In Part 1, “Who Needs a Professional Association for Cannabis Clinicians?”, I wrote about the importance of creating Association of Cannabinoid Specialists (ACS) when I realized there was a big gap in patient care information for clinicians.  I talked about my own background as Harvard faculty, my epiphany that patients were not presenting to my emergency room for cannabis use, and my own research journey which led to understanding the benefits of cannabis as a medicine as well as founding my own cannabinoid medicine practice, inhaleMD. 

ACS is a membership organization.  Our volunteers bring their cannabis expertise to ACS leadership and to the creation of our educational content.  Our main goal is to educate clinicians and cannabis policymakers to improve the patient outcomes, and encourage mainstream clinicians to consider cannabinoid medicine for their patients’ benefit.  

Details about the “big ideas” we’d like you to consider, especially related to a national medical cannabis system, can be found in our white paper here. We’d love your support and participation in moving these ideas forward.  

Key elements include: 

• Prescriptions – clinicians must have the ability and must be required to write a true, binding prescription for cannabis products, like all other medications.  This is important to effectively communicate to the seller what product the patient needs, assure that the patient gets that medication and none other, and prevent the up-selling that is currently the norm.  It also requires that the clinician be knowledgeable about cannabis medicines and take responsibility for the treatment.  
   
• Medical Claims – dispensaries and product manufacturers must be prohibited from making claims about what their products can, or may, do unless they have achieved FDA approval.  This will cut down on the misinformation being used to sell products which is misleading to patients.  This moratorium must be applied to recreational stores and products as well as those that are medical. 
  

• Travel – patients travel and should be able to take all of their medications, including cannabis, with them when they go.  Further, like any other medication, patients should be able to get a refill of their cannabis medicine while they are traveling. 
    
• Safety and Dosing Standards – presently state regulations governing the testing and dosing of cannabis products vary from state to state, and even between medical and recreational programs (oddly recreational standards are often more stringent.)  Safety testing and dosing standards should be consistent and based on evidence.   
   
• Research – while there is now a lot of human data on which we can reasonably base medical treatment with cannabis, there remains much to be learned.  We need a national research agenda that fairly prioritizes both risk reduction and medical treatment and has a robust budget to advance the field.   

I encourage you to learn more about Association of Cannabinoid Specialists, review the educational material we have developed, and join our effort to bring awareness to more clinicians about cannabis as an option to help their patients.  The more professionals we can expose to science-based education the better off our patients will be.

Welcome to ACS' member spotlight, where we shine the light on one of our members as they share their story and what led them to become a member of ACS. 

This month, we shine the spotlight on Frederick A. Slezak, MD, MBA, FACS, FASCRS, FACG.

Q: Tell us a little bit about yourself.

A: Currently I live in Akron, Ohio where I attended the University of Akron and later The Ohio State University College of Medicine from 1975 - 1978 right when all drug policy changes were being made including the DEA and the CSA.  Aside from living in Columbus, Ohio for three years, I spent a year in Champaign/Urbana, Illinois at the Carle Foundation Hospital for my fellowship.  My interaction with cannabis was non-existent throughout all of this time!

Q: Do you have a medical specialty?

A: I am board certified in General and Colon and Rectal Surgery with the latter being my main focus of practice until 2019 when I retired from surgery. 

Q: What got you interested in cannabis as medicine?

A: The Ohio cannabis program (which is unfortunately called the Ohio Medical Marijuana Control Program) was signed into law in 2016 by the governor (having failed a vote initiative a couple of years earlier.)  When I first heard about the program in 2016, I also started receiving questions from patients about the use of cannabis for their symptoms.  My practice included patients with Crohn's Disease, Ulcerative Colitis and cancer, many of whom had chronic pain related to their treatment and not their disease. 

Over the years I had several patients using cannabis (self-treatment) and like many physicians I ignored what they were telling me.  Just before the Ohio program became "legal" I had a patient with Ulcerative Colitis who I thought warranted surgery.  He had been hospitalized for bleeding and was not responding well to medication.  He also was resistant to treatment with the newer biologics.  Instead, he went to Michigan where cannabis was available a year before Ohio.  He was using edibles for his symptoms and improved.  A repeat endoscopy showed marked improvement of his colon and, to date, he has not required surgery.  (Yes, for the skeptics, he is an "n" of one. But he got my attention.) 

