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Frankly, marijuana doctors don’t always have the best reputation. Before the days of recreational cannabis, getting a medical marijuana recommendation from a “420 doc” was the only way to legally access the sweet leaf (in states that allowed it). Obtaining one was often as simple as strolling into a strip-mall office, paying a fee, briefly talking to the doctor about insomnia, writer’s cramp, or whatever condition one was willing to claim, and leaving with a document that would magically open dispensary doors to one’s dank desires.
Now, as public acceptance of the plant grows through the expansion of medical and adult-use cannabis programs across America, a wider variety of medical professionals are taking marijuana seriously as a treatment for epilepsy, brain damage, chronic pain, and a variety of other conditions. More so, the science behind marijuana as medicine is evolving rapidly, with research institutions and Big Pharma making large investments in learning more about the medicinal power of pot. Forget about picking some Bubba Kush to help you sleep — now doctors are breaking down cannabis into its chemical components to find new medications and therapies personalized for individual patients.
Dr. Allan Frankel is one of these pioneers. As the founder of GreenBridge Medical in Santa Monica, California, Dr. Frankel is on the cutting edge of cannabis medicine, developing treatment plants for his patients that entail measured doses of particular cannabinoids targeted towards specific conditions. In doing so, Dr. Frankel aims to give patients an experience closer to that of a traditional doctor’s visit, but without the numerous side effects of conventional pharmaceuticals and procedures.
Dr. Frankel explains how he made journey to practicing medicine through cannabis below, and then we’ll explain what MERRY JANE and Dr. Frankel have in store for you next..
I started my first practice of internal medicine in 1979, after completing medical school and my residency at UCLA.
By 1999, I was growing weary of internal medicine. It wasn’t the workload or the patients; it was ongoing prescription medicine-related issues that had me considering other options. Despite growing a very lucrative practice, I was ready to move on.
The decision was soon taken out of my hands. I developed a viral chest infection that went into my heart. Shortly after falling ill, I experienced heart failure and was given six months to live. I was broken. Not wanting a heart transplant, I became depressed, and didn’t know where to turn. I had never used cannabis before, but a few of my friends urged me to give it a try. I did, and for whatever reason, within three months, I was entirely healed. During those months, I read volumes on the state of cannabis medicine, and at the end of 2006, I opened GreenBridge Medical Services in Venice, California.
Dr. Allan Frankel of Greenbridge Medical
The first few years were a mix of fun and frustration, and certainly very different than any work I had previously done. In that early period, it became clear that a lack of detailed information about cannabis products, as well as having no clear way to measure dosages of any cannabinoid, made it difficult to make good recommendations to my patients. While many patients were able to use smokable cannabis or edibles to meet their needs, only around 20% of population are regular users. The other 80% of my patients didn’t like the feelings brought on by THC, often causing them to become agitated and paranoid.
When we had little or no idea what our patients were consuming, there seemed to be little value for the physician. Under California’s medical marijuana program, we would essentially give “permission slips” to patients to obtain cannabis products at legal collectives that often didn’t even know the cannabinoid content of the flower or other products they sold. The patient had no idea what they were consuming other than its strain name (which was inconsistent at best), and there was little my patients could communicate to me regarding what they had purchased. These early years were spent recommending sativa for daytime, and indica for the night.
It was amazing to me that cannabis worked at all, but it really helped many of my patients. However, in the days before accurate dosing, patients were mostly younger, less ill, and more open to using smokable or edible cannabis products as they were generally already using marijuana. Assisting these patients enabled me to learn about the world of cannabis, but I felt I wasn’t learning much about its medicinal properties — and nothing about dosing.
It became clear by 2008 that we needed to learn how to convert a “bag of weed” into dosed, predictable, and organic cannabis medicines. We knew from work done by GW Pharmaceuticals and others that sublingual or oral-buccal administration was effective, and this is where we started to develop our own treatments.
GW Pharmaceuticals, based in England, was already testing a 1:1 CBD:THC tincture as a medication for multiple sclerosis and neuropathic pain. This product — Sativex — was made from whole plant cannabis, so the dosing and patient trials gave us a ballpark range for testing of how many milligrams of CBD and THC would be effective for our own patients. This brings up a critical point: In the majority of published studies (particularly seven or eight years ago), the cannabinoid medicines used were molecular versions. This means that the CBD used in the studies was single molecule, missing the hundreds of other cannabis molecules that make the plant so special. The combination of cannabinoids, terpenes, flavonoids, plant waxes, and lipids contained within whole plant cannabis medicine is what makes it so effective. Furthermore, these whole extracts can be successfully used in amounts that are a fraction of comparable molecular dosages.
