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Coverage and Commentary on the Top Cannabis Conferences<br />

Welcome to the first issue of Mary’s <strong>Prime</strong> <strong>Time</strong>!<br />

This is the first issue of Mary’s <strong>Prime</strong> <strong>Time</strong>, an occasional publication that will report on presentations from cannabis conferences around the<br />

globe. The goal is as simple as it is complex: to provide the public with the latest research on, and discussion of, cannabis as medicine.<br />

In the past decade there has been an explosion of interest in medical cannabis. A constant stream of ballot initiatives and state legislation in<br />

the U.S. has opened the door for patients to legally acquire this medicine that is still prohibited by the U.S. federal government. Around the<br />

globe there is even more change as entire countries legalize medical access.<br />

Concurrent with reform is an extraordinarily dynamic expansion of research with results being presented at dozens of conferences around the<br />

globe. At Mary’s Medicinals we realized that this valuable information was being shared with the few hundred individuals lucky enough to<br />

be in attendance but little was being done to disseminate it to the thousands who want to know more about the medicinal properties of this<br />

wondrous plant.<br />

We now know that cannabis has been a companion of mankind for tens of thousands of years. But it was not until the early 1990s that<br />

we learned just how cannabis provides the therapeutic action for so many different diseases when the ECS was<br />

discovered. The ECS—endocannabinoid system—creates cannabinoid like substances which help us maintain our<br />

homeostasis (physiological balance).<br />

This discovery ignited a new age of cannabis research. Scientists and pharmaceutical companies were quick to<br />

see the promise of a substance that targets the regulation of a major physiological system. While U.S. researchers<br />

continue to struggle under the shackles of an outmoded federal prohibition, researchers in Europe, Israel, and South<br />

America have been energetically exploring the wonders of cannabis. The results are promising and often remarkable.<br />

Without question, discovery of the ECS began this exciting new age of cannabis-focused scientific discoveries and<br />

research. Mary’s <strong>Prime</strong> <strong>Time</strong> will bring that science to those who need it most -- patients, healthcare providers and<br />

caregivers.<br />

Conference Facts<br />

Alice O’Leary Randall<br />

Editor-in-Chief, Mary’s <strong>Prime</strong> <strong>Time</strong><br />

Title: NUNM Medical Cannabis Conference<br />

Sponsor: National University of Natural Medicine (NUNM)<br />

Dates: July 29-30, 2017<br />

Venue: NUNM Campus, Portland, Oregon<br />

Attendees: 50 in person, about 60 online<br />

Presenters: Eleven total. This publication reports on six presenters.<br />

Meeting Background: This is the third year of the NUNM Medical Cannabis Conference. Recordings of the<br />

conferences (2017 and previous years) are available at the NUNM website. Link: nunm.edu/ceonline<br />

Miscellaneous:<br />

• Currently, 19 states, the District of Columbia, and the US territories of Puerto Rico and the US Virgin Islands all<br />

have laws regulating naturopathic doctors (NDs). In these states and provinces, naturopathic doctors are required<br />

to graduate from a four-year, residential naturopathic medical school and pass an extensive postdoctoral board<br />

examination (NPLEX) in order to receive a license or registration.<br />

• There are seven (7) accredited naturopathic programs in North America including two in Canada.<br />

• MD vs. ND: “ .. the main difference between MD, DO, and ND medical programs is not the content of the<br />

coursework, but rather the underlying philosophy which guides the physician to choose one treatment over<br />

another.” Link: http://bit.ly/2BdYz85<br />

1


What is Naturopathy?<br />

The concept of naturopathy – the use of natural substances to promote<br />

healing and well being – is probably as old as mankind but according<br />

to Wikipedia, the term “naturopathy” wasn’t coined until 1895 and<br />

was first used extensively by Benedict Lust, a German who brought the<br />

concept to the U.S. in the early 1900s. The practice became somewhat<br />

controversial in the mid-1900s as Western pharmaceuticals reached<br />

a zenith in terms of development and promotion, crowding out “the<br />

old ways.” By the end of the 20th century, however, consumers (i.e.,<br />

patients) were revisiting naturopathic medicine and the practice saw a<br />

resurgence of interest that continues today.<br />

There are seventeen states that recognize naturopathy and numerous<br />

schools that teach naturopathic physicians. This includes the<br />

National University of Naturopathic Medicine (NUMN) in Portland,<br />

Oregon. In late July, NUNM presented its third “Medical Cannabis<br />

Conference” sponsored by the continuing education department at<br />

NUNM.<br />

What follows are reports on six of the eleven presentations at the<br />

conference. All reports on the NUNM conference are written by<br />

Mary’s <strong>Prime</strong> <strong>Time</strong> editor-in-chief, Alice O’Leary Randall. Those<br />