Following the implementation of the Ohio program, I obtained my CTR which is the permission to recommend cannabis for purchase at any of the authorized dispensaries in Ohio that first opened in January 2019.  During the last 6 months of my regular practice I tried to convince the hospital to set up a cannabis clinic.  (That went over well!).  I left practice in June of 2019 and continued to learn about cannabis and participate in the recommendation process in Ohio.

Q: Do you have any research interests or any articles or studies to share?

A: Though I have research ideas, I am not in a position to conduct cannabis research unless observational studies.   

I have shared my mnemonic TRICHOME for guiding a clinician to ask more questions when reviewing a medication history.

(Members can download the PDF version here.  If you’re not a member, sign up here.)

Q: What does ACS mean to you?

A: I took the 20-hour course which I found helpful and passed the exam.  The course is more extensive than some offered by others, and I do not think that is a bad thing.  There is quite an overlap of presenters and courses, so content and presentation quality are important to me.   

In particular, I enjoy the monthly sessions and find the membership accessible.  Presently, there are quite a few options available for cannabis organization for clinicians.  I think that the networking and educational aspects are important. 

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Frederick A. Slezak, MD, MBA, FACS, FASCRS, FACG graduated from The University of Akron (Ohio) in 1975 and attended medical school at The Ohio State University College of Medicine receiving his degree in 1978. He completed his residency in General Surgery at Akron City Hospital and a fellowship in Colon & Rectal Surgery at the Carle Foundation Hospital in Urbana, Illinois in 1984. Dr. Slezak is certified by both the American Board of Surgery and the American Board of Colon & Rectal Surgery. From 1984 until June 2019, he practiced in the field of colon and rectal surgery in Akron, Ohio. He has participated in the publication of over 35 peer-reviewed articles, three book chapters, and several instructional videos.

Recently ACS was asked to provide a response to the request for information from Congress with regard to regulation of CBD and derivatives.  The full response is available below.

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Dear Honorable Members of Congress,

I write to you on behalf of the Association of Cannabinoid Specialists. I am a physician, a cannabinoid specialist with over 12 years of practice solely focused on these medications, and an Instructor of Medicine at Harvard Medical School.

Introduction

The Association of Cannabinoid Specialists is an international non-profit of physicians and other health professionals who specialize in using cannabis or cannabinoids for the treatment of patients. We are the experts on how these substances should be used in both medical and non-medical settings. The proper and safe regulation of cannabinoids is of primary concern to us for our patients’ well-being.

The Farm Bill of 2018 essentially made a mistake by allowing the extraction and sale of cannabinoids to consumers. The intention to provide farmers with a new crop, hemp, is laudable and can be achieved by allowing hemp to be used for a wide array of industrial processes including the production of concrete, paper, and textile (1).  However, it should not be used to produce chemicals with biological activity for use by consumers.

Cannabinoids Have Risk, Intoxication Is Not The Only Concern

In the discussion about cannabinoids, often the concept of intoxication is used as the bright-line between permissible and non-permissible. As physician-scientists, we believe this is not a valid line to draw. While intoxication is a potentially dangerous effect of some cannabinoids, other cannabinoids that do not produce intoxication have risks as well (2-4). All of the cannabinoids presently known are biologically active. This means they can interact with the human body to change the normal functioning. This is the definition of a medication. All medications have risks and side effects. In the case of cannabinoids, many of those risks remain to be characterized.

Do we know if CBD or its derivatives like HHC and others might cause cancer or neurodegeneration or liver failure? In fact, we do know that CBD can interact with many common medications and also can cause direct liver toxicity (5-10). We know far less about longer term issues and about the effects of those derivatives.

How Cannabinoids Should Be Regulated

The FDA is correct that CBD and it’s derivatives do not meet the standard for food or supplements on the basis of the known effects and risks, as well as the unknown risks. They are correct that, leaving aside the “exclusionary clause,” the risks known and unknown are too great for the food and supplement pathway.

The alternative pathway, at present, is the drug development pathway. This is expensive and time consuming specifically because it requires significant research in both non-humans and humans to prove safety and efficacy. This is exactly what is required: to prove that CBD and other cannabinoids are safe to use, have proven benefit, and to outline the parameters by which they can be safely and effectively used. Any new, third pathway designed by Congress specific to hemp or cannabis simply circumvents this tried-and-true approach to ascertaining the safety and efficacy of hemp/cannabis.

