease is an issue coming from an immune auto-immune etiology. So you kind of look and say, how is it that something can treat all this, right. We're used to drugs. Like, you know, you take penicillin because you have strep throat. You don't take penicillin when you have back pain. So how is it possible that these compounds can do this? And again, it goes down, it boils down to the location of the endocannabinoid system. And someone once wrote, the location of the receptors informs function. So, you know, where these receptors are located, tells us what the endocannabinoid system is trying to do. And remember the endocannabinoid system is the system that is just working in our body to help maintain balance. And when we're thrown off balance by an infection or inflammation or a genetic disorder, even by an, in a traumatic insult, like a head injury of some sort, our endocannabinoid system goes into action trying to, to right the imbalance, trying to get us back, tell those cells, 'Hey, stop sending the wrong message, send the right message.' Um it's basically a feedback loop. It's our, our internal physiology trying to respond to whatever's coming at us. And it's, it's just a fascinating system. And, you know, it's really located all over. It's densely populated in your brain and your gut and your immune system, but it's also located in your connective tissue and in your liver and in your heart and in your kidneys. And, you know, it's all over. And so that is why when we list all the conditions, it's almost, almost incredible to think that, that these compounds can work in so many different places. But remember, we don't have our endocannabinoid system for this plant. We have it as a tool to help keep us well. And by using the plant, we are just trying to augment the system, trying to help that system get back into balance with a little bit of help.
Kannaboom (17:11): And that is key to people understanding that this isn't a snake oil that people are pitching for whatever ails you. It is something that works with the way our bodies work. The incredible thing to me is, I don't know if this is still true, but a year or two ago, someone told me that only 15% of medical schools are even teaching about the endocannabinoid system. So it's not well understood even in the medical profession.
Dr. Bonni Goldstein (17:35): Well, understood is different than kind of accepted. I think, unfortunately, my colleagues in the medical field are the last kind of get on board. I don't think patients are really, or people are really struggling anymore. I hear about this all the time. I was joking around that day with somebody and I said, I'm on, obviously before COVID in a restaurant, the people behind me are talking about CBD. I was on a plane. The guy in front of me starts a conversation with his neighbor about cannabis. I mean, it's just, everybody's talking about it. And I think you know, again, going back to the medical community, we just don't have the freedom because of the maintenance, you know, the continued schedule, one status. We don't have the freedom to do the research that we need to really know. When people come in to see me, sometimes it's really rare conditions and they'll say, can cannabis help? And then I think, okay, so ultimately, you know, what does this person's rare condition boil down to? I mean, they're having pain. What cannabis can help with that? They're not sleeping. Cannabis can help with that. They're,ua super-anxious and depressed, cannabis can help with that. Will it help with the, with the underlying condition? Sometimes I have to say, 'Look, there's no studies. We don't know.' But at the same time, might it give that person a quality of life that makes it easier for them to deal with their, let's say incurable, you know, rare condition. Well, sure. It could be. And again, going back to it's safe, well, certainly worth a try. And again, especially with medical supervision, I don't see any reason why not my colleagues seem to, you know, I shouldn't say all of them, but many, many people in the medical field are still skeptical. And part of it is that when you go back to medical school, one, we didn't learn it. And two, what we actually were taught was the opposite is that cannabis is a drug of abuse. And yes, there are people who abuse it, but it is very rarely, in fact, almost never that it is a myth, someone using it for medical reasons who was abusing it. And if they are, I've had people come in and kind of explain how they're using it. And I say, you know, this kind of looks like abuse. That's not their intention. They just don't know what they're doing, but I wouldn't expect someone to go out into a pharmacy and walk through the aisles of the pharmacy. Well, let me just take a little of this and let me take a little of that. And I don't really know what this does, but let me take a little bit of that. If medicating with cannabis will work. And again, it, you're not going to harm yourself with that, but you may not find what works for you. And certainly at that point, if cannabis isn't helping, you might need medical supervision, meaning just someone to say, 'Hey, this is what I've tried and it didn't work. Where should I go from here?' And, and again, that's why cannabis specialty, for those of us who practice in this field is, has kind of become a thing.