interested in reviewing the proceedings can access the tapes via www.<br />

nunm.edu/ce.<br />

According to the American Association of Naturopathic Physicians:<br />

“Naturopathic medicine is a distinct primary health care<br />

profession, emphasizing prevention, treatment, and optimal<br />

health through the use of therapeutic methods and substances that<br />

encourage individuals’ inherent self-healing process. The practice<br />

of naturopathic medicine includes modern and traditional,<br />

scientific, and empirical methods.”<br />

The merging of naturopaths and medical cannabis seems, well, a<br />

natural fit. Cannabis is often described as an herb and naturopaths use<br />

many herbs in their regimens. But the decades of false information<br />

and the ongoing U.S. federal prohibition of cannabis had the same<br />

chilling effect on many naturopaths as it has on medical professionals.<br />

Some naturopaths have embraced cannabis, especially its component<br />

cannabidiol (CBD). But other naturopathic doctors (NDs) still<br />

shy away from the substance with worries of addiction and, more<br />

realistically, concerns that the therapeutic abilities of cannabis may be<br />

overblown and lead patients down the wrong pathway, especially in<br />

the treatment of major illnesses such as cancer.<br />

Mary’s <strong>Prime</strong> <strong>Time</strong><br />

Published peridiocally by<br />

Mary’s Medicinals<br />

Editor-in-Chief: Alice O’Leary Randall<br />

alice@marysmedicinals.com<br />

Special Assistant: Jesica Clark<br />

Design: Luminary Digital<br />

Published by Mary’s Medicinals, Denver, CO<br />

Copyright (c) 2017 - All rights reserved<br />

MarysMedicinals.com<br />

This publication is solely for educational purposes and is not<br />

intended to substitute for the medical advice of a treating physician.<br />

Medicine and cannabis research is an ever-changing science.<br />

Therefore, the editor, contributors and publisher do not accept<br />

responsibility in the event of negative consequences incurred as a<br />

result of the information presented in Mary’s <strong>Prime</strong> <strong>Time</strong>. We do not<br />

claim this information is necessarily accurate by rigid scientific and<br />

regulatory standards applied for medical treatment. No warranty,<br />

expressed or implied, is furnished with respect to the material<br />

contained in this publication. Readers are encouraged to consult<br />

with personal physicians with respect to treatment of any medical<br />

condition.<br />

Cannabis in the Therapeutic Order<br />

Presenter: Paul Bergner, ND<br />

Director, North American Institute of<br />

Medical Herbalism<br />

The goal in attending the NUNM Conference was to learn how (or<br />

if) naturopathic doctors are integrating medical cannabis into their<br />

practice. With eleven speakers on the agenda (six are featured in<br />

this issue of Mary’s <strong>Prime</strong> <strong>Time</strong>) it seemed a relatively wide range of<br />

