Vol. 8, Number 8
cheryl riley, James Freire,
Dr. David Bearman,
Gradi Jordan, Ed Glick,
Paul Armentano, Keith Stroup
Sunil Aggarwal, Julie Godard
Al Byrne, Amanda Reiman,
Jim Greig, Chip Whitley,
Sandee Burbank, Joan Bello
Dr. Ethan Russo, Bryan Krumm
Richard Miller, Arthur Livermore
AAMC Rhode Island
How Does Marijuana Exert its Medicinal Effects? - David Bearman, M.D.
Cannabis contains over 500 chemicals, of which over 80 are cannabinoids (a 21-carbon molecule). Many of the over 500 compounds have medicinal value. Research continues to gain more knowledge about these molecules.
How does cannabis exert its medicinal effects? The medicinal effects of cannabis are mediated by the endocannabinoid system. This system includes two neurotransmitters, anandamine and 2AG, two receptors CB1 and CB2 and two enzymes MYGL and FAAH. It is responsible for modulating neurotransmission. An increase in cannabinoids either endogenous or exogenous, increases the amount of the neurotransmitter dopamine in the brain.
We know that the endocannabinoids act in a different way from any other neurotransmitter. Instead of stimulating the next neuron on the pathway up the CNS, the endocannabinoids actually double back and de-polarize the neuron that was just stimulated (the presynaptic nerve). This occurs by causing release of dopamine. Dopamine reverses the concentration of sodium and potassium inside and outside the cell. The effect of this is that it slows down neurotransmission.
So, if a person is having migraines caused by an overload of the electrical circuits in a certain part of the brain, slowing down the speed of neurotransmission, leads to fewer neural impulses, which in turn, decreases the likelihood or severity of a migraine. The same thing is true of people that have panic attacks, if you have negative thoughts that are moving at warp speed to the midbrain, you are overwhelming the emotional control center of the brain, the limbic system.
Cannabis slows down the speed of neurotransmission exposing the cerebral cortex to fewer slower moving neural stimuli. This allows the higher centers of the brain to have time to more rationally assess the relative danger or the negativity and put a more rational point of view on that sensory input and often taking the edge off anxiety or preventing a panic attack.
We were all taught in medical school that 70% of the brain is there to turn off the other 30% - dopamine is one of the “off switches” that helps modulate sensory input. One suggestion is that cannabis and cannabinoids increase the amount of free dopamine in the brain by competing with dopamine from binding to another neurochemical, dopamine transporter. The dopamine transporter and dopamine form an electrochemical bond. This ties up the dopamine so the dopamine is not free to act as one of the brain’s “off switches”. The cannabinoids replace the dopamine and the amount of free dopamine increases.
All human characteristics are distributed on a bell shape curve so some of us will have less natural occurring cannabinoids than others. There are a host of conditions that appear to be tied to an endocannabinoid deficiency syndrome It is not clear why, so if there is not a lower amount of free dopamine present in the brain, neural impulses move more rapidly. This mechanism contributes to the treatment of many conditions (e.g. Crohn’s, migraine, seizures, etc) that can respond to cannabis or cannabinoids.
Cannabinoids compete with dopamine for the binding sites on the dopamine transporter, and in sufficient quantity it wins, thus freeing up more dopamine to help slow down the speed of neurotransmissions. This, in my opinion and many others, is responsible for much of the therapeutic value of cannabis. Although it has effects on certain receptor sites in the brain that contribute to its therapeutic value, it probably directly affects the appetite and sleep centers in the brain, decreases the perception of pain and centrally decreases nausea. Peripherally cannabinoids stimulate CB2 receptors in the GI tract which is what makes cannabis valuable in treating Crohn’s Disease and IBS.
The IND Program and Medicinal Marijuana Movement - David Bearman, M.D.
We have made slow (too slow) but steady progress in reintroducing cannabis into the medical mainstream since the 1972 arrest of Robert Randall triggered the medicinal marijuana movement. Randall was going blind. He was also a recreational user of cannabis. One night he noticed that it alleviated some of his symptoms. After that he started using marijuana therapeutically and growing it. After he was arrested for cultivating a few plants, Randall sued the government. He contended that he would go blind if he did not continue to use cannabis.
The government had Randall evaluated both at UCLA’s Jules Stein Eye Institute and at Johns Hopkins School of Medicine. Both found that cannabis was the only treatment that lowered Randall’s intraocular pressure. They concurred that without cannabis he would go blind. Subsequently, as part of a legal settlement, the government agreed to begin sending Randall cannabis. The Compassionate Investigational New Drug (IND) Program emanated from the court settlement to Randall’s lawsuit.