Kannaboom (20:37): It seems to me you're sort of on the vanguard. I mean, stepping into the breach in between this world that is still politically, we, we still have it as a Schedule One substance with no redeeming medicinal value. And here you are legitimately saying, first do no harm. And this is a less harmful alternative than some of the pharmacological agents that are dispensed every day. For you, you don't have all of the research you'd like, but you know that this is going to reduce suffering for some people.
Dr. Bonni Goldstein (21:07): Yeah, there's no question about that. And the other thing is that slowly but surely, and other from other countries and just a teeny tiny bit in the United States, we are getting studies, look, this whole CBD for epilepsy for children, movement led to the approval and the FDA in the United States, fast tracking a, a CBD pharmaceutical, which is now covered by insurance. And for those families, for whom it works and, or let's say they're in a state where they can't get approval to use cannabis, or they don't have a physician to help them with the whole plant cannabis, meaning the one that we're kind of using under the medical cannabis laws. We now have a pharmaceutical to use. Now I personally would err on the side of using the whole plant, but at the same time, everything should be on the table for a child that has a severe epilepsy. We know that every time they have a seizure, you multiply those, you compound them over time. You put in drugs that have toxic side effects, that child's brain is not going to respond. Well, we know what prolonged seizures do, we know what harsh chemicals do. There's a big burden there that, that sometimes then can change the long-term outcome. It appears that, you know, for some of my patients, certainly when I see some of the patients that are older, who didn't have this option, versus some of the patients who are younger and have had the option, or let's say the intervention of cannabis therapy at the young age of three, four, five, when they started having terrible seizures. And now look, there's a story in the book. One of the first stories about a little boy named Gavin. This is a kid who's doing unbelievably well in school. My goodness, he's winning, you know, winning a self-discipline award and he's winning you know no absent days. I mean, amazing results, which he likely would not have found with pharmaceuticals, especially since he really wasn't being who knows what would have happened had he not used cannabis at the time? And you read in the, in the book that when he first came to see me, he was having terrible side effects from the medication he was on. He was just, it created a, it changed his personality and the family. I'll never forget. They came in the door in tears, they just couldn't live like this anymore. And so, you know, look, it's just another option, albeit a very safe option. And ultimately, you know, I do find that cannabis is being held to a double standard. Like it appears that it has to do better than any other drug, like we'll accept a 30% response rate for most medications, which is pretty low,uin order to get them approved by the FDA. But for some reason, cannabis has to beat that and it has to be perfect. And, you know, and again, it comes from all that propaganda and stigma, you know, from, from back in the day.
Kannaboom (24:17): And you mentioned the story of Gavin, and I think you did a great job throughout the book in bringing anecdotes of real people and real suffering into this. You related the story of your mother who had epilepsy. And that resonates with me. My brother had epilepsy and took Dilantin and I saw how destructive those drugs are. And, and to know, years later that there was this option that was always there. It's really frustrating,
Dr. Bonni Goldstein (24:41): Right. It was taken away from us and not for science scientific reasons. Remember, you know, we, I want to talk about going and I'm not going to go into why it was taken away, but just think about that, like this, this natural plant that you can grow in your backyard was taken away. And when it may have, and look again for thousands of years, it was used as medicine and they didn't know exactly how it worked, but, you know, there's documentation of cannabis being used to treat infantile convulsions by Dr. William O'Shaughnessy in the 1800s. And it's just really, to me, it's criminal, that it was taken away. And it's criminal that my mother in the 1960s didn't have any options whatsoever. She said, they said, 'Here's the medicine, take it, or you could die.' And so she was terrified. So she took it and ultimately, you know, we feel very lucky as a family that she's well, and she's off those medicines. But it, it, angers me that she had to suffer and she still has some leftover side effects from taking those medications for a very long time. And it's just you know, I don't understand what the purpose of that was. I don't, I don't get that. We're here for a short time on earth. Why wouldn't we try to help each other? And it just, you know, it kind of a different approach when you take medicine away from people.