viewpoints would be presented but the first speaker made this writer’s<br />

heart sink.<br />

Paul Bergner is director of the North American Institute of Medical<br />

Herbalism and editor of the Medical Herbalism Journal. A search of<br />

the web after the conference revealed that Dr. Bergner has frequently<br />

spoken on the adverse effects of cannabis and even though he issued<br />

an opening disclaimer that he was speaking neither “for nor against”<br />

medical cannabis his presentation had a distinct lean towards the<br />

latter.<br />

He began by explaining the Therapeutic Order, a concept that is not<br />

necessarily new but has been re-packaged for the modern era by Drs.<br />

Jared Zeff and Pamela Snider.<br />

The Therapeutic Order emphasizes the classical regimen of the<br />

ancients with focus on diet, exercise, rest, and emotions. Under<br />

this scenario, herbal treatments are rather high on the chart. As Dr.<br />

2


how Dr, Bergner treats cannabis dependent patients at his clinic. He<br />

stated it was important to understand heavy cannabis users, which<br />

he loosely described as using “multiple times a day,” as they become<br />

“dependent” on the drug. He also stated that he believes “medical<br />

cannabis users become heavy users.”<br />

Bergner noted, the ancient Chinese felt that “once you resort to<br />

needles and herbs you have already failed.”<br />

But, as Dr. Bergner acknowledged, most naturopathic practitioners are<br />

likely to use herbal remedies more readily than the Therapeutic Order<br />

would dictate. So the question in this writer’s mind was, “Why not<br />

cannabis?”<br />

According to Dr. Bergner the reason lies in the concentrated forms and<br />

high doses of cannabis that are needed. Besides, noted the herbalist, it<br />

is not curative for any condition.<br />

Micro-dosing cannabis apparently has not yet reached the proponents<br />

of Therapeutic Order nor did the effective treatment of symptoms get<br />

much respect from the opening speaker.<br />

Dr. Bergner’s “long term strategies” for medical cannabis use are as<br />

follows:<br />

• Cannabis used for harm reduction.<br />

• Cannabis used in place of, or to wean the patient off a more<br />

dangerous drug, or to reduce its dose.<br />

• Cannabis used to palliate while more substantial cure is put in<br />

place.<br />

My heart sank a little lower. While Bergner acknowledged that: 1)<br />

cannabis is far safer than most pharmaceutical medications, 2) may<br />

be good for those with terminal illness, 3) may help reduce the dose<br />

of opioids, and 4) has no lethal dose (“Let’s have a parade,” he rather<br />

cynically exclaimed), the speaker did nothing to elaborate on these<br />

possibilities. Instead the presentation took a strong right turn towards<br />

“Cannabis Adverse Effects” and for the next forty minutes we learned<br />

His final ten slides did deal directly with therapeutic cannabis use but<br />

even here the bias was obvious as he featured studies that, for the most<br />

part, used the synthetic dronabinol (Marinol), not cannabis.<br />

Dr. Bergner’s full presentation was two hours long and at the<br />

conclusion this writer made a notation, “Focus of talk really treatment<br />

of withdrawal.” While I had no idea what I would find at the<br />

naturopathic conference I expected more tolerance and curiosity.<br />

Only two hours into a two-day conference and I was feeling as if I had<br />

wasted my time and was about to hear the naturopathic version of<br />

“Just Say No.”<br />

Practical Uses of Cannabinoids in Clinical Practice<br />

Presenters: Chris D. Meletis, ND and Brian Martin, BSc, ND,<br />

EmerChanges Health and Happiness Clinic<br />

After such a dismal opening the next speaker, Chris Meletis, proved to<br />

be a bracing gust of fresh air. He immediately distanced himself from<br />

the first speaker saying, “Whereas Paul Bergner was speaking about<br />

the marijuana side of cannabis sativa I am speaking about the hemp<br />

side” and then proceeded to give a robust discussion of the cannabis<br />

component cannabidiol (CBD).<br />

He quickly ran through some informative slides providing information<br />

on the hemp industry and the “self-medicating” population of the<br />

U.S.A. His point was clear: Americans are self-medicating already with<br />

hemp and all manner of other medications. Should naturopaths be<br />

helping them do so effectively?<br />

Dr. Meleits did not come to coddle or hold hands. He expected a<br />

certain level of knowledge from the audience relative to CBD and the<br />

endogenous cannabinoid system (ECS) as well as a proper perception<br />

of the culture today which is, in Dr. Meletis’ view, suffering from a<br />

wide array of inflammatory diseases including depression which he<br />

feels is inflammation of the brain. CBD, he notes, is an excellent<br />

anti-inflammatory agent and there is “plenty of research” to back up<br />

this statement.<br />

Meletis feels that CBD is safe and should be used as a preventative.<br />

“Do you wait until a patient has it?” he asked the audience about an<br />

dementia patient, “Or do you start preventatively?” For Dr. Meletis<br />

the answer was obvious. He acknowledged that cannabinoid science<br />

3


is in its infancy but feels that it has a bright future.<br />

The former Dean of Naturopathic Medicine and Chief Medical<br />