Reference has been made to the studies that allowed approval of Epidiolex as demonstration of the safety of CBD for general consumption. This is false. In fact, it is from the Epidiolex studies that we know there are risks of drug interactions and direct liver toxicity (5-10). Epidiolex was approvable because those risks were known, and it is only available by prescription under the care of a physician. It is the responsibility of the physician to know how to use the medication, including counseling the patient on risks and symptoms of concern, monitoring for adverse events, and prescribing the dose to be taken. None of these safeguards would be in place for over-the-counter (OTC) CBD products.

Furthermore, the “exclusionary clause” does preclude making OTC or competing products until such time as Jazz Pharmaceutical’s patent runs out. Defying this aspect of the law or overturning it will have dire consequence for drug development worldwide going far beyond the discussion of hemp/cannabis.

The Cannabis Industry Is Not Benign and Must Be Regulated

Since CBD and other cannabinoids (except THC (11-16)) have yet to have any proven value to consumers or patients, access to them is solely to the benefit of industry. Evidence for potential risk to pregnant women and children exists, yet studies have also shown that industry, in the absence of legal restrictions, has been promoting use of cannabinoids to pregnant women (17). 

Ultimately, as cannabinoid-medicine physicians, we value rigorous scientific investigation of all cannabinoids and other cannabis derivatives. We need to know that they are safe to use (and under what circumstance) and have demonstrable benefit to disease states. This can only be achieved via the current FDA drug development pathway. 

The current state-legal systems demonstrate that we will never get the data that we need if similar systems are emplaced federally. Many cannabis companies talk about the medical value of their products or of cannabis more generally, yet to date none have invested the time and money needed to prove their point. Realistically, no company will invest in this research if they can simply go to market with unproven products. Pharmaceutical companies make the investment and do the research because without it they cannot go to market. We must enforce this process to ensure the research gets done.

The First Step Needed

It is our contention that the FDA new drug pathway is fine as is, and a new pathway will only undermine the safety and efficacy data that is developed. We believe that the Farm Bill should be amended to restrict the sale of “all derivatives, extracts, cannabinoids, isomers, acids, salts, and salts of isomers,” to research uses or to companies that manufacture FDA approved medications.

Further we content that the real issue at present is a lack of enforcement against companies that are selling products that are neither proven safe nor legal since they are not FDA approved. We call upon Congress to reinforce the authority of FDA to regulate these chemicals, and other executive agencies like USDA and FTC to assist in enforcing these regulations.

Protecting Patients Using State-Legal Products

However, in doing so, and by re-asserting the primacy of the Federal government over states, we endanger the current state-legal medical programs. This, too, would be unacceptable as it would leave millions of Americans without access to medication that they use presently for very real illness under the care of physicians. 

Providing a Clear Path Forward

Therefore, we call for a sunset-provision. We ask Congress to assert a moratorium on new cannabis or cannabinoid products nationally. We ask that the cannabis industry be given 10 years in which to meet the standard set by the FDA new drug pathway or become a recreational product company only. We ask that Congress enact law that sets a national safety testing standard akin to the state of Massachusetts, requires states to provide reciprocity that honors medical prescriptions from other states, and requires of physicians a written (or electronic) prescription for cannabis products.

Further, Congress should reassert the role of FDA in enforcing the ban on medical claims made by cannabis companies, including those operating in the recreational market. No statements should be made by any company as to the utility of their products unless FDA approved. At present, FDA simply does not have the budget to enforce these rules and Congress should allocate funds for this purpose.

State-legal cannabis companies should be limited to selling cannabis and simple extractions thereof, but not be allowed to chemically alter the cannabinoids or terpenes nor their inherent ratios.

Specific Needs and Steps

Cannabinoid products should specify their constituent compounds in milligrams, not percentages nor ratios. THC should be measured as THC + THCA, unless product is intended to be used as THCA (18), then an unit dose should be 20mg but the THC limited to <= 1%. A standard dose of THC (+THCA) should be 5mg in the recreational market. In a medical market useful increments should be 5mg, 10mg, and 20mg. These should be clearly marked on the package to be sure that patients can tell the per piece dose at a glance.