Kannaboom (26:05): When you look at the long list of conditions that 26 conditions, it's not just epilepsy, this prohibition affects just about everybody in the country; beyond the medicinal effects, there's also a lot of people who have been arrested and incarcerated. It's just mind-boggling that we allowed all of this destruction when this plant can be so effective in helping people live better.
Dr. Bonni Goldstein (26:26): That's right. And, you know, just the other night I gave a talk to a group called the Cancer Support Community. It's near my home in Southern California. I had been speaking at this group just about once or twice a year, every year for about 10 years. And I can't believe it kind of dawned on me this, you know, just the other night I did it. It dawned on me that I've been saying the same thing for 10 years, which is that there isn't any research, there's no research on, on human cancer in humans. Like we are, I, I keep repeating the same thing. How is it possible that we know that the compounds in cannabis, THC, CBD, CBG and a multitude of others can actually kill cancer cells, and can block cancer cells from spreading chemicals that tell the cancer cells to metastasize that inhibit growth of tumors. And this is not just one kind of cancer, but a multitude of cancers. And we know this, but yet there's one human clinical trial from Dr. Manuel Guzman in, I think, 2006 in Spain. And then that's it for being published in human clinical trials. And I will share with you that just in this last month, I lost three of my pediatric cancer patients, how frustrating for me and for their parents and for everybody else that we are allowing children to die. When we have this perfectly good plant that we can study. And look, it may turn out that it's only useful a 10th of the time, but OK. Does that mean one 10th of children dying from pediatric cancers will not die? I'll take it, but why aren't we studying it? Why aren't we allowed to study it and, and, you know, give me a good reason why you would let a child die over, letting them use a plant. And I, I used to say sometimes very, u,ming from a frustrated place, a child on cannabis is not worse than a dead child.
Kannaboom (28:39): We live in a broken political system, but what do you think has to happen? I mean, do we all have to become activists to move the ball forward? Is it just going to take a long, long time? Or what can we do to help expedite this process of greater acceptance of this medicine?
Dr. Bonni Goldstein (28:55): Yeah, it's such a great question. So I think ultimately when we vote, we have to look at those who are, you know, for cannabis. Look, it has to be taken off the Controlled Substances Act. So remember, it's on Schedule One, which you mentioned earlier, as a no medicinal value. Well, we know that's not true, so we're already, and that, and if you say that that's true, then you are ignoring thousands of peer reviewed articles. Okay. You're ignoring all of that. You're ignoring the Academies of Science Engineering who came out with a report saying it does work for pain. It does work for chemotherapy induced, nausea and vomiting. And remember all of those studies were using synthetic cannabinoids. So, we can no longer ignore the science. I think the science is irrefutable that there is medicinal value. And I think the lack of safety, while we know that's not true. And then the highest abuse potential. Well, we know that's not true. And what's interesting too, is that if you if people are interested, there's some new information coming out from Dr. Stacy Gruber's group I think she's at Harvard where she's published already a couple articles showing that those patients using medical cannabis actually have improved neurocognitive function compared to, you know, and she's capturing them before they start using cannabis and then testing. And she says, they're the most tested group of people you've ever met. She's testing the heck out of them, scanning their brains and doing memory tests and all kinds of things. And she’s showing these, these really incredible results. And now there's also some other long-term studies of medical cannabis patients showing a really is, you know, there really seems to be something real here, but yet we're still by saying it's a schedule one, we're ignoring all that. We're we're saying, and to me that's willful, that's being willfully ignorant. That's just saying I'm going to ignore the data and that's just not okay. So what do we do? We vote in people who understand that we don't want it rescheduled as a Schedule 2 or a Schedule 3 or 4 or 5, because then it's prescription only. And I think, you know, look, the, the barn doors are open and the horse is long gone. We're not gonna be able to, to reign in all the state laws, so we should de Schedule it. And there should be funds, whether a public or private, to universities and to scientists who already have the experiments set up, the investigations ready to go. They're just waiting for funds and for approval to be able to do it. You know, there's a doctor here in the United States, Dr. Susan Sisley, is doing some really great work with PTSD. I'm sure you've, you've heard of her. She had to wait three years to get her study approved, and she could only use cannabis from the University of Mississippi, which does not reflect real-world cannabis that people are using. It's grown from cannabis propagated from the 1960s. It's not, what's available to patients or to people right now through state licensed dispensaries. So again, we have to de-schedule. And then the big question is, is, you know, how do we do that? We keep petitioning the federal government just to keep working at it. There are so many different advocacy groups that have already tried to do that. And I think that we're closer than ever at this point, because we have something like 33 states that have cannabis laws. We have 11 states that have legalized cannabis and have I think four states coming up with this election and 2020. So we just have to, you know, keep the pressure on and try to try to change it. I think we're closer than ever.