Officer at the NUNM, Meletis feels that hemp derived CBD is a<br />

good option for starting patients on cannabinoid medicine because<br />

it lacks the psychoactive effect (the “high”) of regular cannabis. Can<br />

people get “high” on CBD? Meletis acknowledges that some patients<br />

claim to get high from CBD so he asks them to explain why they feel<br />

they are “high.” Meletis will tell them, “that’s not high, that’s alive.”<br />

The patients, he says, “didn’t know how broken they were” until after<br />

the CBD starts to work and their resulting sense of well-being is<br />

sometimes euphoric.<br />

Martin is clearly fascinated by CBD and stated “there is a huge<br />

amount of interplay” between the body and CBD. An area of<br />

particular interest for him is the role of CBD in controlling cortisol,<br />

a naturally produced steroid hormone. As the body faces stress it will<br />

produce increased amounts of cortisol which, in turn, can increase<br />

blood sugar, suppress the immune system as well as numerous other<br />

effects on the metabolism of humans. Using CBD to control cortisol<br />

results in a win-win situation for the patient.<br />

Meletis was keen on distinguishing between cannabis and hemp, or<br />

as his final slide noted “hemp is not marijuana.” This proved to be a<br />

common theme as the conference moved on through the weekend.<br />

The next speaker was Brian Martin, a naturopathic doctor from<br />

Canada. He continued the cannabidiol enthusiasm of Dr. Meletis<br />

but noted that CBD is not as readily available in Canada as it is in the<br />

U.S. This seemed a particularly odd statement given Canada’s liberal<br />

national stance with respect to medical cannabis.<br />

Unfortunately Martin was too rushed by time constraints to cover all<br />

of the topics that are contained in his slides. His presentation, and<br />

all the presenters, were taped by NUNM and those presentations are<br />

available online.<br />

Dr. Martin feels that CBD has a special place in the treatment<br />

of alcoholism. In a fascinating 2013 study published in Elsevier’s<br />

Pharmacology Biochemistry and Behavior (http://bit.ly/2AvoGvb) it<br />

was discovered that transdermal delivery of CBD lessened alcoholinduced<br />

neurodegeneration in rodents by almost 50%. It is obviously<br />

preliminary research but it demonstrates the potential value of CBD in<br />

medical treatment.<br />

Hand-in-hand with neurodegeneration in alcoholism is the damage<br />

that alcohol causes to the liver. Martin presented excerpts from a<br />

2016 article that appeared in Clinical Liver Disease: A Multimedia<br />

Review Journal entitled “Cannabinoids in liver diseases” (http://<br />

bit.ly/2i9AKKO) that contained some conflicting but nevertheless<br />

promising conclusions. And a study from 2017 demonstrated that<br />

CBD is almost as effective as interferon in treating hepatitis C.<br />

Dr. Martin concluded that “CBD is almost to good to be true.” He<br />

paused for a moment before adding, “if it was a drug I wouldn’t<br />

believe it.”<br />

The CBD Evidence Base & Understanding Terpenes<br />

Presenter: Kevin Spelman, PhD, CEO at Health Education and Research<br />

University of Exeter/University of North Carolina<br />

Kevin Spelman is a very entertaining speaker and that is probably why<br />

he was asked to give two presentations at the NUNM conference. On<br />

the first day Dr. Spelman spoke on “The CBD Evidence Base” and<br />

on the second he discussed “Cannabis Chemistry: Understanding<br />

Terpenes.” Not surprisingly there was some repetition but the purpose<br />

of these conferences is to educate and repetition is a remarkably<br />

effective educational tool. Additionally the two topics do blend nicely<br />

and so both talks will be covered in this report.<br />

Spelman unabashedly loves CBD but also feels that the current<br />

climate is a bit “over zealous” with respect to CBD in general because<br />

“people want to cash in.” He insists, however, that does not negate “the<br />

remarkable science” that is emerging with respect cannabis and CBD<br />

in particular.<br />

He began by dispelling some popular misinformation about CBD<br />

in particular the notion that CBD is non-psychotropic. CBD, says<br />

Spelman, is not “euphoric” but it is “psychotropic.”<br />

4


then re-infused, although there is some controversy about this process<br />

and whether it destroys the desired chemical activity. Terpenes give<br />

cannabis its distinctive odor. They do the same for pine trees, oranges,<br />

lemons and on and on. But the emerging science is showing that<br />

terpenes may influence the properties of cannabis in far more ways<br />

than the aroma. Those who embrace the concept of the entourage<br />

effect nod knowingly at this thought and say, “of course.”<br />

The terpene talk was highly technical and made the audience<br />

keenly aware of the complexities in the emerging field of medical<br />

cannabinoids. Dr. Spelman noted that research is showing terpenes<br />

and cannabinoids can effect even the tiniest of metabolic factors, SNPs<br />

(pronounced “Snips” — Single Nucleotide Polymorphisms) which are<br />

found in your DNA. One questioner at the end of the session pleaded<br />

with Dr. Spelman, “I need you to write a book!,” she said to laughter,<br />

“Because I can know some of these things but this is a lot! This is a<br />

whole specialization and I’m looking at general patients.”<br />