In the medical market at least, smoking should be discouraged (19), despite benign data on long term use (20). Vape pens, on the other hand, have significant associated risks and nowhere near the long-term safety data that we have for smoking cannabis. Vape pens should either be banned or required to meet safety standards that ensure vaporization, not combustion, and no extraneous chemicals are inhaled as a result of chemical reactions or contact with the machinery (21-23). Flower vaporizer machines, on the other hand, are safer devices specifically because they do appropriately control for temperature using direct measurement and a microprocessor controlled negative feedback loop (24). These should be required to meet FDA medical device standards and maintained as the preferred inhalation device.

A Robust Visionary Research Agenda With Funding

We also believe that NIH should be doing more to fund and stimulate a well-planned long-term research agenda. They should map this agenda publicly to address areas not yet well understood and provide definitive answers to current questions. Groups like National Academy of Science, Engineering, and Medicine have provided guidance on research that needs to be done (16). Congress will need to appropriate additional funds to cover this research agenda on an ongoing basis.

Conclusions

Association of Cannabinoid Specialists provide more details via their white-paper here: https://assets.nationbuilder.com/acs/pages/75/attachments/original/1666115916/A-FederalFramework-of-Regulation-for-Medical-Cannabis-Use.pdf?1666115916

By reinforcing the role of the FDA new drug pathway, bolstering FDA’s budget to enforce current regulation, emplacing a moratorium on new hemp/cannabis derivative products, enforcing the ban on medical claims made, and most especially requiring physician prescriptions, Congress can right the wrongs instituted under the 2018 Farm Bill. Providing a clear glide-path for the cannabis industry to meet the bar set by FDA over a known, finite period of time will allow patients to continue to get their state-legal medication until the industry can meet the FDA regulation. In doing so, Congress will protect American’s safety,
allow the cannabis industry to grow into a legitimate pharmaceutical industry, and encourage real medication development that has proven safety and efficacy.

Most Sincerely,
Jordan Tishler, MD
President, Association of Cannabinoid Specialists
Harvard Medical School

About ACS

Association of Cannabinoid Specialists (ACS) is an international association of healthcare professionals on the forefront of cannabinoid medicine. Because ACS was founded by physicians, we are uniquely positioned to ensure the highest standards in the practice of cannabis medicine, safeguard patient care with clinical best practices, and interface with other stakeholders in the cannabis community. We are an advocacy organization striving to provide guidance to law makers and regulators at every level of cannabis control. For all of ACS’ constituents, we provide evidence and experience-based education to support the premise that cannabis should be treated as a medicine and, therefore, patients and related laws and regulations need to be created, modified, and viewed differently than recreational-use laws and regulations.