Kannaboom (32:54): You mentioned in the book too, that a lot of the research is focused on recreational use. I don't know that it's a giant schism. I mean, there's a lot of companies that are jumping in with product that I don't know if it's strictly recreational or slash medicinal. There's not a bright, clear line for that. Do we need a new paradigm where we see this substance that can be used medicinally? Alcohol, I don't think it has medicinal properties. It's used recreationally, and it's very destructive. You know, if you look at how we look at pharmaceuticals, it takes, I don't know, a hundred million dollars and 10 years to develop a pharmaceutical. And then there's,uan atom that is used when a certain diagnosis is made. Do we need a completely new paradigm for this plant-based medicine?
Dr. Bonni Goldstein (33:38): I don't think so. I don't see any reason to recreate the wheel. The plant is there. And the key is education, educate doctors, educate medical students, educate people who are ill, who are seeking information about how cannabis may or may not help them. But part of that is going to have to be the research. You know, when you're designing... Cannabis doesn't fit the, the gold standard, you know, their randomized controlled trial, because it's very hard to mask the taste and the smell when you're giving somebody a product, right. And then be like, 'Oh, I know that's not a placebo' immediately. But also you have to remember that the plant is got, it's got over 500 different compounds in it. So ultimately if I give a child, recommend a certain, let's say, you know, use a CBD and a 25 to one ratio and take X milligrams twice a day. And, you know, 'Mom, let me know how it goes in a week.' and let's say the parent calls me and says, 'Oh, the seizures are down by 50%.' Do I assume it's the CBD in the bottle? Do I assume it's the THC that's in that bottle? Cause remember 25 to one ratio, a little bit of THC in there. Is it both, is it the other cannabinoids that are in there? Is it the terpenes? Is it all of it? So cannabis is very difficult to study, but we're not so stupid that we can't figure it out. I think many other countries have led the way with investigating single molecules, meaning you isolate CBD and they've done this. I mean, I think Israel has done a fantastic job doing it, Italy, the UK, they're looking at what CBD as an isolated compound can do. And then you say, okay, now what does CBD let's compare isolate, CBD with CBD as the plant gives it to us with THC and linalool and some of these other terpenes that we just have to be smart about it. So I don't know that we need to recreate it,uor, or, or just start all over, but we have to remember that it doesn't fit the standard pharmaceutical model and nor should it have to.
Kannaboom (35:54): I get the sense that you're exceptional in your acceptance and your active participation, using this as a medicine for most people in the United States, they're going to have to look pretty hard to find a doctor who is going to prescribe any cannabis. What advice do you have for listeners who may want to integrate cannabis into their, into their regimen?