He also addressed the notion that CBD, when ingested, becomes<br />

THC due to the interaction with stomach acid. While it may be<br />

possible to do this in a test tube, Spelman says, in vivo the idea just<br />

makes “no sense” and cited an article by Grotenhemen and Russo that<br />

“lays to rest” this notion of molecular changes (see page 8).<br />

Dr. Spelman did provide an excellent overview of using CBD in about<br />

a half dozen conditions including inflammation, traumatic brain<br />

injury (TBI), epilepsy, memory, and chronic pain, noting that nearly<br />

all these conditions involve some form of inflammation and hence the<br />

value of CBD. The current problem, one noted by several speakers<br />

and questions from the audience, is dosing Spelman encouraged<br />

using CBD in “nudges.” “It’s all about dose,” he said and noted that<br />

effective doses can be as low as 0.01mg to 20 mg.<br />

Terpenes<br />

Spelman’s second presentation at the conference focused on terpenes<br />

which have taken on a nearly mystical fascination in recent years.<br />

Terpenes are any of a large group of volatile unsaturated hydrocarbons<br />

found in the essential oils of plants, especially conifers, citrus trees<br />

and cannabis.<br />

Cannabis has many different terpenes and the science is so<br />

sophisticated at this point that plants can be bred to possess certain<br />

terpenes. They can be removed from plants prior to processing and<br />

Spelman’s light hearted demeanor became very serious. And rightly<br />

so. This is a question that burdens naturopaths, physicians and nurses<br />

throughout the world. Spelman noted that cannabis is, after all, only<br />

a plant and that naturopaths already use other plants on which there<br />

there is far less data adding that at present “we are over-focused on<br />

cannabis.” He counseled the audience member to begin learning the<br />

cannabis plant just as she has learned about others and recognize that<br />

this is simply a part of being a naturopath--it is a lifetime of learning<br />

about plants. Spelman took one the mantras of cannabis opponents —<br />

“cannabis is a gateway drug” — and put a new twist on it. “Cannabis,”<br />

he said, “is a gateway plant for physicians to start taking medicinal<br />

plants seriously.” Cannabis, Spelman believes, has made medical<br />

doctors sit up and take notice of medicinal plants and, in Spelman’s<br />

estimation, this is a tremendous opportunity for naturopathy and<br />

Western medicine to come closer together.<br />

Cannabinoids for Inflammation and the Immune System<br />

Presenter: Sunil Pai, MD, House of Sanjevani Integrative Medicine Clinic<br />

Unlike the other presenters, Sunil Pai is an M.D., not an N.D. but his philosophy of treatment seems<br />

very in tune with the naturopaths. He is the author of An Inflammation Nation which examines the<br />

prevention and treatment of disease through diet, lifestyle and the use of natural anti-inflammatories.<br />

For Dr. Pai, cannabis, and in particular CBD, is a tailor-made agent for treatment of many inflammatory<br />

disorders.<br />

The operative statement is “tailor-made.” Numerous speakers at the NUNM Conference addressed<br />

the idea of tailoring cannabis to the patient but Dr. Pai is practicing what he preaches at his clinic<br />

in New Mexico. Not surprisingly given the title of his book, he also emphasized the need to treat<br />

inflammation which in medical parlance is an “-itis” as in arthritis, gastritis, rhinitis, etc. There are<br />

over 200 different forms of “itis” in medical books and conventional Western philosophy is to treat the<br />

symptoms as opposed to the cause. Dr. Pai feels that careful treatment of the ECS is one way to actually<br />

resolve inflammation problems and believes “ECS regulation is strongly influenced by the individual’s<br />

microbiome.”<br />

5


He emphasizes the need to treat “the moment” as well as the fact that it is “not as simple as on/off” when it comes to CB1 and CB2 receptors.<br />

Indeed, several speakers at the conference emphasized this latter point: that treating disease via the ECS system is not simply a matter of<br />

prescribing CBD and seeing the patient six months later. One of Dr. Pai’s slides put it well although not succinctly:<br />

This system is not a simple on/off receptor effect. [It is a] complex response mechanism … between the endogenous and exogenous [molecules],<br />

in cross-reactions with non-cannabinoid receptors, and in the plasticity of response, which is dependent on local tissue characteristics (state<br />

of health) or the presence of other molecules.<br />

“The most important thing of my lecture,” Dr. Pai said, “is that CB2 receptors act differently based on the state of pathology.” In fact, according<br />

to Dr. Pai, CB2 receptors are more active in diseased organs. Thus, again, the need for tailoring the treatment on a regular basis when treating<br />

the diseased state as well as microdosing. Too many clinicians err in thinking that a patient who responds well initially to CBD just needs more<br />

CBD. In fact, the opposite may be true because a constant dose of CBD may dull the receptors by interfering with upregulating. Once again,<br />

tailoring the treatment for the patient.<br />

Dr. Pai’s presentation is highly recommended and available for viewing at: https://cemoodle.nunm.edu/course/category.php?id=221<br />