References

1. McPartland, J. M., & O’Sullivan, S. E. (2023). Origins of Cannabis sativa in Ireland and the Concept of Celtic Hemp: An Interdisciplinary Review . Cannabis and Cannabinoid Research, X(X), 1–11. https://doi.org/10.1089/can.2022.0263
2. Brown, J. D., Winterstein, A. G., Brown, J. D., & Winterstein, A. G. (2019). Potential Adverse Drug Events and Drug–Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. Journal of Clinical Medicine, 8(7), 989. https://doi.org/10.3390/jcm8070989
3. Stout, S. M., & Cimino, N. M. (2014). Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. Drug Metabolism Reviews, 46(1), 86–95. https://doi.org/10.3109/03602532.2013.849268
4. Yin, H. Y., Hadjokas, N., Mirchia, K., Swan, R., & Alpert, S. (2020). Commercial Cannabinoid Oil-Induced Stevens-Johnson Syndrome. Case Reports in Ophthalmological Medicine, 2020, 1–5. https://doi.org/10.1155/2020/6760272
5. Gingrich, J., Choudhuri, S., Cournoyer, P., Downey, J., & Muldoon Jacobs, K. (2023). Review of the oral toxicity of cannabidiol (CBD). Food and Chemical Toxicology, 176, 113799. https://doi.org/10.1016/J.FCT.2023.113799
6. Kutanzi, K. R., Ewing, L. E., Skinner, C. M., Quick, C. M., Kennon-McGill, S., McGill, M. R., … Koturbash, I. (2020). Safety and molecular-toxicological implications of cannabidiolrich cannabis extract and methylsulfonylmethane co-administration. International Journal of Molecular Sciences, 21(20), 1–14. https://doi.org/10.3390/ijms21207808
7. Turck, D., Bohn, T., Castenmiller, J., De Henauw, S., Hirsch-Ernst, K. I., Maciuk, A., … Knutsen, H. K. (2022). Statement on safety of cannabidiol as a novel food: data gaps and uncertainties. EFSA Journal, 20(6), e07322. https://doi.org/10.2903/j.efsa.2022.7322
8. Yamaori, S., Ebisawa, J., Okushima, Y., Yamamoto, I., & Watanabe, K. (2011). Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: Role of phenolic hydroxyl groups in the resorcinol moiety. Life Sciences, 88(15–16), 730–736. https://doi.org/10.1016/j.lfs.2011.02.017
9. Ewing, L. E., Skinner, C. M., Quick, C. M., Kennon-McGill, S., McGill, M. R., Walker, L. A., … Koturbash, I. (2019). Hepatotoxicity of a Cannabidiol-rich cannabis extract in the mouse model. Molecules, 24(9). https://doi.org/10.3390/molecules24091694
10. Geci, M., Scialdone, M., & Tishler, J. (2022). The Dark Side of Cannabidiol: The Unanticipated Social and Clinical Implications of Synthetic Δ 8 -THC. Cannabis and Cannabinoid Research, X(X), 1–13. https://doi.org/10.1089/can.2022.0126
11. Casarett, D. J., Beliveau, J. N., & Arbus, M. S. (2019). Benefit of Tetrahydrocannabinol versus Cannabidiol for Common Palliative Care Symptoms. Journal of Palliative Medicine, 22(10), 1180–1184. https://doi.org/10.1089/jpm.2018.0658
12. Li, X., Vigil, J. M., Stith, S. S., Brockelman, F., Keeling, K., & Hall, B. (2019). The Effectiveness of Self-Directed Medical Cannabis Treatment for Pain. Complementary Therapies in Medicine. https://doi.org/10.1016/J.CTIM.2019.07.022
13. Hameed, M., Prasad, S., Jain, E., Dogrul, B. N., Al-Oleimat, A., Pokhrel, B., … Stein, J. (2023). Medical Cannabis for Chronic Nonmalignant Pain Management. Current Pain and Headache Reports, 1–7. https://doi.org/10.1007/s11916-023-01101-w
14. Koppel, B. S., Brust, J. C. M., Fife, T., Bronstein, J., Youssof, S., Gronseth, G., & Gloss, D. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(17), 1556–1563. https://doi.org/10.1212/WNL.0000000000000363
15. Naftali, T., Bar-Lev Schleider, L., Dotan, I., Lansky, E. P., Sklerovsky Benjaminov, F., & Konikoff, F. M. (2013). Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study. Clinical Gastroenterology and Hepatology : The Official Clinical Practice Journal of the American Gastroenterological Association, 11(10), 1276-1280.e1. https://doi.org/10.1016/j.cgh.2013.04.034
16. Practice, H., Division, M., & Academies, N. (2017). The Health Effects of Cannabis and Cannabinoids. https://doi.org/10.17226/24625
17. Dickson, B., Mansfield, C., Guiahi, M., Allshouse, A. A., Borgelt, L. M., Sheeder, J., … Metz, T. D. (2018). Recommendations From Cannabis Dispensaries About First-Trimester Cannabis Use. Obstetrics & Gynecology, 131(6), 1031–1038. https://doi.org/10.1097/AOG.0000000000002619
18. Nallathambi, R., Mazuz, M., Ion, A., Selvaraj, G., Weininger, S., Fridlender, M., … Koltai, H. (2017). Anti-Inflammatory Activity in Colon Models Is Derived from Δ9-Tetrahydrocannabinolic Acid That Interacts with Additional Compounds in Cannabis Extracts. Cannabis and Cannabinoid Research, 2(1), 167–182. https://doi.org/10.1089/can.2017.0027
19. Weinberger, A. H., Platt, J., Copeland, J., & Goodwin, R. D. (2018). Is Cannabis Use Associated With Increased Risk of Cigarette Smoking Initiation, Persistence, and Relapse? The Journal of Clinical Psychiatry, 79(2), 0–0. https://doi.org/10.4088/JCP.17m11522