Dr. Bonni Goldstein (36:14): Well, so there's a lovely group that I belong to called the Society of Cannabis Clinicians. It's been around for 20 years and the website is CannabisClinicians.org. And there is a link on there: find a practitioner. And there are a lot of listed MDs, but also RNs and nurse practitioners who can at least sit down with you, go over your medications, go over what your goals are, and then at least point you in the right direction. One of the reasons I wrote the book too, was to give people a roadmap and I can't remember which chapter it is, but,the chapter called How to Use Cannabis as Medicine, chapter five, tells people kind of in a, and again, this is not to supplant medical supervision, but it, at least if you read it before you start, you kind of say, okay, I understand what I'm doing here. Now, one of the things I want people to understand is that when patients come in to a non-cannabis doctor and you can get diagnosed with a condition and they pick a medication, they're picking that medication for you based on research, right. That they know hopefully. And they're also picking,uthat medication because they have some clinical experience with it for the most part. And also because they feel comfortable with it. Okay. But at the same time, if you've never taken that medication before you have no idea what it's going to do to you, I, I, myself had a medicine prescribed probably about 20 years ago and just about ended up in the emergency room. Cause I had the worst side effects and I call the practice and it's after hours. So I get a different doctor, not my doctor who says to me,uuOh, who says, 'Well, gee, I don't think I would have started with that one,' which of course eroded all confidence that I had in my doctor. Um but at the same time, the reality is that sometimes it takes two, three, four medicines to find the fit, right, or two or two or three different medicines all at once they say, 'Oh, okay, now I'm starting to feel better.' It's no different with cannabis. You're not going to pick, you know, you buy a bottle of CBD, let's say, and you take it. You say, 'Well, gee, it didn't work.' I mean, it's just not that simple. There are some people who get that benefit, but that's not really the way that cannabis works. It takes time to find the regimen. And, u,if I could share anything with listeners, it is, this is natural. This is not a harsh synthetic. So to expect it to fix you on day one is unrealistic. The analogy that I always use is if I'm out of shape and I go to the gym, first thing tomorrow morning, I am not in shape tomorrow night. I've begun the process, but it's going to take some time for my body to respond, especially because it's natural. You know, inflammatory conditions can respond beautifully to steroids, but why do doctors not always, you know, why do we try not to prescribe steroids in general, all doctors who write a prescription for steroids always are thinking, okay, cause it's a double-edged sword for every benefit. There's a risk with, with steroids. And it does work great when you're inflamed. I had a severe allergic reaction again, a number of years ago, and I got on steroids and sure enough, it did help, but I had terrible side effects from it. And the big question is as well, if I've got an inflammatory condition, can CBD help me? Sure. But it's not going to hit me like a hammer. It's gonna take a little bit of time, but that's okay. As long as you understand that and accept that and say to yourself, well for this kind of trial and error and taking a little bit, a little bit of time, the best part about it is it is natural. And if I can figure out a way of the products I need and the dosing I need and the timing I need, this is something I can take for a long time. That is not going to give me negative consequences.
Kannaboom (40:28): We've talked many times on the show about the whole test and learn aspect to this. We all have different genetics. There are different products out there. If you're talking about THC, even set and setting can make a difference. Not everybody's going to have the same experience.
Dr. Bonni Goldstein (40:42): That's exactly right. And, and a big thing is sometimes people will ask, well, what do you use to treat Parkinson's for say, you know, for instance, well, who's Parkinson's? Are they at the beginning of Parkinson's? Are they in the middle of Parkinson's? At the end of Parkinson's? I mean, the body goes through, it's not just one disease, right? It's a, it, it's a disease that changes over time and, and may respond in the beginning to one regimen of cannabis. And in the middle, you might have to tweak it. And at the end and same thing with pediatric patients, I call them moving targets. These are, these children by definition are growing and changing and developing, especially their brain day to day. And what worked when they're four may not work when they're 12 and hitting puberty, they're in a completely different chemical environment. So, it can be a little bit difficult at the same time. Again, having it, if it's, if you're wanting it to work for you, you can usually figure out and get it to work for you. But again, you're going to have to do that little bit of, it's not just as easy as popping a pill. And I do think that, mur very modern society, we're all a little bit trained: "I would just pop a pill and you'll be better.' And that's just, it, we all are seeing what's happening to people who take pharmaceuticals. Long-term.
Kannaboom (42:03): Right. That whole approach of the magic bullet isn't that effective. And I like your metaphor of those of us who do go to the gym. You know, it's, it's a commitment, it's a process. And if you do follow through, you're going to feel better in the long run.
