CBD Madness | AMA 04

– Okay bros, here’s the thing. We all have that one guy on Facebook, who sends you the links like,.

– Okay bros, here’s the thing. We all have that one guy on Facebook, who sends you the links like, CBD man, it cures everything, man. My gout, my anxiety, the fact that I don’t like my
mom ’cause she’s mean. And how do you respond to that, especially as a medical practitioner when this drug, marijuana,
that has been illegal and stigmatized for so many years, now there’s a sea change
in perception about it. And with that sea change,
everyone is saying it’s natural and it cures everything. And now so how do you cut through the haze of the madness online? This video’s gonna try to do that. Okay, this is the thing. CBD, THC, what is that? CBD is cannabinoid oil, or cannabidiol. Cannabidiol is one of the
components of marijuana. It’s a plant, it’s very complicated, there’s a lot of stuff in
it, a lot of cannabinoids. And CBD in particular,
isn’t really psychoactive. It doesn’t cause the stoned effect. In fact, in the real
plant, when smoked with the THC component, it may actually soften some of those, you know, high effects. Now, THC, tetrahydrocannabinol (mumbles), THC, let’s leave it at that, is the part that’s psychoactive that gets you high that’s associated with the effects of recreational marijuana use. Now, what people have been arguing now is this CBD component has
a lot of medical effects. So, could it stop seizures,
could it be anti-inflammatory, could it eliminate anxiety,
could it cure cancer, you see all these things
floating around the internet. Particularly in the naturopath circles and the bro, High Times circles. All right, now I’m sympathetic
actually to marijuana, having been somebody who did inhale, who went to Berkeley and UCSF. However, if you don’t look at the science, then you’re missing the point here. Because even though it’s natural, you still have to study it. And we haven’t been able to study it because it’s been Schedule I, which the government
says is no medical use. We know that’s now untrue. All right, for CBD, there’s
evidence that it does prevent about 20% of seizures in a particular type of rare childhood seizure disorder. So it’s a very narrow indication. And actually, there was recently a pharmacologic agent
made by a pharma company that was approved that’s cannabis-based. Okay, so for that narrow
group of seizures, there’s some evidence that CBD helps. What about social
anxiety, things like that? Only small case studies, animal studies. What about anti-inflammatory effects? Animal studies, small case studies. And again, these studies are terrible, they’re biased, and so we need better data until we can say anything about
CBD oil, or CBD derivatives. What about, you know,
cancer and all of that, in terms of curing cancer? That is anecdote, it is correlation, there’s no evidence of causation. And anyone who sends you that stuff, you better be suspicious
to the 12th degree because they be smoking that chronic. So CBD in particular has problems. Even though it’s natural, like much of the supplement industry
and the supplement industrial complex, it’s
entirely unregulated. So, they’ve looked at CBD preparations, they can contain wild swings in the amount of actual active substance. Which means if you’re
treating it as a drug, you have no idea how much
of the drug you’re taking, or how much dosing you’re taking. That’s important, because it turns out CBD actually interferes with
the metabolism of other drugs. So seizure drugs can be affected, their metabolism, by CBD. So since it interacts, you really need to know what the dose is and how to adjust the doses of
your other medications. It’s not a magical, natural,
easy to use cure-all. The third thing is, these CBD components, one in five of them that were
tested contain actual THC, which is the active component
that makes you stoned. Now, if you’re giving it to your kid who has a seizure disorder,
and you’re thinking, well, they’re not gonna get high, well, you better get
the right preparation. So that’s another problem. And the last piece is it
can cause liver injuries. So in the trials, up to 10% of patients actually had elevated liver enzymes. And two to 3% of those, of the patients, had to stop the drug
because their liver tests were so abnormal that the
doctors were uncomfortable. So this is not a drug
without side effects. Now what about the rest of marijuana, what does the data say overall
about medical marijuana? Well, my friends up in Canada,
James McCormick and others, author on a recent paper
recommending guidelines for how to use medical marijuana. They reviewed all the literature, and we can trust them, because
Canadians get hella high. And they just legalized it. What they looked at
with all the literature was that there are three conditions for which the evidence shows marijuana is better than placebo. And everything else, the
evidence isn’t good enough. These are the three conditions. Number one is chronic pain,
due to neuropathic pain, so it’s a particular type of
pain, or end-stage cancer pain. In which case, using
marijuana in addition, as an adjunct to other medications, can have some benefit over placebo. They don’t recommend it
as the first therapy. First you try the other
medications to alleviate pain and anxiety, and then
you can use marijuana. And they actually recommend
the medical derivative, the actual pharmacologic version, not the smoked version
because of dosing issues. The second condition is spasticity due to multiple sclerosis,
due to spinal cord injury. So there’s evidence that it can help, medical marijuana, as a third-line agent. So you’re using things like
Lyrica and amitriptyline and other anti-spasmodic drugs, and if those fail, you can
add the marijuana component. The third indication where
it actually works better than placebo, and this is
actually the strongest indication, is post-chemotherapy nausea and vomiting. So people who have had chemotherapy, medical marijuana can
benefit above placebo, up to a 30% effect, which is really good. Now, what are the side effects? They are innumerable,
namely getting stoned. So, a lot of people don’t like that. A small number of people
can have acute psychosis, a small number of people
get disassociation symptoms, there’s paranoia, sedation,
dizziness, low blood pressure, enough that people stop using the drug, particularly older patients. So it is not a magical side effectless, you know, natural thing that way. It’s a drug, and we have to study it. So my calls to action are this. Share this with your CBD bro
who thinks that, you know, just because it’s natural,
weed’s gonna cure everything, and send it with a reggae clip, just to take some of the edge off. The second call to action is we need to study this drug more. Which means take it off of Schedule I in the United States, it’s crazy. And study the hell out of it. So we can get good evidence,
and derive the components of cannabis that actually help people for specific conditions,
and tailor it to that. The third call to action is,
if cigarettes and alcohol have been legal for decades,
and they cause untold social and medical devastation, why the hell isn’t
marijuana legal everywhere? So my call to action to everybody is share this, and legalize it. (smoke hisses) ♪ Hits from the bong ♪ (hums) – I came to get high. Share this, we out. (smoke hisses) I’m dying over here. (coughs) Oh God, why? (coughs)

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