20. Tashkin, D. P. (2013). Effects of marijuana smoking on the lung. Annals of the American Thoracic Society, 10(3), 239–247. https://doi.org/10.1513/AnnalsATS.201212-127FR
21. Lim, C. C. W., Sun, T., Leung, J., Chung, J. Y. C., Gartner, C., Connor, J., … Chan, G. C. K. (2022). Prevalence of Adolescent Cannabis Vaping: A Systematic Review and Metaanalysis of US and Canadian Studies. JAMA Pediatrics, 176(1), 42–51. https://doi.org/10.1001/jamapediatrics.2021.4102
22. Oar, M. A., Savage, C. H., Rufer, E. S., Rucker, R. P., & Guzman, J. A. (2022). Thermography of cannabis extract vaporization cartridge heating coils in temperatureand voltage-controlled systems during a simulated human puff. PloS One, 17(1), e0262265. https://doi.org/10.1371/journal.pone.0262265
23. McDaniel, C., Mallampati, S. R., & Wise, A. (2021). Metals in Cannabis Vaporizer Aerosols: Sources, Possible Mechanisms, and Exposure Profiles. Chemical Research in Toxicology, 34(11), 2331–2342. https://doi.org/10.1021/acs.chemrestox.1c00230
24. Lanz, C., Mattsson, J., Soydaner, U., & Brenneisen, R. (2016). Medicinal Cannabis: In Vitro Validation of Vaporizers for the Smoke-Free Inhalation of Cannabis. PloS One, 11(1), e0147286. https://doi.org/10.1371/journal.pone.0147286

I’m Jordan Tishler, the founder and president of the Association of Cannabinoid Specialists.  This is the story of why I founded ACS and why the world needs a place for clinicians to learn more about cannabis medicine and influence cannabis policy.   

I’m a Harvard College graduate and Harvard Medical School graduate. I trained in Internal Medicine at Boston’s Brigham & Women’s Hospital and practiced Emergency Medicine for about 20 years.  The last 15 of those years, I worked at the Veteran’s Administration hospital and bore witness to the sad revolving door of patients who had substance issues.  I became very attuned to and good at treating these problems.   

Around 2012, Massachusetts started discussing a ballot initiative to legalize cannabis for medical use.  Like most physicians, my initial reaction was surprise.  However, I quickly noted that for all the patients with substance issues that I’d seen, I’d never seen anyone actually ill from cannabis.  This apparent lack of toxicity led me to consider whether there might be some merit to the idea that cannabis could function as a medicine.   

At that time, it was fashionable for politicians, pundits, and physicians to say, “well, there’s no data.”  I distinctly recall Hillary Clinton making this remark.  It made me wonder where they were looking.  At that time if you went to PubMed and entered the word “cannabis” into the search you, would get a mere 25,000 studies (presently you get closer to 35,000).  The real problem was digesting and making sense of such a large volume of data.   

Most of the studies were pre-clinical, and most of the clinical studies were focused on trying to prove the harms attributed to cannabis.  However, buried in the avalanche of data were real, useful studies, in human beings, showing safety and efficacy of cannabis for a range of illnesses.   

It took me several years to wade through this data and come to the conclusion that cannabis and cannabinoids could be used to treat the symptoms of several diseases.  Further, all medications have benefits and risks, and cannabis is no different.  Our goal in medicine is always to use medications in a manner that maximizes the benefit while minimizing the risk.  Again, cannabis is no different – and requires the respect we owe all medications.   

Shortly after opening my cannabinoid medicine practice, inhaleMD, I was hanging with my friend and world-renowned cannabis researcher, Dr. Sue Sisley (she appeared on one of Sanjay Gupta’s “Weed” series episodes on CNN), who was teasing me about “being a unicorn.” It was her contention then that I was the only doctor in the cannabis space who cared to educate, advise, and follow my patients (rather than just write a recommendation for a medical card and send the patient off).  Despite this making a good story, I was rather upset by this and did not find it funny at all.  The idea that colleagues were writing cards without providing actual care to patients was mind blowing.  I still don’t understand the ethics behind that sort of behavior.   

To me, cannabis medicine isn’t about cannabis, it’s about the patient.  I don’t inherently care about cannabis unless we’re using it for the benefit of sick people.   

Sue’s ribbing led me to found the Association of Cannabinoid Specialists.  I wanted a forum to find all the good colleagues who were using, or interested in using, cannabis for the benefit of their patients.  I wanted to be sure we all had the best understanding of the human data on these potential benefits, and the risks.  It’s also important to clearly sort the pre-clinical evidence from the clinical and not operate on the basis of what might work in mice.  Of course, it was also very difficult to wade through the mountain of studies and ACS makes several resources available to members to help synthesize this information into usable approaches.   