Dr. Bonni Goldstein (42:16): Yeah. You know, I'll share my, my mother's story a little bit more. So she started to struggle with severe degenerative disc disease in her neck which if you're not familiar with it, basically, you know, just as you get old, your vertebra in your spine start to have issues. And the little discs that are the pillow cushions between the vertebrae start to deteriorate, and you can get pinched nerves and pain. And she was really miserable. She wasn't sleeping. And she's stoic. She's a really tough cookie. She doesn't, she doesn't complain about, that's that generation, you know? And she didn't want to take pills cause she had taken pills for epilepsy and was really very happy to get off of them. And we did not want to go in a different back around to pills. So, and I, I tried to convince her to take cannabis here and there. And she was really reluctant again, that kind of reefer madness mentality from, from back in the day. And I finally convinced her, I said, 'Mom, I give it to kids to little kids. I, I promise you. You're not going to hallucinate. You're not going to have a weird experience. It'll be just fine. Let's try to get, let's just try to get you some relief.' And so I started her on a CBD tincture, you know, drops under the tongue, very low dose to begin high CBD to low THC. What we call a high-ratio CBD to THC product. And I said, 'It is not going to work today or tomorrow, or maybe not even in a week, but I just need you to kind of put your blinders on and I got you a bottle and you just gotta take it kind of until the bottle's empty and then we'll discuss whether or not.' And she took it in that first way. OK 'Go up, mom, go up, go up, go up on the dose.' And we just titrate it up. And you know, we have this saying, which I'm sure that many people have heard 'Start low and go slow,' especially in my Mom's case, who's elderly and just little by little, and I'll never forget that on a Sunday morning, I call to check on her, 'Hey Mom, how you doing?' And she said to me, and it was day 21 of taking CBD oil prior to this. She was like, 'I don't know if it's working maybe a little bit. I'm not sure.' She was very vague. And on that day, she said, 'Today is the first day in years that I have woken up without pain.' It was crystal clear to her. So if you're using cannabis, you have to give it a chance to work.
Dr. Bonni Goldstein (44:47): And if it's working, you're going to know because you know yourself, you know, when things are working, I mean, when we all wake up in the morning, we kind of all know, did I have a good night's sleep or a bad night's sleep? And I think the older you get, the more you look at that, right? Because sleep is so crucial to having a good day and feeling well. That was over five years ago for her. And here and there, she has to take an ibuprofen or something. But I mean, it's remarkable that it has continued to work really well. And I'll just share her dosing is somewhere between 75 and a 100 milligrams a day of CBD. She's added in some of the other cannabinoids CBDA, which is a very potent anti-inflammatory. She takes CBG which is cannabigerol, which helps her with her mood. And she's just thrilled with it. And this is a person who was, you know, I have to share with you growing up majorly anti-cannabis.
Kannaboom (45:44): Well, she's fortunate to have you.
Dr. Bonni Goldstein (45:47): Yes, I know. But...
Kannaboom (45:51): One of the best experts in the country dispensing to her. So in the book you also go into, I don't know if it's reading the label, but you know, looking at the Certificate of Analysis, because there is a lot of, it's a plant there's pesticides, there's solvents, there's residues that you need to look out for here in California. I think you go to the dispensary and it's going to be a tested product. If you go down the legacy market, it may not be, but people need to be aware of that. What other caveats or tips can you give people for shopping for products?