Cannabis in Cancer Care<br />

Presenter: Neil McKinney, BSc, ND<br />

Vital Victoria Naturopathic Clinic<br />

Neil McKinney is a practicing naturopath from Canada who<br />

specializes in treating cancer patients. He has been a clinician for<br />

nearly forty years and his presentation was a delightful mix of<br />

pertinent information along with some homespun common sense.<br />

His comments in the first two minutes of the presentation set the<br />

stage for what was to come when he expressed his fascination with the<br />

ECS and declared how delighted he was to have natural cannabinoid<br />

products available for his patients because “it is part of our biological<br />

heritage, it’s part of our legal right to have this plant.”<br />

He quickly ran through the main cannabinoids — THC, CBD, CBC,<br />

CBN and CBG — making it clear that he is a great fan of aggressive<br />

research into the many cannabinoids but rather confidently predicted<br />

that CBG (cannabigerol) will “be the next big bomb.” He has used<br />

CBG together with CBD and THC to treat cancers with some success.<br />

One of the most informative sections of his talk had to do with<br />

concerns about using cannabis to treat children and he listed the<br />

reasons why.<br />

Dr. McKinney provided a comprehensive look at his philosophy<br />

relative to treating cancer patients with cannabis. He basically<br />

addressed two separate areas. First, he dispelled the concerns relative<br />

to using a natural medicine like cannabis with today’s sophisticated<br />

oncology medications. Acknowledging the number of clinicians in the<br />

audience he stated categorically,<br />

“There are very, very few interactions between natural medicines<br />

and oncology drugs. Period. End of story. Forty years of<br />

experience in the field and I tell you you really don’t have to<br />

sweat it that much.”<br />

Secondly, he addressed the use of cannabis, in particular pure THC<br />

oil, for treatment of cancer, cautioning the clinicians that the high<br />

doses required to make the THC effective can really create adverse<br />

effects in patients. He advocates administering citicoline or CBD<br />

prior to dosing with THC oil saying it will help mitigate the effects<br />

of THC. (Note: some practitioners feel citicoline can be harmful for<br />

cancer patients, especially those with brain tumors.)<br />

Dr. McKinney provided several case studies from his practice as well<br />

as those found in the literature. Space will not allow recounting these<br />

several cases. For those seeking specific information on this topic the<br />

complete talk with powerpoint slides is available at:<br />

http://www.nunm.edu/ceonline<br />

6


Cannabinoids and Opiates: Crosstalk and Connections with Regard to<br />

Reward, Addiction, Dependence and Recovery<br />

Presenter: Kevin Wilson, ND, DAAPM<br />

Kevin Wilson, ND had the unenviable position of final speaker at a<br />

two-day conference. The good doctor never acknowledged it but it<br />

seemed to this writer that he was exhibiting some of the same feelings<br />

as those in the audience. He seemed weary and a bit dazed by the<br />

wealth of information that had come before him. At one point he said<br />

that what he had learned that week-end was a little “overwhelming.”<br />

The room seemed to issue a collective thought of, “Amen!”<br />

Nevertheless Dr. Wilson had come to present on Cannabinoids and<br />

Opioids so he pressed on with his slides in an almost apologetic<br />

fashion. Claiming to be “pro cannabis” he noted that he was beginning<br />

to have “reservations because [cannabis] does lead to dependency”<br />

and later noting that perhaps “we need to put it back in perspective<br />

after this sort of post prohibition time.” Dr. Wilson spoke with the<br />

air of someone wanting to stop the hands of time. It was a peculiar<br />

presentation in that regard.<br />

As the talk proceeded it seemed apparent that what puzzled Dr.<br />

Wilson was what Dr. Pai had addressed in his talk: the complexity of<br />

the cannabis plant and the realization that cannabinoid receptors are<br />

far more complex than “on or off.” For Dr. Wilson, like Dr. Bergner<br />

on the first day, there was almost and annoyance that cannabis was<br />

proving so difficult to fathom.<br />

Award-Winning Transdermal Patch Patch<br />

He noted that in states that have legalized cannabis for medical<br />

purposes there is a drop in prescription pain medications and tipped<br />

his hat to the work of Ashley and W. David Bradford which has shown<br />

significant economic savings in those states.<br />

Dr. Wilson’s confusion is fueled, in part, by his compassion. He<br />

wants to help opioid addicts and those in pain. He views cannabis<br />

as a possible tool in that quest. His admitted a fascination with<br />

neural plasticity (“the love of my [academic] life”) and the vast<br />

complexity of the human brain. As a practitioner he seems frustrated,<br />

almost conflicted, with the unexpected complexity of cannabis,<br />

particularly with respect to dosing. This is a common problem, not<br />

just for naturopaths but also MDs who are recommending cannabis.<br />

Naturopaths, however, seem almost guilty about this internal conflict,<br />

perhaps because cannabis is a natural product.<br />

As Dr. Wilson made his way through his presentation he provided<br />

leads to some excellent research articles. Several of them are listed on<br />

page 8. He made his case for cannabis addiction (which should have<br />

been called THC addiction) by citing several studies (all animal based)<br />

and concluded that approximately 7% of cannabis users are estimated<br />

to become addicted. But then he added, “I’m beginning to realize that<br />

people can be addicted to all kinds of things.”<br />

The final third of his presentation gave attendees some ideas relative<br />

to treating withdrawal with a variety of available pharmaceuticals<br />

including clonidine, Immodium and even ketamine.<br />

It is ironic that the naturopathic conference on medical cannabis<br />

would begin and end with presentations so heavily weighted in the<br />

issue of alcohol and opioid addiction and treatment. Perhaps this<br />

investiture in the recovery community has made it particularly difficult<br />

for NDs to embrace medical cannabis. Certainly this conference<br />

revealed hints of that.<br />

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Bibliographies<br />

The following references are from the presentations of several speakers at the National University of<br />