At the time the IND program was terminated by the George H.W. Bush administration in 1991, there were 15 people in the program. A further 28 (some sources say 35) ad been approved and were waiting to get their cannabis from the government. But the program was terminated because too many people had applied – hundreds, possibly up to two thousand people had submitted the paperwork to get on the program and were waiting to have their requests for medicinal marijuana processed by the government.
The sheer number of people waiting to see if they could be accepted on the program, and the government’s commitment to total prohibition of cannabis, was more than enough to make the government concerned, and the IND program was axed. No more people were approved for the program. Those who were newly approved but had not yet received any cannabis from the government never got it. Only the 15 IND patients receiving government marijuana in 1992 were grandfathered in and continued to receive it.
Dr. Mason, head of the USPHS at the time, is quoted as saying, “If there are too many people on this program people will get the wrong idea that there is something good about marijuana.”
It is past time to say shame on the Congress of the United States for the waste of financial resources, moral capital, family integrity and human life. Shame on the government for blocking research on cannabis for relief of pain, migraine, seizure and cancer.
Today there are still four (4) IND program patients receiving 7 to 9 pounds of cannabis per year from the U.S. government’s cannabis farm in Mississippi.
If current rumors are true and cannabis is rescheduled to schedule II and two tincture of cannabis medicines (Sativex/Nabixamol and Epidiolex) are rescheduled to schedule III, this relic of the drug war can end and access to cannabis and its medicinal properties will be vastly improved. Thank you Robert Randall. Thank you all the medicinal cannabis activists.
Dr. Bearman is author of “Drugs Are Not The Devil’s Tools: How Discrimination and Greed Created a Dysfunctional Drug Policy and How It Can Be Fixed”
Alabama: Considering a medical marijuana law.
Arkansas: Considering a medical marijuana law.
Idaho: Considering a medical marijuana law.
Indiana: Considering a medical marijuana law.
Iowa: Considering a medical marijuana law.
Missouri: Considering a medical marijuana law.
North Carolina: Considering a medical marijuana law.
South Carolina: Considering a medical marijuana law.
South Dakota: Medical marijuana petition drive underway.
Tennessee: Considering a medical marijuana law.
Texas: Considering a medical marijuana law.
Wisconsin: Considering a medical marijuana law.
Featured Recipe - The Green Peril
A Pasta Recipe to delight all
The Green Peril was invented in sunny left coast Southern California. The author had recently returned from a better bud butter seminar and was anxious to test cook the goods. The Canny Bus was left at the airport Sports Bar while the author flew home in all speed.
Dr. Jay was ably assisted in the development of this classic by none other than his Nancy wife. Together this adventurous pair provides the reader a big clue that improvisation is the key to fun and frugal cooking.
Having arrived back in Los Angeles, author and wife made a quick grocery trip and were determined to clear out the refrigerator. The beauty of pasta is that you can make it different every time. Remember. Don't forget to substitute what you have on hand, what your budget will bear, and just what kinky tastes fit your fancy. A note of caution about this recipe: Do not serve to airplane pilots, other users of heavy machinery, nor practicing health care workers. Avoid sharp objects after eating (no knife is necessary in preparation or eating).
Green Peril is delicate, creamy, and moderately dangerous
spinach/ricotta cheese raviolis (dairy section)
Heat olive oil in a large skillet while setting one liter slightly salted water up to boil.
Sauté garlic and shallots until the shallots are just clear. Add pepper, basil, and bud to skillet. Pour in wine and bring back to medium heat. Incorporate the artichoke/pesto sauce. Bring to heat and simmer.
Add pasta to boiling water and cook until firm but tender (al dente). Drain cooked pasta and set aside.
Add bud butter to simmering sauce blending in carefully. Add the drained pasta to the sauce and gently blend. Serve in large bowls with Pecarrino Romano cheese (go easy), fresh basil, and bud as garnish.
Side dishes may include a fresh garden salad and hot buttered toast (you must make sure all excess sauce is soaked up).
Recommended Wine: Any decent Beaujolais
April 14-16, 2016
Baltimore, Maryland USA
Contribute to the AAMC
Legal Fund here:
Medical Marijuana States
District of Columbia #
Rhode Island *
* States with reciprocity law
# States with legal marijuana