Dr. Bonni Goldstein (46:20): Right? So if you Google a product and they don't have a website, that's a little buyer beware right there, they should have a website that has information about their products, about their process and hopefully links or you know, QR codes or something, batch COS, Certificate of Analysis, as you mentioned. If a company says, 'Oh, it's, what we do is proprietary.' I would say that that's a little bit of a, of a you know, something that I would say, maybe not. So there's not that many different things that you can do with cannabis to, you know, there are people that might argue with me about nanotechnology or they're making it water-soluble. And what I say about that is 'Show me the science, show me the studies, show me the tests.' there's a few companies out there that say, 'Oh, you know, we have a product that's absorbed quicker.' Well, where's the study that shows that, you know, we can make any claims about unregulated CBD products. And again, that's kind of the quote hemp market, right? What sometimes people refer to as gas- station CBD, but there's a fair amount of products on that market that are actually quite good. How do you know that? Well, you look at the Certificate of Analysis and sometimes I tell people, try to buy different batches and compare and see if they look very similar, because if they're wildly different, is that really what you want with your medicine? Is one month it's one cannabinoid profile and it doesn't have pesticides, and then you get the next batch and it's completely different? You want consistency. If it's medicine, it should be consistent month to month. So, the companies that are longstanding that are transparent that have QR codes and the COS readily available, who share them readily with people. That's certainly something that I would look for. It can be difficult. One thing that I'm not a big fan of is like, when they say CBD water or CBD in your coffee, I mean the amount I, someone once showed me a bottle of CBD water and it had five milligrams of CBD in it. That's not really a dose. That's not really going to do much. It's certainly not going to harm you. But to me, that's more of a gimmick. I also saw CBD in nail polish. I don't really know why it would be there or in clothing. And I just thought, well, okay, I get hemp for clothing. Right. That's great. Sure. But I did not get why CBD would be in nail polish or clothing. So, you know, but again, when you're looking, take time to research the websites, if there's a phone number, call them, talk to somebody there. If they don't have a phone number and they're not willing to talk to you, to me, that's a little bit of a red flag,
Kannaboom (49:11): Knowing what we know now about the endocannabinoid system. Does it make sense to you to take a little CBD as a preventative, even before you have a condition?
Dr. Bonni Goldstein (49:22): I would say yes. And the reason I say that is because especially adults and with children, I don't know that I would recommend that, but with adults, we all have stress. I don't know anybody who's not stressed out. Seems like this year, particularly in, of course there's a lot going on this year. And remember that your endocannabinoid system is responding to that stress to sleep deprivation, to maybe you're not getting enough exercise to your diet being a little bit off. And again, it's been an unusual year, but I do think that taking some CBD and look all I'm not into CBD, that has no THC in it at all, unless you're being drug tested at your work, or, you know, if you're in the military or something like that, but a little tiny bit of THC has been shown to be... Can be very helpful and you're not going to feel it. That's what you have to remember. You're not going to feel that THC, especially if the compound is dominant, CBD, but remember by augmenting the endocannabinoid, it's kind of like you're giving your endocannabinoid system a little bit of a leg up to help you respond to these various stressors in your life, whether they be physical, mental, or both. And certainly there again, there is no downside to it in those people who are taking other medications that might interact. And right now there's lots of books out that talk about drug interactions that talk about it in my book, there's also websites where they have some information about drug interactions. You can and especially if you're taking on the lower end of dosing, like I said, you know, under 50 milligrams or so 25 milligrams or so it's not going to be a dose in which you're really going to harm yourself. You want to be sure if again, if you're on medications, but I do think that it, it, you may find over time, it's helpful. There are some human trials again from outside the United States where they looked at people taking some low-dose CBD for anxiety and people found it to work. Now, again, anxiety is not something you can really measure objectively, right? It's how you feel. So maybe just by taking something CBG, I feel better cause I'm taking it right. Maybe it's a placebo effect, but maybe it's not. And maybe you might be giving your endocannabinoid system that little bit of boost that helps that we know that yoga meditation a healthy diet exercise all helps boost your endocannabinoid system. So it's not just the cannabis plant that does it, there's other modalities. And we know that. And again, I always tell this to people. If you are chronically stressed and chronically sleep deprived, your endocannabinoid system is likely out of balance and you kind of get into this vicious cycle and it may behoove you to take cannabis in some form to help yourself break that cycle and, and get your endocannabinoid system up and up and running again, where it can benefit you.
Kannaboom (52:34): That's not widely known enough. You do a good job of explaining that CBD is not psychoactive. It's not intoxicating. There may be.