Naturopathic Medicine (NUNM) Medical Cannabis Conference. The citations are, for the most part,<br />

available online, particularly using Google Scholar.<br />

Dr. Kevin Spelman: CBD and Terpenes<br />

Cannabidiol Enhances the Inhibitory Effects of delta-9-Tetrahydrocannabinol<br />

Cannabidiol on Human Glioblastoma Enhances the Cell Inhibitory Proliferation Effects and of delta-9-Tetrahydrocannabinol<br />

Survival, Marcu, et al.,<br />

on Human Glioblastoma Cell Proliferation and Survival, Marcu, et al.,<br />

Even High Doses of Oral Cannabidol Do Not Cause THC-Like Effects in<br />

Molecular Cancer Therapy. 2010; 180-189. https://www.ncbi.nlm.nih.gov/<br />

Molecular Cancer Therapy. 2010; 180-189. https://www.ncbi.nlm.nih.gov/<br />

Humans: Comment on Merrick et al. F. Grotenhermen Franjo, Russo Ethan,<br />

pubmed/20053780<br />

pubmed/20053780<br />

and Zuardi Antonio Waldo. Cannabis and Cannabinoid Research. January 2017,<br />

2(1): 1-4. https://doi.org/10.1089/can.2016.0036<br />

The Path Ahead - What Should We Tell Our Patients about Marijuana<br />

The (Cannabis Path Ahead indica - and What Cannabis Should We sativa)? Tell Our Pizzorno, Patients Integrative about Marijuana Medicine. 2016;<br />

(Cannabis indica and Cannabis sativa)? Pizzorno, Integrative Medicine. 2016;<br />

Cannabidiol in Inflammatory Bowel Diseases: A Brief Overview. G. Esposito,<br />

15 (6): 8-12. https://www.ncbi.nlm.nih.gov/pubmed/28223891<br />

15 (6): 8-12. https://www.ncbi.nlm.nih.gov/pubmed/28223891<br />

et. al. Phytotherapy Research, May 2013, 27(5): 633-636. https://www.ncbi.<br />

nlm.nih.gov/pubmed/22815234<br />

Cannabis Extract Treatment for Terminal Acute Lymphoblastic Leukemia with<br />

Cannabis a Philadelphia Extract Chromosome Treatment for Mutation, Terminal Singh Acute & Lymphoblastic Bali, Case Reports Leukemia in Oncology with<br />

a Philadelphia Chromosome Mutation, Singh & Bali, Case Reports in Oncology<br />

Neuroprotective Antioxidants from Marijuana. A.J. Hampson, et. al., Annals<br />

2013; 6: 585-592. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901602/<br />

2013; 6: 585-592. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901602/<br />

of the New York Academy of Sciences, January 2000, Vol 899. https://www.ncbi.<br />

nlm.nih.gov/pubmed/10863546<br />

Dr. Kevin Wilson: Cannabis and<br />

Dr. Kevin Wilson: Cannabis and<br />

Perceived efficacy of cannabidiol-enriched cannabis extracts for treatment of Opioid Withdrawal<br />

pediatric epilepsy: A potential role for infantile spasms and Lennox–Gastaut<br />

Opioid Withdrawal<br />

syndrome. S.A. Hussain, et.al., Epilepsy & Behavior, June 2015. Vol 47, pos. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use<br />

138-141. https://www.ncbi.nlm.nih.gov/pubmed/25935511<br />

Medical in a Retrospective Cannabis Cross-Sectional Use Is Associated Survey With of Decreased Patients With Opiate Chronic Medication Pain. Use K. F.<br />

in Boehnke, a Retrospective E. Litinas, Cross-Sectional and D.J. Clauw, Survey The of Journal Patients of Pain, With Volume Chronic 17, Pain. <strong>Issue</strong> K. 6, F.<br />

Handbook of Cannabis Therapeutics: From Bench to Bedside, E. Russo and F.<br />

Boehnke, June 2016, E. pages Litinas, 739-744. and D.J. https://www.ncbi.nlm.nih.gov/pubmed/27001005<br />

Clauw, The Journal of Pain, Volume 17, <strong>Issue</strong> 6,<br />

Grotenhermen, Routledge, 2006.<br />

June 2016, pages 739-744. https://www.ncbi.nlm.nih.gov/pubmed/27001005<br />

Substitution of medical cannabis for pharmaceutical agents for pain,<br />

Substitution anxiety, and sleep. of medical B.J. Piper, cannabis R.M. for DeKeuster, pharmaceutical M.L. agents Beals, for et.al. pain, Journal of<br />

anxiety, and sleep. B.J. Piper, R.M. DeKeuster, M.L. Beals, et.al. Journal of<br />