It also became clear to me as I watched the proceedings in the cannabis industry and the political arena, that nobody was ever asking what clinicians need to take best care of their patients.  The discussion is always about what’s best for business or tax revenue, but never about how should the systems be regulated to best improve patient care.  To that end, ACS has become an active advocate for patients’ needs and the needs of the clinicians who serve them.   

That’s it – that’s who I am, why I thought an organization like the Association of Cannabinoid Specialists was necessary to educate and connect those involved in recommending and regulating cannabis.  I think this is very important for patient care, and I hope you do too.  In many ways, the patients who are already getting cannabis care deserve better than we can give them now, but even more important are the millions of patients suffering with illnesses that we could address, but for whom medical cannabis is neither on their, nor on their physician’s, radar.  Join us to help these folk. 

In my next post, I will discuss some of the specific areas ACS focuses on and why we encourage people to spend time digging into the science, the fact-based research and how, together, we can help influence how cannabis is regulated. 

On Sunday evening, August 6, 2023, CNN aired Dr. Sanjay Gupta’s “Weed 7: A Senior Moment” as part of Anderson Cooper’s “The Whole Story” show. Association of Cannabinoid Specialists has taken some time to watch the show, review the transcript and asked our member experts to help “unpack” the information packed into the hour-long episode.  

In the first of our multi-part series, ACS provides a summary of items we thought should be highlighted followed by our opinion or commentary of that item. In future posts, we will provide feedback from our observations, links to research material and useful articles to supplement the episode, and, if needed, point out any helpful data that may “fill in the blanks” with information not discussed or point out any discrepancies we found. 

To start, here’s our summary of the episode: 

• Interesting statement in the show, “Between 2015 and 2018, cannabis use in seniors over 65 jumped 75 percent.” 

• In a written piece published prior to the episode’s airing, Dr. Gupta wrote that he had an epiphany: 

“And I guess that may be the biggest thing that has changed over the past 10 years. I would’ve never imagined a time when I would openly recommend cannabis to my own parents – or a time they would openly consider taking it.” 

At the top of the show, Dr. Gupta spoke to a brand ambassador / dispensary owner who made a remark referred to throughout the episode: “Plants over pills”. 

ACS’ entire mission is to educate and advocate the use of cannabis medicine. However, we also emphasize the continued need for more research funding, clinical trials, and patient data to really understand how the medicine is working or not working. If we presume cannabis is not going to treat every ailment or condition, there is a place for pharmaceuticals (pills). We want to caution people from ignoring science and data by throwing out their prescriptions or ignoring their physicians’ advice unless and until we all feel more plants over pills is proven science. The key is working with your physician to ensure there are not converse interactions between medicines and providing feedback to your physicians so, together, you can determine if there are prescriptions you can eliminate. 

Dr. Gupta interviewed U.S. medical patients / dispensary customers demonstrating their typical evolution starting with self-education and self-administration. 

ACS supports their journey, but it was evident the patients needed a physician to guide them through the best form and dose for their individual situation. Most of those patients interviewed sought medical guidance and were genuinely joyful for the benefits they received. 

Dr. Gupta interviewed several medical professionals in the U.S. and in Israel. The Israeli-based professionals operate in a much more regulated and medically focused environment than in the U.S. Israel has a prescription and pharmacy model which also allows the administration of cannabis medicine in clinics and hospitals. 

ACS encourages U.S. citizens and citizens internationally to advocate for a true medical program like Israel’s that would open more clinical research, allow physicians to prescribe rather than “recommend” cannabis medicine and allow for treatment that may perform better than other medicines for certain ailments and conditions. 

Dr. Gupta mentioned, on several occasions, there is a knowledge gap because some studies only offer preliminary findings or there are no studies to validate anecdotal information. However, both the professionals and patients interviewed strongly emphasized real results for them and hundreds of patients. For example, patients in both the U.S. and Israel state regular cannabis use has improved aggressive behavior and depressive moods brought on by dementia and Alzheimer’s. 

ACS strongly advocates for governmental funding for those entities seeking to conduct further clinical trials and other research into the impact of cannabinoids on specific brain disorders like dementia and Alzheimer’s.