Dr. Bonni Goldstein (52:46): And your brain, it, anything psychoactive should look at is it that it actually has some activity in the brain. So it's that, it's a bit of a misnomer to say that THC is psychoactive and CBD isn't; CBD, stops seizures. CBD helps with anxiety. That's a drug that's psychoactive. It's just not intoxicating.
Kannaboom (53:06): Right? And that's an important distinction to me. Is there anything we should cover that we haven't?
Dr. Bonni Goldstein (53:11): Well, one of the things that sometimes people ask me is 'How do I start the conversation with my physician?' And I think one of the best things you can do is you can say to your doctor, cause look, you won't be the first one and you sure as heck, won't be the last one to say, 'Hey doc, how do you feel about medical cannabis or CBD?' Now there's still some doctors that are going to say to you. 'Oh, Absolutely not.' I still have patients coming in to me with their child, who's having 50 seizures a day on medication on the 10th, 12th, 15th medication saying 'Absolutely not.' And at that point I'm like, well, you know, this is someone who's highly, you know, again, willfully ignorant and has not looked at the research for this particular situation. But if you ask your doctor, just feel it out. And if they say, 'I don't think so, I think it's all garbage,' then, especially if you like the doctor and you feel that they are your partner in health in your health care, it might help for you to print something out on from either Google Scholar, which is a website where if you're not familiar with Google Scholar, kind of like Google images and Google shop, Google Scholar has articles, all the scientific articles. So you can go in and let's say you have chronic pain or Parkinson's you Google cannabis and Parkinson's or cannabis and chronic pain, something like that, or cannabinoids and, and print something out. And by the way, it also has dates. So you may not want to print something from 1970. You might want to look at the last five years, print it out, or email it to your doctor and say, 'Look, I found this and I'm just, I really want to know your opinion. You're my partner in health care.' And maybe you're the one that actually might change this doctor's mind. You may, you may be the one to, get this on your doctor's radar. And again, because many of us are not taught about in medical school and because we're already deep into our medical practice, it just doesn't really come up. But I'm finding that the medical community is actually eager for information. And certainly like I started out where my patients came in and those first, probably four months of working in a medical cannabis practice, I learned so much from my patients. There's no reason we can't do that, but I joke around and I've heard other people say this, doctors have big egos. So you don't want to kind of March in and say, you should know about this and how come you don't know about this because you're probably not going to get a very nice response back. But if you say, 'Hey, you're my partner in my health. And I really want your opinion on this. And I'm going to send you an article. Can you tell me what you think?' Hopefully the doctor will embrace this and start their education. So I do think it's, you know, and I also say, and not just to sell my book, but my book was written not just for the lay person. It was written as kind of an introductory primer for doctors to say, this is a fairly conservative pediatrician who trained well and worked in the real world for many years, who then, you know, came to work in the medical cannabis field and has embraced it. And here is giving me her report on it. She's telling me what she has found. And hopefully again, try, try, just trying to put it on the table as an option because when you've got a condition that's just not responding. Or even if you just don't want to take harsh pharmaceuticals, this should be something on the table. And there's really no excuse anymore for a doctor to at least not have some understanding of how it can be used beneficially.
Kannaboom (56:48): That's great advice. And I do think if someone brings your book under their arm and shows it to their doctor, 'Cannabis is Medicine' it's right there in the title, how medical cannabis, and CBD are healing.
Dr. Bonni Goldstein (56:59): Everything from anxiety to chronic pain.
Kannaboom (57:01): There you go, Dr. Bonnie Goldstein, thank you so much for sharing your expertise. I'm going to urge everyone to buy the book because it's very concise and to the point, and up-to-date, it's a great resource for anybody who cares about their health. Thank you for taking the time today.
Dr. Bonni Goldstein (57:14): Thank you so much.
Kannaboom (57:16): You've been listening to the Kannaboom Podcast with host Tom Stacey, if you like the show and want to know more, please check us out at Kannaboom with a k dot com and please leave us a review at Apple podcasts or wherever you listen, see you next week.
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