Dr. Neil McKinney: Cannabis In Cancer Care Psychopharmacology, Volume 31, <strong>Issue</strong> 5, April 4, 2017. http://bit.ly/2n3BPWb<br />

Psychopharmacology, Volume 31, <strong>Issue</strong> 5, April 4, 2017. http://bit.ly/2n3BPWb<br />

Integrating cannabis into clinical cancer care, Curr. Oncology. Abrams, D., Cannabis and intractable chronic pain: an explorative retrospective analysis of<br />

Cannabis and intractable chronic pain: an explorative retrospective analysis of<br />

2016 ; 23 (2): S8-S14. https://www.ncbi.nlm.nih.gov/pubmed/27022315 Italian cohort of 614 patients. G. Fanelli, et. al., Journal of Pain Research, 2017;<br />

Italian 10: pages cohort 1217-1224. of 614 patients. https://www.ncbi.nlm.nih.gov/pubmed/28579820<br />

G. Fanelli, et. al., Journal of Pain Research, 2017;<br />

10: pages 1217-1224. https://www.ncbi.nlm.nih.gov/pubmed/28579820<br />

Cannabis Use and Risk of Lung Cancer: A Case Control Study, European<br />

Respir. J., Aldington, Harwood, Cox, et al., 2008; 31 (2): 280-286. https:// Opioid withdrawal suppression efficacy of oral dronabinol in opioid<br />

Opioid withdrawal suppression efficacy of oral dronabinol in opioid<br />

www.ncbi.nlm.nih.gov/pubmed/18238947<br />

dependent humans. M.R. Lofwall et. al., Drug and Alcohol Dependence,<br />

dependent Volume 164, humans. July 2016, M.R. pages Lofwall 143-150. et. al., https://www.ncbi.nlm.nih.gov/<br />

Drug and Alcohol Dependence,<br />

Volume 164, July 2016, pages 143-150. https://www.ncbi.nlm.nih.gov/<br />

Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in pubmed/27234658<br />

pubmed/27234658<br />

cancer patients: results of a randomized, double-blind, placebo-controlled pilot<br />

trial, Annals of Oncology, Brisbois, de Kock, Watanabe, et al., 2011; 22 (9): Cannabinoid and opioid interactions: Implications for opiate dependence and<br />

Cannabinoid and opioid interactions: Implications for opiate dependence and<br />

2086-2093. https://www.ncbi.nlm.nih.gov/pubmed/21343383.<br />

withdrawal, J.L. Scavone, R.C. Sterling, E.J. Van Bockstaele. Neuroscience,<br />

withdrawal, Volume 248, J.L. September Scavone, 2013, R.C. Sterling, pages 637-65. E.J. Van https://www.ncbi.nlm.nih.gov/<br />

Bockstaele. Neuroscience,<br />

Volume 248, September 2013, pages 637-65. https://www.ncbi.nlm.nih.gov/<br />

Cannabinoids: A new hope for breast cancer therapy?, Cancer Treatment. pubmed/23624062<br />

pubmed/23624062<br />

Caffarel, Andradas, Pérez-Gómez, et al.,Rev. 2012; 38 (7): 911–918. https://<br />

www.ncbi.nlm.nih.gov/pubmed/22776349<br />

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Cannabinoids induce apoptosis of pancreatic tumor cells via endoplasmic<br />

reticulum stress-related genes. Carracedo, Gironella, Lorente, et al.<br />

Cancer Research. 2006; 66: 6748–55. https://www.ncbi.nlm.nih.gov/<br />

pubmed/16818650.<br />

Medical marijuana: the conflict between scientific evidence and political<br />

ideology. Part two of two. Cohen, P.J. J Pain Palliat Care Pharmacotherapy.<br />

2009;23:120-140. https://www.ncbi.nlm.nih.gov/pubmed/19296351<br />

Comparison of the analgesic effects of dronabinol and smoked marijuana in<br />

daily marijuana smokers. Cooper, Comer & Haney. Neuropsychopharmacology.<br />

2013 Apr 22. https://www.ncbi.nlm.nih.gov/pubmed/23609132<br />

Marijuana Smoking in Patients With Leukemia, Khwaja; Yacoub, Cheema,<br />

et al., Cancer Control 2016; 23 (3):278-283. https://www.ncbi.nlm.nih.gov/<br />

pubmed/27556668<br />

Adverse Structural and Functional Effects of Marijuana on the Brain: Evidence<br />

Reviewed. Mandelbaum & de la Monte, Pediatric Neurology. 2017; 66: 12-20.<br />

https://www.ncbi.nlm.nih.gov/pubmed/27789118<br />

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8

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