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Ask a Pot Doc: Using Cannabinoids to Treat Anxiety, Pain, and Multiple Sclerosis

In the latest edition of our advice column on medical marijuana, Dr. Frankel takes questions from readers on how to use cannabis to cope with a variety of health conditions.

by Dr. Allan Frankel

by Dr. Allan Frankel

Photo via iStock/ KLH49

Frankly, marijuana doctors don’t always have the best reputation. Before the days of recreational cannabis, getting a medical marijuana recommendation from a strip-mall “420 doc” was often the only way to legally access the sweet leaf (in states that allowed it).

Now, as public acceptance of the plant grows through the expansion of medical and adult-use cannabis programs across America, a wider range of medical professionals are taking marijuana seriously as a treatment for epilepsy, brain damage, chronic pain, and a number of other ailments. 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 maladies. 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.

Now, Dr. Frankel wants to help you use cannabis to enhance your own health. Check out his responses to some of our readers’ questions on medical marijuana below, and then learn how you can get some advice from the Doc himself...

Anxiety/ Mental Health

@mediamel_: Which strains specifically are best for anxiety and mental health issues? Mild depression, etc. I know sometimes smoking can “further” the symptoms of these, but I’d love to know if there are specific strains or development into these [issues]...

@kryoung39: I want to know if it makes anxiety better or worse.

Dr. Frankel: For the vast majority of patients, THC can aggravate anxiety. There are clearly a group of patients who benefit from small doses of THC. However, in general, using CBD whole plant products is far better for anxiety. If the patient has benefitted by using THC, then I will often add a little THC to the CBD.

This brings up a big issue: how does a patient know for certain what “strain” they are smoking or vaping? If the patient is able to use, perhaps a 1:1 CBD:THC strain, such as Harlequin, Omrita, or another variety, this can work very well for anxiety. However, most patients out there do not want to smoke, and often prefer a dosed and predictable spray or capsules. For these patients, I’d recommend finding a wide ratio CBD:THC extract, tincture, or capsule. I would start out with just 2 or 3 milligrams (mg) of CBD under the tongue; use your tongue to spread it gently around the inside of your mouth; and then no food or drink for 15 minutes to allow maximal absorption. I would try initially a few mg every 4-6 hours, and increase as needed.

This is another reason why using dosed products is just simpler for many patients: you know what you are taking, and you can discuss with your physician how or if to make a change.

As a peek into the future, THC-V — or tetrahydrocannabivarin — is an ancient cannabinoid that is still very rare. We have been lucky enough to get hold of some and have found that THC-V, with a little THC, is awesome for treating anxiety. In addition, the “Varin” acts on the THC to reduce the edgy feeling of THC and replacing it with “happiness”. Perhaps a touch of “euphoria”, but who could not use that? Finally, as with CBD, it is very focusing. Going forward, using combinations of CBD, THC-V, and small amounts of THC will be very effective for treating anxiety and other mood disorders.

Dr. Allan Frankel of GreenBridge Medical

Chronic Pain/ Opioid Substitution

@leckieSl: I have chronic pancreatitis and severe pains, I am on heavy opiate painkillers. is there way to completely replace them with Med. Cannabis and have similar pain killing effects? Also I have secondary diabetes (treated as type 1).

Dr. Frankel: Both CBD and THC are effective in treating abdominal pain. In addition, THC-A, the raw form of THC without any “stony” effects, is also a great anti-inflammatory which I have seen benefit patients with abdominal pain and further relief.

Depending upon your THC tolerance, I would initially try 3 or 4 mg of THC under your tongue and wait an hour to see the results. You may safely increase, but do it SLOWLY, and no driving or operating machines until you KNOW you are ok.

I would slowly increase perhaps up to 8-10 mg of THC every 4 to 6 hours, and then, start adding some CBD at similar doses and frequency.

@medic454: Is medical weed good for chronic back pain and less addictive than opiates? If so, why doesn’t the medical field use [it] more often?

Dr. Frankel: The mainstream medical world is starting to look to cannabis for help with pain. I will be speaking in Maui on this topic at the end of the month. Kaiser called me, so clearly doctors and hospitals are opening their minds to the use of cannabis to help with both opiate issues as well as other addicting drugs, such as Xanax or Klonopin.

Compared with opioids, cannabis is not an addictive substance. There is no withdrawal syndrome, and the federal government places THC addiction at 5%, while coffee was over 20%.

I see patients every day with back, muscular, and nerve-related pain, and we often are able to get the patients’ pain under control and reduce or eliminate their [use of] narcotics.

Adolescent MMJ Use

@Jaded333: My 18-year-old has anxiety and eating disorder. Will cannabis help her better than the pills they want to give her?

Dr. Frankel: It depends upon what they have in mind, but cannabis — in a entirely dosed and predictable manner — can help many patients with mood and eating disorders. I would suggest first trying cannabis. You would need to work with a physician familiar with dosing, but most likely you will be able to find a treatment plan using sprays and/or capsules to help her with the mood and eating disorder. Often, it is the anxiety that is the underlying issue and this is pretty easy to address with CBD and/or THC-V. I have had a fair amount of experience with these issues, and for years I was the internist seeing the eating disorder patients at UCLA. I wish I had access to high quality cannabis medications for those patients back then. However, we have it now!

@Tristan1Hunnid: i smoke weed to stop headaches and stress but i'm not allowed. Should i tell my parents about it?

Dr. Frankel: I am nearly always a fan of being open with family. Perhaps they already know and just do not know what to say. I would stress the headaches and anxiety as your issues, and [that] you are trying cannabis to help these symptoms. I think more and more parents understand this, and I see many adolescents with their parents discussing what treatment plans might be best. Is smoking or vaping ok, or would the parents be more comfortable with sprays/capsules/etc.?

Let me know what happens!

Multiple Sclerosis

@Holko: Multiple Sclerosis and Medical marijuana... what can you tell me... are there specific strains... does it help with more than spasticity?

Dr. Frankel: As with some other questions, if you are using smoked or vaped cannabis, for sure I would go for a 1:1 CBD:THC product. The studies, using medications from GW Pharmaceuticals in England, show that using a 1:1 product can help with both pain and spasticity. I would keep my eye out for the new THC-V products that will become more available. There is data that THC-V can REVERSE demyelination! We don’t have definitive proof of this, yet, but we have seen many neuropathies respond extremely well to THC-V, and we have now seen some dozens of patients where we believe we are in fact witnessing re-myelination, where [reduced] pain, sensation, and even motor benefits are being seen. In addition, over a few weeks, the dose of THC-V decreases. Maybe it is a critical nutritional item to help nerves heal?

And last but not least, a light-hearted query...

@SlowSpecialist: how can I do astral traveling without leaving my body, which Cannabis have you got for that #AskAPotDoc

Dr. Frankel: To achieve this celestial "trip", I would take way too much of a lot of various strains.

***

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 queries on health and herb using the tag #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.


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Dr. Allan Frankel

Dr. Allan I. Frankel is an internal medical doctor and one of the world’s leading authorities on dosed cannabis medicine. With over 35 years experience in Internal Medicine, Dr. Frankel applies his knowledge of all aspects of the cannabis plant and its therapeutic value to the treatment of multiple serious medical conditions. Learn more about his practice at www.greenbridgemed.com.



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