This means that when we looked at medical cannabis studies conducted at universities, they used single molecule CBD or THC in doses totaling hundreds of milligrams in order to see an effect. This led to many people using these molecular dosing amounts with whole plant cannabis, resulting in doses that were way too high, generally unfeasible for patient treatments, and often laden with side effects. Now that we know the difference between single molecule and whole plant cannabis medicines, we need to respect this distinction.
There was a period around 2012 when a couple of CBD extracts finally became available. These were mostly 1:1 ratios of CBD and THC, and it took a couple more years for a strain from Spain — ACDC, with a 30:1 CBD:THC ratio — to come on the market. This development changed the treatment of anxiety, seizures, and more forever.
As time went by, I saw and treated hundreds of patients. We began to learn which CBD to THC ratio was best for patients with specific diseases, as well as how to manage treatments using multiple cannabinoids in various combinations and doses. This was a big deal, because it was the beginning of true “dosing”. I felt that we could only call what I did medical cannabis if both the patient and physician knew the actual dosage being ingested, and we were well on our way to having that knowledge.
As anticipated, patients who were not casual cannabis users — but were now open to consider “plant-based medicine” — wanted to have consistent dosed cannabis products, with adjustments available from a professional. This would demand a lot of supervising and testing time; I would never recommend a product unless I knew what plant it was and how it was extracted. I also obtain full laboratory reports for each product updated with every batch, including tests for cannabinoid and pesticide content in select cannabis flower, oils, and other manufactured medications.
This brings us to present day: The number and complexity of formulas for cannabis medicine has greatly increased, allowing me to recommend the use of over 30 unique products. My patients are referred by other physicians and medical institutions. They are never interested in “getting high;” they want to get well. Generally many traditional therapies have failed them, and they come to me with very mixed emotions. They’re desperate for help, but are frequently a bit apprehensive regarding cannabis as a medicine, and yet much more fearful that it may not be effective. Once their condition is managed, their aversion to cannabis goes away. They are converts.
I see all new patients for a full one-hour evaluation. During this time, my patients are given a detailed, printed treatment plan. It’s not a legal prescription, but a recommendation instructing patients what cannabinoid dosages to take for particular conditions, as well as how and when to take them. Since very few of my patients have used much THC (if any), I always factor this reality into my treatment plans.
After the office visit, following up with patients is essential. When I am with the patient, I am recommending an initial treatment plan — my best first thoughts on ameliorating their condition. After a few days or less, the patient always has useful feedback on how their symptoms are responding to cannabis, in addition to how they’re tolerating the medicine; this information is critical in helping patients modify their treatment plans as needed. Most interestingly, following up with patients who didn’t respond well to initial treatment recommendations is what has taught me the most. I learned how different patients are, and general rules for cannabis dosing continued to make more and more sense. Every patient becomes a valuable asset in educating ourselves about how cannabis affects specific diseases.
I continue to be gratified by the patients I treat. We have had tremendous success treating ailments as diverse as anxiety, insomnia, pain, seizures, cancer, neuropathy, myasthenia gravis, and many more. To connect with families so deeply hurting from conditions that have lasted for years or even decades — and to witness the changes that cannabis medicines have brought to their lives — confirms my belief that I’m doing the right thing.
Now, my practice of recommending medical cannabis therapies is no different than what I had done for years as an internist, with one big exception. I can now combine a medical visit with excellent follow-up, and an effective, fully customized, measured, organic, predictable, and sustainable medicine — with none of the side effects of the many other prescriptions I have written for my patients over decades. After 12 years of practicing cannabis medicine and seeing the progress we have made, I am in such a good place and looking forward to the years to come.
Now, we want to hear from you: What do you want to know about medical cannabis? Have you wondered how it could be used to treat a nagging health problem, or simply increase your general wellness? We’ll choose select questions for Dr. Frankel to address in upcoming editions of “Ask a Pot Doc” — so don’t wait! The future of cannabis medicine has arrived, and we should all be talking about it. Hit us up on Facebook, Twitter, and Instagram with your questions on health and herb for #AskAPotDoc, so we can unpack the power of plant medicine for everyone.
Disclaimer: This column is not intended to be a substitute for personalized medical advice, diagnosis, or treatment from a certified professional. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical ailment or treatment and before undertaking a new health care regimen.